First 1,001 Days: WAVE Trust view

George Hosking, chief executive and research director, WAVE Trust
Friday, April 5, 2019

In 2014-15, the all-party parliamentary group for conception to age two - the first 1,001 days, took six months' evidence from leading UK academics and practitioners, asking what should be key policies for a child's first 1,001 days of life.

The 2015 report Building Great Britons summarised the study's two main conclusions:

  1. We want to create children who at the end of their first 1,001 days have the social and emotional resources that form a strong foundation for good citizenship.
  2. Without intervention, there will be in the future, as in the past, high intergenerational transmission of disadvantage, inequality, dysfunction and child maltreatment. These self-perpetuating cycles create untold and recurring costs for society. The economic value of breaking these cycles will be enormous.

The report moved on to a series of recommendations, in particular:

Recommendation 1: Achieving the very best experience for children in their first 1001 days should be a mainstream undertaking by all political parties and a key priority for NHS England. The priority given to the first 1001 days should be elevated to the same level as defence of the realm.

Recommendation 2: Require local authorities, CCGs and health & wellbeing boards to prioritise all factors leading to the development of socially and emotionally capable children at age two, by: adopting and implementing a "1,001 days" strategy, showing how they intend to implement it, with their partner agencies, within five years. The "1,001 days" strategies should be based on primary preventive principles, with particular emphasis on fostering mental/emotional wellbeing and secure attachment, and preventing child maltreatment.

Recommendation 3: National government should establish a "1,001-days" strategy fund to support local authorities and CCGs to make a decisive switch over the next five years, to a primary preventive approach in the first 1,001 days.

Sadly, far from following these recommendations, the UK government and local authorities (hit by continuing deep budget cuts) have reduced spending on the first 1,001 days. In Scotland, the picture is different, with strong investment in an increased health visitor workforce, and far more attention to tackling ACEs - adverse childhood experiences.

No area of life is exempt from the damage done by ACEs, be it health, ability to function socially, or to learn and achieve. Let's take two examples, mental health and education.

Research studies link abuse, neglect and other ACEs to significantly higher levels of at least 16 different forms of common and serious mental health problems.

A study in San Francisco found that only three per cent of children with zero ACEs (c.50 per cent of schoolchildren) had learning and behaviour problems at school, compared to 51% of children with 4 or more ACEs (c.15 per cent of children). Twenty one per cent of those with one to three ACEs had such problems. Essentially, it is the children with ACEs who exhibit behaviour and learning difficulties at school.

The peak age for the particularly toxic ACEs of child abuse and neglect is 0-12 months. Preventing ACEs in the first 1,001 days could transform mental health and education in this country - and we know how to do it. 

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