REPORT TO

DUNFERMLINE & WEST FIFE CHP COMMITTEE

THURSDAY 9 MAY 2013

THE EARLY YEARS COLLABORATIVE IN FIFE

ROZ BARCLAY – SERVICE DEVELOPMENT MANAGER

Agenda Item 12

1. INTRODUCTION

1.1. The purpose of this paper is to update the CHP committee on the Early Year Collaborative both nationally and within Fife.

2. BACKGROUND

2.1. As previously noted the focus of the Scottish Government and COSLAs Early Years Framework (2008)i is to encourage partnerships to work in new ways to support the best possible start in life, and improve the life chances, for children and young people and families at risk. The Framework defined early years as pre-birth to eight years old.

2.2. Fife has a newly reviewed and refocused multi agency Early Years Strategy Group, which reports to the Children in Fife Group, focused on the national priorities laid out by the Early Years Task Force. The Children in Fife Group (accountable to Fife Partnership Executive Group) has detailed its objectives in Fife’s Children’s Services Planii; which seeks to deliver on three national frameworks, the Early Year’s Framework being one. Fife’s Early Years Strategyiii sits under the Fife Children’s Services Plan.

2.3. Both the wider plan and the Early Years Strategy are being taken forward within the national Getting It Right For Every Child (GIRFEC) framework. This framework aims to make a difference to children’s life chances on key indicators of risk and well being by ensuring that children, young people and their families have consistent, co-ordinated support which is appropriate, proportionate and timely.

2.4. The GIRFEC Framework is currently in the process of being incorporated within. This recognises the NHS as the universal service for children in the antenatal and early year’s stages of life with the role of the Named Person undertaken by the midwife from birth to day ten and then the health visitor until the child starts school. The named person role within GIRFEC has consolidated these universal services as the lynchpin for communication and enablers of proactive, preventive support in this critical period of the child’s life.

2.5. As noted at the CHP Development session in December the Early Years Collaborative was launched by the Scottish Government Early Years Task Force in January with a two day learning event. The aims of the collaborative are to:

• Accelerate the conversion of the high level principles set out in Getting It Right For Every Child and the Early Years Framework into practical action

• Create a structure in which partners can easily learn from each other and from recognised experts in areas where they want to make improvements

• Support the application of improvement methodology to bridge the gap between what we know works and what we do.

3. THE EARLY YEARS COLLABORATIVE

3.1. The Scottish Government established the Early Years Task Force to take forward the Early Years Framework and co-ordinate policy across the Scottish Government, and wider public sector, to ensure that early years spending is prioritised across the whole public sector.

3.2. The tasks force’s ambition is “To make Scotland the best place in the world to grow up in by improving outcomes, and reducing inequalities, for all babies, children, mothers, fathers and families across Scotland to ensure that all children have the best start in life and are ready to succeed.”

3.3. The task force recognising the potential of the methodology used in the patient safety programme has partnered within the Institute for Healthcare Improvement to utilise improvement science to make a significant impact in the early years in a holistic manner.

3.4. The following three ‘Stretch Aims’ have been set for the collaborative:

1. To ensure that women experience positive pregnancies which result in the birth of more healthy babies as evidenced by a reduction of 15% in the rates of stillbirths (from 4.9 per 1,000 births in 2010 to 4.3 per 1,000 births in 2015) and infant mortality (from 3.7 per 1,000 live births in 2010 to 3.1 per 1,000 live births in 2015).

2. To ensure that 85% of all children within each Community Planning Partnership have reached all of the expected developmental milestones at the time of the child’s 27-30 month child health review, by end-2016.

3. To ensure that 90% of all children within each Community Planning Partnership have reached all of the expected developmental milestones at the time the child starts primary school, by end-2017.

3.5. The detailed workstream diagram (Appendix 1) articulates how the agencies within the partnership will work together to secure these aims, highlighting the requirement to adopt a collaborative approach.

3.6. As noted previously the Fife Community Planning Partnership is committed to embracing this methodology and securing these aims for the children of Fife, acknowledging that there is significant evidence that the early years is the appropriate focus for partnerships to improve long term health and wellbeing outcomes. Susan Manion is Executive Champion for the collaborative in Fife, and Carrie Lindsay, Area Education Officer, is the Programme Manager.

3.7. The following governance structure has been agreed for the Collaborative:

3.8. A team of circa 25 staff from across the Community Planning Partnership attended the national two day learning session in January, this included Ronnie Hinds and John Wilson. A project management group, chaired by Susan Manion, will meet regularly to co-ordinate the work of the Collaborative. This group includes three senior leaders from across the partnership who will act at the work stream lead for each of the stretch aims noted above.

3.9. Following on from the initial national learning session there has been work with the work stream leads to learn from the experience of the initial tests of change, which were initiated at the learning session to enable the CPP teams to work with the methodology. Three local training sessions on the PDSA (Plan Do Study Act) methodology, which is at the heart of the improvement model, have also been undertaken.

3.10. The national team have outlined a significant number of potential indicators (appendix 2) to measure progress against the stretch aims and work is underway with information services colleagues across the Fife partnership to establish a baseline position to support services consider which areas require focus.

3.11. On Thursday 2nd May Fife will have a local multi agency launch to cascade the learning from the national launch. This will also provide an opportunity for a wide group of staff from across all agencies to consider the aims and indicators and ensure that collectively the partnership is focusing improvement activity in the most effective way.

3.12. Within Fife the partnership is drawing on the local learning from Scottish Patient Safety Programme processes. One example being the senior leader walkrounds; both Ronnie Hinds and John Wilson have commenced these, visiting early years services within the Council and NHS Fife.

3.13. The second national learning session will take place at the end of May, with two further sessions planned for later in the year. These have been programmed to ensure continued focus and continuous shared learning. The national team will also be seeking monthly updates on progress against the tests of change CPPs are undertaking.

4. A DIFFERENT WAY OF DOING THINGS

4.1. The national learning sessions highlighted that the Collaborative is not simply a further initiative, rather is a methodology to secure radical change in the way we do things. The improvement model urges services to work with the communities they serve to ascertain what their assets are and work with communities to build on these. The models seek to support practitioners to undertake small tests of change, focused on impacting on the stretch aims, which once proven to be effective can be scaled up, with quality improvement monitored on an ongoing basis to ensure the desired outcomes are being achieved.

4.2. The project management team will co-ordinate the three work streams and lead on work stream 4 (leadership), ensuring regular reporting to the Children in Fife Group, the Scottish Government and to individual agencies. The group will also ensure that staff have the skills, knowledge and information they require to maximise the effectiveness of the improvement model.

4.3. Within NHS Fife the Early Years Health Implementation group will support internal leadership and focus on the collaborative. This group is also responsible for co-ordinating the wider early years work of NHS Fife, such as the Maternal and Infant Nutrition Framework, the HEAT Ante-natal access target. This group will support services utilise the improvement model to secure the wider early years objectives in a manner which contributes to the ‘stretch aims’ and internal collaborative working, thereby enabling sharing of learning.

5. CONCLUSION

5.1. Transformational change is required to make the shift from crisis driven, curative care to preventative and anticipatory care. The Early Years Task Force has proposed that the improvement model can support this shift and Fife Community Planning Partnership has agreed to utilise this collaborative model.

5.2. Various strands of work are underway across services and in partnership to realise this shift, in a sustainable manner within Fife and work is underway with partners to utilise the improvement model to support this.

5.3. Partnership governance arrangements have been agreed to support the collaborative model.

6. RECOMMENDATION

6.1. The Committee is asked to:

i) note the stretch aims and methodology of the Early Years Collaborative

ii) agree to receive an update report on work of the collaborative in six months.

Roz Barclay Service Development Manager 29 April 2013

Appendix 1

Appendix 2– Early Years Collaborative : List of potential Indicators (not exhaustive)

• Proportion of stillbirths.

• Proportion of neonatal deaths.

• Proportion of singleton low birth weight babies.

• Proportion of singleton preterm babies.

• Proportion of women who are identified as smoking at first antenatal booking who quit at 1 month.

• Proportion of mothers recorded at booking, screened for alcohol consumption, offered advice and guidance and where appropriate receive a tailored integrated health and social package of care, including follow up.

• Proportion of children suffer from non-accidental injury/harm from conception to 4-weeks of life.

• Proportion of children diagnosed with Neonatal Abstinence Syndrome being diagnosed within 4 weeks of birth.

• Number of placements for Looked After Children within their first 4 weeks of life (excluding their hospital placement if became LAC from birth).

• Proportion of post-neonatal deaths.

• Proportion of children aged under 3 years of age who have suffered from non-accidental injury/harm.

• Proportion of children aged <3 years registered with a dentist.

• Proportion of children aged <3 years experiencing a dental general anaesthetic.

• Proportion of eligible children receiving their 27-30 month child health review.

• Proportion of children having their vision and hearing assessed as part of the 27-30 month child health review.

• Proportion of infants having a Childsmile oral health assessment and the outcome recorded as part of their 6-8 week Child Health Assessment.

• Proportion of children having their developmental areas assessed as part of their 27-30 month child health review: Social, Emotional, Behavioural, Attention, Early Communication & Language”, “Gross Motor”, “Fine Motor”

• Proportion of babies born to mothers identified as using alcohol during pregnancy receiving a targeted neuro-development assessment by 27-30 month child health review.

• Proportion of children being exclusively breastfed at 6-8 weeks.

• Proportion of looked after children who are looked after continuously for at least 6 months, for whom a permanence decision was made within 6 months.

• Average number of placements experienced by all looked after children aged under 6 years of age.

• Proportion of 5 year olds with no obvious dental decay experience.

• Burden of dental decay in the 5 year old population who experience it.

• Proportion of nurseries participating in the ChildsmileToothbrushing Programme, and the proportion of the roll brushing daily.

• Proportion of children first diagnosed with foetal alcohol syndrome disorder being diagnosed with the condition before the child’s 6th birthday.

• Proportion of children aged under 6 years of age who have suffered from non-accidental injury/harm.

• Proportion of children having their developmental areas assessed at the start of primary school:

• “Social”, “Emotional”, “Behavioural”, “Attention”,

• “Early Communication & Language”, “Gross Motor”, “Fine Motor”

• Proportion of women and their children affected by domestic abuse or domestic violence.

• Proportion of children living in poverty.

• Proportion of children showing secure attachment to their primary carer.

i http://www.scotland.gov.uk/Publications/2009/01/13095148/0 iihttp://www.fife.gov.uk/news/index.cfm?fuseaction=news.display&objectid=6292C21

8-EF1D-669617B52BC17919B6EA

iiihttp://www.fifedirect.org.uk/news/index.cfm?fuseaction=committee.event&evntid=204D74C4-D608-16F6-719C9C33A5FBA71F

File Name: CHP Eyrs update May 2013 Version 1.0 Date: 29.4.13

Author: Roz Barclay Originator: Christine McCafferty