Health and education: sharing is caring

To improve outcomes for five-year-olds, health and education services need to be better integrated and share more data, say experts. What are the hurdles, and what does it mean for CPs? Journalist Anna Scott reports.

The government’s 2028 target outlined in its Best Start in Life strategy is that 75% of five year-olds in England should reach a good level of physical, mental and educational development. It would mean an additional 40,000 to 45,000 children a year hitting goals and an increase from the current 67.7% (DfE, 2025).

But to achieve this, health and education services need to be effectively integrated, finds research by The Local Government Association (LGA, 2026a). The study, Achieving the best start in life: research to support a plan for partners was carried out
across 60 local authority areas in England with councils, stakeholders, parents and carers. It found that barriers including
health visitor workforce shortages and limited access to high-quality early years education are restricting progress towards
the developmental goal (LGA, 2026a).

Integrated services bring together health, education and family support around children and parents’ needs, rather than expecting
families to navigate multiple disconnected systems. ‘Professionals, such as HVs, early years educators, SEND specialists and
family support workers share responsibility, information and goals,’ says Councillor Amanda Hopgood, Chair of the LGA’s children
and young people and families committee.

‘Effective integration is less about organisational structures and more about shared outcomes, relationships and alignment across services, particularly in the 0 to 5 age group period. Integrated approaches help families access the right support earlier and more
easily, reducing duplication and gaps in provision,’ she adds.

THE HURDLES

Among the structural and socio-economic barriers to healthy five-year-olds uncovered by the research were deprivation and poverty, adverse childhood experiences and families who speak English as an additional language (LGA, 2026a).
High-quality childcare was often prohibitively expensive or unavailable, while health, education and social support services were fragmented. Some families also reported a lack of trust in statutory services (LGA, 2026a).

What’s more, a lack of shared, longterm vision among local partners can lead to inconsistent service delivery and a short-term approach to funding, while local authorities often lacked the shared data systems needed to identify children’s progress and any families not accessing support, the research stated.

Another issue is the difference in funding and structural approaches across the UK. Not only do health visiting services in England have fewer visits (five compared with nine in Northern Ireland, 11 in Scotland and 13 in Wales), but it is the only service
not to be wholly embedded in the NHS (Fanner et al, 2025).

This doesn’t necessarily mean services are better integrated in the devolved nations. Across all four countries, there has been a disconnect between a policy ambition of integration and the difference it has made to patients across the lifespan (Reed et al, 2021). Systemic factors are at play, including lack of resources and staff, and divergent cultures and priorities across health and social care (Reed et al, 2021).

But because the HV service in England is funded through public health budgets paid directly to local government from the Department of Health and Social Care, an additional commissioning layer exists between national and local government policies (Fanner et al, 2025). As a result, there’s considerable variation in local interpretation of national child health policy in England: for example, only 75 of 150 eligible local authorities received Family Hubs and Start for Life Policy funding, researchers
found last year (Fanner et al, 2025).

The LGA report also outlines difficulties recruiting and retaining workers in the early years sector, and shortages of specialist
professionals, including educational psychologists and speech and language specialists (LGA, 2026a).

An estimated shortage of 5000 HVs in England is compounded by a shortage of student health visiting places, and increases HVs’ workloads (LGA, 2026a).

Unite-CPHVA view
Unite (health) lead professional officer Ethel Rodrigues says:
‘We welcome the LGA report which shows that an effective coordinated system is needed to address the growing and complex needs
of children’s health and education. This is a wakeup call for the government to step up investment in the workforce for a sustainable future for our children and young people.
With the increasing shortage of health visitors, the government must invest now in health visiting, which is pivotal to its Best Start in Life strategy, if the goals are to be reached.’

THE UNDERINVESTMENT IMPACT

Professor Damian Roland, consultant in paediatric emergency medicine at University Hospital of Leicester NHS Trust, highlights a link between the challenges the health visiting profession faces and the increasing number of children aged 0 to 4 attending emergency departments. He also says that the more deprived children are, the more health-seeking behaviour there is.

‘Evidence is very clear that continued engagement with families is critical and that disadvantaged communities need a trusted point of contact they can turn to before and during episodes of concern,’ explains Professor Roland.

The shortage and changing role of HVs is one of the most immediate pressures, agrees Dr Bina Ram, behavioural and social science research fellow in child and adolescent population health at Imperial College London.

‘Within the last decade, HV workforce shortages (largely driven by public health funding cuts alongside high demands and increasing workload), and significant changes to roles have led to an unequal impact on early years development and gaps in school readiness,’ she says.

Cracks are appearing across early years provision, from health visiting to specialist support, and these can no longer be ignored,
adds Dr Mike McKean, vice president for policy at the Royal College of Paediatrics and Child Health. He agrees that long-term
underinvestment and a sustained lack of focus on young children and the workforce that supports them have left the system
under real strain, despite the fact that the early years are by far the most significant period in a child’s development.

‘It remains far too easy for children, especially those from poorer backgrounds, to fall through the gaps. Without urgent action, these health inequalities will only widen,’ warns Dr McKean.

‘CHILDREN’S DEVELOPMENT DOES NOT FOLLOW SERVICE BOUNDARIES’

WHAT ABOUT HUBS?

Community Practitioner has regularly reported on the progress of family hubs, but where are they now, and how do they fit into the picture? The LGA report identifies challenges for the government’s Best Start Family Hubs, specifically the lack of funding to renovate or secure physical buildings, concerns that the current three year investment might not be replaced by long-term statutory funding and persistent difficulties in sharing data between professionals (LGA, 2026a).

The hubs are designed to ‘take the best of the Sure Start, Family Hubs and Start for Life approaches’ by focusing on early intervention (DfE, 2025). Dr Ram contributed to the national evaluation of Sure Start and co-led the evaluation of the
Early Years GP Child Health Hubs Pilots for the NHS North West London Integrated Care Board. She believes the hubs show
promising attempts to address many of the challenges, particularly around the fragmentation of services and difficulties families face in accessing support.

‘These hubs are delivering on core aims of providing holistic, family-centred approaches and having positive impacts on parent
confidence, which in turn are having a positive impact on parent and child relationships,’ she says. ‘However, [they] are still in their early stages and overall longer-term effectiveness is yet to be established. Compared with earlier integrated programmes, constrained funding may limit scalability, particularly in the most disadvantaged areas where they are needed most.’

Amanda from the LGA agrees that hubs are showing early promise, especially when embedded in a wider system approach. ‘Parents valued family hubs as trusted, non-stigmatising places. Professionals reported that hubs help break down silos between services and make joint working more routine, particularly for early identification of need and support for children with SEND.’

However, ‘success depends on sustained investment and a long-term focus on improving outcomes for children and families,’ adds Amanda. ‘Family hubs are most effective when they are supported by long-term funding, integrated leadership and strong links
to health and education partners.’

Best practice: an LGA case study

Bath and North East Somerset’s health visiting service reaches almost 90% of all reviews at 2 to 2.5 years and 90% for the 1-year review at 15 months. But by the time children are at the end of the Reception year, there is a significant drop in a good level of
development, and the service sees rapid increases in demand for mental health and emotional wellbeing support for children from
the age of 7.

Over the last few years, the service has been working closely with commissioners to influence the implementation of an additional targeted review at 3 to 3.5 years, which was set to be introduced from April 2026. Initially children with needs identified
at the 2 to 2.5 year review, families living in the most deprived areas, and children with safeguarding considerations, SEND and other
vulnerabilities will be targeted.

Health visitors will apply their professional/clinical judgement to identify whether an additional contact, delivered in partnership with
parents, would enable the service to identify and take steps to meet any unmet needs.

At the time of writing, it was too soon to report on progress.
(LGA, 2026b)

‘THE SINGLE BIGGEST THING TO IMPROVE AND INTEGRATE WOULD BE THE ADOPTION OF THE NHS NUMBER IN EDUCATION’

WHAT’S THE ANSWER?

The LGA report outlines several recommendations to support more effective integration at a local level. These include a shared leadership focus on early childhood outcomes with cross-sector integrated leadership teams, and improved use of shared data to identify unmet need, understand patterns of disadvantage and target support more effectively. The latter includes linking HV data to school nurse planning to inform future workforce needs (LGA, 2026a).

Early years recruitment and retention should focus on ‘growing your own’ strategies for HVs and early years entry
level roles, with band 4 nursery nurses progressing through apprenticeship to qualified HV roles, recommends the LGA
report (LGA, 2026a). Successful approaches identified in the report include colocation of multi-agency staff in
family hubs, for example HVs, mental health teams, and speech and language therapists (LGA, 2026a).

‘Children’s development does not follow service boundaries,’ says Amanda. ‘The research shows that key drivers of later outcomes, such as language development, emotional wellbeing and early identification of SEND, sit at the intersection of health and education.’

For paediatric consultant Professor Roland, the ‘single biggest thing to improve and integrate would be the adoption of the NHS number in education’. He says: ‘If we could follow children through health AND education services, the impact of each
would be much easier to understand.’

When services are joined up, children are more likely to receive timely and effective support during the most critical stages of early years development, Dr Ram agrees.

‘Improving outcomes for young children requires a coordinated approach that strengthens the early years workforce, tackles poverty, and ensures all families can access high-quality support. Without this, consequences for children will last far beyond the early years,’ she says.

Ultimately, the research provides evidence that improving children’s outcomes depends as much on how services work together as on what services are delivered. ‘It underlines a need for longterm, place-based investment in early years systems, policy alignment across health, education and family support, greater flexibility for local areas to design integrated solutions tailored to their communities, and recognition of the early years and health visiting workforces as a critical national
asset,’ says Amanda.

While not commenting directly on the report, the government stated elsewhere that local authorities will receive further guidance ‘in the coming weeks’ about how the ‘join-up between early years settings, HVs and SEND teams will be made
easier’ (DHSC, 2026). And that: ‘It is our intention to improve the capacity of healthvisiting services, including through the development of a safe staffing tool, which will be developed over the next few years.’ Amanda concludes: ‘Insights from our
research will inform priority areas for local partners and national government, aligned with the direction set out in the [government’s] Best Start in Life Strategy.’

Image | ISTOCK

REFERENCES

Department for Education. (2025) Giving every child the best start in life. See: https://assets.publishing.service.gov.uk/media/686bd62a10d550c668de3be7/Giving_every_child_the_best_start_in_life.pdf (accessed 30 April 2026).

Department for Health and Social Care. (2026) Government response to the Health and Social Care Committee’s fifth report of session 2024 to 2026, ‘The First 1000 Days: a renewed focus’. See: bit.ly/4wFIV1X (accessed 30 April 2026).

Fanner M, et al. (2025) PROTOCOL: Health visiting interventions with 0–5 year olds and their families: An evidence and gap map. See: doi.org/10.1002/cl2.70078  (accessed 30 April 2026).

Local Government Association. (2026a) Achieving the best start in life: Research to support a plan for partners. See: local.gov.uk/publications/achieving-best-start-life-research-support-plan-partners (accessed 30 April 2026).

Local Government Association. (2026b) Health visiting service identifying the need for an additional targeted contact at 3 to 3.5 years Local authority: Bath and North East Somerset. See: local.gov.uk/case-studies/health-visiting-service-identifying-need-additional-targeted-contact-3-35-years-local (accessed 30 April 2026).

Reed S, et al (2021) Integrating health and social care A comparison of policy and progress across the four countries of the UK. See: https://www.nuffieldtrust.org.uk/sites/default/files/2021-12/integrated-care-web.pdf   (accessed 30 April 2026).