Poverty reduction - Playing a longer game

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Is it possible to break the cycle of poverty through intervention in young children's health and well-being? Pat Gordon-Smith weighs up the potential of different initiatives in England, Wales and Scotland.

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Last month, a cross-party group of MPs launched a manifesto aimed at breaking the cycle of poverty in England through a sharp focus on the health and well-being of children under two. The manifesto, The 1,001 Critical Days: the importance of the conception to age two period, uses the evidence of links between a mother's health, the quality of early attachment and infant brain development to call for 'radical change' that would see a national commitment to proven health and education programmes for at-risk parents, from conception to their child's second birthday.

With the stated goal that 'every baby (should) receive sensitive and responsive care from their main caregivers in the first years of life' - an aim that anyone would hope for - this short document is concerned only with effecting change inside families.

Frank Field, Labour MP and co-author of the manifesto along with Caroline Lucas (Green), Paul Burstow (Liberal Democrat) and Andrea Leadsom (Conservative), is unapologetic in arguing for the focus on family. 'The Beatles were almost right when they sang, "All you need is love",' he says. 'Attachment is key. Neuroscience has shown that pre-birth and the first 1,001 days are crucial. It's where children bond.'

To address early family relationships, the manifesto calls for - among other things - the provision of parent-infant psychotherapy, universal ante-natal classes and a higher priority given to attachment by all early childhood practitioners working with under-twos.

For Mr Field, early success will be measured by changing parent attitudes. 'Stage 1 is for parents and future parents to realise that they are in the driving seat in delivering what their child needs. They can be liberators or they can be neglectful - constraining. I want to move more people into that first category, as the parents' role can trump class or income.'


IN COMBINATION

Helen Barnard, programme manager (poverty) at the Joseph Rowntree Foundation, agrees that work with families in the earliest years can help to raise children's attainment by reducing the effects of poorer primary schooling and difficult family circumstances. But she is clear that it cannot work in isolation. 'Research shows a combination of a good-quality home life plus good-quality pre-school plus good-quality primary school has a massive impact. But you need all of these to get the full effect.'

She also questions the likely success of targeting just one phase of life. 'Early intervention does not address the broader circumstances of the family. To make a real difference, employment has to change,' she explains. 'There are currently two labour markets: one where jobs are secure and well paid, the other with lots of badly paid, insecure jobs that people come in and out of. It's very hard to get out of that cycle.'

Her views offer a glimpse of the complex interrelated problems that often affect people living in poverty: poorer housing and community security, poorer health, poorer education, poorer employment and poorer access to enriching opportunities. And they barely scratch the surface of deeper thinking about inequality - such as that by sociologist Pierre Bourdieu and philosopher Michel Foucault, for example, who described how inequity is maintained through unfair distribution of resources and the controlling power relations that we comply with in everyday life.

Love is nowhere near all you need to get by in these circumstances.

But Mr Field is resolute in defence of the single-phase, family-focused approach. 'Academics and voluntary organisations are very good at saying you need to deal with everything at once, but that's too vague. It's different for politicians. We can't afford to be vague, so we're concentrating on a specific area in the knowledge that, if we don't, we're storing up trouble for later.'

He does have a point, given the Government's determination to target poverty via schools - something tried in the US by the No Child Left Behind strategy, which failed at great expense - and through a business model at the Social Mobility and Child Poverty Commission. It is a policy direction that leads Mr Field to accuse 'serious politicians' of playing politics and treating early intervention as a 'soft subject'.

But hopes for a different landscape, and for serious political investment, are emerging elsewhere in the UK - tentatively in Wales, and with some zeal in Scotland.


WELSH VISION

The Welsh Government recently released its ten-year plan for early years and childcare, Building a Brighter Future, with the stated vision of creating a 'fairer society' in which children are not 'disadvantaged by poverty and inequality'.

The document is welcomed by Eleri Griffiths, early years development officer at Children in Wales, as 'the first attempt since devolution to bring all the areas of policy together'. It emphasises the role of current anti-poverty initiatives such as local Flying Start programmes for families with young children in disadvantaged areas and Families First support for individual families in difficulty. But, in a move that the Welsh Government clearly does not consider 'vague', Building a Brighter Future is also concerned with monitoring and improving access to good housing and appropriate services.

Ms Griffiths explains that while little in the document is new, there are 'ambitious' plans to extend the Early Years Development and Assessment Framework from birth to age seven for all children in Wales. This would see health visitors using a universal assessment that could be picked up by nurseries and schools as children move on. And while its focus is still firmly on young children, the assessment would follow them considerably further than the 1,001 days suggested by the cross-party manifesto in England.

For now, though, Ms Griffiths is wary of being too confident. 'Children in Wales welcomes the vision and intended pathway in Building a Brighter Future, but it's early days. A lot of guidance on delivery is required.' And when asked how much can be achieved in the current financial climate, she responds, 'That is our question.'

It is also a question suggested by Professor Alan Dyson, co-director of the Centre for Equity in Education at the University of Manchester. 'In the current climate, it's improbable that we will get meaningful national policies targeting poverty,' he says. 'One of the mistakes we've made is to look for single initiatives to solve inequality. Even whole strategies like Gordon Brown's child poverty strategy was a single initiative. They will always fail. There is no magic bullet.'


EARLY YEARS COLLABORATIVE

By contrast, Professor Dyson is 'basically positive' about new work unfolding in Scotland, where a cross-departmental anti-poverty strategy targeting young children's health and development to age five is mobilising locally based professionals across the country.

Launched last year, the Early Years Collaborative (EYC) took off during 2013 following meetings attended by 800 practitioners from all sectors working with young children and their families. The initiative is supported in the highest offices of Government.

The EYC is more method than strategy. Based on a model that enabled Scottish healthcare professionals to make significant reductions in hospital-borne infections, it brings people from different sectors together in local-authority-based Community Planning Partnerships (CPPs) to assess the impact of local interventions in relation to three key aims: healthy pregnancies, and children's secure development by the age of 30 months and also on entering primary school.

Although just as determined as The 1,001 Critical Days to be 'evidence-based', there is no plan to roll out ready-made programmes. As Argyll and Bute CPP acting quality improvement officer for early years Kathleen Johnston explains, evidence will be gathered through local 'tests of change': small, incremental adaptations to systems that follow a format of 'plan, do, study, act' and provide the basis for further attempts at improvement.

'Reading to children at bedtime - which fosters both literacy and attachment - is an activity for which any nursery might provide a "test of change",' says Ms Johnson. 'After an initial survey of parents to see how many read to their children, a nursery might devise a leaflet aimed at increasing the number, re-survey parents to see if the intervention made a difference, and plan other interventions according to the result.'

Information at this basic level is reported to the local CPP, which collates all tests on the subject to see what is working locally. Further on, successful practices may spread to other similar areas or even roll out nationally, but only if they prove robust in all circumstances.


FERVENT OPTIMISM

The emphasis on respect for small, local success as the engine for growing a national strategy has generated a near-fervent optimism among those involved in the EYC. 'Whether they are social workers or council workers or nursery workers,' says clinical director of Scotland's Quality Unit in the Health and Social Care Directorate Jason Leitch, 'we have come along with an idea that has given new prominence to what people are doing.'

Work with parents is also key. 'This is a collaborative with families as well,' says Ms Johnston. 'People don't want something done to them. We want to build on strengths, to empower people to be at the heart of the solution to community problems and issues.'

The EYC's decentralised character means there is no expectation for speedy transformation. 'Our methodology means that change will be fast in local settings but will take time on a bigger scale,' says Mr Leitch. 'We're willing to be patient. So with regard to reducing infant mortality we will focus on local approaches to smoking cessation in pregnancy, and see what happens from there.'


THE LONG VIEW

This commitment to playing a longer game is what draws Professor Dyson's approval. 'If Scotland recognises that you can't transform things but can make some change; if it is willing to learn from local models, then that's sensible,' he says. 'What we need is local initiatives embedded in national strategies. Then even if you can't get the big politics, you can make things happen locally.'

Asked if the specific focus on early years is too narrow, he says, 'Better to have a focus on the early years than no focus. If you only target one area, this is where to go.' And that is, of course, an opinion shared by Frank Field, who also expresses optimism about the EYC. 'It's good that things are changing in Scotland,' he says.

Perhaps, if the 'serious politicians' Mr Field so despairs of were to cast an eye northwards, the political pragmatism of a 'magic bullet' initiative like The 1,001 Critical Days might be replaced by something more likely to succeed. For while it may be impossible for politicians to deal with all the problems of poverty at once, or even to acknowledge the deeper inequities of society, the EYC certainly feels like a genuine attempt by Government to recognise its own responsibilities in this regard, and to involve communities and families in bringing about real change to real people.


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