Greater Manchester Combined Authority

Greater Manchester Early Years Integrated Solution

Briefly describe the initiative/ project/service; please include your aims and objectives

Supporting the drive for school ready children in Greater Manchester – Digitally Integrated Early Years Working. It is widely accepted that a child’s early years (from 0-5) and critically, the first 1001 days in a child’s development, are the most important and set them up for the rest of their lives. School readiness figures in GM are lower than the national average, with almost two in every five children not reaching a good level of development by the age of 5. Greater Manchester (GM) has an ambition that all children start school ready to learn. We want GM to be a place where all children are given the best start in life and young people grow up inspired to exceed expectations. To support this ambition, GM needs innovative and integrated digital solutions.

The challenge:
– The nature of early years service provision across Greater Manchester involves multiple services and does not acknowledge local authority boundaries.
– Assessment processes are paper-based due to national constraints with digitising assessments that are copyrighted.
– Information is not shared between professionals consistently
– Organisations have already invested significantly in digital solutions that are not integrated and slow to respond to emerging GM requirements.
– There is a significant variation in the level of digital and data maturity across the organisations.
– Access to parents / carers to undertake assessments has been made more difficult due to the pandemic. This has resulted in a significant number of parent / carers not being assessed.

The key objectives of the Early Years Digitisation Programme:
– Digitally transform the Early Years Delivery Model and provide citizens of Greater Manchester, and the public sector workers that support our citizens, with better data
– Provide integrated solution/s that will facilitate the secure and appropriate sharing of data between citizens, professionals and systems in Early Years.
–  Facilitate a single coordinated information governance model that supports lawful data sharing across localities and agencies

The Early Years Integrated Solution
The GM EYIS has been developed by the Greater Manchester Combined Authority (GMCA) in collaboration with colleagues from the GM (GM) local authorities, GM Health & Social Care Partnership and frontline colleagues in early years services. The GM EYIS transforms current paper-based processes and bridges public sector organisations and local authority boundaries to improve the sharing of data and delivery of early years services across GM. There is recognition of the significant investment in digital systems across organisations and that interoperability, with containerisation of capabilities, is key to really achieve GM-wide adoption and benefit.
The EYIS has been developed using a best of breed, multi-supplier digital platform that utilises a cloud-first approach with modern APIs for integration. The EYIS comprises application development, integration, and user authentication capabilities. GMCA has brought together innovative digital market leaders to collaborate, challenge and ultimately transform the way GMuses digital in the delivery of our early years services.

As part of the EYIS, the Early Years Application (the App) was developed. The App is a new, first of its kind application that transforms previously paper-based assessment processes, releasing rich data and allowing for better data sharing between citizens, professionals and organisations. GM has negotiated independent agreements with the assessment copyright holders – a UK first – and is significantly ahead of the progress nationally to implement a digital solution for early years assessments. To date, GM is the only region that has agreements in place to digitise the national assessments and is leading the way in digital innovation in this space. GM has also brokered agreements with the BBC and other leading early years content providers to embed within the EYIS. This ensures parents & carers have access to quality content to support and better understand the developmental journey of their child.

The EYIS
–  By digitally transforming the way early years services are delivered, valuable time is released for early years professionals –this is estimated to be worth around £10m per year in productivity gains alone (once rolled out fully across GM).
– The EYIS helps professionals to identify developmental issues and provide support for families earlier by improving the ways that information is shared between professionals and between sector and locality boundaries.
– The digital transformation of services releases critical early years data that is currently unavailable to organisations. This enables organisations to make better-informed and data-driven decisions.
– The EYIS starts to put GM citizens in control of their own digital data, enabling citizens to say and when and who they want to share their data with.

What are the key achievements?

The development of the EYIS has been a true GM collaboration. The School Readiness Digitisation Group, made up of senior early years professionals and established to provide governance to the Early Years Digitisation Programme, has guided the development of the EYIS. The group has provided critical assurance to the development of digital capabilities and ensured our continued alignment to programme objectives with outcomes for children and families being our first priority. Almost 20,000 digital assessments have been completed with children. This equates to –
– 30 minutes saved per average assessment equating to approximately 10,000 hours saved
– Estimated that up to £52,000 has been saved on the posting out of paper assessments alone

Outcomes of the programme:
– Data is more readily available operationally and to improve commissioning decision making (public health officers often commission without any underlying historical demand data)
–  Richer data, that can be aggregated with other datasets, is available to support the risk stratification of children most needing support
– Sharing of data between early years professionals has improved to identify and respond to support needs earlier
– Citizens are more in control of their own data

By realising savings through competitive procurement activities, the programme has been able to reuse the budget to respond to emerging requirements in a much more agile way. A much more innovative and integrated solution has now been developed as a result. An extension to the solution bridged the gap between health and local authority early years services. This extension to the planned solution allows for the automated sharing of assessment data between professionals across sectors. This is a significant achievement due to the challenges posed in sharing data across localities.

Other benefits that have emerged through the programme:
– Those accessing the app access video content pertinent to their child’s age range, reducing the number of queries to the health visiting service.
– Ratification of records – records are currently stored in different formats, mediums, and locations. Amalgamation and ratification will improve the quality of the data and access to it, the timelier access to the data and improvements in the ability to share it.
– Management of staff resourcing will be improved as the app will provide clear indications of workload and cases allocated to staff
– Benefit of advance viewing of the forms by professionals. Professionals will be able to review ASQ forms and other background information / pertinent assessment information prior to the appointment.
– Professionals are more easily able to identify complex needs and plan particular areas for review/questioning prior to the appointment, meaning more targeted sessions with parent/carer.
– Reduction in the need for hard copy packs used during assessments, meaning a reduction in costs, time, waste, and a smaller carbon footprint.
– Prior completion of relevant forms means that the appointment session time allocation is better used by the HV to tackle extra activities such as smoking cessation advise or alcohol consumption questions

The benefits for parents and carers include:
– Easier to access and complete forms online – they will no longer need to worry about losing or forgetting the paper forms
– Gives them online access to their child’s development records whenever they need them, increasing their ownership and control of their data.
– Provides videos and other guidance to support their child’s language and development
– Professionals are able to better share information with families
– Aligns the digital offer for early years service provision with citizen’s digital expectations
– Increases involvement in child’s development and engagement with services
– Improves experience of assessment processes as information shared between agencies doesn’t need to be repeated.

The EYIS has successfully integrated with national NHS databases included the NHS Spine and the National Event Management Service. This allows for an automated flow of data from the NHS databases in the solution to update demographic data and inform professionals of key events.

Benefits realised:
– More accurate information about a family, their important relationships and the services they are involved with
– Data quality in existing systems is improved
– Important events such as a child birth or death in GM are more quickly identified through national databases and fed into the EYIS

A significant achievement of the programme is partnership between the GMCA and localities to support the change management to implement a programme of this complexity. A robust approach, with full training and resource library for all users was developed. Senior leaders in stakeholder organisations championed the EYIS and ensured that all users were given adequate time to attend testing & training.

How innovative is your initiative?

GM is innovating to ensure we make the most of the opportunities to integrate our early years services and workforces. This includes developing digital solutions to integrate information and decision-making to provide the right support to families at the right time. GMCA aims to support levelling up in localities and to support localities in achieving local, and consequently, GM objectives and benefits. The EYIS achieves this by being a first of its kind solution that not only enables rapid application development but also leading-edge integration and authentication capabilities.

While GM has an agreed early years delivery model, with 8 universal assessments being offered to each child, local pressures and aspirations have resulted in the model being applied to varying degrees. The EYIS supplements and enriches the existing digital landscape across GM. It does not assume a ‘one size fits all’ approach. The EYIS has brought together 3rd party suppliers (8 suppliers, most of whom are based, or have a significant base in GM) that are leading innovators in their respective fields. We have developed a powerful digital platform that is also flexible enough to respond to locality requirements, resulting from the differing levels of digital maturity, local aspirations and digital road maps across GM localities.

The EYIS has successfully integrated into national NHS databases that facilitate the automated sharing of data into the EYIS. The EYIS is one of the first platforms to integrate into these databases and one of only a very small number of non-NHS platforms to do so. Through rigorous assurance processes, the EYIS has become a partner of leading health system suppliers EMIS and TPP(SystmOne). This will allow the EYIS to integrate into existing health systems that are used by early years professionals and to share data between the solutions in an automated and integrated way. This is a significant achievement and milestone in achieving our vision for the EYIS.

As part of the development of the EYIS, GM Identity was created. GM Identity is a bespoke product that provides the identity access management solution for the EYIS. GM Identity utilises appropriate and tried and tested identity providers to authenticate users. Using GM Identity, the EYIS is one of the first, non-NHS applications to integrate with the NHS Login solution nationally. This provides organisations and citizens with the reassurance that their data is secure. The use of the NHS Login solution also reduces the complexity in maintaining user credentials, as workers accessing the system can use their local credentials to access the EYIS.
The EYIS is attracting national attention with conversations currently happening with local authorities and health providers to blueprint the EYIS for adoption by other non-GM localities. At a national level, the GMCA is in discussions with the Department for Health and Social Care, Department for Education, NHS Digital and the Start4Life Unit to identify opportunities to collaborate and use the capabilities, experience and lessons learnt that have been realised through the GM programme.

There is activity underway to integrate the EYIS with other exciting products. One example of this is the eCare Portal. The Care Portal (provided by Essential Parent) is a 3rd party product that provides an extensive library of content that has been endorsed by trusted organisations such as Barnados and the Royal College of Paediatricians. The EYIS will be integrated with the product to improve the user experience and provide a seamless experience for individuals moving between the solutions. Discussions are underway with NHS Digital to enhance the EYIS further and incorporate a digital version of a Digital Personal Child Health Record (digital version of the Red Book). The Red Book is used by parents & carers to maintain a schedule of immunisations, weigh-ins, routine reviews and screenings. This will ensure that parents & carers in GM have one integrated solution for their child’s early years. The EYIS has been built using the capabilities of the GM Digital Platform. The GM Digital Platform has been built to facilitate GM-wide digital transformation and the improved sharing of data in the public sector.

What are the key learning points?

The EYIS could not have been developed without system-wide engagement throughout the programme. As a combined authority, stakeholder engagement can be challenging. This is due to the large number of autonomous public sector organisations, each with their own strategies and roadmaps. This has certainly been the case in the delivery of the Early Years Digitisation Programme. The provision of early years services is complex and spans acute NHS trusts, community health providers, local authorities and schools. The GMCA has had strong working relationships with the early years system across GM. This has been fostered through significant region-wide engagement and close collaboration with stakeholders. Prior to any solution design, approximately 12 months of engagement was undertaken with stakeholders. This was essential in ensuring buy-in for the vision for digitising early years services. It is critical that any engagement is organisation wide e.g. colleagues from digital services and information governance within stakeholder organisations.

An important mantra of the team is that the goal is not the system, it is more school ready children. As such the EYIS is embedded in the wider GM School Readiness Programme which is chaired by Stockport’s Director of Children’s Services. A specific EY digitisation sub-group of the School Readiness Board is chaired by Salford’s Assistant Director for Early Years services. This strong governance and ownership by professionals has been critical. Adopting an agile approach to product development has been critical. New and changing requirements emerged through product development and adopting an agile approach allowed these emerging requirements to be incorporated into the EYIS. The has significantly enriched the final product. The agile approach was particularly useful when responding to emerging requirements during the pandemic when some early years professionals (health visitors) were redeployed to support in hospitals. An example of this was a requirement to create an internal reporting feature within the Early Years Application that allowed managers to easily identify children that weren’t reaching the expected level of development and, being more informed, target the limited resource available to those children.

It is critical when undertaking digital / data projects of this nature, that cross-organisational information governance expertise is engaged from the start. A significant amount of time has been dedicated to developing the necessary data sharing agreements to be able to safely and legally share data across organisations. This is critical to the success of the programme. Having senior officials responsible for project sign off, e.g. in Information Governance, from an early stage to give them a strong oversight of the project and enable them to ask questions and raise any concerns early on is essential. It helps to facilitate a smooth sign off of the project at the appropriate time and avoid any complications or delays.

One learning point that would be useful to be aware of for future deployments is to ensure there is flexibility within the App to account for any differences amongst localities. There is sometimes divergence from uniform regional policies and processes which are not apparent through initial discovery work – such as differences in which universal assessment forms are used – so having the ability to tailor solutions helps to meet specific user requirements. A key requirement of the EYIS was to be able to securely authenticate users. Use of the NHS Login initially caused some challenges with users not being able or willing to authenticate via the NHS Login process. We were able to resolve this by introducing proportional authentication to some of the.

It is essential that digital inclusion is considered throughout the programme. While the programme ambition was to digitise early years services, it was not appropriate to assume that all parents & carers in GM could engage with digital solutions. Parents & carers were engaged in the process with prototypes of the EYIS demonstrated at assessment clinics. This user-led design and feedback was critical and helped shape the final products.