4National strategy
Funding
70.The evidence we have seen indicates that public expenditure on children has fallen since 2010/11. Total spending per child is projected by the Institute for Fiscal Studies and the Children’s Commissioner to fall by 12% in real terms between 2010/11 and 2020/21, thereby reversing some of rapid increases in spending that occurred during the early 2000s.125 Spending on health and education have been relatively protected. In contrast, between 2010/11 and 2020/21, spending per child on benefits and on children’s services is projected to fall by 17% and 20% respectively.126
71.Just under a third of public spending on benefits is directed towards supporting parents and families with children. This includes tax credits, child benefit and housing benefit. By 2019/20 benefit spending per child is set to be the same as it was in 2006/07, just before the financial crisis.127 The IFS and Children’s Commissioner project a 2% rise in children living in absolute low income, as a result of the two-child limit on tax credit and Universal Credit.128
72.Councils have been operating in a tight financial climate and this trend is expected to continue with local government facing a £7.8bn funding gap by 2025, according to the Local Government Association.129 From 2010/11 to 2016/17 spending on services such as public transport, libraries and children’s centres fell by a third.130 Since 2010/11 councils have shifted spending on children’s services towards acute crisis management and away from prevention and early intervention, as Chart 1, from the Health Foundation, shows. Spending on most public health services has fallen considerably since 2014/15, as shown by Chart 2.
Chart 1: Local authority spending on children’s services from 2010/11 to 2015/16
Chart 2: Public Health Grant net expenditure and percentage change in spend since 2014/15
73.As noted above, responsibility for commissioning public health services for children aged 0–5 transferred from the NHS to local authorities in 2015.131 Councils spent more on this area of public health than any other, often exceeding the amount transferred over to them for this purpose.132 However, spending on public health services for children aged 0–5years has fallen by 9% since 2014/15 and is projected, by the Health Foundation, to fall by another 15% by 2019/20.133 Cuts to other public health services have been much deeper. The greatest reductions in expenditure have been on drug and alcohol services and stop-smoking services, both of which are important to addressing known risks to child health and development (see Chart 2).
74.Spending cuts have negatively affected universal, targeted and specialist services and the wider community assets (e.g. public amenities) available to children, parents and families. As a result of funding cuts, some local services have been closed or decommissioned while others have been reoriented towards more targeted approaches.134 For example, since 2010 over 1000 children’s centres have closed, while others have moved away from an open access neighbourhood model towards a more focused approach in which services operate part-time and focus more on families who are referred or have higher levels of need.135
The case for investment
75.The economic and human costs of intervening late are enormous. The Early Intervention Foundation has estimated the cost of late intervention to the public purse to be £17bn annually.136 However, structural problems in the way Government departments and public services are funded, financed and commissioned disincentivise investment in early intervention. In particular, short-term, siloed approaches to funding and commissioning have presented major, longstanding and widely recognised barriers to investment in prevention and early intervention.137
76.Effective early intervention requires long-term investment. Cashable savings are rarely immediate. Financial savings from early interventions can only be made once commissioners are able to remove costs from the system. This requires sizeable and sustained changes in demand, and existing services not to be used to address previously unmet need.138 Early interventions directed towards supporting children and families are typically commissioned for between one and three years. Services struggle to demonstrate benefits over such a short period.139
77.Siloed approaches to government funding, nationally and locally, act as a disincentive to investing in early interventions, as the long-term benefits, when accrued, are unlikely to benefit the department that made the initial investment. As an example, the Early Intervention Foundation explained that:
Investing to improve the home learning environment and the academic attainment of disadvantaged children, for example, may lead to higher employment, higher tax contributions and reductions in the welfare bill–all of which will benefit the Department for Work and Pensions, HM Revenue and Customs and society as a whole, but not the local authority that invested in the intervention to begin with.140
78.Directing resources towards prevention and early intervention, and doing so effectively, is particularly difficult in a constrained financial climate.141 For instance, there is greater competition between services for the limited funding available. Councils and their public health teams, according to Public Health England, face “increasingly challenging decisions” over what services to invest and disinvest in.142 Some commissioners, for financial reasons, may choose to implement interventions that are less expensive, but also less effective or appropriate.143
79.Early intervention, as our colleagues on the Science and Technology Committee have pointed out, is an “opportunity to make long-term, cost-effective improvements in children’s lives–rather than a demand on resources.” By devoting resources to interventions during this early period of a child’s life the Government can improve the health, wellbeing and life chances of future generations.
80.The Government must use the Comprehensive Spending Review in 2019 to shift public expenditure towards intervening earlier rather than later. We recommend 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.
81.Unfortunately, due to the way Government departments are financed, the department which invests in early intervention is often not the one that stands to reap greatest benefit. This structural problem in the financing of government is a barrier to early intervention. We recommend the ministerial group on Early Years and Family Support address this crucial issue. When we hear from Ministers following the conclusion of the group’s work, we will expect to question them on their proposals to tackle this problem.
82.Reflecting the contribution which early years provision makes to the objectives of a number of Government departments, funding for local plans (see paragraph 42) should be drawn from existing budgets across Government, including the Department for Work and Pensions, the Department for Education, the Home Office and the Ministry of Justice as well as the Department for Health and Social Care.
Whitehall
Leadership
83.The challenge of giving every child the best start in life, we heard repeatedly, requires national leadership, particularly political leadership, to:
- set a vision of the outcomes Government and public services should seek to achieve;
- coordinate the work of multiple departments and agencies;
- provide strategic direction to local areas and hold them to account; and
- ensure the issue remains a priority and continues to attract resources.
84.There were widespread calls for a political consensus on the importance of the early years, with many respondents praising the cross-party manifesto on the 1001 Critical Days. Douglas Hargreaves from the Nuffield Trust, a consultant paediatrician, argued that there should be a “cross-party societal consensus that the health, wellbeing and early development of children in the early years is a national priority.”144
85.Within Government, we heard about the importance of ministerial responsibility and accountability for the first 1000 days, preferably with a seat at Cabinet. The establishment of the Early Years and Family Support ministerial group, led by Rt Hon Andrea Leadsom MP, was widely welcomed within the evidence we received. The ministerial group is made up of ministers from multiple departments with responsibility for the first 1000 days: the Cabinet Office, the Ministry for Housing, Communities and Local Government, the Department for Education, the Department of Health and Social Care, the Department for Work and Pensions and the Treasury. Witnesses told us that it is important that this political leadership and cross-Government collaboration should continue. The Royal College of Nursing told us that a minister should be “responsible for the delivery of this strategy” and be “required to make regular reports on progress to Parliament.”145 The overwhelming majority of organisations who submitted written evidence to our inquiry called for a cross-government approach to the first 1000 days. To be effective a minister responsible and accountable for the first 1000 days of life must able to work cross-government to secure and maintain the contribution of different departments.
86.We recommend that the Cabinet Office Minister represented at Cabinet (currently the Chancellor of the Duchy of Lancaster) should be given specific responsibility for the development and oversight of a national strategy to give every child the best start in life. That minister should chair a new Cabinet sub-committee, consisting of ministers from across Government, who should each be responsible for ensuring the implementation of the strategy in their department and for holding one another to account for delivery of the strategy across government.
Cross-government working
87.Responsibility for supporting children, parents and families in the first 1000 days of a child’s life spans multiple departments and agencies. The evidence we received lists a variety of policies, projects and programmes taking place across different government departments and agencies. However, the current approach is fragmented. Anne Longfield, the Children’s Commissioner, pointed out that, despite occasional examples of good coordination, interventions across Government are conducted in “relative isolation”, with different interventions running across different departments at different stages.146 Public Health England, in its written evidence, suggests that a national cross-government strategy could make existing cross-government arrangements more effective by providing a framework through which departments and arms-length bodies could “collaborate in a structured, visible way.”147
88.We recommend that the Secretary of State should accelerate his consideration of a health in all policies approach to policy-making, as indicated in his statement on prevention in the House on 5th November 2018. This approach should be adopted as soon as possible to support the work of the relevant Cabinet minister and sub-committee.
89.We recommend that a small, centralised delivery team, within the Cabinet Office, should be established to support this new ministerial role. The team will be responsible for coordinating activity between departments and monitoring progress against the delivery of the strategy.
Vision
90.A compelling, long-term strategic vision for giving every child the best start in life is needed nationally as well as locally. Nationally such a vision must extend beyond the 5-year political cycle.148 Extending beyond the 5-year cycle is critical as the benefits of early intervention are not seen immediately.149 As part of a national vision, Government has an important role in setting out the high-level outcomes that should be achieved nationally, and for holding local areas to account for their contribution (see the section on Oversight, support and intervention).
91.The King’s Fund recently made the case for a set of “clear, time-limited, binding high-level national goals” to improve population health.150 These goals should, according to The King’s Fund, be carefully chosen so as to focus on areas where national leadership can support action regionally and locally, move public debate towards a focus on outcomes, reduce inequalities, and incentivise collaboration.151
92.The Government’s recently published Prevention Vision sets out a series of actions government departments are taking to give every child the best start in life, many of which include interventions in the first 1000 days. In taking forward this vision, we would like to see the Government adopt high-level strategic goals that aim to deliver improved outcomes for children and reduce inequalities. Specifically, we would like to see the Government commit to reducing infant mortality, reducing adverse childhood experiences and increasing school readiness, with a focus on reducing inequalities in outcomes in those areas:
- Infant mortality. The majority of deaths in childhood occur before children reach their first birthday. We heard that improvements in infant mortality have stalled in the UK and have continued to lag behind other OECD countries.152,153 Infant mortality is strongly socially determined, with strong links to maternal deprivation and teenage pregnancy, and is influenced by unhealthy behaviours, such as smoking during pregnancy.154 A focus on reducing infant mortality should therefore involve a wide set of actions that encourage healthier pregnancies, with a focus on addressing inequalities.
- Adverse childhood experiences (ACEs). Exposure to adverse experiences in childhood (parental conflict and separation, parents with drug or alcohol problems, parents with mental health problems) is associated with poor health, development and life chances.155 In 2017, a review of 37 studies, published in The Lancet, found that individuals with at least four ACEs were at much greater risk of poor health outcomes (such as problematic drug and alcohol use and self-directed violence) compared with individuals with no ACEs; attempting suicide in adulthood had the strongest association.156 People with four or more ACEs were thirty times more likely to attempt suicide.157 As mentioned earlier, adversity during childhood can influence a person’s parenting behaviour, resulting in the cycles of disadvantage that pass from one generation to the next.158 Preventing the occurrence of childhood adversity, and its impact, requires action across government nationally as well as locally.
- School readiness. Almost a third of children in England do not reach a good level of development, known as school readiness, by the end of reception.159 There has been a rapid increase from 2012/13 to 2016/17 in the rate of children achieving school readiness, up from 52% to 71%, but poorer children lag behind the rest. Only 56% of children on free school meals in 2016/17 were ready to start school at five.160 Improving school readiness requires intervening early and addressing social inequalities. Income-related gaps in children’s language development are evident by the time a child is 18 months old.161
93.We recommend the Government develop, as part of a national strategy, ambitious high-level goals to:
with a focus on reducing child poverty and inequalities, and their impact.
Workforce
94.Having people with the right knowledge, skills, and experiences, and deploying them effectively, is crucial to supporting and empowering parents and families to take care of their children and themselves. During this period of a child’s life every contact children, parents and families have with services matters.162 The voluntary and community sectors can supplement services delivered by the NHS and local authorities, but must not be a substitute for them. To assist workforce planning more research is needed on how professional practice affects outcomes.163 However, when thinking about the workforce covering the first 1000 days three key messages stood out. Government and local areas should:
- Invest in the capacity and capability of staff to build relationships with parents and families. Some services are highly relational by design, such as targeted and specialist services (e.g. PIP and FNP),164 but continuity of care is vital to the delivery of high-quality care throughout this period of a child’s life, not just in targeted or specialist services or during pregnancy.165 The ability of staff to build trusting relationships with the parents and families they work with helps them to identify risks, engage parents about how best to care for their child and themselves and support them to change their behaviour, if necessary.
- Enhance awareness of child development, and its importance, including the factors that promote and threaten healthy development, among all staff working with children, parents and families during this period.166 This includes giving staff the skills and confidence to raise sensitive issues with parents, including issues about their lifestyle.167
- Cultivate a mixed workforce economy locally, with a diverse range of knowledge, skills and experiences. Qualified professionals have an important role in delivering services, which should not be substituted for low-skilled staff. When properly resourced, qualified professionals can also help to upskill the wider workforce. A broad skill mix can enhance local provision. For example, peer support workers are being used effectively to support parents and families in a variety of ways. As the Big Lottery Fund explained, peer support is useful as, “some parents may find it easier to relate to a peer who has gone through similar experiences; they may feel that the peer understands what they are going through and won’t judge them.”168 The Government, and Health Education England, play a critical role in ensuring supply of suitably trained health professionals. However, cultivating a diverse workforce economy also requires action from those operating at local system (e.g. policies that retain healthcare professionals), place-based and neighbourhood levels (e.g. establishing and maintaining links with local volunteers).
95.Improving support for children, parents and families during the first 1000 days is likely to require transforming the way services are delivered. Workforce engagement is a vital part of this. During our visit to Blackpool, we heard how the Big Lottery Fund’s investment had helped create headroom for staff, such as health visitors, to engage in transforming the way services are delivered locally. For example, local health visitors were actively engaged in the changes which has led to Blackpool offering 3 additional visits on top of the 5 mandated ones (see paragraph 29).169 Engaging staff in transformation is difficult. Workforce shortages and rising demand mean that staff are under pressure to implement service changes while maintaining business as usual.
96.Staffing shortfalls across the universal, targeted and specialist services provided during the first 1000 days of a child’s life are a barrier to high-quality support for children, parents and families. Shortfalls across universal services, particularly health visitors, midwives and GPs, have drastically cut the time professionals spend with parents and families,170 particularly those deemed to be less in need. We have also heard examples of qualified professionals, particularly midwives and health visitors, being substituted for less qualified staff.171 The Institute for Health Visiting’s written evidence shows that the number of health visitors employed by the NHS has fallen since 2015 from just over 10,000 to just under 8000 as of April 2018 (though it should be noted that these figures do not provide a full picture of the total number of health visitors in England, as figures on health visitors working in non-NHS providers are no longer collected).172
97.The absence of specialist skills in some local areas inhibits the uptake of targeted and specialist care and support across the country. A shortage of specialist skills means that some specialist services are not commissioned locally, which in turn acts as a disincentive for professionals to specialise, as PIP UK pointed out.173 Many specialist roles do not exist in most areas, such as midwives and health visitors specialising in perinatal mental health.174
98.As part of a national strategy, 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, and other national bodies, will support local areas at a system, placed-based and neighbourhood level to enhance the capacity, capability and skill mix of staff, including voluntary staff, who support children, parents and families during the first 1000 days.
Information sharing
99.Joined-up care and support for children, parents and families has been inhibited by barriers to sharing and linking information. Problems—both real and perceived—with sharing and linking information across professional and service boundaries appear to be ubiquitous.175 These echo concerns about data sharing first raised during the Committee’s 2016 inquiry into public health.176Evidence from the Liverpool First 1001 Critical Days Strategic Group provides an account of problems in sharing and linking information, which are common among other areas. According to the group:
A range of data systems are in use across sectors and organisations with limited if any, connectivity across. This is also coupled with sensitivities about information sharing from frontline staff, even in the presence of information sharing agreements. The limited connectivity across organisations also means opportunities for data linkage are at best, very limited.177
100.One major barrier to sharing information is a fear on the part of professionals about what information they can share, with whom and in what way. Fear about sharing information stems from uncertainty about how to share information legally and in accordance with professional codes of conduct.178 During our focus group in Blackpool we heard that the introduction of the new EU General Data Protection Regulation (GDPR) has created more uncertainty.179
101.Separate data systems between local public services, as well as voluntary sector services that support them, present a physical barrier to providing integrated care for children, parents and families.180 For example, we were told during our visit in Blackpool that health visitors, GPs and social workers had separate case management systems, which had restricted their ability to share information.181 As part of the Big Lottery Fund project, local organisations in Blackpool are being supported to develop a town-wide system to make it easier for local services to share and compare data. Other areas, such as Liverpool, are undertaking similar work in order to share information better and gain a more comprehensive picture of the needs of children, parents and families in their area and their use of services.
102.Public Health England told us that new national standards covering the electronic sharing of information are due to be published this year, as part of the Digital Child Health Programme. These standards will set out the mechanisms for transferring data electronically between clinical settings (interoperability). This is a positive step forward, although it is not clear which clinical settings will be covered within the guidance.182
103.The inability to link data has inhibited the ability of those working at both a local and national level to gain a comprehensive picture of provision during the first 1000 days of life, including how public money is spent, how services are used and the effect of service provision on outcomes. Public Health England confirm that health datasets include unique identifiers which means that they can be linked to other health datasets as well as datasets covering other public services. For example, PHE suggest that linking the Community Services Dataset to the National Pupil Database is possible and would provide an opportunity for “educational progress to be baselined from age two to two and half years rather than at school entry.”183
104.As part of a national strategy, we recommend that the Government provide guidance and support to local areas about how services for children, parents and families can effectively share information. Guidance must explain clearly what is permissible to share, with whom and in what way, in accordance with all applicable legislation.
Oversight, support and intervention
105.The evidence we have received favours a place-based approach, in which local areas are empowered to make decisions about the best way to meet the needs of their local population and to achieve nationally set outcomes. While we strongly support this approach, there are two key reasons why Government and other national bodies should play a an additional and more active role.
106.To begin with, there are widespread, and largely unwarranted, variations at a local level in the provision of services, including what is offered and how services are implemented, and in the outcomes that are achieved. A wide range of approaches have a robust evidence base to show that they can improve outcomes for children, yet these evidence-based approaches are often not commissioned at a local level (see paragraph 38).184 Where evidence-based interventions are applied, they are often done so in a manner that reduces their efficacy, with the intention of saving money.185
107.Secondly, Government and other national bodies can play an important role by helping local areas to continuously improve and adapt. Knowledge about the risks to children is progressing at a faster rate than the evidence base on how to effectively address or mitigate these risks.186 We agree with the Early Intervention Foundation that “expanding the evidence base for early intervention requires national oversight to guide, coordinate and enable a range of new activity designed to fill critical gaps”.187 The Early Intervention Foundation argue that one of the barriers to early intervention is gaps in the evidence base covering:
- interventions that address known risks to children;
- effective professional practice. For example, as noted in the section on workforce, more research is needed to understand the importance of relationships between staff and service users; and
- interventions that work at a system level. Understanding of what works at a whole system level locally is also progressing, but remains in its infancy.188
108.Government, and other national bodies, can also help fill gaps in the evidence by enhancing the capacity and capability of local areas to generate evidence themselves about what works as well as the capability to apply proven interventions locally.189
109.Currently, there is very little information held centrally about aspects of local provision, such as the targeted and specialist interventions commissioned and provided locally.190 Similarly, difficulties in linking data has made it difficult to gain a sophisticated understanding of how services are used and the outcomes they deliver.191
110.Whole system approaches to improving support for children, parents and families are still in their infancy.192 However, we would like to see all local areas, through the development of local plans (see paragraph 42), commit to identify, test and, in time, adopt whole systems approaches that improve outcomes for children. The starting point and circumstances in each area will be different. The Government and other national bodies should develop a nuanced set of approaches to driving improvement tailored to an area’s needs and resources.
111.The system levers at national level are weak. Much of the responsibility for commissioning services has been devolved to local authorities. Public Health England provide guidance, support and advice to local areas, but have no powers to compel them to take up this advice.193 For example, PHE’s written evidence notes a risk that local areas, who are operating in constrained financial circumstances, may not decide to take up evidence-based approaches.194 We have heard evidence of interventions being implemented that do not have a strong evidence-base such as infant massage in the general population.195
112.The Government’s main levers over much of local provision are funding, which is significantly constrained, and legislation.196 Where legislation is in place it has not necessarily been successful. For example, delivery of the 5 mandated checks, as part of the Healthy Child Programme, varies widely. Action for Children informed us that there are questions about the strength of legislation covering the early years. For example, the “The Childcare Act 2006 places a duty on local authorities to improve outcomes for children and reduce inequalities in the early years.” However, the Government does not monitor compliance with that duty.197
113.The NHS, according to the NHS Long-term Plan, may play a stronger role in the commissioning of public health services which are currently undertaken by local authorities. The argument made within the Plan is that these services are closely linked to NHS care and are often provided by NHS trusts. This is a pragmatic step, but the Government should avoid substituting one silo for another. Instead, the Government and national bodies should support the NHS and local authorities to commission services collaboratively through the voluntary pooling of budgets and the establishment of joint commissioning teams, as advocated within the plan.198
114.The Government must to do more to bolster its ability to support local areas, hold them to account and intervene, when necessary. 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. This applies to whole system approaches as well as single interventions. Local authorities should be prevented from continuing to pursue the delivery of programmes for which there is no evidence base.
115.We recommend that an expert advisory group should be established to support the Government by coordinating a national approach to filling gaps in research and to advise on how the national strategy should adapt accordingly over time to reflect this evidence.
116.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 recommend this team should be comprised of, and where necessary be able to call on the advice of other, experts from multiple disciplines, including those with specific professional expertise and skill sets (e.g. implementation science and quality improvement).
117.We support the proposals within the NHS Long-term Plan for the NHS to play a greater role in the commissioning of public health services. The Government and national bodies should encourage the NHS to work collaboratively with local authorities to commission these services, through encouraging the voluntary pooling of budgets and the establishment of joint commissioning teams.
125 The Children’s Commissioners and Institute for Fiscal Studies, Public spending on Children in England, June 2018
126 The Children’s Commissioners and Institute for Fiscal Studies, Public spending on Children in England, June 2018
127 The Children’s Commissioners and Institute for Fiscal Studies, Public spending on Children in England, June 2018
128 The Children’s Commissioners and Institute for Fiscal Studies, Public spending on Children in England, June 2018
134 Royal College of Speech and Language Therapists (FDL0043),Action for Children (FDL0044),Family Nurse Partnership National Unit (FDL0076),National Children’s Bureau (FDL0050).
136 Early Intervention Foundation, Realising the Potential of Early Intervention, October 2018
137 Early Intervention Foundation, Realising the Potential of Early Intervention, October 2018, WAVE Trust (FDL0073), HENRY (FDL0037), Parent Infant Partnership (PIP) UK (FDL0016), The Health Foundation (FDL0081), Family Nurse Partnership National Unit (FDL0076), Barnardo’s (FDL0020)
138 Early Intervention Foundation, Realising the Potential of Early Intervention, October 2018
139 Early Intervention Foundation, Realising the Potential of Early Intervention, October 2018
140 Early Intervention Foundation, Realising the Potential of Early Intervention, October 2018
141 Association of Directors of Public Health (FDL0059),Royal College of Speech and Language Therapists (FDL0043),Royal College of Psychiatrists (FDL0039)
148 Liverpool First 1001 Critical Days Strategic Group (FDL0049), The Association for infant Mental Health (AIMH (UK)) (FDL0032)
149 Early Intervention Foundation, Realising the Potential of Early Intervention, October 2018,
150 The King’s Fund, A vision for population health: towards a healthier future, November 2018
151 The King’s Fund, A vision for population health: towards a healthier future, November 2018
156 Hughes K, Bellis MA, Hardcastle KA, Sethi D, Butchart A, Mikton C, Jones L, Dunne MP. The impact of multiple adverse childhood experiences on health: a systematic review and meta-analysis. Lancet Public Health 2017; 2:
157 The systematic review in The Lancet found that individuals with four or more ACEs had an odds ratio of 30.14 for suicide attempts (confidence interval of 14·73–61·67). This was the strongest association of all the outcomes covered, although suicide attempts are a rare outcome compared to the other outcomes included in the study (e.g. smoking) and are less well covered by population surveys. The odds ratio of 30.14 is based on three studies one of which only included students. When this study was removed the odds ratio fell to 12.53.
163 Family Nurse Partnership National Unit (FDL0076), Early Intervention Foundation, Realising the Potential of Early Intervention, October 2018
168 The Big Lottery Fund, A Better Start: 2018 Knowledge and Learning Programme Briefing, December 2018.
169 A service of first resort: How a refreshed and revitalised model for health visiting helped to transform the lives of deprived families in Blackpool, Lancashire, Community Practitioner, July/August 2018
176 House of Commons Health Committee, Public Health post-2013: second report of the 2016–17 session, July 2016 HC 140
179 See Annex 3
181 See Annex 2
184 Early Intervention Foundation, Realising the Potential of Early Intervention, October 2018
185 Early Intervention Foundation, Realising the Potential of Early Intervention, October 2018
187 Early Intervention Foundation, Realising the Potential of Early Intervention, October 2018
188 Early Intervention Foundation, Realising the Potential of Early Intervention, October 2018
189 Early Intervention Foundation, Realising the Potential of Early Intervention, October 2018
190 Early Intervention Foundation, Realising the Potential of Early Intervention, October 2018
192 Early Intervention Foundation, Realising the Potential of Early Intervention, October 2018
198 NHS England, The NHS Long-term Plan, January 2019
Published: 26 February 2019