Article Text

Original research
Variation in health visiting contacts for children in England: cross-sectional analysis of the 2–2½ year review using administrative data (Community Services Dataset, CSDS)
  1. Caroline Fraser1,
  2. Katie Harron1,
  3. Jane Barlow2,
  4. Samantha Bennett3,
  5. Geoffrey Woods4,
  6. Jenny Shand5,6,
  7. Sally Kendall7,
  8. Jenny Woodman8
  1. 1Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK, London, UK
  2. 2Department of Social Policy and Intervention, University of Oxford, Oxford, UK
  3. 3Public Health Division, Operations Directorate, Kent Community Health NHS Foundation Trust, Ashford, UK
  4. 4Early Help Data & Information Team, East Sussex County Council, Lewes, UK
  5. 5UCL Partners, London, UK
  6. 6Care City, London, UK
  7. 7University of Kent, Canterbury, UK
  8. 8Thomas Coram Research Unit, UCL Social Research Institute, London, UK
  1. Correspondence to Jenny Woodman; j.woodman{at}


Objective The 2–2½ year universal health visiting review in England is a key time point for assessing child development and promoting school readiness. We aimed to ascertain which children were least likely to receive their 2–2½ year review and whether there were additional non-mandated contacts for children who missed this review.

Design, setting, participants Cross-sectional analysis of the 2–2½ year review and additional health visiting contacts for 181 130 children aged 2 in England 2018/2019, stratified by ethnicity, deprivation, safeguarding vulnerability indicator and Looked After Child status.

Analysis We used data from 33 local authorities submitting highly complete data on health visiting contacts to the Community Services Dataset. We calculated the percentage of children with a recorded 2–2½ year review and/or any additional health visiting contacts and average number of contacts, by child characteristic.

Results The most deprived children were slightly less likely to receive a 2–2½ year review than the least deprived children (72% vs 78%) and Looked After Children much less likely, compared with other children (44% vs 69%). When all additional contacts were included, the pattern was reversed (deprivation) or disappeared (Looked After children). A substantial proportion of all children (24%), children with a ‘safeguarding vulnerability’ (22%) and Looked After children (29%) did not have a record of either a 2–2½ year review or any other face-to-face contact in the year.

Conclusions A substantial minority of children aged 2 with known vulnerabilities did not see the health visiting team at all in the year. Some higher need children (eg, deprived and Looked After) appeared to be seeing the health visiting team but not receiving their mandated health review. Further work is needed to establish the reasons for this, and potential solutions. There is an urgent need to improve the quality of national health visiting data.

  • public health
  • organisation of health services
  • child protection
  • community child health

Data availability statement

Data may be obtained from a third party and are not publicly available. The authors do not have permission for onward sharing of the individual-level data underlying this article. Requests to access the CSDS data can be made to NHS Digital.

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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Data availability statement

Data may be obtained from a third party and are not publicly available. The authors do not have permission for onward sharing of the individual-level data underlying this article. Requests to access the CSDS data can be made to NHS Digital.

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  • Contributors JW and KH conceived of the study, were responsible for design of the study and supervised all analyses which were carried out by CF. JW, KH, CF, JB, SB, GW and JS all contributed substantially to the design of the study. CF, KH, JB, SB, GW, JS, SK and JW substantially contributed to interpretation of data. JS, GW and SB provided access to locally held data and gave expert advice on data and the service context. CF and JW drafted the paper and KH, JB, SB, GW, JS and SK substantially contributed to its intellectual content, including in multiple revisions. CF, KH, JB, SB, GW, JS, SK and JW approve the final version of the paper for publication. JW and KH are jointly responsible for the overall content as guarantors.

  • Funding This study was funded by the National Institute for Health Research (NIHR) Policy Research Programme, funder reference: PR-PRU-1217-21301; UCL award code: 177763. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. This project is delivered as part of (ex)PHE’s 2020/2021 Life Course Intelligence business plan for child and maternal health in order to understand CSDS data quality and its suitability for further analysis to understand trends, variation and inequalities in health visiting and outcomes for children in the early years. An honorary contract with (ex)PHE enabled the researcher to work as part of the analytical team and analyse the CSDS for this purpose.This research was supported in part by the NIHR Great Ormond Street Hospital Biomedical Research Centre and the Health Data Research UK (grant No. LOND1), which is funded by the UK Medical Research Council and eight other funders. KH is supported by funding from NIHR (17/99/19).

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NIHR, the Department of Health and Social Care or Public Health England.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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