Welcome to the final, ministerial evidence session for our inquiry into the first 1,000 days, where we are joined by Minister Dalton and officials from both the Department of Health and Social Care and the Department for Education. I am going to ask you to introduce yourselves before I go into my first question.

My name is Liz Ketch. I am the director for early years, children and families at the Department of Health and Social Care.

Hi, I am Susie Owen. I am the director for early years, childcare and families in the Department for Education.

Thank you all very much. I will go straight into my first question. Barnardo’s has recommended that the Government create a network of around 3,500 hubs across the country, costing approximately £2.7 billion. During our inquiry, other organisations and people have told us that they would like hubs to be on more of a statutory model, based within the community setting. The Government have only committed to provide 1,000 hubs by 2028, costing £500 million. Do you feel that is ambitious enough?

Minister Dalton, I don’t mean to stop you mid-flow, but my question was, do you feel that the family hubs are ambitious enough?

I can say what is different about the Best Start family hub programme compared with what has come before, to respond to the question about ambition. More money will be going into these Best Start family hubs than in the previous programme, so there will be family hubs in every local authority, which is a really important part of growing the programme. There will be more funding for parenting and home learning environment interventions to reach more children and families, and they will be particularly targeted in disadvantaged areas to reach the families who stand to benefit most from those interventions. We are also really focused on driving greater outreach. Obviously, it’s not just a physical family hub building that makes a difference, but how you reach those families, so greater outreach will be funded through local authorities to make sure the groups most in need of those services can be reached. Throughout it all, we are also providing more support for children and families with SEND, which we know is a real issue, not just in local services but in early years settings, so there will be a dedicated professional in every family hub who is there to guide families through the SEND system, help to identify those needs early and to make sure those children get the support that they need, whether that is through the family hub directly or in the settings that the children might be attending. Throughout, parents will be involved in that decision making. There will be parent panels that can support the design of those services to make sure that they are providing the services that are needed. We are also requiring local authorities to develop ambitious Best Start for Life plans that will need to set out how local areas will be meeting the target that they have been set for more children reaching a good level of development by age five. This is a step change from what has come before. As the Minister said, it is part of a longer-term programme that we have set out for giving every child the best start in life, with the first phase of that happening now and taking all the learning from Sure Start and from the previous programme, from Start for Life and family hubs, to build a better service for families and children.

Thank you for that. I will go back to Minister Dalton; you can pass this question on if you want to. I want just to push you a little bit on the overview, because other organisations had recommended more hubs, but the fact is that you will have only 1,000 hubs by 2028 and that in your 10-year plan you have increased the age from 1,000 days to five years old. Have I got that wrong? Let me finish my question. Could you help me to understand how you are not going to lose focus with the step change, with what you are trying to do?

Sorry, we don’t have much time. The point is this: how are we going to ensure that the focus is predominantly on the 1,000 days?

Just give me a couple of examples.

I’ll let you have the last word, Liz.

What we have done so far in our work is worked very closely with local authorities to design the programme, so that we have a shared understanding of the outcomes we are trying to achieve, the types of support and services we are trying to provide to families, and then local authorities design those specifically, using a parent and carer panel to help them to design them to meet their local community needs. That will continue, and the way that operates is that the funding is linked to the focus on pre-conception to the age of two and that the things that we measure and the way we track performance are all linked to that. But it is also about recognising that at age two, the family’s needs do not end, and that the wider early years focus goes up to the age of five. That is going to be really important in delivering the Best Start strategy and the goals as part of the opportunity mission. We will retain the focus but recognise that families need more help and support beyond the age of two as well.

Thank you.

Thanks for being here. I want to ask more about the neighbourhood health centres and family hubs. Minister Dalton, you have already outlined that there will be some overlap. Pragmatically, how will those two things work together? Presumably, the services are going to complement each other. Where might they be distinct? Are there gaps that might need addressing?

That is clear, thank you. Looking at the commissioning, with neighbourhood services, it may well be a primary care or other provider that takes on that provision. If the neighbourhood health services are commissioned from the ICB or ICT, and family hubs are a separate entity, and I have a two-year-old and I am phoning the family hub, presumably if it is not appropriate for what I need, then there will inevitably be direct communication where the family hub—even if it is not physically together—will refer into the other commissioned services?

Okay, that is clear. Moving on to how you decided to come up with Best Start family hubs—in which lots of words come together from different things—there is an ongoing evaluation of the predecessor of Best Start family hubs, which is family hubs and Start for Life. That evaluation is not due to report until 2026. Could you talk us through what evidence you used in deciding, prior to that evaluation, to integrate the services into Best Start family hubs?

Probably the most influential piece of research that has been done in recent years is the work done by the IFS on the long-run impact of Sure Start. That has been hugely influential and has obviously made a huge difference and impacted how we have designed this, because we have taken that evidence of what it showed really benefited those children. The research looked at how close a child lived to a Sure Start centre, rather than whether they accessed it or not, and then looked at population-level data. It showed that children performed significantly better in educational assessments at age seven, 11 and 16. The proportion of children achieving five GCSEs at grades A* to C increased, and, importantly, it had a really interesting impact on hospitalisations: it increased them for one-year-olds—our hypothesis is that this was due to greater identification of need—but it averted over 13,000 hospitalisations for 11 to 15-year-olds. As well as understanding how that was done, we looked at how Sure Start was rolled out. It started off with Sure Start local programmes, which were located in the most disadvantaged communities. Over time, the model changed slightly. The IFS work was predominantly focused on that Sure Start local programme, which was very targeted at disadvantage, and that has informed how we are doing the national roll-out of Best Start family hubs. In addition, the model has been informed by some work that was done in Doncaster, which adopted a family hubs model prior to the Best Start family hub programme. Again, that showed an important improvement in outcomes for children at age five who had attended the family hub, so we drew on that. As the Minister says, we have lots of evaluations ongoing to look at it. We know that the impact of these sorts of programmes is long-run. You cannot see an impact in a year, 18 months or two years. It is the long-run work to look at how it affects the lives of children and families as they grow that is really important, hence why we are evaluating, but we need to interpret things cautiously. We need to understand what the data is telling us and what it is not telling us, to inform how this is rolled out. At the heart of it is the integration across education and health, which was a key factor of the programme when it was initiated back in 2021.

Thank you; that is really interesting. So you have taken the footprint of Sure Start and the data and evidence it has given you and built up from that, with some additional input from family hub pilots that happened in Doncaster—is that right?

Yes. The other thing I would add is that the interventions that we pay for, whether that is Department for Education services or Health ones, are also informed by the latest evidence. We have What Works centres that have looked at the effectiveness of parenting programmes and evidence-based interventions. It is both the model of how the services are integrated and then what you choose to do with the families once they come in. That is informed on an ongoing basis by research coming out of the Nuffield Trust, Nesta, What Works centres, the EEF and so on, which really helps us to help local authorities to make the right commissioning decisions for their local populations.

Great. I have one final question. I do not think the data will contradict massively what you are saying, and as you say, it is ongoing data collection, but presumably when this evaluation reports next year, there is flexibility in the model to be able to adapt, depending on what it tells you.

Yes. We have built test-and-learn into the new model. We have already done two test-and-learn pilots in Sheffield and Manchester. That is particularly around outreach and how you ensure those under-represented or seldom heard groups are targeted, but we are building test-and-learn into the approach for the whole model. We are encouraging local authorities to think creatively about their approaches and share that learning across the system—“So-and-so have done it over here. Does that apply to my area?” That is what commissioners need. We do not want to prescribe exactly what they should be doing everywhere, but we do want every local area to be informed by the best practice as it applies to them.

I want to follow on with another question about family hubs, you will be unsurprised to hear, specifically looking at speech and language development. We had a very interesting session focusing on that area. The Royal College of Speech and Language Therapists noted in its written evidence—and this was picked up during our oral session—that the current guidance does not allow early language and home learning environment funding to be used to cover the first 1,000 days. Is that something the Government are looking at changing in the future?

But the RCSLT did specifically pick up on the current guidance for early language and home-learning environment funding. In the 2022 to 2025 period, it could cover only three to four-year-olds and up, and that was extended to cover two to three-year-olds for 2025-26. They ask for that funding be able to be used from birth. Speech and Language UK suggests that you could even use it pre-birth, as some speech and language development does indeed take place in the womb, antenatally, but according to current guidance, they are not allowed to use that funding to cover that period.

It is a DFE programme.

I would echo everything that the Minister said. We build speech and language through everything we do in the early years, right from conception all the way up. It is foundational. We know that those attachments and so on are so important for building speech and language. The funding streams you refer to are specifically the home-learning environment and parenting strands of the existing programme funded by DFE. You are right; initially it was three to four-year-olds, and then it was dropped down to two-year-olds. We are currently going through the process of setting the new programme guide and putting advice to Ministers on that. We have not yet set out what the new programme will look like. As the Minister said, the period post the two to two-and-a-half-year-old check is crucial. It is often where specific speech and language needs are identified. We also require that money to be spent on evidence-based interventions, so where the evidence base lies for the most effective interventions. There are numerous ones at ages two, three and four, and we think it is really important that children are getting those interventions and extra help. A lot of those children can be supported, whether in settings or at home, and then they can catch up to their peers and start school with the requisite speech and language skills. That is a really important age range to be focusing on, but, exactly as the Minister says, that does not preclude local authorities funding various services—as we already know they do—to support babies and children right through the age range.

Thank you. Looking specifically at the first 1,001 days, what is the offer around speech and language therapies and interventions in the nought to two-year-old category,? The Committee visited Blackpool, where they have an extended health visitor programme. I am not going to get ahead of Andrew, who I think is going to talk about that, but one of the things that they offer is speech and language training for their health visitors, so they are able to identify where children may need additional help and support. As I am sure you will be aware, that can be done at a very early age, even when children first start to make eye contact and use certain iterations of noise—only a very tiny bit of speech and language is actual verbal communication. What were the plans around that 1,001 days to make sure that there is a sort of universal offer on speech and language interventions for all children?

Is there a planned target for those who are most in need of this kind of therapy? There is quite a lot of evidence around disadvantaged communities not necessarily accessing some of the support that people in a higher economic bracket will access. Is there a plan for how will that will be targeted, or is the idea to roll it out and see where the need is?

At the moment we are doing some quite intensive work with local authorities who are doing lower levels of checks at the two to two and a half check, but as the Minister and Susie outlined, when we roll out Best Start family hubs we are really focusing on disadvantage and ensuring that the services are accessible to those in greatest need. As we refresh the programme and think about how we deliver the next phase, really focusing on families in need will be at the core of everything we do, recognising that services need to be accessible to those who have the greatest needs.

I will now hand straight over to Helen?

Thank you, Chair. I am Chair of the Education Select Committee. Thank you for having me as a guest.

You are guesting with us today and I really do welcome you; I apologise for not saying that.

Not at all; I am very glad to be here. The interest of my Committee in this inquiry is twofold. We are just reaching the end of a very big inquiry on SEND; we will publish our report soon. We have resolved to undertake an inquiry on early years, which will launch very soon, so we are midway between two significant pieces of work that are relevant to the work of this Committee and this inquiry. My questions will be focused on those areas. In our SEND inquiry we have received an unprecedented amount of written evidence. Much of it says that there is a need for much more early identification of need and much better access to the interventions that address those needs as early as possible in a child’s life, and that at the moment the system does not deliver that very well at all. My first question is relevant to some of the things that Jen asked about in relation to speech and language, but it is much broader than that. What is the strategy to ensure that the Best Start in Life programme delivers a step change in access to early identification of SEND needs and early intervention in support?

Hopefully you saw in “Giving every child the best start in life”, the strategy that we published in July, a real focus on ensuring that early years provision is inclusive and is providing the right support for every child, so it does run through everything you set out. You will know that the Department is doing much broader work on the SEND systems, so I will focus today on the things that we talked about in the early years strategy. Lots of things in the strategy about increasing early identification of need were very much welcomed by the sector. I mentioned the support that will go into every family hub. A trained professional will be there entirely to work with families to identify needs early, whatever they may be, then help the family to navigate the system and access the support they need. We know that is a problem in the system, particularly in the early years. Either families are not being identified early, or a need is first recognised when a child comes to an early years setting, but the setting does not necessarily have access to the right support for the family. The role of the practitioner in a family hub will be to work with all its early years workforce and settings to help families to get the right support to the child at the right time. We also set out various ways that we will support the workforce with training, which will again be similar with what Jen was asking about regarding health statistics and so on. We need to make sure that everyone working in the early years is trained in identifying need. Of course, there will be some children born with very specific needs that are identified at birth, but for lots of children in the early years, their needs emerge over time. As I said earlier, much of that need can be supported in a mainstream setting, and children can catch up with their development if they are given the right support. The idea is that by the end of the early years, you are working only with children who may need some ongoing support in the future. We are supporting our workforce to do that. We have already trained 7,000 practitioners in early years settings to have a SENCO qualification—a level 3 SEND qualification; we are training a further 1,000 this year and will continue that work. We have also published lots of additional resources for settings to help them support children with SEND. We have also been investing in the ELSEC programme, a test and learn programme which has been running for two or three years. We have funded it for an additional year with the £3.4 million that the Minister referred to. That has had some great findings. The idea behind that programme is that it will inform local commissioning by testing various approaches, working with speech and language therapist-led services and then working with local workforces to make sure that children are getting the support they need. The findings emerging from that are positive and will inform ongoing SEND work.

Thank you. Another strand running through much of the evidence that we received relates to health. It is the view of many parents, professionals and local authorities that within the SEND system it is very hard to get Health to the table. NHS services are often absent and although we have education, health and care plans in the statutory part of the system, the H is missing. We heard again and again from our witnesses that you cannot get the H bit to the table. Health is not held to the same standards of accountability as other parts of the SEND system. Minister and Liz, what difference is that work going to make in the early years to ensure that Health is properly at the table and working in partnership with local authorities, settings and other bits of the system that support children and families? It is clear to the Committee that it is largely absent at the moment.

Your attention to that issue would be really helpful. It is not a local problem; it is a national problem. It relates in part to the structures for accountability. For example, SEND tribunals make recommendations that are binding on local authorities but not binding on health services, even though health services could be every bit as important to delivering a child’s education. There is an imbalance in accountability for health. This is a big problem, and it is a problem across the country. Parents, professionals and local authorities have told us in no uncertain terms that health is not at the table as much as it needs to be when it comes to partnership working to support children with additional needs and their families. Your attention to that would be really helpful. This is my final question. Thinking about SEND services as they are delivered in the early years, and then the passporting of those services through to the next stage of a child’s education, another problem we heard about is that very often the need for a diagnosis acts as a gateway to support. In fact, that should not be the case; our system is set up not to require a diagnosis to act as a gateway to support, but all too often it is required, and often a diagnosis not provided in the first 1,001 days of a child’s life. The services you are trying to deliver through the new strategy will, I presume, deliver support when a need is identified and not necessarily when a diagnosis is provided. My question is about the interface between the early years and the formal part of a child’s education. How will you make sure that when needs are identified, support is put in place in the early years through Best Start in Life, and that that support is easily passported to the next stage of the child’s education and stays in place? We hear far too often from families that they have to battle again and again for the support they need at every stage of their child’s education. That clearly needs to change.

One of the big differences of having the strategy and thinking about the Best Start family services is integrating all the bits of the system. We recognise exactly what you are saying. We have had family hubs in one place, and early years settings, schools and health in others. We need them all to be working in concert to support children. There is a real emphasis on transition in the work we are doing, particularly between early years settings, because most children are in an early years setting aged 3 and 4, and reception, as well as a really big focus on the reception year. It is a really crucial year—children come into compulsory school age at the end of reception, and we assess children at age 5 as well. We are putting a real focus on the quality of teaching. One of the things announced in the Best Start in Life strategy was nursery-school partnerships, which are about getting local settings to work with their schools and transfer knowledge either way, so that schools understand where those children have come from, and vice versa. We think that is particularly important for children with additional needs, so that parents are not having to fight again. How we can smooth those transitions into the school system is really important, while also making sure that the school leadership understand the importance of the early years and what has come before, right from birth onwards, so they can better support children on their school journey.

Good morning, Minister. Thanks for joining us. I am going to ask you a few questions about vaccination rates, which the Committee has heard a considerable amount of evidence about during our inquiry. Since 2021-22, we have seen considerable falls in vaccination rates for mothers and babies in the 1,000 critical days period. In 2023-24, coverage decreased in all 14 vaccine areas. A new vaccine strategy was launched by NHS England in 2023, in the midst of that period. In the light of worsening performance, was the strategy wrong, or is it a problem with implementation and resources of the strategy?

We are considerably off. I take your point that there might have been, in data that we have not seen, a slight shift on some measures, but on 14 measures there have been quite consistent decreases since 2022-23.

I am going to come on to health visitors. If your reading of the situation is that the strategy is right, and that there is not a problem with the implementation of resources, why are we so far behind and still falling on most if not all of the measures?

The strategy is the right one and it is being implemented—that is what I am hearing.

That is despite the strategy being in place for three years and us seeing a worsening picture for those three years—the strategy is working. You said it is a local issue. ICSs are going to play a more significant role from April 2026 and have more responsibility for vaccines and vaccine strategies. If it is a local issue, how will ICSs be held to account if their performance does not improve, and if their new powers and responsibilities are not met?

We have heard about that before. Again, I come back to the fact that the NHS England strategy was launched in 2023. We have heard that there is piloting that will take place of health visitors delivering vaccines, with a possible national roll-out in 2026-27. It has been quite a number of years, and we are still talking about pilots in small numbers of areas for health visiting. We have a major problem with vaccination rates. We are having outbreaks of measles in Merseyside; a child died of whooping cough in the last few days. Do these small-scale initiatives and pilots—which are from a strategy from three years ago that is still being pursued despite ever-worsening rates—show a level of impetus, resourcing and prioritisation that is reflective of the scale of the problem?

Are you confident that all the things you mentioned will lead to an increase in vaccination rates next year? Will we, as a Committee, be able to speak to you next year having seen an uptick in the 14 key vaccination areas?

Are you confident, Minister?

I cannot speak for the Committee, but I would personally say that we are in a vaccination crisis in this country among children and pregnant women, which is leading to some of the tragic incidents we are seeing. In the light of this, was it a good idea to remove the WHO 95% vaccine coverage target from NHS planning guidance? Was that the right decision?

It is not in the planning guidance.

If we see further falls in most vaccine levels next year, would you consider putting it back in NHS planning guidance?

Would you agree that the strategy is not working if next year we still see further falls, or no progress in getting towards the 95% target? Is that failure? What is failure? It sounds at the moment that further falls in vaccine levels, further outbreaks, and not making any significant progress towards the 95% target are not considered failure.

Stopping the further falls is positive, but I think we urgently need to get back not just to the levels we were at but to the 95% target, which is a key target for population coverage.

Is there a deadline for meeting the WHO target?

Do you think the Government should set a target?

Thank you.

To be fair, you inherited a bit of a car crash as far as the workforce is concerned, with a 40% reduction in staffing within the sector since 2015. I understand from UNICEF, which has highlighted a Royal College of Midwives survey, that—it seems improbable—57% of midwives are contemplating leaving the service within the next year. One can understand that, given the intense pressure; we are estimated to be about 5,000 health visitors and 2,500 midwives short within the service itself. You mentioned the workforce plan. Can you be more specific about when that is coming out and whether these issues are going to be addressed within the plan?

Before 31 December?

I will come back to health visitors in a minute, but I notice that the Royal College of Occupational Therapists have strongly recommended that they shift a lot of their work out into the community, which, of course, is one of the three shifts that the Government are trying to achieve. They believe that they will have a greater impact by operating in the community, rather than quite so much in a hospital setting. In terms of your workforce plan and the delivery of services for the first 1,000 days of life, do you see that as being something that the Government can actually push and encourage?

You mentioned health visitors. You said there was a proposed health visitor programme in the Labour manifesto. You also suggested that health visitors could take on a larger number of tasks—for example, the vaccine roll-out. At the same time, a large number of health visitors are struggling with stress. Retention is extremely difficult, and recruitment is not easy either. The guideline is a caseload of about 250. The vast majority—only 6%, I think—are below that number at the moment, and you are talking about heaping more responsibilities on them. How does this work?

I do not know whether your niece is saying this, but a lot of health visitors are saying they cannot do their job—there is not sufficient time to perform their duties. They do not feel it is a safe environment in which they feel satisfied that they are giving families the support they need. Are you confident that you can turn that around? The majority of the workforce feel that that is the case.

As you know, there are five mandatory visits from health visitors. The Committee learned that in Blackpool, they have adjusted the way they manage the workforce there to achieve a target of eight visits, which they believe is a better way of both keeping in touch and maintaining an overview of the progress being made in a child’s development. They have done that through the use of non-health visitors: band 5 staff nurses—registered nurses. Do you believe that sort of configuration is the way of achieving improvements in the range of services and giving families the preventive support they need?

We have talked about the evaluation of the family hubs and Start for Life programme. There is a third evaluation that we are doing of a small number of workforce pilots. Local authorities that are part of the programme are also piloting mixed workforce models, perhaps similar to the one that you have heard about in Blackpool. The reason why we were keen to do that in the first phase of the programme was to start to understand different configurations of the workforce, where health visitors are still incredibly valuable but are supported by a mixed-skilled team, so the work is distributed slightly differently. We are not suggesting that we think there will be a one-size-fits-all answer, but we want to evaluate a small number of different workforce models so we can better understand how those might help families to receive better services and the workforce to have a better, more sustainable career path.

This is happening across the NHS: the potential risk—or some might call it dumbing down—of saying that people trained to clinical level x can oversee or allow certain functions to be undertaken by someone who is not so well trained. Do you think those kinds of patterns are safe and deliverable?

Okay, so it will not be done by a central diktat saying, “The Blackpool model will be rolled out nationwide.” It will be a framework within which there will be local flexibility.

I want to touch more on the wider early years workforce. I was wondering what kind of plans you have in place to make sure that the expertise of specific professions, such as occupational therapy, physiotherapy, and speech and language therapy, is best deployed, and when the interventions in that space are best delivered by someone who does not necessarily need to have that level of professional expertise. What is the plan to make sure that those professions are accessed when they are most needed, and that everyone receives those interventions in the early years, so that there is that proportionate universality?

Yes; to access a bunch of these services, you need a diagnosis or a referral, and we have been hearing again and again from professionals in this space that they spend a lot of their time not being able to do the kind of dedicated work that they want to do, because they are dealing with that referral process. Speech and language therapists are not able to offer the interventions at the earliest opportunity they would like to, because they tend to see people only when they hit a certain level of crisis. Similarly, community paediatricians say that they cannot build the kind of relationship with their patients and their families that they would like to, because they tend to see people only when they are coming in through a crisis model or when something has reached a certain level. Will there be something in the workforce plan that details how best to use the expertise in this space, and how best to disseminate that knowledge—task-shifting—down to people, so they do not need to be a speech and language therapist, for example, to deliver speech and language interventions? Is there something that delivers that model a lot more holistically so that professionals who have a level of expertise are able to deploy that at the earliest opportunity? Is there something along the lines of lowering the threshold for intervention or referral? I can give a really good example; my daughter, as you all know, has Down’s syndrome. She has hearing loss, but we were unable to access speech and language therapy for her until she had turned three—until there was a defined problem that they could see. You can say, “It would have been a miracle if she didn’t have a speech and language delay”, but there is a lot in the system where you can do interventions without the need to see an expert. We have also been hearing from these professionals that they would like to see people earlier, so they can make more effective interventions and build a relationship. Will the workforce plan reflect that?

I can add to that. A lot of children are in settings in which the early years workforce—childcare practitioners and early years educators—are really key, and likewise the family support workers that will work in family hubs. It is really important that we support that workforce to understand what normal child development looks like, and train them to recognise what the important milestones that children need to reach, or should be expected to reach, are—obviously in children it is not linear, nor is it the same for every child. The links with those professionals are also really important. Part of the focus of the Best Start family service is to build those links across professional bodies wherever you sit—whether you are in health or an early years setting—and to build trust and understanding between the specialist and the practitioners, so that practitioners feel that they can pick up the phone and check something about a child or a family, whether that is a safeguarding issue, a health-related issue or something else. Those softer connections and networks are so important. That is the learning from the ELSEC programme—the early language support for every child—which has been a SALT-led model. The speech and language therapists are running the programme, but they are training practitioners in settings to identify it, so you are building those connections. That is what you are talking about; not just waiting until a family and a child have gone through a really long, possibly bureaucratic, process and setting and is frustrated and by then, need has escalated. That is the frustration of a professional who meets a family and thinks, “If I’d had some contact with this family earlier, I could have provided guidance.” It is about getting that right. It is not always acute intervention; sometimes, it could be a phone call or a conversation to make sure that what the child is being provided in the setting is right, and that the advice to the family is appropriate, so they can provide the right environment in the home to support whatever that need may be. When we talk about the integration of services, that is such an important part of it—yes, it is about the service provision, but it is actually about how those professionals work together. How that trust is built locally and how they understand and work towards the same goals will be hugely important to reducing that friction that you describe in the system.

We have heard it is also quite crucial for retention, because it allows professionals to do the job that they have entered the profession to do. That has been quite useful. To touch on the issue of recruitment, there are obvious workforce shortages, not just in early years, but across the NHS. One specific area is speech and language. The demand for speech and language therapists has grown threefold since 2019, but the long-term NHS workforce plan does not include a target of a triplicate increase in speech and language therapists. Do you think the long-term workforce plan is sufficiently ambitious, or will the upcoming workforce plan have more ambition to recruit more people into these roles?

Will the workforce plan reflect the rising level of demand? There has been a significant uptick in demand across the piece for speech and language, OT, physio and all those early years services. Or will there be an aim to reduce some of that acute demand, as opposed to meeting that demand via recruitment?

My questions will focus on maternal mental health. Adverse childhood experiences are linked to a number of poor outcomes later in life, including mental health problems, heart disease and stroke. One such experience is some form of parental mental health breakdown, and we are currently seeing record high demand for perinatal mental health services. One in five mothers experience perinatal mental health issues and it is the biggest killer of parents between six weeks and a year of their child’s life. Currently, 68,000 women are accessing perinatal mental health services, or about one in 10 mothers—about half of the one in five who are suffering. Last time this Committee looked into the question, it found a postcode lottery in provision of mental health services. However, the Royal College of Psychiatrists now tells us that almost two thirds of ICBs are making real-terms cuts to their mental health services. Does that concern you?

There are two things here. One is dealing with the individual cases and understanding what has gone wrong there, and one is having the structural ability to take up an increase in demand. If we are cutting mental health services, as we are told two thirds of ICBs are, how are we going to keep up with that demand?

But very specifically on mental health services, you say that you are supporting ICBs. How are you supporting them to put more funding and more support into the mental health services that they are currently cutting?

There is one area that we can perhaps include when you come back to the Committee. One of the service strands that we fund in the family hubs and Start for Life programme is support for mild to moderate perinatal mental health difficulties, recognising that that period is critical. That is really important for the parent’s health, for forming the bond with their child, and for the child’s long-term health and wellbeing. It is one of the strands that we funded specifically through the programme, recognising that it is an area where more support was needed. We can perhaps wrap up more information on that in a more detailed response, if that would be helpful.

My concern is that you are talking in generalities about maternal health, but there is one specific area of maternal health where there is a crisis. It is all very well saying that it is up to ICBs, but we know that ICBs are also having cuts. How are we going to make sure that those services are delivered, and find a way to deliver those services when we have record high demand and only about half the women experiencing these problems are currently accessing the service?

I guess that opens up another question. You are talking about broader training of health visitors and so forth. One suggestion that has come in on perinatal mental health is training health visitors and midwives to identify mental health problems, and to provide support. Is that something that might come up in the workforce plan?

Thank you for that. I am now going to shift gears and talk about GDPR, because why not? We will move on to discuss the single identifiers. When do you expect the pilots of using the NHS number as a single identifier to be complete?

Yes, that is one of our programmes, although we are obviously working very closely with Health. It is being designed as an iterative programme to understand how best to use a single unique identifier, with all the complexities that happen. As you know, the current pilot is under way in Wigan. It will then move through further phases to test specific things. At the moment in Wigan we are testing the ability of local authorities to automatically access the NHS number for children known to social care, to see how that operates. Further pilots will focus on how the use of that number can enrich the data that a professional has and enrich the datasets we have around safeguarding, and on the system changes that will be needed to make that a really seamless process. The second pilot is starting in September. We have not yet given details about when we will be publishing findings from that, but obviously the whole way we are approaching this programme is to test and learn, starting on a small scale and identifying the challenges and problems that exist, both for professionals and the system issues that exist, and then building on that to move towards a further roll-out. We will definitely be sharing more details in future about how those pilots have gone to inform the next stages of that evolution.

During the inquiry, one of the concerns we heard about the pilots is that we do not have NHS numbers for everybody—migrant children, for example. What are we doing to ensure that we get them?

It is exactly those sorts of issues that the pilot will uncover. You have named one; there are also adopted children, where the NHS number changed when they were adopted. Those specific issues will be tested through the pilots, so we are making sure that we understand where this works for the majority of children and how it will operate for those subsets of children, who are likely to be a small minority. That will inform the work of the pilots as we go through. We are very aware of that issue, and are working to address it.

Another thing—this is one all the kids are waiting for—is GDPR. We previously heard that professionals would find it helpful for there to be a national agreement about how to manage GDPR concerns and third-party data, to make sharing it easier. Is that something the Government are considering creating?

We are working closely with the Information Commissioner’s Office on this, as we know it is a key issue, and ensuring that data protection issues do not get in the way of safeguarding and promoting the welfare of young children. Current data protection law allows practitioners to share information where needed, and to identify children who have safeguarding and welfare needs. That provides a framework that enables that sharing in a fair, proportionate and lawful way, but we know that more needs to be done to make sure that is communicated. You will probably also be aware that there is a provision in the Children’s Wellbeing and Schools Bill around data sharing, to provide that legal framework and give confidence to professionals. Many are already doing that, but we know there are issues and specific areas to provide that underpinning legal framework, to enable them to have confidence to share the information in an appropriate way.

I guess the problem is that if you have NHS numbers and NHS data being shared, the problem arises when it comes to sharing with education. We have heard about the challenges faced by the DFE when it comes to data linkage and children’s experience before five. What are you doing to explore that data link between Departments?

At the moment it is that specific thing of using a single unique identifier to ensure that professionals are speaking about the right children, and therefore have access to the right information as appropriate. It is not about open access, where you get a number and suddenly have access to all the data; this is very much about what is the appropriate unique identifier. You will know that we are testing the NHS number—it is part of the pilot to test whether that is the appropriate one. That has not been decided yet, but all the issues that you are referring to are exactly the sorts of things that are being investigated through the pilots. That is why we are taking this very phased and iterative approach to the process, to make sure that we are surfacing issues—I am sure there will be others that you have not touched on—around this area. This is something that has been long wanted, but we need to do it carefully and intentionally to ensure that we are doing it in the right way.

On the back of that, what are the timescales for this?

Pilot No.1 is under way now in Wigan, and the second one is starting in September 2025.

When will it finish, so we can start seeing some results?

Obviously, it was a manifesto commitment from the Government, so there is an ambition to complete it by the end of the Parliament. But there is an iterative approach, so it will depend on what is found in the pilots and how quickly that can go. There is huge ambition to get this right and do it as quickly as possible, but in a considered and sensitive way, given the issues that your colleague has already identified.

To follow on from data collection and hopefully bring it to a positive conclusion, during the inquiry we had a lot of people giving evidence, and sharing frustrations about the lack of a common outcomes framework. As all three of you have rightly pointed out, that is health, education and children’s social care. For example, Alison Morton, the CEO of the Institute of Health Visiting, said that she would like “specific, small numbers of key metrics that we want to share across Departments…it is like a triangle.” She did not mean “wheelbarrows full of questionnaires”, which is heartening. I am sure this is something you have heard before but, as the Minister has pointed out, we are a mission-led Government. I wonder what the appetite is for a shared outcomes framework across the Departments, and whether any progress has been made.

As the Minister said, it is a really good step forward that we have the local government outcomes framework. That is a really clear target. The good level of development both at age five and at two to two and a half is a broad-based measure that encompasses a range of things, and we think it is really important. As the Minister said, it will be confirmed, post the consultation, what measures will be in place by April 2026. We are also following up with individual local authorities. We are setting individual local authorities targets around the age five metric, in line with the 2028 Best Start in Life target for 75% of five-year-olds to achieve a good level of development. As I said earlier, we are requiring local areas to produce Best Start local plans. They should be building on plans that are already in place. Many local authorities already have, with their partners, a clear focus on the early years. We are just making sure that is consistent across them, and that those plans are in place. As the Minister said, in the strategy we did not commit to looking at whether a more detailed outcomes framework is needed, drawing on the lessons from Every Child Matters. That needs to be done carefully because, as Alison said, we need to avoid the danger of wheelbarrows, metrics for metrics’ sake and turning it into a bureaucracy. We need to ensure that, when you decide what metrics to measure, that drives behaviour. Sometimes that can drive the wrong behaviour, or there can be perverse incentives in there. It does need to be carefully considered, but we think the local government outcomes framework is a really good starting point. We will build on that with the Best Start local plans. As you alluded to earlier, this whole programme needs to iterate and learn from what is working. We will consider that, rather than rush to a more detailed national framework, which could end up being quite a top-down, bureaucratic process. We need to get that balance right.

That makes sense. Are the available outcomes data that you have sufficient, or have you identified key gaps across the three directorates—the three areas—that you think we need to look at more?

I can speak to age five, and maybe Liz or the Minister can come in on two to two and a half. At age five, every child is assessed at the end of reception year against the early years foundation stage profile, which covers a number of areas of learning. That is a comprehensive dataset. Obviously, the vast majority of children are in reception and take that dataset, so we are confident that we have that data. As I say, it is a broad-based measure, which is really helpful. Obviously, within that dataset we can also break down at a local authority level, and we are also working to produce a tool that allows schools to look at their data in more detail and compare it with schools in similar contexts to see how that is coming out. We are doing a lot of work to give schools and local authorities the tools they need to understand that.

One specific thing on that. That is great, but when you are disaggregating that data and looking at disadvantage in that area, are you using free school meals as a proxy?

We are.

Okay. I am sure that you are aware that there are issues there. It doesn’t scrutinise non-working families, and that can cause real problems. I don’t know whether you want to speak to the Committee about that, but there is a potential issue around that data.

It is the proxy that we use, and we also look at SEND, because there are big gaps in the experiences with SEND. You are right that it is a blunt tool, as ever. As you can imagine, in every Department there are lots of debates about how to measure disadvantage in the most appropriate way. When we have set the local targets, we have required that to meet their target, they have to meet the overall target but also ensure the FSM children are moving at the same pace as the rest of the children. I take your point that that does not cover every—

On the non-working families thing, there has obviously been the very welcome announcement that we are going to fund childcare for working families. Great, but obviously we have non-working families, and we need to be really mindful about how we measure that potential gap.

Yes. Obviously, one of the big focuses is on ensuring that those children who are entitled to the two-year-old offer, which is 15 hours for low-income families, are all accessing that offer, and driving that through. That will be part of the Best Start family service as well, to ensure that those families are being identified earlier and getting the support either through the family hub or, as I say, being referred on to settings where they are eligible for that entitlement. That is really key.

So you are aware of that particular glitch in the matrix; that is good. I will ask you about disaggregation of data—as Josh says, it is another very exciting thing, but it is important. During our inquiry, we heard about waiting list times for children, and at the moment the disaggregation of data looks at adults and children, but there is not any further age-based disaggregation. Dr Fuller, the medical director for primary care at NHSE, highlighted that she thought there should be greater disaggregation to include early years to give greater insights—because obviously, if you are two years old, waiting may have greater impact that it would on a 16-year-old. What do you think about further disaggregation of those data? Is that possible? Have you considered it at all?

It would be good if you let the Committee know when we could expect to see the disaggregation of those data.

Thank you very much for coming today, Minister. I would like to ask about the Government’s plans to protect babies from much of the dangerous baby food out there at the moment. It is quite clear that too much of the baby food in our shops is over-sweetened, over-salted, innutritious, unnecessary mush that is actually contributing to childhood obesity and health decay. I get that from the evidence I have read and from the Government’s paper. I hugely welcome the Government’s new guidelines to crack down on sugar and salt in baby foods—baby drinks as well—and to crack down on misleading labelling and marketing. When it comes to sugar and salt, the Government has committed to bring out a progress report. It has given food producers 18 months, so it is committed to bring out a progress report after—not in—February 2027, in the light of which it will consider “additional or alternative measures”. Will there also be a report on labelling and marketing coming out to check whether companies have improved and are not claiming that things are healthy when they are not?

Will you be issuing a report on marketing and labelling as well?

By “mandatory measures”, you mean that you are prepared to consider legislation.

Okay, so that may include legislation.

That is very positive, but your timeframe says that it will be only after 18 months that you issue these progress reports. If they have not done what is needed—I hope that they will do what is needed—we are only then going to consider legislation. Given the time that that will take to prepare and go through Parliament, we may not get anything done on this absolute disaster, which is increasing childhood obesity and tooth decay, until after the next election. Is that good enough?

I take from that that it may be the case that, if they are not doing what is needed, and we require legislation to force them to do what is needed, babies are unlikely to get the protection they need from baby food until after the next election.

Brilliant. But isn’t the thing about progress that it is not just a fixed point in time, and that you can assess progress towards things? We do not have to wait 18 months to see whether any progress is being made; the industry can inform you, on an ongoing basis, of the changes they are making. Shouldn’t we be assessing and publicising the outcome of progress on an ongoing basis, in case we do find that we are going to need legislation, statutory instruments or further measures? I would like to suggest that we publish a report from now, every six months, on how the industry is doing in reaching the 18-month target. Would that be possible?

I agree, but on reasonable timescales, you have given the 18-month timescale. I am not challenging that. Some people might, but I am not. But I have worked in business. When you ask somebody to deliver a project within a timeframe—you may give them six months or a year—you regularly check in with them to see how it is going, whether they are encountering any problems, and whether you need to give any support, push or nudge in the direction of getting to the outcome. Just leaving it for 18 months until you do the analysis—and remember that you are going to do the report only after 18 months—will surely mean that it is far too late. Could you not, on the way, reassure yourself by seeing whether they are going in the right direction? If they are not, you may need to start to prepare additional measures sooner. Waiting 18 months is not what would be done in business, and I do not know why the Government would do that.

If we as a Committee asked for a report in six months on whether you were satisfied that producers were starting to get their act together to implement the guidelines, would you be able to provide us with that?

So we will have no assurance that they are actually doing anything until 18 months from now—or after 18 months, because it is after February 2027 that the report will be published.

I gather that, in the Government paper, it says that the metrics for assessing progress are being considered. What is the timeframe for developing those metrics? Are we expecting them to be delivered in three months or four months, or will it take longer?

Would you be able to write back to the Committee on that? That would be great.

Finally, the industry, as you say, has been co-operative, but the history of the food production industry is not one of co-operation; it is one of only doing things when they are forced to do things, or being frightened that legislation is coming in. I do not know if you are aware, but I have been told by friends that one huge baby food producer, which I could name but I will not today, has just contacted a number of public affairs firms to bid on what they call a rapid influence campaign, to influence the development of healthy food standards, so you can expect some lobbying coming your way—seriously, even more than you have had already. I guess that part of it will be promoting the usual dubious claims by industry-related scientists about certain things, but they are planning to do this campaign, despite saying that they intend to improve matters. It would be helpful if you could commit, over the next 18 months, to ensuring that all meetings between Ministers and civil servants, whether they are in the Department of Health, public health people or in other Departments, and the food industry, whether that is the food industry producers themselves or their public affairs consultants, are properly, transparently recorded and published—that all meetings between the industry and Government are transparently recorded and published.

If Members of Parliament stand up and make representations to the Government as this roll-out of the guidelines takes place, do you consider that they ought to say whether or not they have had meetings with and taken information from public affairs—

So it is something the parliamentary standards committee might want to look into. Good. Well, I wish you luck with this. I think it is going to be fascinating progress. We will probably still want to have some idea of whether they are going in the right direction before 18 months are up, because otherwise, babies are going to get overweight and their teeth are going to fall out, as is happening now, for longer—although this should not happen at all—than is necessary.

That is brilliant, honestly. I thought the announcement this morning was terrific. I think we all here welcome what you are doing. It is a fantastic to have a Government who are actually taking these things seriously, finally. On the supermarkets having to have mandatory targets on healthy food, what is going to happen if they do not meet those targets?

I hope that all the healthy carrots you put in place work, and that you will not need to bring in a stick.

Can I ask one question? It is a really simple one. Ben spoke about a report every six months, which we understand you cannot give, but you are meeting with these people on a regular basis. It is not just that you are going to see them in 18 months’ time; it is ongoing and you are seeing them regularly to monitor, even though you have not done a formal report. Is that right?

Great stuff. Minister, just for clarity, at the beginning of the session, I talked about 1,000 days, and so did many Committee members throughout. That is because we are following on from a previous inquiry. We realise it is 1,001 days, but we are following on.

I know. I had this issue in the first place, but we are following on from a previous inquiry. On that note, thank you for coming today. It has been a really interesting session. I really appreciated you and the Committee being so honest, as well as Susie and Liz. Thank you.