Public Service Reform Programme
Greater Manchester Early Years Shared Outcomes Framework
2 August 2013
TO:
Early Years Steering Group
FROM:
Early Years Data Group
CONTACT OFFICER:
David Morris, New Economy
1
INTRODUCTION
Greater Manchester is in the process of moving towards a new way of delivering services
and support for all children aged 0-5. Access to robust and up-to-date data and evidence will
be crucial to the success of this new delivery model (NDM).
Since the Early Years (EY) City Region pilots of 2010, repeated efforts have been made to
reach a GM-level agreement on how we measure the impact of our EY work. In 2012, as
part of the Early Years business case development process, 30 different pieces of data and
information (or KPIs) were identified as potentially being relevant to the NDM. These were
placed within a draft shared outcomes framework.1 The Early Years Data Group was
established to refine and finalise this initial work. The group includes representatives from all
10 GM localities (both policy and performance and Children’s Services staff) and the NHS.2
The group’s ambition is two-fold:
1. For GM to be able to robustly, regularly and usefully demonstrate at GM and locality
level the impact that the NDM is having upon children, families, the services that they
access and the funding that is called upon to deliver these services. This
demonstration would come in the form of regular reports, showing GM and where
possible locality/cohort scores for the agreed outcomes and the direction of travel in
that outcome over the quarter and over the previous 12 months; and
2. For GM to have a system or systems in place that enable the proportionate
gathering, analysing and sharing of child-level data between officers and agencies so
that children and families receive the support they need to progress. If successfully
realised, this could mean officers having access to charts and graphs plotting the
progress of an individual child along the 8 stages of the NDM and giving them the
ability to drilldown to understand the reasons behind changes in progress and the
referrals which were made in responses to such changes. On the following page we
illustrate what such an output could look like:
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2
Towards an outcome framework for early years in Greater Manchester
The group’s membership and a list of meeting dates and attendees can be provided on request.
1
Figure 1: Illustration of possible output from NDM individual child tracking system
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In light of this ambition, we are working towards two objectives:
1. To identify the KPIs which will need to be reported under a shared outcomes
framework in order for GM to have:
a. A population-level picture of the impact of the Early Years NDM;
b. A functional Early Years investment agreement; and
c. The child-level information needed for specific parts of the NDM to function.
2. To make recommendations on how to overcome the technical (e.g. hardware and
software), cultural (e.g. resourcing and staff training) and legal (e.g. data sharing
legislation) barriers that currently block the sharing of these KPIs.
This report details our progress to date against these objectives.
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POPULATION-LEVEL KPIs FOR INCLUSION IN THE SHARED OUTCOMES
FRAMEWORK
The 30 KPIs proposed in 2012 were all population-level indicators, i.e. they give a snapshot
of conditions within a particular cohort but do not explain the factors that have given rise to
these conditions. Each KPI has been objectively and robustly assessed using a three-stage
methodology3:

At stage 1, all group members scored each of the 30 KPIs based upon their
performance against 8 criteria. This provided initial opinions on which of the draft
KPIs seemed well-defined, unique, and relevant to the NDM;

For stage 2, group members with detailed knowledge of a specific KPI were asked to
undertake further research on this KPI and to rate the KPI in terms of its relevance
and data availability. The findings from this stage were combined with those from
stage 1 to identify 10 KPIs that the group felt should be proposed for the final shared
outcomes framework; and

Stage 3 involved a GM-wide online consultation, to which 77 responses were
received, offering views on the 10 KPIs identified at stage 2 and giving respondents
the opportunity to suggest alternative KPIs to be included in the final outcomes
framework. Feedback from the consultation was considered by the group, the final
shared outcomes framework altered accordingly, and presented in this report.
At each stage we have applied the principles that the final shared outcomes framework
should be brief, should cover the varied factors that enable a child to be ready to learn, and
should gather data that is of use to families and public agencies alike.
The shared outcomes framework proposed below includes both KPIs indicating a need for
NDM intervention and KPIs showing the impact of the NDM’s work. We have not separated
the two categories because several of the proposed KPIs sit in both categories or perform
different roles for different agencies – for example, a child welfare KPI could indicate that a
family needs additional support or that the NDM is better at intervening to take a child out of
harm. For each proposed KPI we give a short case for its inclusion. Later on in the section
we discuss those KPIs which were considered for inclusion but ultimately rejected.
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More detail on each of the three review stages can be provided on request
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2.1
Population-level KPIs for which regular collection at the GM and/or locality
level is already undertaken or will be easy to achieve
2.1.1
Children achieving a ‘Good level of development’ at the end of the EYFS
The percentage of children defined as having reached a ‘good level of development’
at the end of the EYFS is the headline measure of the NDM’s success. This is a
universal and statutory measure and data is already collected and reported by all
localities; collation of these reports into a single GM figure would not be a major
undertaking. The Data Group is aware that there is currently a national consultation
on changes to pupil assessments in primary school that may have an impact on the
statutory requirement to collect data and is advising on the GM response to the
consultation.
2.1.2
Breastfeeding rates at 6-8 weeks
We found lots of robust evidence of the link between breastfeeding and positive
outcomes for children and mothers and advice in relation to breastfeeding will be
central to the initial stages of the NDM. We feel that it makes more sense to record
sustained breastfeeding rates than breastfeeding initiation rates given that a third of
mothers stop breastfeeding soon after birth.
The percentage of infants being totally or partially breastfed at 6-8 weeks is a piece
of data that is supposed to be submitted to DOH on a quarterly basis. However,
despite being a longstanding public health indicator, reporting is not robust across
GM. The group proposes that NHS England be asked to work with providers to
ensure reporting is improved.
2.1.3
Hospital emergency admissions caused by unintentional and deliberate
injuries in children
The group views this KPI as an important indicator of child health and potentially of
where further NDM intervention is required. By helping to improve parenting skills, by
identifying vulnerable children earlier, and by better linking up health and children’s
services, the NDM should generate a reduction in hospital emergency admissions.
There was strong support from consultees for an indicator relating to the
hospitalisation of young children. Public Health England has confirmed that the
indicator will be included in the new Public Health Outcomes Framework, with clearer
guidance to medical staff on how to code admissions. One minor challenge will relate
to identifying 0-4 year olds within the broader dataset; this is something that GM is
already addressing with CCGs via the investment agreement modelling work.
2.1.4
Child welfare
Those children in GM who are referred to social care services represent our most
vulnerable cohort and there is evidence showing a correlation between child welfare
concerns and subsequent poor educational attainment. The NDM could influence this
metric in either direction: helping to improve standards of parenting should see this
KPI fall, whilst increased assessments and joint-working between agencies could see
this KPI rise.
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In terms of collecting the KPI, the Children in Need census is an annual submission
which records all children who are referred to children’s social care services; this
cohort includes those who are in care, those who are supported in their family and
those subject to a child protection plan. A sub-group will be formed to define
whether this KPI covers all three categories of children or a subset. Once the
definition is confirmed, calculating a single GM number can begin.
2.1.5
Domestic abuse
Exposure to domestic abuse is known to have significant impact upon child outcomes
and is often cited in serious case reviews. The NDM will result in increased
communication between midwifery and other EY services, which should result in
increased awareness of those families where we have a domestic abuse concern.
Incidents of domestic abuse are universally collected by midwifery from all women at
multiple points in the antenatal/neonatal pathway. There was strong support for a KPI
related to this topic but concern over the logistics of collecting the data and requests
for further detail on the support pathway that would sit behind the identification of an
incident of domestic abuse. The Data Group will work with the recently formed
Domestic Abuse group to address both issues.
2.1.6
Childcare offer
A more integrated EY system for GM will be better able to plan childcare provision,
link the funding of this provision to improvements in quality, and help parents to takeup childcare opportunities.
Statutory childcare sufficiency assessments are available for all GM localities but are
more useful from a service provider’s rather than a family’s perspective. The Data
Group therefore proposes working with the day care group to develop a hybrid
KPI that shows the rate of uptake of early education places within Ofsted-rated
good or outstanding childcare settings. This new KPI would tell us about both the
quality of childcare in GM and the take-up of quality childcare.
Recommendation – the Steering Group is asked to agree that the 6 population-level
KPIs listed above be included in the shared outcomes framework and that work
begins to establish a baseline position for each KPI
2.2
Population-level KPIs for which regular collection at the GM and/or locality
level will require further work
2.2.1
Children living in poverty
There is a clear link between childhood deprivation and educational attainment, with
the impact of deprivation upon a child being seen in the first few years of life. Having
data on the numbers of children living in poverty will help GM to develop and target
capacity within the NDM; however we would not expect the activity of the NDM to
have a major direct influence on childhood deprivation given the importance of
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factors such as rates of economic growth and welfare policies upon this outcome.
These additional factors are out of GM’s control.
The old national indicator definition (the percentage of children living in families in
receipt of out of work benefits or in receipt of tax credits where their reported income
is less than 60% of median income) is felt to have its problems. In its place proxies
such as Housing Benefit or Council Tax Benefit data have been proposed to us along
with a new bespoke measure such as the numbers of households where a parent is
in work. A sub-group will be formed to look at the pros and cons of these
alternatives and to recommend a KPI(s) and the steps by which a GM metric(s)
is/are to be created. The sub-group will work with the Worklessness and Skills PSR
theme in undertaking this research.
2.2.2
Secure attachment
Secure attachment not only stimulates brain growth but affects personality
development and lifelong ability to form stable relationships. Improving GM’s parentchild attachment scores should lead to longer term savings from higher end reactive
services. The NDM, through its support for breastfeeding and use of universal and
targeted parenting interventions should help to improve parent-child attachment.
The group and consultees feel that GM should collect an indicator relating to the
quality of parent-child relationships but there is no widely used or understood way of
doing this at present. A sub-group will quickly review the pros and cons of
different measurement tools. If a suitable tool is not identified, it may be
possible to build up a GM-level indicator of secure attachment via the
individual child level assessment activity (e.g. from interrogation of responses
to Ages and Stages questionnaires).
2.2.3
Home Learning Environment
If we know those children at risk due of lower attainment due to growing up in a poor
home learning environment well before they start school the NDM can help to make a
great difference. A strong home learning environment has been found to be one of
the strongest influencers of later attainment – stronger even than family income or
socio-economic class.
The group and consultees feel that GM should collect an indicator relating to the
quality of home learning environments. The limitations of the existing EPPE Home
Learning Index have been pointed out to us. Data Group members will support
officers in the 8 stage assessment group who are looking at how a GM HLI
could be created for earlier and more widespread use.
Recommendation – the Steering Group is asked to agree that the 3 population-level
KPIs listed above be included in the shared outcomes framework subject to
GM-suitable tools and approaches being identified
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2.3.
Population-level KPIs which were considered for inclusion in the shared
outcomes framework but ultimately excluded
As noted, the group inherited 30 potential population-level KPIs from the 2012 work. Some
of these, such as ‘levels of parental self-efficacy’ and ‘self-reported measures of parental
well-being’, were rejected due to a lack of available data and/or robust measurement
technique. Others such as ‘numbers of lone parents’ and ‘family over-crowding’ were
discounted because we found no/little evidence of how these linked to educational
attainment. In a few instances we decided that combining KPIs into a composite would be
best (e.g. the proposed childcare offer KPI combines the existing ‘childcare sufficiency’ and
‘childcare entitlement’ take-up measures).
Discussion was had regarding the large number of child health and development KPIs
originally proposed. For some such as the ‘rate of smoking at time of delivery’ we found no
evidence that this linked to school readiness. For others such as ‘population vaccination
coverage’, ‘obesity levels at reception year’ and ‘prevalence of tooth decay in 5 years olds’
the group felt that high scores were not necessarily an indication of parental neglect or that
they posed a serious risk to school readiness when compared to the 9 indicators proposed in
the previous section. This is not to say that Public Health colleagues will not find wider value
in continuing to compile such datasets.
During the consultation there was support for the addition of KPIs relating to child speech
and language skills and maternal mental health. The former issue will be picked up via
individual child Ages and Stages checks and through referrals to additional support services
(e.g. Every Child a Talker); the latter is partly covered in the secure attachment measure
proposed above but will also be collected via the standard midwife checks at stages 1 and 2
of the NDM. Thus, for both it will be possible to produce a GM-level indicator if so needed at
a later date.
2.4.
Mapping the shared outcomes framework back to the EY business plan
In the 2012 EY business case, three pre-requisites to children being ready to learn were
identified. These were:

Improved family health and well-being;

Improved family economic well-being; and

Improved parenting skills.
The Data Group has mapped the proposed population-level KPIs to confirm that the shared
outcomes framework will cover all three pre-requisites. This mapping is shown below:
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Figure 2: Aligning the proposed KPIs to the EY NDM objectives
Children ready to learn
Early Years Foundation Score at Reception year
Improved family
health and wellbeing
Improved economic
wellbeing
Improved parenting
skills
Breastfeeding rates
at 6-8 weeks
Children living in
poverty KPI(s)
Childcare offer KPI
Hospital emergency admissions
caused by unintentional and
deliberate injuries to children
Secure
attachment
KPI
Home Learning
Environment KPI
Number of incidents of
domestic abuse recorded in
pregnancy by midwifery
Child welfare KPI
The proposed population-level KPIs will provide GM with a balance of information across the
three NDM sub-objectives. Family health and wellbeing measures (which dominated the
draft framework developed in 2012) will remain central to the shared outcomes framework
but will be complemented by three new indicators of parenting skills and childcare quality.
The work of the sub-group to identify a children living in poverty KPI(s) will be crucial in
providing information relevant to the improved economic wellbeing sub-objective.
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IDENTIFYING INVESTMENT AGREEMENT KPIs FOR INCLUSION IN THE
SHARED OUTCOMES FRAMEWORK
GM officers, supported by Social Finance, are in the process of identifying which EY
outcomes will be tracked in order to trigger payments into or draw-downs from a GM-wide
EY investment agreement. This will involve identifying those EY outcomes for which GM has
a clear understanding of the costs they entail for agencies plus discussions with budget
holders to understand how changes in KPIs will influence their future investment decisions.
The work is due to be completed in September/October. Once it has completed, we will work
with the investment agreement team to ensure that those KPIs included in the final
investment agreement are also included in the shared outcomes framework.
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4
IDENTIFYING CHILD-LEVEL
OUTCOMES FRAMEWORK
DATA
FOR
INCLUSION
IN
THE
SHARED
Collecting the suite of KPIs listed above will give a regular indication of improvement, and
the financial impact of that improvement, to be considered against our starting point of 40%
of GM children being judged as not school ready; however, these KPIs will not in themselves
enable measurement of the success of individual interventions.
Each GM locality is developing plans to adopt the New Delivery Model or aspects of it. A
child-level dataset is required as a matter of urgency for use in localities that are preparing to
roll out the full model in a ward and work is underway to draft this. In addition to this plans
are being progressed to outline pathways from universal assessments into targeted
assessments, interventions and specialist services. The Data Group will work with the
localities and the pathway groups to seek answers to questions such as what data and
information is (or is not) currently collected by each specific assessment tool or intervention,
who collects this information, in what format, how that data is stored, and legal issues
relating to information sharing. This dataset will include information that relates to the
monetisable outcomes within the PSR programme.
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LINKING TO OTHER GM WORK ON INFORMATION SHARING
Within the field of NHS information sharing, on 1 April NHS England (NHSE) assumed
responsibility for commissioning Child Health Information Systems (CHIS). Locally, the NHS
England GM (NHSE GM) team has undertaken a quick scoping exercise to understand
which CHIS are currently in use. The Data Group has met with the NHSE GM team to
explain how we are identifying which pieces of health data and information are needed to
inform the operation of the NDM. In time, NHSE GM will be considering whether a single GM
CHIS could be commissioned. It has been proposed that once the EY Data Group has
confirmed what NDM data and information are needed that we restart discussions with the
NHSE GM group, helping them to develop an IT solution that can support the work of GM
partners beyond just those dealing with public health.
Within the field of public service reform, a paper on information sharing is currently being
prepared for submission to the PSR Executive. A discussion has been had with the authors
on whether the work of the EY Data Group could act as example of how other streams of
PSR work could approach the issue of information sharing, and whether a single approach
to training GM officers in information sharing best practice could be developed. Taking a
PSR-wide approach to information sharing training would deliver economies of sale in terms
of how much training could be delivered, increase the understanding amongst non-EY
officers of which pieces of their data and information is needed for the EY NDM to function,
and prevent the EY Data Group from duplicating tasks being undertaken by other PSR
streams/working groups
Recommendation – the Steering Group is asked to lobby the PSR-Executive to
identify information sharing as a cross-cutting theme of PSR work that is to be
resourced accordingly
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RISKS
Developing a system that can deliver the ambition described in the introduction to this paper
will not be easy; there are likely to be legal, cultural and technical barriers to the sharing of
the necessary data and information. Each set of barriers has implications for the future work
and membership of the Data Group:

Where there are presently legal barriers which prohibit the sharing of specific pieces
of data and information considerable resource may be needed in terms of either i)
putting in place a system of informed consent and communicating this system to
officers and families, or ii) lobbying government departments on ways of overcoming
the legal barrier;

Overcoming cultural barriers to information sharing within agencies will require staff
training (as referenced above and potentially involving thousands of officers) and
widespread communication of what GM wants to share in relation to Early Years; and

The technical barriers to EY information gathering and sharing will perhaps be the
greatest of all. The NHSE GM work has already identified a multiplicity of different
CHIS in use across GM. Added to this will be a variety of Children’s Services, Adult
Services, Clinical Commissioning Groups, provider IT systems and so on. Each will
vary in terms of age, coverage, functionality etc. Anecdotal evidence is that much EY
relevant information is still gathered in paper format, with use of mobile technologies
such as the iPad still in its infancy. Also, it should be remembered that current data
recording systems have been procured to do more than collect data and inform
decisions on school readiness. Individual agencies may be reluctant to switch
systems just because one element of their work requires the change.
Given the likely multiplicity of barriers, some sort of new system/approach is likely to be
required. This new system/approach could take the form of patches/amendments to existing
data gathering systems and practices; or it may require procedures for extracting and
warehousing relevant data from existing systems; or it may need the commissioning of a
single new system. None of these options is likely to be quick or cheap. Decisions may need
to be taken, potentially at the GM level, to end the commissioning of certain systems and to
replace these with different hardware/software. IT procurement processes can take
considerable time and require technical and procurement expertise beyond what is currently
available to the EY Data Group.
Recommendation – the Steering Group is asked to develop a plan such that GM has
the resources it needs to design and procure any IT systems required for the
functioning of the NDM
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7
NEXT STEPS
The Data Group aims to have the shared outcomes framework, including investment
agreement outcomes, finalised and baseline positions established for each indicator in the
framework in time for the October meeting of the GM Health and Wellbeing Board.
To meet this deadline, the next steps for the Data Group will be to:

Establish a GM baseline for the EYFS, breastfeeding and emergency hospital
admissions KPIs;

Confirm definitions for the childcare and child welfare KPIs and establish a GM
baseline for both;

Ensure that collection of the domestic violence KPI is linked into the pathway
development work of the domestic abuse PSR work stream;

Develop proposals for a GM child poverty indicator to be discussed with the
worklessness and skills PSR work stream;

Reach decisions on whether to record home learning environment and secure
attachment KPIs at a GM population level or leave these as family-level datasets;

Work with Social Finance to confirm the EY Investment Agreement KPIs and
establish a GM baseline for each; and

Produce a report which sets out the GM baseline for each indicator in the shared
outcomes framework;

Begin work with the localities and the pathway groups to seek answers to questions
such as what data and information is (or is not) currently collected by each specific
assessment tool or intervention, who collects this information, in what format, how
that data is stored, and legal issues relating to information sharing.
These tasks will be shared out amongst Data Group members and regular updates will be
provided to the Early Years Project Team.
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