Universal Health Visiting Pathway evaluation - phase 1: main report - primary research with health visitors and parents and case note review

The Universal Health Visiting Pathway was introduced in Scotland in 2015 to refocus the approach to health visiting. This is the first report of 4 that provides findings of the National Evaluation of Health Visiting. It focuses on primary research with health visitors and parents and case note review.

7. Suggested improvements to the UHVP

An open question included in the survey invited both health visitors and parents to make suggestions of how they felt that UHVP could be improved.

Amongst health visitors, the most common suggested changes to the UHVP related to:

  • Resources (34%) – with suggestions including more staff, reduced caseload sizes, greater support from non-health visiting staff, better IT systems, more/better training, and more/better equipment e.g. scales.
  • Contacts/visits (30%) – with suggestions including a less prescriptive service/more scope for professional judgement and the reintroduction of clinics.
  • The pathway schedule (28%) – including combining the three and four month visits, adding a review around 18 months and conducting the 4-5 years review at clinic/nursery.
  • Efficiencies (14%) – mainly relating to reducing/simplifying documentation and paperwork.

Amongst the parents, half (52%) suggested changes (in response to an open question) as to how health visiting in Scotland could be improved. Whereas a fifth of parents (20%) did not suggest any improvements as they were happy with the service while a further 27% did not know how it could be improved.

  • Suggested changes fell under the themes shown in Table 7.1, with the most common suggestions relating to an increased number of contacts.
  • The suggested improvements also provide an indication of the sources of dissatisfaction among those who said they were dissatisfied with the health visiting service as a whole. Among this group, 72% suggested improvements. The improvements in which there was a significant difference between those who were satisfied and those who were dissatisfied are shown in bold in the table below. They suggest that dissatisfaction may stem from issues related to levels of contact, relationship and communication with the (same) health visitor and feeling listened to and supported.
Table 7.1 Suggested improvements to the health visiting service
Suggested improvement Overall % % of parents satisfied overall with health visiting service % of parents dissatisfied overall with health visiting service
More contact with health visitor (in general) 18% 11% 37%
Contact with the same health visitor 6% 6% 15%
More contact for older children/children over 2 years 3% 3% 5%
More face-to-face contact with the health visitor (responses did not always specifically refer to during lockdown) 3% 3% 2%
Organise the appointments better/stick to appointments 3% 2% 10%
Be easier to contact 2% 3% 2%
Employ more health visitors/some areas have no health visitors 2% 2% 5%
Reintroduce drop-in clinics 2% 2% 2%
Better communication 2% 1% 6%
Better communication between health visitors and other services – e.g. GPs/paediatricians 2% 1% 6%
More advice/information (in general) 7% 8% 10%
Listen to the parents/their concerns 4% 2% 15%
Better qualified health visitors 4% 3% 11%
More support for the mother/mother’s mental health 3% 3% 8%
Better professionalism/be less judgemental 2% 2% 8%
More support for breastfeeding 2% 1% 5%

Base: all parents (550)


Email: Justine.menzies@gov.scot

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