The government has launched a review of whether it should still be a legal requirement for young children to receive five checks by health visitors before they reach the age of two and a half.
The statutory requirement was introduced when local authorities took over responsibility for commissioning health visiting services from the NHS in October 2015, but is due to expire in spring 2017.
It was designed to ensure the recent boost to health visitor numbers – following a Conservative party pledge to increase the size of the workforce by almost 50% – was maintained after commissioning transferred.
“PHE will look at the impact of the transfer, the appetite for mandation…and risks to the sustainability”
PHE letter to stakeholders
If no action is taken, the checks – which take place during the mother’s antenatal period, in the first two weeks of birth, eight weeks after birth, at 12 months and when the child reaches two and a half years old – will no longer be mandated from March 2017.
Public Health England has been commissioned by the Department of Health to carry out the review. The arm’s length body has written to local council leaders and chief executives, directors of public health, clinical commissioning groups, NHS England’s regional lead nurses and health visitors.
The letter said the review would “comprise an assessment and assurance of the sustainability of health visiting and the 0-5 years Healthy Child Programme [and] future commissioning intentions”.
It said the impact of “innovative service models” would also be considered and called on stakeholders to take part in a survey about the impact of the legislation on services.
The letter, signed by PHE chief nurse Viv Bennett and Phil Norrey, children and families spokesman for the Society of Local Authority Chief Executives, said the review would look at the “contribution of health visitors in the six high impact areas which link directly to measurable outcomes”.
“The worry is that without that mandation the five checks won’t even be guaranteed, it could drop way below that”
These impact areas are defined as transition to parenthood, early weeks maternal mental health, breastfeeding, healthy weight and nutrition, managing minor illnesses, and the health, wellbeing and development of the child at age two.
It also said the review would assess the potential for health visitors to “support delivery against national priorities such as childhood obesity, life chances and the new tobacco strategy”.
PHE will publish its findings in the autumn and government ministers will then make a decision on whether to continue the five mandated checks.
“In order to inform this decision PHE will look at the impact of the transfer, the appetite for mandation, the evidence of service transformation and risks to the sustainability of the service from a range of perspectives using data from different sources and direct input from a wide range of stakeholders,” added the letter.
Dave Munday, professional officer at Unite’s Community Practitoners’ and Health Visitors’ Association, urged health visitors to take part in the survey to highlight the importance of the five mandated checks in sustaining services.
He said it was “critical” they told PHE about concerns around cuts to services and jobs across 0-19 services.
PHE should also look at increasing the number of mandated checks beyond five to avoid this being viewed as a maximum standard, he said, noting that Scotland aimed to provide 11 family visits as part of its health visitor programme.
“In some respects five is nowhere near good enough and families should be able to expect more. But the worry is that, without that mandation, the five checks won’t even be guaranteed – it could drop way below that,” he said.
“In the first instance, I hope the five checks continue. But as part of that, PHE and organisations need to look at seriously increasing it beyond that,” he added.