Sue Hillsden, Quality Improvement Development Lead, FNP National Unit
I don’t have to cast my mind back too far into my public sector career to remember a time when the interplay between the early years, health and wellbeing, education and long-term employment was not as well recognised as it is now, in theory or in practice.
Research has made clear the link between attainment at school and long term income: those who achieve good GSCE grades (A*-C, or 9-4) will earn £80,000 more over a lifetime. Meanwhile, five-year-old children with “poor vocabulary” are “more than twice as likely to be unemployed when they are aged 34.”
These gaps are often clear early on in life – even in the first 1,000 days – and the risk factors that can lead to poorer outcomes are well known. The children of teenage parents, for example, are likely to have poorer health, wellbeing and attainment outcomes compared to the general population.
That’s why it’s so brilliant to see speech, language and communications skills acknowledged as “an important indicator of children’s wellbeing” in the recent Department of Health and Social Care green paper, Advancing Our Health: Prevention in the 2020s. The paper clearly positions work to support the development of these skills as a “preventative measure … to narrow inequalities” as part of the focus on the first 1,000 days of life.
In 2018, 71.5% children achieved a “good” level of development in the early years foundation profile. This means 28% of children finished reception without the early communication language and literacy skills they need to thrive. Disadvantaged children are disproportionately represented in this group.
The Department for Education has an ambitious target to halve this by 2028, with its Early Years Social Mobility Programme as the main driver to improve outcomes for children in local services and early years settings, as well as in their home environment.
The work to achieve improvements for those most in need will be a many layered thing. This is something which is acknowledged in the paper’s statement that success in shifting outcomes will require “leadership across education, health and social care.”
I know from my work supporting local areas to build value in and from their FNP teams that many local authorities are working hard to bring together health, social care and early years services for maximum impact. I can think of some great examples of councils which are trying to create a more holistic approach to identifying and meeting the needs of young children and their families through joint commissioning arrangements and whole workforce training and development.
Cross-government work shows there is real movement on this at a national level too. Joint work on speech, language and communication between Department of Education and Public Health England, for example, acknowledges the work of public health practitioners in helping to support long term development, attainment and education outcomes for children.
There seems to be something of a groundswell in the public and third sector in response to the challenge as well, with schemes like Look, Say, Sing, Play from the NSPCC, Wonder Words from Save the Children, Tiny Happy People from the BBC, as well as the Department for Education’s Hungry Little Minds. It’s fantastic to see so many high quality resources being made available to parents.
The role of FNP, in this many layered context, is important. It is a targeted service for a population (young parents) whose children are, in general, less likely to thrive in terms of health and attainment. When local authorities commission FNP, alongside health visiting and as part of a wider early years and early help strategy, they know it has an important role to play in helping to ensure disadvantaged children enter school with the skill and language development they need.
The FNP programme places a particular focus on improving the home learning environment, starting in pregnancy, with a depth and an intensity that reflects the needs of the young mums who join the programme. Infant and toddler development in FNP is assessed at 4, 10, 14, 20 and 24 months using the Ages and Stages Questionnaire, offering parents the opportunity to reflect on a child’s development with their family nurse – and celebrate successes, as well as monitor concerns and seek a referral where additional needs are identified.
In addition to the focus on the developing child, FNP also supports young mums and dads to reach their own goals in terms of returning to education and/or work. These young parents also have potential that can be realised with the right support – and, in some cases, even reinvested in the very system that helped them.
In addition to direct work with first-time, disadvantaged young mothers, FNP teams offer learning sessions for other local professionals which help to spread some of the concepts and theories underpinning the FNP programme. More than 3,100 health visitors, school nurses, voluntary and public sector workers across England attended ‘knowledge and skills exchange’ learning sessions delivered by FNP teams in 2018/19.
Work to “prevent problems from arising in the first place, rather than dealing with the consequences” is a concept that is at the heart of the prevention green paper. It acknowledges the fact we “start building our health asset as a baby in the womb” and this includes the scaffolding on which powerful early learning is built in the months and years that follow, such as parent-infant interactions, attachment and the home learning environment. These ideas are baked into FNP, but it still feels fresh and powerful to see them acknowledged in the paper, and thoroughly inspiring to see so many positive, creative responses to help support parents from right across the public and third sector.
I have the privilege in my current role to see the successful results of what happens when we get this right. Meeting with FNP clients who have come along to local FNP board meetings to share their stories is both inspiring and humbling. When you can see a young person’s growth in every area of their own lives, having become an assured, nurturing parent to a lively, curious, confident two-year-old who is already a little talker, you can almost hear that cycle of disadvantage snapping.