The case for looser childcare ratios rests on confusion

The government claims to want to reduce costs and increase quality. It can't have it both ways.

This morning’s announcement on childcare ratios should be just the hors d'oeuvre before the government sets out its plans to increase childcare support for parents. According to the latest rumours, it now looks likely that the majority of any new money will be spent on tax relief for higher income households, making this a potentially important political moment. For now, though, today’s announcement merits some serious attention. Nursery workers are to be allowed to look after six two-year-olds at a time, up from four today, while childminders will be able to look after four young children, up from three today. Any provider wanting to use these new ratios will have to meet new quality standards, though the government is yet to set out what these will be.

These are fairly big changes and the government’s case for them rests on a number of confusions. First, the argument for relaxing ratios has gradually shifted from an emphasis on reducing costs to one of increasing quality. In some ways, this is an admirable shift to a more defensible position. Now, though, the government wants it both ways. On the one hand, briefings have claimed that ratio changes will free up money for investment in staff, raising pay and qualifications. On the other, looser ratios are intended to reduce childcare costs. This double counting might be ok if new ratios would free up large sums of money in a competitive and smoothly-functioning childcare market. But with many childcare providers already struggling to stay afloat, and with the market for childcare all but broken, this seems unlikely. The government needs to clarify what it wants looser ratios to achieve.

Second, there is the appealing idea that childcare ratios are tighter in the UK than in other countries and that this ‘over regulation’ can explain our sky-high childcare costs. Yet these variations in ratios rarely reflect the reality on the ground. In France, for example, the government cites a ratio of eight one-year -olds per member of staff. Yet academics argue that a ratio of 4:1 is more common. And nor is this a simple case of disputed data. While some aspects of the childcare debate do lack good evidence, there is a strong consensus among practitioners about the appropriate ratios for different ages of children. While the Department for Education may point to varying ratios rules, the UK does not appear to be an outlier in practice. It’s doubtful that ratios are the main explanation for high costs.

Third, there is the idea of a simple trade-off between staff quality and ratios. This allows the government to say it wants "to shift the debate away from quantity towards quality". Of course training matters greatly, but ratios are an important dimension of quality in their own right. This is partly because very young children learn by interacting with adults and need close attention; no amount of training allows a nursery assistant to give one-to-one time to more than one baby at once. But it’s also because the ratios debate ignores the reality of a room full of two year olds. In practice, a 1:4 ratio doesn’t mean one nursery assistant sitting calmly with four children. It means one nursery assistant dealing with a two year old having a meltdown while the other watches over the remaining seven. As one childcare provider put it at a recent Resolution Foundation event, "I don’t have enough laps and hips to calm down four two year olds as it is – I don’t know how I’d cope with six".

These confusions help to explain why today’s proposals have received short shrift from most parent groups and providers. In practice, this opposition might well be their saving grace – it wouldn’t be surprising if very few providers take up the offer of looser ratios. And even this will need to await a government consultation on what exactly the new quality requirements will mean. If international experience is anything to go by, let’s hope this is the case. The Netherlands gives us a good example of what happens when you relax childcare ratios: when this choice was made there, in the mid-2000s, the quality of childcare fell. It’s an important warning of the consequences of not paying due attention to the evidence.

James Plunkett is director of policy and development at the Resolution Foundation 

David Cameron is pictured during a visit to a London Early Years Foundation nursery in London. Photograph: Getty Images.

James Plunkett is director of policy and development at the Resolution Foundation

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A swimming pool and a bleeding toe put my medical competency in doubt

Doctors are used to contending with Google. Sometimes the search engine wins. 

The brutal heatwave affecting southern Europe this summer has become known among locals as “Lucifer”. Having just returned from Italy, I fully understand the nickname. An early excursion caused the beginnings of sunstroke, so we abandoned plans to explore the cultural heritage of the Amalfi region and strayed no further than five metres from the hotel pool for the rest of the week.

The children were delighted, particularly my 12-year-old stepdaughter, Gracie, who proceeded to spend hours at a time playing in the water. Towelling herself after one long session, she noticed something odd.

“What’s happened there?” she asked, holding her foot aloft in front of my face.

I inspected the proffered appendage: on the underside of her big toe was an oblong area of glistening red flesh that looked like a chunk of raw steak.

“Did you injure it?”

She shook her head. “It doesn’t hurt at all.”

I shrugged and said she must have grazed it. She wasn’t convinced, pointing out that she would remember if she had done that. She has great faith in plasters, though, and once it was dressed she forgot all about it. I dismissed it, too, assuming it was one of those things.

By the end of the next day, the pulp on the underside of all of her toes looked the same. As the doctor in the family, I felt under some pressure to come up with an explanation. I made up something about burns from the hot paving slabs around the pool. Gracie didn’t say as much, but her look suggested a dawning scepticism over my claims to hold a medical degree.

The next day, Gracie and her new-found holiday playmate, Eve, abruptly terminated a marathon piggy-in-the-middle session in the pool with Eve’s dad. “Our feet are bleeding,” they announced, somewhat incredulously. Sure enough, bright-red blood was flowing, apparently painlessly, from the bottoms of their big toes.

Doctors are used to contending with Google. Often, what patients discover on the internet causes them undue alarm, and our role is to provide context and reassurance. But not infrequently, people come across information that outstrips our knowledge. On my return from our room with fresh supplies of plasters, my wife looked up from her sun lounger with an air of quiet amusement.

“It’s called ‘pool toe’,” she said, handing me her iPhone. The page she had tracked down described the girls’ situation exactly: friction burns, most commonly seen in children, caused by repetitive hopping about on the abrasive floors of swimming pools. Doctors practising in hot countries must see it all the time. I doubt it presents often to British GPs.

I remained puzzled about the lack of pain. The injuries looked bad, but neither Gracie nor Eve was particularly bothered. Here the internet drew a blank, but I suspect it has to do with the “pruning” of our skin that we’re all familiar with after a soak in the bath. This only occurs over the pulps of our fingers and toes. It was once thought to be caused by water diffusing into skin cells, making them swell, but the truth is far more fascinating.

The wrinkling is an active process, triggered by immersion, in which the blood supply to the pulp regions is switched off, causing the skin there to shrink and pucker. This creates the biological equivalent of tyre treads on our fingers and toes and markedly improves our grip – of great evolutionary advantage when grasping slippery fish in a river, or if trying to maintain balance on slick wet rocks.

The flip side of this is much greater friction, leading to abrasion of the skin through repeated micro-trauma. And the lack of blood flow causes nerves to shut down, depriving us of the pain that would otherwise alert us to the ongoing tissue damage. An adaptation that helped our ancestors hunt in rivers proves considerably less use on a modern summer holiday.

I may not have seen much of the local heritage, but the trip to Italy taught me something new all the same. 

This article first appeared in the 17 August 2017 issue of the New Statesman, Trump goes nuclear