By Accountable Care Journal-
'We need an early years revolution' says a new report from the Health and Social Care Committee looking into services targeted at children in their first 1000 days of life. Is it time for investment in prevention and early intervention strategies to address health inequalities and boost outcomes?
Throughout the months from conception to age two, crucial developments take place that have a significant bearing on individuals for the rest of their lives. Over this period, the foundations of a child's development are laid down with more than a million new brain connections made every second.
This is the foundation of the report, which places an emphasis on the importance of these early years of childhood development, calling on the government to produce a long-term, cross-government strategy for the first 1000 days of life. This would involve reducing adverse childhood experiences, improving 'school readiness' and combating child poverty.
Dr Paul Williams MP, who led the Committee for this inquiry, slated past cuts to health visiting and the closure of children's centres as part of the reason for what he called the "crisis in children's mental health." He blamed this, alongside an increase in childhood poverty for causing issues that are being felt later in life.
The impacts of this period can be life-long. A study in the Lancet in 2017 found that adverse childhood experiences (ACEs) increase the likelihood of heart disease, cancer and mental health problems in later life. Further to this, individuals who reported ACEs were found to be thirty times more likely to attempt suicide than those who have not.
The Royal College of Paediatrics and Child Health welcomed the report, commending the recommendations for a cross-government strategy with 'clear goals' and 'framework for delivery. ' Dr Max Davie from the college called for the strategy to "focus on a number of key areas including infant deaths, smoking during pregnancy, breastfeeding and immunisation." These disproportionately affect children in deprived areas, meaning the knock-on effect of health inequalities on poorer communities is a worse start in life for young people.
The committee has proposed that local authorities develop plans in collaboration with local NHS providers, communities and the voluntary sector to implement the strategy across regions. For meaningful outcomes to be achieved, an integrated approach that spans public sector services, the independent sector and even involves collaboration with families and parents, is necessary. Of course, this will involve pooled funding, service coordination and a consistent process for measuring outcomes. Establishing just one of these frameworks is likely to prove challenging given the complexities of the organisations involved, despite a drive towards prevention and integration across the health sphere.
From here the government must take a lead. As Dr Williams says: "If our country is serious about prevention and reducing health inequalities then we must make massive investments and drive coordinated action right at the start of life."
Healthy Child Programme
The report calls for the government’s Healthy Child Programme to be revised and improved, primarily by expanding its focus. If the recommendations are to be implemented, this would involve a greater focus on the whole family with support beginning before conception and being restructured to provide greater continuity.
The current programme allows families to receive five visits from health visiting services until their child reaches the age of two and a half. However, an extra visit a year after this point and extra support for children whose development is off track are among the recommendations. This could likely involve elements of the Flying Start programme in Wales and Family Nurse Partnership in other parts of the UK.
In the past, early years and children's services have been subject to funding cuts, to the detriment of health outcomes. As Tim Elwell-Sutton, Assistant Director of Strategic Partnerships at the Health Foundation, outlines: "Spending on children’s services for 0-4 year olds (as part of the public health grant) has already fallen by 9 per cent since 2016/17 and is set to fall further next year (2019/20) - amounting to an overall reduction of 15 per cent," While the resource focus has, in part, been shifted to the acute sector, pressures there remain high too.
For the recommendations made in this report to become a reality, significant funding boosts will be needed. Will the Comprehensive Spending Review be used to provide the necessary investment in prevention and early intervention strategies? The committee is calling for such steps. However, with pressures on public budgets just as tight at the other end of the age spectrum, some tough choices will need to be made.
The full report can be accessed here.
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