Health visitors to play integral role in improving childhood vaccinations uptake

Health visiting is ready to contribute to improving uptake of childhood vaccinations, says Alison Morton of the Institute of Health Visiting, but work is needed first to rebuild the health visitor workforce.

As part of its pledge to ‘give every child the best start in life’ and ‘create the healthiest generation of children ever’, the Labour government has called on health visitors to improve uptake of childhood vaccinations.

Alongside clean water, vaccinations have been one of the most impactful public health tools for preventing poor health, saving millions of lives across the globe every year. However, there is widespread concern about declining rates of routine childhood vaccinations, with the UK performing well below the World Health Organization (WHO) target of 95% vaccination coverage to protect children and vulnerable groups.¹

Concerns about vaccine coverage

Vaccination coverage in the UK is lowest in England, followed by Northern Ireland. The latest figures show that no vaccines met the 95% target in England – the last time we hit this target was in 2020, with overall rates declining since then.² There are also wide disparities in vaccine uptake across England and London consistently has the lowest vaccination rates.

While most parents get their children vaccinated without hesitation, the current decline in vaccine uptake rates, and widening disparities across ethnic and economically disadvantaged groups, have left too many children exposed to avoidable harm.

There are many reasons for this, including systemic barriers which impact both vaccination supply and demand, making it harder for certain groups to access vaccinations.

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Parents can face challenges booking appointments or difficulties getting to appointments and it has also become harder for parents to access trusted sources of advice – with loss of contact with health visitors cited as a barrier by families. Other barriers include vaccine hesitancy, misinformation, fear of injections and perceptions of risk.

Can we reverse the trend?

The good news is that there is lots of evidence on how to reverse the current trend – captured in the practical recommendations in the recent report from the Royal College of Paediatrics and Child Health, Vaccination in the UK: access, uptake and equity.

By working together across national government and local systems, we can tackle the systemic barriers that make it harder for some families to get the vaccines their children need. This includes investing in health visitors, who remain parents’ first port of call for trusted advice and, with sufficient workforce and funding, are ideally placed to deliver vaccinations to vulnerable groups.

It is encouraging to see that the government is focusing on health visitors’ public health role

As part of its plan to improve vaccination uptake, it is encouraging to see that the government is focusing on health visitors’ public health role and potential to drive innovation in this area through its Pathfinder project. The aim of the project is to improve access and uptake of childhood vaccinations in underserved groups. There has been strong support for the concept from the health visiting profession, with many seeing the improvement of access and uptake of vaccinations as a fundamental public health function of their role.

The Pathfinder project received ministerial sign-off in January and will test different models of enhanced health visiting provision across a mix of sites across England. The project’s recent call for expressions of interest attracted a huge amount of interest, with numerous submissions setting out a range of enhanced health visiting model options. These included vaccinations delivered during a home visit by a health visitor, vaccinations delivered by another registered healthcare professional who accompanies the health visitor on a targeted home visit, and community outreach approaches led by health visiting teams to administer vaccines in alternative settings, such as health visitor child health clinics or Family Hubs.

The Pathfinder project aims to maximise health visitors’ public health expertise and unique role in reaching all families with babies and young children, providing support for all and a vital safety-net for the most vulnerable. As Specialist Community Public Health Nurses, health visitors are widely trusted and welcomed by families, with a legitimate ‘health function’ which is non-stigmatising. Health visiting’s ability to reach all families is particularly important for those on the margins of society who are often invisible to other services and are often the least likely to access health services and may never attend a Family Hub – these are the families that the Pathfinder project aims to reach.

We are confident that, when adequately resourced, health visitors can play a significant part in improving vaccination uptake

We are confident that, when adequately resourced, health visitors can play a significant part in improving vaccination uptake, by building relationships with families, providing a trusted source of advice to answer their questions and supporting families to register with GPs and book appointments. With the right training and vaccination infrastructure, they are also ideally placed to provide options for vaccinations at home or in community settings if families face specific challenges in accessing vaccinations.

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Challenges ahead for health visiting

However, we cannot ignore the challenges that health visiting services currently face in England, with huge disparities in services across the UK, and a national health visitor workforce shortage.

When asked, health visitors were clear that in order to ensure wider system rollout, the government needed to get the basics right for health visiting. Their top three priorities to support vaccination uptake were: an increase in the health visitor workforce (69%), more training on vaccination programmes so they can answer parents’ questions confidently and accurately (48%) and more training to support practitioners to administer vaccinations safely and effectively to specific groups (48%).³

The message to the government is clear – health visitors want to be part of the solution and ensure that all children get the healthcare they deserve. But it is essential that the government also plays its part and fulfils its pledge to strengthen health visiting, rebuild the health visitor workforce and end the postcode lottery in healthcare that families are currently experiencing.

Alison Morton is CEO at the Institute of Health Visiting

References

1 Danechi S. Childhood Immunisation Statistics. ​ House of Commons Library; 23 May 2025. [accessed 28 June 2025]. Available from: https://commonslibrary.parliament.uk ​

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2 NHS England. Childhood vaccination coverage statistics, England 2023–24. NHS England; 17 September 2024. [accessed 28 June 2025]. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-immunisation-statistics/england-2023-24

3 Institute of Health Visiting. State of Health Visiting, UK survey report – From disparity to opportunity: the case for rebuilding health visiting. Institute of Health Visiting; 27 January 2025. [accessed 28 June 2025]. Available from: https://bit.ly/4hmR3Me