The First 1000 Days: a renewed focus

Status / emerging findings

• Health visitor workforce has collapsed by 43% since 2015 (5,000-post shortfall), with remaining staff managing dangerously high caseloads exceeding 750 children per person
• Government's £500 million commitment for 1,000 family hubs by 2028 falls far short of Barnardo's evidence-based recommendation for 3,500 hubs costing £2.7 billion
• One-third of families with disabled children forced into private treatment due to NHS waiting lists; children wait up to three years for diagnosis in community paediatrics
• Sure Start research proves £2 return per £1 spent with long-term benefits (reduced hospitalisations, better GCSE outcomes), but austerity cuts since 2010 eliminated two-thirds of funding
• Data fragmentation and lack of shared outcomes framework prevent services from identifying and reaching families with greatest need; Core20PLUS5 health inequality initiative lacks comprehensive datasets

Why it matters

England records some of Europe's worst child health outcomes; how well services identify and support infants in their most critical developmental window determines long-term poverty, health, and educational inequality across millions of children.

Tone arc

Inquiry opened cooperatively with Marmot's evidence on health inequalities and austerity's damage, shifted toward critical scrutiny as witnesses revealed waiting-list crises and funding gaps, then became mixed-frustrated when ministerial evidence confirmed the Government's ambitions remain below expert recommendations despite £500 million investment.

Key witnesses

Professor Sir Michael Marmot (UCL Institute of Health Equity), Barnardo's (early intervention evidence), Institute for Fiscal Studies (Sure Start cost-benefit analysis), NHS England (community paediatrics, waiting times), Royal College of Paediatrics and Child Health, Minister Ashley Dalton (Department of Health and Social Care), Hull City Council (family hub model), Royal College of Speech and Language Therapists