The UK's school readiness policy is centred on the government's Opportunity Mission target of having 75% of five-year-olds achieve a good level of development by 2028, as measured by the Early Years Foundation Stage Profile (EYFSP) assessment.
Currently, there are deep disparities in school readiness between different demographic groups. Analysis by the Institute for Government highlights that:
- School readiness does not follow a steady downward trend from higher-attaining to lower-attaining groups – there is a cliff-edge. Four groups of children persistently fall far behind their peers:
- children eligible for free school meals
- children identifying as Gypsy/Roma
- Travellers of Irish heritage
- children with special educational needs and disabilities (SEND).
- The strongest demographic predictors of local authority performance on ‘school readiness’ are the proportion of children with SEND, followed by the proportion of children from low-income households (identified through eligibility for free school meals (FSM)).
- There are in-group variations – children with SEND do relatively better in local areas where there are more of them – and the same is true for children eligible for FSM.
- A significant gender gap also exists, with boys falling behind girls – most notably in lower-attaining groups, where there are large differences.
Children achieving a good level of development (GLD) are those achieving at least the expected levels across 17 early learning goals in the EYFSP assessment, categorised under 3 prime areas and 4 specific areas of learning. These include communication and language, physical development and self-care, and personal, social and emotional development.
Children learn and develop well in enabling environments – and this starts in the earliest years of life. Parents and carers are the child’s first and most enduring educators, and their involvement is crucial to a child’s success. Health visiting has a key role to play in achieving the Mission target as part of a whole system response:
- Reaching all children. Health visiting is the only service that proactively and systematically reaches all babies and young children, bringing wider system benefits. The very best child development and SEND interventions will only be effective if our services reach those who need them.
- High-quality health visiting universal holistic assessments to identify children with developmental delay, atypical development, or at risk of poor outcomes, at the earliest opportunity. Health visitors are often parents’ first point of contact when they have concerns about their child’s development. Some families, especially the most vulnerable, may not be aware of the extent of their child’s health or development needs, or services to support them.
- Early intervention, with a personalised response based on individual need – including support for parents/ carers. Health visitors also play a key role in connecting children and families to specialist services and wider community support where indicated.
Importance of high-quality holistic assessments:
The scope of the health visitor holistic universal assessments is set out in the relevant UK nation’s policies (see UK Health Visiting policy) and covers: physical and mental health (for the baby/young child – and parents/ carers), child development and growth, social needs, and safeguarding.
Through their universal and targeted work, health visitors are ideally placed to identify babies and children with signs of atypical development, or with significant impairments likely to result in disability. Using their clinical and observation skills, they can also identify “risk factors/ red flags” for serious conditions that can be mitigated, through early identification and effective management (for example, early signs of cerebral palsy – see Commissioning framework for children and young people with cerebral palsy which provides a blueprint for an integrated pathway for SEND).
Known limitation of the Ages and Stages Questionnaire (ASQ-3): Some UK nations use the ASQ-3 as a population measure – it is important to note that this only forms part of the health visitor’s holistic clinical assessment at 2 to 2½ years. The ASQ was introduced into the UK as a population measure of child development and does not meet the UK Screening Committee criteria to be used as a standalone screening tool. See UK research: Wilson et.al. 2022 which found that the ASQ performs poorly as a language screening tool, missing one-third of cases of low language ability; similar errors have been found in other domains of child development including motor development, and social and emotional development (Lysons J., et.al., 2026). Similar findings were found in research on the Early Language Identification Measure which found significantly improved sensitivity and specificity when completed by health visitors using clinical observation and judgement alongside the assessment tool, compared to an early years practitioner. Both provide good examples of the importance of avoiding a ‘tick box’ approach.
Importance of relationships and home visiting: UNICEF UK described the universal role of the HV as “the backbone of early years services” and the “safety net around all families”. Seeing a baby or child interacting with their family in their home provides valuable insight into their world, as well as the risk and resilience factors that can impact on health and wellbeing. Babies and young children with clinical or safeguarding vulnerabilities are often invisible to other services unless their caregivers reach out. The relationships that HVs build with families are central to the success of the service, supporting better identification of need, uptake of health-promoting messages, and improved child and maternal outcomes for disadvantaged families (with global evidence to support this – for example, Scotland; Japan; Australia).
Child safety: Evidence from research, frontline practitioner intelligence and the Child Safeguarding Practice Annual Review (2020) highlight increased risks of virtual assessments (which were linked to almost half of the child deaths and serious incidents investigated). This was also flagged as ‘safety-critical’ in evidence to the UK Covid Inquiry Module 8 for children and young people.
Engaging and supporting parents: Parents/ carers play a vital role in supporting their baby/ child’s development and engagement in early intervention. Yet, we also know that many families are themselves struggling with a range of economic, social and personal health issues which can impact on child outcomes. With growing concerns about the number of invisible vulnerable children and those who are not “ready for school”, it is therefore vital that we do not consider the child in isolation. Alongside supporting the child, services must also consider the needs of parents/primary caregivers and ensure that they are supported to thrive in their role.
Statutory responsibility to notify: Section 23 of the Children and Families Act requires health bodies to notify local authorities of children under compulsory school age who they believe have, or probably have, special educational needs or a disability (SEND).
