A Unique Child: information sharing - Pulling together

Effective information sharing lies at the heart of best practice, and as the numbers of children with special educational needs continues to grow, safeguarding remains an issue and we edge towards the introduction of a unified Progress Check at Two, the importance of data sharing will need to be recognised and addressed by settings across the sector.

Sue Robb, head of early years at 4Children and a member of the task and finish group on information sharing, explains, ‘It is absolutely vital that as much as possible is done to enable robust information sharing between health and early years to support the needs of children and their families.’

 Current barriers to effective information sharing and how to overcome them are now outlined in documents available at: www.foundationyears.org.uk. These are: Information Sharing in the Foundation Years — a report from the task and finish group, and Good Practice in Information Sharing in the Foundation Years.

The task and finish group, headed by Jean Gross, former communication champion for the DfE, was established by health and education ministers in 2011 in reponse to ongoing problems of poor communication between agencies, particularly between health services and children’s centres.

 BARRIERS AND RECOMMENDATIONS

Typical real-life examples of poor information sharing, says the report, include:

• a six month-old child of a depressed mother in a failing relationship, where the local Sure Start Children’s Centre did not know of her existence and so was unable to provide support, and
• a private nursery where staff did not share concerns about possible safeguarding issues because they were afraid they would lose the parent’s trust and subsequent custom.

At a service level, the report notes:

• local authorities struggle to get information from the health service about live births so that children’s centres can inform new parents about their services
• health professionals struggle to find out what schools children attend so preventing school nurses from passing on to teachers vital information about some children’s healthcare needs
• education and children’s services staff are not always sufficiently aware of parents’ rights to be asked for consent to share information or may have to use information governance models that breach sensible boundaries of information and privacy.

 The main barriers to effective information sharing have been identified as a lack of:

• up-to-date and straightforward guidance
• trust between health, social care and children’s centre staff
• dedicated strategic local leadership
• strong operational management and awareness among manager of the benefits of integrated working
• compatible IT systems
• clarity about the role of children’s centres
• continuous professional development, education and training.

Passing information across borders is also described as challenging.

Recommendations

The report makes a wide variety of recommendations on how to tackle the barriers. Among them, it recomends to ministers that Government:

• creates a single birth-to-five programme, setting out a single set of outcomes for children and families as well as the roles and responsibilities of agencies and professionals. The programme should have a single reward system for achieving the outcomes. Additionally, the Government should amend the draft SEN provisions to allow for joint commissioning of integrated education, community child health and care provision for all children, not just those with SEN.
• explores the feasibility of providing regular updates of bulk data on live births to each local authority for their resident populations
• considers how EYFS Profile data can be provided to local authorities on children who have accessed children’s centre services in one area but attend school in another.
• publishes information for health professionals on the role of the children’s centres.
• develops an e-learning module on information sharing in the early years — an online support package for health and early years professionals on information sharing has already been action and will be available at http://www.foundationyears.org.uk
• incorporates clear expectations about information sharing in the revised Ofsted inspection framework.

 CASE STUDIES

Good Practice in Information Sharing in the Foundation Years outlines a series of case studies to illustrate how current barriers have been overcome in some areas. Examples include:

Integrated services in Brighton and Hove

This is an example of full integration of health and local authority services. Children’s centres are managed as a city-wide service, led by three Neighbourhood Sure Start Service Managers, two with health visitor backgrounds and one from social work. The entire health visiting service for the city has been seconded into the Council through a Section 75 agreement and work as an integral part of the children’s centre service.

The integrated children’s centre teams are led by health visitors, who supervise outreach workers. In addition there are specialist city-wide teams offering specific support - for example, breastfeeding coordinators to encourage initiation and sustain breastfeeding in areas of the city where this is low.

Traveller and asylum seeker families are supported by a specialist health visitor and early years visitor post. Teenage parents are supported by named health visitors and early years visitors at each children’s centre.

This model has delivered value for money, transparent and effective use of resources, and safe evidenced based health care delivery. The impact is evident in improvements in breastfeeding rates, obesity rates and a sharp rise in the percentage of children living in the most disadvantaged areas who achieve a good Early Years Foundation Stage Profile score – from 33 per cent in 2008 to 55 per cent in 2011.

The most recent children’s centre to be inspected by Ofsted was judged to be outstanding in every area; inspectors noted that the health-led model plays a fundamental part in streamlining services and integrating provision. Ante-natal and post-natal services are delivered directly from this Centre. As a result, the Centre reaches 100 per cent of children aged under five years living in the area and has made an impressive impact on children’s welfare and family well-being.

Integrated approaches in Bristol

Every children's centre in Bristol has a linked health visitor and speech, language and communication therapist. The children’s centres receive sophisticated data to inform the priorities for their community, and all live birth and GP move data to support effective outreach work and the delivery of universal and targeted services. Protocols are in place to share information between health visitors and children's centre leaders (with parents' permission) on any families or children considered vulnerable at the 14-day check. This enables a holistic joint plan to be agreed and hopefully prevents later escalation of difficulties. A number of specialist children's centres offer community based health assessments for children with multiple and complex needs, associated therapies and a specialist resource base, alongside the regular children's centre core purpose. Joint funded (health and education) Early Support Developmental Assessment posts are an effective example of aligned resourcing and support a shared vision and purpose. The attendance rate at clinics has improved dramatically since the introduction of the Specialist Centres, as families can now access appointments locally and feel much more confident in an environment that they know and trust.

From April 2013, two key members of the Public Health team - the Healthy Early Years Lead (Nutrition and Exercise) and the Breast Feeding Lead, will be joining the Early Years Service in Bristol. This will again strengthen an aligned and integrated approach to achieving improved outcomes for children and families, including those associated with obesity and oral health as well as healthy life styles and early attachment.

Example of first visit forms: Warwickshire Early Implementer Site

Birth data is shared using the ‘first visit’ form that health visitors complete at the first baby review. On this form the parents give consent to share the birth date, name and address with local children’s centres.

The Child Health department enters the data on the appropriate system and each month an encrypted list is sent to the data lead in the local authority, who then sends this out to all the appropriate children’s centres. The children’s centres then send a ‘welcome’ card with details of all the centre’s activities to families.

Children’s centres have agreed not to visit families unless a referral for services has been made - or the parents get back to the children’s centres and register for services. As a double check, midwives and health visitors ask parents to register at children’s centres. The Trust also informs the children’s centres about the total number of babies that have been born each month so that they can gauge the numbers families not registering in their reach area.

 Training in Burnley

At Lancashire Care NHS Foundation Trust’s Chai Centre in Burnley, health visitors have provided coaching and support to children’s centre staff on how to keep good records – such as how to identify sources of evidence, and clearly differentiate fact from opinion when writing. They might sit by colleagues and say, for example, ‘What made you think that?’, or ‘What were you thinking when you wrote that?’ This has really helped break down barriers caused by different perspectives on record-keeping.

 Working with GPs: Bowthorpe Children’s Centre

Bowthorpe Children’s Centre has been singled out as a model of good practice in partnership with GPs. Shared processes, policies and protocols across the professionals working within the Centre include a child health record keeping system, which is also shared with GPs.

The Centre worked with a local GP practice to pilot the East of England Strategic Health Authority System 1 Safeguarding Template, prior to roll out across Children’s Services in autumn 2012.