The return (or reinvention) of early intervention or just more sticking plaster?

Published by Professional Social Work magazine, 9 November, 2021

It’s difficult not to see family hubs as children’s centres in another guise. Likewise, Best Start for Life – the over-arching government strategy of which they are part – is more than a little reminiscent of New Labour’s Sure Start programme launched in the late 90s.

This reinvention of the wheel was not lost when Chancellor Rishi Sunak announced plans to create 75 hubs in the autumn budget as part of £500 million to support children and families.

Nor too the irony of it coming from a government that has spent the last ten years slashing funding for early intervention and preventative services.

Nottingham City Council's plans to close six children centres and replace them with the hub model as part of cost-cutting moves may also raise fears.

But despite the politics, the principle of investing in early years and improving support to families within communities was welcomed as cause for optimism.

The National Children’s Bureau called it a “turning point for children and families”. Children’s charity WAVE said it could represent a “revolution” in how we support parents.

The government has earmarked £82 million for 75 new family hubs. On top of this it’s launched a £12 million family hub transformation fund for 12 local authorities to apply to set up additional hubs.

The aim is to create a network of one-stop centres for families providing joined-up universal services from 0-19, or 25 for children with disabilities. Services range from parenting classes, antenatal education and breast-feeding support to help with relationships, or even English tuition for non-native speakers.

The talk is of a “hub and spoke” system, with a physical building – the hub – becoming an established and welcoming part of the local community. The spoke bit is outreach services connecting to harder to reach communities or geographically remote areas. It will also connect people with voluntary sector support and community groups.

Learning lessons from the pandemic, the hubs will offer a mix of face-to-face support in a physical building as well as online and virtual services. The latter is expected to increase participation as travelling can present a hurdle to some families. Some people might prefer online support, for example, mothers needing help with breast-feeding or fathers accessing counselling.

The government’s strategy is based on research underlining the link between so-called adverse childhood experiences and poorer outcomes later in life: get the early years right in the first 1,001 “critical days” and you reduce far greater cost to society later.

Dame Andrea Leadsom, a key architect of the strategy, wrote in a foreword to her The Best Start for Life report published earlier this year: “Two is too late! We spend billions on challenges in society from lack of school readiness to bullying to poor mental health to addictions and criminality; and further billions on conditions such as obesity, diabetes and congenital heart disease.

“Yet the building blocks for lifelong emotional and physical health are laid down in the period from conception to the age of two and we don’t give this critical period the focus it deserves.”

Dame Leadsom, Conservative MP for South Northamptonshire, added: “Prevention isn’t only kinder, but it’s also much cheaper than cure…”

Speaking at a conference hosted by the Anna Freud National Centre for Children earlier this month, Will Quince, newly-appointed minister for children and families, said: “Education and in particular early years is at the heart of the levelling up agenda. Not only does it start with, but at its very heart is the family.”

He added: “I want support for families to be a golden thread running through government.

"This is the beginning of a conversation on family hubs. It is a hugely exciting time.”

The ethos behind family hubs is similar to that of children’s centres, of which there were more than 3,600 at their peak but around 1,000 have since been forced to shut due to cuts. A key difference between the two, however, is that the latter was aimed at suppoting children from birth to the age of five.

Key to their success, says Dame Leadsom, is their accessibility and focus on holistic support as part of the fabric of local communities.

“I would like to see them open all day six days a week. Universal access, non-stigmatising. To be able to have your antenatal sign-on in a family hub, register a baby’s birth in a family hub, attend antenatal parenting classes. Get the dad’s or other partners in, make it a really welcoming place so everyone goes there, so it is as normal to go to a family hub as it is to go to the GP or the local library.”

This, and the Best Start in Life strategy, represents a shift from targeted support programmes, such as Troubled Families focused on a small number of families with the most complex needs; something underlined by the repetition of phrases such as “non-stigmatising” and “universal services” by those spearheading the roll-out.

Creating a one-stop integrated service also aims to tackle the weariness families feel at having to repeat themselves to lots of different services.

Dr Camilla Rosan, strategic lead for the National Centre for Family Hubs and head of early years at the Anna Freud Centre, said: “Families find it very hard to tell their stories multiple times to multiple professionals. This is associated with disengagement. They just don’t want to do it again.

“We need to join up the vision within integrated care systems and other integrated models of practice. The hubs also need to join up with third sector and other community capacity.”

For Dr Rosan, the case for early support is incontestable.

“Everyone can agree on the need for early intervention because we know the impact when early adversity is not addressed,” she says.

“We know it across a wide range of domains. Educational outcomes, emotional development, behavioural development but also physical health and motor development.

“We also know these patterns are intergenerational and societal. There is a huge cost associated with unmet early adversity. We really need a systems-wide intervention to be able to start to break these patterns and give families the chances they deserve.”

Not everyone, however, is comfortable with the focus on adverse childhood experiences (ACEs) as the root cause of problems.

Writing in PSW last year, Professor Morag Treanor criticised it as a “deterministic concept” based on a “deficit model of the family and mothers especially”.

She believes a focus on ACEs ignores the “structural circumstances in which children and families live”, adding: “Children are more likely to experience adversity in childhood when they also experience poverty and inequality.”

While policy planning shouldn’t ignore adversities, Prof Treanor stresses “the whole family context, including financial and societal, needs to be taken into consideration”.

The fact that the roll out of family hubs is taking place against a backdrop of increasing cost of living, an imminent tax rise from next April and removal of the universal credit uplift is part of that context.

So too the fact that it is happening in the wake of a decade of savage cuts to public services and an exacerbation of inequalities caused by the pandemic.

A recent report found 28 per cent of health visitor appointments and 12 per cent of baby and toddler groups are no longer available to new parents as a result of the pandemic.

Labour’s shadow education secretary Kate Green branded family hubs “sticking plaster” that “rings hollow after 11 years of Conservative cuts”.

Everyone will agree that investing in early intervention is crucial to supporting families. However, if the government doesn’t meaningfully address the structural inequalities that keep some families disadvantaged, then family hubs could well end up being little more than just sticking plaster.