On 27th February 2020 the Bishop of Gloucester, Rt Revd Rachel Treweek, led a debate in the House of Lords on improving early years interventions to support children and families. Her opening speech and that of the Minister responding is below, and the whole debate including the speeches of all others taking part can be seen here.
Children and Families: Early Years Interventions
Motion to Take Note
The Lord Bishop of Gloucester: That this House takes note of the case for improved early years interventions to support children and families.
The Lord Bishop of Gloucester: My Lords, it is a great privilege to initiate this debate today on early years intervention. My interest in this subject comes from my experience as a paediatric speech and language therapist, then in parish ministry and now as a bishop committed to the flourishing and well-being of diverse individuals and communities. In light of that, I draw your Lordships’ attention to my entry in the register of interests.
The experiences we have as children, and in particular as young children, shape the rest of our lives. A child’s development score at just 22 months can serve as an accurate predictor of educational outcomes at 26 years. Adverse childhood experiences—ACEs—have significant public health and social consequences. Having had four such experiences is associated with poorer physical and mental health, drug and alcohol abuse and inter- personal and self-directed violence. There are stories up and down the country, including those I hear in prisons and women’s centres, about those who are now adults who were deprived of appropriate early years intervention, and about those who are turning their lives around for their children and their families as a result of receiving early intervention for their children and for themselves as parents.
My intention in tabling this debate today is to reflect on how government, both centrally and locally, can work with families and communities to support children’s well-being, particularly at the start of life—I deliberately use the word “with”. The Government have plenty of evidence that early interventions are not just good for children’s life chances, they are also sound financially. The old adage, “an ounce of prevention is worth a pound of cure”, rings true here. Despite this, the Children’s Society estimates that local authority spending on early intervention services for children and young people fell by 49% between 2010 and 2017.
Health visitors are a highly effective intervention and support for all babies and families across the social spectrum, yet their number is falling. Similarly, most areas in England have experienced a real-terms reduction in reported spending on speech and language therapy over the last three years, despite the fact that children with poor vocabulary skills at the age of five are three times as likely as their peers to have mental health problems in adulthood, and twice as likely to become unemployed.
For those in government concerned about money, it should be enough to point out that, when we provide early support and catch problems early, intervention is far less expensive. However, we have to be able to do this. The Government’s troubled families programme comes too late. The families it supports are already in trouble, not simply struggling or at risk.
Increases in government spending on children’s services have been largely a result of the increased number of looked-after children and the Government’s expansion of free childcare hours, while spending on children’s centres and provision for families has decreased, particularly in the most deprived parts of the country where they are most needed to address inequality. In the case of looked-after children, this is by far the most drastic and expensive intervention the Government can make in a child’s life. What assessment have the Government made of the causes of this rise?
On childcare, academic research shows that pre-schooling and paid childcare improve children’s outcomes only if they are of high quality. Where children are looked after by private providers, vital links with local authorities can be missed and staff may not have the specialist training required to spot early issues. Research done by the Institute for Fiscal Studies and the Joseph Rowntree Foundation suggests that the free entitlement for three and four year-olds does not effectively target the most needy and at risk. What assessment have the Government made of the quality of this provision and its effect on early years outcomes for children?
Child poverty has a strong link with child development. Children who have lived in persistent poverty during their first seven years of life have cognitive development scores on average 20% below those of children who have never experienced poverty. The Millennium Cohort Study shows that poor children are four times more likely than rich children to develop a mental health problem by the age of 11. Gaps in achievement open up early on, and by the time they start school the poorest children are already 11 months behind their more advantaged classmates. Overcrowded, poorly maintained housing can lead to children sleeping in living rooms or with parents, which has consequences for physical and mental health. Poverty puts families under pressure, and that stress can be a source of ill health and family breakdown, leading to expensive work by public authorities further down the line.
Simply expanding both entitlement to free childcare for disadvantaged two year-olds and the number of free hours that older children are entitled to is unlikely to counteract the effect of benefit changes and the two-child limit. To put it simply, incentivising single mothers to work is not a panacea for their child’s development. Can the Minister explain what analysis the Government have made of the impact of DWP changes on child poverty, particularly the two-child limit, and any impact assessment of the effect that this will have on children’s life chances and well-being?
We also know that worklessness is no longer the root of poverty. Seven in 10 children in poverty are now in a working family. Part of the problem is that families have to pay the entire cost of free childcare up front before they can claim back the 85% that the Government will cover. Many low-income families do not have the capital to pay this up-front cost or risk going into debt. Moreover, childcare support has been capped at £175 per week since April 2016, while childcare costs continue to rise. The deep irony of this situation is that most childcare workers are themselves women on low pay, and 44% of childcare workers claim state benefits or tax credits.
To paraphrase the Sutton Trust and the Marmot review published earlier this week, it is difficult to see how even well-designed policies to support parenting and ensure access to high-quality early education can have the optimal impact against a backdrop of a sharp increase in child poverty.
Furthermore, navigating the benefits in the childcare system is hugely complicated, especially as families begin to migrate on to universal credit. Anecdotally, we hear that this is something that churches and toddler groups help with around the country. Toddler groups —many provided by churches and other community-based groups—do a huge amount of early intervention and signposting work, informally across the country. It amounts to thousands of hours each year. Often, these are the only places in a community where children from different backgrounds mix and parents and care givers are provided with support. Yet toddler groups are almost invisible in impact studies and government reports. They are a tremendous asset to the country, provided by hard-working, committed volunteers. We want to encourage this sort of expression of civil society, but the Government must partner with the community to make sure that local services are joined up, holistic and sufficiently funded. This work cannot simply be outsourced to stretched volunteers.
While I welcome the Government’s commissioning of research on family hubs, surely the case for children’s centres is already well known. For each Government to have to learn the benefits of early intervention for themselves is frustrating and a poor use of resources. One of the most important parts of Sure Start was co-creation with the local community—a bottom-up approach that listened to the needs of service users. Will this happen with family hubs? What support will the Government provide for children and their families from all walks of life to ensure that parents who have concerns about their child’s welfare and development have somewhere to turn?
If I had longer, I would have liked to say something about families of children who have a disability. The long-term well-being of such children and families is about not only access to early diagnosis but appropriate early intervention. Early intervention by definition needs to be made early, and I hope that the Minister, in her reply, will explain how the Government are working across departments to improve early years policy, given that the interministerial group on the early years has been disbanded. Will the Government introduce a cross-departmental early years strategy as part of the plan to level up Britain, and ensure that every child can achieve their potential? What attention have the Government paid to the work of the Early Intervention Foundation and its analysis of what works as effective interventions? Will the Minister assure the House that local authorities have sufficient ring-fenced funding to deliver them?
There is an urgent need for join-up. At present, we do not have a single framework, even across health and education, to assess and support the development and well-being of every child. This is more than join-up across health and education—although that would be a good start. This is about every aspect of life if we are rightly to look at the whole child in the context of the family.
In this debate, we are not simply focusing on little people. We are talking about investment in the start of life, which affects the long-term well-being of individuals, families, households, communities, our country and beyond. There is a very strong case for improving early years interventions and having a clear and joined-up strategy for doing so. I look forward to hearing the contributions of other Members on this topic today.
The Parliamentary Under-Secretary of State, Department for Education and Department for International Trade (Baroness Berridge) (Con): My Lords, I too congratulate the right reverend Prelate the Bishop of Gloucester on securing this debate and all noble Lords who have spoken on this important issue. I am grateful for this opportunity to set out the Government’s approach to improving early years interventions. I hope that the level of co-ordination, although not perfect, will assure the right reverend Prelate and other noble Lords that we are moving in the right direction.
The approach of the Government is based on a number of principles: that early, rather than late, intervention is the key, as noble Lords have outlined; that it is central government’s role to support, facilitate and work with local government and other partners to tackle the issues together; that our solutions should be focused on outcomes and underpinned by evidence; and that successful strategies should be identified and shared widely.
This is the first debate in my widened portfolio, and it is a serious and complex matter. It straddles a number of central government departments, including the Department for Education, obviously, the Department for Work and Pensions, the Department of Health and Social Care and the Ministry of Housing, Communities and Local Government. But a co-ordinated approach to tackling early intervention is what the Government aim to achieve. There are meetings between the Department for Education and the Department of Health and Social Care on the advisory programme board to ensure that there is co-ordination across government. The noble Baroness, Lady Wilcox, mentioned the Welsh example, which is open to the What Works institutions that the department has set up—so there is a spread internationally and from the devolved institutions.
The need for a national strategy has been clearly outlined to me by many noble Lords. That need is under review, but I will take back to the department the clear message that while co-ordination with local government is essential, noble Lords also believe that a national strategy is valuable in this area. With this co-ordination in mind, the Government have prioritised three areas: first, improving social mobility, supported in the early years by high-quality early education settings and learning in the home; secondly, protecting vulnerable children through effective children’s social care; and, thirdly, improving mental and physical health in pregnancy and childhood. This is underpinned by our work to empower local areas to improve multiagency working and build the evidence base—not necessarily the type of research that the noble Lord, Lord Mawson, would talk about—for what works.
Early educational entitlements are not a panacea, but there is extensive evidence to demonstrate that high-quality childcare supports children’s development and prepares younger children for school. This is why the Government have made sure that all three and four year-olds, and disadvantaged two year-olds, can now access at least 15 hours of free childcare each week. In 2020-21, this is at a cost of £3.6 billion.
As many noble Lords outlined, when children start their formal education, the reception year presents a window of opportunity to address the key development gaps between disadvantaged children and their peers, before they have a chance to widen. The noble Baroness, Lady Tyler, mentioned disadvantaged two year-olds. The take-up rose from 58% in 2015 to 68% in 2019, but there was a slight decrease last year, so the department is working with the Family and Childcare Trust and Coram to ensure that there is an upward trajectory in the take-up for those disadvantaged two year-olds.
The noble Baroness, Lady Armstrong, and the noble Lord, Lord Addington, focused on the early years foundation stage. Too many children leave the reception year with poor outcomes, and the current assessment system involves too much paperwork and reduces the time that reception teachers have to support children. The proposed reforms to the early years foundation stage profile will free up teachers to interact with and support children to ensure that they develop the rich vocabulary, skills and behaviours that they need to thrive in school and to access the education on offer to them. There is good news in relation to this assessment: in 2013, 51.7% of children achieved a good developmental score; by 2019, it was 71.8%. The assessment of language and development skills will also be introduced into the universal child assessment for all two year-olds. We have also set a 10-year ambition to halve the proportion of children who finish their reception year without the necessary language and literacy skills they need to thrive.
The home learning environment, as many noble Lords outlined, is also important. We are supporting parents to improve the quality and quantity of adult-child interactions—a point made by the noble Baroness, Lady Bennett. A three-year campaign called Hungry Little Minds has been launched by the department to encourage parents to chat, play and read with their children—the noble Baroness, Lady Prosser, talked about a very moving example she witnessed on public transport—so that they can help to set their children up for school and beyond. We are taking a society-wide approach to get that message out, with different organisations, including charities and businesses, playing their part. The campaign will build on the department’s work with the National Literacy Trust. An interesting example arising from that partnership has been the work of Penguin Random House with Arriva, the train company, to give away books at stations and to train staff to have the confidence to interact with young children on public transport. So we all have a responsibility when we interact with children to help improve their outcomes.
Looking beyond parents, charities and businesses, we are committed to supporting the workforce in this sector to gain the appropriate skills and knowledge—a point made by the right reverend Prelate and the noble Lord, Lord Addington. Alongside our training of 1,000 health visitors to identify and support children with speech, language and communication needs, we have invested £20 million to ensure that practitioners in disadvantaged areas have access to high-quality professional development. On the point raised by the noble Lord, Lord Watson, we are also supporting graduates into the sector through funding the Early Years Initial Teacher Training programme, including fees, bursaries and employer incentives.
In relation to the points made by the noble Baroness, Lady Wilcox, and the noble Lord, Lord Addington, early help of course plays an important role in promoting safe and stable families. It is about supporting and intervening with families at the right time and in the right way. Of course, that does not detract from the need for statutory guidance: Working Together to Safeguard Children is clear that local areas should have a comprehensive range of effective, evidence-based services in place to address assessed needs early. Although many noble Lords have made the point in relation to children’s centres, there is a statutory underpinning that local authorities still need to meet, when looking at services, to meet the needs of the most disadvantaged in their communities. We have also strengthened the duty placed on police, heath and local authorities to work collaboratively to safeguard and promote the welfare of children. Since September of last year, multiagency safeguarding partnerships have been in operation in England. We are implementing those reforms to try to see a further cultural shift in the way that police, health and local authorities work together in local areas to secure the outcomes for children.
I am grateful to my noble friend Lady Wyld for raising the issue of maternity and perinatal health. Since April 2019, new and expectant mothers have been able to access specialist perinatal mental health community services in every part of the country. Public Health England is currently undertaking a systematic review and refresh of the Healthy Child Programme in England to ensure that the future approach is both universal in reach and personalised in response to those families needing extra support. I am pleased to inform the right reverend Prelate that a revised health visitor and school nurse model is being looked at within that work. Also in relation to health, the noble Baroness, Lady Tyler, raised the issue of childhood obesity. The Government’s childhood obesity plan sets the ambition of halving obesity by 2030, and successful initiatives include breakfast clubs and doubling the PE and sport premium up to £35 million of expenditure.
As I have repeatedly outlined, local areas have a key role in commissioning and delivering effective early years interventions to meet the needs of children and families, and I have some examples of where we are supporting that. First, an additional £165 million has been announced for the troubled families programme, which many noble Lords mentioned, bringing the total expenditure to over £1 billion. Of the children on that programme, 34.2% are under two, showing that this is not always an intervention that is too late. This will ensure that more families get access to the programme’s support.
A key aspect of the programme is the key worker, who goes in and builds a trusted relationship with a family, with practical instructions and advice, but also helps that family access the specialist support on offer in their area. Many noble Lords referred to the fact that, often, the person needing the support is least able to be the advocate to go and get that support. That key worker reminds me of my noble friend Lady Wyld’s reference to the people who are around to help you in those years. As the noble Lord, Lord Mawson, said, it is the person who is on your side. I pay tribute to the local authorities—for schools, health provision and particularly those key workers—because this project has been and will continue to be evaluated.
When reading in preparation for today’s debate, there were moments that caused one to forget all the policy, the research and the words and to think about the lives that are being affected by this. The evaluation of this programme shows that, 19 to 24 months after starting to receive support, the proportion of children on the programme going into care—compared with a similar cohort—is reduced by a third. Those key workers, health professionals and local authorities have affected and changed the lives of hundreds, if not thousands, of children who, as we stand here today, are not in care and are still with their families. I thank them for all that work. Also, the proportion of adults on the programme going to prison has reduced by a quarter and juvenile convictions have reduced by 15%. So this is not an intervention that is always too late—and, of course, everybody would wish that we did not have to make any interventions with any families at all.
Secondly, my noble friend Lady Newlove spoke very movingly about the issues for families facing adversity. There is now the Reducing Parental Conflict programme, with £39 million of funding. I am pleased to say that 98% of first-tier local authorities have taken up work on this programme. We know that children who are exposed to parental conflict can suffer long-term harm, and intervening early to help parents reduce conflict obviously affects the outcomes for both children and parents. Through this programme, we are supporting local authorities and their partners to integrate support to reduce parental conflict into their local services for families. DWP is working with 30 local authorities across England to test eight face-to-face interventions aimed at reducing conflict. There is a theme here: it is the face-to-face, the key worker, the person who is there to intervene in situations.
Parental conflict is related to wider family risk factors including, for example, domestic abuse, poor mental health and substance misuse. The noble Baroness, Lady Tyler, referred to alcohol in this particular context. We are investing £6 million to improve the outcomes of children of alcohol-dependent parents who are also engaged in parental conflict. A key thing to say is that adult social services, which deal with the adult with the alcohol problem, work together with children’s social services to ensure that it is joined up.
The noble Lord, Lord Sheikh, asked specifically whether funding was going into local government. The early years local government programme has funding of £8.5 million and is focused on how local services work together across health, education and early help to improve the outcomes for five year-olds. As part of this work, multidisciplinary peer reviews are supporting councils to identify reforms to services, and our early outcomes fund has provided approximately £6.5 million of grants to local authority partnerships. Gloucestershire County Council, in particular, in partnership with Swindon, was successful in securing an early outcomes grant and is using the fund to develop and pilot an early language support pathway: I hope that the right reverend Prelate, with her professional background, will be very pleased to hear that that is happening in her location.
The local government programme also includes work by the Early Intervention Foundation to review effective models for provision. The foundation is reviewing what family hubs and children’s centres can offer. There are still more than 2,000 children’s centres and we do not want to throw out the baby with the bathwater. That evaluation will look at everything that works, and I assure noble Lords that it does not matter what badge is on it: we need to focus. The needs are so acute and these children need such help that it does not matter. What matters is what works: that is the threshold. The Government will continue to champion the role of family hubs because they are a slightly different model to children’s centres—to respond to the question from my noble friend Lady Wyld.
I assure my noble friend Lady Newlove that we are doing all we can for those children who live through adverse and traumatic experiences in childhood, such as abuse or neglect, or who have grown up in complex family circumstances. She has, in me, someone who did not relish school holidays and who is therefore going to take seriously these matters within the department. Such experiences can, and often do, have lasting consequences for children.
Many noble Lords raised the issue of mental health. New mental health support teams are going to be established in 25% of the country by 2023 and the Department for Education will be funding training for senior mental health leads in schools and colleges. The Government remain strongly committed to the What Works initiative. On the point made by the noble Lord, Lord Mawson, about research, I will be going back to the department to ask about the three foundations that the department funds: the Early Intervention Foundation, the Education Endowment Foundation and the Centre for Children’s Social Care—these are “what works”. I will take back his insightful experience in the use of research and the need to monitor how far What Works is spreading from one authority to another: who is using this information to improve and share what is going on.
A number of noble Lords raised the issue of special educational needs, in particular the diagnosis of autism. The NICE recommendation is that the length of time between referral and first appointment to start an assessment should be no longer than three months. Learning disability and autism is one of the priorities in the NHS long-term plan. Over the next three years, autism diagnosis will be included alongside work with children’s and young people’s mental health services to test and implement the most effective ways to reduce those waiting times. I was most moved by the contributions of my noble friend Lord Astor and the noble Lord, Lord Touhig, in this space, particularly regarding children with dyslexia. The Department for Education has contracted the Whole School SEND Consortium to deliver a two-year, £3.9 million programme to help embed SEND in school improvement. As I am sure the noble Lord, Lord Addington, is aware, from 2011 to 2018 the department funded the British Dyslexia Association and other organisations to provide resources to assist schools and local authorities in early identification of those needs.
On funding to tackle child poverty, there is to be a 4.4% real-terms increase in the local authority settlement. The specific issue was raised that local authorities have often prioritised spending on adult social care and other areas at the expense of children’s social care. The department is working with MHCLG to develop a robust and up-to-date fair funding distribution for children’s and young people’s services, which we are aiming to implement as part of a major funding reform package from 2020-21.
On child poverty, I have outlined that the 850,000 most disadvantaged two year-olds have been given free childcare places, and there is an additional 15 hours for lower income families in relation to the entitlement for three and four year-olds. There is also an early years pupil premium, which is just over £300 per pupil. It has been interesting to see how these issues all intersect and relate to that. I hope that the research into family hubs and children’s centres will enable us to look at how best we locate services and help the most disadvantaged children. The Government stand by our position that work is the most effective way to bring these children out of poverty, but of course we recognise that free childcare is needed for many parents to take advantage of that.
I apologise to noble Lords whose questions I have not answered, but I will conclude by responding to the two invitations I was kindly offered. The noble Baroness, Lady Tyler, invited me to the APPG. I think that may be for my honourable friend the Minister for Children and Families, but I will take the invitation back to the department. I apologise for my late response to the persistent invitations of the noble Lord, Lord Mawson, in relation to his wonderful work. I look forward to catching up with that and I hope that one of my first visits will be up to Rotherham. I thank noble Lords for their involvement in such an important debate.
The Lord Bishop of Gloucester: I thank the Minister for her comprehensive response and all those who participated in this excellent debate. I do not have time to mention everyone, but I thank those who shared personal and professional experiences. I am sorry that the noble Lord, Lord Mawson, feels he has heard another bishop say, “It’s all down to the state”, particularly as that was not what I was saying. I am passionate about community engagement and how we enable that, not least through our churches, our faith groups and all sorts of charities and communities. In order to enable that, we need a comprehensive, joined-up early years strategy and I am glad that that point has been clearly heard. This is about how we are investing not simply in small children but in children who grow up to be adults: we are investing in families for long-term impact, and I agree with the noble Lord, Lord Mawson, that this is about the impact on our communities in the long term.