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Author Linda Macdonald

Contributors John Barber, Tim Shakespeare, Camille Stengel, Lara Greening, Magdalena Bruna Pérez, Katherine Parkin, Angela Mitchell and Fiona McFarlane

Published September 2026

Acknowledgements

We would like to thank everyone who has contributed to this report. The findings and recommendations presented here have built on what we have heard through a wide range of research and engagements.

In particular, we appreciate the generous time and expertise provided by the representatives from the six participating local authority areas – Fife, Highland, North Ayrshire, North Lanarkshire, South Ayrshire, and West Dunbartonshire – who took part in our workshops and follow-up interviews to provide input on this project.

We are also incredibly grateful to the representatives from East Lothian, Glasgow, and South Lanarkshire who participated in data-specific interviews that helped inform our findings in Theme 5.

We would like to thank the members of our steering group from the Scottish Government and Public Health Scotland who assisted with the design of the overall project, ensuring its strategic alignment and relevance.

Our research and analysis were made stronger through collaboration with our dedicated partner, the Centre for Excellence for Children's Care and Protection (CELCIS). We'd like to thank them for their support and delivery of key research, including the design and delivery of the survey, analysis and sense-making to support the final outputs.

We would like to thank Horizons Research for carrying out the workshops with the local areas and delivering individual area reports and recommendations to the participating areas.

Finally, our thanks go to the members of Scotland's wider early childhood third-sector community, who generously fed back on the report recommendations to help shape our final conclusions.

Any errors are the author's own.

Introduction

The first years of life are a critical period in which the foundations for physical, cognitive, emotional, and social development are established, influencing a child's path for decades to come. Beyond building this groundwork for later life, getting it right in these crucial early years ensures that every child experiences the care they need and deserve.

Through this project, Nesta set out to develop a clearer understanding of the support currently available during the first years of a baby's life and to identify practical opportunities to transition Scotland's early childhood system towards a more preventative, consistent and integrated model. This work provides invaluable insights and reflections from leaders and practitioners working to support babies and young children across Scotland now.

This report sets out Nesta's key insights and recommendations informed by that work. These recommendations directly support the ambitions of a number of key national policy areas in Scotland: specifically driving public sector reform and shifting to prevention, improving population health, tackling child poverty, improving early child development and keeping The Promise.

While the project focused specifically on early childhood, many of the recommendations have broader applicability and offer valuable insights for all services and programmes supporting children and families.

The report identifies the rationale for some specific additional funding, however the main thrust of our recommendations focuses on the opportunities to drive change within the existing system by unlocking the immense latent value and capacity that exists within current infrastructure.

Achieving this requires coordinated action at both national and local levels. While local authorities have significant scope to shape services and systems for families, national partners must establish the enabling conditions that empower local implementation.

Ultimately, our aim is to ensure that every child in Scotland grows up feeling safe, healthy and loved, and that we have the vision, policy, strategies and support for families in place that ensures this.

Summary findings and recommendations

The current landscape: strengths and challenges

The project examined the existing environment for supporting early childhood in Scotland. It identified the following key strengths and challenges in the system.

Existing strengths to build on

• Cross-sectoral commitment: There is unified dedication to the principles of prevention, relational practice and placing families at the heart of all services.
• Building trust through continuity of care: Recognition that trust is fostered through consistent relationships and warm handovers.
• 'No wrong door' approach: There is a commitment to collaboration as a way of ensuring families are easily able to engage with support, regardless of their entry point.
• Third sector cornerstone: The third sector is recognised as a valuable and essential foundation of the current service landscape in Scotland.
• Getting it right for every child (GIRFEC) as a driver: GIRFEC remains the key enabler and primary driver of professional practice.

Key challenges to address

• A strategic 'baby blind spot': Policies and plans often prioritise all-age approaches or older age groups leaving babies under represented.
• Inconsistent and reactive service pathways: The current system prioritises immediate risk over early help meaning many families remain unsupported until they reach a breaking point.
• Short-term and disjointed funding: Funding is frequently time-limited and siloed, limiting opportunities for local areas to develop longer-term and joined-up approaches.
• Workforce challenges: Capacity constraints force practitioners to prioritise high-need cases over preventative care and limit collaborative planning.
• Weaknesses in data infrastructure: Unlinked datasets and systems increase admin burdens and limit evidence-based planning.

Key themes and recommendations

Overall aim: Babies and families get better, earlier and more consistent support and services to support their wellbeing and development

Theme 1: Strategy, leadership and governance

Key recommendation: Make early childhood a priority

What will happen as a result: Pregnancy and early childhood is elevated as a national priority and leaders across systems work to champion joined-up support for babies and their families

Theme 2: Support available to families

Key recommendation: Ensure a consistent and accessible offer of early help is available

What will happen as a result: All families can access early support, in a format that suits them, through a seamless 'no wrong door' journey

Theme 3: Funding, accountability and improvement

Key recommendation: Ensure funding and accountability mechanisms drive vision aligned-delivery

What will happen as a result: Multi-year funding commitments and pooled budgets ensure that preventative work in early childhood receives guaranteed, proportionate funding

Theme 4: Workforce skills, capacity and collaboration

Key recommendation: Develop a sustainable and capable workforce

What will happen as a result: multi-agency collaboration becomes a system standard and practitioners regain the capacity for sustained, relationship based early help

Theme 5: Data and operational infrastructure

Key recommendation: Develop seamless data infrastructure and guidance that enables best practice

What will happen as a result: Seamless data sharing arrangements reduce the burden on practitioners and families while partners use data proactively to inform planning decisions

The full list of national and local recommendations is included in the detailed theme section and appendix 2.

Detailed findings and recommendations

Theme 1: Strategy, leadership and governance

What would good look like?

• Strategic prioritisation and policy alignment: Early childhood is prioritised and aligned within and across policy and strategic planning at the local and national level and backed by clear, actionable guidance
• Integrated governance: Robust governance structures at local and national level dismantle traditional silos, ensuring clear accountability and the seamless alignment of priorities, budgets and plans across agencies.
• Clear and distributed leadership: Leaders across the system work to champion joined-up early childhood support, empower teams to experiment and collaborate and foster a culture of innovation and improvement.

What are the current challenges?

• The 'baby blind spot': In both national and local policy, early childhood is frequently overshadowed by broader, all-age initiatives leaving infants underrepresented in strategic planning.
• Fragmented governance and siloed stewardship: Early childhood governance is frequently fragmented and lacks clear, cross-system stewardship and accountabilities.
• Reliance on individual 'champions': Translating strategic aspirations into frontline practice remains difficult because success often relies on the efforts of specific individuals rather than a systemic, collective and sustainable framework.
• Overlooked third sector: The third sector is recognised as a vital delivery partner but often viewed as an add on when it comes to strategic planning.

"There's a misconception that it's about delivering babies, then weighing babies – it's all nice and simple – that the real work starts when children get older. So there's something about how we frame the importance of this agenda. Making the case and taking babies out of the shadows."

Area lead interviewee

Recommendation 1: Make early childhood a priority

Scottish Government must

Set out a vision and policy commitment

• Define a clear vision: Set out early childhood priorities that re-establish babies and early childhood as a top Scottish Government priority.
• Embed across policy: Ensure the vision and priorities are reflected in national policy, frameworks and delivery programmes.

Enshrine governance mechanisms

• Adopt a cross-government approach: Align early childhood priorities across broader child policies, including Whole Family Support, ELC, The Promise, and tackling child poverty.
• Establish accountable governance: Drive progress with cross-portfolio oversight, regular reporting to Cabinet and Parliament, and independent scrutiny (via a Cabinet sub-committee, parliamentary committee, or expert external panel).

Local areas must

Establish pre-birth and early childhood as a shared strategic priority

• Unite to create a singular, cross-agency vision for early childhood aligned to national government priorities.
• Embed this across all governance and planning structures with clear and transparent accountabilities for delivery and measuring progress.
• Formally integrate third sector as core partners in strategic planning and governance.

Theme 2: Support available to families

What would good look like?

• Available services and supports: Families can access a seamless continuum of practical, financial and emotional support that ranges from universally accessed early help to highly targeted, intensive interventions.
• Support focuses on early help pathways: There are clear, well-communicated and consistent routes for families to be supported before needs emerge or become critical.
• Family involvement: Families are actively involved in the design of services.

What are the current challenges?

• Inconsistent service offer: Service availability, particularly for the crucial tier of 'additional' support (eg play and stay, family 'drop in' support) that sits between universal (eg universal health visiting) and intensive (eg intensive family support teams), varies significantly across local areas due to pressures on universal services, erosion of community-based provision, and the absence of a nationally defined 'core offer' of support.
• Reactive systems: Current delivery structures prioritise acute risk management and high-threshold crises over proactive early intervention and lower-level help.
• Unclear support pathways: Lack of well-established and communicated pathways means there is a 'missing middle' of families with emerging needs who are often left to navigate services independently until challenges escalate.
• Universal touchpoints drop off at a crucial point: Routine universal services drop off after a child's first birthday at the very point where many development needs become more apparent.
• Gaps in family-led planning: Family input into service design and improvement is more often viewed as a compliance check than a tool for engagement and improvement.

"There's definitely a gap in terms of that middle group of families. You're relying on parents being quite proactive – understanding, noticing what's happening with their child."

Workshop participant

Recommendation 2: Ensure a consistent and accessible offer of early help is available

Scottish Government must

Update and strengthen expectations around delivery

• Update Getting It Right For Every Child (GIRFEC) guidance: Refresh the GIRFEC framework and practice model with specific guidance for pregnancy and early childhood.
• Define a national 'core offer': Establish clear guidance for a universal support package from pregnancy through early childhood, emphasising community-based, co-located services for early help and establishing clear pathways for families.

Review and strengthen elements of existing national touchpoints

• Fulfill the national health visiting action plan: Fully implement the recommendations in the enhancing delivery of the health visiting service action plan.
• Review relationships and responsibilities between key services: Review the relationship between health visiting and other potentially contiguous services such as midwifery and Early Learning and Childcare (ELC) to ensure responsibilities are most effectively distributed and to strengthen coordination, handovers and touchpoints between services.
• Test innovative local approaches: Use improvement methodologies to support tests of change around assessment points, support pathways, multi-agency pathways and extra visit opportunities.

Local areas must

Review existing local early childhood systems and services

• Carry out a review of existing supports and services: Use recognised guidance (ideally provided by Scottish Government) to identify strengths and areas for improvement within existing systems of pre-birth and early childhood support.
• Develop a prioritised improvement plan: Based on this review, develop a cross-agency improvement plan that clearly defines shared strategic priorities for change, sets out roles and responsibilities, and monitoring arrangements to track progress.
• Strengthen protocols and pathways for supporting lower-level and emerging need: Work cross agency to map and strengthen standardised pathways of support particularly for emerging and lower-level need and focusing on how families are supported into and between services.

Theme 3: Funding, accountability and improvement

What would good look like?

• Sustainable, long-term funding that supports high-quality services: Funding enables strategic and sustainable delivery.
• Aligned and proportionate accountabilities: Reporting is aligned and actively used to inform local and national decision-making.
• Impact, learning and improvements: Evidence, data and information sharing drive planning, learning and improvement.

What are the current challenges?

• Short-term and insecure funding cycles: Funding is frequently time limited and volatile, creating operational uncertainty, staff instability and recurring disruption to long-term relational work with families.
• Siloed and rigid commissioning: Resources are tied to specific sectors or rigid targets rather than holistic family needs, forcing local services to adapt to funder requirements over community priorities.
• Under investment in early childhood (ages 0−1): Funding streams routinely prioritise older age groups or all-age cohorts, leaving infants underrepresented in resource allocation.
• Misaligned accountabilities and short-term metrics: Reporting frameworks focus heavily on short-term quantitative outputs rather than qualitative evidence or system learning.
• Lack of structures for continuous learning and improvement: Reporting demands prioritise compliance over reflective practice, offering limited time, space or support for cross-sectoral peer learning networks and iterative service improvement.

"Sustained and long-term funding commitments are essential to embed preventative early childhood support. Short-term funding cycles create uncertainty and limit workforce stability."

Survey respondent

Recommendation 3: Ensure funding and accountability mechanisms drive vision-aligned delivery

Scottish Government must

Maximise, prioritise and align existing funding and spend on early childhood and early help

• Review funding alignment: Examine Scottish Government baby/child/family funding to streamline and simplify local distribution.
• Identify new investment needs: Target gaps in core national programmes Universal Health Visiting Pathway (UHVP), Family Nurse Partnership (FNP), Allied Health Professionals (AHPs), national data infrastructure, and local co-located community support.
• Ensure fair allocation: Guarantee babies and young children receive a proportionate share of existing national funding programmes.
• Provide multi-year funding: Shift local authorities and third-sector partners to indicative multi-year commitments to stabilise staffing and support long-term planning.
• Refine financial tracking: Introduce an annual tracking framework to monitor spend by programme, age cohort, and prevention type, aligned with the Prevention Unit's budgeting guidance.

Establish shared progress measures, success indicators and reporting structures

• Mandate early childhood planning: Amend the Children and Young People (Scotland) Act 2014 to place a statutory duty on local areas to plan and report specifically on early childhood prevention and early help.
• Unify success measures: Collaborate nationally and locally to establish a shared set of early childhood success indicators aligned with the updated National Performance Framework.
• Streamline reporting: Replace disjointed national programme reporting for Children's Services Planning Partnerships (CSPPs) and other strategic bodies with a single standardised format, using the Whole Family Wellbeing Fund toolkit as a foundation (with specific additions for pregnancy and early childhood).

Develop opportunities for learning and improvement

• Establish a national learning network: Create a national support network providing peer-to-peer learning and improvement opportunities for local areas.

Theme 4: Workforce skills, capacity and collaboration

What would good look like?

Workforce skills and capacity: The workforce has the skills and individual and collective capacity to use family-centred practices and address emerging needs.

Workforce and organisational collaboration: Individual organisations are coordinating to design and deliver seamless support for families.

"I think everybody comes to work to want to do a really good job, but the work pressures, the time pressures you've got – you've not always got the time to phone everyone you might want to phone."

Workshop participant

What are the current challenges?

• Capacity constraints: Staffing shortages, high caseload and complexity, and administrative burden leave the system with 'no elastic' forcing practitioners to prioritise acute crisis management over proactive, relational help.
• Loss of vital roles and workforce instability: Short-term and insecure funding cycles drive high staff turnover and the loss of experienced practitioners, particularly impacting third-sector partners and non-statutory family support roles.
• Training gaps and reduced practice-based learning: A shift towards classroom and online training has reduced opportunities for practice-based learning, peer networking, and cross-sector training, leaving some practitioners lacking confidence to address emerging needs without over-escalating.
• Fragmented collaboration and loss of co-location: Operational collaboration relies heavily on informal personal relationships rather than systemised processes, while the post-pandemic loss of shared physical bases has weakened daily communication and cross-agency role clarity.

Recommendation 4: Develop a sustainable and capable workforce

Scottish Government must

Ensure short- and long-term capacity and sustainability of the workforce

• Develop a long-term workforce strategy for early childhood: This should consider headcount, retention, pay, progression, and workload-reducing technology across health, children's services, and ELC.
• Invest in critical roles: Fund national training and recruitment to address shortages in midwifery, health visiting, speech and language therapy, and ELC.

Enhance support to develop the skills and capabilities of the workforce

• Standardise core competencies: Create a high-quality, cross-sector learning framework to embed essential early childhood knowledge into workforce training.
• Enhance core curricula: Partner with education providers, regulators, and royal colleges to embed infant mental health, attachment theory, neurodiversity, and preventative practice across professional training.
• Expand practical training: Work with development bodies like Public Service Delivery Scotland to significantly boost hands-on, practical training for both students and current practitioners.

Theme 5: Data and operational infrastructure

What would good look like?

Enabling data and operational infrastructure: Operational systems and processes work in a way that minimise administrative burden and improve organisations' ability to strategically plan and coordinate services around the family.

"In this technological world that we live in, surely there could be a straightforward data infrastructure system that could be utilised across the partnership."

Interview participant

What are the current challenges?

• Unlinked and fragmented datasets: Systems and data platforms across agencies and at a national level are disconnected, increasing administrative burdens on practitioners and preventing a cohesive, system-wide view of family needs.
• Limited use of data for improvement: Although vast amounts of data are routinely collected, they are more often used for reporting and accountability purposes than applied to drive service planning and improvement.
• Staff skills, capacity and confidence gaps: Practitioners often lack the data literacy, confidence and dedicated time required to interpret information and apply insights effectively in preventative, relationship-based work.
• Governance and risk tolerance barriers: Rigid institutional governance structures and varying levels of risk tolerance inhibit safe data sharing, cross-agency collaboration, and innovative local testing.

Recommendation 5: Develop seamless data infrastructure and guidance that enables best practice

Scottish Government must

Develop seamless national data infrastructure and guidance that enables best practice

• Issue procurement guidance: Establish minimum standards for data and client systems, focusing on interoperability, data sovereignty, user testing with frontline staff, and AI guardrails.
• Enable cross-sector data linkage: Mandate shared standards and operational rules to link child identifiers across health, education and social care.
• Standardise local data sharing: Develop guidance to streamline local data collection and build practitioner confidence around legal, safe information sharing.
• Digitise administrative processes: Reduce local paperwork burden by introducing streamlined digital options.
• Launch a national data portal: Establish a single children and families portal giving local areas easy access to cross-sector population data at the lowest geographical level.
• Simplify reporting: Review data upload requirements to enforce a 'write once, share once' approach for local areas.

Support local capacity and build confidence to engage with data

• Build local data confidence: Create a national learning programme to help frontline staff and leaders comfortably use population and individual data for planning and decision-making.
• Enhance technical analytics: Boost advanced analytical capacity via a centralised specialist team or creative partnerships (for example, matching post-graduate and PhD researchers with local areas for targeted data projects).

Aims and approach

Aims

Nesta's A Fairer Start mission aims to ensure every child across the UK will have the same chance of developing to their full potential in early childhood.

This project set out to generate robust intelligence and actionable insights regarding the current landscape of support available to babies and young children from birth to age three in Scotland, setting out clear recommendations for systemic change at both national and local levels to support the delivery of effective early help to families during the first three years of a child's life.

The project set out to explore the following questions:

Current landscape What services and support currently exist across Scotland during the first three years of a child's life?

Prevention and early help To what extent are local offers identified as prevention or early help?

Enablers for success How are key delivery and strategic enablers across systems working to support the development and delivery of joined-up local support and services?

Recommendations for action What needs to change at national and local levels to ensure joined-up, early help and support is available during pregnancy and the first three years?

What do we mean by 'early help'?

We use the terms 'early help' and 'prevention' in this report to refer to work that falls into the categories of primary prevention and secondary prevention as set out in the Scottish Government Prevention Unit's recently published definitions.

Scottish Government definition of levels of prevention

• Primary prevention: Population-level action, or action which targets a large subset of the population, to build resilience and stop known risks from developing into problems.
• Secondary prevention: Targeted action to identify and respond to early signs of a problem to prevent escalation.

Alignment with CELCIS research

Early in planning, Nesta and CELCIS (University of Strathclyde) aligned research efforts to generate insights on early childhood support in Scotland while minimising demands on local authorities. While CELCIS' study explored universal and targeted support from pregnancy through early infant care, Nesta focused on national and local changes needed to strengthen early childhood development from birth to age three.

This report serves as a companion piece to CELCIS' research. As both projects explored parallel aspects of support for families, we agreed to share findings from our research. We worked to identify areas of shared insights, ensuring that our respective recommendations remain distinct yet complementary, and that our combined intelligence provides a coherent picture of the landscape.

Methodology

Nesta's mixed-methods approach combined qualitative workshops (delivered by Horizons Research) and validation interviews across six local authorities (Fife, Highland, North Ayrshire, North Lanarkshire, South Ayrshire, and West Dunbartonshire) with a national survey administered by CELCIS to all 32 Scottish local authorities (25 responding). Full details of project methodology are included in appendix 3.

Research and analysis were structured around a 'key enablers framework' (see appendix 4) developed by Nesta for this project. The resulting recommendations in this report represent Nesta's independent interpretation of the opportunities identified with local partners. While the focus of this work was on the first three years of life, some of the recommendations extend into pregnancy and ages 4-5, recognising the need for consistent, aligned care across all stages of pregnancy and early childhood without a hard cut-off between these elements.

Context and strategic importance

The earliest years of life serve as the critical foundations for a child's physical, emotional, and social development. With 90% of brain development occurring by age five, this formative window establishes the core architecture for all future learning, health and behaviour. Evidence shows that children with stronger cognitive and socio-emotional skills at age five are significantly more likely to achieve higher educational attainment, income, and overall health later in life.

Early support can directly influence long-term outcomes for decades to come. This underscores why early childhood is such a pivotal window of opportunity. Equal access to stable and nurturing support in these initial years is vital to ensure that all babies and young children grow up feeling safe, healthy and cared for and to reduce lifelong inequalities, improve educational success, and enable all children to thrive.

The current situation

Not every child born in Scotland today experiences the same start in life. One in six under fives in Scotland are growing up in poverty, with 39% of children under one living in relative poverty. One in five children (16.5%) are not meeting their developmental milestones at 27-30 months (rising to 19% at 4-5 years).

The poverty-related attainment gap, much focused on within educational policy and settings, is identifiable long before children start school: children from disadvantaged backgrounds are 2.6 times more likely to have developmental concerns at the 27–30 month review compared with children from the least deprived areas. Given everything we know about the importance of early childhood, and the impact it can have on later life, these inequalities mark significant missed opportunities to set every child off on the right course in life.

The policy landscape in Scotland

Scotland has long aimed to reduce early childhood inequities. The NSPCC report 'Over 25 years of early years' notes that Scottish Government policies, strategies and practice guidance have continuously acknowledged the importance of preventative support in early childhood. However, despite this recognition, policy prioritisation in this area has been inconsistent, leading to gaps in both national and local service planning and delivery.

These findings around the inconsistent prioritsation of children in the first years of life are borne out by recent research which Nesta commissioned into public spending on under fives in Scotland. This showed that spending per child on 2–4 year olds in Scotland increased by approximately 50% between 2011 and 2023 (£8,000 to £12,000), while over the same period, spending for 0–1 year olds has remained constant at approximately £6,000 per child.

Looking ahead, there are significant opportunities within the current and emerging policy environment in Scotland to ensure early childhood is firmly established as a national strategic priority. Policy initiatives and programmes such as the newly-established Scottish Government Prevention Unit, the Whole Family Support programme, and wider public sector reform commitments provide key operational mechanisms to align policy with practice. Together with the Early Child Development Transformational Change Programme and the Population Health Framework, these developments offer a timely opportunity to join up governance, integrate preventative spending, and embed early childhood support at the heart of local and national service planning.

Detailed findings and recommendations

This report sets out a framework of interconnected recommendations for national and local action, organised around five key themes. Our findings demonstrate that delivering impactful preventative early help requires clear, deliberate action at both national and local levels.

Across all workshop areas, partners recognised the important and distinct roles played by both national and local government in driving collective ambition and improvement across the system. Local areas hold significant power, scope and autonomy to shape and deliver their early childhood systems, but Scottish Government has a vital role to play in creating the conditions for optimal local action.

Scottish Government leadership is essential to establish a clear national vision for early childhood, to define quality standards, to ensure adequate resourcing is available, and to enable core infrastructure. Creating a more consistent national foundation would remove many of the uncertainties and barriers which local areas currently experience while still allowing for local variation and adaptation.

Because of the distinct roles of national and local partners, we treat our recommendations for national and local level differently. Our national recommendations are unequivocal: we believe these actions are essential, and should be delivered in full, to create the conditions for success across Scotland.

For local systems, we set out a more tailored approach that recognises variations in existing local systems and delivery models. We present a series of considerations for local action, accompanied by non-exhaustive suggestions for the types of action local areas should consider taking, depending on local context.

We do urge every local area to commit to two foundational recommendations:

1. Establish pre-birth and early childhood as a shared strategic priority embedded through a cross-agency vision and robust governance.
2. Commit to a formal review of local early childhood systems and services to identify specific opportunities for reform and improvement using a recognised self-assessment tool or maturity matrix (ideally Scottish Government mandated) for early childhood.

Together, these national and local actions provide a roadmap to shift Scotland's early childhood support toward a proactive, preventative model.

Theme 1: Strategy, leadership and governance

What would good look like?

Strategic prioritisation and policy alignment: Early childhood is prioritised and aligned within and across policy and strategic planning at the local and national level and backed by clear, actionable guidance.

Integrated governance: Robust governance structures at local and national levels dismantle traditional silos, ensuring clear accountability and the seamless alignment of priorities, budgets and plans across agencies.

Clear and distributed leadership: Leaders across the system work to champion joined-up early childhood support, empower teams to experiment and collaborate and foster a culture of innovation and improvement

The view from the ground

The 'baby blind spot'

Participants highlighted a 'baby blind spot' in national policy, where the vital importance of early childhood gets lost in policy that focuses on older children or generic all-age approaches. This leaves babies as the 'least heard' population group.

Workshop participants noted this blind spot is being replicated at the local level. While local plans do include prevention and wider family support, babies and young children are still often overlooked as a specific demographic. Because of this, there were strong calls to change how early childhood is framed and to make the explicit case for babies.

The need for a national vision

There was a strong appetite for Scottish Government to make the case for babies and set out a clear, long-term vision and national framework for early childhood, supported with enhanced guidance on how this should be delivered. Fourteen out of 25 local authority survey responses mentioned the need to strengthen strategic leadership on pre-birth to age three as a priority going forward. While four local authorities explicitly requested this focus in long-term plans, another 10 local authorities implicitly demanded it by calling for major structural overhauls, such as unified 1,000 days long-term strategies.

"The emphasis on free childcare for three-to-five year olds has overshadowed the critical foundations laid in the years before. We need a fundamental rethink of the framework."

Area lead interview

While the lack of a singular, national vision for early childhood was not viewed as precluding local areas from making their own decision to strategically prioritise early childhood, participants felt that having clear direction at a national level would go a long way to focusing local action in this space.

A simplified national policy landscape for children

There were repeated calls to simplify and streamline the existing national policy and governance landscape relating to children and poverty, support further integration across strategic areas, and ensure that babies and young children were a priority within this refined policy landscape.

"There remains a lack of clarity around the different Scottish Government directorates and policy teams. This can lead to confusion, duplication and frustration at a local level when different directives are instructed, sometimes with overlap. The policy landscape also remains very cluttered and would benefit from being streamlined."

Survey respondent

Authorities consistently highlighted the opportunities that further integration of strategic planning would bring:

"Moves to integrate strategic planning arrangements around the Children's Services Plan, Child Poverty.....and children's rights, provide an opportunity to refocus efforts (on) giving children in (this local authority) the best possible start in life."

Survey respondent

Participants were keen to see early childhood prioritised within this refined policy landscape and in a way that continues to recognise the key social determinants that drive early childhood experiences, particularly relating to child poverty. There was agreement of the benefits of whole family support approaches.

"At a strategic level, continued emphasis on whole-family, trauma-informed and poverty-aware approaches is welcomed. National leadership that supports integration across health, education, social work and third-sector partners will be key to sustaining positive outcomes for babies and young children."

Survey respondent

National direction and guidance, local flexibility to act

Participants agreed that a national vision, framework and delivery guidance for early childhood would bring much-needed focus to local planning. Crucially, it would help to end the 'postcode lottery' where the quality of support depends on where a family lives.

"National clarity on the core 0–3 offer and consistent expectations across Scotland would support benchmarking and reduce variation."

Survey respondent

However, this national framework must balance consistent expectations with the flexibility required for place-based approaches. A one-size-fits-all model does not reflect the realities of local need, and local systems must retain the ability to adapt their delivery to address their specific context.

“Whilst a national position is helpful, there needs to be flexibility offered to allow local areas to deliver services and support in the way that best meets the needs of the local population."

Survey respondent

Fragmented ownership and governance at local level

A critical barrier identified across the workshops is the lack of clear, cross-system stewardship for early childhood at local level. Strategic ownership of early childhood at the systems level remains fragmented. Participants noted that early childhood is often viewed as being 'held by health' and is underrepresented in broader education, corporate parenting, and children's services planning. 'Early childhood' has consequently become a vague catchall term lacking a dedicated strategic vision or home.

"Who holds early childhood? Health? Education? Social work?"

Workshop participant

This ambiguity around who is responsible is reflected in perceived weaknesses in local governance. Participants described navigating a cluttered landscape of multiple groups with overlapping responsibilities and unclear decision-making pathways. In essence, in making early childhood everyone's problem, it has become no-one's problem. There was unanimous agreement that the current structure lacks the unified vision and clear governance required to embed true cross-system ownership.

Strong, visible connections between Children's Services Planning, strategic planning, GIRFEC processes, and improvement activity were seen as being key enablers. Within the workshops, participants reported that making these clear links directly strengthens priorities, decision-making, and frontline practice. While still emerging, individual authorities provided examples where this type of connected planning is already successfully underway.

"Our strategic leadership teams are working to ensure alignment across services which in turn will develop effective operational leadership focused on early childhood."

Survey respondent

Third sector as a key strategic partner

There was recognition of the invaluable role that the third sector plays in delivering services for families, and the wealth of knowledge held about families and services within these organisations. However, it was felt that third-sector organisations can often be treated as an add-on in strategic planning and governance. Several areas called for third-sector organisations to be routinely involved in planning, governance and pathway development.

The need for distributed leadership

The crucial role of strategic leaders such as chief officers, directors and heads of service in setting a unified vision, defining success metrics, and enabling change was strongly emphasised. Participants called on leaders to explicitly endorse and model collaborative, relationship-based practice, rather than just managing performance. When leaders send strong messages of trust and permission, it empowers staff to work across systems and drives cultural change.

"Leadership should work to remove barriers that currently inhibit partnership working, including challenges around organisational protectionism, data sharing, secure communication and encouraging the shift towards greater power sharing between statutory services and the third sector."

Survey respondent

The workshops highlighted challenges relating to system leadership rather than leadership within individual organisations. While examples of individually committed and passionate leaders were identified, participants frequently described prevention and early intervention activity as relying heavily on individual champions rather than being supported through shared accountability, collective decision-making and cross-system leadership arrangements.

Across all areas, there was a keen sense of the need to ensure that leadership is distributed across organisational structures and hierarchies. It was noted that even when senior leaders promote a shared vision, there can still be a lack of confidence and permissions further down the chain for staff to act on permissions. This can be driven by a performance-driven culture and administrative burdens pushing staff back into professional silos.

"Sometimes down the chain there might not be the professional confidence to act on permissions given by leadership to do things differently."

Workshop participant

In particular, operational managers such as service managers, locality managers and team leaders across all sectors were seen to hold the power to either create barriers or opportunities for prevention work and allow their staff to broker knowledge, ideas and those all-important relationships across system boundaries.

"We have much more control and influence than we thought – there is a lot we can do collectively."

Workshop participant

What needs to change

Scotland needs a fundamental shift in how early childhood is prioritised and governed nationally and locally. Ensuring that early childhood is central to national and local planning requires adoption of a clear, unified national vision that sets clear expectations and elevates babies out of the shadows of all-age policy frameworks. The Scottish Government should integrate disparate children's policy commitments into a single, cohesive strategy, centred around the life course and create absolute clarity for local systems regarding the importance of support in the earliest years of life. This should be supported by clear guidance and frameworks for local delivery that sets direction, but allows for local adaptation.

At a local level, planning partners should come together to create a singular cross-agency vision for early childhood and ensure that it is embedded across governance and planning structures with clear accountabilities for delivery. Local leaders emphasise that while a cohesive national direction is necessary to set expectations and support local delivery, it must offer the flexibility required for place-based approaches so that services can adapt to distinct community needs and geographical challenges.

There is a need to formally integrate third-sector organisations into strategic planning, governance, and pathway development as core partners, moving beyond their current role as an add-on in service delivery.

A transformation in local leadership culture is required, moving away from professional silos and performance-driven management, toward an environment where practitioners are given explicit permission and capacity to work relationally and collaboratively.

Recommendation 1: Make early childhood a priority

Scottish Government must

Set out a vision and policy commitment

• Define a clear vision: Set out early childhood priorities that re-establish babies and early childhood as a top Scottish Government priority.
• Embed across policy: Ensure the vision and priorities are reflected in national policy frameworks and delivery programmes.

Enshrine governance mechanisms

• Adopt a cross-government approach: Align early childhood priorities across broader child policies, including Whole Family Support, ELC, The Promise, and tackling child poverty.
• Establish accountable governance: Drive progress with cross-portfolio oversight, regular reporting to Cabinet and Parliament, and independent scrutiny (via a Cabinet sub-committee, parliamentary committee, or expert external panel).

Local areas must

Establish pre-birth and early childhood as a shared strategic priority

• Unite to create a singular, cross-agency vision for early childhood aligned to national government priorities
• Embed this across all governance and planning structures with clear and transparent accountabilities for delivery and measuring progress.
• Formally integrate third sector as core partners in strategic planning and governance.

Local areas should consider*

Transforming leadership culture (eg, by):

• Invest in system leadership: Develop a cross-sector leadership programme for middle and operational managers focused on relational, preventative practice and navigating complex systems.
• Embed collaborative practice: Introduce performance expectations for middle managers that reward collaboration, relationship building, and joint working across service boundaries.
• Empower operational management: Provide explicit, codified decision-making authority for operational managers to share data, budget, and resources in real time.

*these suggestions are not comprehensive and would be chosen and shaped by local context

Theme 2: Support available to families

What would good look like?

Available services and supports: Families can access a seamless continuum of practical, financial and emotional support that ranges from universally accessed early help to highly targeted, intensive interventions.

Support focuses on early help pathways: There are clear, well-communicated and consistent routes for families to be supported before needs emerge or become critical.

Family involvement: Families are actively involved in the design of services.

The view from the ground

Key services are not consistently available

Findings from our research identify a rich, but inconsistent landscape of services for early childhood. Across the 25 areas responding to the survey, 32 broad categories of support (including categories such as breastfeeding, financial support, speech, language and communication) were identified as being delivered to families. However, only two of these broad categories (family wellbeing and parenting support) were reported as being delivered in more than 50% of responding areas.

The survey identified 11 different parenting programmes being used across 22 areas. However, only two of these interventions (FNP and PEEP) were identified as being delivered in more than five areas. In this context, we use 'parenting programme' to denote a formal, manualised programme with a standardised delivery framework that has been formally evaluated to demonstrate positive relational or developmental outcomes.

In remote and rural areas, this inconsistency is heightened by factors such as workforce shortages: a more widespread issue that is particularly acute in these communities. Even where services exist rurally, they often remain physically out of reach of families due to transport challenges. Complementing face-to-face provision with accessible digital services and hybrid formats can help bridge these geographical gaps, ensuring consistent access regardless of location.

Stakeholders also identified specific gaps in the current service offer. There was a stated need for more dedicated support for fathers, trauma-informed interventions for parents navigating pregnancy loss, and for women who have experienced the removal of children, in order to break cycles of repeated crisis. Targeted support for key priority groups, such as families experiencing multiple deprivation, families at risk of poverty, asylum seekers and care-experienced young people was also identified as a priority.

While participants value the flexibility to adapt services to local community contexts, they noted that lack of a nationally defined 'core offer' of support creates significant ambiguity regarding the level and quality of support families should fundamentally expect to receive.

A missing layer of support

Support in early childhood is best understood through a three-layer model that forms a comprehensive continuum of care:

• Universal: Foundational services for every family during pregnancy and early childhood (for example, maternity care, UHVP, vaccinations).
• Additional: Universally accessible support with extra, targeted help for families with emerging or specific needs, or identified as being at risk of developing a need (for example, enhanced breastfeeding support, play and stay groups, lower-level perinatal mental health, financial inclusion, parenting support).
• Targeted and intensive: Specialist services triggered by specific referral thresholds, higher risk, or severe needs (for example, children and families social work, specialist perinatal mental health).

This three-tier model highlights the critical additional layer (grounded in proportionate universalism from the Marmot Review) which acts as a bridge between universal care and specialist intervention. By offering a range of non-stigmatising, and timely entry points, it allows the system to intervene in a genuinely preventative way by supporting families identified as being at risk before specific needs emerge or escalate to crisis point.

However, this additional layer of support, in particular, remains inconsistently available across Scotland, and the pathways into these supports for families are often less well-established than the pathways from universal into targeted and intensive services.

Given the recognised importance of this additional layer of support in providing preventative and early support to families, and of getting families to the support they need as early as possible, these inconsistencies represent a missed opportunity in Scotland's offer of early childhood support.

Together, these levels and their connecting pathways represent the expected 'core offer' for families. Figure 1 outlines this core offer across universal, additional and intensive support levels providing examples of the types of support that should be available in each.

Under-developed formal pathways for lower-level needs

Participants observed that even in areas with a broad range of services, families rarely experience a seamless journey. Rather than a coordinated path, they encounter a series of disjointed access points and a confusing array of professionals.

In particular, the absence of formal pathways for lower-level needs leaves families to manage emerging challenges alone until escalating to a crisis or qualifying for targeted support. This can mean that even where services do exist, families are not always being supported to access them in a consistent way.

Poorly coordinated handovers and disconnected provision means accessing help often depends on parental confidence and knowledge, deepening inequities for overwhelmed or isolated families attempting to navigate these opaque pathways.

"The system can appear supportive, yet for families struggling with low self-esteem, the process can feel entirely overwhelming."

Workshop participant

Because no single agency holds responsibility for a family's overall experience, parents are often forced to act as their own care coordinators, repeatedly retelling their stories across different practitioners.

Ultimately, support is available ‘if you know about it', leaving access to be determined by geography and parental capacity until situations reach a crisis point.

A system set up to respond to crisis and manage risk

The current system views early childhood support through a lens of risk management and safeguarding, requiring families to meet a specific threshold of vulnerability before unlocking resources, rather than taking a proactive, needs-based approach to address problems early.

"We're good at bringing all the services together at the crisis point."

Workshop participant

This creates a 'missing middle' of families who are just about coping. Their emerging needs, such as social isolation, housing strains, or mild perinatal mental health issues do not meet the criteria for targeted support, leaving them without accessible preventative help.

"There's definitely a gap in terms of that middle group of families. You're relying on parents being quite proactive understanding, noticing what's happening with their child.”

Workshop participant

Operational pressures drive this immediate risk focus: in a system constrained by resources and facing growing demand, funding and staff are continually redirected toward acute statutory needs.

"There's a resource challenge – we've had the same amount of staff for 15 years, but there's more demand and need out there now."

Workshop participant

Expanding focus to proactively offer targeted help to at-risk populations before issues escalate would significantly enhance early support, shifting the system from reactive intervention to true community-wide prevention.

Universal touchpoints drop off at a crucial point

Routine universal services miss key opportunities to engage families during crucial transitional windows along the early childhood journey.

A major systemic gap is the drop-off in routine support after the 13–15 month review under the UHVP. Participants highlighted the irony of routine support decreasing precisely when children's speech, language, attachment, and neurodevelopmental needs become more apparent.

"There's a gap in service provision from 13 to 30 months. During that time it's dependent on parents understanding the stages of development, their knowledge."

Workshop participant

The system assumes families will remain stable if they are doing well at the 13–15 month assessment, failing to account for fluctuating family circumstances.

To address this drop-off, stakeholders proposed introducing more regular touchpoints for families after a baby's first birthday. One suggestion was introducing an additional health visitor review at 18–20 months, although there was acknowledgement that current workforce capacity would make such an expansion challenging.

Pressure on universal services

Across the six workshop areas, practitioners highlighted the fundamental importance of midwifery, health visiting, and the intensive home-based interventions provided by Family Nurse Partnership (FNP) during the perinatal period and infancy.

Health visitors, in particular, are viewed as the central pillar of the early childhood landscape, serving as an essential diagnostic net and the entry door for families. Often fulfilling the 'named person' role under GIRFEC, they provide the necessary continuity of oversight and coordination across multiple agencies. Stakeholders consistently described this workforce as the glue that maintains system cohesion through relationship-based practice, enabling early identification and attachment support.

However, workshop feedback indicates that these universal provisions are under significant strain due to increasing case complexity, workforce capacity issues and administrative burdens. Data from the national survey revealed that at least a quarter of local authorities are currently unable to deliver the full pathway at present. This reflects findings from Public Health Scotland that shows that coverage for health visitors reviews varies significantly, with delivery of the 4–5 year review showing particularly high levels of variation (range 56% to 94%).

A consequence of these capacity squeezes is that health visitors are increasingly pulled away from early intervention and forced to focus heavily on families with the highest level of need. The breadth of their expected offer – providing preventative messages, building relationships, signposting, practical guidance, and escalation – is simply becoming too difficult to deliver consistently.

"When pressure comes, you tend to focus more on what you think of as your own core job and just want to get through the workload."

Workshop participant

Participants further highlighted the structural disconnects that persist between midwifery, health visiting, and other parts of the system such as GP and ELC settings. They reported that transitions from antenatal to postnatal support often feel like fragmented handoffs rather than a seamless journey, hindering the smooth flow of information, established relationships, and shared responsibility.

Addressing this capacity crisis requires genuine multi-agency integration rather than a sole focus on increasing health visitor head count (although this may also be required). Fully delivering the recommendations set out in the Scottish Government's Enhancing the delivery of the health visiting service action plan would directly address these barriers. By creating the conditions for enhanced service delivery and better integrating health visiting remits into wider children and family support services, the framework provides a clear roadmap to alleviate these exact systemic pressures.

The central role of the third sector and erosion of community-based services

Across all workshop areas, participants identified strong examples of community-based and third-sector support which were viewed as highly effective in reducing stigma, building trust and engaging families earlier. Services such as Home Start, breastfeeding groups, Tea and Tots, Bookbug, Play Talk Read, PEEP and locality hubs were often described as creating accessible, low-pressure opportunities for families to build confidence, peer connection and relationships with practitioners.

The survey responses reflected this critical role. Within the categories of support mentioned, 43% of all mentions of support being delivered are attributed to the third sector (197 mentions).

Participants reflected on the loss of universal community-based services such as play groups and baby clinics, arguing that these are hugely important in trust building, peer connection and earlier identification of need. The reduction in availability of these services was put down to a combination of cuts within third and public sector, the loss of groups post-Covid, and an unintentional consequence of the move to in-house health visiting which has seen a move away from health visitors delivering community based clinics.

Workshop participants were clear that these more informal community spaces and services are not merely supplementary; they are often where primary prevention occurs.

They provide low-pressure opportunities for families to connect and ask questions, allowing practitioners to gradually introduce additional services while reducing the need for families to navigate complex systems independently.

"Not only is it beneficial for families for us to be in the community, but it also creates a space for professionals to interact, and support across transition points.”

Area led interview

By creating additional support in the community, they also act as a bridge between universal services such as the UHVP, and more targeted support offers which may only be accessed via a formal referral.

Co-location of services

Participants in every workshop area and in multiple areas in the survey response highlighted the value of bringing services together in trusted community locations, reducing stigma and improving awareness of available support. Community-based hubs are viewed as potential solutions to fragmented pathways, bridging the gap between universal and crisis services while strengthening the link between statutory and third-sector provision.

Area leads identified an increased investment in co-located community services as one of the most important areas for improvement going forward.

Proactive relationships and warm handovers

Participants consistently emphasised that prevention relies on relationships rather than referral forms. Families engage best when support feels personal, familiar and non-judgemental, which requires practitioners to have the time and capacity to foster genuine connections.

Proactive mechanisms like warm handovers, designated contacts, and 'Team Around the Child' models keep families connected, though high caseloads and crisis demands currently undermine this coordination.

Embedding community navigators or connectors within local hubs can bridge system gaps by reducing stigma, simplifying referral pathways, and offering tailored relational support before crisis points occur.

Family voice shaping services

Workshop feedback from all areas showed a clear gap between aspiration for family-led planning and operational reality. While services recognise the need for family input into service design and improvement, their reflection was that feedback can more often serve as a compliance check for care rather than a tool for improvement.

Current care planning lacks a consistently family-centred approach with no standard practice for engaging families on how they wish to be supported. In some areas, referral pathways are described as administratively burdensome and potentially retraumatising, particularly where families must retell their stories multiple times.

Participants emphasised that success is unique to every family and often differs from professional metrics. Capturing these individualised goals requires family voice, including the voice of the infant, to be embedded in all processes.

Despite these challenges, some areas demonstrate participatory potential through tools like Care Opinion, empathy mapping, and service review processes. Participants observed that when systems listen and involve families, it increases family awareness of available support. However, engagement only builds trust if it leads to tangible action. Consulting families is insufficient unless there is a visible response – whether through improved communication, changes in service delivery, or increased community provision. Without such action, families are likely to disengage.

What needs to change

To provide the right support at the right time, provision must move away from a reactive model that defaults to crisis management. This requires establishing a clear core offer of universally available support that a family can expect to access, and creating more touchpoints and opportunities for engagement during critical, currently unserviced developmental windows that improve identification of escalating need.

The core offer should ensure every family in Scotland has immediate, stigma-free access to support that enhances parent and child health and wellbeing, early parent-child relationships, and a stronger home learning environment. It should explicitly build on the existing foundation of the principles of Whole Family Support and the GIRFEC National Practice Model, and the work being delivered via the UHVP.

To ensure true equity of access, services should be delivered in local, non-stigmatising locations and flexible formats, both digital and face-to-face, at home and in the community, that are comfortable, culturally responsive, and easily accessible for all families.

Universal services must act as a 'no wrong door' network: when a need is identified the practitioner involved either delivers support directly, or facilitates a warm handover to community, targeted or specialist services, ensuring families receive coordinated care without having to retell their story.

Capacity needs to be built into the system to allow for practitioners across services and agencies to develop relationships and develop clear aligned pathways for families, and especially lower-need families.

Ensuring that there is a standardised protocol for screening and identifying lower-level needs, well-supported handovers between services and a clear pathway of support set out via a combination of universally available and targeted services is one of the clearest opportunities for strengthening the existing system of early help for babies and young children.

Families must be elevated to active partners in service design and individual care planning with the voice of the infant central to all planning and design.

Recommendation 2: Ensure a consistent and accessible offer of early help is available

Scottish Government must

Update and strengthen expectations around delivery

• Update Getting It Right For Every Child (GIRFEC) guidance: Refresh the GIRFEC framework and practice model with specific guidance for pregnancy and early childhood.
• Define a national 'core offer': Establish clear guidance for a universal support package from pregnancy through early childhood, emphasising community-based, co-located services for early help and establishing clear pathways for families.

Review and strengthen elements of existing national touchpoints

• Fulfill the national health visiting action plan: Fully implement the recommendations in the enhancing delivery of the health visiting service action plan.
• Review relationships and responsibilities between key services: Review the relationship between health visiting and other potentially contiguous services such as midwifery and Early Learning and Childcare (ELC) to ensure responsibilities are most effectively distributed and to strengthen coordination, handovers and touchpoints between services.
• Test innovative local approaches: Use improvement methodologies to support tests of change around assessment points, support pathways, multi-agency pathways and extra visit opportunities.

Local areas must

Review existing local early childhood systems and services

• Carry out a review of existing supports and services: Use recognised guidance (ideally provided by Scottish Government) to identify strengths and areas for improvement within existing systems of pre-birth and early childhood support.
• Develop a prioritised improvement plan: Based on this review, develop a cross-agency improvement plan that clearly defines shared strategic priorities for change, sets out roles and responsibilities, and monitoring arrangements to track progress.
• Strengthen protocols and pathways for supporting lower-level and emerging need: Work cross agency to map and strengthen standardised pathways of support particularly for emerging and lower-level need and focusing on how families are supported into and between services.

Theme 3: Funding, accountability and improvement

What would good look like?

Sustainable, long-term funding that supports high-quality services: Funding enables strategic and sustainable delivery.

Aligned and proportionate accountabilities: Reporting is aligned and actively used to inform local and national decision-making.

Impact, learning and improvements: Evidence, data and information sharing drive planning, learning and improvement.

The view from the ground

Preventative and early childhood spend: policy us practice

The view from participants was that, while prevention is prioritised in policy, this is not reflected in funding or practice. Resources are routinely pulled toward immediate, acute demand. Shifting funds upstream into prevention is difficult without creating risk elsewhere.

This creates a catch-22 situation for local areas where local core budgets are reduced at the same time as needs within the community are rising and national funding is inflexible and time limited. Consequently, it is increasingly difficult to move to preventative delivery, or to target money specifically at early childhood.

Additionally, babies and early childhood are frequently also underrepresented in funding streams. Investment is often routinely targeted at older age groups (for example, ELC, school-aged attainment funding), while all-age funding streams routinely overlook specific needs of younger populations in favour of more immediate demands from older cohorts of children.

This reflects findings from Nesta's recently commissioned report into early childhood spending in Scotland that showed that per child investment in 0-1 year olds has slightly reduced over the last 12 years, while spend on 2-4 year-olds has increased significantly.

The impact of short-term funding

Having access to long-term and sustainable resourcing is seen as a critical enabler. In fact, 48% of survey respondents (12 out of 25 local authorities) specifically highlighted that short-term funding cycles and budget constraints act as a significant barrier to progress.

Participants in every workshop area argued that prevention requires long-term relational infrastructure. Trusting relationships with families can take years to build but this work is routinely disrupted when short-term or fixed-purpose funding ends.

"Sustained and long-term funding commitments are essential to embed preventative early childhood support. Short-term funding cycles create uncertainty and limit workforce stability."

Survey respondent

Short-term funding cycles create intense uncertainty, limit workforce stability and are often driven by unhelpful targets and accountabilities. The third sector is seen as being particularly vulnerable to the impacts of short-term funding. Fragile funding limits their ability to plan long-term and collaborate with partners, and their capacity to support families. Cuts across the third sector are seen as contributing to the reduction in the range and number of community-based services available to families.

"Our workforce feels more stable. Third-sector colleagues' funding feels more fragile than ours then (it's) harder to collaborate."

Area lead interview

Siloed and rigid commissioning

In addition to duration of funds, commissioning was also described as siloed and inflexible, with funding attached to specific sectors or outcomes rather than whole-family need. Participants highlighted that different funds can come with conflicting priorities, requirements, and reporting frameworks leading to administrative duplication, increased workload and service gaps. This can force local areas to shape programmes to meet the needs of funders, rather than the needs of communities.

This makes it difficult to sustain integrated support across health, education and social care, despite the complexity of families' lives. Instead of strengthening existing local services, short-term national funding streams often create temporary, disjointed initiatives.

"Funding tends to shift our focus we often end up having to bend what we're doing to help families within the limits of what the funders are asking us to do."

Workshop participant

There was a recognised tension between the desire for flexible, pooled funding aligned with overall outcomes, and the need for ring-fenced or protected funds which target prevention in the under-three population. Local areas emphasised they do not want further complication of the existing funding landscape by adding additional funds targeted at specific aspects of early childhood or prevention. Instead, they want to see a simplified and rebalanced funding landscape for children, where pregnancy and early childhood and prevention receive a fair, guaranteed allocation of these funds.

Unhelpful and misaligned accountability and metrics

Reporting is viewed as being heavily focused on short-term, sector-specific outputs. Services report being expected to demonstrate measurable impact within unrealistic timescales even though systems change and relational work with families can take years to evidence.

There was also seen to be an overprioritisation of quantitative metrics, with little room for qualitative inputs. Reporting requirements vary from national fund to fund. These conditions leave limited room to focus on long-term system learning or improvement.

Priorities for investment

There is recognition that in addition to how funding is made available, additional targeted investment will need to be made. Within these financially challenging times, there are evidently difficult decisions to be made about where any additional investment will be required within the early childhood system and where that resource comes from. Additional resourcing into core workforce, data infrastructure, third-sector and community infrastructure (including increased availability of community-based, co-located services and community connectors that support informal engagement with families) were all identified as key areas that would benefit from increased investment.

A culture of learning and improvement

Across all of the workshops, and the thematic areas explored, there was a clear desire for increased opportunities for cross-sectoral and cross-geography peer learning and improvement support and networks. Leaders at both Scottish Government and local level should develop opportunities for more workforce learning and improvement.

What needs to change

There needs to be a move towards sustainable, multi-year funding and accountability that provides flexibility for local areas to develop programmes of work as required locally. Accountability should be via a shared measurement framework and reporting mechanisms that values qualitative evidence and system learning alongside more traditional metrics and indicators. Resources should include rebalancing of existing funds targeted at children to ensure a fair, proportionate and guaranteed allocation for early childhood and prevention work.

To operationalise this shift, clear statutory planning duties, unified success measures, and streamlined reporting mechanisms are required to establish the necessary structural framework for lasting reform.

At a national level, work should be done to improve recording and tracking of spending on all children's services to allow for better understanding of where money is going, and what impact different policies are having. This should include being able to identify preventative spend in these areas.

Work should be undertaken at a national level to develop and fund dedicated opportunities for cross-sectoral and cross-geographical peer learning and improvement support, enabling leaders and the workforce to share knowledge, refine practice, and drive systemic service transformation. .

Recommendation 3: Ensure funding and accountability mechanisms drive vision-aligned delivery

Scottish Government must

Maximise, prioritise and align existing funding and spend on early childhood and early help

• Review funding alignment: Examine Scottish Government baby/child/family funding to streamline and simplify local distribution.
• Identify new investment needs: Target gaps in core national programmes Universal Health Visiting Pathway (UHVP), Family Nurse Partnership (FNP), Allied Health Professionals (AHPs), national data infrastructure, and local co-located community support.
• Ensure fair allocation: Guarantee babies and young children receive a proportionate share of existing national funding programmes.
• Provide multi-year funding: Shift local authorities and third-sector partners to indicative multi-year commitments to stabilise staffing and support long-term planning.
• Refine financial tracking: Introduce an annual tracking framework to monitor spend by programme, age cohort, and prevention type, aligned with the Prevention Unit's budgeting guidance.

Establish shared progress measures, success indicators and reporting structures

• Mandate early childhood planning: Amend the Children and Young People (Scotland) Act 2014 to place a statutory duty on local areas to plan and report specifically on early childhood prevention and early help.
• Unify success measures: Collaborate nationally and locally to establish a shared set of early childhood success indicators aligned with the updated National Performance Framework.
• Streamline reporting: Replace disjointed national programme reporting for Children's Services Planning Partnerships (CSPPs) and other strategic bodies with a single standardised format, using the Whole Family Wellbeing Fund toolkit as a foundation (with specific additions for pregnancy and early childhood).

Develop opportunities for learning and improvement

• Establish a national learning network: Create a national support network providing peer-to-peer learning and improvement opportunities for local areas.

Local areas should consider

Aligning and pooling local budgets (eg, by):

• Joint resource allocation: Establish cross-agency joint budget planning to explore pooling resources across health, education and social care, creating a protected funding stream for early childhood that prevents early help resources from being diverted to acute crisis management.
• Stabilise third-sector partners: Where possible, transition to indicative multi-year funding commitments for local third-sector and community partners to reduce staff turnover, preserve organisational knowledge, and stabilise the relational infrastructure needed to support families.

Developing a unified local outcomes framework and consolidate reporting (eg, by):

• Shared success measures: Collaborate across agencies within CSPPs to establish a shared early childhood outcomes framework aligned to national measures.
• Streamline reporting mechanisms: Consolidate disjointed reporting requirements from different national and local funds into a single, standardised reporting format including opportunity for systemic reflection and learning.

Embedding a culture of collaborative learning and improvement (eg, by):

• Establish a regular multi-disciplinary forum: Create a recurring planning and learning forum that brings together the early childhood workforce across sectors to share practice, co-design local improvements, and embed a culture of continuous reflection.
• Foster 'test and learn' approaches: Actively implement structured, multi-disciplinary improvement approaches.

Theme 4: Workforce skills, capacity and collaboration

What would good look like?

The view from the ground

Workforce capacity

Across the participating areas, staff were described as compassionate and committed to prevention and whole-family support, and well aware of the importance of trauma-informed practice.

In the workshops, workforce pressure was repeatedly identified as the major constraint everywhere, with staff describing the system as having no elastic left due to high caseloads, increased complexity of caseloads, staff turnover, and waiting lists. This lack of capacity creates immense frustration for practitioners who possess strong values and relational skills but lack the time to practise as they believe families need. As one participant noted:

"I think everybody comes to work to want to do a really good job, but the work pressures, the time pressures you’ve got – you’ve not always got the time to phone everyone you might want to phone."

Workshop participant

Furthermore, excessive administrative burdens prevent staff from delivering preventative care. Health visitors in one of the six workshop areas reported spending approximately 70% of their working week completing notes and navigating systems. This point mirrored wider concerns on the tension between relational practice and an organisational emphasis on recording, quantifiable data and risk management.

Staff skills and training

Staff turnover, driven by factors including an ageing workforce, and short-term and insecure funding is seen as leading to the loss of knowledge and experience within staff teams. There is recognition that some vital roles, such as family support workers, and roles within the third sector, have disappeared altogether, further hindering capacity across the workforce.

Ongoing investment in the workforce to address these capacity issues, both nationally and locally was seen as crucial. There were numerous calls for the Scottish Government to review staffing levels and invest more in student pathways, particularly for key roles such as midwives and health visitors, to build more capacity into the system. Securing long-term and sustainable funding for other roles, particularly for some key AHPs and the third sector, in addition to identifying opportunities for more effective and efficient collaboration across the system, was also seen as key to boosting capacity across the system.

Overall, participants recognised the wide array of knowledge that practitioners working with babies and young children need to have: from early attachment, aspects of early communication, neurodivergency, to trauma and poverty-informed practice. They recommended that more is done to standardise cross-sector learning on these key elements, including via ensuring that they are embedded within pre-registration training for key professions and roles.

There were concerns that younger or newly-qualified professionals lack the confidence and support needed to know how best to respond to emerging concerns without over-escalating them. Opportunities for practice-based learning were reported as having reduced compared with the past, with too much training now focused on classroom-based learning.

"Peer learning within offices [has been] lost as a result of Couid it would be good to invest in relationships/networking."

Workshop participant

Several areas also highlighted the importance of role visibility and understanding what other staff did. In the cross-system workshop, it emerged that the AHPs felt that other professionals did not always understand what they do or how they could contribute. In the same discussions, third-sector colleagues reflected feeling peripheral or overlooked, and health visiting teams were asked to collaborate on a wide range of issues, reflecting both their central role and their overloaded position.

At a local level, recommendations for improvement included: individual training and CPD to improve role clarity and promote mutual understanding; multi-agency induction, shadowing, and on-the-job opportunities for networking and skill development; and increased protected reflective and learning time. Ensuring involvement of third-sector colleagues in key opportunities for workforce development and collaboration was a consistent message.

Workforce and organisational collaboration

Practitioners are highly positive about how support is organised around individual families, noting that multi-agency working thrives when a specific, (usually higher-risk) issue is identified. Mechanisms like Team Around the Child, GIRFEC approaches, pre-birth discussions, locality huddles, and informal cross-sector relationships are the most effective parts of the current system. These allow professionals to share information, coordinate support, and build a complete understanding of family circumstances.

Specific co-delivery models were also highlighted, such as early speech and communication teams co-delivering PEEP sessions with other agencies, and joint working between health visitors and speech and language professionals to support early communication.

However, day-to-day collaboration is heavily hindered by workload, and physical and administrative silos. Participants emphasised that multi-agency working thrives on strong personal relationships, which have been eroded by fragmented communication and a shift towards remote work.

Ultimately, where professionals know and trust one another, families are more likely to experience joined-up care. However, operational collaboration is still seen as relying heavily on personal relationships between practitioners, rather than the existence of formalised systems. Operational collaboration therefore usually works despite the system rather than because of it. Joined-up working is strongest not because of embedded planning, but because professionals know each other, are co-located, and can rely on informal communication routes or pick up the phone.

Workforce collaboration at a broader population level to design and coordinate wider support is reported to be under-developed. Participants felt this was driven by a lack of shared accountabilities or collective decision-making, capacity issues, and siloed and misaligned priorities.

To move beyond silos, a genuine culture of collaboration must be embedded at both strategic and operational levels. This requires an intentional effort to create joint planning and reflection spaces.

Potential avenues include expanding integrated locality planning, developing cross-agency working groups, or establishing communities of practice. For example, one local area successfully established a short-life working group to map specific strengths and needs by locality, sharing learning to support multi-agency workforce development for babies, infants, and young children, and directly reporting recommendations to senior leadership.

There are significant opportunities to expand collaboration with key partners across the early childhood system. ELC providers, who interact daily with young children, are uniquely positioned to help identify emerging needs earlier and to carry out assessments with children in their care. Leveraging regular ELC contact could enable more responsive support while releasing capacity within the wider early childhood workforce. This topic was explored in depth in the recently published Building Bridges report, report by Isos Partnership, which recognises the significant roles ELC providers play in supporting an integrated approach to family support. However, it also emphasises the need for this work to be properly resourced going forward.

Staff co-location

There was a call across workshops for more regular opportunities for midwives, health visitors, GPs, ELC staff, AHPs and social workers to work alongside each other in person.

There was broad consensus across participants that shared working environments facilitate informal communication and proactive problem solving, which reduces reliance on formal referrals and helps practitioners develop a holistic view of family needs.

There was acknowledgement that the loss of co-location following the Covid-19 pandemic significantly weakened these ties:

"We had better relationships previously. People were more accessible. Covid was a shift, and I don't think we're back to where it was in terms of partnership working."

Workshop participant

Participants contrasted current reliance on emails and referrals with the benefits of physical proximity.

"In my last job, the team I managed ended up being co-located with social work – and the quality improvement work we were able to undertake was amazing... the curious conversations – it only happened because we were co-located."

Workshop participant

What needs to change

The early childhood workforce requires reinforcement through increased capacity and sustainable student pathways, especially for health visitors and midwives, and investment in third-sector and family support roles. Increases in headcount need to be accompanied by work to reduce the administrative burden on staff. These reinforcements are vital to ensure there is sufficient capacity to meet need, that exceptional existing skills and experience are not lost, and that the workforce is treated as a key asset to build on.

Professional development should incorporate increased focus on practice-based learning, cross-sector training and opportunities for building multi-agency understanding through joint inductions and job shadowing.

Workforce collaboration and multi-agency working needs to be systemised and strategically supported as a key driver of improvement, with a focus on co-location of staff, multi-agency planning and decision-making through mechanisms such as integrated local planning mechanisms and communities of practice.

Recommendation 4: Develop a sustainable and capable workforce

Scottish Government must

Ensure short- and long-term capacity and sustainability of the workforce

• Develop a long-term workforce strategy for early childhood: This should consider headcount, retention, pay, progression, and workload-reducing technology across health, children's services, and ELC.
• Invest in critical roles: Fund national training and recruitment to address shortages in midwifery, health visiting, speech and language therapy, and ELC.

Enhance support to develop the skills and capabilities of the workforce

• Standardise core competencies: Create a high-quality, cross-sector learning framework to embed essential early childhood knowledge into workforce training.
• Enhance core curricula: Partner with education providers, regulators, and royal colleges to embed infant mental health, attachment theory, neurodiversity, and preventative practice across professional training.
• Expand practical training: Work with development bodies like Public Service Delivery Scotland to significantly boost hands-on, practical training for both students and current practitioners.

Local areas should consider

Prioritising multi-agency collaboration through shared spaces and practice (eg, by):

• Co-location: Actively foster opportunities for co-location of professionals from across professions and services (for example, midwifery, health visiting, ELC, children's services, third sector) to facilitate informal network and relationship building.
• Cross-agency planning: Standardise cross-agency working via working groups that focus on shared accountabilities and joint planning, and team 'huddles' to create regular, structured opportunities for teams to share information, coordinate support and proactively problem solve, reducing reliance on formal referrals.

Investing in practice-based and peer-to-peer learning (eg, by):

• Create time for reflective practice and on-the-job development: Include implementing multi-agency inductions, job shadowing, and communities of practice, which help newer professionals build confidence, and ensure all staff including third-sector partners – have a clear understanding of roles and contributions across the wider system, and have time to engage in reflective practice.

Theme 5: Data and operational infrastructure

What would good look like?

Enabling data and operational infrastructure: Operational systems and processes work in a way that minimise administrative burden and improve organisations' ability to strategically plan and coordinate services around the family.

The view from the ground

Disconnected systems and lack of interoperability hinder information sharing at the family and individual level

Universal frustration exists regarding the continued use of outdated, fragmented recording systems and restrictive information governance rules. While multiple platforms are in use (for example, Care Partner, Ayrshare, SEEMiS, BadgerNet), they do not consistently communicate or capture the same data. This lack of interoperability severely hinders cross-agency collaboration, forces repetitive data sharing agreements, and complicates care continuity across service and geographical boundaries.

"In this technological world that we live in, surely there could be a straightforward data infrastructure system that could be utilised across the partnership."

Interview participant

Because no single, shared view of the family exists, different services hold isolated pieces of information. With no dedicated administrative capacity to support coordination, the burden falls entirely on frontline practitioners. Staff must manually duplicate data, update multiple systems, and rely on informal networks to fill gaps, increasing their administrative workload and risking missed family needs when time is limited.

Crucially, this system failure directly impacts families, who are forced to repeatedly retell their stories to different workers.

"Families are having to tell their story again and again... sometimes repeating trauma. It depends on who has recorded information and how well. From service to service it depends on a worker to record accurately."

Workshop participant

Governance and risk tolerance barriers

The lack of a mechanism which enables children to be identified across different parts of these systems and across time also adds an additional layer of complexity of trying to support individual families between areas such as health, ELC, social work and education.

Ultimately, these challenges are being replicated across multiple local authorities, wasting significant time, effort and money. Participants strongly called for Scottish Government to implement a unified, national solution to local data and information-sharing infrastructure.

"Much of what we do is repeating (things) time and time again... if we could resolve them nationally that would be wonderful."

Interview participant

Over and above the operational barriers caused by multiple non-aligned information systems, there are also governance barriers, including around GDPR. Participants highlighted uncertainties about what can be shared and when, and the lack of standardised processes for information exchange across services.

These challenges are exacerbated by differing risk thresholds between partners even in the same geographical area. Participants reflected that sometimes it felt that fairly high risk decisions around information sharing were being left in the hands of individual practitioners, and there was a request for some of the risk burden around sharing personal information to be held by leaders further up the system.

Participants called for clearer guidance on what information can and should be shared when, and for more work within and across teams to agree workable arrangements for this.

"It is important to share [information], but we have to be careful when and how. Some information from the past is super personal about families, about mums, that might not be relevant now."

Interview participant

Data built for accountability, not prevention

Across all six areas, participants argued that existing data systems are designed for activity recording and accountability, rather than identifying emerging needs, planning early interventions, or supporting whole-family care. The core issue is not simply poor IT infrastructure, but a failure to use available case-level data at a population level to target support or inform service design.

There was recognition that the need is not only to improve IT infrastructure, but also to foster an analytical and reflective culture where data is used to target support or inform service design.

Population-level data is difficult to access in one place and at the right level

"We gather lots of data already, but we are not using data for improvement because we don't have that culture of analysis, which builds on reflective practice.”

Area lead interview

Despite these challenges, pockets of good practice have emerged. One area stood out for routinely combining population data and qualitative feedback through its children's services planning groups to adapt service delivery.

Awareness of, and access to, population-level data sources was clearly a significant barrier. A range of local and national dashboards and datasets exist which include administrative data relevant to local children and young people services from across different sectors. These include the Public Health Scotland dashboard, Improvement Service ELC dashboard, Scot-PHO dashboard and Public Health Scotland Discovery tool. Findings from both the workshops and interviews indicated varying levels of staff awareness about these datasets and how to use them.

In conversations about ideal futures relating to data, a repeated ask was for all relevant individual and population-level data to be brought together into a single place. One interviewee described the dream scenario of having one shared platform for all partners and one uniform way of collecting the data on the same platform.

Multiple areas talked about the importance of having access to data at the lowest possible geographical level and the value of being able to overlay data. The Marmot approach was mentioned as one approach where this had been made possible. By analysing where multiple risk factors overlap – such as high maternal smoking combined with developmental concerns – they can strategically co-locate holistic, multi-agency one-stop shops exactly where the community needs them most.

Staff skills, capacity and confidence

Interviewees and workshop participants spoke of a lack of dedicated data capacity (for example, localised analytical staff), meaning that practitioners and managers were being left to analyse data directly. They felt that they often lacked the time, confidence, permission and skills to do this.

Enablers for future data use identified included dedicated thinking time for teams to engage with data, and provision of nationally provided coaching and training for the local workforce on how to use data for quality improvement. However, support from a dedicated analytical function is also required to make data more accessible to the general workforce.

Qualitative and quantitative data

Several participants also stressed that data should include qualitative evidence and family voice, not just quantitative indicators. One area explicitly recommended strengthening family feedback and lived experience as qualitative evidence within commissioning and decision-making because current systems over-prioritise quantitative reporting.

What needs to change

Data and information governance most clearly emerged as the theme where local areas felt there was a critical central role for Scottish Government to play in supporting and improving local delivery. Improvements are required to data infrastructure and governance to enable better inter-agency sharing of data at a local level. Creating a single, easy-to-access repository of relevant cross-sectoral population-level child data, available to the lowest geographical level, and presented in a way that non-data analysts could engage with, was seen as a key priority.

Support is also required at the local level via a dedicated analytical service, and training for general staff to build accessibility to data, and confidence in using it.

Recommendation 5: Develop seamless data infrastructure and guidance that enables best practice

Scottish Government must

Develop seamless national data infrastructure and guidance that enables best practice

• Issue procurement guidance: Establish minimum standards for data and client systems, focusing on interoperability, data sovereignty, user testing with frontline staff, and AI guardrails.
• Enable cross-sector data linkage: Mandate shared standards and operational rules to link child identifiers across health, education and social care.
• Standardise local data sharing: Develop guidance to streamline local data collection and build practitioner confidence around legal, safe information sharing.
• Digitise administrative processes: Reduce local paperwork burden by introducing streamlined digital options.
• Launch a national data portal: Establish a single children and families portal giving local areas easy access to cross-sector population data at the lowest geographical level.
• Simplify reporting: Review data upload requirements to enforce a 'write once, share once' approach for local areas.

Local areas should consider

Support local capacity and build confidence to engage with data

• Build local data confidence: Create a national learning programme to help frontline staff and leaders comfortably use population and individual data for planning and decision-making.
• Enhance technical analytics: Boost advanced analytical capacity via a centralised specialist team or creative partnerships (for example, matching post-graduate and PhD researchers with local areas for targeted data projects).

Improving local data governance and reducing administrative burden (eg, by):

• Audit local data sharing arrangements: Conduct a comprehensive review of local data sharing arrangements to identify and resolve barriers. Use this to develop clear, standardised, inter-agency guidance.
• Review data collection mechanisms: Identify opportunities to minimise repetitive tasks and streamline administrative processes for frontline staff.

Building analytical capacity and practice (eg, by):

• Enhance dedicated analytical support: Either through internal specialist staff or creative partnerships in order to bridge the gap for non-data analysts.
• Upskill broader staff teams: Provide practitioners and leads with support and training to increase their confidence in engaging with data.
• Foster data-led planning and reflective practice: Shift the purpose of data usage from activity reporting and accountability towards active planning and improvement. Create protected 'thinking time' for teams to engage regularly with data, ensuring qualitative evidence – such as family voice and lived experience – is integrated alongside quantitative indicators.

Appendix 1: Full list of national recommendations

Theme 1: Strategy, leadership and governance

Recommendation: Make early childhood a priority

Scottish Government must

Set out a vision and policy commitment

• Define a clear vision: Set out early childhood priorities that re-establish babies and early childhood as a top Scottish Government priority.
• Embed across policy: Ensure the vision and priorities are reflected in national policy, frameworks and delivery programmes.

Enshrine governance mechanisms

• Adopt a cross-government approach: Align early childhood priorities across broader child policies, including Whole Family Support, ELC, The Promise, and tackling child poverty.
• Establish accountable governance: Drive progress with cross-portfolio oversight, regular reporting to Cabinet and Parliament, and independent scrutiny (via a Cabinet sub-committee, parliamentary committee, or expert external panel).

Theme 2: Support available to families

Recommendation: Ensure a consistent and accessible offer of early help is available

Scottish Government must

Update and strengthen expectations around delivery

• Update Getting It Right For Every Child (GIRFEC) guidance: Refresh the GIRFEC framework and practice model with specific guidance for pregnancy and early childhood.
• Define a national 'core offer': Establish clear guidance for a universal support package from pregnancy through early childhood, emphasising community-based, co-located services for early help and establishing clear pathways for families.

Review and strengthen elements of existing national touchpoints

• Fulfill the national health visiting action plan: Fully implement the recommendations in the enhancing delivery of the health visiting service action plan.
• Review relationships and responsibilities between key services: Review the relationship between health visiting and other potentially contiguous services such as midwifery and Early Learning and Childcare (ELC) to ensure responsibilities are most effectively distributed and to strengthen coordination, handovers and touchpoints between services.
• Test innovative local approaches: Use improvement methodologies to support tests of change around assessment points, support pathways, multi-agency pathways and extra visit opportunities.

Theme 3: Funding, accountability and improvement

Recommendation: Ensure funding and accountability mechanisms drive vision-aligned delivery

Develop opportunities for learning and improvement

• Establish a national learning network: Create a national support network providing peer-to-peer learning and improvement opportunities for local areas.

Theme 4: Workforce skills, capacity and collaboration

Recommendation: Develop a sustainable and capable workforce

Theme 5: Data and operational infrastructure

Recommendation: Develop seamless data infrastructure and guidance that enables best practice

Appendix 2: Full list of considerations for local action

For local systems, we set out a more tailored approach that recognises variations in existing local systems and delivery models. We have set out two key actions which local areas must take, accompanied by non-exhaustive suggestions for the types of action local areas may want to take, depending on local context.

Theme 1: Strategy, leadership and governance

Recommendation: Make early childhood a priority

Theme 2: Support available to families

Recommendation: Ensure a consistent and accessible offer of early help is available

Theme 3: Funding, accountability and improvement

Recommendation: Ensure funding and accountability mechanisms drive vision-aligned delivery

Theme 4: Workforce skills, capacity and collaboration

Recommendation: Develop a sustainable and capable workforce

Theme 5: Data and operational infrastructure

Recommendation: Develop seamless data infrastructure and guidance that enables best practice

Appendix 3: Methodology

This report draws on mixed-methods, triangulating data from national survey findings, workshops conducted across select local authority areas, and validation interviews with representatives from these local authorities.

This qualitative work was complemented by a concurrently run national survey designed and administered by CELCIS to all 32 Scottish local authorities, with 25 authorities completing the survey to provide a comprehensive nationwide overview.

Overarching analytic approach: enablers framework

At the project's outset, Nesta reviewed several existing frameworks (see 'enabler sources' in appendix 4 for details) to identify what conditions are required to create effective support in early childhood. We built on these existing frameworks to create a list of key enablers that we then used in the project (see appendix 4 for detail). This list of key enablers, referred to as the 'enablers framework', formed the foundation of Nesta's research approach through the design and delivery of the data collection activities and the basis for the data analysis.

Data collection activities

Participatory workshops and validation interviews with local authorities

Nesta commissioned Horizons Research to design and deliver a series of deliberative workshops held between March and May 2026 across six Scottish local authorities: Fife, Highland, North Ayrshire, North Lanarkshire, South Ayrshire, and West Dunbartonshire.

The workshops sought to explore how effectively local early childhood systems support families during pregnancy and the first year of a child's life in Scotland. The local authority workshops were designed to create a structured space for collective reflection on the strengths, challenges and opportunities within local delivery systems. The workshop discussions were anchored in the enablers framework (see appendix 4).

Workshop participants were a multi-disciplinary group (between 15 and 30 in each area) of practitioners, managers and strategic leaders from across early childhood support professions, including representation from third-sector organisations, maternity and wider health services, health visiting, other AHPs, social work, education, ELC, family support services, and community learning and development.

The workshop engagement was structured in two phases. First, each local authority area participated in two in-person, area-specific workshops to explore their local early childhood delivery context. Second, a final pan-regional workshop brought together participants from all six areas to cross-examine findings and share learning. In order to increase the robustness of our insights, Nesta also conducted follow-up validation interviews with representatives from each local authority area to review, refine, and verify the emerging findings and strategic recommendations that emerged from the research.

National survey with local authorities

CELCIS designed and administered a national survey to 32 local authority areas in Scotland. The aim of the survey was to capture a comprehensive, nationwide understanding of the early childhood landscape. A total of 25 local authorities completed the survey. For the purpose of this report, Nesta focused on a subsect of the survey data that focused birth to age three.

Data analysis

The enablers framework was the underpinning structure guiding our analysis. A report produced from the workshops, notes from the interviews and open text responses in the survey were analysed using combined qualitative thematic and framework approaches, drawing on deductive codes from the enablers framework and inductive codes that emerged directly from the workshop and interview data.

We analysed the anonymised survey data for birth to age three related to delivery of universal and targeted services, covering: what tools local areas were using for assessing family need; where responsibility sat within local systems for coordinating early childhood care; how parent and infant voices were incorporated into planning; what is viewed as working well; and what strategic support is required from both local and national government. The quantitative survey data was analysed by standardising the free text responses given by local authorities in order to match mentions of early help programmes to known and established programmes in the sector. If local authorities' responses did not match specific programmes, they were matched with established subject areas in the sector.

We also triangulated our analysis drawing on additional insights from other sources, including targeted data conversations held with local authorities. The specifics of these conversations have not been included in this report but were used sense check the emerging overall analysis.

Nesta's relationship with CELCIS

In the early stages of planning this study, Nesta became aware that CELCIS, a research and innovation centre based at the University of Strathclyde, was also working to generate intelligence and insights about existing pregnancy support in Scotland. In acknowledgment of the current staff pressures in local authorities and health and social care partnerships, it was agreed that while each study had distinct aims, we would work together to minimise additional ask of the sector participating in both pieces of research

The CELCIS study aimed to increase understanding of the universal, additional and targeted support in place across Scotland during pregnancy and in the first few months of a child's life, and to explore how this support was delivered.

The aim of Nesta's study was to explore what change was required nationally and locally to strengthen and improve early childhood development from a child's birth to their third birthday, to support longer-term outcomes and the conditions which need to be in place to enable improvement.

As a result, a detailed review of pregnancy is not included in this report due to it being covered in the report being produced by CELCIS

This report can be read as a companion piece to the research produced by CELCIS. As both projects were exploring parallel aspects of support for families, and we shared the findings of our individual research with each other, there are inevitable areas of overlap across the two sets of findings. Nesta and CELCIS have worked closely to acknowledge these shared insights, ensuring our respective recommendations remain distinct yet complementary, and that our combined intelligence provides a coherent picture of the current landscape.

Steering group

The project was supported by a steering group made up of representatives from Scottish Government and Public Health Scotland.

Limits of research scope

While there was high coverage of local authorities in the response to the CELCIS survey, the analysis of services is not a comprehensive overview of all programmes used by all local authorities. Some local authorities did not respond, others may not have mentioned every available programme or service, and there may be differences in local authorities' judgement of what is considered a programme or a programme variant which would affect this analysis.

While pre-conception is recognised as providing a valuable opportunity for early intervention work, this was not included within the scope of the research.

This study intentionally focused on capturing the insights and operational perspectives of professionals working directly within the sector. Engaging families to capture their lived experiences was deliberately excluded from the scope of this research. This decision was guided by two primary considerations: first, an ethical commitment to minimise any potential engagement burden on families, and second, the recognition that recent external research has already robustly documented family perspectives. Consequently, this study prioritises an internal systemic critique, leaving further dedicated engagement with families to be progressed as a distinct, separate piece of work.

Appendix 4: Key enabler framework

At the outset of this project, we aimed to ascertain how well local areas in Scotland provide services and support to families during pregnancy and the first three years of a child's life.

Drawing from established evaluation reports, research and frameworks, we defined what good looks like to map out the architecture of a successful early childhood system. From these sources, we established a set of key enablers that directly shaped our overall research methodology – guiding the design of our local workshops and structuring the analysis of our workshop findings, interviews and the CELCIS national survey.

Key enablers

Enabler sources

EIF Maturity Matrix: maternity and early years: A self-assessment tool to support local partners to understand the position on early childhood intervention, identify areas for improvement, and work together to deliver positive change. EIF/Foundations, 2020

Nurturing Care for Early Childhood Development: A global roadmap developed by the WHO, UNICEF, and the World Bank Group which sets out the conditions required for young children to survive, thrive, and reach their full developmental potential. WHO, 2018

10 years on: An evaluation of Lambeth Early Action Partnerships: The report offers lessons from LEAP's experience to inform and improve future policy and practice in similar contexts. Dartington Service Design Lab, 2024

A new era for the early years: A high-level blueprint for how the family hubs programme in England can most effectively deliver support for all children and families. Nesta, 2025

Changing local systems to improve early learning outcomes: A learning resource for systems change programmes, practitioners and funders to share key insights from Save the Children's Early Learning Communities programme. NPC, Collaborate, Save the Children, 2023

Better Start - Building Systems for Early Childhood Development: A practical framework drawing on a decade of place-based systems building in Blackpool. It emphasises an integrated early life course approach, relying on collective strategy, progressive universalism, and the need for a dedicated executive team to drive delivery, innovation and learning. Better Start, 2024

The Whole Family Wellbeing Funding Self-Assessment Toolkit: A Scottish national toolkit designed to help CSPPs evaluate and deliver holistic, whole-family support. Available via request from Scottish Government, 2026

Quality statements

As a result of the project work, we refined these key enablers into the 12 quality statements that can be found at the start of each of the five themes set out in the report.

• Strategic prioritisation and policy alignment: Early childhood is prioritised and aligned within and across policy and strategic planning at the local and national level and backed by clear, actionable guidance.
• Integrated governance: Robust governance structures at local and national levels dismantle traditional silos, ensuring clear accountability and the seamless alignment of priorities, budgets and plans across agencies.

• Clear and distributed leadership: Leaders across the system work to champion joined-up early childhood support, empower teams to experiment, and collaborate and foster a culture of innovation and improvement.

• Available services and supports: Families can access a seamless continuum of practical, financial and emotional support that ranges from universally accessed early help to highly targeted, intensive interventions.

• Support focuses on early help pathways: There are clear, well-communicated and consistent routes for families to be supported before needs emerge or become critical.
• Family involvement: Families are actively involved in the design of services.
• Sustainable, long-term funding that supports high-quality services: Funding enables strategic and sustainable delivery.
• Aligned and proportionate accountabilities: Reporting is aligned and actively used to inform local and national decision-making.
• Impact, learning and improvements: Evidence data and information sharing drive planning, learning and improvement.
• Workforce skills and capacity: The workforce has the skills and individual and collective capacity to use family centred-practices and address emerging needs.
• Workforce and organisational collaboration: Individual organisations are coordinating to design and deliver seamless support for families.
• Enabling data and operational infrastructure: Operational systems and processes work in a way that minimise administrative burden and improve organisations' ability to strategically plan and coordinate services around the family.

Appendix 5: Analysis of service provision

This appendix sets out more detailed findings from the analysis of the CELCIS survey of local authorities regarding programmes and services delivered by each local authority.

CELCIS issued a survey to all 32 local authorities in Scotland and received a response from 25.

The responses were analysed and responses broken down into two broad categories:

• Programmes: defined here as a formal, manualised parenting support programme with a standardised delivery framework that has been formally evaluated to demonstrate positive relational or developmental outcomes.
• Other subject areas: all other services and types of support that did not fall under the definition of a programme.

The programmes were analysed quantitatively by searching for matches between known programme names and the responses provided by local authorities. Programmes were matched based on exact names, name variations, multiple consecutive words, or many non-consecutive words. Stop words and stop phrases were also used, and this analysis was checked carefully after matching to limit false positives or negatives. However, we cannot guarantee that every match is correct. After the local authority-reported programmes were checked against known programme names, any which did not match were removed or matched on subject areas using exact phrases, name variations, and manual matching.

This analysis is not a comprehensive overview of all programmes used by all local authorities. Some local authorities did not respond, others may not have mentioned every available programme, and there may be differences in local authorities' judgement of what is considered a programme or a programme variant which would affect this analysis.

Analysis of parenting support programmes

Survey respondents mentioned use of 11 formalised parenting programmes.

21 of the 25 respondent areas mention using at least one formal parenting programme (by formal we mean a manualised programme included in the Foundations Parenting Programme Guidebook).

The highest number of programmes recorded in any one local authority is six. For the 21 areas which were using at least one programme, the average number being used was 2.6.

The Family Nurse Partnership (FNP) operates in 15 local authorities, making it the most widely recorded adopted programme, closely followed by PEEP which is active in 14. FNP was the most commonly mentioned programme to be referenced as 'targeted'. All of the other programmes being used were referenced as being universally available in at least one local authority area.

Analyses of other categories of support delivered

Across the 25 areas responding, 33 categories of support were identified from the responses as being delivered in at least one local authority area. The most commonly mentioned forms of support were family wellbeing and parenting support. There was wide variation across the local areas as to how many other categories of support were mentioned as being provided – 24 being the highest, and with five areas stating only one or no other support. It is noticeable that only two of the categories of support are reported as being delivered in more than 50% of the respondent areas – highlighting the inconsistent nature of service delivery across Scotland.

When considering who is delivering these services, the reliance on third sector delivery is significant. Almost half (43%) of all mentions of other support being delivered are attributed to the third sector (197 mentions). The next largest provider of services by subject area of support are statutory providers of parenting support.

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