Call to introduce health visitor check for three-year-olds

Health visiting provision should be increased as part of an "early years revolution" to ensure disadvantaged young children can get the best start in life, say MPs.

Members of the health and social care committee are concerned that current early years support is not effectively helping vulnerable families with young children, who are at risk of issues such poverty, poor housing and parental conflict.

To counter this, the committee's First 1,000 days of life report includes the recommendation to increase investment for health visiting services so they have an greater role in supporting families.

Under the government's 2009 Healthy Child Programme families are entitled to five visits from a health visitor up to the age of 30 months.

The committee wants to see an extra check added, when a child is between three and three and a half years old. They say this is needed to check on their development and ensure they are likely to be ready to start school.

Almost a third of children in England do not reach a good level of development by the end of reception year at school, according to evidence presented to the committee.

"Ten years on from its inception, we are calling for the Healthy Child Programme to be revised, improved and given greater impetus," states the committee's report. 

"We recommend that the programme should begin before conception, extend home visits beyond the age of two and a half years, become more family focused, and ensure children, parents and families experience continuity of care during this critical period."

Successful schemes, such as Better Start Partnerships, that offer targeted specialist support to disadvantaged families with young children, should be replicated England-wide, adds the report.

The committee visited one such Better Start service in Blackpool that has invested £1m in its local health visiting service to ensure families receive a minimum of eight visits. These visits also have a stronger focus on supporting parents and children's mental health.

Another is Flying Start, the Welsh government's early years programme that supports disadvantaged families with children aged up to four.


The committee is also calling on the government to introduce a long-term, cross-government strategy for the first 1,000 days of life, to be led by the minister for the Cabinet Office.

This strategy should then be implemented in all local areas by councils in partnership, through pooled funding, with local NHS organisations and charities.

Another recommendation is for a separate plan to be developed to improve the workforce for services covering the first 1,000 days of a child's life. This should clearly set out how ministers will support local areas to develop capacity and skills of staff who support young children.

The committee raised concerns that cuts to children's centres, health visiting and specialist support, such as drug and alcohol services, is resulting in early years support being too varied across local areas.

Inquiry lead Paul Williams, Labour MP for Stockton South, said: "There is a crisis in children's mental health in this country. But all we are seeing are cuts to health visiting, children's centre closures and increasing child poverty. Government must now show inspiring leadership to help children get the best possible start in life.

"If our country is serious about prevention and reducing health inequalities then we must make massive investments and drive co-ordinated action right at the start of life."

Ian Hudspeth, chairman of the Local Government Association's community wellbeing board, backed the committee's call for extra government investment in early years support.

"Councils have pulled out all the stops to try to prioritise early years and intervention services, but can only do so much in the face of such funding pressures," he said.

"Therefore it is vital that in the forthcoming Spending Review, the government reverses the £700m of public health reductions, to enable councils to work more closely with the NHS, implement best practice and most importantly help give children the best start in life."

Neil Leitch, chief executive of the Early Years Alliance, said: "The integrated review should have been implemented in 2015 but, four years later, is nowhere near being fully rolled out. Instead, we have a programme implemented in some areas and not others with cuts to the very services, such as children's centres and health visitor training, that make early intervention possible."

Dr Jo Casebourne, chief executive at the Early Intervention Foundation, welcomed the report and "the strong case that it makes for increased leadership, co-ordination and investment for support designed to tackle the problems that can undermine children's life chances".

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