Evidence-based Early Years Intervention

Chris Skidmore Excerpts

Thursday 21st March 2019 Westminster Hall

[The Minister for Universities, Science, Research and Innovation (Chris Skidmore)]

It is a pleasure to serve under your chairmanship, Mr Davies. I congratulate the right hon. Member for North Norfolk (Norman Lamb) on securing this important debate on behalf of the Science and Technology Committee. I know this is an area that he cares passionately about, and I pay personal tribute to the work he did in a previous Parliament as Minister of State for Community and Social Care between 2012 and 2015.

I also thank other hon. Members who have participated in today’s debate. Their contributions have shown not only clarity of thought about these issues, but real passion about what is taking place in their local areas. It is a tribute to those Members’ local commitment that they have worked with their communities to address these issues. We have heard from the hon. Members for Bristol North West (Darren Jones), for Stockton South (Dr Williams), for Linlithgow and East Falkirk (Martyn Day) and for Batley and Spen (Tracy Brabin), and there have also been important interventions from the hon. Members for Stroud (Dr Drew) and for East Lothian (Martin Whitfield). I am grateful for the opportunity to set out the Government’s approach to addressing early childhood adversity and trauma, and the actions we are taking to improve children’s life chances through early intervention.

The Government are strongly committed to effective early intervention in childhood. That means not only effective prevention, identification and support for children and families in need, but building a strong evidence base to underpin those things. The hon. Member for Bristol North West asked whether I, as Science Minister, would commit to ensuring that we take forward an evidence-led approach. I passionately believe that the investment we make in research must not only go into healthcare research, but into the social sciences.

[Norman Lamb]

I appreciate the point that the Minister is making, but does he recognise that without collection and national analysis of data, we have no idea how public money is being spent across the country and whether it is being spent effectively?

[Chris Skidmore]

I appreciate the right hon. Gentleman’s point, and I agree with what he has said about data collection; I will return to that topic later on. I am also a new Minister in the Department for Education, covering the universities sector. I recently set up a higher education data advisory committee, because I value the importance of such evaluation at both local and national level— for example, when we look at university access and participation. We have also set up the Evidence and Impact Exchange in partnership with King’s College London and Nottingham Trent University, to examine the methodology behind encouraging more disadvantaged pupils to have access to, and opportunities at, university. That is at one end of the scale, but today we are talking about what we need to do at a far earlier stage of a child’s education.

When it comes to scientific research, and early years research in particular, we must ensure that we listen to the scientific community when it comes to neuroscience and cognitive behaviour; that we are careful about how we use that scientific research to make public arguments and develop public policy; and that we work with those scientists. I am sure that they will develop new innovations and scientific research, which may even challenge our understanding of these policies. It is important that we work together as a community, understanding that evidence base and drawing on the good work already conducted at national and local level.

I welcome the recent establishment of the early years ministerial group on family support, which is reviewing how to improve the support available to families in the first two years of a child’s life, identifying opportunities for co-ordination and improving cost-effectiveness. I look forward to the valuable contribution of that group, which will provide specific recommendations to the Secretary of State. I am unable to provide a timetable for that, as the hon. Member for Batley and Spen asked me to, but I will ensure that the group is aware of today’s debate. I am sure that its members will all wish to engage with the Science and Technology Committee regarding specific issues raised in its report, and on any future work that the Committee does. The Government value the work of that Committee and recognise its place in public discourse. As we proceed, we will make sure that we engage with some of the recommendations that the Committee has made.

[Mike Gapes in the Chair]

Turning to the role of Government in early intervention, the model for adverse childhood experiences gives us a helpful focus for action on early intervention. We must also ensure that there is an overarching model for care and support. Fundamental to that is the belief that local areas are best placed to understand the needs of their local communities, and to commission early intervention services that best meet those local needs as part of a whole systems model. We have heard about some excellent examples of local innovation, such as the one given by the hon. Member for Bristol North West, who talked about the work of Bristol City Council. The fact that the council had to hold its conferences twice clearly demonstrates the demand for those services. We also heard about the work in Greater Manchester. It is important that we allow that innovation and creativity to flourish as part of future work, but, importantly, we should not expect local areas to do that work alone. The matter is a serious and complex one, and our approach, which reaches across all Departments and Governments, reflects that.

Our approach is based on a number of principles, which are as follows. First, early rather than late intervention is key; secondly, the role of central Government is to support, facilitate and work with local government and other partners to tackle these issues together; thirdly, our solutions should be focused on outcomes and underpinned by evidence; and fourthly, successful strategies should be identified and shared widely within the sector. With that in mind, we have prioritised three key areas for central Government focus to build resilience to adversity and trauma. Those are: physical and mental health in pregnancy and childhood; protecting vulnerable children through effective children’s social care; and improving social mobility, supported in the early years by high-quality early education settings and learning in the home. That is underpinned at all levels by our work to improve services and partnerships locally, and to build the evidence base for what works.

I will address each of those areas in turn. First, when it comes to supporting physical and mental health in pregnancy and childhood, the Government recognise the serious impact that adversity in early childhood can have on children as they grow up; the hon. Member for Stockton South set out some striking examples. Support must begin as early as possible, and maternity services have a central role to play. The NHS long-term plan will make the NHS one of the best places in the world to give birth by offering mothers and babies better support. It will also expand the provision of quality mental health support for new and expectant mothers and their families. The evidence shows that this is a key opportunity to improve outcomes for mothers and children.

[Dr Williams]

I thank the Minister for highlighting the importance of maternal mental health, in particular. However, the National Childbirth Trust has identified that half of all women who experience mental health problems during the perinatal period say that they were never asked about their mental health, and that their mental health problems remain undiagnosed. Given what the data and evidence show, will the Minister commit to looking at that issue and making representations to the Department for Health and Social Care? Although the Department has acknowledged the problem, it has failed to adequately adhere to the National Institute for Health and Care Excellence guidance, which states that all new mums should have routine assessments in their general practices at six to eight weeks, to better identify perinatal mental health problems.

[Chris Skidmore]

I thank the hon. Gentleman for raising that issue, which I am happy to raise with the relevant Minister. I am meeting the Minister with responsibility for mental health shortly to discuss mental health issues surrounding students, and I will make sure the issues are placed on the agenda for my discussion with her.

[Tracy Brabin]

Although we welcome the recent announcement of 5,000 additional health visitors, can the Minister say whether there will be an opportunity to collect data on how many visits a child has? To increase the number of visits from the statutory five, we need the data to enable us to know whether the extra health visitors are having the impact that I know the Government want.

[Chris Skidmore]

I will come to the question of health visitors later in my speech, but I will be more than happy to pass on the hon. Lady’s point about the collection of data and look at what evaluations might be possible. I will certainly make sure that hon. Members’ contributions are reflected in my discussions with the Department.

Local authorities are receiving £16 billion between 2015 and 2021 to spend on public health functions, which includes funding to support the healthy child programme and the mandated five health visits, which the hon. Lady mentioned, for children between the ages of nought and five. We are seizing the opportunities presented by such moments with families. A key piece of partnership working between the Department 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 community needs early. The health visitors will then cascade the training to provide even greater reach. It is important to make sure that an evaluation takes place to make sure it is as effective as possible.

On the recruitment of additional health visitors and the quantity of visits, health visiting services are commissioned by local health authorities, and health visitors are employed by the local health service providers. However, the Government will continue to work with partners, child development experts and professional organisations representing health visitors to ensure that the healthy child programme remains an effective and evidence-based framework providing good health, wellbeing and resilience for every child.

On the wider issues around early intervention and making sure it is adversity-targeted among the early years workforce more broadly, it is crucial that early years practitioners are well trained to protect young children from the impacts of adversity and trauma. As part of the early years foundation stage statutory framework, service providers are obliged to ensure that all staff have up-to-date knowledge of safeguarding issues and are equipped to identify and address signs of abuse and trauma. We want to equip the early years workforce to deliver outstanding services, to adopt evidence-based approaches, to learn from best practice and to deliver quality outcomes. The Government are supporting that with a professional development fund and similar programmes, such as the newly established Social Work England, which will ensure that social workers receive the highest quality initial education access and continuing professional development.

[Norman Lamb]

It is helpful to hear what is happening now. Does the Minister see value in defining a national strategy—the approach taken in Scotland and Wales—to try to drive the good things that he says he wants and make sure they happen everywhere, or does he resist the idea? It is important for us to understand whether there is an opportunity to work together with the Department to try to achieve something that is greater than the sum of its parts. Is he up for that and could he persuade his colleagues, or does he positively resist what we are arguing for?

[Chris Skidmore]

The right hon. Gentleman has stolen the latter part of my speech. When it comes to the broader point, I recognise that the Committee’s work, for which the Government are extremely grateful, reflects on the development of a national strategy. Currently, the Government do not consider the formal publication of a national strategy to be necessary. However, the Government will seek to review the approach through the spending review and the upcoming prevention Green Paper, which will build on the November 2018 Department of Health and Social Care report “Prevention is better than cure”, and its priorities. Also, we will look forward to the value that the early years family support ministerial group will add to the Government’s approach. Although I cannot commit in today’s debate to taking forward a national strategy, the Government are certainly working on a future Green Paper and the approach might change.

It is important to reflect on a balanced collection of the evidence that demonstrates what works, which will then inform any future approaches as part of the future prevention Green Paper. I realise that my response does not entirely answer the right hon. Gentleman’s question, but I want to reflect on the fact that the present does not necessarily rule out a change of direction in future.

Various Members mentioned children’s centres. The Government believe that children’s centres have an important role to play in early intervention, but it is right that local councils continue to decide how to use them as part of the wider system of local services. As part of our local government programme, local authorities are looking into how early years services can be improved. The right hon. Gentleman raised the question of Ofsted inspections. When inspections of children’s centres were suspended, there was at the time an agreement that they were not fit for purpose. However, children’s social care services and all registered early years prevention, including that delivered in children’s centres, remain subject to robust and regular Ofsted inspections.

When it comes to the consultation that has been mentioned and the delay in moving forward, the Department still needs to understand how local authorities effectively use centres to improve outcomes as part of their broader strategy before we go further. That is why we will be investing in What Works, which I will talk about later in my speech, working with the Education Endowment Foundation and delivering the £8.5 million local government programme. The programmes will inform the next steps in our strategy, including any future consultation. We need to look at the evidence from the programmes before deciding whether a consultation is indeed the correct way ahead.

[Tracy Brabin]

The Minister probably will not be able to answer this, but is there a timeframe for the consultation on What Works? Is it a two-year strategy? How long will local authorities have to wait to get something out of the Government for their children’s centres?

[Chris Skidmore]

I will talk later in my speech about issues around evaluation, What Works and the Education Endowment Foundation. As for the timeframe that the hon. Lady asked about, if I am unable to provide an answer in this debate, I will ensure that the Department writes to her and the Committee about it.

On the free hours provision that the hon. Lady mentioned, the proportion of disadvantaged two-year-olds taking up a Government-funded place continues to increase and has risen to about 72%—higher than ever before—so the entitlement is still successfully reaching the families who need it most. The 30 hours provision continues to help a wide range of families, and a lone parent has to earn only around £6,500 a year to access the 30 hours of free childcare. Parents are also eligible if they are self-employed or on a zero-hours contract. We will continue to provide local authorities with lists of potentially eligible parents in order to support them and directly target hard-to-reach families. It is important to reflect on that when we look at the evidence. There is an opportunity for positive data sharing and using data to inform local authorities.

[Tracy Brabin]

The Minister is being incredibly generous with his time, and I am grateful. I know that this is not necessarily his brief, but I want to flag up that I hear from maintained nurseries that eligibility for access to the 30 hours for two working parents is resulting in a widening of the disadvantage gap between children who access 15 hours as statutory and children whose parents work. Although it is a positive step to provide childcare for working parents, the disadvantage gap cannot be allowed to continue.

[Chris Skidmore]

The Government’s independent evaluations of early delivery showed that with 30 hours of free childcare about 78% of parents report greater flexibility in their working life, and a quarter of mothers can now work more hours. That is one aspect of the evaluation, but it is important that we continue to monitor all areas of the policy’s impact. We will continue to monitor the impact of the offer closely. I will ensure that the Department reflects on the comments that the hon. Lady has made about the 30 free hours issue.

On the question of protecting vulnerable children through effective children’s social care, we know that many children in need have experienced adversity and trauma, which is why we are strengthening children’s social care to ensure that it is effective and that it protects vulnerable children. The Department for Education children’s social care innovation programme has invested almost £200 million in 98 projects to develop, test and scale new approaches to supporting children in the social care system. We have also committed £45 million to the partners in practice programme, where we are working with 20 of the best local authorities to deepen our collective understanding of what excellent children’s social care services look like, while providing practical support to the sector. We are spending around £3.5 billion in total on our early education entitlements this year alone—more than in any previous year under any Government. We are supporting parents to improve the quality and quantity of adult-child interactions, as positive adult-child relationships are key protective factors against adversity and trauma. Following our successful home learning environment summit in November, we continue to work with businesses and other partners and are developing a campaign to launch later this year.

Looking beyond parents, we know that a skilled early years workforce is also key. Alongside our training for health visitors, we are investing £20 million in our early years professional development fund, which will offer training to practitioners in disadvantaged areas, particularly for the support of early language, literacy and numeracy outcomes. As I have already outlined, local areas have a key role to play in commissioning and delivering effective early intervention services to meet complex and specific needs locally. The Government want to support them in that task, as they should. I will give three examples, the first of which is the troubled families programme, where a multi-agency, whole family approach is advocated, in work with local areas to transform the way services are delivered. We committed £920 million to the troubled families programme between 2015 and 2020; we achieved significant, sustained progress with 130,000 families; and we aim to achieve a similar improvement for 400,000 families by 2020. Forty-nine per cent. of families on that programme have at least one child under the age of five.

The second example is the reducing parental conflict programme, which works with councils across England to integrate approaches and services to address parental conflict. It is supported by £6 million that we are investing to improve the outcomes of children of alcohol-dependent parents, because we know that alcohol misuse has a severe impact on parental conflict and childhood adversity.

The third example is the Department’s early years local government programme, which I mentioned earlier, which will focus on how local services work together across health, education and early help, to improve outcomes at age five. As part of that work, multidisciplinary peer reviews will support councils to identify reforms to services and to our early outcomes fund, which will provide £6.5 million of grants to local authority partnerships to improve the delivery of services. That programme will also look at what works, including effective models of service provision, and spread that learning across the sector.

As I have said, the Government remain strongly committed to the What Works initiative, embodied in three What Works centres—the Early Intervention Foundation, some of whose data analysis the right hon. Member for North Norfolk has mentioned, the Education Endowment Foundation and the centre for children’s social care. To improve the way organisations create, share and use high quality evidence for decision making and implementation, those centres are already producing a diverse range of important materials and support for local commissioners. Part of Government’s funding for the Early Intervention Foundation is being used to establish an early years transformation academy, which will provide a framework for sharing learning, including events and online material for leaders, commissioners and other stakeholders. More intensive academy work will begin in June 2019 and provide further opportunities to pool learning.

The Government will also, as we refresh individual Departments’ areas of research interest, consider including further research into early intervention methods for addressing childhood adversity. Some of the Departments’ published research aims for 2018 and 2019 already seek to tackle issues raised in today’s debate. For example, the Department for Work and Pensions will continue to investigate how best to support families in distress to reduce parental breakdown and separation. The Ministry of Housing, Communities and Local Government is taking forward work to support effective local government, which is key to delivering effective early intervention strategies. The Department of Health and Social Care is focusing on research on mental health. I have outlined the work that is being done to support children’s mental health and wellbeing in schools, which will help to build resilience to adversity and trauma. Interventions in the health system more generally will be tested to maximise effectiveness and cost-effectiveness. Finally, the Department for Education investigates the early years and seeks to foster childhood development for those with disadvantaged backgrounds, who are at higher risk of experiencing adversity and trauma in childhood.

Separately from departmental research budgets, UK Research and Innovation funds research and innovation across all disciplines and sectors, including disciplines directly relevant to this area. Funding for the Economic and Social Research Council has included co-funding a project with the Early Intervention Foundation. UKRI will continue to consider what future funding is most appropriate in that research area.

The right hon. Member for North Norfolk raised the issue of national data collection. There are currently two separate data collection and national reporting systems for universal health visitor review data. Data is collected via Public Health England’s interim process, which is a voluntary submission of aggregate data provided by local authorities that covers universal health visitor service delivery metrics and outcomes. However, that method of data collection is due to be superseded by a record-level collection through the community services dataset, for which NHS Digital has published the information standards and established the technical infrastructure.

It is also important that we reflect on the use and sharing of data at a local level. I mentioned the troubled families programme in connection with co-ordinating local approaches; the programme has also taken forward an early help service transformation model and toolkit, which provide practical advice on service transformation, explaining what it means, how it can be developed and how to measure and monitor progress locally. That will be shared with local partners. The local government programme will also allow local authorities to spend on digital advancements in data collection. As part of the peer review programme, best practice on data collection and sharing will then be disseminated nationally.

As to increasing the use of evidence-based programmes in free childcare, the Government are supporting early years settings to put in place high-quality evidence-based provision. I mentioned the £20 million professional development fund; the Government are also investing £4 million in trials focused on interventions that improve the home learning environment, delivered by the Education Endowment Foundation. Results from the trials will be available over the next two years and will be used to inform future policy for commissioning decisions.

[Tracy Brabin]

I am very interested in staff training. To return to a question that I asked in my speech, at what point—level 3, university, or whatever—would the relevant training be included? I would be very interested to hear the answer, because high-quality staffing is certainly at the heart of closing the disadvantage gap. It is about not just childcare, but education, so we need to ensure that all staff have all the tools at their fingertips.

[Chris Skidmore]

I have touched on some of the Government programmes that have been taken forward for staff training. The hon. Lady is absolutely right that we need to ensure that staff training takes place at every level, from those starting off in the early years workforce right through to continuous professional development for early years workforce leaders. I will have to write to her on her specific point about timing, as well as on the points she raised earlier. I hope that that is satisfactory.

As I mentioned, the Department for Education is reforming the early learning goals at the early years foundation stage. The first stage of these reforms will be followed by an external evaluation of the pilot, helping to generate learning in this area and allow reforms to be refined ahead of full roll-out.

The Government are absolutely committed to What Works and improving how the Government and other organisations create, share and use high-quality evidence for decision making alongside the What Works centres, including the Education Endowment Foundation and the What Works centre for children’s social care.

The Early Intervention Foundation has an important role to play in testing and communicating what works to improve outcomes through early intervention. The EIF has played a key role in bringing evidence and rigour to the early intervention debate. The Government have provided funding of £7.3 million to the EIF until 2020, and the Government will review funding for the EIF in the forthcoming spending review. The right hon. Member for North Norfolk mentioned the Chancellor of the Exchequer’s spring statement, and I am sure he will make representations to the Chancellor. I will ensure that this debate and its text are communicated to the Treasury so that it is aware of the points raised by the Committee in its report and by the debate today about the importance of continuing funding for the EIF going forward into the spending review.

I assure Members that the Government take the Committee’s report and the issues it raises incredibly seriously. I have set out our approach to childhood adversity and trauma, which includes the actions taken through programmes that are run and funded centrally. It is also about supporting local areas to ensure they are commissioning and delivering evidence-based early intervention services.

I have mentioned the specific issue of the strategy. The Government do not consider the formal publication of a national strategy to be the best approach at this time, and I have set out our current approach through the various programmes. The Government are confident that those programmes will bear fruit, but we will seek to review that approach through the spending review and the upcoming prevention Green Paper, which will build on the November 2018 Department of Health and Social Care report, “Prevention is better than cure”, and its priorities, which I set out earlier.

I have also mentioned that the early years ministerial group on family support will add to the Government’s current approach. I am sure that the Leader of the House, given her passionate commitment to this specific area and to taking forward cross-Government work, will take a keen interest in reviewing the contributions made in this important debate.

It is the role of Government to provide guidance on local approaches to early intervention, but there is a fine balance to be struck between local direction and central Government oversight. The Government believe that it is fundamentally for local authorities to determine how their services best meet the complex demands of their areas, not central Government, but we will nevertheless continue with our responsibility to support What Works initiatives and ensure that local systems are working well. The Government will also consider including further research into early intervention methods for addressing childhood adversity as we refresh individual Departments’ areas of interest. The issues that make up childhood adversity and trauma, such as verbal, physical and sexual abuse, parental separation, mental illness and alcohol abuse, are at the core of the work of numerous Departments and major programmes.

We want to ensure that we build long-lasting protective factors against adversity and trauma in the early years. The Government have invested in the early years. By 2019-20, we will be investing around £6 billion a year in early education and childcare support to cover free entitlements, tax-free childcare and the childcare element of universal credit. The Government see effective early intervention as essential to our work to bring about cost efficiency in public services and, above all, to ensure that the human factor is there to improve people’s lives and that children are not put at risk. The factors that Members have mentioned help to ensure that children have strong and healthy lives. As I have already outlined, the Government are putting research funding investment into early intervention initiatives.

Finally, as Members can probably see, I am the Minister for Universities and Science, so I wish to put on record the apologies of the Minister for Children, my hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi), for being unable to speak in the debate. He will happily meet the hon. Member for North Norfolk to reflect on the report and take forward any issues of concern that have been mentioned in the debate.

The Government are keen to continue to engage fully, as I do—wearing a different hat, as Science Minister—with the Science and Technology Committee. We are very grateful for the conclusions the Committee came to in its report.