Organising health visiting services in the UK: Frontline perspectives

Whittaker, Karen; Appleton, Jane V.; Peckover, Sue; Adams, Cheryll M.

doi:10.12968/johv.2021.9.2.68

Cited by 8 publications

(4 citation statements)

References 5 publications

(3 reference statements)

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“…Maternal mental and physical health problems would normally lead to primary care intervention in the NHS in England. However, recent reports have suggested that the universal health service has been compromised and general and nurse practitioner services have become less accessible for some families (Whittaker et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Predictors of Mother and Infant Emergency Department Attendance and Admission: A Prospective Observational Study

Mason‐Jones

Beltrán

Keding

et al. 2023

Matern Child Health J

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Objective To explore the predictors of emergency department attendance and admission for mothers and their infants. Methods Self-reported emergency department (ED) attendance and admission, sociodemographic, mental health, and other measures were recorded at baseline and at 12 months at 4 sites in England between May 2017 and March 2020. Results Infants’ gestational age (OR 0.73, 95% CI 0.61 to 0.88, p = 0.001), mothers’ mental health (OR 2.40, 95% CI 1.30 to 4.41, p = 0.005) and mothers’ attendance at ED (OR 2.34, 95% CI 1.13 to 4.84, p = 0.022) predicted infant ED attendance. Frequency of attendance was predicted by ED site (IRR 0.46, 95% CI 0.29 to 0.73, p = 0.001) and mothers’ age (IRR 0.96, 95% CI 0.92 to 1.00, p = 0.028). Infant hospital admissions were predominantly for respiratory (40%) and other infectious diseases (21%) and were predicted by previous health problems (OR 3.25, 95% CI 1.76 to 6.01, p < 0.001). Mothers’ ED attendance was predicted by mixed or multiple ethnic origin (OR 9.62, 95% CI 2.19 to 42.27, p = 0.003), having a male infant (OR 2.08, 95% CI 1.03 to 4.20, p = 0.042), and previous hospitalisation (OR 4.15, 95% CI 1.81 to 9.56, p = 0.001). Hospital admission was largely for reproductive health issues (61%) with frequency predicted by having attended the ED at least once (IRR 3.39, 95% CI 1.66 to 6.93, p = 0.001), and being anxious or depressed (IRR 3.10, 95% CI 1.14 to 8.45, p = 0.027). Conclusions for Practice Improving the reproductive and mental health of mothers may help to avoid poor maternal and infant health outcomes and reduce emergency service utilisation and hospitalisation.

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Section: Discussionmentioning

confidence: 99%

Predictors of Mother and Infant Emergency Department Attendance and Admission: A Prospective Observational Study

Mason‐Jones

Beltrán

Keding

et al. 2023

Matern Child Health J

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“…Local authorities and their provider partners have faced funding cuts, low numbers of health visiting staff and high levels of family need, putting pressure on the service [4,[6][7][8]. Case studies and surveys have shown that local authorities have responded differently to these challenges, leading to variations in models of service delivery, priorities, and capacity [2,7,9].…”

Section: Introductionmentioning

confidence: 99%

Local area variation in health visiting contacts across England for children under age 5: a cross-sectional analysis of administrative data in England 2018-2020

Liu,

Woodman,

Mc Grath-Lone

et al. 2024

IJPDS

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BackgroundThe health visiting service in England leads the government's Healthy Child Programme (HCP) for children under five years. Local authorities and their provider partners deliver this service differently across England. ObjectiveTo describe local authority variation in the delivery of health visiting to children under five years in England (2018-2020). MethodsWe used publicly available statistics on mandated health visiting contacts, and administrative data from the Community Services Dataset (CSDS) on duration, location, and medium of contacts. We mapped population coverage of mandated contacts (new birth visit, 6-8-week review, one-year review, and 2-2½ -year review) and described the frequency and characteristics of mandated and additional contacts across local authorities. ResultsBased on publicly available data, almost all eligible children received their new birth visit, 6-8-week review and one-year review (89%-99%), with substantial variation across local authorities in children receiving he 2-2½ -year review: median 81%, range 33%-98%. Based on CSDS, 80% of local authorities (n=46/57) delivered more additional than mandated contacts: a median of 1.6 additional contacts (range: 0.1-8.5) were delivered for each mandated contact. There was also significant variation in the duration of contacts and the percentage of contacts delivered face-to-face and at home. ConclusionsDespite decreases in funding and workforce since 2015, in 2018--2020, health visiting teams reached nearly all babies and most children face-to-face via mandated contacts, and conducted over one and a half times the number of additional contacts relative to mandated contacts, with variation between local areas. This represents a significant public health infrastructure to support the health and development of babies and children and the wellbeing of their families in the critical period before school. Our study highlights the importance of taking into account additional contacts. Further work is needed to understand variation, including in the way additional contacts are used.

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“…While the objectives of the universal CHPs across the four nations of the UK are similar, there is considerable variation in how they are organised and delivered 2. For example, there is variation in the number and intensity of core contacts between families and services, where those contacts may take place and who should undertake them 3. While models of health visiting can be found elsewhere, the policy contexts influencing service commissioning, delivery, organisation and nursing/professional education differ significantly across countries 4…”

Section: Introductionmentioning

confidence: 99%

Health visiting in the UK in light of the COVID-19 pandemic experience (RReHOPE): a realist review protocol

King

Gadsby

Bell³

et al. 2023

BMJ Open

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IntroductionHealth visiting services, providing support to under 5s and their families, are organised and delivered in very different ways in different parts of the UK. While there has been attention to the key components of health visiting practice and what works well and how, there is little research on how health visiting services are organised and delivered and how that affects their ability to meet their objectives. The COVID-19 pandemic rapidly disrupted service delivery from March 2020. This realist review aims to synthesise the evidence on changes during the pandemic to identify the potential for improving health visiting services and their delivery.Methods and analysisThis review will follow the RAMESES (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) quality standards and Pawson’s five iterative stages to locate existing theories, search for evidence, select literature, extract data, synthesise evidence and draw conclusions. It will be guided by stakeholder engagement with practitioners, commissioners, policymakers, policy advocates and people with lived experience. This approach will consider the emerging strategies and evolving contexts in which the services are delivered, and the varied outcomes for different groups. A realist logic of analysis will be used to make sense of what was happening to health visiting services during and following the pandemic response through the identification and testing of programme theories. Our refined programme theory will then be used to develop recommendations for improving the organisation, delivery and ongoing postpandemic recovery of health visiting services.Ethics and disseminationGeneral University Ethics Panel approval has been obtained from University of Stirling (reference 7662). Dissemination will build on links to policymakers, commissioners, providers, policy advocates and the public. A range of audiences will be targeted using outputs tailored to each. A final stakeholder event focused on knowledge mobilisation will aid development of recommendations.PROSPERO registration numberCRD42022343117.

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Organising health visiting services in the UK: Frontline perspectives

Cited by 8 publications

References 5 publications

Predictors of Mother and Infant Emergency Department Attendance and Admission: A Prospective Observational Study

Predictors of Mother and Infant Emergency Department Attendance and Admission: A Prospective Observational Study

Local area variation in health visiting contacts across England for children under age 5: a cross-sectional analysis of administrative data in England 2018-2020

Health visiting in the UK in light of the COVID-19 pandemic experience (RReHOPE): a realist review protocol

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