Background Health visiting is a universal, preventative, public health service to improve child health in the early years. While there are five mandated contacts that all children across England should receive, the service is devolved, so all 150 local authorities (LAs) deliver their own models of health visiting. This study aimed to explore this complex picture by exploring variation in the delivery of health visiting contacts within and between LAs in England and the factors that drive this variation.

Methods We used national, administrative, individual-level data (the Community Services Dataset hosted by NHS Digital) alongside additional, similarly structured data accessed directly from an LA case study site for financial years 2018/19 and 2019/20. We described the proportion of children receiving each mandated contact and how each contact was delivered. We used generalised linear modelling to explore the characteristics associated with delivery of health visiting contacts.

Results Nationally, delivery of the mandated new birth visit was highest (89.5% of eligible children received the contact; 394,580/440,890) and the 2–2.5-year review was lowest (74.2%; 360,860/486,395). Of those children who received their mandated contacts face-to-face, 94.5% received their new birth visit as a home visit, but this ranged from 56.1% to 99.7% across LAs. For the 2–2.5-year review, 21.3% of children received a home visit (ranging from 1.1% to 97.4%). Children living in the most deprived neighbourhoods were less likely to receive their 2–2.5-year review compared to the least deprived (risk ratio [RR] 0.97, 95% confidence interval [0.96–0.99] in England and 0.91 [0.89–0.93] in the LA case study). In the LA case study, children living in the most deprived neighbourhoods were more likely to receive additional contacts (RR 1.80 [1.55–2.09]). Taking all health visiting contacts into account, children living in the most deprived neighbourhoods were equally as likely as the least deprived to receive health visiting contacts (RR 1.00 [0.99–1.02]).

Conclusion We found substantial variation in delivery of health visiting contacts both within and between LAs. In our LA case study, children in the most deprived neighbourhoods were less likely to receive mandated contacts, but more likely to receive additional contacts, compared to the least deprived. This may be suggestive of prioritisation of safeguarding over prevention and promotion work. Further work should be done between LAs and NHS Digital to support the process of data submission to the Community Services Dataset, to allow more complete data for analysis of health visiting services across England.