Every child in Herefordshire has the best possible start in life: growing up safe, healthy, loved and ready to learn, with parents and carers supported by welcoming communities and services that work together.

We will focus on pregnancy and the first five years because early relationships, health, communication, play and learning shape children's future outcomes.

We will act early, reduce avoidable inequalities and make support easier to find—wherever a family lives in our rural county.

Herefordshire has strong community assets, and many children achieve good outcomes.

However, rurality, travel and access to services can make support harder to reach; disadvantage can be hidden in rural communities as well as concentrated in parts of Hereford and market towns.

The county's Joint Strategic Needs Assessment (JSNA) identifies best start in life as a core health and wellbeing strategy priority.

Sources: OHID Public Health Outcomes Framework, Herefordshire at-a-glance profile (latest values shown); Understanding Herefordshire, Inequalities page; Herefordshire JSNA Summary 2024 (updated April 2025). See source list. The 2024/25 figures above supersede older values quoted in earlier local reports where the same indicator is available.

Rural access and outreach opportunities

We know to access services some people have to travel long journeys across the county, limited public transport, digital exclusion and dispersed need.

We will deliver outreach where we can, using community venues to deliver some services, while aiming to offer flexible appointments.

Poverty and practical pressures

Family Hubs will connect early years support with welfare advice, housing, food support, parental employment and mental wellbeing services.

Inequality within the county

We will use area and service-level data to identify underserved communities, while avoiding assumptions that rural households are uniformly affluent.

Early development

We will preserve our strengths in the early years and support a child's readiness for school, while improving early identification at the 2 year and 3 year health review.

Prevention

Continue work on smoking in pregnancy, infant feeding, vaccination, oral health, healthy weight and safe, nurturing relationships.

Our values and principles

A child-centred approach

We will aim to deliver family-led and strengths-based approaches, recognising what families already do well and build confidence.

Inclusive and anti-discriminatory

We will adapt support where possible for disability, SEND, neurodivergence, language, culture, care experience and differing family structures.

Prevention and early help

We will aim to provide the right help at the right time proportionate to need, before difficulties escalate.

Place-based and accessible

We will design Family Hubs and network sights around the realities of Herefordshire's rural geography and local communities.

Joined-up integrated working

Practitioner and our partners will work together to support families, providing a more joined up approach.

Evidence-informed and accountable

We will measure impact, evaluate programme and learn from families. We will change approaches that are not working.

Co-production

Parents, carers and people with lived experience will support us to help design, deliver and review services.

Outcome 1 - The proportion of children securing a good level of development is well above the national average including for those defined as disadvantaged

Aim: children develop the communication, social, emotional, physical and early learning skills they need for a positive transition to school.

• Promote everyday talking, singing, reading, shared play and interaction from pregnancy and birth onwards, using trusted local messages.
• Strengthen communication-friendly practice in early years settings and build links with speech and language therapy and community services.
• Use the two-year review, health visiting contacts and early years observations to identify concerns early and agree practical next steps with parents.
• Support high-quality transitions between home, childcare, early years settings and Reception, with consent-based sharing of useful information.
• Target additional help to children facing disadvantage, children with SEND, children in care, children experiencing housing instability and those with limited access to early education.
• Use Herefordshire's 2024/25 school-readiness baseline of 72.0% achieving GLD and align the plan to the local target of 80% by 2028. For children eligible for Free School Meals, use the 2024/25 baseline of 51.7% and the local target of 57.2% by 2028.
• Monitor outcomes for children with SEND separately; the Health and Wellbeing Board reported that 19.7% of children with any special educational needs achieved GLD.
• Childcare providers, schools and early years practitioners have the skills, resources and partnership links to support every child.
• Maintain a countywide early years improvement offer, including practical training, peer learning and support for quality and inclusion.
• Strengthen support for SEND and emerging developmental needs, including advice on reasonable adjustments, early identification and routes to specialist help.
• Promote trauma-informed, attachment-aware and communication-rich practice across early years settings.
• Support settings to work effectively with health visitors, family support, speech and language services, social care and parents.
• Use local data and practitioner insight to target support to settings serving communities experiencing greater disadvantage or access barriers.
• Share effective practice in healthy eating, physical activity, oral health, outdoor play and transition to school.

Proposed measures: GLD at end of Reception; GLD for children eligible for Free School Meals; development at age 2–2½; communication and language indicators; early years attendance and take-up; family-reported confidence in supporting learning at home.

Provider participation in training and improvement support; practitioner confidence; inclusion and SEND support response times; setting-level trends in GLD and attendance; provider feedback.

Outcome 2 - Reduction in tooth decay in children at 5 years

Aim: Reduce the prevalence and severity of tooth decay in 5-year-old children across Herefordshire.

Priority actions:

• Reduce inequalities in oral health, particularly among children living in areas of deprivation and those at greater risk of dental decay.
• Improve parents' and carers' knowledge of good oral health practices, including toothbrushing, healthy eating and limiting sugary foods and drinks.
• Increase the number of children brushing their teeth twice daily with fluoride toothpaste from an early age.
• Support families to access NHS dental services and preventative dental care as early as possible.
• Promote a consistent, partnership-based approach to improving children's oral health across health, education and early years services.
• Deliver oral health advice and support through health visitors, family hubs, early years settings, nurseries and children's centres.
• Encourage parents and carers to establish toothbrushing routines as soon as their child's first tooth appears.
• Provide practical advice on brushing twice daily with fluoride toothpaste and supervising young children's toothbrushing.
• Deliver and expand the supervised toothbrushing programmes in schools and early years settings, prioritising children at greatest risk of tooth decay.
• Provide settings with appropriate resources, training and guidance to support safe, consistent toothbrushing routines.
• Work with parents and carers to encourage continued toothbrushing at home.
• Promote the importance of a child's first dental visit by their first birthday and regular dental attendance thereafter.
• Work with local dental services and partners to help families understand how to find and access NHS dental care.
• Signpost families who experience difficulties accessing dental services to appropriate local support.
• Promote water and milk as healthier drinks for young children and encourage families to reduce sugary drinks, snacks and foods.
• Embed oral health messages within existing healthy weight, nutrition and early years programmes.
• Provide clear, practical advice to parents and carers on reducing the frequency of sugar consumption.

Proposed measures: Progress will be monitored using available national oral health survey data, local public health intelligence and information from participating services. Activities and priorities will be reviewed regularly to ensure support reaches children and families most at risk.

Outcome 3 - Improvement in healthy parenting routines and behaviours

Aim: To empower parents with the tools to build positive daily habits and ensure families can find trusted information, practical help and peer support from pregnancy through to teenagers.

Priority actions:

• Create a Best Start in Life website where clear information is available to families from pre-pregnancy to teenagers to help them navigate their parenting journeys. Provide clear information around Herefordshire's Family Hubs and community-based support.
• Promote a shared core offer covering pregnancy, infant feeding, attachment, parent-infant relationships, sleep, emotional wellbeing, oral health, safety, play, communication and school readiness.
• Expand parent-led and peer-support opportunities through Family Hubs, libraries, community groups, and voluntary and community organisations.
• Offer evidence-informed parenting and home-learning programmes, with flexible timing, accessible venues, and outreach where needed.
• Ensure families can access practical help with benefits, debt, food, housing, fuel costs and essentials through warm referrals rather than signposting alone.

Proposed measures: Use parent feedback and community insight to identify groups who are not accessing support and redesign the offer with them.

Proposed measures: Awareness of the local offer; Family Hub and community participation; parent-reported confidence and belonging; proportion of referrals resulting in contact; reach among priority groups.

Outcome 4 - Improve perinatal health and wellbeing (reducing infant mortality/healthy babies)

Aim: Families receive timely, joined-up support for physical health, emotional wellbeing, communication and development.

Priority actions:

• Improve timely new birth visits and follow-up for families who miss appointments, using flexible contact and locality-level monitoring.
• Increase access to the integrated two-year review and ensure clear pathways from identified developmental concerns to advice, assessment and support.
• Strengthen the partnership between health visiting, maternity services, primary care, early years settings, speech and language services and SEND support.
• Continue evidence-based support for breastfeeding and infant feeding, respecting informed parental choice and offering practical, culturally appropriate help.
• Maintain targeted smoking cessation support before and during pregnancy and after birth, linking maternity, health visiting and stop-smoking services.
• Improve uptake and timely completion of childhood immunisations through reminder systems, outreach, trusted conversations and better recording across services.

Proposed measures: New birth visits within 14 days; two-year review coverage and outcomes; vaccination coverage; breastfeeding at 6–8 weeks; LG Inform Data 2022-2024 Hereford had a 2.9:1000 IM rate. (Workstream carried out across the LMNS Herefordshire/Worcestershire). Reduced smoking rates at time of delivery baseline (2023/24): 4.2% of women smoking at time of delivery. Target (by 2030): 4% or below.

A countywide offer should be delivered flexibly to reflect different needs across Herefordshire and its market towns and rural communities. Partners should use local data and family insight to determine where outreach, additional sessions and targeted resources are most needed.

We will develop and establish Family Hubs and community venues as welcoming connection points for advice, groups, parenting support and links to specialist services.

Rural outreach

We will develop an outreach strategy partnering with libraries, schools, community organisations and health to deliver sessions across the country which takes into account rurality and transport barriers.

We believe digital plus human support is important and we will maintain accessible online information while preserving telephone, face-to-face and interpreter-supported routes.

Community Navigators

Our Community Navigators will work with voluntary and community groups, parent champions and trusted local organisations to reach families who are less likely to engage with formal services. Our Early Help Information and Signposting Officers will be the first point of contact at Family Hubs and support you in accessing services, help and support.

Strategic accountability

Herefordshire Health and Wellbeing Board oversees delivery as well as The Children and Young People's Partnership Board.

The BSIL/Early Years Partnership Board (includes The Family Hubs Steering Group) oversee the delivery of the multi-agency plan and reviews performance.

The plan should improve access and outcomes for all children while giving proportionate additional attention to those facing greater barriers.

Engagement aims to include families with disabled children, children with SEND, care-experienced families, fathers and non-birthing parents, young parents, families from minority communities, families with limited English, and families living in rural isolation or poverty.

Delivery should make efficient use of existing venues and trusted community networks, reduce avoidable travel where remote support is appropriate, and ensure online options do not exclude families without reliable connectivity or digital confidence.