The foundations for a happy, healthy life are laid during pregnancy and a child’s first few years. This is why The National Lottery Community Fund set up and funded A Better Start – a 10-year, £215m programme, designed to improve the life chances of babies and young children from pregnancy to four years old. This month, the programme celebrates its fifth birthday and half a decade of National Lottery funding aimed at transforming the lives of thousands of children across England.
A Better Start works through five local multi-agency partnerships in Blackpool, Bradford, Lambeth, Nottingham, and Southend that develop and test new approaches to boosting child development in their most deprived wards. It covers three key areas of child development – social and emotional development; speech, language and communication; and diet and nutrition. Each partnership works closely with statutory services, voluntary and community sector organisations, and, most importantly, local families to devise and implement services the area needs. From Southend’s Fathers Reading Every Day scheme to Blackpool’s support services for mothers who experienced childhood trauma, no two partnerships are the same, as illustrated by the examples over the next three pages.
So far, more than 23,000 families have engaged with the programme and this has demonstrated that when it comes to boosting child development, parents are best placed to shape solutions. That is why they are involved in every aspect of A Better Start – sitting on partnership boards, making decisions, delivering and promoting activities, and encouraging other local families who could benefitto get involved.
One such parent is Salma Nawaz, a mum of four, who sits on the Better Start Bradford Partnership Board. She has a range of skills, as well as personal experience of mental health issues, so her insights are invaluable to the partnership. According to Nawaz, her involvement in the scheme is “helping me to find myself” again. Involving parents and carers like Salma as equal partners is critical to the success of A Better Start.
There have been challenges. Some families have engaged more readily than others and the programme has not reached all those it would have liked to have reached. With more than 200 partner organisations involved, referral pathways and communication between services have not always been clear. Finding frontline staff with the skills not just to deliver but also to measure and evaluate services has also been tricky.
FIVE LESSONS FROM A BETTER START
With more than 800 volunteers involved, 4,000 practitioners trained, and 20,000 children engaged, there are numerous lessons from A Better Start. Five in particular stand out.
- Effective preventative services require not just allocating resources but fostering a culture centred on identifying problems before they occur.
- Better trained, informed, and supported employees and volunteers mean better, more sustainable services for local families.
- Working in partnership is not just about delivering a service together – it is about sharing information and data too.
- Building parents’ skills and confidence will help to ensure the legacy of a project – beyond its lifetime.
- Real co-production means ensuring families’ voices and ideas – including those of children – genuinely shape how services are designed and delivered.
At a national level, The National Lottery Community Fund is regularly collecting data and monitoring performance to support the development of local services. Meanwhile, the National Children’s Bureau leads on gathering and sharing knowledge and learning from A Better Start. Locally, partnerships have commissioned their own evaluations, tailored to what matters to them and their community. Most of the individual services are evidence-based with targets that are monitored quarterly.
The next five years will see the partnerships continue to refine their pathways and services, sharing what works with local authorities and building sustainability into their plans so their knowledge and learning can influence and improve child outcomes for years to come.
By Dawn Austwick, chief executive, The National Lottery Community Fund
AWARD SUPPORTS SETTINGS TO BECOME COMMUNICATION-FRIENDLY
Early years settings in Lambeth are being supported to become “communication-friendly” through an awards scheme.
The Evelina Award is delivered by the Evelina London Speech and Language Therapy Service – part of Guy’s and St Thomas’ NHS Foundation Trust.
The award existed before the Lambeth Early Action Partnership (Leap) was formed but was mainly used with children’s centres, explains Cathy Johnston, one of the speech and language therapy team leads for early years and community.
Additional funding from Leap has enabled the service to develop and deliver the award for private, voluntary and independent (PVI) sector settings.
The award includes an audit to identify how well settings promote early speech, language and communication skills.
It also includes training and coaching for early years practitioners to help them identify and speech, language and communication needs and improve children’s skills through everyday activities.
“To date the main challenge has been getting our practitioners confident to make referrals,” says Johnston. “Many can identify the children, but actually completing referrals and having those tricky conversations with parents has been a huge part of coaching sessions.”
The award has two stages – a foundation and an enhanced level. Currently, 17 out of 20 PVI settings in the four Leap wards are involved with three planning to progress to the advanced award. The offer has been extended to some statutory and maintained nursery settings.
The scheme, now coming to the end of its second year, has seen a steady increase in referrals from nurseries to speech and language therapy services.
“We weren’t having any referrals from many of the PVI nurseries we’re going into so our referral rates from those settings has increased significantly,” says Johnston.
Thanks to Leap, the service has also been able to offer three extra weekly drop-in Chattertime sessions run jointly by speech and language therapists and early years workers for children with moderate communication needs and their parents as well as a Baby Chattertime session for children under 18 months old.
EARLY SCREENING IS HELPING REDUCE GAPS
A Better Start Southend is starting to see some exciting early results from investment in services to boost children’s early speech, language, and communication, according to director Jeff Banks.
It commissioned Essex Partnership University NHS Foundation Trust to deliver the Let’s Talk project in March 2016.
The programme – delivered by highly specialist speech and language therapists – comprises a range of services including early screening, weekly courses, workshops and home visits for families, and training for early years settings.
To date the programme has worked with more than 1,200 children aged from birth to four in A Better Start Southend’s six wards.
For children in those wards there is evidence of a “marked closing of the gap” in speech and language skills at the end of reception compared with those in more affluent areas.
Results for the Early Foundation Stage Profile in 2019 show a 7.7 per cent increase in children achieving a good level of development in speaking to 86.5 per cent and a 6.5 per cent increase in the proportion achieving a good score in listening and attention to 86.4 per cent.
The project also appears to have led to a 25 per cent reduction in inappropriate referrals to specialist speech and language therapy services, which have “almost disappeared”, says Banks.
“On the other side we have seen a marked increase in appropriate referrals,” he adds.
Where there is a low-level concern about a child’s language development families can join a group or activity designed to boost early communication and language skills such as Talking Toddlers for children aged 12 to 18 months.
“It is freeing up significant resources in the system so specialist services can focus on those who need them,” says Banks.
The Let’s Talk programme has informed other local and national initiatives including the Department for Education-funded First and Foremost project run by the Early Years Alliance in seven other areas.
It has also led to the Talking Transitions scheme in Southend to forge partnerships between early years settings and feeder primary schools.
INVESTMENT IN PARKS REAPS REWARDS
A £1.8m investment in parks and open space by Blackpool Better Start has led to a host of positive outcomes, according to Sharon Mather, senior community development manager at the Centre for Early Child Development.
Public consultation revealed families felt disconnected from touristy areas including Blackpool’s seven mile-long beach and some of the larger parks and were keen to see facilities on their doorstep improved.
As well as investing in measures to enhance 11 parks, outdoor space at seven children’s centres and four open spaces, the project has included the creation of an early years park ranger service delivered by Blackpool Council.
The rangers are qualified to deliver Forest School activities and run events in all seven A Better Start wards designed to get children and families enjoying nature and outdoor play together, including a flower festival.
Between April 2017 and December 2019, more than 3,700 children aged 0 to 3 accesses park ranger activities.
A junior park ranger scheme, jointly funded by the partnership, council and Headstart programme, gives young people the chance to learn gardening skills and get involved in running park-based activities.
This is one of a raft of spin-off projects to come out of the investment, which also include a new volunteering pathway and community group called Park Voice.
“We did not expect our park project to blossom in the way it has,” says Mather, who says the project has helped make parks “focal points for our community”.
There is evidence the project has led to a drop in antisocial behaviour in parks and surrounding areas and that families are using parks and outdoor spaces more.
“It has changed their behaviour because they didn’t engage in park spaces before,” says Mather.
MIDWIVES GIVE CONSISTENT CARE
Better Start Bradford has invested in a number of schemes around pregnancy including a new midwifery model to ensure continuity of care for women.
“While doing research for our bid we found women in our area often didn’t take up antenatal care, rarely attended antenatal classes and were often late in presenting with their pregnancy,” says Better Start Bradford head of programme Gill Thornton.
The project builds on a three-year personalised midwifery scheme, which saw promising results especially when it came to reducing maternal mental health problems and missed appointments.
It has seen the creation of a new team of midwives – the Clover Team – who work in a small area in Bradford with caseloads of 150 to 180 women.
The idea is each woman has “continuity of carer” – a named midwife who supports them during and after pregnancy and – whenever possible – with the birth itself.
Better Start Bradford is also funding work to share learning from the personalised midwifery and continuity of carer schemes with midwifery teams across the city.
The midwives, who are employed by Bradford Teaching Hospitals NHS Foundation Trust, provide a mixture of clinics and home visits.
The hope is that consistent support and advice will lead to an increase in straightforward births, more mothers starting and continuing to breastfeed and improved maternal mental health.
The partnership is working closely with local maternity services to look at ways of rolling out continuity of carer models.
“Hopefully they will see this model works and can be done within existing resources or by slightly re-designing the system so continuity of carer can be offered – if not across the entire system – then to the vulnerable women who will benefit most,” says Thornton.
CAMPAIGN TO ENCOURAGE FAMILY INTERACTION
There is no shortage of advice for parents and carers on topics from screen time to nutrition. However, this often focuses on what families must do rather than why it is important.
The Big Little Moments campaign, part of the A Better Start programme, aims to do things differently by equipping families with a better understanding of why the early years matter.
The campaign, run across the five A Better Start areas, is designed to boost interactions between children and parents by highlighting everyday activities that help build social, emotional and language skills.
Crucially, it explains in clear terms why these “big little moments” are key to young lives.
The campaign, which was launched last year, is based on evidence of how brain development takes place in babies and very young children and presents this information in a fun format that is easy to understand.
Developed by advertising agency 23Red, it used targeted digital and social media advertising to prompt parents and carers to do 15 basic activities such as sharing stories, singing songs and making time for play.
The campaign has been taken forward by each A Better Start area and their partners using posters, leaflets, colourful mascots and banners on buses. An evaluation is due to be published this summer.
Resources from the campaign can be downloaded for free at
FAMILY MENTORS OFFER VALUED SUPPORT
A family mentor service commissioned by the Small Steps Big Changes (SSBC) partnership in Nottingham is having a positive impact.
The project was informed by feedback from parents who said they wanted a “different kind of workforce” to help them, explains SSBC programme director Karla Capstick.
“They wanted people who lived in their community, understood what it was like to raise children and live and work in those areas and some of the challenges they face.”
The service has been running since 2015 and involves paid mentors working with families to deliver the bespoke Small Steps at Home programme – developed by experts at SSBC and covering all three of A Better Start’s key child development outcomes.
It is delivered by trusted local voluntary sector providers who recruit mentors “based around personal qualities and values and lived experience rather than professional qualifications”, explains Capstick.
Mentors undergo a two-day interview process and extensive training. There are just over 70 mentors working in Nottingham’s’ four A Better Start wards where the service is offered to all families expecting a new baby.
Mentors visit once a week for the first six weeks, moving to fortnightly visits until the child is six months old then monthly visits to age two. After that the service, which continues until a child is four, generally moves to phone chats.
Evaluation by Nottingham Trent University found families value their relationship with mentors and the consistency of support, and report increased confidence in parenting.
Other early positive results include a drop in obesity rates at reception – with a greater drop in A Better Start wards. Three out of four wards have also seen an increased narrowing of the gap in speech and language scores compared with other areas.
The scheme is also seen as a valuable stepping stone for mentors to progress their careers and embark on professional training.