Written evidence submitted by NCT (The National Childbirth Trust) (FTDOO53)
About NCT (The National Childbirth Trust)
NCT is a charity with a clear mission: to support people as they become parents, through pregnancy, birth, and early parenthood.
With a 65-year history of transformative change, we are a vibrant community of volunteers, practitioners, peer supporters, members and advocates. We are the largest parenting charity in the country and over the decades we’ve supported millions of people on their unique journey into parenthood.
While many know us for our antenatal classes, we also do much more. We provide infant feeding support, and run thousands of free community events and activities led by our amazing volunteers. We also support families facing challenges like social isolation, feeding difficulties, and poor mental health. We offer support in communities, in hospitals and online, 365 days a year.
Policy submission summary: strengthening community-based support for parents and babies
NCT’s submission calls for urgent investment in community-level antenatal care and education, infant feeding support, and postnatal mental health services to improve outcomes for families across the UK.
Better outcomes through community and voluntary sector models
To meet these needs effectively, a peer-to-peer support model, supported by the voluntary and community sector (VCS), offers scalable and empathetic care. Digital tools like a postnatal app and 24/7 advice line can extend reach, improve service navigation, and reduce inappropriate A&E attendance.
Towards proportionate universalism
NCT advocates for a strong, universal baseline of care that is genuinely accessible to all, complemented by targeted interventions for families facing the greatest disadvantage—especially in areas of high deprivation or among groups underrepresented in statutory services. Local VCS organisations, using co-production approaches, are uniquely positioned to deliver tailored support that bridges systemic gaps and ensures no family is left behind. By combining universal access with personalised, community-rooted interventions, and leveraging digital tools for consistency, we can build a more responsive and equitable system for families across the UK.
To effectively tackle inequalities in access and infant health outcomes among underserved groups—including families with disabilities, from ethnic minority backgrounds, or living in deprivation—the Government must go beyond funding and prioritise how services are delivered. This means co-producing services with local communities to ensure they are culturally relevant and meet real needs; offering support in multiple formats (in-person, digital, written, and verbal) to accommodate different access needs; using trusted community connectors for outreach in public spaces; and investing in peer-support models that offer relatable, empathetic care. Integrated hubs should serve as joined-up, inclusive entry points to a range of services, ensuring timely, knowledgeable support and effective referrals—especially for those who often face systemic barriers.
DETAILED RESPONSE
What progress has been made since the previous Committee’s 2019 First 1000 days of life report in terms of outcomes for children and young people in delivering integrated early years through Family Hubs?
We know that so-called ‘universal’ provision is often far from truly universal but rather a postcode lottery. Targeted services – often delivered by the grassroots, voluntary sector – are plugging gaps and meeting local need based on their in-depth understanding of local people and communities – understanding their circumstances, needs and barriers (via co-production service design approaches). Our starting position is that there should be a strong universal baseline, with effective universal provision available and accessible to all, strengthened through personalised and locally available interventions. However, where targeted services are commissioned or set up, there is benefit in targeting areas with high levels of socioeconomic deprivation and child poverty, communities and populations facing severe and multiple disadvantage, and groups who are less likely to engage with statutory provision.
We recognise the challenge of striking the right balance between the consistency of a universal offer and the flexibility to respond to local contexts, and suggest that a model that harnesses technology to bridge digital and in-person provision could help provide a consistent, universal offer (e.g., a multi-channel digital platform) that has the functionality to signpost into appropriate local provision (both statutory and voluntary sector), facilitating an integrated, joined-up service user experience.
By bringing together key services under one roof — including midwifery, health visiting, and early years support – Family Hubs mean that antenatal care can be better connected to wider support for families, such as parenting programmes, mental health services, and relationship support.
We strongly supported the creation of hubs as in the Better Births policy, which recommended: ‘Community hubs should be established, where maternity services, particularly ante- and postnatally, are provided alongside other family-orientated health and social services provided by statutory and voluntary agencies’ and we continue to believe this is the best policy for families throughout the maternity journey. Accessibility to such hubs should be assured by providing interpreting services suitable for the local community; making the venue physically appropriate; and being aware of transport links to reduce expensive travel costs.
Despite investment into Family Hubs, evidence suggests that both the quality and quantity of postnatal care has reduced over past decades. The Chief Medical Officer’s report in 2014 identified postnatal care then as ‘not fit for purpose’¹ and there has been a continuing and worsening failure to improve it. Annual surveys of maternity care in England carried out by the Care Quality Commission (CQC) have shown successive reductions in responders’ satisfaction with postnatal care, compared with antenatal and intrapartum² ³.
Effective postnatal support in the community is essential to support new mothers. The Care Quality Commission recommends that during the 6 to 8 weeks following birth, monitoring of maternal health (including physical and mental health), infant feeding and infant health should continue. NICE guidance on postnatal care suggests a minimum of 3 contacts with women and their baby⁷. Postnatal care should be provided face-to-face and supplemented by virtual discussions and written formats.
The current system, especially in England, means that the first six weeks’ postnatal care for one woman may often be commissioned and provided by up to four different institutions: an NHS hospital trust commissioned by an Integrated Care Board; a different, more local NHS trust giving community-based care; health visitors employed by a local authority pursuing a programme of care designed by the Office for Health Improvement and Disparities (OHID); and GPs or physician associates working in primary care. Issues of communication and data-sharing among these different bodies are fraught with technical and regulatory restrictions that increase the likelihood of professionals’ not being familiar with the notes on someone’s maternity care and any background to their lives that is relevant. Delays or omissions in communication can exacerbate the lack of timely support; they also add to parents’ challenges in learning how to make their way through the complexities of the system.
According to the report from The National Maternity and Perinatal Audit (NMPA), the rate of maternal postnatal re-admission is 3.3% across England & Wales, with more women re-admitted after caesarean (4.3%) than vaginal birth (2.9%)⁶. Women are too frequently being sent back to hospital for wound infection, hypertension, haemorrhage, when better care at home or in the community would mitigate the need for disruptive and expensive readmission to acute care.
This fragmented system is compounded by staffing shortages. The health visiting profession has witnessed a loss of almost 40% of its workforce since 2015, with the Institute of Health Visiting (IHV) estimating a current shortfall of 5,000 health visitors⁵.
Timely access to GP provision is also an issue: The 2023 General Practice Patient Survey found that - while most patients who do get an appointment with a GP receive one within 48 hours of initially trying to book - almost a third of patients find the process of contacting their practice and making an appointment difficult. Against this backdrop, it is unsurprising that babies under one have the highest rate of A&E attendance compared to any other age group. The rate of 0–4-year-olds attending A&E has increased by 42% in the last 10 years, even though the majority of babies who attend A&E do not need medical treatment. There has been a substantial deterioration in A&E waiting times for this group; with nearly one in five babies under two waiting longer than four hours to be seen.
As the UK’s national charity for parents, NCT is increasingly concerned at the volume and nature of stressful and often traumatic experiences we are hearing from new and expectant parents trying to access or receive appropriate support and care in the postnatal period.
“I have a friend who had twins and one of them has awful issues with feeding - been told it’s colic, constipation, reflux and all sorts but she can’t get a referral to a paediatrician - her daughter literally screams whenever she is fed and is now refusing the bottle (12 weeks old) she’s crying in her sleep too. Is there a way you can self refer to? She’s also gone to A&E and no one is listening to her?”
Parents need unbiased, evidence-based information and support to enable them to feed their babies in the way they decide.
Breastfeeding rates in the UK are among the lowest in the world, and a new report by the World Breastfeeding Trends Initiative (WBTi) has singled out England as falling behind the rest of the UK on measures that protect and promote breastfeeding⁹.
This is evidenced by a comparison of CQC survey of maternity services 2019 and 2024 which suggests that in some cases support for baby’s health and progress and infant feeding is declining³ ⁴.
We know that 81% of women in the UK start breastfeeding and 80% stop before they want to. However, time constraints and staffing shortages often prevent midwives on the postnatal wards from being as present or hands-on as many mothers and new parents may need. This “time poverty” is a notable challenge particularly with breastfeeding support, which often requires not just practical guidance but also a sense of attentiveness and reassurance that can take more time than midwives have available during shifts (Gleeson et al., 2022; UNICEF UK, 2023)⁴ ⁸.
The NHS should enable and support parents to make, and carry out, informed decisions about feeding their babies.
Research shows more than one in five women and birthing parents will face a mental health challenge during pregnancy and after birth.
Although maternal deaths are generally low in the UK, perinatal mental illness is associated with maternal mortality. 40% of deaths within the year after pregnancy were from mental health causes.
We know that a complex set of social factors determines our health outcomes and life expectancy, often impacting those who are at the greatest disadvantage.
Peer-led mental health support can be a lifeline, especially for those experiencing isolation, anxiety, or postnatal depression. Based on a peer support model, NCT Parents in Mind is delivered by volunteers, with lived experience of wellbeing difficulties. During the programme pilot, two thirds of mothers reported lowered anxiety and depression scores, and 86% of mothers reported feeling less isolated and alone.
Digital support for the postnatal period, 24/7, 365 days a year
We’re calling for the introduction of an postnatal app to navigate services and provide clear pathways for accessing support, and a 24h postnatal advice line. Accessible ‘out of hours’ support could act as an effective early intervention to address non-critical issues to support parents and babies – which the above evidence currently suggests may be referred to A&E.
Monitoring and evaluation of NCT’s Infant Feeding Line demonstrates that parents increasingly need timely, expert and holistic support around a wide range of interconnected issues, covering more than just infant feeding, including areas such as sleep, broader infant care needs and neurodevelopment, postpartum physical and emotional recovery and perinatal mental health.
Our insights also reveal that parents often need guidance navigating these statutory health services and other third-sector provision, and help understanding under what circumstances it may in fact be necessary to see a GP or midwife (or even visit A&E) or which other specialist resources are available (e.g., Tommy’s for medical concerns during pregnancy; Bliss for concerns regarding a premature baby).
Parents tell us that they struggle to find and access this type of support. There is currently no such universal offer in the UK: users of our NCT infant feeding helpline often report that it is the only place they can turn to for instant support that is evidence-based, non-judgmental, holistic and not time-constrained.
There is real potential to act as an early intervention, help bridge the postnatal gap and offer continuity of care. Such a service would impact positively on significant health issues such as perinatal wellbeing, infant feeding challenges and infant A&E admission rates, where clinical interventions are not always necessary.
In addition to the above, we’re call for the government to focus on:
3. How effective have Family Hubs and the introduction of integrated care systems been in improving early childhood outcomes?
Family Hubs and the introduction of Integrated Care Systems (ICS) show promising potential in improving early childhood outcomes, particularly for families who are already engaging with services.
Where systems are effectively integrated, Family Hubs can offer a more streamlined and coordinated approach—helping parents to access the right support without needing to navigate multiple agencies. This reduces confusion, saves time, and builds trust, especially when families feel that services are genuinely working together around their needs.
However, there are significant challenges. The 0–21 age remit is extremely broad, and there is a risk that the specific and intensive needs of families with young children get diluted in the wider age range. Additionally, while Family Hubs are proving beneficial for those who are engaging, there remains a concerning gap for families who are more marginalised or less likely to access services in traditional ways. Currently, there is limited support for those outside the hub model, which risks deepening inequalities.
Some Family Hubs have taken important steps to reduce barriers to access—such as offering services in community venues, building trusted relationships with families, or using outreach models. However, this good practice is not yet consistent across all hubs, and more must be done to ensure that accessibility and inclusion are prioritised nationally, not just locally. We also think there should be opportunities to share good practice - what has and hasn't worked to prevent others making similar mistakes and learn from what is working and why.
To be truly effective in improving early childhood outcomes, Family Hubs and ICS need sustained investment, inclusive design, and a commitment to reaching those families who are least likely to walk through the door on their own.
4. What are the key barriers to delivering high-quality early years services, particularly in Family Hubs and through neonatal and paediatric services, and how can they be addressed?
In our experience, the voluntary, community and faith sector is often not adequately represented in statutory perinatal and early years advisory or working groups. We have observed problematic power dynamics at play, with the voluntary sector often not being viewed as an equal partner. For example – one-way referral pathways (statutory into VCFS but not vice versa); expectation that voluntary sector will be quick to act and respond vs. difficulties for the VCFS engaging with statutory services, not receiving replies etc.; expectation that we will share information with them, but not vice versa. We appreciate that due to established structures, policies and processes, the voluntary sector often has the ability to be more agile, adaptable and flexible. We would like to see a greater recognition from the statutory sector of our contribution to the local care infrastructure, as we fill gaps and use our flexibility to offer continuity of care and consistency. Investing in VCFS led innovation is key - we can innovate and need investment to leverage the insight, relationships and data we have. As mentioned before, we firmly believe that having a diversity of voices – both lived experience and professional – involved in decision-making lends itself to improved service user experiences and outcomes, as well as efficiencies in delivery.
While we appreciate that information-sharing can be a barrier from a GDPR perspective, from a service user perspective, effective information sharing can prevent unnecessary stress or even trauma that can arise from having to start from scratch and tell your story over and over again – which then becomes a barrier to accessing or engaging with support. It is also helpful for service to be able to quickly gain a holistic understanding of a service user’s journey, rather than learn about it from a particular professional vantage point. We feel that easier processes and policies for information sharing between services will support stronger interagency working and a more positive service user experience.
Delivering high-quality early years services is significantly hindered by the prevalence of short-term funding, which undermines strategic planning, long-term sustainability, and service continuity.
This model also contributes to a context of competition with the voluntary sector, hindering partnership and integration, with organisations competing – often on 1-2 yearly cycles – for the same, short-term funding. Longer-term commissioning of contracts for VCFS projects would enable improved planning, sustainability, testing and innovation, and more effective partnership working and greater transparency across the sector. While funding for core costs is key, it is also important to support VCFS-led innovation - we can innovate and need investment to leverage the insight, relationships and data we have. We are especially interested in social investment plus grant models, where there is potential for more innovation funding; construction/ development levies should be targeted at perinatal and Early Years services.
The lack of certainty around future funding often leads to staffing gaps, low morale, and disengagement—an issue we observed acutely towards the end of last year when many Hubs were unsure whether funding would be renewed, resulting in high staff turnover.
While the voluntary and community sector (VCS) is unfortunately accustomed to this cycle, statutory services—less familiar with the instability of short-term funding—struggled to navigate the uncertainty and support their teams effectively. Establishing robust systems such as data-sharing agreements and referral pathways takes time, as does building trust with families and raising awareness of new services. This uncertainty also disrupts momentum, with some services hesitant to invest in partnership working without assurance of continuity. Furthermore, creating truly safe and supportive environments requires trauma-informed spaces, privacy, and staff who are trained to work with parents from diverse communities and with a wide range of needs. Without long-term investment, these essential foundations are difficult to establish and maintain.
5. How can vaccine uptake be most effectively increased and supported in the first 1000 days?
Vaccine uptake in the first 1000 days can be most effectively increased through a combination of accessible, culturally sensitive, and community-driven approaches. First, providing simple and accessible awareness and education is key—ensuring that information is clear, consistent, and tailored to the concerns of new and expectant parents across NHS and charity platforms. It’s also vital to address distrust in multiple languages, recognising that language barriers and cultural differences can significantly impact understanding and confidence.
Engaging trusted community figures, such as faith leaders, can play a powerful role in curbing suspicion and building trust within specific communities, particularly where institutional distrust is high. Finally, offering vaccinations in diverse and familiar environments—such as children’s centres, community hubs, and places of worship—can make access easier and more comfortable for families, especially those who may be hesitant to engage with more formal healthcare settings.
6. How can the Government most effectively tackle inequalities in access and infant health outcomes for those from underserved groups including those with disabilities, or from ethnic minority or deprived backgrounds?
In addition to focusing on funding allocations for early years services outlined above in question1, we believe the Government should:
1. Focus on co-production - ensure that services reach the right families within areas by co-producing services.
2. Provide services in a range of formats
3. Outreach via community connectors within public spaces
4. Utilise peer-supporter service models
5. Use integrated hubs to create joined-up, knowledgeable support and impactful referrals.
Coproduce services
We can ensure that services reach the right families within areas by co-producing services. Targeted services should be co-designed with families with relevant lived experience to ensure the service meets their needs, is inclusive, nuanced and accessible. For example, we run regular focus groups with service users to help shape the service ensuring it stays relevant and impactful. Authentic co-production leads to an awareness of power dynamics of working with service users as a professional, in a context where relationships are often characterised by feelings and experiences of inequality, and where we need to challenge the notion that the professional voice is valued over lived experience.
CASE STUDY –
Newham Nurture: Empowering Marginalised Mothers
Newham Nurture (NN) is a perinatal service co-designed by migrant and marginalised women, addressing the unique challenges faced by Newham’s most vulnerable families. The programme, delivered through a partnership with NCT, the Magpie Project, and Alternatives Trust East London, supports over 600 women and babies annually, including refugees and asylum-seekers living in hardship. Services include bespoke ESOL antenatal education , postnatal and infant feeding support, trauma counselling, peer support and link work to advice and livelihood assistance. This holistic approach bridges gaps in healthcare access, empowers women, and fosters trust by offering culturally sensitive and practical support.
The programme is guided by a Steering Group of mothers with lived experience, ensuring it remains relevant and impactful. Since its inception in July 2021, NN has supported nearly 2,000 women and babies, improving their confidence and resilience. By addressing barriers to healthcare and advocating for rights, the initiative transforms lives, creating long-term positive changes for families and communities. One mother highlighted the programme’s significance, sharing, “to be in this position means I’m being listened to, and for me, it feels like I’m finally picking up all my pieces.”
Provide services in a range of formats
In our experience, providing a range of formats for support improves access and engagement – for example, our targeted services offer co-located (in already trusted spaces) in-person facilitated group support, in-person 1-2-1 support, telephone and online support. As mentioned above, a co-production approach to service design and ongoing implementation with both people with relevant lived experience (ensuring diversity of cultural and religious backgrounds, additional needs, disabilities etc.), as well as a diversity of professional voices (including the voluntary/faith sectors), ensures a deep understanding of key challenges, barriers and facilitators to accessing and engaging with support and helps generate effective solutions. Ongoing involvement of this diversity of voices in decision-making helps cultivate trust and a sense of belonging and ownership when decisions are implemented. In the long run, this can also empower service users to become advocates for their communities and take on leadership roles.
Outreach
Outreach is essential – going to ‘spaces of trust’ where priority communities feel comfortable and welcome. Providing outreach via community connectors within public spaces to help inform families about services and support access is beneficial, specifically, helping with: referrals, filling out application forms, physically accessing services and engaging effectively with support received. Joined up working between the statutory and voluntary, community and faith sectors, with professionals (e.g., GPs) and social prescribers/ family navigators who have a strong knowledge of their local communities is essential.
A joined-up approach will help reduce inequalities and remove barriers
A joined-up approach will help reduce inequalities and remove barriers to children’s learning, helping to maximise benefits and accessibility of services for families where children are not supported at home. Integrated hubs provide staff with opportunities to work with other professionals, gain further knowledge and expertise and share best practice and learning leading which in turn leads to more joined-up, knowledgeable support and impactful referrals. Schools have a critical role to play here, as they can be spaces of trust – but also fear. For example, by including them within an integrated hub, teachers could be provided with greater understanding of behavioural and emotional needs, the role of early intervention, and the benefits of holistic, family-focused support. This would mean that they are better placed to effectively support a family who may be struggling with unsuitable housing than the current practice, which often focuses on pupil attendance issues in isolation – which can lead to school becoming a space of fear, not trust.
While we appreciate that information-sharing can be a barrier from a GDPR perspective, from a service user perspective, effective information sharing can prevent unnecessary stress or even trauma that can arise from having to start from scratch and tell your story over and over again – which then becomes a barrier to accessing or engaging with support. It is also helpful for service to be able to quickly gain a holistic understanding of a service user’s journey, rather than learn about it from a particular professional vantage point.
Our work with transient communities such as migrants and asylum seekers demonstrates a need for ‘cross-border’ continuity across/ between boroughs/ different areas, especially regarding mental health support. There needs to be liaison with Housing agencies and domestic refuges, so people don’t fall through gaps – too often, we find that once people are relocated, they are ‘dropped’ by critical services such as mental health. This applies both to geographic areas with more transient populations, such as London, but also to specific communities - refugees and asylum seekers, or Roma communities, for example.
Peer supporter model
Peer supporters can play a crucial role in engaging underserved groups in early years community services by building trust, connection, and accessibility from within the communities they aim to support. As parents themselves—often with lived experience of perinatal emotional and wellbeing challenges—peer supporters bring a non-judgemental, relatable approach that resonates deeply with families who may feel marginalised or hesitant to engage with formal healthcare systems. Their non-clinical, volunteer-based presence helps reduce stigma and break down barriers, particularly in areas of high deprivation or where mistrust in services exists. By working alongside communities and reflecting their lived realities, peer supporters create safe entry points into wider networks of care and support, fostering inclusion and helping families access the help they need during the crucial early years.
Case Study – Infant Feeding Peer support
Our Hospital Peer Supporters offer person centred, Infant Feeding support to new mothers and parents at an extremely vulnerable and pivotal time as they begin to initiate breastfeeding. This could not have been defined in a more beautiful way than when Hoda Bennett one of our Peer Supporters put her bilingual skills to amazing use when she noticed a new mother struggling to understand her. Hoda was able to support the mother in her first language – Arabic. Hoda shared “I noticed there were a few words she didn’t understand, so I got the chance to practice my very rusty Arabic. I made sure to neutralise my accent and gesticulate a lot as well as use simpler terms.” This turned out to be vital for the mother who had misunderstood information given to her previously by healthcare professionals and thought she couldn’t feed her baby more than 3hrly, which was causing distress to both her and her newborn baby.
Case study: Mental health peer support
Lara has long term anxiety which became much worse when she was pregnant, so her midwife referred her to NCT Parents in Mind. Although she was very nervous about meeting her one-to-one volunteer for the first time, there was rapport right away: “She made me feel very comfortable … there were certain things that I could say to [the volunteer] that I would feel guilty if I said to someone else.”
Lara found that fortnightly peer support meetings helped her in way that was different from her previous experience of therapy: “[The volunteer] was just this person that was proof that it will end… [She] really made me feel normal. She listens like it’s okay not to be okay, and that’s really how I felt every time I left: I really walked in there so up and downs and all, and then I leave, I just feel like, ‘I so needed that, that was just what I needed.’” When Lara started to feel better, she changed over to group support.
She used NCT Parents in Mind for 9 months, during which her HADS anxiety score reduced by 7 points from clinically significant to normal and her depression score reduced by 6 points from mild to normal. She believed that Parents in Mind was key to this improvement: “I never thought I would ever feel myself again … They helped me get through my pregnancy and feel sane.”
7. What could the Government learn from examples of best practice that exist in local authorities, NHS Trusts, or internationally?
To drive real progress, the Government should invest in creating structured, accessible opportunities for sharing what works—and what doesn’t. Currently, many local areas are duplicating efforts, repeating mistakes, or missing out on proven models simply because there is no national platform or mechanism to facilitate learning across the 70+ local authorities and Integrated Care Systems. A more connected approach would reduce inefficiencies and help scale success more effectively (The King’s Fund, 2023).
Crucially, the knowledge and relationships that underpin successful local delivery often disappear when individuals leave roles, particularly when services rely on short-term funding. This disrupts continuity, slows progress, and leads to gaps in service. Long-term investment and consistent knowledge-sharing infrastructure are essential to preserving learning and momentum (Local Government Association, 2022).
Additionally, the voluntary, peer support and charitable sectors have played a vital role in amplifying the voices of families—ensuring that Family Hub strategies are shaped by lived experience and remain responsive to local needs. These grassroots insights are key to improving service design and should be meaningfully embedded in planning and evaluation processes going forward (Parent-Infant Foundation, 2021).
While there is still significant work to be done, both Scotland and Northern Ireland have shown the profound impact of political commitment to infant feeding and a clear vision to support parents to feed their babies in the way they decide. As highlighted in the World Breastfeeding Trends Initiative (WBTi) UK report (WBTi UK, 2022), several key elements have contributed to improved outcomes:
Both nations have a national framework in place designed to support infant nutrition and to enable parents to breastfeed as much as they want to. These strategic plans define a clear vision and set targets for increasing breastfeeding rates (Public Health Scotland, 2023).
In Scotland, the proportion of babies receiving any breastfeeding at 10–14 days rose from 44% in 2002/03 to 57% in 2022/23. Notably, the most significant increases have been seen among younger mothers and those from more deprived communities, contributing to reduced inequalities (Public Health Scotland, 2023).
In Northern Ireland, the introduction of the 10-year breastfeeding strategy has yielded positive outcomes, including an increase in babies still breastfed at six weeks (from 29.8% in 2017 to 34.6% in 2021), with consistent gains across three, six, and 12 months (NI Department of Health, 2022).