Overview of the six early years
high impact areas
Why have these Six
High Impact Area
documents been
developed?
The Early Years High Impact
Area documents have been
developed to support the
transition of commissioning to Local Authorities and
to help inform decisions around the commissioning
of the health visiting service and integrated
children’s early years services.
The purpose of the High Impact Area documents is
to articulate the contribution of health visitors to the
0-5 agenda and describe areas where health
visitors have a significant impact on health and
wellbeing and improving outcomes for children,
families and communities.
The six High Impact Areas are:
nn Transition to Parenthood and the Early Weeks
Maternal Mental Health (Perinatal Depression)
nn Breastfeeding (Initiation and Duration)
nn Healthy Weight, Healthy Nutrition (to include
Physical Activity)
nn Managing Minor Illness and Reducing
Accidents (Reducing Hospital
Attendance/Admissions)
nn Health, Wellbeing and Development of the
Child Age 2 – Two year old review (integrated
review) and support to be ‘ready for school’
The areas do not describe the entirety of the role
and work of the health visitor. There is still an
expectation to deliver all elements of the Healthy
Child Programme within the service model;
Universal, Universal Plus, Universal Partnership
Plus and Community.
The documents are informed by NICE Guidance
and underpinned by the 4 principles of health
visiting. The four contemporary principles of health
visiting were first published in 1977. They are:
nn
nn
nn
nn
Search for health needs
Stimulation of an awareness of health needs
Influence policies affecting health
Facilitate health enhancing activities
They complement and are aligned with the Guide to
the Early Years Profiles, published on 10th March 2014.
Who is the intended audience/who have
the documents been developed for?
Local Authorities, elected members, early years
professionals, service providers, NHS and Local
Authority commissioners and the public.
Who has been involved in the
development of the Six High
Impact Areas?
The Six High Impact Area documents have been
developed in partnership between the Department
of Health, Public Health England, Local Government
Association, NHS England, Early Intervention
Foundation and Health Education England. The
documents were shared with a wide range of
partners for comment.
This document was produced by the Department of Health in collaboration with the Local Government Association,
Public Health England, NHS England, Health Education England and Early Intervention Foundation.
Many of comments received have been addressed
in final versions of the documents, however a
number of comments were deemed to be outside of
the scope of the six areas, these include:
Future commissioning decisions
Caseload numbers/workforce profile and grade
Decisions on inclusion of additional reviews
Child Health Systems and technicalities of how
information is collected and reported
nn Children with complex health needs and
looked after children
nn Performance management
nn Supervision
nn
nn
nn
nn
Key policy drivers
nn The Health Visiting Programme - A Call to
Action. Department of Health, 2011
nn Marmot M. Fair society, healthy lives: Strategic
Review of health Inequalities in England post
2010. London: Marmot Review, 2010
nn Annual Report of the Chief Medical Officer
2012. Our Children Deserve Better:
Prevention Pays. Department of Health, 2013
nn Healthy lives, healthy people: our strategy for
public health in England. Department of
Health, 2010
nn Healthy lives, healthy people: update and way
forward. Department of Health, 2011
nn Healthy, lives healthy people: Improving
outcomes and supporting transparency.
Department of Health, 2013
nn Early Intervention: The Next Steps. An
Independent Report to Her Majesty’s
Government Graham Allen MP 2011
Core principles
There are a number of principles that are common
and assumed in each of the High Impact Area
documents:
nn Universal services are essential for primary
prevention, early identification of need and
early intervention. Universal services lead to
early support and harm reduction
nn Early intervention evidence-based
programmes should be used to meet the
needs and to ensure that needs are identified
in a timely way
nn All areas focus on improving health outcomes
and reducing inequalities at individual, family
and community level
nn Outcome measures align between health and
education/other early years providers and there
should be shared outcomes across the system
nn Safeguarding is a thread throughout all of the
six areas ranging from identification of risk and
need, to early help and targeted work, through
to child protection and formal safeguarding
nn Clinical judgement will be used alongside
formal screening and assessment tools
nn Health visitors have an important role as
leaders of the Healthy Child Programme which
should form part of multi-professional care
pathways and integration of services for
children 0-5
nn Public health, health promotion, prevention and
safety is covered during every contact
nn It is recognised that early years practitioners,
voluntary organisations, peer supporters,
Family Nurse Partnerships, GPs and primary
and secondary care providers all have an
important contribution to make toward delivery
of child health outcomes
nn Partnership, integration, communication and
multi-agency working are key to improving
outcomes
nn Outcomes are measured in line with national
outcome frameworks and commissioning
reporting requirements; however other
reporting requirements and measures are for
local determination
nn Additional outcome measures should not add
burden to data collection, be collected within
current systems and align to national reporting
requirements
nn Engagement with fathers and the family is an
important component of the Healthy Child
Programme
Pauline Watts
Nursing Professional Officer/Clinical Advisor
Public Health Nursing & National Health Visitor
Programme
Department of Health
Email: Pauline.Watts@dh.gsi.gov.uk
1 July 2014