23rd February 2026
Health visiting is one of the quiet foundations of public health in Scotland. It is the service that visits families in their homes after a baby is born, checks development, supports parents' mental health, identifies safeguarding concerns early, and helps prevent small problems becoming crises.
Yet in Highland, health visiting has become a service that exists largely out of public sight not because it is unimportant, but because of how it is organised, funded and reported.
The history of Health Visiting numbers the last few years is complicated by national changes relating to Health Boards and councils with added complexities of the Lead Agency model adopted by Highland and now being wound down. So apologies for a winding explanation of what happened and why it seems so difficult to get numbers and where it is going now.
This invisibility has consequences
A Service Most People Never See — Until It Is Gone
Most members of the public would struggle to say who employs health visitors in Highland, how many there are, or whether numbers are rising or falling. That is not public apathy; it is a failure of transparency.
Across much of Scotland, health visitors are clearly NHS staff, counted in national NHS workforce statistics and discussed in public health reports. In Highland, however, health visiting has followed a different path and one that has left it largely absent from national data and local public debate.
The Highland Exception: A Different Model, Different Risks
Highland is unique in Scotland because of its Lead Agency model, introduced in the early 2010s. Under this arrangement:
Children's community health services, including health visiting and school nursing, were transferred from NHS employment to Highland Council.
Adult health and social care services moved in the opposite direction, becoming the responsibility of NHS Highland.
This was done with good intentions: to reduce organisational barriers, improve integration, and make services feel more joined-up for families. But one unintended consequence has been that health visiting effectively disappeared from NHS workforce reporting, while also failing to sit comfortably within council-style public reporting.
The result is a service that falls between systems.
Counting What Is Not Counted
Because Highland health visitors are council employees, they are not included in national NHS Scotland health visitor workforce datasets. This makes simple questions such as "Have numbers gone up or down?" are surprisingly difficult to answer.
What can be pieced together from local papers and committee reports suggests that:
Highland expanded its health visiting establishment around the rollout of the Universal Health Visiting Pathway.
Vacancy rates were high several years ago but appear to have improved more recently.
Training continues, with small numbers of new health visitors qualifying each year.
But these fragments do not amount to a clear, public, year-by-year picture. There is no easily accessible, authoritative dataset showing:
total posts,
filled posts,
vacancies,
or changes over time.
In an era of intense budget pressure, that absence matters.
Budgets, Pressure, and the Risk of Quiet Erosion
Both Highland Council and NHS Highland face profound financial challenges. Savings plans, service redesigns and staffing freezes are now routine features of public sector management.
In this context, services that are:
preventative rather than acute,
community-based rather than hospital-based,
and poorly understood by the public,
are especially vulnerable to quiet erosion rather than explicit cuts.
Health visiting may not be "cut" in name, but it can be hollowed out through:
unfilled vacancies,
larger caseloads,
reduced capacity for home visits,
or prioritisation of crisis work over early intervention.
These changes rarely make headlines, yet their effects may be felt years later in poorer child development outcomes, increased pressure on GPs, or higher attendance at emergency departments.
The Paradox of Prevention
Health visiting illustrates a long-standing paradox in public services: the better it works, the less visible it is.
When health visitors succeed:
parents cope better,
developmental issues are picked up early,
safeguarding concerns are addressed before escalation,
and demand on acute services is reduced.
But because these successes are measured in problems that do not happen, the service struggles to justify itself in annual budget rounds dominated by immediate financial pressures.
Without transparent data, it becomes even harder for the public or elected members to see what is at stake.
A Democratic Deficit in Plain Sight
At present, Highland residents cannot easily answer basic democratic questions about health visiting:
How many health visitors serve the area?
How does this compare to previous years?
How does it compare to other parts of Scotland?
What level of service should families reasonably expect?
This lack of clarity is not inevitable. It is the product of structural complexity combined with limited public reporting. Integration was meant to simplify services for users — not obscure accountability.
Bringing Health Visiting Out of the Shadows
If health visiting is to be properly valued and protected, several things are needed:
Clear, routine publication of workforce statistics for Highland health visitors, regardless of employer.
Plain language explanations of how the Lead Agency model affects children's services.
Public discussion of preventative services, not just crisis pressures.
Recognition that invisibility is itself a risk to service sustainability.
Health visiting in Highland is not failing but it is largely unseen. In a time of tightening budgets and rising need, services that operate in the shadows are the easiest to overlook and the hardest to defend.
If early years support truly matters, then so must the transparency that allows the public to see, understand and debate it.
Health Visitor Numbers: England vs Scotland
England
In England, the number of health visitors has fallen sharply since around 2015.
Official analysis shows a reduction of more than 40 % in England between 2015 and late 2024 from around 11,000 qualified health visitors in 2015 to about 6,300 by December 2024. This reflects staff losses and fewer new training places.
Scotland
Published national workforce statistics specifically for health visitors in Scotland over the last 15 years are limited. Scotland's official workforce reporting does not disaggregate health visitors separately from nurses and midwives in general workforce reports like Turas Data.
Early estimates suggest Scotland had around 2,300 health visitors around 2019, but consistent year-by-year figures are not routinely published.
Scotland introduced the Universal Health Visiting Pathway (UHVP) in 2015, backed by funding to increase recruitment (e.g., ~500 additional posts were invested in by around 2018).
Training data indicate the number of health visitor students (future workforce) rose in the mid-2010s (from 99 in 2013/14 to 252 in 2016/17) and then fell again to around 146 in 2021, showing challenges maintaining training pipeline growth.
Workforce Perceptions
In a UK-wide health visiting survey, 42 % of practitioners in Scotland reported falling numbers locally — lower than the proportion reporting decline in England, but still signalling workforce pressure.
Scotland appears not to have suffered as deep a proportionate drop in health visitors as England, but workforce pressures and declines (especially in training intake) are reported, and exact long-term headcount trends are not as well published as English data.
What Can Health Visitors Affect? Evidence on Outcomes
Health visitors work with families of young children and in community settings. Evidence and expert statements suggest they can influence:
Early Child Health and Development
Scotland's UHVP was designed to offer up to 11 structured contacts with families in early years to support child development, maternal mental health, immunisation, and feeding.
Research evaluating UHVP implementation reports variable delivery by health boards but highlights early years contacts as a key part of identifying needs and supporting families.
Preventive Impact
In England, research shows that health visitor workforce cuts have been linked with increased strain on other services, with some analyses indicating concurrent rises in A&E attendance for children aged 0-4 years over the same period workforce fell. (For example, a parliamentary submission cited a 42 % increase in A&E use for young children during cuts, though attribution is complex and context matters.)
Referral and System Pressures
Many health visitors across the UK report that workforce shortages make it harder to support families when needs are identified, potentially shifting care later into more acute settings like general practice or hospital care.
Health Service Use Trends in Scotland
While direct causal UK research on reduced health visiting causing more GP or A&E visits in Scotland specifically is limited, broader NHS performance data show rising pressures across emergency departments and general practice, which are affected by many factors — not just health visiting levels.
What This Means for Children and Older People
Potential impacts when health visitor services are strained or reduced:
For children
Delayed identification of health or developmental concerns (e.g., growth, speech, behaviour)
Lower early support for parenting and maternal wellbeing
Possible increase in unplanned acute care use if preventative contact is reduced
Research from England suggests that where health visiting is stronger and more consistent (as in parts of Scotland), families may receive better early support, although outcomes depend on full service delivery and workforce capacity.
For older adults
Scotland's health visiting services are focused on families with young children and do not generally serve older people directly. However, improved preventive community health services (including continuity through primary care and community nursing) can contribute to overall older people’s health by supporting carers and reducing avoidable health deterioration.
Who employs health visitors in Scotland as most in England are employed by local councils.
In Scotland, health visitors are not generally employed by local councils as in England. Instead, the situation is different:
Who employs Health Visitors in Scotland
Further down an explanation of what happened just in Highland.
Health Visitors in Scotland are primarily employed by NHS Scotland boards.
Scotland’s health system is run by 14 regional NHS Health Boards (e.g., NHS Greater Glasgow & Clyde, NHS Grampian, NHS Highland), and these boards directly employ community health staff — including health visitors — as part of their community nursing and children’s services.
Job postings and workforce information confirm that health visitor positions (band 7 or similar) are NHS board jobs, indicating they are NHS employees rather than council employees.
Role within NHS and Integration with Other Services
Health visitors deliver the Universal Health Visiting Pathway (UHVP) — a national programme backed by the Scottish Government and implemented by NHS boards.
They work within wider NHS community services and often coordinate with Health and Social Care Partnerships (HSCPs), which are joint arrangements between NHS boards and local councils to plan and deliver integrated services locally. But the employment contract remains with the NHS, not with the council.
Comparison with England
In England, health visitors are often employed by local authorities (councils) as part of public health services — a structure that has changed over time as commissioning moved from the NHS to councils.
In Scotland, the employer remains NHS Scotland (via health boards), even where health visitors work closely with local authority services through integrated partnerships.
In Scotland, health visitors are usually employed directly by NHS Scotland health boards (part of the national health service).
Unlike in England, they are not typically council employees — although they coordinate with local councils through integrated health and social care partnerships.
Did health visitors transfer to local authorities in Scotland when the integrated joint boards were set up?
No — in Scotland health visitors did not automatically transfer employment to local authorities when Integration Joint Boards (IJBs) were set up, and there wasn’t a mass or compulsory transfer of health visitors to councils in the way that happened in England with the 2015 public health changes.
Here’s a clear explanation of what did happen and why the confusion might arise:
Integration Joint Boards didn’t automatically change who employs health visitors
The Public Bodies (Joint Working) (Scotland) Act 2014 created Integration Joint Boards (IJBs) to plan and oversee how health and social care services are delivered locally. IJBs do not themselves employ staff. Staff remain employed by either NHS boards or local authorities unless a specific transfer is agreed.
Most of the functions that could be delegated to IJBs focus on adult social care and community health services (like district nursing), but delegation of children’s services (including health visiting) is optional and a local choice, not mandatory.
What this means:
Even where IJBs plan and resource services, health visitors normally remain NHS employees (through NHS Health Boards) unless a specific local decision was made to transfer a service.
In most areas health visitors stayed with the NHS
Under integration arrangements, IJBs coordinate resources and direct Health Boards and councils on service delivery. But unless the parties agreed to delegate children’s community health services to an IJB and then specifically transfer staff, health visitors remain employed by the NHS board.
Most health and social care functions delegated to IJBs are adult services, not children’s services, and transfers of staff only happen if the integration arrangement explicitly includes that function.
An exception — the Highland Lead Agency model
In Highland, there was an earlier move before nationwide IJB establishment:
Around 2012, Highland implemented a lead agency arrangement where some NHS staff (including health visitors and school nurses) moved onto the council payroll, and adult social care staff moved in the other direction into the NHS, as part of early integration testing.
This was a local agreement and not the standard model across Scotland.
Why people thought there was controversy
The confusion likely stems from two related reforms happening around the same period:
Named Person / GIRFEC (Getting It Right for Every Child)
A child welfare policy that placed a named person on every child’s record (often a health visitor or teacher) attracted major public controversy and legal challenge.
Although disputed publicly, it was unrelated to employment status and didn’t transfer health visitors to councils.
B. Integration reform
Integration focused largely on adult health and social care and shared planning and budgeting, which does affect how community services are delivered in practice — but didn’t automatically change employer status for health visitors.
Did health visitors automatically transfer to local authorities in Scotland when IJBs started?
No
Who employs health visitors now?
Generally the NHS Health Boards
Could local arrangements transfer health visitors?
Yes, but only through specific local delegation agreements (rare)
Was there controversy? Yes — but mainly about GIRFEC/Named Person policy, not a mass employment transfer
A detailed, evidence-based explanation of the unique Highland position on health visitor (and wider community health and social care) integration compared with the rest of Scotland — including what happened historically and what’s happening now.
What Highland Did That Was Different from all other 31 council areas
In most of Scotland, community health services (including health visitors) remain employed by NHS Health Boards and are delegated to IJBs for planning and strategic oversight. But Highland Council and NHS Highland took a different legal route in the early 2010s:
Lead Agency Model (2012)
Highland was the only area in Scotland to adopt a Lead Agency arrangement for health and social care integration.
Under this model:
Highland Council became the lead agency for children’s community health and social care services meaning responsibility for planning and delivering children’s health services (including health visitors) was delegated to the council.
NHS Highland became the lead agency for adult health and social care.
In practical terms, around 250 health visiting, school nursing and related staff transferred from NHS Highland to Highland Council payroll under this arrangement — while around 1,400 adult social care staff moved the other way to NHS Highland.
This happened because both partners believed that "joint services" were too complex and that a realignment of responsibilities would simplify governance and improve integration on the ground.
This wasn’t just an IJB direction — it was a deliberate staff transfer under lead agency arrangements, which is why in Highland health visitors were technically council employees (unlike most of Scotland where they stay employed by NHS).
Why It Happened
Highland Council and NHS Highland strategically negotiated a council-led delivery of children’s services including health visiting because of local geography, population distribution and a desire to reduce organisational barriers between health and social work services.
The Lead Agency model was established using existing community care legislation (before the 2014 integration law came into full effect).
What This Meant in Practice
Children’s Services Under "One Roof"
Health visitors, community nursing for children and some social work roles were brought together formally under Highland Council leadership.
Highland developed multi-disciplinary family teams combining health visitors, early years practitioners, school nurses and social workers, aiming for more seamless support to families than typical NHS/council splits elsewhere in Scotland.
Complexities Around Budgets and Governance
Despite service delivery being delegated, both the Council and NHS Highland retain statutory accountability for their respective areas — so governance and oversight were still shared through joint committees.
Has This Changed? Recent Developments
Shift Back Toward IJB-Style Integration
As of 2024-2025, Highland has signalled a move away from the Lead Agency model toward a more standard body corporate / IJB model — aligning with other areas in Scotland.
Councillors and NHS Highland have agreed to change the current lead agency model, with plans for public consultation and planning for the transition.
2025 Planning Agreement
From 1 April 2025, under a new planning framework, Highland Council remains lead agency for children’s services and NHS Highland for adults — building on the earlier model but formalised under integrated planning arrangements.
However, detailed implementation may still be subject to further legislative changes as Scotland’s care system evolves.
What This Means for Health Visitors in Highland
Unlike most of Scotland, historically in Highland:
Health visitors and children’s community health staff were transferred from NHS Highland to Highland Council under the Lead Agency Model around 2012.
This made Highland an exception compared with the rest of Scotland where most health visitors stayed employed by NHS boards even if services were coordinated through IJBs.
With new integration reforms underway, the future employer / governance structure may shift, but the historical lead agency transfer is a key reason health visitors in Highland were managed by the council rather than NHS Highland for many years.
Unique Highland Position
NHS Health Board (delegated to HSCP/IJB)
Historically NHS → Lead Agency transferred children’s services (incl. health visiting) to Highland Council
Highland (2012-mid-2020s)
Council employed health visitors
Part of a bespoke Lead Agency integration model
Highland (2025 and beyond)
Transitioning toward a more standard IJB model Councils and NHS planning a shift from the older Lead Agency model.
What we can piece together about health visitor numbers and trends in Highland particularly in light of council and NHS budget pressures even though there are no simple published year-by-year headcount tables specific to Highland (because most national workforce statistics exclude Highland’s health visitors due to their employment by Highland Council rather than NHS Highland).
Why Highland figures aren’t fully visible in national statistics
National Scotland workforce figures for health visitors — like those published as part of the evaluation of the Universal Health Visiting Pathway (UHVP) — do not include Highland health visitors in the standard NHS data because most are employed by Highland Council, not NHS Highland. These posts are counted in the 500 additional places pledge by the Scottish Government, but are not included in the workforce data displayed in those workforce tables.
This complicates efforts to track Highland health visitor numbers over time using national NHS workforce statistics.
Available local evidence and trends
Historic staffing and establishment
After the lead agency transfer in 2012, Highland Council took on health visitors and expanded the service to support the Universal Health Visiting Pathway. By 2018-19, Highland Council had established an agreed workforce of around 62.25 whole-time equivalent (WTE) health visitor posts (compared to the 43 WTE that originally transferred from NHS Highland), supported by Scottish Government funding and training.
Highland had been training additional health visitors over successive years to both fill vacancies and staff its Universal Health Visiting Pathway —with 20 trainees qualifying by early 2019 and more in the pipeline.
Vacancy trends
According to recent Highland Council reports, the vacancy rate for health visitors fell significantly from around 30 % in 2019 to about 8 % in 2023, showing local recruitment efforts have improved staffing levels overall.
However even a small numeric vacancy rate can mask service pressure in rural areas where teams are small and a single vacancy can disrupt coverage, with some parts of Highland historically experiencing high vacancy rates in specialist nursing roles.
Older local reports (2019) show that Highland Council’s roster of health visitor vacancies was shrinking compared with earlier years, despite recruitment challenges.
Training and workforce development
Highland Council continues to invest in training health visitor and school nurse trainees to sustain staffing — e.g., reports show a number of trainee health visitors qualifying each year (e.g., 5 trainees in 2023/24 and 5 in 2024/25 noted in recent workforce planning). This reflects an ongoing effort to grow or at least maintain staffing levels.
What this suggests about trends
1. There isn’t clear evidence of major cuts to the number of health visitors in Highland in recent years.
Local reports do not show a clear numerical decline in the headcount of health visitors; rather they reflect efforts to recruit, train, and retain staff and decreasing vacancy rates.
2. Workforce pressures still exist because Highland is geographically rural and recruitment is challenging.
Even with vacancy rates down from their peak, rural recruitment remains difficult and small teams are affected when health visitors are absent or in training.
3. Highland’s employment structure (Council rather than NHS employer) means that national NHS workforce datasets do not easily reflect Highland trends in published figures — which can give a misleading impression compared with other areas of Scotland.
Service delivery context and potential impacts
While we can’t give exact annual numbers for Highland’s health visitors over the last several years, the data that is available combined with local reports shows:
Training and recruitment continue
Highland Council is actively training and recruiting health visitors to maintain workforce capacity.
Vacancy rates have reduced
A high vacancy rate in earlier years improved significantly by 2023, indicating better staffing coverage overall — though challenges remain, especially in remote areas.
Impacts on service delivery
Even where staff numbers are stable, rural geography and workforce challenges can constrain how many visits can be completed, potentially affecting uptake of developmental reviews at the ideal ages. For example, local health service performance data notes that participation rates for key infant health reviews (e.g., 6-8-week checks) are below targets, and this is partly linked to availability of qualified health visitors on the ground.
The Official Reports
Health Visitor Numbers in Scotland
Target and Requirements: The Scottish Government, through its Health Visiting Action Plan 2025-2035, has set a minimum requirement of 49.98 Whole Time Equivalent (WTE) Band 7 Health Visitors per 10,000 children (0-5 years old) to deliver the Universal Health Visiting Pathway.
Workforce Trends: While NHS Scotland saw a 2% increase in total staff in 2022, the health visiting sector has experienced pressure from rising caseloads and demand.
Service Delivery: In Scotland, 90% of health visitors reported they can provide continuity of care to families "all or most of the time," with 69% managing caseloads of 250 or fewer per full-time equivalent (FTE).
While most boards achieve high coverage, national statistics indicate that the proportion of eligible children receiving all health visitor checks at various stages (11-14 days to 4-5 years) has decreased annually since 2020/21.
Health Visitor Numbers in Highland (NHS Highland)
Staffing Levels
Previous reports highlighted challenges in reaching required staffing levels, with a 2018 report noting that 62.25 FTE health visitors were required.
Recruitment: Efforts to increase numbers have included training 17+ health visitors via funded places, though, like elsewhere, recruitment of qualified HVs has been difficult.
In the Highland region, health visitors are often employed by the Highland Council rather than directly by NHS Highland.
Visiting Frequency: Due to the rural nature of the Highlands, visit frequency can range from 4-7 times annually per household, compared to 8–10 in more urban areas.
Key Findings
Pressure on Service: 84% of practitioners reported that the demand for health visitor support has increased over the last 12 months.
Service Model: The Universal Health Visiting Pathway consists of 11 home visits, with 8 in the first year of a baby's life.
Future Outlook: The 2025–2035 action plan is currently reviewing caseload weighting tools to better reflect the needs of different communities and ensure adequate staffing.
Conclusion
So the outlook does not inspire much confidence.