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EARLY YEARS STRATEGY

Section 1: Introduction and Background

Purpose of the Early Years strategy

1. The purpose of this new Early Years Strategy is to set out a framework for the effective provision of universal and targeted services for children and their families, from pre-birth to age 5. The strategy draws together existing policies for health, education and social care services which are directed at the early years of a child's life and at the parents and families of those children. By aligning Scottish Executive policies on early years and drawing these together in a single document, we can capitalise on the complementary role that health, education and social care services play in securing the best start for all our children and promoting their well-being and the well-being of their families and wider community.

2. The strategy presents a coherent vision of integrated services which together can meet the universal, and more individual needs of families and young children. Building on current policies such as Sure Start Scotland, the Childcare Strategy and Starting Well, it promotes an integrated approach to local needs assessment, to service planning, commissioning and funding and to service delivery across key agencies in order to deliver effective, seamless services for young children and their families. In this way we will not only deliver effective universal services, but be able to target those children and families who need extra support, in order to give all children the best possible start in life.

3. This strategy will:

• align Executive policies across Departments to enable a co-ordinated and coherent framework for promotion of the health and wellbeing of children in their early years, and that of their families
• create greater coherence in relevant Executive funding to enable fully integrated early years services delivery
• propose a set of clear outcomes for local partners, targeting health improvement and narrowing the opportunity gap for children in vulnerable and disadvantaged families
• support joint planning, commissioning and single system service delivery of early years services in local authorities and NHS Boards and Trusts
• provide a framework to monitor and evaluate impact drawing on analysis of Children's Services Plans, the NHS Performance Assessment Framework and commissioned research

Who the strategy is aimed at

4. The strategy is aimed at all those involved in planning and delivering early years services such as providers of childcare, pre-school, health and social services - in the statutory, voluntary and private sectors.

Why is support in the early years important?

5. Effective early years support can make a significant difference to the lives of children, families and the wider community. Through universal services such as childcare, health and pre-school provision, we can secure the best start for all of our children, and provide a strong foundation for the future health, learning, personal and social development of our youngest citizens. Universal services can also provide an important route through which to identify children and families who may need more specialist, targeted support to meet particular needs, whether on a short term or longer basis.

6. There is compelling evidence to suggest that patterns throughout life are heavily influenced by experiences in early childhood. A research review carried out by Barnardos Scotland into the management of transitions in the lives of children and young people ¹ identified and described effective strategies in education, social work and health to promote resilience. Resilient children are better equipped to resist stress and adversity, cope with change and uncertainty and recover faster from traumatic events. Among the report's conclusions were that in order to promote resilience in children, services should:

• ensure that well co-ordinated health and social care services are delivered to low income mothers from early pregnancy
• provide reliable lay or professional support to isolated mothers during the child's infancy
• encourage appropriate involvement of male partners in child care
• make available high quality pre-school provision based on sound pedagogic principles i.e. taking account of the needs of the whole child

7. There is strong evidence that early years education and childcare can play an important role in raising cognitive and social/behavioural outcomes and thereby increase the ability to learn. The best available UK evidence, the Effective Provision of Pre-School Education study ², has found that certain types of pre-school provision between 3 and 5 years result in higher attainment at the start of primary school. This result applies to all children, irrespective of socio-economic background.

8. Research shows that experiences in early childhood can heavily influence the rest of a child's life in terms of fitness and health. The Scottish Executive's Physical Activity strategy ³ emphasises the importance of encouraging children and young people to be physically active. It highlights the fact that physical activity is vital for healthy growth. In particular, it can reduce the risk factors for heart disease, diabetes and some cancers, promote the development of healthy bones, a healthy weight and promote positive mental health. Inactive children are at risk of poorer self-esteem, higher anxiety and stress levels, and are also more likely to smoke and use alcohol and illegal drugs than active children. Whilst the direct effects of physical activity on a child's health are important, ingraining the attitudes, skills and behaviours for lifelong physical activity and health are as important.

9. In relation to offending, the importance of early intervention is clear. Some forms of early years provision can have a significant effect in preventing crime. A US study ⁴ concluded that "Government could greatly reduce crime and violence by assuring families access to school readiness childcare programmes".

10. There is ample evidence that risk factors and vulnerabilities in infancy and early childhood are associated with mental health problems in children and young people. These in turn are associated with greatly heightened risk of mental illness in adult life. The ability to improve mental health and well being in the 'early years' is a vital area for action.

11. Targeted services in early years can help tackle inequalities in health, education and social and economic circumstances. It is important to identify children who need help early on. The longer family problems persist, the greater the potential for damage to a child's development. And problems in early life do not go away without some remedial help. The earlier that problems become apparent, the greater the risk that those problems, if left alone, will become entrenched and bring about long-term damage and disadvantage. One research overview showed that about two thirds of three year olds displaying significant behavioural disturbance still had difficulties when assessed at age eight or twelve ⁵.

Relevant current early years policies

12. Key existing policies and programmes in Health, Education and Social care focusing on the early years include the Childcare Strategy, Pre-school Education, Sure Start Scotland, and Starting Well. In addition, mainstream services such as health visitors, learning disability services, speech and language therapy, physiotherapy and occupational therapy are key to effective early years provision, although they do not focus exclusively on young children.

All contribute to one or more of a broad set of objectives which are:

• to improve children's health;
• to improve children's social and emotional development;
• to improve children's ability to learn;
• to strengthen families and communities;
• to reduce barriers to employment, especially for lone parents, since work is the best route out of poverty.

Why is it important to integrate early years work?

13. The strategy document Improving Health in Scotland - The Challenge will set out a framework for action to improve the health of all the people in Scotland and to narrow the health gap in the form of a Challenge. It proposes that a key objective should be to create an integrated programme of health improvement in the early years. This strategy paper responds to that remit.

14. Recent reports (detailed below) highlight that better joined up working across agencies delivering early years services results in better services for those children and families. There is already extensive and diverse support for children and families across Scotland. Many skilled and committed professionals in health, social work and education services and in voluntary organisations are working hard to help families with young children. Whilst there are many instances of good joint working, we know from these reports that there is also much work that is poorly co-ordinated and fails to reach those children in most need.

15. An Action Team of professionals reviewed children's services provided by local authority social work and education departments, the NHS and the voluntary sector, to assess how well they were working together. The Team's report For Scotland's Children, Better integrated children's services, was published in 2001 and set out the strengths and weaknesses in existing services and ways of working. The Child Protection Review ⁶ and the report on support services for vulnerable families with very young children ⁷ also highlighted shortcomings in inter-agency practices. Problems identified were:

• support and services were not always easy to access with families having to approach several different agencies and being asked the same questions again and again
• support may be duplicated; equally some families may fall through the net altogether, and many agencies and professionals can be involved without knowing about the contribution of others
• support may come too late with services failing to intervene until problems are serious and much more difficult to tackle even when the risks are very clear
• some services hold such stigma for both professionals and families that families who need help are too frightened or ashamed to use them.

16. For Scotland's Children, the Child Protection Review and Growing Support all found that services working well together:

• understood and focused on the needs of the service user, and put these needs first
• shared a commitment to working together and a vision of what good services could provide from the perspective of the user
• put that vision before professional or organisational loyalties
• understood and respected the different perspectives, roles and responsibilities of their partner agencies and professionals, and
• used these creatively to identify solutions to partnership problems and cultural diversity
• were willing to share information - for planners this meant clarity about respective priorities and resources; for professionals this meant appropriate sharing of information about assessment or diagnosis, care plans, interventions and progress
• were striving for continuous improvement.

This strategy aims to help progress towards this effective joined-up working across early years service provision. As such, it aims to contribute to Best Value by helping local authorities to deliver better, more responsive public services.

17. To achieve the best outcomes, particularly for the most disadvantaged children, it is essential that all agencies work together effectively. We now have good evidence from Sure Start Scotland that bringing the skills and expertise of a range of disciplines together in an integrated service can bring real benefits for families. These services can provide access to a wider range of more effective supports, reduce stigma and promote reorientation of support towards prevention, health promotion and early intervention.

18. This strategy aims to secure benefits for users and providers of services by achieving more coherence across the existing Executive policies and programmes, drawing these closer together to make best use of available resources and expertise. The benefits include:

• a better service for users in seamless delivery, early preventative action and reduced risk of people falling through the net - providing the right services at the right time
• more flexibility for those commissioning or delivering services
• increased efficiency for agencies, for example by reducing unnecessary repetition of information
• better long-term outcomes for children, for example fewer children needing protection, fewer children offending and reduction of health inequalities.

Section 2 - Where we want to be

19. Some of the specific early years policies already in place are making a significant difference to peoples lives. Our Social Justice Annual Report 2002 reports on progress against milestones to tackling poverty and injustice, and shows that children are now getting a better start in life:

• there is now a free part-time pre-school education place for every 3 and 4 year old whose parents wish it
• Fewer mothers are smoking during pregnancy, and more are breastfeeding
• The numbers of dependant children living in workless households has reduced by 5% since 1997
• The numbers of lone parents in work has increased to 56% from 42% in 1997

20. However, there is still more that needs done to meet Ministers' longer term Social Justice ⁸ goals.

21. All young children have a range of needs that must be met if they are to reach their full potential. These include:

• nourishment
• physical care
• secure attachment to a consistent carer or carers
• stimulation and human interaction
• stable and consistent routines
• opportunities to explore the world around them and have increasing independence
• protection from danger

22. They will benefit from opportunities to learn and play, to live in a safe environment and to be able to access services as and when they need them. The integrated early years strategy will seek to support well nourished, well balanced and healthy children who are well prepared to benefit from education. It will, importantly, seek to promote resilience in children and young people. The child does not have needs in isolation, but in the context of their parents' or carers' needs and situation, and of their wider community.

23. Parents and families have the major role to play in ensuring that their children's needs are met. Children have the best chance of achieving good health, social and emotional development and learning skills when their parents and families provide consistent, reliable good basic care, meet their child's social and emotional needs responsively and are sensitive to the child as an individual, however young. The extent to which all these needs are met will influence the development of the child and the future of that child as an adult and as a parent themselves. This integrated early years strategy will seek to develop confident, competent, well informed and supported parents, including fathers, who feel secure in their role; to reduce exposure to tobacco, alcohol and other drugs for pregnant women; and to increase the proportion of mothers breastfeeding. It will also seek to support improved family circumstances, coping abilities and family mental health.

24. A child's needs will also relate to the community in which they live. Communities that are strong and vital will be more nurturing places for children to grow up and learn. Strong communities will have effective community links, accessible services such as health, education and childcare, good transport options, places to buy good quality nutritious food, decent, affordable housing and low crime levels. Communities in turn will benefit where the families and children who live in them are healthy, resilient, well-adjusted and able to contribute to that community.

25. All public services have a distinctive part to play in identifying how to support parents, families and communities in caring for the youngest and sometimes most vulnerable members of those communities. Local authorities have a responsibility to educate, support and, where necessary, provide homes for families, and to ensure protection for vulnerable children at risk. Health services have a responsibility to provide health care when it is needed, promote good health, through education, advice and family support, and tackle the causes of ill health and health inequalities. Voluntary sector services can augment the responsibilities of statutory sector agencies by developing innovative and creative ways of meeting families' needs and increasingly by providing services directly on behalf of statutory agencies. Community bodies can build empowerment and a sense of ownership, and independent or private organisations have a role to play in meeting demand for services such as childcare. The more that agencies join-up to provide the services to meet the various needs of families with young children, the more those needs can be met in a seamless way and we can ensure that children are not "lost" in the system.

26. What we want to achieve is a future where our children are happy, healthy, safe and able to achieve their full potential from early childhood into adulthood; where families are strong and supportive; and where our communities are thriving and vibrant. The provision of flexible and responsive services provided by a range of agencies in an integrated, joined-up way is essential to the achievement of this vision.

27. Elimination of discrimination and promotion of diversity, equality of access and opportunity should be the hallmark of quality early years services. Services should be accessible and affordable to all, including key interest groups such as lone parents (including students), ethnic minorities, young parents, looked after children, asylum seekers, deprived and vulnerable children, children with multiple needs, children affected by substance misuse, disabled children and their families and homeless children.

Section 3 - How do we get there?

28. We want all of our children to have the best start in life. This is particularly important for those children who start with reduced life chances. This may be because their families are more vulnerable as a result of disability, substance misuse or health problems. It may be because they live in a deprived area, or in a remote rural area. It may be because the parents are young, or are lone parents or are from minority ethnic groups, all of which may lead to social isolation and increased vulnerability. That is why the Executive has set the key target in the Scottish Budget 2003-2006 to ensure that at least 15,000 vulnerable children under 5 will have an integrated package of health, care and education support that meets their needs by 2006.

29. This strategy seeks to support this through the following 5 building blocks:

• align Executive policies across Departments to enable a co-ordinated and coherent framework for promotion of the health and wellbeing of children in their early years, and that of their families
• create greater coherence in relevant Executive funding to enable fully integrated early years services delivery
• propose a set of clear outcomes for local partners, targeting health improvement and narrowing the opportunity gap for children in vulnerable and disadvantaged families
• support joint planning, commissioning and single system service delivery of early years services in local authorities and NHS Boards and Trusts
• provide a framework to monitor and evaluate impact drawing on analysis of Children's Services Plans, the NHS Performance Assessment Framework and commissioned research

Aligning Executive policies

30. Existing Executive programmes, such as Sure Start Scotland, the Childcare Strategy, the provision of free pre-school education for all 3 and 4 year olds whose parents wish this, and the range of initiatives funded through the Health Improvement Fund, all make a vital contribution to the quality of life of young children and their families, and to their future prospects. In addition to these services specifically focused on young children and their families, it is also important to consider the range of broader universal services such as GPs and health visitors. For Scotland's Children emphasised the importance of ensuring inclusive access for all children to relevant universal services in health and education.

31. The Childcare Strategy and the provision of free part-time pre-school education are universal programmes, intended to reach all those who wish to use these services. High quality, affordable, accessible childcare should be available from the earliest age, and from age 3 years to entry to primary school, should include wraparound provision, in order to complement part-time pre-school provision. (Childcare for school age children is examined in detail in the Executive's document "Schools Out" published in February 2003. ⁹) High quality childcare is essential for parents to access employment opportunities, and also contributes to children's social and personal development. Childcare must be able to meet the different needs and individual circumstances of all families across Scotland. This means that childcare policies must be informed by, and link in to rural policies, social justice policies and wider education policies such as the development of New Community Schools.

32. Sure Start Scotland and other targeted initiatives provide a range of additional services to support vulnerable families, building on, and complementing, universal social care, health and education programmes for early years. Support through Sure Start Scotland covers a diverse range of provision for families and very young children such as centre-based support, childcare, outreach services, nursery and day care services. It also provides an important means of delivering a range of support to parents, such as peer support groups and a wide range of parenting skills classes. The Starting Well health demonstration project, and the recently-announced social justice funding for employment and childcare are further examples of targeted initiatives designed to improve the life circumstances of some of our most vulnerable citizens. Further details of all these initiatives are in Annex 4.

33. A range of further support is available through services such as health visitors, learning disability services, speech and language therapy, physiotherapy and occupational therapy. Building on this range of health work, the new national heath education and promotion organisation, NHS Health Scotland, will develop a framework of education materials and resources to underpin the family health plan for family support. NHS Health Scotland is reviewing education and support for parents in the antenatal period and will work with the Executive to redesign antenatal support with the aim of making this more attractive to a wider range of families, and in particular those who need additional support to access services. The Executive will work with NHS Health Scotland and other partners in the NHS, local authorities, employers and industry to strengthen measures designed to encourage breastfeeding and develop greater community support for breastfeeding. The Executive will also issue national guidance in autumn 2003 in response to the recommendations in the Hall 4 report which argues for a reduction in programmes of universal surveillance on the basis that there is little robust evidence of clinical benefit or health gain.

34. We must now build on all these important developments, by thinking of them as the components of a single service directed towards young children and their families, and by exploiting the linkages between them. This requires a new approach to how we use existing funding sources, to how we plan and deliver services and to our understanding of their purposes. These issues are developed below.

35. We specifically want to avoid creating any artificial barriers between early years and other services. It will be important to ensure that joint working extends to enable better integration of early years services with other children's services, so that children are able to make smooth transitions, for example moving from pre-school to primary school or a vulnerable family continuing to receive support once their child has reached the age of 5. So we need to continue to ensure strong links with new community and health promoting schools and out of school care.

Securing greater coherence in funding

36 .All organisations have argued strongly for greater coherence between Executive initiatives and central funding, and the capacity to use central funding more flexibly to support cross-agency working, rather than meet tight Departmental objectives.

37. The Cabinet Sub-Committee on Children's Services, chaired by the First Minister, is taking forward work on integrating children's services and developing a more integrated and outcome focused approach to resources as a key part of this. There are significant resources being invested in the range of early years services and under the Scottish Budget 2003-2006 these are set to rise further. Some of this funding is directed to local authorities, some to NHS boards, and some to the voluntary sector. Some is available jointly to all three sectors. We have tested this approach through the Changing Children's Services Fund. A more outcome focused approach is being piloted through pilot local outcome agreements with local authorities in education and children's services.

38. To support integrated service provision across early years services, we propose to align some of the resources currently allocated to different agencies by the Executive against a common set of objectives. These include the following funding streams:

• funding for Sure Start Scotland
• follow on funding from the national health demonstration project Starting Well
• a proportion of resources from the Health Improvement Fund
• funding for child care for 0-5s through the Childcare Strategy
• funding for pre-school education.

39. We will still channel resources to local authorities and Health Boards in the normal way. However, we expect local authorities and Health Boards to focus these resources on services which will be jointly planned and agreed by all partners, and to deliver against a common set of outcomes and objectives.

40. For the longer term more ambitious proposals might be considered, building on the work of Community Planning partnerships. This should help highlight and tackle some of the institutional and organisational barriers to effective joint working and improve services to children.

41. Providing greater coherence in Executive funding, reducing perceived barriers and agreeing a common set of outcomes across early years policies will allow agencies greater flexibility. Existing early years policies are already working towards::

• meeting the Scottish Budget target of ensuring that at least 15,000 vulnerable children under five have an integrated package of health, care and education support which meets their needs;
• providing a free part time pre-school education place for all 3 and 4 year olds whose parents want one;
• ensuring that everyone who wants it should be able to access affordable, high quality childcare;
• ensuring every family with a new-born baby should have an assessment of their family's needs for health care, advice and continuing support by a trained health professional within the first weeks of life (which will provide an initial building block for ensuring an integrated package of support is in place); and
• providing targeted support for families with children aged 0-3, particularly the most vulnerable and deprived.

Provided the funding is still used in pursuance of meeting these fundamental aims, agencies will have the flexibility to look at all the programmes as one overall pot of money for early years services, working towards the following set of common outcomes.

Developing a common set of agreed outcomes

42. To deliver a more joined-up approach to early years, it is important to identify a single common set of outcomes against which the range of these initiatives can be measured. These outcomes will feed into Children's Services Plans, the NHS Performance Assessment Framework and any early years research which the Executive undertakes (see paragraphs 59-64 on monitoring and evaluation for more details). These outcomes must ensure that agencies are reaching all children by providing inclusive, universal services, but must also effectively close the opportunity gap and target more vulnerable and deprived children and families. Outcomes must be based on making a difference to service users, and must be capable of measurement.

43. The core outcome measures we propose include a number of measures already identified, for example through the Social Justice Annual Report. But we have also included some suggested outcomes which we consider to be of particular relevance to early years interventions, and these are marked with an asterisk below (for further detail on the outcomes, such as data sources, see Annex 5). We have grouped the suggested outcomes under the broad set of objectives underlying the main early years policies, as outlined in paragraph 12. While outcomes are listed under one particular objective, there is frequently overlap with the other objectives. Later in Section 4, we will be seeking your views on these outcomes, particularly whether they will allow us to measure whether we are successfully targeting the more vulnerable; and on the mix between 'hard' quantifiable indicators and 'softer' qualitative data.

To improve children's health

• Increase the proportion of women breastfeeding
• Reduce the proportion of women smoking during pregnancy
• Reduce the percentage of low birth-weight babies
• Reduce dental decay among 5 year olds [increase number of 5 year olds free of dental caries]
• Improve children's diet
• Reduce infant mortality rates

To improve children's social and emotional development

• Increase the proportion of children aged 5 years old with normal levels of personal, social and emotional development for their age*
• Increase numbers of children reaching the recommended levels of physical activity
• Reduce referrals to the children's hearings system

To improve children's ability to learn

• Increase the educational attainment of all children by increasing the proportion of pupils in P3 achieving or exceeding Level A in reading, writing and mathematics.
• Increase the educational attainment of the lowest attaining 20% of the school population by reducing the proportion of pupils not attaining Level C by the end of P7.

To strengthen families and communities

• Improve parenting skills, including those of fathers, through increasing the number of parents accessing support and learning opportunities, including parenting skills*
• Reduce the level of child injuries, including fatalities
• Reduce rates of post-natal depression, self-harm and suicide in new mothers through increased early intervention

To reduce barriers to employment - especially for lone parents, since work is the best route out of poverty

• Reduce the number of children living in workless households
• Increase access to, affordability and availability of suitable childcare provision, particularly for disadvantaged groups including lone and student parents, rural families, families affected by substance misuse and families in poverty*.

Supporting joint planning, commissioning and single system service delivery of early years services

44. We have discussed the outcomes that we think will enable us to begin to measure whether a child is happier, healthier and safer. To achieve these outcomes requires agencies to continue to build and develop effective joint working - right through from planning and auditing need to delivery on the ground.

45. Scottish Executive guidance on developing Children's Services Plans stresses the importance of involving the range of agencies concerned at the planning stage (revised guidance was issued in October 2001). While the Children (Scotland) Act 1995 holds local authorities to account for producing the plan, is important that all service deliverers - including health boards and voluntary organisations - participate in the planning process. We asked NHS Boards to align their strategies for child health in Local Health Plans with the local authority-led Children's Services Plans. In some areas this is already happening. Community planning will provide further impetus for this joint approach to planning. The Local Government in Scotland Act 2003 places a duty on local authorities to initiate, facilitate and maintain the community planning process and a duty on key public bodies such as NHS Bodies to participate.

46. The voluntary sector should be an equal partner in the planning and delivery of children's services. The voluntary sector can contribute significantly through the ability to attract additional resources; the commitment made by volunteers; drawing on the easier relationship that exists in some circumstances between children and young people and voluntary organisations; experience of service delivery and working with children and families; and experience of innovative and flexible approaches. For Scotland's Children found that tendering exercises were absorbing staff and financial resources that could be better directed towards service provision. The Executive has recently issued guidance for consultation on funding arrangements between the voluntary and statutory sectors (local authorities and the National Health Service) in children's services. This provides guidance on the variety of possible approaches to funding.

47. Service users should be central to any decisions taken about their needs and how they should be met. Parents and families and/or groups who represent them must be involved in the planning and delivery of all children's services - including early years services. The views of parents, and where appropriate, children, should be actively sought and should inform decisions about service planning and delivery. The views of parents are essential to the development and delivery of accessible and, in the case of childcare, affordable early years services. All families need to know that they can access flexible, responsive services, which are able to adapt to the changing needs of families and children, whatever their current life circumstances.

48. Childcare Partnerships continue to play a key role in helping local authorities to identify unmet childcare needs locally and contribute in this way to the development of Children's Services plans. They also provide a valuable vehicle for engaging key stakeholders, including the voluntary and independent sectors and service users, in the process of planning children's services. We may need to re-examine existing planning mechanisms to ensure that the wider range of early years interests reflected in this strategy are involved fully in service planning. This might be achieved through the creation of an Early Years Planning Forum in each local authority area - which could be created through a refocusing of the remit and membership of Childcare Partnerships. Alternatively, Partnerships might continue in the current form, but operate as a sub group of any future Early Years Planning Forum. Local areas would need to consider the best way forward, in the light of local circumstances. We would welcome views on these proposals.

49. Joint commissioning and resourcing is an important way of joining up agencies' work in the delivery of early years services. Local authorities are receiving significantly increased resources for early years services over the next 2-3 years. Under the Scottish Budget 2003-2006, funding for Sure Start Scotland will rise to 50 million and funding for childcare will rise to 40.65 million by 2005-06. The best way of delivering against the outcomes outlined in paragraphs 42 and 43 above may well be to pool some of these resources with partners to deliver key inputs. For example, local authorities and health boards might consider pooling resources to expand health visitors' services for families and children.

50. We have already learned a great deal about the challenges and benefits of joint planning and commissioning from implementing the Joint Future agenda in community care, and from developing local projects for health improvement in the first round of expenditure of the Health Improvement Fund, many of which were linked to local authority services in New Community Schools or community resources. We now need to apply these lessons systematically to early years services.

51. Single service delivery in early years services will involve a range of inputs and activities from a range of agencies - covering childcare, health visitor support, family centres, outreach support to parents of very young children etc - which are covered by the existing policies and initiatives described in paragraphs 30-35 and at Annex 4.

52. The Executive is also seeking to develop additional tools to help more effective integration of all children's services - including early years services. In particular, we are developing a national framework for children's assessment and piloting approaches to develop an off-the shelf model for national use. This will be of particular use in the delivery of services to very young children and their families. And we have recently produced good practice guidance to a range of agencies working with children and families affected by substance misuse ¹⁰.

53. Ministers recognise the crucial role that well-qualified and highly motivated staff play in delivering the vision of high quality, integrated services that give children and young people the opportunity to have the best possible start in life. Over the next few years, our priorities for the early years and childcare workforce are to:

• increase the number of qualified workers;
• expand the workforce and widen opportunities for training;
• encourage both progression up the career ladder, and also lateral movement across the early years and childcare sector as a whole;
• encourage diversity among the workforce that better reflects society.

54. The Scottish Executive is currently developing a workforce strategy for the early years childcare workforce. This will outline options for securing the competent, qualified and well-regarded workforce we need. We know for example that there is considerable competition for staff across the early years workforce particularly at the lower levels of qualification. We know, too, that many workers are lost to the workforce, often citing poor career prospects or pay as the reasons behind this. The early years workforce strategy will seek to address these issues. It will examine training and qualifications issues, career paths and progression routes, the status of the workforce and recruitment/retention issues. Whilst pay and conditions are a matter for employers, these too are critical factors affecting workforce development and expansion. In addition, the Scottish Executive is working with other UK Departments and stakeholders to developing Sector Skills Councils which can best address the issues facing the early years and wider children's services workforce.

55. This is set against the backdrop of the forthcoming requirement for the early years and childcare workforce to register with the Scottish Social Services Council (SSSC). In order to register with the SSSC, individuals will need to hold, or be working towards, an accredited qualification.

56. Integrated service delivery however is dependent on a wider range of staff than the childcare and early years workforce. In particular, it depends heavily on joint delivery of services by health and social care staff.

57. Although there are many examples of good working relationships and effective joint working between the different professional groups involved in delivering early years services, this is not universally the case. Tensions between professions, can arise as a result of misunderstandings of one another's roles, or negative experiences in the past, or different professional and organisational cultures. Such tensions can have a negative impact on the extent to which services are genuinely integrated, and can thus have an adverse effect on the quality of the experience for children and families. Joint training, as part of the continuing professional development of workers from different professions is one way to counteract these tensions. Other options include work-shadowing, secondments and similar arrangements. Service providers will need to look closely at how they can address these issues locally in the short term in order to secure the best possible outcomes for children and their families.

58. Examples of a range of best practice in joining up service delivery are attached at Annex 3. There is a range of mechanisms in existence or being developed to enable learning about best practice and what works. NHS Scotland is establishing an Early Years National Learning Network to bring together and disseminate evidence and information to all professionals working with young children about what works, with examples of promising practice and to support wider implementation of lessons learned. NHS Health Scotland in partnership with Aberdeen University is also supporting a national centre for research - the Scottish Evidence Based Child Health Unit - to review and bring together evidence about effectiveness in promoting health in children and young people.

Monitoring and evaluation

59. Monitoring and evaluating progress against outcomes will be crucial in gauging whether we are succeeding in reaching children. Ensuring effective evaluation will depend on the use of all the existing mechanisms at our disposal, as well as new research which is planned.

60. We will continue to monitor progress against the range of identified existing outcomes. The Executive will also continue to review Children's Services Plans to assess how far services are being jointly planned and targeted on the needs of children, particularly the most vulnerable. The guidance will be reviewed this year to take account of developments and experience. The Performance Assessment Framework (PAF) forms the mandatory core framework for assessing the performance of the NHS in Scotland and provides the stimulus for continuous performance improvement. The PAF is NHS-focussed and therefore doesn't cover every specific area of health activity in Scotland. However, there are a number of key indicators relating to children - including low birthweight babies, breastfeeding rates, immunisation uptake and dental health.

61. It is always difficult to attribute outcomes to early years intervention. Economic development, demographics, and social trends could have a significant effect on eventual outcomes. In terms of new research, the Scottish Executive has recently commissioned consultants to conduct a feasibility study as the first stage of an early years evaluation. The early years evaluation will examine the effectiveness of early years policies in achieving their key objectives of bringing about beneficial changes in the lives of young children, their families and communities. If the feasibility study is successful, the evaluation (stage 2) will be commissioned in the latter part of 2003. The rationale for having a feasibility study first is that we need to establish that there are sound sources of available information on which indicators for a range of early years policies can be based. The consultants will then construct a draft evaluation framework based on this information. The feasibility stage should illuminate a number of the data issues relating directly to the outcomes outlined in this strategy and the output of this research has the potential to inform the way the selected outcomes should be monitored in future.

62. The Scottish Executive is also planning a Long Term Data study, the primary aim of which is to collect data about children and families (including particularly their experiences and views) in order to study the longer term outcomes of early years policies. The scoping element of this major initiative is now being developed and will be specified to consider the specific data requirements outlined in this strategy.

63. Both the early years evaluation and the long term data study will explicitly address the difficulties of obtaining information from the vulnerable and "hard to reach" groups (specifically ethnic minority parents) who form an important target group for many early years policies.

64. This strategy aims to deliver a network of services and support which will reach all young children and their families but target most intensive help on those with additional needs, including families who are vulnerable because of social exclusion, disability, ill-health or other disadvantage. Setting this network in place will rely on the fostering of integrated approaches in early years services by and between all service providers. To facilitate this process, the Executive is committed to removing barriers to action, both within the Executive and in other agencies. Many NHS Boards and Trusts, local authorities and voluntary organisations are already working hard to make joined-up services a reality. This Early Years Strategy is the next logical step on the road to rolling out and enabling this approach across Scotland and begins to take us some way towards the community planning model.

Section 4 - Conclusion

65. This strategy discusses the reasons why early years support is important; and why it is important to integrate this work around the needs of the young child and their family. The Executive would welcome your views on the following proposals for how we can better integrate early years services to improve outcomes for young children:

Aligning Executive policies across Departments and creating greater coherence in Executive funding

• What more might the Executive do to improve coherence between funding streams?

Proposing a set of clear outcomes for local partners

• Are the proposed outcomes the right ones to let us measure if we are successfully meeting the needs of children in the early years?
• Are there any that you think should be added in and if so, are they capable of measurement?
• Will the proposed outcomes allow us to measure if agencies are successfully targeting the needs of more vulnerable and deprived children and families?
• Is there the right mix between "hard" quantifiable indicators and "softer" qualitative data?

Supporting joint planning, commissioning and single system service delivery

• What changes might be needed to planning mechanisms to ensure that the range of early years interests reflected in this strategy are involved fully in service planning? What would this mean for the role of childcare partnerships? Would early years planning fora provide a way forward?
• What barriers are there to developing and delivering integrated early years services in your area? What changes and actions would remove these barriers and improve service delivery? How far would the proposals in this draft strategy help?

Providing a framework to monitor and evaluate impact

• Are the proposals on monitoring and evaluation sufficient to ensure we are making progress against the set of outcomes?
• What might agencies need to help them adequately monitor their performance?
• How can existing good practice and research relating to integrated service provision in the early years be better shared and disseminated to and between all service providers and agencies? It would be helpful if you could give any examples of service provision that, in your view, particularly demonstrates good practice.

66. A response sheet setting out these consultation questions, together with contact details, is at Annex 6.

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