1.Promote and protect the health and wellbeing of children from pregnancy

(for example through positive parenting, high immunisation rates and

tackling smoking in pregnancy).

The midwife and health visitor are more than likely the main professionals expectant parents rely on during pregnancy so the services they provide are of vital importance. Where possible there should be a named health visitor so relationships can be built up. It is within this trusting relationship that early discussions on smoking, immunisation and positive parenting can take place. It is important that information is given in a format and a language that is easy to understand.

 It is also in these early stages that links can be made with the third sector in signposting parents to Parent and Toddler groups and support agencies so that parents have access to peer support and opportunities for them and their child to socialise and play. The system works well in Flying Start areas but it is equally important in non Flying start areas that relationships are built up between Health Visitors, parents and Parent Toddler groups and also with early years’ settings that provide childcare and education . 

Many parents and families would benefit from clear direction on what is most appropriate for their circumstances regardless of their economic demographic.  Current strain on universal health related services such as Health Visiting is seeing a reduction in the availability of a dedicated professional to guide parents through the fog of information.  Conversely, heavy investment in this arena in Flying Start designated areas allows for more intensive support for those deemed to reside in specified postcodes, thus leading to two tier availability of support.  While it is apparent that Flying Start interventions are having a positive effect on outcomes for relevant children and their families, lack of universal access to these services is denying some children and families much needed support purely because they live in the wrong part of a town or community.  A need for support particularly when dealing with children in their first days, weeks and years knows no geographic or economic boundaries. It would be helpful if Government policy could reflect this rather than subscribing to the sometimes divisive situations currently used.

The provision of additional universal services for parents eg. Smoking, the ”Give it Time initiative which can be further developed providing increased   relevant information on the effects on screen time, how to implement a good sleeping patterns and why these routines are needed, tummy time, advantages of stories and singing at a young age, healthy diet, effects of dummies etc

Mention has previously been made of Parent and Toddler groups. These informal play sessions have provided a low cost parent support solution in many locations throughout Wales for many years. These sessions have allowed parents and carers to become engaged with their local communities and meet parents in similar circumstances.   A common thread of these groups has been camaraderie, friendship and support and often a lifeline to parents who may feel unsupported or lacking local family support.  Due to austerity measures, many funding opportunities for supporting universal services such as these is being lost leading to the closure of these informal parenting support groups.  we recognise that similar groups are still being established in designated Flying Start areas but there is a danger that without hitherto ‘soft' universal services, more parents and children will require higher level interventions in the future, thus increasing strain on services.

2. Deliver improved child health outcomes across Wales (for example prevention of obesity and the promotion of health-enhancing behaviours for every child such as eating a well balanced diet, playing actively, and having an appropriate weight and height for their age and general health).

The Healthy and Sustainable pre-school award is now undertaken by many early years and childcare settings in Wales and it is an excellent way of promoting healthy eating and a healthy lifestyle to pre-school children. The Golden Standard Healthy Snack Award is not only undertaken by childcare settings but also by Parent and Toddler groups which is a way of promoting healthy eating to parents and children and more settings should be encouraged to take up this award.

There is a perception among many parents that healthy food is expensive so there is a need for Parenting sessions in cooking together, cooking on a budget and what does a 'heathy body' look like? These sessions are often given in Flying Start areas but again there is a need for this to be universally available perhaps using the skills of third Sector organisations.

Parents need to be made aware of registering children with an optician and dentist from an early age so that the child becomes familiar with these professionals and thus helps ease any fear and leads to early identification of any problems.

Design to Smile is an excellent programme and while some authorities roll it out as an universal service to childcare settings other restrict it to Flying Start.

3. Tackle child health inequalities, with a specific focus on child poverty and disabled children.

As we all know, Flying Start is a postcode lottery but pockets of poverty exist elsewhere so it would be good to see those areas approached. It is widely recognised that inequalities result in poor health, social and educational issues and families become trapped in an ongoing cycle of poverty and deprivation.

Assisted Places schemes to help low-income families place their child in their local pre-school but this is no longer available in all counties across Wales.  It is recognised within the Children Act 2004 that “quality early education is the most important factor bar none in determining a child’s life chances” and we believe it is therefore vital to support and develop early years’ settings which are accessible and affordable for local parents.

Although the effectiveness of preventative services is notoriously difficult to prove, children who do not have the benefit of pre-school experience are considered to be at a disadvantage in terms of peer sociability, concentration, independence, co-operation and conformity -  behaviours which are important for successful adjustment to mainstream school.

In the case of children with behavioural problems, extra adult support during their pre-school time nearly always results in the child being able to go on to school without further assistance.

Parents of disabled children often feel very alone as they don’t know who to contact and what services are available to them. Parents need to know what help is available and while the Family Information services do provide good information this needs to be more widely advertised, making use of board space in hospitals doctors surgeries and libraries would be a starting point.

4. Reduce child deaths and injury prevention, particularly in the most deprived parts of Wales where infant mortality is much higher than the least

Deprived.

The role of the Health visitor is very important here in educating parents in basic safety routines such as the best position to place your baby to sleep and the dangers of passive smoking to name but two.

  Parents should be made  more safety aware of  Home safety – Carbon Monoxide and Smoke Alarm fittings and checks to be promoted wider, fire guards, stair gates, safety plugs etc (often provided to Flying Start only families, should be available to more families in other areas of need).

Childhood Injury Prevention Awareness Sessions /Training – raising the awareness of hazards in the home (blind cords, washing tablets etc).

There is potential here for safety information to be delivered to Parent and Toddler groups if funding was available.

5.Support effective child development and emotional and social well-being - specifically interventions that are delivered outside the health service which can help to detect and address developmental delays.

Parents often don't know where to look for childcare which suggests that  promotion of the Family Information Services is required. Parents also need to be aware of the CSSIW and the importance of choosing good quality childcare. Parents should be made aware that childcare is not only for working parents but that a good sessional care provision provides excellent experiences for children that will help them in their child development. 

In the case of children with behavioural issues, extra adult support during their pre-school time has been shown to have positive results in the child being able to go on to school without further assistance.

Early intervention results in improved socially acceptable behaviour and less stress for a child’s  family.

Additional Needs Referral Schemes need supporting especially in Early Years Settings. All children’s physical, emotional and social development is nurtured in playgroup.  A county referral scheme where in place ensures that children with special or additional needs are given the opportunity of attending a pre-school setting along with their peers and are not isolated within their community. The budgets for some schemes are decreasing and support, where available, is often only for two sessions a week and while this might suit some children others would benefit from being able to attend more sessions. 

6. Focus on improving learning and speech and language development

through the home learning environment and access to early years’ provision

(including childminders, preschools and day nurseries).

It is important that as many childcare practitioners as possible access training in order to help them support children with speech and language difficulties and support parents in furthering this within the home. The Elkan training is excellent and staff who have attended find it useful when working with children with Speech and language difficulties. The problem is this training is often only delivered to Flying Start settings and if it was universally available it would offer more support to children with speech and language problems.   

Children are  now able to develop their skills and begin to be bilingual from an early age and parents would, benefit from having support so that they can continue their child’s bilingual skills in the home

Funding for language and play has been withdrawn or reduced from certain local authority areas in recent times but  this is an excellent programme for encouraging parents to play and talk with their child which is so important in language development and needs to be re-introduced where it is no longer widely available.

Agency support in the rural areas: such as HV, speech and language etc isn't always available in certain areas or have to travel to get the services or wait longer.