Healthy Surrey:

Healthy Surrey

Best Start for Surrey Strategy 2022 - 2027

Supporting services in Surrey to promote improved outcomes for Surrey families throughout pregnancy and early childhood.

Foreword

The Best Start for Surrey Strategy is for everyone who wants babies and children to have the very best start in life. The Strategy starts with families and brings together the work of midwives, health visitors and other health professionals; child minders, day-care providers, and other early years settings; libraries; family support services and social care; and private, voluntary, and independent providers of all the other activities families with young children participate in.

This strategy is ambitious. It will challenge barriers that currently exist that can prevent families getting the services they need. This will make a real difference to pregnant women and other pregnant people, babies, children, parents, carers, and our workforce. This strategy evolved from the realisation that services alike had shared ambitions and a common focus on getting the best outcomes for families. By creating a single overarching strategy that draws together the First 1000 Days, Early Years, Inclusion and the Special Educational Needs and Disability strategies for 0–5-year-olds, we can improve what we offer to families within their communities and neighbourhoods. This enables everyone to access truly universal services and support provided by knowledgeable, experienced, and caring staff.

Our aim for the Best Start for Surrey Strategy is that families are empowered to make the choices that are right for their lives. The strategy can't possibly detail all the great work already happening for babies, children, and families at every stage from pregnancy to age five. Instead, it focuses on how we will all continue to work together in partnership for the benefit of Surrey's families. Every family in Surrey is at the heart of this Best Start strategy. Parents and carers, professionals and wider partners all have a role to play in the strategy's development and delivery over the next five years. We want families to know and experience the importance that everyone in Surrey places on giving our children the very Best Start.

"Science shows that life is a story for which the beginning sets the tone. That makes the early years of childhood a time of great opportunity, but also a great risk. Children's brains are built, moment by moment, as they interact with their environments (and caregivers). In the first few years of life, more than one million neural connections are formed each second – a pace never repeated again. The quality of a child's early experiences makes a critical difference as their brains develop, providing either strong or weak foundations for learning, health, and behaviour throughout life." Unicef, Early Childhood Development

Rachael Wardell
Executive Director of Children, Families and Lifelong Learning
Surrey County Council

As part of Surrey County Council's commitment to environmental sustainability, we want to encourage readers to use this online version, but you can download a copy of the Best Start for Surrey Strategy (PDF) if needed.

Introduction

Why is the pregnancy and early childhood period so important?

Babies start learning about their world from the moment of conception onwards, through the sensitive responsiveness of their parents, siblings, carers, and wider community. Even during pregnancy, babies are listening to and recognising the voices of their family and taking in whether their environment feels calm, safe, and welcoming. When we follow their unique signals and needs from the start, babies learn healthy rhythms for sleeping, eating, movement and being able to take delight in those who care for them.

As human beings we have many intense emotional experiences, and our babies and young children are not excluded from life's richness and intensity. At times it can be even more overwhelming because babies and young children are biologically and psychologically dependent on adults to respond and help them process and make sense of their experiences. Supporting parents and carers is key if we are to enable children to have a best start in life. In all truthfulness, being a parent or carer of a baby or young child is consistently intense, worrying, exhausting, relentless and, if we are lucky, peppered with moments of joy. Parents need a community of other families to share this journey, and benefit from supportive, accessible, and thoughtful universal and specialist services in their neighbourhoods when needed so they can be the parents they want and need to be for their children. All parents want their children to be happy and healthy and in Surrey we want to enable each baby, child, parent, carer, and family to have the Best Start possible.

There is an important golden thread that runs throughout pregnancy and the early years, that has a significant impact on children's lifelong health and wellbeing, which is the quality of their relationships with their attachment figures (parents, close family, and carers). What we know is that in the first 1000 days of life (conception to age two) the main foundation stone for babies is to form secure relationships with sensitive and responsive parents and carers in nurturing environments at home and in the community. In the second 1000 days (age two to age five) toddlers and young children are often developmentally ready to engage with exploring their world and asserting their need for independence. In order to do this successfully they need their parents and carers to support them with learning how to manage intense emotions in response to daily life experiences.

stock image - familyFrom pregnancy into the early years, access to good relationships with GPs, midwives and health visitors helps to identify and support any needs or difficulties early. Good quality childcare and early education provision is an important part of the child and family's network and helps to lay the foundations for all education yet to come and helps to improve outcomes for children. In creating and supporting early years provision in every community, we can ensure that children have a nurturing environment where they are able to develop a love of learning and the opportunity to develop relationships with peers and other adults. Local access to parent and toddler groups and other family-based activities creates relaxed and confident families, and happy, healthy children.

For children with additional needs in the early years we want to guarantee early identification and intervention through access to services. We know that having a child with an additional need (SEND) sometimes adds to the support families need. We want to ensure that families are empowered to make informed decisions for their child.

As parents, practitioners, and communities we all influence the experiences of babies and children from pregnancy onwards by the way we listen, show kindness, understand, and meet the myriad needs of families. We know that we can make a difference to children's lives beyond the age of five, however these early days are the greatest opportunity to make the biggest difference to babies and children starting life well.

Our approach

The Best Start strategy articulates how we, as a network of partners and organisations across Surrey, work in more integrated and collaborative ways for the good of the families who live here. When we use the term 'families', we are referring to pregnant women and other pregnant people, babies, children, parents, extended family members and carers.

We value the Time for Kids Principles that we collectively signed up to and seek to build upon the fantastic work already underway that supports families during their pregnancy and early years.

We want to consider how improved co-ordination enables us to identify gaps and improve services to ensure that no one is left behind. For those in our communities who experience health and economic inequalities and those who have been further disadvantaged as a result of Covid-19, we want to ensure an equitable system.

The Best Start Strategy will be:

  • Family focussed – We will put the everyday lived experience of families and what we can do to improve
    their lives at the heart of all we do.
  • Inclusive – We will develop ways of working together which take account of the needs of all and enable improved equity of opportunity.
  • Proactive - We will identify needs as early as possible (upstream focus) and respond to the unique needs of each family at the right time, in local communities/neighbourhoods.
  • Co-produced – We will work in collaboration with children, parents and carers, and partners in design and delivery.
  • Collaborative – We will respond to opportunities and challenges by working in partnership.
  • Strengths based – We will help families to build strength and resilience through providing good access to information and support.
  • Place based – We will understand the unique assets, resources and challenges of different neighbourhoods and tailor our approach to services.

Pregnancy and early childhood in Surrey

What is the pregnancy and early years system?

The pregnancy and early years system is a term used to describe all the organisations and services that may come into contact with a Surrey family – from the day their baby is conceived, throughout pregnancy, until their child reaches the end of reception year at school.

Families at the heart of this strategy

We know that families play a vital role in service design and delivery, which is why we believe that family contributions are integral to the success of all aspects of the Best Start for Surrey strategy.

How have we heard from families to date?

Over the last two years, engagement with parents and carers has taken place to support many of the strands of work. This engagement has directly influenced the priorities and activities outlined in the Best Start for Surrey strategy. The input from families has enabled us to rapidly establish priorities, allowing work to commence on addressing these.

This strategy draws upon learning from:

  • First 1000 Days initial strategy engagement
  • Research into family's digital information and advice needs via Best Beginnings and the Children's Digital Programme
  • Families (0-2) experience of the COVID-19 pandemic
  • The Lighthouse report for additional needs 0-4
  • Autism strategy engagement
  • Ongoing evaluation of services e.g., breastfeeding audits

We are also actively engaging with families via additional pieces of engagement:

  • Children's Community Health Services re-commissioning
  • Asylum Seekers digital maternity needs
  • Parent and carers views of the Surrey SEND system
  • Early Help continuous improvement engagement

How will we continue to work in partnership with families?

We will take a co-production approach to developing our major projects that enable the delivery of the Best Start strategy. Below are a few ways that we can continuously bring families into the conversation:

  • Maternity Voices Partnerships
  • Family Voice Surrey
  • Healthwatch
  • Children's Citizen Ambassador
  • Birth to Five Partnerships
  • Perinatal engagement grant with Surrey Minority Ethnic Forum
  • User Voice and Participation

Who are our key partners?

Many of our key stakeholders have been involved in the creation and design of this strategy. Some are listed below:

  • Parents and carers
  • Maternity services and perinatal mental health services
  • Hospital and GP services
  • Children's Community Health Services (0-19 and therapies)
  • Early help and social care teams
  • Early years education and childcare settings
  • Charities and voluntary organisations

What is going well?

Surrey continues to make great progress in many areas across the pregnancy and early years landscape. Here are a few:

  • Since April 2021, increasing numbers of children have had an early years inclusion pathway planning meeting to enable more children with additional needs to attend an early years education setting of their choice that is close to home.
  • During the first year of a pilot project, 400 unwell babies and their parents have been supported by a psychotherapist working in neonatal units to support the bonding between babies and parents / caregivers.
  • Early Intervention Funding (EIF) provides financial awards for early years settings to enable them to support children with barriers to accessing education such as delays in learning, additional needs, and health needs.
  • The newly established antenatal contact visits led by Health Visitors has seen 200 new families in the first 6 months of 2022 to support them on their journey to parenthood.
  • During the pilot of the Baby Buddy App, 6056 pregnant women and other pregnant people and new parents have downloaded the app to support them on their pregnancy and early parenthood journey.
  • BookTrust supports all families to initiate shared reading at the earliest opportunity, antenatally and in the first 12 months. It also supports groups of less affluent families who have children aged 0-5 who need more help to make shared reading a regular part of their lives.
  • Following the success of our Maternity Voices Partnership, our new Birth to Five Years Community Health Partnerships have launched, enabling families' views to be more central to the redesign of our early years children's services.

Where does it feel challenging?

  • We are operating in a system that is still feeling the impact of COVID-19 and is now experiencing a cost-of-living crisis. Therefore, families may require more support in their community or from services.
  • There is a desire to focus more on prevention and early intervention, but resource and workforce challenges do not yet enable this to always happen.
  • The pregnancy & early years landscape across Surrey is complex, with a broad range of commissioning intentions and services, and a mix of existing and newly developing strategies.
  • Support from health and education professionals for children is not delivered in a timely and consistent manner due to waiting lists,
  • difference in service delivery and lack of awareness of what is available.
  • The needs of families vary dependent on where they live in Surrey, and our services need to adapt to meet this need.
  • Prejudices that are sometimes engrained in services and communities can be difficult to address when encountered and needs a Surrey-wide approach to acceptance and inclusion.

Ambitions

  • Promote and facilitate good health, emotional wellbeing and healthy relationships - pregnant women and other pregnant people, babies, children and families' health, emotional wellbeing and relationships are supported, and the needs of parents and carers are considered as fundamental to supporting their baby and/or child.
  • Recognise and promote the importance of development and early learning - families are at the centre of a system which understands and enables babies and children to learn and develop holistically. Children flourish in communities where health, early education, and social care professionals come together with caregivers to ensure that every child can thrive.
  • Enable partnership working and collaboration - pregnant women and other pregnant people, babies, children, parents and families achieve their potential and thrive through the support of practitioners who collaborate and work together as part of an integrated early years system.
  • Recognise the benefit of fully inclusive services, communities and neighbourhoods - the pregnancy and early years system proactively creates equal opportunities and support for vulnerable families in order to develop a culture in Surrey of acceptance and inclusivity with the greatest impact on outcomes for all.

Ambition 1 - promote and facilitate good health, emotional wellbeing and healthy relationships

Pregnant women and other pregnant people, babies, children and families' health, emotional wellbeing and relationships are supported, and the needs of parents and carers are considered as fundamental to supporting their baby and/or child.

stock image - family imageWhat do we want to achieve?

  • Families are empowered to have the best emotional wellbeing, physical health, and mental health.
  • Practitioners have a common understanding of how to promote families living healthy, fulfilling lives with good emotional wellbeing.
  • Families who have communication difficulties/needs are given a voice to communicate health, wellbeing and relationship concerns in a way of their choice.
  • A central focus on relationships and secure attachment between babies, parents, and caregivers.
  • Healthier relationships in the home, with a focus on strengthening parental relationships.
  • For every early years professional to recognise families who may be needing support to leave an abusive relationship.
  • Increased understanding of health needs and what services are available within the local community.
  • Proactively improving the prevention and management of long-term conditions.
  • Children with complex health needs are supported to access local provision and families receive support at the point of diagnosis.
  • Children's health needs are supported in mainstream education provision.
  • Families are knowledgeable about the benefits of nutrition and breastfeeding to support a healthy lifestyle.
  • Personalised end of life care to every family with a child who has a terminal illness or life limiting condition.
  • Breastfeeding is supported for the first 6 months of life with continued breastfeeding alongside solid foods for at least the first year of life.
  • Parents, carers, and children take up the offer of routine immunisations.

What difference will this make to families?

  • Support to develop healthy relationships between family members within the home or community setting ensuring that the harmful effects of domestic conflict on child outcomes are reduced.
  • Improved recognition of mental health needs and prompt access to support during pregnancy and the postnatal period for all parents when needed.
  • Consistent approach to the messages that we give around building positive attachments between babies, children, parents, and caregivers.
  • Working collaboratively to support families to know where and when to seek help in the community to address minor illness in the most appropriate setting.
  • Dedicated teams across Surrey coordinate the Team Around the Family approach that brings health, social care, and education together and act as the key person for the family, so families are not having to repeat themselves and professionals understand the family's current story.
  • System approach to long-term conditions in children, such as asthma, obesity, and type 2 diabetes, with a focus on health inequalities and prevention.
  • Tailored, additional support for families of babies and children with a health/education need, from practitioners that understand the complexities of having a child with additional medical needs, special educational needs and/or a disability and can help with a package of support.
  • Families understand the importance of nurturing relationships and know how to build these.
  • Practitioners have a strong understanding of the importance of emotional wellbeing, attachment and health needs and feel confident to discuss these with pregnant women and other pregnant people and families.
  • A confidence in early years settings and schools to support children with health needs.

How will we know that we have made a difference?

Key strategic measures will include:

  • Increase in breastfeeding rates (data available)
  • Reduction in 0-4 attendance at A&E (data available)
  • Health care plans for children in Nursery and Year R, with an increase in HCPs and decrease in EHCPs (data available)
  • Improved parental mental health (longitudinal outcome)
  • Improved attachment/bonding between infant and caregiver (longitudinal outcome)
  • Improvement in pre-school immunisation uptake

Further localised measures will be developed during the implementation and lifecycle of this strategy.

Ambition 2 - recognise and promote the importance of development and early learning

Families are at the centre of a system which understands how babies and children learn and develop holistically.

Children flourish in communities where health, early education, social care, and voluntary sector professionals come together with caregivers to ensure that every child can thrive.

What do we want to achieve?

  • Beginning with pregnancy, every parent is supported to know how to nurture their baby/child's development and all practitioners have a shared knowledge to achieve this.
  • Babies and children thrive through attending parent and toddler groups, stay, and play sessions and/or childcare and early years educational provision.
  • Families feel empowered to bring up their babies and children in the knowledge they are supported within their community and know where to access additional information or support should they need it.
  • Families can discuss any needs they feel their children have with experienced and supportive practitioners.
  • Families can access affordable, high-quality childcare and early education that supports early learning and working parents.
  • Practitioners recognise when children require additional support and have access to early intervention, ensuring that specialist referrals are made when appropriate.
  • Children with Special educational needs and/or disabilities can access an appropriate childcare or educational setting close to where they live, in a setting that feels confident and supported to include children with additional needs.
  • A transition between early years settings, teams and interventions that flow successfully into a child's Reception year and onto Year 1 so that schools feel supported to meet the child's needs.

What difference will this make to families?

  • There will be a family centres, education settings and community-run groups in local neighbourhoods providing integrated health and education support at the earliest opportunity.
  • Families will understand their children's development because they have easy access to local, neighbourhood and voluntary groups and can form trusted relationships with other parents, and with knowledgeable practitioners.
  • Early years childcare, education and school provision provide a responsive and coordinated offer to babies and children in each community with the family at the centre.
  • Early years settings work in collaboration with parents and caregivers, valuing them as partners to support children's development and learning.
  • Parents and carers will understand the role that Health visitors, Community Nursery Nurses and School Nursing team have in their babies and children's lives, including how to contact them and what to expect from that support.
  • Children's speech, language and communication development are understood and valued by families and early years professionals and support is available where children and families require something additional.
  • Support for speech and language delay/disorders are identified early and interventions put in place that work with the family and educational setting.
  • More children will access mainstream education in their local community.
  • If early years settings can provide interventions for children supported by therapy teams, the need for a child to attend regular therapy could be less frequent.
  • The child is at the centre of all transition arrangements, ensuring that support around learning and development and any additional interventions are seamless between teams and provision.

How will we know that we have made a difference?

Key strategic measures will include:

  • Improved attainment measured through Foundation Stage Profile data, with a particular focus on those children at risk of disadvantage (data available excluding during the pandemic)
  • Increased take up of Free Early Education for Two-year-olds hours in early years provision (data available)
  • Improvement in child developmental outcomes at 2 ½ years and reception year (data available)
  • Improve speech, language, and communication for children (data available, longitudinal outcome)
  • Further localised measures will be developed during the implementation and lifecycle of this strategy

Ambition 3 - enabling partnerships and collaboration

Pregnant women and other pregnant people, babies, children, and families achieve their potential; and thrive through the support of practitioners who collaborate as part of an integrated early years system.

What do we want to achieve?

  • Families and practitioners can find the information, advice, and services that they need.
  • Children and families receive support that is provided through a consistent approach with professionals using the same terminology.
  • Pregnant women and other pregnant people and families experience a seamless transition between professionals, teams, and services and transitions are minimised wherever possible.
  • Practitioners work together holistically to provide services and support to children and families, reducing the number of times families tell their story.
  • Families can receive support close to home and within their neighbourhood/community.
  • Practitioners are given the space to build relationships with other practitioners, and with families.
  • Delivery of care and support focuses more on local neighbourhoods and communities.

What difference will this make to families?

  • Families will be able to meet with other families and practitioners in their local neighbourhood as part of a place-based strategy across Surrey.
  • Families at the centre of every conversation. Teams across Surrey come together from health, education, the private and voluntary sector, and social care to put children and families at the heart of their support and decision making.
  • Families have access to consistent digital information and advice across all health, social care, and education partners, that uses an accessible language.
  • Improving use of data and data sharing, for the benefit of families.
  • Improve access to support by provision of accessible apps, webinars, and other learning tools.
  • Seamless transition from early years services when a child reaches the end of their reception year. Services not ceasing when a child reaches school age without handing child/family onto another professional.
  • There is good communication between midwifery and health visiting, to ensure families feel supported as they start their parenthood journey.
  • Stronger relationships across primary, secondary, tertiary care and community providers for earlier discharges home after giving birth or needing a hospital admission and more community-based support.
  • Collaboration between pregnancy and early years services and the health system, operating in neighbourhood teams in accordance with the Fuller Stocktake.

How will we know that we have made a difference?

Key strategic measures will include:

  • Improve staff experience, recruitment, and retention (data available)
  • Uptake of training by practitioners (process measure)
  • Improved experience of care and increased confidence in services by pregnant women and other pregnant people, children, and families (qualitative measure)
  • Confidence of practitioners in working with families (qualitative measure)
  • Families are engaged in service development (process measure)
  • Increased uptake of digital tools by families (process measure, data available)

Further localised measures will be developed during the implementation and lifecycle of this strategy.

Ambition 4 - fully inclusive services, communities and neighbourhoods

The pregnancy and early years system proactively creates equal opportunities and support for vulnerable families to develop a culture in Surrey of acceptance and inclusivity with the greatest impact on outcomes for all.

What do we want to achieve?

  • Achieving greater equity in outcomes, so that every pregnant person, baby, child, and family achieves health outcomes that are as good as those who currently have the best experience
  • Surrey's most vulnerable families receive increased support to enable them to thrive
  • Surrey advocates for a culture of acceptance and inclusion through its leaders, practitioners, teams, and services; and challenges any discrimination or non-acceptance of disability, health need, special educational need, or neurodiversity.
  • The diversity of Surrey's population is reflected in the uptake of our services, with improved uptake from Surrey's Health and Wellbeing Strategy priority population groups.
  • Maternity settings, Early year's childcare and educational settings welcome every child and family regardless of gender, race, religion, or additional need. Policies are fully inclusive and proactively consider how to tackle all sources of discrimination.
  • Babies and children with additional needs and their families have improved access to services/support within their local communities.
  • Health, education, social care, and private and voluntary practitioners understand the needs of neurodiverse families.
  • Babies and children with a range of diverse needs including medical and/or developmental needs can access appropriate care and/or education close to where they live, in a setting that feels confident to support them. A system-wide confidence in the Surrey early years system that babies and children will have access to appropriate, targeted support when they require it.

What difference will this make to families?

  • Families feel included within communities across Surrey and know where they can access support should they need to.
  • Practitioners understand the shame and stigma felt by families when they need to ask for help due to poverty, social exclusion or family breakdown and respond sensitively and professionally in enabling appropriate support from early help or social care.
  • Support is available in Surrey for families who require access to digital services; including information in languages other than English or because of a specific learning need.
  • There is an understanding from voluntary groups and services that there will be different cultural needs and expectations across communities within Surrey that should be celebrated.
  • Services are located within neighbourhoods and local communities and are proportionate to the needs in each district and borough.
  • Services are re-designed to enable improved access for Surrey's Health and Wellbeing Strategy priority groups.
  • There is the data and understanding available so we can focus our attention on the families experiencing the greatest inequity.
  • Support is given at the earliest opportunity once a practitioner is aware that a baby, child, or family needs something in addition to universal services.
  • Early years childcare, education and health colleagues are supported to create inclusive settings where every child is included within their local community.
  • Education providers are able to support children with additional needs and disabilities (SEND) in line with SEND Code of Practice 2014.

How will we know that we have made a difference?

Key strategic measures will include:

  • Decrease in the number very young children going into care (data available)
  • Decrease in non-accidental injury in babies and young children (data available)
  • Reduction in smoking for families (data available)
  • SEND Support Notifications (SSNs) and whether the child can access an early years educational provision (process measure, data available)
  • Number of Education, Health, and Care Plans (EHCPs) (process measure, data available)
  • Provision of Early Intervention Funding (EIF) (process measure, data available)

Further localised measures will be developed during the implementation and lifecycle of this strategy.

Delivering the strategy and measuring success

Implementing the strategy

The Best Start Strategy is a five-year strategy, and as such does not hold the detail on the delivery of this strategy to ensure this document is future proofed. Sitting alongside this strategy will be a detailed implementation plan. Actions and projects will be developed to address the priorities outlined in the strategy. Families, practitioners, and stakeholders will be actively engaged in the development of this plan.

Measuring success

As part of our planning for the delivery of this strategy, we will ensure we assess the impact of the work we are doing. Examples of how we will do this are listed below:

  • Best Start Strategy Dashboard
    • High-level strategy dashboard pulling together key measures outlines within the strategy
  • Data and insight workstream
    • Explore population health management approaches
    • Address data access, quality and integration issues
    • Early years data dashboard
  • Evaluation projects
    • Commitment from programme team to plan and implement evaluation approaches to assess the impact of projects
  • Voices of families
    • Commitment within the strategy to prioritise engagement with families
    • Development and delivery of engagement mechanisms such as Birth to Five Partnerships

We will also report to the Best Start Transformation Board on our progress regularly, with key updated going to Surrey's Children's Strategic Leadership Board.

Appendices