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

Practitioner involved in review

The UHVP policy documentation emphasises the importance of delivery of the programme by a qualified health visitor. This differs from previous guidance for health visiting (Hall 4 guidance) which stated that many aspects of the service could be delivered by any member of the primary care or wider child health support team, including general practitioners, staff nurses, early years support workers or health visitors.^[3] Occasionally, however, more than one practitioner would be involved in a review: for example, a health visitor and a GP or staff nurse or nursery nurse or family support worker might be present. Additionally, the 6-8 week review has always been intended as a two-stage review involving both GP and health visitor. The presence of all practitioners at a review could be recorded and therefore in some years the sum of the bars in Figures 23-27 may slightly exceed 100%.

First visit

As with the location of the first visit, information regarding the practitioner involved in the visit was not able to be recorded for the first four years, and sparsely recorded in 2015/16 as the field was introduced in February 2016 (health visitor was recorded as being involved for 17.4% of visits; practitioner involved in visit was missing for 82.3% of visits). For the final three years and since the introduction of the UHVP (2016/17 to 2018/19), a health visitor was involved in more than 94% of visits (see Figure 23).

6-8 week visit

Information regarding the practitioner involved in the 6-8 week visit was not able to be recorded in the first four years, and only sparsely in 2015/16. In the three years since the UHVP has been implemented, the percentage of visits in which a health visitor was present increased (Figure 24), from 80.3% to 91.0%, and the presence of another practitioner similarly declined, from 58.0% to 50.2%. It should be noted that a GP should be involved in all 6-8 week reviews, although the review is often completed in two separate appointments, which may explain why the rates of other practitioners being present is not always accurately recorded.

13-15 month review

There are less year-on-year comparator data for the 13-15 month reviews as the review was only deliverable from April 2017 (see Figure 25). In each of the two years, a health visitor was present in about 75% of reviews and another practitioner in about 25%; details of the professional present were missing in less than 1% of reviews.

27-30 month review

The 27-30 month review was deliverable from April 2013, so that all babies born from 1 January 2011 were eligible to receive this review. Initially, a health visitor was involved in 72.6% of reviews (in 2013/14); this percentage decreased slightly over the following two years (to 68.4%) prior to the full introduction of the UHVP. From 2016, when the pathway was introduced the percentage of reviews where a health visitor was present steadily increased to 77.8% (see Figure 26). An obverse pattern is observed with other practitioners involved in the review: in the first year, 29.5% were involved, rising to 33.4% in 2015/16, before decreasing steadily to 24.4% in 2018/19.

4-5 year review

As described elsewhere, limited data are available for this review since its planned introduction was April 2020. Where the review was introduced early, in 90% of reviews a health visitor was involved and in 10% another professional; information about the practitioner involved was missing in about 1% of reviews (see Figure 27).

Note: Practitioners involved in review started to be recorded on the new CHSP form during February 2016, i.e. a few weeks before the end of financial year 2015/16.

Note

Practitioners involved in review started to be recorded on the new CHSP form during February 2016, i.e. a few weeks before the end of financial year 2015/16.

Notes to Figure 23-27

1. Multiple practitioners can be recorded as being involved in the delivery of the first visit, hence the total number of practitioners may be greater than the total number of reviews.

2. See Table 1 above for the number of reviews delivered in each financial year. If fewer than 1,000 reviews were delivered in a financial year, data for that year have not been analysed (e.g. for the 13-15 month review, 125 were conducted in 2016/17; for the 27-30 month review, 296 were provided in 2012/13; and for the 4-5 year review, 19 were provided in 2016/17).

Source for Figures 23-27

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