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)

Abstract

ObjectiveThe 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, participantsCross-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.AnalysisWe 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.ResultsThe 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.ConclusionsA 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.

Scaling up breastfeeding in England through the Becoming Breastfeeding Friendly initiative (BBF)

“…The developing CSDS records personal patient data and risk indicators such as ‘social and personal circumstances’ or ‘safeguarding vulnerability factors’ (relating to the child as opposed to the mother) (NHS Data Model and Dictionary, 2021). The CSDS is not currently in the public domain, though it may be accessed through NHS Digital to access ‘research ready’ subsets of data (Fraser et al, 2020). Concerns persist about the accuracy of the data due to potential miscoding or misclassification by health professionals entering the data (Fraser et al, 2020).…”

“…The CSDS is not currently in the public domain, though it may be accessed through NHS Digital to access ‘research ready’ subsets of data (Fraser et al, 2020). Concerns persist about the accuracy of the data due to potential miscoding or misclassification by health professionals entering the data (Fraser et al, 2020).…”

Study protocol: evaluation of the 0–5 public health investment in England – a mixed-methods study integrating analyses of national linked administrative data with in-depth case studies

“… 17 CSDS includes information on individual health visiting contacts, including whether the appointment was ‘attended’ or ‘scheduled but not attended’, and whether it was a correspondence or face-to-face contact. 18 ECHILD links data from hospital admissions, outpatient attendances, A&E and mortality (Hospital Episode Statistics (HES)), education (National Pupil Database) and children’s social care services (Child in Need and Looked after Children) for all children in England born from 1995. 17 We will use ECHILD to create longitudinal trajectories for mother and child, capturing information on maternal education, maternal history of contact with children’s social care, maternal age at first birth, and number of siblings.…”

Linking data to build a bigger picture of paediatric referral pathways

“…The issue of missing GP data is not limited to Scotland—in England, GP data available through the Clinical Practice Research Datalink cover around 25% of the population, and are not all linked with secondary care data. Nor is the problem limited to GPs—consistently recorded data on health visiting contacts are also lacking 6. This is a particularly important part of the picture given the contribution of feeding problems to short-stay admissions for infants.…”