Workers must unite for children's health
Chris Hanvey
Monday, December 12, 2011
Change is always difficult. Even when evidence for doing things differently is available.
The RCPCH recently hosted a conference, with the Department of Health and the Faculty of Public Health, on children's public health in the foundation years - pregnancy to five years.
It is one of those areas where a whole range of professionals can profitably come together. Psychology helps with attachment theory and the importance of making those first bonds. The neurosciences are becoming increasingly accurate about, for example, the alarming effects in young brains of sustained sensory neglect.
Social science research into birth cohorts can look at social outcomes and this feeds directly into economic wellbeing. And, of course, the growing social work literature on early intervention points towards what works. One telling slide from the conference showed so clearly that the greatest returns
on a unit pound invested were in the earliest years. With time comes a diminution of rewards.
Yet, somehow, those lessons don’t get realised in practice. So, early years services are an easy cut to make in this age of austerity and we still fail to connect up services so that we can have a maximum impact on the lives of very small children.
In some ways, this is almost a wider expression of what happens in child protection. There is intense pressure on directors of children’s services to manage that fine line between maintaining a balanced budget and avoiding a child protection tragedy on their patch. But the response to the latter is, largely, to put money in to what is crudely called "the heavy end" – in other words, the investigation of cases where abuse is suspected or proven.
It takes a brave director to say that the bulk of the councils’ resources will go into preventive services in order to stop circumstances deteriorating. And what is more, that all other council services will be similarly reorganised so that, for example, all low-income families will no longer be located on sink estates.
There is, of course, a series of logical answers as to why this never happens. First, it would not be seen as a cogent defence in the case of a child’s death. Second, it is never a question of certainty as to which early interventions work – although we have much better data on this, if we were prepared to use it. Third, we don’t run other services in this logical way. We don’t, for example, have a preventive health service. Nor do we shape our environment, in terms of housing or community spaces that will permit us to prevent tension.
Two more challenges remain with early years’ provision: sustainability and targeting. The problem over sustainability is one of sticking with interventions long enough to really test out if they work. This is a particular problem for social work, which doesn’t have a very good history of learning what works and sticking with it. And, of course, it’s not helped by political agendas that usually want quick fixes rather than well thought through solutions that will inevitably take a while to implement.
The second further challenge – targeting – is making sure services really do meet those in greatest need. Some earlier criticisms of the Sure Start programme were that it focused on articulate parents being able to access services to the detriment of those whose requirements were greater. Clearly, the debate about universal as opposed to targeted services is one that continues to reverberate.
Faced with increasing evidence of the importance of early intervention, two actions are necessary. First, the public health reforms should be used actively to bring together those professionals charged with affecting the health and welfare of the under-fives in shared services.
And second, a sustained and evidence-based campaign is required to remind politicians that there are no quick fixes for fractured societies caused by fractured services. E M Forster’s message to "only connect" is as true of services for under-fives as it is of human relationships.
Dr Chris Hanvey is chief executive of the Royal Society of Paediatrics and Child Health