Guidance

Annexes

Published 6 February 2026

Applies to England

Annex A: key performance indicators

Delivery of health visiting services (ages 0 to 5)

The following key performance indicators (KPIs) can be used to evaluate the degree of success in delivering the healthy child programme ages 0 to 5 health and development reviews.

New KPIs for health visiting

There are 3 new KPIs that are used to measure the effectiveness of the delivery of ages 0 to 5 health visiting services going forward, which apply to tables 1 to 6 below. They are as follows:

• practitioner undertaking the visit
• place of visit
• additional non-face-to-face contacts (not part of the statutory offer)

To measure the KPI of ‘practitioner undertaking the visit’, data is collected on the number and types of practitioners that undertake each health and development review. Such types might include:

• specialist community public health nurse (SCPHN)
• staff nurse
• other registered practitioner
• non-registered health visitor assistant
• nursery nurse
• other non-registered practitioner

To measure the KPI of ‘place of visit’, data is collected on where reviews take place (at one or more of the following locations):

• the family’s home
• clinic (either one to one or in a group)
• GP surgery
• Best Start Family Hub
• other community venue

To measure the KPI of ‘additional non-face-to-face contacts (not part of the statutory offer)’, data is recorded on whether these contacts take place:

• virtually (such as by video call)
• by telephone
• by letter
• by email or through electronic communication

In addition to these 3 new metrics, there are specific KPIs for each health and development review as follows.

Table 1: KPIs for the antenatal health and development review

Reporting requirement	Expected threshold	Measurement method (numerator)	Measurement method (denominator)
National	98% of antenatal health and development reviews are delivered by a SCPHN in the home	Number and percentage of pregnant women (28 weeks and after) who have received an antenatal health and development review	Total number of pregnancy notifications received from maternity providers
Local	Early identification of vulnerable expectant parents and joint reviews with maternity services are in place	Number and percentage of expectant parents who received antenatal health and development review before 28 weeks of pregnancy	Total number of pregnancy notifications received from maternity providers
Local	All expectant parents with additional needs are identified for targeted or specialist support	Number and percentage of parents offered additional support following their or their child’s health review	Number and percentage of expectant parents who received antenatal health and development review

Table 2: KPIs for the new birth health and development review

Reporting requirement	Expected threshold	Measurement method (numerator)	Measurement method (denominator)
National	100% of new birth health and development reviews are delivered by a SCPHN in the home	Number and percentage of infants who turned 30 days old who received a new birth health and development review within 14 days from birth	Total number and percentage of infants who turned 30 days old
National	100% of new birth health and development reviews are delivered by a SCPHN in the home	Number and percentage of infants who received a new birth health and development review after 14 days but before 28 days	Total number and percentage of infants who turned 30 days old

Table 3: KPIs for the 6-to-8-week health and development review

Reporting requirement	Expected threshold	Measurement method (numerator)	Measurement method (denominator)
National	100% of 6-to-8-week health and development reviews are delivered by a SCPHN in the home	Number and percentage of infants aged 6 to 8 weeks who received a health and development review	Total number of infants who turned 8 weeks old

Table 4: KPIs for the 12-month health and development review

Reporting requirement	Expected threshold	Measurement method (numerator)	Measurement method (denominator)
National	100% of 12-month health and development reviews are delivered by a SCPHN in the home or other appropriate in-person setting	Number and percentage of children who received a 12-month health and development review by the age of 15 months	Total number of children aged 9 to 15 months in the reporting period

Table 5: KPIs for the age 2-to-2-and-a-half-year health and development review

Reporting requirement	Expected threshold	Measurement method (numerator)	Measurement method (denominator)
National	100% of 2-to-2-and-a-half-year health and development reviews are delivered by a SCPHN in the home or other appropriate in-person setting	Number and percentage of children who received a 2-to-2-and-a-half-year health and development review by the age of 2 and a half	Total number of children aged 2 and a half

In their reporting for all statutory ages 0 to 5 health and development reviews, commissioners and providers should outline:

• details of the additional visits or interventions that were undertaken
• reasons why the expected threshold was not met
• planned actions towards improvement

Table 6: additional visits

This table refers to additional data that should be collected to provide evidence of the delivery of a targeted and specialist offer.

This includes additional health and development reviews, visits and contacts to provide support and interventions for babies, children and families, as set out in the ‘Age 0 to 5 health and development review summaries’ section in ‘Part 2: health visiting - ages 0 to 5’ of the Delivery of the healthy child programme guidance.  

Reporting requirement	Expected threshold	Measurement method (numerator)	Measurement method (denominator)
Local	All pregnant women and parents with additional needs are identified for targeted or specialist support	Number and percentage of parents offered additional support following a health and development review	Number and percentage of parents who received each health and development review

Table 7: KPIs for referrals

Reporting requirement	Expected threshold	Measurement method (numerator)	Measurement method (denominator)	Examples of referral types
Local	All pregnant women and parents with additional needs are identified for targeted or specialist support	Number and percentage of parents referred to another service	Number and percentage of pregnant women and parents	Social care or safeguarding, maternal mental health, housing or speech and language

Child development outcomes

Table 8: KPIs for child development outcomes at age 2 to 2-and-a-half years

Reporting requirement	Expected threshold	Measurement method (numerator)	Measurement method (denominator)
National	Percentage of children achieving expected level of development at 2 to 2-and-a-half years old	Number and percentage of children who received an ASQ-3 and ASQ:SE (or equivalent assessment) as part of their 2-to-2-and-a-half-year health and development review, and number and percentage of children reaching a good level of development (GLD) at 2 to 2-and-a-half years old	Total number of children aged 2 and a half, and total number of children aged 2 and a half who received an ASQ-3 assessment

Table 9: other ASQ-3 child development assessment outcomes 

Reporting requirement	Expected threshold	Measurement method (numerator)	Measurement method (denominator)
Local	Percentage of children achieving appropriate levels of development (option to compare with expected patterns based on local demographics) at 2-and-a-half and 5 years old	Number and percentage of children reaching appropriate levels of achievement at 12-month health and development review and school entry health needs assessment (aged 5) - with comparison to ensure identification of all children who need support at age 2 and a half	Total number of children who received an ASQ-3 assessment and expected percentages given local demographics

Table 10: breastfeeding KPIs

Reporting requirement	Measurement method (numerator)	Measurement method (denominator)
National	Numbers and percentage of infants fully or partially breastfed at 6-to-8-weeks old	Total number of infants who have turned 8 weeks old

Table 11: health visiting workload KPIs

Reporting requirement	Measurement method (numerator)	Measurement method (numerator)	Measurement method (numerator)
Total number of children who form the age 0 to 5 population	Total number of children receiving universal offer each quarter	Total number of children receiving targeted offer each quarter	Total number of children receiving specialist offer each quarter

Delivery of school nursing services (ages 5 to 19)

There are no statutory or national reporting requirements for school nursing services.  Local areas are recommended to collect data on the following activities: 

Table 12: school nursing data recommended for collection

Support level	Support level descriptor	Examples of types of provision for children and young people	Examples of types of school and community support
Community	Population-wide approaches designed to create healthy environments and reduce health inequalities	Health promotion campaigns, community events and outreach	Assessing local population needs and data analysis (through available data), influencing local policy, delivering training, and promoting inclusive access to services
Universal	Universal interventions are delivered to all school-aged children and young people	National Child Measurement Programme assessments and follow-up, completed health needs assessments at major transition points (such as school entry and transition to secondary school), drop-in sessions, and childhood immunisations and vaccinations	Named public health nurse for each school; promotion of immunisation uptake; developing, promoting and supporting holistic approaches, early intervention and prevention strategies for wellbeing, health and inclusion in schools; signposting and linking to local groups and resources (such as children’s wellbeing practitioners within mental health support teams); and providing general advice to schools on inclusion, risk management and reasonable adjustments
Targeted	Targeted support provided to children and young people with emerging or known vulnerabilities or needs that require more than the universal offer	Additional health needs assessments or contacts, support for children with additional needs (such as for young carers or those with long-term conditions), behaviour change work, brief interventions or support for vulnerable children or young people, and contribution to early help assessments	Liaison with parents and school staff; collaborative working with system partners such as Best Start Family Hubs, developmental centres and therapy services (including those for mental health); health education input into curriculum (such as personal, social, health and economic education); and input into education, health and care plans (EHCPs)
Specialist	Specialist support is offered where children and young people have more complex needs that require longer-term co-ordinated and often multi-agency intervention	Safeguarding or child protection, and support for children with long-term or complex health conditions	Collaborative working with system partners such as Best Start Family Hubs, developmental centres, child and adolescent mental health services and therapy services; providing support through diagnostic pathways; and giving specialist advice to schools on inclusion, risk management and reasonable adjustments

Workforce

Table 13: workforce data recommended for collection

Profession	SCPHNs	Other registered staff	Non-registered staff	Admin and management	Caseload
Health visiting	Total number of full-time equivalent (FTE) SCPHNs, and number of FTE SCPHNs working directly with families	Total number of other registered nursing staff supporting families, by role and grade	Total number of non-registered support staff supporting families, by role and grade	Total number of staff providing administrative and management support with no caseload	FTE SCPHNs (health visitors) per age 0 to 4 child population
School nursing	Total number of FTE SCPHNs, and number of FTE SCPHNs working directly with families	Total number of other registered nursing staff supporting families and children or young people, by role and grade	Total number of non-registered support staff supporting families, children or young people, by role and grade	Total number of staff providing administrative and management support with no caseload	FTE SCPHNs (school nurses) per age 5 to 19 population or by school

Annual national workforce data collection will start in January 2026 and will be part of the oversight process. 

Annex B: information relevant to population needs assessments

To meet local needs, it is necessary for commissioners to understand what needs exist in their population through a population needs assessment. This assessment should incorporate a range of intelligence including:

• the statutory joint strategic needs assessment (JSNA), as mandated under the Local Government and Public Involvement in Health Act 2007
• nationally collected data
• local insights
• current service outcomes

Guidance on JSNAs is available as part of the Statutory guidance on joint strategic needs assessments and joint health and wellbeing strategies.

The needs of the population will be informed by a number of data sets and qualitative information such as:

• population and demographic data
• health inequalities data
• climate and environmental data
• national prevalence data for different kinds of special educational needs and disabilities (SEND)
• the number of local children with EHCPs
• use of out-of-area placements for those with low incidence needs
• the outcomes of developmental assessments (between ages 0 to 5)
• KPIs that are shared across health, education and social care
• information from the early years foundation stage profile
• where children or young people with SEND are educated
• teenage pregnancy rates
• local data on disabled children from the register of disabled children in their area (including those with impaired vision or hearing)
• immunisation uptake
• the numbers of children in care
• the numbers of children on safeguarding plans
• school absence and attendance data

Annex C: information relevant to commissioning strategies 

Following analysis of a population’s needs, commissioners should develop a commissioning strategy. The commissioning strategy should:

• secure resources and develop services to meet the needs identified within the JSNA and health needs assessment for the local authority’s population
• allow for a smooth transition from maternity to health visiting services, and close integration with other services such as local:
  • GP surgeries
  • schools
  • early years settings
  • specialist mental health and SEND services
• include metrics for performance and impact, and a plan for regular meetings between the local authority and provider organisation for the contract’s lifetime
• contain contingency plans if performance is not meeting requirements

Recognising the importance of good implementation, commissioners may want to include specific implementation metrics as part of monitoring service delivery - for example:

• reach
• adoption
• sustainability (including in an environmental sense)
• workforce skills and capability

Other than in exceptional circumstances, service expectations should be specified between one contract ending and another being awarded. A quality impact assessment should be completed and documented for all proposed major service changes.

Annex D: examples of vulnerability 

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

• housing insecurity or poor housing that may impact child health
• poverty or financial hardship
• poor parental mental or physical health
• substance misuse
• learning disabilities and other types of neurodiversity
• 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
• exposure to neglect, emotional, physical or sexual abuse, or other forms of harm (inside or outside the home and/or online)
• domestic abuse
• presence of unknown adults in the home, particularly where risk factors are unclear or unassessed
• a history of interactions with the criminal justice system
• children with a parent involved in the criminal justice system
• a record of sustained absence from school (even if due to suspension or exclusion)
• those with current or historic experience of children’s social care, including any of the following:
  • children with a social worker and those subject to child in need assessments
  • where enquiries are being made under section 47 of the Children Act 1989 to determine if any action is needed to safeguard or promote the child’s welfare
  • where child protection plans are in place
• those with SEND or complex health needs, or those undergoing palliative or end-of-life care
• a tendency (historic or ongoing) to go missing
• a risk of exploitation, child sexual exploitation or modern slavery

Annex E: references

1. Heckman J. Schools, skills, and synapses. Economic Inquiry 2008: volume 46, issue 3, pages 289 to 324.
2. Martin S, Lomas J and Claxton, K. Is an ounce of prevention worth a pound of cure? A cross-sectional study of the impact of English public health grant on mortality and morbidity. BMJ Open 2020: volume 10, issue 10.
3. Durlak J and DuPre E. Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation. American Journal of Community Psychology 2008: volume 41, issue 3, pages 327 to 350.