Health visiting: action plan 2025 to 2035

1. Introduction

The role of Health Visitors

The first years of a child’s life are crucial to their overall development. A child’s experiences and opportunities between pre-birth and the time they start school will have a significant impact in shaping their future health, wellbeing and overall life chances. A keen and sustained focus on the provision of nurturing care in the early years is therefore of vital importance.

Health Visitors are at the forefront of work to protect and promote the rights of children and enhance opportunities within the early years. They offer support to all of Scotland’s pre-school children through a universal home visiting service which contributes to the continuum of care between the maternity and the school nursing service. Through the schedule of home visits, Health Visitors are able to develop valuable and trusting relationships with the children, families and communities they serve. Those relationships provide a solid foundation upon which Health Visitors can deploy their professional skills and competencies as specialist community public health nurses (SCPHNs). This involves assessing child and family health and wellbeing, supporting parents and carers to provide nurturing care, responding to any child health and development concerns and preventing poor child health outcomes altogether.

In addition to their own unique professional contribution, Health Visitors are also pivotal in coordinating care and advice across interrelated services. Health Visitors usually take up the named person^[1] role under Scotland’s 'Getting it right for every child' approach and can therefore offer a single point of contact for families when their child needs support in the years before primary school. Health Visitors use their named person role to help families access relevant services from across the NHS, local authorities and the third sector – promoting collaboration and partnership working in the process.

The depth and breadth of a Health Visitor’s contribution is therefore significant and will be guided by the needs of the children and families they support. However, all Health Visitors in Scotland share a common focus in delivering the Universal Health Visiting Pathway (UHVP) as a core part of their role. The UHVP reflects the minimum standard of support that a pre-school child and their family can expect from the health visiting service. The core home visiting schedule is set out below and further detailed in Scotland’s Universal Health Visiting Pathway (UHVP) document^[2].

• Antenatal visit (32-34 weeks of pregnancy)
• First Visit (11-14 days)
• 3-5 weeks
• (visit one)
• 3-5 weeks
• (visit two)
• 6-8 week visit
• 3 month visit
• 4 month visit
• 8 month visit
• 13-15 month child health review
• 27-30 month child health review
• 4-5 year child health review

Why is a health visiting action plan needed?

The evaluation of Scotland’s Universal Health Visiting Pathway (UHVP) confirmed that the health visiting service is highly regarded by parents and carers^[3]. It also provided evidence that the pathway itself supports the early identification of need, the building of positive Health Visitor/family relationships and the facilitation of multidisciplinary team working which meets the specific needs of children^[4] underpinned by the ‘Getting it right for every child’ (GIRFEC) approach. However, the evaluation also indicated that increased identification of need has led to additional visits being offered and that those additional visits, combined with long wait times following referrals to some specialist services, has placed additional strain on Health Visitor capacity^[5].

Furthermore, national statistics show that the proportion of eligible children receiving Health Visitor contacts at 11-14 days, 6-8 weeks, 13-15 months, 27-30 months and 4-5 years has decreased annually for each visit since 2020/21 (Figure. 1). Separately, and over the same time period, we have seen an increase in the proportion of children with a developmental concern identified between 13 months and 5 years (Figure. 2) and the gap between the prevalence of concerns within our most and least deprived communities is widening (Figure. 3).

The aforementioned national statistics combined with the findings of the UHVP evaluation indicate that, whilst the health visiting service is delivering significant value, there is potential and crucially a clear need for that value to be further maximised. It is that conclusion that has been the main driver for the development of this action plan.

How will this action plan make a positive difference?

This action plan aims to create the conditions to allow the enhanced delivery of the health visiting service and the full and consistent delivery of the UHVP as a central offer within the service. This will be achieved by committing the Scottish Government and its delivery partners to a suite of actions focused around the following four interconnected strategic objectives.

• We have a skilled, confident and knowledgeable health visiting workforce able to fully promote and protect child health and development in line with professional expectations.
• We have sufficient health visiting workforce capacity to identify and appropriately respond to the needs of all pre-school children and their families.
• Health Visitors have a clear role and remit which is coherently integrated into wider children and family support services.
• The health visiting service is appropriately prioritised and promoted by relevant leaders and decision makers in recognition of its role in prevention and early intervention.

The following logic model demonstrates the expected short, medium and long term outcomes that the actions under each strategic objective will collectively deliver.

What will success look like?

Successful implementation of this action plan will result in the enhanced delivery of Scotland’s health visiting service, resulting in a higher proportion of pre-school children being able to develop to their full potential and attain the highest possible level of health and wellbeing.

Delivery of that long term outcome will be monitored by tracking progress towards the following aims related to the delivery of the health visiting service.

Action plan aims

Area of focus

National Coverage Data

Specific aim

The proportion of pre-school children receiving their Health Visitor contacts at:

• 11-14 days (First Visit);
• 6-8 weeks;
• 13-15 months;
• 27-30 months; and
• 4-5 years

will have increased at a national level by 2030/31 when compared to 2022/23^[9].

Area of focus

Meaningful child development data (national level)

Specific aim

The proportion of child health reviews (at 13-15 months, 27-30 months and 4-5 years) with meaningful data recorded against each developmental domain will have increased at a national level by 2030/31 when compared to 2022/23.

Tracking data related to the coverage of key health visiting contacts, and the comprehensive assessment of child development within some of those contacts, will provide assurance that eligible children and families are accessing quality interactions with a Health Visitor and potentially having their outcomes positively influenced as result.

How will progress be monitored?

Key performance indicators are included within this action plan.

The suite of indicators have been developed to help assess the extent to which the action plan is having a positive impact on progress towards the aforementioned aims. This includes indicators to monitor health visitor coverage and the robust assessment of child development at each child health review.

The Scottish Government will lead work to periodically assess data relating to performance indicators. Any instances of key performance indicators not being met will prompt the Scottish Government to work collaboratively with delivery partners to further investigate related causes and pursue any possible improvements.

What is the timeframe of the action plan?

Actions set out within the plan will be fully delivered by 2030 but the plan’s strategic objectives will guide the Scottish Government’s approach to supporting the health visiting service for at least the next decade, until 2035. This will ensure that national level support for the health visiting service in Scotland is guided by clearly stated strategic objectives and that associated actions have sufficient time to be implemented and take effect.

Who is this action plan for?

The plan is primarily for the Scottish Government and its delivery partners who are named alongside specific actions. The plan will guide the action those bodies will take to support the health visiting service over the next 5 years. However, the plan will also be of interest to everyone involved in, or benefitting from, the health visiting service. That includes, but is not limited to, children and families, Health Visitors, practitioners working in wider health visiting teams and colleagues from across the NHS, local authorities and the third sector who work closely with the health visiting service. For those groups, the action plan communicates the national vision for health visiting support and improvement.

Will the action plan replace the Universal Health Visiting Pathway (UHVP)?

No, the UHVP will continue to be the document which all Health Visitors in Scotland use to guide their core interactions with families. Health Visitors will also continue to demonstrate how they are meeting the competencies set out in the Nursing and Midwifery Council’s (NMC) Standards of Proficiency for Specialist Community Public Health Nurses.

This action plan aims to complement that work and to create the conditions to allow enhanced delivery of the UHVP and the wider competencies set out in the NMC standards.

How does this action plan align with other national priorities?

Scotland's 'Getting it right for every child' (GIRFEC) approach forms the underpinning framework for this action plan, capturing the offer of support provided to all children and families. This holistic, rights-based framework facilitates a whole family approach to supporting babies, infants, children and young people, including through the early years, by providing Health Visitors with a shared language and mechanism for identifying any support required to improve wellbeing.

Implementation of the action plan will also contribute to wider national priorities relating to the health, wellbeing, early learning, development and prosperity of children and families. The Scottish Government wants to ensure that every child born in Scotland has the best start in life and, through our Early Child Development Transformational Change Programme, we are committed to reducing developmental concerns at 27-30 months by a quarter by 2030 – resulting in the lowest levels recorded. This action plan will significantly contribute to the delivery of that ambition and therefore the future health and wellbeing of Scotland’s population. In doing so, it will also support broader work on population health which will be set out in the Population Health Framework later in 2025.

The Scottish Government and its partners will also seek to ensure that delivery of the action plan coherently aligns with other relevant programmes of work including the delivery of recommendations produced by the Nursing and Midwifery Taskforce, Scotland’s commitment to promoting children’s rights and the Scottish Government’s mission to eradicate child poverty.