Health visiting in the first year of life in England: a longitudinal analysis of linked administrative data (Community Services Dataset) 2016–20

Health visiting services provide public health interventions to support children and families in the early years. We describe how health visiting is delivered across the first year of life to children in England. We used data from the Community Services Data Set, capturing health visiting contacts for 52 555 children in ten local authorities in England with complete longitudinal data for 12 months between April, 2016 and March, 2020. Maternal records in Hospital Episode Statistics were linked to explore variation in mandated and additional contacts up to age 1, according to maternal adversity (maternal admissions for mental health, self-harm, violence or substance misuse in the 3 years prior to delivery). Almost all children (99%) were seen by the health visiting team, with 79% of children receiving all three postnatal mandated contacts by age one. Almost two-thirds (63%) received ≥1 additional contact and 25% of children received ≥3 additional contacts. The median number of contacts was 4, with a median cumulative duration of 2 hours 35 minutes. Of 6275 (12%) of children in families with maternal adversity, 4845 (77%) received all mandated contacts and 4520 (72%) received ≥1 additional contact (36 490/46 280 [79%] and 28 335/46 280 [61%] respectively in those without maternal adversity). 2115/52 555 (4%) of all children and 605/6275 (10%) of children with maternal adversity received ≥10 additional contacts. We provide evidence of repeated contact between health visiting services and the majority of families that goes far beyond a narrow focus on mandated contacts. This represents a vital infrastructure for early years health and wellbeing. Policymakers and commissioners should consider how health visiting services can be expanded or targeted more effectively to ensure all families receive the support they need. Our study was limited by a lack of information on the reason for, or content of, additional contacts. National Institute of Health Research.