Responsibilities and Funding
The responsibility for commissioning health visiting was transferred to local authorities in 2015.
Funding for health visiting in England is provided to local authorities through the Public Health Grant from the Department of Health and Social Care (DHSC). The Grant is ring-fenced funding and must be spent on the public health service areas specified in the grant conditions published in the local authority circular from the Department of Health and Social Care.
These conditions include commissioning health visiting and school nursing services in accordance with the standards set out in the Healthy Child Programme (HCP) (updated guidance published by the Department of Health and Social Care on 6 February 2026).
Since 2015, the Local Government Association has calculated that the Public Health Grant received by councils has been reduced in real terms by £858 million (between 2015 and 2024), with different levels of impact across local authorities and health visiting services in England.
Policy
The latest national policy blueprint for health visiting and school nursing was published on 6 February 2026 - presented in a suite of three publications:
- Delivery of the healthy child programme: This guidance outlines the delivery expectations for public health nursing teams for ages 0 to 19 and their provider organisations.
- Healthy child programme: commissioning public health nursing services: This guidance sets expected standards for commissioners to establish, monitor and assure the quality of public health nursing services for ages 0 to 19 delivered by provider organisations.
- Healthy child programme: high-impact area framework: Complements the guidance by translating principles into nationally recognised, actionable priorities across ages 0 to 19.
All local authorities are expected to deliver four levels of service offer – based on the principles of proportionate universalism - ensuring that all families receive essential support, while those with additional or complex needs are offered extra personalised targeted or specialist support and interventions, helping to reduce inequalities and improve outcomes.
Every family should be allocated a named health visitor who provides continuity throughout their HCP journey. Health visitors lead and are accountable for care delivery. They can delegate elements of care; delegation must involve appropriately qualified and trained staff, and ongoing supervision - accountability is retained by the health visitor.
The 4-level service offer is used to:
- meet diverse needs effectively and equitably
- intervene early, preventing issues from escalating
- ensure resources are focused where they will have the greatest impact
- enable joined-up working and information sharing across services, supporting seamless pathways of care.
The universal level offer includes the role of the health visitor in leading and delivering five mandated health reviews and three recommended/ targeted reviews:
- Antenatal health promoting review (mandated)
- New Baby Review (mandated)
- 6-to-8-week review (mandated)
- 3-4 month contact
- 6-month contact
- 1-year review (mandated)
- 2 to 2½-year review (mandated)
- 3½ years.
The HCP sets out six health visiting high impact areas which are nationally recognised priorities (for universal, targeted and specialist support) across ages 0-5 years:
- Transition to parenthood
- Maternal and family mental health
- Breastfeeding
- Healthy weight and nutrition
- Health literacy, managing minor illness and reducing accidents
- Healthy, well and ready to learn.
Service delivery metrics
Quarterly and annual data on health visiting service delivery (universal contacts) to pregnant women, children and their families during pregnancy and early childhood are published by the Department of Health and Social Care.
Other policy aligned to health visiting in England:
The Department of Health and Social Care’s priorities are set out in the following policy directives:
The Plan for Change: Milestones for a mission-led government - which sets out the Government’s five key mission priorities. The ‘health’ priority sets out the ambition to “build an NHS fit for the future”. It is also noteworthy that one of the five priorities is centred on children, with an ambition to “create the healthiest generation of children ever”.
The NHS 10-Year Health Plan for England (‘Fit for the Future’, (July 2025)) sets out the Government’s plans to create a truly modern health service designed to meet the changing needs of our population. This will be focused on the three shifts that the government, health service, and experts agree need to happen:
- moving care from hospitals to communities
- making better use of technology
- focusing on preventing sickness, not just treating it.
Health visiting has an important role to play in all three “shift” areas.
This presents a new way of working for the NHS, local government (including health visiting), social care, and partners, where integrated working is the norm and not the exception – set out in three policy documents:
- 2025/26 Priorities and Operational Planning Guidance: Sets the priorities for ICBs and providers for 2025/26, including a move to a neighbourhood health model.
- Neighbourhood Health Guidelines 2025/26: Guidance for ICBs, local authorities and health and care providers. Sets out the 6 core components of neighbourhood health.
- Guidance on Neighbourhood Multidisciplinary Teams for Children and Young People (CYP): This detailed guidance on neighbourhood multidisciplinary teams for CYP recognises that, “identifying and meeting their [CYP] needs at the earliest opportunity is vital to giving them the best possible start in life”.
The Three year delivery plan for maternity and neonatal services to make care safer, more personalised and more equitable across the whole perinatal health pathway. This includes improving postnatal healthcare in the first year of life – the new national toolkit ‘Improving postnatal care: a toolkit for integrated care boards, partners and providers’ supports ICBs and place-based partners (including local authorities) to improve the postnatal care experience and both short and long-term maternal and infant health.
The Government’s manifesto commitment to increase childhood vaccination uptake through health visiting. Some areas are piloting health visitors administering childhood vaccinations to eligible underserved children in England (they won’t be giving a universal offer). These systems will test the feasibility and value for money of different approaches and provide evidence to inform national roll-out from 2027 (see NHS England Urgent and emergency care plan 2025/26).
Improving SEND provision. Several system level challenges are influencing forthcoming reforms for SEND provision. The iHV has set out the role of health visitors in SEND in its submission to the recent SEND Inquiry. And was also involved in the development of NHS England’s Commissioning Framework for children and young people with cerebral palsy – whilst condition specific, this framework provides a helpful blueprint on which to model local SEND “health” pathways for other conditions, with key roles for health visitors in early identification and supporting early assessment/care planning.
Department for Education policy priorities and changes:
The Plan for Change: Milestones for a mission-led government commitment to “Break down barriers to opportunity” – “giving every child the best start in life”. This means delivering accessible, integrated maternity, baby and family support services through the first 1,001 days of life, and high-quality early education and childcare to set every child up for success.
Giving every child the best start in life (published July 2025): this government strategy recognises the vital role that health visitors play in prevention, identification and early intervention as part of a whole system response to improve child development and children’s life chances – with a mission target that 75% of 5-year olds in England have a good level of development by 2028.
Best Start Family Hubs and Healthy Babies – Preparing for implementation April 2026 (published December 2025): Guidance to help all local authorities prepare for provision of Best Start Family Hubs.
Children social care reforms - Keeping children safe, helping families thrive: And the Children’s Social Care Prevention Grant Determination 2025-2026 underpins the early implementation phase of social care reforms with a ring-fenced grant for prevention activity (ahead of planned new legislative duty in the Children’s Wellbeing and Schools Bill designed to strengthen children’s social care).
Safeguarding
Working Together guidance, 2023: The iHV Joint Policy Position: The Safeguarding Role of Public Health 0-19 Services, developed in partnership with Association of Directors of Public Health (ADPH) and School and Public Health Nurses Association (SAPHNA), sets out the areas where health visitors and school nurses can make the biggest difference to child safeguarding.
Families First Programme: To support the Government’s “Plan for Change” through children’s social care reforms, to ensure that every child is kept safe and has the opportunity to succeed. Details on the Programme and role of health visiting are contained in the “The Families First Partnership Programme Guide”.