Early Help: Policy context
Derren Hayes
Monday, August 26, 2019
The Early Intervention Foundation (EIF) defines early intervention as identifying and providing early support to children and young people who are at risk of poor outcomes - such as mental health problems - poor academic attainment, or involvement in crime or antisocial behaviour.
In Realising the Potential of Early Intervention, it says this can "take many different forms, from home visiting to support vulnerable parents, to activities to support children's early language development, to school-based programmes to improve children's social and emotional skills, to family therapy to improve children's behavioural development".
While the years before a child starts school are a particularly important stage of development, problems can arise at any stage. Effective interventions can improve children's life chances at any point during childhood.
A House of Commons briefing on early intervention highlights how programmes can be both universal and targeted at specific groups of vulnerable children and families at greater risk of poor outcomes. "The common thread between different definitions is their focus on the importance of early support for children and their families, to improve children's later life chances, health and wellbeing," it states.
Funding
In 2011/12, the Early Intervention Grant (EIG) was introduced to replace a number of specific grants covering spending on under-fives, support for families and some young people. Worth £2.2bn to local authorities, the funding was non-ringfenced to allow for greater flexibility on how to spend it.
Reforms introduced by the Conservative and Liberal Democrat coalition government saw some of this money siphoned off to pay for 15 hours of early education for the 20 per cent most disadvantaged two-year-olds - by 2014/15, when the offer was extended to 40 per cent most deprived, it saw £760m removed from the EIG.
Public sector austerity has also hit the EIG - both in the overall reduction in the fund and in councils using the money to offset cuts elsewhere in their children's services budget. In 2019/20, the fund was worth £1.03bn, a 54 per cent reduction on the 2011/12 level.
Since 2015, there have been a number of one-off pots of prevention-focused funding introduced by the government, including the £200m Children's Social Care Innovation Programme to test new approaches to reducing the need for care and the £22m Early Intervention Youth Fund offering grants for youth organisations tackling violence.
The key government initiative has been the Troubled Families programme, which has seen council early help teams target packages of support to 400,000 families affected by a range of problems including anti-social behaviour, truancy, unemployment and mental health.
In its report, Realising the Potential of Early Intervention, the EIF acknowledges that spending on early help is "difficult to measure and track over time". However, analysis in 2015 by the National Children's Bureau and The Children's Society predict that as a result of austerity, local authorities will be spending 72 per cent less on early help by 2020.
Analysis by the National Audit Office published this year shows that the proportion of children's services spending on prevention services fell from 41 to 25 per cent between 2010/11 and 2017/18.
Since October 2015, councils have been responsible for all 0-19 public health services. This saw funding and staff transfer from the NHS to councils, which received £3.1bn for public health services in 2019/20. This is a £72m fall on the previous year.
Analysis by The Children's Society this year shows that while spending on early help has halved since 2010, the amount councils spend on late interventions has risen 12 per cent (see research evidence).
The cost of underinvestment should be set against the estimated £17bn annual cost of spending on late interventions - largely domestic violence and looked-after children's services - to address problems. The EIF analysis shows local authorities largely bear the brunt of funding these late interventions (see graphics).
Pre-school services
The government's approaches to children's mental health, obesity and childcare focus more on intervening after age two than earlier. For example, 15-hours funded childcare kicks in for the 40 per cent most disadvantaged children on their second birthday, while 30 hours of provision is available for all three- and four-year-olds of parents working 16 hours a week.
The government sees funded childcare as a key part of its prevention agenda. It claims this investment will total £6bn by 2020. It believes high-quality early education is the best way of closing the attainment gap between disadvantaged children and better-off peers. Studies show that children in the poorest parts of England start school 18 months behind developmentally than those in wealthier areas.
The early years pupil premium (EYPP) is additional funding for early years settings to improve the education they provide for disadvantaged three and four-year-olds. It was introduced in 2015/16 and is worth up to £300 per eligible child and £50m in total.
The EYPP is allocated to early years providers except where a child is subject to a care order - then, the funding is given to the council's virtual school head, who distributes funds to childcare providers and in some cases will pool money for activities that benefit all looked-after children.
Giving evidence to the recent health and social care committee inquiry, Professor Edward Melhuish from the University of Oxford said funded childcare for two-year-olds had achieved "positive results", but that "the government is missing a trick" in its deployment. He said: "The two-year-old offer is targeting the 40 per cent most disadvantaged families. You have a ready-made audience for a range of strategies for improving children's development."
However, the Social Mobility Commission has questioned the impact of the 30-hours offer on disadvantaged families, calling for the extension of the entitlement to parents working just eight hours a week to kick-start social mobility.
Children's centres have been the focus of much of local authorities' early help provision for 20 years. In recent years, many of these have undergone fundamental change in their scale and shape, and the range of services they offer. Budget reductions have seen councils close hundreds of them in the past five years. Department for Education figures show there were 2,362 main centres open in February 2019, down from 3,632 designated centres in 2010. There are an additional 722 former centres that now offer some early childhood services. Critics say many of these sites offer little more than occasional stay-and-play sessions.
The government claims that many of the closures have been in more affluent areas, enabling councils to retain centres in poorer communities. However, research by charity Action for Children found the deepest reductions in use of centres over the past four years have been in the most deprived areas.
As councils have reduced their network of centres, many have focused on maintaining a network of fewer centres offering a wider range of services including help with finding work and mental health support for parents. In Coventry, the council is working with voluntary agencies to create local hubs through an initiative called Ignite (see practice example). These hubs are designed to work closely with families to identify their needs earlier and put support in place.
Campaigners have been calling on the government to undertake a review of children's centres to inform a clear vision for their future role, but there is little sign of this happening, fuelling concerns that centres will continue to bear the brunt of council funding cuts.
In June, the government announced it would invest £22m in creating up to 1,800 new school-based nursery places in disadvantaged areas as part of the School Nurseries Capital fund, part of the 2017 Social Mobility Action Plan. It set out ambitions for the four key life stages of people's education, including "closing the ‘word gap' in the early years". It highlighted the importance of the early years in the development of "strong cognitive, social and emotional foundations on which future success is built", and proposed a range of measures to improve early years literacy and communication.
Health support
Through the 2015 public health reforms, councils have been required to carry out five mandated child development reviews, providing a national, standardised format to ensure universal coverage and ongoing improvements in public health.
The five mandated reviews are the antenatal health promoting visit; the new baby review; the six to eight week assessment (the health visitor- or family nurse-led check); the one-year assessment; and the review at 24-30 months.
The reviews are based on evidence showing that these are the key times to ensure parents are supported to give their baby the best start in life, and to identify early those families who need extra help. New regulations, passed in March 2017, ensured this duty remains with councils.
Health visitors' role in undertaking child development reviews makes them a key member of the early help workforce. The 2010 coalition government oversaw an increase in health visitor numbers with one being attached to every children's centre. However, these gains have been largely undone with numbers of health visitors falling 25 per cent between October 2015 and December 2018.
A key piece of partnership working between the Department of Health and Social Care and Public Health England will see the Institute of Health Visiting train up to 1,000 health visitors in 2019 to identify and support children with speech, language and communication needs.
The health and social care committee and the Commons science and technology committee started inquiries into early intervention policy in 2018. Both called on the government to review the provision of the Healthy Child Programme and set a date for achieving complete coverage in the number of children who receive all five mandated health visits.
The health and social care committee recommended that the government set out proposals for increasing the number of routine visits. It also praised the work of the Children and Parents Service in Manchester which works with pre-school children experiencing emotional and behavioural problems (see practice example).
The Five Year Forward View for Mental Health committed to invest £365m by 2020/21 in perinatal mental health services to ensure that 30,000 more women each year are able to access evidence-based specialist mental health care.
The NHS Long Term Plan, published in January, included a commitment for a further 24,000 women to be able to access specialist perinatal mental health care by 2023/24.
Meanwhile, the children and young people's mental health green paper, published in December 2017 by the Department of Health and Social Care and the Department for Education, sets out plans to improve the identification of emerging mental health problems in children by placing specialist practitioners in schools. They will be able to refer pupils to community mental health teams so they receive support quickly.
Other interventions
The Troubled Families programme is delivered by local early help teams and is branded differently across the country. The £440m five-year programme runs out in March 2020, and uncertainty surrounds what replaces it. Council leaders warn that without the funding being repeated - or increased - their ability to deliver early help services will be severely curtailed.
A recent national evaluation of the programme found it has delivered positive outcomes. When comparing families on the programme with a matched comparison group, the analysis indicated that it reduced the proportion of looked-after children by 32 per cent, juvenile convictions by 15 per cent, instances of youth custody by 38 per cent and jobseeker's allowance claimants by 10 per cent.
The programme has become an integral part of the landscape, and the EIF believes its next evolution should involve the skills development and recognition of the early help workforce.
Initiatives to support young people at risk of poor life outcomes have also been invested in by policymakers. The government has pledged to do more to tackle high levels of school exclusion, a significant indicator of children getting involved in gangs and criminal activity. Analysis has shown the correlation between pupils achieving good exam results and increased income in adulthood. Projects such as London Youth's Talent Match work with young people struggling in education to boost vocational training opportunities (see practice example).
Amid rising concern over youth violence, the government has unveiled initiatives to invest in projects working with vulnerable young people, such as the £200m Youth Endowment Fund. However, critics say such initiatives are piecemeal in comparison to the £400m fall in youth work spending (see research evidence).
As the EIF states in its report, early intervention can lead to reductions in public service use, but in many cases this will not lead to "cashable savings" because the return will not be realised until a child is much older. However, arguments for early intervention that rest solely on short-term cashable savings miss the bigger picture and the reasons why investment is critical and the societal benefits large.
ADCS VIEW
Government must heed evidence for investing in early help
By Rachel Dickinson, ADCS president 2019/20, and executive director people at Barnsley Metropolitan Borough Council
As we prepare to work with a new top team in the Department for Education and beyond, I have been reflecting on how best to convey the daily pressures we face. Youth centres and children's centres are closing, and schools and childcare providers are struggling to make ends meet. Young people are being criminally exploited by dangerous gangs and young lives are being lost on our streets as a result of knife-related injuries. Growing numbers of learners are being excluded, more hold education, health and care plans, and to our shame, millions of children continue to live in poverty.
With so many pressing priorities, it is hard to know where to begin. We need long-term solutions. A genuine commitment to, and funding for, all forms of early intervention to allow us to support anyone at risk of poor outcomes is urgently required. Acting early on childhood problems doesn't only help the individual, it contributes to healthier, happier and more productive communities too.
Political changes have delayed this summer's comprehensive spending review. We regularly hear from civil servants that the team at the Treasury value evidence above all else, so here's what I'd say to the relevant ministers making the case for investing in children and families.
The Education Policy Institute's 2019 annual report showed that progress on closing the attainment gap has stopped, yet we know even small increases in academic attainment can have significant economic returns. If the GCSE performance of disadvantaged pupils in all regions matched their London counterparts, this would lead to an overall economic benefit of £20bn in present value terms, according to 2017 DfE research.
A six-year study on the impact of children's centres demonstrated improvements in maternal mental health and family functioning, while a report this year by the Institute for Fiscal Studies found a reduced use of acute hospital care for children in deprived areas who had received Sure Start services, resulting in savings for the NHS.
Evaluations of the Troubled Families programme have consistently reported better outcomes for families. Some of these claims have been challenged, but the importance of this funding cannot be overstated given our early intervention grants have fallen by two-thirds. Despite criticisms of the programme, it is a lifeline. Without a commitment to continue funding beyond March 2020, progress will slow or be lost as skilled staff begin to look elsewhere for roles.
It's wrong to expect short-term cashable savings from investing in early intervention, but without a relentless focus on the provision of help earlier, need will continue to grow but life chances will not.
We need a co-ordinated cross-government approach to early help
By Donna Molloy, director of policy and practice, the Early Intervention Foundation (EIF)
High-quality, well-targeted early intervention can benefit children, young people and families at risk of poor outcomes. Yet, we are a long way from support being available for all those who need it at the time they need it. There have been commitments from individual government departments on early intervention, but there is an urgent need for cross-government action to ensure that resources are used in a co-ordinated, well-planned and evidence-led way.
We have seen, for example, the Department for Education launch its ‘home learning environment' campaign; the Department of Health and Social Care publish the Prevention Green Paper; and the Ministry of Housing, Communities and Local Government state its intention to pursue funding for continuation of the Troubled Families programme. But the policy landscape is still fragmented, with accountability for children sitting across multiple government departments and agencies, and the reality on the ground is that early intervention is still not available for all those who need it.
A strategic, cross-government approach to early intervention is required, which takes a whole systems approach. This should be overseen by a taskforce, led by a cabinet minister who is able to secure and maintain the contribution of all relevant departments and drive the co-ordination of resources. Crucially, this taskforce should focus on early intervention for children of all ages. While we welcome the focus brought by the Inter-Ministerial Group on Early Years Family Support, it is clear that development continues into early adulthood.
Government also needs to move away from short-term funding streams. The new 10-year Youth Endowment Fund which aims to prevent youth crime is a welcome example of a long-term, evidence-based approach. We need to support local areas to develop integrated whole-system approaches to early intervention, involving councils, schools, the police, and the voluntary and community sector. Evaluating the impact of these approaches is critical. Currently, much of the evidence of ‘what works' rests on studies that test the impact of individual programmes, rather than the combined effects of a comprehensive, place-based approach. A vital next step, therefore, is to test the population-level impact of whole-system approaches to early intervention.
FURTHER READING
- Early intervention briefing, House of Commons library, July 2019
- First 1000 days of life, health and social care committee, February 2019
- Evidence-based early years intervention, science and technology committee, October 2018
- Realising the potential of early intervention, Early Intervention Foundation, October 2018