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Primary Prevention –
 cheaper than cure,
better outcomes for
      children
Afternoon session June 13th 2012

                           Supported by
The Health perspective
 Dr Ann Hoskins, Interim Regional
      Director of Public Health/
Director of Children, Young People &
              Maternity



                             Supported by
C4EO/ WAVE Trust conference
                       13th June 2012
Dr Ann Hoskins, Interim Regional Director of Public Health /
  Director Children, Young People and Maternity Services




   Healthier Horizons
Giving Every Child the Best Start in Life is Crucial to
   Reducing Health Inequalities Across the Life Course
• Ensure high quality maternity services,
  parenting programmes, childcare and
  early years education to meet need
  across the social gradient
• Ensuring that parents have access to
  support during pregnancy is
  particularly important
• An integrated policy framework is
  needed for early child development to
  include policies relating to the prenatal
  period and infancy, leading to the
  planning and commissioning of
  maternity, infant and early years
  family support services as part of a
  wider multi-agency approach to
  commissioning children and family
  services
The Scientific Base
1. A child’s early experience has a long lasting impact on the
   neurological architecture of their brain and their emotional and
   cognitive development

2. Pregnancy and birth a key time for change – parents have an
   instinctive drive to protect their young and want their child to be
   healthy and happy and do well in life

3. Evidence that effective preventive interventions in early life can
   produce significant cost savings and benefits in health, social care,
   educational achievement, economic productivity and responsible
   citizenship

4. There is scientific consensus that origins of adult disease are often
   found in pregnancy and infancy

                                                                           5
Revised slideshow afternoon session for e circulation june 13th
The Task of Commissioning for
            Prevention


To prevent early adversities
 becoming biologically embedded
              723,165 new
          opportunities available
           each year in the UK
Factors That Can Hamper Positive
      Development During Pregnancy
• Low birth weight in particular is associated with poorer long-term health and
  educational outcomes
• Smoking can cause a range of serious health problems, including lower birth weight,
  pre-term birth placental complications and perinatal mortality. In addition smoking
  during pregnancy has been associated with poor child behaviour at age 5.
• Drug use in pregnancy can increase the risk of low birth weight, premature delivery,
  perinatal mortality, cot death and impairment to the unborn child’s development.
• Drinking alcohol during pregnancy is associated with increased risk of miscarriage,
  risk of Fetal Alcohol Syndrome whose features include: growth deficiency for height
  and weight, a distinct pattern of facial features and physical characteristics and central
  nervous system dysfunction.
• Maternal depression during pregnancy may affect brain development in the foetus,
  reduce foetal growth and poses risks of premature labour. Antenatal depression has
  also been linked to altered immune functioning in the baby after birth. Antenatal anxiety
  at 32 weeks’ gestation has been linked to behavioural and emotional problems in the
  child at age 4
Commissioning for Prevention
The strength of association
Using maternal factors to consider likely outcomes at 5 years old


                               •Data already collected in
                               maternity units
                               •Predictive for outcomes at
                               population level
                               •Informs commissioners decision
                               making for early years resources/
                               services


                               Predictive Maps available for,
                               Behaviour, Learning and
                               Development , Health outcomes
                               www.chimat.org.uk
Find Out About the Early Years
         Needs in Your Area
Child Health                   Learning, Development and
                               Behaviour

http://www.chimat.org.uk/prof http://www.education.gov.uk/
iles                          researchandstatistics/datasets/
                              a00198391/dfe-early-years-
                              foundation-stage-profile-
                              results-in-england-201011

                               Navigate to Figures at Local
                               Authority Level
Getting the Best Prevention from the
Resources you have for early years
• Plan strategically at a population level;
  intervene proportionately at an individual
  level. E.g. Family Nurse Partnership
• Health Visiting Service offers for families;
  universal children’s service
• Promoting a ‘resilience developing’ asset
  based style to underpin all interactions
Where Should Support for
   Foundation Years Come From?
• Co-ordinated by health visitors: lead a system
  for solutions, not services
• Children’s Centres – PbR pilots
• Building from & on citizens capacity
• Third sector and charities
What do parents                                   What is HV contribution?
        want?                A community that
                             supports children
                                 and families
                                                                  Needs
                                                                 Predicted
                                   Services that
                                                                 Assessed
                               give our baby/child
                                                                 Expressed
                                   healthy start.
                                Best advice on a
                                  being a parent
                               To know our health
                                visitor and how to              Health Visitor
                                   contact them


To have the right              A quick response if we
people to help over a          have a problem and to
longer term when               be given expert advice             Response
things are really              and support by the                  Provide
difficult                      right person                        Delegate
To know those people
                                                                    Refer
and that they will work
together July 2012with us.
         25 and                                                              15
Health Visiting Services –
   Offers for Families
FNP Short Term Impact on Outcomes
Pregnancy & Birth   ↓smoking in pregnancy
                    ↓ pregnancy related complications
                    ↑ uptake of antenatal care
                    ↑breastfeeding initiation
                    ↑birth weights in very young teens
                    ↑improved diet & nutrition in pregnancy

Infancy             ↓A&E visits –all reasons & for injuries and ingestions (indicator of abuse
(0-2 years )        and neglect)
                    ↓ hospital admissions for injuries and ingestions
                    ↓language delay
                    ↓punitive parenting
                    ↓subsequent pregnancies and births
                    ↓welfare use
                    ↑ more sensitive care giving
                    ↑ father involvement in parenting
                    ↑better home learning environment
                    ↑employment
                    ↑emotional development
FNP Medium /Long Term Impact On Outcomes
Medium term   ↓ severe behaviour problems
(2-9 years)   ↓ future pregnancies & births (greater duration between births)
              ↓ welfare use
              ↓involvement with criminal justice system (mother)
              ↑ employment and participation in education (mother)
              ↑ sustained relationship with child’s father/partner (mother)
              ↑ language development
              ↑ school readiness
              ↑ school achievement scores (reading and maths)
              ↑ home learning environments
              ↑ stimulating parenting

Longer term   ↓ child abuse and neglect
(Age 15+)     ↓ Less criminal and anti-social behaviour (child)
Can it Be Justified in Current
           Economic Climate?
• US economic modelling- $1 spend prevents $5 spend.
  Cost recovery by age 4.
• UK – because of licensing, get same outcomes as US;
  economic analysis will be part of RCT scope
• Babies born to teenage parents at higher likelihood of
   – £2,500/week to keep a child in residential care
   – £400/week to support a child in need at home
   – Up £300,000 /year for a child with additional support needs
   – £1000 /unscheduled ante-natal admission for investigation with
     overnight stay for under 18
   – £15,000/year public service cumulative costs for a child with
     ’troubled behaviour’
The New Commissioning Landscape
                               Department
                                of Health
                                 NHS
  Public
  Health
 England
                   NHS             Monitor       CQC
                Commissioning     (economic     (quality)
                   Board          regulator)   HealthWatch

(Local health     Clinical Commissioning
improvement                                      Providers
                           Groups
   in LAs)

                   Local authorities (via health &
                                                                Local
                         wellbeing boards)                   HealthWatch
The universal prevention and early intervention pathway from pre-pregnancy to 5




  Pre-pregnancy information
    and services (e.g. stop
  smoking clinics) to improve
       women’s health

                Woman discovers she is pregnant and
              chooses which maternity service to book
             with via the GP or directly with the midwife


          Conception

   GP Team

                  Midwife




                                                            Online resources, books, leaflets and websites




                            Promoting parents’ self-efficacy & helping them to care well for their child.
                            Linking to other community resources and services including SSCCs.
                            Facilitating community groups & community action
How Third Sector
organisations can help to
    “make it happen”


Fiona Sheil, Public Service Delivery
          Officer, NCVO
                             Supported by
How Third Sector organisations
can help to “make it happen”
                      13th June 2012

                         Fiona Sheil
                       @fionapsdn
               fiona.sheil@ncvo-vol.org.uk
                   Public Services Team
        National Council for Voluntary Organisations
What is the voluntary sector?
58.2% work with children and young
people

Including
-7,910 playgroups and nurseries
-7,775 education
-6,580 scout groups and youth clubs
Why does this matter to you?
Delivering Services




            http://www.ncvo-vol.org.uk/psd/public_services_history
http://www.ncvo-vol.org.uk/commissioning/from_grants_to_contracts
Government Expenditure on the VCS 2009/10
Revised slideshow afternoon session for e circulation june 13th
Workforce &
Economic weight




         Social capital
           & assets
Participation,
 Democracy &
representation
Information
       & commissioning




 Participation,
 Democracy &
representation
Revised slideshow afternoon session for e circulation june 13th
Delivering Services




  Workforce &                                            Information
Economic weight                                        & commissioning




                                                 Participation,
         Social capital
                                                 Democracy &
           & assets
                                                representation
Revised slideshow afternoon session for e circulation june 13th
Thank you!

NCVO Public Services Delivery Network
  –   fiona.sheil@ncvo-vol.org.uk
  –   www.ncvo-vol.org.uk/psdnetwork
  –   0207 520 2411
  –   @fionapsdn
Prevention and early
  intervention – a
Croydon perspective
Jon Rouse, CEO, Croydon Council




                         Supported by
Prevention and early intervention – a
Croydon perspective

Jon Rouse
Chief Executive
Croydon
  Borough
  of contrasts


Low wage
economy with
increasing
unemployment

Diverse population
                                                 Major transport hub
40% minority ethnic
                                 Good education system
           Population growth –
           baby boom
A philosophy – integrated teams around the
citizen to manage complex requirements



                        ●   Adult Learning Disabilities
                        ●   Adult Mental Health
                        ●   Family Justice Centre
                        ●   Turnaround Centre
                        ●   Youth Homelessness
                        ●   Integrated Offender Management
                        ●   Family Resilience Team
Croydon’s Journey from Total Place to
prevention and early intervention
• Customer-led transformation

• Evidence based approach

• A whole system approach to
  early help

• Continued focus on early ‘early
  intervention’

• Working out the metrics
The Escalating costs of intervention
                                                                                                                                 Child looked after in secure
                                                                                                                                 accommodation – £134,000
                                                                                                    Child looked after in
                                                                                                                                 per year placement costs
                                                                                                    children’s home – £125,000
                                                                                                    per year placement costs

                                                                                                                                               Cost
                                                                                          Multi-dimensional Treatment
                                                                                          Foster Care – £68,000 per year
                                                                                                                                               Costs increase as
                                                                                          for total package of support
                                                                                                                                               children get older.
                                                                                                                                               Increasing related
                                                                                      Child looked after in foster
                                                                                                                                               costs such
                                                                                      care – £25,000 per year
yi mf / di hc r ept s o C




                                                                                                                                               healthcare and the
                                                                                      placement costs
                                                                                                                                               criminal justice
                                                                                                                                               system make it
                                                                          Family Intervention Projects –                                       clear joined up
                                                                          £8-20,000 per family per year                                        working is a core
                                                                                                                                               part of cost
                                                                                                                                               effectiveness
 l a l




                                                                        Multi-Systemic Therapy –
                                                                        £7-10,000 per year
                                        Parenting programme
                                        (e.g. Incredible Years –
                                        £900-1,000 per family
                                                                    Family Nurse Partnerships –
                                                                    £3000 per family a year
Information services –
Around £34 via telephone helpline
Around £2 via digital services                                     PEIP – £1,200 -
                                                                   3,000 per parent




                            Children’s Centres - around £600 per user

                            Schools - £5,400 per pupil


                                                         Severity of assessed need
What our Total Place pilot told us
Revised slideshow afternoon session for e circulation june 13th
Revised slideshow afternoon session for e circulation june 13th
After Total Place - progress
Children’s Centres - based on collaborations – engaged
  parents and communities in redesign
- hub of their community
- universal through to targeted support
- early help

Family Space - website in place and network of children’s
                 centres
Family Advocates & Peer to peer support - ‘Family
  Navigators’ and commissioned services
After Total Place
  Geographically based Family Engagement Partnerships
  with early years practitioners equipped to spot early signs of
  needs, know how to engage parents quickly in high quality
  services including early identification and peer2peer
  support

Struggling with Preparation for Parenthood
• children and parents experience system from
  conception onwards which supports & develops
  parenting capabilities
• pre-natal care holistic preparation for parenthood;
  emotional needs of parents supported
Continuing to develop preventative and
early intervention service in Croydon
• Use a whole system approach and build our evidence
  base
• Use the ‘wedge’ to help us plan interventions
• Reduce high cost families so that we can reinvest in
  preventative services
• Continue to work with health colleagues
• Develop our metrics across the whole programme of
  interventions
Mapping Change for Croydon EIFS: Driving better long-term outcomes for children and families
                                   Target service level outcomes (Identified at
EYS objectives/drivers of change                                                           Broader immediate outcomes   Long-term outcomes for children & families
                                   practitioner workshop)

  Greater family                   Sense of control and autonomy over decisions
                                                                                                                           Increased likelihood of parent
  resilience and
                                   Improved social networks & sense of community                                           keeping / finding a job
  autonomy


                                   Stable housing and reduced homelessness                    Improved emotional            Increased likelihood of financial
                                                                                              resilience                    security for the family

                                   Stronger home learning environments
                                                                                                                            Reduction in number of children on
                                                                                                                            Child Protection Register/ looked
                                   Higher learning achievement among parents                                                after children
                                                                                              Improved child
  Improved educational
                                                                                              behaviour at home and
  achievement                      Improved learning outcomes among children                                                Reduced likelihood of children
                                                                                              school
                                                                                                                            becoming NEET

                                   Secure attachment between parent and child
                                                                                                                            Improved long-term and
                                                                                              Reduced risk of child         intergenerational health including
                                   Less abuse/ family violence                                protection issues             reduced risk of mental ill-health
  Improved parent-child
  relationship
                                   Improved parenting skills
                                                                                                                            Reduced likelihood of drug misuse
                                                                                                                            among parents, children/young
                                   Optimise health of children and mothers                                                  adults
  Improvements in child                                                                       Reduced anti-social
  and maternal health              Having somewhere to play/ be active                        behaviour/ community
                                                                                                                            Reduced contact of parents with
                                                                                              violence
                                                                                                                            criminal justice system

                                   Integration of family skills/experience into services
                                                                                                                            Reduced likelihood of children
  More responsive and                                                                                                       entering the criminal justice system
                                   Staff awareness of child well-being
  consistent services
                                   Early identification of needs
                                                                                                                             Greater take-up of
                                                                                                                             universal services
                                   Well coordinated, consistent services
Early Help & Staged Intervention

   Support at Stage 1
                                         Support at Stage 2
         CRISS;
     Family Space &                           Family
       Practitioner                        Engagement
        websites                                                               Support at Stage 3
                                           Partnerships
                                                                                      Family
                                           Peer2peer
                                                                                    Resilience
                                        Family Navigator
                                                                                     Service
                                           Parenting
                                          Programmes
                                                                                    Troubled
                                                                                     Family
                                           Find me Early
                                                                                   Navigators



      UNIVERSAL                     LOW/VULNERABLE                             COMPLEX                             ACUTE
Children & Young People requiring   Children & Young People with low     Children, Young People &           Children, Young People &
      personalised universal         level additional needs requiring   Families with high level needs.       Families with complex
            services                   single agency support or an                                          additional needs requiring
                                       integrated response using a       These children/young people      specialist/statutory integrated
                                          common assessment.               include ‘Children in Need’        response; includes child
                                                                            (Section 17) who require       protection (Section 47) and
                                                                         integrated, targeted support     children whose needs / safety
                                                                                                            cannot be managed in the
                                                                                                                   community
Croydon – working across the wedge, whole system approach


                                                            Cost




                                                                                                                                                    Severity of need
                                                                                                                           R
                                                                                                                         Pb
                                                                                                                    lies
                                                                                                                  mi
                                                                                                            d   Fa
                                                                                                         ble
                                                                                                    rou
                                                                                               e–T
                                                                                           vic
                                                                                       Ser
                                                                                    ce
                                                                               lien
                                                                            esi                           bR
                                                                       ly R                            –P
                                                                     mi                             es
                                                                   Fa                           vic
                                                                                            ser
                                                                                        re
                                                                                     ent
                                                                                 ’s c
                                                                           ren
                                                                        ild




                                                                                                                               Universal Services
                                                                     Ch                                s
                                                                                                   ilie
                                                                                              fam
                                                                                          all
                                                                                      for
                                                                                   lp
                                                                                He
                                                                            rly
                                                                          Ea
Reducing High Cost Spend through Croydon’s
Family Resilience Service


               Av.
               savings                                     Net saving
               per year     Caseload   Caseload   Net      per family per
         No.   per family   savings    costs      saving   year




Phase
1 - 60    60 £48.5k         £2.91m     £840k      £2.07m   £34.5k


Whole
Pilot
231      231 £48.5k         £11.2m     £3.23m     £7.9m    £34.5k
Capturing net value – a complicated
business
• Costs to society include the
  benefits foregone from not using
  the resources for some other use
• Large differences in the
  methodologies adopted by studies
  (few UK studies) aiming to evaluate
  the economic impact of early years
  interventions
• Difficult to compare results across
  interventions
• BUT emerging UK studies do
  provide indications that early years
  interventions generate benefits in
  the long term that outweigh the
  costs
Where we need to go next?
• Children and parents to experience system from conception
  onwards which supports and develops parenting capabilities

• Pre-natal care holistic preparation for parenthood; emotional
  needs of parents strongly supported

• Maternity services within hospitals transformed and
  characterised by holistic preparation for parenthood

• Continue to build our early intervention approach - evidence
  based and builds the resilience and autonomy of parents to
  ensure young children thrive and develop
The journey continues….
Innovation from local
        areas



Choice of Workshops to showcase
 response from call for evidence


                          Supported by
Q&A’s to panel
  members




             Supported by
The benefits of primary
      prevention
    Andrea Leadsom, MP




                         Supported by

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Revised slideshow afternoon session for e circulation june 13th

  • 1. Primary Prevention – cheaper than cure, better outcomes for children Afternoon session June 13th 2012 Supported by
  • 2. The Health perspective Dr Ann Hoskins, Interim Regional Director of Public Health/ Director of Children, Young People & Maternity Supported by
  • 3. C4EO/ WAVE Trust conference 13th June 2012 Dr Ann Hoskins, Interim Regional Director of Public Health / Director Children, Young People and Maternity Services Healthier Horizons
  • 4. Giving Every Child the Best Start in Life is Crucial to Reducing Health Inequalities Across the Life Course • Ensure high quality maternity services, parenting programmes, childcare and early years education to meet need across the social gradient • Ensuring that parents have access to support during pregnancy is particularly important • An integrated policy framework is needed for early child development to include policies relating to the prenatal period and infancy, leading to the planning and commissioning of maternity, infant and early years family support services as part of a wider multi-agency approach to commissioning children and family services
  • 5. The Scientific Base 1. A child’s early experience has a long lasting impact on the neurological architecture of their brain and their emotional and cognitive development 2. Pregnancy and birth a key time for change – parents have an instinctive drive to protect their young and want their child to be healthy and happy and do well in life 3. Evidence that effective preventive interventions in early life can produce significant cost savings and benefits in health, social care, educational achievement, economic productivity and responsible citizenship 4. There is scientific consensus that origins of adult disease are often found in pregnancy and infancy 5
  • 7. The Task of Commissioning for Prevention To prevent early adversities becoming biologically embedded 723,165 new opportunities available each year in the UK
  • 8. Factors That Can Hamper Positive Development During Pregnancy • Low birth weight in particular is associated with poorer long-term health and educational outcomes • Smoking can cause a range of serious health problems, including lower birth weight, pre-term birth placental complications and perinatal mortality. In addition smoking during pregnancy has been associated with poor child behaviour at age 5. • Drug use in pregnancy can increase the risk of low birth weight, premature delivery, perinatal mortality, cot death and impairment to the unborn child’s development. • Drinking alcohol during pregnancy is associated with increased risk of miscarriage, risk of Fetal Alcohol Syndrome whose features include: growth deficiency for height and weight, a distinct pattern of facial features and physical characteristics and central nervous system dysfunction. • Maternal depression during pregnancy may affect brain development in the foetus, reduce foetal growth and poses risks of premature labour. Antenatal depression has also been linked to altered immune functioning in the baby after birth. Antenatal anxiety at 32 weeks’ gestation has been linked to behavioural and emotional problems in the child at age 4
  • 10. The strength of association
  • 11. Using maternal factors to consider likely outcomes at 5 years old •Data already collected in maternity units •Predictive for outcomes at population level •Informs commissioners decision making for early years resources/ services Predictive Maps available for, Behaviour, Learning and Development , Health outcomes www.chimat.org.uk
  • 12. Find Out About the Early Years Needs in Your Area Child Health Learning, Development and Behaviour http://www.chimat.org.uk/prof http://www.education.gov.uk/ iles researchandstatistics/datasets/ a00198391/dfe-early-years- foundation-stage-profile- results-in-england-201011 Navigate to Figures at Local Authority Level
  • 13. Getting the Best Prevention from the Resources you have for early years • Plan strategically at a population level; intervene proportionately at an individual level. E.g. Family Nurse Partnership • Health Visiting Service offers for families; universal children’s service • Promoting a ‘resilience developing’ asset based style to underpin all interactions
  • 14. Where Should Support for Foundation Years Come From? • Co-ordinated by health visitors: lead a system for solutions, not services • Children’s Centres – PbR pilots • Building from & on citizens capacity • Third sector and charities
  • 15. What do parents What is HV contribution? want? A community that supports children and families Needs Predicted Services that Assessed give our baby/child Expressed healthy start. Best advice on a being a parent To know our health visitor and how to Health Visitor contact them To have the right A quick response if we people to help over a have a problem and to longer term when be given expert advice Response things are really and support by the Provide difficult right person Delegate To know those people Refer and that they will work together July 2012with us. 25 and 15
  • 16. Health Visiting Services – Offers for Families
  • 17. FNP Short Term Impact on Outcomes Pregnancy & Birth ↓smoking in pregnancy ↓ pregnancy related complications ↑ uptake of antenatal care ↑breastfeeding initiation ↑birth weights in very young teens ↑improved diet & nutrition in pregnancy Infancy ↓A&E visits –all reasons & for injuries and ingestions (indicator of abuse (0-2 years ) and neglect) ↓ hospital admissions for injuries and ingestions ↓language delay ↓punitive parenting ↓subsequent pregnancies and births ↓welfare use ↑ more sensitive care giving ↑ father involvement in parenting ↑better home learning environment ↑employment ↑emotional development
  • 18. FNP Medium /Long Term Impact On Outcomes Medium term ↓ severe behaviour problems (2-9 years) ↓ future pregnancies & births (greater duration between births) ↓ welfare use ↓involvement with criminal justice system (mother) ↑ employment and participation in education (mother) ↑ sustained relationship with child’s father/partner (mother) ↑ language development ↑ school readiness ↑ school achievement scores (reading and maths) ↑ home learning environments ↑ stimulating parenting Longer term ↓ child abuse and neglect (Age 15+) ↓ Less criminal and anti-social behaviour (child)
  • 19. Can it Be Justified in Current Economic Climate? • US economic modelling- $1 spend prevents $5 spend. Cost recovery by age 4. • UK – because of licensing, get same outcomes as US; economic analysis will be part of RCT scope • Babies born to teenage parents at higher likelihood of – £2,500/week to keep a child in residential care – £400/week to support a child in need at home – Up £300,000 /year for a child with additional support needs – £1000 /unscheduled ante-natal admission for investigation with overnight stay for under 18 – £15,000/year public service cumulative costs for a child with ’troubled behaviour’
  • 20. The New Commissioning Landscape Department of Health NHS Public Health England NHS Monitor CQC Commissioning (economic (quality) Board regulator) HealthWatch (Local health Clinical Commissioning improvement Providers Groups in LAs) Local authorities (via health & Local wellbeing boards) HealthWatch
  • 21. The universal prevention and early intervention pathway from pre-pregnancy to 5 Pre-pregnancy information and services (e.g. stop smoking clinics) to improve women’s health Woman discovers she is pregnant and chooses which maternity service to book with via the GP or directly with the midwife Conception GP Team Midwife Online resources, books, leaflets and websites Promoting parents’ self-efficacy & helping them to care well for their child. Linking to other community resources and services including SSCCs. Facilitating community groups & community action
  • 22. How Third Sector organisations can help to “make it happen” Fiona Sheil, Public Service Delivery Officer, NCVO Supported by
  • 23. How Third Sector organisations can help to “make it happen” 13th June 2012 Fiona Sheil @fionapsdn fiona.sheil@ncvo-vol.org.uk Public Services Team National Council for Voluntary Organisations
  • 24. What is the voluntary sector?
  • 25. 58.2% work with children and young people Including -7,910 playgroups and nurseries -7,775 education -6,580 scout groups and youth clubs
  • 26. Why does this matter to you?
  • 27. Delivering Services http://www.ncvo-vol.org.uk/psd/public_services_history http://www.ncvo-vol.org.uk/commissioning/from_grants_to_contracts
  • 28. Government Expenditure on the VCS 2009/10
  • 30. Workforce & Economic weight Social capital & assets
  • 32. Information & commissioning Participation, Democracy & representation
  • 34. Delivering Services Workforce & Information Economic weight & commissioning Participation, Social capital Democracy & & assets representation
  • 36. Thank you! NCVO Public Services Delivery Network – fiona.sheil@ncvo-vol.org.uk – www.ncvo-vol.org.uk/psdnetwork – 0207 520 2411 – @fionapsdn
  • 37. Prevention and early intervention – a Croydon perspective Jon Rouse, CEO, Croydon Council Supported by
  • 38. Prevention and early intervention – a Croydon perspective Jon Rouse Chief Executive
  • 39. Croydon Borough of contrasts Low wage economy with increasing unemployment Diverse population Major transport hub 40% minority ethnic Good education system Population growth – baby boom
  • 40. A philosophy – integrated teams around the citizen to manage complex requirements ● Adult Learning Disabilities ● Adult Mental Health ● Family Justice Centre ● Turnaround Centre ● Youth Homelessness ● Integrated Offender Management ● Family Resilience Team
  • 41. Croydon’s Journey from Total Place to prevention and early intervention • Customer-led transformation • Evidence based approach • A whole system approach to early help • Continued focus on early ‘early intervention’ • Working out the metrics
  • 42. The Escalating costs of intervention Child looked after in secure accommodation – £134,000 Child looked after in per year placement costs children’s home – £125,000 per year placement costs Cost Multi-dimensional Treatment Foster Care – £68,000 per year Costs increase as for total package of support children get older. Increasing related Child looked after in foster costs such care – £25,000 per year yi mf / di hc r ept s o C healthcare and the placement costs criminal justice system make it Family Intervention Projects – clear joined up £8-20,000 per family per year working is a core part of cost effectiveness l a l Multi-Systemic Therapy – £7-10,000 per year Parenting programme (e.g. Incredible Years – £900-1,000 per family Family Nurse Partnerships – £3000 per family a year Information services – Around £34 via telephone helpline Around £2 via digital services PEIP – £1,200 - 3,000 per parent Children’s Centres - around £600 per user Schools - £5,400 per pupil Severity of assessed need
  • 43. What our Total Place pilot told us
  • 46. After Total Place - progress Children’s Centres - based on collaborations – engaged parents and communities in redesign - hub of their community - universal through to targeted support - early help Family Space - website in place and network of children’s centres Family Advocates & Peer to peer support - ‘Family Navigators’ and commissioned services
  • 47. After Total Place Geographically based Family Engagement Partnerships with early years practitioners equipped to spot early signs of needs, know how to engage parents quickly in high quality services including early identification and peer2peer support Struggling with Preparation for Parenthood • children and parents experience system from conception onwards which supports & develops parenting capabilities • pre-natal care holistic preparation for parenthood; emotional needs of parents supported
  • 48. Continuing to develop preventative and early intervention service in Croydon • Use a whole system approach and build our evidence base • Use the ‘wedge’ to help us plan interventions • Reduce high cost families so that we can reinvest in preventative services • Continue to work with health colleagues • Develop our metrics across the whole programme of interventions
  • 49. Mapping Change for Croydon EIFS: Driving better long-term outcomes for children and families Target service level outcomes (Identified at EYS objectives/drivers of change Broader immediate outcomes Long-term outcomes for children & families practitioner workshop) Greater family Sense of control and autonomy over decisions Increased likelihood of parent resilience and Improved social networks & sense of community keeping / finding a job autonomy Stable housing and reduced homelessness Improved emotional Increased likelihood of financial resilience security for the family Stronger home learning environments Reduction in number of children on Child Protection Register/ looked Higher learning achievement among parents after children Improved child Improved educational behaviour at home and achievement Improved learning outcomes among children Reduced likelihood of children school becoming NEET Secure attachment between parent and child Improved long-term and Reduced risk of child intergenerational health including Less abuse/ family violence protection issues reduced risk of mental ill-health Improved parent-child relationship Improved parenting skills Reduced likelihood of drug misuse among parents, children/young Optimise health of children and mothers adults Improvements in child Reduced anti-social and maternal health Having somewhere to play/ be active behaviour/ community Reduced contact of parents with violence criminal justice system Integration of family skills/experience into services Reduced likelihood of children More responsive and entering the criminal justice system Staff awareness of child well-being consistent services Early identification of needs Greater take-up of universal services Well coordinated, consistent services
  • 50. Early Help & Staged Intervention Support at Stage 1 Support at Stage 2 CRISS; Family Space & Family Practitioner Engagement websites Support at Stage 3 Partnerships Family Peer2peer Resilience Family Navigator Service Parenting Programmes Troubled Family Find me Early Navigators UNIVERSAL LOW/VULNERABLE COMPLEX ACUTE Children & Young People requiring Children & Young People with low Children, Young People & Children, Young People & personalised universal level additional needs requiring Families with high level needs. Families with complex services single agency support or an additional needs requiring integrated response using a These children/young people specialist/statutory integrated common assessment. include ‘Children in Need’ response; includes child (Section 17) who require protection (Section 47) and integrated, targeted support children whose needs / safety cannot be managed in the community
  • 51. Croydon – working across the wedge, whole system approach Cost Severity of need R Pb lies mi d Fa ble rou e–T vic Ser ce lien esi bR ly R –P mi es Fa vic ser re ent ’s c ren ild Universal Services Ch s ilie fam all for lp He rly Ea
  • 52. Reducing High Cost Spend through Croydon’s Family Resilience Service Av. savings Net saving per year Caseload Caseload Net per family per No. per family savings costs saving year Phase 1 - 60 60 £48.5k £2.91m £840k £2.07m £34.5k Whole Pilot 231 231 £48.5k £11.2m £3.23m £7.9m £34.5k
  • 53. Capturing net value – a complicated business • Costs to society include the benefits foregone from not using the resources for some other use • Large differences in the methodologies adopted by studies (few UK studies) aiming to evaluate the economic impact of early years interventions • Difficult to compare results across interventions • BUT emerging UK studies do provide indications that early years interventions generate benefits in the long term that outweigh the costs
  • 54. Where we need to go next? • Children and parents to experience system from conception onwards which supports and develops parenting capabilities • Pre-natal care holistic preparation for parenthood; emotional needs of parents strongly supported • Maternity services within hospitals transformed and characterised by holistic preparation for parenthood • Continue to build our early intervention approach - evidence based and builds the resilience and autonomy of parents to ensure young children thrive and develop
  • 56. Innovation from local areas Choice of Workshops to showcase response from call for evidence Supported by
  • 57. Q&A’s to panel members Supported by
  • 58. The benefits of primary prevention Andrea Leadsom, MP Supported by

Notes de l'éditeur

  1. In recent years research has shown that a child’s experience in the womb and in early life has a strong influence on their health, development and well being throughout life During the rapid development of the brain in the first years of life the neural pathways, synaptic connections and bio-chemical responses are significantly influenced by a child’s environment and experience. The quality of early care giving and the infant-parent relationship has a major influence on the child’s outcomes equal, if not greater, than socio-economic circumstances. Deficient early years parenting experiences have been linked to a range of adverse later life outcomes including anxiety and depression, poor learning and cognitive development, increased risk of abuse and neglect, poor behavioural outcomes, criminality and anti-social behaviour. Early parenting experiences are especially critical in the development of the child’s emotional regulatory system and a large proportion of adult mental health problems are thought to have their origins in early childhood The high level of malleability in the brain during this period means this is also the time when it is most open to influence and change so intervening early and ensuring positive experiences and preventing negative experiences provides the greatest opportunity for improving children’s outcomes and, in turn, adult outcomes.
  2. Shirley - the title in green and the ‘to prevent early…..” should be on slide, then babies and 723,165 opportunities appear on next click – please can you tweak animation to make it work.
  3. Factors at child’s age 9 months and child’s subsequent outcomes at age 5. What factors will you target to either prevent or mitigate for pregnant women and families with new babies?
  4. Where is the local need in the most immediate timescale? How will you expect your commissioned health visiting services (likely to be the only truly universal service for children under 5 in the mid-term future) to be deployed to get better outcomes?
  5. Aim is to keep families moving towards the Communities Offer and return families up stream after a ‘resilience dip’ has meant they needed support from Universal Plus and Universal Partnership Plus offers.
  6. Cost to support with FNP = £3000 per year so £6000/child. Recovered by age 4. So each team of FNP can support at least 110 families. Even if only one antenatal stay, one children’s A&E admission, and 1 week without additional family support at home was avoided for every family supported with FNP at least £3000 spend is avoided. If attendance is more than this then potential for avoiding spend and making a saving. So initially where to spend the same money and what additional value. For example additional value through mothers more confident and use GPs less, mothers more likely to return to education, more likely to be employed etc etc.
  7. An overview of how the new system works. (Still a bit simplified – e.g. doesn’t show NICE or Information Centre) Animated: DH allocates £ and sets objectives for NHS CB. No longer any NHS HQ in DH NHS CB allocates to GP consortia Who commission services from a range of providers Who are regulated on a consistent basis (no longer some of them managed by SHAs): by CQC as now for quality and by Monitor as economic regulator (3 functions: 1 promote competition, 2 regulate prices, 3 ensure continuity of essential services) Meanwhile LAs have new role shaping NHS commissioning LAs also feed into new public health service, with their role taken from PCTs of promoting local population health improvement. And Public Health England itself is now part of DH, with a separate, ring-fenced budget. More details published in Healthy Lives, Healthy People White Paper Then adult social care: no change to structure (the debate is about financing – Dilnot commission) Finally, HealthWatch, nationally and locally So DH does strategic coordination at national level; LAs at local level.
  8. Provides a visual picture of the health pathway from preconception to 5 years.
  9. Introduce NCVO Early Action Task Force Obviously there are a number of challenges: Making the economic case work Infrastrcuture in place to have it happen This is the story of involving the VCS through the process
  10. Micro – 5% state funding; larger 1/3 Concentration because: Empathetic development of organisations (kids first) Early action / prevention is obvious Also: 22,677 culture and recreation 13,552 religious
  11. Most obvious – as illustrated by last slide Value of services are: Local – responsive local governance User led Flexible / need driven Trusted Specialist R&D Fuelled by grants Form follows funding – what is good about it and research ON PAGE THAT FLOATS IN PbR examples: financial incentive as opposed to public incentive
  12. Expected drop of 1.246 billion over spending review (cuts only – not loss through competition)
  13. Although very little is state funded 13.9 billion 2009 from 8.6 billion 2001 Total sector income is 36.7 billion
  14. Second areas of relevance – social and financial economy Very existence: proof of need and resource Further column of funding to support social services and interventions (eg social investment and state funding) Where we have been poor though is in measuring the value of these more fluid things: what does this mean for communities? Support and investment is required to prove the case
  15. Skip straight into next slide…
  16. Crucial voice in commissioning LVAC anecdote: stories to action. ‘story of place’: that’s what the VCS is. And this story of cause and effect is exactly what early intervention seeks to trace and address. How are organisations involved?
  17. Originally published as Arnstein, Sherry R. "A Ladder of Citizen Participation," JAIP, Vol. 35, No. 4, July 1969, pp. 216-224
  18. What you end up with: -multi layered and integrated partnership -parallel to govt and economic structures; formal and informal
  19. 3 points: Commissioning is about partnership: which requires communication and engagement throughout the process Needs assessment: causal and integrated Maximise social capital by integration, development and SV Bill; and through procurement that reflects and enable preventative services to work
  20. Thank you.