Labour are planning an increase in outreach workers at Surestart centres, as one way of supporting parents with young children. That's their idea. But money is tight and we've got to make choices. So I believe that instead of more untrained outreach workers, we need more trained professionals who really know what they're doing. They exist already. They're called health visitors.
He proposes more health visits for families, focused most regularly in the first few months of a child’s life. No doubt at all: that would be a good thing. But, as he says, money is tight, and so he wants to cut the extension of outreach services, focused across a wider age range, that will have been implemented by the time he gets to fight an election.
No doubt at all: that cut would be a bad thing.
He cavalierly waves that away as not really important, insinuating that these outreach workers aren’t “trained professionals who really know what they're doing”. Certainly, they’re not trained as health visitors, but that’s not their purpose. Their role is to make home visits to parents of young children, offering information about services available and families’ entitlements, as well as advice, advocacy and support in navigating the system. They can also refer families to more specialised professionals – such as health visitors.
A report [PDF] assessing Sure Start outreach services gives lie to the insult that these workers are bumbling amateurs:
The components of training for outreach staff are extensive, since these workers need to be prepared to respond to a whole variety of questions and needs. Typical ingredients include courses on domestic violence, child protection, first aid, confidence building, peer support/breast feeding, drugs, Islam awareness training, child and adolescent mental health, early childhood and learning, baby massage, baby yoga, speech and language, signs and symptoms of postnatal depression and general mental health.
Some of this I admit I roll my lefty eyes at: baby yoga the world could surely live without. Most of the rest seems reasonable, though – including, to my distaste, Islam awareness. But to imply that outreach staff are little use is as dishonest as would be claiming that health visitors know about nothing other than health issues.
Cameron claims that his plans to divert resources into health visiting are popular: “it's not surprising that overwhelmingly, parents say it's this kind of help and support they want”. It’s not surprising that a politician claims public support for his plans. But the truth may not be so straightforward, according to the assessment:
there are local variations in what is acceptable in the way services are delivered. Some areas report that non-professional home visitors are not acceptable, whilst professionally qualified staff are. In others the reverse is reported. In some areas professionals are considered threatening (especially if there is an association with Social Services Departments) and paraprofessionals from the local community are welcomed. Particular sensitivity is required in understanding the local context and preferences…
Exactly: letting local people shape the public services they want is what Cameron so regularly emotes about. And yet, here he is, saying that it all should work his way.
The report notes the different approaches that local programmes take:
Where local Health Visitor managers joined the Sure Start partnership at the planning stage, it was likely that the health visiting service would be the structure on which the Outreach and Home Visiting service was built. … When this happened there was unlikely to be a major input from para-professional home visitors, other than as a support resource for this health team.
Where SSLPs [Sure Start Local Providers] had a strong community development ethos the opposite model was more likely, with the outreach and home-visiting work spearheaded by community workers and para-professionals, many of them local parents, with health and other practitioners called upon where specialist input was requested by visiting parents or considered necessary by home visitors.
Why insist that that the form where the “community development ethos” predominates, and in which parents themselves play a greater role, is wrong?
Health visitors are the kind of support that parents want. Not laissez-faire: just leaving parents to get on with it. Not nanny-state: some bureaucratic system telling parents what to do. Just sensible, practical, personal support that people trust.
And yet he can’t see that he himself is being too directing and top-down in his approach. Nor does he realise that he’s not bringing any new principles to the table. Compare the sentiments in his quote with those of this, from a training pack for the Sure Start outreach workers that he wants to cut:
It is not our role to take over a family’s problems and issues. We are there to support them in doing for themselves, to present families with choices and to respect and abide by the decision made by the family.
That’s not a lofty ministerial soundbite; it’s what the front-line workers are having drilled into them.
One other thought: specialist health visitors are good, and so is the support from more generalist outreach workers. But the latter more disproportionately benefits the most socially excluded families, less aware of and able to navigate the system than the well-educated, better-off middle class. So Cameron’s policy, as well as redistributing support from youngish children to new babies, will tend to redistribute away from poorer families.
If “money is tight and we've got to make choices”, why not choose to forsake some of that inheritance tax cut?