Concerns raised over integrated review's effectiveness

Research by the National Children's Bureau (NCB), published last week, outlines the experiences of Islington Council and Warwickshire County Council, which developed and implemented 'viable' integrated review models.

Both local authorities were involved in the pilot of the integrated review at age two, which was rolled out nationally last month by the Department of Health and Department for Education. The review brings together the Healthy Child Programme, health and development review, and the EYFS Progress Check.

Islington has implemented a joint meeting model where health and early years practitioners come together with the parent and child. Warwickshire decided to operate a model of separate meetings, with information being passed from the early years practitioners to the health professionals via the parent. The local authority decided a joint meeting model was unrealistic in terms of cost and time.

While the follow-up report outlines the successes, it also reveals concerns expressed by those involved in the delivery of the integrated reviews, particularly in light of an absence of reliable evidence of impact.

Specific concerns include individual practitioners reporting relatively few referrals from the integrated review and that it does not assess the child at an early enough age to have a significant impact on their 'school readiness'.

Health professionals in Islington reported very few referrals coming through those integrated reviews involving private early years settings compared with other settings.

Those involved also expressed concerns about limited capacity in local health visiting teams and private, voluntary and independent (PVI) early years settings, as well as the longer term sustainability of delivering the integrated review to all children aged two to two-and-a-half in the local authority area. They questioned whether a more targeted approach could be a more effective and less costly option moving forward.

Key successes

Success reported included early years practitioners developing a greater understanding of the health professional's role and a growing willingness to discuss concerns about a child.

For health professionals, the review gave them opportunities to build stronger relationships with early years settings.

Parents generally reported positive experiences of their integrated review meeting.

Challenges

Both local authorities faced the same obstacle of not being able to share information electronically between early years and health because of data protection and data sharing protocols. Islington partly overcame this by adopting a joint meeting model where both practitioners were present.

In Islington, health professionals found that working with PVIs was time-consuming and that it was difficult to engage effectively, as one comment in the report from a locality manager for health visiting explains: 'We get settings that don't want to do it or settings are not ready.'

• Read the report at www.ncb.org.uk/integratedreview. Our new series on the integrated review starts here.