The first 1000 days of life, from conception to age 2, is a critical phase during which the foundations of a child’s development are laid. If a child’s body and brain develop well then their life chances are improved. Exposure to stresses or adversity during this period can result in a child’s development falling behind their peers. Left unaddressed, experiences, such as abuse or conflict between parents, can stay with children throughout their lives, can cause harm to them and to others, and might be passed on to the next generation. Individuals with four or more adverse childhood experiences (ACEs) are at a much greater risk of poor health outcomes compared to individuals with no ACEs. They are also thirty times more likely to attempt suicide. Intervening more actively in the first 1000 days of a child’s life can improve children’s health, development and life chances and make society fairer and more prosperous.
Enhancing the ability of services to support and empower parents and families to take care of themselves and their children is vital, but not sufficient. Social stresses—poverty, poor housing and unstable employment—act against the ability of parents and families to create a safe, healthy and nurturing environment for their children. Improvements in service provision will only provide a ‘sticking plaster’ if the circumstances in which some of this country’s poorest children grow up do not improve. We call on the Government to consider the needs of the most vulnerable families in all its policies across all departments.
Improving support for children, parents and families during this vulnerable period requires a long-term and coordinated response nationally and locally. The Government should lead by developing a long-term, cross-Government strategy for the first 1000 days of life, setting demanding goals to reduce adverse childhood experiences, improve school readiness and reduce infant mortality and child poverty. The Minister for the Cabinet Office should be given responsibility to lead the strategy’s development and implementation across Government, with the support of a small centralised delivery team.
High-quality local services for children, parents and families should be founded on the following six principles:
Each local authority area should develop, jointly with local NHS bodies, communities and the voluntary sector, a clear and ambitious plan to improve support for children, parents and families in the first 1000 days of life, which reflects these principles and sets out how each area will meet key national goals. The Government should establish a fund, to which multiple departments contribute, to incentivise the transformation of local commissioning (including the pooling of resources between commissioners) and provision of services, in accordance with the six principles we have specified.
We have found significant variation in the way that local areas prioritise and support families in the first 1000 days. The Government must to do more to bolster its ability to support local areas, hold them to account and intervene, when goals are not being met. In particular, the Government should seek to foster an environment of continuous improvement by filling gaps in research and encouraging local areas, through support and incentives, to identify, test, adopt and spread ‘what works’ to improve outcomes. We recommend the establishment of an expert advisory group to coordinate a national approach to filling gaps in research, and we agree with our colleagues on the Science and Technology Committee that local authorities would benefit from the support of a central specialist team with experience in effectively and sustainably implementing early intervention programmes.
We have found significant variation in staffing numbers, skills and the level of contact with families. Local areas must be supported to cultivate a skilled workforce, with an enhanced awareness of child development and adversity, and enhanced capacity and capability of staff to build relationships with the children, parents and families they work with. We recommend that the Government should publish a holistic workforce plan for services covering the first 1000 days. The plan should set out how the Government will support local areas at a system, placed-based and neighbourhood level to enhance the capacity, capability and skill mix of staff who support children, parents and families during the first 1000 days.
In 2009, the Government launched the universal Healthy Child Programme (HCP), with the aim of improving outcomes and reducing inequalities through a combination of universal provision and targeted support. The HCP is central to the delivery of the universal offer of prevention and early intervention services for children and families in England. 10 years on from its inception, we are calling for the Healthy Child Programme to be revised, improved and given greater impetus. We recommend that the programme should begin before conception, extend home visits beyond the age of 2½ years, become more family focused, and ensure children, parents and families experience continuity of care during this critical period.
Children and families who may need targeted support should be identified at the earliest opportunity, especially during pregnancy. Based on the experience of the Family Nurse Partnership and the Flying Start programme in Wales, we recommend that the Government should develop a programme that children and families who need more targeted support can access.
Investing in the early years is the best investment any government can make and saves money in the long-term. We recommend that the Government use the 2019 Spending Review as an opportunity to initiate the next early years revolution with a secure, long-term investment in prevention and early intervention to support parents, children and families during this critical period.
Published: 26 February 2019