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Between strategy and delivery: how the whole-system view helps to build stronger plans and partnerships


8 Mar 2022

Gail Barker, health visitor professional lead at Devon County Council, reflects on the process of using the EIF maturity matrix to assess their local early childhood system, and how this learning has been fed through into decisions and changes at a strategic and partnership level.

As health visitor professional lead, it is great to have the opportunity to consider how our local system works together to support the outcomes of children. Often it feels that there is a gap between high-level programmes and the actual experiences of those receiving a service, that these are not always presented together as one system. Working with EIF and using the EIF maturity matrix provided an opportunity to close this gap: to evidence the link between the Best Start in Life programme and the actual delivery of care that impacts on the outcomes of children and young people experiencing that care.

This self-assessment gave us a chance to reflect, and to consider how well the whole system works together to influence children and young people’s outcomes. The system in Devon includes a range of voluntary, community, statutory and provider organisations. To coordinate any multi-organisational self-assessment you need direction and leadership to drive it forward. Our Best Start in Life project – comprising representatives from public health, children’s services, public health nursing, maternity services, Action for Children (our children’s centre providers) and CCG services – provides this element.

I undertook part of this self-assessment, focusing on my area of health visiting delivery. Other partners focused on their areas of specialism, each aiming to evidence intervention and outcomes, while considering how we can evaluate these. As a rural county, Devon has a large population with varying needs and complexities. It has hidden deprivation and rural isolation, alongside a crucial mix of community and voluntary services.

The process itself was detailed and thorough. We had to ask ourselves how we evidence that this assessment and intervention makes the difference in a child’s life when there are multiple variables, and how we know this approach is the right one for that child. This might sound easy. But after hours of looking at service delivery and outcome measures, alongside questions of social deprivation, health inequalities and the number of touch-points that families, children and young people have with the system, you soon reflect that systems are messy and complex, and that interventions and outcomes can be hard to evaluate, given the changeable nature of children’s development and the timespan involved. The structured matrix tool provided a methodical framework to help us think through the system and the outcomes. It forced us to look beyond individual children and focus on the whole population, whole-system interventions and their outcomes.

This process, in turn, helps with strategically shaping the objectives and actions for our Best Start in Life programme. It gives structure and direction to this programme, with the ultimate aim of ensuring that it connects with real-world experience for children and young people. It allowed us to consider how we can broaden our strategic partnership engagement, while building up capabilities in early identification, early intervention and evaluation to meet children, young people and their families’ needs. It also informed Devon’s bid for the DfE Family Hubs transformation programme.

As health visitor professional lead, I sit between the strategic discussion and practical delivery. This enables me to reflect from a certain viewpoint on how this work continues to impact on the families within our system. The learning from this process continues to inform multiagency working across Devon, including the development of Devon’s Vulnerable Pregnancy Pathway and the Helping Us Grow Supported (HUGS) programme, both of which sit strongly within early help. It has influenced consideration of outcomes within our refugee and asylum-seeker work, and our children with speech and language challenge, as well as universal interventions, such as self-weigh-in libraries during ‘Bounce and Rhyme’ sessions, which help to promote early language development and parent child bonding.

The opportunity to evaluate a whole system is an opportunity to reflect and develop, but I’m convinced it should not be used in isolation or as a one-off. Here in Devon there is plenty more reflection to be done, and as health visitor professional lead I welcome that opportunity.