WIREDGOV

The UK has some of the worst health outcomes for young children in Europe. But a new report by the Health and Social Care Committee says that improving access to health visitors and Family Hubs whilst boosting vaccine uptake would help improve the lives of infants in England. 

• Read the report (HTML)
• Read the report (PDF)
• Inquiry: The First 1000 Days: a renewed focus

The cross-party Committee’s report focuses on the first 1,000 days of life, from conception to age two. This period is universally recognised as a critical window for shaping brain development and future mental and physical health. 

A primary recommendation to the Government is that Family Hubs, where parents can get expert advice and support, should be rolled out to more communities where need is greatest. Family Hubs should also offer improved perinatal mental health services to caregivers. 

The last decade has seen a collapse in the number of health visitors meaning they can’t help everyone who needs it because of excessive caseloads. The Government must commit to recruit at least 1,000 more. Every parent and infant should receive a minimum of six health visits during the early years. 

The Government urgently needs a new strategy to turnaround the falling vaccination rates and should aim for 95% coverage throughout England. It should explore ways to train health visitors to deliver vaccinations; increasing the size of the workforce should simultaneously improve vaccination rates. 

Chair's comment

Speaking on behalf of the Committee, Paulette Hamilton MP said:  

“Children growing up in our country today stand too great a chance of becoming overweight, developing asthma or tooth decay, or catching life-threatening yet preventable diseases due to missed vaccines. The Royal College of Paediatrics and Child Health says the UK has some of the worst health outcomes for young children in Europe. This should be a source of shame. 

“Over the last two decades we have seen a hollowing out of health services for infants – the Family Hubs programme still barely touches the sides of what was once provided by Sure Start centres before they were forced to close. And our provision of health visitor appointments is woefully inadequate in some parts of the country.  

“This Committee now calls on the Government to reestablish health visiting as a cornerstone of the state’s support for families in communities across England, offering help with perinatal mental health, advice on a range of issues on health and development and helping to get more children vaccinated against illnesses which should be all but non-existent in 21st century Britain.” 

Revive the health visitor workforce 

Unicef and the NSPCC highlighted the essential work of health visitors in addressing inequalities and giving parents space to discuss sensitive concerns about their baby’s development. 

But the number of health visitors has plummeted over the last decade. By December 2024 there were only 6,300 in England – a 43% reduction since 2015. The Institute of Health Visiting said individual health visitors in some areas have caseloads of up to 1,000. 

Recommendations: 

• The Committee recommends that the Government must commit to recruiting 1,000 health visitors, and to use individual caseloads as a measure of how many will need to be recruited every year.
• The Government must set out steps to improve poor performance of local authorities where families are not receiving sufficient health visits. Some councils delivered 100% of the target – for every parent or caregiver to receive five visits by age two-and-a-half. The worst performing council had only 4% take up.
• Ministers should commit to increasing the number of mandatory health visitor contacts for children in England from five to six, alongside plans to scale up the health visitor workforce. England is an outlier in only mandating five health visits – Scotland mandates 11 visits, Northern Ireland mandates nine visits and Wales six. 

Family Hubs in every community 

Family Hubs are local centres that act as one-stop shops for children and caregivers, offering access to midwives, GPs, youth workers, family support workers, and early years practitioners. Research by the Centre for Social Justice found that every £1 spent on Family Hubs saves £2.60 in provision of services later in a child’s life. The Hubs could also address the inequitable access to services. Over one third of parents from low-income households are unable to access children’s centres or family hubs in their local area, compared to 23% of parents on average incomes. 

Recommendations: 

• The current policy of expanding Family Hubs to every local authority is a positive step, but the Government should set out plans to expand the network to every community, with ringfenced, long-term funding. This should happen beyond the current £500m tranche of funding up to 2028/29.
• MPs also urge the Government to spell out how Family Hubs will work alongside its recently announced Neighbourhood Health Centres to avoid potential overlap. 

Vaccination Strategy branded a failure 

In 2024, the UK recorded the highest number of measles cases since 2012, with 2,911 confirmed cases in 2024 and one child dying. 11 infants tragically died from whooping cough in the same year. 

The UK’s routine immunisation schedule provides protection against 15 vaccine-preventable infections during childhood, including in the first 1,000 days of life. 

Pre-school vaccination rates in England have been declining since 2012/13. While the UK Health Security Agency's latest annual data shows modest increases in vaccine coverage for children up to age five, the latest quarterly data shows that coverage decreased across all vaccinations, part of “an ongoing declining trend”. 

Recommendations: 

• The Government should accelerate a pilot scheme of training health visitors to deliver vaccines to families in their homes or at medical centres and Family Hubs.
• Government should reinstate its target, based on World Health Organisation advice, to achieve 95% vaccine coverage across England. This target was dropped in 2025/26, the Government said, to give local NHS leaders greater flexibility over use of resources.
• The 2023 Vaccination Strategy should be branded a failure and a new plan should be developed with a specific focus on improving uptake in early years settings. The Committee recommends that every Integrated Care Board should have a named officer with responsibility for co-ordinating coverage in their area. 

Perinatal mental health support 

During this inquiry, the Committee was struck by the amount of evidence it received regarding perinatal mental health concerns. The Mental Health Foundation highlighted how mental health difficulties could negatively affect mother-infant attachment and the child’s emotional and psychological development, leading to long-term issues in mental health, emotional regulation, and resilience. 

Recommendation: 

The Government should set out what actions it will take to improve access to perinatal mental health care within Family Hubs, supported by specific targets to improve access for women from ethnic minority backgrounds who have disproportionately poorer mental health outcomes.