Children: Early Intervention

Baroness Walmsley Excerpts

Thursday 17th March 2011 Lords Chamber

Moved by

[Baroness Walmsley]

To call attention to the cost-effectiveness, and impact on quality of life, of early intervention in the first few years of a child’s life; and to move for papers.

[Baroness Walmsley]

My Lords, I am grateful for the opportunity to debate this very important topic and look forward to hearing from the star-spangled cast assembled in the Chamber. In particular, I look forward to the maiden speeches of my noble friend Lord Storey and of the right reverend Prelate the Bishop of St Edmundsbury and Ipswich.

The successful development of our children is one of the most crucial responsibilities of government, both for their sake and for the sake of society and the economy as a whole. There are about 12 million children in the UK, of whom about 1.5 million are growing up in “at risk” situations. However, only 25,000 were on the “at risk” register when it was discontinued. Practitioners have had to raise the bar for intervention because of lack of resources. For example, if one or even both parents are drug addicts, that is no longer sufficient cause to act.

Each child has rights under Article 19 of the UNCRC which compels Governments to intervene on their behalf. It states:

“Governments should ensure that children are properly cared for, and protect them from violence, abuse and neglect by their parents or anyone else who looks after them”.

That is why, although in our culture government intervention in family life is a sensitive issue, we must respond to the evidence that is stacked up so high about the importance of the early years.

It is parents who should bring up their children, and we must help them do it well. In his recent report, Graham Allen states that,

“if we could equip parents to optimise … maternal responsiveness and their impact on their 0-3 year old children, we would be laying secure and strong foundations for all the work that the public sector did thereafter … Crucially, it would enable public expenditure to become developmental and not just remedial”.

The WAVE Trust states:

“The evidence overwhelmingly indicates that dysfunction strongly correlates with adverse experience in early life”.

The relationship with the mother or first carer is the most crucial in the whole of life. Unless there is attachment and attunement, the child will find it very difficult to form future relationships. Unless she feels warm and safe, is rocked and stimulated, has eye contact and a lot of love, her brain and the rest of her body will not develop to its full potential and may become very damaged. Damaged brains mean damaged people, damaged lives and damage and cost to society. To coin a popular phrase, it is a “no-brainer” that investing in that crucial relationship and the early years is money well spent.

There are multiple reasons why I was anxious to have this debate at this time, in the hope of influencing the Government. The Budget is next week. The Government have emphasised their firm intention to improve social mobility during their term of office, and their strategy will be published soon. We also await the child poverty strategy, which will no doubt respond to the report by Frank Field. Graham Allen produced last December his report entitled Early Intervention and its equivalent in Scotland, the Deacon report, has already had a major influence on the policy of the devolved Government. There has been a report on children's services from Professor Eileen Munro, and the important Green Paper on special educational needs. Dame Clare Tickell's review of the foundation years will be out soon. All these government-commissioned documents demonstrate the determination of this coalition Government to get things right for children. What we need to know now is how the Government are going to respond to all this well-evidenced advice, and I look forward to hearing about that from my noble friend the Minister.

There is an enormous amount of evidence which shows that the prenatal and first three to five years of a child’s life are the most important. This is because of the biological fact that the human brain is so complex and so large that we have to be born three years premature. In other words, our brain is not fully developed at birth. It reaches 85 per cent of its potential at age three, and development goes on into the teenage years. During this development, the brain is extremely vulnerable to trauma and responsive to the child’s experience.

Several studies show that it is possible to predict things about a child’s future from as early as 22 months. The Prime Minister himself is clearly aware of this. He said to the Local Government Association in 2007 that if you,

“ask a primary school teacher with a class of 5 year olds, which ones are likely to be in trouble”—

with the law—

“in 5 or 10 years’ time—and chances are, the teacher will be able to tell you with total accuracy”.

It is not just the law where effects will be seen. Education, health, working life and relationships will all be affected. A number of important longitudinal studies all point to the fact that, if we get things wrong in the early years, the results will be long-lasting and expensive.

So what do we mean by early intervention? The word “early” can be ambiguous. It can mean intervening early in a child’s life or early in the genesis of a problem that develops at any stage. All the evidence shows that, if you do enough of the first kind, you avoid the need to do a great deal of the second kind. It is also more cost-effective, bringing returns of £7, £9, £12 or even £19 for every pound invested in various programmes. A £600 family programme can save £45,000 to keep a child in custody for a year.

Some countries are leading the way—notably Sweden, where they start very early indeed with prenatal care. Nearer home, in Scotland, the Finance Committee of the Scottish Parliament has concluded a six-month investigation into preventive spending. It ended with the unanimous cross-party conclusion that a shift to investment in early-years preventive spending should be a priority for action by the Scottish Government, and that it should be carried forward in a non-partisan, all-party manner not just during the next Parliament but over the next 20 years. I believe that we should do the same in the rest of the UK because the problem extends well beyond today’s generation of children. Graham Allen said:

“Those who are dysfunctional have to be assisted not only because of the problems they create in the here and now for themselves and society, through their involvement in crime, drugs and violence. Even more importantly, they also need to be assisted because in their role as parents such problems will impact adversely on newborns and be perpetuated intergenerationally”.

Therefore, we need to take action now for the sake of future generations.

The economic costs of falling behind are enormous, and we are falling behind other countries. UNICEF’s Report Card 9 has a league table of inequalities in child well-being, which shows the UK in 21st position among other OECD countries. The consequences of this include the risk of poorer health and nutrition, more frequent visits to health services, impaired cognitive development and educational under-achievement, reduced linguistic ability, lower skills and aspirations, reduced productivity and adult earnings, higher rates of unemployment and welfare dependence, increased behavioural difficulties, crime and antisocial behaviour, and a greater likelihood of teenage pregnancy and drug or alcohol dependence. The significant costs are borne by business and the economy as a result of lower rates of return on investment, greater expenditure on social services and the justice system, and lower productivity and tax revenues. There is also a price tag on social cohesion and the overall quality of life.

Our Government are relying on growth to improve our economic situation, and growth relies on the abilities of the workforce. A recent report by the Nobel prize-winning economist, James Heckman, on the crucial importance of the pre-school years for skill formation, and the critical role of skill formation in programmes to reduce inequalities, shows that gaps in achievement are primarily due to gaps in skills; skills determine success; families are major producers of skills; gaps emerge early; and investment in the early lives of children in disadvantaged families will help to close achievement gaps. He points out, too, that the skills needed for success require more than cognition and IQ; also important are soft skills such as conscientiousness, perseverance, motivation, ability to work with others, and so on.

Frank Field has outlined the link between child poverty and achievement. He acknowledges the massive amounts of money that the previous Government spent on trying to get families out of poverty but accepts that they had limited success. He now believes that the spending was not sufficiently targeted at the early years and recommends that Governments concentrate not just on supplementing incomes but on providing services to support families. Poverty contributes to educational failure, family stress—which in its turn leads to poor child development—mental health problems, family separation and often violence, so its effects are not just about how big a television you can afford or even whether you can buy good, simple food.

So when and how is it best to intervene? The Chief Medical Officer for Scotland, Harry Burns, concluded that there are four key periods when one can make the greatest difference—pregnancy, age zero to one, pre-school, and the transition from primary to secondary school—and that we should focus investment on interventions for each of these periods based on the strongest evidence.

The Graham Allen report talked about a virtuous circle of interventions: a prenatal package, a postnatal programme, Sure Start children’s centres, primary school follow-on programmes, anti-drug and alcohol programmes, and pre-parenting education through PSHEE in schools for teenagers before they become the next generation of parents. He is right to start with the period before birth. Professor Michael Meaney from McGill University recently explained the important physical changes that take place in the brain as a result of early life experiences and that some of these changes persist throughout life. He did this via the science of epigenetics, which explains how the early life environment changes the function and structure of our very genes, such that twins with identical parental DNA could end up with very different effective DNA. He claimed that early family environment is correlated strongly with many health problems. He said that the child’s experiences affect messenger RNA—a substance through which DNA has its effect on our cells—and that the effects of various chemicals produced during abuse and stress affect the development of the brain and the personality. He emphasised the critical importance of protecting mothers from stress during pregnancy. Pregnancy is the peak period in relationships when domestic violence occurs. Whereas outside pregnancy men mainly hit their partners on the face, during pregnancy the principal target is the woman’s stomach. Therefore, in the argument between nature and nurture, nurture wins and it is the only one that Governments can affect.

All the evidence leads to the importance of fathers as well as mothers and the benefits of investing in parenting programmes. However, there is compelling evidence from the charity Relate that programmes that do not include work on the relationship between the parents are not as effective or enduring in their effect. It tells us that 70 per cent of relationships deteriorate in the first year of a child’s life and that 20 per cent break up. However, trained counsellors and health visitors can and do offer help, so Relate is calling for all health visitors to receive training on the importance of the parental relationship to child development and on how to identify and address the problems.

We can have effective early intervention only if we identify problems early. Here, I should like to mention my concern at the reduction in posts for educational psychologists, who play such an important professional role in identifying not just educational problems but many other mental and emotional problems. There are many effective interventions. Other colleagues will speak about the importance of early intervention in autism, speech and language therapy, child safeguarding, special educational needs, children in care, literacy and counselling in schools.

Getting children into high quality early education is vital, especially for the disadvantaged two year-olds who are now about to receive free early years provision. I am proud to tell the House that, even during all the budget cuts that local authorities have had to endure recently, not one Liberal Democrat authority has closed a single Sure Start centre. It is a matter of priorities and they have made the right decisions. When children get to school it is important that there are follow-on programmes which involve their parents. School Home Support and the FAST programme from Save the Children both help parents to get involved with their children’s learning. Programmes which help children to develop emotional resilience and relationships are also essential. I believe that the SEAL programme and a high quality PSHE come in here.

Where do we go from here? Graham Allen proposes a national assessment centre to do research and evaluate initiatives. Personally I feel that we already have plenty of evidence and need to get on with it. There is, of course, the need to measure the value for money of programmes so that local authorities have a good evidence base to help them to choose on what to spend their money, but that evaluation must be done well. There must be a political will, such as now exists in Scotland and Wales, and there must be money up front. But Graham Allen is talking to the banks about that.

In conclusion, we cannot affect the genes that a child receives—that is up to his parents. However, we can affect how his mother is treated and supported when she is pregnant. We can affect the information that parents receive about what babies need. We can set up a system to identify and work with families that need extra help and support. We must do all that or continue to fail our children.

--- Later in debate ---

[Baroness Walmsley]

My Lords, I thank my noble friend and all those who have taken part in this debate today. Our two maiden speakers proved the truth of the saying that it is not just what you say, it is who you are when you say it, because we would not have had such respect for what they said without our knowledge of the experience that they bring to their opinions.

I take away a number of particular points from today's debate. My noble friend Lady Benjamin has given me a new mantra: a hug a day keeps the doctor away. I shall stick to that. The noble Baroness, Lady King of Bow, reminded us what 4Children has said so perceptively; the Minister reflected on the need for a culture shift. The noble Lord, Lord Ramsbotham, reminded us of the importance of food for thought; perhaps we should bring back school milk, orange juice and cod liver oil. The noble Baroness, Lady Brinton, brought us up short in a serious debate by reminding us that childhood is a time for happiness and fun.

The noble Baroness, Lady Warwick, made an important point about early-years staff and our ridiculous upside-down funding. Only this week, I was told that staff who work with the early years are paid half what teachers of five to 18 year-olds are paid. Does that not reflect the value we put on their work? There really is a need for a culture shift. I look forward very much to the statement, to which the Minister referred, in the summer of the Government’s early-years strategy when no doubt we will debate it again. With that, I beg leave to withdraw the Motion.

Motion withdrawn.