Health visiting: action plan 2025 to 2035

2. Health Visiting Action Plan

Vision – The delivery of Scotland’s health visiting service is enhanced, resulting in more of Scotland’s pre-school children being able to develop to their full potential and attain the highest possible level of health and wellbeing.

Strategic objectives and actions

Strategic Objective 1 - 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.

To ensure progress towards this objective Health Visitors will need to be able to maintain the professional skills and competencies required to deliver appropriate support to children and families.

Action Number

1.1

Action

The Scottish Government will work with NHS Education for Scotland (NES) to develop and publish an online health visiting learning site which provides Health Visitors with access to relevant guidance and resources including how they can be utilised to support each of the UHVP’s 11 visits.

Justification

Each of the 11 visits within the UHVP provide a platform for a Health Visitor to assess child development, promote child health and support family wellbeing. We want to ensure that Health Visitors are well supported in delivering these visits and the health visiting role more broadly.

The new learning site will bring guidance and resources relevant to the health visiting role together in one place. This will support Heath Visitors to maintain their skills and confidence across all aspects of health visiting. It will also support consistency in the understanding of the purpose and focus of each home visit.

Adding this content to a digital platform will also increase the ease by which associated resources can be refreshed and kept up-to-date.

Action Number

1.2

Action

The Scottish Government will work with NES and Health Boards to agree professional development priorities in response to a 2024 survey of Health Visitor learning needs.

Justification

In 2024, NES conducted a survey of professional learning needs amongst Health Visitors.

By offering professional development in areas identified by survey respondents, we can support Health Visitors to improve their skills and confidence and be better placed to help children and families.

Action Number

1.3

Action

The Scottish Government will promote and share guidance to support Health Visitors to comprehensively assess and record child development at child health reviews.

Justification

Health Visitors in Scotland assess child development across 8 developmental domains at three child health reviews (13-15 months, 27-30 months and 4-5 years).

A renewed focus on supporting Health Visitors to make these assessments will put them in the best position to determine if development is as expected or if developmental concerns may be present and additional support required.

Action Number

1.4

Action

Representatives from speech and language services will work collaboratively with Health Visitors to understand and guide the needs of the health visiting service in relation to supporting early speech, language and communication.

This work will include:

• working with NES to refresh the Health Visiting speech, language and communication (SLC) resource tools;
• working with BBC Tiny Happy People and Parent Club to help streamline appropriate universal and targeted interventions, making them clear and accessible for parents and professionals; and
• working alongside NES, BBC Tiny Happy People and Parent Club to deliver a workshop promoting: factors associated with SLC outcomes; key SLC messages; and where to access SLC information and resources.

Justification

Since 2020/21 there has been a national level increase in developmental concerns relating to speech, language and communication recorded at the 13–15 month, 27–30 month and 4-5 year child health reviews.

There is evidence to suggest that the presence of known risk factors for preventable speech, language and communication needs (SLCN) can have lesser impacts when supportive factors, such as positive adult-child interactions and responsiveness are in place.

Health Visitors provide a vital role in identifying and understanding health needs and risk factors for families and have the clinical and observational skills to recognise and respond to factors associated with preventable SLCN. This suite of actions will aid Health Visitors in the delivery of that support.

Action Number

1.5

Action

The Scottish Government will work with the Money and Pensions Service to make the Money Guiders professional learning programme available to Health Visitors.

Justification

We know that poverty is a determinant of poor health. That is why the UHVP directs Health Visitors to routinely enquire about money worries and family finances at periodic points throughout the home visiting schedule. The Money Guiders programme helps practitioners to gain the skills and confidence to have these conversations and respond appropriately when concerns are identified.

The roll out of the programme in Scotland will be informed by feedback from a group of early adopters within the health visiting and family nurse job families. This will help to ensure that the training is appropriately tailored to the needs of Scotland’s Health Visitors.

Strategic Objective 2 - We have sufficient health visiting workforce capacity to identify and appropriately respond to the needs of all pre-school children and their families.

To ensure progress towards this objective:

• Health Boards and Integration Joint Boards (IJBs) must be well equipped to manage Health Visitor caseloads;
• Health Boards and IJBs must be supported to recruit and retain Health Visitors; and
• health visiting should continue to be viewed as an attractive career choice.

Action Number

2.1

Action

The Scottish Government will reassess the health visiting caseload weighting tool.

Justification

The caseload weighting tool supports Health Boards in understanding how many Health Visitors are required to meet local population need. Evidence from the evaluation of the UHVP and from Scottish Government dialogue with Health Boards indicates that the tool may benefit from a reassessment to ensure it still represents the best approach to caseload weighting. Findings from the reassessment will aim to inform improvements in health visiting service delivery.

Action Number

2.2

Action

The Scottish Government will develop and share guidance on how Health Boards can make best use of the caseload weighting tool to support Health Visitor deployment and workforce planning.

Justification

The Scottish Government has committed to reassessing the caseload weighting tool as part of this action plan. Once that reassessment is complete we will share related guidance across health visiting leadership. Putting them in the best position to use the tool effectively.

Action Number

2.3

Action

The Scottish Government will conduct a review of Health Visitor recruitment and retention practices.

Justification

Effective recruitment and retention is vital in maintaining workforce capacity. A Scottish Government review of Health Visitor recruitment and retention will aim to highlight effective practice and relevant findings will be shared across all Health Boards and Integration Joint Boards.

Action Number

2.4

Action

The Scottish Government will work with delivery partners to establish mechanisms to develop and share messaging on:

• the role and contribution of Health Visitors in Scotland: and
• career pathways into health visiting.

Justification

Health Visitors deliver a vital service to children and families across Scotland. It is important to fully promote the significant contribution Health Visitors make to child health and wellbeing, child development and family resilience in an effort to attract more individuals into the profession.

Action Number

2.5

Action

The Scottish Government will provide Health Visitors with opportunities to increase their skills, knowledge and confidence in relation to supporting parenting, infant feeding and perinatal mental health.

This work will include:

• working with NES to refresh the suite of e-learning modules focused on breastfeeding and the introduction of complementary foods;
• working with the Perinatal Mental Health Network Scotland (PMHNS) to promote and disseminate materials on how Health Visitors can support perinatal mental health and, where appropriate, support families to access Perinatal Mental Health Care Pathways; and
• ensuring that Health Visitors are considered in forthcoming Scottish Government work aimed at empowering parents and carers to provide nurturing care through access to relevant guidance and services at the right time.

Justification

The evaluation of the UHVP found that the 5 Health Boards involved in the case note review were undertaking a “substantial number of additional visits” outside the core pathway. These additional visits most commonly focused on:

• parenting;
• infant feeding; and
• perinatal mental health.

Providing Health Visitors with opportunities to gain skills and confidence across these topics will leave them better placed to offer appropriate support to children and families. In some cases additional visits will still be appropriate but in others, Health Visitors may be able to offer support before concerns escalate and additional contacts are required.

Strategic Objective 3 - Health Visitors have a clear role and remit which is coherently integrated into wider children and family support services.

To achieve progress against this objective there needs to be clarity on the role and remit of Health Visitors. This includes ensuring that the Universal Health Visiting Pathway is clear in its expectations of Health Visitors throughout the home visiting schedule.

We also need to ensure that Health Visitors are aware of the importance of working in partnership with other services for children, families and pregnant women across the NHS, local authorities and third sector. Ensuring a close alignment between health visiting and other relevant services provides children and families with the best opportunity to receive well-coordinated care in ways which best meet their individual needs.

Action Number

3.1

Action

The Scottish Government will convene a short life working group to consider if the UHVP should be proportionately amended in response to contemporary evidence including the findings of the UHVP evaluation.

Justification

The UHVP provides a well informed, detailed and comprehensive support offering which all families with a child between pre-birth and school starting age are entitled to.

The pathway continues to represent a significant part of the health visiting service across Scotland and in doing so it supports positive outcomes for Scotland’s youngest generation.

While there is no strong evidence to review the pathway in its entirety, there is evidence to suggest that some aspects of the pathway may benefit from further consideration.

A short life working group which sources relevant expertise from across child health policy and delivery, as well as the views of mothers, fathers, other carers and children, will guide this work. Outputs from the group will inform if any aspects of the pathway need to be amended.

Action Number

3.2

Action

The Scottish Government will enhance health visiting information on the Parent Club website to include more interactive information on what parents and carers can expect from the health visiting service.

Justification

Enhanced Parent Club information on health visiting and the Universal Health Visiting Pathway will allow parents/carers to be able to learn about their health visiting entitlement in a more interactive and engaging way.

This can help Health Visitors to communicate how the health visiting service works in partnerships with parents and carers to promote the health and wellbeing of their children.

Action Number

3.3

Action

The Scottish Government will commission the development of clinical guidance on the appropriate use of skill mix in relation to supporting delivery of the health visiting pathway.

Justification

Many Health Visitors work within wider children’s nursing teams. This approach allows a mixing of skills and the opportunity for Health Visitors to work collaboratively with colleagues such as Nursery Nurses, Health Care Support Workers (HCSWs) and Community Children’s Nurses.

The use of skill mix teams allows Health Visitors to arrange for other colleagues to support families outside the core health visiting pathway. New clinical guidance will provide clarity on work which Health Visitors should undertake and work which may be delegated to colleagues in a wider team.

Action Number

3.4

Action

The Scottish Government will conduct a feasibility assessment on introducing a digital early child development tool to enhance current paper based processes. This will be in line with wider work to progress and modernise child health systems and processes.

Justification

Health Visitors in Scotland currently use the Ages & Stages Questionnaire 3 (ASQ-3) and Ages & Stages Questionnaire: Social and Emotional, 2nd Edition (ASQ:SE-2) to aid their assessment of child development. At present, these tools are only available in paper format in Scotland.

The addition of a digital early child development tool (alongside current paper based offerings) has the potential to streamline assessment, data recording and data analysis related to child development.

This can make the process of assessing, and ultimately responding to, any developmental concerns more efficient.

Action Number

3.5

Action

The Scottish Government will conduct a review of how health visiting teams identify and access connections and pathways to other children and family support services across the NHS, local authorities and third sector. Innovative practice identified through the review will be shared across Health Boards and Integration Joint Boards.

Justification

The health visiting service provides significant support to children and families. However, we know that families also rely on a number of other services.

It is imperative that Health Visitors are able to work with those other services so that families can receive integrated support. This approach is central to the Scottish Government’s commitment to ‘Getting it right for every child’ (GIRFEC).

A review of how health visiting teams map and establish connections with related services will help to identify innovative practice which supports a ‘Getting it right for every child’ approach. Effective practice can then be shared across all Health Boards and Integration Joint Boards.

Action Number

3.6

Action

The Scottish Government will use the opportunity provided by 2025/26 GIRFEC national and regional engagement events to strengthen knowledge and understanding of key GIRFEC roles and responsibilities including how best to work with the named person.

Justification

Outputs from this session will aim to strengthen the understanding of the role of the Health Visitor (often a child’s named person) in supporting working relationships across services under the GIRFEC multi-agency approach.

The sessions will also aim to identify examples of good practice where Health Visitors, as the named person, have facilitated pathways to other services when providing support to a child and their family.

Strategic Objective 4 - 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.

To achieve progress against this objective we must ensure that relevant leaders and decision makers consistently have access to contemporary evidence which demonstrates the value of the health visiting service in supporting child health, wellbeing and development and promoting and protecting children’s rights.

Action Number

4.1

Action

The Scottish Government will re-convene the Children, Young People and Families Nursing Advisory Group.

Justification

The health visiting service will have the opportunity to operate most effectively when it can benefit from appropriate oversight and support from relevant leaders.

Re-convening the Children, Young People and Families Nursing Advisory Group will provide well informed strategic direction for the service. It will also provide a forum to which shared challenges and opportunities can be escalated.

Action Number

4.2

Action

The Scottish Government will establish twice yearly bilateral meetings with:

• territorial Health Boards delivering the health visiting service; and
• universities delivering the Health Visiting Specialist Community Public Health Nursing (SCPHN) course

to discuss health visiting across different geographical areas.

Justification

While health visiting is a universal service, methods of delivery will vary across localities as Health Boards and Universities consider the requirements of specific local populations.

Scottish Government discussions with Health Boards and Universities provide a picture of the different challenges and opportunities health visiting teams face transferring policy into practice. Ultimately these discussions can inform appropriate support and help to ensure consistent service delivery across Scotland.

Action Number

4.3

Action

The Scottish Government will work with Public Health Scotland to arrange annual webinars on national Health Visitor coverage and early child development statistics.

Justification

The webinars will allow representatives from Health Boards and Integration Joint Boards to better understand latest national statistics including how they compare to health visiting delivery and early child development within their own areas.

This data can support NHS Boards and IJBs to pursue continuous improvement.

Action Number

4.4

Action

The Scottish Government will engage with Chief Officers of Integration Joint Boards (IJBs) to discuss the value of investing in early child development activity including the health visiting service.

Justification

The provision of the health visiting service is the responsibility of territorial Health Boards. However in some localities, Health Boards have chosen to delegate responsibility for the service to their local IJB. This allows integration of health visiting with relevant local authority children’s services such as social work.

A number of Chief Officers of IJBs therefore have an interest in the health visiting service and it is important to ensure that they continue to be aware of the value of the service and its contribution to child health and early child development.

Action Number

4.5

Action

The Scottish Government will engage with Directors of Finance, or an appropriate subgroup, within NHS Boards to discuss the value of investing in early child development activity including the health visiting service.

Justification

The health visiting service is overseen by nursing leadership within NHS Boards. However, appropriate investment within the service is contingent on NHS Directors of Finance also being aware of the value of the service.

Scottish Government engagement with Directors of Finance (or an appropriate subgroup) will further support their understanding of how health visiting’s focus on prevention and early intervention can realise financial value in the longer term i.e children well supported in the early years are more likely to become healthier and happier adults who are less likely to become reliant on NHS services in the future.

All engagement with NHS Directors of Finance will be cognisant of the financial landscape within which discussions take place and the continuing need for all NHS spend to be fully assessed and to achieve value for money.

Action Number

4.6

Action

The Scottish Government will promote the importance of health visiting to Children’s Services Planning Partnership Strategic Leads. This will be done as part of a series of facilitated workshops on a range of topics during 2025.

Justification

The Children and Young People (Scotland) Act 2014 requires every Local Authority and its relevant Health Board to jointly prepare a Children’s Services Plan for the area for each three-year period. This is done in collaboration with specified service providers, other public bodies, the third sector and children, young people and families. Outlining the importance of the health visiting service to those who lead on the development of these plans will help ensure that health visiting remains a central consideration in the strategic planning and delivery of integrated children’s services.