Joint Commissioning Strategy
for Early Intervention & Prevention 2012
DRAFT v3– 16/03/2012
N.B. This document is still a working draft
Prepared by the Early Intervention & Prevention Strategic Commissioning Group
March 2012
1
Hertfordshire Health & Wellbeing BoardJoint Commissioning Strategy for Early Intervention & Prevention 2012
CONTENTS / PAGE
Foreword from the Chair / 3
Our Vision / 4
Introduction / 6
Context & Key Drivers / 7
Objectives of the Strategy / 12
Objective 1 - Reducing Childhood Poverty / 12
Objective 2 – Reducing the Impact of Domestic Abuse on Children & Young People / 14
Objective 3 - Preventing Children becoming Looked After / 16
Objective 4–Maintaining a Healthy Weight / 16
Objective 5 – Reducing the numbers of Unplanned A&E Admissions / 18
Engagement / 19
Equality & Diversity / 19
Resourcing the Strategic Objectives / 20
Performance Management of Objectives / 20
Foreword from the Chair of the Early Intervention & Prevention Commissioning Group
I am pleased, on behalf of the Early Intervention & Prevention Strategic Commissioning Group, to introduce this first commissioning strategy for Early Intervention and Prevention which sets out how we propose to make a real difference in improving outcomes for children, young people and families in Hertfordshire.
The Early Intervention and Prevention Strategic Commissioning Group has the broadest remit of all of the Children’s Commissioning Groups and it is critically important that we identified objectives that collectively, working in focussed multi agency groups, we can tackle and make a difference to the lives of more vulnerable children. We are very clear that by focussed work on the identified objectives we can achieve this and, by adopting a preventative approach, reduce the need for more specialist high cost intervention.
This strategy sets out five strategic objectives and a cross cutting theme that aims to support the most vulnerable families to thrive. The five strategic objectives support areas where we need to make significant progress in improving outcomes and were a result of consensus support across the relevantpartners. They are also areas where we believe that harnessing the contributions of individual agencies into a single coherent approach can make major difference to outcomes. Our cross cutting work in supporting vulnerable families to thrive is being developed in the recognition that to improve outcomes for some children we need to support their families to address the challenges and barriers they face. We believe that the approaches developed through this work will provide a wider template for service development in the coming years
This strategy sets out clearly the evidence base for the strategic objectives and what we propose to do to improve outcomes.I hope that in twelve months time I will be able to report significant progress in addressing these objectives.
Andrew Simmons
Chair of the Early Intervention & Prevention Strategic Commissioning Group
Our Vision
The C4EO definition of early intervention:
‘Intervening early and as soon as possible to tackle problems emerging for children, young people and their families or with a population most at risk of developing problems. Early intervention may occur at any point in a child or young person’s life’.
Early Intervention and Prevention have been at the heart of the national and local change for children agenda’s, following the Children Act 2004 (‘Every Child Matters’) which brought together all children’s services together within each Local Authority and with all partner agencies though Children’s Trusts. This continued interest in early intervention and prevention as a fundamental objective reflects the widespread recognition that it is more effective to identify problems early and intervene effectively to prevent their escalation than to respond only when there is a need for action.
In Hertfordshire we have strong ambition for children and young people to succeed. It is essential to give them the best possible start in life and, whenever and wherever they experience problems, be able to provide flexible responses to ensure that support is given and initial problems do not become barriers that prevent children and young people achieving.
Our aim is to enable all children and young people in Hertfordshire to aspire to, and achieve their full potential, giving them the foundation for a successful life.
A key element of this strategy will be to maximise the use of existing resources to provide more co-ordinated preventative services that enable families to live within a positive and supported environment.
In developing this commissioning strategy , it was clear that different agencies and professional working with children often have different views on what early intervention and prevention means, and there is a need for us to have clear expectations of how we all work together to ensure we have a common understanding of early intervention and prevention. As we prepared thisstrategy we sought the views of different agencies, workingacross all age ranges, about what early interventionandprevention looks like to them.
The Early years
For young children, early intervention and prevention means ensuring every child has a positive early childhood and their foundation year’s development is supported so that they are ready for the transition into school.
'Supporting Families in the Foundation Years' is the current policy document referring to early intervention and prevention in the early years. The document states:-
‘The first few years of a child's life are fundamentally important. Evidence tells us that they shape children’s future development, and influence how well children do at school, their ongoing health and wellbeing and their achievements later in life. The Government is clear that all young children, whatever their background or current circumstances, deserve the best possible start in life and must be given the opportunity to fulfil their potential
In Hertfordshire, early years services are delivered through public, private and voluntary sector agencies who work together strategically and locally to provide a range of services from when a mother becomes pregnant through to the child reaching the end of the Early Years Foundation Stage at age 5 years. Early years services aim to ensure all children and their families can access local, inclusive services where any emerging or identified concerns can be supported through targeted and specialist interventions.
.But this is not just about doing the best for individual children and families. A strong focus on the first few years of children's lives leads to huge economic, social and emotional benefits later on, both for individuals and for society as a whole.
We are committed to making the best of the opportunities presented during pregnancy and the first five years of a child's life to set them on a course for success. The Government has already shown that commitment through our plans to increase the number of health visitors; to double the coverage of the Family Nurse Partnership programme; to provide 15 hours a week of free early years education for all three and four year olds; and our plans to extend this to the most disadvantaged two year-olds’.
Introduction
This strategy sets out the shared commissioning objectives of key agencies in Hertfordshire for the children and families in our County. The commissioning strategy provides a framework for identifying children and young peoples needs and gaps in service provision; setting our commissioningintentions and evaluating options for meeting these, including developing the market;identifying the key outcomes we are seeking to achieve; detailing the collective resources available; and setting targets for reducing expenditure.
This joint commissioning strategy is one in a series of cross cutting strategies which underpin Hertfordshire’s new Health & Wellbeing Joint Commissioning Framework,which has been introduced in response to Liberating the NHS: Legislative Framework and Next Steps. Its aims are also consistent with the Joint Service Plan for Education & Early Intervention and Safeguarding & Specialist Services.
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Hertfordshire is an “early implementer” for Health and Wellbeing arrangements set out in the Joint Commissioning Framework and is part of Hertfordshire’s emerging Health and Wellbeing Board arrangements. The Children and Young People’s Strategic Commissioning Group (CYPSCG)will be responsible for developing the children’s element of the joint health and wellbeing strategy, developing and interpreting the Joint Strategic Needs Analysis to shape commissioning and spending plans and developing an overarching commissioning strategy for children and young people. The CYPSCG will be the key commissioning group for the prioritisation and co-ordination of services commissioned for children and young people, and will provide the strategic join up across the three strategic commissioning groups, which are;
- Early Intervention and Prevention (EI & P)
- Children with Complex Care and Additional Needs (CCCAN)
- Children and Young People Living Away from Home (CYPLAH)
The Early Intervention & Prevention Strategic Commissioning group will be responsible for overseeing the implementation of the Early Intervention & Prevention Commissioning Strategy.
The strategy provides a holistic commissioning approach for addressing the health, education, and social care needs of children and their families across Hertfordshire. The benefits of a joined up approach will ensure that we;
Share intelligence about needs;
Target our services to give the greatest impact on outcomes;
Avoid duplication of services;
Achieve efficiencies and ensure value for money;
Develop co-ordinated services;
Share best practice and expertise.
Context and Key Drivers
There have been a number of reports commissioned by Central Government with a focus on early intervention and prevention that allow for a greater knowledge and understanding of development and the ability to recognise problems earlier.
The first report, produced by Graham Allen MP – Early Intervention: The Next Steps – states that Early Intervention is an approach which offers a real opportunity to make lastingimprovements in the lives of our children, to forestall many persistent problems social problems and end their transmission from one generation to the next, and to make long term savings in public spending. It covers a range of tried and tested policies for the first three years of children’s lives to give them the essential social and emotional security then need for the rest of their lives. It also includes a range of well-established policies for when they are older which leave children ready to face the challenges of each stage of childhood and of passage into adulthood – especially the challenge of becoming good parents to their own children.
The Munro Report, commissioned by Michael Gove, in June 2012, as an independent review of child protection in England, with a specific function to move from an “over-bureaucratised” system to one that was child-focussed. The question that lays at the very heart of this report is “what helps professionals make the best judgements they can to protect a vulnerable child?” An over-bearing and standardised set of compliance, as identified by Munro, suggested that social workers were so heavily burdened with paperwork and systems that it stilted the impacts and outcomes they had in a direct working with a child, and proved restrictive in making decisions based on individual needs.
It is of a similar ethos by the reviews led by Graham Allen MP, in terms of highlighting the importance of early intervention, and the value of preventative services in producing better outcomes for children than reactive services. It explores working “with” children and families, rather than what is “done unto them” as could have been described historically under standardised systems. Early identification, therefore, should be in partnership with the child and their families, and a better joined-up approach to supporting families to avoid “inefficiencies and omissions”, rather than a “match-up” of need to social services criteria.
Preventative services are seen as key not only to address and identifying need but also in preventing the escalation of those needs, or possible abuse or neglect. It discusses the links with parental problems, listing examples as “poor mental health and domestic violence” and how ambiguous needs can be and interwoven between those of the adults and of the child. For those who work with families, it was recognised that there was a definite need for access to the expertise of social workers to enable concerns to be discussed and whether a referral to social care was the right pathway.
The role of health services, children’s centres, schools and voluntary sector organisations in delivering and supporting effective early intervention cannot be underestimated – from early pregnancy and support for families with young children, throughout childhood and adolescence. The active engagement of health commissioners and providers in both identifying need at the earliest opportunity and supporting to meet these needs, is vital.
Children’s Centres are at the hub of the community in providing a continuum of support for children, families and communities, but require an effective outreach strategy to ensure that interventions target and support the most vulnerable.
The government vision for Sure Start Children’s Centres is that they should have a clear core purpose. The core purpose of children’s centres is to improve outcomes for young children and their families, with a particular focus on families in greatest need of support, in order to reduce inequalities in:
- child development and school readiness;
- parenting aspirations, self esteem and parenting skills; and
- child and family health and life chances.
In order to meet the core purpose children’s centre will
- assess need across the community
- provide access to universal early years services in the local area including high quality and affordable early years education
- provide targeted evidence-based early interventions for families in greatest need
- act as a hub for the local community
- share expertise with other early years settings
- respect and engage parents
- work in partnership across professional/agency boundaries
Payment by Results trial for children’s centres
Hertfordshire County Council is part of a Department of Education trial involving 27 local authorities to test Payment by Results (PbR) during 2012-13. The purpose of the trial is to incentivise a local focus on the importance of early intervention and the core purpose. The national measures being used for the trial are as follows:
- Early Years Foundation stage profile results- with gap narrowing
- Prevalence of breastfeeding at 6-8 weeks
- Take up of the two-year old free place entitlement
- Take up of the early education free place for disadvantaged three-year olds
- Proportion of parents with children under five completing evidence-based parenting programmes
- Proportion of parents with children under five in greatest need having sustained contact with children’s centre services
There are currently 82 Children’s centres across Hertfordshire and existing contracts are being extended until March 2014. During this time, an evaluation to assess evidence of impact is going to be developed within the existing Children’s Centre arrangements, to be completed by the end of December 2012. The outcome of this evaluation will inform any future development of how Children’s Centres will operate from April 2014. Hertfordshire’s children’s Centres are also included in the Governments Payment by results (PbR) programme.
The revised Children’s Centres Statutory Guidance form the DfE outlines the responsibility of Local Authorities. Within the guidance it states that Local Authorities and health services should consider both universal and targeted services, to improve outcomes for both children and families and that effective information sharing between services can lead to earlier identification and support of children and families in need.
It also states that Local Authorities must ensure that a network of Children’s Centres is accessible to all families with young children in their area and, importantly, not to close an existing children’s centres site in any reorganisation of provision that where they decide to close a children’s centre site, the outcome for children, particularly the most disadvantages, would not be adversely affected.
Health Visitor Implementation: The start of life is a crucial time for children and parents. Good, well resourced health visiting services can help ensure that families have a positive start, working in partnership with GPs, maternity and other health services, Sure Start Children’s Centres and other early year’s services. Therefore the Coalition Government has made the commitment to substantially increase the number of health visitors by 2015 and establish a new service model for health visiting ensure that that all parents and children have access to the support they need to get off to the best possible start. For Hertfordshire there will be an additional 61 WTE Health visitors phased into post by 2015.
The new service model will operate at 5 levels:
Community -developing with local communities’ resources to support self held and sustainable development
Universal - Delivering the core elements of the Healthy Child programme to all families
Universal Plus – Providing targeted time limiting support to families with an identified need.
Universal Partnership Plus – Provide ongoing regular and additional support for vulnerable families (includes Family Nurse Partnership)
Safeguarding –High level of health visiting intervention based on the multi agency plan.
The above service model will provide early intervention to ensure additional support for those who need it, including the most vulnerable families. Intervening early, working with families to build on strengths and improve parenting confidence and, where required, referring early for more specialist help, including specialist mental health services. This is the most effective way of dealing with health, developmental and other problems within the family.