Climbing ladders: From treatment to prevention (2025)

Maya found out she was pregnant when she was 18.  She was living with her boyfriend, Dan, and his Mam and Dad at the time.

She was anxious about being pregnant and it was all she could talk about, but Dan seemed to prefer spending time with his mates, which lead to a lot of rows. 

After splitting up with Dan, she needed to find a new place to live. His Mam said she could stay as long as she liked, but it was too awkward for her.

She moved in with a friend, and despite still feeling anxious about her pregnancy, got support from Gateshead's Family Nurse Partnership (FNP). They helped her to find a safe and stable home, as her friend's sofa was only a short-term solution, and worked with her to build her confidence.

They referred her for a Baby Box, which included toys, books, a tooth brushing kit and a mat and towel for when the baby arrived. They also supported her with breastfeeding, which Maya found tricky at first, but with their continued support kept going.

Dan went with Maya to Blaydon Winlaton Family Hub to register Isla's birth. It was closer than the Civic Centre and they both wanted to be named on the birth certificate. Whilst they were there, they found out about activities and support that they could go to with the baby.

Despite parting ways, Dan and Maya regularly took part in a range of fun, stimulating activities that supported Isla's development at the Family Hubs. Over time, they built a trusting relationship with Jo, the Parent Outreach Worker, who provided parenting advice, practical support and helpful information about local services.

Isla is now 4 months old and Maya is enjoying being a mum. She has made friends through a parenting group at the Family Hub and is beginning to think about training opportunities for when she's ready to go back to work.

The snakes and ladders in Maya's story

Snakes

Poverty: Children in deprived areas face poorer early development and higher health risks¹⁵, while stigma and poverty limit access to mental health support. ¹⁶

Homes: Housing insecurity is linked to health problems, developmental delays, and emotional stress for children and young people as well as their parents.¹⁷

Mental health: One in four women experience mental health issues around pregnancy, which can also negatively affect their children's physical and mental health and development.¹⁸

Ladders

Access to services: Maya and Isla benefit from the Family Nurse Partnership (FNP), an intensive home-visiting programme for first-time young mums. Support began in pregnancy and continues until Isla is around two, helping Maya stay healthy, support Isla's development, and reach her goals.

Friends, family and support networks: Maya and Dan took Isla to a Family Hub to register Isla's birth.  Whilst they were there, they found out about the Best Start in Life offer which includes help with parenting, infant feeding and support for parents/carers to manage their own wellbeing. (Dan found out that Family Hubs weren't just for mums, but dad's too!) Maya now attends a parent support group at a Family Hub with Isla every week and Dan takes Isla for 'stay and play' sessions to spend quality time with his daughter, improving his relationship with both Isla and Maya.

Upping prevention

When Maya is ready, access to training could help her secure a good job. Affordable, high-quality childcare supports parents to work and benefits children's development. However, unemployed single parents like Maya are not eligible for the government's funded childcare for children aged 9 months to 4 years (30 funded hours per week). As a result, Maya may find it difficult to return to training, and Isla may miss out on early learning opportunities. This national policy deepens existing inequalities, as families in Maya's position face barriers to learning and training and their children miss crucial early development experiences.

When Isla turns two, Maya may be able to access 15 funded childcare hours a week if she meets the criteria to qualify for Early Learning¹⁹ for two-year-olds. However, this would still be much less than the 30 hours working parents are entitled to. A recent study found that reducing economic inactivity among parents with childcare responsibilities could unlock major economic gains. Recommendations included widening eligibility for the 30 funded hours to include those in training or education, enabling parents to upskill or reskill, improve their job prospects, and contribute to higher productivity and reduced skills gaps across the economy.²⁰  

Measuring impact

For a long time, there has been a public sector focus on measuring targets based on service use. This means that while we know if services have been delivered, we don't always know whether these are the right services, delivered in the right way to the right people to achieve the outcomes people want. It is human nature to look at complex problems and try to simplify them.  While this works well for some processes and products, it doesn't always take account of the complex nature of issues like people's social circumstances, the inequalities they experience, and preventing harm that accrues because of these things.

More recently there has been recognition that looking towards outcomes rather than just outputs would be useful, but this isn't an easy task and changing to accommodate new and unfamiliar approaches is difficult. Trying to measure the impact of prevention is inherently difficult. For instance, how do you measure something that hasn't happened, and how do you know which intervention made the difference when so many factors are at play? Often, prevention efforts aren't delivered at sufficient scale to make a meaningful difference or are funded with time limited resources, for example Gateshead's falls prevention work which has found itself funded year to year despite excellent results.

The answer is to acknowledge that there are a range of indicators that when taken together provide a fuller picture of what is happening. This requires recognition that targets are only part of the picture and that a more layered approach to measuring impact is needed. For instance, engaging more proactively with target populations to help design intervention and to hear about their experience, can provide insights that allow services (and measures) to evolve over time. This in turn can feed into longer term evaluation and trend analysis which builds evidence and demonstrates how things can change over the longer-term. But this represents a challenge to current performance and target-based approaches.

Additional approaches to measuring impact would need to be agreed and trialled, but the current HiAP approach provides an example of how this can work in parallel with current practice.

Example indicators

• indicators by life stage: good level of development in under 5's, employment rates, smoking prevalence
• equity-focused monitoring using Marmot indicators
• indicators by life stage and Building Blocks:
  • good level of development in under 5's, employment rates, housing quality, food insecurity, smoking prevalence
• health indicators: vaccination uptake, screening coverage, smoking prevalence.
• economic indicators: reduced emergency admissions, improved employment rates, cost savings from reduced demand on acute services
• NHS metrics: digital health check usage, social prescribing referrals, reduction in emergency admissions
• equity-focused monitoring using Marmot indicators