This module is part of the background information section along with Family hubs and early help: an overview and Family hubs funding explained. We recommend you also read those modules before moving on the strategic ‘golden thread’ section.
This module provides:
- an overview of the policy and implementation guidance on Best Start for Life (referred to as Start for Life)
- a summary of the six actions areas to embed the Start for Life baby-centred vision and transform support for families with babies and young children. These areas fall into two categories: ensuring families have access to the services they need and ensuring the Start for Life System is working together to give families the support they need.
- an overview of other relevant policy and practice initiatives: supporting families, reducing parental conflict, integrated care systems, the youth review, the SEND review
- links to further resources.
Start for Life policy
Guidance on Start for Life has developed over recent years. This section summarises salient aspects of the guidance and signposts to further sources of information.
In July 2020 the Prime Minister commissioned the government’s Early Years Adviser, Rt Hon Dame Andrea Leadsom DBE MP to conduct the Early Years Healthy Development Review. The Best Start for Life: a vision for the 1001 critical days report was published in March 2021 as an outcome of the review. The review focused on the period between conception and the age of two – the first 1,001 critical days – when the building blocks for lifelong good emotional and physical health are laid down through the love, care and nurture babies and young children receive. Evidence gathered from families, professionals, volunteers and wider research sources through the review identified an urgent need for accessible and joined up support for families with babies, action to address health inequalities, and a need to improve the evidence base on what helps to improve outcomes for babies, children and their families in different contexts.
Start for Life six action areas for change
The Start for Life vision (2021) proposed action in the following six areas to develop baby-centred transformation of support. The six action areas are considered below.
Ensuring families have access to the services they need
- Seamless support for families
Guidance for the Start for Life Family Hubs transformation programme (August, 2022) gave details of improvement in six universal Start for Life services:
- Health visiting
- Parent-Infant Mental Health
- Infant Feeding
- Special Education Needs and Disability
In addition to the six areas above, the Start for Life Family Hubs programme guidance (August,2022) set out ‘minimum expectations’ and ‘go further’ options in developing Start for Life provision for the 75 local authorities receiving additional funding in the following service areas (you can read more about funding in our Family Hubs Funding Explained module).
Parenting support through universal advice for families entering parenthood and targeted evidence-informed parenting programmes for parents with further needs, an evidence-based service model for delivering parenting support, improved referral pathways, improved access to training for parenting practitioners.
Infant mental health, parent–infant relationships and perinatal mental health support
Infant mental health, parent–infant relationships and perinatal mental health support including improved universal parent-infant relationship services. An Implementation Toolkit – Parent-Infant Foundation (parentinfantfoundation.org.uk) shares learning, information and advice for commissioners and providers who want to set up, improve or expand parent-infant relationship teams in the UK.
AiMH – The Association for Infant Mental Health professionals in the UK is a not-for-profit organisation with resources for professionals and families on infant mental wellbeing. A guide for families on Getting Started – Perinatal Treatment (wordpress.com)
Workforce development is key to ensure that staff and volunteers are updated with the best clinical advice and that they are confident in responding to the needs of families with protected characteristics. A competency framework for all those working in perinatal mental health is available here Competency framework for perinatal mental health | Health Education England (hee.nhs.uk)
As a potential early identification point for women with more complex perinatal mental health issues the Start for Life workforce will need a good understanding of overall provision for perinatal mental health within the NHS https://www.england.nhs.uk/mental-health/perinatal/
Early language and improving the home learning environment
Early language and improving the home learning environment support through advice on creating spaces for playful creative learning supported by nurturing adults e.g. Children’s language development and parenting advice – BBC Tiny Happy People
Parent and carer panels
Parent and carer panels which are accessible, flexible and inclusive of a diverse range of families with recent experience of the first 1001 critical days –see guidance Establishing your parent and carer panel – GOV.UK (www.gov.uk)
Co-producing the Start for Life offer
Co-producing the Start for Life offer to be available digitally and in hard copy with an associated communications strategy so that families and staff are aware of and take up the offer. LAs are encouraged to develop an approach to monitoring the reach, evidencing the impact and planning continuous improvement of the local Start for Life offer, areas of specific Start for Life provision and associated Start for Life workforce development strategy. See guidance on Publishing your Start for Life offer – GOV.UK (www.gov.uk)
- A welcoming hub for families
Family Hubs are at the heart of the vision for baby-centred services, designed to give every baby the best start for life. They provide universal and seamless support and encouragement to every new family and are a warm base from which to connect with antenatal services such as midwifery and public health nursing and wider services e.g. advice on debt, employment, immigration or housing. Family hubs represent a common approach – beyond the emphasis on buildings and branding – to improving outcomes for families across services and geographical boundaries.
Co-designing service improvements with communities will ensure that they develop in response to local needs for example, through mobile provision in rural areas offering pop-up antenatal clinics or family hubs co-located within other frontline services e.g. in fire stations or sports centres.
See the National Centre for Family Hubs case study library for searchable case studies on Start for Life Family Hub transformation from around the country.
- The information families need when they need it
The Start for Life offer will bring together information on Start for Life services for all families (universal) and information on how to access more support (targeted and specialist services). The offer should respond to the strengths and needs of families and be available digitally, virtually and by telephone. For families, that could mean bringing together information on support that they might otherwise not know about – in one leaflet printed in common community languages that can be shared in community settings such as places of worship, school receptions and supermarkets. There should be a telephone/text service available 24-hours a day, 7 days a week that families can contact for non-judgemental, empathetic advice and support in the language of their choice.
Further guidance on developing the local Start for Life offer and examples of implementation case studies are available here https://www.gov.uk/government/publications/how-to-publish-your-local-start-for-life-offer-local-authority-guidance/publishing-your-start-for-life-offer
Ensuring the Start for Life system is working together to give families the support they need
- Developing a modern skilled workforce to meet the changing needs of families
A Start for Life workforce transformation strategy will be integral to local plans to develop the warm, empathetic and culturally responsive (for example, anti-racist) relational approach vital to supporting families with babies and young children.
Development of Start for Life workforce strategic reform
The government’s Start for Life progress report (February, 2023) together with local implementation case studies gathered through the National Centre for Family Hubs and partners have highlighted the following areas as pertinent to the development of Start for Life workforce strategic reform:
- the development of a keyworker approach to improve continuity of care through warm, trusted relationships and growing involvement with the family through the life-course.
- a skill-mix approach where a range of professionals and volunteers work with midwives, health visitors and other services to increase capacity, improve skills and recruitment and retention rates
- peer supporters (who are trained and receive ongoing supervision) to give parents practical advice on infant feeding and communication and language development for example in plurilingual families who speak multiple languages
- training commissioned by Health Education England on evidence-based parent-infant relationship interventions and modules for busy frontline staff to remember the importance of demonstrating reassurance, empathy and cultural competence when supporting families and understand the links between different issues that families might face so that they are better equipped and more confident in providing holistic support
- senior supervision for parent-infant relationship support workers
- NHS England’s plans for implementing Better Births Maternity Transformation including how maternity services in England are developing to become safer, more personal and kinder for the women and families using them.
A sample of local authorities have been selected as Start for Life Family Hubs workforce pilots: Westminster, Kensington and Chelsea, Newcastle, Leeds and Somerset. Case studies from these LAs will be published in December 2023.
See also the sections of this implementation toolkit on workforce development and the National Centre for Family Hubs case study library.
- Continuously improving the Start for Life offer
Evidence-informed partnership plans will need to be developed through ongoing analysis of rich data from multiple sources. These data sources are likely to include:
- National sources such as Child and Maternal Health – OHID (phe.org.uk) and Fingertips
- Local strategic partnerships e.g. the Integrated Care System (ICS), Health and Wellbeing Board Joint Strategic Needs Assessment (JSNA), and commissioners of the 0-19/25 Healthy Child Programme.
- Wider voluntary, community and social enterprise providers (national/local) who have documented population needs and conducted evaluations of improved outcomes (often with local universities or consultancies) through commissioned services e.g. through breastfeeding advice or perinatal mental health support.
- Lived experience data on community strengths and needs from national/local family representative networks e.g. FIVEXMORE (on maternity disparities amongst racially minoritized communities) and local families themselves obtained through a variety of mechanisms which may include qualitative ethnographic/peer research studies, surveys, mystery shoppers, patient public involvement approaches and evaluations.
Impacts of COVID-19 lockdown
Evidence shows that the harshest impacts of COVID-19 lockdown have been felt amongst racially minoritized and economically deprived communities and that health inequities that existed before lockdown have been exacerbated Build Back Fairer: The COVID-19 Marmot Review – The Health Foundation. During lockdown many areas also witnessed an increase in asset-based community development approaches – sometimes referred to as mutual aid, offering swift and targeted support to families. Local area staff also reported higher levels of collaboration, creativity and joint problem-solving as necessitated by the crisis. In response to the ongoing cost-of-living crisis and local authority fiscal constraints, many of these new ways of working have persisted beyond lockdown.
An opportunity to develop a coordinated approach to disparate initiatives
The Start for Life and family hubs transformation programme presents an opportunity to develop a coordinated approach to disparate initiatives to address entrenched population health disparities. Start for Life complements National Maternity Transformation processes including Better Births. This policy covers the importance of continuity of carer, safety initiatives to improve care standards and outcomes for women, babies and their families, and delivering against the national ambition to halve the number of stillbirths, neonatal and maternal deaths and brain injuries by 2030.
For example, in response to national NHS policy, ICSs have recently consulted families on their experience of Local Maternity Systems (LMS) to develop maternal equity and equalities plans. These plans address health inequities experienced by patients particularly those faced by racially minoritized families and those living in poverty and inequalities experiences by the NHS workforce.
Some ICSs have developed an equalities data dashboard through their local approach to Core20PLUS5. This is a national NHS approach to tackling health inequities including in Maternity provision.
Parent carer involvement in interpreting and analysing evidence is integral to co-design of improved Start for Life services.
Some LAs are using the Lundy Model of participation to move beyond a consideration solely of parental ‘voice’ to consider also their ‘space, audience and influence’ as integral factors for co-production Social Care and Education Participation Approach (leicester.gov.uk)
It is also helpful to consider how parent carer engagement in Start for Life fits within the ecosystem of co-production and participation approaches – from the Family Hubs Parent Carer Panel, local Maternity Voices Partnerships, Parent Carer Forum and self-help groups for families with experience of Special Educational Needs and Disabilities (SEND), other local parent champion initiatives, youth councils (to encourage the involvement of young parents and young people considering parenthood), LGBTQ+ parenting groups, and faith groups. Guidance is available to support the development of parent carer panels Establishing your parent and carer panel – GOV.UK (www.gov.uk)
- Ensuring local and national accountability and building the economic case
Local authorities who applied for the government’s Start for Life Family Hubs programme were required to identify a single accountable leader for the Start for Life offer. In signing up to the transformation programme all local authorities had to document agreement from their Directors of Children’s Services and Public Health and Lead Members for the Joint Health and Wellbeing Board and Children’s Trust.
Other policy and practice initiatives
An important strategic function of local leaders is to ensure that the Start for Life approach develops in line with other LA priorities and programmes seeking to support improved family outcomes and delivering to external funding streams.
Supporting Families is a programme funded by the Department for Levelling Up Housing and Communities (DLUHC). This is designed to build the resilience of the most vulnerable families and ensure that services are integrated to support the best outcomes. Many LAs are combining the positive outcomes for families framework from this programme with their Start for Life outcomes framework Annex A: National Supporting Families Outcome Framework (publishing.service.gov.uk)
More information on the programme is available here: Supporting Families Programme guidance 2022 to 2025 – GOV.UK (www.gov.uk)
A commissioning guide was produced for Supporting Families coordinators available here: Commissioning parenting and family support for Troubled Families | Early Intervention Foundation (eif.org.uk)
Reducing Parental Conflict
Reducing Parental Conflict (RPC) is another programme that complements Start for Life and Family Hubs. This is funded through the Department for Work and Pensions. There is strong evidence that conflict between parents – whether together or separated – can have a significant negative impact on children’s mental health and long-term life-chances. RPC aims to reduce conflict between parents as early as possible by providing the workforce with the training and tools to help families early and in an integrated way through a keyworker approach.
What Works for Early Intervention and Children’s Social Care have created a hub for local leaders, commissioners, practitioners and researchers who are looking to reduce the impact of parental conflict on children. It provides a central repository of key ‘what works’ evidence and tools, including why parental conflict matters for children’s outcomes, and guidance on how to take action. The hub will continue to grow as new evidence and tools are created. Reducing Parental Conflict Hub (eif.org.uk)
Workforce development resources and a commissioners guide to support the RPC programme in LAs are available here Reducing Parental Conflict programme and resources – GOV.UK (www.gov.uk). A NCFH webinar on how family hubs can support RPC is available here https://youtu.be/V-DYaX713fI
Children’s social care
Although the Independent Care review is about the upper end of targetted support upwards, it’s important to consider how family hubs work can coordinate with children’s social care in a preventative way. You can read more about the government’s response on children’s social care implementation strategy and commitments around ‘family help’, in their 2023 report Children’s social care stable homes built on love consultation.
Integrated Care Systems
- Integrated Care Systems (ICSs) are the centrepiece of the reforms introduced through the 2022 Health and Care Act and are part of a fundamental shift in the way the English health and care system is organised. Previously the emphasis was on organisational autonomy, competition and the separation of commissioners and providers, ICSs depend instead on collaboration and a focus on places and local populations as the driving forces for improvement as do Family Hubs
- ICSs are partnerships that bring together NHS organisations, local authorities and others to take collective responsibility for planning services, improving health and reducing inequalities across geographical areas. There are 42 ICSs across England, covering populations of around 500,000 to 3 million people.
- Integrated care boards (ICBs) are statutory bodies that are responsible for planning and funding most NHS services in the area.
- Integrated care partnerships (ICPs) are statutory committees that bring together a broad set of system partners (including local government, the voluntary, community and social enterprise sector, NHS organisations and others) to develop a health and care strategy for the area.
Working through their ICB and ICP, ICSs have four key aims:
- improving outcomes in population health and health care
- tackling inequalities in outcomes, experience and access
- enhancing productivity and value for money
- helping the NHS to support broader social and economic development.
ICS development is happening alongside local service improvement, which is already underway to tackle health inequalities as outlined in the NHS Long Term Plan for example on improving maternity services and parent infant support and in the healthy child programme 0 to 19: health visitor and school nurse commissioning.
In addition a national Start for Life website offers trusted NHS support and advice that complements local Start for Life offers Start for Life (www.nhs.uk)
The Youth Review: Summary findings and government response – GOV.UK (www.gov.uk), published 1 February 2022, Department for Digital, Culture, Media and Sport (DCMS), emphasises that young people must be at the centre of our country’s recovery from the pandemic and its findings provide the direction for how this will be achieved – investing to develop the skills, creativity and energy of this country’s youth to build back better. This can complement the Start for Life work and is an integral part of the Family Hub offer.
The Special Educational Needs and Disabilities review
The Special Educational Needs and Disabilities (SEND) review (March 2022) sets out government’s proposals for a system that offers children and young people the opportunity to thrive, with access to the right support, in the right place, and at the right time, so they can fulfil their potential and lead happy, healthy and productive adult lives. This represents significant transformation and this work needs to be an integral part of local family hub developments.
The National Centre for Family Hubs hosted webinar on Best Start for Life and Family Hubs on 19th January 2022. The event explored how Family Hubs can support the delivery of effective start for life services during the critical 1,001 days.
The programme included:
- An update on the work of the Start for Life Unit from the Rt Hon. Dame Andrea Leadsom DBE MP, Government Early Years Healthy Development Adviser
- An overview of the evidence on the importance of the first 1001 days and delivering integrated maternity and early years services.
- An interactive panel session to explore implementation challenges and learning from local areas, including methods of introducing families to hubs, co-locating start for life workforces in family hubs, start for life workforces transitioning to whole family working within a hub approach, and integrating start for life service delivery models.
- An interactive session to explore the six services within a Universal Offer as envisaged by the Best Start for Life: Vision for the 1,001 Critical Days, what could be delivered through a family hub and how.
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