The provision of healthcare support services in the period between conception and age two, House of Commons, 15 December 2020

Councils’ public health grant has been reduced by over £700 million since 2015. This grant funds 0-19 services, as well as substance misuse, sexual health and weight management services, which all contribute to outcomes in the early years.


Key messages

  • Local government has a crucial role to play in ensuring children receive the support they need during the initial formative stage of life. The Early Years Healthy Development review is welcome and will be important in setting the agenda for this work going forwards. 
  • An integrated, place-based approach to service delivery is vital to improving outcomes and developing excellence in early years healthy development. Local authorities, working with their partners in the NHS and the voluntary and community sector, are best placed to determine the local strategy that meets the needs of their communities.
  • Redesigning services around the needs of individuals in a place provides the best opportunities to improve people’s health and wellbeing. Any national strategy should enhance the integration work that is already taking place at local level and adopt a place-based approach.
  • Councils’ public health grant has been reduced by over £700 million since 2015. This grant funds 0-19 services, as well as substance misuse, sexual health and weight management services, which all contribute to outcomes in the early years.
  • To develop ‘excellence’ in the early years, the Government will need to reverse the reductions to the public health grant and ensure local authorities have the resources they need to commission innovative and effective services with a sufficient number of specialist practitioners and public health nurses.
  • Health inequalities are a key concern for councils. Reducing health inequalities by breaking the generational disadvantage that drives these should be a national priority. In order to achieve this, it is important that 0-5 services are delivered holistically. This should include services such as promoting community resilience and parental mental health; access to secure, affordable housing; access to skills and employment; quality childcare and financial security.
  • The Early Years Local Government Peer Review Programme, led by the LGA and the Early Intervention Foundation in partnership with the Department for Education, has been delivered to 27 local councils and has been shown to be successful in implementing a coordinated pathway for service delivery, bringing about systems change and generating better outcomes for children and families. It is vital this important work continues and the current funding, which is due to end in March 2021, should be extended to ensure important projects are not closed.

 

The role of councils

Health visiting touches on the wider determinants of health, health improvement, health protection and reducing premature mortality. Councils have a responsibility for delivering all of these through the public health outcomes framework.

Councils are also responsible for delivering prevention and early intervention services that have an impact on wider determinants of health such as housing, welfare and the environment. They also deliver the support that wraps around children and their families. This ranges from social care support to short breaks, mental health support, children’s centres to libraries and leisure centres, parks to the arts and much more.

It is important to note that children in the most deprived areas are less likely to reach a good level of development by age five than those in the least deprived areas. Although many councils are targeting resources at the most deprived areas, these resources are limited.

Councils want to protect our world class health visiting service by attracting, training and keeping new essential workers. The LGA has offered to work with the Department of Health and Social Care, the NHS and Health Education England to get the right number of training places commissioned and to deliver policies to ensure health visiting remains an attractive and valued career.

We are calling for a properly resourced, integrated workforce plan that underpins the current refresh of the Healthy Child Programme. In addition to ensuring we have a sufficient supply of specialist public health nurses, a workforce strategy should recognise the benefits of having a diverse range of health visiting, school nursing, children’s centre and other early years staff in children’s and health services. We believe that this will lead to better outcomes for children and families

Councils need the flexibility to meet the public health needs and priorities of their local communities. Whilst the current five mandated health visitor checks provide an assurance for a universal service, they are rigid and do not necessarily reflect local priorities. Local joint strategic needs assessment and health and wellbeing strategies are the statutory tools that help identify the needs and priorities of local communities. They can also help to identify local health inequalities, gaps and pockets of deprivation and local strategies for tackling these. This is not something that can be done at national level.

In our recent report A Child-centred Recovery we outlined further recommendations to improve outcomes in the early years and wider children’s services:

  1. The Government should properly resource councils to enable investment in preventative universal and early help services to ensure that children, young people and their families receive the practical, emotional, education and mental health support they need, as soon as they need it, especially in relation to the long-term impact of Covid-19.  Councils are innovative and adaptable, but we are approaching the point where there are no further efficiencies to be made, and no further innovations that can be cost-effectively delivered to protect local services.
  2. Dedicated action is needed to prevent the attainment gap from widening, including immediate work to stabilise the early years sector and support children and young people to attend school or to continue learning from home where required. The Early Intervention Grant has fallen from £2.8 billion in 2010/11 to £1.1 billion in 2018/19 – reinstating the lost £1.7 billion would provide a significant boost to early help services and the children and families who need them.
  3. The Government should review the early years system to ensure that investment supports its ambitions and that parents are clear on the best options for their children.

Early years peer review programme

A recent evaluation has found that The Early Years Local Government Programme has been instrumental in helping councils shape priorities and improve services and prospects for children and families.

The Early Years Local Government Programme includes a peer review designed and led by the Local Government Association and the Early Intervention Foundation in partnership with the Department for Education, has been delivered to 27 local councils across England as of March 2020. It aims to tackle development gaps in early language and literacy skills at the earliest opportunity and improve the prospects of disadvantaged young children.

An external evaluation of the peer review programme found that 92 per cent of councils said the peer review had contributed ‘a lot’ or ‘somewhat’ to raising the profile of early years among senior leaders and to developing and implementing an integrated strategy in their council. 83 per cent of councils felt that the peer review had contributed ‘a lot’ or ‘somewhat’ to implementing a coordinated pathway for service delivery; bringing about systems change; generating better outcomes for children and families.

As well as the peer review, the Local Government Programme also includes the Early Outcomes Fund, which provided grants of between £500,000 and £1.5 million to eight local authorities/partnerships to help them improve early years language outcomes and develop legacy tools.

It is vital this important work continues and the current funding, which is due to end in March 2021, should be extended to ensure important projects are not closed.

Contact

Jade Hall, Public Affairs and Campaigns Adviser

Jade is the LGA’s public affairs lead on community wellbeing, including adult social care, public health and mental health, and community safety, including licensing, counter-terrorism, domestic violence, and fire safety. Jade also leads on transport and air quality. Jade joined the LGA in October 2019, having previously worked for Alzheimer’s Society and ukactive.

jade.hall@local.gov.uk