Conclusions and recommendations
Improving support for children, parents and families
1.We recommend that the Government consider the needs of vulnerable families in all policies. (Paragraph 22)
Local service delivery
2.Each local authority area should develop, jointly with local NHS bodies, communities and the voluntary sector, a clear and ambitious plan for their area, which sets how they will improve support for local children, parents and families during the first 1000 days and how they intend to achieve national goals. The development and delivery of these local plans should be led by a nominated officer, accountable for progress. Local plans should include a comprehensive assessment of local provision, including targeted and specialist interventions provided locally, and describe how each area will adopt the core principles for local service delivery outlined in this chapter. (Paragraph 42)
3.We agree with our colleagues on the Science and Technology Committee that the Government should incentivise and support local authorities to make long-term investment in the early years. (Paragraph 27)
4.Drawing on the successes of the transformation funding for the A Better Start areas, we recommend that the Government should establish a fund to incentivise the transformation of local commissioning and provision covering the first 1000 days in accordance with the objectives set by the Government’s national strategy (see ‘Vision’ section), and the six principles we have outlined in this chapter. (Paragraph 41)
Healthy Child Programme
5.10 years on from its inception, we are calling for a revised Healthy Child Programme, with interventions that:
- are family focused;
- begin before conception;
- extend beyond 2 ½ years; and
- ensure continuity of care including improved links between health visiting, midwifery, obstetrics and primary care, and ensuring that women see the same midwife and same health visitor for each visit. (Paragraph 51)
6.We recommend that a revised Healthy Child Programme should be expanded to focus on the health of the whole family and examine how this affects the physical and mental health of the child, recognising that the physical health and mental health of a baby’s parents, and the strength of their relationships with each other and their child, are important influences on their child’s health. (Paragraph 55)
7.We recommend that the revised Healthy Child Programme should include the provision of pre-conception support to parents who are planning a pregnancy, or to parents who could have benefited from more support prior to a previous pregnancy. This should begin at school, where there should be focused attention on healthy relationships, pregnancies, including advice about smoking, alcohol, substance misuse and parenting. (Paragraph 57)
8.We recommend that an additional mandated visit at 3–3½ years should be included in the Healthy Child Programme, to ensure that potential problems that may inhibit the ability of children to be ready to start school are identified and addressed. (Paragraph 59)
9.We recommend that a revised Healthy Child Programme, with an increased focus on continuity of care, should include the explicit objective that so far as possible a family will see the same midwife and the same health visitor, at each appointment or visit. (Paragraph 62)
10.We agree with the Science and Technology Committee that the first priority should be for every child to receive all the five mandated visits, in a manner that does not compromise the quality of these visits. We also agree with the Science and Technology Committee that the Government should set a date for when this will be achieved. However, we also recommend as part of a refresh of the Healthy Child Programme that the Government set out proposals for increasing the number of routine visits. (Paragraph 49)
11.We recommend that all checks should be carried out by a health visitor, and that a minimum number of contacts should include a home visit. (Paragraph 50)
Targeted support
12.Children in need of targeted support should be identified during pregnancy. We recommend that the Government, working with local areas and the voluntary sector, develop a programme into which children and families who need targeted support can be referred, drawing on the experience of the Family Nurse Partnership in Scotland, Northern Ireland and in some parts of England, and of Flying Start in Wales. Children in need of such targeted support should be identified during pregnancy. We agree with our colleagues on the Science and Technology Committee that commissioners should continue to appraise the evidence base for the Family Nurse Partnership, as well as for other targeted interventions, and consider investment or disinvestment accordingly. (Paragraph 69)
Funding
13.Early intervention, as our colleagues on the Science and Technology Committee have pointed out, is an “opportunity to make long-term, cost-effective improvements in children’s lives–rather than a demand on resources.” By devoting resources to interventions during this early period of a child’s life the Government can improve the health, wellbeing and life chances of future generations. (Paragraph 79)
14.The Government must use the Comprehensive Spending Review in 2019 to shift public expenditure towards intervening earlier rather than later. We recommend the Government use the 2019 Spending Review as an opportunity to initiate the next early years revolution with a secure, long-term investment in prevention and early intervention to support parents, children and families during this critical period. (Paragraph 80)
15.Unfortunately, due to the way Government departments are financed, the department which invests in early intervention is often not the one that stands to reap greatest benefit. This structural problem in the financing of government is a barrier to early intervention. We recommend the ministerial group on Early Years and Family Support address this crucial issue. When we hear from Ministers following the conclusion of the group’s work, we will expect to question them on their proposals to tackle this problem. (Paragraph 81)
16.Reflecting the contribution which early years provision makes to the objectives of a number of Government departments, funding for local plans (see paragraph 42) should be drawn from existing budgets across Government, including the Department for Work and Pensions, the Department for Education, the Home Office and the Ministry of Justice as well as the Department for Health and Social Care. (Paragraph 82)
Leadership
17.We recommend that the Cabinet Office Minister represented at Cabinet (currently the Chancellor of the Duchy of Lancaster) should be given specific responsibility for the development and oversight of a national strategy to give every child the best start in life. That minister should chair a new Cabinet sub-committee, consisting of ministers from across Government, who should each be responsible for ensuring the implementation of the strategy in their department and for holding one another to account for delivery of the strategy across government. (Paragraph 86)
Cross-government working
18.We recommend that a small, centralised delivery team, within the Cabinet Office, should be established to support this new ministerial role. The team will be responsible for coordinating activity between departments and monitoring progress against the delivery of the strategy. (Paragraph 89)
19.We recommend that the Secretary of State should accelerate his consideration of a health in all policies approach to policy-making, as indicated in his statement on prevention in the House on 5th November 2018. This approach should be adopted as soon as possible to support the work of the relevant Cabinet minister and sub-committee. (Paragraph 88)
Vision
20.We recommend the Government develop, as part of a national strategy, ambitious high-level goals to:
- reduce infant mortality;
- reduce adverse childhood experiences; and
- increase school readiness,
with a focus on reducing child poverty and inequalities, and their impact. (Paragraph 93)
Workforce
21.As part of a national strategy, we recommend that the Government should publish a holistic workforce plan for services covering the first 1000 days. The plan should set out how the Government, and other national bodies, will support local areas at a system, placed-based and neighbourhood level to enhance the capacity, capability and skill mix of staff, including voluntary staff, who support children, parents and families during the first 1000 days. (Paragraph 98)
Information sharing
22.As part of a national strategy, we recommend that the Government provide guidance and support to local areas about how services for children, parents and families can effectively share information. Guidance must explain clearly what is permissible to share, with whom and in what way, in accordance with all applicable legislation. (Paragraph 104)
Oversight, support and intervention
23.The Government must to do more to bolster its ability to support local areas, hold them to account and intervene, when necessary. In particular, the Government should seek to foster an environment of continuous improvement by filling gaps in research and encouraging local areas, through support and incentives, to identify, test, adopt and spread what works to improve outcomes. This applies to whole system approaches as well as single interventions. Local authorities should be prevented from continuing to pursue the delivery of programmes for which there is no evidence base. (Paragraph 114)
24.We recommend that an expert advisory group should be established to support the Government by coordinating a national approach to filling gaps in research and to advise on how the national strategy should adapt accordingly over time to reflect this evidence. (Paragraph 115)
25.We agree with our colleagues on the Science and Technology Committee that “local authorities would benefit from the support of a central specialist team with experience in effectively and sustainably implementing early intervention programmes.” We recommend this team should be comprised of, and where necessary be able to call on the advice of other, experts from multiple disciplines, including those with specific professional expertise and skill sets (e.g. implementation science and quality improvement). (Paragraph 116)
26.We support the proposals within the NHS Long-term Plan for the NHS to play a greater role in the commissioning of public health services. The Government and national bodies should encourage the NHS to work collaboratively with local authorities to commission these services, through encouraging the voluntary pooling of budgets and the establishment of joint commissioning teams. (Paragraph 117)
Published: 26 February 2019