Universal Health Visiting Pathway evaluation: phase 1 report - routine data analysis - implementation and delivery

13-15 month review

Reviews provided each month

The 13-15 month review could have been provided from April 2017 onwards (that is, when the children born after the UHVP was intended to be implemented - on 1 April 2016 - reached an appropriate age for the review); however, some health boards delayed implementing the review. This situation is displayed graphically in Figure 11. Between August 2017 and March 2019, the mean number of 13-15 month reviews delivered in a month was 2,975.

Overall coverage

Data for this evaluation were extracted in May 2020; allowing time for completed paper reports to be returned to the relevant health board and the contents keyed into the CHSP-PS system, this extract can be considered to provide complete information on reviews provided to the end of December 2019. However, although the review is recommended for children aged 13-15 months, the maximum age of a child receiving the review is 18 months; therefore the last birth cohort reliably to be able to make a complete contribution to the data extraction would have been born in June 2018. In practice, most children born up to about September 2018 should have had their 13-15 month review in time for their data to be included in the current extract.

The monthly coverage for this review was much lower than that for the two earlier visits (see Figure 12). For children born in September 2016, coverage was 67.0% and slowly rose for each birth cohort, until reaching a peak for children born in September 2018 (91.4%). The coverage after this point is not reflective of the birth cohort as most children born in subsequent months have their review recorded on CHSP-PS after the date of this extract. The low overall coverage can be explained by the fact that several health boards introduced this review later (see Supplementary Table 1 in the appendix for dates when health boards introduced each review).

Coverage stratified by SIMD quintile

Figure 13 presents 13-15 month review coverage, stratified by SIMD quintile. As can be observed, during the first three years after introduction coverage was less than 80%. Low coverage can be explained, in part, by the fact that the largest health board (NHS Greater Glasgow & Clyde) only started to introduce this review for children born on or after 1 January 2018. In addition, data for children born after about September 2018 may not have been keyed into the CHSP-PS system by the time the data were extracted in May 2020. Therefore after September 2018 figure 13 is not reflective of overall coverage for this review.

Over the three years of implementation of this review, children living in the most deprived areas had the lowest coverage, although children in the least deprived areas had the second lowest coverage. There is considerable disparity in the number of live births in each SIMD quintile (see Figure 2): the mean number of births per year over the three-year period is 13,060, 11,000 and 8,875 in SIMD 1, SIMD 2, and SIMD 5 respectively, although the difference in size between the quintiles has decreased over time.

The pattern in Figure 13 almost certainly reflects the fact that different health boards implemented the review at different times, and their resident populations have different deprivation profiles. Thus early inequalities primarily reflect the fact that some children are not being offered the review as the health board had not yet rolled out the full pathway. For those children born in 2018/19, the difference between highest and lowest coverage rates in terms of SIMD quintiles had decreased to 2.6 percentage points (SIMD 3 was 75.2%, SIMD 1 was 72.6%); however, it should be borne in mind that follow-up for this year is not complete (due to the date of the data extract in May 2020) and this gap could narrow or widen.

Comparison of review coverage between SIMD 1 and SIMD 5

Review coverage was only available for the last three years of the period and is displayed in Table 5. The first and last years are likely to be incomplete for reasons outlined above. Although the absolute difference between children living in most and least deprived areas is wide for the first two years, the absolute difference in the final year is 1.9 percentage points (this can be observed in Figure 13, where the lines converge).

Notes to Figures 11-13

1. The 13-15 month review should be provided before the child reaches 18 months. However, gestational correction is required when scheduling reviews for children aged up to 24 months. Thus children born prematurely (at less than 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.

2. The review is deliverable from April 2017 and should therefore be delivered to all children born from April 2016 onwards. However, 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.

3. Overall coverage = Number of children born in month with subsequent record of a health visitor 13-15 month review on CHSP-PS (by May 2020)/ Number of children born in month eligible for review.

4. Coverage of SIMD 1 reviews = Number of children born in financial year in SIMD 1 area with subsequent record of a health visitor 13-15 month review on CHSP-PS (by May 2020) / Number of children born in financial year in SIMD 1 area who are eligible for review.

Source for Figures 11-13

The source for all child health data is CHSP-PreSchool May 2020, Public Health Scotland. The source for births data is NRS.

Notes

The 13-15 month review was deliverable from April 2017 onwards: that is, for babies born from March 2016 onwards.

*March 2019 shows part-year data which is likely to increase as more reviews are inputted onto the data system.

Source:

The source for all child health data is CHSP-PreSchool May 2020, Public Health Scotland. The source for births data is NRS.