The best start for life: a progress report on delivering the vision

Question 1

Foreword by the Secretary of State for Health and Social Care

Accepted Answer

We often talk about the arrival of a new baby as a time of great joy, but it can also present new challenges.

Having access to timely and high-quality support during pregnancy and the first 2 years of a baby’s life can help families lay the foundations for their baby’s lifelong emotional and physical wellbeing.

Failing to provide the right support early on costs individuals, society and the economy. It can also drive demand for public services by leaving issues unaddressed, with families then needing more support later in life. To give just one example, late intervention for children and young people is estimated to cost around £17 billion a year – approximately one-fifth of these costs fall to our NHS.

The government’s The best start for life: a vision for the 1,001 critical days, published in March 2021, set out 6 action areas to improve the health outcomes of all babies in England. Implementing these commitments is a critical part of putting the needs of babies at the heart of Start for Life services, delivering immediate and long-term benefits for families, the NHS and other public services.

I am proud of the progress that we have made to date. Investing in the 1,001 critical days is one of the best things we can do for our country’s children. That is why the government committed over £300 million to create a new Family Hubs and Start for Life programme at the 2021 Autumn Budget and Spending Review. As part of this, £150 million has been dedicated to delivering new and improved infant feeding services, and perinatal mental health and parent-infant relationship support. A range of guidance has also been published to support all areas to deliver the Best Start for Life vision.

There is, of course, more to do. Improvements to Start for Life services must be data and evidence led. The quality of early years data still varies, and the evidence base on what best helps families in different contexts needs strengthening. The focus on improving the evidence base through the Family Hubs and Start for Life programme – including the commissioning of a national evaluation – will drive improvements across these areas. We must now continue on this path we have set.

Strong leadership of this agenda is also vital for success. I am delighted to announce that the Rt Hon Dame Andrea Leadsom MP will continue in her role as the Government’s Early Years Adviser until the end of this Parliament. Working with Dame Andrea and ministers across the government, I will also continue to champion the needs of babies at cabinet. Together we will ensure that every baby gets the best start in life.

The Rt Hon Steve Barclay MP, Secretary of State for Health and Social Care

Question 2

Foreword by the Minister for Children, Families and Wellbeing

Accepted Answer

Families are at the heart of what makes us happy and well. As Minister for Children, Families and Wellbeing, I am passionate about helping all families get off to the best start.

The government is determined to turn the vision set out in The best start for life: a vision for the 1,001 critical days report into a reality for thousands of families across the country.

We know that what happens in the Start for Life period – the critical 1,001 days from conception to age 2 – is hugely important in ensuring children do well in school, and it affects their health and wellbeing. I am proud that we are rolling out family hubs across the country. These will be ‘one-stop shops’ to support parents with children of all ages.

Through the government’s £300 million investment, family hubs will include high-quality services in the period from conception to age 2 – such as midwifery and health visiting – together with parenting support to help make the transition to parenthood as smooth as possible, meaning that more children are healthy and ready to learn at age 2 and ready for school at age 5.

I am delighted and grateful to be working with the Department for Health and Social Care and the Rt Hon Dame Andrea Leadsom MP on this vital agenda.

Claire Coutinho MP, Minister for Children, Families and Wellbeing

Question 3

Introduction from the Government’s Early Years Adviser

Accepted Answer

We all support education for every child and good health for every citizen in our country. These are rights – with the freedom and lifelong opportunities they offer – that are woven into our national fabric.

Joined-up services to deliver the best start for life for every baby should be a core part of this universal offering.

It is during the 1,001 critical days – from conception to the age of 2 – that the building blocks for good lifelong emotional and physical health are laid down. Nurtured babies are able to develop strong relationships and, as they grow up, they are better equipped to tackle the challenges that life throws at them.

Therefore, providing brilliant support during the 1,001 critical days will help every baby make the most of the universal education and healthcare that is their right.

Investing in Best Start for Life services is also good economics. Professor James Heckman’s work shows that societies get the best results when governments invest in the earliest years – later interventions as the child grows older become progressively more expensive and less effective. Prevention is not only kinder but also significantly cheaper than cure.

I was delighted when, in July 2020, Prime Minister Boris Johnson appointed me to lead the Early Years Healthy Development Review. During the review, we heard from mums, dads, carers, grandparents, volunteers, professionals, academics and cross-party parliamentarians on how we could support all families to give their babies the best start for life. In March 2021, we launched The best start for life: a vision for the 1,001 critical days and, since then, the Start for Life team and I have focused on transforming support for every parent, carer and baby in England.

As this report shows, great progress has already been made. I have personally visited all parts of England, meeting with local authorities, NHS trusts, service providers and families. Some areas are already transforming services for families in response to the vision. Many are fizzing with ideas for putting policy into practice.

2023 is the year of rolling out the vision. During this year, families will:

really begin to see a difference in the level of support for them and their baby
know what help is available and where to get it
be able to access services face to face, virtually and in their community

Support for building strong, secure relationships between parents and babies will be available in more areas, and help with parenting advice and with infant feeding will become the norm in new or transformed family hubs.

Parents and carers will be invited to their family hub to have antenatal checks, health visitor meetings or to meet other families. Birth registration may be offered in the hub to encourage every family to come along and feel welcome.

Start for Life offers will be made available to new families, with information about how to find help. And we will start to roll out digital personal child health records with incremental improvements and features over the next 2 years to support every baby’s health and wellbeing.

Just as Aneurin Bevan and Rab Butler introduced radical visions for universal healthcare and education that have stood the test of time, we must be equally ambitious for the Best Start for Life rollout.

I will personally continue to champion the needs of babies across and beyond government. Perhaps the happiest sound on earth is that of a laughing baby – their big eyes and tiny limbs are irresistibly cute and bring out a protective instinct in most of us. But we adults must recognise that the very future of our world depends on their happiness and wellbeing. Tiny babies do not yet have a voice of their own, so we need to raise ours in support of giving each one the best start in life.

The Rt Hon Dame Andrea Leadsom MP, the Government’s Early Years Adviser

With grateful thanks to the many local authorities and their delivery partners who have opened their doors to give us the benefit of their invaluable insight, advice and support.

Question 4

Executive summary

Accepted Answer

The 1,001 critical days from conception to the age of 2 set the foundations for an individual’s cognitive, emotional and physical development. Investing in this critical period presents a real opportunity to improve outcomes and tackle health disparities by ensuring that thousands of babies and families have improved access to quality support and services.

This is why, in July 2020, the then-Prime Minister asked the Rt Hon Dame Andrea Leadsom MP to chair the Early Years Healthy Development Review (the review). The goal was to create a vision for ‘brilliance’ during the 1,001 critical days from conception to a child’s second birthday. The review met with families, academics, frontline professionals, charities and volunteers to understand what was going well and where change was needed. The review saw excellent examples of people helping families when they needed it most, but it also heard how hard it could be for parents and carers, grandparents, and the wider family to find support.

The government published The best start for life: a vision for the 1,001 critical days (the vision) in March 2021. The vision set out 6 action areas to improve support for families between pregnancy and age 2. This progress update sets out the progress that the government has made in implementing the vision since its publication. This includes:

These achievements sit alongside wider support for families including the government’s £200 million uplift to the Supporting Families programme and support for families with the rising cost of living.

However, there is more to do to make sure that every baby gets the support they deserve through the 1,001 critical days. To achieve this, the government will focus on 3 priority areas over the coming months. The priority areas are:

To ensure the Family Hubs and Start for Life programme delivers rapid, visible support for families.
To develop a digital version of the personal child health record to give parents easy access to information about their child, and to enable professionals to understand the support babies and their families may need.
To develop a Start for Life outcomes framework, review the regulatory framework for children’s health services, and ensure there is a proportionate and effective inspection regime.

Working together with local authorities, local health organisations and the third sector, we will make sure that every baby gets the very best start in life.

Question 5

Context

Accepted Answer

The Early Years Healthy Development Review

In July 2020, the then-Prime Minister asked the Rt Hon Dame Andrea Leadsom MP to chair the Early Years Healthy Development Review (the review). The goal was to create a vision for ‘brilliance’ during the 1,001 critical days from conception to a child’s second birthday.

The review met with families, academics, frontline professionals, charities and volunteers to understand what was going well and where change was needed. The passion of those working with families was impressive, and the review saw excellent examples of people helping families when they needed it most.

But the review also heard how hard it could be for parents and carers, grandparents, and the wider family to find support. Families struggled to understand:

what was available in their local area
where they could go to get help
where they could find trustworthy advice online

Information about their baby’s development was also not available in a form they could easily access and share.

Big caseloads, insufficient interdisciplinary training and the coronavirus (COVID-19) pandemic made it hard for some dedicated professionals and volunteers to give the best support to families. This support was also not always developed in partnership with parents and carers to fully understand the help they needed. Sometimes, professionals and volunteers did not know what good joined-up services looked like. Some families were afraid to get help because of the stigma they might face. It was also unclear which leaders were accountable locally or nationally for the support provided during the 1,001 critical days.

Everyone the review met agreed that joining up services to give every baby the best start in life should be the goal. They all wanted to improve how we support families during the 1,001 critical days, recognising that this period is vital for a child’s lifelong opportunities.

The best start for life: a vision for the 1,001 critical days

The government published The best start for life: a vision for the 1,001 critical days (the vision) in March 2021. The vision set out 6 action areas to improve support for families between pregnancy and age 2.

Through delivering these actions, we can be confident that the best support is provided to every family, laying the building blocks for their baby’s lifelong emotional and physical wellbeing.

Action areas

Ensuring families have access to the services they need

This includes:

seamless support for families: a coherent joined-up Start for Life offer available to all families
a welcoming hub for families: family hubs as a place for families to access Start for Life services
the information families need when they need it: designing digital, virtual and telephone offers around the needs of the family

Ensuring the Start for Life system is working together to give families the support they need

This includes:

an empowered Start for Life workforce: developing a modern skilled workforce to meet the changing needs of families
continually improving the Start for Life offer: improving data, evaluation, outcomes and proportionate inspection
leadership for change: ensuring local and national accountability and building the economic case

Evidence, challenges and opportunities

The international, evidence-based consensus

The vision highlighted the international, evidence-based agreement on the importance of the 1,001 critical days. During this time, our brains lay the foundations for the emotional health, physical wellbeing and social skills needed to live a healthy, happy life.

Figure 1: human brain development from the Center on the Developing Child at Harvard University

A line graph showing human brain development from conception to age 19 years. The data shows that sensory pathways (vision, hearing), language and higher cognitive function development peaks between 3 months and 1 year.

The above line graph shows human brain development from conception to age 19 years. The data shows that sensory pathways (such as vision and hearing), language and higher cognitive function development peaks between 3 months and one year of age.

Research shows that supporting babies’ development can lead to lifelong benefits, including increased economic chances, longer life expectancy and reduction in crime.

Providing high-quality services and support for babies is not only good for their lifelong potential, it can also reduce demand for public services by responding to risks early. Conversely, not dealing with issues at the earliest opportunity leaves individuals requiring more support later in life. This can be expensive. To give just one example, the Early Intervention Foundation estimated the cost of late intervention to be £17 billion a year in England and Wales.

To help minimise these costs and bring lifelong benefits to babies, Start for Life support must be focused on the right things and be well delivered. There are many services that all families rely on during the 1,001 critical days. These include:

midwifery
health visiting
infant-feeding support
perinatal mental health and parent-infant relationship support

Some families also require additional help across a range of areas such as:

smoking cessation
drugs and alcohol support
domestic violence reduction
debt and housing advice

Evidence points to several important areas that particularly impact a baby’s health and development, and where improvements in services are needed. This includes, but is not limited to, services that support breastfeeding, parent-infant relationships and perinatal mental health.

The importance of breastfeeding

Breastfeeding is the most nutritious food source for babies, and has important benefits for both the mother and child -for example, it is associated with lower breast cancer rates for the mother, reduced risk of infections for the baby and may support the baby’s cognitive development^{[footnote 1]}^{[footnote 2]}

The World Health Organization recommends that babies should be exclusively breastfed for the first 6 months of life. However, the 2010 Infant Feeding Survey states that only 1% of babies in the UK are exclusively breastfed until that age (compared with 34% in Portugal). Over 80% of mothers who stopped breastfeeding in the first 2 weeks reported that they would have liked to have carried on for longer. More recent data appears to show a similar picture. In 2021 to 2022, just 49.3% of babies were breastfed at 6 to 8 weeks – a stark drop from the 73.1% of babies who had breastmilk as their first feed.

We know that breastfeeding is a skill that it takes time to get the hang of and many women who choose to breastfeed encounter challenges. The reasons why women do not breastfeed or stop breastfeeding earlier than planned are complex. Commonly cited barriers^{[footnote 3]}^{[footnote 4]} include:

a lack of support (both in the community and at home)
inability to access services
difficulties breastfeeding or expressing in the workplace
cultural barriers
misinformation

In June 2020, a UK survey found that 28% of breastfeeding women did not feel they had the support they needed. This feedback, combined with the high proportion of women who stop breastfeeding in the first few weeks post-birth, emphasises the need for improved support for women who want to breastfeed, particularly during the critical postnatal period.

It is also important to facilitate women’s choices around feeding their babies. Some women are unable to breastfeed and some decide that formula feeding is the preferred option for them.

Personal choice should be respected, and objective advice and support should be offered to all parents and carers, irrespective of whether they are breastfeeding, expressing, using formula or a combination of approaches.

There are significant regional variations in breastfeeding rates. For example, in 2021 to 2022, just 36% of babies in the north east of England were breastfed at 6 to 8 weeks, compared with 52% in the east of England. Breastfeeding is also correlated with levels of deprivation. In 2021 to 2022, babies in the least deprived areas were much more likely to be breastfed than babies in the most deprived areas.^{[footnote 5]}

The reasons for this are complex, but variation in local service provision may be a contributing factor. In some areas, women have access to:

regular peer support sessions
out-of-hours support
free antenatal breastfeeding education
specialist professional support to deal with issues such as latching difficulties or tongue-tie

However, that is not the case everywhere and many women are currently unable to access the support they need when they need it.

This shows that there is a clear need for consistent support across the country.

Given the health benefits associated with breastfeeding and England’s relatively low rates, there is more to do to ensure every family can access the services they need to achieve their breastfeeding goals.

Breastfeeding support from services in Salford

18 year old Mia’s son was born with a tongue tie – the strip of skin connecting his tongue to the bottom of his mouth was shorter than normal. This made breastfeeding difficult, and Mia knew she needed help.

Local services in Salford worked together to support Mia with her choice to breastfeed. Her health visitor referred Mia’s baby to the tongue tie clinic and they also let Mia know about further support offered by her local family hub. The health visitor also gave Mia practical support with how to express and store breast milk, as well as emotional support.

Mia’s confidence as a new mum grew significantly with their support.

Note: names have been changed.

The importance of perinatal mental health and parent-infant relationships

Parent-infant relationships and perinatal mental health lay the foundations for a baby’s social, emotional and cognitive development. When babies grow up in a stable and loving environment, they are better placed to develop and flourish.

The negative effects of poor perinatal mental health on a baby’s development can be long lasting. A report estimated that the lifetime societal cost of perinatal depression and perinatal anxiety to one mother and their child is approximately £74,000 and £35,000, respectively.

While the impact of the COVID-19 pandemic on families is varied, emerging evidence shows that it increased instances of poor perinatal mental health. A UK survey found that 43% of mothers showed symptoms of depression during the pandemic compared with 16% pre-pandemic, and 61% demonstrated symptoms of anxiety compared with 15% before COVID-19.

At the same time, the Royal Foundation Centre for Early Childhood found a rise in the proportion of parents who feel uncomfortable asking for help with how they are feeling. 18% of parents felt this way before the pandemic, rising to 34% during it. The same report suggested this may be due to not knowing who to contact, a fear of being judged or shame at feeling unable to cope.

These apparent consequences of the pandemic may have lasting effects on some parents, carers and their babies’ emotional, cognitive and physical development. This makes it even more important that families receive the best possible support during and beyond the 1,001 critical days.

Becoming parents in lockdown

Mario and Amy had twin boys during the COVID-19 pandemic in June 2020. Necessary restrictions to limit the spread of the virus meant that Mario was unable to join Amy for some of her pregnancy scans. He then briefly accompanied her for the birth of their twins, before having to leave the hospital.

The birth was complicated with one of the twins needing the hospital’s neonatal intensive care unit. Amy was in hospital for a total of 12 days, but Mario was only able to give Amy support and see his new baby boys over video calls.

Eventually Amy and the twins came home, but she had found the experience traumatic.

Her GP was sympathetic and offered antidepressants, but what Amy wanted was to talk to a therapist. Lockdown also made it harder for Mario and Amy to get support from friends and family during the exciting but challenging time after the birth of their twins.

They said that:

The vision’s commitment to joined-up Start for Life services will ensure that families like ours receive the support they need before and after birth. It will also reduce the time that parents spend repeating their health history to different frontline professionals.

An increasingly challenging context

The rising cost of living means that Start for Life services support families in a challenging context. A survey by the Children’s Commissioner in March 2022 found that 42% of parents with children under 3 said it was fairly difficult or very difficult to ‘make ends meet’.

While all families need support during the 1,001 critical days, families living in poverty can struggle with additional challenges. Evidence shows that poverty is linked with:

adverse childhood experiences
low birth weight
poor physical and mental health

A review from the Institute for Fiscal Studies (IFS) noted research that shows children growing up in deprived families have poorer outcomes later in life.

However, the consequences of these challenges can sometimes be reduced. To give just one example, the IFS found that 58% of children in the poorest households with a high level of positive parenting had a ‘good level of achievement’ in the first year of school compared with 19% of children in the poorest households with low-quality parenting.

The vision will play an important part in addressing this, ensuring that families have access to the right support where and when they need it.

Investing in change

The government is committed to supporting families and, as part of this, it confirmed it would be investing over £300 million in a new flagship Family Hubs and Start for Life programme at the 2021 Autumn Budget and Spending Review. Since then, the Department of Health and Social Care (DHSC) and the Department for Education (DfE) have led jointly on designing the programme.

The programme will fund 75 local authorities in England until March 2025 to provide more support to families. At the heart of this will be new and improved Start for Life services delivered through family hubs. Family hubs support families with children of all ages – from conception to age 19 or up to the age of 25 for those with special educational needs and disabilities (SEND).

The 75 eligible areas were chosen by prioritising places with the greatest need while also ensuring the programme can build the evidence base in urban and rural settings. To achieve this, local authorities were first pre-selected using the Income Deprivation Affecting Children Indices (IDACI) – average rank scores. The highest scoring 25% of local authorities from each Rural Urban Classification were pre-selected for the programme. The remaining local authorities were pre-selected in rank order using the IDACI – average rank scores, irrespective of their Rural Urban Classification. Read further information on the selection process.

Objectives for the Family Hubs and Start for Life programme

The programme aims to:

provide joined-up support for parents and carers so they can nurture their babies and children, improving health and education outcomes for all
contribute to a reduction in inequalities in health and education outcomes for babies, children and families across England by ensuring that support provided is communicated to all parents and carers, including those who are hardest to reach and/or most in need of it
build the evidence base for what works when it comes to improving health and education outcomes for babies, children and families in different delivery contexts

Eligible local authorities will now begin to deliver new and improved Start for Life services during 2023. The Family Hubs and Start for Life programme will ensure that families in their areas can access:

family hubs that offer family services physically, virtually and in the community. This includes a range of services, from each area’s own Start for Life offer to housing advice and youth services
parent-infant relationship and perinatal mental health services to lay the foundations for babies’ emotional, physical and cognitive development
infant feeding services to help mums to understand the benefits of breastfeeding and meet their breastfeeding goals
parenting support to help families care for their babies
a published Start for Life offer by April 2023 that gives families easy access to local services
a local parent and carer panel by April 2023 where families can share their views on the design and delivery of Start for Life support
educational support on creating effective home learning environments, to help young children to recover from the pandemic

The programme will also deliver innovative Start for Life workforce pilots in a small number of areas (approximately 5). These pilots will test ideas on how best to support the workforce to give babies the best start in life.

DfE is also investing £12 million in a separate family hubs transformation fund to support an additional 12 local authorities across England to move to a family hub model by March 2024. The family hubs will support families with children of all ages with Start for Life services at their core.

Taken together, 87 local authorities across England are receiving additional funding for Start for Life services and/or family hubs, helping them deliver the vision.

Local authorities receiving additional funding to move to a family hubs model

Figure 2: map of local authorities receiving additional funding to move to a family hubs model

A map of England divided into nine colour-coded and numbered regions. Each region is represented by a numbered pin, page 24 lists the 75 local authorities participating in the programme by region.

Local authorities receiving funding under the Family Hubs and Start for Life programme and family hubs transformation fund.

The above map and key show that the following local authorities are receiving additional funding to move to a family hubs model.