Greater Manchester (GM) has the scale and potential for

Greater Manchester (GM) has the scale and potential for

Greater Manchester Public Service Reform Programme
Early Years Update June 2014
Intro
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GM has the scale and potential for sustainable economic growth but punches below
its weight in terms of productivity.
As part of a broader strategy the Manchester Independent Economic Review (MIER)
recommended "sustained efforts to improve the very early years experience of all
young people" in GM. This recognises the clear evidence that it is in the crucial
development window from late pregnancy to age 3 that the foundations for life are
set – including physical and mental health, social and communication skills,
behaviour and future academic success.
What are we trying to achieve?
 The best available measure of the effectiveness of Early Years interventions is the
extent to which children are "school ready", based on the level of development
achieved as measured by at the end of the Reception year in school (the Early Years
Foundation Stage Profile.
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In GM in 2012 40% of children were considered to be "not school ready". While on
the average this compares well to an England average of 37%, in some parts of GM
this rises to 45%. Regardless of the comparison to the England average, it is
alarming that so many children in GM are not school ready.
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School readiness is a key indicator of the extent to which individuals will be able to
fulfil their ambition and potential, whether GM will be the economic powerhouse it
has the potential to be, and whether the current unsustainable demand for public
sector services across GM can be reduced. It is a measure of physical and social
skills development and is a precondition for children to benefit from school.
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Getting children on the right trajectory from the very start will mean they can
succeed at school, get better qualifications and ultimately be equipped for the world
of work. By investing in the skills of our future labour market, we not only improve
outcomes across the board but in particular those of our most disadvantaged,
tackling entrenched health inequalities, and starting to break intergenerational
cycles of poverty and dependency.
A new approach
 The need for a concerted and sustained programme of work across GM on
improving school readiness requires new multi-agency delivery models, reducing
commissioned activity with no evidence base, and moving public sector money
associated with poor outcomes into programmes that rapidly improve the
performance across GM.
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Even with the positive direction of travel signalled in Families in the Foundation
Stage and the Health Child Programme, the current Early Years system constitutes a
missed opportunity and can perpetuate a cycle of dependency and
underachievement.
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Current services are fragmented, frontline professionals often only see part of the
picture and miss wider factors / determinants, interventions are timed to miss much
of the crucial development window, and all the obligations are on the state not the
parents. The system costs £363m per annum in GM and still a disproportionate
number of children are failing to reach their full potential.
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In addition, parents who have significant contact with services often tell us that we
fail them through the multiplicity of assessment points which are not shared, and
through ill-co-ordinated interventions - or worse still an absence of intervention, just
another referral. This lack of integration is ineffective and a poor use of resources.
What we did
 Our starting point was that school readiness levels in GM have a long term negative
impact on work, skills and growth.
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We reviewed the evidence of what was working in GM and scoured the international
market place for evidence.
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We took a systemic, whole family and whole system approach. We considered the
developmental timelines of assessment, the tools we use to assess, reviewed the
context and location of an assessment, considered how the assessment data is
shared in the system, and how the assessments would profile targeted cohorts. We
identified a suite of highly evidence based interventions which could be sequenced
as timely and appropriate packages of support that work. We undertook a Cost
Benefit Analysis (CBA) of all the interventions to identify the impact of all, based on
common family pathways.
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Our approach is as much as about ensuring parents with young children are
economically active as much as ensuring we reach our long-term target of ensuring
infants mature to be adults with the right skills base for GM. Our work supports
affordable, quality, accessible and sufficient daycare and supporting providers to
work in partnership with parents to promote learning in the home.
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We believe our phased implementation approach, with ongoing evaluation that
feeds into the longitudinal study, ensures we have a risk reduction strategy in place
to continually review our CBA so we can replace the assumptions with evidence and
refresh the financial model on an on-going basis.
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We have called our plan the Greater Manchester Early Years New Delivery Model.
An evolving picture
 Much work has gone on across GM to improve integration, and the New Delivery
Model builds on this in line with a drive from central government - evidenced by the
proposals to pilot an integrated two year old check and indeed the transfer of 0 to 5
public health commissioning to local authorities in 2015.
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But it’s taking place within a complex and evolving landscape, especially on the
health side. From 2013 accountabilities for improving outcomes for 0-5s has been
shared between local authorities, the NHS Commissioning Board (NHSCB) and
Clinical Commissioning Groups (CCGs).
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The New Delivery Model has support from key governance bodies of the Greater
Manchester Health and Well-being Board, the health commissioning system,
including CCG chairs, Directors of Public Health and NHS England as a way of
reducing the risk of dispersed accountability and co-ordinating work to improve
outcomes and safeguard young children.
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Implementation in local authorities is being taken forward through working groups
working to Health and Wellbeing Boards and/or Children’s Trusts.
The New Delivery Model
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The NDM has eight key elements:
1. A shared outcomes framework, of population indicators and individual child
measures, across all local partners;
2. An eight stage common assessment pathway across GM: eight common
assessment points for an integrated (‘whole child’ and ‘whole family’) assessment
at key points in the crucial developmental window, building on existing assessment
points, with the remaining Healthy Child Programme visits to continue as standard;
3. Evidence-based assessment tools have been selected to identify families reaching
thresholds for intervention or having multiple risk factors as early as possible;
Needs assessment triggers referral into an appropriate evidence-based pathway;
4. A suite of evidence-based interventions has been identified, which alongside other
public service interventions forms a package of transformational support to families.
Areas are able to ‘top up’ the suite of interventions with additional services
according to local circumstances;
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5. Ensuring better use of early learning /daycare: new ‘contract’ with parents eligible
for targeted twos early learning entitlement to drive engagement in education/
employment/ training/ volunteering, and introducing new common principles to
support all early years settings, notably supporting them to work with parents to
promote home learning
6. A new workforce approach, to drive a shift in culture: enabling frontline
professionals to work in a more integrated way in support of the ‘whole family’ and
with other services to collectively reduce dependency and empower parents;
7. Better data systems to ensure the lead professional undertaking each assessment
has access to the relevant data to see the whole picture, to reduce duplication and
confusion and to track children’s progress;
8. Long-term evaluation to ensure families’ needs are being addressed and add to
national evidence for effective early intervention.
Who are we targeting?
 Improved universal preventative services will aim for 100% coverage of the 38,000 live
births in GM each year. Additional Health Visitors are critical to our plans, promoting
secure attachment, assisting parents with their parenting skills, encouraging healthy life
choices and promoting communication and language development – so getting children
on right trajectory from outset.
 Evidence-based targeted interventions will be available for all who meet clinical
thresholds, which we estimate as follows:
o It is estimated that 25% of the 38,000 children and their families will need a targeted
intervention in the first year of life, and a similar proportion in the second year.
o Many of these will be the same families, since no single intervention will be a magic
bullet and in practice a sequenced package of interventions will sometimes be
required
 Improved use of daycare (higher quality, better assessment and tracking of children,
and helping parents eligible for targeted twos into education / employment / training)
will target the 40% of targeted twos and all who take up universal 3-4 yr old entitlement.
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How far have we got?
 Governance: Early Years is one of a number of GM Public Service Reform themes,
being driven forward the Chief Executives of the ten local authorities and partners.
Multi-agency implementation groups are in place in each locality, all working towards
establishing one or two early adopter sites in April 2014.
 Integrated outcomes framework: we have identified key indicators that will measure
our progress through relevant population measures and are working on the detail
behind these and how we will track progress for children.
 Single assessment pathway: we have identified 8 common assessment points and
proposed the evidence based assessment tools that should be used at each point to
identify needs and track progress and developed outline pathways into support.
 Evidence based interventions: we have identified the interventions with the strongest
evidence base to improve school readiness. We are describing outline pathways for
use in localities to ensure swift and easy access into not jus the evidence based
interventions but also into specialist services such as Speech and Language Therapy
and Adult Mental Health. We are developing service specifications which detail the
standards expected across GM
 High quality daycare: We are developing a specification describing the role of
providers in supporting parents into education/employment/training/volunteering/
evidence based interventions, e.g. an Incredible Years parenting programme and in
the role of setting in promoting home learning.
 Workforce: The implications for the workforce have been identified and we are
commencing work to develop a programme going forward.
 Investment: We have costed the current position, the ‘As Is’, costed the New Delivery
Model, undertaken a Cost Benefit Analysis and developed a Financial Model that
enables us to know the investment requirements across GM and what the impact of
the NDM will be. We are now revising this taking into account the impact of council
efficiencies.
Changes that may be required nationally:
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Health Visiting role / commissioning spec needs to be sufficiently flexible to allow
capacity for additional GM elements and move towards an integrated EY workforce;
Changes to the designation of SureStart centres and associated funding streams so that
targeted intervention programmes can be funded separately under Early Intervention
Grant from Children’s Centres and non evidence-based programmes no longer need to
be directly funded (though their provision by VCS groups should be encouraged and
facilitated if families want them);
Changes to inspection and assessment frameworks, to remove the unintended
reinforcement of silo-based working and move eventually to a single inspection
framework for Early Years services.
What services will cease or reduce as a result?
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Our proposal is that, particularly in the current challenging economic circumstances,
public resources should be prioritised in the first instance towards those services that
are proven to be effective and good value for money.
Key to the NDM is increasing the effectiveness of universal services whilst working with
community partners to co-produce aspects of this provision. Plus funding targeted
evidence-based interventions for all children and families in the Early Years who are
assessed as requiring them.
Areas within GM can then take decisions to commission additional ‘top up’ services
according to local circumstances and/or to facilitate their provision by VCS and other
groups where there is local demand.
What about costs and benefits?
We have developed a comprehensive financial model that shows that we are spending
£363m in early years preventative services, including elements of the New Delivery Model.
We know that
 Implementing the model would make a significant population level shift in school
readiness, and increase parental employment
 Early fiscal savings largely result from more parents supported into work. Long-term
fiscal savings result from lower benefits spending as the children enter the labour
market (linked to them achieving better results at secondary school), the children
having better health, and less likely to be involved in crime and anti social behaviour
 LAs only receive around 3% of the fiscal benefits. The main beneficiary is central
Government, not local partners: 1 DWP/Treasury, 2 DfE/schools, 3 Health
 There is also a strong economic and strategic case for LAs contributing investment.
 More than £400m of additional GVA is estimated over 25 years, resulting from higher
earnings and increased productivity as the children enter labour market.
Where are we up to?
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Districts and partners are working on the detail of what the new model means for
them based on a local version of the financial model
Areas of GM are developing early adopter sites in one or two wards, to test the
model and gather early evidence of needs and impact
Workforce appraisal complete and plans being taken forward. Awaiting outcome of
non-recurrent investment bid to help us progress further, faster.
Learning from our development work for our (unsuccessful) Big Lottery Fund A
Better Start bid will be embedded within our strategy
Proposal under development for the Transformation Challenge Awards
We are talking to GM schools and Health partners including Public Health.
By 15/16 we hope to have a stronger evidence – based on more actuals and fewer
assumptions – to approach potential investors
We are hoping to have conversations with central Government, Treasury, Cabinet
Office and Number 10, as well as DWP & DfE as they will receive significant value
from the impact of delivering the model at scale.
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