a better start nottingham strategy october 2014€¦ · safer, healthier and happier; more...

A BETTER STARTNOTTINGHAM STRATEGYOctober 2014

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FOREWORD 2

KEY SECTIONS:

1. EXECUTIVE SUMMARY 3

2. A BETTER START FOR NOTTINGHAM – OUR STRATEGY 7

ANNEXES:

A. LOCAL NEED 41

B. PROJECT IMPLEMENTATION 50 C. MONITORING AND LEARNING 79

D. MARKETING AND COMMUNICATIONS 94

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In January 2013, the City of Nottingham embarked on an important and exciting journey.

Parents, health professionals, community representatives and City leaders came together, united by one ambition – to transform the lives of our local children.

Small Steps Big Changes is a partnership born out of change. It builds on the learning and successes of Nottingham’s existing early intervention programmes, but will take a new primary prevention approach. Led by CityCare, an innovative social enterprise that has emerged from the NHS, it will leverage strong community ethos and existing knowledge, local reach and additional resources to deliver genuine co-production and sustainable outcomes.

Our vision is as simple as it is ambitious – to grow our children together, with love and respect. Working together, we will change the lives of our children and help them to grow into fulfilled and active citizens who will make a positive contribution to their communities and to our City. At the same time, SSBC will be a catalyst for transforming the systems and services that serve them, embedding community capacity and parent-powered change, at the heart of our approach.

Nottingham City has embraced Big Lottery’s call to action and this once in a generation opportunity to improve the lives of children from 0-3. The Small Steps Big Changes partnership is already demonstrating early signs of change, as professionals and parents work hand in hand to develop improvements in outcomes for local children and work towards system change.

This document sets out our plans for how we will build on our existing achievements and utilise the building blocks that we already have in place, to successfully implement life-long sustainable change for our future citizens.

We are ready!

Signed

FOREWORD

Ian Curryer Chief Executive Chief Executive Nottingham City Council

Lynn Bacon Chief Executive Nottingham CityCare Partnership

Dawn Smith Chief Executive Nottingham City Clinical Commissioning Group

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EXECUTIVE SUMMARY

children at the heart and parents leading the way

The need for ‘A Better Start’ for the children in our City is stark and severe. Our four target wards - Aspley, Bulwell, Arboretum and St. Ann’s - have poor outcomes across all key childhood development measures. From the outset, Small Steps Big Changes will achieve transformational, population-level change in development outcomes for children in our target wards. We will then go on to roll this success out across the City.

To achieve our aspirations and ambitions for children in Nottingham we are seeking investment from the Big Lottery Fund of £44,991,807 We will enhance this with additional leverage funding of £29,949,796 identified by working with our strategic partners, Nottingham City Council and Nottingham Clinical Commissioning Group to be released over the lifetime of our programme. This is underpinned by £65,858,408 spent on existing services for nought to threes which will directly support programme delivery and contribute to achieving the BLF outcomes for ‘A Better Start’.

SSBC will position parenting at the heart of our programme as a primary public health issue. We will build on the intrinsic motivation of prospective parents to be the best parents they can be and capture this key ‘teachable moment’ to prepare and support parents to achieve the best outcomes for their children.

We will put in place a new portfolio of activities and interventions that focus on primary prevention. At the core of this portfolio will be a solid platform of evidence-based parenting support programmes guaranteed to improve child development and health outcomes.

These will be complemented by a range of science-based interventions all of which are expertly constructed, and drawn from the emerging evidence base. They strongly indicate that they will impact positively on the trilogy of priority ‘A Better Start’ programme outcomes.

In addition we will nurture a programme of local ‘innovations through participation’ - as a direct result of engaging parents and communities and responding to their wishes.

Our programme portfolio will be outcomes driven. Our primary purpose will be to achieve our three priority development outcomes for SSBC children, which are that:− They will have improved, healthy and positive social and emotional development− They will be empowered through improved, effective and age-appropriate verbal and non-verbal communication skills− They will have improved nutrition through support to parents to make healthy feeding choices (for themselves and their child) during pregnancy, early years and beyond.

EXECUTIVE SUMMARY

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SSBC will be led by Nottingham CityCare Partnership (CityCare), an innovative social enterprise and VCS organisation that has emerged from the NHS and is now Nottingham’s leading provider of community health services. CityCare currently delivers services to parents and prospective parents through provision of the Healthy Child Programme Birth to Five, reaching 96% of children. CityCare sits on key local strategic decision-making bodies including the Local Strategic Partnership (One Nottingham) and the Health and Wellbeing Board. CityCare is itself a commissioner of services and has a unique position in the provider market. It has all the information and management systems necessary to coordinate and administer a project with the scope and reach of SSBC.

SSBC has been developed and designed through an exciting and innovative process of partnership-working and co-production that has brought together local children, parents and grandparents working with City leaders, health commissioners and health professionals, VCS managers and workers, private sector staff and community representatives. We are committed to the continuation and development of this process throughout the life of SSBC and beyond.

Our fourth priority outcome will be to achieve BLF’s ambition for system change: − System transformation through our ‘community connection’ model that brings all our partners together and builds on their strengths to ‘turn the system on its head’, reduce costs and create a sustainable legacy.

Our ambition for system change is to ‘turn the system on its head’ by ‘injecting’ parents and communities into the system and involving them in all planning, decision-making and commissioning processes for children and young people’s services in the City. We will develop a new model of ‘community connection’ to embed this process in the forward development of SSBC and City services.

SSBC will be governed by a new Partnership Board with 50% parent representation. Parent Champions will be trained and supported to play a leading role as Board members. An Independent Chair will ensure the Board is able to take a dispassionate view of our programme and its achievements, take account of everyone’s views and remain accountable to the children, parents and communities it serves. Membership of the Board by leading strategic partners including the highly-respected national private sector company – Boots PLC – will ensure it is able to provide robust and challenging governance in all aspects of our programme.

SSBC will be delivered by a new partnership between health professionals (Midwives and Health Visitors), Children’s Centre staff, early years PVI provider staff and an innovative new workforce of Family Mentors recruited from within our local communities. They will come together in new Delivery Teams in each area. Some aspects of our programme will be commissioned out to local providers form VCS, statutory and private sectors.

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We will deliver an effective integrated model through the co-ordination and management of a new Programme Manager and Programme Team. Directly employed by our Lead Agency (CityCare), the Programme Manager and Team will be responsible for all aspects of the implementation, management, delivery and development of SSBC at ground level in our target wards.

The long-term aspiration for the future of SSBC is to work towards the creation of a new Small Steps Big Changes social enterprise that will take our project beyond the life of BLF funding and beyond Nottingham. As lead agency, CityCare is itself a CIC and has the ethos, experience, expertise and resources to help guide the SSBC partnership towards achieving this goal. This long-term vision is supported by our key stakeholders, including local parents and community members. However the development and implementation of a suitable vehicle and the detail of how it might operate will require discussion and planning with BLF and all our stakeholders.

SSBC will contribute to bringing change at a national level by working with our Learning Collaborative and with the Programme Level Evaluator (Warwick Consortium) to evidence the achievement of programme outcomes, the impact on children, parents and communities and the overall effectiveness of our project. We will promote and share this learning with partners and stakeholders at national level. We will work with BLF to create a replicable model that is portable, can demonstrate evidence that it works, achieves outcomes and impacts and is sustainable. Thus encouraging other local authority areas, funders and government departments to work with us to replicate or learn from our model (The SSBC Way).

We want to place SSBC at the centre of a child development debate nationally and internationally working towards transforming the lives of children everywhere!

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A BETTER START FOR NOTTINGHAMOUR STRATEGY

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Our vision for Small Steps Big Changes (SSBC) is ‘Growing our children together with love and respect.’ SSBC will transform the lives of children in Nottingham’s most disadvantaged wards - achieving a step change in child development outcomes - putting children at its heart, with parents (and prospective parents) leading the way. Our key message to local parents is ‘They only need you!’ We will build on the intrinsic motivation of prospective parents to be the best parents they can be and capture this key ‘teachable moment’ to prepare and support parents to achieve the best outcomes for their children. At the core of our project will be a platform of evidence-based parenting support programmes guaranteed to improve child development and health outcomes. SSBC will test new approaches and activities, scale what works and support, inspire and empower parents and communities. Put simply, SSBC children will be safer, healthier and happier; more confident and capable and able to express themselves positively. They will have better lives and improved life chances as a result.

SSBC will have a strong outcomes focus. We will take a population- level and strengths-based approach to achieving project outcomes. It will put parenting at its heart as a primary public health issue - working with families as the experts in the wellbeing of their children. SSBC will provide Universal Parenting Support and Parent Child Relationship programmes; improve child social behaviours, emotional development and nutrition; encourage and support learning activities to improve language and literacy. It will ensure children are ready for school. It will improve maternal and child mental and physical health, tackle family conflict and improve parents ability to provide protective relationships, therefore reducing the impact of ‘toxic’ stress.

Nottingham is an ‘Early Intervention City’ and is on a 20 year journey to transform children’s services to intervene early in the development of our children, using evidence-based approaches, rather than reacting when it’s too late. As lead agency for SSBC, Nottingham CityCare Partnership (CityCare) will work with our local authority partners in the City Council to build on this commitment. We will take an honest and open approach that learns from what has worked and what hasn’t. In the first five years of our early intervention journey we have not achieved the shift in outcomes we hoped for. There have been some successes but we acknowledge that a change of approach is required. We will use ‘A Better Start’ as a catalyst which will shift the emphasis fromintervention to primary prevention to achieve a step-change in child development in the trilogy of priority programme outcomes identified by the Big Lottery Fund.

VISION

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Our vision for radical system change through SSBC is to turn public services for pregnant women, parents and the nought to threes on their head - with parents leading the way and children at the heart of everything we do. We will achieve this through: − The strength of our local partnerships with parents, professionals, strategic leaders and communities− The ability of CityCare to promote, catalyse and embed change from its position at the centre of the current system providing services to children and families− Ensuring SSBC’s emphasis on primary prevention impacts on key strategies and priorities for Nottingham and nationally − Shifting investment in services during the lifetime of our project and beyond− A new and innovative ‘community connection’ process, driven by local parents and communities and designed to put parents and communities at the centre of design, commissioning and decision-making for services to young children in Nottingham− Saving money by reducing the need for targeted and treatment interventions required later in the lives of our children, such as, but not limited to: • Treatingavoidableinjuriesanddentaltreatment • Tacklingneglecttoreducetheneedforsome safeguarding interventions • Reducingtheneedforspecialeducationalsupportin schools • ReducingavoidableGeneralPracticeappointments “The services are the community; we are all part of the same fabric.” (David Mellen, Portfolio Holder for Children & Families and Ward Councillor)

“I think that’s what’s really helped this to move along so quickly and to be so successful... the parents really feel they’re being listened to and are involved... and because we feel we are being listened to, and we are involved... and it’s showing that we’re being listened to... that’s making us want to continue...”(Local Parent)

We will adopt a strengths-based approach to our work that builds on the intrinsic motivation of all parents and communities to want to do the best for children. We will move from the current approach that ‘delivers’ services and programmes to people with ‘problems’, to an approach where parents (and prospective parents) are seen as the ‘experts’. This approach starts with what parents can do - building on positive assets - and builds their confidence and capacity to set development goals for their children, keep them safe and nurture them. It means that parents, their support networks and professionals work together to co-produce services and activities that are focused on primary prevention. We know from the learning from our Family Nurse Partnership (FNP) programme and from wider experience, that this approach gives us the best chance of success. We also know that this will be a challenge and that there are risks involved. We are confident that collectively we have the expertise, experience, structures and resources to meet the challenge. We know that a considerable change in our collective cultures and ways of working is what our children,parents and communities need.

“My parents are the people I turn to first for help, so they need to be taught what I am taught so that we can collectively turn the system around.” (Local Parent)

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We will improve the social and emotional development, communication and language, and nutrition of children aged nought to three in four of Nottingham’s most disadvantaged wards (Aspley, Bulwell, Arboretum and St Ann’s) and over time, in the rest of the City. The only way we will bring about the level of transformational change we seek will be by involving our communities in all our activities and by putting them in control.

A new workforce of paid ‘Family Mentors’, commissioned, trained, developed, supported and monitored by CityCare, working alongside health and child development professionals and voluntary sector staff will support the delivery of core aspects of SSBC. This ambitious and innovative commitment will directly create 66.5 new full-time equivalent (FTE) jobs for people from local communities - contributing to the delivery of one of Nottingham’s strategic priorities - creating local jobs for local people.

Building on our successful development stage Engagement & Participation (E&P) Strategy - we will continue to fully engage parents, communities and partners in the evolution of SSBC. We will involve parents (and prospective parents) and the community in the design, delivery and oversight of all that we do. This will include authentic participation in the governance and strategic development of Small Steps Big Changes. We believe this deep and extensive involvement, combined with a wide range of paid and volunteering opportunities, will help to better connect parents with each other and their communities, which will in turn have benefits for them and their children.

“We parents are the experts. I may not know everything, but it has to be a start.” (Local Parent)

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Nottingham is bidding for Big Lottery Funds of £45 million to transform the lives of pregnant women, babies and children under four in the four wards of Aspley, Bulwell, Arboretum and St Ann’s. These neighbourhoods are home to a quarter of the children in Nottingham. Our focus for Small Steps Big Changes is on these four wards initially but our aim is to bring improvement and change that will benefit all children in the City.

Together with our strategic partners we will deliver change across the city through scaling what works, levering investment from traditional commissioning sources and ‘injecting parents into the system’. We will further develop and sustain this change beyond the life of ‘A Better Start’ funding by generating 100% of our income from trading, commissioning, funding and fundraising strategies.

In 2008, Nottingham declared itself to be an Early Intervention City and made a 20 year commitment to its children. We now need to take the opportunity presented by ‘A Better Start’ to develop a new strategy which is driven by Primary Prevention in early years, based on the current and changing needs of our children and families. The joint commissioning of interventions and services which has begun needs to continue and grow, with integrated working practices and data sharing continuing to be consolidated. We will continue to build on our core Workforce Development Standards to create a consistent and unified approach across all local organisations working with children and families.

CityCare is uniquely placed to lead Nottingham’s ‘A Better Start’ programme. As a staff-led social enterprise, originating from the NHS, CityCare is integral to the primary care system. It sits on key local strategic decision-making bodies including the Local Strategic Partnership - One Nottingham. It is the major provider of community based health services, reaching 96% of all children aged 0 - 5 in the City and employing all local Health Visitors. CityCare is itself a commissioner of services and has a unique position in the provider market. It has the information and management systems necessary to coordinate and administer a project with the scope and reach of SSBC - including a national patient records system, System One - which CityCare has significantly adapted locally for enhanced data capture, extraction and analysis. It is an innovative and entrepreneurial VCS organisation which works directly with statutory and voluntary sector partners.

Extensive and innovative approaches were used during the preparation of our strategy to ensure authentic community involvement. Our ‘A Better Start’ strategy has been prepared by key stakeholder groups - statutory agencies, voluntary organisations, private sector partners, parents and the community. Nottingham has a strong track-record of effective partnership working. SSBC has been able to build on the strength of local relationships throughout the development of our programme. We are confident that together we have ‘what it takes’ to deliver our ambition for transformational change through SSBC.

INTRODUCTION

“Handing down solutions doesn’t work; nothing we’ve done around that works. We have to do things jointly, led by the community.” Jon Collins, Leader of Nottingham City Council

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Nottingham is a large, ethnically diverse city in the East Midlands, with a population of over three hundred thousand people. It is one of the most diverse cities in England outside London. Two fifths (42%) of children in Nottingham are from black and minority ethnic groups. The City’s population has grown by 15% in ten years and it has the highest birth rate it has seen in recent history.

There are 62,394, 0 -17 year olds in Nottingham City as a whole, with approximately a quarter of them (15,702) living in the four target wards. Of these, just over 5,000 live in Arboretum and St Ann’s and just over 10,000 live in Aspley and Bulwell.

There are 4,242 children aged nought to three in the target wards (1,446 in Arboretum and St. Ann’s, and 2,796 in Aspley and Bulwell) and each year approximately 1,100 babies are born.

The four target wards for Small Steps Big Changes each have distinct differences, communities and challenges in their own right. For the purposes of the programme it is helpful to view them as two areas with Aspley and Bulwell to the North West of the City and Arboretum and St. Ann’s around the city centre. Aspley and Bulwell have more settled and traditionally White British communities with a large level of council owned housing. Arboretum and St. Ann’s have become much more culturally diverse, with more transient communities living in red brick terracing. Arboretum is the smallest ward in terms of numbers of children but has some of the poorest outcomes for the children that live in the area. Within Arboretum and St Ann’s 60% of children are of non-White British background, whilst in Aspley and Bulwell the figure is 31%.

We see this diversity as a local strength. It provides SSBC with the opportunity to develop innovative ways of working with children and families from diverse communities, learn from those opportunities and promote them nationally. It gives our provider partners and other areas a golden opportunity to replicate interventions that work with diverse communities at a national level.

Nottingham is one of the most disadvantaged cities in the UK - evidenced by the needs information in annex A. The levels of deprivation experienced by families living in Nottingham present significant challenges to the SSBC project. However, we are confident that our approach and delivery model are grounded in the best available evidence, which includes not only established evidence-based programmes, but also innovative interventions routed in best practice knowledge and the existing science base. SSBC provides a real opportunity to work with local disadvantaged families to bring a step-change improvement in child development outcomes and lasting system change.

CONTEXT

“...at its most basic level, it’s a sense of community... it’s caring about the kids in your area...”(Local Parent)

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A year long process, coordinated by CityCare and involving leading strategic partners, voluntary sector agencies, private sector providers, parents and community representatives has produced this strategy. We started from strong foundations as a result of Nottingham’s commitment to consultation and track record of collaborating as an Early Intervention City.

“By working together, listening to each other and sharing what we know about our community’s needs and resources, we were able to develop a strategy that we all own and we will all deliver.”(Lyn Bacon, Chief Executive of Nottingham CityCare Partnership)

We built on this by undertaking extensive consultation with families. This included direct conversations with in the region of 1,500 families, (including children) through local events, informative fun days, street surveys, focus groups and one-to-one questionnaires. This process has sparked many more conversations within our communities.

We have developed a draft Engagement & Participation Strategy to ensure this process continues and grows - to provide every opportunity for local parents and communities to shape the evolution for SSBC. Our strategy will be co-produced as a living document and living process - putting parents in the lead of everything we do.

We see this bid as a turning point in the way that we engage, consult and involve parents and the community in the design, delivery and oversight of services - this is what we mean by co-production. Our work in this phase has been extensive and innovative, but we see it as the beginning only - a small step - informing how we plan to work in the future. Together we have embarked on an exciting and challenging journey and we want to continue on this journey through the opportunity to make SSBC a reality and improve the lives and life chances of of our children.

The strong and active participation of 19 local mums and dads at our Strategy Days on 23rd and 24th January demonstrated how effective our efforts have been so far. Parents were joined by 20 representatives from partner and stakeholder agencies including statutory and voluntary sector agencies as well as City Leaders such as the Leader of Nottingham City Council, the Portfolio Holder for Children’s Services and the local Director of Public Health.

HOW NOTTINGHAM’S STRATEGY WAS DEVELOPED

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Nottingham is ranked 20th most deprived out of 326 districts in England according to the Index of Multiple Deprivation 2010. This compares with 13th in the 2007 index and 7th in the 2004 index. In the Index of Multiple Deprivation, 45 of the 176 City Super Output Areas are amongst the 10% most deprived in the country and 91 of the 176 are in the 20% most deprived.

39% of children living in Nottingham are classed as living in poverty. One in four adults in the City has no formal qualifications. Half of all children in care in Nottingham come from the four SSBC target wards. In terms of health, children in Nottingham fare worse than the national average on many indicators. For example, the City is in the bottom quartile for obesity at age five and eleven. Rates of low birth weight babies are also high – 9% for Nottingham compared with 7.5% nationally.

The trends for education are similar to those in health, with the City in the bottom quartile for attainment at Early Years Foundation Stage, Key Stage One, Key Stage Two and Key Stage Four and school absence. In the Foundation Stage, pupil attainment in Nottingham is furthest away from national averages within Communication & Language, and Literacy.

Nottingham is also in the bottom quartile nationally for teen pregnancy, though this is against a back drop of year-on-year improvements for the last decade and a narrowing of the gap between the City and similar authorities.

A similar picture is evident in the youth justice system. The proportion of first time entrants to the system is one of the highest in the country, but over the last six years there have been considerable reductions and the current figures are at an historic low.

“The teenage boys we work with see only two things in their future - prison or the dole. Our challenge is to change that!”(Local VCS Agency Worker based in Bulwell)

‘A Better Start’ funding will enable a step change in improvements in Nottingham - starting with improved outcomes in the early years of life that secure positive and lasting improvements to their lives and life chances into adolescence and adulthood.

NEED

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By implementing our strategy, we aim to transform the social and emotional development, communication & language skills and diet & nutrition of our children aged nought to three. Our three priority development outcomes for SSBC children are:− They will have improved, healthy and positive social and emotional development− They will be empowered through improved, effective and age-appropriate verbal and non-verbal communication skills− They will have improved nutrition through support to parents to make healthy feeding choices (for themselves and their child) during pregnancy, early years and beyond.

Our fourth priority outcome relates to system change: − System transformation through our ‘community connection’ model that brings all our partners together and builds on their strengths to ‘turn the system on its head’, reduce costs and create a sustainable legacy.

We will measure impact and improvement through a range of mechanisms, including nationally reported data, existing and new local ward level data and through recommissioning the Area Wellbeing Profile (AWP).

According to the AWP just over one third (37%) of children aged 0-5 in Nottingham have poor social and emotional development. This compares with a Better Start average of 38% and 43% for the target wards. We will reduce this to 25% for the target wards, which will also impact positively on the City average.

One in ten (10%) children in Nottingham aged 0-5 years has poor communication and language development. This compares with 9% for the Better Start average and 12% for the target wards. We will reduce this to 7% in the target wards, again this will impact positively on the City average. Ward level data indicates that Communication and Language is of considerably higher concern than the AWP figures indicate. We will explore this further through introducing standardised tools to measure and track impact.

The level of breastfeeding across the City is low, with fewer than 50% of mothers breastfeeding at 6 weeks. Aspley and Bulwell both have rates below 30%, whereas St. Ann’s and Arboretum are higher at almost 55% and 70% respectively. We will improve breastfeeding rates in Aspley and Bulwell by 6% year-on-year throughout the programme. Interviews and focus groups with parents indicated they were most likely to take advice on infant feeding choice from friends and family and that the difference in rates is largely due to cultural norms.

PROJECT OUTCOMES

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The percentages of children in Nottingham who are obese, at both Reception and Year 6, are above the national and regional rates. The levels of obesity for Reception aged children have fluctuated over time whereas those for Year 6 children appear to be deteriorating.

Children in Nottingham also have a significantly higher rate of poor dental health than the national average; almost double the rate of decayed, missing or filled teeth and this can be taken as a proxy measure for nutrition status.

Our targets for change in these areas are set out in the SSBC Outcomes, Indicators and Activities tables.

Just over two in five (44%) children in Nottingham live in a household that believes the community is not socially cohesive or supportive. This compares with 40% for the Better Start average and nearly three in five (58%) for the target wards. We will reduce this to below the City average in the target wards and impact positively on the City average.

These outcome areas were not the only ones highlighted by local data and the AWP as requiring intervention and change through SSBC. Findings from these exercises highlight high numbers of children experiencing early onset behavioral problems, chronic health conditions, unhealthy gestation and birth and poor school readiness. To impact on these outcomes we will deliver activities and interventions that tackle the toxic stress that comes from family conflict and domestic abuse, parental substance misuse and parental mental health problems. Interventions will include support to access specialist services, for example Women’s Aid Integrated Services (WAIS local domestic abuse specialist and support) and Recovery in Nottingham (RiN substance misuse and recovery specialists). We are confident that by putting parenting at the core of our project, delivering our portfolio of activities with fidelity, building capacity in our local communities and forging strong links with targeted services we will address this range of problem issues.

From local data we expected the profile of the four target wards to be quite different. We requested additional analysis of the AWP data to identify any differences between the areas that might suggest a need for different priorities in each. The data suggested that the four priority outcome areas are relevant to all areas but that there will be particular value in focusing on breastfeeding and parental substance misuse in Aspley and Bulwell. In Arboretum and St Ann’s there will be value in addressing children’s exercise. We are mindful that these findings are based on small sample sizes. We will treat them with some caution, compare them with other data and test our hypotheses as we work through our programme.

SSBC outcomes, indicators and activities are set out in detail in the tables provided at Annex B Project Implementation Chapter

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Working with our local experts from the existing and emerging evidence base and in collaboration with our communities, we have designed and will deliver a portfolio of evidence-based and science-based interventions to achieve our priority outcomes and tackle the key risk factors. This will include both universal and targeted approaches funded through ‘A Better Start’ grant enhanced by existing and leveraged funds. With all our interventions we will be striving to reach all eligible parents and children, in other words to achieve programme delivery at ‘scale’. Our target of supporting 80% of the eligible population will enable us to reach 12,000 children and their families over the life of the programme.

We have considerable experience in Nottingham of implementing evidence-based programmes, including Family Nurse Partnership (FNP), which currently reaches almost 40% of all eligible families; and the Healthy Child Programme, which currently reaches 96% of eligible families across the City. We are aware of and have successfully overcome the challenges of implementing these approaches with quality and fidelity. We understand what is required to effectively reach out to and engage all potential beneficiaries.

We are committed to testing and evaluating all our proposed activities and interventions. We will use findings form our monitoring and evaluation frameworks to scale what works and modify or discard what doesn’t. We will do this by working with our internal evaluation partners and the Warwick Consortium and involving SSBC parents, family mentors and the existing workforce. A portfolio of evidence-based programmes guaranteed to improve child development outcomes through building the capacity and confidence of parents and tackling known risk factors will be at the core of SSBC. This will be complemented by a range of expertly constructed science-based programmes, that have either been previously tested at smaller scale, or are new innovations.

In order to achieve a step change in the improvement of outcomes for nought to threes in the target wards, SSBC will take an innovative approach to delivering interventions and activities.

PORTFOLIO OF ACTIVITIES

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Activity

Creation and integration of a new Family Mentor Peer workforce

Asset based approach Children at the heart, parents leading the way

The Dad Factor Strategy

Enhanced UniversalDelivery of the healthy Child Programme,Birth to 5

Description

Male and female parent and grandparent Family Mentors will be recruited from the local community, trained and supported to provide intensive one to one and group support through a range of programmes designed to improve child development outcomes. They will literally walk alongside families in the target wards, working in partnership with existing statutory services, focusing on the Big Lottery Trilogy of child development outcomes.

Existing and new cross partnership workforce will be trained in a suite of strength based approaches (motivational interviewing, signs of safety, solution focused therapy and Solihull approach). We will reframe parents as the lead experts in the care and education of their child. Working with them to identify their priorities and achieve best outcomes for their children.

Appoint a strategic lead who will work with senior leaders, commissioners, existing and new service providers, early years and education institutions to ensure father-inclusive practice is embedded across services and all relevant local agencies work together to systematically engage with fathers.

The Healthy Child Programme is an evidenced based universal preventative programme which provides families with access to immunisation, health and child development reviews

Families reached per year

1100

1000

Strategic reach

1100

The SSBC programme portfolio of activities and interventions is detailed in the tables below.To develop and embed our new and innovative approach, ‘The SSBC Way’ we will deliver the following activities:

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Activity

SSBC Language for Life strategy

Implementing the communication trust evidence based competency framework across partnership workforce including Family Mentors

Description

An overarching strategy which will be implemented at population level in the target wards including•SocialMarketing•Progressiveworkforcedevelopment•Parentknowledgeandskillsdevelopment•Arangeofcommunitygroupandonetoone

activities

A comprehensive training framework will be in place that ensures all competencies at the universal and enhanced levels of this framework are available to all SSBC and Early Years practitioners across the area. This will be delivered by qualified speech and language therapists who will also provide mentorship and support across SSBC areas. It will allow practitioners who want to act as “Language Leads” to have enough knowledge and skills to achieve SSBC accreditation and the Level 3 award in Supporting Speech, Language and Communication. This award will be available at a lower cost for settings and practitioners as the training and expert witness role will be taken on by the SSBC SLT. Training will include;

Universal:•TalkingMatters–anawareness-raisingintroductory

course including developmental norms and basic advice.•Let’sInteract–aHanen-basedcoursewhichuses

video interaction to hone practitioner skills in interacting with children.•CommunicationforAll–introducespractitionersto

the benefits of using signs and symbols and other visual support to develop children’s language skills.•WorkingwithchildrenwhohaveEnglishasan

additional language.

Enhanced:•LeadingonLanguage,includinghowtosupport

parents to develop language at home.•NuffieldEarlyLanguageProgramme•TalkingTime.

Training for SSBC professionals such as Health Visitors and Midwives so that they are able to share key language development messages at key points, using the Nottingham Natters materials. Additional training for Health Visitors to implement a screen to supplement their developmental checks at age two so as to provide a health visitor delivered preventative package and to support early identification of children at risk of environmental language delay and therefore requiring the Home Talk programme.

Children reached per year in Target Wards

4000

4000

To improve communication and language development in the target wards, we will begin by implementing the following key activities. It is important to note that many of the activities which will impact on communication and language will also have a positive impact on social and emotional development.

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Activity

Enhanced Book Gifting

Family Mentors

Growing Talk and Toddler Talk

Elklan Let’s Talk

Say and Sign

SSBC Speech and Language Therapists

Midwives and Health Visitor advice

Video Interaction Guidance for improved communication

Description

Continue centrally funded Book start and complement with Dolly Parton Imagination Library. Train those who are book gifting in ways to support parents to read interactively with children and not to be afraid of using books as a toy, making up their own words. Signpost parents to book sharing activities in the local area delivered by those who have had enhanced training in book sharing with young children, including babies.

All will be trained to model good interaction with children and will provide advice and support on how to raise children in language-rich environments. They will also share developmental norms with parents to raise aspiration around what children can achieve with their language development and will be attuned to any degree of developmental delays which they can discuss with the SSBC SLTs if needed.

Fun language focused family learning group, whereby a trained tutor models language development activities and techniques with parents and children together.

A training course for parents on how best to develop children’s language which can lead to a OCN Level 1 award.

A family learning course that uses parent’s interest in signing to support good, general language development messages.

Will support all the training and mentorship for practitioners and the SSBC workforce. They will provide ongoing mentorship and support, including networks and will deliver/co-deliver/attend community events on a regular basis. They will know the families in the community and will be available for informal advice and support and will link with other groups such as nutrition to incorporate good interaction messages across the programme e.g. talking together at meal times. They will provide a link to specialist services as required.

Midwives and health visitors will provide language development advice, including gifted books and Nottingham Natters information to all new parents at the appropriate time. Health visitors will also provide enhanced language development advice using the 2 year language screen advice package at 2 years.

SSBC SLTs will work with practitioners who are delivering this as part of the PSED element of the SSBC programme to incorporate any needed enhancements to the interactions elements.


1000

1500

500

50

300

1500

1000 new

To be determined

21

Activity

Language rich PVI early years settings and child-minder homes

Home Talk

Nuffield Early Language Intervention Programme

Talking Time

Awareness raising for schools about the importance of SLC on every child’s attainment and social and emotional development, including the impacts of SLC on the child’s behaviour.

Fathers Reading Every Day (FRED)

Description

The training and mentorship programme will allow all Early Years environments to be language rich and communication friendly. Settings will be able to track children’s progress in language development and will provide enhanced targeted groups for those who are at risk of delay. Setting staff will also use the Nottingham Natters materials to support their work with parents to develop the Home Learning Environment and develop language in everyday situations.

Children highlighted as at risk of language delay at 2 years but not meeting criteria for SLT are offered a 6 week programme in their own home. This is delivered by an enhanced skilled worker, mentored by the SLT. The focus is around developing language and play in everyday situations.

A 30 week intervention programme to be delivered to targeted children by PVI staff who have been trained and mentored in the delivery. It aims to improve children’s vocabulary, develop narrative skills, encourage active listening and build confidence in independent speaking.

An interactive oral language intervention package designed to support language development and to foster communication with and between pre-school children, targeting vocabulary, inferences and recount a narrative.

Links will be made with schools by the programme SLTs who will also utilise the Communication Trust’s resources and models, to highlight ways that schools can enhance the communication environment in their schools and how they can track children’s progress and provide appropriate support.

This is a family literacy programme to encourage fathers/father figures to read to their children (aged from 2 upwards) daily and instil new reading habits in families through nursery and reception and beyond. Fathers will receive a pack containing a reading log, tips for reading aloud and recommended book lists. FRED engages strongly with mothers too – explaining the importance of the programme for their children, consulting with them about any issues it raises for them (eg if the father is absent).


All families accessing PVI settings and child-minders

500

100

200

5000 Children attend target ward primary schools

300

22

Activity

Home Learning Environment Scale

Description

The HLE scale was used in the National Evaluation of Sure Start (NESS) and in the Millennium Cohort study. It looks at parental behaviours that are known to improve children’s skills e.g. reading to child, activities done with child, songs and rhymes etc. The Home Learning Environment Scale can be used by trained Home Visitors /Health visitors at agreed points in time.


500

23

Children reached per year in Target Wards 600

400

400

700

200

600

Activity

Preparing for Pregnancy Birth and Beyond

Hit The Ground Crawling

Friend / relative Doula training programme

Universal parenting programme Triple P Levels 1-3

Targeted Parenting programme Triple P Levels 4 and 5

SSBC individual support and wellbeing plan

Description

Locally designed and culturally sensitive Preparing for Pregnancy Birth and Beyond - developed from the Department of Health Evidence-Based Tool Kit

Hit The Ground Crawling for dads, a peer mentoring programme for expectant and new fathers, which enhances expectant fathers’ confidence and skills to co-parent effectively and support the mother of their child. A parallel programme of peer support for expectant and new mothers, which enhances expectant mothers’ confidence and skills to co-parent effectively and support the father of their child. This will be enhanced with a session for expectant mothers and fathers embedded in antenatal provision, drawing on the key antenatal elements of Family Foundations, which will foster attitudes and skills that support effective co-parenting and positive family relationships.

Doula – a word of Greek origin, refers to an experienced lay birth attendant who provides continuous nonmedical physical, social and emotional support to a woman and her partner during labour and birth. SSBC will develop a programme of training and support, drawing on the evidence of a published randomised controlled trial which trained a close friend or female relative to undertake this support. Outcomes include, positive prenatal expectations of childbirth and perceptions of their infants, improved self-worth, increased breastfeeding rates and improved satisfaction with hospital care and support.

The Triple P – Positive Parenting Program is a multi-level evidence-based parenting program. It provides participating parents simple and practical strategies to help them confidently manage their children’s behaviour, prevent problems developing and build strong, healthy relationships. Triple P is currently used in 25 countries and has been shown to work across cultures, socio-economic groups and in all kinds of family structures.

Following on from universal primary preventative Triple P levels 1 – 3 the targeted levels 4 and 5 provide a range of interventions which continue to offer targeted tailored advice and support to parents with identified needs.

A stage appropriate plan starting during pregnancy - SSBC Family Mentors will work with families to identify their support systems and create wellbeing priorities which are gestation or age appropriate.

To improve social and emotional development in the target wards, we will begin by implementing the following key activities. It is important to note that many of the activities which will impact on social and emotional development will also have a positive impact on communication and language and nutrition.

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Activity

Antenatal and Postnatal Promotional Interviewing

Universal maternal mental health screen with the Edinburgh Postnatal Depression Scale

Structured Listening Visits (PoNDER)

Universal Parent Infant relationship assessment with progression to Video Interactive Guidance for indicated families

Social and emotional Ages and Stages Questionnaire with associated development activities

Infant massage sessions

They Only Need You – A social marketing campaign designed on the “serve and return” and Toxic stress concepts from the Centre on the Developing Child Harvard University

Description

Is a proactive and non-stigmatising approach to promoting the early psychosocial development of babies and young children through supporting the transition to parenthood. It seeks to create and foster an understanding relationship between parents and their health visitor. Supporting parents to consider and connect with their developing and newly born infant.

An evidence based universal screening tool to identify women at risk of developing postnatal depression.

Specialist evidenced based training for health visitors to identify depressive symptoms based on the EPDS and clinical assessment and provide a psychologically informed intervention where indicated. Theintervention is associated with a reduction in depressive symptoms at 6 and 12 months postnatally.

An intervention which supports parents to understand the importance of responsive, sensitive, reflective relationships with their infant and the impact this has on emotional and social development. Parents will be supported in the observation of infant states and how they can respond in an attuned way.

An evidence based assessment tool designed to provide parents with information about the developmental status of their child young child across five developmental areas: communication, gross motor, fine motor, problem solving, and personal-social. The assessment tool is available in 21 versions to allow measurement of development between 2 months to 60 months.

Infant massage is a type of complementary and alternative treatment that uses massage therapy for infants. Although there is a limited evidence base for its impact on outcomes, it is commonly accepted as a way to engage parents and provides teaching opportunities in relation to baby cues and parenting strategies. ‘They Only Need You’ will highlight the parent as the most essential tool in the development of their child. This draws from the published work on baby brain development, and the importance protective relationships provide in response to stress situations during pregnancy and in the early years of life. This will capitalise on the ‘window of opportunity’ provided by pregnancy and early childhood development as key teachable periods in parenting and early years.


1000

400

1000

1500

300

1100 families

25

Activity

Accident prevention programme

Family Nurse Partnership

Healthy Relationship Toolkit

Children’s Emotional Mental Health and Wellbeing Team

SSBC Stronger Families

Specialist Smoking Cessation support during pregnancy and in the early years for families

Description

Test in one ward and then systematically deliver evidence-based injury prevention across all target wards and evaluate outcomes working in conjunction with leading clinical experts, and local University. The Family Nurse Partnership is a voluntary home visiting programme for first time young mums and dads, aged 19 or under. A specially trained family nurse visits the young mum regularly, from early in pregnancy until the child is two.

A locally developed, CityCare owned preventative set of tools which work with either women alone or couples to identify what a healthy relationship looks like. There are tools for use in both the antenatal and postnatal period; the multiple tools explore the impact on the baby of both a healthy and unhealthy relationship. They explore with women where they feel their relationship is on a spectrum. It also works with couples to highlight the changes and potential impact and implication having a baby brings to relationships

Following referral from universal preventative services, the team will facilitate early intervention approaches; appropriate and timely multi-disciplinary assessment and diagnosis (if clinically indicated); and ensure on-going care planning and support for the children, young people and family/carers including transition to adulthood. It coordinates involvement between different agencies and promotes partnership working with parents/carers and the children and young people. The pathway will be delivered within an integrated system and supported by integrated strategies, policies and procedures.

The SSBC Stronger Families Programme will support children and mothers living in Nottingham City, who have experienced domestic abuse and aims to begin the healing process. Over a 12 week programme, SSBC will work with a commissioned provider to test adaptions to the programme for use with families with younger children.

An evidence-based specialist service to address an aspect of parental substance missuse which adversely impacts on the developing baby and children


65 families (target wards = 100% coverage at 80% uptake from eligible population.)

800

200

50

400

26

Activity

UNICEF baby feeding Initiative Training

Breastfeeding peer support training

Best Beginnings Interactive Application

Role specific workforce development

Culturally appropriate pregnancy specific nutrition groups including cook and eat sessions

Culturally appropriate weaning groups

Creative cook and eat sessions

Universal vitamin D and healthy start vitamins

Description

Tiered cross partnership workforce training ensuring consistent messages for ante-natal and post-natal periods and infant feeding.

Training provided to paid family mentors and volunteer infant feeding champions to discuss feeding during antenatal period deliver one to one face to face, hospital in reach and telephone support as well as organising and facilitating infant feeding café and support groups / drop ins.

Nottingham is an agreed early implementer site for the prototype application and we will work with National charity to innovate the use of SMS proactive and reactive support for mothers.

Comprehensive cross partnership workforce development programme for existing and new service providers which will include •Healthyeatingonabudget•Deliveringpracticalfoodactivitiesinthecommunities•Nutritioninpregnancy•Culturallyspecificweaning•Toddlernutrition•Cookandeatgroupfacilitation•UNICEFBabyFeedingInitiative•Peersupportbreastfeeding

Promoting healthy lifestyles in pregnancy for mum dad and baby including•Practicalcookandeatsession•Shoppingandbudgeting•Healthyrecipes•Foodlabellinganddailyintakeguidelines

Key messages and practical support for parents around moving from milk to solid food including•Whentowean•Firstfoods•Nextfoods•Movingontofamilymeals

Promoting healthy family lifestyles including•Practicalcookandeatsession•Shoppingandbudgeting•Healthyrecipes•Foodlabellinganddailyintakeguidelines

Ensuring Vitamin D supplementation available to all (in addition to those who qualify for Healthy Start Vitamins)


1100

600 families initially progressively increasing as prevalence increases

1000 families

1000

300

700

500

1500

To improve nutrition in the target wards we will begin by implementing the following key activities. It is important to note that many of the activities which will impact on nutrition will also have a positive impact on social and emotional development and communication and language.

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Activity

Age and stage appropriate play and activity sessions

Toddler specific nutrition sessions

Oral public health campaign

Description

Linking nutrition and healthy lifestyle to activity from an early age. Promoting family activity sessions and using the immediate environment, local parks, recreation and leisure facilities.

Promoting nutritious and healthy diets for toddlers including•Keymessages•Practicalsupport•Faddyeating•Importanceoffamilymealtimes

The Oral Health campaign will begin in pregnancy. It will deliver key oral health messages and good practice, in order to address health inequalities and improve oral health in the target wards. It will seek to:•Reducethelevelsofdentaldiseaseinthelocalarea•Ensurelocalcommunitiesreceiveappropriatedental care by encouraging regular attendance with local dentists •Increaseknowledgeaboutoralhealthbyproviding consistent and accurate messages.


1500

700

2000

We are conscious that many of the activities and interventions set out above are science-based innovations, rather than evidence-based programmes. They are all designed to impact positively on the trilogy of child development outcomes. SSBC will take a programme approach to this improvement with many interventions having a cross outcome focus.

Scaling and learning from FNP will be a primary focus of our science-based innovations. CityCare already provides one of the largest FNP programmes in the UK. We will use the principles and practices of FNP to change how the Health Visiting workforce delivers the Healthy Child Programme. We will take a careful and thoughtful approach to this development, rigorously testing our assumptions before rolling the approach out across the workforce.

We want to build on and further test the emerging evidence-base for improved outcomes from peer delivery. Current evidence shows that it is effective in single issue interventions. Through SSBC Family Mentors we want to innovate and test the impact of peer delivery across a range of SSBC activities and interventions at scale. We want to develop a role for FNP graduates to work alongside Family Nurses and other primary care staff to contribute to this new workforce.

We will also focus on the adaptation of existing programmes to meet the cultural needs of our diverse communities. We are aware that adaptations often reduce the impact of an effective programme, but we also know from experience that failure to make adaptations means that some families and communities are potentially excluded. It is vital that Small Steps Big Changes ensures equality of access for and is culturally sensitive to the needs of all parents and their children.

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“I wanted things to help me meet people when I was pregnant. I didn’t know anyone and I didn’t speak English very well. I wanted someone to talk to and encourage me to go out with them and meet others.” (Local Parent)

In addition we want to test a range of new approaches that have yet to be rigorously evaluated. SSBC includes a basket of local innovations which are suitable for evaluation. We will work with the Programme Level Evaluator to ensure any local evaluation contributes to, and enhances, their work at a national level.

The SSBC portfolio includes activities that are neither evidence-based nor science-based - activities that that we have called innovation through participation. If we are to establish trust with our communities, we need to be responsive to the needs expressed by local families. It was clear through our engagement and participation process that parents would like to have opportunities to meet each other in safe, child-friendly places. They want safe, local places for children to play outdoors. They want activities to take place in locations within ‘pram pushing’ and ‘toddler tolerance’ distance. They want better transport to make it easier to access services. They want the opportunity to access affordable exercise. They want to improve inter-generational learning form shared experiences.

In direct response to these ideas, SSBC will continue the forums and processes that have stimulated and supported these local innovations and build them into the development and delivery of our programme. We have already carefully selected our 16 Delivery Centres to meet the ‘toddler tolerance’ distance test and provide safe outdoor play areas. We have committed to recruiting grandparents within our Family Mentor workforce. Examples of what we will do going forward include:− Opportunities for older people to read to children− Cook and eat sessions run by grandparents− The potential development and delivery of a supported low-cost transport service for families along the lines of the national ‘Dial A Ride’ scheme for people with mobility problems.

To help deliver our fourth priority outcome and achieve our radical aspirations for system change - ‘turning the system on its head’ - we will establish our ‘community connection’ model. In order to catalyse this process in local communities we propose to develop and evaluate the effectiveness of a number of new structures.

“At the very beginning it was hard to see how everybody was going to work together, it was hard to see how parents would be listened to... but then I’ve been proven wrong on all this so far...” (Local Parent)

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HOW WILL OUR SYSTEMS CHANGE?

At system level, local parents and communities want SSBC to help bring parents, families and communities together and bring radical system change through a new relationship between themselves as parents and the system created to serve them - which they have expressed as ‘turning the system on its head’.

We are fortunate in Nottingham to have a considerable head start compared to other areas. CityCare already reaches 96% of all new parents - giving us the confidence that SSBC will be delivered at scale in the target wards. As a community based health provider it has the trust and confidence of parents and communities. It also has an information system that works across health and the local authority. We already have the ability to share information through local systems and existing protocols. However, we also know that a great deal needs to change.

The first change we will make is to our workforce and by this we mean our Health Visitors, Children’s Centre staff, Early Years staff, Midwives, Social Workers and volunteers. Through an enhanced Workforce Development Strategy we will change how our staff work with families. We will have one approach, rooted in ‘The SSBC Way’ and its core values, adopted by everyone, which takes a positive approach to families and builds on their strengths. An example of what this means is encapsulated in the work of a local VCS organisation - Bulwell Community Toy Library (BCTL). Throughout our development process local parents have highlighted how BCTL is open and accessible, gets alongside them, respects who they are, understands their problems and supports them to find solutions. We will work with and learn from BCTL and we will work with all our partner providers to spread and embed the principles of this approach.

The second change is to make services available at times and places that better suit families. This will mean being accessible in the evenings and weekends and in places that are within ‘pram pushing or ‘toddler tolerance’ distance, i.e. how far a toddler is prepared to walk without tantrums!

We will take much of our programme out into people’s homes. We will deliver other aspects - group sessions and fun-based activities - in 16 local Delivery Centres across our communities. All of them are locations known to and used by local parents and families. Local Delivery Partners will provide activities and interventions in their own community-based resources and we will signpost parents and prospective parents to other local providers. All the work of SSBC will be delivered locally.

The third change is to develop opportunities for parents and other members of the community to take on roles (paid and unpaid) providing support and assistance to families. They will work closely with professionals and will help create a common interest in raising

30

Nottingham’s children. We plan to create a ‘new workforce’ of paid Family Mentors, drawn from local communities, who will support the delivery of core aspects of the programme. We will recruit, train, support and guide local parents and grandparents into these roles. We will also create an additional 100 new volunteering opportunities to support our programme delivery.

The fourth change is to dramatically improve the way we communicate with parents and professionals to let everyone know what we are doing and get them involved in shaping and delivering SSBC. We will embrace social media, social marketing and creative approaches to communications that meet the needs of parents and staff across our target wards. We will spark a conversation with parents and communities that will be at the heart of the development and delivery of our programme. We will link this to our communications and language outcome through our social marketing campaign ‘They Only Need You’ - emphasising the vital role parents play in early brain development and outcomes for children.

“I wanted information, someone to talk to me about different ages of children and what I need to do to help them to develop.” (Local Parent)

We expect to change the entire system of children’s services across the City, and not just services in the four target wards. We will develop and test all innovations in our target wards and roll out only those that are effective, suitable for scale and sustainable. We can already evidence experience of delivering programmes at scale - for example, CityCare provides one of the largest scaled FNP programmes nationally delivering to almost 40% of the eligible population across the City. We want to change services and systems to ensure they are more open and accessible, less bureaucratic and obstructive, focus on prevention, meet real needs and respond to actual demand, are more child, parent and family-centred, and ultimately that they are shaped, planned, designed and commissioned by involving parents.

We want to change where and how money is spent on children through a new Investment Plan that will:− Shift investment from older children and adults and into primary prevention− Shift resources from statutory budgets into VCS ownership and delivery - led by CityCare as our lead agency− Enable us to identify and shift cost savings through the impact of our programme.

By achieving our outcomes and impacting on ‘toxic problems’ we want to make savings in statutory budgets, e.g. reducing the cost of treating accidents, tackling behavioural problems and safeguarding issues and treating the consequences of parental substance misuse and shift these savings into ‘upstream’ interventions. We want to involve private sector partners for example by involving Boots PLC as one of our core strategic partners - encouraging them to support and get involved in SSBC, make contributions in kind or in cash and sign-up to our approach to working with children and families. We want to ensure that SSBC lives beyond BLF grant funding. We will do this through levering in new money, securing additional investment and making savings through the impact of our work.

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SSBC will develop a robust local Social Value evaluation framework to review the programme’s direct, indirect and wider outcomes. This will look at the required outcomes of the programme and the further impact and social value these outcomes create. It will be complementary in style, format, themes and outcome of the Programme Level Evaluation. This is explained in more detail at Annex J: Monitoring and Learning.

We will create what we have called ‘The SSBC Way’ - which encapsulates our vision, our approach and our key messages. We will communicate and promote this to all our partners and stakeholders, from local parents to national government.

We will work with BLF to create a replicable model that is portable, can demonstrate evidence that it works, achieves outcomes and impacts and is sustainable - encouraging other local authority areas, funders and government departments to work with us to replicate or learn from our model (The SSBC Way). We want to be at the centre of a child development debate nationally and internationally - sparking interest, visits, conferences and research into our programme.

The long-term aspiration for the future of SSBC is to work towards the creation of a new social enterprise that will take our project beyond the life of BLF funding. As lead agency CityCare is itself a CIC and has the experience, expertise and resources to help guide the SSBC partnership towards achieving this goal. This long-term vision is supported by our key stakeholders including local parents and community members but the development and implementation of a suitable vehicle and the detail of how it might operate will require discussion and planning with BLF and all our stakeholders.

CAPACITY

Nottingham already has in place the building-blocks needed to deliver our ambitious ten-year strategy for ‘A Better Start’:• AstrongLocalStrategicPartnership(LSP)-OneNottingham- bringing together leading City organisations (including CityCare) to plan and commission local priorities, strategy and services• Astrongandeffectivegovernancestructureandpartnershipfor SSBC• Nationallyrecognisedcommissioningstructuresandprocesses• Effectiveinformationsystemsandlocalinformationsharing protocols• Astrongandvibrantvoluntarysector-withover100local providers who want to be involved in SSBC• TwoleadinglocalresearchUniversities• Localcommunitieswhowanttobethebestparentstheycanbe and contribute to change• LocalparentsandfamilieswhoarealreadycommittedtoSSBC- with over 1,500 parents involved so far.

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CityCare is an innovative organisation that can demonstrate strong capacity to lead, coordinate and deliver SSBC. It is in a unique position as an innovative social enterprise that has grown out of the statutory health provider community. It currently delivers 57 health programmes, including employing all Health Visitors, with 1,600 staff in total. It has a forecast annual turnover for 2013-14 of £47million. It has the leadership, management and staff resources in place to lead and deliver SSBC including Finance, HR, IT and Administration Teams.

CityCare can evidence its ability to recruit, train and support peer workers through its existing network of paid and volunteer breastfeeding peer supporters. It has developed and refined bespoke competency frameworks and partnered with another local VCS provider to develop and deliver an accredited comprehensive, progressive training programme.

CityCare has strong research and evaluation expertise as evidenced by recent shortlisting and commendation by the Health Service Journal Awards for Progressive Research Culture 2013. Since 2011 CityCare has approved and collaborated on 30 research studies.

RESOURCES

Nottingham currently spends over £277 million on services for children and young people aged 0-17 across primary health, education, social care and the voluntary sector. This equates to £4,436 per child. Expenditure on the nought to threes is approximately £37 million. This equates to £1,238 per head when midwifery costs are taken out. Current expenditure on named evidence-based programmes is approximately £1 million.

‘A Better Start’ investment of £44,991,807 by BLF would virtually double investment in nought to three year olds in the target wards. In addition, working together, strategic partners have been able to identify and secure short and medium-term leverage funds of an additional £29,949,796 – shifting these resources from current budgets into primary prevention. We will develop a progressive Investment Plan to carry SSBC to the end of BLF funding and support city-wide scaling and long-term sustainability – contributing to our exit strategy.

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Financial Impact 2

Potential reductions in the need for Social Care interventions within the target wards.

The number of young people seeking professional careers in key under represented careers. Reduced unemployment and the need for recruitment of foreign nationals.

Improved community support resulting in increased community cohesion and reductions in nuisance, ASB and crime.

Reduction in state benefits.

Increased use of local suppliers and therefore tax receipts.

Financial Impact 2

Reduction of poor health leading to reduced demand for public sector resources across all departments, i.e. time associated with appointments for GPs, Doctors, Nurses and Community Staff.

Increased earning potential of young people as a result of the engagement of the programme, i.e. increase in pension contributions and tax receipts in the community.

Increased community engagement and resilience to support other projects resulting in reduction in costs.

Health and Wellbeing

Education

Social

Employment

Economy

Financial Impact 1

Reduction in demand on Acute Health Care services, i.e. A&E visits, Inpatient nights, Outpatients service and GP appointments.

Increased levels of young people’s educational attainment and improved employment and career prospects, i.e. the improvement of life time earnings and Tax/NI contributions to the state.

Increase in volunteering hours and added value.

Increase in Tax/NI and Pension contributions by parents and children in the future.

Increase in the local expenditure from employees within the community.

SSBC will achieve lasting impact and sustainability through our Investment Plan, by securing cost savings in existing interventions and services and by enabling additional investment through social value, employment and wider economic impacts. This is summarised in the table below.

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As lead agency for SSBC, CityCare will ensure robust, effective, transparent and inclusive governance arrangements are in place for programme delivery. We will build on our Interim Governance structure to put in place a new and inclusive Partnership Board, comprising 50% parent representation alongside City leaders, CityCare’s CEO, senior representatives of all key stakeholder organisations and representatives from the community accountability structure described below.

The Partnership Board will elect an Independent Chair, whose appointment will be subject to confirmation and contracting by the Lead Partner. The holder of this post will be reviewed every two years by the Partnership Board. The Partnership Board will also elect a Deputy Chair to ensure business can be conducted in the Chair’s absence.

The Partnership Board will be responsible for:

• StrategicDirection

• RiskManagement

• PolicyandProcedure

• InvestmentandFinance

• Development

• PerformanceManagement

• EvaluationandReview.

CityCare will carry responsibility for the ‘A Better Start’ investment, as well as the money that is identified in other services budgets through our Investment/Leverage Plan for re-direction into primary prevention. It will be accountable to the SSBC Partnership Board for how all investment is spent and the outcomes and impacts it delivers. CityCare will prepare and circulate a quarterly financial report to the Partnership Board to include a statement of the income received for the Programme (including grant payments from the Big Lottery Fund) and expenditure on the Programme (including by the organisations that are sub-contracted to deliver specific elements of it).

The Partnership Board will at all times recognise and be mindful of CityCare’s legal and contractual responsibilities as the Lead Partner and contract holder and as such no decision may be taken by the Partnership Board that is contrary to the Purposes, Guiding Principles or effectiveness of the Programme, to the requirements, terms and conditions of the contract with the Big Lottery Fund, or to the interests of the beneficiaries.

GOVERNANCE

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As Lead Partner, CityCare will be accountable to the Big Lottery Fund for the delivery of the Programme and the expenditure of the grant. If CityCare believes that an actual or potential action by the Partnership is contrary to the terms and conditions of the contract with the Big Lottery Fund, or to the interests of the beneficiaries, it will have the authority to change, amend or reverse decisions of the Partnership Board - after discussion with the Big Lottery Fund.

The CityCare Director of Operations and Transformation and the SSBC Programme Manager (employed by CityCare) will attend and report to Board meetings on all aspects of SSBC development, delivery and performance.

The role and operation of the SSBC Board is set out in more detail in our Partnership Agreement. SSBC will develop a new model of community accountability wrapped around our governance structure with the SSBC Board at its centre. This structure is set out in the diagram on page 37. It has been designed through parent engagement and participation to maximise the strength and impact of the parent and community voice within our governance arrangements and ensure SSBC is accountable to the communities it serves.

CONCLUSIONWhy Nottingham needs BLF funding for Small Steps Big Changes

Whilst Nottingham is five years along a twenty year journey as an Early Intervention City, it is clear that we need to shift focus to primary prevention, as outcomes for children remain poor.

As indicated above, and detailed at Annex A: Local Need, the need in Nottingham is stark and severe. The four target wards have poor outcomes across all key measures. With 25 of the 37 SOAs in the four wards within the most deprived 10% nationally; 40% of all the City’s ‘Troubled Families’ living in the target wards; these wards account for 35% of Child Protection, Children in Need and Children in Care cases; 30% of domestic violence incidents are reported from these wards; they are below the national and City average on indicators of early years attainment, and longer term school attainment.

‘A Better Start’ funding will transform the City’s ability to focus on primary prevention. BLF funding will almost double the amountinvested in each child aged 0 to 3 in the City, enhanced further by the additional funds levered into SSBC. This will enable a step change in improvements in Nottingham - starting with improved outcomes in the early years of life that secure positive and lasting improvements to their lives and life chances into adolescence and adulthood.

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BLF can be confident in investing ‘A Better Start’ programme funding in Nottingham because:

• Wehaveavisiontotransformthelivesofourchildren,families, communities and our City.

• Wehavealeadagencyandpartnershipwiththevision,capacity, infrastructure, resources and expertise to deliver this transformation.

• WehaveastrongandrobustProjectPlanthatsetsoutindetail how we will achieve our vision.

• Wehaveaportfolioofsolidevidence-basedprogrammes, science-based interventions and innovations guaranteed to bring about population level improvements to child develop outcomes and reductions in toxic stress.

• Wewillreachover1,000new-bornchildrenandtheirfamilies each year, and 12,000 over the lifetime of our project.

• Wehavesecuredsignificantshortandmedium-termlevered investment and will secure additional investment to support the long-term delivery of SSBC and secure its sustainability beyond the life of ‘A Better Start.’

• Wehavethefullsupportandinvolvementofourparents,families and communities, and a new model for community connection to enable them to lead the way in transforming childhood development outcomes as well as services and systems.

• Wearecommittedtosystemchangeandhavetheambition, aspiration and plans in place to achieve it.

Nottingham has been on an exciting journey and has developed an innovative and ambitious vision for ‘A Better Start’ in Nottingham. This journey has included everyone from City Leaders to health professionals to local Mums, Dads and children. We want to have the opportunity to continue on this journey to develop Small steps Big Changes and change the lives of our children, parents, communities and our City. As concluded by a group of parents at one of our SSBC Community Partnership events - We are ready!

WHY BIG LOTTERY FUND CAN BE CONFIDENT IN INVESTING IN NOTTINGHAM

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SSBC PARTNERSHIP GOVERNANCE STRUCTURE

SSBC Partnership Governance Structure

NCCP Director of Operations and Transformation

SSBC Programme Team

NottinghamChildren’sPartnershipBoard

SSBC Delivery Group Including ParentChampions

SSBC PartnershipBoard50% parents

NottinghamHealth and Wellbeing Board

CityCare Board

Managementand oversight

Board/subcommittee

Group/Forum

Key

Learning Collaborative

Assistant DirectorSSBC

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THE SSBC COMMUNITY ACCOUNTABILITY STRUCTURE

40

ANNEXES

41

A. LOCAL NEED

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Nottingham is a city with a population of 305,680 according to the 2011 census. The population has increased over the last 10 years by 15% (over 38,000). The population increase has been largely due to an increasing birth rate, increasing numbers of students, and inward migration particularly from overseas. The birth rate has increased from an historic low of around 3,200 per year in 2001 to an historic high of 4,477 in 2010. The number of births in 2010 was the highest since before 1977 (the earliest date for which information is available). This has contributed to an increase in 0-4 year olds of 30% between the 2001 census and the 2011 census.

Nottingham is also becoming more diverse in terms of ethnicity. Over a third (35%) of the population is non-White British, a significant increase from 10 years ago when it was 19%, and it is a trend that will continue to grow. There have been increases in most ethnic groups, but particularly large increases in Pakistani, White Other and African groups. Nottingham has the highest proportion of people of Mixed or multiple ethnic groups outside London.

The four wards that form Small Steps Big Changes each have distinct differences, communities and challenges in their own right. For the purposes of the programme it is easier to view them as two areas - with Aspley and Bulwell to the North of the city and Arboretum and St. Ann’s around the city centre. Aspley and Bulwell have more settled and traditionally White British communities with a much larger level of council owned housing. Arboretum and St. Ann’s have become much more culturally diverse, with lots of red brick terracing and a more transient community. Arboretum in particular has large numbers of students, it is the smallest ward in terms of numbers of children but has some of the poorest outcomes for the children that are living there.

The four wards chosen as part of SSBC are all becoming more ethnically diverse. Within Aspley the total population is 70% White British, however this is significantly less than a decade ago when it stood at 89%. Bulwell is currently 81% White British although this has fallen from 92% a decade ago. Arboretum and St. Ann’s have for a long period of time been amongst the city’s most ethnically diverse wards and this has continued over the last 10 years so that both wards now have 50% of their total population from BME groups.

The under 18 population of the city is even more ethnically diverse, with 45% of city being non-White British. Within Aspley 61% of under 18’s are White British, in Bulwell it is 72%, in Arboretum it is just 22% and in St. Ann’s 39%.

DEMOGRAPHICS AND POPULATION

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Nottingham is ranked 20th most deprived out of 326 districts in England according to the Index of Multiple Deprivation 2010. In the Index of Multiple Deprivation 45 of the 176 City Super Output Areas are amongst the 10% most deprived in the country and 91 of the 176 are in the 20% most deprived. The lowest ranking SOA in the city is in Aspley, which ranks 97th most deprived nationally out of 32,482. All bar one of Aspley’s SOAs are in the 10% most deprived nationally.

COMMUNITY AND SUPPORT

The AWP highlights that residents within Arboretum & St. Ann’s perceived the risk factor of ‘poor social cohesion’ to be better in their area (34.8%) than those in Aspley & Bulwell (68.8%), even though they perceived there to be a poorer ‘community environment’ than there was in the two northern wards.

According to the census 25% of Arboretum properties and 22% of St. Ann’s properties are overcrowded compared to an average across the city of 12%. The data does not point to this being such an issue in Aspley and Bulwell where the figures are 10% and 9% respectively.

The number of households across the whole city that do not have a car or van is high at 44%, nationally the figure is 25%. All 4 SSBC wards have a higher number of households without access to a car or van ranging from Bulwell at 48%, Aspley at 50%, Arboretum at 62% and St. Ann’s at 65%.

An independent survey commissioned as part of the SSBC community engagement programme showed some interesting results in particular about support networks for parents. It found that if people had a question or concern during pregnancy 75% of respondents would go to a midwife for advice, however half of them would also go to their mother (a higher level than would go to their GP). This also followed through into after the child was born, with over half turning to mum for advice, only slightly below the figures who would also go to their Health Visitor and GP.

When asked where they would like to receive any help/support/advice the top five answers were In my home (60%); At a clinic (48%); At a local playgroup (32%); Children’s Centre (26%); and Telephone (26%). Overwhelmingly people said the best time for them to receive support was Monday to Friday 9-5, although 27% also said during the evening through the week, and 22% Saturday daytime.

Around 60% of people would like to have the option of someone with them when accessing services, with 60% of those answering positively saying they would like it to be their partner. Interestingly, and supporting the earlier findings about who people turn to, 43% of respondents would also like to be able to take mum and 40% would also like it to be able to take their friend. Just 17% picked the option of support worker.

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HEALTH

Around 90% of respondents said that the following issues were either ‘Important’ or ‘Very Important’:- To know what are the best foods for mum and baby; Support for mums wanting to breastfeed; Support for mums wanting to bottle feed; How to wean my baby onto the right food; Picky/faddy eaters; Feeding the family on a budget.

The results seemed to clearly suggest that fathers were not being included enough by services. In response to the question ‘Do you think dads have enough support/information/advice’ over 52% of respondents answered ‘No during pregnancy’ and 48% answered ‘No during the early years’.

Nottingham has significantly higher rates of low birth weight babies (9%) than England (7.5%). Ward data shows Aspley and Arboretum rates are amongst the highest in the city at over 10% whereas St. Ann’s has better rates that are below the city average but still higher than national.

The level of breastfeeding across the city is low, with fewer than 50% of mothers breastfeeding at 6 weeks. The rates vary hugely across the city and appear to be determined largely along cultural lines. Aspley and Bulwell both have rates below 30%, whereas St. Ann’s is pushing 55% and Arboretum is almost 70%.

Teenage pregnancy rates in Nottingham City have seen year-on-year improvement for the last 10 years and the city is one of the most improved in the country, rates have fallen by over one third from the 1998 baseline of 74.7, to 49.5 per 1000 girls aged 15 to 17 in latest annual figures. The city has closed the gap to national, regional and comparable authorities but is still in the bottom quartile nationally of all authorities. Ward figures over a 3 year period show that all 4 SSBC wards have some of the highest rates of teenage conception in the city, with every ward more than 2.5 times the national rate.

These measures and outcomes around healthy gestation and birth are also highlighted in the AWP for Nottingham. It also shows that some of the prenatal risk factors such as smoking at delivery and breastfeeding are poor. The risk factors support the administrative breastfeeding data above where the two northern wards have poorer breastfeeding rates than Arboretum and St. Ann’s

The high level of ‘poor parental mental health’ is another key risk factor in the AWP meriting attention of the SSBC programme. At 20% of people in the target wards it is higher than both the local authority and BEBS site average.

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SAFEGUARDING

The percentages of children in Nottingham who are obese (at both Reception and Year 6) are above the national and regional rates. The levels for Reception aged children have fluctuated over time whereas those for Year 6 children appear to be deteriorating.

At Reception Year Arboretum is the only ward of the 4 SSBC wards below the city average (24% Overweight or Obese), with St. Ann’s the highest at 32%. Nottingham is in the bottom quartile of all authorities on both measures. Ward figures show that 3 SSBC wards have over 39% of all their children at Year 6 measured as Overweight or Obese, and Bulwell the only ward below the city average at 37%.

High levels of Obesity were also evident in the AWP, although interestingly there also appeared to be the perception that children in the area were not necessarily doing insufficient exercise compared to the other BEBS sites. This does however vary enormously between Aspley & Bulwell where 28% thought their children were doing insufficient exercise, and Arboretum & St. Ann’s where it was over 78%.

Emergency hospital admissions for children (unintentional and deliberate injuries) have risen for the last couple of years of published figures after a steady decline for the years previously. The city is now above national and regional rates and is in the third quartile.

The city sees a significantly higher rate of referral to social care services than nationally, at over 4,200 referrals in the last year this equates to 683 per 10,000 population compared to 520 per 10,000 across the country. The four SSBC wards account for over 30% of all referrals in the city and have a rate per 10,000 significantly in excess of the city average, ranging from 790 to 888. The social care referral rate for children aged 0-3 is even higher again, with a rate per 10,000 population across the city of 846. The four SSBC wards again account for in excess of 30% of all referrals in the city and their rates per 10,000 range from 984 to 1,135.

Nottingham has a significantly higher rate of children subject to Child Protection Plans, as at 31st March 2013 it was almost twice the national rate. Children living within the four SSBC wards account for over 42% of all the children in the city on Child Protection Plans. All four wards had rates above the city average, with two wards more than double the rate per 10,000 population seen across the city.

As at 31st March 2013, the four SSBC wards accounted for half of all Children in Care aged 0-3 across the city, and 43% of the city’s total number of Children in Care. Over that previous year Aspley in particular had a large imbalance between the number of children coming into care and leaving care, there were 49 children of all ages taken into care resident within the ward and only 24 leaving, for those aged 0-3 there were 19 taken into care and only 3 leaving.

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There was also an imbalance in St. Ann’s but not to the same extent as in Aspley. Across the city as a whole the numbers entering and leaving care were much more balanced.

The level of reported domestic violence across the city is high. However, a concerted effort by agencies to increase the level of reporting over the last decade has influenced this. Despite this it is still estimated that 60% of all domestic violence goes unreported. Across the city over the last few years there are on average around 11,000-12,000 domestic violence incidents reported to the police. In just the last 18 months over 6,200 individual children have been recorded by the Domestic Abuse Referral Team as living at households where there has been a reported domestic incident, this is around 1 in 10 of all under 18’s in the city. Aspley has the highest level of reported incidents in the city accounting for 12% of all DART referrals.

High levels of ‘poor family management’, ‘family conflict’ and ‘parental substance misuse’ were highlighted as risk factors in the AWP, with higher levels seen in the target wards than the local authority as a whole. There appeared to be significantly higher levels of both ‘family conflict’ and ‘parental substance misuse’ in Aspley & Bulwell than there was in Arboretum & St. Ann’s.

The percentage of children achieving at Foundation Stage had continuously improved since 2006. However, the city is in the lowest quartile of authorities and its national ranking has been worsening due to slower than average improvements. The area of learning that Nottingham is furthest away from national average is Communication Language and Literacy (CLL). The ward breakdown of the 2012 Foundation Stage results showed that just 27% of children in Arboretum achieved a ‘Good’ level of development (6+ at CLL and Personal Social and Emotional (PSE) and 78 points overall), this was significantly less than any other ward and less than half the city average of 58%. Children in the other 3 SSBC wards were also below the city average level of ‘good’ development but not to the same extent as in Arboretum.

The 2013 Early Years Foundation Stage Profile assessment has changed significantly so it is not possible to directly compare to previous years. Ward level results should also be treated with a degree of caution as the new processes establish themselves. However, Arboretum ward remained the lowest of the SSBC wards in each of Communication & Language, Personal Social & Emotional, and Literacy. In fact at Literacy the four combined SSBC wards have just 39% of pupils reaching the ‘Expected’ level of development, almost 10 percentage points behind the Nottingham average of 48% and over 20 percentage points behind the England average of 61%. At both Communication &

ATTAINMENT

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Language (59%) and Personal, Social & Emotional (64%) the combined results for the four SSBC wards show that the number of pupils achieving the ‘Expected’ levels are below the Nottingham average. They are also 13 and 12 percentage points respectively off the England average.

At Key Stage 1 Nottingham is in the bottom 10 of all local authorities nationally for 2013 outcomes on Reading, Writing, Speaking & Listening. Attainment has been rising in the city but only at the same pace as nationally, meaning that the gap has not closed to national results.

Ward level data for 2012 results shows that all 4 SSBC wards are below the city average for the percentage of pupils achieving a Level 2+ at Key Stage 1 Reading, with St. Ann’s and Arboretum being the two poorest in the city. At a combined average of 78.5% the four SSBC wards are 4 percentage points behind the city average and over 10 percentage points behind the England average. At Key Stage 1 Writing, 72% of pupils in the 4 SSBC wards combined achieved a Level 2+, all four wards are again below the city average, by 5 percentage points, and are 13 percentage points of the England average.

At Key Stage 2 Nottingham has seen year-on-year improvement up to 2013 and has been closing the gap to national rates. There has been a particularly strong improvement in Level 4+ Writing, although this was the measure with most room for improvement; however the city remains in the bottom quartile of all authorities, and despite its improvement is among the bottom 10 authorities for Writing.

Key Stage 2 ward data for 2012 shows that Aspley and Bulwell children are achieving less well in both Reading and Writing than children in Arboretum and St. Ann’s. At Reading children in Arboretum and St. Ann’s are just below the city average of 82% achieving Level 4+, while in Reading they are achieving exactly the city average at 76%. When taking all four SSBC wards combined, children are achieving 4 and 3 percentage points worse than the city average and 8 and 10 percentage points worse than the England average in Reading and Writing respectively.

At Key Stage 4 (5+ GCSE’s including English and Maths) although Nottingham has seen year-on-year improvement it has not quite been as fast as nationally over the last 5 years. The city remains in the bottom 10 of all authorities nationally for 2013 results.

Ward data for 2012 GCSE results shows that just 38% of pupils in the four combined SSBC wards achieved 5+ A*-C including English & Maths. This means that they are almost 12 percentage points behind the city average, and 22 percentage points behind the England average.

The levels of pupil absence from school shows year-on-year improvement almost each year for the last 10 years. The gap to national and regional rates has again closed but the city remains in the bottom quartile, with one of the highest levels of school absence in the country within both primary and secondary schools. Primary school absence levels in the city appear to have not seen the same level of improvement over the years as secondary school absence.

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The latest ward breakdown of primary and secondary school absence showed that Arboretum, Aspley and Bulwell were the wards with the highest levels of absence in the city each with overall absence over 6.5% and around 1 in 10 of all pupils classed as Persistent Absentees.

2012/13 absence by ward for just primary school pupils shows Persistent Absence levels for children in the 4 SSBC wards is at the city average of 5.1%, although this is 2 percentage points higher than the England average. Unauthorised absence for pupils in the 4 SSBC ward is at 2%, half a percentage point above the city average and almost 3 times the England average of 0.7%, although pupils in St. Ann’s have just 1% unauthorised absence. Overall pupil absence in the 4 SSBC wards is 5.9%, only slightly above the city average of 5.6%, but still 1.5 percentage points above the England average of 4.4%.

The 3 Key Developmental Outcomes in the AWP which may particularly impact on attainment - ‘Poor Communication (0-5 years)’, ‘Poor Social Emotional Development (0-5 years)’ and Not Ready for School (3-8 years)’. The survey results show high levels of poor outcomes in all three of these key developmental measures, with either the local authority as a whole or the target wards being worse than the BEBS site average in all three.

On top of this, the Risk Factor Profile in the AWP also shows that there is ‘low parental involvement in learning’ particularly in the target wards, and ‘poor parental verbal reasoning’. Both of these seem slightly worse in Arboretum & St. Ann’s, but confidence intervals would probably negate any perceived difference.

CRIME AND ANTI SOCIAL BEHAVIOUR

The number of First Time Entrants to the Youth Justice System during 2012/13 is at an historic low in the city, there were 235 young people entering the system which is almost a quarter of the number since a high in 2006. However, even though the rate in the city has halved from the previous year, at 921 per 100,000 population, the city still has significantly higher rates than nationally. This is almost double the national average rate of 533 per 100,000 population, and is in the top 15 highest rates in the country. Data for 2012/13 showed that young people were receiving a custodial sentence at more than double the rate of that seen nationally. Ward data shows that one third of all recorded offences committed by young offenders were by young people resident within the four SSBC wards.

The AWP shows that there are high levels of ‘Early Onset Behaviour Problems (4-8 years)’ and ‘Poor self-regulation (4-8 years)’, both of these Key Developmental Outcomes may impact on future offending as well as school behaviour. Within the AWP it is also worth highlighting risk factors such as ‘Hyperactivity’, ‘Permissive parental attitudes to ASB’, and ‘Low parent social support’ that were all poor and were at or above the BEBS site average. All of these Key Developmental Outcomes and Risk Factors appeared to be significantly higher in Aspley & Bulwell than they were in Arboretum & St. Ann’s.

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ECONOMY

The percentage of children under 16 living in poverty stands at over 39% and equates to over 19,000 children. Bulwell and Arboretum have 45% and 48% of children living in poverty respectively, with 59% of children in both Aspley and St. Ann’s living in poverty.

Across the city 25% of the working age population have no formal qualifications, only slightly higher than the national average of 22.5%. However in wards where there are low numbers of university students the figures are much higher. In Aspley and Bulwell the working age population with no formal qualifications totals 38% and 39% respectively. In St. Ann’s the figure is the same as the city average, and in Arboretum due to the large numbers of students the figure is lower at just 16%.

21% of Nottingham young people participate in Higher Education, lower than both the England and East Midlands rates of 34% and 32% respectively. Within Nottingham the lowest HE participation rates are in Aspley Ward where just 7.6% of young people participated in HE, ranking the ward 19th lowest in England out of 7,992 wards counted. Bulwell was the next lowest at 10.3% participation (ranking the ward 90th lowest in England). St. Ann’s was also below the city average at 16% and Arboretum was at the city average of 21%.

BibliographyOffice for National Statistics 2011 CensusOffice for National Statistics Mid Year Estimates 2001 and 2011 and components of change data up to 2010Office for National Statistics Births data (VS Tables) Office for National Statistics 2011 Census – DC2101EW ethnic group by ageDepartment of Communities and Local Government 2010 Indices of Deprivation. The results can be found at: http://www.nottinghaminsight.org.uk/d/63285 Area Well Being Profile (0-8) for Nottingham, The Social Research Unit at Dartington, January 2014Office for National Statistics 2011 Census – QS408EW – Occupancy Rating (Rooms)Office for National Statistics 2011 Census – QS416EW – Car or van availabilityArea Well Being Profile (0-8) for Nottingham, The Social Research Unit at Dartington, January 2014Office for National Statistics and Nottingham CityCare Partnership – System OneNottingham CityCare Partnership – System OneConceptions per 1000 15 to 17 year old girls – 2009-2011 pooledNational Child Measurement Programme – DH ward tables at: http://www.noo.org.uk/NCMP/ 10 10 13 National_report Ward and SOA prevalence data – NCMP 2009/10 to 2011/12Social Services CareFirst data – 1st April 2012 to 31st March 2013Nottingham Police – Domestic Incident calls to Police between 2010 and 2013Domestic Abuse Referral Team database reports – Age and Residence July 2012 to Jan 2014Department for Education Statistical First Release – SFR23_2012Early Years Foundation Stage Keypas Analysis - 2012EYFSP 2013 – Keypas flat file aggregated to wardDfE: Phonics screening and National curriculum assessments at key stage 1 in England: 2013Key Stage 1 2012 ward level data available at www.nottinghaminsight.org.uk Department for Education Statistical First Release – National curriculum assessments at Key Stage 2 2012 to 2013Key Stage 2 2012 ward level data available at www.nottinghaminsight.org.ukDepartment for education Statistical Release 01/2014Key Stage 4 2012 ward level data available at www.nottinghaminsight.org.ukDepartment for Education Statistical Releases – Full year Absence (Latest: SFR10/2013)Local analysis from school census data – 2011/12 academic yearMinistry of Justice – Youth Justice Statistics 2012-13 – table ch2.6 and 2.7 Numbers and rates of young people receiving their first reprimand, warning or conviction by Local Authority of residence (2002/03 to 2012/13)Ministry of Justice – Youth Justice Statistics 2012-13 – Use of Custody YOT and Region 2012-13 tableNottingham City Council Youth Offending Team data 2011 – published in Nottingham City Ward Report 2012; available at http://www.nottinghaminsight.org.uk/d/91373 www.localhealth.org.uk percentage aged 0-15 living in income deprived households, Income Deprivation Affecting Children Index, 2010Office for National Statistics 2011 Census – QS502EW qualifications gainedHigher Education Funding Council for England - POLAR3 Young participation rates in higher education report available: http://www.hefce.ac.uk/pubs/year/2012/201226/#d.en.75676 Interactive map and data for download available: http://www.hefce.ac.uk/whatwedo/wp/ourresearch/polar/mapofyoungparticipationareas/

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B. PROJECT IMPLEMENTATION

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The SSBC project has been developed by a partnership of city leaders, health experts and professionals, representatives from the local voluntary sector, local parents and community representatives. It will put children at the heart with parents leading the way.

We will carry out our project by reframing parenting as a primary public health concern - putting parenting at the core of our delivery model. Our focus will be on achieving a step-change in child development outcomes through a strengths-based approach that sees parents as the experts - preparing and supporting them to be the best parents they can be to achieve the best outcomes for their children.

We will deliver a balanced portfolio of activities and interventions. Evidence-based programmes guaranteed to improve child development outcomes through building the capacity and confidence of parents and tackling known risk factors will be at the core of SSBC. This will be complemented by a range of expertly constructed science-based programmes which have either been previously tested at smaller scale or are new innovations. In order to achieve the step change we seek SSBC will take an innovative approach to delivering interventions and activities. This innovation includes the creation of a new parent-led workforce – our Family Mentors - who will working alongside and with the guidance of health professionals to support the delivery of our portfolio of activities.

SSBC will be located in 16 Delivery Centres at the heart of some of Nottingham’s most disadvantaged communities – Aspley, Bulwell, (North), Arboretum and St. Ann’s (Central). It will reach all families including those who feel excluded and are less likely to engage. It will work in and be sensitive to the needs of Nottingham’s most diverse communities.

SSBC will be an outcomes-focused, outcomes-driven project. We will put in place a robust Performance Management System that ensures we are able to deliver our programme outcomes. We will work with our internal and Programme Level Evaluators to ensure we have a monitoring and evaluation framework that enables us to evidence outcomes, measure impact, promote and share what we achieve.

DELIVERY MODELHOW WE WILL CARRY OUT OUR PROJECT

“If anyone is going to do a project I think this is what it should look like...” (Local Parent)

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We will deliver our programme portfolio through what we might describe as a mixed economy of providers. CityCare will directly employ the SSBC Programme Team who will coordinate and monitor delivery of the programme. They will also directly deliver elements of the SSBC model including an enhanced Healthy Child Programme Birth to Five which will be the platform upon which SSBC stands. They will also provide an increased FNP programme to ensure universal access for all eligible teenage mothers in the target wards. SSBC will also commission local voluntary sector organisations to recruit, employ and manage our new Family Mentor workforce and deliver specific activities. We will also work with, and in some instances, commission private sector providers to support elements of SSBC delivery. We believe this balanced approach will deliver the best outcomes for local children. Our rationale for taking this approach is set out below.

Local community engagement is an essential part of SSBC. This programme has been co-produced with local families, encouraging everyone in the community to get involved and see themselves as playing a role in its development. In programme delivery their involvement will move from co-production to co-delivery through the Family Mentor and volunteering roles. This is central to our programme values ‘Growing our children together with love and respect’ – rooted in the principle that ‘it takes a village to raise a child’. We will achieve this through our focus on engaging, supporting and working with local parents and families and through what we have described as our ‘Community Connection’ model (identified in Annex B: Lasting Impact and Annex M: Organisation and Partnership Summary). This model will drive engagement and participation and will be central to achieving our aspirations for system change.

SSBC will achieve lasting impact by developing and implementing our Investment Plan. This will enable us to lever-in significant funding from our key strategic partners – Nottingham City Council and Nottingham City Clinical Commissioning Group. This relies on the programme being able to evidence impact on its key outcomes and targets so that stakeholders see the benefit of investing long term in 0-3 year olds across the City. Long term system change will require the programme to be self-funded. This will be achieved through leveraged savings across the health, education and social care system, supplemented with income generation and social investment - for example, redirecting schools’ pupil premium into SSBC preventative interventions for children.

We will deliver a project that achieves excellence in services and outcomes by utilising a range of quality and service improvement tools promoted by the NHS Institute for Innovation and Improvement (now hosted by NHS Improving Quality). These cover service commissioning; quality and value in service delivery; service innovations; productive and effective service provision.

We will develop and put in place a quality assurance framework and quality standards for SSBC. Quality standards will be embedded within service specifications and delivery contracts. We will monitor and evaluate the achievement of quality standards through the management, monitoring, evaluation and review processes described in annex C.

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The Programme Team will be responsible for overall programme management and quality assurance, with particular focus on:• design• innovations• quality• fidelity• productivity• valueformoney• sustainability• resourcemanagement.

We will be continuously learning, changing and improving our programme through strong monitoring and evaluation, details of which can be found in Annex C: Monitoring and Learning.

DELIVERY OPTIONS

We have carried out an Options Appraisal exercise to identify the best delivery option for meeting local needs and achieving our priority outcomes. The findings from this process are summarised below:

1. CityCare as sole direct provider: under this model the portfolio of activities would all be delivered directly by CityCare as lead agency. This model would maximise the use of CityCare’s expertise and resources. Other potential advantages would be greater control over the programme and thereby minimal risk to delivery. Potential disadvantages include a lack of choice; a very limited if any role for partner agencies; limited diversity; limited creativity, flexibility and change; value for money concerns.

2. Delivery through CityCare and statutory health partners only: This option would have similar advantages and similar drawbacks to the first. Additionally, a key aspiration and programme driver is change at service and operational level. BLF, SSBC partners, stakeholders and crucially parents and communities expect, want and need new approaches and different services. It is difficult to envisage how this change would be enabled through this option.

3. Delivery through the VCS sector only: under this option all programme portfolio activities and supporting structures would be delivered by a range of VCS partners with no direct role for the lead agency. The role of CityCare would be limited to procurement. The potential advantages of this model might be to drive down costs and maximise opportunities for other providers. Potential disadvantages might include services procured solely on price; the loss of the expertise and experience of the Lead Agency from delivery; loss of control and increased risk; loss of programme identity and integrity; potential exclusion of smaller providers; a lack of coordination and consistency; the creation of another layer of commissioning – diverting funding away from front-line services.

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4. Partnership Delivery - A mixed economy: under this model the SSBC Programme Team is hosted by the Lead Partner and drives and coordinates programme delivery. The Lead Agency also delivers programme activities where it can best use its expertise and current reach. All other activities are delivered by health professionals or through commissioned third sector, statutory sector or private sector partners. This option provides a balance between direct delivery and opportunities through the procurement of services. Advantages include a clear and inclusive programme identity encompassing and maximising the strengths and expertise of all sectors; a consistent approach to service delivery; commissioning of specific expertise; a balance between efficiency and creativity/flexibility; the delivery of change and appropriate recognition of the risk management, responsibility, accountability and expertise of the Lead Partner.

DELIVERY MECHANISMS

THE SSBC PROGRAMME PORTFOLIO (fully detailed in the Strategy section)The primary delivery mechanism designed to meet need and achieve outcomes is our programme portfolio of activities and interventions comprising:

• Evidence-basedprogrammesguaranteedtoimprovechilddevelopment outcomes through building the capacity and confidence of parents and tackling known risk factors. For example, Universal provision of Triple P; Home Talk; Unicef Baby Feeding Initiative.• Arangeofexpertlyconstructedscience-basedprogrammeswhich have either been previously tested at smaller scale or are new innovations. For example the creation of a new workforce – Family Mentors; pregnancy specific nutrition/cook & eat groups; enhanced Preparing for Pregnancy, Birth and Beyond; Nottingham Natters• Asetoflocalinnovationsidentifiedthroughengagingandinvolving parents and communities – which we have described as innovation through participation. For example Doula training for friends and relatives; community connection model; learning from inter-generational shared experiences.

SSBC FAMILY SUPPORT AND WELLBEING PLANSEach child and family who benefit from SSBC will have their own individual SSBC Family Support and Wellbeing Plan. These plans will be led by the parents and developed through discussion and agreement with Family Mentors and Health Professionals. They will start with an assessment of the child’s and family needs. They will identify the stress factors that impact on child development and the parenting preparation and support activities and interventions that parents need. They will set individual child development goals and goals for parents. They will identify the key staff involved and a local support network for parents. They will include a timetable for achievement and for regular review. The plans will be reviewed every three months between parents and workers.

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AREA HUBS AND LOCAL DELIVERY CENTRESSSBC support will be delivered in the home and 16 Delivery Centres located at the heart of our four communities – putting the emphasis on local delivery that responds to and meets diverse local needs. 4 of the 16 Centres will serve as area hubs, accommodating Programme Team and Delivery Team staff.

FAMILY MENTORS: A NEW WORKFORCE A new workforce of paid ‘Family Mentors’, commissioned, trained, developed, supported and monitored by CityCare. Working alongside health professionals they will help to deliver core aspects of our programme. This ambitious and innovative commitment will create 66.5 FTE paid posts - employing around 120 people from local communities. Family Mentors will work alongside health professionals, taking SSBC activities into family homes and co-delivering group sessions. They will be a peer workforce and therefore will be parents or grandparents who understand the needs, challenges and aspirations of people from their local areas.

WORKFORCE DEVELOPMENT STRATEGYA new Workforce Development Strategy designed to train and support all professionals, Family Mentors, Community Animators and volunteers in new ways of thinking and working with parents and families. All paid staff and volunteers will be trained in ‘The SSBC Way’ – putting parenting at the forefront of our delivery and working with parents as the experts. The Strategy will include:• Jobdescriptions• CompetencyFramework• TrainingMatrix• SupervisionModel.• ProfessionalDevelopmentPlans.

THE DAD FACTOR STRATEGYA strategic level lead will be appointed within the Programme Team who will work with local fathers to identify and understand their needs. This will then inform work with senior leaders, commissioners, service providers, early years and education institutions to ensure father-inclusive practice is embedded across services; leading to all relevant local agencies working together to systematically engage fathers as an important partner in securing better outcomes for their children.

PARENTS LEADING THE WAY: Parent (and community) Powered ChangeKey SSBC delivery mechanisms have been developed through a process of co-production with parents and communities - embedding ‘parent-powered change’ in the development and delivery of all aspects of SSBC. Parent beneficiaries have been fully engaged in designing our approach, our priorities and our portfolio. This process has been instrumental in creating:• Ourcommitmenttoestablishparentingasaprimarypublic health concern; which sets the agenda for our programme• Ourstrengths-basedapproach–seeingparentsastheexpertsin the development of their children

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• Ourlocaldeliverymodel–usinglocalcommunityandchildren’s centres familiar to, used by and in some cases loved by local parents• Ourportfolioofparentsupportandparentingpreparation programmes and activities• OurproposednewFamilyMentorworkforce–paidlocal parents and grandparents who will work alongside (and with the support and guidance of health professionals) – to support the delivery of core aspects of our portfolio.

Further detail identifying the key programme portfolio delivery activities, a description of each activity and the numbers of children and parents that will benefit are set out in the Programme Portfolio Outcome, Indicator and Activity Summary Tables at the end of this Annex.

MANAGEMENT AND COORDINATION

SSBC PROGRAMME TEAMA new Programme Team (PT), employed directly by the lead agency CityCare, will manage, drive, coordinate and administer the operational delivery of SSBC. This will ensure that that as Lead Agency and Accountable Body for ‘A Better Start’ grant CityCare is able to guarantee effective management and operational delivery, manage risk and ensure the project achieves its outcomes and impact.

The SSBC Programme Team will be managed by a Programme Manager (PM), accountable to CityCare’s Director for Operations and Transformation and directly to the Partnership Board – in the role of Contract Manager. The PM will be responsible for all aspects of the day-to-day delivery of the SSBC project and portfolio including managing, supervising and supporting all PT staff, liaison with delivery partners, procurement and contracting, performance management, outcomes monitoring, evaluation and impact.

The Programme Team will comprise:• AssistantDirector-SSBC• ProgrammeManager• SystemChangeLead(IndependentChair)• AreaCoordinatorx4(Arboretum,Aspley,Bulwell,StAnn’s)• Outcome,MonitoringandEvaluationLead• Finance,ITandProgrammeAdministrationLead• ParticipationandEngagementCoordinator

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DELIVERY TEAMSDelivery Teams will work from our Delivery Centres and in family homes to deliver core elements of our portfolio of activities. They will work to the guidance, support and supervision of SSBC Area Coordinators. They will comprise existing health professionals – primarily Midwives and Health Visitors - working alongside new Family Mentors. Family Mentors will work alongside health professionals, taking our activities out into family homes and helping to run group sessions. They will all be parents or grandparents who understand parent’s needs, challenges and aspirations.

VCS organisations will be commissioned to recruit, manage and operate the Family Mentor (FM) Workforce. It has been agreed by SSBC partners that Family Mentors should be located within the VCS to take advantage of the approach they bring, the trust of local communities that they have established, their flexibility, local knowledge local connections and profile. It is considered that they are best placed strategically and operationally to employ the Family Mentor workforce. It is also considered that the VCS is likely to offer best value for money in this case.

A Specialist Delivery and Supervision Team employed directly by CityCare will:• ProvideasignificantproportionofSSBCprogrammetraining• Inputintothedesignandimplementationofprogramme evaluation and related research• ProvideoutcomespecificsupervisionforourFamilyMentorsand wider workforce• Directlydeliverportfolioactivitiestofamilies• Contributetocatalysingchangeatlocallevel.

COMMISSIONED SERVICES: PARTNERSHIP DELIVERY

Alongside the SSBC Delivery Teams, commissioned providers – Delivery Partners – will provide aspects of our portfolio of activities. These providers will be commissioned through open and transparent procurement procedures following CityCare procedures and working to formal contracts managed by CityCare. They will be statutory, voluntary sector and private sector organisations contracted to provide identified SSBC activities. Delivery Partners will work in close liaison with our delivery teams and particularly with our Area Coordinators.

SYSTEM DELIVERY

Some aspects of our portfolio of activities will be delivered by what we have described as ‘the system’. This generic term describes currently commissioned statutory services including Midwifery, Health Visiting, Children’s Centres and Early Years providers. SSBC activities delivered by system staff will not be funded by BLF. They will be funded through current budgets and leveraged investment.

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It will be the role of the Programme Manager and Programme Team to ensure that all SSBC delivery is fully integrated and effectively coordinated. This will be achieved through:

• SSBC’srobustgovernanceandeffectivemanagementstructures• Sign-upbyalldeliverypartnersandstafftoSSBCvalues, approaches and key messages - The SSBC Way including joint training, development and supervision models• TheworkofourSpecialistSupervisionandDeliveryTeam• ParticipationofallSSBCdeliverystaffinourWorkforce Development Programme• CoordinationoflocaldeliverybySSBCAreaCoordinators• Joint-attendanceatlocalprogrammestaffmeetings• Day-to-daycommunicationandliaison• Sharedsystemsandworkingpractices• Clearandspecificcontractualrequirementsandservice specifications/expectations• AttendanceandparticipationinourproposedCommunity Connection and Accountability model and at SSBC workshops and seminars.

INTEGRATED DELIVERY

IDENTIFYING, IMPLEMENTING AND MANAGING CHANGE

Whist we are confident that our portfolio of activities and interventions will achieve the ambitious, transformational change we seek we are also conscious that our programme will need to change and adapt over time to respond to changing needs and a constantly changing context. We know that some aspects of our portfolio will need to adapt and change, some will be developed at scale and some might need to be jettisoned.

We will identify what needs to change through our performance monitoring and outcomes framework and through our evaluation and review process and programme.

Regular performance and outcome reports to our Partnership Board will enable us to identify what is working and what needs to change at an early stage. The Programme Team Manager will report to the Board on progress and will identify early problems and potential changes. The Board will agree plans to make changes to the programme. Where these changes make a significant impact on our Implementation Plan and portfolio we will discuss proposed changes through regular meetings and liaison with BLF.

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We will constantly review progress against our Implementation Plan milestones. The Programme Manager and Programme Team will work with delivery partners to ensure we are on track and make any necessary changes to the plan timetable.

Working with our Internal and Programme Level Evaluation partners we will evaluate and review our programme quarterly and annually. This process will enable us to take an overview of achievements and impacts and make adjustments at a larger scale where necessary. It will also enable us to identify what is working well and what can be scaled, and when, across the City.

Parents and communities will be fully involved in this process. We will have 50% parent (and prospective parent) representation on our Board. Our community Accountability structure, for example through the development of new community structures will feed into and influence Board discussions and decisions and recommend what might need to change.

SSBC will use a ‘Theory of Change’ model and process to continue to develop and embed System Change in the City. The model will enable the Programme to be clear about its aims for system change, create a structure for achieving and evidencing change, identify intermediate outcomes along the way to sustainable change and focus on activities that will promote and deliver change.

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Indicator

Number of parents reading to their children measured through enhanced Book Gifting

By the end of the 10 year programme, SSBC children will be empowered through improved, effective and age-appropriate verbal and non-verbal communication skills.

Indicator Level

1000 families will benefit from enhanced book gifting initiative

Short Term Outcomes

Parents understand the fundamentals of communi-cation and language development for their children

Timescales

12 months (on-going)

Activities / Initiatives

•EnhancedUniversaldeliveryofTheHealthy Child Programme Birth - 5 •SSBCLanguageforLifeStrategy•NottinghamNatterssocialmarketing

campaign•Implementevidence-based

competency framework developed by the Communication Trust•Progressivetieredtrainingacrossthe

workforce including Midwives, Health Visitors, Nursery Nurses, Children Centre staff, Parent Mentors, VCS Staff, volunteers to cover all aspects at universal and enhanced levels of this framework, supported by SSBC Speech and Language specialists. •EnhancedBookGifting(BookStart

and Dolly Parton Imagination Library) •IntroduceCommunicationand

Language champions (Family Mentors)•ToddlerTalksessionsforparents•FathersReadingEveryDay(FRED)•ElklanLet’sTalkOCNLevel1for

parents and volunteers.•Sayandsigngroupsforparents•Adviceandsupportforparentsand

practitioners from project SLTs.•Enhancedlanguagedevelopment

advice into all sessions parents attend and enhanced language development advice from SSBC midwives and health visitors supported by Nottingham Natters materials and training.•VIGforparentsstrugglingtointeract

with their babies.

Programme Portfolio Outcome, Indicator and Activity Summary Tables

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Indicator

Introduce Home Learning Environment Scale

% of children achieving the expected com-munication and language level at Early Years Foundation Stage assess-ment

% of children achieving the expected level of literacy at Early Years Foundation Stage assessment

Indicator Level

25% Staff trained

50% Staff trained

75% staff trained

15% improvement from 2013 result


Medium TermOutcomes

Increased parental involvement in their children’s learning

Children make good progress through pre-school and are more school ready.

Timescales

Year 3

Year 4

Year 5

4 years

5 years


See above plus•HealthVisitorsandFamilyMentors

trained to implement the HLE scale•HomeTalkhomebasedvisiting

programme implemented by commissioned enhanced skilled staff to support parent to develop language in everyday situations •PVIearlyyearssettingsusethe2

year summative assessment and the Nottingham Natters materials to support Home Learning.

See above plus•NuffieldEarlyInterventionProgramme

evidence-based programme to support vocabulary and attention skills in early years•TalkingTime–focusedlanguagework

in nursery settings

See above

Indicator

Outcome of Ages and Stages Questionnaire at age 2

Indicator Level

Baseline level to be identified

10% improvement from baseline


20% improvement from baseline.

Short TermOutcomes

SSBC children have will have age appropri-ate communi-cation and can use language to express their physical needs and have positive social interaction.

Timescales

6 months

24 months

36 months

48 months


See above plus•UniversalassessmentwithASQ’satkey

development stages•Languagedevelopmentsupported

by signs and symbols across the SSBC area, including all PVI early years settings.•SSBC–accreditedLevel3in

supporting language leads in settings ensuring language rich environments in day care environments, including baby and toddler rooms.

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Indicator

% of children achieving level 4+ at Key Stage 2 Reading

% of children achieving level 4+ at Key Stage 2 Writing

Number of special educational needs children with speech, language and communication needs (school action plus)

Indicator Level



25% reduction

Long TermOutcomes

Children con-tinue to have better literacy and language skills and better school achievement

Timescales

10 years

10 years

10 years


See above

See above

See above

Indicator

% of children achieving level 2+ at Key Stage 1 Reading

% of children achieving level 2+ at Key Stage 1 Writing

% of children achieving level 2+ at Key Stage 1 Speaking and Listening

Indicator Level




Medium TermOutcomes

Children have better literacy and language skills and better school achievement

Timescales

6 years

6 years

6 years


See above•AwarenessraisinginSchools•DevelopmentofaTalkingtoLearn

Model, based on the national Talk of the Town project.

See above

See above

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Indicator

Number of parents supported by SSBC during the antenatal period.

Number of parents sup-ported through preparation for parenthood sessions

Number of par-ents supported through univer-sal parenting programmes

Number of par-ents supported through target-ed Parenting Programmes

Number of mothers in re-ceipt of antena-tal promotional interview

Number of mothers in re-ceipt of postna-tal promotional interview

PoNDER Targeted Structured listening visits

By the end of the 10 year Programme, SSBC children have improved healthy and positive social and emotional development.

Indicator Level

700 Expectant Families in con-tact with Parent Mentors

1100 Families in contact with SSBC Midwives

500 Families

700 Families

500 Families

700 Families

300 Families

700 expectant mothers

1000 families

450 families

Short Term Outcomes

Improved preparation for and capacity to parent effec-tively

Improved par-ent infant re-lationship and attunement

Timescales

12 Months

12 months

12 Months

24 months (on- going)

12 Months

24 Months (on-going)

24 Months (on-going)



Year 3 (on-going)


•IntroduceFamilyMentors•AntenatalconsenttosignuptoSSBC

through Midwives and HV’s •Individualpregnancysupportand

wellbeing plan•FamilyMentorantenatalhomevisits•HealthyRelationshipToolkit

See above plus•EnhancedPreparingforPregnancy

Birth and Beyond•HitthegroundCrawling(Fathers)•HittheGroundCrawling(Mothers)

•StayPositive(TriplePsocialmarketing)•Level2and3TripleP

•Level4and5TripleP•ScaledFamilyNursePartnership•SSBCStrongerFamilies

•PromotionalInterviewTraining•SSBCHealthVisitors

•PromotionalInterviewTraining•SSBCHealthVisitors

•UniversalScreenwithEdinburghPostnatal Depression Scale•Specialisttrainingtoundertake therapeutic structured listening visits with fidelity

Programme Portfolio Outcome, Indicator and Activity Summary Tables

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Indicator

Number of parents involved in infant massage

Number of children triggering the need for Video Interactive Guidance (VIG) through universal assessment

Number of children scoring within expected level on S & E ASQ’s at 2 years

Indicator Level

700 Families


10% reduction from baseline





Short Term

Improved par-ent infant re-lationship and attunement (continued)

SSBC children will have good social and emotional development, with lower levels of high aggression in pre-schoolers

Timescales

18 months

18 months

36 months

6 months

24 months

36 months

48 months


•FamilyMentors•InfantMassagetraining•InfantMassagesessions

•VIGtraining•Universalparent/infantrelationship

assessment•TargetedVIG•SocialandemotionalAgesand

Stages questionnaires with associated supportive activities

As above plus•24monthsocialandemotionalAges

and Stages Questionnaires at age 2•EmotionalHealthandWellbeing

service •TheyOnlyNeedYouSocialMarketing

Campaign

Indicator

% of children achieving the expected Personal Social and Emotional Development level at EYFS assessment

Indicator Level


Medium Term

Children make good progress through pre-school and are more school ready.

Timescales

4 Years


As above

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Indicator

% of Unauthorised Absence from school

% of Persistent Absence from school

Number of children with behaviour, emotional and social difficulties (school action plus)

Indicator Level

50% reduction

30% reduction

25% reduction

Long Term

SSBC children will have improved primary school behaviour and engage positively with peers and teachers

Timescales

10 years

10 years

10 Years


As above

As above

As above

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Indicator

Number of parents having supported conversations about infant feeding choices.

Breast feeding initiation rates in Aspley and Bulwell Wards

Number of mothers breast feeding at 6 – 8 weeks in Aspley and Bulwell Wards

Number of parents introducing solid foods to their children after six months

% of babies born with a low birth weight (<2500g)

Indicator Level

1000 families

2% year-on-year improvement from 2012 baseline

6% year-on-year improvement from 2012 baseline





4% improvement on 2012 baseline



Short Term

Parents supported to make informed nutrition choices during pregnancy and throughout the early years, resulting in improved con-fidence and understanding of nutritional issues

More babies born with a healthy gesta-tional weight

Timescales


12 months (on-going to achieve 20% overall at year 10)

12 months (on-going to achieve 60% overall at year 10)

6 months

24 months

36 months

48 months

2 years

4 years

8 years


•FamilyMentors(paidandVolunteer)•UNICEFBabyFeedingTraining•PeerSupportBreastFeedingTraining•BestbeginningsinteractiveApplication•BreastfeedingWelcomescheme•BeAStarSocialMarketingCampaign

As Above Plus•HospitalinreachFamilyMentor

Contact

As Above Plus•BreastfeedingSupportGroups•BabyFeedingCafés

As Above Plus•Culturallyappropriateweaninggroups•Rolespecificbestpracticeworkforce

development training for SSBC Health Visitors•Rolespecificworkforcedevelopment

training for Family Mentors

•FamilyMentors•CulturallyappropriatePregnancy

Specific Nutrition Groups including healthy eating on a budget•Rolespecificworkforcedevelopment

training for SSBC Midwives •Rolespecificworkforcedevelopment

training for SSBC Health Visitors•CreativeCookandEatsessions

By the end of the 10 year programme, SSBC children will have improved nutrition through support to parents to make healthy feeding choices (for themselves and their child) during pregnancy, early years and beyond.

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Indicator

% of children overweight or obese in reception year (NCMP data)

Drilled Missing Filled Teeth at age 5

Indicator

% of children overweight or obese in Year 6 (NCMP data)

Indicator Level

10 % improvement from 2012 Baseline

30% reduction

Indicator Level

10% improvement from 2012 baseline

Medium Term

More children are a healthy weight at school entry age

Fewer children have dental decay

Long Term

More children are a healthy weight at entry to secondary school

Timescales

Year 7

2018

Timescales

Year 10


As Above Plus•SpecificToddlerNutritionSessions

As Above Plus•OralPublicHealthCampaign–City Smiles


As Above

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Indicator

BLF A Better Start grant Secured

Leverage plan identifying additional resource in place

Robust financial governance in place

Risks identified and a risk management and reduction plan created

Recruitment and Training plan developed

Referral pathways/partnership agreements development and signed

Project Manager in place and Project Plan developed and monitored

Indicator Level

N/A

N/A

N/A

N/A

N/A

N/A

N/A

Short Term

Appropriately resourced programme

Timescales

Month 1

Pre Submission

Month 1

Within 1 month of Successful Application





•Theidentificationofdirectandindirectrisks and a robust management plan to reduce and manage risks

•Thecreationofarecruitmentandtraining plan for all staff, volunteers and stakeholders•Createprotocolsforresearching

training needs and delivery

•Createcommunicationandengagement protocols•Developrobustreferralpathways

within partnerships and public sector

•Createaprojectplanincludingcriticalpath, roles and responsibilities, and accountability

System transformation through a ‘community connection’ approach that builds on the strengths of all partners– delivering integrated systems and services, reduced costs and a sustainable legacy.

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Indicator

Bespoke Workforce Development Framework

Procurement of VCS Delivery Partner(s)

Family Mentors in post

Support agreement signed with University

Sign up to and launch of community social change programme

Passing of system resource and governance to SSBC governance

Statutory provider staff engaged in development of Social Change programme

Indicator Level

The recruitment of 50% of employment and volunteers coming from the local community of Nottingham

The identified agreement to provide Masters/PhD students for Social Value measurement

All strategic leaders and statutory partners sign up prior to programme commencing

75% of all local organisations that support children under 5, sign up to social change programme

Short Term

Creation and development of new paid Family Mentor and volunteer opportunities (mother, father, grandparent)

Strategic part-nership with University for engagement with Student Researchers

Strategic lead-ers and statu-tory partners committed to sustainable community social change programme

Timescales

4 months


Prior to operational delivery

Year 2


•SmallStep,BigChangesawarenessprogramme campaign•Jointrecruitmentcampaignwith

children centres, job centre and community centres

•Developagreementforskills,knowledge and learning exchange

•Createsocialchangeprogrammeofsupport•Createaninformationandawareness

campaign using traditional social media to increase knowledge, understanding and awareness

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Indicator

Quarterly Programme review and development meetings of all strategic and operational partners

The creation of an effective and efficient report

Indicator Level

4 meetings per year throughout programme

Strategic and operational challenges identified and a management plan created to reduce challenges and develop best practice, efficiency and effectiveness

All stakeholder groups represented

Short Term

Operational meetings with key partner-ships, local authorities and community organisations

Identify service approach and delivery improvements to deliver resource and cost savings

Timescales

Throughout project

Annually


•Developamemorandumofunderstanding and terms of reference

•Createcommunicationconduitwithin community and throughout stakeholders

•Createoperationalandstrategicfocusgroups with stakeholders to feedback possible areas of improvement, change and development

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Indicator

Measure the trust and legitimacy that stakeholders are placing on the programme

An easy read reporting process created that analyses financial and non-financial outcomes, impact and value to the community, public sector resources, key stakeholders

Community Connection Model implemented

Community Accountability Structure fully established

Parent involvement in commissioning for children and family

Indicator Level

The strength of the trust and legitimacy of the programme is over 90%

N/A

All stakeholders are aware of the purpose, contents and support model

All stakeholders are aware of accountability structures

All children related contracts have a local community representative on the review panel for public sector contracts

Medium Term

Social Contract

Social Value reporting de-velopment and communica-tion

Communities fully engaged and involved in SSBC Change agenda

Timescales

Every 2 years

Interim reports produced annually

Final report at end of the pro-gramme

Year 1

10% in year 1

30% in year 2

50% in year 3

75% in year 4

100% in year 5+


•Createmeasurementframeworkwithinsocial value reporting

•CreateaSocialValuereportusinginternal evaluation method for financial and non-financial outcomes, indicators and value

•Communicatereporttoallstakeholders through local and regional media

•Structuredcommunicationthroughoutwider stakeholder base

•Structuredcommunicationthroughoutwider stakeholder base

•Localfamiliesinvitedtohavelocalrepresentation at the interview stages of the procurement service for children services

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Indicator

SSBC Centre of Excellence Established

Full implemen-tation of cross partnership workforce development strategy

Research and evaluate the predicted legacy of the programme through identifying the direct, indirect and wider value of the programme.

Research and implement best practice and share learning with stakeholders and key influ-encers

Indicator Level

All partnerorganisations commit to transparent information sharing, best practice development and knowledge exchange

All cost savings identified

All resource savings identified

All of the local and community value identified


Medium Term

Asset-based approach em-bedded across services for children and families

Identify unintended and intended short, medium and long term outcomes and impact

Identify service approach and delivery improvements that deliverresource and cost savings and implement

Timescales

Year 1

Year 8

Annually


•Implementationofcrosspartnershipapproach and outcome specific workforce development strategy

•ResearchusingSocialReturnonInvestment, Local Multiplier Effect, Social Audit and Accounting, Outcome Stars and Health and Wellbeing measures

•Resourceusingqualitativeandquantitative measures and outcomes

•Creationofwrittenandvisualreportingfor impact and value of development and changes

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Indicator

Create a strate-gy that defines how the programme can be success-fully replicated through the area and wider afield

Generate 100% of income across trading, commissioning, funding and fundraising required for sustainability

Develop service pro-gramme across all wards within Nottingham

The production of a 5-10 cost, resource saving to the public sector and the value to stake-holders and community

Research and implement best practice and share learning with stakeholders and key influ-encers

Indicator Level

N/A

Secure 100% of income for the delivery of services over a 3 year period

All wards receive support and intervention from the programme

All cost savings identified

All resource savings identified

All of the local and community value identified


Long Term

Replication Strategy

Develop and implement a plan for income devel-opment and sustainability

Scale pro-gramme across city

Financial and Non-Financial Impact and Value report

Identify service approach and delivery improvements that delivery resource and cost savings can implement

Timescales

5 Years

From 5 years on-wards

From 5 years on-wards

Year 8

Annually


•Clearlydefineoperationalmodel•Incomegenerationmodel•Impactandvaluemodel•Communityengagementandsupport

model

•Engagewithinvestors,funders,commissioners and public to raise funds

•Createaprojectplanforacitywiderollout

•ResearchusingSocialReturnonInvestment, Local Multiplier Effect, Social Audit and Accounting, Outcome Stars and Health and Wellbeing measures

Creation of written and visual reporting for impact and value of development and changes

Create a final report that builds on the outcomes, impacts and value of the programme, its net benefits, financial and direct and indirect value locally

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C. MONITORING AND LEARNING

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SSBC is focused on developing sustainable, consistent and measurable outcomes, impact, community value and a long term wellbeing legacy of the programme for local children and local communities within Nottingham that can be replicated nationally and potentially internationally.

As lead agency for SSBC, CityCare has the expertise, systems and resources in place to lead the monitoring and evaluation of programme outcomes and achievements, and to share and promote learning. It collects and stores data on all children aged 0-5 in the City within its management information system (System One). It has data and information sharing protocols already in place with key strategic partners. It has strong research and evaluation expertise, as evidenced by recent shortlisting and commendation by the Health Service Journal Awards for Progressive Research Culture 2013. It has the infrastructure in place to support all monitoring and evaluation activities. As the leading local commissioned community health service provider, monitoring and evaluation is in the DNA of CityCare.

In order to satisfy a range of commissioners, CityCare is required to monitor evidence and report on hundreds of indicator data lines each month. It has an efficient performance management framework in place that ensures performance and activity is on-track and includes agreed procedures to address variance from expected performance levels.

Set out below are some of the main SSBC monitoring objectives and the key questions we will use to monitor and evaluate our programme. These are not exhaustive and not a complete list. We will work to develop and refine these with our internal evaluation partners and the Programme Level Evaluator.

“We won’t get it all right at the beginning, will we? We will need to learn and change things as we go along and all of us will need to be involved…”

(Local Parent)

MONITORING AND LEARNING

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Key SSBC monitoring objectives will be to:

− Inform the Programme Team, governance structure and BLF of what works, and what is not working− Enable decisions to be made on what to scale City-wide, what needs to change or what might need to be decommissioned− Demonstrate real time outcome, impact and value of the programme− Demonstrate impact on key outcomes and targets− Demonstrate the level of activity and support offered by the programme− Demonstrate the financial and non-financial value to parents, partners, the community and public sector stakeholders− Evidence value for money− Demonstrate the Social Return on Investment for the public sector− Galvanise support across a range of partners and stakeholders to ensure continuing support and positive engagement− Create a replicable evidence base − To communicate to potential social investors, donors and corporate partners to promote future income generation opportunities and non- financial support to maintain the legacy and sustainability after the grant has ended− Work effectively and collaboratively with the Programme Level Evaluator− Demonstrate and evidence a replicable and portable delivery model that can be used nationally and internationally− Promote and support shared learning and best practice.

MONITORING OBJECTIVES

Key questions that will enable SSBC to effectively monitor programme outcomes and achievements will include:

− How many children and families is the programme reaching?− Are we reaching all children and families including the most disadvantaged/excluded the right ones?− Are we meeting our outcomes targets?− Are we achieving key programme milestones on target?− Which elements of our programme are working and which are not achieving expected targets and outcomes?− Are the activities the right ones to achieve programme goals and do we have the right blend of activities and interventions?− Have we got the right delivery model?− Can the activities that are not working be changed and if so how?− Which activities might need to end or be decommissioned?− Is the intensity of interventions and support strong enough?− What additionality are the Family Mentors bringing to the delivery model?

KEY QUESTIONS FOR MONITORING AND EVALUATION

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− Are we achieving short-term, medium-term and long-term outcomes?− What level of impact is the programme having on children, families, services and systems overall?− How is the programme being received by families?− What impact are we having on communities?− How is the programme being received by beneficiaries and key stakeholder organisations?

Through asking and answering these and other key questions we will be able to evaluate and report confidently on:

− What has changed (outcomes) as a result of the Small Steps Big Changes programme for our direct, indirect and wider stakeholders?− What can and is being done differently as a result of the Small Steps Big Changes programme?− How has the public sector, partners, children and parents and the local community benefited from the programme?− What is the financial and non-financial value of the programme and who is affected by the value?− What is the theory of change for the core stakeholders?− What would have happened anyway without the programme?− Has the engagement and intervention displaced the inequality to another location?

As the provider of all Health Visiting services, CityCare already has information and data sharing protocols in place with partners that can be used as part of the programme delivery.

For instance, CityCare is routinely notified of all maternity bookings by Midwives via the enhanced data sharing model with the National Patient Record System (System One). Midwives can consent families and share care antenatally with Health Visitors. This gives the organisation universal identification of, and early access to, all families who would be eligible for SSBC - facilitating early sign up and delivery to parents.

As well as this, CityCare has enhanced information sharing with Nottingham City Council, and in particular the Children’s Centres, via a form at the front of the child health record system - ‘The Red Book’. Every new parent and child working with CityCare Health Visitors signs the information sharing at the front of the ‘Red Book’ allowing their details to be shared with the Children’s Centres and Nottingham City Council. There are plans to make this process electronic. This will allow efficient cross delivery and fertilisation between the SSBC Programme and the Children’s Centres and City Council staff. In future years it will allow outcomes data such as school attendance and attainment to be analysed at an individual level.

System One will be used as the key management information system for SSBC. Delivery partners will be given access to specific elements of the system to enable them to record their activity with parents and children. For example, activity data such as number of parents supported through preparation for parenthood sessions, or parenting programmes, will be recorded and analysed.

METHODS TO TRACK PROGRESS

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It will be possible to see who completes the sessions and where drop off rates are high. Reports will be set up and run frequently to look at day-to-day programme management and activity, reach, work of individuals and teams, as well as outcomes achieved. It will enable a very high degree of quality assurance of what is being delivered, to whom, where, when and how effective it is. Using this system will enable the Programme Team and Delivery Partners to analyse what is working and delivering well, and where improvements need to be made, allowing quick alterations to practice or delivery.

Another benefit of using System One for programme delivery is that as the National Patient Record System it is the tool used by all the Health Visitors to record their activity and outcomes. Thus, as well as enabling easy analysis of programme delivery, it will also enable analysis between Health Visitor measurement/screening and programme impact. It will be possible to analyse most key SSBC outcomes and targets at an individual level rather than just aggregated Ward/Super Output Area level. Through this we will in effect be building a Citywide compare and contrast model. We will know all the individuals in the SSBC wards who are part of the programme and will be able to compare their outcomes to those within the same wards who have not been part of the SSBC Programme. This will enable much more rigour and certainty in the measurement of the impact of the programme locally. Rather than just saying that there had been an improvement in Breastfeeding or Communication & Language development across the whole ward, we will be able to say that the ward as a whole improved but also that the improvement for those involved in the programme was much greater than those who had no involvement or lived elsewhere in the City.

This is made possible because CityCare, through the Health Visitors, is responsible for collecting information relating to breastfeeding by all mothers across the City. Data about Breastfeeding Initiation and at 6 weeks is stored in System One against every individual child in the City. Analysis of breastfeeding rates will be possible for every individual - allowing us to compare those involved in the programme and those not involved, as well as those in and out of the target wards.

Similarly CityCare, through providing the School Nursing service in the City, is responsible for collecting and storing all the information for the National Child Measurement Programme. The details of every individual child who is weighed and measured as part of the programme is stored on System One. Not only will we be able to say what the obesity rates are for each ward, we will be able to say what the obesity rates are for each child. We will be able to compare the obesity levels of those that had previously been through the SSBC Programme to those children who had not been through the programme.

As part of the enhanced offer, every child in the City at their two year review will be screened by Health Visitors through the Ages & Stages questionnaire on Communication & Language and Personal, Social & Emotional Development. New indicator codes will be created for this that will be stored on System One, and in the same way as outlined above will enable detailed and individual level analysis across the City for those involved, or not, in the SSBC programme.

Through information sharing protocols and consent agreements already in place with parents and Nottingham City Council we will be able to do the same individual level cohort analysis on school pupil results and absence. The Local Authority collects and holds pupil level data at Early Years Foundation Stage, Key Stage 1 and Key Stage 2, as well as pupil absence and Special Educational Need data through the school census. It will be possible to match consented

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records between System One and these records in order to do similar individual level analysis on these medium and longer term outcomes. Within System One each child’s unique identifier is their NHS Number, within the school systems each child’s unique identifier is their UPN (Unique Pupil Number) and both these numbers stay constant throughout their life. These unique identifiers will make cross matching between the organisations much simpler and once done will make identification of outcomes possible for children involved, or not, in the programme throughout their school life.

As lead agency for SSBC, CityCare will develop and put in place new Performance Management, Outcomes and Evaluation Frameworks, based on current procedures, processes and systems adapted specifically for our programme.

We are aware that the volume of data that will need to be collected and analysed on a quarterly, six monthly and annual basis will be large and therefore robust data processes need to be in place to manage this area.

Collating, reviewing and using performance monitoring information and findings will be the day-to-day responsibility of the Programme Manager and Programme Team supported by CityCare’s Business Development and Contracting Team.

The Programme Team will include a new Outcome Monitoring and Evaluation Lead who will be responsible for:

− Managing and coordinating programme monitoring− Collating and contributing to reporting performance monitoring, and evaluation reports alongside the Programme Team Manager for the SSBC Partnership Board, BLF and key stakeholder organisations− Working with internal and external evaluation partners and with parents to ensure effective and robust programme evaluation− Working with the Independent Chair, partners, parents (and prospective parents), other BLF funded areas and the Big Lottery Fund to promote the programme at a local, regional and national level− Developing methods and tools for gathering and sharing learning at local, national and regional level - alongside parents, BLF and all key partners and stakeholders.

The SSBC Performance Management, Outcomes and Evaluation frameworks will include a quarterly review cycle. Reports on Outputs, Activity, Outcomes and Impacts will be prepared quarterly and reported to BLF, the SSBC Partnership Board, the Health and Wellbeing Board, CityCare CEO and Senior Management Team (SMT) and key strategic partners including Nottingham City Council.

Monitoring and evaluation reports will be used to manage performance, track and review progress, and make decisions on programme development and delivery. They will inform management plans and the management of sub-contracts with Delivery Partners.

COLLATING, REVIEWING AND USING MONITORING INFORMATION

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An annual report will also be produced for stakeholders and beneficiaries, identifying progress throughout the year and evaluating the key outcomes and impacts of the programme as it moves forward.

Monitoring information and reports will be used to contribute to and support the work of our Programme Level Evaluator, promote our programme, and share learning and best practice as detailed below.

SSBC will use monitoring and evaluation findings to ensure the continuous development of the programme - enabling the optimum outcomes and achievements, and engagement of all stakeholders. We will review the impact and value the programme is having quarterly in order to:

− Discuss and agree future best practice− Reduce duplication and misunderstanding− Improve stakeholder relationships and integration into the community− Improve the impact and value to stakeholders through financial cost savings, resource savings and social development− Continuous learning and developing of new methods of engagement, added value and positive outcomes.

These areas will be essential to the Programme Manager and stakeholders and throughout SSBC, and will inform the overall reporting process on an annual basis.

CityCare has significant experience of research design and analysis as a health provider. We have close links to the local Universities, both hosting and teaching their students and working closely with them on funded research projects. CityCare were the first social enterprise to be directly awarded a research grant from the National Institute for Health Research. We work extremely closely and collaboratively with experts in Public Health who have contributed significantly to the programme development so far, and will continue to be involved in the programme during delivery. We also work closely with the Local Authority Insight and Analysis Teams, who have also been involved in supporting the programme and will bring a large amount of expertise, in particular on the longer-term school outcomes.

Since becoming a social enterprise in April 2011, CityCare have approved 30 individual research studies across 19 themes (see diagram). These include:

• ARandomisedControlledTrial(RCT)ofaninterventiontoreducefire related injury in young children• FASTfirstaidtrainingforparents• COPPIComparisonofPre-schoolParentingIntervention• AnRCTofaninterventiontoreducechildren’sexposuretosecond hand smoke• FIRSTSTEPSRCToftheeffectivenessofGroupFamilyNurse Partnership

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CityCare staff have contributed to these studies through a range of activities:

• Identifyingresearchquestionsandcontributingtostudydesign• Activeparticipationonresearchstudysteeringgroups• Identifyingpotentialparticipants• Introducingstudiestopotentialparticipants• Datacollectionandanalysis• Writingforpublicationandpresentingatconferences.

As part of the programme it is proposed to re-run the Area Wellbeing Profile (AWP) in years five and eight of the programme. On a broad level this will show if Key Developmental Outcomes and Risk Factors have shown any movement since originally measured during the bid process.

CITYCARE RESEARCH THEMES

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It will be possible to measure longer term outcomes beyond the life of the programme in much the same way as the short to medium term outcomes detailed above. Nottingham CityCare holds the obesity data at Year 6 (11 year olds) so easy analysis at an individual level can be done. In conjunction with the City Council, analysis of secondary school data such as pupil absence, exclusions and Key Stage 4 outcomes for each pupil can be completed at an individual level. Once children are starting to feed through to secondary schools the programme will be looking for schools to fund it through their pupil premium in much the same way primary schools will have been doing. Because of this it is important for the programme to be able to track children long term into secondary school and be able to demonstrate the impact it has had on their outcomes compared to children who have not yet been involved in the programme.

Understanding programme delivery and outcomes will be vital; learning what is working as we progress will help improve outcomes for our children and make the programme more efficient and effective. Being able to demonstrate that the programme is having impact will be essential for sustainability - contributing to making the case for funding beyond the life of ‘A Better Start’. For example, commissioners and schools would be reluctant to fund the programme in the coming years unless it can demonstrate that it has made a significant impact on outcomes for children and families in the City.

SSBC will be able to provide a rich source of information for the Programme Level Evaluator (Warwick Consortium). The local programme will work closely with our internal evaluators and Warwick to look at the best ways of progressing their work, and how SSBC and Warwick can collaborate for maximum benefit. We are confident our consent, data capture and information sharing will facilitate an excellent opportunity for outcome analysis. Our Outcome Monitoring and Evaluation Lead will be the key point of contact with Warwick and will work with them to develop local evaluation tools and processes, and contribute to their work at national level.

We propose to develop a new SSBC ‘Learning Collaborative’ that will contribute to evidencing, promoting and sharing learning. The Learning Collaborative will support all aspects of learning around the programme. It will be outward looking - researching, scoping connecting and interacting with other programmes and initiatives locally, nationally and internationally. It will work with our local level evaluator and the Warwick Consortium, helping to co-ordinate research and learning through the processes of SSBC and share this learning locally (a part of our scaling wide), nationally and internationally. It will support new learning initiatives and workforce development for parents, participants and practitioners in the programme, including collaboration with academic institutions and other learning organisations. The SSBC programme is highly ambitious in its scope and in its practice - and learning will be central to its success.

SHARING AND PROMOTING LEARNING AND COMPLEMENTING THE WORK OF OUR PROGRAMME-LEVEL EVALUATOR (WARWICK CONSORTIUM)

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In addition we will create a new Nottingham ‘Centre of Excellence’ that works in collaboration with Health Education England to bring innovation into the training and education of new and developing health professionals - such as Doctors, Midwives and Health Visitors - based on the learning from our programme. It will provide them with a unique opportunity during their training to ‘walk alongside’ parents and understand their aspirations, motivations and challenges. This innovation could also act as a source of income generation for SSBC.

Much of the delivery model and activity proposed as part of Nottingham’s bid will be replicable and scalable throughout the rest of the City, and ultimately if successful the rest of the country. A key element of our monitoring framework that other Lead Voluntary Organisations are unlikely to be able to offer at this stage, is the level of detailed monitoring, learning and analysis of outcomes outlined above. Other Lead Voluntary Organisations may find it challenging to access individual child and patient level records from NHS and health providers, meaning they may not be able to build in contrast groups to their analysis. As CityCare will also work with the whole population across the City this will not present a challenge. From this perspective CityCare is in a strong position to provide a level of rigour and detailed analysis that can inform national policy and thinking about what works into the future.

As highlighted throughout our SSBC Project Plan, our programme and our approach has been developed through a process of co-production with parents and communities. We will continue this process within the monitoring and evaluation of SSBC, and our commitment to promoting and sharing learning and best practice.

We will ensure that parents and Parent Champions contribute to promoting and sharing learning. They will get involved in our Learning Collaborative and help with the Programme Level Evaluator (Warwick Consortium). They will help SSBC evidence the achievement of programme outcomes, the impact on children, parents and communities, and the overall effectiveness of our project. Parents will help promote and share this learning with partners and stakeholders at local and national level. They will help to produce promotional literature and outcomes reports, contribute to our digital communications, contribute to local and national research, and attend workshops, seminars and conferences.

INVOLVING BENEFICIARIES AND WIDER ORGANISATIONS

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As set out at Annex D: Marketing and Communications, our primary communications objectives with other organisations, partners and stakeholders will be to:• PromotethesharedstrategicvisionoftheSSBCprogrammelocally, regionally and nationally• Alignourprojectwithkeylocalandnationalstrategicagendasand priorities• Communicatekeysuccesses,milestonesandgoodnewsstories• InspireleaderstochoosetoworkwithSSBCandtorecognisethevalue of it • SharelearningandideaswithotherBetterStartareastopromotethe benefits of the programme• Stimulate,create,influenceandshapeachangeagenda–locallyand nationally.

We will work with BLF, the Programme Level Evaluator and local and national stakeholders towards the creation of a replicable model that is portable, can demonstrate evidence that it works, achieves outcomes and impacts, and is sustainable. Thus encouraging other local authority areas, funders and government departments to work with us to replicate or learn from our model (The SSBC Way) across the country. We want to be at the centre of a child development debate nationally and internationally – sparking interest, visits, conferences and research into our programme.

SSBC will create a robust local Social Value evaluation framework to review direct, indirect and wider programme outcomes and how they contribute to the required outcomes of ‘A Better Start’. We will look at the further impact and social value these outcomes create, that is complementary in style, format, themes and outcomes to the work of the Warwick Consortium.

We will use a blended approach by capturing and measuring social value through adopting a range of principles of core qualitative and quantitative Social Accounting models including:• SocialReturnonInvestment(SROI)• LocalMultiplierEffect(LM3)• SocialAuditandAccounting(SAA)• HealthandWellbeing• OutcomeStars.

Social Value Reporting Outcomes will:• Clearlydemonstratethefinancialsavingstothestateandthe resources saved as a direct and indirect result of the Small Steps Big Changes programme• Demonstratethechangeinlocalandcommunitysocialengagement, participation and development• Highlightthelocalandcommunityvalue,anditseffectonemployment and education• Definewhatindividualstakeholdersvalueabouttheprogrammeto identify and promote active citizenship, communities and promote social cohesion

SOCIAL VALUE AND SOCIAL RETURN ON INVESTMENT

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• Visuallydepictsocial,emotionalandphysicalchange• Mapanddefinethejourneyofchangeforthechildandparent• Enablethemeasurementofthesocialcontractwithinthelocal community, direct and indirect stakeholders that demonstrate the strength of trust, involvement, engagement and social worth• Enablequantitativeandqualitativeprogressionreportingofthestatus of each of the defined outcomes.

Due to the diverse range of stakeholders, a wide range of research methods are required to engage, effectively communicate and collect data throughout the programme. We will work with our commissioned local evaluator but anticipate the use of the following tools to evidence social value:

EVIDENCING AND REPORTING SOCIAL VALUE OUTCOMES

Tools

Value Intelligence

Financial Value

Resource Value

Local and community Value

Health and Wellbeing

Emotional

Physical change

Engagement

Social Contract

Purpose

To carry out social research with all direct and indirect stakeholders to understand “what they value” and “what is important” and use this information to report on social value.

The use of Social Return on Investment (SROI) principles to measure the financial impact and wide range of cost savings and value to the State.

Build upon the financial value to capture the outcomes, impact and value of the changing needs of resources including time and capacity, as a result of the intervention and grant programme.

Build upon the principles of the LM3 to measure the retained economic outcomes and build upon these to capture the local value across employment, education, social inclusion and development.

Build upon the health and wellbeing outcomes to capture and report the effect of children’s emotional, psychological and physical development and the effects of your health and wellbeing.

The capture of the soft value created using spoken words, stories, emotions and passion using the principles of SAA.

The use of a range of Outcome Stars to map the change in an individual’s behaviour and journey of change.

Create a formalised ‘people first’ approach to stakeholder engagement and data capture for performance and Social Value monitoring and evaluation.

The use of research to define the strength of community and stakeholder relations and trust.

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Social Value will be created as a result of a chain of events or interventions initiated by CityCare and its partners through SSBC and the value a stakeholder places on them. It is these values that form the basis of our social value measurement.

Set out below is a visual representation of the key stage of Social Value reporting within SSBC.

Input− The receipt of financial and non-financial contribution to enable the delivery of the programme, this includes the voluntary contribution of stakeholders.

Value Intelligence− The creation of the knowledge that enables the organisation to understand the value it has on its stakeholders and the core values of those who receive its products and services.

Social Outputs− The frequency and type of support and intervention received by a stakeholder (internal/external).

Social Outcomes− The direct and indirect benefits of the services being delivered to/with a stakeholder, i.e. what has changed as a result of the product/service being received.

Social Impact− As a result of the outcomes (defining what has changed) being achieved, impact (what is now being done differently) is created within health, education, employment, social and the local, regional and national economy.

Input SustainableSocialAction

Value Intelligence

SocialOutputs

Social Outcomes

SocialImpact

SocialValue

SocialWorth

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Social Value− The financial and non-financial value of the impact being achieved, together with the location in which the value has been created.

Social Worth− The value to the lives of individual and community stakeholders.

Social Action− The sustainable Social Value that could/is being achieved and the legitimate lasting effect and legacy it has on a community.

The measurement of our defined outcomes will be complemented with a range of areas that can be easily communicated to the local community, partnerships and wider stakeholders in a language that is easy to understand and one where SSBC can be held to account by its stakeholders.

The SSBC programme and portfolio of activities include a range of innovations. These have been designed through co-production between field experts, relevant professionals, local parents and communities. We will implement them with confidence and at the same time we wish to propose some to be considered for local research or evaluation. These Include:

• PeerFamilyMentorintegrationwithtraditionalservices• Transformationofstatutoryservices• TheHealthyRelationshipToolkitadomesticabusepreventative intervention.• SSBCStrongerFamilies• Accidentpreventionintervention• Doularelativetrainingprogramme• Proactive/reactiveSMS• PopulationlevelParentingSupportprimarypreventionuptotargeted levels • PreparingforPregnancyBirthandBeyonddeliveredinmulti-cultural communities• RangeofSocialmarketingelements

CityCare will lead SSBC evaluations and will commission relevant local evaluation partners to inform design and support process. We will work with our commissioned partners and with the Programme Level Evaluator (Warwick Consortium) to discuss and move forward the evaluation of the accepted innovations set out above through specific research or evaluation projects.

EVALUATING INNOVATION

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D. MARKETING AND COMMUNICATIONS

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Marketing and Communications is fundamental to both the development and delivery of SSBC. Not only is communication one of our key programme outcome areas which we will highlight through our Marketing and Communications (M&C), but our M&C strategy is a key vehicle for ensuring the delivery of the SSBC approach across the programme. This is about putting parents at the heart of the process and we will do this by sparking conversations across families, communities, partner organisations and stakeholders. Our Marketing and Communications Strategy is not about delivering messages or creating an exchange of information, instead, it’s about constantly asking our communities what they want, addressing the issues that matter and turning their ideas and inspiration into relevant services that are wanted and which create a lasting impact.

SSBC’s Marketing and Communications Strategy is also about managing and building relationships across the community, between parents and families and professionals that are critical to the successful delivery of the programme. It will seek to shape the attitudes and behaviours which define the SSBC approach - recognising the importance these have in building trust and confidence and thus the reputation of the programme. At the heart of our strategy is our vision - ‘Growing our children together with love and respect’ - underpinned by a set of core values developed with parents:

− Children at the heart and parents leading the way − We are all experts− We are all learning− Recognising shared accountability− Respecting multiple perspectives and diverse views.

We will also use our M&C Strategy to develop, communicate and promote the ‘SSBC Way’. We will celebrate and share success and we will be open and honest about what isn’t working in order to learn from it and change it. We will use our M&C Strategy to promote BLF and its objectives and acknowledge the importance of our relationship with BLF. A primary aim of our M&C Strategy will be to inform, influence and change policy and practice at local and national levels.

“I wanted information, someone to talk to me about my children at different ages and what I needed to do to help them develop.” (Local Parent.)

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The SSBC M&C Strategy will be developed and delivered on two distinct levels:− Local children, parents and local communities− Stakeholders and wider partners.

Our objectives and our communication methods and tools will vary as appropriate to the needs of each audience. We will work with and involve SSBC parents and communities in all our Marketing and Communications with partners and stakeholders; using the power of their passion, individual and collective experience/expertise and commitment to promote our approach.

Children, parents and communitiesOur communications are conversations rather than giving information. Our primary communication objectives with parents will be to:− Turn up the volume on the local community conversations that will build the foundation for the programme to be successful− Inform parents and communities about the importance of talking to, engaging with and investing time in their children− Go viral - verbally and digitally− Reach and engage with excluded parents and communities− Engage with children and young people in the community− Reach and listen to everyone important to the SSBC programme − Utilise CityCare’s 96% reach in the City and the willingness of parents to better the lives of their children. Other organisations, other Better Start areas, BLF, wider partners and stakeholders and governmentCommunicating at this level will focus on evidencing our achievements, sharing successes and being honest about what’s not working, sharing our learning, promoting ‘the SSBC Way’ and influencing and changing services, systems and policy.

Our primary communications objectives with other organisations, partners and stakeholders will be to:− Promote the shared strategic vision of the SSBC programme locally, regionally and nationally− Align our project with key local and national strategic agendas and priorities− Develop an ethos for SSBC (towards kite mark approved SSBC providers, and partners including local businesses)− Highlight the long term plan for SSBC and how the money will be spent− Promote, support and encourage engagement from stakeholders− Communicate key successes, milestones and good news stories− Inspire leaders to choose to work with SSBC and to recognise the value of it − Share learning and ideas with other Better Start areas to promote the benefits of the programme− Share our success with others and be honest about what doesn’t work− Stimulate, create, influence and shape a change agenda – locally and nationally.

KEY COMMUNICATIONS OBJECTIVES

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We have identified a wide range of target audiences for our Marketing and Communications (M&C) Strategy. We will target each audience using a range of methods and tools appropriate to their needs and to our key communications objectives. Our audiences are:− Children and Parents− Neighbourhoods and Communities− VCS partners− Statutory partners− Local Businesses− Strategic stakeholders and decision-makers− BLF and other BLF funded ‘A Better Start’ areas− Local and national media− Government representatives and departments.

TARGET AUDIENCES

Developed through co-production with parents, this will encapsulate our core values and approach and our big messages – some of which are currently:• Growingourchildrentogetherwithloveandrespect(ourvision)• Theyonlyneedyou!• Whatwouldyourbabythink?!• Talktoandpraiseyourchildmore–it’sessentialandit’sfree!• Thediamondsareinthebackyard• It’sallaboutchildren!• You(parents)aretheexperts.

MESSAGING

All our communications will use a consistent, welcoming and ‘open’ tone of voice and will be written using plain English (translated into a range of community languages). They will be accessible, appealing, engaging, exciting, colourful and full of life! We believe our visual branding captures this perfectly – and we will use it and build on it in all our communications.

TONE OF VOICE

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We will use a range of communication methods and tools to publicise and promote SSBC and to get all our audiences engaged and involved. The methods we will use range from stimulating a conversation with parents in community venues such as Children’s Centres and local cafés to daily tweets highlighting our successes to new apps for mobile phones to stories and case studies for local and national media to research papers and reports to local, national and potentially international conferences and events.

The table below sets out the range of methods we will use and which audience we will target for each method.

HOW WE WILL PUBLICISE OUR WORK AND ACHIEVEMENTS AND WHO THE TARGET AUDIENCE IS FOR EACH COMMUNICATION METHOD

Wider & national stakeholders (including government departments)

√

√

√

√

√

Communication Method

Community Conversations

Community forums and events

Posters, leaflets, flyers

SSBC Website and email

Facebook, Twitter, YouTube & other social media

Mobile Phone - Apps & Text

Workshops, Seminars, Conferences

Research reports and publications

Press releases, interviews, stories, promotional DVDs

Local businesses

√

√

√

√

√

Target Audience

Local media

√

√

√

√

√

Parents and Community

√

√

√

√

√

√

√

National media

√

√

√

√

√

Local Partners & Stakeholders

√

√

√

√

√

√

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A primary aim of our M&C Strategy will be to inform, influence and change policy and practice at local and national levels.

We will achieve this by:

− Aligning SSBC with the agendas of local and national decision-makers and communicating how what we are achieving can/will help them achieve their strategic priorities and goals

− Develop our concept and promote ‘The SSBC Way’ as a new, innovation and effective/evidence-based programme for improving child development outcomes and impacting on families, neighbourhoods and communities

− Working with our learning collaborative, local Evaluator and the Programme Level Evaluator (Warwick Consortium) to evidence our achievements, outcomes and wider impact, including exploring models of social value and social return on investment and sharing and promoting these with all our partners and stakeholders.

− Working with BLF and other ‘A Better Start’ areas to share achievements, good practice and learning and promote this at national and potentially international level.

− Creation and sign-up to an SSBC City-wide ‘Change Manifesto’ developed by strategic leaders and all key partners including parents and communities.

We will work with BLF to create a replicable model that is portable, can demonstrate evidence that it works, achieves outcomes and impacts and is sustainable – encouraging other local authority areas, funders and government departments to work with us to replicate our model (‘The SSBC Way’) across the country.

We want SSBC to be at the centre of a child development debate nationally and internationally – working with partners and stakeholders to spark interest, visits, research, seminars, webinars and conferences about our project and ‘A Better Start’ overall. The current evidence base surrounding what works in early childhood development is limited, fragmented and emerging. The ambition and scope of the BLF ‘A Better Start’ programme represents a once in a generation opportunity to generate a programme level, comprehensive and robust evidence base that will enable government, commissioning bodies and providers to improve the life chances of children by achieving step-change in the use of preventative approaches. This opportunity will impact at national and potentially international level and across generations. We will ensure that Nottingham’s SSBC project both contributes to and learns from this exciting and ambitious opportunity.

HOW SSBC WILL INFORM OR INFLUENCE POLICY AND PRACTICE WITHIN OTHER ORGANISATIONS, STATUTORY SERVICES AND GOVERNMENT - SYSTEM CHANGE

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Digital and on-line communications will be a key channel for the delivery of our Marketing and Communications strategy. We will harness the power of appropriate digital channels, such as SMS and websites, to engage parents and young families through the provision of relevant advice and support.

We will also develop an SSBC website to help broadcast our programme and its achievements and promote and share our learning and our success.

Activities will include:

− Mobile phone communication since our research shows it is the most used channel by our most important target audience – with SMS the unifying tool.− Facebook as the accepted common online community platform.− Smartphone as the primary method of internet access, with Google as preferred search tool and some usage of baby-related apps.− An SSBC website to provide advice and support, signpost parents to activities, services and events and to host local and national discussion forums− Using a social media channel for SSBC videos.

The primary objective of our digital strategy for partners and stakeholders is to maximise the opportunity presented by digital media, including our website to publicise and promote our work, provide information and news on significant developments and events, share learning and success, promote and host debate and discussion and publicise and share research and evaluation.

This will include:

− A new SSBC website to provide information, publicise monitoring, evaluation, research and review reports, host debate and discussion forums, share learning and best practice,; publicise and promote events− Use of email - as above− Use of social media including twitter as instant communication highlighting news, achievements and significant events.

DIGITAL AND ON-LNE COMMUNICATIONS

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It is essential that SSBC is able to reach and involve all members of our local communities – including those who are most excluded. This process is already underway through our engagement and participation work which has to date reached 1500 parents in the four wards and across the whole City. Many of the parents and families reached so far have expressed how they have felt excluded from services and how services have failed to understand and support them. These views were articulated particularly well by the 19 parents who attended our two strategy days.

In order to build on this early success in engaging excluded parents we will:

− Continue to develop our engagement and participation process and strategy− Use our parents and the power of word of mouth to spark conversations about SSBC− Get out into all local communities to make sure everyone hears about and gets involved in SSBC− Work with local VCS partners including BME organisations who are in touch with and support the most excluded and isolated− Work through Children’s Centres and other local services− Communicate using appropriate tone of voice and a range of community languages− Use fun events in local communities with local and ethnic activities and food to encourage everyone to come along and get involved.

We will recognise, be sensitive to and celebrate the diversity of our local communities in our M&C Strategy. As we have indicated above all our communications will use a consistent, welcoming and ‘open’ tone of voice and will be written using plain English translated into a range of community languages. They will be accessible, appealing, engaging, exciting, colourful and full of life!

Our Marketing and Communications strategy will recognise the uniqueness of our different audiences, by using communications messages, channels and tools that are relevant, accessible and compelling to them. At the same time we will galvanize all of our activity around the shared passion and commitment that all of our parents and communities have to the long-term wellbeing of their children and use this to bring parents and communities together to get involved in, shape and celebrate SSBC. We will publicise and promote what we have described as our ‘Community Connection’ model as one of the primary means of achieving this aim.

REACHING ALL OUR COMMUNITIES – INCLUDING THE MOST EXCLUDED AND ISOLATED

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Some of the key messages we will communicate as we implement, develop, adapt and scale our programme are set out below. These are our views at this stage in the development of SSBC and thinking ahead - they will of course themselves be reviewed and will change as the project progresses.

MARKETING & COMMUNICATIONS PHASES: TIMELINE

Celebrating SuccessSparking ConversationsThey Only Need YouGetting Started

Developing the MessageEstablishing and Embedding SSBCEarly AchievementsEarly Learning and Sharing

Evidencing Outcomes and ImpactsPromoting and Sharing

Changing the SystemAchieving SustainabilityLife beyond ‘A Better Start’

Key SSBC Communications Messages

Year One

Years Two to Four

Years Five to Seven

Years Eight to Ten

SSBC4 27.10.2014

a better start nottingham strategy october 2014€¦ · safer, healthier and happier; more...

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