Angela Mitchell: Hello, everybody. Thank you for joining us, and welcome to our latest Nesta Talks To, our conversational event series with today's most exciting thinkers on the big topics related to our emissions and innovation methods. My name is Angela, and I'm the head of Nesta Scotland. And at Nesta, we design, test, and scale solutions to some of society's biggest problems.

Our three missions are to help people live a healthy life, create a sustainable future where the economy works for both people and the planet, and to give every child a fair start. Now, within our fair start mission specifically, our aim is that by 2030 the UK will have eliminated the development gap between children experiencing poverty and their peers at the point when they start school.

Now, as you probably know, this is Challenge Poverty Week, and today's theme is adequate income. Scotland provides a unique opportunity to consider the role of family income in not just addressing child poverty, but in addressing the early years outcome gap. And that's something that we're very particularly interested here at Nesta. But there's so much to learn from other countries.

Look at Australia, or take Australia. It's a high-income country with universal health care, education, and social care provision. But even so, 1 in 6 children are living in poverty, and at least double that are missing out on essentials like food, stable housing, and health care. Like Scotland, Australia is a signatory to the 2015 United Nations sustainable development goals, which means it's committed to halving child poverty.

And certainly, since the change in federal government last year, there's been a number of equitable policies introduced, including a national well-being budget and increases in childcare and the minimum wage. So I think it's fair to say there's been a definite policy shift to recognising the importance of investing in early childhood and supporting parents, families, and carers. And that's why I'm particularly delighted to be joined today from Australia by Professor Sharon Goldfeld and Dr. Anna Price.

Professor Sharon Goldfeld is a paediatrician. Welcome to you both. Professor Sharon Goldfeld is a paediatrician and director of the Centre for Community Health at the Royal Children's Hospital, as well as being director of Population Health at the Murdaugh Children's Research Institute in Melbourne. Dr. Anna Price is a senior postdoctoral researcher and the child health equity scholar at the Centre for Community Child Health in Melbourne.

Good morning, good evening, indeed to you both. Now before we start and jump in, I've got a couple of things that I just want to cover off. So before we start, I would like to invite everybody who's joining us today to join in the conversation in the comments box on the right-hand side of your screen. Ask any questions, and we'll do our utmost to get to those during the course of the conversation today.

And closed captions can be accessed via the LinkedIn live stream. So we've got about 25 minutes, Sharon and Anna, for us to have a bit of a conversation, and then we'll open it up to the floor. So welcome. First question to you, Sharon, but hello to you both.

Sharon Goldfield: Thanks so much, Angela. Hello to you back.

Angela: And Sharon, can you tell us why, or is indeed, early childhood important in determining life success?

Sharon: Look, thanks so much, and thanks so much for inviting us here from the other side of the Earth. In Australia, we start every meeting with an acknowledgment of country. So what that means is we acknowledge the traditional owners of the land that we're standing on. Where I am, it's the Bunurong people of the Kulin Nation, and I pay my respects to elders past, present, and emerging in any First Nations people anywhere around the world who are joining us here today.

I also acknowledge that the land that I'm on has and always will be Bunurong people land. And we stand at an interesting alternate precipice here in Australia where we're voting to change our constitution to both recognise our Aboriginal nation and also to recognise a voice to parliament. And sadly, it's our own little Brexit, and perhaps that's another conversation for another time.

But let me use that as a segue to talking about early childhood, and in particular, the importance of a window of investment that I think is gaining a lot of traction around the world. And many of you online will already know this about the emerging evidence that really suggests that investing in early childhood and the early childhood years really are the brain development foundations of the rest of children's lives.

And we know that the environment that children grow up in in those first few years actually do determine so much of their later health, development, well-being, and then later life outcomes. I was interested in your, by the time they get to school outcome. In Australia, we have a national child development measure called the Australian Early Development Census. So we measure the development of all children starting school every three years. It's quite extraordinary. I'm happy to talk about it a bit later if we have time.

But what's really confronting about those data is that right here, right now, in 2021, two things have happened. We've been collecting those data since 2009. We have not shifted equity in that time. So in other words, those children living in the low-income versus high-income areas of Australia, there are three times the difference of developmental vulnerability.

And that's right now. That's not all those other people. That's all children. Three times the difference by the time they start school. So that's the big gap for us, and one that we haven't shifted in more than a decade. And so one has to stare that down, and perhaps we'll talk about that today. The definition of insanity is to keep doing the same thing and expect a different outcome.

And I think the conversation today is, how do we stare down some of the things that we know are important, because to be honest, if children are not kicking goals by the time they get to grade 3, they are on a different life trajectory to their peers. And by all estimates, it's almost impossible to change that trajectory by grade 3. So I think there's a real challenge for us.

Angela: Thanks, Sharon. Anna, to bring you in, tell us your thoughts in terms of, how do you see poverty impacting in that early childhood stage?

Anna Price: Well, as Sharon said poverty can affect all aspects of a child's life and their family's life. So from the child's brain development, the way their body grows, their health, well-being, their lifelong opportunities. And it can pass between generations, too. The mechanisms are complex, but they can be broadly considered through two pathways. So the investment pathway, where household income, having more money, benefits children directly through better food, stable housing, and health care.

And then the other pathway's around family stress where if you have lower financial resources, it can affect children indirectly through poorer parental mental health, so more stress and less parenting capacity. And so these are the sorts of pathways that we've been trying to get to with the work we're doing in the early years.

Angela: Thank you. I'm interested in the term that you're using, investment, as an investment approach. And I'm wondering, we're going to get into-- in a short while we'll get into some specifics around the things that you're doing and the projects that you're working on. But I wonder if you can tell us a bit more broadly about the type of approaches that you, and indeed Australia, are taking. And what does an investment approach actually mean to you?

Sharon: And I think it's really interesting on where we come in. And obviously, there's a lot of people working in the child poverty area, not just us. But we've been very interested in taking this investment approach, particularly with the government's appetite at the moment for the early years. So if you like, in looking just at poverty, one of the real challenges is, where does that line go? Below poverty, above poverty-- we all know that children move in and out and families move in and out of poverty.

And that in fact, the bottom whatever it is, 30% to 40%, is really where we need to be looking, not the bottom 5% to 6%. And so as soon as we go to child poverty, people's mindset go to a spend mindset and a welfare mindset. And what we've found is that kind of loses the communication, both with the public and with policy makers. So we've sort of moved away from that, firstly because I think it's probably targeting to fewer people, even though I'm sure we all agree that child poverty is an important issue. That is not trying to move away from that.

But it's also trying to say, it's probably not enough if we're actually going to close the gap that we're both talking about, which is by the time kids hit school, we're not seeing inequities. That is not going to be sufficient if we just target small numbers of children. And so we've been talking about this idea of investing. We want to invest in children at a time when that investment is likely to have the greatest return on investment.

And that fits into a whole human capital agenda and a whole human capital narrative away from a welfare sort of paternalistic handout narrative toward a narrative that says our commitment as a country and as a community is to invest in children in order that they, number one, have a great childhood, but number two, then can grow up into adults that will then have a great contribution to society. And that's quite a different narrative.

And we've found that narrative getting more traction than the welfare narrative, but they're good complements. And it's good that we're kind of-- I'm a developmental paediatrician and a public health researcher. And Anna is a psychologist and a public health researcher. So we bring a different lens to it, even though we're very closely working with economists, et cetera.

So I think it's a different and I think complementary narrative to the child poverty narrative. And what we're finding is it sort of seems to work.

Angela: Where would you say you are in your journey in terms of shifting that narrative, though? You're saying it's gaining traction. I'm just interested in terms of your reflections of where you are in that journey, because it's a big thing to shift the narrative, isn't it?

Sharon: It really is. And I have to say that money is still a big issue in Australia, like it is everywhere. But a couple of things happened during COVID that kind of just created that enough rupture in what we normally do to start getting, as you can imagine, just to get your foot in the crack and start widening it.

So during COVID our government, which was a conservative government at the time, gave a huge number of families about $26,000 Australian, so that's, what, about 30,000 pounds-- I'm sorry, 13,000 pounds. I wish it was 30,000 pounds-- in order to keep their jobs. So people were losing their jobs. So that was pretty much mind blowing that people were just being given money.

And what it did was open this door about how easy it is to just shift the poverty level by, goodness, you just give people more money. The other thing is-- and Anna led this work-- we kind of were looking at how families were doing during COVID. And what we found was that it wasn't the small percentage of families who were doing it tough. It was about 66% of families who were both not making ends meet or just making ends meet.

And so suddenly, the narrative isn't about 13% of the population. It's about 60% of the population. And that's been incredibly stable through COVID, and we think is probably a pre-COVID phenomenon that we just weren't measuring. So it's opening up the door for us in this policy agenda that we've got in Australia, which is around three things.

One is an generational report that basically said, within the next 50 years, if we don't improve the health of the population, we're pretty much stuffed in terms of the health care budget. We're just going to be so sick that the health care budget will just fall over. And I imagine it's exactly the same in the UK. So that's the first entrance. The second thing is our government has a Measuring Well-Being Agenda that aligns with the Measuring Well-Being Agenda in New Zealand.

And so they're looking at, well, what are we going to do in that space that's actually going to make a difference to children? And the third is an early years strategy that our federal government is putting together, of which they have not taken poverty or giving people money off the table. And so I think that's the traction we get. Nobody's saying to us, here we go.

The only final thing I'll say is that we're trying to pull together a randomised controlled trial of non-conditional cash transfer. We're not exactly sure how that's going to work.

And we're getting quite a bit of interest, both from philanthropy and from government, government more behind the scenes because, of course, they have to help make it work, and philanthropy from in front of the scenes so that we can actually say, does giving families more money, what sort of difference in reality-- not modelling, not guessing-- what does it actually do to families in Australia? And to date, we don't know.

Angela: Thank, Sharon. Anna, just to bring you in there in terms of the evidence that we need or that there is, obviously picking up on Sharon's point about the RCT that you're interested in doing, I'm particularly interested in that role of family income within that.

Anna: Yeah. We've been thinking about this a lot recently and trying to really understand the current state in Australia. And it's been, like Sharon's been saying, the level of need throughout COVID is much higher than is normally talked about in terms of poverty. Poverty is measured in terms of an income threshold, but that's not the lived experiences of families trying to make ends meet each week.

And a colleague of mine at the Melbourne Institute, Anna Gamarra Rondinelle, who's an economist, has been looking at two decades of household income data and looking at what happens to household income when you have your first baby. And it's this paradox that in the first 2,000 days when money matters most for our brain development and our future trajectories, it's the time that your income drops substantially.

It doesn't seem to recover for at least five years, and that burden is predominantly borne by women and especially by sole-parent families. So we're thinking about, well, what are the levers we have to get in that time and make a difference? And money has an opportunity to make a big difference.

Angela: All right. Sharon, anything you want to add to that before we move on?

Sharon: I would like Anna to talk about some of the work she's been doing about giving people money in different ways. But before I do that, I will just say-- this is kind of a breaking news, sort of breaking news-- we've been doing some modelling using observational data to do causal modelling about what happens to children's development at 7 to 8 if you give families money.

We've just modelled a chunk of change, which turns out to be the $26,000 we just modelled on the money that was given during COVID. If you give it to families in just a 0 to 1 period, if you give it to them in 0 to 1 and 1 to 2, what happens to the equity gap between the bottom 15% and the top 85%? We're very interested in this equity gap rather than actually moving the actual mean.

And what's really interesting and somewhat demoralising is it doesn't close the gap very much when you model it. But what we think is that we're not able to really model trickle-down effects. So we can just make families look like other families because we're using target trial analysis. But actually, what we can't do is measure those trickle-down effects. How would those families actually have been different? What choices might they have made if they had been given money?

And that's what for us is the really important bit about, number one, doing the randomised controlled trials so we can actually see the actual effect of what happens when you give families money, and number two, just to be conscious that even giving people money is not a silver bullet. And if we actually want to make a difference to those differences at school entry, we need a whole stack of things to be thinking about, both continually over the 0 to 5 period and complementing it, targeting families and communities.

And so whilst we see giving people money as a really important part of that investment stack, we don't see it as the only part of that investment stack. And in fact, we think if we have that silver bullet mentality, we'll probably fail.

Angela: What else would you say is important in addition to cash, then, as part of that stack?

Anna: I'm so glad you asked.

Do you want to jump in, Sharon, on that?

Sharon: Do you want me to?

Anna: Yeah. Well, it depends-- yeah, go for it. Why not?

This is a real chat, you see. We haven't rehearsed, clearly. So we've been talking about this idea of creating a full stack. And I guess that stack can be as big or as small as you like. But if you imagine over the kind of 0 to 8 period, continually from a service point of view-- and we already spent a lot of money on services. So great quality antenatal care, early childhood education care, first three years of school as that continuous platform.

And then complementing it, all sorts of things that target the family. So the parenting programmes, sustain nurse home visiting, right up to what sort of health care needs do they have for children with additional needs, right up to what are the built environments that children are living in, right up to giving people more money, so right up to the social determinants and including housing. And I think it's a good debate to have about what's in the core stack. You could argue there's five things or 10 things.

And then start to think about, how do you create that stack in a way that it's equitable? In other words, families are getting the right dose, the right quality, and there's a right amount. And we don't actually think that way because governments can't think that way. They think about their programme. But communities can, and place-based effort can. And that's, I think, the sort of thing we're thinking about.

How do we, number one, test giving people money independently, and number two, think about money as part of a stack? Because increasingly, we're just not convinced that any single intervention is going to close that gap. And we've published on this widely now, and unfortunately every time we do it, we're waiting for the magic. It doesn't come.

Angela: Great. Thank you. Anna, anything you want to add to that before we dive in? Because I'm interested to get into some of the detail. We're starting to get into some of the detail of the things that you're specifically working on. And I wonder if you want to share a bit more about Healthier, Wealthier Families, for example. And then we'll come back to the cash trial, I think, as well. Some interest on that in the comments coming in.

Anna: Well, Healthier, Wealthier Families is one we borrowed from Scotland. So it's an adaptation of a model that has been originated in Glasgow and has been successfully running there for over a decade now. And this was over about five years ago now where one of the areas we work in is, how do we use our existing infrastructure and our existing services to better support the needs of families?

So there's a lot out there. And how can we use it better? And we liked Healthier, Wealthier Families because it's about using universal health care services that are meant to be available to all families in the early years to start systematically asking about money and financial hardship, and then referring clients in need to financial well-being services that also happen to be available in the community free of charge for families.

And so we were really excited by this model, and we worked to adapt it to the Australian context accidentally during the pandemic, but I think that made it a much stronger model. And we ended up with a really nice, feasible linkage pathway in an outer metropolitan area of Victoria. And it generated substantial benefits to families in terms of finances.

So of an average of about 3,400 pounds in today's money in government benefits that families were missing out on because they didn't know how to access it. And in interviews, the caregivers told us that it reduced their stress, it improved their financial knowledge, it empowered them, and it improved their well-being. So we're now seeking to fund the model so we can deliver the benefits to more families and evaluate it at scale.

Angela: Fantastic. Thank you. Sharon, as well as the cash transfer and thinking about that stack that you talked about, can you share some of the other projects and work that you've been doing?

Sharon: Well, I think it's worth saying the cash trial will be really interesting. And you can see the narrative we've started to build, Angela. You've got the Healthier, Wealthier Families, which is making sure families get the money they actually are entitled to. And in Australia, it's very important because it's often non-English-speaking families and young families that are missing out on the money they're entitled to.

We want to couple that with a trial of actually giving people more money. But we've been working on several things about, how do you drive more equitable system change? So I mentioned before that we have as part of our initial stack, sustain nurse-home visiting. So you can see we're starting to get into these parenting aspects. So the sustain nurse-home visiting trial we do, which was right at home, which Anna led with me-- and actually a version of it, which is called MESH is in the UK-- is actually targeting families.

That's a prevention model about families being and parents being the parents they want to be, targeting risk factors in the antenatal period-- some of which are economic, some of which are mental health, some of which are social-- and then targeting those families and offering them two years of home visits, but only about 24 home visits.

Angela, in my line of work-- so I'm a public health researcher. I do a lot of randomised control trials at a population level. And I've got to tell you, I've published and been part of a number of null trials, beautifully designed, beautifully implemented null trials, particularly in language. So we were pretty blown away when we were seeing the results of a population-wide intervention that was delivered to women at risk in nine different areas across two different states.

So you can imagine the practise changes and the practise variation in that. And even with all of that, at the age of two, these children were better off in terms of self-regulation or regulatory activities, the home learning environment, and the parent connectivity with their child. So that was pretty mind blowing. And we've followed those kids up now to 6, and we're still seeing impacts four years later.

So I think these are the sorts of things where it's not just one RCT. So that's one RCT, so great. Let's build that as part of the stack. We know there's a good evidence space for parenting programmes. And I'll stop talking because I'll keep talking for ages, but we are thinking very seriously about, what are the data needs you need, as well, to drive that system change? So if you can see, we're trying to build out the whole system change machinery, the trials you need to do, the better utilisation of the existing system, and then putting data into the hands of the front line providers to actually drive system change. And all of that is designed to address inequity.

Angela: Great. We encourage everybody to keep dropping questions in. We're going to come to questions shortly, and thank you to those that have already posed some questions. I know there's some specific questions and interest in the cash trial. So we will come back to that. Two quick questions from me, then, before we move on to the wider questions. In your view, what needs to happen in terms of, what are the key critical success factors, do you think?

You've talked already about the fact there isn't a single silver bullet, but I wonder if you've got any thoughts on the wider, what needs to be in place?

Anna: Shall I jump in on this one? Yeah. So we've been talking about this a lot recently. I've been looking at the-- or we've been looking at the leadership from the European Childhood Guarantee, which is very appealing, which is looking to ensure that every child at risk of poverty has access to the most basic rights.

So this would be about agreeing on a set of priorities across government that impact those drivers of poverty like finance, housing, early childhood education and care, health, those sorts of things. Like Sharon said, we need data systems that actually run in real time across these sectors that help us understand what the challenges are, whether our changes in policy and practise make any difference, and how we can improve.

And a big one for me is that we need an appetite to learn from our mistakes. So for trial and error, for experimentation and that desire to improve, but unless we face where things are going wrong and things are going well, we can't make those gains. How about you, Sharon?

Sharon: Yeah. I think you've sort of covered it all. I will say-- and this is happening in Australia. I don't know if it's happening in the UK in the same way. This is probably the biggest policy window we've had open for children in more than a decade. And I'm still trying to decide if that's a good thing or a bad thing because I don't think there's been more submissions that we've done in such a short amount of time. Everybody's exploring everything and we're just all running off our feet, but for all the right reasons.

And I feel that political will, if you think about the things-- Kingdon talks about these ideas of what you need to drive an agenda, and you need a policy window that's open. You need interventions that you know work. And you need data to drive the whole system. And that's the mindset I'm thinking about at the moment. We've got this policy window.

As researchers, what I don't want to squander is thinking about what sort of legacy data and interventions do we want to put in place, particularly given that governments in both our countries already make multi-billion dollar investments into systems that, at least in our country, have failed to address the equity gap. So how do we repurpose those systems? And how do we do that pretty quickly? Because we think we've probably got a five-year window to make a difference.

We can talk about this a bit later, but the cache at the moment is place-based. People are very interested in saying, we can't boil the ocean. Can we at least try and do some things in some places where there is higher degrees of disadvantage and make a difference? And that's been very challenging work, and I'd love to hear what you guys are doing because it's both challenging, interesting, and lacks a really good evidence space.

Angela: And it's one of the most challenging things. Often I find in place-based work is actually even just focusing on a place and deciding, even just coming to an agreement around where to focus geographically can often be a huge challenge, isn't it?

Sharon: Well, look what you've got in the UK or the lotto and cities. So we do a fair bit of work talking to the Bradford group, which is Better Start Bradford. And there's just enormous challenges, even though they had quite a good pot of money, and just, how do you do that in a way that hears the voice of community? So you've got to bring that to the table.

So we would argue three things to make place work. One is you need to decide what are the core things you really want to deliver. What's in that stack? Because if you start having debates about all of that, it's kind of lost. And there would be absolutely no problem coming up with-- no one's going to argue you shouldn't have antenatal care. Everyone gets that.

Then the second thing is you need co-design for implementation. So what it looks like in Bradford versus Blackpool versus Glasgow is going to look different because context matters. You shouldn't get crappy antenatal care because you live somewhere different, but you might get antenatal care delivered quite differently because the community needs it delivered in a different way.

And the third is-- and this is the bit that never gets funded and drives us completely batty-- is data and systems to drive change. And that's both human systems and IT systems and data systems. And we don't fund-- at least in Australia, I shouldn't say about everywhere-- but those things tend not to get funded in human systems.

We fund them in business systems because who would-- I always say, if I was Coca-Cola, believe me, in my community, we'd be drinking Coca-Cola before we knew it. But we don't apply the same sort of energy and effort to change human systems. So there, to me, are the three pillars of what we could do in community that I think could accelerate where we go.

Angela: Great. Thank you. OK, I'm going to open it up to some questions from the floor. We've had a question from Stephanie Woodrow, and that's a question, I think, for you, Sharon, about the cash transfer. Can you tell us a bit more about what that will look like, what you will measure, and how you're hoping to influence policy?

Sharon: Yeah. So it's a really good question. And I have to say, some of the things are a little bit unanswered. It turns out it's really expensive, running cash transfer trials. So we're just starting on that journey. But we've got a few things that make it really, let's say affordable. So the first thing, we're trying to work out how much we should be giving families. We're sort of settling at around about $750 to $1,000 a month. But that's up for debate.

So you can imagine, so that's $12,000 a year for two years Australian. That's a lot of money when you do it at scale, obviously. And that's not going to actually close, really, the poverty gap per se, but we're going to see what that does. The second is we need to sort out the outcomes, the short-term outcomes and the medium and long-term outcomes.

Now, in a lot of these trials, what people are really interested in is, did the child development outcomes change? We don't want to wait that long because we've got a policy window now. We've got policy makers interested now. So we're going to look at those short-term parenting employment outcomes. And the third is, amazingly, we have something called Gen V in Victoria. So we've been recruiting the entire state into one giant cohort.

So we've got about-- at this point in time we've got about 50,000 babies in about 120,000 families, so mums and mothers and other partners. And we can now use that as an intervention platform to randomise and to follow up those families. So that's kind of where our thinking is at the moment.

What's interesting to us in our conversations with policy makers-- and I think this is a really good lesson for all of us, actually-- is they do not want to be in front of the house on this. They do not want to be seen to be making promises they can't keep. And they are really interested to be back of the house. They want to be there. They want to be at the table. They want to know what's happening. But they don't want to make announcements about things.

So relying on philanthropy to be front of house and policy makers to be back of house, not the least of which is if you give people money, they can lose entitlements and we have to get around that.

Angela: Great. I feel like we're going to have to come back to you in a year or two to find out how that works.

Sharon: Well, I'm hoping this will do-- I'm hoping Nesta will do a sister trial with us and we'll get in the trenches together.

Angela: Another question then from the floor, a question from Lina, or Lena. How can we capture how money is spent?

Sharon: Do you want to answer that, Anna?

Anna: Well, I think we've got-- in Australia, we are lucky to have a few really fantastic ongoing cohort studies that seek to capture this. And we rely quite heavily on those data platforms to tell us what's going on for families. And so the study I mentioned before that has two decades of household income data, that's the resource that we use.

And I know there's been a lot of efforts over the last few years to work on linking the government-held data platforms, as well, across tax and health care use and those sorts of things, which various researchers and groups can access to understand what's going on for families.

I'll tell you another little trick we're thinking about, which is, if we can work with a bank, we'll actually give them money through a card. And if we have it through a card, we'll be able to see what people spend their money on. So we're also thinking about some tricks that will help us do that.

Angela: OK. Questions are coming in thick and fast. I've got a question from Sonya Scott. Do cash transfers reduce relative income inequalities in modelling?

Sharon: So we didn't look at income inequalities in the modelling that we looked at. We looked at outcome inequalities, so child development outcome inequalities and parent mental health inequalities. And the answer to that is yes, but not as much as you think. Relative reductions of around about 10% to 12%, absolute reductions of 2% to 3%. So not as much as you think.

And that's the inequality in outcome. And that's kind of what we're trying to show, that can you show that giving money reduces outcomes, as opposed to income inequality. We didn't look at that. It makes sense, if you give people money, you and decrease income inequality.

Angela: I'm going to go to a question from Patricia Lucas. What is the difference that you think money makes? And I think she's saying she's particularly interested in the difference between the direct impact on resources that you can buy today and something more indirect from a sense of financial stability. And what does that then mean for how you might implement giving cash to families?

Anna: This is such-- I mean this is the question, isn't it? And this is why we want to do a trial because what are all those complex impacts of more money, both direct and indirect? And you should come on and help design the trial with us. It would help us figure out which are the measures that matter most to families, and what are the things that they're going to spend their money on, and what are the things the money's going to change for them.

Sharon: I don't know what it's like in the UK, but in Australia, we had something called the baby bonus, which was when your babies were born-- it was over a decade ago now-- they gave a $5,000 one-off payment. Unfortunately, they didn't do it as a randomised controlled trial and no one's ever quite worked out what its impact was. But what it did was generate this enormous backlash in terms of people saying, all those poor people were just spending it on televisions and going out and spending it on alcohol.

And I know we've looked at the trials that you've looked at, as well. That's just not the case when you can actually look at it. So I think it's really interesting. That's why we've also pivoted to the investment strategy, which it is not about handouts for the poor, which is kind of this paternalism that we end up seeing in our society. But actually, we're investing as a society in our children. And that's a much better narrative to take to policymakers.

Angela: Yeah. That actually speaks to your point earlier about the importance of shifting that narrative, absolutely, doesn't it? I'm going to go to a question from Samuel Lee which is, I'd love to know the panel's opinion on the role of the private market in developing solutions to the childcare crisis.

Sharon: Oh my goodness. Wow. OK. Well, Samuel, I'm going to go out of my swim lane for a bit here, so apologies. I will tell you what's very interesting in childcare in Australia. So childcare is a mixed market, predominantly private market. It has not solved the childcare crisis. And in fact, it has probably created the childcare crisis.

In Australia we have incredible inequitable uptake of childcare, inequitable availability of quality childcare. We have prices that we're struggling to cap, even if the government is trying to actually give families more of a concession. So there's just all sorts of challenges in the privatisation of childcare. So if you want to have a look at a case study of what happens when you privatise childcare, understand what's happening in Australia and the challenges there are in creating an equitable childcare system.

We are one of the most expensive childcare systems in the world in terms of out-of-pocket expenses. But I can't tell you any more than that because I'm not probably-- then I'll swim way out of my swim lane.

Angela: Thank you. OK, I'm going to move on to a question from Ed Pybus, and back to cash payments. Any thoughts on means-tested versus universal, unconditional cash payments? And I think he's particularly interested in or asking that question because of the work the Scottish government is doing and key partners around the minimum income guarantee.

Sharon: I might say a little bit, and then Anna, you probably have something to say, as well. So you've probably worked this out. We're trying to walk a fine narrative line to intersect with the current policy environment in Australia in the way that we're thinking about giving families more money. The whole idea of having a basic income, which is essentially what you're talking about there, is not easy to fly in Australia, and in fact gets a lot of pushback.

And so we've been walking this fine line of not doing that. One of the things we really wanted to do was be able to give people money right up to about the bottom 70%. And we figured that's almost universal, or universal enough. We can deal with that through the narrative. We're struggling to deal with the amount of money we need to do that in an actual trial.

But that's what we'd like to see. That's our way of trying to cross over into a universal benefit to see whether or not and how that actually translates across different population groups. But we know other countries do have a universal benefit and that it actually equalises communities in all sorts of ways that I don't think we think about when we think about money as a cash handout.

Anna: And we can see the evidence that the policy levers with giving money in Australia now. So the modelling we've been doing, looking at what the current family benefits do, shows that they reduce poverty substantially. They almost halve the levels that would otherwise have been in those first years of life when you're just having a baby. But they bring it back to this pretty steady level of about 1 in 6 kids that we seem to be satisfied with, which is higher than the adult levels of poverty. So we're happy with the kids living in more poverty than our grown-ups.

And then in COVID, we had this incredible precedent where we got this basic income, and childhood poverty dropped from about 19% in one quarter to about 14% the next quarter. And because it was too short term, we can't see the long-term impacts of that. But modelling by the Australian Council of Social Services and University of New South Wales shows that could have been more effective if it was tailored better.

So they're the sorts of things we're thinking about. Where would it make the best impact? And we're saying the early years where the opportunity for investment and return on investment is greatest.

Angela: We've got a question now from somebody who's joined us via LinkedIn. And what would it look like to apply a rights-based lens to this early years agenda? And I think we're very interested here in Scotland particularly because we're in the process of embedding the UN Convention and the Rights of the Child.

Sharon: Man, you guys are way ahead of us on this. So Australia has signed up to the Convention on the Rights of the Child, but just to give you just a bit of a sense of the lay of the land in Australia, we do not use a rights-based lens for almost everything to do with children in Australia. It's really interesting for those of us who are trying to navigate that through Australia.

But I think one of the big issues about the Rights of the Child is the rights of the child to not live in poverty, of course, is one of the rights of the child. But it's also the access to education, health care, all the things that are in that stack. But not just the rights to it, but the equitable rights to those sorts of things. And I think that is the embedding of a rights framework is that really strong sense of, what does it take to create an equitable system?

You can create mediocre systems pretty easily, actually, and we tolerate high levels of mediocrity, at least in our country. But actually, to create from a rights point of view, to think about the rights for education, the right to health care, the right to safety, the right to not live in poverty, that takes a whole different way of a government thinking and a different sort of commitment.

And it comes back to my stack because if you just pick a right and you don't think of all the rights, I think we're just not going to close that equity gap. So how does that work across all of the rights? One good question would be-- which would be a fair enough question-- is there one right to bind them all? And I don't know the answer to that. I don't think any of us do. And I don't know if there is one, to be 100% honest.

Angela: OK, questions coming in thick and fast. I'm going to go to the question from Simran.

Sharon: You're under a lot of pressure.

Angela: There's a couple of questions, again, back to cash transfer and your RCT. How did you go about deciding the amount for the cash transfer?

Sharon: So a really good question. I'd love to tell you there was a really hugely scientific approach that we took to it, but actually, what we wanted was more money than was just a small amount. So for example, there was just a small amount really given in the US trial that's going on, which is really targeting poverty. So we wanted a substantive enough amount that would count for a family, which is why we're going somewhere between $750 and $1,000 a month. So it felt substantive.

And we needed to run the line of, it's enough that would make a difference and not so much that nobody would fund it or no government would actually fund it. So that's the line we're drawing. And we're talking to our funder about the potential of a larger trial that would allow us to trial different amounts. It's a really good question. Is there a threshold?

In the modelling we did, what was really fascinating is more money made a tiny bit of difference, but not a whopping bit of difference when we looked at more money, and nor did it made a difference to all families right up to a family threshold of 100,000 Australian. What's that, 50,000 UK.

So we looked at people below 50,000 Australians, so 25,000, right up to 50,000 pounds, and it made a difference to everybody, which is really interesting. So it wasn't just the poor people that made a difference to. It actually made a difference to everybody. But the amount, sure, more made a bit of difference, but it didn't make a whopping difference.

So that's how we've threaded that needle in trying to answer that. And we've used the modelling that we've looked at. That was 26,000 that we just thought, that's just never-- it couldn't fly unless we were doing a really targeted poverty intervention, and we're trying not to do that.

Angela: And how does the cash transfer then interact with an existing welfare payment? And I think that's an interesting question that's come in from Ed.

Sharon: And this is the thing we want to work on with our policy makers because it's a flat amount, so it doesn't matter how much you earn through entitlements or whatever. If your income was below-- to be debated whether it's the bottom 70% or the bottom 50% or 30%, that's still being debated. No matter what, whether you're on welfare of one sort or another or other income, everybody gets the same amount.

The question is not losing your welfare payment if we give you this. That is a really important question. And the response we've had to that is everything from, we can probably make that happen, to we need to change legislation, which is somewhat confronting as a researcher.

Angela: Question from Sonja about how you consider power within that, and specifically around how you redistribute power for children and families. So it's power with rather than power to or power over.

Sharon: Oh, wow, that's such a hard question to answer. Do you want to have a go at that, Anna?

Anna: Oh, gosh. It's a really good question. I think it's-- no. It's something I need to process. The ideas of-- I was thinking about Sharon's comment before about us being further behind Scotland, and it really is because when we were starting out with Healthier, Wealthier Families, and we were doing it because the notion of asking for more money for families 10 years ago was not a possibility.

It's changed since COVID, but it was not a possibility back then. So it was, how do you get money into families' pockets, and especially those who are missing out on what they're entitled to? And when we were looking at Scotland, the thing that really stood out was that you had this National Childhood Poverty agenda. And we haven't had a poverty agenda for a couple of decades.

And so you had that as a galvanising outcome intention for the work, this umbrella of work. And it looks quite powerful from where we sat when we went out to the community and said, how about this? How about we start asking about money? It looked really powerful. And so I wonder if we're also behind Scotland. You can tell us in that idea of power sharing and how you go about doing that in these sorts of settings.

Sharon: I might follow up with one thing because this really came up when we were doing our sustained nurse home visiting trial. So the conceptual framework behind that was a salutogenic framework. It wasn't about us riding in on our white horses to save all these families. It was actually about the sharing of power across the professional and the parent and looking at what the parent actually wanted to work on that they felt was important for them.

And one of the really important bits about that is it's about an agenda where the parent and what they want is right at the Centre. And I think one of the questions always with these interventions where we're kind of riding on our white horse to save people is, some of the questions we might want like, do families actually want money? Is this something that they actually think is important?

And so you get everything from, what do you mean, you're doing an RCT? Were you giving some people money and other people not? That's terrible, right through to, what do you mean, you're just giving people money without even asking them? And it's a trial, so they'll obviously be able to opt in, but they won't know whether or not they get the money until after they've been randomised.

So I think all of those are really legitimate and interesting approaches. And I think you'll know this in the place-based work, there's more and more thinking about, how do we bring the voice of what people want to the table? How do we engage with families, because they know what they want and need? And then also, how do we build evidence at the same time?

So when they do say they want XYZ, we know how to actually make X, Y, or Z work. And I think those tensions are exactly what we should be kind of facing into, not just stop doing trials because we should do that, but also not to just pretend that's what everybody wants, as well. And we need to do both those things concurrently and at speed.

Angela: Great. Yeah. It's a big question. It feels like we could talk about that specific issue for quite a while, but I'm going to try and squeeze another couple of questions in. We've had one from Lisa Sutherland, which is a good question around, how do you go from an RCT to scaling up interventions with all of the implementation differences and resources at all the various different levels and scales?

Sharon: Anna, do you want to talk about Right at Home? Sometimes we need alcohol when we talk about Right at Home. It is evening here, so we're allowed to drink. It's after five.

Anna: Well, I was thinking about-- yeah. Well, Right at Home is based around the core of the Right at Home nurse home visiting model that we developed for our universal child and family health service. The core of it is the mesh model, which is led by Lynne Kemp at Western Sydney University.

And she has developed this really detailed fidelity monitoring of any programme that she delivers with a community where she looks at what's being delivered to families and feeds back to practitioners in the hope that they are able to deliver the intervention as designed. And she has this model that now she's been able to develop with multiple different communities across many, many countries. And it's been adapted. I mean, it was developed in Victoria, in Tasmania, in Australia.

But it's been adapted to sites in Queensland and sites to the Northern Territory here. And all those communities have different needs. So I think there's that model of-- there's an example of a successful model going out, but against that, we're faced with many of the examples we've had where scaling has been very, very challenging. And so Sharon, that's for you to have a go at.

Sharon: Yeah. So we've had some amazing things. So for example, that child development measure that I spoke to you about. So we are the only country in the world, actually, that has this child development. It's based on the Canadian Early Development instrument where we actually have this population level data on children's development on the ADI.

And that was a point in time. So you've got all these things that happen, aren't they, when they scale. There just happens to be a politician or a policy window that goes, hey, we needed that measure. Great. Let's just do it across the whole country, which be careful what you wish for, by the way, when you have to scale something across the whole country within a year.

But the other thing about scaling is-- and I've been impressed with the roots to scaling, which is a framework. I was just trying to think about, can I google while I'm actually on here? But it's a UK organisation that's come up with this roots to scale. And it's very nice because it talks about all the building blocks you need for scaling. The biggest thing that I think you need for scaling is to think of scaling from the get go.

So if you're thinking sequentially about scaling, you probably won't get there. So it's really, where do you want this thing to go right from the beginning? When you think about innovation and design, they don't go, oh, we're only going to do this for 40 people. They actually go, we want everybody to have this, and then they course correct. And I'll just talk about research for a moment.

Research is not designed for course correction. It's designed for prototypes that stop at prototype phase. So if you think about the standard trial-- get the money, do a trial. Write it up. Oh my God, I got to get on the treadmill to get some more money to do the next trial. And maybe Nesta has the opportunity to work quite differently, but that idea of innovating, prototyping, course-correcting, and that's how you get to-- that's how you actually get to scale.

I think trials of interventions that get to scale are often just good luck and sometimes good planning. But actually, we don't actually plan very well for the research we do. But anyway, that's a much bigger whinge about research funding that's not fit for purpose. And the researchers online are probably going, yep, same here.

Angela: I'm going to try and squeeze in two quick questions. We've had another question around your RCT, and specifically relating to the control group that you were talking about. So a question from Moria, and what is the control group receiving? And how did you decide on this?

Sharon: And the caveat on all of this is we don't actually have the money in the bag for this RCT, unless anyone online would like to give us some money. The beauty about having Gen V-- and we're sort of still debating this, but we actually can have a passive control group. So because we actually have all these families that have consented to be part of Gen V, they also consent to have all their data linked, et cetera, et cetera.

So the greatest likelihood, although we're still determining it, is that we will have a passive control group. We did have this other question, do we have an active control group? And we give them a smaller amount of money, so $20 a month or something. So you're actually giving that to them and connecting with them. We aren't sure yet which one we go to. It'll depend a bit on how easy for hard it is to actually do that and keep your control group with you.

One of the things, in order for us to get all the final outcomes, we do have an app that we're following up with the families, but obviously not every family completes the app. But we will be paying families for their outcome data, and we're doing that more and more these days as remunerating families for participating in trials. So it may be for the consent group. It will be for the consent group. We will still remunerate them for their data.

Angela: Thank you. And anything you want to add our own social finance, or should I go to the one last question? And I'll squeeze in the last question, then, from Kirsty Whiteside. This is kind of back to the point you made earlier about shifting the narrative, I think. Early intervention is key. As professionals, we know this. However, historically we access services when in crisis. So how do you think we do shift our mentality to moving further upstream?

Sharon: Do you want-- I'm happy to have a go at this and hand over to Anna, and Anna should have the last say. So I think this is fundamental. And I thank you so much Kirsty, for that question because first of all, professionals are absolutely-- my view is if we don't change what happens at the front line, it's pretty much game over for an equitable system. So that's the first thing I want to say.

The second thing is it isn't just about the service delivery, although that's obviously a huge part of it. We've done a little bit of work. So we've been doing some work on hubs, this idea of co-locating and integrating different services-- health, social care. We're doing education. We're doing different sorts of services together that meets the needs of that population.

And when we talk to families about meeting their what we call life challenges, a number of them actually feel unworthy. They won't actually access the service themselves unless they're in some sort of crisis because they feel like there's somebody more worthy than them. So there's a whole lot of layers to early intervention that isn't just about reorienting the system, which is obviously part of it.

Frontending the system, we don't frontend. So we pay-- for example, in Australia, we spend more per capita in the last 10 years of life, not in the first 10 years of life. So we don't frontend our system. We kind of need to u-shape it because I'm pretty sure when we all get old, we'd like people to spend money on us when we get there. But we need to frontend the system, and that's the early intervention bit. But the other is, there's a lot of work in what a universal, equitable, early intervention system really looks like.

And it goes back to my thing of, what are the core things we need to deliver? What are the kind of implementation co-design elements, and what are the data and systems we need to be able to do it? And that's my view of what an early intervention system for children will actually look like. And that's, I think, a city that can get their head around that if you don't say, here's the 250 things you could do, but here are maybe the 10 things you could do. Anna, over to you.

Anna: Yeah, much the same. It's how do you work with the policymakers to start prioritising early childhood and the core conditions that families need to help their children thrive? And then at the practitioner level and the family level, what can you do within the existing services or out in communities to meet the needs that families have this week, next week?

And the work that we're trying to do, I guess, with these universal services, at least from my perspective, is to start using these incredible platforms to better address those social, cultural determinants of health. We've got these really fabulous health platforms in Australia, but the things driving health are outside that sector. So how do you use what we've got to start paying attention to those things? Because we can do it.

Angela: Great. Oh, we're running out of time. Cat Reynolds has asked, can you share a link to your search. so that we can read it in full? So I think we will try and do that and follow up with event notes. But would you point anybody to anywhere particular if they have got any?

Sharon: Yeah, the Centre's website, so the Centre for Community Child Health. We're actually just spinning up a new micro website. So that's got a lot of the resources that we do, everything from the service delivery work we do, the core conditions work, the trials. We've done a lot in COVID, as well. We run a lot of webinars that are already recorded that might be also of interest to people.

Angela: Great. And just one final question, I guess, is there for us. What can we learn? Is there one thing that you want to leave us with from today?

Sharon: Well, no doubt we would learn much from you, to be honest. So I'm not sure what you're learning from us, but I do think-- and I've been thinking about this a lot. This kind of dedication and discipline to thinking about stacking is kind of where most of our work is going now and moving away from silver bullet solutions. That's the big thing, I think, is we've got to go stacking and away from silver bullets.

Angela: Great. Thank you. I'm sorry. We are actually running out of time, which is a real shame. We've had a fantastic conversation, hopefully the first of many. Thank you both, Sharon and Anna, for joining us this evening. Thank you to everybody and everybody out there who has joined us, as well. Hope you've enjoyed our conversation today.

Before we close, can I ask you to fill in a short survey to help us keep improving our events? And that link will be shared in the chat, and it's also available in the events description, as well. And as a thank you, we will enter your name into a draw for a survey for a 50-pounds bookshop voucher. And if you haven't already, please do sign up for our newsletter to hear more about our future events, as well. And I think the final thing is just to say thank you very much. Good evening to you both, and goodbye to everybody else.

Thanks so much.

Thanks, Sharon.

Bye, everybody.