Guidance

Part 1: principles of delivery

Published 6 February 2026

Applies to England

Core components of the healthy child programme

The healthy child programme sets out a structure of public health work for health visiting and school nursing teams, which includes the following components.

Health and development reviews

Early years (ages 0 to 5) health and development reviews

These reviews must be offered at 5 specified stages to a:

• woman who is more than 28 weeks’ pregnant (referred to as the ‘antenatal health and development review’)
• child who is between 1 day and 2 weeks old (referred to as the ‘new birth health and development review’)
• child who is 6 to 8 weeks old (referred to as the ‘6-to-8-week health and development review’)
• child who is 9 to 15 months old (referred to as the ‘12-month health and development review’)
• child who is between 24 and 30 months old (referred to as the ‘2-to-2-and-a-half-year health and development review’)

It is considered best practice that these reviews are delivered individually and face to face in the home by a health visitor, enabling and strengthening the following:

• contextual assessment
• clinical safety and safeguarding
• the relational foundation for ongoing support

Some reviews, particularly the 12-month review and 2-to-2-and-a-half-year reviews, may be delivered in alternative settings such as clinics, neighbourhood health centres or Best Start Family Hubs, when these options better meet the needs of the child and family.

School years (ages 5 to 19) health needs assessments

These assessments are strategically placed at significant developmental stages to support children and young people’s health, wellbeing and development, enabling early identification of emerging health needs and informing appropriate support. The stages are listed below:

• school entry
• year 6
• year 8
• year 10

Proportionate levels of service to meet individual needs

The healthy child programme consists of 4 levels of service situated on a spectrum:

• community
• universal
• targeted
• specialist

The community level involves the least complex and intense support, with this level generally encompassing non-personalised, promotional public health activity.

The specialist level involves the most complex and intense support and is generally delivered through specialised programmes tailored to individual and family needs.

The level of support offered to each person and family is determined according to proportionate universalism. This means that those with the greatest needs receive the highest level of service, while those with milder needs receive lower levels of service.

All babies, children and families are eligible for at least the community and universal levels of service.

Support and delivery of screenings and immunisations

In some areas, elements such as the National Child Measurement Programme or the routine childhood immunisation programme may be commissioned separately and delivered by dedicated teams in collaboration with other services.

Delivery of evidence-based advice and interventions

These are given by appropriately qualified practitioners and tailored to the developmental stage of the baby, child or young person and the needs of families.

Early identification of risk and safeguarding concerns

This involves assessment and appropriate referral, and co-ordinated multi-agency responses, to protect babies, children, young people and families.

The role of qualified specialist community public health nurses

Qualified specialist community public health nurses (SCPHNs) lead the 0 to 19 public health nursing workforce and play a pivotal role in improving outcomes through:

• early identification and intervention
• disease prevention
• family centred care

Their specialised training enables them to understand the wider determinants of health and address health needs and inequalities - be these physical, emotional, social or environmental. 

Working collaboratively across health, education, social care and community settings, qualified SCPHNs:

• lead and co-ordinate holistic care
• maximise the value of a diverse skill mix within teams
• ensure that babies, children, young people and families receive timely, tailored support from the most appropriate practitioner

This includes active participation in neighbourhood teams and children and young people’s multidisciplinary teams, as outlined in NHS England’s Guidance on neighbourhood multidisciplinary teams for children and young people. This guidance promotes integrated working and place-based approaches to meet the needs of babies, children, young people and families within their local communities.

As clinical leaders, qualified SCPHNs are accountable for the quality and safety of care delivered within their teams, including work delegated to other practitioners. Delegation should be:

• appropriate to the practitioner’s role, competence and scope of practice,
• accompanied by clear guidance, supervision and support

Qualified SCPHNs retain professional accountability in line with the Nursing and Midwifery Council’s (NMC) The Code: professional standards of practice and behaviour for nurses, midwives and nursing associates, which sets out expectations for safe delegation, oversight and professional judgement. Clear lines of accountability should be maintained within teams to ensure that care is delivered ethically, safely, and in accordance with national standards and local governance frameworks.

Leadership

Qualified SCPHNs’ clinical expertise, strategic leadership and professional accountability are essential to ensuring safe, effective and equitable care. As NMC-registered professionals, qualified SCPHNs uphold standards, guide safe delegation, and support service improvement through supervision, mentorship, research and evidence-based practice.

Some qualified SCPHNs hold dual registration in both health visiting and school nursing. Their expertise:

• supports continuity of care
• strengthens safeguarding responses
• enables more integrated working across the 0 to 19 pathway

Commissioners and providers should consider how dual-qualified staff can be deployed strategically to enhance service responsiveness and workforce sustainability.

System leaders and active partners in neighbourhood teams

At the heart of the SCPHN profession is a mission to enable every child and young person to thrive, regardless of family background.

For children and young people with the highest levels of need, health visitors and school nurses play a critical role in identifying concerns early and facilitating access to specialist services by:

• initiating referrals
• co-ordinating with other professionals
• advocating for appropriate support to be in place  

Health visitors

Health visiting forms the foundation of neighbourhood health services for children. Health visitors serve families as trusted healthcare advisers during a period of great transition and transformation. They also serve society more broadly, identifying and often preventing the emergence of disease in childhood by delivering interventions before problems escalate. This helps keep healthcare rooted in communities and enables families, who may otherwise require hospital care, to remain close to home.

Health visitors reduce inequality by assessing all aspects of children’s development, and supporting parents to promote early learning and nurturing interactions. This targeted support helps children reach developmental milestones and start school ready to succeed, breaking the link between background and future success. 

Neighbourhood teams benefit greatly from health visiting expertise. Among child health services, health visitors often have insight into the workings of family life due to their experience of working in family homes. In turn, health visiting teams gain significant value from working closely with other child health professionals locally. For example, they may:

• adopt evidence-based speech and language techniques through regular interaction with speech and language therapists
• collaborate with GP services to help families manage minor ailments

These collaborative relationships also support health visitors to maintain and develop their professional competencies, ensuring their practice remains current, evidence based and responsive to evolving community needs.

Membership of extended neighbourhood multidisciplinary teams is expected to include professionals such as health visitors.

School nurses

School nurses guide children and young people in their experiences of a wide range of public health needs, including:

• hormonal changes
• mental health struggles
• long-term management of medical conditions

School nurses play a pivotal role in safeguarding, ensuring that any risks to a child’s welfare are promptly identified and assessed, and appropriately addressed in line with statutory responsibilities.

The continuity and trusted relationship enabled by a consistent school nurse or team is essential to the effectiveness of the healthy child programme. School nurses offer confidential support in familiar, non-stigmatising settings, bringing clinical, observational and motivational skills to improve access to advice, early intervention and referrals.

A large part of the school nurse’s role involves:

• championing prevention
• promoting healthy behaviours
• enabling health needs to be met in the community, helping to avoid unnecessary hospital attendances

Prevention is a cornerstone of the government’s plans for neighbourhood health - alongside moving care closer to home, it is one of the 3 strategic shifts outlined in the Neighbourhood health guidelines 2025 to 2026.

Membership of extended neighbourhood multidisciplinary teams is expected to include professionals such as:

• speech and language therapists
• social workers
• dietitians
• justice link workers
• school nurses

Preceptorship and mentorship

Qualified SCPHNs provide preceptorship, mentorship and coaching to support the development of both newly qualified and existing staff. This includes the following.

Preceptorship

Preceptorship is a structured period of support for newly qualified practitioners or those transitioning into new roles. It provides a foundation for safe, confident and competent practice.

Provider organisations should ensure preceptorship is in place for all new practitioners delivering the healthy child programme, in line with national standards such as NMC’s Principles of preceptorship. This should include the following:

• protected time for learning and supervision
• clear learning objectives and outcomes
• regular feedback and reflection
• documented progress and capability

Mentorship

Mentorship is defined as ongoing professional development and support for students and skill mix colleagues. In both health visiting and school nursing teams, mentorship is essential to:

• ensure competency
• support safe delegation
• embed reflective practice

Qualified SCPHNs should have protected time and recognition for their mentorship responsibilities, with clinical oversight remaining with a qualified SCPHN, even where operational line management is shared.

Supervision and reflective practice

Supervision is a cornerstone of professional development in public health nursing. It provides a structured space to:

• reflect on complex cases
• apply clinical reasoning
• strengthen professional judgement

For practitioners working with emotionally charged, complex or safeguarding-related issues, high-quality supervision is essential (see reference 1) for:

• risk assessment and management
• emotional resilience and wellbeing
• safe, responsive care

Supervision should be delivered through a blend of one-to-one and group formats, and tailored to practitioner roles and caseloads. This includes the following:

• safeguarding supervision for risk management and child protection
• restorative supervision to support emotional wellbeing
• managerial supervision to ensure accountability and role clarity

Supervision should be embedded as a core component of service delivery, with scheduled sessions, protected time and appropriately trained supervisors. Clear lines of accountability and quality assurance are essential.

Value of skill mix

A well structured skill mix model enhances the capacity, flexibility and responsiveness of services. When appropriately delegated and supervised, skill mix staff:

• bring diverse skills and perspectives that enrich service delivery
• build trusted relationships with children, young people and families
• enable more targeted and timely interventions
• support continuity of care and improve access to services, particularly in underserved or high-need areas

When targeted support is required, qualified SCPHNs should lead the planning of purposeful intervention, assigning specific elements as delegated tasks to skill mix colleagues where it is assessed as clinically appropriate. Delegation should be:

• based on assessed need
• aligned with the individual’s scope of competence
• delivered under appropriate supervision

These interventions should be purposeful, time bound and outcome focused, with the qualified SCPHNs retaining clinical oversight and responsibility throughout.

Delegation and accountability

Qualified SCPHNs lead multidisciplinary teams comprising both registered and unregistered staff, including:

• registered nurses
• registered nursing associates
• nursery nurses
• early years practitioners
• support workers
• administrative colleagues

As services increasingly rely on skill mix models, clear governance is essential.

In specified circumstances under regulation 5B of the Local Authorities (Public Health Functions and Entry to Premises by Local Healthwatch Representatives) and Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny Regulations 2013 (as amended), a health visitor can decide that a suitably qualified health professional or nursery nurse may carry out a universal health visitor review with guidance from, and supervision by, the health visitor. The suitably qualified health professional or nursery nurse must agree to carry out the review with delegated accountability to the health visitor.

The NMC Code requires registered professionals to be accountable for their decisions to delegate tasks. This includes:

• delegating only within an individual’s scope of competence
• providing appropriate oversight and support
• ensuring delegated work is completed to the required standard

Qualified SCPHNs remain accountable for all delegated practice. Delegated tasks should align with the individual’s competencies and not replicate the full expertise of a SCPHN. Robust competency frameworks, supervision structures and governance processes are essential to ensure safe, ethical and effective care, as outlined in the Delegation and accountability: supplementary information to the NMC Code (PDF, 11.4KB).

Where risk or vulnerability is identified, the qualified SCPHN should ensure that complex decisions are made by professionals with the appropriate training, registration and accountability.

Where practitioners are unregistered, this should be made explicit in service protocols and supervision arrangements. Delegation to unregistered staff should be carefully considered, clearly documented and supported by robust governance.

Examples: appropriate delegation from the SCPHN health visitor

Parent-infant relationship support

Following an observation that a parent is misreading their baby’s cues, a staff nurse delivers a structured 4-to-6-week intervention. This intervention aims to help the parent recognise and respond to their baby’s cues using techniques that promote mind mindedness and mentalisation. It may include:

• video feedback
• guided observation
• reflective discussion

Developmental delay

Following identification of mild gross motor skills delay during a 6-month targeted health and development review, an associate or staff nurse provides targeted play-based sessions to encourage movement and co-ordination. These sessions may incorporate sensory motor activities and parent coaching.

Progress is monitored and reviewed by the health visitor.

Healthy weight and nutrition support

Following concerns about faltering growth or unhealthy weight gain, a community nursery nurse delivers a series of home-based sessions focused on:

• responsive feeding
• portion guidance
• establishing healthy routines

The intervention includes practical support such as meal planning, interpreting food labels and modelling positive mealtime behaviours.

The health visitor oversees progress and liaises with the GP or dietitian if additional input is needed.

Examples: appropriate delegation from the SCPHN school nurse   

Emotional wellbeing and low-level anxiety

Following concerns from school staff about a number of children in a year group, a staff nurse or school nurse assistant co-facilitates a small group on coping skills and emotional regulation, using evidenced-based resources.

Healthy weight and lifestyle support

Following completion of school entry health needs assessments, a small group of pupils is identified as being at risk of overweight. The school nurse delegates delivery of a structured 6-to-8-week health eating and physical activity programme to a nursery nurse.

Managing minor illness and health literacy

A staff nurse runs drop-in sessions to provide advice and support on managing common conditions (such as asthma and hay fever), with clear escalation and referral routes.

Transition support

Following a qualified SCPHN’s assessment, a skill mix practitioner provides one-to-one sessions with a pupil who is moving from primary to secondary school, focusing on their specific needs (including confidence building and routine planning).

Sexual health and healthy relationships

A staff nurse co-delivers elements of a classroom session on puberty, healthy relationships and sexual health, using approved evidence-based materials.

These examples illustrate how skill mix staff deliver meaningful, targeted support when delegated appropriately. They also reinforce the importance of:

• structured planning
• clear outcomes
• ongoing clinical oversight

Service sustainability

Service sustainability depends on strategic investment in the qualified SCPHN workforce across both health visiting and school nursing services. Commissioners and provider organisations should ensure there is sufficient SCPHN capacity to lead, deliver and research care safely and effectively for all babies, children, young people and families.

Indicators of service sustainability include the following:

• robust workforce planning, protected time for training and development, and opportunities for service innovation
• clear career pathways for skill mix staff to progress into SCPHN roles, including advanced and consultant level practice, in line with the national 10 Year Health Plan for England: fit for the future
• retention strategies that support experienced practitioners, such as manageable caseloads, supportive working conditions and career progression
• implementation of digital tools, wherever possible, to reduce administrative burden and enable staff to focus on core clinical duties

A stable, well trained workforce is essential to delivering safe, equitable and responsive services based on best-available evidence and emerging research.

Ongoing training, digital innovation, inclusive practice and quality assurance are critical to building a skilled, supported and diverse workforce that is capable of meeting the needs of all babies, children, young people and families.

Digital tools, data and reporting

Purpose and impact

Practitioners working as part of public health nursing services for those aged 0 to 19 play a vital role in collecting and using data to shape care for babies, children, young people and families. When data is gathered consistently and used well, it supports:

• early identification of need
• recognition of emerging trends across communities
• evidence-based service improvement
• tailored person-centred care

Digital tools and technologies can enhance this work by streamlining administrative tasks, improving communication and freeing up time for direct relational practice.

Digital enablement

Access to the right digital tools makes a meaningful difference to day-to -day practice. This includes technologies such as:

• ambient artificial intelligence (AI), such as automated note-taking tools
• secure messaging platforms, such as ChatHealth
• digital health assessments

These can:

• support responsive communication
• improve record keeping
• reduce administrative burden

However, digital solutions should never replace relational practice in 0 to 19 public health nursing services. Meaningful in-person interaction remains foundational to building trust, enabling early intervention and supporting ethical decision making.

Practitioners should be all of the following:

• properly trained and supported to use digital tools confidently
• given access to systems that work reliably in real-world settings
• involved in shaping how new technologies are introduced

Digital developments should enhance aspects of service delivery, not replace them.

Data collection and use

As part of everyday practice, health visiting and school nursing teams contribute to national and local data sets. They should have access to shared systems that enable:

• timely, accurate record keeping
• safe, lawful information sharing
• avoidance of unnecessary duplication

In line with the Child health information systems: information requirements and output specifications guidance, providers and commissioners should only use appropriately recognised child health data systems to ensure data integrity and enable safe, lawful information sharing across services.

Data is not just about reporting - it is a tool for all the following:

• improving clinical decision making
• targeting interventions effectively
• advocating for appropriate services
• evaluating the impact of work

Practitioners should be supported to engage with and interpret data meaningfully, using it to understand local needs and shape care.

Statutory reporting requirements

Providers of publicly funded community health services are required to submit person-centred data to NHS England through the Community Services Data Set (CSDS), as required by the data provision notice issued under section 259 of the Health and Social Care Act 2012. This may include data from the healthy child programme, such as:

• for health visiting - information on babies and families, including health and developmental reviews and additional contacts
• for school nursing - health contacts and outcomes for children and young people

Commissioners are expected to:

• review CSDS data regularly
• identify population-level challenges (for example, low school readiness and rising developmental or emotional needs)
• ensure services are responsive, equitable and appropriately resourced

See the Healthy child programme: commissioning public health nursing services guidance for further information.

Parental engagement and inclusive practice

Services delivered by 0 to 19 public health nursing teams as part of the healthy child programme should actively engage families from the earliest point of contact, beginning in the antenatal period. The involvement of both parents and wider family members (where possible) is valuable to the process of achieving positive child and family outcomes.

Fathers and partners play essential roles in:

• supporting child development
• nurturing relationships
• contributing to overall family wellbeing

Their active engagement is an integral part of realising positive outcomes. However, fathers’ needs are often under-recognised. Services should proactively support fathers’ involvement and wellbeing.

Public health nursing teams should offer inclusive, culturally sensitive and trauma-informed care that is responsive to today’s diverse families. Services should be:

• co-designed with children, young people and families
• tailored to their circumstances and strengths
• delivered in ways that feel safe, accessible and empowering

Teams should actively recognise and address health inequalities, ensuring equitable access and outcomes for all - including those from marginalised, minoritised or underserved communities. This includes being responsive to differences in:

• culture
• language
• disability
• gender identity
• sexual orientation
• socioeconomic status
• lived experience

School nursing teams provide opportunities for children and young people to engage in services independently from their families. This is important in the development of health literacy and self management, as well as providing a safe space to discuss concerns. This requires:

• skilled engagement
• accessible services
• the ability to assess the child or young person’s capacity to understand and ability to consent

Practitioners should also be alert to families who may be at a higher risk of disengaging from services, including (but not limited to):

• parents who have previously had children removed from their care
• families with a history of children’s social care involvement
• parents facing language barriers, trauma, or mistrust of services
• situations where professionals have concerns about engagement or wellbeing

These families may require enhanced support and proactive outreach to:

• build trust
• reduce stigma
• ensure they feel safe accessing care

Findings from safeguarding reviews highlight the importance of early, sustained engagement with vulnerable children, young people and families to reduce risk and improve outcomes

Co-production and the voice of children and families

The design, delivery and review of services should be shaped in response to feedback from children, young people and families. Provider organisations are responsible for ensuring accessible and inclusive feedback mechanisms are in place, enabling practitioners to routinely collect feedback during their interactions.

Local authorities and providers should also have systems to analyse, respond to and act on feedback, using it to inform service improvement and commissioning decisions. Embedding a culture of listening, learning and co-production:

• promotes trust in public health services
• ensures the healthy child programme reflects the lived experience and priorities of those it supports

Vulnerability

In this guidance, vulnerability is defined as:

a state of being at greater-than-normal risk of physical and/or emotional harm and/or of experiencing poor outcomes.

This definition is paraphrased from No child left behind: understanding and quantifying vulnerability.

Decisions about the level of support to be offered to families should be informed by a holistic assessment of child and family need, recognising that vulnerability may relate to the child, parents or both. Parental vulnerabilities - such as neurodiversity, mental health difficulties, substance misuse or social circumstances - can have a significant impact on children’s health and wellbeing, just as a child’s own vulnerabilities may require additional support for the family as a whole.

Vulnerabilities include (but are by no means limited to) the following:

• housing insecurity or poor housing
• poverty or financial hardship
• poor mental health
• substance misuse
• disability or long-term health conditions
• limited networks of support
• lived experience of the care system (care leavers are eligible for healthy child programme support up to the age of 25)
• young parenthood
• a history of interactions with the criminal justice system
• sustained school absences, suspensions or exclusions
• previous involvement with child protection services, including children who have been previously removed
• exposure to:
  • neglect
  • emotional, physical or sexual abuse
  • other forms of harm
• domestic abuse
• the presence of unknown adults in the home, particularly where risk factors are unclear or unassessed

Identifying and responding to vulnerability

Identifying and responding to vulnerability is a shared responsibility for health visitors, school nurses, families and partner agencies. It should be based on a comprehensive assessment that values family strengths and insights, and depends on effective collaboration across health, education, social care, housing and the voluntary sector to ensure families receive the right support at the right time.

Building on the 4 levels of service delivery (community, universal, targeted and specialist), practitioners should identify children, young people and families who may benefit from targeted or specialist input.

This includes recognising major life circumstances that may increase vulnerability or create barriers to accessing universal offers, such as:

• stigma
• fear
• practical constraints

Services should proactively reach families who may be unable to access support through standard pathways, ensuring inclusive, equitable provision.

Vulnerability does not arise in isolation - it is shaped by the interplay of systemic factors such as:

• poverty
• discrimination
• lack of access to and poor-quality housing
• access to services

Practitioners should adopt a systemic and intersectional lens, recognising that children and families may experience multiple overlapping disadvantages that compound their risk and affect their ability to access support.

Practitioners should be mindful of the cumulative impact of multiple risk factors (such as substance misuse, poverty and poor mental health) and the increased risk they may pose to babies, children and young people. Where multiple vulnerabilities are present, families are likely to require at least a targeted level of support to address their specific challenges.

Practitioners should:

• be mindful of the impact of poverty, health inequalities, ethnicity and immigration status, including for children and families seeking asylum
• ensure that services are inclusive, equitable and trauma informed

A trauma-informed and proportionate approach supports early identification, and ensures that responses are all of the following:

• non-stigmatising
• relational and emotionally attuned
• tailored to individual needs and family context

A strengths-based approach is essential. Reviews and assessments should not only identify risks and needs, but also recognise and build upon the existing strengths, resources and resilience within families and communities.

Vulnerable babies, children and young people, including those with special educational needs and disabilities (SEND) and complex health needs, may experience fluctuating levels of vulnerability across their lives. The level of service provided under the healthy child programme should be adaptable to these changing needs.

Importantly, children and young people may not always recognise the risks associated with their experiences or behaviours. School nurses use their communication skills to engage and work sensitively and collaboratively with them, helping to co-determine the most appropriate level of support.

Specific vulnerable groups

In addition to the general indicators of vulnerability above, some babies, children, young people and families may benefit from tailored approaches due to their specific life circumstances.

There are some specific demographics for whom the healthy child programme plays a particularly vital role in:

• identification
• early support
• enabling access to services

These groups include (but are not limited to):

• care-experienced children
• looked-after children
• young carers and young parents
• those with SEND (details are provided in ‘Annex A: specific populations’)

Children who are not in school, missing in education or home educated may be at increased risk of vulnerability due to reduced contact with universal services such as school nursing. Although the school nurse role is limited in relation to these groups, commissioners may choose to commission support for home-educated children and those missing from education.

Local areas should recognise the vulnerabilities of these groups, and put arrangements in place to ensure their health and wellbeing needs are identified and met.

Safeguarding

Babies, children and young people may not always verbalise their experiences directly, but they communicate through their:

• behaviour
• developmental progress
• emotional responses
• peer dynamics
• interactions with trusted adults

Early identification of risk and vulnerability is a core function of public health nursing. Health visitors and school nurses are often among the first professionals to recognise abuse, neglect, exploitation and other safeguarding concerns - whether through universal access to family homes or contact in education settings. Their clinical expertise and trusted relationships position them to:

• assess wellbeing
• recognise both risks and resilience
• work in partnership with families, schools and agencies to prevent harm and promote positive outcomes

Both health visitors and school nurses should be alert to additional vulnerabilities, including those faced by children with disabilities, neurodiversity or communication challenges. Assessing safeguarding risks in these contexts requires tailored approaches and close collaboration with education staff, families and other professionals.

Disclosures, whether direct or indirect, should be taken seriously. Children and young people should be regarded as credible informants and witnesses. Safeguarding responses should be tailored to their developmental stage, communication needs and lived experience.

Safeguarding within public health nursing teams should be led by qualified SCPHNs. Their leadership ensures that the most appropriate team member is involved at the right time, based on:

• their expertise
• their relationship with the child or family
• the nature of the concern

Domestic abuse

Domestic abuse is a significant safeguarding issue that can directly and indirectly harm babies, children, young people and families. Public health nurses should remain alert to signs of abuse, including:

• coercive control
• emotional harm
• exposure to violence in the home

Health visitors may identify abuse from pregnancy onwards. Abuse can impact infant development, parental mental health and the safety of the home environment. School nurses, through their regular access to education settings, may be among the first professionals to notice changes in:

• mental health
• school attendance
• peer relationships
• overall wellbeing

Public health nurses contribute to prevention by promoting healthy relationships, emotional resilience and safe environments, whether through:

• secure parent-child attachments in the home
• positive peer dynamics in school and community settings

Abuse can occur in any family structure (including same sex, trans and non-traditional households) and may involve any person (such as a parent, carer, partner or sibling). Language and practice should reflect this diversity and avoid assumptions.

All practitioners should enquire with professional curiosity about who else is in the family home, including extended family members, partners or others who may pose a risk or offer support.

The Domestic Abuse Act 2021 and the National Institute for Health and Care Excellence’s (NICE) recommendations under quality standard [QS116] Domestic violence and abuse should be considered, alongside Working together to safeguard children, to ensure a comprehensive safeguarding response.

The Families First Partnership programme guide provides further support for safeguarding partners in developing effective multi-agency approaches and should be referenced in local safeguarding arrangements.

Partnership working

‘Working together to safeguard children’ is statutory guidance that sets out expectations for all practitioners and organisations involved in child safeguarding. It provides the framework for identifying, assessing and responding to risk and vulnerability in babies, children, young people and families in England.

Safeguarding is most effective when practitioners work in partnership with other agencies, including:

• local authorities
• the police
• education providers
• voluntary sector organisations

Where concerns about a child’s safety or wellbeing cannot be resolved within the public health nursing team, practitioners should escalate these concerns to safeguarding partners in line with local multi-agency protocols.

Practitioners have a statutory duty under ‘Working together to safeguard children’ and the Children Act 2004 to share information with safeguarding partners where there are concerns about a child’s safety or wellbeing. This applies even where consent has not been obtained, if sharing timely and effective information is:

• necessary to protect the child
• essential to safeguarding
• supported by national guidance

Decision-making should be collaborative, drawing on the expertise and statutory responsibilities of all relevant agencies. This includes participation in multi-agency strategy meetings, case conferences and partnership panels.

Practitioners should be proactive in seeking advice, sharing information and contributing to joint assessments and plans to ensure the best outcomes for babies, children, young people and families.

Under section 27 of the Children Act 1989, specified authorities (which includes health bodies such as NHS trusts and foundation trusts) are required to comply with requests from local authorities to support children in need, looked-after children or their families - provided this does not conflict with their own legal responsibilities or significantly affect their ability to carry out other functions.

Paragraph 139 of ‘Working together to safeguard children’ reinforces this duty of co-operation. Health visiting and school nursing teams contribute to this duty in line with professional regulations and standards of competence.

Qualified SCPHN lead practitioner roles and local safeguarding protocols

Supporting children in need (section 17)

Under section 17 of the Children Act 1989, local authorities have a general duty to safeguard and promote the welfare of children in need by providing a range and level of services appropriate to those children’s needs. These children may not meet the threshold for statutory child protection intervention, but still require co-ordinated, multi-agency support.

For children receiving support under section 17 of the act, health professionals, including health visitors and school nurses, can act as the lead practitioner for children, when appropriate. This role involves:

• co-ordinating the multi-agency plan
• maintaining oversight of progress
• ensuring the child’s needs remain central

Decisions about who should take on the lead practitioner role should be based on:

• a clear assessment of the practitioner’s capacity and capability
• whether their involvement is right for the child and family, considering relationships, expertise and continuity

It should not be assumed that health visitors and school nurses always take the health lead - this must be balanced with their capacity to deliver the full healthy child programme. These decisions should be agreed locally and formalised in a shared local protocol, as outlined in ‘Working together to safeguard children’ on page 53, paragraph 141.

Local authorities, with their safeguarding partners and any relevant agencies, should:

• develop, agree and publish these local protocols for assessments and support
• ensure they reflect the local practice framework for work with children and their families
• be publicly accountable for them

All organisations and agencies have a responsibility to understand these protocols.

Responding to significant harm (section 47 enquiries)

In line with section 47(1)(b) of the Children Act 1989, when a local authority has:

reasonable cause to suspect that a child who lives, or is found, in their area is suffering, or is likely to suffer, significant harm, the authority shall make, or cause to be made, such enquiries as they consider necessary to enable them to decide whether they should take any action to safeguard or promote the child’s welfare.

These enquiries are known as section 47 enquiries.

In line with ‘Working together to safeguard children’, section 47 enquiries are typically led by local authority children’s social care. A qualified social worker usually leads the assessment, engages with the child and family, and co-ordinates the multi-agency response. This reflects the specialist safeguarding expertise required to lead formal child protection investigations.

Health visitors and school nurses play a critical role within the multi-agency response, including:

• sharing relevant health information to inform the assessment
• observing and interpreting the child-parent relationship
• identifying health-related risk factors (for example, injury, neglect or developmental concerns)
• supporting the child and family through co-ordinated care and follow-up

The local safeguarding children partnership oversees the effectiveness of local safeguarding arrangements. It is responsible for ensuring that:

• agencies work together to protect children from harm
• protocols for section 47 enquiries are followed consistently and in line with statutory guidance