Guidance

Public health nursing commissioning guidance

Published 6 February 2026

Applies to England

© Crown copyright 2026

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This publication is available at https://www.gov.uk/government/publications/healthy-child-programme-commissioning-public-health-nursing-services/public-health-nursing-commissioning-guidance

This guidance should be read by all commissioners and providers of public health nursing services for 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)) in England.

Introduction

Local authorities are under a legal duty to take steps they consider appropriate to improve the health of people in their area, as set out in section 2B of the National Health Service Act 2006. By commissioning public health nursing services for babies, children and young people aged 0 to 19 (known as the ‘0 to 19 pathway’), local authorities meet this duty and further this goal.

Commissioning of these services occurs within local public health teams and is overseen by the director of public health for the area. Commissioning follows a cycle of activity that is determined locally and based upon procurement rules set out nationally.

Commissioners should be aware of the following when commissioning these services:

  • relevant current legislation and guidance
  • population need
  • existing service provision
  • available resources
  • reporting requirements

The importance of commissioning

Commissioning decisions made today will directly influence the health of this generation and many more to come. Therefore, such decisions should reflect the compelling evidence that investment in the early years is not only societally essential but also economically effective (see reference 1 in Annex E).

Research estimates that local authority public health expenditure delivers an additional year of perfect health (at population level) for approximately £3,800 (see reference 2 in Annex E), which is approximately 3 to 4 times more productive than NHS healthcare spend.

The notion that commissioning decisions have generational impacts is reinforced by the government’s commitment, in the 10 Year Health Plan for England: fit for the future (referred to throughout this guidance as the ‘10 Year Health Plan’), to raise the healthiest generation of children ever, as well as publication of the Our Children, Our Future: Tackling Child Poverty strategy.

This refreshed guidance therefore has a particular focus on:

  • improved collaboration
  • quality improvement
  • what good looks like

Developed in collaboration with a wide range of stakeholders, this publication summarises the expected standards for a public health nursing service based on:

  • the best evidence
  • nursing standards
  • implementation science
  • relevant legal obligations

This guidance is intended to assist local authority commissioners, and provider organisations, of public health nursing services (for those aged 0 to 19) by clarifying commissioner and provider responsibilities to:

  • babies, children, young people and families
  • the public health nursing workforce

Terminology and wider products

See the ‘Terminology’ and ‘Wider healthy child programme publications’ sections of the introduction to the Delivery of the healthy child programme guidance to read more about the:

  • specific terms used in this guidance and their definitions
  • relationship between the various healthy child programme publications and their target audiences

Legislation

The following acts, among others, contain requirements for local authorities relating to children:

The Local Authorities (Public Health Functions and Entry to Premises by Local Health Watch Representatives) Regulations 2013 (as amended by 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) (Amendment) Regulations 2015) prescribe steps local authorities must take in exercising their public health functions, including arranging for public health services for children and young people aged 0 to 19.

These regulations include the requirement for local authorities to provide, or secure the provision of, universal ages 0 to 5 health and development reviews for eligible people at the following points in time. They must be offered 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 24 to 30 months old (referred to as the ‘2-to-2-and-a-half-year health and development review’)

Provider organisations for all activities must adhere to all relevant legal and clinical requirements, including:

Service design

The service model

The healthy child programme is organised into the following 4 levels of support:

  • community
  • universal
  • targeted
  • specialist

These 4 levels of service form the foundation of the healthy child programme and are embedded within the updated Healthy child programme: high-impact area framework. The high-impact areas complement the healthy child programme guidance by translating its principles into actionable priorities across the 0 to 19 pathway. The framework helps services to:

  • identify population needs
  • align resources
  • ensure that support is tailored, equitable and responsive to local context

You can read more about each level of support offered as part of the programme below.

Community support

Community-level support includes population-level public health protection, promotion, screening and surveillance.

Universal support

All people aged 0 to 19 are eligible for community and universal support.

Between the ages of 0 and 5, the universal statutory offer consists of 5 health and development reviews, which must be offered at 5 set stages with additional support based on assessment of need.

Between the ages of 5 and 19, the universal school years offer consists of 4 recommended core health need assessments (typically offered at school entry, and in years 6, 8 and 10).

Targeted support

Targeted support covers 2 types of support as follows:  

  • targeted selective support is offered proactively to families who are at higher risk of poor outcomes due to known vulnerabilities such as young parental age, social isolation, housing instability or a history of trauma. This support aims to prevent problems before they occur and may include enhanced:
    • home visiting
    • parenting support
    • group-based interventions
  • targeted indicated support is provided when a specific concern has been identified. For example:
    • a sensory impairment
    • delayed speech and language
    • mild to moderate mental health difficulties in a young person and/or parent
    • atypical attachment and bonding
    • the social impact of neurodiversity

All targeted interventions should be tailored to the family’s circumstances and may be delivered - sometimes jointly with partner agencies - in home visits, clinics or community settings. Practitioners should be mindful that not all families are able or willing to attend group-based services, and home-based support may be essential to ensure equitable access.

Commissioners and provider organisations are expected to ensure that their services adequately meet the needs of their local population. In accordance with proportionate universalism, targeted or specialist services should be provided for those most in need (who often but not always belong to vulnerable populations).

Specialist support

For a small number of babies, children or young people who are particularly vulnerable, a specialist level of service will be required, such as for:

  • teenage parents
  • looked-after or care-experienced children
  • those with SEND or complex health needs
  • those persistently absent from school
  • refugees
  • young carers
  • Gypsy, Irish Traveller and Roma families
  • parents who repeatedly have children removed
  • those whose parents have physical and/or mental health needs

All local authorities should have a specialist programme at a scale appropriate to local need.

Specialist programmes should offer families evidence-based support that is more intensive than that delivered as part of the healthy child programme’s universal service - including frequent, detailed and personalised health interventions for specific challenges.   

The Foundations, the national What Works Centre for Children and Families’ guidebook features evidentially robust specialist programmes for children and families such as the Family Nurse Partnership programme, which delivers sustained improvements in child development, school readiness and maternal self-efficacy, breaking cycles of disadvantage for young parents and children who are often marginalised and least likely to access services.

Public health nursing services across the 0 to 19 pathway are not responsible for meeting routine complex clinical healthcare needs (such as those experienced by some children who attend special educational needs schools). Instead, these services should be delivered by other nursing services and commissioned by integrated care boards (ICBs) or NHS England.

Role of the qualified specialist community public health nurse

The qualified specialist community public health nurse (SCPHN) leads the delivery of the healthy child programme. This is crucial to ensure quality and safety.

An SCPHN is a qualified health visitor or a school nurse (occasionally both) who:

  • is accountable to their employer (on behalf of a local authority) for the universal offer of ages 0 to 5 health and development reviews and additional support, core ages 5 to 19 health needs assessments, care planning, and caseload management, with some delegation as clinically appropriate (see the ‘Delivery of the healthy child programme’ guidance for more details)
  • remains accountable for all practice they delegate, in line with NMC’s The Code: professional standards of practice and behaviour for nurses, midwives and nursing associates, including ensuring that:
    • the competency of the practitioner undertaking a delegated task is compatible with safe delivery
    • appropriate supervision is in place

Commissioners should be certain that providers of their 0 to 19 pathway have clinical systems in place to enable the safe and effective delivery of their public health nursing services.

Types of contacts and locations

Visibility of the child is paramount to the value and impact of the service - so points of contact by health visitors and school nurses (known as ‘contacts’) should be face to face wherever this is most appropriate.

For the first 3 health and development reviews that occur before age 5, the most appropriate setting will almost always be the home. For the other ages 0 to 5 health and development reviews, the most appropriate environment will either be the home, a Best Start Family Hub or a clinical setting. However, the determination of setting should always be based on family context and need, rather than service capacity or convenience.

In the case of school nursing, health needs assessments can occur either at school or a similar setting such as a youth hub.

A focus across the healthy child programme should be to build reliable, trusting relationships with babies, children, young people and families so that health needs can be identified and addressed. Service delivery can therefore take place across a variety of family-friendly settings including home and community venues such as clinics, GP surgeries and Best Start Family Hubs, so long as each venue is appropriate to a child’s age (as detailed above).

In-person public health nursing contacts can also be supplemented, but not replaced, by digital forms of support such as online messaging. For example, to best serve school-aged children, there may be a need for a combination of contacts ranging from schools or drop-in clinics through to online, text or telephone support.

Travel costs for public health nursing teams require budgetary consideration when commissioning.

The 10 Year Health Plan presents an ambition for neighbourhood health centres, which will require a greater focus on joint working and consideration of the advantages of working in co-located office premises - particularly with other agencies that engage with the same families, such as:

  • GPs
  • early help or social care teams
  • Best Start Family Hubs
  • schools
  • mental health support teams

This co-location aims to:

  • encourage the sharing of mutually beneficial information
  • build positive professional relationships between partners
  • enable better joined-up services that secure the best outcomes for families

Service availability

Public health nursing services across the 0 to 19 pathway should be accessible to all families residing within the geographic boundaries of the relevant local authority. To ensure such access for all, local authorities should expect to work closely with partner organisations. Where a family is homeless or living in temporary accommodation, the service should still be offered, with the needs of the baby, child, young person and family identified and met.

Public health nursing is not an emergency service - it should respond to need and provide support to access other services. Each family should be allocated a named health visitor and every school allocated a designated school nursing team member. This arrangement promotes:

  • continuity of care
  • the relationships required for effective practice

Flexibility of service operation

Services should be:

  • attuned to the needs of working parents or carers
  • inclusive towards fathers and non-birthing partners
  • considerate of traditionally underserved groups

Therefore, services should be flexible and operate outside core working hours. It is expected that a lone working policy will be in place for staff to ensure safety.

Digital considerations 

Delivery of public health nursing services for those aged 0 to 19 is enhanced by access to the right digital tools. Tools help to:

  • streamline administrative tasks
  • free up practitioner time (to undertake more direct work with families)
  • identify areas where demand is outstripping capacity

New technologies - including ambient artificial intelligence (AI) (such as automated note-taking tools) or secure messaging platforms (such as ChatHealth) - hold real potential to enhance day-to-day practice.

Commissioners should ensure that providers are using digital tools to support the delivery of a quality service. This includes support for staff training to enable tools to be used effectively.

Examples of electronic solutions that can reduce the administrative burden and missed appointments include:

  • a self-booking appointment system for parents
  • text message and/or smartphone notification reminders

Tools used should be compatible with data systems, wherever possible, to ensure quick transfer of records and information.

Adoption of technology should complement the relational work of health visitors and school nurses, including home visits and in-person contacts. Reviews completed solely by video or telephone or through posted questionnaires would not meet the expected standard for the 5 statutory ages 0 to 5 health and development reviews, and, therefore, should not be reported as such. This is because serious clinical and safeguarding issues could go undetected if a child is not physically seen.

Providers should mitigate against digital exclusion by implementing the framework for NHS action on digital inclusion.

Equality, diversity and inclusion

A core aim of public health nursing is to reduce health inequalities. This goal requires:

  • serving the largest possible proportion of the general population
  • assessing the impact of services on typically underserved populations

For families who are underserved (including those who are living in temporary accommodation, children who are refugees or asylum seekers and those persistently absent from school), it is vital that health visitors and school nurses are able to offer a variety of opportunities for engagement with their services.

Commissioners should ensure provider organisations perform equalities impact assessments for their services, reviewing these when any changes to service delivery are made. Doing so helps demonstrate compliance with the public sector equality duty imposed by section 149 of the Equality Act 2010.

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 contacts.

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

Vulnerability is defined, for public health nursing purposes in Understanding and quantifying vulnerability in childhood, as the state of being:

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

Examples of vulnerability are listed alongside this guidance in ‘Annex D’.

It is vital that practitioners are encouraged to identify children, young people and families who may benefit from additional or specialist input. This includes recognising major life circumstances that may increase vulnerability or reduce access to universal offers.

A trauma-informed, proportionate approach supports early identification and ensures responses are non-stigmatising, relational and tailored to individual needs. 

Identifying vulnerability should not rely on checklists but should be:

  • based on a comprehensive assessment, undertaken in partnership with the family, that builds on their strengths and insights
  • combined with the clinical expertise of health visitors and school nurses

Vulnerable babies, children, young people and parents (including those with neurodiversity) may experience fluctuating levels of vulnerability throughout their lives. The level of service provided to them under the healthy child programme should be adaptable to accommodate this fluctuating and unpredictable need.

Specific populations

The following set of groups is non-exhaustive, but highlights specific demographics for whom the healthy child programme plays a crucial role in:

  • identification
  • early support
  • access to services

Looked-after children

Like their peers, children in care are eligible for the universal healthy child programme offer.

Under section 7 of the Care Planning, Placement and Case Review (England) Regulations 2010, local authorities are required to arrange health assessments for children they look after at specified points. These assessments fall outside of the remit of the healthy child programme and therefore should be commissioned by the relevant ICB.

The needs of children in care should be considered in the development of the local joint strategic needs assessment (JSNA) and should avoid diluting resource or capacity assigned to public health interventions.

Care leavers

The Children Act 1989 provides for care leavers to be supported by their local authority up to the age of 25. The support provided to these young people from their local authorities includes healthy child programme services where relevant.

Care leavers may require extended support - for example, as they transition through school and into adult services. Their experiences may affect how they engage with services, requiring sensitive, proactive and non-judgemental outreach to ensure they are not underserved by universal offers.

Commissioners should:

  • identify the needs of care leavers as part of the JSNA
  • ensure that the public health nursing service offer for those aged 19 to 25 reflects the level of need identified

Young carers

Carers Trust’s Caring and classes: the education gap for young carers report states that there could be 2 young carers in every classroom. The school census Schools, pupils and their characteristics data for England recorded 64,500 pupils identified as young carers in the academic year 2024 to 2025 - an increase of almost 20% from 2023 to 2024.

Commissioners should obtain data from provider organisations and the school census to aid in identifying demographic information about young carers within their local authority. This will ensure the needs of young carers are appropriately considered as part of the JSNA and the specification of 0 to 19 public health nursing services. 

Babies, children and young people with SEND

Under section 20 of the Children and Families Act 2014:

A child or young person has special educational needs [SEN] if he or she has a learning difficulty or disability that calls for special educational provision to be made for him or her.

A child of compulsory school age or a young person has a learning difficulty if he or she has a significantly greater difficulty in learning than the majority of others of the same age, or has a disability which prevents or hinders him or her from making use of facilities of a kind generally provided for others of the same age in mainstream schools or mainstream post-16 institutions.

For the purposes of that section, ‘young person’ is defined as:

a person over compulsory school age but under 25.

And, finally, section 20 states:

A child under compulsory school age has a learning difficulty or disability if he or she is likely to be within… [the definition of learning difficulty or disability set out above], when of compulsory school age (or would be likely, if no special educational provision were made).

Some children and young people have SEN without disabilities, and some disabled children and young people will not have SEN.

Commissioning arrangements should set out the services that those aged up to 25 who have SEN and/or disabilities can access - whether or not they have an education, health and care plan (EHCP). See the SEND code of practice: 0 to 25 years for more information on this.

To identify children who are vulnerable and/or may have emerging SEN or disabilities, it is vital that all babies, children and young people receive the statutory offer of 5 universal health and development reviews before age 2 and a half, plus any additional health and development reviews as recommended by practitioners. 

The healthy child programme is a vital tool regarding SEND as health visitors and school nurses are often the first professionals to identify SEND, enabling appropriate care to commence at an early stage. Health visitors and school nurses work in partnership with families and other services to ensure that disabled babies, children and young people and/or those with SEN access the health support they need, including referrals to specialist services.

Health visitors and school nurses should be informed by the local authority when a child has SEND or SEND is suspected. Conversely, health visitors and school nurses should also inform the local authority, with parent or carer consent, when this is identified as part of the provision of the healthy child programme.

The needs of families with disabled children and disabled parents should be considered in the commissioning and delivery of public health nursing services.   

Local authorities have specific responsibilities regarding babies, children and young people with SEND. These responsibilities are captured in the Children and Families Act 2014 and the ‘SEND code of practice: 0 to 25 years’.

Part 3 of the Children and Families Act 2014 sets out local authority responsibilities in respect of children and young people within their boundaries who have been identified by the local authority or brought to a local authority’s attention as having (or potentially having) SEN or a disability.

Under section 22 of the Children and Families Act 2014, a local authority must exercise its functions with a view to securing that it identifies all children and young people who have (or may have) SEN or a disability.

Disabled children are taken to be children in need under section 17 of the Children Act 1989. Under this act, local authorities have a general duty to:

safeguard and promote the welfare of children within their area who are in need and, so far as is consistent with that duty, to promote the upbringing of such children by their families.

When working with children who have SEND, partnership between services is essential to ensure that:

  • families only tell their story once
  • information is shared legally between agencies
  • a full picture of the child’s circumstances emerges, allowing the right support to be swiftly put in place

By identifying and then promptly addressing the needs of babies, children and young people with SEND (through delivery of the healthy child programme), local authorities can optimise the health outcomes of members of their community who live with additional needs.

Families with no recourse to public funds

Children in families with no recourse to public funds remain eligible for the healthy child programme as this is a universal public health programme.

Safeguarding children and young people

Safeguarding and promoting the welfare of children is:

  • a statutory responsibility for local authorities and other specified agencies as set out in the Children Act 1989
  • an essential function for all organisations working with children and young people as set out in statutory guidance such as Working together to safeguard children

Health visitors and school nurses play a vital leadership role in safeguarding, using their expertise and relationships with families and communities to identify concerns early and contribute to effective multi-agency responses. Their regular contact with families means they are often the first professionals to identify abuse, neglect and other safeguarding concerns, both inside and outside the home.

Multi-agency working

Under section 27 of the Children Act 1989, the following organisations have a duty to co-operate by assisting in carrying out the local authority’s children’s social care functions, provided that this is compatible with their own duties and obligations, and does not interfere with the performance of their own functions:

  • health organisations
  • other local authorities
  • other parts of the local authority, such as housing

The ‘Working together to safeguard children’ statutory guidance sets out clear expectations for:

  • multi-agency working to safeguard and promote the welfare of children (see pages 16 to 18, paragraphs 19 to 27)
  • national multi-agency practice standards for child protection (see pages 80 to 81, paragraphs 216 to 218)

All safeguarding partners should follow this guidance to ensure a consistent and effective response to child protection concerns.

Co-operation should be proportionate and in line with professional standards. It should not be assumed that health visitors or school nurses will always take the lead - their capacity to deliver the full healthy child programme should be prioritised.

Commissioners should ensure safeguarding responsibilities are balanced with the delivery of the wider healthy child programme offer through local partnership agreements.

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 appropriate services. These children may not meet the threshold for statutory child protection intervention but still require co-ordinated, multiagency support.

In accordance with page 45, paragraph 12 of the ‘Working together to safeguard children’ statutory guidance, and pages 11 and 12 of the Early Help System Guide, health professionals - including health visitors and school nurses - may act as the lead practitioner in respect of children receiving support under section 17, where appropriate. The lead practitioner 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 practitioner’s capacity, capability and suitability for the child and family
  • agreed locally and formalised in a shared local protocol (as outlined on page 53, paragraph 141 of ‘Working together to safeguard children’)

The local authority remains accountable for ensuring these protocols are in place.

Responding to significant harm (section 47 enquiries)

Under section 47 of the Children Act 1989, where 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, it has a duty to make such enquiries as it considers necessary to decide whether to take any action to safeguard or promote the child’s welfare.

These enquiries - known as section 47 enquiries - are led by children’s social care, and a qualified social worker is responsible for the assessment and co-ordination of the multi-agency response.

Health visitors and school nurses play a critical role within the multiagency response, including:

  • sharing relevant health information to inform the assessment
  • observing and interpreting the child and parent relationship
  • identifying health-related risk factors, such as 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, ensuring that:

  • agencies work together
  • protocols for section 47 enquiries are followed consistently and in line with statutory guidance

Other relevant safeguarding resources

The relevant Domestic Abuse Act 2021 requirements and National Institute for Health and Care Excellence (NICE) 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.

Reporting, monitoring, contract management and data requirements

Quality and implementation

Commissioners should adopt a well defined approach to quality assurance and quality improvement.

To support the commissioning of a safe and effective service, commissioners should ensure provider organisations have processes in place to embed continuous learning and quality improvement in their services. The quality of implementation is crucial to achieving intended outcomes (see reference 3 in Annex E). Commissioners can support effective implementation in a range of ways, such as by:

  • creating governance boards to oversee service scrutiny
  • building positive partnerships with provider organisations as well as other stakeholders

The contract should include the following:

  • expectations about a clear approach to monitoring, auditing and benchmarking to secure the expected outcomes for babies, children, young people and families
  • engagement between a local authority and provider organisation, using quality and outcome information to aid service improvement
  • quality and performance contract monitoring - including workforce vacancies, sickness absence and financial spend - should take place on at least a quarterly basis

Commissioners should consider how the provider is supporting continuous professional development for health visiting and school nursing teams, recognising the impact of investment in staff development as a means of increasing staff retention and the quality of service delivery. Preceptorship, mentorship and supervision all play a vital role in:

  • embedding learning
  • developing skilled and confident staff
  • offering a high-quality service

You can read more about this in ‘The role of qualified specialist community public health nurses’ section of the ‘Delivery of the healthy child programme’ guidance.

Staff who are not yet qualified SCPHNs should be enabled to enter training to ensure available workforce continuity, with emphasis in local career planning on recruitment of band 5 nurses and midwives over unregistered professions. Commissioners should also ensure providers encourage practitioners to access all training available to them, such as the professional nurse advocate programme.  

Alongside this refreshed guidance, the Department of Health and Social Care (DHSC) has established an ages 0 to 19 Quality Improvement Partnership Forum, which is working collaboratively to strengthen shared learning and quality improvement across the country.

The forum builds on the quality improvement work that is already happening in local areas by:

  • facilitating peer review and the sharing of good clinical practice
  • providing a bridge between policy and practice at local, regional and national levels

Patient safety and serious incident reporting

Patient safety incidents are any unintended or unexpected incidents (including omissions) which 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
  • 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 registered 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 comply with the requirements.

Commissioners should ensure that their service specification reflects this and that it is monitored through appropriate contractual processes.

Data collection, storage, sharing and processing

Accurate and appropriate data collection, storage and analysis is central to the effective functioning of healthy child programme services. Commissioners should ensure that provider organisations:

  • have appropriate data system capability
  • 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, which includes development of the NHS App and future national reporting requirements

Providers of publicly funded community health services are required to submit data to NHS England’s Community Services Data Set (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 as well as normal UK General Data Protection Regulation (GDPR) requirements
  • ensure that the supplier has the appropriate reporting systems and capabilities

It is important that consent to share information between maternity services and the local authority is gained from data owners and controllers so that the care of women, babies and families can start at the earliest antenatal opportunity. Data systems:

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

Providers need to ensure that robust systems are in place to meet the legal requirements of the UK data protection regime (comprising UK GDPR and the Data Protection Act 2018) and safeguard personal data at all times.

Electronic, contemporaneous clinical records should be kept, with accurate and appropriate data made available to the local authority’s child health information service (see ‘Child health information services’ below) as well as all those with a duty of care for the child.

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

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

Local data-sharing agreements should be in place to facilitate sharing of information to support 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.

Commissioners are encouraged 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.

Details of the CSDS’s reporting requirements and guidance on its implementation are available from NHS England. To help providers and commissioners of the healthy child programme understand what data they need to submit to NHS England, DHSC is currently developing supplementary guidance on CSDS v1.6, which will be published in due course.

Data processing requirements relevant to the National Child Measurement Programme (NCMP) are included within the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013, such as regulations 13 (processing of information by local authorities) and 14 (disclosure of information to parents).

Child health information services (CHIS)

CHIS providers have a responsibility to hold accurate, live electronic child health records that capture relevant demographic and clinical information to support the delivery of:

  • screening
  • vaccination
  • healthy child programme interventions

However, in some instances, these systems have been developed to support the delivery of care to individual children and have become integrated within an electronic community child health record.

CHIS providers are responsible for electronic interfaces that allow information to be sent, received and, where appropriate, accessed by educational, local authority and NHS care system users for direct care purposes. While interoperability of CHIS and wider systems remains an aspiration that would enable professionals to have up-to-date information about the health of children for whom they hold a responsibility, agreed processes for sharing data are currently required. Such processes should be electronic, where possible, to avoid a need to re-type information. 

CHIS specifications do not govern or determine delivery of the NCMP, which has its own data collection system hosted by NHS England. Guidance on delivery of the NCMP is provided by DHSC through the NCMP: operational guidance.

Performance monitoring

Key performance indicators (KPIs) are quantifiable measurements used to assess how effectively an organisation is achieving its objectives. They are crucial for performance monitoring because they:

  • provide a clear picture of progress (which identifies areas in need of improvement)
  • guide data-driven decision making

A full list of KPIs for national reporting is provided in ‘Annex A’. Commissioners are encouraged to introduce their own local KPIs (such as number and percentage of local children successfully toilet-trained at completion of the fifth universal 2-to-2-and-a-half-year health and development review) in addition to, and not instead of, the ones stated in Annex A.

KPIs include completion of the statutory universal offer of health and development reviews, which must be completed at 5 specified stages. These data points collectively represent the minimum data set required to provide an overview of service performance for children aged 0 to 5.

The statutory universal offer:

  • enables needs to be identified
  • is the basis for further professional activity in response to need

Referral data can be used locally to inform service delivery and current or future commissioning.

Transition from interim data reporting to the Community Services Data Set

The present arrangements of Interim data submission for the health visiting service will shortly come to an end. Providers of publicly funded community health services are now required to submit data to NHS England’s CSDS, including data from the healthy child programme.

The data is required under section 259 of the Health and Social Care Act 2012 to support a direction from the Secretary of State for Health and Social Care to NHS England. Organisations that are in scope of the data provision notice are legally required to provide the data in the form and manner it specifies.

Commissioners should ensure provider organisations are able to meet this obligation.

See the ‘Data collection, storage, sharing and processing’ section above for further information, and links to this notice and relevant CSDS guidance.

Assessment against outcomes

Commissioners should expect the impact of interventions to be demonstrable and, more specifically, sufficiently attributable to the intervention (as opposed to extraneous factors). A robust outcome assessment is vital. A range of qualitative and quantitative assessment tools should be employed such as:

  • service user feedback
  • practitioner insights
  • national statistics
  • local population-level data

The KPIs and reporting metrics are designed to support the monitoring of the healthy child programme at national and local level, and align with the upcoming local government outcomes framework.

One outcome within this framework consists of the proportion of children achieving a good level of development (GLD) at the age of 2 and a half. This outcome:

  • is shaped (albeit not exclusively) by the quality of healthy child programme service delivery in providing early universal support, including identification of additional need, to most children within a local authority’s area
  • should be considered alongside the proportion of:
    • children (with additional needs) identified after age 2 and a half
    • GLD attainment at age 5

Digital tools and technical requirements

Public health nursing for those aged 0 to 19 relies on a wide range of resources, including:

  • validated assessment tools for child development and health need identification (either paper or digital) such as the Ages and Stages Questionnaire (ASQ)
  • validated tools for assessing individual health outcomes
  • equipment for measuring children’s weight and height
  • resources available through the NHS App
  • personal (digital) child health records (often referred to as the ‘red book’): a new ‘My Children’ tool in the NHS App will store information about babies and young children in one convenient place. The paper version of the red book will remain available, ensuring equitable access and preventing digital exclusion
  • IT systems and mobile technology for recording interventions and outcomes in the clinical database, thus capturing real-time data and reducing duplication
  • compatible IT systems to enable national and local reporting
  • access to equipment to support agile and lone working - for example, mobile phones and tablets
  • social networking and other web-based tools to enable workforce training, professional networking, and support for babies, children, young people and families
  • national and local campaign materials, for example:

Future-proofing services 

This guidance will be reviewed periodically and refreshed so that it remains current in the context of wider guidance. In light of this, several future developments are signalled below so that local authority commissioning is best positioned to be forward looking and dynamic.

Commissioners should ensure services offered in their local area can evolve and flex in response to new developments.

Immunisations

In addition to current work supporting uptake of immunisations, some regions will be trialling an initiative to improve uptake of childhood immunisation.

The trial will involve the administration of vaccinations at health visits for those who may find it difficult to access GP-based services. We anticipate that this will be a service commissioned separately by the health service and working closely with local authorities. Once the trials have identified effective methods, national rollout is expected. 

Commissioners may want to continue to engage with ICBs, if required, to understand how best to accommodate this service in any partnership or contractual arrangements. 

10 Year Health Plan

The 10 Year Health Plan commits to the inclusion of health visiting services within neighbourhood health centres. How this evolves is still to be determined, but the benefits of closer working relationships between professionals and convenience of access to a range of clinical services will support families.

Such proximity between services also offers advantages to the child health workforce (including GPs, health visitors, school nurses and other staff) in terms of:

  • co-location
  • enabling better integrated ways of working, such as information sharing

The 10 Year Health Plan includes a commitment to develop a professional strategy for nursing and midwifery in England. The strategy will set out future goals for the professions in the context of the 10 Year Health Plan and wider system policy drivers. This will include a focus on how professional models, education and training can support delivery of the 3 shifts outlined in the 10 Year Health Plan, including the professional role in neighbourhood health.

Health services are also a major component of effective Best Start Family Hubs. Health visiting services should be offered in hubs (in cases where this is an appropriate option) in addition to the home and clinics.  

Children’s social care reforms

In December 2024, the Children’s Wellbeing and Schools Bill was introduced to Parliament. The bill aims to protect children at risk of abuse and stop vulnerable children falling through gaps in the system. 

The Children’s Wellbeing and Schools Bill sets out the following ambitions.

Improve information sharing

Proposals involve establishing a single unique identifier and a new information sharing duty to give professionals greater clarity and confidence about when they can share information about a child.

Establish multi-agency child protection teams

Statutory local safeguarding partners (local authorities, ICBs and police) already have a joint and equal duty to safeguard and promote the welfare of all children in their area. This legislation would place a joint duty on the local safeguarding partners to establish multi-agency child protection teams (MACPTs) with a minimum nominated membership of a:

  • social worker
  • registered health practitioner
  • police officer
  • person with experience of education

MACPTs will support local authorities in delivering their statutory child protection functions under section 47 of the Children Act 1989.

MACPT legislation will come into force, accompanied by regulations and revised statutory guidance, subject to consultation.

The workforce

The workforce that delivers the healthy child programme - and its numbers, skill mix ratios (and therefore competencies of the different staff) and training commissions - should be based on the current population need. There should be scope to respond to changes in need over time (as outlined in Emond A’s Health for all Children, such as to reflect changes in population as a result of new housing or job creation.

The provider organisation’s responsibility is to ensure that services are delivered by enough appropriate practitioners with the necessary qualifications, skills and experience to carry out the work effectively.

The public health nursing service should be led by qualified SCPHNs, who are regulated professionals accountable to NMC’s Standards of proficiency for specialist community public health nurses. These practitioners offer clinical expertise and professional leadership, ensuring safe, high-quality care and the upholding of regulatory responsibilities.  

To be accountable for decisions to delegate tasks and duties to other people, the NMC Code requires that registered professionals: 

  • only delegate tasks within the individual’s scope of competence, ensuring clear understanding of instructions
  • make sure that everyone they delegate tasks to is adequately supervised and supported so they can provide safe and compassionate care
  • confirm that delegated tasks are completed to the required standard

The qualified SCPHN remains accountable for:

Health and development reviews should be conducted holistically by regulated and clinically competent staff. All ages 0 to 5 health and development reviews and ages 5 to 19 school years health needs assessments require skilled clinical assessment.

A competency framework for those providing 0 to 19 services should be produced by the provider organisation, which 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
  • avoid skill dilution

Skill mix members of the workforce make a vital contribution to healthy child programme delivery, including:

  • registered nursing associates
  • registered nurses
  • nursery nurses
  • early years practitioners
  • community health practitioners

When appropriately delegated to and supervised, they bring diverse skills and build trusted relationships with families, enhancing the public health offer.

Skill mix in teams should not be used to the extent that clinical governance by qualified SCPHNs cannot be maintained at a safe level.

The provider organisation should ensure there is a clear governance and accountability framework in place to cover:

  • professional accountability
  • supervision
  • clinical oversight (of practice and records)
  • delegation
  • continuous professional development
  • preceptorship support for newly qualified health visitors and school nurses
  • the process for revalidation under NMC regulations
  • career development opportunities

Continuous professional development, as well as service improvement, is supported by engagement in audit, evaluation and research. Provider organisations are expected to support research activities within the field of public health nursing. 

Commissioners and providers should consider how dual-qualified staff (in both health visiting and school nursing) can be deployed strategically to enhance service responsiveness and workforce sustainability.

Providers should promote an ethos of professionalism and trust, actively supporting the health and wellbeing of the staff they employ. There is clear evidence, as discussed in the National Institute for Health Research-funded award into Patients’ experiences of care and the influence of staff motivation, affect and wellbeing, of the relationship between:

  • staff wellbeing
  • the quality of patient experience
  • outcomes achieved

Nurse prescribing

Nurse prescribing enhances the health visitor’s and school nurse’s ability to support families to manage minor illnesses, reducing hospital admissions and school absence (including by means of symptom management through knowledge of specific medications).

Health visitors and school nurses who actively prescribe should undertake regular prescribing updates and ensure ongoing fitness to prescribe under NMC’s Standards for prescribers.

Commissioners should:

  • consider the benefits of adding nurse prescribing as a requirement in their service specification, particularly when it comes to taking advantage of the possibilities of neighbourhood health centres
  • ensure that providers report on the levels of prescribing activity as part of contract assurance

Health visiting and school nursing 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 they have 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:

  • 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
  • retention strategies that support experienced practitioners through 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 that are based on the best available evidence and emerging research. The following 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:

  • ongoing training
  • digital innovation
  • inclusive practice
  • quality assurance

Conclusion

Commissioning decisions have far-reaching and long-lasting consequences for the communities they affect.

To establish, monitor and quality-assure local 0 to 19 public health services that are to a standard capable of raising the healthiest generation of children ever, commissioners will need knowledge of:

  • relevant legislation
  • their population’s needs and vulnerabilities
  • the healthy child programme and its upcoming service specification model
  • appropriate (digital) tools and technologies
  • the public health nursing workforce for those aged 0 to 19 (including professional requirements)
  • contract management
  • performance monitoring through KPIs
  • data requirements (including those around information sharing)

A number of upcoming changes are due to affect the child health landscape (see future proofing section above for more details). Commissioners should be aware of these upcoming changes and ensure new contractual arrangements can accommodate them.

To realise the full potential of the healthy child programme and the public health services that underpin it, investment in professional leadership, workforce capacity, integrated systems and measurable quality improvement is essential.

Commissioners and providers should ensure that public health nursing teams are equipped to deliver safe, equitable and responsive care - care that reflects the diversity of children and families, adapts to evolving needs, and remains rooted in evidence, compassion and community.

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