• New report welcomes Health Secretary’s pledge to return Sure Start services to every area and says strengthening the two-year health review is a critical first step to putting health at the heart of early childhood.

A new report by the Centre for Young Lives think-tank published today (Tuesday 20 October) calls on the Department of Health and Social Care (DHSC) to play its full part in ensuring children get the best start in life, starting with the health and development review offered to every child aged two to two-and-a-half.

[.download]Download the full report[.download] [.download] Download the executive summary[.download]

The report, “Starting Well: Putting health at the heart of early childhood”, finds that this review is a missed opportunity to identify which children might need more support, and deliver on the Government’s targets to boost school readiness and give every child the best start in life. 

Too many children – more than half, in some areas of the country – are missing out on the review. The quality of the review is also patchy following cuts in funding for health visiting, which have led to many health visitors having very high caseloads.

The report welcomes Health Secretary Yvette Cooper’s ambition to “put the cradle back at the heart of the NHS” and “bring back those Sure Start health services into every family centre”. It sets out how DHSC can step up further, alongside the Department for Education – which has led the way on Best Start Family Hubs and the Best Start in Life strategy – to put giving all children the best start firmly on its agenda. 

However, almost two years after the Government set a target for 75% of children to reach a good level of development by 2028, the Government is on track to miss that target. 

Today’s report argues that, while the recent announcement on the Healthy Babies programme is welcome, health services have not matched the ambition shown by education in supporting early childhood development. Children account for only a tenth of the NHS budget, despite making up one quarter of the population, and the Public Health Grant – which funds the Healthy Child Programme – has been cut by £900 million over the past decade or so. 

The two-year review is the final universal, mandated review of the Healthy Child Programme. It can spot issues such as speech and language delays, emerging special educational needs and challenges at home, while there is still time to act before children start school. A new study from researchers leading the Born in Bradford study shows that children showing a good level of development at the two-year review had more than three times the odds of achieving a good level of development at age five.

Yet while this review is a vital chance to act early, today’s report shows that it is too often a missed opportunity.

The report highlights how:

Children and families are being missed. One in five children did not receive their review in 2024/25, and in some local areas less than one in three children received it. Those who miss out are often those who need the most help.

The quality of the review varies. Nearly all health visitors (94%) work above the recommended caseload of 250 children; some have a caseload of over 1,000 children. Local authorities described the review as often a ‘tick-box exercise’ rather than a meaningful interaction with a family.

Need being identified does not always lead to help being provided. Less than half of health visitors feel confident they can meet the needs of vulnerable babies and children all or most of the time. Too often, information on children is not shared with other services.

Drawing on six local case studies, the report sets out a framework to strengthen the review, built around three core principles:

1. Every child should be reached, particularly the most vulnerable: Local areas should remove families’ barriers to attending the review, use birth data to know which families need one, and follow up on every missed appointment the same day.

2. Every review should be done well, so that need is identified early: Reviews should be carried out by a skilled, stable health visiting workforce with time to build relationships with families.

3. Every review that identifies need should lead to a meaningful pathway of support: The review should be a gateway into a joined-up offer of support, where children and families have access to the right support when and where they need it - with a single front door through Best Start Family Hubs.

The report calls on DHSC to take a much greater role in early childhood by developing, in partnership with others, a national quality improvement framework for the review. It should also become an key funding partner for early childhood by committing an additional £500 million over the next Spending Review, on top of what has already been committed to Healthy Babies. This would be used to expand health visiting, confirm Healthy Babies funding to 2029, and protect funding for the Healthy Child Programme.

The report reiterates the Centre for Young Lives’ calls for legislation to put Best Start Family Hubs, the Healthy Babies programme and remaining children’s centres on a single statutory footing with a duty to commission them. To strengthen these services further, the report argues for a refreshed national ‘Sure Start’ brand that brings them together under one name which families recognise and trust.

Haroon Chowdry, Chief Executive of the Centre for Young Lives, said:

"Despite the government’s focus on school readiness, it is failing to make the most of one of the best tools we have to address children's needs before they start school. 

"The review children have at the age of two to two-and-a-half is a golden opportunity, but for too many children it isn’t delivered well – if at all. And too often it is disconnected from the wider support that children and families need.

"Our framework, developed in consultation with local areas, sets out how they can ensure this review does its job properly: with every child, no matter where they live, being seen and getting the help they need to thrive.  

“To achieve this, central government will also need to step up through additional investment, a clear mandate for better data infrastructure and data sharing, and guidance and shared outcomes to ensure local services are better aligned. 

“There has been welcome action from government on supporting children and families from birth. But more is needed to ensure that every child, in every part of the country, gets off to a good start.”  

Anna Heuschkel, author of the report, said:

“We welcome the Health Secretary’s pledge to bring Sure Start health services back into every family hub. The two-year review is the place to start – it already reaches four in five children. But health visiting is so stretched that too many children’s needs go unnoticed until reception.

“The local areas we spoke to show what is possible. With the right support from central government, every area can do the same. That is how we begin to deliver on the government’s ambition to put the cradle back at the heart of the NHS.”

[.download]Download the full report[.download] [.download]Download the executive summary[.download]

Notes to editors:

1. Research on the ASQ-3 from Born in Bradford: https://borninbradford.nhs.uk/our-impacts/publications/the-association-between-the-ages-and-stages-questionnaire-3-assessment-at-age-2-and-the-early-years-foundation-stage-at-age-5-a-longitudinal-observational-study-using-routine-data/

2. Starting Well brings together the Centre for Young Lives' work on the early years. It sits within our Early Impact priority, which makes the case for intervention and support for children and families at the earliest opportunity, to boost life chances and tackle the high cost of crisis. Our first report, A Fresh Start for Children and Family Support, published before the Best Start in Life strategy, took stock of what was left of integrated family support across the country. Our second report, Best Start (November 2025) sets out six principles for the Government's new Best Start Family Hubs. Starting Well (June 2026) responded to the Government's target for 75% of five-year-olds to reach a good level of development.