Universal Health Visiting Pathway evaluation: phase 1 report - routine data analysis - implementation and delivery
The Universal Health Visiting Pathway was introduced in Scotland in 2015 to refocus the approach to health visiting in Scotland. This is the final report of four that provides findings about the implementation and delivery of the pathway as part of the national evaluation of Health Visiting.
Child health review coverage
The numbers of the different child health reviews delivered each month, between 1 January 2011 and 31 March 2019, are presented in Figure 3. The mean number of first visits and 6-8 week visits provided each month over this period are 4,509 and 4,300 respectively. The 13-15 month visit was introduced in April 2017, and mean number of visits after that date was 2,635 per month. The 27-30 month review began on 1 April 2013: a monthly average of 4,157 reviews have been delivered between then and 31 March 2019. The 4-5 year review was introduced early by certain health boards, although it was intended to begin on 1 April 2020. Between 1 April 2017 and 31 March 2019 an average of 1,094 reviews were delivered each month.
Figure 4 displays the coverage for each review (that is, the percentages of children born in a specific month for whom a relevant review has been recorded), for babies born between 1 January 2011 and 31 March 2019. Over this entire period, an average of 98.1% of babies received a first visit and 93.0% the 6-8 week visit. Of babies born between 1 May 2016 and 31 December 2018 (babies born later will not have had their visit recorded on CHSP-PS by the time of the May 2020 extraction), 74.0% received a 13-15 month review. Similarly, of babies born between 1 January 2011 and 31 July 2017, 91.0% have a 27-30 month review recorded. Mean coverage of the 4-5 year review is very low at 35.6% for children born between 1 April 2013 and 31 March 2016, but this review was intended to start with babies born on or after 1 April 2016 therefore the data presented indicate early implementation of this review.
The number of each of the child health reviews provided in each financial year is displayed in Table 1. In the financial year 2017/18, the number of 13-15 month reviews recorded was 25,182; these reviews were delivered to children born between 1 October 2015 and 28 February 2017. In contrast, the number of reviews recorded for each birth cohort are displayed in Table 2. In 2017/18, there were 52,494 live births, 38,544 of whom were recorded as having received a 13-15 month review.
Number of reviews, review coverage and coverage by SIMD are explored in greater depth for each individual CHR below.
X All members of birth cohort were eligible for review to have been delivered by December 2019
Y Dashed lines represent data that are likely to be incomplete because not all children will have received that review yet, due to their age (i.e. they were not old enough to have received that review at the time of data extraction in May 2020).
Notes to Figure 1-4
1. Overall coverage equals the number of children born in month with subsequent record of a health visitor first visit on CHSP-PS (by May 2020) divided by the number of children born in month eligible for review.
2. The first visit should be delivered by the time the baby is 14 days old. However, in certain instances, it may be delayed; for example, for sick children in neonatal care. Thus some 'late' reviews will be expected (and are clinically appropriate). The review is deliverable from January 2011 and should therefore be delivered to all children born from January 2011 onwards.
3. The 6-8 week review should be provided before the child reaches 12 weeks. However, gestational correction is required when scheduling reviews for children aged up to 24 months. Thus children born prematurely (at <37 completed weeks gestation) are scheduled for the 6-8 week review by their due date rather than their actual date of birth. Some 'late' reviews will therefore be due to appropriately delayed provision of reviews for preterm babies. The review is deliverable from January 2011 and should therefore be delivered to all children born from January 2011 onwards.
4. The 13-15 month review should be provided before the child reaches 18 months. Gestational correction is required when scheduling reviews for children aged up to 24 months, and thus children born prematurely (at <37 completed weeks gestation) are scheduled for the 13-15 month review by their due date rather than their actual date of birth. Some 'late' reviews will therefore be due to appropriately delayed provision of reviews for preterm babies. The review is deliverable from April 2017 and should therefore be delivered to all children born from April 2016 onwards. Note some babies born after June 2018 may have had this review after the data-extraction date, and therefore their data may not be included in this figure (dashed line).
5. The 27-30 month review should be provided before the child reaches 32 months. The review is deliverable from April 2013 and should therefore be delivered to all children born from January 2011 onwards. However, some babies born after April 2017 may have had this review after the data-extraction date, and therefore their data may not be included in this figure (dashed line).
6. The 4-5 year review should be provided before the child reaches 5.5 years. It was intended that the review would be deliverable from April 2020, when the first children who had been fully exposed to the UHVP were of an age to receive the review. Despite full implementation of the UHVP being delayed in most health boards, conversely the 4-5 year review was introduced early in some health boards. In the financial year 2017/18, more than 6,000 reviews are recorded and more than 20,200 are recorded in the following year. This report is based on data extracted in May 2020 (and therefore the 4-5 year review would not have been included in this report, had it not been provided early). The dashed line represents data that are likely to be incomplete because not all children will have received the review at the time of data extraction (May 2020), due to their age.
Source for Figures 1-4
The source for all child health data is CHSP-PreSchool May 2020, Public Health Scotland. The source for births data is NRS.
| Financial year | First visit | 6-8 week visit | 13-15 month review | 27-30 month review | 4-5 year review |
|---|---|---|---|---|---|
| 2011/12 | 57,324 | 55,001 | 0 | 0 | 0 |
| 2012/13 | 56,101 | 54,236 | 0 | 296 | 0 |
| 2013/14 | 55,067 | 52,663 | 0 | 43,467 | 0 |
| 2014/15 | 55,132 | 53,130 | 0 | 51,911 | 0 |
| 2015/16 | 54,126 | 51,039 | 0 | 50,493 | 0 |
| 2016/17 | 53,302 | 49,887 | 125 | 51,809 | 19 |
| 2017/18 | 51,541 | 48,850 | 25,182 | 50,260 | 6,043 |
| 2018/19 | 50,216 | 46,758 | 38,048 | 51,357 | 20,220 |
Note
This table presents the number of each CHR delivered in each financial year, i.e. 1 April to 31 March in the following year.
13-15 month review was to be introduced by April 2017, however, some health boards delayed implementing the review
27-30 month review was to be introduced by April 2013
4-5 year review was to be introduced by April 2020
Source:
The source for all child health data is CHSP-PreSchool May 2020, Public Health Scotland. The source for births data is NRS.
| Financial year | Number of live births in year | First visits delivered to children born in this year | 6-8 week visits delivered to children born in this year | 13-15 month reviews delivered to children born in this year | 27-30 month reviews delivered to children born in this year | 4-5 year reviews delivered to children born in this year | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| n | % | n | % | n | % | n | % | n | % | ||
| 2011/12 | 58,817 | 57,424 | 97.6% | 55,284 | 94.0% | 0 | 0% | 52,510 | 89.3% | 3 | 0% |
| 2012/13 | 57,296 | 56,123 | 98.0% | 53,867 | 94.0% | 0 | 0% | 50,942 | 88.9% | 548 | 1.0% |
| 2013/14 | 55,953 | 55,005 | 98.3% | 52,795 | 94.4% | 0 | 0% | 50,801 | 90.8% | 12,994 | 23.2% |
| 2014/15 | 55,983 | 54,975 | 98.2% | 52,512 | 93.8% | 0 | 0% | 51,353 | 91.7% | 21,286 | 38.0% |
| 2015/16 | 55,258 | 54,045 | 97.8% | 50,768 | 91.9% | 428 | 0.8% | 51,269 | 92.8% | 25,170 | 45.5% |
| 2016/17 | 54,201 | 53,244 | 98.2% | 49,653 | 91.6% | 31,901 | 58.9% | 50,710 | 93.6% | 141 | 0.3% |
| 2017/18 | 52,494 | 51,594 | 98.3% | 48,542 | 92.5% | 38,544 | 73.4% | 29,900 | 57.0% | 0 | 0% |
| 2018/19 | 51,201 | 50,311 | 98.3% | 46,694 | 91.2% | 38,704 | 75.6% | 1 | 0% | 0 | 0% |
Note
This table presents the number of live births in each financial year, and the number of child health reviews subsequently delivered to these children. For example, in the financial year 2011/12, there were 58,817 live births recorded; 57,424 of these babies received a first visit, 55,284 a 6-8 week visit, and 52,510 a 27-30 month review.
The first visit and 6-8 week reviews are long-standing reviews; these reviews could be recorded for all children born in the financial years under consideration.
The 27-30 month review was introduced in 2013, and was thus available for children born from 1 April 2011. However, the data extract used in this report was May 2020, and therefore not all reviews for children born from 2017/18 and 2018/19 had taken place or been recorded on CHSP-PS by then.
Contact
Email: justine.menzies@gov.scot
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