Families falling through the gaps as new report calls for stronger child and family health system

Australian families are falling through gaps in a fragmented child and family health system, with where families live, what they can afford and whether they know support exists, influencing their ability to access critical services during the first five years of a child's life.

That's one of the key findings from a new report from the Centre for Policy Development (CPD), which is calling for greater attention to child and family health as Australia progresses a significant period of early childhood reform.

Healthy Starts: The state of Australia's child and family health service system maps the experiences of families accessing health and developmental services from the recognition of pregnancy through to school entry, encompassing what is commonly referred to as the first 2,000 days.

The report finds that although parts of Australia's child and family health system are working well, access remains fragmented and inconsistent, with families in regional, remote and outer metropolitan communities facing some of the greatest barriers.

The findings come as governments pursue significant reforms across the early years, including moves towards universal early childhood education and care (ECEC), expanded paid parental leave and the development of new foundational supports through Thriving Kids.

CPD argues these reforms need to be underpinned by a stronger, more accessible and connected child and family health system.

Australia's child and family health system extends across a broad network of services and practitioners.

It includes general practitioners, antenatal and postnatal hospital care, midwifery, Child and Family Health services, allied health and parenting and developmental support programs.

Collectively, these services play an important role in monitoring the health, wellbeing and development of children and their parents and caregivers, identifying emerging developmental or health needs and connecting families with support before challenges escalate.

The report identifies three key periods when families' needs change and transitions between services become particularly important: pregnancy recognition and antenatal care; the transition from birth to home; and development beyond the newborn period.

It is at these transition points that effective coordination between services can become critical.

However, CPD found inconsistent referral and handover arrangements between general practitioners, hospitals and child health services can leave families navigating complex systems themselves.

Access is one of the most significant challenges identified in the report.

Workforce shortages and limited service availability mean families living in regional, remote and outer metropolitan areas can experience long waiting periods, closed books and shorter appointments.

CPD says families in these areas are twice as likely to miss out on developmental health checks.

Cost creates another barrier.

Although child health services are generally free after birth where they are available, the report identifies a gap during pregnancy, when average out-of-pocket GP fees can range from $40 to $60.

For families already experiencing financial pressure, repeated costs associated with accessing health care can make early and preventative support more difficult to obtain.

Awareness of available services is another significant issue.

The report found 44.1 per cent of parents with children under five did not attend child health appointments because services were unknown, inaccessible or they did not perceive a need to attend.

The finding highlights a challenge that extends beyond simply making services available.

Families also need to know what support exists, why it matters, when they should access it and how different parts of the system connect.

The report also identifies limited flexibility within existing service models.

Families can find themselves moving between standard universal services and more targeted supports governed by specific eligibility criteria, leaving fewer options when their needs sit somewhere between the two or change over time.

The report describes a system in which services are not always effectively coordinated or integrated.

GPs, maternity services, hospitals and child health providers can operate through different referral and information-sharing processes, creating additional complexity for families.

CPD also identifies inconsistent inclusivity and cultural safety across the system, particularly for families whose circumstances may be influenced by housing instability, employment conditions, mental health needs or cultural considerations.

Limited data and digital infrastructure, coupled with a lack of national oversight, further contributes to variation in service delivery and quality.

The result can be a system in which families are expected to navigate multiple services at precisely the time they may most need clear and coordinated support.

Although Healthy Starts focuses primarily on Australia's child and family health system, its findings have significant implications for the early childhood education and care sector.

Early learning services increasingly sit within a broader ecosystem of support surrounding children and families.

Educators and service leaders may be among the people who notice emerging developmental needs, changes in behaviour or circumstances affecting a child's participation and wellbeing.

The effectiveness of the services surrounding ECEC therefore matters.

A universal early education and care system cannot operate in isolation from maternal and child health, developmental services, allied health and family support.

CPD argues that seamless integration between health, education and care will also be important to the success of initiatives such as Thriving Kids, particularly as Australia moves towards earlier, more inclusive developmental support based on children's needs rather than diagnosis alone.

Rather than continuing with a collection of disconnected services, CPD is calling for a child and family health system that is accessible to all families, embedded within everyday community settings and able to increase or decrease the intensity of support as family circumstances change.

The report identifies the need for greater investment and reform to improve the availability of services, strengthen family engagement, improve coordination and create greater consistency across jurisdictions.

It also points to the importance of workforce capacity, improved data and digital infrastructure and stronger connections between the different services families encounter throughout the first 2,000 days.

The objective is to identify risks earlier, respond to children's developmental needs sooner and provide families with support before challenges become more complex.

Australia's current early childhood reform agenda represents a significant opportunity to reconsider how children and families are supported.

But Healthy Starts makes the case that expanding access to early education and care is only one part of that picture.

Children's development does not begin when they first walk through the doors of an early learning service.

The systems surrounding families through pregnancy, birth, infancy and the preschool years all contribute to the foundations on which children's health, development and learning are built.

As governments continue to reshape Australia's approach to the early years, the report suggests the challenge is not simply to expand individual services, but to ensure health, development, family support and early education operate as parts of a more connected system.

The Centre for Policy Development's Healthy Starts: The state of Australia's child and family health service system report can be accessed through the CPD website here.