Universal Health Visiting Pathway evaluation: phase 1 report - routine data analysis - baseline outcomes

Conclusions

This report set out to ascertain baseline patterns of outcomes of children aged up to 3 years relating to (a) parental health-related behaviours; (b) child development; (c) child physical health; and (d) child safety, prior to the implementation of the Universal Health Visiting Pathway. Additionally, inequalities by deprivation level were explored (see Supplementary Table 2 in Appendix 3 below).

In terms of the parental health-related behaviours examined, signs can be seen of improvement in the percentage of children receiving exclusive or some breast milk, at age 6-8 weeks, dental attendance by age 2 years, and both parental smoking and child exposure to second hand smoke at 27-30 months. The proportion of children who have received all their childhood immunisations started, and remained, high, at 93.8%. Differences by SIMD quintile were found across all of these outcomes, with the exception of immunisations, where less variation was seen.

Overall, 17.9% children had a developmental concern of any kind recorded at 27-30 months, with a gradual decrease from 20.3% for children born in the quarter ending March 2011 to 15.2% for those born in the quarter ending March 2016. To a lesser extent, Speech, language and communication concerns and Social and emotional concerns were found to decrease over the same period. Substantial variation was seen by SIMD quintiles across all three developmental outcomes, with children in the most deprived quintiles being more likely to have concerns reported. Changes in data completeness were also seen; these occur at the time of the new version of the 27-30 month review form, on which several of the domain boundaries changed, and are at least partially likely to reflect the exclusion of Greater Glasgow and Clyde from the data due to that health board using a different developmental assessment.

The two physical development outcomes measured in the routine data related to (a) overweight and obesity, recorded at the 27-30 month review, and (b) unintentional injuries, explored up to the child's third birthday. Levels of overweight and obesity at this age were high, with two-fifths of children falling into this category, and 11.9% were considered to be clinically obese. This level of overweight and obesity appeared high, and possibly reflected the use of the WHO standard, rather than UK90, and/or selective weighing of heavier children by health visitors at this age. Data completeness for height and weight was poor, with fewer than two-thirds of children having height and weight available. Unlike almost all of the other outcomes measured, there was no variation by SIMD quintile in relation to being in the overweight or obese group, and only small differences within the 'obese only' group, with those from the most deprived areas being slightly more likely to be obese (excluding overweight) than those from less deprived areas for this age group. Levels of unintentional injuries were very low with 3.4% of children experiencing an unintentional injury at this age. No change could be seen in prevalence of any of the unintentional injury outcomes for children born between 1 January 2011 and 31 March 2016, and little discernible difference between deprivation groups, primarily due to the very small numbers of cases.

The final group of outcomes related to child safety, and encompassed child protection registrations and Looked After Child status. The percentage of children experiencing either of these events was relatively low. The proportion of children with a child protection registration rose somewhat over the same period: from 1.2% in the birth cohort born in the quarter ending March 2011 to 3.5% in the cohort born in the quarter ending March 2016. However, this is likely to be due to changes in data recording rather than a 'true' difference.