Annex 3: Focus groups with local commissioners and charities
As part of the visit to Blackpool, the Committee held three focus groups with representatives working in councils, clinical commissioning groups and the other A Better Start sites across country. The discussions covered some of the common issues local commissioners face as well as views on what role the Government should play in the first 1000 days. This annex provides a summary of the following five areas covered: national priorities; universal and targeted approaches to local service delivery; integration; outcomes and performance; and prevention and early intervention.
National priorities
In terms of national Government, the Committee heard that local areas think a balance needs to be struck between the role of national and local bodies. Attendees widely supported the implementation of national framework, consisting of some high-level outcomes, that local areas needed to deliver. Strategic partnerships between key local players (commissioners and providers, including the voluntary sector) are critical.
Local service delivery: universal and targeted approaches
Some councils have seen 50% reductions in funding for children centres. However, one council which closed a local children’s centre had expanded its outreach services. In making these changes, the Committee heard that, from the point of view of some representatives, communities can be attached to buildings, rather than the services that are delivered within them. National policy on children’s centres is ambiguous in places. For example, the guidance says that children’s centre provision needs to be “sufficient” to meet the needs of their population, but sufficiency is not clearly defined.
Government also has a role in spreading best practice by showing local areas the sorts of models they can move towards. The Troubled Families Programme had adopted a bid approach to funding, in which funding was allocated based on compliance with specified criteria. This was supported by some members, although others were concerned that this competitive approach was unhelpful, as areas bid against each other and there are always winners and losers.
Integration
On the subject of integration, data sharing was a major issue. Professionals locally were often using different case management systems, which is a barrier to data sharing. The General Data Protection Regulation (GDPR) was widely viewed to have made information sharing harder, and it can be a bugbear for local people when they are repeatedly asked for their consent.
The group emphasised the importance of a systems approach. Budgets across government need to be pooled together, rather than dispersed between departments. Currently, the fragmented system nationally means that it is up to local commissioners to pull money in from different pots, which attendees thought was inefficient.
Issues, such as geographical footprints and political dynamics, can make joint working difficult. One attendee mentioned that the post of Director of Commissioning had been created in their council to bring teams together, with closer commissioning relationships with CCGs. Another representative spoke about how their council had implemented joint commissioning across a range of disciplines, with a much greater emphasis on commissioning across a whole system.
Improving outcomes and performance
In terms of outcomes data, the Committee heard about A Better Start’s common outcomes framework, and the challenges of data collection and interpretation therein. One representative wanted a review of outcome measures, and others thought that some measures, while rigorous, were not helpful in evaluation. Attendees said that they wanted the potential of data linkage between services to improve, including the ability to overlay social data with school and prison data. However, they reported that this is difficult because of poor communication between systems. The Committee heard about nascent life cohort studies being conducted in various areas, but also that these studies are usually not useful for real time analysis to identify and support individuals.
At a national level, some attendees called for the renewal of national child poverty indicators and a national target to reduce child poverty. Attendees raised this as an issue in terms of the knock-on effect it has on the co-ordination of services and continuity of care, for example when parents and families in temporary housing have to move because their contract has come to an end or their landlord has increased the rent.
Prevention and early intervention for first 1000 days of life
There was support for taking a ‘child health in all policies’ approach and an aim to address wider determinants of health in the first 1000 days. Ringfencing resources for prevention and early intervention was supported, but the Committee heard that this is only as good as the period for which it lasts. There needs to be a sustained commitment on longer cycles (for example 10 years rather than just for the duration of one parliament).
Published: 26 February 2019