“All the changes drain the life out of you”: a qualitative study of variation in health visiting across three local areas across England

Background: Health visiting is a universal service aimed at improving child health and school readiness for under-fives. Understanding how services are experienced locally is needed to inform service improvements across England.Aims: To explore differences in professionals’ and parents’ experiences of the role and support delivered by health visiting services in their local area.Methods: In three sites across England, we conducted qualitative interviews with 14 health visiting professionals and parents.Findings: We developed three themes: (1) a service under pressure, encapsulating how health visiting was influenced by pressures in other health and social care services, (2) perceived purpose of health visiting, capturing participant experiences of key performance indicators and availability of services, and (3) staff are humans too, describing the impact of commissioning and service structures.Conclusions: Perceived purpose of health visiting and commissioning structures should be considered when evaluating and monitoring health visiting services.