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Disadvantaged children ‘being missed by health visitors’

Young children from deprived backgrounds are less likely to be assessed for developmental problems by GPs and health visitors than those from more privileged areas, says NHS Scotland research.

In results described as ‘disappointing’ by researchers, they found a reduction in the number of child health reviews in Scotland in July 2007 – from six to two – had meant children from deprived areas were now less likely  to be reviewed.

The reduction in the reviews was designed to improve the impact of the scheme, but the researchers from NHS Scotland found an ‘inverse care law’ now applied to the coverage of the scheme in deprived areas.

In the BMJ Open study, researchers assessed the child health reviews given to 80,000 children in Scotland born between November 1998 and June 2008. Reviews are normally undertaken by health visitors, although GPs are sometimes involved.

Although coverage for the first review in infancy was high (99%), it progressively declined as children got older, down  to 86% for the 39 to 42 month review.

Coverage was lowest in the most deprived groups, with coverage of 78% and 92% between the least and most deprived groups in the 39-42 month review.

Study leader Dr Rachael Wood, consultant in public health medicine in the Information Services Division of NHS Scotland said: ‘The finding that there has been no change is disappointing.’

‘It appears that a minority of families, with relatively high health needs, continue to miss out on their child health reviews.’

‘The inverse care law continues to operate in relation to provision of ‘universal’ child health reviews.’

Dr Dean Marshall, chair of GPC Scotland, said: ‘There was a move away from these reviews because the evidence showed that  they didn’t pick up a lot of developmental problems, but many GPs thought they were an opportunity to deal with a lot of other issues about parenting.’

‘That’s why they were more useful for parents from deprived backgrounds. A lot of GPs felt that seeing the children at that stage was an opportunity to form a bond with the parents, although the benefits are difficult to measure and would only be seen later.’

In 2011 the Scottish government recommended re-introducing the 24 -30 month review although this has not been fully implemented, the authors note. In England, where this is established policy, only 60% of PCTs commission 24-30 month reviews.

BMJ Open 2012;2:e000759