Nesta Finds a Baby Blind Spot in Scotland’s GIRFEC Promise

In Scotland’s most deprived fifth of areas, 24% of children had a developmental concern recorded at their 27 to 30 month review in 2024/25. Public Health Scotland put the share in the least deprived fifth at 9%.

Nesta’s September 2026 report, Getting it right for every baby, says that gap is not fixed in stone. It sits inside what the foundation calls a strategic baby blind spot. Getting it right for every child policy is the national brand, yet plans, cash and data still slide toward older children and toward families already in crisis.

Nesta Says GIRFEC Has a Blind Spot for Babies

Linda Macdonald, Nesta’s mission manager for Scotland, published the findings after workshops in six councils and a national survey run with the Centre for Excellence for Children’s Care and Protection (CELCIS). Twenty-five of Scotland’s 32 local authorities replied. Horizons Research ran the local workshops. A Scottish Government and Public Health Scotland steering group helped shape the project.

The report’s first challenge is blunt. National policies and local plans often cover all ages, or older children, and leave babies under-represented. Macdonald’s follow-up note on 7 October 2026 asked ministers to write a clear national vision from pregnancy to age three and to put it into how government is run.

There is a policy blind spot in Scotland when it comes to babies. National policies and local plans are often focused on all ages or older age groups, overlooking the specific needs of babies.

Linda Macdonald, mission manager for Scotland, Nesta

Nesta wants the GIRFEC guidance and practice model refreshed with specific material for pregnancy and early childhood, plus a national core offer of early help that arrives before a family hits breaking point. The full paper sets out actionable insights from six local areas: Fife, Highland, North Ayrshire, North Lanarkshire, South Ayrshire and West Dunbartonshire. Extra data interviews were held in East Lothian, Glasgow and South Lanarkshire.

The irony is in the title. Scotland has spent years telling staff to get it right for every child. Nesta’s mapping says the years when that work would change most lives are the years the system still treats as a side room.

The Toddler Check Still Shows a 15-Point Gap

Public Health Scotland’s 2024 to 2025 early child development statistics cover reviews offered at 13 to 15 months, 27 to 30 months and 4 to 5 years. The 27 to 30 month check is the one ministers have chosen as a national marker. The Scottish Government wants the share of children with a concern at that review down to 13.5% by 2030.

In 2024/25 the headline barely moved. 17% of children who received the 27 to 30 month review had a concern noted in at least one area of development, the same share as in 2023/24. That is 7,211 children from 43,632 reviews, which reached 90% of those eligible. Speech, language and communication was the most common domain, recorded at 12% (5,041 children).

DEVELOPMENTAL CONCERNS AT 27 TO 30 MONTHS, 2024/25

The 15 percentage point gap between SIMD 1 and SIMD 5 is the widest of the three review ages. At 13 to 15 months the spread was 5 points, 16% against 11%. Across all children, 14% had a concern at 13 to 15 months and 19% at 4 to 5 years, the latter up from 18% in 2023/24.

Nesta’s reading of the same release puts boys at 21% and girls at 11% at 27 to 30 months. Among children who were looked after at the time of that review, 37% had a concern, against 16% of children overall on Nesta’s comparator. More than half of the speech, language and communication concerns flagged at 27 to 30 months had not been recorded at the earlier review, which is why Macdonald argues that waiting for the toddler check is already too late.

Infant Spending Has Sat at £6,000 for a Decade

Nesta commissioned Alma Economics to review public spending on children aged zero to four from 2010 to 2023, in 2025 prices and per child, so a falling birth rate would not flatter the totals. Identifiable spend per child aged 0 to 4 held near £7,200 through the 2010s, then rose to almost £9,700 in 2023-24. Almost all of that rise is early learning and childcare, which nearly tripled from £1,600 per child in 2010-11 to £4,670 in 2023-24.

WHERE THE EXTRA EARLY YEARS MONEY WENT

By 2022-23, spend per child aged 2 to 4 was double spend per child aged 0 to 1. Healthcare per child did rise, from £910 to £1,290, about 41%, with A&E and mental health among the faster-growing lines. Identifiable children’s services and social care sat at £880 per child in 2023-24, even after the Promise and a Whole Family Wellbeing Funding commitment Nesta records at £500 million over the parliamentary term.

A Scottish Government parliamentary answer in 2026 put actual Whole Family Wellbeing Funding at more than £154.5 million since 2022, with £50 million in the programme for 2026-27. Those are different pots from the per-child children’s services line, and the Alma Economics review said the published data still cannot separate prevention from crisis work by age.

First Minister John Swinney said on 3 September 2026 that childcare support would expand from 9 months until 12 years, with a further £15 million for flexible childcare. That is the same older-infant and toddler band that already absorbed the ELC surge. It does not refill the under-one year that Nesta says has been left on hold at about £6,000 a head.

Health Visitors Are Older, and There Are Fewer of Them

Health visitors are the named person for most children under five, and they carry the Universal Health Visiting Pathway, 11 contacts from pregnancy through to school. The Scottish Government told the UK Covid-19 Inquiry it recruited 500 extra health visitors between 2014 and 2018, spending more than £40 million and then £20 million a year to keep the extra posts. The Royal College of Nursing’s 2026 Scotland workforce paper says that lift was not held.

HEALTH VISITING HEADCOUNT IN SCOTLAND

• March 2020: 1,969.4 whole-time equivalent registered nurses in health visiting teams.
• Latest RCN figure: 1,812.5 WTE, the lowest since September 2017.
• Age: about a quarter of the current health visiting workforce is 55 or older.
• Training: student numbers have been falling since 2022, against a government pledge to maintain or raise them.
• Qualification: 93.5% of the workforce are specialist community public health nurses, with a board range from 67.7% to 100%.

Nesta’s local work found the same squeeze on the ground. Teams triage high-need cases and drop preventative visits and joint planning. Shortages named in the recommendations run across midwifery, health visiting, speech and language therapy and early learning and childcare. Macdonald wants a long-term early childhood workforce plan covering headcount, retention, pay, progression and tools that cut admin.

Ministers already have a written route. The health visiting action plan for 2025 to 2035, issued on 26 March 2025, commits the government to a skilled workforce, enough capacity, a clear role inside family support, and leadership that treats health visiting as prevention. Nesta’s second recommendation is that this plan is delivered in full, and that ministers review how midwives, health visitors and childcare share handovers so families are not lost between services.

Fourteen of 25 Councils Want a Plan That Starts Before Birth

The CELCIS survey is the clearest local signal in the pack. Fourteen of 25 responding authorities said strategic leadership on pre-birth to age three needs to be stronger. Four asked for that focus in long-term plans in so many words. Another 10 made the same demand by calling for structural overhauls, including unified first-1,000-days strategies.

That is not a plea from the six workshop areas alone. It is a majority of the councils that bothered to reply, spread across urban and rural Scotland. Nesta says local government already has the legal room, through children’s services planning, to name pregnancy and early childhood as a shared priority and to review how families with lower-level or emerging needs move between services.

What local staff described instead is a missing middle. Universal contacts thin out after the newborn period. Pathways for families who are struggling, but not yet in child protection, are thin or informal. Third-sector play, peer and advice services have been doing that work, and have been eroded by short, siloed grants. Co-location helps when it exists. Warm handovers are still a person-to-person favour, not a system.

Funding matches that pattern. Money arrives tied to a sector or a target, on a short clock, so councils cannot plan a single family offer. Nesta wants indicative multi-year settlements and pooled budgets, with a fairer slice of existing funds pointed at the Universal Health Visiting Pathway, the Family Nurse Partnership, allied health professionals, national data kit, and local community support under one roof.

What Families Would Get Under Nesta’s Core Offer

The proposed national offer is a stack, not a new brand. Foundational services that already exist would stay universal. Preventative services that some areas run well would be available everywhere. Extra help would sit on top for families flagged as at risk, with intensive programmes for higher need. The point is that a family should not have to wait until a social worker is at the door.

THE CORE OFFER NESTA WANTS IN EVERY AREA

• For every family: maternity care, vaccinations, and funded early learning and childcare.
• Open to all, as prevention: stay-and-play sessions and infant mental health support, with more for those identified as at risk.
• For higher need: targeted, intensive programmes, including the Family Nurse Partnership where it fits.
• National touchpoints: full delivery of the health visiting action plan, and a reset of duties between midwifery, health visiting and childcare.
• Data: a single children and families portal, linked records, minimum standards for client systems, and training so local teams can actually use the numbers.

The data chapter is the unglamorous half of the same problem. Practitioners work across disconnected systems, so nobody has a shared picture of a family, and staff burn hours retrieving basic facts. Nesta wants population data at the lowest geography, plus matches that pair postgraduate researchers with councils on tight local questions. East Lothian, Glasgow and South Lanarkshire were already trying to make that material usable. The report says they should not have to invent a national spine on their own.

Shared progress measures would replace the current habit of counting activity inside each silo. Nesta also wants a culture of joint learning, so a stay-and-play that catches speech delay in one area can be copied without a new pilot grant every spring.

Public Service Reform Has Yet to Name the Baby Years

Scotland is in a long argument about how public services should shift from crisis to prevention, including a stated aim to move 5% of health and social care spending to preventative work by 2030. Nesta’s closing claim is that pregnancy to age three has to be written into that shift, or the toddler gap will still be there when the 13.5% target falls due.

The tools already on the table are GIRFEC, the health visiting pathway, Whole Family Wellbeing Funding, the Promise, and children’s services plans. None of them, on Nesta’s evidence, currently force a baby-years offer that is consistent from Unst to the Clyde. Local authorities can still act without waiting for a white paper. The survey suggests many of them want the cover of a national vision before they rewire budgets.

Macdonald and CELCIS scheduled a joint webinar on the findings for 8 October 2026, from 12:00 to 13:30. The 2030 clock is already running: 17% against 13.5% at the toddler review, and a 15-point spread that has been visible in the 27 to 30 month data since 2013/14.