Official Statistics

Health visitor service delivery metrics, 2023 to 2024: statistical commentary

Published 5 November 2024

Applies to England

What’s new

The following indicators have been updated with England, regional and upper tier local authority data for 2023 to 2024:

• coverage of new birth visits by a health visitor within 14 days
• coverage of new birth visits by a health visitor after 14 days
• coverage of new birth visits by a health visitor within and after 14 days
• coverage of 6 to 8 week health visitor reviews
• coverage of 12 month health visitor reviews by 12 months
• coverage of 12 month health visitor reviews by 15 months
• coverage of 2 to 2 and a half year health visitor reviews
• percentage of 2 to 2 and a half year reviews with a completed Ages and Stages Questionnaire 3 (ASQ-3)

Introduction

Good health, wellbeing and resilience are vital for all our children now and for the future of society. There is good evidence about what is important to achieve this through improving children and young people’s public health. This is brought together in the national healthy child programme 0 to 19.

The 0 to 5 element of the healthy child programme is led by health visiting services and the 5 to 19 element is led by school nursing services. Together they provide place-based services and work in partnership with education and other providers where needed.

Universal health visitor reviews

Regulations for children’s public health, part of the healthy child programme, include 5 health reviews in the pregnancy and the early years, for which all families are eligible. These ideally should be face to face and delivered by a health visitor, or under their supervision.

The 5 mandated health visitor reviews are:

• antenatal health promoting review, for women more than 28 weeks pregnant
• new birth visit, for children aged 1 to 2 weeks
• 6 to 8 week review, for children aged 6 to 8 weeks
• 12 month review, for children aged 9 to 15 months
• 2 to 2 and a half year review, for children aged 24 to 30 months

The 2 to 2 and a half year review is a holistic review of child health, development and growth, to identify children who are not developing as expected and/or in need of additional support. The review mandates the use of a recognised, validated tool for assessment of developmental review. This is currently the Ages and Stages Questionnaire, third edition (ASQ-3) which covers 5 domains of development including:

• communication
• gross motor
• fine motor
• problem solving
• personal-social skills

The health reviews may be targeted towards children who are likely to need more support. This includes those living in the most deprived areas and children who are known to be vulnerable due to family or other circumstances. This may contribute towards low coverage for some local authorities.

Main findings

This update shows:

• the coverage of timely universal health visitor reviews in England increased during 2023 to 2024 compared with 2022 to 2023. However, coverage of some reviews (new birth visits within 14 days, 6 to 8 week reviews) remains lower than the pre pandemic 2019 to 2020 period
• differences in coverage between regions, upper tier local authorities and deprivation groups remain
• in the most deprived areas of England (2 most deprived deciles of upper tier local authorities) the coverage of health visitor reviews is consistently above the England average. This holds for the 4 health visitor reviews delivered during infancy and childhood and for completion of ASQ-3. This indicates that some local authorities may be targeting services in more deprived areas

Detailed findings

New birth visits within and after 14 days of birth

In 2023 to 2024, 83.0% of infants received their new birth visit within 14 days of birth, an increase of 3.1 percentage points from 2022 to 2023. However, this is a decrease from 2019 to 2020, when 87.1% of infants received their new birth visit within 14 days of birth (figure 1). The combined percentage of infants in England who receive a new birth visit within or after 14 days, up to 30 days after birth, is stable with 97.8% of babies in England receiving a new birth visit in 2023 to 2024.

Figure 1: the percentage of infants in England who received a new birth visit within 14 days, 2017 to 2018 to 2023 to 2024

Coverage varies across regions of England and across upper tier local authorities. There is a 12.7 percentage point gap between the East of England region, which was the lowest at 77.1%, and the East Midlands region, which was the highest at 89.8% (figure 2).

Figure 2: the percentage of infants who received a new birth visit within 14 days, regions of England, 2023 to 2024

Across upper tier local authorities, coverage of new birth visits within 14 days ranged from 18.9% in Barnet to 99.0% in Darlington in 2023 to 2024. Coverage of new birth visits within or after 14 days ranged from 62.1% in Barnet to 100% in Darlington, Durham, Gateshead, Middlesbrough, Northumberland, Redcar and Cleveland, Sunderland, Blackburn with Darwen, Bolton, Trafford, North Yorkshire, Wakefield, Herefordshire, Enfield, and Lewisham.

One in 10 upper tier local authorities report 100% coverage of new birth visits, with most taking place within 14 days.

6 to 8 week health visitor reviews

In 2023 to 2024, 81.8% of infants received their 6 to 8 week review by 8 weeks, an increase of 2.2 percentage points from 2022 to 2023. However, this is lower than 2019 to 2020, when 85.1% of infants received their 6 to 8 week review by 8 weeks (figure 3).

Figure 3: the percentage of 6 to 8 week reviews by 8 weeks, 2017 to 2018 to 2023 to 2024

Coverage varies across regions of England and across upper tier local authorities. There is a 17.5 percentage point gap between the East of England region, which is lowest at 74.0%, and the North East region, which is highest at 91.5% (figure 4). London region did not pass validation, and does not have a rate published.

Figure 4: the percentage of 6 to 8 week reviews by 8 weeks, regions of England, 2023 to 2024

Among upper tier local authorities, coverage of 6 to 8 week reviews by 8 weeks ranged from 3.0% in Luton to 99.0% in Blackburn with Darwen.

12 month health visitor reviews

Coverage of 12 month reviews are collected at 2 time points, when the child is 12 months old, and when the child is 15 months old, which gives a more complete picture. In 2023 to 2024, coverage of the 12 month review by 15 months increased to 86.5%, an increase of 3.9 percentage points from 2022 to 2023. The overall coverage of 12 months reviews by 15 months has increased since 2019 to 2020, when coverage was 83.6%.

Figure 5: the percentage of 12 month reviews by 15 months, 2017 to 2018 to 2023 to 2024

Coverage varies across regions of England and across upper tier local authorities. There is a 22.2 percentage point gap between the North East region, which is the highest at 95.7% and London region, which is the lowest at 73.5% (figure 6). London and the South East regions have a lower coverage of 12 month reviews by 15 months than the England average. Yorkshire and the Humber region did not pass validation and does not have a rate published.

Figure 6: the percentage of 12 month reviews by 15 months, regions of England, 2023 to 2024

Among upper tier local authorities the coverage of 12 month reviews by 15 months ranges from 26.9% in Slough to 99.5% in Darlington.

2 to 2 and a half year health visitor reviews

In 2023 to 2024, 78.4% of children received their 2 to 2 and a half review, an increase of 5.2 percentage points from 2022 to 2023. However, the overall level is similar to 2019 to 2020, when coverage was 78.6% (figure 7).

Figure 7: the percentage of 2 to 2 and a half reviews, 2017 to 2018 to 2023 to 2024

Coverage varies across regions of England and across upper tier local authorities. There is a 26.9 percentage point gap between London region, which is the lowest at 62.6%, and the North East region, which is the highest at 89.5%. London and the East of England regions have a lower coverage than the England average.

Figure 8: the percentage of 2 to 2 and a half reviews, regions of England, 2023 to 2024

Coverage across upper tier local authorities ranges from 5.1% in Central Bedfordshire to 100.0% in East Riding of Yorkshire.

2 to 2 and a half year reviews with a completed ASQ-3

In 2023 to 2024, 93.3% of children had a completed ASQ-3 as part of their 2 to 2 and a half year review, an increase of 0.8 percentage points from 2022 to 2023. The overall level is higher than 2019 to 2020, when it was 92.6%.

Figure 9: the percentage of children with a completed ASQ-3 as part of their 2 to 2 and a half year review, 2015 to 2016 to 2023 to 2024

Coverage varies across regions of England and across upper tier local authorities. There is an 8.7 percentage point gap between London region, which is the lowest at 88.1%, and the South East region, which is the highest at 96.8%.

Figure 10: the percentage of children with a completed ASQ-3 as part of their 2 to 2 and a half year review, regions of England, 2023 to 2024

Among upper tier local authorities, the lowest coverage of ASQ-3 is 58.2% in Kirklees and the highest is 100% in Rochdale, Dudley, Herefordshire, Solihull, Bedford, Central Bedfordshire, Brighton and Hove, Buckinghamshire, Isle of Wight, Portsmouth, Southampton, and West Sussex. 12 local authorities achieved 100%.

Deprivation and health visitor service delivery

In the most deprived areas of England (2 most deprived deciles of upper tier local authorities) the coverage of health visitor reviews is consistently above the England average. This holds for the 4 health visitor reviews delivered during infancy and childhood and for completion of ASQ-3. This indicates that some local authorities may be targeting services in more deprived areas, which is in line with expectations on need for additional support within families.

Background

The information within this publication relates to the service coverage for health visiting services funded via the local authority public health grant for children’s public health 0 to 5 years. All pregnant women and children are eligible for a schedule of 5 mandated health reviews (Universal Health Visitor Reviews). This publication covers the 4 reviews which take place after delivery, the new birth visits within 14 days, 6 to 8 week reviews by 8 weeks, 12 month reviews by 15 months and 2 to 2 and a half year reviews.

The data has been obtained via OHID’s interim reporting system for children’s public health 0 to 5 years which collects health visiting activity and related outcomes (breastfeeding at 6 to 8 weeks and child development outcomes aged 2 to 2 and a half years) at a local authority level.

Caution should be exercised when interpreting these figures as it is a voluntary data collection. Any figures shown at a region or England level are based on an aggregate total of local authorities within those areas who supplied data items which complied with validation criteria for each indicator.

In the longer term, reporting on health visitor activity and related outcomes (breastfeeding and child development outcomes) will increasingly draw data from NHS England’s Community Services Data Set (CSDS). This solution will allow more flexibility in reporting, including options for metrics at lower geographical levels, and for inequalities to be described and monitored. Reporting from a record-level data set enforces standard definitions in a way that was not previously possible.

The technical guidance contains full details of the health visiting, breastfeeding and child development indicators, including definitions and methodology. Previous related publications are available on the Child and maternal health statistics page for:

• breastfeeding at 6 to 8 weeks
• child development outcomes at two to two and a half years

Contact information

For media enquiries please contact the Department of Health and Social Care media team.

For all other enquiries relating to the statistics or to offer feedback on the publication please contact us at [email protected].

All the data is available on Fingertips.