5th Report - First 1000 days: a renewed focus
- HC No.
- HC 802
- Published
- 22 Jan 2026
- Items
- 26
- Response
- Response document linked Read government response ↗
Select Committee · Health and Social Care Committee
The First 1000 Days: a renewed focus
Status: Closed
Opened: 21 Mar 2025
Closed: 18 Aug 2026
18 recommendations
8 conclusions
1 report
Inquiry scope
The first 1000 days of life, from conception to age two, are widely recognised as a critical period for child development, shaping long-term health, well-being, and life outcomes.The previous Committee examined this period in its 2019 First 1000 days of life inquiryconsidering national strategy, current spending and barriers to investment and local provision. Since then, there have been a number of significant policy developments in this area.The most notable being the shift to integrated care services (ICSs) under the previous Government in 2022.The current Government has allocated £126 million for early years support and the expansion of Family Hubs under its mission to “break down the barriers to opportunities”.The Committee’s inquiry will examine progress made since 2019, the effectiveness of family hubs and integrated care systems in improving early childhood outcomesand how inequalities in access can be most improved.Reports
Recommendations & Conclusions
Family Hubs funding remains significantly below Sure Start levels despite broader remit.
Conclusion · source text
We welcome the additional funding that the Government has announced for Family Hubs and its plans to open a Hub in every local authority. This is a positive step in increasing the support available to families during the critical first years of a child’s life. However, the funding available for these programmes is still significantly below the level of Sure Start, while Hubs are being expected to cater to a much broader age range of children and young people. (Conclusion, Paragraph 18)
Department of Health and Social Care
Set out plans to expand Family Hubs with sustained funding and issue guidance for 0-2 services.
Recommendation · source text
We call on the Government to set out plans to further expand the network of Family Hubs to provide access to a Hub every community. This plan must be supported by sustained and ringfenced funding. Previous research on the benefits of the Sure Start Programme clearly set out the long-term benefits and financial returns of such an investment and would directly support this Government’s ambition to give every child the best start in life. We also ask the Government to set out when it will confirm the funding arrangements for new areas and when it plans to issue guidance to those areas on services for children between the ages of 0 and 2. (Recommendation, Paragraph 19)
Department of Health and Social Care
Create dedicated roles to support parents of children from all disadvantaged groups.
Recommendation · source text
Successive governments have rightly focused on targeting Family Hubs and other early year interventions on those with the greatest need. We welcome the announcement that Hubs will have staff specifically trained to support the parents of children with additional needs navigate the service. We recommend that Government consider creating similar roles to support the parents of children from other disadvantaged groups. (Recommendation, Paragraph 22)
Department of Health and Social Care
Perinatal mental health investment remains insufficient and geographically limited to address needs.
Conclusion · source text
Perinatal mental health is as important as physical health, with poor mental health outcomes having potentially significant long-term consequences for both the mother and child. We were struck by how frequently mental health concerns were raised in evidence. Given that the Government’s 54 new investment is available only to the original 75 local authority areas this will struggle to address the need identified by witnesses. (Conclusion, Paragraph 32)
Department of Health and Social Care
Set actions to improve perinatal mental health access within Family Hubs for ethnic minority women.
Recommendation · source text
The Government should set out what actions it will take to improve access to perinatal mental health care within Family Hubs, supported by specific targets to improve access for women from ethnic minority backgrounds who have disproportionately poorer mental health outcomes. (Recommendation, Paragraph 33)
Department of Health and Social Care
Revise early language funding guidance to cover 0-2 year olds with maximum provider flexibility.
Recommendation · source text
We recommend that the Department for Education revise its guidance on early language and home learning environment funding to allow it to be used to provide support that covers the 0–2-year period, to allow providers the maximum flexibility in how they deploy this funding. (Recommendation, Paragraph 39)
Department of Health and Social Care
Potential overlap between Neighbourhood Health Centres and Family Hubs requires clear management strategy.
Recommendation · source text
We welcome the Government’s intention for Neighbourhood Health Services and Neighbourhood Health Centres to work in partnership with Family Hubs. Given that both models aim to bring together health and broader support services in a “one stop shop”, it will be important that families know where to go to access support and that partner organisations are not stretched too thin attempting to provide a presence in multiple locations. We invite the Government to provide further information on how it will manage potential overlap between Neighbourhood Health Centres and Family Hubs in its response to this report. (Conclusion, Paragraph 44) Health visiting
Department of Health and Social Care
Decimated health visitor workforce threatens government ambition for children's early life outcomes.
Conclusion · source text
The Government will fail to deliver on its ambition to give every child the best start in life unless it takes urgent action to rebuild the health visitor workforce, which has been decimated over the last 10 years. (Conclusion, Paragraph 55)
Department of Health and Social Care
Create plan to rebuild health visitor workforce and recruit at least 1000 additional staff.
Recommendation · source text
The Government must create a specific plan to rebuild the health visitor workforce in its forthcoming NHS Long Term Workforce Plan. This plan must be informed by safe staffing tools to ensure that health visitors have a manageable workload. As an initial step, we call on the Government to immediately commit to recruiting at least another 1000 health visitors. (Recommendation, Paragraph 56)
Department of Health and Social Care
Set out actions to hold poorly performing local authorities accountable for health visit delivery.
Recommendation · source text
We are also highly concerned about the variation in performance amongst local authorities in delivering health visits. While it is clear that the system as a whole needs additional resourcing, it is unacceptable that some local authorities managed 100% uptake while others were as low as 4%. We call 55 on the Government to set out what action it will take to hold to account poorly performing local authorities and improve their delivery of health visits. (Recommendation, Paragraph 57)
Department of Health and Social Care
Government's health visit ambitions are inadequate compared to other UK nations' provision.
Recommendation · source text
The Government’s ambitions for the number of health visits are woefully inadequate. Children in England receive fewer mandated health visits than children in any other part of the UK. While the Government’s immediate priority must be supporting and growing the workforce to deliver the current programme of five visits, in the longer term the Government should aim to deliver a service comparable to the rest of the UK. (Conclusion, Paragraph 60)
Department of Health and Social Care
Commit to increasing mandatory health visitor contacts from five to six for children in England.
Recommendation · source text
We recommend that the Government commit to increasing the number of mandatory health visitor contacts for children in England from five to six. To help it deliver this it should look at the approach that the devolved administrations have taken, where families can expect between 6 and 11 contacts with a health visitor, and set out the lessons that it can learn from their approach in its response to our report. (Recommendation, Paragraph 61) Workforce
Department of Health and Social Care
Significant shortages across children's health workforce are impacting care delivery and patient safety.
Conclusion · source text
Throughout this inquiry we heard that the children’s health workforce is being stretched to breaking point. There are significant shortages across multiple disciplines which prevent professionals from delivering the care young children and their families need and that, in some cases, significantly impacts on patient safety (Conclusion, Paragraph 76)
Department of Health and Social Care
Create sustainable children's health workforce with specific recruitment targets in the NHS Plan.
Recommendation · source text
The Government must take the opportunity presented by the forthcoming NHS 10 Year Workforce Plan to create a sustainable and well-resourced children’s health workforce. While we understand the Government’s desire for the workforce plan to go beyond numbers, a plan that does not set out a clear, achievable and funded road map for addressing staff shortages would completely lack credibility. We recommend that the workforce plan contains specific targets for recruitment to all disciplines that deliver care in the first 1000 days that, as a minimum, ensure that safe staffing ratios are delivered in all settings. (Recommendation, Paragraph 77)
Department of Health and Social Care
Set plans to support non-NHS children's health professionals and review multidisciplinary team guidance.
Recommendation · source text
Many professions which play a key role in delivering children’s health care are not entirely or primarily employed by the NHS. We recommend the Government sets out how it plans to support those professions in non- NHS settings, particularly allied health professionals and early years practitioners, in a child’s health workforce strategy that should accompany the NHS 10 Year Workforce Plan. We also recommend that the Government 56 review its current guidance on multidisciplinary teams to ensure that due prominence is given to the role that allied health professional can play in such teams. (Recommendation, Paragraph 78) Vaccinations
Department of Health and Social Care
Declining childhood vaccination levels represent an ongoing public health crisis requiring urgent action.
Conclusion · source text
The continuing decline in childhood vaccination levels since 2012 is a national disgrace; children should not be dying of entirely preventable diseases. The continued failure to effectively grapple with this is a significant and ongoing public health crisis and will lead to increased costs for the health service in the longer term. (Conclusion, Paragraph 86)
Department of Health and Social Care
Government dropping 95% vaccination target from NHS guidance causes concern.
Conclusion · source text
We are disappointed that the Government has dropped the 95% vaccination coverage target from NHS planning guidance and were unconvinced by the Minister’s arguments that it remained an “expectation” despite its removal. While we agree with the Government’s desire for the NHS to have a smaller number of priorities, we believe that vaccination coverage must absolutely be one of those priorities. (Conclusion, Paragraph 87)
Department of Health and Social Care
Reinstate 95% vaccination coverage target in NHS guidance for all vaccinations.
Recommendation · source text
We recommend that the Government immediately reinstate the 95% vaccination coverage target in NHS planning guidance for all vaccinations, including those given during the first 1000 days to mothers and children. We also call on the Government to commit to hitting this target no later than the end of this Parliament. (Recommendation, Paragraph 88)
Department of Health and Social Care
Develop new vaccination plan to improve early years uptake, with named ICB leads.
Recommendation · source text
Despite the measures contained in the Government’s vaccination strategy, vaccination rates are continuing to fall and the strategy is failing to deliver the improved coverage that is so desperately needed. The Government should brand the currently strategy a failure and develop a new plan with a specific focus on improving vaccination uptake in early years settings. As part of this new strategy, we recommend that the Department consider having a named individual in each ICB who is responsible for co-ordinating the vaccine offer across ICB services. (Recommendation, Paragraph 97)
Department of Health and Social Care
Accelerate health visitor vaccination pilot programme and report findings within six months.
Recommendation · source text
The plan for delivering vaccination by health visitors has real potential to help the Government achieve the 95% coverage vaccine target. We recommend the Government explore ways to accelerate the pilot programme and to report back on its findings within 6 months. (Recommendation, Paragraph 101) 57 Integration between services
Department of Health and Social Care
Single Unique Identifier pilots demonstrate potential for simplifying early years data sharing.
Recommendation · source text
The introduction of a Single Unique Identifier has the potential to significantly simplify data sharing across the early years landscape and we hope that currently planned pilots proceed smoothly and at pace. We ask that the Government commit to providing regular update on the progress of the pilots. (Conclusion, Paragraph 111)
Department of Health and Social Care
Government lacks essential data on children's health outcomes in first 1000 days.
Conclusion · source text
The Government does not have access the data it needs on children’s health outcomes during the first 1000 days. Without this data it will struggle to deliver meaningful improvements or implement a shared outcomes framework. (Conclusion, Paragraph 116)
Department of Health and Social Care
Produce plans for disaggregated children's outcome data and introduce separate waiting time reports for under-twos.
Recommendation · source text
We recommend that the Government work with all NHS and early-years settings to produce plans for greater disaggregated data concerning service delivery and outcomes for children. This should include data broken down by age group, as well as ethnicity, disability, socioeconomic status, access to services, and other categories that will allow for more targeted interventions and specified outcome planning. As a minimum, we call for the Government to introduce separate reports on waiting times for children under the age of two, as a first step to minimising delay in accessing services at this critical stage in a child’s development. (Recommendation, Paragraph 117)
Department of Health and Social Care
Concerns about data sharing legislation act as a barrier to effective partnership.
Conclusion · source text
Throughout this inquiry we heard that concerns about the legislation around data sharing was acting as a barrier to partners working effectively together. While some local areas have developed their own systems to support effective data sharing, stakeholders were clear they needed greater central support. (Conclusion, Paragraph 123)
Department of Health and Social Care
Simplify data sharing guidance with Integrated Care Systems to improve provider collaboration.
Recommendation · source text
We recommend that the Department of Health and Social Care work with Integrated Care Systems to simplify data sharing guidance to improve data sharing between providers. (Recommendation, Paragraph 124)
Department of Health and Social Care
Support shared outcomes framework with implementation plan and clarify ministerial responsibility across departments.
Recommendation · source text
The absence of a shared outcomes framework undermines accountability and hinders strategic planning across local systems. We welcome the Government’s plans to produce a shared outcomes framework. We recommend that the final framework be supported by an implementation plan that sets out how the Government will use the introduction of the framework to drive improved integration across the early years landscape. The Government should set out clearly who holds ministerial responsibility for the shared outcomes framework in both the Department of Health and Social Care and the Department for Education and what further steps they will take to promote cross-departmental working. (Recommendation, Paragraph 135) 58
Department of Health and Social Care
Oral evidence sessions
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| Date | Session and witnesses | Source |
|---|---|---|
| 3 Sep 2025 |
Oral Evidence
Ashley Dalton MP · Department of Health and Social Care,
Liz Ketch · Department of Health and Social Care,
Susie Owen · Department for Education
|
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| 2 Jul 2025 |
Oral Evidence
Anna Bird · Disabled Children's Partnership,
Dr Amit Aggarwal · Medical Affairs and Strategic Partnerships,
Dr Claire Fuller · NHS England,
Dr Doug Simkiss · Royal College of Paediatrics and Child Health,
Dr Helen Skirrow · Department of Primary Care and Public Health, Imperial College London,
Dr Helen Stewart · The Royal College of Paediatrics and Child Health,
Dr Sally Payne · Royal College of Occupational Therapists,
Jane Harris · Speech and Language UK,
Janet Cooper · Royal College of Speech and Language Therapists
|
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| 4 Jun 2025 |
Oral Evidence
Alison Morton · Institute of Health Visiting,
Dr Christine Farquharson · Institute for Fiscal Studies,
Rachel Roberts · Hull City Council,
Rukshana Kapasi · Barnardos
|
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| 7 May 2025 |
Oral Evidence
Professor Sir Michael Marmot · University College London (UCL),
Rt Hon Dame Andrea Leadsom DBE · Early Years Healthy Development Review
|
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Written evidence
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| Reference | Date | Submitter |
|---|---|---|
| FTD0074 | 27 Jan 2026 | Home-start UK |
| FTD0097 | 27 Jan 2026 | Mental Health Foundation |
| FTD0114 | 8 Jan 2026 | Parent-Infant Foundation |
| FTD0042 | 17 Dec 2025 | Bradford health and care partnership |
| FTD0045 | 17 Dec 2025 | Professor Anna Tarrant, University of Lincoln |
| FTD0113 | 17 Oct 2025 | The National Organisation for FASD |
| FTD0018 | 26 Jun 2025 | Dr Michael Daly, University of Bristol |
| FTD0017 | 26 Jun 2025 | Professor Samantha Johnson, University of Leicester |
| FTD0016 | 26 Jun 2025 | NSPCC |
| FTD0015 | 26 Jun 2025 | The For Baby's Sake Trust |
| FTD0014 | 26 Jun 2025 | Royal College of Obstetricians and Gynaecologists |
| FTD0013 | 26 Jun 2025 | The Nuffield Foundation |
| FTD0012 | 26 Jun 2025 | Alexandra Rose Charity |
| FTD0010 | 26 Jun 2025 | The Traveller Movement |
| FTD0009 | 26 Jun 2025 | Auditory Verbal UK |
| FTD0008 | 26 Jun 2025 | The Centre for Emotional Health |
| FTD0006 | 26 Jun 2025 | Ruth Kipping, University of Bristol |
| FTD0005 | 26 Jun 2025 | Dorset Parent Infant Partnership (DorPIP) |
| FTD0004 | 26 Jun 2025 | Dr Melanie White, Norfolk and Suffolk NHS Foundation Trust |
| FTD0003 | 26 Jun 2025 | Dr Laura Abbott, University of Hertfordshire |
| FTD0002 | 26 Jun 2025 | Mrs Debbie Brace, Hounslow PAIRS team |
| FTD0035 | 26 Jun 2025 | Sands |
| FTD0034 | 26 Jun 2025 | Academy of Medical Sciences |
| FTD0033 | 26 Jun 2025 | Sands and Tommy's Joint Policy Unit |
| FTD0032 | 26 Jun 2025 | Booktrust |
| FTD0031 | 26 Jun 2025 | Stephanie Gillibrand, The University of Manchester |
| FTD0030 | 26 Jun 2025 | Maternal Mental Health Alliance UK |
| FTD0028 | 26 Jun 2025 | UK Council for Psychotherapy |
| FTD0027 | 26 Jun 2025 | Child Health Unit, School of Public Health, Imperial College London. |
| FTD0026 | 26 Jun 2025 | Institute of Health Visiting |
| FTD0025 | 26 Jun 2025 | Blackpool Parent Infant Relationship Service |
| FTD0024 | 26 Jun 2025 | The National Literacy Trust |
| FTD0023 | 26 Jun 2025 | Speech and Language UK |
| FTD0022 | 26 Jun 2025 | British Psychological Society |
| FTD0021 | 26 Jun 2025 | parent and baby psychology service islington (PBPS) CAMHS |
| FTD0020 | 26 Jun 2025 | Professor Eva Lloyd, University of East London |
| FTD0057 | 26 Jun 2025 | Cllr Eunice O'Dame, Bensham Manor Ward |
| FTD0056 | 26 Jun 2025 | The Royal College of Midwives |
| FTD0055 | 26 Jun 2025 | Professor Angharad Beckett, School of Sociology and Social Policy and Centre for Disability Studies, University of Leeds |
| FTD0054 | 26 Jun 2025 | British Association of Teachers of Deaf Children and Young People (BATOD) |
| FTD0053 | 26 Jun 2025 | NCT (The National Childbirth Trust) |
| FTD0052 | 26 Jun 2025 | Mr Keith Aubrey, n/a |
| FTD0051 | 26 Jun 2025 | Alder Hey Children's Charity |
| FTD0050 | 26 Jun 2025 | Parenting Programmes Alliance |
| FTD0049 | 26 Jun 2025 | The Food Foundation |
| FTD0048 | 26 Jun 2025 | Bliss - the charity for the newborn |
| FTD0047 | 26 Jun 2025 | EasyPeasy |
| FTD0046 | 26 Jun 2025 | MSD |
| FTD0040 | 26 Jun 2025 | Anna Freud |
| FTD0039 | 26 Jun 2025 | Family Action |
Who gave evidence
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| Witness | Organisation | Sessions |
|---|---|---|
| Alison Morton · CEO | Institute of Health Visiting | 1 |
| Anna Bird · Chair | Disabled Children's Partnership | 1 |
| Ashley Dalton MP · Parliamentary Under-Secretary of State for Public Health and Prevention | Department of Health and Social Care | 1 |
| Dr Amit Aggarwal · Executive Director | Medical Affairs and Strategic Partnerships | 1 |
| Dr Christine Farquharson · Associate Director | Institute for Fiscal Studies | 1 |
| Dr Claire Fuller · National Medical Director | NHS England | 1 |
| Dr Doug Simkiss · Chair of the British Association for Community Paediatrics | Royal College of Paediatrics and Child Health | 1 |
| Dr Helen Skirrow · Clinical Research Fellow | Department of Primary Care and Public Health, Imperial College London | 1 |
| Dr Helen Stewart · Officer for Health Improvement | The Royal College of Paediatrics and Child Health | 1 |
| Dr Sally Payne · Professional Adviser for Children, Young People and Families | Royal College of Occupational Therapists | 1 |
| Jane Harris · CEO | Speech and Language UK | 1 |
| Janet Cooper · Expert Adviser | Royal College of Speech and Language Therapists | 1 |
| Liz Ketch · Director for Early Years, Children & Families | Department of Health and Social Care | 1 |
| Professor Sir Michael Marmot · Director of the Institute of Health Equity and Professor of Epidemiology | University College London (UCL) | 1 |
| Rachel Roberts · Strategic Lead for Early Help and Prevention, Children, Young People and Family Services | Hull City Council | 1 |
| Rt Hon Dame Andrea Leadsom DBE · Chair | Early Years Healthy Development Review | 1 |
| Rukshana Kapasi · Director of Health | Barnardos | 1 |
| Susie Owen · Director of Early Years, Childcare, Families and Analysis | Department for Education | 1 |
Correspondence
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| Published | Direction | Letter |
|---|---|---|
| 28 Apr 2026 | — | Correspondence from Minister Hodgson - First 1000 Days Response |
| 15 Oct 2025 | — | Correspondence from Minister Dalton re First 1000 days evidence session |
| 2 Jul 2025 | — | Correspondence from Minister Daby re the First 1000 Days |