Best Start in Life

LTP Priority: Children and Young People : Healthy Child Programme

Population Intervention Triangle: Segments (link to Section 1 PHE PBA): Service

Type of Interventions: Best Start in Life: Service

Major driver of health inequalities in your area of work

Giving children the best start in life is a fundamental part of improving health and reducing health inequalities. Individual behaviour plays an important role in determining how healthy or unhealthy people are.  Inequalities in children’s development originate in multiple disadvantages, which compound to affect children’s long-term outcomes, undermine the development of human potential where children from disadvantaged and families quickly fall behind.

Effective interventions to address health-harming behaviour therefore requires a broad and complex set of responses. The Healthy Child Programme HCP is the early intervention and prevention public health programme which focuses on a universal preventative service for children and families. It provides an invaluable opportunity to identify families that are in need of additional support and children who are at risk of poor outcomes.  The HCP was last updated and published in 2009. It has been supplemented by additional evidence over the last decade however a modernised programme is required, and incremental modernisation has begun lead by PHE and involving many partners including NHS England

Comparable child health and wellbeing outcomes demonstrate inequalities across the health and social care (evidence- PHOF, PHE Fingertips data).  Different population groups are more disproportionately affected by poor health outcomes, the Healthy Child Programme targets the most disadvantaged groups in society.

Target groups

Deprivation, inclusion health and protected characteristics


Healthy Child Programme


he Healthy Child Programme provides a framework to support collaborative work and more integrated delivery. The Programme aims to:

  • help parents develop and sustain a strong bond with children
  • support parents in keeping children healthy and safe and reaching their full potential
  • protect children from serious disease, through screening and immunisation
  • reduce childhood obesity by promoting healthy eating and physical activity
  • identify health and wellbeing issues early, so support and early interventions can be provided in a timely manner
  • focus on the health needs of children and young people ensuring they are school ready (SEND Code of Practice 0 – 25 years, 2017)
  • make sure children are prepared for and supported in all child care, early years and education settings and especially are supported to be ‘ready for to learn at two and ready for school by five’

NB See previous – the HCP is being modernised to enable improved application of evidence, links to improved data aligned to Child Digital Strategy (NHSX and NHSD)

Ready for school is assessed as every child will have reached a level of emotional development, which enables them to:

  • communicate their needs and have good vocabulary
  • become independent in eating, getting dressed and going to the toilet
  • take turns, sit still and listen and play
  • socialise with peers and form friendships and separate from parent(s)
  • have physical good health, including dental health
  • be well nourished and within the healthy weight for height range
  • have protection against vaccine-preventable infectious diseases, having received all childhood immunisations

Commissioning the Healthy Child Programme supports local authorities to evidence their statutory duties for children, including:

  • establishing arrangements to reduce child poverty
  • promoting the interests of children in the development of health and wellbeing strategies (joining up commissioning plans for clinical and public health services with social care and education to address identified local health and wellbeing needs)
  • leading partners and the public to ensure children are safeguarded and their welfare promoted
  • driving the high educational achievement of all children


The 0-5 element of the Healthy Child Programme is led by health visiting services providing place-based services and working in partnership with other providers. These professional teams provide the vast majority of Healthy Child Programme services. The universal reach of the Healthy Child Programme provides an invaluable opportunity from early in a child’s life to identify families that need additional support and children who are at risk of poor outcomes.

Health visitors use strength-based approaches, building non-dependent relationships to enable efficient working with their population (children, young people and families) to support behaviour change, promote health protection and to keep children safe. Health visitors have the opportunity of engaging with all families in their own homes. This is essential for early identification and interventions to mitigate problems worsening in the future, thus contributing to demand management in areas of statutory requirements.

Health visitors have a crucial leadership, co-ordination and delivery role within the Healthy Child Programme. They work with key partners to deliver a comprehensive service.

The 4-5-6 model is an evidence based approach to deliver the healthy child programme. It encompasses the reach and impact of health visiting services through:

  • 4 tier offer
  • 5 universal reviews
  • 6 high impact areas

The six High Impact Areas described in the 4-5-6 model have been developed to improve outcomes for children, young people and families. They are based on evidence of where these services can have significant impact (for all children, young people and families and especially those needing more support) and impact of health inequalities.

NB the modernised HCP will update this model to ‘universal reach – personalised response’ including more specificity in targeting of additional and intensive service

Expected outcomes (not limited too)

  • Improved immunisation rates
  • Reduction in tooth decay Improved indicators demonstrating positive mental health
  • Contributing to reduction of infant mortality and reduction in inequality of distribution
  • Improved overall health and wellbeing in children, young people and families
  • Contribution to reduction in hospital attendances admissions from preventative illnesses