Harry Benson is the author of “Let’s
Stick Together – the relationship book for new parents” and Communications
Director of The Marriage
There is a fundamental flaw at the heart of
current attempts at “early intervention”. Until recently, we used to have a terrific
NHS post-natal system run by health visitors. Programmes lasted a few weeks,
were preventive, educational, focused, supportive and extremely well-attended
by as many as 40% of all first time mothers.
In the last few years, that system has more
or less collapsed, supplanted by the broader Sure Start Children’s Centre early
years support groups. The problem is that Sure Start is failing
to attract anything like the same numbers of parents. Those who do attend tend
to stay in their groups for many months in what feels less like early
intervention and more like state-sponsored coffee shop.
For the last six years, I and my volunteers
have run an early intervention for new parents in both NHS post-natal clinics
and Sure Start centres in the Bristol
area. We teach couples how to stay together through a single session
relationship programme called “Let’s Stick Together”. It’s early intervention,
it’s preventive and it’s evidence-based. Once people realise that they’re not
being counselled, almost everyone finds it enjoyable and useful. Our programme
is short and sweet but it accesses a higher proportion of parents than has ever
been achieved in the UK.
Over seven years, we’ve accessed 4,000 first time mothers in Bristol.
My joint venture with a national charity is currently being evaluated, and
funded in part, by the Department for Education.
The flow of our work in Bristol
tells the story of early intervention. Within the last few years, we have seen
at first-hand the near collapse of the post-natal system. Health visitors have
been sucked away from routine post-natal care of new mothers into child
protection and paperwork. Most of the post-natal clinics that we used to visit
have shut down as a result. In 2008-9, NHS post-natal clinics made up 90% of
our work. Today, it’s less than a third.
Sure Start could and should have taken up
the slack. In 1999, Sure Start centres were set up “to enhance the life chances
for young children growing up in disadvantaged neighbourhoods”. After 2005,
centres expanded into all communities. Today there is a 3,500 strong network of
shiny new centres, many of which attached to primary schools. The idea is good. As a new parent, you
simply wander into your local Sure Start centre and find professionals who can
provide you with all sorts of information about being a parent and early years
support groups that you can join.
But Sure Start has never really acquired
the kind of easy attraction of ante-natal or post-natal. You’re pregnant. So
you go to either free NHS or paid NCT ante-natal classes. According to the
Millennium Cohort Study, ten years ago 70% of first time mums did exactly that.
You’ve just had the baby. So you go on to post-natal clinic. In 2009, when we
reckoned we were accessing almost all post-natal clinics in Bristol,
we reached 33% of all first time mums. So perhaps 40% of first-time mums used
to go on to post-natal.
Sure Start is not taking up the slack.
Their frustrated staff – who are definitely not the problem – tell me time and
again how hard it is to attract new parents into the centres. The biggest reason why Sure Start doesn’t
get the numbers is down to basic social psychology. If a health visitor invites
a group of pregnant mothers to come back for post-natal clinic after they’ve
had their babies, most come along. The place and faces are familiar. Mums come
back because it’s made easy for them and it feels secure.
Asking the same mums to come to a Sure Start early years group, usually in another
location and with other group members they won’t know, doesn’t feel so good. In
the exhausting and confusing land of new parenthood, the tiniest of barriers is
enough to prevent good things from happening. The language of treatment rather
than prevention doesn’t help. “It’s for people who need it”.
Perhaps it’s not surprising that the mums
who do come along to Sure Start groups tend to stay on for several months. It’s
become less “intervention” and more “support”. Our figures bear this out. We are really
good at finding new groups. Yet our numbers today are down by nearly half from
our peak in 2009. At the NHS post-natal clinics that still
operate, we average three and a half visits a year. Programmes roll over every
few weeks so we get new mums every time. At Sure Start, we average two visits
per year and the groups are smaller. We can’t run more regular sessions because
the same mums are there for months.
The different ethos of these two groups –
NHS “post-natal” and Surestart “early years” – also has a huge bearing on early
intervention. The whole point of going to a handful of post-natal sessions is
to learn. Support and friendship with other mums happens. But it is secondary.
Post-natal groups are always attentive and always easy to teach as a result.
Interventions within this kind of positive environment have the best chance of
making a difference. However the primary purpose of going to a
Sure Start group is much less obvious. Many mums keeping coming back because
they enjoy chatting with familiar faces more than they are there to learn.
Running any kind of intervention within this environment is challenging at best
and painful at worst.
Sure Start has become a sacred cow, with
strong political and individual backing. All parties have bought the concept
and many thousands of parents have accessed services at Sure Start Centres. A
recent accusation that Sure Start is being cut inspired outrage at PMQs. Yet there is little evidence that the vast
expense poured into Sure Start has made much of a difference. The most recent
of several official evaluations from University
of London, Birkbeck,
finds that mums say they have benefited in various ways. However there is “no
impact on child outcomes”.
One tiny piece of good news is that we are
beginning to see the first hints that the government expansion of health
visitors may rebuild the shattered NHS post-natal system. Three health visitors
have already hinted to us that their groups may start up again this year. There is a solution to the Sure Start
problem. It means taking a leaf out of the NHS post-natal system. Post-natal
has been so successful because it feeds off ante-natal and is explicitly a
short programme of learning. That’s what needs to happen with Sure Start.
If all ante-natal classes were held in Sure
Start centres, mums would be far more likely to come back soon after having
their baby. With a far bigger proportion of parents wanting to attend, Sure
Start staff will have no choice but to recycle groups quickly and introduce
real purpose and focus. Only then might Sure Start begin to achieve
what it could and should have been doing in the first place. Early