Greater Manchester Combined Authority - GM Digital Team

Greater Manchester Combined Authority – GM Digital Team

Early Years Application

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

The new, first of its kind Early Years application, allows parents and carers to access information and support for their child whenever they need it. The app was developed by the Greater Manchester Combined Authority (GMCA) with colleagues from the GM (GM) local authorities, GM Health & Social Care Partnership and frontline colleagues within the NHS.The app is transforming the way health information is delivered and shared in GM. The app means that paper-based assessments used to review a child’s development up to the age of 2.5 years are now digitised, allowing parents and carers to efficiently complete the assessments online and access their records. The new system will help health visitors to identify developmental issues earlier and provide support for the child and their families quicker than current methods. It will also free-up valuable clinical time for health visiting teams, thought to be worth around £10m per year in productivity (once rolled out to the rest of GM), enabling health visitors more time to provide better quality care for our youngest citizens.

In GM, we are doing digital differently, we are committed to being a digital city-region that puts our residents at the heart of our plans and are working towards our ambitions to be recognised as a world leading digital city-region. Home to more than 2.8million people and with an economy bigger than that of Wales or Northern Ireland. Our vision is to make GM one of the best places in the world to grow up, get on and grow old. We want to empower people through digital and ensure that everyone in GM, whatever their age, location or situation, can benefit from the opportunities digital brings. Through our GM Digital Blueprint, we have committed to:

– Offering digital access to public services that is joined up, user friendly makes sense.
– Making sure everyone can get online to access public services within their community.
– Helping everyone to be confident internet users and helping people avoid internet harms like online fraud.
– Giving plentiful opportunity to feedback, recognising the importance to people that their voices are heard.

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; increasing to one in every two children when in receipt of free school meals. Along with commitments made in our Digital Blueprint, the ‘Taking Charge of our Health and Social Care in GM’ strategic plan identified reform of Early Years provision as key to increasing the productivity of families. The plan committed to increase the number of GM children who reach a good level of development.

Through the GM devolution agreement, the transfer of Health Visiting commissioning to local Authorities, free early education places for disadvantaged 2 year old’s, The Early Years Pupil Premium and the development of integrated services for 0-2.5 years we are presented with an opportunity to develop system-wide transformation. Supporting a sustainable shift from expensive and reactive public services to prevention, proactivity and early intervention. This will begin to break the intergenerational cycles of poverty and reduce levels of complex dependency.

The ambition of our programme’s is to improve outcomes for children and their families by establishing a more consistent, integrated pathway with an emphasis on promoting early intervention and prevention. The programme has been developed to implement the Start Well Strategy and meet key objectives across the following themes:

– A healthy start, with supported parents and good early development
– Stable families and strong relationships
– Good early years provision in a caring environment
– Places to play, develop and learn

The issues that professionals working within the Early Years Model are experiencing can be summarised as:

Existing model uses different local case management systems or paper-based processes. This causes problems with the correct data being shared and in a timely manner.  A need for increased information sharing and more robust, comprehensive agreement to facilitate information sharing across the 8 Stage Model. No consistent model of assessment and data recording across Early Years Settings. The 8 Stage Model has been adopted differently across the 10 local authority areas.

The app offers an integrated portal to view and manage data and complete digital assessments, gives mobile access to digitalchild development records for both parents and health practitioners and has digitised paper based development assessments. The app uses a Digital Outcome Record to provide a cumulative record of a child’s development to share with other early education settings and facilitates the uploading and sharing of documents between health professionals and parents/carers.

What are the key achievements?

The initial outlined benefits of the Early Years project were:

– Increase capacity of Heath Visiting (approx. 30% based on Salford pilot) so that families digitisation of assessments can be supported more effectively.
– Provide professionals with accessible and mobile data that is currently locked in paper records.
– Better commissioning as public health officers often commission without any underlying historical demand data.
– Creates richer data that will support risk stratification work.
– Data shared with Early Education Settings and schools ensures support needs are identified earlier.
– Puts the citizen in control of their own data

Following the completion of a problem statement matrix with the service in Bury, further emergent benefits have also been identified. Using the original benefits and tracking those emergent benefits, the following list of tangible benefits was created;

– Those accessing the app access video content pertinent to their child’s age range and this will reduce the number of queries to the HV 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 HVs. HV will be able to review ASQ forms and other background information /pertinent assessment information prior to the appointment. HV will gain the ability to focus on 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 could be better used by the HV to tackle extra activities such as smoking cessation advise or alcohol consumption questions.
– An electronic file is made readily available for extraction and sharing if necessary. Documentation is less likely to contain mistakes and lack of clarity caused by handwriting would be removed. The key driver outlined in the PID is, “to get more children ready to start learning at school at age 5”. The assessment forms have been digitised to help ensure children are developing as expected and provided with additional support when needed. The benefits for parents and carers include:

– Makes it easy 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.
– Enables their health visitor to share documents with them through the app.
– Meets people’s expectations of being able to use technology in many aspects of their lives.
– Increases involvement in child’s development and engagement with services.
– Improves experience of assessment process as information shared between agencies doesn’t need to be repeated.

Benefits for health practitioners and commissioners include:

– Provides accessible and mobile data currently locked in paper records.
– Better tracks a child development to more quickly identify children who require additional support.
– Easier tracking of caseload and child records.
– Less time spent on manual form filling and preparing paperwork for appointments.
– Automatic scoring on assessment forms.
– Option to review forms submitted by carers in advance of an appointment.
– Ability to print or save assessment form and child data

Additional benefits across GM include:

– Transforms the way services are used to better meet people’s needs.
– Provides a consistent model of assessment and data recording across localities.
– Better information sharing across agencies and avoids repeating and duplicating information.
– Breaks down data barriers between families and health and education services.
– Information is held in one place and is easily available to staff and parents/carers.
– More effective commissioning.
– Savings in staff time and service costs.

This work will pave the way for other public service areas to digitally transform the service citizens receive, by digitising paper-based forms, joining up different parts of the system and sharing information safely and securely. The app is hosted on GM’sDigital Platform, an advanced technology solution that allows data from multiple sources to be re-used by a variety of systems, allowing health and public sector professionals to use and share accurate and appropriate information at a quicker pace.

What are the key learning points?

Throughout the development of the Early Years App, GMCA has had strong working relationships with the health visiting teams in the early adopter localities. We’ve worked closely with them to establish their requirements and worked collaboratively on the content and design of the App. This helped to ensure that the App was fit for purpose from deployment, enabling parents/carers and workers to complete digital assessment forms and share documents and have mobile access to child records and video content.

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, e.g. which universal assessment forms are used, so having the ability to tailor the application helps to meet specific user requirements.

It is also beneficial to involve 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. This helps to facilitate a smooth sign off of the project at the appropriate time and avoid any complications or delays.

Additional Comments

Work is underway to integrate Early Years with the Patient Demographics Service to pull through demographic data for new births, and in future to integrate with local Electronic Patent Record systems. Additional localities in GM will be adopting the Early Years app, either as a standalone app or when integrated with their local systems. The Early Years app is also being expanded to include additional WellComm and developmental data for older children in Early Education Settings.

COVID-19 Response Recognition Award

The existing way of working, in relation to early years assessments, in GM localities was largely paper based, which prohibits access to data and creates inefficiencies. Coupled with significantly reduced capacity in front-line health visiting services due to the pandemic, there was a negative impact on the delivery of universal child developmental assessments. This reduced the ability to deliver the Healthy Child Programme for the early life stages which focuses on a universal preventative service, providing families with a programme of screening, immunisation, health and development reviews, supplemented by advice around health, wellbeing and parenting. The majority of the Health Child Programme assessments and activity completed by Health Visiting Services had stopped during the pandemic, with the exception of the Pre-Birth Visit at 28 weeks pregnancy and the New Birth Visit within two weeks of the child’s birth. The app utilised digital technology to enable parents, carers and health practitioners to complete assessment forms digitally, meaning assessments could continue.

This meant parents still receiving support through that assessment but also having a longer term impact on children by ensuring assessments are not missed during the pandemic Universal assessment forms at the key stages are automatically generated by the system in the staff and parent/carer portal. Parents/carers are sent automatic email and push notifications asking them to compete the relevant assessment form. The digital form scores the assessment results automatically, removing the need for manual calculation. Health Visitors can easily activate additional targeted forms on the app or deactivate universal forms to prevent them from being generated.

Other digital tools available on the app include the ability for staff to upload documents and share them with the carer, add case notes to a child’s profile and export child and assessment form data. When the app is used to capture developmental data and provide targeted support, issues are identified, and remedial activity can be actioned sooner. The GMCA has worked with trusted content providers such as the BBC and others to provide a resource library within the app that will support parents and carers and aid child language and development. The available content will aid users and support with queries that may normally be directed towards Health Visitors. The initial build of the app was adapted to respond to the challenge of the Covid-19 to support health visiting services during the pandemic. Reporting functionality was added to the app in response to the Covid-19 pandemic to enable staff to filter assessment form data entered by parents and carers so they could prioritise their resources with the children who needed the most support. The app can provide reports to Health Visitor Services (or other services) to identify the children who haven’t met the expected level of development in order that targeted support be provided to those children (e.g. through visits/calls or sharing home learning resources to aid the child’s development).

They can now focus their appointment scheduling with parents/carers of children who have not met the expected level of development for their age and with parents/carers who haven’t completed the assessment forms. Automatic emails are sent to parents of children who are at the correct developmental level for their age. The method of capturing the data in a report to be actioned appropriately in localities is less resource heavy than each individual form having to be individually moderated by a health professional (as per the previous model). If no resource is available to support the parent/carer, the app is capable of presenting the assessment scores directly back to the carer (if appropriate) and provide activity sheets or guidance around identified needs, requiring minimal staff input.

Adopting the Early Years application has truly made a difference to health visiting services during the pandemic, ensuring an enhanced continued service provision that allows for parent led assessments using the application. It has given health practitioners mobile access to the child’s records and enabled parent/carers to view their child’s assessment forms whenever they wish to, without worrying about losing or storing the paper forms. Parents/carers have been able to view video content to aid their child’s language and development and view digital documents shared with them by their Health Visitor on the app. Practitioners have been able to read the submitted assessment form prior to the appointment with the parent/carer, making them aware in advance of any pertinent background information and specific concerns highlighted on the form. It has saved health practitioners time by enabling them to enter details and complete forms directly onto the app and removing the need for handwritten documentation.