'Everybody is saying the same thing': Is government meeting its goal to set every child up for success in their first 1,000 days of life?

The first 1,000 days of a child’s life are widely agreed to be pivotal in influencing their long-term health, success and wellbeing. But children in the UK now have some of the worst outcomes in Europe across a number of key metrics, acting Health and Social Care Committee chair Paulette Hamilton tells CSW, “with a fifth of children aged five classified as overweight or obese and childhood vaccination rates falling below the World Health Organization’s recommended levels”.

“And we had a 250% increase in the prevalence of life-limiting and life-threatening conditions in children and young people from 2001 until 2018 – and it was still getting worse,” she adds.

These are some of the statistics the committee had in mind when it launched its inquiry into the subject in March.

The committee last tackled this theme in 2019, finding significant variation in the provision of support during children’s first three years. The report from the 2019 inquiry called for a “long-term, cross-government strategy for the first 1,000 days of life, setting demanding goals to reduce adverse childhood experiences, improve school readiness and reduce infant mortality and child poverty”.

Fast forward to 2025 and there is now a cross-government mission focused on breaking down barriers to opportunity and a commitment to “set every child up for the best start in life”. But have things improved for children since 2019?

Two big themes have emerged so far in the inquiry, The first 1,000 days: A renewed focus, echoing the findings of the previous one. The first, “and I know you’re not going to be surprised,” says Hamilton, is funding. The witnesses the committee saw before recess were in agreement “that the resources going into family hubs, daycare, any type of position for children were just very hit or miss, depending on where you were in the country”, she says.

The second major theme is workforce constraints – with shortages in fields including health visiting, speech and language therapy, educational psychology and paediatrics, leading to long waits and preventing early referrals. The NHS long-term workforce plan, published in 2023, said local services were reporting more than 112,000 vacancies.

“Everybody was saying the same thing,” Hamilton says of the witnesses so far. “We need to invest in training, we need to invest in recruiting people, we need to invest in retaining our staff… and career progression for early years professionals through dedicated workforce initiatives.”

The committee has held three evidence sessions so far. Experts from healthcare, think tanks and local government have contributed, as well as Sir Michael Marmot, who led a 2010 review of health inequalities in England, and Dame Andrea Leadsom, a former health minister who led the Early Years Healthy Development Review that led to the family hubs programme.

All of this has given the committee “lots to draw from” in its upcoming evidence session with public health minister Ashley Dalton, Hamilton says.

There are two new elements for the committee to examine this time round. The first is Integrated Care Systems – partnerships between NHS bodies, local authorities and other partners that replaced clinical commissioning groups in England in 2022. The second is a programme, set up in 2021, to establish family hubs across the country to act as “one-stop shops” for parents seeking support in areas such as breastfeeding, housing issues and children’s early development and language. The government now has a goal of setting up 1,000 of these hubs by the end of 2028 under its Best Start programme.

Hamilton is keen to press Dalton on her plans for family hubs, given “we’re not 100% sure that they totally work in the format that they’re in”.

In particular, she says, she wants to explore witnesses’ concerns about short-term funding for the hubs: “We knew that we needed to bring the health visitors, midwives, GP outreach, domestic abuse [services] and food banks all together. We knew this ‘one-stop-shop’ [model]... would be a benefit, but the problem that it suffered was it didn’t have enough funding, they had capacity constraints, and also the budget seemed to come from everywhere.”

The committee has also received written evidence from a broad range of organisations. One such submission from the United Nations children’s aid agency UNICEF noted that investment in family hubs and children’s centres has fallen by 77% since 2010. “Short-term, fragmented national funding undermines the ability of services to plan and deliver quality care,” it said.

The NHS Confederation meanwhile identified funding – “including how ICSs want to see longer-term, better-aligned funding cycles across Whitehall departments to enable partnership working locally” – as one major barrier to Integrated Care Systems achieving their aim of “promoting and enhancing collaboration among sectors in local communities which are helping to support children in their first 1,000 days of life”. Other barriers included capital issues, particularly in primary care infrastructure; digital capacity gaps; and 50% cuts to the running costs of ICSs announced earlier this year.

“Additionally, the increasing focus on delivery within the acute sector of the NHS means there is a risk more long-term ambitions, such as improving the first 1,000 days of life to drive improved health outcomes, are not something systems are able to prioritise,” added the membership body, which represents organisations that commission and provide NHS services in England, Wales and Northern Ireland.

One statistic that particularly struck Hamilton came from Dr Christine Farquharson, associate director at the Institute for Fiscal Studies, who gave evidence in June. She told the committee that funding for Sure Start stood at a little over £2bn a year in today’s prices at its peak in 2010. “Whereas for family hubs, even if you take the maximalist approach of counting everything that local authorities are doing, and potentially double-counting some spend, you are looking at something less than £600m a year,” Farquharson said. “So there is a massive difference in the scale of resource going into these services right now.”

"We knew this ‘one-stop-shop’ model would be a benefit, but it didn’t have enough funding, they had capacity constraints, and the budget seemed to come from everywhere"

Alongside funding and workforce woes, what other themes have emerged in the inquiry so far? Hamilton points to technology and new ways of working – “AI is massive, and I think we have got to start thinking in more innovative ways” – and working with partners. Government, both local and national, can seem “quite remote” and inaccessible to external organisations, she notes.

Then there is joined-up working within government. For obvious reasons, the committee is focusing its efforts on the NHS and the Department for Health and Social Care, but Hamilton says it will be looking for answers from the Department for Education too.

“Where government joins things up, the success rates are far higher. The problem is you have the left thumb doing a job, and it struggles sometimes to join with the left finger doing a similar job. But they just need to come together,” she says.

Hamilton hopes the committee’s inquiry will lead to a more joined-up approach to supporting families and that “the government will take on board, from the recommendations that we give, that a more joined-up approach will be far better for outcomes for children”.

Setting children up for success during “the first 1,001 days of life” is one of four key areas of focus for the government’s opportunity mission. The goal encompasses integrated maternity, baby and family support services and early years education and childcare. Does Hamilton believe the mission-led approach will be effective?

“That is a really good question, and I am not sure I can answer that,” she says. “I do like the mission approach. The only thing is, I’m not sure people understand it. I’m not sure if it will join up this sector unless we really start to do some education so that people understand the mission.”

As part of their research for the inquiry the MPs visited Blackpool this summer, where they spoke to professionals at a family hub about their goals, funding and how they work with different communities.

Hamilton says she was struck by the importance of midwives, who keep close contact with mothers throughout pregnancy, and health visitors, who continue home visits until the child is three or four years old. She compares it to services in her own constituency of Birmingham Erdington, a deprived and predominantly working-class area, where she says “you barely see a midwife because the shortages are so bad”. And where many new parents are being asked to come into clinics, rather than having home visits, “so midwives and health visitors are not seeing the home environment, if anything’s going wrong, if Mum is coping”.

In Blackpool, Hamilton says, “I liked the fact that they really tracked the mothers and they were able to absolutely see what was going on in a family. Whereas I think that in areas like Birmingham, we seem to be losing that a little bit. You’re lucky if you get health visitors coming to see you more than once.”

The Blackpool hub also operates a drop-in service that Hamilton says she’d love to see in her constituency. “You could go as often or as little as you wanted… you could get advice and feel it was open to you, and the professionals were at hand to support if needed,” she says.

“And the provision was well resourced. Mums didn’t have to travel that far to get to the resource and it was accessible to all… you saw couples in there with their little babs and they were there playing, and if they had any difficult questions, they could ask.”

This service could be especially valuable for people who are transient in the community, Hamilton says, as she has seen in her own constituency. “They’re not tracked very much. And I felt as long as they were in Blackpool, they were being tracked, so someone was keeping an eye on them,” she says.

“It’s not just about the big technical things, because most authorities will tell you what they’re doing, but it’s how they keep an eye on people,” she adds.

“I’m a black woman, I was a single mum. Healthcare workers don’t know what’s going on in the household, they don’t know how I’m coping... there was nowhere for me to go to ask questions”

She thinks back to her own experience of being pregnant. “I’m a black woman, I was a single mum. [Healthcare workers] don’t know what’s going on in the household, they don’t know how I’m coping with the pregnancy. I go to the hospital once, I feel no one is listening to any of my stories or what have you unless I hit crisis point. In Erdington, we haven’t got a single hub. So at the end of the day, there was nowhere for me to go to ask questions as a first-time mum.”

Even now as an MP, it can be difficult to know where to direct constituents who are in dire need of help. Hamilton explains how she used her contacts in the community recently to help a mother of four who contacted her office saying she had no way to feed her children – directing her to a food bank and sourcing secondhand school uniforms. But there was no central resource or hub to send her to for further support.

For Hamilton, this underscores the importance of the committee’s inquiry and the work it is examining. “It is so important that we become our brother’s keeper,” she says.

“So we do need the finances, we need the support mechanisms. We need the services working together and we need the resource of proper, organised hubs. And I do believe it can work.” 

This article first appeared in CSW's autumn 2025 issue, out now