The first five years of a child's life are the most crucial – so why do we consistently underestimate their importance?
The Princess of Wales is in a church hall in Southwark, happily drinking a make-believe cup of tea offered to her by a toddler. The little boy, George, neither knows nor cares who she is, other than a new playmate who shows suitable appreciation for his imaginary brew.
The Princess is in her element - the children around her, oblivious. If it wasn’t for the part-nervous, part-incredulous glances from a room full of mothers and staff, she could almost be an ordinary volunteer.
An hour or so later, she leaves with sticky fingers from making fruit kebabs and a head full of information gathered directly from those on the front line of a sector that has never felt so essential. The visit, one of countless public and private trips over the last few years, was designed to shine a spotlight on the “early years”, the period from birth to five years old, that experts now agree is utterly critical to building happy, healthy adults.
After more than a decade in the Royal family, and as she embarks on a new era as Princess of Wales, the future Queen, who started life in the public eye as Kate Middleton, has pledged to do everything she can to change the fortunes of generations to come.
Ambitious? Yes. But possible? Experts think so.
The problems facing the early years sector are vast, from a looming childcare crisis to the huge repercussions of the Covid-19 pandemic on our youngest generation. At nurseries, community centres, hospitals, research departments, charities, schools, homes, and in her own newly set up Centre for Early Childhood, the Princess has spent years quietly consolidating evidence of what needs to be done.
As she has worked, The Telegraph has been alongside her: watching, listening and interviewing those she has consulted. Now, as the public hears directly from the Princess in her clearest terms yet about her passionate commitment to the “youngest members of society”, there is no doubt about her conclusion: the under-fives need our attention like never before.
At the Angel Nursery, set in the middle of grey blocks of flats in a deprived area of Pimlico, a three-year-old is tickling the nursery’s chief executive under her chin with a feather and laughing like a drain. June O’Sullivan MBE, who runs 40 nurseries under the banner of the London Early Years Foundation (LEYF) - three-quarters of them in disadvantaged areas - takes her chance to teach the little girl as she plays along, sounding out the word “feather”, and giving a description of its colour and texture.
Next to her, a confident playmate, also three, is busy listing the jobs he’d like to do when he’s older (pilot, knight or member of the King’s Troop) and reciting the Julia Donaldson book one of his teachers has just been acting out. They are surrounded by staff who never seem to sit down, art tables laden with leaves and flowers for glueing, real vegetables they can chop up, and a nature corner complete with giant African snails bringing a bit of the outdoors into central London.
This nursery is officially “outstanding”, the LEYF chain held up as an example of the difference quality childcare can make when it gets it right. But O’Sullivan, rightly proud of those achievements, is still worried about the bigger picture. “There should be a decent nursery that parents can afford, no matter where you live,” she says. “There shouldn't be a random option, leaving some lucky children and some unlucky children.”
The statistics separating the lucky and unlucky are stark. From conception to school, children and those who care for them are facing unprecedented challenges, in existence since before the Covid-19 pandemic. To say the challenges have been exacerbated by lockdown is an understatement. Those working face-to-face with toddlers and pre-schoolers cannot escape the marked drop they have seen in language and communication skills; the slower physical development of young children cooped up in flats; the missed toilet training due to harassed parents dealing with multiple children resorting to iPads and nappies just to keep the show on the road.
“We’re not really shockable, but it is shocking,” O’Sullivan says of the effect of the Covid lockdown on the children she sees. UK childcare costs are among the most expensive in Europe. Full-time care for those yet to start school costs almost 24 per cent of the average earnings of a two-parent family, compared with 6.24 per cent in Germany and 2.62 in Sweden.
The system to access free or subsidised care is also labyrinthine in its complexity: the “free hours” for two- and three-year-olds come with hidden costs; £2.4 billion allocated for the tax-free childcare scheme unclaimed as even well-educated, high-earning parents struggle to untangle its tortuous workings.
Ofsted has identified 4,000 childcare providers lost in the past year, with widespread recruitment and retention problems in staff that are typically young and low-paid. The big picture shows the early years as consistently undervalued: unsung carers leaving the workforce, child development misunderstood, and a lack of general public awareness about why any of it is important.
“The evidence is now absolutely clear: our environment and experiences in the earliest days, weeks and months of our life are critical to how our lives turn out and to the kind of society we create,” Kate Stanley, an adviser to the Princess’s Early Years Steering Group, has said. “And yet, as a nation, we don’t behave as if this is the case.”
Why not - and why does it matter?
By the age of two, scientists know, the brain is already 80 per cent of its adult weight, with more than a million synapses forming per second. It has “unique plasticity” in the earliest years, affected by positive experiences and attachment, according to The Center on the Developing Child at Harvard University.
It is a time of huge potential. But it is also the moment where the circumstances of lucky and unlucky children, through no fault of their own, can set them on very different paths. As Paul Ramchandani, Lego professor of play in education, development and learning at the University of Cambridge, puts it: “We have, as a country - and not just our country - overlooked young children and early years.
“Babies seem as if they just get on with it and just need physical care, but there’s an enormous amount going on which can have a huge effect on their development.”
At the Princess’s Centre for Early Childhood, launched last year, staff have been busy pulling together a compelling picture in its “Big Change Starts Small” report. Distilling studies from the Department for Education, the Children’s Commissioner and university research departments around the world, it pinpoints the need for holistic care starting in the womb. The mental health of mothers has a direct link with brain activity in their babies, it points out. Pre-school children who have parents with mental health issues are three times more likely to follow suit.
Even pre-pandemic, disadvantaged children were already 4.6 months behind their peers by the end of Reception, with the gap predicted to widen.
In a 2020 survey, teachers reported that nearly half of children arrived at school without the necessary abilities to listen, play and share with other children, hold a pencil, eat independently, and use the toilet. “For children to be nurtured, they need nurtured adults around them,” the report, overseen by the Princess, concluded. “Primary caregivers play the most critical role but they do not exist in a vacuum.”
In other words, it still takes a village to raise a child.
These days, that village stretches from midwives to nursery staff and everyone in between: the mental health experts, the volunteers running the playgroups, the extended families picking up childcare while showering their grandchildren with love. The point, in an ideal world, is to weave them together.
“One of the things that worries me, and one of the challenges, is creating a more coherent journey for babies and families through the system,” says Ed Vainker, the chief executive of the Reach Foundation, which co-founded a school that takes children from ages two to 18 (or “cradle to career”).
“It’s not clear whose role that is. You see your midwife, you have a ten-day visit, you might see a health visitor once... there’s no handover to nursery.
“That’s a big challenge and it needs decision-makers to be figuring out that more seamless journey through the system. In our community, we are providing that role. Our objective in our work is to reduce stress and build capability among parents to help their children.”
The challenges are felt at all stages from pregnancy onwards. The Royal College of Midwives describes a shortage of 2,000 midwives and counting, even as the birth rate in England rose by more than 10,000 between 2020 and 2021. Less than a month ago, the Care Quality Commission published a damning review of the “unacceptable” crisis in NHS maternity services, with more than half of units failing on safety.
Midwives and nurses speak of working all hours to plug the gaps caused by staff shortages, running on goodwill and concern for their patients. For health visitors, the workforce has dropped by almost 40 per cent since 2015, with an estimated shortfall of 5,000. Only nine per cent of health visitors are now working within the recommended ratio of 250 children per case load, the Institute of Health Visiting says. Half in England work with 500 or more; a quarter with more than 750 children aged from birth to five.
When they can attend to young families in person, health visitors paint a concerning picture of what they find. An 81 per cent rise in perinatal mental-health problems in mothers was reported last year, with a 71 per cent increase in child safeguarding concerns. Some 42 per cent of health visitors expressed worry that they cannot do enough to protect babies and children.
Nearly nine in ten had seen an increase in speech, language, and communication problems in children, 80 per cent had observed behavioural problems, and 72 per cent noted a rise in families living in poverty. Parental loneliness has increased drastically.
The Royal Foundation’s own research, conducted by Ipsos Mori in 2020, found only a quarter of parents recognise the importance of the first five years of a child’s life. Sixty-four per cent said they were unaware of the unique, super-sized period of brain development before the age of two.
If it feels complicated, that’s because it is. It is not, however, insurmountable. For a sector so vast and seemingly disparate, there is an unexpected level of consensus and optimism.
“There’s quite a lot of agreement about what works at nursery level,” says Vainker. “A stimulating environment, some direct instruction and teaching. A lot of it is focused on building speech and language, collaborating, building relationships. Personal social and emotional development is the key. Then there’s building a really strong partnership with parents.”
At Reach, they attempt to fill the gaps by bringing parents in, from offering yoga classes and baby massages to setting up network-building Whatsapp groups. At nurseries like LEYF, staff concentrate on working to connect parents and other local services, from flagging dental check-ups to cross-referring to speech and language therapists. The Princess of Wales has made a point of visiting centres where services are “joining the dots”.
At Colham Manor Children’s Centre in Hillingdon, west London, where specialist psychiatry staff, midwives, health visitors, social workers, and charities are all on hand, she recently told mothers: “I think more places like this would be so valuable in communities, bringing people together. It’s not about having more services, it’s actually about being able to integrate them.”
The critical importance of the “first 1001 days” of a child’s life is now universally agreed, as are the simple things parents and carers can do to boost child development at home. Talking to babies and maintaining eye contact is invaluable, experts say, as is noticing and following their interests and simply letting them play. Getting outside, teaching young children to understand their feelings, and prioritising social and emotional development is universally recommended.
“There are very few parts of human development that, if you miss a small period you’re completely stuffed,” says Prof Ramchandani. “It’s pretty much always possible to catch up, but the time available to do so gets less and less as you go on through life.”
Vainker points to the importance of parents avoiding stress, “which is easier said than done when they’re experiencing adversity”, and for services to metaphorically “hold both the baby and the parent”. When it comes to the early-years workforce - aside from the issue of better pay - it would be possible to improve morale through better career progression and a sense that their work is properly valued.
Vainker describes a current “inversely proportional” pyramid of status and financial investment, that prioritises older children and later education at the expense of the first five years that “matter most”. “If you were starting a system now and you knew the science and what mattered, you would flip your investment,” he says. “You’d say, ‘if we can support parents and get it right in this period, actually we’re going to reap the benefits of this down the road’.”
Early-years leaders hope politicians can be persuaded to take a longer view. The Government, says Prof Ramchandani, should put policies “through a filter of ‘what effect will it have on children in 20 years’”.
There is cynicism on the ground about the ability of politicians to make a wholesale change. “We’re still stuck in the idea that nursery is just a bit of care, and a bit of changing nappies,” says O’Sullivan. “When you hear ill-considered government-led potential policy changes which say things like ‘just deregulate’, it depresses us because it shows such a lot of ignorance.”
The minister responsible for the sector, she points out, lasts an average of 10 to 14 months. “They always start by wanting to look overseas, ignoring the fact that a lot of what is happening in the UK is fantastic.”
If early-years care was just about babysitting children so their parents could go to work, things might be easier. But to think that is to miss the point. “As a country, we’re focused on childcare as an economic thing - children need to be looked after so parents can get back to work,” says Vainker. “But it misses the part of the conversation about the experience of this time of life. One of the great things that the Royal Foundation has done is building a sense of the value of this time of life for its own sake - the idea of having a great happy childhood.”
For the Princess of Wales, who has never relished being the centre of attention, it has taken time to find the confidence to lead the way. It was her first projects as part of the Royal family, she has said, that led her to here. Working with addicts, the homeless, mothers in prison, and those suffering mental health issues, she heard time and again how the roots of their problems could be traced back to their earlier, formative years.
“In all the work she was doing, whether it was in addiction, mental health, or the Duke’s work on homelessness, it became clear all these issues have their roots in early childhood,” says Jason Knauf, the former chief executive of the Royal Foundation.
“She reads absolutely constantly. Academic papers, parenting books, she has meetings with experts. She wanted to take the time to show that she was interested and learning, and hearing where she could make a real difference. And she, rightly, felt like she had the opportunity to really reframe this. She came up with the idea that we have to make this the social equivalent of climate change.”
Trying to pull the threads together, the Princess has taken on patronages to support children and children’s hospitals, mothers and maternity services. In 2021, she set up her Centre for Early Childhood in a small, modern office in central London. She has visited beleaguered services for morale-boosting engagements, flown to Denmark to see the many things their system gets right, and increasingly found her voice as a children’s champion on a global stage.
It is not always easy. The hours of work that go into an engagement do not always receive the attention of the right kind; a serious message overshadowed in coverage by the cute babies she has cuddled or the little asides about her own royal offspring. There is the eternal issue of where to draw the line - wholesale change of an early-years sector requires political will and billions of pounds in investment, neither of which she can do much about in the confines of her royal role.
But there are high hopes.
One of the most powerful things the Royal Foundation can do, Prof Ramchandani says, is to “bring attention to things in the way a professor at a university can’t. Simply being concerned and talking about this in a thoughtful way is incredibly powerful. Having a convening, focusing role is incredibly helpful. If the Princess says something, it reaches a totally different audience”.
‘With this privilege comes a duty to act now’
For Vainker, “it really boosts nurseries and the whole sector when she [the Princess] visits, you feel like she’s really advocating for you”.
O’Sullivan, who says the Princess already has the “credibility, warmth and interest” to have the ear of the sector, urges her to “use that voice to get a really clear message to the UK that supporting small children matters”.
For experts who have worked with young children for decades, there is no need to reinvent the wheel. Instead, the Princess hopes to amplify the right people, places and research.
It won’t happen quickly, but the Princess - whose future working life is measured in decades - has time and patience. The ambition, ultimately, is to convince a busy nation of its shared responsibility to every child.
As Dr Alain Gregoire, the chairman of the Global Alliance for Maternal Mental Health, puts it: “We are the first generation to have this scientific knowledge and to be privileged with such an extraordinary opportunity to improve the lives of so many for generations to come.
“With this privilege comes a duty to act now.” Or, as the Princess has said: “It won’t be easy - transformation never is - but big change starts small.”
