Scottish Government

Executive Summary

Sure Start Scotland is part of a broader programme of action to promote social inclusion 'through a positive start in young children's lives'. The objectives of Sure Start Scotland are to:

• improve children's social and emotional development
• improve children's health
• improve children's ability to learn
• strengthen families and communities

This mapping exercise was conducted between November 2004 and April 2005. It builds a picture of the development and expansion of Sure Start Scotland services since 2001 when a previous mapping exercise was conducted. Sure Start Scotland was introduced in 1999/00. Local authorities have autonomy in shaping their services to meet the overall Sure Start Scotland objectives in the context of local structures and local needs. In 2000, local authorities were guided to focus on integrated support, on more deprived groups and on meeting needs identified by parents.

This mapping exercise aims to provide:

• An update on the quantitative data obtained form local authorities in 2001
• A description of the planning processes within local authorities
• An assessment of the impact of Sure Start Scotland services and funding on children and their families

Research design

This mapping exercise involved quantitative and qualitative components.

• Quantitative data templates collected information on Sure Start Scotland services within each local authority. This included information on main service type, age of children supported, intensity of service and funding. Twenty-seven local authorities responded reporting on 246 services.
• Self-complete, semi-structured questionnaires collected information on the views of Sure Start Contact Officers about the progress and impact of Sure Start Scotland, service provision and gaps, planning, evaluation and monitoring. Thirty questionnaires were completed.
• Telephone interviews, using a semi-structured format, followed up on the questionnaire data providing more depth about services and their impact, to consider issues of training and also to focus on ideas for the future. Thirty-one interviews were completed.
• Telephone interviews, using a semi-structured format, were conducted with a key planner to focus in depth on the planning process, decision making and joint working. Thirty interviews were completed.
• Two case study areas, Aberdeen City and West Lothian, were the focus of more in-depth study with additional telephone interviews being conducted with planners (4), service providers (7) and service users (4).

The range and use of Sure Start Scotland services

There has continued to be a year on year increase in the numbers of places for children and parents from the baseline figure of 3,387 children supported in 1999/00 to the 2003/04 figure of 15, 400 places for children and 9,600 for parents. The figures for 2001/02 comprised 8,563 places for children and 4,277 for parents; for 2002/03, 12,413 for children and 6,016 for parents. Although it was not possible to obtain data on the number of integrated packages of care form across all local authorities, a figure of 5,075 children receiving integrated packages of care was derived from returns from 7 local authorities. The qualitative evidence provided through the telephone interviews suggests that flexibility of service provision enabling integration and a holistic approach was a hallmark of Sure Start Scotland across local authorities, so it can be robustly assumed that the Scottish Executive target of 15,000 vulnerable children aged 0-3 are receiving an integrated package of care involving a range of services.

Sure Start Scotland services were reaching children across the 0-3 age range but were also including pre-birth services. Qualitative evidence also indicated that some services were going beyond age 4. Sixty-six services reported serving the pre-birth age group.

The service templates show that Sure Start Scotland is providing intensive, group and resource-based services, and one service may well offer more than one type of provision. One hundred and twenty-six services reported providing intensive support; 166 group support and 43 resource-based support. Intensive provision might involve home based support; group provision might provide training and crèche facilities; resource provision might involve a toy library or books. Centre-based provision was the main type of service provided with templates being returned from 71 centres (25% of all services for which data were available). In a few local authorities such provision was not well developed either because of a lack of premises or because such provision was inappropriate for rural areas.

Other types of services provided included: playgroups, outreach support, parent and toddler/baby groups, other day care or nursery, crèches, learning support to child or parent, resources and staff training. Outreach services accounted for 20% of reported provision. Centres provide a range of services including day care, visiting sessions, play groups, crèches.

The services for which data were collected were meeting the range of Sure Start Scotland objectives, although fewer claimed to be meeting the objective 'to improve children's health'. However, other evidence from the interview and questionnaire data suggests that it is in the area of health that some of the most innovative developments were taking place.

The development and delivery of Sure Start Scotland services

The mapping exercise found that 56% of services where data were available were set up after 2001 suggesting an increase in overall provision across Scotland. The qualitative data reinforced this as Sure Start Contact Officers described how local authorities were trying to mainstream services. Provision was thus being extended and enhanced rather than replaced by new services. Local authorities were also reported as mixing funding streams, with 71% of services being funded from more than one funding stream. Other funding streams included Changing Children's Services Fund, Health Improvement Fund, New Opportunities Fund and Better Neighbourhood Services Fund.

The main ways in which Sure Start Scotland was described as developing were through the expansion of services and through improved integration and collaborative working. A few local authorities reported difficulties with expanding and developing services because they had a baseline of very little provision or because of funding and staffing difficulties.

New or innovative practices include the development of new posts, especially those committed to joint working, linking health with other sectors. Other forms of innovation relate to the development of new forms of needs assessment and in some areas, new family support or similar teams.

Sure Start Contact Officers reported considerable developments in integrated working across sectors although many said that further improvements could be made in integrating with health. Nonetheless there was evidence of joint working with health at planning and delivery level. Additionally, visiting sessions within centre-based provision often involved health care staff, such as health visitors, providing specific input, with 90 services reporting health visitor input.

Integrated packages of care, as noted earlier, are hard to measure: families might be accessing a range of services at one point in time or over time suggesting considerable flexibility in support and provision. Illustrative case examples of services and their impact suggest the value and importance of such integration. It can meet the needs of different family members and support can be built up and reduced according to changing needs. Thus, a combination of intensive, group and resource-based provision may dynamically serve a vulnerable family in a holistic way.

Specific groups are also being targeted within Sure Start Scotland, although the overall ethos is one of non-stigmatised support for vulnerable groups within the context of more universal provision. Enabling parents to access services and supporting them to achieve that is one way of combining a targeted and universal approach.

The area of staff and parent training was highlighted by many local authorities as something that had been developed further since 2001. Supporting the development and retention of a skilled workforce was considered important as was supporting parents to improve their skills as parents and through other training. Many services reported that they offered some kind of training for parents including 137 services providing parenting training.

The perceived impact of Sure Start Scotland

Sure Start Contact Officers described the way in which families were helped and how the nature of the services enabled such support. Most concurred that impacts are hard to measure and are not reflected in a 'number of places' approach, but that the impacts of Sure Start Scotland are visible and tangible. Some services were oversubscribed and those services aiming to serve the hardest to reach groups were reporting success. Some Sure Start Scotland services had formal evaluations in place and the majority of local authorities carried out formal consultations. Many Sure Start Contact Officers stressed the need for monitoring and evaluation to be developed further.

The Sure Start Contact Officers provided evidence from case examples as well as evidence drawn from local evaluation and monitoring to illustrate the value of Sure Start Scotland. Impacts related to improved child behaviour and development, increased self-esteem of the parent, preventing more intensive social work involvement as well as improvement in health. Some examples demonstrated wider community level effects such as involvement of parents in service related committees on in training for childcare work. Evidence from the case examples showed the impact of single, short term interventions as well as longer term, integrated interventions. Service users' views from the case study areas also demonstrated the positive impacts of Sure Start Scotland on their lives. Issues for improvement, from the service users' point of view, included upgrading premises, continuity of service and more information about services.

The Sure Start Contact Officers highlighted a few areas of concern about Sure Start Scotland. These included a concern that demand outweighs supply, the provision of support beyond age 3, balancing the needs of the highest priority families with preventative work with other vulnerable families and a concern that support does not become intrusive.

The planning process

Most local authorities reported that there had been significant changes in the ways in which decisions and planning for early years services were conducted. Sure Start is becoming embedded within overall integrated planning and delivery. A change in culture as well as structure supported joint planning, is leading to a more holistic approach. However, integrated planning was reported as being time consuming. Some local authorities had put in place radical change in their planning structures; for others change was more incremental. The development of new committee and group structures facilitates joint planning and decision-making and local authorities were reported as working towards integration although still had some way to go.

Different partners seemed to be increasingly involved in planning at both the top and bottom ends of the process, including the voluntary sector and in some cases the private sector. Nonetheless, there were factors that hindered integrated planning and joint working. With respect to health, this included boundaries not being coterminous, different planning structures and internal reorganisation.

Difficulties at planning level were not necessarily reflected at service delivery level, where many examples of joint working with health were provided. In some local authorities there was continuing debate about the location of budgets and lines of responsibility; however in others decisions had been made to establish departments that crossed boundaries. New or joint appointments were also described has helping to transcend boundaries. On the whole, the funding process for Sure Start Scotland was viewed favourably with advantages perceived in flexibility at local level. However, in a few local authorities the lack of ring-fencing meant that Sure Start monies might be eroded under pressure from other council requirements. Some also cited the need for capital funds.

An overall assessment of Sure Start Scotland

Throughout the mapping exercise the positive aspects of Sure Start Scotland were keenly expressed by those participating in the research. The expansion of services to meet the needs of the most vulnerable and the move towards joint working were both cited as achievements. Specific areas where improvements could be made included involving men, evaluation and monitoring, developing preventive services, developing services for the most marginalised and vulnerable children and families. Other issues included the need to look flexibly at the Sure Start criteria to support transitions for parents and children, the need to involve health even more, continued mainstreaming, the need to reach rural areas and the need for even more integration. Sure Start Contact Officers suggested that future developments might be enhanced by the sharing of good practice, the use of a centrally funded pot for capital builds, further integration of funding streams, guidance on integrated working and shared budget management, longer term planning, greater involvement of parents and further development of partnership working.

Recommendations

This mapping exercise has demonstrated a considerable increase in activity across local authorities regarding Sure Start Scotland. Although local authorities have developed different structures and approaches to the planning and delivery of services, all support the integrated approach of Sure Start and work towards meeting its core objectives by supporting vulnerable families in flexible and non-stigmatising ways.

Sure Start continues to provide a flexible approach, combining universal and targeted services, and respondents in this study all thought that Sure Start Scotland made a difference to the planning and delivery of services as well as to the families being supported.

• Sure Start Scotland's flexibility and responsiveness should be regarded as strengths; any move towards increased targeting should be carefully managed to maintain a non-stigmatised approach
• Flexibility should be supported across age ranges so that services do not stop at age 3
• Flexibility should be supported through formal and informal integration so that families are supported to meet their needs in holistic and unobtrusive ways
• The persistence of unmet need suggests that Sure Start needs to develop and expand further if vulnerable families are to be supported adequately
• Sure Start will take a long time to have significant effects as it is introducing new ways of working and embedding itself into early years' policies; there should be little expectation of rapid transformation in terms of impact and outcome
• Although intensive support may be costly, it is preventive and may save more costly interventions later on. There needs to be some assessment of longer term impacts, perhaps by focussing on key transitions, for example into nursery or primary school
• There is an need for a review of monitoring and evaluation within and across local authorities
• Local authorities would value the sharing of good practice and plans should be developed to support this through seminars and other methods
• Consideration should be given to capital spend in those local authorities in need of additional premises.
• Issues of rurality may need to be addressed, especially in terms of additional transport needs and the reach of services
• Wider workforce issues need to be addressed as recruitment and retention were reported as concerns, although many local authorities were working towards improved quality through training. There is a need for men to be more involved as both carers and workers.
• Given that Sure Start funding is not ring-fenced, mechanisms should be in place to ensure adequate spend in all local authorities