This Government strongly believes that every child should have the chance to fulfil their potential, and that where you start in life should not determine future success. Evidence on adversity and vulnerability shows the period from conception through to 2 and a half years is a critical time for a child’s development, their future life chances and resilience in adulthood. That is why we have prioritised improving social mobility, physical and mental health in pregnancy and childhood, the quality of early childhood education and care provision, children’s social care, and the support offered in and out of school for children that have had a social worker. In each area we are building the evidence base for ‘what works’, using high quality evidence to inform our approach, and encouraging innovation. We have already seen improvements across a number of areas:
However, we know there is more to be done to ensure every child has the best start in life. The vision document Prevention is better than cure noted that our early experiences help shape life-long health reinforcing the need for action before and during pregnancy, through childbirth and into childhood. The newly established Early Years Family Support Ministerial Group will be considering how the Government can improve the coordination and cost-effectiveness of early years family support, and identify gaps in available provision. The Ministerial Group will make recommendations to Secretaries of State, and includes ministers from the Treasury (HMT); Department for Work and Pensions (DWP); Department for Education (DfE); Department of Health and Social Care (DHSC); Ministry of Housing, Communities & Local Government (MHCLG); and the Home Office (HO).
We look forward to working with the Select Committee in future to build on the positive steps that have already been taken.
1.The Government should ensure that it is making the most of the opportunity for early intervention to effectively and cost-effectively address childhood adversity and trauma, and the long-term problems associated with such experiences. (Paragraph 25)
2.There is now a pressing need for a fundamental shift in the Government’s approach to early intervention targeting childhood adversity and trauma. The Government should match the ambition of the Scottish and Welsh Governments, and build on the example set by certain English councils, to make early intervention and childhood adversity a priority, and set out a clear, new national strategy by the end of this Parliamentary session to empower and encourage local authorities to deliver effective, sustainable, evidence-based early intervention. (Paragraph 46)
3.The Government should ensure that it has better oversight of the provision of early intervention around the country, so that it can identify approaches that are working well, detect local authorities in need of support and hold local authorities to account. It should determine what information is needed to be able to assess the local provision of early intervention and set out a framework as part of the new national strategy that ensures that all local authorities will provide such information, with as little disruption to their working practice as possible. (Paragraph 47)
4.In addition to the focus on data-driven practice and the delivery of relevant training and ongoing expert supervision, the new national strategy for adversity-targeted early intervention should encompass the latest evidence from implementation science, incorporating elements such as a commitment to model fidelity and the adoption of realistic timeframes for service redesign and deadlines for results. The Government should consult academics and practitioners to achieve this, and ensure that lessons from services that have successfully implemented evidence-based early intervention with positive outcomes are also taken into account. (Paragraph 132)
The Government strongly agrees with the importance of early intervention, which can mitigate the impact of adversity and trauma, as a guiding principle for national government programmes, and for local spending decisions and service delivery.
Our commitment to early intervention can be seen in the significant investment Government has made in programmes with this aim. These include:
The Committee calls for a single strategy for early intervention in order to address the variable practice and outcomes locally. This Government believes that local areas are best placed to understand the needs of their local communities, to commission early intervention services to meet those needs and to deliver interventions as part of a whole system approach to produce the best outcomes for families. We will keep this approach under review, and will consider where a national strategy is needed to drive focus and attention on a particular set of outcomes or services.
The Government considers that the issues raised are best addressed by taking a policy approach that has early intervention as its guiding principle; that is focused on outcomes and underpinned by evidence; involves government working with local partners to tackle priority issues together; and ensures successful strategies are identified and shared widely within the sector. This approach can best be seen in a number of programmes:
Lastly, we are working closely with the Scottish, Welsh and Northern Irish governments in the early years policy area. Officials from the four education departments of the UK meet twice a year at a forum convened by the British Council to share details of current policies and best practice. Each year, two policy topics are identified as priority areas for more in-depth study where there is a particular shared interest. Early years has been identified as a priority in 2019 by all four departments and there is a workshop planned in March where policy officials will share knowledge on what works in improving early years quality particularly in relation to workforce training and development; the home learning environment; and the early years curriculum development. At ministerial level, the 2019 International Summit of the Teaching Profession hosted by the Organisation for Economic Co-operation and Development (OECD), Education International and the Finnish education department includes a theme on early years education and childcare. This summit will provide an opportunity for participating education ministers from other countries and the UK to discuss early years polices and explore possible areas for collaboration.
The Government believes that early intervention and effective implementation are best supported locally through approaches such as the programmes outlined above. The Government will keep this approach under review.
5.As it starts working towards its goal of improved interdisciplinary collaboration, UK Research and Innovation should co-ordinate research into child development and early intervention methods for addressing childhood adversity, across different academic disciplines. Particular focus should be on developing interventions to address adverse childhood experiences for which no effective intervention has been demonstrated, including sexual abuse, parental substance misuse or parental incarceration and crime. (Paragraph 31)
This Government is committed to improving the evidence base for what works and supporting research to inform evidence-based policy. Alongside the research programmes of individual departments, the Government has also invested in the EIF to build evidence on early intervention initiatives, and invested £10 million in the What Works Centre for Children’s Social Care to improve the evidence base in children’s social care and to make sure this evidence is translated into better practice.
Learning is already being generated from the individual evaluations of the Children’s Social Care Innovation Programme. The programme launched in 2013 and we have invested £200 million since then across 95 Innovation Projects. We have a comprehensive programme to share learning and enable LAs to adopt and adapt the most successful innovations from the Innovation Programme.
The Government will consider including further research into early intervention methods for addressing childhood adversity as we refresh individual departments’ areas of research interest (ARIs). We will engage UK Research and Innovation (UKRI) as we develop our thinking.
Separate to departmental research budgets, UKRI funds research and innovation across all disciplines and sectors. In particular, the Economic and Social Research Council (ESRC) invests in research and capabilities in a broad range of disciplines, many of which are directly relevant to this area. For example, ESRC funds the International Centre for Language and Communicative Development – a five-year research collaboration to deepen our understanding of how children learn to communicate with language. ESRC is also co-funding a project with the EIF. Further funding is available through the UKRI councils’ open calls.
Going forward, UKRI will continue to consider what more is required in this area, with a particular focus on departments’ ARIs, which help UKRI to engage with researchers to build their understanding and respond to the Government’s research needs. UKRI will consider what future funding is most appropriate, which could be through ESRC or through a potential future wave of UKRI’s Strategic Priorities Fund, balancing this against other government priorities.
6.Further, we recommend that the Government should ensure that academic researchers can access Government administrative data relevant to childhood adversity, long-term outcomes and the impact of early intervention, while ensuring appropriate privacy and safeguarding mechanisms are in place. UKRI should consult the relevant academic community to determine which data would be beneficial, and work with Government departments to ensure researchers can access that data as appropriate. (Paragraph 32)
We welcome this recommendation, and the Government is helping to set up a new Administrative Data Research Partnership (ADRP) to maximise the potential of administrative data as a resource for high-quality research in the UK. Supported by a £44 million investment through the ESRC, the partnership will provide a secure route for accredited researchers to use de-identified data from across government departments, local authorities and health authorities. High quality research projects using the data will address a range of major societal challenges, including understanding the long-term impacts of childhood adversity, as well as the impact of early intervention.
The Strategic Hub team leading the ADRP investment is based within ESRC and is working closely with the Office for National Statistics (ONS) and the three ADRP hubs in Scotland, Northern Ireland and Wales. The ONS will provide secure access to data for researchers and utilise its existing infrastructure and its expertise in data acquisition, curation and provision to support the ADRP. The centres in the devolved administrations have a wealth of knowledge gained from the previous work undertaken on the Administrative Data Research Network. These centres will work with UK government departments, as well as devolved governments in Wales, Scotland and Northern Ireland and a range of partner universities, utilising datasets acquired by ONS alongside data from devolved services.
7.This [ministerial] group should: make tackling childhood adversity a focus of its work; improve cross-Government co-ordination on this issue; and ensure that there is clear accountability for driving this agenda across all Government departments. (Paragraph 48)
The broad nature of early intervention means that it is crucial that multiple government departments work together to address specific and shared areas of focus. The Ministerial Group has been established to consider how government can improve the coordination and cost-effectiveness of early years family support, and identify gaps in available provision, and will make recommendations to Secretaries of State.
8.The Government should review the current provision of the Healthy Child Programme across England and set out, as part of the new national strategy, a date for achieving complete coverage in the number of children who receive all five mandated health visits. Given existing workforce pressures, the Government must ensure that this required increase in coverage does not negatively impact the quality of health visits. It should consult the Institute of Health Visiting on how this can be managed, and be ready to recruit additional health visitors as required. (Paragraph 54)
The HCP provides a framework of support beyond five mandated visits and an increased focus on vulnerable children and families. Families with need should be seen based on clinical judgement of health visitors as lead professionals. Current practice includes support for positive parenting, to make strong bonds, and to understand resilience in a developing child.
Public Health England has provided a range of guidance to support local authorities and providers in commissioning and implementing children’s services including commissioning guidance, cost-effectiveness and return on investment of interventions. They also collaborate with the EIF on ‘what works’ e.g. the activities identified as having good evidence of improving child and parent outcomes – as well as those that are considered as having no effect. The Government will continue to work with partners, child development experts and professional organisations representing health visitors and other early years professionals to ensure the HCP remains an effective and evidence-based framework providing good health, wellbeing and resilience for every child.
9.If the Government commissions future major studies of significant early intervention programmes—which we would welcome—it must ensure that the outcomes it decides are to be assessed, and other elements of the design of such studies, are supported by the early years practitioner community. The Government must then act upon the evidence generated by those studies. (Paragraph 60)
The Government agrees with the committee that the provision of early intervention will clearly benefit from studies that can provide a strong evidence base. That is why the Government launched the What Works Network in 2013, which includes the EIF and the EEF; and has moved to establish the What Works Centre for Children’s Social Care.
We are also investing £5 million in trials focused on interventions that improve the home learning environment, delivered by the EEF, with bids drawn from the sector. Results from the trials will be available over the next two years, and will be used to inform future policy and commissioning decisions.
All early years EEF projects co-funded with the DfE are identified through an open call for proposals – responding to the most promising ideas from the early years sector. The successful projects go through an extensive design process, in which the delivery team (e.g. practitioners from a school or charity), an independent research team, and the EEF, work together to agree the approach to evaluation, including which outcomes will be measured.
The DfE has a long-standing and ongoing commitment to collecting a robust evidence-base on early childhood development, working with the academic research community. The Effective Pre-school, Primary and Secondary Education (EPPSE) study was a longitudinal study on the attainment and development of children from pre-school to the end of key stage 4. Our ongoing Study of Early Education and Development (SEED) is a major longitudinal study following nearly 6,000 children from across England from age two through to the end of key stage one (age seven). The study is being carried out by NatCen Social Research, Frontier Economics, the University of Oxford, and Action for Children, on behalf of the DfE. It is evidencing how the characteristics of the early environment, including early childhood education and care, relate to child development over time. We are also a participant in the OECD International Early Learning Study that assesses children at age five across three countries, identifying key factors that drive or hinder the development of early learning.
In addition, the DWP’s Reducing Parental Conflict Programme will encourage councils across England to integrate evidence-based services and approaches to addressing parental conflict that work for their local families.
10.The Government should clarify its position on Sure Start centres. In response to this Report, it should specify if—and when—it intends to hold a consultation. If it intends to proceed with a consultation, this should be held within three months. The Government should also set out the focus and purpose of such a consultation. If a consultation is not going to be held, the Government must urgently reinstate Ofsted inspections of children’s centres and make clear its thinking on the role and value of children’s centres. (Paragraph 64)
Children’s centres have an important role to play in achieving our social mobility ambition, but it is right for local authorities to decide how to use them as part of the wider system of local services. We need to better understand how local authorities use children’s centres to improve outcomes as part of their broader strategy. Our £10 million investment to build the evidence base for ‘what works’, together with our £8.5 million local government early years programme, will inform the next steps in our strategy to raise outcomes for children, including considering any future consultation on the role of children’s centres.
As part of the Early Years Social Mobility Local Government Programme DfE is partnering with the LGA to design and deliver a peer review programme, building on existing peer review models. Funding for the programme will run until March 2020, with evidence and learning emerging by its conclusion. Through the peer reviews and the new Early Outcomes Fund (announced on 15 November 2018), the programme will spread best practice and help councils looking to close the gap between disadvantaged children and their peers.
On the question of Ofsted inspection, when inspections of children’s centres were suspended, there was general agreement that they were not fit for purpose. However, Children’s Social Care services and all registered early years provision, including that delivered in Children’s Centres, remains subject to robust and regular Ofsted inspection. In circumstances where there are specific safeguarding concerns, Her Majesty’s Chief Inspectorate (HMCI) still has the power to inspect any children’s centre, and the Secretary of State has the power to direct HMCI to inspect any centre. Ultimately, local authorities are responsible for managing children’s centres and ensuring the services they provide through children’s centres meet appropriate quality standards.
11.As it develops its action on children and young people’s mental health, the Government should recognise the importance of child development and the impact of adversity in the early years, and ensure that it adopts ‘transformative’ ambitions and policies for pre-school aged children alongside its work targeting schools and colleges. (Paragraph 68)
The Government is committed to improving perinatal mental health services for women during pregnancy and in the first postnatal year, so that women can access the right care at the right time and close to home. This is supported by £365 million of investment to 2020/21 so that at least 30,000 more women each year can access evidence-based specialist mental health care during the perinatal period. We recognise the importance of child development, and the impact of adversity in the early years. Early intervention is key to improving mental health and wellbeing, and that adverse childhood experiences (including having a parent with a mental health problem) can have a major impact on future life chances.
This is why, as part of the green paper, Transforming Children & Young People’s Mental Health, we have committed to further research in a number of areas relevant to adverse childhood experiences, including parent-child attachment, parental conflict and parenting programmes. We will continue help develop the evidence base on early interventions demonstrating ‘what works’. We are currently supporting the EIF to conclude a rapid review on the evidence of how to engage vulnerable families in parenting and parental conflict programmes. This will provide an up-to-date summary of the evidence and allow us to assess where the gaps are for further research. PHE has also convened a special interest group bringing together academics, practitioners and professionals, to identify key prevention evidence and its relevance to practice. This evidence will underpin further activity, including where there is a need for further research.
12.The Government should set a policy for primary and secondary schools that seeks to promote wellbeing as well as improving the early identification of, and support for, emerging problems. (Paragraph 70)
The DfE Single Departmental Plan, updated in May 2018, sets out that one of the elements of world-class education is that it ‘builds character, resilience and well-being’. In October 2018, the Prime Minister announced our plans to provide schools with a framework to support them to measure the wellbeing and mental health of their pupils. This support will aim to put schools in a better position to assess the effectiveness of steps they take to promote the wellbeing of their pupils as well as to identify and address any problems as they emerge. The Prime Minister also made a commitment that government will publish a yearly ‘State of the Nation’ report on World Mental Health Day, highlighting the trends and issues in young people’s wellbeing – the first time it will be reported in this way. Work is underway in support of these commitments. In early 2019 we will carry out a system mapping exercise to help us develop a stronger evidence base on the drivers and influences, both positive and negative, on children and young people’s wellbeing.
This work will complement the delivery of the new curriculum requirements we are introducing. We are making Relationships Education compulsory in all primary schools, Relationships and Sex Education compulsory in all secondary schools and Health Education compulsory in primary and secondary schools. The consultation on the draft guidance and regulations closed on 7 November. We are currently considering the responses and plan to lay the regulations next year. Schools will be encouraged to teach the new subjects from September 2019, with the requirement to teach the new subjects following from September 2020. In Health Education, there is a strong focus on mental wellbeing, including a recognition that mental wellbeing and physical health are linked, supporting work between DfE and DHSC on children and young people’s mental health.
We will support school practice in other ways. We have commissioned a programme of trials to develop evidence about what works in promoting good mental health and wellbeing in a school environment. One trial has a particular focus on light touch approaches to promoting wellbeing in primary and secondary schools through mindfulness, relaxation, and strategies for safety and wellbeing. The approaches include exercises, routines or activities that can be led by classroom teachers or school staff within the school day.
For the most vulnerable, findings from the Children in Need Review are helping primary and secondary schools recognise and overcome barriers to education, where children’s experiences of adversity and trauma have caused difficulties in attendance, learning, behaviour and wellbeing. Schools are encouraged to consider how they can identify difficulties early, using assessments and planning to implement graduated support, which makes a difference to children and their outcomes. This ranges from inclusive whole school approaches, adjustments to promote educational outcomes and, for the children that need them, targeted interventions that may be based on attachment theory and trauma-informed practice. The review will consider the challenges that schools and children’s services face in providing this support, and what can be done to help.
13.The Government should work with researchers and practitioners to examine how new specifications on the free childcare it funds could increase the use of evidence-based programmes, and what the impact would be on the families affected. Such specifications could rapidly increase the number of families receiving evidence-based programmes and we call on the Government to review this by the end of this Parliamentary session, although local providers should be given a period of time to adjust to any new specifications. (Paragraph 74)
Research suggests that there are short and long-term educational and socio-emotional benefits of attending early childhood education and care. That is why we have prioritised investment in early education, including 15 hours of free early education for disadvantaged 2 year olds and 15 hours of free early education per week for all 3 and 4 year olds. Three and 4 year old children of working parents are also entitled to an additional 15 hours childcare, primarily to support them to work or work more hours if they wish to do so.
The Government recognises the importance of having evidence-based programmes and continues to work closely with independent researchers and the sector, in the delivery of its childcare offers and early years policies. Evidence shows that high-quality childcare supports children’s development and prepares younger children for school. It also gives parents the ability to balance work and family life, allowing them to enjoy the benefits of a job safe in the knowledge that their children are in good hands. We know from the Year One Evaluation of 30 hours Free Childcare and our annual Childcare and Early Years Survey of Parents that the offer is making a real difference to family lives.
Through the Early Years Professional Development Fund we are investing £20 million in high quality, evidence-based training and professional development for pre-reception early years staff in disadvantaged areas, to increase their skills to support young children’s development in early language, literacy and numeracy. This work will drive up quality in the pre-school years, so more children arrive at school with the foundations in place to make the most of primary school. In addition, the professional development in the early years fund, jointly funded by DfE and EEF, is funding trials of promising evidence-based programmes to improve practice in settings.
We have also invested in large-scale longitudinal research, including EPPSE, and more recently SEED. These have shown the benefits of time spent in early education for child development in the short term and academic and behavioural outcomes in the long term, and provide insight into the characteristics of early education that are associated with outcomes, such as the quality of settings. We also invest in large-scale annual surveys of childcare providers and parents to understand supply and demand-side trends within the early years sector, and to monitor the impacts of government policies. We conduct and publish regular high-quality evaluation of early years policies and programmes, most recently of the 30 hours free childcare. This research provides an evidence base that informs government decision making in relation to funded childcare on an ongoing basis.
14.The Government should ensure that the accreditation criteria for social workers include knowledge of child development science, the impact of adversity and methods for addressing this, as well as good practice in collecting and using data. The knowledge required should be tailored to the different roles and responsibilities of practitioners, supervisors and leaders. The Government must further ensure that training is available to allow social workers to meet these criteria. (Paragraph 99)
We want all social workers to be equipped to deliver outstanding services, able to adopt evidence-based and innovative approaches, learn from the very best practice and deliver quality outcomes for all service users. The newly established Social Work England will ensure that social workers benefit from the highest quality initial education, access to continuing professional development whilst in frontline practice, and experience strong, supportive supervision and leadership.
The Government’s National Assessment and Accreditation System (NAAS) is based on the knowledge and skills statements (KSS) that represent the post-qualifying standards for child and family social work. The KSS already include statements for practitioners on child development; abuse and neglect of children; and analysis, planning decision-making and review. The assessment is offered at practitioner and practice supervisor levels and the knowledge and skills statements are tailored to each role. The use and interpretation of evidence and data feature in the KSS at both levels, to emphasise the importance of robust decisions and conclusions. Local authorities are responsible for providing training for social workers to meet the KSS. The Government is currently supporting a small number of local authorities to prepare child and family social workers for assessment and aims to roll out the system to all local authorities from 2020.
15.The Government’s new strategy for adversity-targeted early intervention should include plans to improve the use of data for assessing early intervention and identifying families who could benefit from early intervention, at local and national level. The strategy should promote the value of data collection and analysis by drawing on case studies of local authorities or their partners using data to improve outcomes. It should also set out the general principles of good practice with data collection and analysis, such as collecting baseline data in preparation of assessing a new intervention and avoiding the use of self-reported measures. (Paragraph 115)
16.The new strategy should set out what local authorities should measure to assess their early intervention initiatives or to identify families who could benefit from receiving early intervention support, and give examples of specific data that would capture this. These measures should be identified in consultation with child development experts and local authorities themselves, and cover aspects such as social, emotional and language development from birth through to the start of school. Consideration should be given to the burden of collecting the data and the compatibility of its collection with existing practice. In identifying these measures, the Government should ensure that it seeks opportunities for local authorities to make use of data that they or their partners already collect. (Paragraph 116)
17.The new strategy should also address challenges in data-sharing between different organisations working with young children. It should include guidance to local authorities and their partners on data protection legislation and provide examples of best practice in data sharing, focusing specifically on childhood development, trauma and related early interventions. The Government should additionally consider what infrastructure and licences could facilitate efficient, interoperable data processing by local authorities and assess the cost-benefit of providing funding towards this. (Paragraph 117)
The Committee’s report sets out a range of challenges that hinder the consistent and effective use of data to assess the effectiveness of local early intervention – including the complexity of actors and services within and between local partners; professional culture; resources and technological infrastructure; and natural variation in local practice.
The Government maintains that the issues raised are best addressed by taking a policy approach that has early intervention as a guiding principle; that is focussed on outcomes and underpinned by evidence; and involves government working with local partners to tackle priority issues together. That includes issues relating to the use and sharing of data.
With reference to paragraph 115 of the committee’s report, there is already much material in existence about what good practice looks like in the use of data, including the EIF’s own guides, Evaluating early intervention at the local level: Five rules of thumb, and Evaluating early intervention programmes: Six common pitfalls, and how to avoid them.
For example, the Troubled Families Programme provides a national framework to help local authorities identify the families most in need of early help and measure the progress those families make after they have received support. These measures cover the wide range of problems faced by families including poor health, poor school attendance, financial exclusion as well as social, emotional and language development. The programme’s framework, which was developed in partnership with local authorities, includes examples of specific data sets which local authorities can use, including both data collected by local authorities and data already collected by their partners such as police, health and schools.
This has driven significant changes in the ways that local authorities, government departments and local partner agencies systematically share information to identify and work with families with complex problems. The effective use of data is also a part of the early years social mobility peer reviews. Additionally, we are funding EIF to produce good practice case studies, which will include effective data sharing, as part of the local government programme.
Nevertheless, there are some actions that can be taken centrally, and the Government considers several recent steps as being particularly significant. The Digital Economy Act 2017 represents the most significant package of new data-sharing powers for government in decades and includes a specific power to allow specified bodies, including local authorities and their partners, to share personal information in order to provide services, including early intervention, to households facing multiple disadvantages.
The Government recently published updated guidance: Information sharing: advice for practitioners providing safeguarding services. This is intended to support all frontline practitioners and senior managers working with children, young people, parents and carers. The advice sets out the rules and key principles of sharing information and includes a myth-busting guide aimed at dispelling common myths that prevent the effective sharing of information. The new guidance also recognises the reforms being introduced following the passage of the Children and Social Work Act 2017 to introduce new multi-agency safeguarding arrangements in order to ensure shared and strengthened ownership of local safeguarding, replacing Local Safeguarding Children Boards.
The Government consultation response Reporting and acting on child abuse committed us to supporting the Child Protection Information Sharing project. This IT system links information on looked after children and children on child protection plans between local authorities and unscheduled health settings. The DfE is investing in an accelerator fund to support local authorities and health settings to implement the system.
The Ministerial Group is considering ways in which local coordination of services for children during the period from conception to two years old could be improved, which may include issues related to data sharing.
18.In addition to ensuring full coverage of the health visits mandated by the Healthy Child Programme, the Government must ensure that the data collected during such visits is reported nationally. It should consult the Institute of Health Visiting and child development experts to determine if the Healthy Child Programme should include assessments of social and emotional development prior to the fifth mandated visit, and if so provide the resources necessary to allow for this. (Paragraph 118)
19.The new adversity-targeted early intervention strategy should also set out measurable objectives for progress on data collection, such as the proportion of local authorities supplying full data from the Healthy Child Programme mandated visits, or the proportion of local authorities identified by Ofsted as delivering sufficiently data-driven early intervention. If data collection and analysis does not consequently improve within two years of the strategy’s implementation, the Government should consider introducing statutory requirements for the reporting of data that can be used to monitor the delivery and impact of early intervention. (Paragraph 119)
In 2017, regulations confirmed five universal reviews for pregnant women, new mothers and children from birth. The reviews address an antenatal visit, new born review, six to eight week check, one-year review and two to two and a half year review. Data on the coverage of health visits mandated by the HCP is currently published through quarterly and annual datasets. This is together with wider commentary for local authority health visits to pregnant women, children and their families during pregnancy and early childhood.
Health visitors already discuss and support social and emotional development as part of their routine visits and mandated reviews. The Early Years High Impact Area 2 – Maternal (perinatal) Mental Health outlines the scope and breadth of the health visiting offer to support maternal mental health and wellbeing. There is an increased focus on maternal mental health through the Maternity Transformation Programme, and further work will support this, as well as the mental health and wellbeing of partners and fathers, as evidence suggests this may affect attachment and the emotional health and wellbeing of infants during the early years.
Currently, there are two separate data collection and national reporting systems for Universal Health Visitor Review data. The current data collection is via PHE’s interim process. This is a voluntary submission of aggregate data provided by local authorities, which covers universal health visitor service delivery metrics and outcomes (including breastfeeding at six to eight weeks and child development outcomes at two to two and a half years).
This method of data collection is due to be superseded by collection through the community services dataset, for which NHS Digital has published the information standards and established the technical infrastructure. This will be a mandatory submission of record level data from service providers for all publicly funded services, which covers health visitor service delivery comprising mandatory, universal and non-mandatory targeted service, coded health assessments, referrals to other services and outcomes including breastfeeding and child development outcomes.
An assessment is made of personal-social development at two to two and a half years using the Ages and Stages Questionnaire (ASQ-3). Social and emotional development can be assessed at the same time using ASQ-SE. Data from both ASQ-3 and ASQ-SE will flow to the Community Services Dataset as coded assessments (using SNOMED coding). The infrastructure to enable this data flow and the subsequent reporting at national and local level is already in place.
20.The Government’s new national strategy for adversity-targeted early interventions must include steps to increase the knowledge that professionals across the early years workforce have of: the impact of childhood adversity or trauma and what can be done to remedy this; how to identify those families that could benefit from early intervention; how to access and use relevant, up-to-date scientific evidence; how to make best use of data in offering and delivering early intervention services, and in understanding and evaluating the effectiveness of those services; and child development and the importance of early years experiences. The strategy should identify and define the ‘early intervention workforce’, comprising the full range of professions that engage with young children or their families and that could either: help to identify those who would benefit from early intervention; or would play a role in delivering early intervention services. The Government should then review the pre-qualification training and continuing professional development offered to the different professions in the early intervention workforce and ensure that each covers the different elements outlined above, at a level appropriate to the profession in question. (Paragraph 122)
The Government agrees with the importance of effective training for early years practitioners, and that the right way to proceed is to assess what training in child development might be useful. We consider that this is best done through programmes with a clear focus on particular skills, needs and outcomes.
We know that children learn best when they are healthy, safe and secure, when their individual needs are met, and when they have positive relationships with the adults caring for them. The DfE’s Early Years Foundation Stage Statutory Framework sets out the standards for learning and care for children aged 0–5, including safeguarding and welfare requirements. It states that early years providers must take all necessary steps to keep children safe and well. The requirements explain what early years providers must do to: safeguard children; ensure the suitability of adults who have contact with children; promote good health; manage behaviour; and maintain records, policies and procedures.
Providers must train all staff to understand their safeguarding policy and procedures, and ensure that all staff have up to date knowledge of safeguarding issues. Training made available by the provider must enable staff to identify signs of possible abuse and neglect at the earliest opportunity, and to respond in a timely and appropriate way. These may include:
An example of a specific intervention aimed at boosting the capacity of the early years workforce is DfE and PHE’s partnership to address early language acquisition amongst disadvantaged children, a key driver of later life chances. The Government recently awarded the Institute of Health Visitors a contract to deliver training in the latest evidence on early language skills and needs, and provide guidance on how best to support families.
Alongside this, DHSC funds Assessed and Supported Year in Employment (ASYE) in adult services disbursed to employers by the Department’s delivery partners, Skills for Care. The ASYE programme for adults is a twelve month, employer-led programme of support and assessment against the Knowledge and Skills Statement for social workers in adult services. The ASYE programme for adults provides planned access to regular and focussed support and development within the workplace, together with the assessment of an individual’s professional practice against national standards.
The Government believes that this type of targeted support for workforce development, supported by sector-led improvement programmes discussed above, are the right way to make progress on this issue.
21.As part of a new national strategy for adversity-targeted early intervention, the Government must make clear that in commissioning evidence-based programmes, local authorities should ensure that there is sufficient accredited, ongoing, specialist supervision from qualified supervisors in that programme for the workforce, throughout the delivery of the programme. Local commissioners should aim to support the development of their own accredited supervisors, to enable cost-savings and deliver an experienced and expert workforce, leading to greater sustainability. (Paragraph 125)
The Government agrees that supervision is a crucial component of effective practice. Regarding the arrangements for implementing a particular evidence-based programme, however, the Government believes that these are a matter for local commissioners and leaders.
22.The new adversity-targeted national strategy should promote the opportunity presented by the Apprenticeship Levy as a source of funding for training early years practitioners. The Government should monitor the number of local authorities that make use of the Levy in this way, evaluate the impact where authorities have used it, and provide guidance to assist other local authorities in using the Levy funding if it proves to be successful. (Paragraph 127)
Apprenticeships are offering a range of opportunities to local authorities to make sure they get the skills they need to deliver world-class public services, including for the early years. We published specific guidance on apprenticeships for local authorities in October 2017, and the Education and Skills Funding Agency (ESFA) works directly with employers to help them overcome any challenges to recruiting the apprentices they need. In addition, we are continuing to work closely with the LGA, who understand the sector and its priorities fully, to make sure local authorities are fully supported. As part of this, the ESFA has grant-funded the LGA £140,000 to pilot a dedicated offer of support to local authorities, to help them scale up their recruitment of apprenticeships. The first stage of this pilot is due to complete in early 2019 and, subject to an independent evaluation, will be rolled out further across the sector from spring 2019.
23.As part of the forthcoming Spending Review, the Government should review funding for the Early Intervention Foundation with a view to increasing and extending it, to ensure that the Foundation has greater long-term security, and so that it can meet the Children’s Minister’s aims of achieving for local authorities what the Education Endowment Foundation has achieved in schools. (Paragraph 138)
24.In working to deliver on the new adversity-targeted early intervention strategy, local authorities would benefit from the support of a central specialist team with experience in effectively and sustainably implementing early intervention programmes, to help with planning and delivering evidence-based early intervention and to overcome the various challenges we have identified. An expanded Early Intervention Foundation would be well-placed to host such a team, and the Government should invest in the Foundation to achieve this aim. (Paragraph 139)
25. The new national strategy should be targeted at, and acted upon by, all local authorities. In addition to this, the Early Intervention Foundation should identify local authorities willing to become ‘Early Intervention Places’, which would receive particular support from the central, specialist team we have recommended. Together with the central team, these local authorities would utilise implementation science to build sustainable implementations of evidence-based programmes, simultaneously generating new knowledge that can be rolled out to other local authorities at a pace consistent with the development of sustainable service transformation. (Paragraph 141)
The Government is committed to what works, and to improving the way government and other organisations create, share and use high quality evidence for decision-making. Alongside other What Works Centres including the EEF and the new What Works Centre for Children’s Social Care, the EIF has an important role to play in in testing and communicating what works in improving outcomes for children and young people through early intervention. Through the forthcoming Spending Review, the Government will review funding for the independent EIF.
Part of government’s funding for the EIF is being used to establish an Early Years Transformation Academy (EYTA), which aims to help local multi-disciplinary leaders and commissioners to transform integrated early childhood services. The EYTA will provide a framework for sharing learning, and will include events and online material for leaders, commissioners and other stakeholders. The start of more intensive EYTA work with four sites from June 2019 will provide further opportunities to pool learning.
We are also funding the EIF to support the delivery of the Early Years Social Mobility Peer review programme between 2018 and 2020. The EIF have worked with the LGA to develop the EIF maturity matrix: speech, language and communication in the early years. The matrix will provide a framework for reviews, including examples of what good practice looks like. It has been co-produced and validated with local authorities and their delivery partners, and will continue to be developed over the life of the programme, as practice develops and further evidence of good practice emerges.
To help local authorities and their partners deliver efficient and joined up early help services for families, the Troubled Families Programme’s national team has developed an Early Help Service Transformation Model and toolkit. This provides practical advice on service transformation, explaining clearly what this means, how it can be developed, and how to measure and monitor progress. The Troubled Families Programme supports the sharing of knowledge and good practice between local authorities, for example through a good practice blog. The programme’s national team has also commissioned an EIF evidence summary to ensure that families with complex needs receive the right evidence-based support in priority areas, such as parenting.
26. In adopting a new national adversity-targeted early intervention strategy, the Government should see effective early intervention as an opportunity to make long-term cost efficiencies—as well as improve people’s lives—rather than a demand on resources. The Government should correspondingly make the necessary funding available where elements of the new strategy will require funding from central Government. The new strategy should also seek to drive a general shift in the focus of current expenditure on ‘late interventions’, required where problems have escalated, to earlier intervention. Although this may require an initial increase in expenditure, there is good reason to expect this to lead to long-term savings across diverse sectors. The new strategy should seek to identify ways in which the cost of early intervention can be brought down without compromising its effectiveness, for example by reviewing the evidence for digital early intervention services, as well as considering how local authorities can be incentivised—rather than penalised—for making long-term investments. Where local authorities cannot invest in early intervention initiatives that are expected to deliver long-term cost-benefits, the Government should be ready to provide additional funding to ensure the opportunity to improve lives and save public money is not missed. (Paragraph 146)
This Government sees effective early intervention as essential to its work to bring about cost efficiency in public service and to improve people’s lives. This is why, as outlined throughout this response, we are putting sound academic research, funding, and investment into our early intervention initiatives.
We look forward to working with the committee in future on this important subject.
9 Early Years foundation stage profile results: 2017 to 2018, Gov.uk, Department for Education, 18/10/2018,
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13 National Evaluation of the Troubled Families Programme 2015–2020, Gov.uk, Department for Communities and Local Government, 12/2017, , page 10
14 Areas of Research Interest, Gov.uk, Government Office for Science and Cabinet Office, 28/06/2017,
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20 Resources, eif.org.uk, Early Intervention Foundation,
21 Financial framework for the Troubled Families Programme, Gov.uk, Ministry of Housing, Communities and Local Government, 08/12/2017,
22 Information sharing: Advice for practitioners providing safeguarding services, Gov.uk, Department for Education, 07/2018,
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24 Health visitor service delivery metrics: 2017 to 2018, Gov.uk, Public Health England, 31/01/2018,
25 Early years high impact area 2: Maternal mental health, Gov.uk, Public Health England, Department of Health & Social Care and Public Health England, 11/2018,
26 Maternity Transformation Programme, England.nhs.uk,
27 Statutory framework for the early years foundation stage: Setting the standards for learning, development and care for children from birth to five, Gov.uk, Department for Education, 03/03/2017,
28 Troubled Families: Early help service transformation maturity model, Gov.uk, Ministry of Housing, Communities & Local Government, 04/04/2017,
29 Troubled Families Programme, Gov.uk, Ministry of Housing, Communities and Local Government,
30 Commissioning Parenting and Family Support for Troubled Families, eif.org.uk, Kirsten Asmussen, Stephanie Waddell, Donna Molloy and Haroon Chowdry, 10/2017,
Published: 8 February 2019