A New Look at Hall 4 – the Early Years – Good Health for Every Child

Guidance setting out the way forward for the successful delivery of Health for All Children (Hall 4) in the early years.


The Health Plan Indicator ( HPI) was developed following the publication of the 2005 guidance, for use by health practitioners to enable them to allocate to a core, additional or intensive programme of support, depending on a child's assessed level of need. Although the timescale for allocation of the HPI was not defined, as the 2005 guidance was implemented the default milestone for allocation became part of the 6-8 week review in the majority of cases. This has been attributed mainly to the changing role of the Public Health Nurse - Health Visitor in the years following the publication of the 2005 guidance.

The use of the HPI has varied across Scotland with some areas using it as a corporate tool to measure workforce requirements or levels of deprivation within communities. It should be clear that the HPI is a tool to reflect the child's needs in their family, community or wider context.

The allocation of the HPI requires to be flexible and should reflect the changing needs of the child and family as situations and circumstances change. These changes happen throughout a child's life but, for the purpose of this guidance, are particular to the early years. The HPI is a snapshot of a moment in a child's life but is an appropriate indicator for use by practitioners as a measure of the mutually agreed support for the child and his or her family.

Applying a GIRFEC approach means that an assessment of needs should determine whether proper access to universal services and the core support they provide are sufficient for the family or whether additional input is required to help the child reach its full potential. In line with GIRFEC, there will now be 2 categories of HPI - 'Core' and 'Additional'.

Timescale for Allocation

Children and families have diverse needs. The level of support which they require will be dependent on a comprehensive assessment undertaken in partnership with parents/carers. The HPI should be allocated by 6 months. However, the HPI may, where appropriate, be allocated ante-natally, in consultation with the family, midwife and other key professionals. The period prior to the allocation of the HPI should be a period of support and assessment, using the GIRFEC National Practice Model, the Pathway of Care for Vulnerable Families (0-3) and supported by local tools to ensure a full assessment is carried out and appropriate, proportionate and timely levels of support are provided.

Key Recommendations

  • The HPI should be allocated in response to the assessed level of support required by the child and family.
  • All children should have an HPI by age 6 months.
  • There are 2 categories of HPI - 'Core' (receiving the universal health visiting service) and 'Additional' (receiving additional health visiting support and/or support from other disciplines/agencies).
  • Assessment should be carried out using the Getting it Right for Every Child National Practice Model, the Pathway of Care for Vulnerable Families (0-3) and supported by local tools.
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