Integrating services from conception to age 5yrs by Carey Oppenheim

carey oppenheimIntegration matters, because public services are there to respond to the needs of the people they serve, not the professionals or systems within them. The traditional silo model is not delivering the life changing outcomes we all want for children and at its worst reinforces inequalities.

Whilst national policy has long emphasised the importance of integrated care and support in the early years in many local areas people are struggling to coordinate their health and local authority systems and services. We all recognise this is a complex landscape with different responsibilities that fall across NHS England, CCG’s and local authorities. The 20 Pioneering Places the Early lntervention Foundation is working with tell us this very clearly and want to know what are the best examples nationally of ‘joining up’ a coherent ‘early start’ offer in a local place.

Organising things more coherently really matters for families who don’t want to have to repeat their story endlessly and who expect services and practitioners to share information and as a result plan their care and support more effectively.

This week the EIF will publish our report “Getting it right for families” which brings together some of these examples of promising practice in the early years with recommendations for both local and national policy and practice.

The report identifies what is achievable when there is a commitment from strategic leaders, commissioners and practitioners to improve outcomes for children through integration. This involves a real change in culture and behaviours of staff across the early years that puts families and children front and centre of all they do ahead of professional and organisational self-interest. It’s about doing things differently on the ground and not simply ‘restructuring’.

One clear message is that effective local joint commissioning with a clear vision to improve children’s outcomes using evidence based interventions is key. Swindon for example, is currently commissioning health visiting and early years services against a shared outcomes framework agreed by health and the Local Authority.

More operationally some areas are innovating in developing integrated models of delivery. There is currently no single consistent method for assessing vulnerability in the early years and areas such as Greater Manchester are testing how to introduce a consistent model of assessment throughout the core stages of the Healthy Child Programme (HCP) and Early Years Foundation Stage (EYFS).

The sharing of information between public agencies in order to ensure families who need help do in fact receive it is one area where the inefficiencies of public services are perhaps most apparent. Yet some areas are finding a way through this. Information sharing agreements and trusting relationships are making a real difference in Islington where midwives ask mums to be for consent to share information with Children’s Centres at booking appointments and missed immunisation appointments are routinely shared by GP’s with Children’s Centres as well as housing and benefits data.

Bringing together the two year development check from the HCP delivered by Health Visitors and the EYFS progress check for children is an opportunity to obtain a rounded picture of how children are developing and identify problems early.

Ultimately we need to see these examples of more effective integration becoming the norm, rather than the exception, if our services are to meet the needs of children and families.


Carey Oppenheim is the Chief Executive of the Early Intervention Foundation

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