The Best Start for Life: a vision for the 1,001 critical days was published by the Department for Health and Social Care (DHSC) in March 2021, following the Early Years Healthy Development Review, which was commissioned by the Prime Minister and chaired by Rt Hon Dame Andrea Leadsom DBE MP. Family Hubs are at the heart of this vision for baby-centred services, designed to give every baby the best start for life.
The review focused on the period between conception and the age of two – the first 1,001 critical days – and considered evidence gathered from a wide range of sources: through virtual visits to local areas and meetings with parents, carers, academics, practitioners, civil society organisations, representative bodies and many others. It learnt about good practice and identified where change was needed to make a real difference to the lives of parents, carers and babies.
The resulting vision sets out an ambitious programme of work to transform how families are supported. The goal is to ensure the very best support throughout these 1,001 critical days, setting babies up to maximise their potential for lifelong emotional and physical wellbeing. To achieve this, work will focus on six action areas.
Ensuring families have access to the services they need:
1. Seamless support for families
A coherent joined up Start for Life offer available to all families.
2. A welcoming hub for families
Family Hubs as a place for families to access Start for Life services.
3. The information families need when they need it
Designing digital, virtual and telephone needs around the needs of the family.
Ensuring the Start for Life system is working together to give families the support they need:
4. An empowered Start for Life workforce
Developing a modern skilled workforce to meet the changing needs of families.
5. Continually improving the Start for Life offer
Improving data, evaluation, outcome and proportionate inspection.
6. Leadership for change
Ensuring local and national accountability and building the economic case.
Research for the review demonstrated clearly that what parents and carers want is accessible, joined-up services, available in one place, both physically and virtually. Family Hubs can become that home for services during this critical period from conception to the age of two, providing universal and seamless support and encouragement to every new family.
The Best Start for Life vision is for Family Hubs to be open access, so any parent or carer can drop in whenever they need to, and for Family Hubs to offer a welcoming place with baby-friendly facilities ranging from antenatal checks to birth registration to health visitor meet-ups. The experience of lockdown has added a new dimension to the Family Hub offer and the development of virtual tools offering easy access and convenience for parents and carers has been a positive consequence of the pandemic. From mums nervous about seeking face-to-face breastfeeding assistance to fathers asking for mental health support, online and virtual services have an important role to play, especially at a time when a baby’s needs can be exhausting. A strong local offer in each area will give flexible and accessible support to new families.
Why are the first 1,001 days critical?
The science of early brain development tells us that the construction of the basic architecture of the brain begins before birth and that more than a million new neural connections are formed every second in the first year of a baby’s life. This is the peak period of brain development. The 1,001 critical days set the foundations for an individual’s cognitive, emotional and physical development.
These 1,001 days are a critical time for development, and they are also a time when babies are at their most vulnerable. A healthy pregnancy sets up the unborn baby for a healthy life. Pregnancy changes life for parents, carers and the family around them. The mental health and wellbeing of mums, dads, partners and carers is very important for the development of the baby. Stress and adverse experiences in the 1,001 critical days – whether caused by repeated abuse, severe maternal depression or extreme poverty – have a negative impact on a baby’s development and can have long-lasting or even lifelong impacts.
What is the vision’s definition of a Start for Life offer?
The first action area is Seamless support for families. The vision supports local authorities, working with other local partners, to develop a coherent and joined-up Start for Life offer, which explains clearly to parents and carers the services they are entitled to and how they can access them. The ambition for Start for Life is to include a universal offer which brings together critical services for every new family:
- health visiting
- mental health support
- infant feeding advice with specialist breastfeeding support.
Every universal offer must include safeguarding and services related to special educational needs and disabilities.
Supplementing the four core services, the vision encourages local authorities and their partners to look at delivering a ‘universal+’ offer, relevant to the needs of their communities and covering a range of services such as parenting support, early language development, debt and finance support, housing support, smoking cessation services and drug and alcohol support.
In delivering these services, local authorities may want to consider several factors:
- parent and carer panels to inform and guide the direction of planning and service delivery
- publishing the offer and making it clearly available, so parents can easily access information
- access and engagement: minimising any stigma that may exist for some parents, carers and families
- parents, carers and families being allocated a key contact to help them navigate services and systems
- staff being well-trained and trained together, learning between and across professions
- monitoring of impact, and the gathering, analysis and evaluation of outcome data, to feed into ongoing improvement
- local leadership as specific, clear and accountable
- and, of course, delivery through a Family Hub model.
The vision identified key themes where more work is needed to support families, including several key considerations:
- young parents
- single parents
- same-sex parents and carers
- dads and partners
- grandparents and kinship carers
- adoption and fostering
- minoritised ethnic groups
- support for disabled babies and their parents and carers
- families experiencing baby loss
- outreach and virtual services
- multidisciplinary teams.
Critical 1,001 Days in Family Hubs
The second action area is A welcoming hub for families. Although Family Hubs are designed to support families from conception to 19 (or 25 if they have special educational needs or have disabilities), the Best Start for Life vision is for services to be offered as a core part of the local Family Hub network. A locally published Start for Life offer would ensure that families know what is available to them.
A welcoming Family Hub that is accessible to each new family during pregnancy and beyond will be extremely valuable, allowing families to access face-to-face and digital support in a single place. Family Hubs also offer parents, carers and families the opportunity to connect and communicate with others in their area and build a local support network with people who have had similar experiences. They can provide a place where parents, carers and families meet with others, as well as volunteers and support workers, extending the network of people available to offer help, advice or a friendly chat when needed.
Having a place to go is important for families but a single, centralised location may not be able to meet the needs of all families in a community. More rural locations, and more diverse communities, will need different specialist or outreach services that are part of the wider Family Hub network but tailored for the needs of that particular community. Local Family Hub networks can consist of both physical and virtual places where services supporting families from conception to two years can come together. Services such as midwifery, health visiting, mental health support, parenting courses and infant feeding advice could all be delivered through a Family Hub network, along with services for families with older children. All of the many ‘wrap-around’ services provided by local authorities, health organisations and voluntary and community sector providers for the crucial 1,001-day period could also be accessible through Family Hubs.
Many local authorities are already taking great strides towards The Best Start for Life vision for Family Hubs. Examples include Doncaster, the Isle of Wight and Westminster.
Doncaster, a local authority with an urban population, has 12 Family Hubs delivering services across the 0–25 age range. Among other objectives, these aim to:
- enhance parents’ wellbeing and emotional and mental health
- improve parenting and the quality of parent–child relationships
- improve children’s early language and literacy
- improve children’s early social and behavioural skills
- enhance children’s wellbeing and emotional and mental health.
Doncaster offers a wide range of services for the critical Start for Life period. Its coordinated, multiagency approach to identifying need during pregnancy enables the coordination of timely and appropriate support to meet those needs before the birth of baby. This paves the way for parents to be better prepared for birth and family life. Prenatal maternal health advice and support is offered at Family Hubs, alongside emotional and mental health support for parents and carers, and baby and infant health advice. Midwives and health visitors are based at the hubs, which is particularly valuable in establishing trusting relationships between parents, carers and professionals. Family Hubs deliver interactive Stay & Play sessions and parenting programmes that support the development of high-quality parent–child interaction and parenting.
Isle of Wight
The Isle of Wight was one of the first areas of the country to develop Family Hubs. With three main Family Hubs and six ‘spoke’ sites, the island’s children and families are able to access joined-up early help and support in their local community. Effective early support can improve children’s wellbeing, educational attainment and life chances. Working with families and the wider community, the Isle of Wight Family Hubs draw on a strength-based, restorative approach, developing families’ own capabilities and community resilience.
The hubs offer a wide range of support for families with children aged 0–19 (including antenatal support), ranging from appointments with health professionals (e.g., midwives and health visitors), to open Stay & Play sessions for families, to more intensive and bespoke family support.
Midwifery-led antenatal sessions, Five to Thrive for new parents, DadzClub, breastfeeding support, toddler talk early language groups, healthy eating groups, support to young carers and intensive family support in family workers classes are all delivered at the Family Hubs.
There is also a wide range of parenting courses for parents, carers and families, including Baby Incredible Years and the Family Links Nurturing Programme, as well as specialist programmes relating to special needs and disabilities and adolescence. Parents can access relationship support to help or rebuild existing relationships and during or after separation. Family time (contact) is provided at the centres for children in care, offering a safe, secure and child-friendly space where parents and carers can access the wide range of support on offer.
The hubs also offer volunteering opportunities, together with support and guidance to access education, employment and training, and career development through partnership working with the Department for Work and Pensions and work coaches.
At Westminster City Council, extensive work is taking place to deliver integrated services from the time of conception to two years across three Family Hub sites: Bessborough Family Hub, Portman Early Childhood Centre and Queen’s Park Children’s Centre.
A wide range of services is delivered through Family Hubs, including health visiting, midwifery, baby groups, support around special needs and disability and mental health support groups for families. Bessborough offers Café Mama sessions, where families with children under the age of one can drop in to receive infant feeding support and advice. Similar services are delivered at the Portman and Queen’s Park sites.
The Council works hard to ensure that the professionals who support families work together in a joined-up way and maximise the support available through the voluntary sector to enhance opportunities for families. One example is the commissioning of maternity champions, a trained team of local volunteers who provide support for expectant and new parents. The hubs also run a befriending volunteer service for families with children aged up to five. Outreach is a key component of the model, with teams dedicated to engaging with vulnerable and isolated families as a core service at the hub. Birth registrations on-site are set to restart, following a pause during the coronavirus pandemic.
Westminster is also currently in the process of commissioning an integrated pre-birth to five service model where health visitors will form part of the wider early help service. These models aim to ensure that all practitioners are best equipped to deliver on the national and local commitments for The Best Start for Life.
How will the National Centre for Family Hubs support the implementation of The Best Start for Life vision?
There are several ways that NCFH will support the implementation of the Best Start for Life:
- ensuring councils understand how best to build a Family Hub network, including incorporating existing Sure Start children’s centres into their network where appropriate
- supporting all Family Hubs with their specific Start for Life offer
- working with relevant government departments to identify the practical steps that should be taken at a national and local level to reduce the stigma some experience when asking for help
- working with relevant government departments to identify the best way to introduce families to their local hub, including encouraging local authorities to consider offering birth registration services at Family Hubs.
The Best Start for Life vision also includes action around building skills across the Start for Life workforce, strengthening continuity of care and developing a modern workforce that can better meet the needs of all families. This includes working with local leaders and NCFH to further explore the concept of a ‘key contact’ for every family, to ensure a good level of continuity within the multidisciplinary team providing support to babies and families.
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