Achieving emotional wellbeing for looked after children

by Richard Newson July 24, 2015

Children in care's mental health needs can be met - Grace Trevelyan in our research team looks at the steps needed.

We have known for some time that the children who are looked after within our care system are at far greater risk of experiencing poor mental health than children who live with their birth families.

In fact, they are four times more likely to have a diagnosed mental health disorder than children in the general population.

The case studies featured in a new NSPCC report bring this stark statistic, and its consequences, to life.  Stories such as those belonging to 16 year old Joe highlight an all too familiar state of affairs; one where emotional distress becomes both a cause and a symptom of placement instability and proliferating needs.

However, rather than merely describing a disjointed system that inflicts further emotional harm on already traumatised young people as a fait accompli, this report takes an important step forward by asking how care could be redesigned to promote positive mental health and setting out a vision for a care system where emotional wellbeing is prioritised, the key features of which are highlighted below. 

Five priorities for change

  • Embed an emphasis on emotional wellbeing throughout the system
    Professionals working in the care system need the skills and knowledge to understand how they can support the emotional wellbeing of looked after children and young people.
  • Take a proactive and preventative approach
    Support for looked after children should begin with a thorough assessment of their emotional and mental health needs.
  • Give children and young people voice and influence
    Looked after children and young people need more opportunities to identify what is important to them and influence their own care.
  • Support and sustain children’s relationships
    Children’s carers require training and support to be sensitive, understanding and resilient.

  • Support care leavers’ emotional needs
    Help young people identify and strengthen their support networks.

Here at NCB’s research centre we are extremely pleased to note how strongly the NSPCC’s priorities for change chime with the findings of much of our own research:

  • The importance of equipping ALL professionals working with children and young people with the skills and knowledge about emotional wellbeing emerged strongly from our work on the MindEd e-learning portal.
  • Giving young people a chance to influence their own care is the key principle which underscores NCB’s work on the ‘Taking it to the Next Level’ project which works with corporate parents and Children in Care Councils. Our evaluation of this project can be found here.
  • Our research into the skills and qualifications of the staff in children’s homes, meanwhile, strongly reinforces the need for carers to receive training that supports them to be sensitive, understanding and resilient. 
  • We welcome, in particular, the focus on strengthening the support networks around young people as they leave care. The need for ongoing emotional support as children exit the care system is a key finding of our research into the Prince’s Trust From Care to Independence Programme.

Overall, we are inspired by this vision as it is set out by the NSPCC. It feels like an important step towards establishing a greater focus on recovery within the care system, which NCB recently called for along with other leading children’s charities as part of the Alliance for Children in Care.

Click here to download Achieving Emotional Wellbeing for Looked after Children: A Whole System Approach

 

 

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Changing the odds in the early years

by Richard Newson July 21, 2015

Local services for young children have a vital role in reducing the effect of low-income. But what do the young children and families think? Heather Ransom considers findings from a project that listened to their views.

The Office of the Children’s Commissioner (OCC) has published ‘Changing the Odds in the Early Years’, a report which examines the role of national and local government and what works in tackling poverty during a child’s  early years.

To inform the report, NCB’s Research Centre was commissioned to carry out interviews and focus groups with low-income parents to find out about their experiences of housing support, early years provision, and health services.

 

In addition, a researcher trained in the Mosaic Approach, worked closely with young children alongside their parents and practitioners, to make sure their voices were heard too. The report also examined the challenges facing local authorities when tackling child poverty, with this work being carried out by OCC. 


 

So what did families and young children themselves say about the services they rely on?

 

Housing was identified as the area where improvements were most needed. Too many families were found to be living in poor quality accommodation – difficult to heat, too small, or in need of repairs – or which was simply not suitable for those with young children. For instance, a high rise flat with no access to a garden or nearby park. Moreover, young children’s views were rarely sought by housing staff.

 

The report recommends that housing strategies and quality standards be reviewed in order to improve access to quality social housing and make private housing more affordable.

 

Parents valued access to free early years services, enabling them to access play and learning opportunities for their children they would not have been able to afford otherwise. They were also happy with the quality and accessibility of health services, especially those using the Family Nurse Partnership, although some difficulties were reported in getting GP appointments.

 

But the threshold to be eligible for early intervention services was often felt to be too high, resulting in some families feeling they needed to have reached a crisis point before support was given. Given the impact of budget cuts on families, the report is calling for free early years and health services to be protected, along with increased availability and access to preventative support for parents.

 

With child poverty on the rise again, and Ofsted reporting last week that the development of disadvantaged children is significantly behind their peers by age 5, more emphasis needs to be placed on ensuring that low income families are able to access support and opportunities so that they can provide their children with the best start in life.

 

‘Young children’s experiences of services aimed at reducing the impact of low-income’ is available from: www.ncb.org.uk/low-income

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Young people’s views on hospital care

by Richard Newson July 14, 2015

What does a survey of 19,000 children and young people tell us about the health system? Young NCB member Jack Welch asks some difficult questions.

With the quality of young people’s healthcare playing such a vital role in our lives, it was fitting that a small team from Young NCB were invited to challenge the people behind the latest survey produced by the Care Quality Commission (CQC) in the House of Lords. Myself and three fellow representatives of Young NCB probed and scrutinised the findings of this new survey – the first of its kind for 11 years!

Speaking to the All Party Parliamentary Group for Children, CQC’s Deputy Chief Inspector of Hospitals, Professor Edward Baker, admitted that the time delay between the last survey and the present day was not acceptable and would be reconsidered in future consultations.


The report, which focused on those aged between 8 and 15, found that 90% of children and young people felt safe in the ward they were on and 75% felt that medical procedures were explained to them clearly.

However, Young NCB members were concerned that the limited age range meant that issues relating to the transition to adult services and how in-patients received treatment for mental health care were somewhat neglected. As Professor Baker revealed in his responses to our questions, while only 1% of under 15s were treated in adult wards, this significantly increased for those over that age. It was more worrying still that the facilities on paediatric wards were not at all suited to teenagers’ but were aimed much more towards younger children.

Further questions from the meeting included whether surveys were an appropriate tool to gather the opinions of young people, many of whom may not be inclined to give honest answers when they are around other people or may not be best engaged with this method. Professor Baker recognised this as a potential drawback, but believed that the survey was an important one to get the views of young people in hospitals heard.

What I found to be particularly worrying was the contrast in results for those young people who had disabilities or mental health issues, which suggested they were not always getting the same standard of care as other young patients.

Less than half of parents in this respect said that they thought that doctors had understood the needs of their child, with 72% of parents of children without a pre-existing condition agreeing with this statement. I questioned Professor Baker on this front, especially when it came to transitioning to adult care and how many of those with learning disabilities often struggle in their development once over 18. Other audience members also asked in regards to the care of BME groups and if standards of care fared any better regardless of background.

At the end of the event, we felt satisfied that CQC had listened to our views, that our questions were more than challenging and that action will be taken to improve the quality of children and young people’s healthcare in general.

Results from CQC’s survey of children and young people is available at: http://www.cqc.org.uk/content/children-and-young-peoples-survey-2014

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Summer budget: a view from Young NCB

by Richard Newson July 8, 2015

The budget will have far-reaching consequences, says Young NCB member Jack Welch.


With the most anticipated political event since the General Election now complete, the Government’s announcements on welfare and spending will have significant ramifications for those under 25. The measures included in Chancellor George Osborne’s speech today included: 

  • Housing Benefit to be scrapped for under-21s. Exemptions for the most vulnerable. Automatic claims will also be ended. 
  • Maintenance Grants, which are means tested for low paid families with students going to university, are to be converted into repayable loans from the 2016/17 academic year. Like tuition fees, students will pay this once they earn £21,000 or over. 
  • Young people up to 21 will be expected to ‘earn or learn’ – described as a ‘Youth Obligation’, more restrictions will be in place if young people are to claim Job Seekers Allowance or Housing Benefit.   
  • A new National Living Wage for workers over 25 by 2020. will start next year in 2016, when current minimum wages will go up from £6.50 to £7.20.  
  • Child Tax Credits will be restricted to two children per family for new claimants by April 2017. 

These announcements today may come as a surprise to some people, particularly around the scale of the reforms which will occur over the course of the next Parliament.

The changes to Housing Benefit may see many of the most vulnerable young people, who are already struggling to make ends meet, pushed over the edge and for those who are unable to return home to family, the risk of homelessness becomes ever more likely.

A report released this week by Cambridge Centre for Housing & Planning Research shows that at least 83,000 young people have been homeless between 2013/14, an increase on previous years. It is not acceptable to simply assume that young people are lazy or that they enjoy relying on benefits, given that so many of them face difficult situations. This measure must be given greater scrutiny before any implementation can take place.

It is welcoming to see the Government raise the Living Wage in the country, but when 16-20 year olds are often paid no more than £3.87 to £5.20 per hour, this development is likely to only benefit those who are already in work and may further disadvantage those young people, including graduates, who are just starting out in the job market. With Apprenticeship wages still lower than this, this otherwise positive development may have little benefit to the younger generations.  

NCB’s analysis, produced with The Children’s Society and Children & Young People Now, indicates that services such as early intervention are likely to be hit the hardest by local authority spending cuts. Additionally, families may now also bear the brunt of these measures meaning that more and more of the country's poorest children are likely to slip further into poverty. 

The Government must think very seriously now about these reforms that they are taking. Many of the country's poorest young people may feel they have to bear the burden of these cuts and this is not acceptable if all children and young people are to have equal opportunities in their lives. 

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‘One Nation’ budget for whom?

by Richard Newson July 8, 2015

The Chancellor said his Summer Budget "sets the way to secure Britain’s future". But what does that future hold for children, asks Anna Feuchtwang?

 

It was no surprise that today’s Budget announcement centred on major cuts to the welfare system. Despite Osborne laying his trump card – a welcome introduction of a National Living Wage – the fears of those working with vulnerable children are yet to be allayed. 

 

Hard times ahead   


We know that children and families have been hit by the previous government’s below inflation increases in child benefit and child tax credits. Our research [[http://www.endchildpoverty.org.uk/our-campaign/short-changed-how-children-are-hit-by-benefits-freezes] with the End Child Poverty coalition showed that 7.7 million children were affected by that decision, and that one in five families said they had to cut back on food and heating as a result.  

 

 


Today the Chancellor confirmed he would go further – with a freeze on benefit rates, decreased support for larger families, a lower benefit cap and housing benefit withdrawn from many young people. It is unfortunate that children were not afforded the same protection as older people. Along with the End Child Poverty coalition, we have called for a ‘triple lock’ on children’s benefits, so that they, like the state pension, increase by at least 2.5 per cent.  

 

It remains unclear whether the Living Wage will really make up the losses. However, with these cuts and the government making moves to erase the duty to eradicate child poverty, we have to ask whether the Summer Budget will result in a wider gap between children living in disadvantage and their better-off peers.  

 

Cuts that cost 


As families come under increasing pressure to pay the bills, local councils will be facing more demand for early help services, demand they’ll want to meet if they are to prevent problems becoming more serious and more costly. Today’s announcement that Manchester councils will be given more powers to play a greater role in children’s services could provide a real opportunity for local leaders to develop innovative approaches to providing cost effective early intervention.  

 

However, there’s no getting away from the fact that these services are under increasing pressure as funding for local authorities is cut – early intervention funding for local authorities was cut by over half over the last Parliament (http://www.ncb.org.uk/cutsthatcost ). While local authorities are clearly making an effort to protect children’s centres, young people’s and family support services, this will continue to be a challenge as budgets tighten further.  

 

It’s time that the government introduced longer term, dedicated and protected budgets for early intervention services.  

 

Children first 


All in all, the Summer Budget appears to be a missed opportunity to put children first. Apart from additional free childcare, there was little that will help achieve the government’s manifesto pledge to ensure every child gets the best start in life. All eyes will be on the Spending Round in the autumn, where we will see whether this ‘One Nation’ government will secure a happy and safe future for our children.   

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Trends in investment in early help

by Richard Newson July 7, 2015

With the summer budget about to take place, Anna Feuchtwang considers the importance of spending early to prevent problems later.

Politicians from across the political divide rarely come together to make a united stance. So when they all signed up to the early intervention cause at the start of the last parliament, it was a significant moment.

Five years on, with a new government preparing its spending plans, it’s important to take stock and try to establish what’s happened to early intervention spending.

What has happened to funding for early help services?

‘Cuts that cost: Trends in funding for early intervention services’, an investigation by The Children’s Society and the National Children's Bureau (NCB) in collaboration with Children & Young People Now, sets out trends in funding from central Government, and in spending on early help services by Local Authorities.

This isn’t easy as there is no agreed definition of what constitutes this spending across central and local government, something which needs to be urgently addressed if there is to be an effective means of measuring spend and examining trends.

At present the only way to get an indication of funding for early intervention is by looking at the allocation that is included in the local government finance settlement each year. In 2010, a number of different funding streams for early intervention were pulled together into what was then called the Early Intervention Grant.

This included support for children’s centres; information and advice for young people including careers services; teenage pregnancy and substance misuse services; young offender and crime prevention services; family support services; and early years and children’s social care workforce development.  

The total value of the Early Intervention Grant when it was introduced was around £3.2 billion in today’s prices. By 2015 however, the value of the grant has been more than halved to around £1.4 billion. By the end of this financial year the allocation provided to local authorities will been cumulatively reduced by £6.8 billion

Early intervention funding by local authority

We have produced an interactive map which shows how changes in funding break down for each local authority in England. These changes are presented in real terms and all amounts are given in 2015-16 prices.

What has been the impact on Local Authority spending on Early Help?

The evidence is indisputable that the money available to councils for vital prevention and early help services such as children’s centres, youth facilities and advice services has been substantially reduced. But councils have done their best to cushion the blow and protect these services.

The data that is available from annual returns to the Department for Education shows that spending on children’s centres, young people’s and family support services fell by 24% in the five years to 2015 - a cut of over £700 million per year which is not as dramatic as the reduction in funding provided for early intervention services by central government. However it still amounts to cumulative spending reductions of over £1.5 billion over the five years to 2015.

It would appear that where possible local authorities have tried to protect services through doing things differently and creatively drawing on funds from elsewhere, such as the schools grant. And not surprisingly when government provided funding for family support through the Troubled Families programme it helped areas reconfigure provision.

What needs to be done?

It is far from straightforward trying to get a clear picture of the impact of reductions in spending on early intervention provision but what seems to be the case is that councils have tried to protect services as much as possible.

The question now is whether local authorities will be able to find sources of income or other ways to protect these services should further cuts be introduced, or whether they will have to make even more difficult decisions about the future of their services.

If government really wants to see a shift towards early intervention, rather than costly late intervention, there is no doubt it will have to prioritise early help funding to ensure local authorities can maintain these services.

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Children's rights: worth fighting for

by Richard Newson July 1, 2015

Are we protecting children’s rights in the UK? Keith Clements, Policy Officer at NCB, explains why these are key to ensuring good health for all children.

The current proposals to abolish the Human Rights Act have brought the idea of rights back to the political fore. A rights-based approach helps us and policy makers focus on making sure that all children can expect the same basic protection, support and quality of life - no matter what their needs and regardless of any political barriers we might perceive as preventing this from being achieved

Later this year, the fifth periodic review on the UK’s adherence to the UN Convention on the Rights of the Child (UNCRC) will take place. A group of charities, led by the Children’s Rights Alliance for England (CRAE) have compiled a voluntary sector response to what the Government submitted to this review, to give our side of the story. One of the areas we looked at was children’s health.

Childhood mortality is declining, but UK is still amongst the worst performing in Western Europe, and those that do die young are more likely to come from a poor background. Some approaches to inequality may place the blame on the decisions of parents and discourage any supportive intervention from the state and public services. Such approaches are not compatible with the fact that all children, no matter what their background, have the same right to the highest attainable health, and our response to them must not be coy in reflecting this.

The abuse at Winterbourne View, a residential hospital for people with learning disabilities, uncovered in 2011, was truly shocking. It also raised an important question – why were so many people, including children, stuck in such settings, so far from home, in the first place?

Article 23 of the Convention makes reference to the right of the disabled child to special care, and the UN Committee on the Rights of the Child has said it expects children to receive care as close to home as possible. This must be part of our arsenal in holding decision makers to account on the provision of support for children with learning disabilities in their own neighbourhood.

Children and young people’s needs are thankfully being considered as part a recent increased political focus on mental health more generally. Since May, Government has taken encouraging steps, starting to implement the proposals of the taskforce on children and you people’s mental health, which published its report in March.

There is a long way to go and this must remain an ongoing priority. In this case and in others, we may hear arguments that decisions are ‘down to local clinicians’, squabbles about which local agencies budget should foot the bill, or the competing pressures put on health services by an ageing population. We must remember that this does not absolve the UK of the commitments it has signed up to under the UNCRC.

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From care to independence – getting it right

by Richard Newson June 26, 2015

Keith Clements, Policy Officer at NCB considers ‘what work’s’ in supporting care leavers.

For all young people, getting on in life is not just about gaining knowledge and having opportunities, but also about the developing the skills, confidence and resilience they need to make successful transition to adulthood.

An increased national focus on mental health and wellbeing, particularly in education policy, which is visible in the election commitments made by the new government is a welcome reflection of this fact.

While the support that schools and colleges offer to develop life skills and confidence will often vary, most young people can at least, rely on a strong family network to fill in the gaps and help them to work through the personal challenges they face.

The typical experience of a young person in care will be very different.

The fallout from their pre-care experience, and often frequent placement moves within care will make the development of strong, supportive relationships a challenge for many.

The ability of schools and other formal services to track and contribute to the development of life skills and confidence will be hindered by these factors. And, of course, the age at which these young people are expected to become independent is much lower than that of their peers, with most leaving care at age 18, and others earlier, and the support the state provides them as care leavers dropping away completely in their early twenties.

This is why programmes such as ‘From Care to Independence’ (FC2I) are so important.

FC2I is a programme of support delivered through The Prince’s Trust Fairbridge Programme and partner agencies, which aims to support care leavers to develop personal and social skills that could help them to stabilise their circumstances and make positive steps forward.


Research has revealed that half (55%) of the care leavers who received a package of group activities and one-to-one sessions successfully moved into employment, education, training or volunteering, emphasising the role that continued support for care leavers can have on their lives.

An overwhelming majority of care leavers found the model of support offered by the project useful, with 98% saying the one-to-one sessions with advisors had helped them achieve their goals.

It is heartening that, in spite of their troubled start in life, few of the young people working with FC2I have let this stop them setting aspirations for their future. It is clear that, of all young people, care leavers are better placed to achieve their goals with the right one-to-one support.

The findings also, however, give us a timely reminder of some of the challenges care leavers face and the need to continue to improve how their day to day needs are met, including accommodation, emotional and practical support and access to mental health services.

There are encouraging opportunities for these issues to be addressed, such as proposals for the reform of child and adolescent mental health services, and the ongoing work to explore how all care leavers are able to benefit from ‘staying put’.

The research into the effectiveness of FC2I, like much of the sectors’ work supporting care leavers, demonstrates the vital role the voluntary sector plays in improving outcomes, through service delivery, innovation, evaluation, finding solutions, and challenging the status quo.

From Care to independence: Interim Findings May 2015 is available from www.princes-trust.org.uk/about_the_trust/what_we_do/from_care_to_independence.aspx

And

www.ncb.org.uk/what-we-do/research/our-research/a-z-research-projects/from-care-to-independence

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Improving male health for the next generation

by Richard Newson June 18, 2015

As Men's Health Week closes, Emily Hamblin asks how we change men's and boys' attitudes to health.

This week is Men’s Health Week, an international initiative which exists because men are at higher risk of premature death from most health conditions that should affect men and women equally.

So how does this gender disparity arise, and what does this mean for children?

Evidence shows that men have poorer health literacy than women, are more likely to engage in behaviours that pose a risk to health and are less likely to acknowledge health issues. Men tend to under-utilise professional health care services.

Some researchers have linked male gender roles that characterise men as independent and in control, to men’s perception that seeking medical help involves a risk of losing control and self-esteem, and an admission that they cannot sort the problem out on their own.

Results from our survey of 138 men aged over 16 seem to support these findings. We asked men about the factors, influences and thinking behind their attitudes to health, and what they believed might help to protect and promote the health of the next generation more effectively.

They told us how readily they would use health services for different reasons.

Men’s reluctance to access health services is concerning, particularly in relation to emotional or psychological issues as suicide is the leading cause of death for men under 50 in the UK, and the number of suicides in 15-29 year olds registered between 2010 and 2013 was five times higher for males than females.

When asked what changes might help enable boys and young men to address their health needs effectively in the future, men called for change in social factors such as discourse amongst boys and men (93 per cent), social expectations of men and women (91 per cent), role models (81 per cent) and family attitudes and communication around health (80 per cent).

Our findings from men informed our subsequent consultation with boys aged 9-11 on their attitudes to health. The boys’ ideas about health were at an interesting point of development: still children, they heeded health messages from adults and other authority figures, yet felt varying degrees of agency about decisions that affect their health, and were conscious of external forces that can shape opinions and behaviours.

Improving health outcomes for boys and young men will need a multi-pronged approach involving policymakers, health professionals, parents, teachers and, crucially, boys themselves. This should involve:

  • Supporting public services to respond to boys’ and men’s health needs
  • Improving knowledge and evidence about boys’ and young men’s current and future health needs and behaviours
  • Nurturing and promoting positive health-seeking attitudes and behaviours in boys and young men
  • Considering what parents, carers and teachers need to guide and support boys with regards to their health and wellbeing.

In addressing these issues, we must avoid problematising masculinity or inadvertently reinforcing stereotypes about strength and competition. Instead we should promote the idea that a boy or man’s care for his own physical and mental health is a normal and important part of achieving his aspirations.

For more information read NCB’s reports: Improving male health for the next generation: Findings from NCB’s survey for men and Findings from NCB’s focus groups with boys.

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Lords begin debates on Govt’s plans for more free childcare

by Richard Newson June 16, 2015

As the Childcare Bill starts its passage through the House of Lords, Zoe Renton, NCB’s Head of Policy, asks whether it will deliver for young children.

Today (16th June), Lords and Baronesses will be getting their teeth into a new government Bill on childcare, starting the long process of Parliament’s scrutiny of the legislation. The Childcare Bill aims to give 15 extra hours of free childcare to three and four year-olds with working parents, extending the amount of free childcare to a total of 30 hours per week over 38 weeks.  It’s a welcome ambition, as we know that a lack of childcare does pose a barrier to parents working and good quality early education can help children develop well. But, at only six clauses long, the Bill provides little detail about how the government will deliver on its surprise manifesto commitment.

Here are some of the questions I hope MPs and Peers will be asking as the Bill progresses through Parliament.

What will count as childcare?

The original free entitlement to 15 hours of early education was aimed at both improving young children’s outcomes and enabling parents to work. It is vital that this additional offer does the same. We know that good quality early education or childcare is particularly beneficial for those growing up in poverty or disadvantage, and poor quality care can have a neutral or even negative impact on the child. So, what standards will childcare settings have to meet in order to deliver the additional free hours?

How will we cover the costs?

Concerns about the current under-funding of childcare places have been widely reported – an estimated total of £177 million according to the Pre-School Learning Alliance. Providers and experts say that this poses a barrier to delivering good quality childcare, in particular for young children with additional needs, such as those with special educational needs and disabilities (SEND). This problem will only get worse if the planned rapid expansion in the number of hours on offer is not underpinned by sufficient funding, so the government’s review of the funding situation is welcome. But how will this review take account of the additional costs associated with delivering childcare to disadvantaged children and children with SEND?

Who’s doing the childcaring?

A well-qualified, confident and experienced workforce is key to good quality early years services that improve young children’s outcomes. Whilst there are signs of a gradual improvement in the quality of the workforce, a significant minority of practitioners are without a Level 3 (A-Level) qualification, only 14 per cent of private, voluntary and independent childcare settings employ a graduate, and there continue to be concerns about staff vacancies. So the third question for the government, is will they develop a strategy for expanding and improving the quality of the early years workforce, as part of plans to deliver on their childcare ambitions?

Hopefully there will be full and robust answers to these and other questions as the Bill progresses through Parliament. Because, if implemented effectively and with the needs of young children in mind, this policy could be positive news for children and families.

Read NCB’s briefing about the Childcare Bill at: http://www.ncb.org.uk/media/1219249/childcare_bill_2nd_reading_briefing_ncb_.pdf

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