MD3197 Child Health and Early Years Programmes 2024-25 to 2025-26

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 environmental 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. 
1.3.    The Healthy Early Years London (HEYL) and Healthy Schools London (HSL) programmes primarily support the first of these themes. However, they act as a key mechanism for supporting all five themes in relation to child health specifically. 
1.4.    The Mayor of London’s HEYL programme was established in 2018. It is a key ambition of the HIS, and is targeted at London’s 13,000-plus childcare settings. It has the aim of setting a new industry standard and tackling health inequalities across the city at the earliest opportunity in a child’s life. 
1.5.    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 have signed up (representing 89 per cent of schools in London).
1.6.    In February 2023, the GLA appointed the National Children’s Bureau (NCB) as the delivery partner for both HEYL and HSL until March 2024 (MD2974). The NCB is working closely with the GLA to refresh and align the two programmes, supported by existing regional partnerships including the Office of Health Improvement and Disparities (OHID) and ADPH London which represent Directors of Public Health (DsPH). The refresh has a number of aims including better alignment between the two programmes, to reflect the priorities of wider health partners and to embed Mayoral priority programmes; including water only schools and support for mental health and wellbeing. The programmes will be refreshed following a period of engagement ensuring they meet the aims of the Mayor and regional partners.
1.7.    Working with the chosen delivery partner, the GLA aims to ensure the HEYL and HSL programmes are running as efficiently and effectively as possible.
1.8.    This decision seeks approval of £336,000 to continue ongoing delivery of the programme as well as implementing an engagement strategy to ensure the programme meets the needs of local partners and London boroughs.

Summary of expenditure and activity
1.9.    The table below provides a breakdown of the approval being sought under this MD for 2024-26 expenditure: 

Purpose of funding
2.1.    To commission a delivery partner for two years to provide operational delivery of the current HSL and HEYL programmes consisting of issuing awards, facilitating regional networks and day-to-day support to schools, early years providers and borough leads; and to continue engagement across the sector to inform the refresh of the programmes to meet the Mayor’s ambition to reduce child health inequalities so that every child has the best start in life regardless of their background and where they live.

Expected deliverables and outcomes
2.2.    To continue the successful delivery of HSL and HEYL programmes and increase uptake across London boroughs by:
•    continued successful operational delivery of current programmes - increase the percentage of new or renewed Bronze Awards across HSL and HEYL programmes 
•    continue engagement with schools, settings and borough leads and increased engagement with new schools and settings 
•    increased strategic support from the programmes across all London boroughs. 
2.3.    To continue the refresh of programme framework by working collaboratively with partners and borough leads by:
•    successfully coproducing a refreshed programme framework, ensure feedback from boroughs and partners is successfully reflected in the refreshed programme (including GLA prioritise such as Water Only Schools)  
•    improving content alignment with regional priorities and recognition of both programmes to support the delivery of key regional priorities on reducing child health inequalities in schools and early years settings 
•    securing buy-in from borough leads, schools and settings to both programmes. 

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.    Child obesity is a huge challenge in London, where over 40 per cent of Year 6 children are overweight or obese. This can have profound impacts on the health and life chances of children. There is a strong relationship between deprivation and obesity. Supporting evidence from the National Child Measurement programme (NCMP) demonstrates that the effects of deprivation can be seen at ages 4-5 when children start school, and in year 6 when children are 10-11, and they widen with age. Significant differences in overweight and obesity in health outcomes, including weight, also exist between ethnic groups in London, some of which will be due to the confounding factor of deprivation. Due to the strong links between deprivation and being overweight, HPHW mission activities are prioritised in areas that fall in the bottom 30 per cent in the indices of multiple deprivation, and/or areas with particularly poor health-related outcomes. A principle of the mission is that communities should be central to its design, and work should promote community-centred and culturally competent best practice.
 

Key risks
4.1.    Key risks are detailed below:

Links to Mayoral strategies and priorities
4.2.    The proposed activities will contribute directly to the following strategies:
•    the Health Inequalities 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
•    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’. Without the right support to be healthy, children cannot learn and therefore are not afforded to fully access the benefits of the education system
•    the Economic Development Strategy, which 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’
•    the Mayor’s ‘Inclusive London’ Equality, Diversity and Inclusion Strategy
•    the Mental health and Wellbeing London recovery mission which seeks to support Londoners where they live, work and play. 
4.3.    Activity directly contributes to the London recovery missions, particularly Good Work for All, Building Strong Communities and A Robust Safety Net.
4.4.    Tackling child obesity has been a long-term priority for the Mayor and is reflected in the HIS and the London Food Strategy; and in the development of the HPHW mission. In 2018 the Mayor established the London’s Child Obesity Taskforce (LCOT) to give every child in London the chance to grow up eating healthily, drinking plenty of water and being physically active. The LCOT has now transitioned into the Mayor’s Advisory Group on Child Healthy Weight. In this guise, it continues to provide expert advice to the Mayor on delivering against the LCOT’s ambitions.
4.5.    Reducing child obesity is one of the 10 areas of focus for pan-London collaboration for London’s health and social care partners. The work of the mission is included in the Every Child a Healthier Weight Delivery Plan, to which the Mayor is a signatory.
4.6.    There are no conflicts of interest to declare for any of the officers involved in the drafting or clearance of this decision form.

Impact assessments and consultations 
4.7.    Extensive consultation has taken place with both HSL and HEYL borough from April 2023. This insight has built on a review of the programmes content lead by the Health Education partnership. The future work plan will build on this past engagement. From November 2023 until March 2024, NCB and GLA are entering a period of engagement with key regional stakeholders and system partners to inform the refresh of HSL and HEYL programmes to align them with regional and local priorities. 
 

5.1.    Approval is being sought for the expenditure of £336,000 over two financial years, as detailed in the below table.

5.2.    The expenditure will be funded from the Early Years programme budget held in the Health, Children & Young Londoners Unit.
5.3.    Funding for future financial years is subject to the GLA’s annual budget setting process and is subject to change.
5.4.    Any contracts that commit the GLA in future years are subject to appropriate break clauses.

6.1.    The foregoing sections of this report indicate that the decisions requested of the Mayor concern the exercise of the Authority’s general powers and fall within the Authority’s statutory power to do such things considered to further or which are facilitative of, conducive or incidental to the promotion of social development in Greater London and in formulating the proposals in respect of which a decision is sought officers have complied with the Authority’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
•    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 between persons who share a relevant protected characteristic (age; disability; gender reassignment; marriage and civil partnership; pregnancy and maternity; race; religion or belief; sex; sexual orientation) and persons who do not share it 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.
6.3.    The decision seeks approval for expenditure of up to £336,000 for the ongoing management and delivery of the child health programmes until the end of March 2026. Officers are reminded to comply with the requirements of the Contracts and Funding Code, when they procure services or supplies in furtherance of the project or when award grant funding. Furthermore, officers are reminded to put in place appropriate contracts and grant agreements between the GLA and the relevant service providers and/or recipients.
 

7.1.    The schedule for this project is detailed below: