75.In this Report, we have so far identified the potential for effective early intervention targeting childhood adversity and trauma to improve lives and save costs, and urged the Government to set out a national strategy to seize this opportunity. This Chapter explores the main challenges that local authorities and their partners face in delivering evidence-based early intervention, specifically: funding constraints; challenges in collecting and analysing data; and skills gaps in the early years workforce.
76.In 2017, the Association of Directors of Children’s Services warned that the ability of local authorities to provide early intervention was “being eroded due to the lack of available financial resources”, which it said was “driving up both referrals to, and demand for, statutory child protection services”. The Association of Directors of Public Health similarly told us that evidence-based early intervention programmes can often be too expensive for local authorities to deliver widely, and that “progressing this long-term preventative agenda with no additional funding will be a challenge”. A group of academics from the London School of Economics and Political Science further noted that “current expenditure patterns from both the US and the UK show that little is spent on young children”, with social services expenditure peaking for children aged 15.
77.Multiple changes to the funding structure for local authorities over recent years, combined with flexibility in how local authorities spend their funding, makes it impossible to say exactly how spending for early intervention has changed in recent years. The Children’s Minister told us that “the investment profile has shifted from bricks and mortar towards direct intervention to the individual child” and outlined £6bn of spending on childcare. However, there appears to be reasonable agreement that the spending levels for early intervention specifically have fallen. The Ministry of Housing, Communities and Local Government has continued to publish estimates of the nominal early intervention funding that English local authorities have received since the end of the Early Intervention Grant in 2013. According to these figures, early intervention funding has reduced from £1.71bn in 2013–14 to £1.21bn in 2017–18, and is forecast to reach £1.02bn in 2019–20 (a ~40% reduction from 2013–14 levels). A coalition of UK children’s charities estimated in 2017 that local authority spending on early intervention had fallen by £1.4bn between 2010–11 and 2015–16, from £3.6bn to £2.2bn. The Minister for Mental Health and Inequalities acknowledged that “local authorities have borne the brunt of significant cuts”.
78.It is important to look at the specific funding allocated to early intervention because such services can be de-prioritised relative to other children’s services. The Association of London Directors of Children’s Services noted that they had already seen a “reduction in investment in early intervention as local authorities have been under increasing financial pressure, on the basis that preventive services are often discretionary and late intervention services mandatory”. The Greater Manchester Combined Authority similarly told us that the funding requirements of statutory services can put pressure on resources for early intervention:
The challenge is sustaining non-statutory services at times of reducing budgets coupled with rising demands for statutory interventions, determined often by wider issues than the quality of the early intervention offer e.g. poverty, quality of housing stock.
79.The impact of financial pressures on local authority decision-making is not only early intervention programmes being cut because of priority being given to statutory services. In 2017, the Social Mobility Commission reported that local authorities often provided cheaper, un-evidenced programmes rather than more expensive programmes with proven effectiveness. It cited a 2013 evaluation of children’s centre services that found “in many areas, just a dozen or so parents per year were benefiting from programmes known to be effective”, and stated that “matters are not likely to be any better today”. Donna Molloy, Director of Policy and Practice at the Early Intervention Foundation, told us that local authorities were also reluctant to invest in evaluating the programmes they were delivering because “it is expensive to evaluate interventions, and most people would prefer to deliver a service rather than invest in a research project”. She said that this “drive to prioritise getting services to people” was “completely understandable”, but “leaves us with a context in which we know very little about the performance of some of the things that are being delivered in this space”.
80.George Hosking, CEO of the WAVE Trust, told us that the Trust had also found funding constraints to be one of the main barriers to early intervention cited by local authorities and early years practitioners, but he argued that:
We did not believe that the [financial] reason was a valid one because we found that quite a significant number of local areas were implementing prevention and early intervention, and reporting that they were saving money by doing so—for example, Essex and Gloucestershire. Therefore, the areas that said they could not afford to do it were not grasping the opportunity provided to bring in approaches that, when they were implemented by slightly more courageous areas, were proving beneficial.
However, Martin Pratt described two “inherent system difficulties” that local authorities faced in investing in early intervention:
First of all, the beneficiaries of the investment in early intervention—either particular budget holders or particular departments—are not necessarily those that have to make the investment. Secondly, [the benefits do not accrue] necessarily over a timescale that fits with either the electoral cycle or the priorities of those organisations.
The Greater Manchester Combined Authority noted similar challenges. Action for Children, a UK children’s charity, has also noted the short-term duration of the spending review cycles and the consequent difficulties for local authorities in planning or commissioning early intervention programmes. Dr Caroline White, Head of the Children and Parents Service in Manchester, similarly complained that “there is often short-term funding”:
We are very short-sighted in how to implement things, rather than building for sustainability. I am always thinking five years ahead, even though I have never had a five-year contract in my service; it has often been for 12 months.
81.Even with constraints in funding, we heard that this did not mean no progress on early intervention could be made. Professor Alan Harding, Chief Economic Adviser for the Greater Manchester Combined Authority, told us that although “cutbacks clearly give local authorities incredible challenges”, “the sense of comments from colleagues is that it is not purely about resourcing”. Instead, he said that system change was more important than restoring funding. Similarly, Dr Caroline White told us that “generally, we could be doing a lot better, even with the resources we have, before we even start thinking about additional resources”.
82.Despite the long-term savings associated with effective early intervention, the amount of funding available to local authorities that is nominally destined for early intervention is declining. This can result in early intervention activity being sacrificed in favour of statutory duties, in addition to the commissioning of cheaper, unproven interventions as well as a reluctance to properly evaluate interventions that are being delivered. Nevertheless, funding constraints should not be used by local commissioners and others as an excuse to avoid acting upon the latest evidence regarding childhood adversity and early intervention—especially given the savings that some programmes can deliver for local authorities, particularly in the long-term, and given the positive impact on the life chances of children.
83.As discussed in Chapter 2, although early intervention programmes can demonstrate strong evidence of long-term positive impact, this is not true of all interventions that have been evaluated. Professor Feinstein, Director of Evidence at the Children’s Commissioner’s Office, told us that “the general case that early intervention can work can never support the specific case of a specific service or activity for a specific client group”. Alison Michalska, the then President of the Association of Directors of Children’s Services, has stated that “it is rarely the case that any initiative or intervention can be simply lifted and shifted wholesale from one place where it appears to work, to another place, without contextualized modifications”. Dr Caroline White, Head of the Children and Parents Service in Manchester, took a slightly different view and told us instead that “where we fall down [nationally] is in the implementation of those programmes”. In either case, the importance of data collection and analysis for evaluation of early intervention programmes was stressed by many of our witnesses. Donna Molloy pointed out simply that local authorities “will not know [if a service is effective] if they have not evaluated it”.
84.In the UK, statutory guidance for local authorities, clinical commissioning groups and police forces requires only that information on “how the safeguarding partners will use data and intelligence to assess the effectiveness of the help being provided to children and families, including early help” be published. Dr Caroline White told us that guidelines for evaluation of early intervention services were also frequently missing from NICE guidance. Alison Michalska, the then President of the Association of Directors of Children’s Services, argued in 2017 that the lack of statutory data collection requirements was responsible for the fact that “local authorities do different things in respect of recording and monitoring early help—indeed some do not record at all”. The Early Intervention Foundation has similarly found that data collection for monitoring early intervention is not common practice in the UK, leaving a “vast amount of services being delivered in many local areas [that] are not well evaluated”. Donna Molloy, Director of Policy and Practice at the Early Intervention Foundation, explained that “without that basic monitoring of data and understanding, it can be quite hard to have a sound basis for making decisions about how things might need to change in local service configuration”.
85.In addition to using routine administrative data to help assess the impact of specific early intervention programmes, Martin Pratt, Chair of the Association of London Directors of Children’s Services, told us that there was also a second, “broader” use of data:
We refer to it as forensic visibility, thinking about the information that is gathered from the earliest opportunity. It begins to identify children who have had adverse childhood experiences, where there are developmental issues emerging and there may be other warning indicators. This is not to get into a situation where we are thinking in a deterministic way, but a number of those indicators should cause us to pay attention and therefore to work with the family and think about that child’s circumstances.
In this context, the Greater Manchester Combined Authority noted that “when you look at human potential and adversity, it is crystal clear that gestation to aged 2 years are the most critical years, and yet we have no measure of progress tracking those time frames from a child development viewpoint”. This echoes the 2011 Allen Review, which identified a similar gap and recommended that “all children should have regular assessment of their development from birth up to and including 5, focusing on social and emotional development”.
86.Public Health England does publish indicators of public health from data supplied voluntarily by local authorities, which Professor Viv Bennett, Chief Nurse at Public Health England, told us could be used to identify families who could benefit from particular support. However, none of the 67 ‘early years’ indicators correspond directly to ACEs and only three relate to child development. NHS Digital collects data from providers of health visiting services for all five mandated health visits of the Healthy Child Programme as part of its Community Services Data Set, but currently receives this data from under half of all local authorities (Public Health England told us that it is working with NHS Digital to increase this number). NHS Digital has started publishing experimental statistics on breastfeeding rates at the 6–8 week visit and child development scores at the 2–2½ years visit, and is hoping to publish experimental data covering all five visits by the end of 2018. NHS Digital is also “in the early stages of exploring the longitudinal potential of the Maternity Services Data Set and the Community Services Data Set”. For example, data covering the maternity period through to starting school could be linked with other datasets such as the national pupil database. However, Professor Bennett indicated that this would not be achieved for some time:
If there was a perfect system tomorrow, it would still take five years, because clearly it takes five years for children to reach that level of maturity. As to how quickly we think the system will start to do that work, I hope that within the next two years we will start to see some of that improvement. Some of it will depend on investment.
In addition to working to ensure data collection from each mandated visit of the Healthy Child Programme, NHS England is also working to digitise children’s health information (including the ‘Red Book’) so that it can be more readily accessed by the variety of agencies that need it. The Government told us that “the digital child health programme’s transformation strategy will be in development until at least 2020”, although it qualified that “it may be brought forward once technological advances with e-messaging and digital self-care applications come on stream”.
87.The Government’s 2016 vision for children’s social care acknowledged that “we still do not get full value out of the wealth of data we collect”, and set out measures to address this, including:
88.The collection and analysis of appropriate data is vital to monitoring the impact of early intervention initiatives to ensure that they are achieving the desired effect and to inform further improvements. It can also help to identify families that may benefit from early intervention. Despite these critical uses, the local collection and analysis of data is not conducted as widely or as thoroughly as it should be around the country. Collation of relevant data at a national level is also insufficient, with fewer than half of local authorities submitting data on the five mandated visits of the Healthy Child Programme to NHS Digital. Public Health England’s public health indicator data does not appear to include any measures sufficiently focused on childhood adversity or early intervention. The early years are a critical period for child development so it is unacceptable that there is no national system of data collection assessing such development before the age of two. Two years on from the publication of the Government’s ‘vision’ for children’s social care, it is clear that there is still significant work to be done to achieve its aim of making full use of data in the early years system.
89.During our inquiry, we heard of a variety of challenges local authorities and their partners face in collecting and analysing data to evaluate early intervention initiatives. Martin Pratt, Chair of the Association of London Directors of Children’s Services, suggested that it was a matter of prioritising limited capacity:
In the busyness of trying to deliver a wide range of services, we have to be able to collect the right [data] simply; otherwise, we are deploying more resource on gathering the data than on delivering the interventions. That is the balance that we are constantly trying to strike.
Dr Caroline White accepted that data collection could be “hugely time-consuming”, but argued that it was “crucial” to ensuring the effectiveness and cost-effectiveness of interventions. She added that there was “some good evidence” that “having practitioners collect data improves their practice”.
90.Ailsa Swarbrick, Director of the Family Nurse Partnership National Unit, suggested that sometimes the required data was often already captured, but was held by different organisations:
There is plenty of information around. Rather than collect lots of new data, it is important to think about ways of streamlining data matching, about the information governance arrangements around that.
Many others also reported problems related to data-sharing between the different organisations of relevance to early intervention. Reporting on projects trialled as part of the Children’s Social Care Innovation Programme, the evaluation team recounted that:
Despite recognising the importance of multi-agency data-sharing in principle, this was not realised in practice in many projects with any degree of success, due to the complexity of different organisational targets, systems and priorities.
Dr Caroline White told us that data-sharing problems could arise from inadequate technological infrastructure. As an example, the Greater Manchester Combined Authority noted that the Department of Health and Social Care’s decision to purchase only the paper version of the ASQ-3 licence “makes the fast-paced sharing of this evidence and tracking very cumbersome”. Dr Woods-Gallagher told us that their analysis suggested that digitising ASQ-3 assessment would increase the capacity of their frontline health visiting workforce by 40%. In addition to challenges with infrastructure, we heard that data-sharing could be hindered by concerns regarding privacy requirements. The Children’s and Mental Health and Inequalities Ministers acknowledged that professionals could be wary of sharing data, and assured us that the UK Government was working to ensure data protection concerns did not get in the way of safeguarding child welfare. The Minister did not make clear, however, whether or not this extended as far as facilitating sharing of routine data for evaluating early intervention programmes.
91.Besides challenges in finding capacity for data collection and in sharing data, Dr Woods-Gallagher made the point that “people tend to go into frontline practice roles because they passionately care about the work that they do”, and they typically did not have an interest in analysing and interpreting data and did not think that it was core to what they did.
92.Local authorities and their partners face a combination of challenges in collecting, sharing and interpreting data relevant to childhood adversity and early intervention. These include a lack of capability or capacity, as well as problems with sharing data between different services and systems. However, robust data collection and analysis is critical to the delivery of effective evidence-based early intervention. Although data collection can be time-consuming, it can improve frontline practice and—implemented properly—lead to efficiencies elsewhere.
93.The early years workforce comprises a range of different professions. Teachers, social workers, health visitors, midwives, other medical practitioners and the police can all come into contact with young children who may benefit from early intervention, in addition to those specifically running early years services, such as in children’s centres. We heard from a variety of sources that there should be greater awareness of the importance of early years experiences for child development, and of the potential efficacy of appropriate early intervention, across this diverse workforce. For example, in a joint submission, the First Step children’s psychological health service and the Tavistock and Portman NHS Foundation Trust told us that:
Despite overwhelming evidence from research, the perception that young children are somehow immune from and unaffected by early experience remains pervasive, particularly in social care settings. This results in a ‘wait and see’ approach that means that interventions are not offered until the difficulties have become entrenched in later childhood, and more difficult to treat.
Barnado’s, a children’s charity, similarly told us that “there is a need for a much wider public and professional understanding of the impact of ACEs and the tools and approaches required to mitigate and reduce their negative impact on the outcomes for children and young people”. Beyond leading to missed opportunities for early intervention, the Early Intervention Foundation warned that “there is also some evidence that underskilled and undersupervised practitioners can make things worse for vulnerable families and even, in some cases, cause harm”.
94.Dr Shirley Woods-Gallagher, Special Advisor on School Readiness for the Greater Manchester Combined Authority, summarised some of the specific aspects of child development and early intervention that she felt professionals in the early years workforce should know:
There will be something about screening tools, something about pre- and post-[intervention] measures, something about being system ready and something about being able to navigate your role as a professional in an interdisciplinary team, and being confident about that […] There is also child development, and understanding the difference between chronological child development and neurological child development, and the disconnect between the two and what we can do to address some of those things.
Noting the low rate of referrals of infants and young children to child and adolescent mental health services, the Association of Child Psychotherapists suggested that “training and opportunities for specialist consultation are therefore needed for health and social care professionals to develop skills in recognising and addressing dysfunctional interactions and in enhancing sensitivity and responsiveness in caregivers”.
95.Building on the discussion of the importance of data collection and interpretation in the last section, Dr Woods-Gallagher added that training should also “include evidence, interpretation and data interpretation”, and should ensure that practitioners understand the importance of this to their practice. Martin Pratt, Chair of the Association of London Directors of Children’s Services, told us that an increased priority on literacy in evidence and making use of the evidence base was needed for early years practice leaders, from initial training onwards:
On the development of practice leaders, being literate in the understanding of the evidence base is increasingly important for lead practitioners, managers and practice leaders. That is something to pay attention to across the system, not just in initial training, although that is certainly where the foundations are laid.
Dr White stressed the value of those in leadership positions having a thorough understanding of the interventions being delivered, and experience of frontline work, as well as knowledge of policy, strategy and funding. Where this is not available internally, she said that specialist expertise should be “bought in”.
96.In a 2016 policy statement, the Government conceded that “excellent practice [in social work] is not found consistently across the country” and stated that the Health and Care Professions Council (the then regulator for health and care professionals) “has an approach designed to maintain minimum standards of public safety and initial education across a range of professions, rather than drive up standards in any one profession”. The Children and Social Work Act 2017 subsequently made provisions for the establishment of a new regulator specifically for the social work profession, Social Work England. The Government said that Social Work England would drive improvements in social work practice by:
The Government’s initial aim was for the new regulator to have fully assessed and accredited every children’s social worker by 2020. However, Nadhim Zahawi MP, the Parliamentary Under-Secretary of State for Children and Families, told us that there would instead now be a “phased roll-out” of this process, with the new system being applicable in five local authorities in 2018 and ten more in 2019.
97.The establishment of Social Work England constitutes an opportunity to review and transform children’s social worker skills and update the practice to reflect the latest science in child development, adversity and trauma, as well as the importance of data collection and interpretation. Martin Pratt, Chair of the Association of London Directors of Children’s Services, told us that the new regulator should seek to balance practical experience during pre-qualification training with more theory:
We have moved to a degree programme over the last few years as the social work qualification. It is clearly focused on practice, but you cannot really develop your practice unless you understand both child development and the evidence base. They try to squash quite a lot in, and there should be greater emphasis on that area.
98.The Government has published statements of the knowledge and skills that will be expected of social work practitioners, supervisors and leaders under the new system. Although these statements cover the impacts of different adverse childhood experiences and include the need to make use of research and evidence, they refer to data collection only as a means of managing demand, rather than recognising the importance of data collection and interpretation for ongoing evaluation of the impact of services being delivered.
99.The establishment of Social Work England constitutes an important opportunity to review the training given to children’s social workers. 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.
100.The Early Intervention Foundation highlighted the contrast between the opportunity presented by the establishment of Social Work England for raising awareness of trauma-focused early intervention among social workers, and the attention given to other professionals:
There is currently no common approach, central support or guidance covering how best to train, develop and supervise early intervention practitioners and the children’s sector more generally. This is in stark contrast to the attention given by the Department for Education to supporting social work practice.
Dr Woods-Gallagher told us that pre-qualification curricula for professions outside of social work should be reviewed, giving the example of midwives and health visitors:
They will be taught about things such as the Healthy Child Programme, and that is brilliant, but we know that the [Newborn Behavioural Observations tool] and the [Neonatal Behavioural Assessment Scale] are really important screening tools that should be used on wards, and it is really important to think about the home learning environment—past trauma of the parent as well as current trauma, and not just a safeguarding issue—as part of midwifery practice.
In a similar vein, the Institute of Health Visiting warned that “there is no nationally agreed competency framework either for health visitors or skill-mix roles to deliver the Healthy Child Programme”.
101.Addressing early intervention training outside of the social work profession, the Children’s and Mental Health Ministers flagged ongoing development of speech and language training for health visitors and elements of the Transforming Children and Young People’s Mental Health Provision Green Paper that aimed to share innovative practice for school workers. However, neither of these focused on early years adversity or trauma. The Government’s 2017 Early Years Workforce Strategy focused on early years provision in an educational setting and did not explicitly target increased awareness of addressing adversity and trauma, or skills in using data.
102.In addition to building the required knowledge and skills among the early years workforce, it is important that the services they deliver are based upon up-to-date science and evidence of local impact. However, Dr Caroline White told us that the extent to which the different roles across the early years workforce are currently delivering evidence-based practice seemed to her to be “very small”, and said that the workforce represented a resource that could be used “much more effectively”. Newcastle University agreed:
There remains an important job to do in skilling up the relevant practitioners and indeed the commissioners of services so that they are able to make judgements about the quality of intervention evidence and engage with and trust these resources to inform their practice.
103.Accounting for the “very variable” use of evidence-based interventions found by the Early Intervention Foundation across the country, Donna Molloy, Director of Policy and Practice at the Early Intervention Foundation, told us that “a lot depends on local leadership and the extent to which evidence is prioritised by local lead members, senior officers and so on”. She went on to explain that:
We come across some council leaders who very clearly create a culture in which evidence is prioritised, questions are asked about any changes and the extent to which there is evidence to support those changes and shifts in investment and spending and so on, but there are other areas where evidence seems slightly less of a priority.
Donna Molloy added that part of the problem was the complexity of engaging with evidence and told us that in the Early Intervention Foundation’s experience, “one of the biggest reasons” for the gap they observed between the latest evidence and local practice was a “lack of capacity in local government and public services to engage with evidence”.
104.There is scope for improved awareness of the importance of early years experiences on child development, and knowledge of the latest science in this domain, across the early years workforce. The capacity and motivation to engage with evidence should also be improved, in particular for those in leadership positions. The establishment of Social Work England constitutes an important opportunity to review the training given to children’s social workers, but the early years workforce encompasses a much broader range of professions than social workers alone.
105.A further workforce issue raised repeatedly during our inquiry was the importance of families maintaining contact with the same practitioner throughout their interaction with a particular service. Ailsa Swarbrick, Director of the Family Nurse Partnership National Unit, highlighted the ongoing relationship built between a family and their dedicated family nurse as a particular advantage of the FNP programme, saying that the nurse “can role-model, in a sense, how a trusting, respectful relationship can continue over the course of the two years”, providing a “template for the client’s relationship with her child”:
There is something about the long-term trusted relationship that enables the mother to feel confident in her ability to parent and to make the right choices both for herself and for her child in the long term.
106.Better Start Bradford, a charitably-funded local partnership, agreed in the value of families building a relationship with a specific practitioner—especially in relation to ACEs—but warned us that stretched resources meant this was often not being delivered. The Institute of Health Visiting similarly told us that “the most valued and effective element of health visiting is the quality of relationships with families, but this is diluted by lack of continuity of carer”, reporting that 49% of English health visitors stated ‘lack of continuity’ as one of the biggest barriers they faced in “making a difference” to families. The Association of Child Psychotherapists told us that their members “regularly encounter older children who have suffered terribly as a result of being cared for in hospital by a team of shift nurses, rather than having the essential and consistent attention of a secure attachment figure”.
107.Although many organisations report that intervention outcomes benefit from families receiving support from the same practitioner throughout their interaction with a particular service, constraints in capacity are a major contributory factor resulting in many services not consistently achieving such continuity of care.
246 Association of Directors of Children’s Services, ‘’ (2017), p8
247 Association of Directors of Public Health ()
248 Bonin et al., London School of Economics and Political Science ()
249 Q399; The Department for Education clarified that local authorities’ self-reported spend on children’s services was approximately £9.2bn in 2016–17, with around £6.5bn spent on “the most vulnerable children” (for example looked after children or adoption services) and around £1.1bn spent on family support services—Department of Health and Social Care and Department for Education ()
250 The Early Intervention Grant was introduced in 2011–12 to enable local authorities to respond to local needs, drive reform and promote early intervention more effectively. In 2012–13, the Grant was one of nine rolled into the ‘Start-Up Funding Assessment’ funding for local authorities, with the introduction of the business rates retention scheme.
251 ‘ ’ and ‘’, Ministry of Housing, Communities and Local Government, accessed 19 July 2018
252 Action for Children, the National Children’s Bureau and The Children’s Society, ‘’ (2017)
254 Association of London Directors of Children’s Services (); Tom McBride, Director of Evidence at the Early Intervention Foundation, similarly told us that “we are talking about a constrained system that prioritises statutory services over prevention and early intervention, and that is one of the barriers to implementing early intervention, let alone evidence-based early intervention”—Q194
255 Greater Manchester Combined Authority ()
256 The Social Mobility Commission, ‘’ (2017)
259 WAVE Trust, ‘’ (2014)
262 Greater Manchester Combined Authority (); problems with siloed funding was also raised by George Hosking, CEO of the WAVE Trust (Q206) and Donna Molloy, Director of Policy and Practice at the Early Intervention Foundation (Q207)
263 Action for Children, ‘’ (2013)
267 We note that the 2018 Budget contained two announcements of potential relevance to funding for early intervention: “5.16: The Budget provides a further £410 million in 2019–20 for adults and children’s social care. Where necessary, local councils should use this funding to ensure that adult social care pressures do not create additional demand on the NHS. Local councils can also use it to improve their social care offer for older people, people with disabilities and children.” and “5.18: The Budget provides £84 million over 5 years for up to 20 local authorities, to help more children to stay at home safely with their families. This investment builds on the lessons learned from successful innovation programmes in Hertfordshire, Leeds and North Yorkshire.”—HM Treasury, ‘’ (2018), paras 5.16 and 5.18
268 Children’s Commissioner’s Office, ‘’, accessed 27 March 2018; Donna Molloy, Director of Policy and Practice at the Early Intervention Foundation, similarly told us that “nothing works everywhere and for all families, and what works in one context might not work in another”—Q178
269 Alison Michalska, President of the Association of Directors of Children’s Services, Early Intervention Foundation National Conference , 11 May 2017 (accessed 29 May 2018)
270 Q215, Q225 and Children And Parents Service (CAPS) Early Intervention (); The Centre for Mental Health, a mental health charity, similarly told us that programmes often fail “because of poor quality implementation or ineffective delivery—Centre for Mental Health ()
271 For example, see Better Start Bradford () and Qq82, 98, 107, 193, 249–250, 276
273 HM Government, ‘’ (2018), paras 38–39
275 Alison Michalska, President of the Association of Directors of Children’s Services, Early Intervention Foundation National Conference , 11 May 2017 (accessed 29 May 2018)
279 Greater Manchester Combined Authority () and Qq258–259; the Association of London Directors of Children’s Services also stated that “the most critical years are 0–2 but there is no consistent measure for tracking child development at that age” and highlighted this as a key challenge to evaluating early intervention ()
280 Graham Allen, ‘’ (2011), p56; this was reiterated in NICE guidelines on social and emotional wellbeing in early years that stated that “there is limited UK data on the indicators that provide an overall measure of the social and emotional wellbeing of children aged under 5 years”—NICE, ‘ (2012)
281 These indicators of public health are listed under Public Health England’s Public Health Outcomes Framework, for more information see Department of Health, ‘’ (2016); Prof Bennett told us that local authority data submission is currently voluntary but “very well subscribed to”—Q306
283 Two indicators of adult health corresponding to ACEs are collected (1.11 ‘Domestic abuse’ and 2.15 ‘Drug and alcohol treatment completion and drug misuse deaths’) but are not focused on adults with young children—Department of Health, ‘’ (2016)
284 Public Health England, ‘ ’, accessed 6 June 2018—the three indicators relating to child development are: school readiness; average strengths and difficulties questionnaire score for looked after children; and proportion of children aged 2–2½ offered ASQ-3 as part of the Healthy Child Programme or integrated review. Professor Bennett acknowledged that “most of those are factors relating directly to what you might term physical health”, but argued that they identify risk factors and correlate with the need for additional support—Q355
285 Public Health England ()
286 Experimental statistics are new official statistics undergoing evaluation, published “in order to involve users and stakeholders in their development and as a means to build in suitability and quality at an early stage”—Public Health England ()
287 ‘’, NHS Digital, accessed 27 July 2018
288 Public Health England ()
289 Public Health England ()
292 NHS England, ‘’ (2016)
293 Department of Health and Social Care and Department for Education ()
294 Department for Education, ‘’ (2016), pp38–41
297 Q266; Dr White suggested, for example, Bickman et al., ‘ ’, Psychiatric Services vol 62 (2011)
299 For example, see Greater Manchester Combined Authority (), Association of London Directors of Children’s Services (), Better Start Bradford () and Qq83, 262 and 324
300 Department for Education, ‘’ (2017), p63
302 Greater Manchester Combined Authority ()
304 Qq426–429; the new statutory guidance for safeguarding child welfare includes a ‘myth-busting’ guide to data-sharing for safeguarding purposes—HM Government, ‘’ (2018), p20
306 In addition to examples listed in main text, see also: Association of Child Psychotherapists ();
307 First Step, Tavistock and Portman NHS Foundation Trust (), para 5
308 Barnardo’s (), para 18
309 Early Intervention Foundation (), para 23
311 Association of Child Psychotherapists ()
312 Qq256 and 276
316 Department for Education and Department of Health, ‘’ (2016)
317 Children and Social Work Act 2017,
318 Department for Education and Department of Health and Social Care, ‘’ (2018), pp5–6
319 ‘’, Department for Education (2016), accessed 21 August 2018
322 Department for Education, ‘ ’ (2018)
323 Early Intervention Foundation ()
325 Institute of Health Visiting (); ‘skills mix’ practitioners are staff who are not fully-qualified health visitors but who perform elements of the health visitor role
327 Department for Education, ‘’ (2017)
329 Newcastle University ()
334 Better Start Bradford ()
335 Institute of Health Visiting ()
336 Association of Child Psychotherapists ()
Published: 14 November 2018