Healthy Early Years Development and the Best Start for Life

  • By Samira Islam

Background 

The early years healthy development review was led by Andrea Leadsom MP with a view to improve health outcomes for babies and children in England. The Review began in September 2020, during the Covid 19 pandemic. The “Best Start for Life” policy document, published in March 2021, sets out the government’s vision for best practice across the health system to ensure that every baby is nurtured to fulfil their potential. The action areas will be taken forward by the review team, working with the organisations indicated. The work undertaken in the next phase of the Review will be subject to future funding decisions.

The care provided during the first 1,001 critical days (from conception to age 2) has more influence on a child’s future than at any other time in their life, with a significant effect on health, wellbeing and longer term outcomes. The foundations of cognitive, emotional and social capabilities are formed in this period. Their development must be monitored as some babies might have a disability or may have development delays. Early identification and diagnosis can improve long term outcomes.

Children from disadvantaged households face significantly worse health outcomes than other children.

Analysis

Support for families in England is delivered by a number of services. These include midwifery and health visiting services, alongside universal services like General Practitioners (GPs) and NHS 111. Additional services may include breastfeeding support, mental health support, smoking cessation and intensive parenting support, which are usually offered in response to need.

The review found that services are patchy and that it can be hard for families to know what’s available locally, where to get help in person and online. (see fig 1)

 

Other Local Authority responsibilities

Safeguarding

Local authorities, working with partner agencies, have a statutory duty to safeguard and promote the welfare of all babies and children in their area. The local authority has different roles and responsibilities to lead the assessment of children in need, who may need support to achieve or maintain a reasonable level of health or development, and to lead child protection enquiries where there are concerns about a child’s welfare.

In addition to exacerbating existing funding and workforce pressures, the Covid-19 pandemic has had considerable implications in terms of access to parenting support, identifying developmental delays, monitoring safeguarding risks and finding opportunities to provide further support.

Special Educational Needs and Disability (SEND)

A baby might have difficulties or delays which affect their developmental progress or they might have a disability. Under the Children and Families Act 2014, local authorities have a statutory duty to ensure services are accessible to parents and carers who have children with additional needs.

Early Help

The Troubled Families Programme provides co-ordinated early support to disadvantaged families with a range of complex problems. It is delivered by local authorities and their partners including police, probation, housing, health organisations, schools, Jobcentre Plus, voluntary and community services, and others. The government has announced that the Troubled Families programme will be replaced by the Supporting Families programme which will focus on building the resilience of vulnerable families, and on enabling system change locally and nationally.

 

Six point action plan

The policy document outlines six key areas of action to improve health outcomes and life chances.

1. Seamless support for families: a coherent joined-up Start for Life offer available to all families

The government’s vision is that local authorities, working with other local partners, pull together a joined up Start for Life offer. The offer should explain clearly to parents and carers what services they are entitled to and how they can access them.

2. A welcoming hub for families: family hubs as a place for families to access Start for Life services

The government will work with local partners to maximise resources and facilities they already have, in order to ensure the best offer is made available to families. Where local partners are already providing Start for Life services, they use a range of buildings including Sure Start Children’s Centres and Family Hubs. What matters is that every family knows where they can receive high-quality advice and support. The government is providing a £14 million investment in Family Hubs to champion the model.

3. Information families need when they need it: designing digital, virtual and telephone offers around the needs of the family

The government will work closely with NHSX and in consultation with parents and carers to develop the Digital Personal Child Health Record, replacing the existing paper Personal Child Health Record (‘Red Book’). This will contain babies’ details and information about their growth and development for all new births from April 2023.

4. An empowered Start for Life workforce: developing a modern skilled workforce to meet the changing needs of families

The government will work with the Start for Life sector (as set out in Figure 1), professional bodies, the education sector, Department of Health and Social Care, Ministry of Housing, Communities and Local Govt and HM Treasury to develop costed proposals to strengthen the Start for Life workforce. This will include how to increase diversity in professions, how to address issues with workload and supervision, and how to ensure we are training and retaining the skilled professionals needed to support families.

5. Continually improving the Start for Life offer: improving data, evaluation, outcomes and proportionate inspection

This will include improving the quality of data so that local authorities can implement best practice; establishing Parent and Carer Panels to co-design services and provide feedback on them; building consensus for a new Outcomes Framework for the Start for Life system; and developing a new and proportionate inspection regime.

6. Leadership for change: ensuring local and national accountability and building the economic case

DHSC will consult with local partners, parents and service providers to establish the Parent and Carer panels that help local leaders to co-design the Start for Life offer and also provide effective and meaningful feedback to ensure continuous improvement.

Commentary 

The policy paper recognises that local authorities play a vital role and sets an ambition that each local authority will have a single, identifiable leader who is accountable for the Start for Life offer.

London Councils supports the broad approach of the review, particularly its emphasis on a joined up offer with local authorities working alongside NHS and other partners. However, we have concerns about the impact of limited funding (e.g. Public Health Grant and the fragility of the provider market) and the need for a stronger sense of connection and presence in wider reforms (e.g. ICS reform and wider PH change), which we raised in our submission to the review and are summarised below.

Funding

The pandemic has unfolded against a background of reduced funding for public health. While the 2019 Spending Round announcement of an additional £17.9 million for public health funding in London in 2020/21 was welcome, consecutive reductions to the Public Health Grant since 2015/16 have impacted the ability of local authorities to deliver vital early years public health services.

London Councils calls on the government to increase public health funding to at least 2015 levels (in real terms) and provide sustainable medium-term (3 or 4 year) funding allocations to promote more strategic and effective use of public health resources.

Health visiting and workforce

Local authorities commission health visiting services up to the age of five as part of the Healthy Child Programme, the national public health framework for children and young people which covers children’s health right up to the age of 19, extending to age 25 for children with particular health needs.

Recruitment and retention issues persist across the Health Visiting workforce. London Councils calls for national workforce policy to be more closely aligned across health, social care and public health. For example, health visiting and school nursing roles should be considered and prioritised as part of the planned expansion of the nursing workforce.

Covid recovery and catch-up

Many public health services anticipate a sharp rise in demand as a result of backlogs due to staff redeployments during the first phase of the pandemic.

Short-term policies to address service backlogs and deliver immunisation catch-up programmes are needed alongside urgent measures to address workforce shortages across the sector to ensure that early years services have the capacity to respond to unmet need that is likely to arise in coming months.

Integration

Aligning processes and pathways so that all early years professionals have a holistic view of the needs of a child and their family and the interventions currently being offered to them is crucial. Across London improving health and care integration has been identified as a key ambition. Covid-19 has shone a light on the unique power of place-based working, including through joint planning for the fast, efficient and safe discharge of Londoners from hospital during the pandemic, coordinating support to shielding individuals and collaboration on the deployment of the vaccine so that steps are being taken to ensure that all eligible Londoners are reached and not excluded. These are a few examples where the power of partnership working at the borough level has meant Londoners are better served.

High quality early years provision can provide vital support for children with SEND, helping to transform their outcomes at an early age. This aspect of early years provision could be picked in the review’s work with family hubs.

National, regional and local efforts are needed to align priorities, processes and pathways for young children and their families in touch with multiple health, care and education services.

There is a need for closer place-based partnerships which are built around the needs of children and parents/carers, with clear roles and responsibilities for professionals and services delivering support for babies and young children. This would benefit from joined up thinking and providing space for local health and local government leaders to develop models which reflect local needs and circumstances, albeit within a national framework.

London Councils will keep an eye on how the review’s proposals develop and keep members updated with any progress.

Samira Islam, Principal Policy & Project Officer