The Start for Life offer and other policy and practice initiatives

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 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 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

Infant feeding to promote breastfeeding in line with WHO guidance and to support parents to achieve their infant feeding goals through a programme along the lines of The Unicef UK Baby Friendly Initiative

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 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)

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: 

1. 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. 
2. 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 
3. 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 
4. 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  
5. senior supervision for parent-infant relationship support workers 
6. 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. 

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. 

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) 

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 (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 

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.

1. 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 
2. 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. 
3. Integrated care boards (ICBs) are statutory bodies that are responsible for planning and funding most NHS services in the area.
4. 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:  

1. improving outcomes in population health and health care 
2. tackling inequalities in outcomes, experience and access 
3. enhancing productivity and value for money 
4. 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 (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.