5th Report - First 1000 days: a renewed focus

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)

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)

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)

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)

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)

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)

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

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)

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)

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)

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)

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

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)

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)

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

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)

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)

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)

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)

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

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)

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)

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)

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)

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)

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