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The health visiting profession is proud to have achieved a number of significant changes over the last four years. The Health visitor implementation plan: call to action in 2011 transformed and modernised the health visitor workforce, enabling it to deliver a service which meets the health needs of the 21st century. The number of health visitors has substantially increased to become the highest in recorded history. A huge investment in training and supervision has been rolled out to ensure that both the care and interventions offered to families are evidence based, personalised and responsive. This growth and transformation owes its success to the hard work and commitment from all parts of the profession: practitioners, practice teachers, mentors, students, managers and university tutors.

Although the call to action programme is now complete, the emphasis on prevention and early intervention for families is still the priority. All families now receive a universal service as set out in healthy child programme, thus providing an evidence based public health programme for children and families.

A more intensive and targeted approach is built in to address additional needs, which benefits the most disadvantaged families and to reduce health inequalities. One example is the universal support of breast feeding where mothers need more support to improve breastfeeding rates. This has numerous documented health benefits for mothers and children, and NICE has calculated that £17 million can be saved by increasing population breastfeeding rates.

The future of health visiting is shaped by a new model known as HV 4,5,6. It includes four levels of service: community, universal, universal plus and universal partnership plus.

The five universal health visiting contacts (antenatal, new birth visit, maternal mood review and health reviews at one and two years) have now been mandated in England by parliament. The Department of Health (DH) has also outlined six high impact areas where health visitors can demonstrate they make the biggest difference to health outcomes, these include: transition to parenthood, breastfeeding, maternal mental health, healthy weight, managing minor illnesses, accident prevention and child development at two and two and a half years. At a time when the commissioning for health visiting transfers to local authorities, the HV 4,5,6 model provides a useful framework to define the unique contribution of health visitors in improving outcomes for children. This model means:

- Improved access.

- Improved experience.

- Improved health outcomes.

- Contribution to reducing health inequalities.

It is now widely accepted that the views of children, parents and families should be at the heart of service design. Health visiting services are using various ways of collecting and collating local parent feedback at a national level including using social media.

The recent week of action run by Public Health England (PHE) and the DH included evidence from parents with positive accounts of how they had found the service and ideas where improvements were needed. These events continue to act as a demonstration of quality services.

The four authors of this foreword are currently seconded part time to DH/PHE. This exciting role aims to bridge the gap between practice and policy, ensuring that the experiences of front line health visitors are influencing policy during its formation. Since our appointment we have been able to support the national leadership team through involvement in a number of policy developments including a summary of the healthy child programme rapid review and updating DH pathways and revisions to the framework for personalised care and population health.

As health visiting faces the future we are constantly aware of the sense of a renewed energy and motivation within the profession. Across the country innovative approaches to practice have started to flourish and ideas are being shared more freely using social media. Renewed efforts by organisations like Community Practitioners and Health Visitors Association and the Institute of Health Visiting are supporting communities of practice to harness the collective energy of health visitors.

The service is 153 years old, bigger, better and stronger than ever before, responsive to the needs of an increasingly complex society and still making a difference.