The Early Years

Policy concentration on the early years is of vital importance for the wellbeing of children now and for their future health outcomes and life chances. Evidence-based research points to the need for a focus that is properly holistic and to precipitate intervention to promote a healthy diet, regular patterns of activity and rest and give children the best start in life. In 2005, The United Nations Committee on the Rights of the Child (General Comment No. 7) acknowledged the need for a fresh strategy, pinpointing research findings indicating that a failure to prioritise early years’ welfare exposes children to the ills of ‘malnutrition, disease, poverty, neglect, social exclusion and a range of other adversities.’ Professor Dame Sally Davies, Chief Medical Officer of the United Kingdom, considers that robust early years’ policies make both social and economic sense: ‘Too many children and young people do not have the start in life they need, leading to high costs for society, and too many affected lives’ (Forward to ‘The 1001 Critical Days’, June 16th 2014). This observation is significant because there remains much to do. In 2012, the NSPCC reviewed the United Kingdom policy scenario for babies and very young children and concluded that identifiable advances in maternity and early years’ provision did not detract from the fact that: ‘babies are still particularly vulnerable’ and ‘their rights are not always recognised or realised’. (‘All Babies Count – But what about their rights?’ Sally Knock and Lorriann Robinson, January 2012). Knock and Robinson highlight glaring gaps of support and provision – especially in maternity services whereby the fostering of a strong parent-child bond is invariably sacrificed to a concentration upon purely medical practicalities such as labour, birth and the immunisation programme. The All Party Group on a Fit and Healthy Childhood aims, in this report, to offer the incoming Government recommendations for an early years’ strategy that are credible, feasible and evidence-based and will enable the United Kingdom to set the standard in a crucial policy field both at home and abroad. In defining ‘early childhood’, we follow the example of The United Nations (2005) Convention on the Right of the Child by examining the period of 0-8 including, as it does, the vital transition phase from pre-school to primary school. We consider the antenatal period and maternal physical and mental health, methods of feeding the newborn, parental support services both hospital and home-based and infant nutrition and socioeconomic factors that may impact upon the health and wellbeing of young children. The report examines the optimum balance between sleep, rest and activity, the need for freely-chosen play, safeguarding measures and the importance of respecting cultural diversity in all early years’ settings. Above all, we analyse the relationship between young families and the professionals whose role it is to ensure that babies have the very best start in life, supported by parents who have confidence in the choices that they make and the advice that they are given. Just as new families require mentoring so that they can act in the best interests of their children, so the early years’ workforce needs training and continuous professional development to ensure that the advice given is of the highest possible quality and specifically tailored to the individual family. Early Years’ students from The University of Northampton (interviewed) explain what a positive difference their newly acquired knowledge has made to their performance in the settings and Government recognition of The Early Years as a developmental stage in its own right and the creation of the new posts of Early Years Teacher and Early Years Educator have been positive. Yet as the Ilkeston ‘Mums Group’ (interviewed) makes clear, there is still no guarantee of uniform excellence in the delivery of services nationwide and no assurance of continuity between, for example, advice on feeding from the midwife and the health visitor, or the emphasis put on freely-chosen play in an early years’ setting and a primary school. If young children are to thrive, we believe it is essential that there is a national consensus and political will behind multi-disciplinary working in the early years. We see the early years as a window of opportunity and make no apology for the fact that each section of this report is accompanied by many policy recommendations. It has not been possible to produce a uniform handful of ‘asks’, just as the early years itself is a rich, complex and multifarious developmental phase. However, neither do we consider it to be feasible to achieve everything that we recommend in the lifespan of a single Government. This is a two, even three term journey. However, if the nation’s families and the early years workforce are to embark upon it, the Government must be prepared to provide the resources; the Cabinet Minister for Children and Families, the commitment to multi-disciplinary co-operation to achieve an early years workforce that is truly ‘joined up’ and, above all, the finance to make well–intentioned aspiration a reality. In an age of austerity, by spending early, the later savings to education, health, social or criminal justice services will be immense. Investing in the children of today is not a gambl

A REPORT BY THE ALL - PARTY PARLIAMENTARY GROUP ON A FIT AND HEALTHY CHILDHOOD THE IMPACT OF SOCIAL AND ECONOMIC INEQUALITIES ON CHILDREN’S HEALTH

A child born into circumstances of social and economic inequality in the 21st century United Kingdom will start life with one hand tied behind their back. Nowhere is the disparity of experience more marked than in that of health and this, in turn, impacts the entire life course. In the same way that priority is given to securing the national infrastructure, prioritising the health of children from all areas and in all circumstances from the outset would therefore seem to be prudent rather than profligate. Yet as this Report demonstrates,successive Governments have skimped rather thansaved; failedto build upon existing policy and played a costly policy game of ‘catching up later’ instead of deploying the early ntervention me asures that are cheaper andmore effective in the long term

The Primary PE and School Sport Premium

Central to London’s successful bid to host the 2012 Olympic and Paralympic Games, was the Government’s commitment to improve competitive sport and the sporting habits of young people (Ofsted, 2014). On the 12th March 2013, the then Prime Minister, David Cameron, announced that Primary Schools in England would receive funding worth £150 million per year to create a sustainable infrastructure for long-lasting change and improve the provision of physical education (PE) and sport across all state maintained primary schools. Speaking at the time, he said: ‘We can create a culture in our schools that encourages all children to be active and enjoy sport.’ He added: ‘The Olympic and Paralympic Games marked an incredible year for this country and I will always be proud that we showed the world what Britain can do. I want to ensure the Games count for the future too and that means capitalising on the inspiration young people took from what they saw during those summer months.’: https://www.bbc.co.uk/sport/21808982 Six years on, and with a total investment now of over £1.2 billion, the Primary PE and Sport Premium (here onwards referred to as the PESS Premium) has been a defining feature of the London 2012 legacy. Invariably funding streams at this level do not last forever or in the same format, which raises significant questions about what impact the funding has had on young people since 2013. We believe that a significant investment from Government merits debate and accountability at the highest possible level and that it should acknowledge where the opportunities and shortcomings of such a policy have left us. During the years of austerity, mounting concerns have arisen over the present and long term state of children’s health and the need for the debate to be heard is now imperative. To date there has been little critical appraisal of the PESS Premium funding. This report aims to begin a necessary process and in doing so, brings together evidence from across the sector to consider the future of the PESS Premium post 2018. During the course of the report, we outline and underpin the holistic value and importance of PE for every child. We examine the historic status and funding of PE and Sport and the nature and increasing diversity of the workforce. How has the PESS Premium funding impacted the way in which the subject is regarded and the ability of those tasked with delivering it to discharge their responsibilities? We have uncovered an abiding uncertainty about the nature of the PESS Premium itself; the ways in which it may be spent and its effect on an increasing divide between PE specialists, generalists and externally contracted coaches. Will its legacy be to have established a secure foundation for lifelong physical activity, sport and education – or is it, in effect, another temporarily seductive mirage, leaving PE precisely where it has become accustomed to be; regularly sidelined, delivered largely by those who are not qualified teachers and perpetuating the status quo for the children who already belong to groups that are perceived to be at a disadvantage? The PESS Premium funding is a significant sum and these questions deserve answers. This report is therefore our contribution to an essential debate, containing practical suggestions that we hope will be of use to policy makers. We invite all who care about the physical and mental health and emotional wellbeing of children to join the discussion

Wellbeing and Nurture: Physical and Emotional Security in Childhood

While there is increasing concern about developing and reinforcing children’s physical and emotional security, researchers have been busy working out the actual mechanics, even at the cellular level, of how this can be achieved. This report will provide a concise update on what is known about optimising children’s wellbeing and security in childhood and far beyond. In examining the ways in which children grow and develop, we can learn from that because their physical and emotional wellbeing and therefore that of our future society will depend on it. This report represents what we have learned and we hope that it will contribute in a small way to the making of the brave new ‘post-Covid’ world

Mental Health Through Movement

Children’s mental health: ‘has become an issue of real concern, in the media and to both politicians and NHS leaders, over the last five years in particular. It has prompted numerous inquiries, reports, recommendations and pledges by politicians and NHS leaders to improve the situation’: https://www.theguardian.com/society/2018/nov/22/what-is-happening-withchildrens-mental-health On July 1st 2019, the Local Government Association released statistics to show that: ‘There were 205,720 cases where a child was identified as having a mental health issue in 2017/18, compared with 133,600 in 2014/15- up 54%’: https://www.local.gov.uk/about/news/councils-seeing-more-560-child-mentalhealth-cases-every-day It is within this context that the All-Party Parliamentary Group on A Fit and Healthy Childhood presents its 14th Report: ‘Positive Mental Health Through Movement’. With 1 in 10 children now having a mental health diagnosis and 1 in 4 an undiagnosed mental health issue, this, our third Report on the issue of child mental health, addresses the link between positive mental health and physical activity and movement experiences at a time when, paradoxically, today’s children and young people are more inactive and play less than ever before. The growing recognition of a link between mental health and movement is fortuitous because from September 2019, health education in English schools will be statutory alongside the expectation that they will offer their pupils at least 30 ‘active minutes’ per day. The APPG on A Fit and Healthy Childhood welcomes the change whilst recognising that those responsible for implementing the new strategy (including practitioners and families) will need guidance as they help children to develop individual strategies to address future adverse events and foster the positive sense of self that will enable them to lead fulfilled, healthy lives. This Report is therefore presented as a practical contribution to an essential debate. It offers new strategies against the persistence of historical and traditional ways of thinking; examines and collates best practice in the devolved Home Countries as well as the wider world and discusses exactly what is required to ensure that future child mental health strategy is holistic. It is respectful of equalities and is aware that the successful outcome of policies is entirely dependent upon the expertise and confidence of those tasked with the responsibility of delivering them. As the 21st century advances, we consider the effects of the digital age and its impact on children and young people’s mental health and wellbeing and the crucial role of parents and carers who want the best for their children in a societal climate where, all too often, fears of ‘nanny state’ meddling serve to isolate families who suffer in silence – until a disaster that may have been all too predictable and preventable overtakes them, making a private grief a public concern. The trajectory of progress in mental health policy has been ‘stop start’ rather than linear, with legislative change in 1959 and 1983, an increase in spending from 1997- 2010 and radical changes to child and adolescent mental health services (CAMHS) in 2000. The Wessely Independent Review of the Mental Health Act is another such milestone: https://www.gov.uk/government/groups/independent-review-of-the-mentalhealth-act The APPG on A Fit and Healthy Childhood anticipates that the Government will fulfil its pledge to parents, children and practitioners by introducing much needed mental health legislation - and that our trio of Reports and the holistic theme of this one will help to inform a strategy that works for 21st century children

Nanotechnology, governance, and public deliberation: What role for the Social Sciences?

In this article we argue that nanotechnology represents an extraordinary opportunity to build in a robust role for the social sciences in a technology that remains at an early, and hence undetermined, stage of development. We examine policy dynamics in both the United States and United Kingdom aimed at both opening up, and closing down, the role of the social sciences in nanotechnologies. We then set out a prospective agenda for the social sciences and its potential in the future shaping of nanotechnology research and innovation processes. The emergent, undetermined nature of nanotechnologies calls for an open, experimental, and interdisciplinary model of social science research

Autonomous vehicle interactions in the urban street environment: A research agenda

© ICE Publishing 2018. All rights reserved. The Venturer project is trialling an autonomous vehicle (AV) in the context of use on urban roads. This paper summarises a literature review undertaken to assist in developing a research agenda for the trialling. The first contribution of the paper is a framework of four use scenarios for AVs as follows: (1) fully segregated AV network, (2) motorway or expressway network, (3) typical urban network, (4) shared space. The paper then focuses on a review of the social interactions in the street environment and discusses issues concerning human behaviour in relation to autonomy. The second contribution of the paper is a set of research questions for AV trialling in relation to other road users, including, pedestrians and cyclists, which have emerged from the literature review.

Study design and methods of the BoTULS trial: a randomised controlled trial to evaluate the clinical effect and cost effectiveness of treating upper limb spasticity due to stroke with botulinum toxin type A

Background Following a stroke, 55–75% of patients experience upper limb problems in the longer term. Upper limb spasticity may cause pain, deformity and reduced function, affecting mood and independence. Botulinum toxin is used increasingly to treat focal spasticity, but its impact on upper limb function after stroke is unclear. The aim of this study is to evaluate the clinical and cost effectiveness of botulinum toxin type A plus an upper limb therapy programme in the treatment of post stroke upper limb spasticity. Methods Trial design : A multi-centre open label parallel group randomised controlled trial and economic evaluation. Participants : Adults with upper limb spasticity at the shoulder, elbow, wrist or hand and reduced upper limb function due to stroke more than 1 month previously. Interventions : Botulinum toxin type A plus upper limb therapy (intervention group) or upper limb therapy alone (control group). Outcomes : Outcome assessments are undertaken at 1, 3 and 12 months. The primary outcome is upper limb function one month after study entry measured by the Action Research Arm Test (ARAT). Secondary outcomes include: spasticity (Modified Ashworth Scale); grip strength; dexterity (Nine Hole Peg Test); disability (Barthel Activities of Daily Living Index); quality of life (Stroke Impact Scale, Euroqol EQ-5D) and attainment of patient-selected goals (Canadian Occupational Performance Measure). Health and social services resource use, adverse events, use of other antispasticity treatments and patient views on the treatment will be compared. Participants are clinically reassessed at 3, 6 and 9 months to determine the need for repeat botulinum toxin type A and/or therapy. Randomisation : A web based central independent randomisation service. Blinding : Outcome assessments are undertaken by an assessor who is blinded to the randomisation group. Sample size : 332 participants provide 80% power to detect a 15% difference in treatment successes between intervention and control groups. Treatment success is defined as improvement of 3 points for those with a baseline ARAT of 0–3 and 6 points for those with ARAT of 4–56