Integrated Systems, conception to five

1. Integrated Systems, conception to five eif.org.uk @TheEIFoundation The Early Intervention Foundation

2. Integrated Systems for EI -conception to five • What makes an effective integrated system? • OBR review, effective systems • Initial review on programmes • Outcomes • Data collected by completion of template, follow up calls, three deep dives • 18 Places identified this as a priority • 14 returned completed templates/accepted offer of a phone interview Account-ability Commissioning planning Programmes Delivery Support Systems Workforce User

3. Integrated Models Range of models • Children Centre based, a number are reviewing commissioning of CC • Locality teams • Virtual/co-located Workforce / Management Structures • VCS, EI, family support, HV,MH support, Job centre plus in CC • Most of HV now based in community, Worcestershire currently based in GPs surgeries • Swindon - Single management structure, HV, FNP, SALT, SN, education welfare, Ed Psych, TAMHS, families first. Locality teams

4. Delivery Identification & Assessment • All Places had the basis of a CAF process to assesses need across partner agencies • Birth data • Essex, Herts, Solihull - 2 year entitlement • Essex – developed CAF to Family Facilitated Meeting • Hertfordshire – Team Matters Meeting to discuss CAFs • Westminster review families of concern at a monthly meeting between health and CC, including 2 year development review • 2 Places referred to the quality assessment of CAF process Access to Interventions • TAF approach to integrated interventions • Single point of access • Essex - Early Help Hub

5. Support Systems Current position • Integrated information IT sharing systems very limited • 9 Places had local information sharing agreements and processes in place to share live birth data • Individual info shared through CAF process was more common Examples of promising practice • Herts - use of NHS number by CCs for 2,3, and 4yr olds free place • Swindon - access to IT systems • Dorset - locally developed eCAF • Islington - additional info shared with CC on housing and benefits

6. Lessons learnt – What Places have told us CommunicationCulture Leadership Time Cultural change takes time Common vision and outcomes Data sharing is crucial “Hearts and Minds” careful consistent communication across teams Leadership, commissioning, operational Effective partnership persistently revisit and define basic principles of integration e.g. shared outcomes, governance, tools, protocols and user pathways. Build professional trust, team building, acknowledge expertise Manage independencies when with whole system change

7. Barriers • Data sharing • Present accountability and governance arrangements predominantly drive organisations and reduces focus on integration • Capacity of workforce • limited joint training opportunities • Capacity for development and evaluation • Fragmentation of commissioning, Range of employers • Financial remodelling required • ICT • Difficulties arising from co-location in some areas such as H&S issues for infection control • Lack of GP involvement in 0-5 integration • During health transition 2012 a number of previous agreements lost, info sharing, commissioning and some co-location