First 1,000 Days of Life

Health and Social Care Committee

We now come to the Select Committee statement on behalf of the Health and Social Care Committee. Paulette Hamilton will speak for up to 10 minutes, during which no interventions may be taken. At the conclusion of her statement, I will call Members to ask questions on the subject of the statement. These should be brief questions, not full speeches. I emphasise that questions should be directed to the Select Committee Chair and not the relevant Minister. Front Benchers may, however, take part in questioning.

On behalf of the Health and Social Care Committee, it is a pleasure to present to the House our fifth report of this Parliament, which is on the subject of the first 1,000 days of life. I thank the Backbench Business Committee for allocating time for this statement. We chose this subject because this period of life is crucial for long-term health, educational outcomes and life chances, and because child health in this country is in an alarmingly poor state. As the Royal College of Paediatrics and Child Health has stated, our children have some of the poorest health outcomes in Europe. That is why this report is so important, and why it is essential that we get this right.

We know that investment in early intervention is highly cost-effective, yet we continue to see rising obesity, uneven vaccination coverage and persistent inequalities. We therefore welcome the Government’s expansion of the family hub network. However, we must be clear about the scale of the challenge those hubs are being asked to address—supporting a much broader range of children than the previous Sure Start system with fewer resources. That is why we have called on the Government to go further by ensuring access to family hubs in every community, underpinned by reliable, long-term funding. A single hub per county is simply insufficient and will leave families isolated. This must be matched by urgent action to restore the health visitor workforce, which is the backbone of early years care. Since 2015, numbers have fallen by 43%, leaving a shortfall of 5,000 posts. Caseloads remain dangerously high, sometimes exceeding 750 children. We have therefore called for a funded plan to recruit at least 1,000 additional health visitors.

The wider workforce is also critical. Health visitors are not the only key professionals involved in supporting children and their parents during that first 1,000-day period—midwives, children’s nurses, general practitioners, early years practitioners, speech and language therapists, paediatricians and others all play incredibly important roles. The Government’s forthcoming NHS 10-year workforce plan must include specific, funded targets for increasing the number of professionals working in early years roles, underpinned by updated modelling of future demand. However, we cannot focus solely on the NHS, as many of these professionals work outside it. That is why we have supported the call of the Royal College of Paediatrics and Child Health for a children’s health workforce strategy to address the staffing needs holistically.

It was a pleasure to serve under the chairmanship of my hon. Friend during our Committee’s inquiry into the first 1,000 days of life. I was particularly struck by how, at this crucial period in a child’s lifetime—for those who are not aware, the 1,000 days begins at the moment of conception and goes up until they are two years old—so many services that should basically be placing a hug around the family and around the child have instead been decimated. Those services come at a critical stage. I am grateful that the Minister for Early Education, my hon. Friend the Member for Reading West and Mid Berkshire (Olivia Bailey), is on the Front Bench to hear the statement.

Does my hon. Friend the Member for Birmingham Erdington (Paulette Hamilton) agree that if the Government does not grasp the scale of this challenge or accept our Committee’s recommendations—I urge them to do so in full—we run the risk of undermining some of our reforms in special educational needs and disabilities? By investing in the early years and by taking the action that that my hon. Friend has outlined—we must ensure early intervention and that we rebuild the health visitor network, so that the families who need extra support and care are identified early and can be got into the network of family hubs to receive that support—the rest of our reforms, including to the SEND system, can go ahead. Without that investment, and without the Government taking heed of what our Committee has recommended, we run the very real risk of all that work being undermined.

I thank my hon. Friend for all the hard work she put into this report. It could not have been achieved without everybody on the team working so diligently. Family hubs are an incredibly valuable resource, and they deal with all the issues that she raises. The problem is that we just have not got enough of them. One per county will not do. If we are really talking about early prevention, working with families and raising standards of care, we need more family hubs and more healthcare professionals and paediatricians within those services. We need to ensure that we are looking at this holistically, and not just as a preventive measure.

I thank my hon. Friend for her statement and the Health and Social Care Committee for all its work on this vital stage of childhood. Last year, the Education Committee published our report, “Solving the SEND Crisis”, which highlighted the following: the importance of early identification of special educational needs and disabilities; the absence, all too often, of health from the network of support that children with SEND need; the lack of accountability around these services; and, inconsistent access to expertise on SEND in early years settings. I welcome the Health and Social Care Committee’s call for a children’s health workforce strategy. Will my hon. Friend say more about how the Government can help to ensure that we have the early years workforce we need? Did the Committee look specifically at the question of accountability for health services in delivering support for SEND?

My hon. Friend raises a crucial point. These services are just not joined up. We have got young children who, from birth to two and a half years old, are not getting the health services they need. They then go into the education system and are falling behind. The strategy is just not appropriate, as has been highlighted. As the Committee highlighted, we need a new strategy, and it must be joined up. We need a strategy that takes into account not just health issues, but education and care issues. Through that, we will incorporate all the professionals who are needed for that wraparound service to be delivered.

I thank my hon. Friend for today’s statement and for her excellent work in chairing the Committee’s important inquiry. It is much appreciated. There is much to welcome in this report. Colleagues have already touched on a number of the measures, so I will focus in particular on vaccination.

The state of vaccination rates in this country shocked me during the inquiry. I think we all came to accept the success, the prevalence and the uptake of vaccinations, but now, for a number of reasons—including disinformation, some of which comes from elements in this Chamber—vaccination rates have been declining across the board for many years. This week, the UK lost its measles elimination status, which is shameful and an indictment of the situation in which we have got ourselves.

In the light of that, does my hon. Friend agree that we need to accelerate things such as the health visitor pilot for delivering vaccinations? We heard positive things about that in the Committee, but progress has been slow. Does she agree that we need to accelerate those actions already in train? Does she agree that we should restore the World Health Organisation target of 95% vaccination uptake nationally? Finally, does she accept that the last Government’s vaccination strategy, developed in 2023, has clearly failed, considering where we are today? Does she think that the Government need to look again at a new national vaccination strategy so that we can get back to where we once were and then make more progress, ensuring that every child has the vaccination they need to protect them and to live a healthy and fulfilling life?

My hon. Friend is passionate about the administration of vaccinations, and he has asked quite a lot of questions. I absolutely agree with them all, but I will focus on his questions relating to health visitors and to having more of a strategy on vaccinations. I hope that everybody present has read the report, which states very clearly that health visitors have massive caseloads of over 750. That means they are not able to give children the time that they need. We have recommended that we employ 1,000 extra health visitors, but we have also noted in the report that health visitors have a statutory right to visit children five times until they get to the age of two and a half. We have said that we should increase that to a minimum of six visits, which is what already happens in Wales. The minimum number of visits in Scotland is 11, and I think it is nine in Northern Ireland—I apologise if I have got that figure wrong. England has the lowest number of visits in the United Kingdom, and it needs to be increased.

I absolutely agree with my hon. Friend that we need to have more of a focus on vaccine levels, and to get the new strategy in place. Without a strategy, we are not going to get what we need in this area as quickly as we need it to happen.