Cambridgeshire: System-wide integration to improve ease of access to services for families

Recognising that helping families across the whole of Cambridgeshire could lead to better outcomes, Cambridgeshire County Council and Peterborough City Council began working together on an Early Years Strategy in 2017, in partnership with colleagues across the children’s health system and communities. The two local authorities collaborated to deliver the Best Start in Life strategy, a strategy for supporting families during the crucial conception to aged 2 period. Following the publication in 2021 of the Government’s The Best Start for Life – A Vision for the Critical 1001 days report, the Early Years Strategy was revisited.

Unlike its neighbouring local authority, Peterborough, Cambridgeshire does not receive Family Hubs and Start for Life programme funding. However, Cambridgeshire County Council has still chosen to move towards the Family Hubs model. The teams in both LAs have worked collaboratively to integrate services to ensure that families within the local area receive the support they need. This involved improving integration across early years, education, health, social care and voluntary sector organisations to deliver Family Hubs and Start for Life services across both areas. By doing so, the joint team aimed to build a sustainable model for service delivery, which was responsive to the needs of families within the local area.

1. Build desire for the system to integrate: The team recognised that the first step to achieving integration was gaining buy-in from system partners across the county and being aware that they all had a shared vision. This vision was to ensure that “every child will be given the best start in life supported by families, communities and high-quality integrated services”. The recognition that this vision could be better delivered if services worked together was the starting point for the work on integration.
2. Introduce co-ordination lead: Cambridgeshire County Council hired a staff member to coordinate the central integration of services and this proved to be crucial. This central coordination capacity was helpful in supporting services in overcoming their individual priorities and working towards the shared vision. The role of this staff member was also to identify opportunities where services could better integrate. For example, the health visiting service within Cambridgeshire was developing a “Getting Ready for Change” questionnaire to send to families with children of reception age. The early years team also had similar resources used across early years settings to support school readiness. Having this central coordination role meant that opportunities to achieve synergies through integration were recognised and acted upon; “there was a challenge back saying actually we think this will be strengthened if we work together on it.” Additionally, five key workers were recruited within Cambridgeshire. Key workers were tasked with building relationships with families from the antenatal period and connecting them to the relevant services that could best support their specific needs.
3. Develop a system-wide information sharing agreement: This included all partners within the system (for example, hospital trusts, the local authority, public health, health visiting and the voluntary sector).
4. Ensure consistent messaging across services: Feedback from families suggested that they had received mixed messages from practitioners, which was confusing. Therefore, the joint team focused on ensuring consistent messaging across services. Furthermore, to ensure that practitioners are “speaking the same language” to families, underpinning training has been implemented as it was identified that practitioners were often unsure which approach they were using; “So if we’re introducing a new way of working together, such as Pathway to Parenting in the area, the first thing we’ll do is go, ‘who are the workforce? Who is going to be doing this? How do we make sure they’ve all got that same underpinning training and bring them together to train on what that whole programme is going to look like?’” To address this inconsistent messaging more generally, the joint team implemented a workstream focused on communication. They developed a logo that visually signals to families that services are part of the wider Family Hubs model rather than individual elements. Additionally, they developed a joint social media plan in collaboration with partners across the system to ensure consistent and impactful messaging.
5. Use shared online resources across partner agencies: For example, Cambridgeshire’s ‘50 things to do before you are 5’ app offers resources, advice and guidance that can be accessed in one place to help parents prepare for birth and parenthood. The app is promoted by partners across the early years system, including within Family Hubs and by health visitors.
6. Use data to create join up: Analysis of local data from across Cambridgeshire and Peterborough suggested that more work was needed to identify at risk pregnancies, so the team worked with local midwifery colleagues to ensure better join-up. The team now receive 20-week scan data to get early information on at risk pregnancies. This has enabled them to identify women who would benefit from information and advice on preparing for parenthood.
7. Introduce regular touchpoints for colleagues to come together: To support integration of services across the county, colleagues are brought together physically. Team managers from across the system are encouraged to get to know each other, meet regularly, share learning and develop plans to continue to work well together moving forward.
8. Strengthen underpinning structure: The team reflected that they have a structure which supports integration. The Partnership Board was well established and encompassed representatives from across the system (e.g. children’s services, education, health trusts and maternity providers). Underneath that board are various networks, all of which have their own integrated strategies that feed back up into the board. These include but are not limited to:

• an infant feeding network;
• a perinatal mental health network; and
• a school readiness network.

Impact on services: The team noted that the integration of services across Cambridgeshire local authority teams, health and community partners has laid the foundations for a more sustainable delivery model. This is helping to offset the difficulties in expanding interventions due to not receiving funding through the Family Hubs and Start for Life programme.

Impact on families: Improved integration in Cambridgeshire allows services to be more responsive to families’ needs, regardless of where they live in the county. In addition, key workers are helping to guide families towards relevant services to ensure their needs are met. The team have worked to raise awareness of the role of these key workers across services, leading to an increase in referrals. Key workers also help to improve continuity of care. The team provided an example:

“Perinatal Mental Health services referred three women with serious mental health issues who were being discharged from their service. Key workers were then able to connect them, stay with them and hand hold them into community support and ease them on to the next stage after that discharge.”

Anecdotal evidence suggests that parents feel supported by key workers, who provide them with personalised care based on the individual needs of families. Additionally, the information sharing agreement prevents families having to repeat their story to multiple practitioners.

Impact on staff members: Integration has supported staff in building system-wide knowledge and skills, leading to an increased understanding of the services being delivered across the areas and the appropriate service delivery team to refer families to. It has created and solidified bonds across different services, with staff members building trust and mutual respect for each other as their awareness of other roles and responsibilities has increased. Similarly, the introduction of the information sharing agreement, which all parties signed, provided reassurance to frontline practitioners that it is safe to share information on babies, children and families to ensure their needs can be met.

Impact on the wider system: Relationships with the wider system have improved, enabling the team to take advantage of opportunities for improvement. For example, conversations with Oral Health Commissioners revealed a need to revisit the Supervised Brushing service. The team worked together to identify relevant individuals across the wider Early Years team to undertake Oral Health Accreditation for Family Hubs. As a result, more early years settings are trained to deliver supervised brushing and a range of complimentary activities supporting oral health are provided to parents. The team is also leveraging relationships with Public Health to ensure they have all the information required to support families with oral health.

Throughout the Best Start in Life delivery, there were dedicated colleagues across Cambridgeshire and Peterborough who focused on understanding and integrating the voices of families into service improvements. This proved to be a successful approach. The team are committed to continuing to include the voice of families, particularly amongst underrepresented groups, throughout the delivery of their services.

This case study has been produced by the Start for Life Unit within the Department of Health and Social Care, in partnership with RSM and Cambridgeshire County Council . By sharing promising examples of delivery, we hope to facilitate connections between LAs across the country and support local delivery of Start for Life services. For further information please contact familyhubs.startforlife@dhsc.gov.uk

The data included in these case studies is self-reported by Local Authorities and has not been quality assured by the Department of Health and Social Care. The views expressed are those of the authors and not necessarily those of the Department.