DD2023 Health Early Years: Final beta testing

Type of decision: 
Director's decision
Code: 
DD2023
Date signed: 
21 November 2016
Decision by: 
Jeff Jacobs, Head of Paid Service

Executive summary

The GLA has been consulting extensively on how it can best deliver on the Mayor’s manifesto commitments to tackle childhood obesity, reduce health inequalities and provide high quality and affordable childcare for Londoners. The consultation has included, amongst others, the 44% of Boroughs who already operate a form of healthy early years programme all of whom would welcome a co-ordinated and standardised approach across London. In response to both the Mayor’s priorities and that of consultation with stakeholders, a Healthy Early Years (HEY) Outcomes Framework has been developed. It builds on existing learning and evidence from the Healthy Schools London Outcomes Framework, whilst being responsive to the early years industry needs, with a view to crafting high quality, healthy learning and play environments that will improve children’s health, wellbeing and school readiness. 

Whilst we are confident that the HEY Outcomes Framework will be effective (due to the fit with existing HEY approaches), elements of it still require operational testing prior to launch. Beta testing of the Outcomes Framework will be conducted in six London Boroughs, including some with their own HEY programmes, some without, and early years settings registered but not fully engaged with their local authority. Refinements will be then be made to the HEY Outcomes Framework before the full HEY Programme is rolled out towards the end of 2017/18 as part of the Mayor’s new Healthy London Children programme (working title). 

The development of a HEY Programme of this scale, because of the breadth and depth the Outcomes Framework, would be a world-first. In full operation the HEY Programme will be open to up to 13,000 early years settings. It will seek to recognise the standard of good health and wellbeing practice and provision in all early years’ settings in London whilst raising the standard and pushing for excellence through a Mayoral Award scheme. The role of the Outcomes Framework will be to guide those standards and support the programme and its partners in providing evidence-based tools, support, best practice and peer-networking opportunities.
 

Decision

The Executive Director approves expenditure of up to £50,080 to deliver the Healthy Early Years Outcome framework as set out in this decision form.

Part 1: Non-confidential facts and advice

Introduction and background

The GLA has been consulting extensively on how it can best deliver on the Mayor’s manifesto commitments to tackle childhood obesity, reduce health inequalities and provide high quality and affordable childcare for Londoners. Our vision is for a Healthy Early Years (HEY) Outcomes Framework to be used by early years’ settings to create high quality, healthy learning environments to improve children’s health, wellbeing and school readiness. A number of London boroughs have also developed their own approaches to Healthy Early Years but have called for consistency and standardisation across London, in particular to reduce the risk of exacerbating health inequalities in the capital. The HEY Outcome Framework requires operational beta-testing in order to make final adjustments and tweaks before full programme roll-out in 2017/18. Six London Boroughs, some with HEY programmes, some without, will support the beta testing of the HEY Outcomes Framework.

The costs and aim of this aim of this decision form is to:
1.    Secure consultant support to finalise the Healthy Early Years Outcome Framework in preparation for beta testing: £10,000 
2.    Secure consultant support to finalise the Healthy Early Years Outcome Framework in post-beta testing and preparation for full roll-out (including reviewing beta testing,  updating materials and tools, tweaks to quality assurance and preparing awards process): £20,000
3.    Secure consultancy support to the Healthy Schools Team to allow for Senior Project Officer to focus on management of Healthy Early Years Outcome Framework beta testing.  Approximately backfill of grade eight post for three days a week for six months: £16,380 (incl. on-costs)
4.    Secure backfill for Junior Support Officer (grade 5) post in the Health Team one day a week for six months to provide administrative support to the delivering of beta testing: £3,700 (incl. on-costs)

A London-wide HEY programme has been identified as the most effective way in which the GLA could support some of the key issues (identified below) around health in the early years by engaging with childcare providers who work with c.49% of London parents.
•    Children with speech and language difficulties are at high risk of having difficulty with reading and writing, difficulty making friends, having behavioural problems, low self-esteem and lack of confidence
•    Obese children are at risk from a range of health consequences, both physical and psychological. Obesity is likely to impact on school readiness due to illness, poor sleep and consequent absences from early year’s settings. 
•    Poor social and emotional wellbeing predicts a range of negative outcomes later in life such as mental health problems, poor social and economic outcomes, criminal behaviour and substance misuse.
•    Problems with oral health can affect children’s ability to eat, sleep, speak, play and socialise. It is an important part of overall health and can impact on children’s school readiness.
•    A considerable proportion of London children are either, not receiving routine immunisations or receiving them much later than recommended, increasing the amount of time that they are at risk from vaccine preventable diseases.
•    Early intervention in childhood can help reduce physical and mental health problems and prevent social dysfunction being passed from one generation to the next.

To date the GLA has commissioned a draft Healthy Early Years Outcomes Framework (see appendix DAR Healthy Early Years Outcomes Framework). This has been consulted on via a survey in May 2016 and a roundtable event in June 2016. Key stakeholders from LA’s, Education, Health, and Childcare Provider sectors have provided constructive feedback and given a clear indication that a programme would be welcomed with several LA’s already submitting an expression of interest in beta testing the operational delivery of the HEY Outcomes Framework.

Next Steps
Whilst the HEY Outcomes Framework is considered to be the correct model for London, best practice suggests final testing of the Outcomes Framework should be carried out to take into account operational and delivery refinements before the full programme is launches in late-2017/18 as part of the Mayor’s new Healthy London Children.  Engagement with stakeholders will continue along with a transparent and fair recruit process for the six boroughs who will support the beta testing. The associated costs for this (as laid out on page one) will be funded from the Education and Youth Team - Early Years Education Budget (£10,000) and Health Team - Childhood Obesity Budget (£40,080). 

It is not anticipated that the final beta testing of the HEY Outcomes Framework will present major refinement issues and so further funding will be requested to support the full role out of the HEY Programme in 2017/18 as part of the Mayor’s new Healthy London Children programme. Resourcing a three year programme (September 2017/18 – September 2020), inclusive of web maintenance, programme office, awards ceremonies, independent evaluation, communications and stakeholder management is anticipated to cost c£775k.

It is important to note that the success of the Healthy Early Years programme in the longer term is intrinsically linked to the emergence of the Mayor’s new Healthy London Children programme and within that the existence and refresh of the Healthy Schools London programme. This in part due is to the personnel that develop, drive and work across both programmes; the similar outcome frameworks being used by both HEY and HSL; the new branding and reputational association that will need to be developed; transference of best practice, programme delivery and technical/industry knowledge. With regards to future funding for the Mayor’s new Healthy London Children options for industry appropriate-sponsorship with the commercial partnership team are being explored to expedite the delivery of the Mayor’s new programme, invest in research and development, improvement tools for settings, and to enhance programme reach. We have interested parties and are confirmation of core funding before advancing any partnership arrangements. 
 

Objectives and expected outcomes

The objective of this funding is to support the GLA Health, Education and Youth teams to refine a Healthy Early Years London (HEY) Outcomes Framework (criteria, tool and guidance) and run final beta testing in in six London Boroughs.

The expected outcome is that the final beta testing stage will confirm whether the HEY Outcomes Framework is operationally fit for enabling childcare settings to create high quality, healthy learning environments to improve children’s health, wellbeing and school readiness.

In September Healthy Schools London published a three-year evaluation by the London School of Hygiene and Tropical Medicine and the National Institute for Health Research. Part of the recommendations from that evaluation was for the HSL Outcomes Framework to be extended into early years settings. Further, it highlighted the strong association between health promotion and setting improvement with increased attendance and improved learning. It is highly likely, according the researches and with the appropriate sensitivity, this approach can be extended to early years settings with similar impact for London’s young children. Longer term expected outcomes for a London-wide Programme are that:
•    Children will benefit from: 
o    knowledge of how to keep themselves healthy, including through exercising and eating healthily 
o    emotional security, through emotional attachments with practitioners and carers, and their physical and emotional health
o    Improved school readiness through increased language development and social awareness. 
•    Raised awareness across whole settings could lead to behavioural changes with staff and parents, in addition to children, improving health outcomes on a wider scale. 
•    Improved OFSTED ratings, particularly for smaller organisations/childminders with less resource which may be able to take real advantage of toolkit case studies and networking opportunities to share best practice.
•    Early years setting managers considering health and wellbeing to be at the heart of child development and setting improvement. 
•    Early years settings like kudos and are competitive.  Being associated with the new Mayoral Healthy London Children programme, the Healthy Early Years stream will incentivise engagement and reinforce the value a focus on healthy practices and environments.
 

Equality comments

This would support and recognise good health and wellbeing practice and provision in all early years’ settings that engage with it by providing tools, support and networking opportunities to raise quality and improve consistency across London. This supports the ambitions contained in “Better Health for London: next steps” to give all London’s children the best start in life.  

The Marmot review 'Fair Society Healthy Lives' (February 2010), identified that cognitive development in the early years (along with physical and social development) is an important influence on school readiness, future educational success and health. Socio-economic status has an important influence on this, with children whose parents are of low socio-economic status doing less well than those with more educated or wealthy parents, even if their early cognitive scores are higher.

This HEY Outcomes Framework and awards scheme is being developed in conjunction with colleagues in the Diversity and Social Policy Team to ensure equality considerations are kept at the forefront of the scheme, taking into account accessibility and impact for beneficiaries and users.  
 

Other considerations

The Mayor (Sadiq Khan) has committed to improving the cost, quality and provision of childcare in London in his manifesto  and at the Healthy Schools London Celebration Event 24 June 2016 stated:

“To build a healthier future for London we must start with our children and make healthy living a habit, not a chore”.  

The Mayor (Sadiq Khan) has stated that he would like to see the Healthy Early Years Programme invested in by stating, in response to an oral question at September 2016’s Mayor’s Question Time, that:

“I am proud to be extending this programme [Healthy Schools London] into early year’s settings. This birth to 5 years period can make or break a child’s future - if we can get that right then we give every child in London the best chance to succeed in education later on”.

The Childhood Obesity Pan London Improvement Plan (2016) aims to: 
‘’Provide continued support for the development of the Healthy Early Year’s scheme, and on-going endorsement of the healthy early year’s scheme, and ongoing endorsement of the Healthy Schools Programme…’’

The Healthy Schools London Evaluation (June 2016) recommends expanding Healthy Schools London to the Early Years.

A Health/Health Inequalities Impact Assessment for Healthy Early Years London – July 2016 has been conducted and is attached as an appendix. 
 
Cross-directorate Childcare and Early Years Education Strategy (underway) – The current market is very fragmented and we are working across the GLA to scope what further support the GLA can provide. We want to support all young children and their families to access high quality childcare and early year’s provision, but especially ensure that new models enable disadvantaged children to access the best provision. We are currently exploring activity which can make a difference at the regional level. HEY would go some way to addressing the Quality element of this strategy by improving standards within settings through a values led, supportive approach which would also upskill the workforce.

 

Risk

Action

  • Local sector cuts may mean boroughs are unable to dedicate resource to supporting the programme, in particular the communications/marketing and quality assurance aspects.
  • There is currently a lack of local governance, partnerships and multi-level champions e.g. loss of local Healthy School steering groups/QUAGS & Healthy Schools Co-ordinators and few established local health/wellbeing boards
  • Programme may be taken up by one type of setting or borough but not others causing disparities.
  • Programme may be seen as a duplication of existing standards rather than a tool to support achievement of these and upskilled workforce.
  • Early engagement with stakeholders is essential to ensure buy in.
  • Alongside HEY, tools are being developed in partnership with stakeholders to ensure they are accessible, useful, and complementary to existing provision. 
  • Ensure that programme objectives are able to be met be settings of all types, i.e. are accessible to childminders and children’s centres.
  • The Outcomes Framework has been developed to help providers evidence Ofsted requirements, achieve a higher rating and reflects the EYFS guidance.

 

Financial comments

5.1    Approval is being sought for expenditure of up to £50,080 to support the GLA HSL, Education and Youth teams to finalise Healthy Early Years London Programme (HEYL) and make revisions to the Outcomes Framework (criteria, tool and guidance) established through final beta testing with six London Boroughs, launched from October 2016.

5.2    The total funding will be met from within the Community and Intelligence Directorate:-
•    £10,000 will be met from Education and Youth (Research and Consultancy) 
•    £40,080 will be provided from carry forward income from NHS London. The receipt of this income was approved by MD919. (LHIB Balance –Childhood Obesity). The total carry forward LHIB budget is £120,000. All appropriate budget adjustments will be made.

5.3    The final beta testing stage will confirm the Outcomes Framework is operationally fit for enabling childcare settings to create high quality, healthy learning environments to improve children’s health, wellbeing and school readiness. It is not anticipated that the final beta testing of the Outcomes Framework will present major refinement issues and so a further funding for a full HEY Programme will be requested to develop web/app resources and a communications strategy to enable the launch of a three year Pan London programme.  
 

Planned delivery approach and next steps

Stage

Milestone

Description

Stage Dates

Stage 1: Scoping and consultation

Completion of Stage 1

Develop a Healthy Early Years London programme; assess suitability of HSL Outcomes Frame work for HEY; consider existing HEY Programmes and alignment; consult with stakeholders

Present- April 2017

Stage 2: Final Beta Testing Stage

Launch (and review) of beta testing

HEY Outcomes Framework tested with six London boroughs, including, awards process, communications activity, debrief/refinement

 

April 2017 - December 2017

Stage 3: Delivery (NOT INCLUDED IN THIS DD)

Delivery of full HEY Programme and awards scheme

Launch of pan-London awards programme.

 

Web and printed materials developed and distributed.

 

Workshops and seminars delivered across London.

 

Agreed processes for application and recognition in action.

 

Pan-London HEY Programme evaluation undertaken.

January 2018 - September 2020