MD2974 Child Health and Early Years Programmes 2022-23 to 2023-24

1.1 The Mayor’s Health Inequalities Strategy (HIS) 2018-28 sets out an approach to tackling London’s health inequalities. An updated Implementation Plan for the Mayor’s HIS was published in December 2021. Integral to delivering this statutory strategy is action to address the social, economic and environment factors that drive health inequalities – known as the wider determinants of health.

1.2 The current HIS sets out a 10-year vision to make London a healthier, fairer city, where no one’s health suffers because of who they are or where they live. The Mayor is acting on these root causes of health inequalities by including health in all his strategies and policy development, from housing to economic development to transport. The HIS has five themes: Healthy Children; Healthy Minds; Healthy Places; Healthy Communities; and Healthy Living. The Child Health programmes primarily support the first of these themes but act a key mechanism for supporting all five themes in relation to child health specifically.    

1.3 London’s early-years sector is essential in promoting social cohesion, improving school readiness, and closing the inequality gap between disadvantaged children and their better-off peers – something that has become more important as a result of COVID-19. The sector is also essential to the city’s economy, providing access to high-quality early education and childcare which supports parents who wish to return to work. Quality early education is a key driver across many of the Mayor’s priorities including health, equalities, adult education and the economy. Likewise, London’s school environments provide a unique opportunity to support the health of London’s children. While the new Child Health programmes will support inspections frameworks, they also allow schools to be recognised for going further in addressing the health of children and young Londoners.

1.4 The impact of the pandemic has significantly increased the need for action, with markedly greater challenges in supporting the health, wellbeing and development needs of children who have themselves suffered the ill effects of the pandemic and lockdown. This has exacerbated the existing, deep-seated inequalities across the country and within London. Some communities have already fared worse than others, including people living in more deprived areas; people working in certain occupations; and people from some Black, Asian and minority ethnic groups.

1.5 The impact of the pandemic on the early-years and education sectors has been particularly hard, with providers experiencing a lack of resources; a fall in demand for places; staff furloughs and redundancies; and permanent and temporary closure of some settings. This has left the early-years sector at a significant risk, with the greatest impacts falling on the most disadvantaged families. Evidence from national reports suggest that the pandemic had a negative impact on children’s physical and mental wellbeing as well as on behaviours and development. 

1.6 This work is part of the Mayor’s commitment to supporting the youngest Londoners to recover from the pandemic, and tackling health inequalities across the city for all young Londoners and children.

Child health programmes

1.7 Healthy Early Years London (HEYL): The Mayor of London’s HEYL programme was established in 2018. It is a key ambition of ‘Better Health for Londoners’, London’s Health Inequalities Strategy, and is targeted at London’s 13,000-plus childcare settings, 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. 

1.8 Healthy Schools London (HSL): The Mayor of London’s HSL programme was established in 2013. It provides a framework for schools to address health and wellbeing issues, and supports London schools to create an environment and culture that helps their pupils to be healthy. All schools across every borough are eligible to join the programme; to date, over 2,500 are signed up (representing 89 per cent of schools in London).

1.9 In 2022, the GLA commissioned a rapid review of the HSL and HEYL programmes to improve the functionality and interface of both programmes. The objectives of the work are to:

i. review existing feedback, evaluation findings and potential for greater alignment with national policies; and to seek further feedback from the GLA, borough leads and wider stakeholders

ii. use that insight to refresh the programmes’ functionality – including, but not limited to, the application process, content, criteria, and delivery approach

iii. bring HEYL and HSL programmes together under a single brand and online entry point. 

1.10 This review will help the Mayor to continue to work effectively with the wider health and education system – e.g. engaging with public health professionals, health promotion activities and agencies, and other providers. Even though the Mayor does not have statutory powers in the early-years sector, nor in education for under-18s, he recognises the importance of high-quality childcare and education in narrowing the inequalities gap. He is committed to working with partners from across the sectors, e.g. borough leads, the Association of Directors of Public Health for London and the Office for Health Improvement and Disparities (previously PHE London).

1.11 This MD seeks approval for expenditure of up to £261,000 to: implement recommendations from the programme reviews undertaken throughout February and March 2022; build a new single web portal; and manage future delivery of the child health programmes across 2022-24 (£163,000 in 2022-23 and £98,000 in 2023-24). Funding for 2023-24 will be subject to the annual GLA budget-setting process; therefore, no commitments to spend will be made prior to this process. It should, however, be noted that provision has been made in the current three-year budget to support these programmes as part of the wider Recovery Mission to support all London’s families to find it easier to eat healthy food, and to be active where they live, learn, shop, work and play.

1.12 The procurement process(es) will be conducted in accordance with the GLA’s Contracts and Funding Code. A competitive process will be used to select the delivery organisation(s), which will be appointed using the standard contracting procedures. Internal GLA resources are being used to support the rebuild of the web portal, which will be fully aligned with the new london.gov.uk web portal.

Early years one-stop shop and triage tool

1.13 The GLA commissioned a rapid evidence review on inequalities in relation to COVID-19 and their effect on London, and found that mothers were 47 per cent more likely than fathers to have lost or resigned from their jobs, and 14 per cent more likely to have been furloughed. Women have taken on more childcare responsibilities when working from home; yet more than half of those who needed childcare reported that they did not have sufficient provision in place, and that the lack of childcare was a substantial contributor to loss of a job and being furloughed. All of these factors will have long-term economic consequences.

1.14 The GLA-commissioned research, undertaken in November 2020 by the Early Years Alliance (EYA) and Ceeda, found that over 60 per cent of nurseries and childminders feared bankruptcy in the next six to 12 months. This increases to 70 per cent for nurseries and childminders located in deprived areas.

1.15 The research produced three key recommendations on how the early-years sector can be supported through and post-COVID-19:

i. by bringing greater coordination and accessibility to the offer of business support for the early-years sector in London

ii. by delivering a sustainability support initiative across London during 2021-2022

iii. by promoting the essential importance of high-quality early childhood education and care to London’s employers, parents, carers and the wider public.

1.16 DD2520 (February 2021) approved £150,000 to address these recommendations, and to develop a regional web-based one-stop shop and triage tool, specific to the early-years sector, hosted on the London Business Hub.

1.17 To date the Mayor’s Strong Early Years London Programme has supported over 790 early-years providers, with reach across all London boroughs via a number of webinars, business connect events, online surgeries, and one-to-one business consultancies. The one-stop shop for early-years business support on the London Business Hub is the first sector-specific page to be piloted on the site and has achieved good traction until March 2022, with 1,466 unique page views.

1.18 The support provided by the “Strong Early Years London” initiative is due to end on 31 March 2022. However, the challenges faced by London’s early-years sector are far from over, especially due to the recent wave of Omicron cases. As in other sectors, there is an immediate, short-term risk posed by staff absence due to illness and self-isolation. Attendance within early-years settings is still fluctuating, and the sector continues to grapple with longer-term issues around funding, recruitment and retention – all of which have been brought into sharper focus by the pandemic. In contrast to previous waves of the pandemic, current government support for businesses, including private early-years providers, is limited, with the Coronavirus Job Retention Scheme no longer available.

1.19 As the pandemic becomes more protracted, it can be expected that the financial impact will also extend further into the future than initially anticipated. As a result, there will be a need for ongoing access to business support and advice to early years providers. Ceeda’s most recently quarterly survey of London early-years providers (conducted in Autumn 2021) revealed that 52 per cent of nurseries, and 35 per cent of childminders, identified their businesses as “struggling: focused on survival over the next 12 months”. Furthermore, 3 per cent of nurseries and 11 per cent of childminders identifying as “distressed: at immediate risk of closure.” Although these figures represent an improvement on Summer 2021, they remain concerning – especially given that the survey was carried out before the full impact of the Omicron variant was felt in London. Anecdotal evidence from Strong Early Years London, backed up by Ceeda’s survey, suggests that, whilst many early years providers recognise that they need business support, they are also struggling to find time and resources to access it in the midst of this crisis.

1.20 This MD seeks approval for expenditure of up to £30,000 to extend the current grant agreement with the EYA to develop sustainability of the business support one-stop shop, specific to the early-years sector, hosted on the London Business Hub and developed through the Mayor’s Strong Early Years Programme.

1.21 The activities will include gathering resources for, and maintaining, the one-stop shop for early-years business support, which has been created on the London Business Hub. From the start, it was envisaged that this webpage would be a key legacy of the programme. It is essential that information included is up to date and relevant for users.

1.22 The grant extension process will be conducted in accordance with the GLA’s Contracts and Funding Code.

Child health programmes

2.1 To date over 2,500 schools are signed up to HSL (representing 89 per cent of schools in London) and 2,100 of London’s 13,000-plus early-years settings and childcare providers have signed up to HEYL. This expenditure will ensure that the level of engagement in HSL is maintained; and that we are able to increase representation among early-years providers by making the scheme simpler to navigate and ensuring appropriate levels of resourcing are allocated to support the programmes.

2.2 This will be achieved through the following:

i. managing and maintaining network arrangements for sharing priorities, updates and learning across London boroughs and the settings

ii. oversight and running of the programmes and/or portfolios; and defining clear roles, responsibilities and accountabilities that align with GLA priorities

iii. working closely with the GLA Child Policy Lead to manage stakeholders, taking account of their levels of influence and particular interests

iv. identifying and/or developing frameworks and methodologies through wide engagement with borough leads, strategic partners and GLA teams to ensure management of programmes and/or portfolios will be comprehensive and consistent

v. establishing and managing reviews at appropriate points during and after projects, which will inform their achievements by providing evaluations of progress.

Early years one-stop shop (OSS)

2.3 To date the Mayor’s Strong Early Years London Programme has supported over 790 early-years providers, with reach across all London boroughs. The one-stop shop for early-years business support on the London Business Hub has achieved good traction until March 2022, with 1,466 unique page views. The OSS has performed comparatively well during its initial setup phase, especially given the pressure the sector is under - it has performed better than EU advisers and property advice in terms of page views and unique page view. This expenditure will ensure more time and resource to publicise it and to ensure it’s a high-quality and sustainable resource. This will support a long-term sustainability of the one-stop-shop.

2.4 This work will:

i. ensure all London boroughs are represented on the OSS

ii. ensure information from sector specific organisations is included on the OSS (e.g. PACEY, Hempsall’s) and remains up to date

iii. ensure a plan is in place to sustain the OSS beyond the extended funding period

2.5 This work will contribute to:

i. building the sector’s capacity to respond to future challenges and changes in demand

ii. increased the knowledge capacity and business acumen of London’s early-years sector

iii. increased the early-years sector’s resilience and sustainability.

3.1 Under section 149 of the Equality Act 2010 (the Equality Act), as a public authority the Mayor must have due regard to the need to eliminate discrimination, harassment and victimisation, and any conduct that is prohibited by or under the Equality Act; and to advance equality of opportunity, and foster good relations, between people who share a protected characteristic and those who do not.

3.2 This business support for early-years settings helps ensure that sufficient childcare places are available for London parents who want to work – especially in deprived areas and for children with protected characteristics, including disabled children.

3.3 Findings from the GLA’s research, undertaken in November 2020 by the EYA and Ceeda, found that over 60 per cent of nurseries and childminders feared bankruptcy in the next six to 12 months; this increases to 70 per cent for nurseries and childminders located in deprived areas.

3.4 Children from certain groups and communities do much worse than their peers, with initial gaps in development widening as those children get older. There is a gap of 13 percentage points between the highest-achieving ethnic group (Chinese) and the lowest-achieving ethnic group (Black/Black British). The gap between children eligible for free school meals and their peers is 12 percentage points, up from 11 percentage points in 2018. Children living in the most deprived areas are also behind those living the least deprived areas; the current gap between these two groups is at 13 percentage points, up from 12 percentage points in 2018.

3.5 Childcare remains one of the biggest barriers to accessing work and training opportunities. This disproportionately affects women, as the primary care givers. Data published by the Office of National Statistics from the Labour Force Survey, shows that 69 per cent of mothers with dependent children in London are in paid work. This is less than the national level.

Key risks

Links to Mayoral strategies and priorities

4.1 The proposed activities will contribute directly to the following strategies:

i. the Health Inequality Strategy, which identifies the importance of support to parents in the early years, and the impact that quality early-years provision can have on a child’s development and school readiness

ii. the Skills for Londoners Strategy, which focuses on education and skills with the aim to “empower all Londoners to access the education and skills to participate in society and progress in education and work”

iii. the Economic Development Strategy identifies the importance of early years and childcare, with access to high-quality early-years education and childcare providing a “world-class education – which gives every child the best start in life”

iv. the Mayor’s ‘Inclusive London’ Equality, Diversity and Inclusion Strategy.

Activity directly contributes to the London Recovery Missions, in particular to the Good Work for All Mission, Building Strong Communities, and the Robust Safety Net.

Impact assessments and consultations

4.2 According to the EYA survey, fewer than half of parents with young children plan to take up their childcare entitlement. Government-commissioned research found that around half (49 per cent) of 0-to 4-year-olds that received formal or informal childcare before COVID-19 have parents who intend to return their child to early-years settings.

4.3 The GLA-commissioned research into early-years sector-specific business support needs shows that, at the time of the survey, over 60 per cent of nurseries and childminders feared bankruptcy in the next six to 12 months; this increases to 70 per cent for nurseries and childminders located in deprived areas.

4.4 There are no conflicts of interest to declare for any of the officers involved in the drafting or clearance of this decision form.

5.1 Approval is being sought for expenditure of £291,000 as detailed in the below table.

5.2 The expenditure will be funded as follows:

i. 2022-23 – £163,000 (including £65,000 carry forward from Healthy Food programme) from the Mission Delivery programme budget held in the Health, Children & Young Londoners Unit within the Healthy Place, Healthy Weight mission.

ii. 2022-23 – £30,000 from the Convening & Partner programme budget held in the Health, Children & Young Londoners Unit within the New Deal for Young People mission.

iii. 2023-24 – £98,000 from the Mission Delivery programme held budget in the Health, Children & Young Londoners Unit within Healthy Place, Healthy Weight mission.

5.3 Funding in future years will be subject to the annual budget setting process and is subject to change. Appropriate break clauses will be included in any contracts that span financial years in order to avoid entering into commitments ahead of the budget setting process for 2023/24.

6.1 The foregoing sections of this report indicate that:

i. the decisions requested of the Mayor concern the exercise of the GLA’s general powers, falling within the GLA’s statutory powers to do such things considered to further or that are facilitative of, or conducive or incidental to, the promotion of social development

ii. in formulating the proposals in respect of which a decision is sought, officers have complied with the Authority’s related statutory duties to:

ii.i. pay due regard to the principle that there should be equality of opportunity for all people

ii.ii. consider how the proposals will: promote the improvement of people’s health, and health inequalities between persons; and contribute towards the achievement of sustainable development in the United Kingdom

ii.iii. consult with appropriate bodies.

6.2 In taking the decisions requested, the Mayor 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, and foster good relations, between persons who share a relevant protected characteristic (race, disability, gender reassignment, age, sex, sexual orientation, religion and belief, pregnancy and maternity, and marriage and civil partnership status) and persons who do not (section 149 of the Equality Act 2010). To this end, the Mayor should have particular regard to section 3 (above) of this report.

6.3 If the Mayor makes the decisions sought, officers must ensure that:

i. to the extent that expenditure concerns the:

i.i. award of grant funding: it is distributed fairly, transparently, in manner that affords value for money and in accordance with the requirements of the GLA’s Contracts and Funding Code; and grant-funding agreements are put in place between, and executed by, the GLA and recipients before any commitment to fund is made

i.ii. payment for services: those services are procured in liaison with TfL Procurement, and in accordance with the GLA’s Contracts and Funding Code; and contracts are put in place between, and executed by, the GLA and contractors before commencement of such services

i.iii. variation of current agreements: such variations are agreed; documented in accordance with the corresponding provisions of those agreements; and executed by the GLA and the counterparty (or counterparties) before any commitment to vary is made

ii. no reliance is placed upon, nor commitment made to, expenditure stated as being subject to the FY 2023-24 budget-setting process until that process has been completed, and the corresponding budgetary provision has been approved.