How could early intervention be improved?
The NHS could do a far better job if they spent more on early intervention and prevention. Engaging the mother (and her partner) to promote her physical and psychological health when she is pregnant and accessible gives the forthcoming baby a much better chance in life.
We need an effective multidisciplinary perinatal service that includes social services and active outreach antenatal care, with physical and mental health checks as routine. This would help pregnant women and their partners who are under stress, which recent research has shown is damaging to the future child's health and prospects.
Depression in either parent after the birth of a baby is common and easily missed, yet it has an impact on learning and mood well into the child’s teens, especially on boys. Health visitors should be expected to visit every newborn baby as a matter of course.
Paid parental leave in the first year actually saves lives. It is not well known that the more a national Government pays for parents to care for their own children in the early months the lower the rates of infant mortality in that country.
How could these services be funded?
There would be more funding for early intervention if the Government thought it would save money sooner, but it might take ten or more years, and most do not expect to be in power for that long. Governments spend money on things they think they have to do, such as going to war. They assume that that taxpayers don’t want to pay for new services like this because they have already had their babies or have chosen not to have children. Yet this is the most accessible and vulnerable point in the lifecycle. Paying for preventive services means having different priorities.
What are the potential benefits?
Everyone understands the benefits of early intervention. Better outcomes for children means a reduction in later spending on hospital care, special education, children in care, teenage pregnancy, prison, welfare benefits etc., but people still find ways of objecting. It's easy to say that universal services for new families are expensive and wasteful. Public services are hard to defend when we are being told every day that there is no money left.
What do you believe are the barriers stopping effective intervention taking place?
Most of us don’t like to think about helpless infants in distress. It might even remind us of childhood experiences we would rather forget. A further problem is that most existing services - medical, social, psychological, psychiatric - too often work separately and fail to communicate with each other.
A 19-year-old pregnant woman who is unhappy with her partner tells a midwife that she is having problems. The midwife says she should see a psychologist. The young woman feels she is being told she is mad and refuses go to any such appointment. What needs to happen is that a psychologist works in the same corridor as the midwife so that they can easily talk about the problems there and then. Social workers are often needed at this point too. Hospitals are places where all these services could be co-ordinated so that parents don’t have to be passed round from one agency to another.
It would require great political leadership to establish a national service for all-round perinatal health. The proposed reform of the NHS in England is aimed at making more of a market in healthcare. An integrated perinatal service needs to be planned, not bought and sold. Social interventions are not like hip operations.
What successful measures are already in place and how can we build on them?
Children's centres are the greatest social innovation since the foundation of the NHS. New Labour got a lot of things wrong, but they got that right. It is shameful that the Coalition Government is now making huge cuts to these centres while declaring that it wants to protect them.
We need better trained (and therefore better paid) staff in children's centres and nurseries. To target dads specifically it could help to have more male staff working in early years settings. The bloke who likes football and a beer with his mates might not want to go and talk about babies, even though he is proud of his ability to care lovingly for his own child. In that way fatherhood can be a very private thing. Female staff need to understand that too.
The power of children's centres depends as much on the support parents can give each other – and the lasting networks of friendship formed there – as on the professional contacts and guidance they receive. In one of the most unequal countries in western Europe this makes a small contribution towards social equality; almost everyone can talk easily to each other about small children.
In the earliest weeks and months of life there are good services that have been shown to help new parents in difficulties love and enjoy their babies, instead of being afraid or persecuted by them. But these are few and far between, and require very skilled staff. Yet in terms of later savings these are not expensive.
What needs to happen now?
We need to raise consciousness of the benefits of early intervention – and the dangers of not doing so - through media (like this magazine), film and narrative, rather than scientific pictures of babies' brains; impressive to politicians but they don’t connect with parents' experience (and may even make them feel guilty). Many people are moved when they see video or hear stories of what can be done to strengthen parenting and improve the life chances of the next generation.
