DD2432 Receipt and Expenditure of funding from Vital Strategies

In 2017, the Mayor accepted an invitation extended by Bloomberg Philanthropies to participate in the $5 million Partnership for Healthy Cities (PHC) Initiative. The PHC is a global network of cities committed to saving lives by preventing noncommunicable diseases (NCDs) and injuries. The Partnership engages cities across the globe and provides technical, financial, and communication support to bring visibility to the cities’ work on NCD and injury prevention. The Partnership is supported by Bloomberg Philanthropies, with the World Health Organization (WHO) and Vital Strategies as implementing partners.

On 20 September 2017, Bloomberg Philanthropies approved HEYL’s proposal to commission a process and impact evaluation of the first year of the Healthy Early Years London programme which concluded in December 2019. Approval for Phase 1 funding for the receipt and expenditure of $100,000 from Bloomberg Philanthropies to commission the evaluation, was approved through DD2158 and MD2439 (attached). Cavill Associates were commissioned to undertake the evaluation and finalised a report in December 2019.

In October 2019, Vital Strategies approved Healthy Early Years London’s September 2019 Phase 2 submission and implementation plan to improve early years menu provision in up to 10 boroughs with high child overweight/obesity at Reception age 4/5 years and will grant the GLA an additional grant of USD $50,000 for the period of 1 November 2019 to 31 December 2020. The transfer will be in pounds £40,179 and will be made in April 2020. A sub-grant agreement has been issued for signature by the GLA and Vital Strategies.

Global Recognition: Last year the Mayor’s Healthy Early Years London programme featured in a new World Health Organisation Cities report, released on 31st October 2019 World Cities Day http://www.who.int/ncds/publications/tackling-ncds-in-cities/en/ and HEYL case study https://www.who.int/ncds/publications/London-case-study-final.pdf?ua=1. Additionally, in the Annual Report of the Chief Medical Officer, 2019 Health, our global asset – partnering for progress, Michael Bloomberg stated, ‘’In London, Mayor Khan’s administration is pioneering a comprehensive approach to improving childhood nutrition, the Healthy Early Years London program.’’

We currently have 218 early years settings that have achieved the HEYL Bronze Award and met England’s Voluntary food and drink guidelines and so are serving healthy food to their under-fives in childcare. The current HEYL Evaluation which concluded in December 2019, assessed the extent to which settings comply with the Voluntary Food and Drink guidelines for Early Years settings in England. It has identified local capacity issues for supporting settings in meeting the guidelines and reaching the most deprived children and families. With this Phase 2 funding, we need to:

• explore how HEYL, local authorities and partner agencies can better support and quality assure settings implementing these guidelines effectively e.g. for staff, caterers and boroughs to be able to understand and implement the guidelines, check menus and improve food/drink provision overall and to encourage children and families to choose, prepare, cook, eat and drink healthily, particularly in boroughs with high child overweight and obesity in Reception aged children;
• consider the impact of ongoing local austerity measures on local capacity to support and quality assure HEYL settings implementing these guidelines and achieving HEYL awards; and
• modify the HEYL Framework and Bronze award audit tool to make it more user-friendly so to encourage accelerated achievement of HEYL Bronze.

The HEYL programme is an awards and recognition programme which supports early years’ settings to address several health and education priorities including childhood obesity, social, emotional and cognitive development and parental support. It was launched by the Mayor in October 2018 and has exceeded its March 2020 take up with now over 1600 settings engaged in 31 boroughs apart from Bexley (March 2020 target 1330 (10%) of 13,300 settings engaged) and Brent (due to start in Spring 2020).

HEYL provides tools, support and networking opportunities to early years’ settings, enabling them to create high quality, healthy learning environments to increase access to healthy food, provide opportunities to be more physically active and help improve physical, social and emotional health and wellbeing and school readiness. The Bloomberg funded HEYL Evaluation reported on the first year of HEYL December 2019 including findings outlined in Section 4.

Bloomberg Phase 2 Objectives and Outcomes

Food policy: Set nutrition standards for foods served and sold in public institutions

HEYL is seeking to create and pilot new sustainable models of support for increasing the number of HEYL settings implementing menus that meet England's Voluntary Food and Drink Guidelines (2017) whilst working towards achieving HEYL Bronze, in up to 10 targeted boroughs with high child overweight and obesity in Reception aged children 4/5 years)

• To increase by (minimum) 10 settings per borough implementing menus that meet England's Voluntary Food and Drink Guidelines whilst working towards achieving HEYL Bronze, in a minimum of 6 targeted boroughs with high child overweight and obesity i.e. minimum of total 60 settings in 6 boroughs.
• Improve quality of implementation - identify how well settings are implementing the guidelines and what support they need.
• Propose a model of support for scaling up - identify a sustainable approach to supporting HEYL settings in implementing the food and drink guidelines including strategic and operational support e.g. policy/funding options, players, alignment to monitoring frameworks e.g. Ofsted, training, tools, peer/boroughs.
• Modify the food element of HEYL Bronze, Silver audit tools aligned to new WHO guidelines/Evaluation recommendations to make the tools more user-friendly and effective.

Outcomes

By December 2020:

• An increase by (minimum) 10 settings per borough implementing menus that meet England's Voluntary Food and Drink Guidelines whilst working towards achieving HEYL Bronze, in a minimum of 6 targeted boroughs with high child overweight and obesity i.e. minimum of total 60 settings in 6 boroughs.
• Up to 10 (high child overweight/obesity) boroughs have identified sustainable models of support (including training and resources) to scale up and enable more settings to meet the food and drink guidelines.
• Modified HEYL Bronze and Silver Award audit tools (food element) aligned to new WHO guidelines and Evaluation recommendations, which will enable more settings to achieve HEYL Bronze and Silver awards more easily and provide healthier food.
• Publish report identifying new evidence-base, findings, current status, needs, challenges and recommendations for scaling up and building capacity across London to provide local support and resources to help HEYL settings implement menus that meet England's Voluntary Food and Drink Guidelines whilst working towards achieving HEYL Bronze.

Under Section 149 of the Equality Act 2010, as a public authority, the Mayor of London must have ‘due Regard’ of the need to eliminate unlawful discrimination, harassment and victimisation as well as to advance equality of opportunity and foster good relations between people who have a protected characteristic and those who do not.

The Mayor’s Healthy Early Years London awards programme sits within strategic objective 14 of the Mayor’s Equalities Diversity and Inclusion (EDI) Strategy for London: To help understand which groups of children and young people are most likely to experience physical and mental health issues and help them to access treatment and support by:

• Maintaining and building on the 10% of all London’s early years settings signed up to the Healthy Early Years London programme. The target was for 2020 but has been completed ahead of time.
• Maintaining the commitment of the 17 identified ‘priority’ boroughs with the worse child health and development outcomes.
• Healthy Early Years London linking to work on child obesity, with healthy eating and physical activity as core elements of both programmes.

The Mayor’s Healthy Early Years London awards programme sits within strategic objective 34: To work with communities, employers and the voluntary sector to ensure London’s diverse populations no longer experience stigma associated with mental ill-health by:

• Embedding mental health and related inequalities in City Hall strategies and programmes (including the Healthy Early Years London programme)

The Mayor’s Healthy Early Years London awards programme is a key ambition of ‘Better Health for Londoners’, London’s Health Inequalities Strategy and is targeted at London’s 13,000+ childcare settings (circa 300,000 children under five in childcare) with the aim of setting a new industry standard and tackling health inequalities across the city at the earliest opportunity in a child’s life

HEYL supports and recognises early years setting achievements in child health, wellbeing and development, ensuring London’s children have healthy places in which to learn, play and develop.

In January 2016, HEYL commissioned a Health Inequalities Impact Assessment (HIIA) which informed the design and development of HEYL. The current HEYL Evaluation which reported in December 2019, establishes the extent to which involvement in HEYL is associated with reducing health inequalities.

HEYL’s Health Inequalities Assessment carried out in January 2016 suggested that the programme will have a positive effect on both health and education inequalities. It recommended some changes to the existing tools to maximise the positive effects, and that further consideration needs to be given to the support available, from both the GLA and Local Authorities, to settings and childminders who participate in the programme. After the initial pilot, the assessment also recommended that an evaluation should take place to assess whether the programme is having an impact and identify any changes required. The HEYL Evaluation concluded in December 2019 and reported the following:

• HEYL has contributed to reducing health inequalities among children across London through delivering a universal programme (available to all childcare settings across London) which is also targeted (aiming to ensure involvement among the more deprived boroughs and settings).
• At a macro level, HEYL has done very well in reaching the more deprived communities. Of the 17 priority boroughs identified by HEYL in 2018, sixteen have confirmed or are committing local resource to the HEYL programme (the other is joining in spring 2020).
• Within boroughs, however, there is clearly an ongoing challenge in reaching and recruiting more settings in the more deprived communities, and reaching the most deprived children and families, especially if parents/carers are out of work. Borough leads are very focused on this issue, and given more time and resource, would be able to reach out to recruit and influence more settings in deprived areas. This remains a core challenge for HEYL.
• It is evident, from the survey of borough leads, that they prioritise efforts to target the hard to reach communities, with 44% targeting work with children from more deprived backgrounds, 16% with children from Black, Asian and Minority Ethnic (BAME) communities and 22% on children with Special Educational Needs (SEN). The early years settings also prioritise these areas, however they place a greater emphasis on each of these areas in particular SEN (53%).

To achieve the HEYL Bronze award, settings need to demonstrate that:

• Children’s individual needs, interests and stages of development are considered when planning experiences that will support each child’s health, wellbeing and education
• Practitioners are able to identify early and plan for children’s additional physical, social, emotional and mental health needs, including working with parents, carers and partnership agencies
• All practitioners celebrate diversity and promote equality and inclusive practise in all aspects of work with children and families, reflecting the ‘Fundamental British Values’ of democracy, rule of law, individual liberty, mutual respect and tolerance for those with different faiths and beliefs
• Resources reflect diversity of London as well as children in the setting
• Practitioners know how to support children who have a different language
• Practitioners support children to develop an understanding, appreciation and respect for different people, families and communities

There is no conflict of interest from anyone involved in drafting or clearance of this DD.

Approval is being sought for the receipt and expenditure of $50,000 in grant funding from the Bloomberg Philanthropies Healthy Cities Programme, to commission Phase 2 of the Healthy Years London (HEYL)’s programme plan.

The income is scheduled to be received in April 2020, with the related expenditure also occurring during the 2020/21 financial year.

This additional income will take the total receipts of Bloomberg income to USD $150,000.

The income and expenditure will be managed by the Healthy Early Years London programme held within the Health Unit.

Paragraphs 1 to 2 of this report indicate that the decisions requested of the Director concern the exercise of the GLA’s general powers, falling within the GLA’s statutory powers to do such things considered to further or which are facilitative of, conductive or incidental to the promotion of economic development and wealth creation, social development or the promotion of the improvement of the environment in Greater London; and in formulating the proposals in respect of which a decision is sought officers have complied with the GLA’s related statutory duties to:

• Pay due regard to the principle that there should be equality of opportunity for all people;
• Consider how the proposals will promote the improvement of health of persons, health inequalities between persons and to contribute towards the achievement of sustainable development in the United Kingdom; and
• Consult with appropriate bodies.

In taking the decisions requested, the Director must have due regard to the Public Sector Equality Duty; namely the need to eliminate discrimination, harassment, victimisation and any other conduct prohibited by the Equality Act 2010, and to advance equality of opportunity between persons who share a relevant protected characteristic (race, disability, gender, age, sexual orientation, religion or belief, pregnancy and maternity and gender reassignment) and foster good relations between persons who share a relevant protected characteristic and persons who do not share it (section 149 of the Equality Act 2010). To this end, the Mayor should have particular regard to Section 3 (above) of this report.

Officers have indicated in paragraph 1.3 that the contribution of £40,179 to the GLA from Vital Strategies amounts to the provision of grant funding and not payment for services. The agreement between Vital Strategies and the GLA is subject to New York state law. Officers have indicated they do not wish to take New York state law advice on the terms of the agreement as Vital Strategies have indicated that the terms are non-negotiable and the GLA has entered into agreements with Vital Strategies before on the same terms so are content to proceed without such external advice.

Key activities that will be implemented to meet this objective by December 2020.

• February/March 20 - Procure consultants through the GLA Commercial Procurement process to implement project -Nutritionists/ Early Years Education & Health Leads involved in HEYL with strategic, operational and evaluation expertise.
• April 20 - Organise focus groups and surveys for stakeholders to identify needs, challenges, roles and to seek borough expressions of interest in participating.
• April 20 - Develop, implement and evaluate surveys for stakeholders and settings (Consultants).
• April 20 - Conduct needs analysis and create action plan- identifying baseline, challenges, needs.
• April-November 20 - Develop, implement and evaluate training and resources.
• April-November 20 - Identify, trial and evaluate potentially sustainable models of support to enable settings to effectively meet food and drink guidelines e.g. policy/funding options, alignment to other monitoring frameworks, peer/borough support, GLA role, behaviour change tools.
• July 20 - Interim report.
• July-September 20 - Align HEYL Evaluation food and drink recommendations (2019) and WHO ECEC food and drink guidelines (2020) to HEYL framework and Voluntary food and drink guidelines.
• July-September 20 - Modify food element of HEYL Bronze/Silver audit tools to make it more user friendly and effective.
• December 20 - Publish report – identifying new evidence-base, findings and recommendations.