The health service provides a Child Health Programme (CHP) to all children to help
them attain their health and development potential. Core elements include screening,
immunisations, growth and development surveillance, health promotion advice, and
parenting support. The surveillance/advice/support components (known as Child
Health Surveillance CHS) are delivered through a series of universally offered child
health reviews mainly provided by Health Visitors (HVs) supplemented by
additional support as required. Scottish policy issued in 2005 led to considerable
changes to the CHP. The number of CHS reviews was substantially reduced to
enable more intensive support of children who required it. A three category indicator
of need was introduced at the same time to facilitate the identification of children
requiring enhanced support. This thesis aims to explore the shift to more targeted
provision of CHS that occurred from 2005 onwards, and to examine the impact of
this on the preventive health care provided to pre-school children.
The specific objectives are:
· To describe the development of professional guidance on the CHP and how this
has been adopted into Scottish policy.
· To compare the CHP provided in Scotland to that offered in other high income
countries.
· To examine the impact of the changes to CHS on the coverage of universally
offered child health reviews.
· To explore, following the changes to CHS, which factors are associated with
children being identified as in need of enhanced CHP support.
· To assess the impact of the changes to CHS on the totality of preventive care
provided to pre-school children by HVs and General Practitioners (GPs).
The key methods used are literature review, policy analysis, and analysis of routine
health data. Selected findings include the following:
· All the high income countries studied provide the same basic elements as the
Scottish CHP but the detail of the different programmes varies considerably.
Some of the variation may reflect the different needs of different populations, but
much seems to reflect different approaches to evidence interpretation and policy
making in different settings.
· Not all children offered ‘universal’ child health reviews actually receive them.
Children from deprived areas are less likely to receive their reviews. Inequalities
in review coverage have remained unchanged after the changes to CHS.
· Many factors, including those reflecting infant and maternal health and family
social risk, are associated with being identified by HVs as needing enhanced
CHP support. The threshold at which children are identified as needing enhanced
support varies between areas across Scotland.
· GP provision of child health reviews has reduced after the changes to CHS as
would be expected. Recorded GP provision of other preventive care
consultations is uncommon and has not changed. Currently available routine
data do not allow trends in the totality of HV provided care to be examined.
In summary, the Child Health Programme makes an important contribution to
supporting young children and their families but it is a complex service and
considerable uncertainty about aspects of its content and delivery remain