Chapter 7: Conclusion and Recommendations
'Sure Start must sit at the heart of the government agenda for early years services' (Sure Start Contact Officer)
Introduction
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 broad: to improve children's social and emotional development; to improve children's health; to improve children's ability to learn and to strengthen families and communities. Sure Start Scotland is increasingly being delivered within the wider context of early years policies and services.
This research design for this mapping exercise involved quantitative and qualitative components. Data templates involved information about services across local authorities. Self-complete questionnaires for Sure Start Contact Officers collected information on the progress and impact of Sure Start Scotland. Follow up telephone interviews provided more depth in aspects of service delivery and development and also on best and more difficult aspects of Sure Start Scotland. Interviews with planners provided data on the planning process and joint working. Additional information from service providers and users was collected from two case study areas: Aberdeen City and West Lothian. This, along with case examples drawn from the interviews and questionnaires provided qualitative evidence about service delivery, its integration and impact.
The overall picture of Sure Start Scotland provided by this mapping exercise is a very positive one. The mapping exercise identified increased provision in terms of numbers of services and numbers of families supported. It also identified greater embeddedness of Sure Start Scotland with overall planning structures for early years services, suggesting an internalisation of the overall objectives of the programme alongside mainstreaming provision to ensure sustainability. Key issues of flexibility and integration were highlighted in the evidence provided by Sure Start Contact Officers and key planners. The impact of services, identified through qualitative case studies and case examples, reinforces this message of the value of flexible services provided in a holistic way to meet the diverse needs of vulnerable families. This final chapter provides a summary of the report and suggests recommendations drawn from the analysis of the data provided by local authorities.
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. Although it was not possible to obtain data on the number of integrated packages of care 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. Evidence also indicated that some services were going beyond age 4. The need for flexibility regarding ages of children supported was reported in the interview data and the impact of such a flexible approach was clear in some of the case examples provided by local authorities to illustrate how Sure Start Scotland was supporting vulnerable families.
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. 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 although 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. 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. Indeed, when discussing examples of joint working, collaborations with health were often cited as examples of good practice.
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.
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. However, Sure Start Contact Officers also noted issues such as the variety and flexibility of provision, the responsiveness to local need, the development of centre-based provision and the targeting of vulnerable families through non-stigmatised services. 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. Innovative practice was often highlighted as aiming at early identification of need and therefore offering preventive intervention. The examples provided illustrated the range of developments. In the case study areas, the examples of service development show the involvement of the voluntary sector, the importance of targeting of hard to reach groups with specific services as well as the need to bring vulnerable families in touch with services through outreach support.
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. 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 both 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. Meeting additional support needs within universal provision is another way. Moreover, sometimes specific groups were reported as being supported through targeted provision, for example children with special needs. Overall, meeting the needs of all vulnerable families with young children, through additional support, seemed to be the overarching aim.
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.
The perceived impact of Sure Start Scotland
Qualitative evidence from the interviews and questionnaires gave an indication of the impact of Sure Start Scotland. Sure Start Contact Officers described the way in which families were helped and how the nature of the service 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. Small issues for improvement, from the service users' point of view, included upgrading premises, continuity of service and more information about services. More generally across the local authorities, service users were involved in the planning and delivery of services mostly through the gathering of their views by service providers but also through wider consultations.
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, leading to a more holistic approach. However, integrated planning was 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. However, 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 sectoral 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. The expansion of services to meet the needs of the most vulnerable, the move towards joint-working were both cited as achievements. These can be considered specific elements of success, alongside the embedding of Sure Start Scotland within early years' policies, planning and services more generally. 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.
Conclusion and 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. Evidence to support such a conclusion comes from:
- The increase in numbers of children and parents supported by local authorities' Sure Start funded services
- Reported increase in range of services and expansion of existing services
- Reported increase in integrated and joint working both at planning but more especially at service delivery level
- Perceived and felt impacts observed through evidence collected on the ground and also through case examples
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 in the planning and delivery of services as well as for the families being supported. A number of recommendations can be drawn from the evidence in this report and from the specific suggestions made by the Sure Start Contact Officers and planners:
- 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
'People know there are better outcomes but life doesn't become easier'. (Sure Start Contact Officer)