Health visits ‘key to early diagnosis’

A Government review of health visiting practice could lead to developmental delays and other health problems among children going unnoticed, early years experts have warned.

A Government review of health visiting practice could lead to developmental delays and other health problems among children going unnoticed, early years experts have warned.

Changes could also disrupt progress on delivering an integrated two-year-old health and education review, and place extra burden on early years workers.

Public Health England is currently surveying local authority leaders and children's services staff about whether to uphold a mandate that requires community health professionals to see children five times before they are 30 months old.

A clause enforcing this requirement comes to an end in March 2017; the Government handed commissioning responsibility to local authorities for birth to five-year-olds’ public health in October 2015.

Community Practitioners and Health Visitors Association (CPHVA) lead professional officer, public health, Ros Godson told Nursery World that without the mandate, local authorities would be able to deliver a public health plan for children without health visitors.

‘There's no requirement for local authorities in England to have any health visitors or any school nurses,’ she said.

‘We suspect it's unlikely the Government will mandate because the difficulty with mandating things is this Government doesn't like rules and regulations. It's much more likely to say it's up to local commissioners to decide the needs of the local population.’


Health visitors are qualified nurses or midwives with additional qualifications.

They deliver the five checks to a mother before birth, within two weeks after birth, when the child reaches six to eight weeks, between nine and 15 months, and between two and two-and-a-half years.

As well as carrying out children's developmental checks, they support families and communities by looking out for issues such as postnatal depression, or providing guidance on healthy eating and contraception.

Ms Godson said without the obligation, local authorities could reduce the number of checks as a means of saving money. They face increasing cuts to public health funding with government investment set to fall by 9.7 per cent by 2020/21.

‘Given the choice I suspect a lot of local authorities would say, “we can sort out or own public health, we don't need these visits”. That would leave a huge loss of contact of any health professional with young children,’ she added.

‘Parents might not pick up that their child has got a speech delay or hearing problem. If they do, they maybe won't know what to do about it.

‘The purpose of public health is early diagnosis and intervention. Without the checks, [not] until there's a problem will things get identified, and that's the difference.’

Ms Godson said few professionals in communities had the training required to deliver health visitor services. She ruled out GPs as an alternative, saying they were already too busy.

Institute of Health Visiting director Cheryll Adams said without mandation, local authorities would be likely to focus their resources on children with greater need rather than provide universal support. She said this would not only disadvantage children, but could put off people from joining the health visiting profession.

‘It would be very easy for local authorities to say, “we can't see any need for a universal service, let's drop that and health visitors can just do the tough stuff”,’ she said. ‘That would have an effect on recruitment – it's a very risky situation that's developing.’


She warned that with fewer health visitors, early years settings would be more likely to see children starting nursery with developmental problems. ‘If you don't have someone reviewing these children then they're going to be starting nursery with speech delays, other developmental delays not picked up, lacking social confidence and so on – all the things a health visitor works on from day one.’

Ms Adams also suggested a fall in the number of health visitors could have a negative impact on the Integrated Review, which brings together the Early Years Foundation Stage progress check and the health visitor's health and development review at age two to two-and-a-half.

Some local authorities have struggled to implement the joint review since its introduction in September last year. Ms Adams said that a lack of health visiting resources would further impact its progress.

Commenting on whether health visiting responsibilities might fall to early years professionals as a result, Ms Adams said this would be unlikely as they did not have the specialist training required.

‘Health visitors have got a minimum of four years’ graduate-level training. There's virtually nobody in early years who would have that,’ she said. She added that it would be difficult for early years professionals to refer children to other health professionals, such as a paediatrician.

4Children (now part of Action for Children) head of early years Sue Robb agreed that early years professionals did not have the knowledge required to deliver the health checks. ‘That would be another burden,’ she said.

She urged the Government to maintain the obligation on local authorities. ‘After many years of really huge amounts of work – health visiting has improved so much – it would be important to keep that workforce and the visits they make, and also to invest in what has been achieved in recent years with that profession,’ she said.

Communication charity I CAN chief executive Bob Reitemeier backed the call. In an open letter he pointed out that children not receiving childcare outside of the home could miss out on having any developmental check at age two.

‘If the five health checks are scrapped, there is likely to be a significant impact on the support and advice parents get for their child's development and on early identification,’ he said.

‘This is particularly important for the 32 per cent of disadvantaged two-year-olds who are not attending early years settings. They would not receive any formal language checks until they enter school.’

A Public Health England spokeswoman told Nursery World it would report the findings of its current review to the Department of Health in October, and publish a full report in the autumn. Ministers at that department have the final say on whether to continue mandation.

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