Health visiting: action plan 2025 to 2035

3. Key Performance Indicators

The following key performance indicators have been developed to help assess the extent to which progress is being made towards the action plan’s aims. The indicators should not be seen as targets but as mechanisms through which the delivery of health visiting can be periodically reviewed in an effort to identify and respond to any relevant opportunities and challenges.

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.

Primary Indicators- which will help assess progress towards the action plan’s overarching aims

Reference

PI 1

Area of focus

National health visitor coverage data

Key performance indicator

National data showing the percentage of eligible 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

either maintains or increases each year.

Justification

Annual data on the coverage of Health Visitor contacts provides an important indicator of the reach of the health visiting service.

Actions taken under our four strategic objectives should help Health Visitors to deliver more of the UHVP to more families. If national level coverage rates maintain or improve each year we will be able to infer that our action plan is having a positive impact and that we are making progress to one of the action plan’s aims (increased coverage by 2030/31 when compared to 2022/23).

Any reduction in coverage rates at the national level will prompt the Scottish Government to further investigate related causes in partnership with Health Boards.

Source of data

Child Health Pre-School Review Coverage Data – published annually by Public Health Scotland

Reference

PI 2

Area of focus

Meaningful child development data (national level)

Key performance indicator

National data showing the percentage of child health reviews (at 13-15 months, 27-30 months and 4-5 years) with meaningful data recorded against each developmental domain either maintains or increases annually.

Justification

All children are entitled to child health reviews at 13-15 months, 27-30 months and 4-5 years. At each of these reviews a Health Visitor will assess development against 8 developmental domains and they should conclude and record either:

• no concern;
• concern newly suspected; or
• concern or disorder previously known.

If one of these outcomes is not entered then it is documented as ‘assessment incomplete’ and categorised as a review without meaningful data against each domain within annual early child development stats.

Our focus on supporting Health Visitors to access relevant professional development relating to the assessment of child development should increase the number of reviews with meaningful data against each domain.

This will provide a good indication that children are having their development comprehensively assessed and responded to. It will also increase the completeness of national level data on early child development.

Any reduction in the proportion of reviews containing meaningful information against each domain will prompt the Scottish Government to further investigate related causes.

Source of data

Early Child Development Statistics – published annually by Public Health Scotland

Secondary Indicators – which will influence the primary indicators

Reference

SI 1

Area of focus

Annual coverage data within local authority areas (comparison with Health Board’s previous performance)

Key performance indicator

The percentage of eligible 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

either maintains or increases each year within each local authority area.

Justification

The percentage of eligible children receiving their Health Visitor contacts within each local authority area will have a direct impact on national Health Visitor coverage.

By tracking coverage within each local authority area, the Scottish Government will be able to discuss causes and solutions with Health Board partners should there be instances of reduced coverage in any particular locality in Scotland.

Source of data

Child Health Pre-School Review Coverage Data – published annually by Public Health Scotland

Reference

SI 2

Area of focus

Meaningful child development data (comparison with Board’s previous performance)

Key performance indicator

The percentage of child health reviews (at 13-15 months, 27-30 months and 4-5 years) with meaningful data recorded against each developmental domain either maintains or increases annually within each local authority area.

Justification

The percentage of child health reviews with each local authority area with meaningful data recorded against each developmental domain will have a direct impact on meaningful child development data at the national level.

By tracking meaningful data within each local authority area, the Scottish Government will be able to discuss causes and solutions with Health Board partners should there be instances of reduced data recording in any particular locality.

Source of data

Early Child Development Statistics – published annually by Public Health Scotland

Reference

SI 3

Area of focus

Health Visitor workforce numbers (provisional)

Key performance indicator

The number of whole time equivalent (wte) Band 7 Health Visitors per 10,000 0-5 year olds in Scotland remains at or above 49.98.

Justification

The health visiting caseload weighting tool provides guidance on the number of Health Visitors required per head of the 0-5 population across different SIMD deciles. This approach ensures that a greater number of Health Visitors are deployed in communities more likely to have their health negatively impacted by socioeconomic deprivation.

The caseload weighting tool and population data across SIMD deciles indicates that 49.98 whole time equivalent health visitors are required per 10,000 0-5 year olds in Scotland.

A rate of no fewer than 49.98 Health Visitors per 10,000 0-5 year olds can therefore be seen as the minimum number of Health Visitors required to deliver the UHVP and a notional key performance indicator.

However, it is possible that an amended caseload weighting tool (action 2.1 in this plan) will dictate a change in the minimum number of Health Visitors required to deliver the UHVP to all eligible families.

This indicator will therefore remain provisional until the Scottish Government has completed a reassessment of the caseload weighting tool in partnership with relevant stakeholders. Once the reassessment of the caseload weighting tool is completed this indicator will be finalised and the action plan appropriately updated.

Source of data

National Records of Scotland - Population Estimates by Scottish Index of Multiple Deprivation and NHS Scotland – Official Workforce Statistics

Reference

SI 4

Area of focus

Health Visitor student numbers

Key performance indicator

The number of active health visiting students either maintains or increases annually.

Justification

The vast majority of Health Board students in Scotland are funded to undertake their postgraduate training by their Health Board employer. This approach allows Health Boards to respond to expected workforce turnover and maintain Health Visitor numbers.

Actions within this plan aim to promote health visiting as a career and encourage continued investment in Health Visitor training by Health Boards. A robust pipeline of new Health Visitors will be crucial if we are to improve coverage and support improved outcomes for children and families.

We will therefore monitor annual Health Visitor student numbers, working with Health Boards and Universities should there be instances of reducing intakes.

Source of data

NHS Scotland – Official Workforce Statistics

Balancing measures – which will monitor impacts of the plan on other parts of the health visiting service

Reference

BM 1

Area of focus

Equality of health visiting provision

Key performance indicator

The variation in the coverage of Health Visitor contacts at 11-14 days, 6-8 weeks, 13-15 months, 27-30 months and 4-5 years remains within 3 percentage points across all SIMD quintiles.

Justification

Health visiting is a universal service and the 11 core visits set out within the UHVP should be offered to all families as a minimum standard.

Annual data on the coverage of 5 Health Visitor contacts (First Visit, 6-8 weeks and all three child health reviews) is broken down by each SIMD quintile. This annual data demonstrates that equality of provision is strong and that the difference in coverage across SIMD quintiles is minimal. Percentage coverage across quintiles has only twice exceeded 3 percentage points for any of the 5 visits in the last three reporting years – the 4-5 year review in 20/21 and 21/22 reported a range of 3.6% and 3.2% respectively between the SIMD quintile experiencing the highest coverage and the quintile experiencing the lowest.

Any further instances of a range in excess of 3 percentage points will prompt the Scottish Government to investigate. This will help to ensure that any national increases in coverage are not at the expense of equality of provision.

Source of data

Child Health Pre-School Review Coverage Data – published annually by Public Health Scotland

Reference

BM 2

Area of focus

Health Visitor turnover rate (headcount)

Key performance indicator

The national turnover rate for qualified Health Visitors does not exceed 10% in any year.

Justification

Turnover is the rate at which employees leave the workforce and is calculated by dividing the number of leavers over the year by the staff employed at the start of the period.

In the last five years between March 2019 and March 2024 the turnover rate for qualified Health Visitors has not exceeded 10%. Achieving increased Health Visitor coverage and data completeness will require a relatively settled workforce. We will therefore monitor the qualified Health Visitor turnover rate on an annual basis to provide an indication of whether actions within this plan can be seen to be impacting on Health Visitor wellbeing and staff movements.

Source of data

NHS Scotland – Official Workforce Statistics