Guidance

Example service specification for ages 0 to 19 public health nursing services

Updated 12 March 2026

Applies to England

How to use this example service specification

 This example service specification outlines:

• the purpose of the healthy child programme and the aims of your service
• the overall scope of the service, including:
  • where it will be delivered and by whom
  • the 4 levels of service offer
  • how it will ensure confidentiality, equality and safety
  • who is eligible for the service
• elements of service delivery - how the service will be implemented, managed, staffed and quality checked, including:
  • data collection, storage, sharing and record keeping
  • safeguarding
  • your responsibilities to local children and young people with special educational needs and disabilities
• how often you will review the specification during the duration of the contract

The following is only an example - it is not a formal template that must be followed by each local area. We have drafted this example to help you to develop your own service specification.

Where content is in square brackets, you will need to customise your specification to fit your own local needs, demographics, priorities, processes and partners.

Purpose

This specification should be read alongside the latest guidance for the healthy child programme, including the rest of the Healthy child programme: commissioning public health nursing services guidance.

Where national guidance is refreshed during the contract, the provider must co-produce an implementation plan with the commissioner within [number] weeks of publication.

Aims

The objective of the service is to deliver the healthy child programme to all babies, children and young people aged 0 to 19, or up to the age of 25 for care leavers and those with special educational needs and disabilities (SEND). This is the national delivery model by which public health nursing services are provided.

The aims of the healthy child programme are to:

• ensure a healthy start to life
• identify and address health needs early
• prevent health problems
• support school readiness and learning
• protect children and families
• promote health equity

The service will apply the principle of proportionate universalism, offering a universal service for all with additional targeted and specialist support and interventions based on assessed levels of need. This includes:

• universal reach for all babies, children and young people
• the provision of services that are personalised to meet individual needs
• the early identification of additional and/or complex needs

About the programme

The healthy child programme is the Department of Health and Social Care’s (DHSC) universal, community-based public health service for babies, children, young people and families. It provides an evidence-based programme of interventions to improve health and development for all children and young people.

The healthy child programme is led by specialist community public health nurses (SCPHNs) and structured around 2 age-based phases:

• pregnancy and the early years (ages 0 to 5) delivered by health visiting teams
• the school years (ages 5 to 19) delivered by school nursing teams

Each phase reflects the specific developmental priorities of that age group and draws on the professional expertise of SCPHNs and their teams to ensure a continuous, preventative public health offer from pregnancy through to young adulthood.

Public health nursing services are commissioned by local authorities to improve the health of their local population. Providers must adhere to all relevant legal and clinical requirements, including the following:

• being registered with the Care Quality Commission (CQC) for the appropriate regulated activity, as described under section 10 of the Health and Social Care Act 2008. It is expected that delivering the healthy child programme will involve undertaking a regulated activity and therefore providers should be registered with CQC
• ensuring health visitors, school nurses and their appropriate team members meet legal requirements for professional registration and revalidation. This should be in line with revalidation requirements for practice issued by the Nursing and Midwifery Council (NMC)

Providers should have local standard operating procedures and processes in place to ensure that the service delivered is appropriate to support the required outcomes.

The service specification has been informed by the local commissioning strategy (including the joint strategic needs assessment and population health needs assessment) and aligns with the outcomes and impact required.

[Include details of your local commissioning strategy.]

This service specification will be regularly reviewed and updated as necessary to maintain and improve the quality of the service. The commissioner:

• will review all available evidence regarding the service provision
• reserves the right to revise or vary this service specification to reflect changes in law, guidance or local need
• must provide a minimum of 6 months’ notice of any changes to this specification, except where statutory or safety reasons require a shorter period

Expected outcomes

Outcomes expected include those set out within the Public Health Outcomes Framework and the Community Services Data Set (CSDS).

This specification sets out how [name of local authority] and [name of health provider] will work together, in collaboration with health, social care and other system partners, to deliver the healthy child programme.

The specification, along with the agreement or contract pertinent to section 75 of the National Health Service Act 2006, will form the basis for collaborative working with each other and partners to get the best and most fitting service for babies, children, young people and families in [name of local authority].

This specification will be reviewed regularly and may need to be amended, in collaboration, dependent on:

• changes in national policy
• identification of changing local need
• changes in best practice
• changes to the healthy child programme landscape

Scope

Service description

Local context

[In this section, outline information such as:

• local population size and demographics
• areas of deprivation (including the Index of Multiple Deprivation)
• the number of babies, children and young people, including a breakdown of those:
  • aged 0 to 5
  • aged 5 to 19
  • aged 19 to 25
  • with SEND]

Proportionate universalism and levels of support

The provider will offer services within the healthy child programme across the following 4 levels of support:

• community
• universal
• targeted
• specialist

The level of service provided to each family should be determined through holistic assessment and in collaboration with families. All 4 levels of support must be available within the local authority, with service delivery tailored to assessed individual needs. Proportionate universalism means offering more intensive support for families facing greater challenges, while maintaining universal provision for all. Families receiving targeted or specialist support must also continue to receive universal service provision.  

The healthy child programme sets out the public health activity of health visiting and school nursing teams, which includes (but is not limited to):   

• 5 statutory universal in-person health and development reviews for children aged 0 to 5
• 4 recommended health needs assessments for children aged 5 to 19 years and the statutory National Child Measurement Programme (NCMP) for all school-aged children
• a proportionate level of service to meet individual needs (community, universal, targeted and specialist)
• delivery of screenings (such as vision and hearing screening) and immunisations, or delivery support for such activities
• delivery of evidence-based advice and interventions by practitioners
• infant feeding support

[See the Delivery of the healthy child programme guidance for further details and add local priorities.]

Public health teams work in partnership with a range of professionals and wider services to deliver a comprehensive universal offer and proportionate support for families with additional needs. Such partners are likely to include (but are not limited to) the following:

• GPs
• maternity services
• schools
• paediatricians
• social care
• Best Start Family Hubs

Access to the service

All families with a baby, child or young person aged under 19 (or up to the age of 25 for care leavers and those with SEND) are entitled to receive this service. Where communications are issued to parents and carers, these should be provided to all parents and carers within a family.

Core working hours should be provided between 8am and 6pm. Services should be flexible and:

• attuned to the needs of working parents or carers
• inclusive towards fathers
• considerate of underserved groups

Therefore, the service should operate outside core working hours on several days each week. It is expected that a lone working policy will be in place for staff to ensure safety.

The service provider must include mechanisms to ensure parents are able to both understand (as well as act on) information provided and communicate with the service. Such mechanisms may include:

• accessible literature and websites
• translation services
• out-of-hours availability

Services must proactively engage with underserved groups using trauma-informed approaches and actively follow up on non-attenders or children who are not brought to appointments.

For young people, apply Gillick competence or Fraser guidelines and publish a plain English privacy notice.

Confidentiality

The service provider will be expected to demonstrate that the collection, storage and transfer of information to other services, including that in electronic format, is secure and complies with any data protection requirements.

The provider must work to ensure that local data-sharing agreements are in place to support the safeguarding of children and healthcare professionals’ roles, including with maternity services (for more information, see the ‘Data sharing’ part of the ‘Delivery’ section below). These arrangements should balance the ‘need to know’ principle with the sensitive and confidential nature of some information. Fear about sharing information should not obstruct keeping people safe. 

Equality and diversity

The service provider shall ensure that the service offered is respectful and does not discriminate on grounds of:

• age
• sexual orientation
• disability
• sex
• gender reassignment
• marriage or civil partnership
• pregnancy or maternity status
• race
• religion or belief

Services should be sensitive to the needs of clients whose first language is not English and those with a hearing, visual or other disability.  

The provider has a duty to undertake equality impact assessments. The provider will co-operate with the commissioner’s equality impact assessments process.

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.

Providers will:

• have systems in place to analyse, respond to and act on feedback, using it to inform service improvement
• work in partnership with the local authority to ensure quality improvement

Embedding a culture of listening, learning and co-production promotes trust in public health services, and ensures the healthy child programme reflects the lived experience and priorities of those it supports.    

Patient safety and serious incident reporting

Patient safety incidents are any unintended or unexpected incidents (including omissions) that could have, or did, lead to harm for one or more patients receiving healthcare. Recording a patient safety incident supports the NHS to learn from mistakes and take action to keep patients (including babies, children, young people and families) safe.

All providers who are registered with CQC must comply with the general duty of candour under regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This requires registered providers and managers (registered persons) to act in an open and transparent way with people receiving care or treatment from them. Regulation 20 also defines a notifiable safety incident and specifies how registered persons must apply the duty of candour if these incidents occur.

Providers registered with CQC must have systems in place to comply with these requirements.

Geographic coverage and boundaries

The health visiting service will be provided to all babies, children, young people and families within the local authority in which they live. Where a family is homeless or living in temporary accommodation, the service should still be offered so that the needs of the child and family are identified and met.

The school nursing service is primarily based in schools within a local authority area. This:

• includes academies and alternative providers, such as pupil referral units
• does not include independent schools and family homes where children are home schooled, which fall outside the scope of local authority-funded school nursing services

[If you have chosen to include a local determination, outline the offer of school nursing services expected for home-educated children and children at independent schools.]

For pupils educated in a different local authority to where they live, schools should ensure there are mechanisms in place to work with relevant health services, such as a pupil’s GP surgery, to support continuity of care. 

Interdependencies

There are some individuals and organisations that the provider will be expected to develop close links with. These include:

• maternity care providers and the local maternity and neonatal system
• child and family early help hubs
• GPs
• social care
• child and adolescent mental health service providers
• safeguarding
• housing
• child health information services (CHIS)
• schools and virtual schools
• early years settings
• integrated care boards
• community paediatrics
• youth justice or youth offending teams
• dentistry
• voluntary, community and social enterprise sector partners
• Ofsted, CQC and joint inspections

[Amend the above list to reflect local service provision.]

Partnership working is required to ensure adequate preparation for inspections such as local Ofsted, CQC and joint inspections. Providers and commissioners will work together to ensure adequate provision of evidence for these processes.

Relevant networks

The provider shall engage with the following networks as appropriate:

• the local maternity network (local maternity and neonatal system)
• DHSC
• the Department for Education

[Amend the above list to reflect local networks.]

Delivery

Implementation

The quality of the service implementation is vital to achieving the intended outcomes. A governance board will be established by the service provider in partnership with [name of local authority] to:

• oversee service scrutiny
• affirm good practice
• provide a forum where service development can be discussed

Implementation metrics should be used by both commissioners and providers to monitor service implementation, embed new learning, and continuously improve practice and outcomes.

Health visiting activity response times and prioritisation

Upon receiving notification of the following clients, contact should be made to arrange a health and development review or visit within the following time frames:

• pregnant woman: 7 working days
• notified high-risk pregnant woman: 2 to 5 working days
• a new birth: 2 to 7 working days
• transfer in to the area: 7 working days (or 2 working days if the family is in temporary accommodation)
• urgent referrals, including safeguarding referrals: same day or next working day (the referrer) and 2 working days (the family). The response should align with local safeguarding procedures

Families seeking telephone or online advice and support from a nurse or health professional should receive a response within one working day.

School nursing activity response times and prioritisation

School nurses must respond to all referrals of school-aged children in state education within the following time frames:

• referrals, from whatever source: 5 working days (the referrer and the family)
• urgent referrals, including all safeguarding referrals: same day or next working day (the referrer) and 2 working days (the family)
• new admission to school: 14 working days

Procedures must be in place to:

• trace and risk-assess missing children and those whose address is not known
• follow up and trace children who do not attend scheduled assessments
• ensure the service is aware of new GP registrations and movements out of a practice

Transition between health visiting and school nursing services

The provider will have in place a local protocol that describes the process of transitioning a child from the health visiting to the school nursing service. Direct contact between professionals will be made to hand over all child protection cases.

Performance management requirements

Quality and performance contract monitoring - including workforce vacancies, sickness absence and financial spend - will take place, as a minimum, on a quarterly basis.

Monitoring performance is a joint activity between the provider and commissioners to ensure that the best:

• outcomes are reached for babies, children, young people and families
• value for money is achieved for the public health grant and the local authority

Case studies and additional reports will be agreed as and when appropriate, such as when they are required to add value to the running of a service or demonstrate impact. For example, when:

• there is a specific practice issue that requires exploration
• understanding is needed of the impact and benefit of a new development or policy

Team size, skills and structures

The size of the team and service capacity is determined by the population need. The provider organisation will ensure that:

• staffing levels and the level of skill mix reflects the identified population needs [enter local additions as required]
• the commissioner is informed of any changes to skill mix capacity

The public health nursing service must be led by SCPHNs, who are regulated professionals accountable to NMC. SCPHNs ensure safe, high-quality care and uphold regulatory responsibilities.

NMC’s The Code: professional standards of practice and behaviour for nurses, midwives and nursing associates requires that registered professionals: 

• only delegate tasks within the individual’s scope of competence, making sure instructions are clearly understood
• supervise and support those they delegate to, ensuring safe and compassionate care
• confirm that delegated tasks are completed to the required standard

Providers should ensure that staffing structures allow these requirements to be met.

The statutory offer of 5 health and development reviews should be delivered by regulated, clinically competent SCPHNs, ideally with a named health visitor or consistent contact for each family.

The provider will ensure that, when targeted support is required, health visitors and school nurses lead the planning of a structured intervention and assign specific elements as delegated tasks to skill mix colleagues.

Where elements of the review process or additional offer are delegated, tasks should align with the individual’s competencies and not be expected to replicate the full expertise of an SCPHN.

Delegation to unregistered staff should be clearly documented and supported by robust governance to ensure safe, ethical and effective care. Where practitioners are unregistered, this should be made explicit in service protocols and supervision arrangements.

The provider organisation must have processes in place to safeguard the integrity of the service and ensure that babies, children, young people and families receive consistent, high-quality care from an appropriately skilled practitioner.

Quality standards should be:

• monitored for both the statutory offer and additional support
• considered against the local expectations of need and service outcomes - see, for example, the key performance indicators (KPIs) on ‘Child development outcomes’ and ‘Workforce’ in Annex A of the ‘Healthy child programme: commissioning public health nursing services’ guidance

Competency framework and continuous professional development

A 0 to 19 competency framework should be produced by the provider that explicitly describes the role, expectations and professional boundaries of the different team members within the public health nursing team. This will underpin a quality skill mix and avoid skill dilution, as described in the ‘Healthy child programme: commissioning public health nursing services’ and ‘Delivery of the healthy child programme’ guidance.

The provider will ensure there is a clear governance and accountability framework in place covering professional accountability, supervision, clinical oversight (of practice and records) and delegation. It should outline:

• continuous professional development
• preceptorship and mentoring support for newly qualified health visitors and school nurses
• the process for revalidation under NMC regulations
• career development opportunities

The provider will develop a recruitment strategy that supports career progression across the nursing workforce so that all staff have access to regular opportunities for professional development and growth, and evidence-based supervision is provided and adhered to.

Nurse prescribing

Health visitors and school nurses may be trained in nurse prescribing with associated regular prescribing updates to ensure fitness to practise under NMC’s Standards for prescribers.

This enhances the practitioner’s ability to support families to manage minor illnesses, thereby reducing:

• GP attendances
• numbers of school absences
• hospital admissions

It is a cost-effective intervention to improve outcomes for families, and providers are encouraged to offer this service.

The provider must report on levels of prescribing as part of contract assurance.

Service and staffing variations

The service provider will have a workforce development plan that reflects a commitment to staff development, support for students and engagement with research.

The provider will inform the commissioner of any service or staffing variations from the commissioned capacity and skill mix. This will include:

• vacancies
• sickness absence rates
• recruitment and retention challenges

Data collection, storage and record keeping

Accurate and appropriate data collection, storage and analysis is central to the effective functioning of healthy child programme services.

Provider organisations are expected to:

• have appropriate data system capability to meet the obligation to report to CHIS and CSDS
• promote practices of data accuracy and completeness in recording and reporting
• have the digital capability to follow the ‘analogue to digital’ shift, as outlined in the 10 Year Health Plan for England: fit for the future, such as:
  • the use of the NHS App for appointments
  • suitable methods for out-of-hours advice
  • to meet future national reporting requirements

Up-to-date electronic health records should be kept, with accurate and appropriate data made available to CHIS as well as all those with a duty of care for the child.

Providers of publicly funded community health services are required to submit data to NHS England’s CSDS - as required by the CSDS data provision notice - in relation to person-centred information for children (and adults) who are in contact with those services. This includes data from the healthy child programme. The contract between the service provider and their IT system supplier should specify that:

• providers:
  • have a legal responsibility to comply with the data provision notice for the CSDS
  • ensure that robust systems are in place to meet the legal requirements of the UK Data Protection Regime (comprising the UK General Data Protection Regulation and the Data Protection Act 2018)
  • safeguard personal data at all times
• the supplier has the appropriate reporting systems and capabilities

Providers should refer to the Healthy child programme: supplementary guidance for completing the CSDS, which provides guidance on completing the necessary data tables and fields.

Data sharing

Local data-sharing agreements should be in place to facilitate the sharing of information and support the safeguarding of children and healthcare professionals. These arrangements should balance the ‘need to know’ with the sensitive and confidential nature of some information. Fear about sharing information should not obstruct keeping people safe.

Consent to share information between maternity services and the local authority should be gained from data owners and controllers so that the care of women, babies and families can start at the earliest antenatal opportunity.

The provider should have agreed data-sharing protocols with partner agencies to enable effective holistic services to be provided to babies, children, young people and their families. Such agencies include:

• other healthcare providers
• children’s social care
• the police

Data systems:

• should support the secure sharing of data between agency partners
• should not be a barrier to working in an integrated way

Commissioners and providers will work together to ensure that the delivery metrics and outcome indicators for the healthy child programme are covered in contracts or ‘in-house’ arrangements in a way that supports local data collection in the standard national format.

Safeguarding

Safeguarding children is a vital responsibility for all health professionals and organisations. In line with the Working together to safeguard children statutory guidance and the Children Act 2004, it is essential that the provider:

• ensures the health, welfare and protection of babies, children and young people is always paramount
• delivers appropriate and responsive care to all children

Therefore, safeguarding vigilance will run through all levels of intervention. The provider will:

• maintain appropriate and effective safeguarding services
• be expected to adhere to and implement relevant national and local requirements and guidance, wherever necessary
• have a safeguarding policy in place that is compatible with their own duties and obligations. This should:
  • reflect [outline local safeguarding partnership procedures]
  • give clear assurances around individual and organisational safeguarding reporting and accountability arrangements, including an identified executive lead for safeguarding children
• ensure safe recruitment processes are in place and that all staff working with children have been appropriately vetted, including Disclosure and Barring Service checks

All staff will have access to safeguarding training and supervision to the level and standard appropriate for their role.

Staff working frequently with children and young people will require Level 3 Safeguarding Children training.

Movements into and out of an area

Where a child moves out of area, the public health nursing services will ensure that the child’s health records are transferred to the new area within 2 weeks of notification.

Direct contact between professionals must be made to hand over all child protection cases. Systems should be in place to assess the risk to children and young people whose whereabouts are unknown.

Identification of children with SEND

Local authorities have specific responsibilities regarding babies, children and young people with SEND. Partnership working with children and young people who have SEND is essential to ensure that:

• families only tell their story once
• information is shared between agencies
• a full picture of the child’s circumstances emerges
• all health and development reviews and health needs assessments progress at appropriate time points

The provider will work in partnership with the local authority to help fulfil these responsibilities, recognising that health visiting and school nursing teams are often the first professional to identify an emerging special educational need and/or disability.

By identifying and then promptly addressing the needs of babies, children and young people with SEND (including ensuring delivery of the statutory offer of 5 health and development reviews), the provider will support the local authority to optimise the health outcomes of members of their community who live with additional needs.  

Risk management and clinical effectiveness

The provider will have responsibility for ensuring that services are safe, consistent and of a high quality.

The senior leaders working with the commissioners will be able to monitor and mitigate risks, reporting into the appropriate organisational governance structures.

A culture of openness in relation to incident management helps service safety to continually improve.   

Reviews

[Complete the table below to show when this service specification was last reviewed, adding additional rows as needed.]

Review type	Date	Time	Venue
[Enter review type]	[Enter date]	[Enter time]	[Enter venue address]

Formal review of the service will be ongoing and will inform the end-of-year service review process, which will be used to determine if the service is to be extended or decommissioned.

Following the review, the commissioner will decide whether the service has been effective. If not, the commissioner will discuss with the provider any formal escalation or recovery plan.

[Add any relevant KPIs you are using to evaluate the success of the delivery of your service. You can find a full list in Annex A of the ‘Healthy child programme: commissioning public health nursing services’ guidance.]