Child: Family: Place: Radical efficiency to improve outcomes for young children. Croydon

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1 Child: Family: Place: Radical efficiecy to improve outcomes for youg childre Croydo

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3 cotets Foreword...5 Executive summary Cotext...13 The public sector eeds ew models to improve public services...14 Early Years services are ripe for this type of chage...15 Backgroud to Croydo Our approach...19 Buildig o our successes...20 Backgroud to our approach...21 Stage 1: Discover: Creatio of ew iformatio ad isights...23 Stage 2: Defie: Developig ad testig...27 Stage 3: Develop: Testig, prototypig ad refiig...29 Stage 4: Deliver What we leared: from research What we leared: from listeig to others...35 Listeig to families...36 Listeig to practitioers ad maagers What we leared: from mappig...43 Mappig activity ad resources...44 Mappig the customer jourey...48 What we foud out Coclusios from the evidece...57 What we have leared...58 Leadership of place The way forward...61 Our visio...62 Our propositios...63 How it all fits together Projected costs ad savigs...83 Our approach to projectig costs ad savigs...84 Makig savigs over time To implemetatio ad beyod...87 This is just the start of the jourey...88 A ew form of orgaisatio?...88 Takig the learig forward...89 Implicatios for Whitehall...91 Where ext for Croydo?...94 Bibliography...96 Those who supported our work...98 cotets 3

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5 foreword Across the public sector, the imperative to deliver better services for less cost is clear. We face uprecedeted budget cuts alogside cotiuig demads for improvemet. I Croydo we feel this acutely, we are the largest Lodo borough, with more youg people tha ay of our peers, ad sigificat social challeges. But i Croydo we are also ambitious. We kow that there is potetial to improve what we already do by doig it better, together. We are also cofidet that workig together i ew ways, across orgaisatios ad i partership with residets, ca lead to both radical improvemet i outcomes ad savigs to the taxpayer. We agreed to apply this approach to oe of Croydo s most vital areas: outcomes for our yougest residets. Through the resources provided by Total Place we have all of us goe through a eye-opeig experiece, which has challeged the way we work together, how we thik about services ad ultimately the relatioship betwee the public sector ad those we serve. We have leared a lot more tha we aticipated whe we started ad are excited about the directio of travel. We take great pride, therefore, i sharig the story of our jourey. We hope that it provides isight ad ispiratio to others who recogise the eed to fid a ew way of thikig about public services trasformatio; that it exposes the challeges of movig from thikig about services to thikig about systems; ad that it adds to the weight of evidece for workig with families ad citizes, for startig from their experiece ad their capabilities. We have ot yet reached our destiatio but we are well o our way. We welcome your thoughts, isights ad challeges as we cotiue our jourey to become better leaders of our place. Carolie Taylor, CEO NHS Croydo Jo Rouse, CEO Croydo Coucil foreword 5

6 I just wat a happy child Sarah 30, Upper Norwood 6

7 executive summary I the ed, achievig great performace i the public sector requires ulockig the iitiative, creativity, ad motivatio of leaders throughout the system, rather tha just those at the top. This caot be doe without substatial devolutio ad/ or providig the freedoms of a quasi-market. I short, you ca madate awful to adequate, but you caot madate greatess, which must be uleashed. Sir Michael Barber, Former Director, Prime Miister s Delivery Uit oe: executive sectio headig summary 7

8 We are o a jourey to radical improvemet For at least a decade, the prevailig paradigm for public service improvemet has bee a top-dow model. Natioal targets have bee set, delivery chais established, ad large amouts of moey have bee pushed dow the resultig commad ad cotrol structures to achieve chage at groud level. I areas where public sector performace was previously very weak, e.g. hospital waitig times, levels of serious violet crime, it is a model that has achieved geuie success. However, this liear model of thought ad actio aroud public service trasformatio is comig to the ed of its useful life. Improvemets i stadards ad outcomes i may areas of public service seem to be reachig a plateau, or will ot deliver the scale ad ature of chage that is ow eeded. I Croydo we are passioately iterested i what comes ext. Buildig o a bedrock of trust withi our Local Strategic Partership we have bee pilotig ew solutios for the last few years, i areas as diverse as combatig domestic violece, addressig teeage deliquecy ad aligig services for people with demetia. We have already leared a lot about the beefits of joiig up multi-agecy teams aroud the customer, about co-desigig services with the citize ad their ow support etwork ad about breakig dow professioal boudaries. We are also learig about how best to balace rights with resposibilities, how to reduce depedecy ad how to achieve a better balace betwee State support ad idividual edeavour. Total Place has give us the chace to stretch our wigs. Co-led by NHS Croydo ad Croydo Coucil, ad ivolvig all Local Strategic Partership members icludig the Police, the local hospital ad the Volutary ad Commuity Sector, we have explored a Total Place approach which cosiders all the public sector moey i a geographical area as oe virtual pot. We have listeed deeply to citizes eeds ad experieces, ad combied that kowledge with other ew perspectives to create ew models of place-based leadership which supersede idividual orgaisatios ad fuctios. 8

9 The earliest years are vital Our focus has bee o early years for the simple reaso that we believe it matters most whe it comes to gettig public services right. The evidece is uarguable that a good start i life, i terms of physical, emotioal ad cogitive developmet, will result i better idividual ad social outcomes later i life. A early childhood that is characterised by the deepest attachmets to parets or other primary carers who love ad care for their child, is likely to result dow the lie i less depedecy o the State, ad reduced call o the public purse. The evidece we have gathered through our desiged process has bee utterly persuasive of the eed for system redesig i the early years. We listeed directly to families. We heard from mothers who told us - despite our best efforts ad well desiged strategies - they do ot kow where to get help ad support, from fathers who explaied how awful the discotiuities betwee services ca feel. We realised that our most vulerable parets lack the very social etworks which form the bedrock of support for most families. We the followed families joureys through our system. As you will see later from the experiece of the Li ad Richards families, we leared that our system is ot desiged to help people through problems ito idepedece ad capability; we ofte deliver bitty solutios to parts of problems. We are ot seeig the importace of pickig up o early warig sigs; whe a paret of a child with behavioural problems declies a offer of help, othig else seems to happe. Time-lags betwee idetificatio of eed ad effective respose mea we do ot respod quickly eough to prevet problems becomig etreched. Decisios made i oe service based o budget thresholds ca create huge uiteded costs elsewhere i the system. We mapped the moey ad activity i our system, ad saw how it is just ot desiged aroud the joureys families aturally make ad the lives that they lead. Moey is ivested i ruig services, ot deliverig solutios: it flows ito a highly complex array of orgaisatios ad services, ito which families must the somehow fid their way. A very small proportio of the coucil s spedig o childre ad youg people is determied locally. 50% of taxpayers moey spet i Croydo o families from coceptio to age seve flows direct to families i beefits ad tax credit, yet there is o lik made betwee that ivestmet ad ay other activity i the locality. executive summary 9

10 Our uderstadig has had a sigificat step chage The deep dive ito the jourey from coceptio to seve years illustrated i the followig chapters has geerated sigificat breakthroughs i our shared uderstadig of the problems ad challeges iheret i our curret childre ad families system. We have uderstood where there are opportuities to support our families more effectively. We have idetified key places where we ca obtai much better public value for taxpayers moey. We have spotted iefficiecies which, whe removed, will reduce admiistrative expediture. We have secured commitmet to reimagiig the cofiguratio of service delivery across orgaisatioal boudaries. We have realised the potetial of workig together to support ad haress the eergy ad aspiratios of families. We have idetified thigs that are best doe locally, ad other thigs that we should be doig but are ot curretly give the opportuity to ifluece. Most importatly, we have forged a clear visio of how, workig flexibly ad collaboratively, we ca achieve a sigificat shift i ivestmet ad activity towards prevetio ad early itervetio work. This report details the resultig propositios ad the sigificatly improved outcomes at reduced cost we believe they will deliver over time, focused especially o gettig prevetio ad early itervetio right. We estimate savigs o a Net Preset Value basis of over 8.3m durig the spedig period 2011/ /14, 25m by the ed of the ext spedig period (edig 2016/17) ad more tha 62m by the time our curret four year olds tur 18 i 2023/24. But - crucially this report also tells the story of how we got to this stage: what we have leared about ourselves, the wider system, ad the way we eed to work together very differetly to secure the future which all our citizes eed ad deserve. It is clear to us that this learig though exemplified curretly through our work o Early Years services applies across the breadth of the public sector. All complex services, particularly those which ivolve chagig or ifluecig behaviours, ad supportig the idepedet eergies ad capabilities of citizes to improve life outcomes, will beefit from similar shifts i approach. We have reached this stage of our jourey excited about what we believe will lead to a fudametal redesig of may of our public services here i Croydo: supportig citize capability ad idepedece, creatig opportuities for much greater professioal fulfillmet, but most importatly, better outcomes for our residets ad better value. 10

11 Healthy start stickers we give them... They work really well. They eat i order to achieve stickers... Lucy 29. South Norwood executive summary 11

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13 1 : cotext We eed a ew paradigm to improve outcomes for our yougest residets withi a cotext of complexity ad shrikig budgets. We eed ew ways of thikig, ew ways to judge progress ad ew eergy. cotext 13

14 The public sector eeds ew models to improve public services A sigificat shift i the jourey of public sector reform seems to be close at had. The model of public service trasformatio supported by sigificat ivestmet which characterised the last decade is comig to the ed of its life; improvemets i stadards ad outcomes i may areas seem to be reachig a plateau or will ot deliver the scale ad ature of chage we ow eed. Tougher atioal focus o priority activities ad moitorig of performace do ot seem likely to take us to the ext level. At the same time, we are experiecig the biggest global recessio for a geeratio, with huge implicatios for the public sector. The pressure is o for all parts of govermet to deliver sigificatly better outcomes for sigificatly lower costs. However, balacig the books caot be see as a ed i itself. Such a approach is likely to lead to salami-slicig, as each orgaisatio seeks to protect its ow budget ad employees, rollig back improvemets i joit workig ad shared agedas. It is clear that a ew paradigm is required if we are to secure improved outcomes for our citizes withi a cotext of itesifyig demad, icreasig complexity, ad a backdrop of sigificatly tighteig budgets. We eed to fid ew ways of thikig, ew measures of success, ad ew resources - icludig brigig the eergy ad ideas of citizes ad commuities to bear. Iovatio - always evidet o the periphery - eeds to be brought cetre stage. There is a collective agreemet that we eed a ew arrative: a ew discourse about the role of govermet i helpig society to address highly complex problems ivolvig choice ad behaviours such as iequality, climate chage ad security. Attempts to reform services dow sigle departmetal, professioal or issue-based lies have ofte give rise to uiteded cosequeces; thikig arrowly about policy solutios ca mitigate oe eed, but exacerbate others 1. We eed to take a systems thikig approach. Trasformative iovatio teds to happe whe ew voices eter the desig or policy-makig process. We do ot have all the aswers. Govermet will eed to become more porous: we are coviced that there is power i lettig people ito the previously closed systems of policy makig. 2 The people who ca ofte offer the most ad ofte have bee least welcomed are the users of public services themselves, ad ideed those who choose ot to use them. 1 Systems thikig i the Public Sector: Joh Seddo Ulockig iovatio: why citizes hold the key to public service reform: Sophia Parker, Simo Parker, DEMOS

15 Early Years services are ripe for this type of chage Croydo Coucil, NHS Croydo ad other Local Strategic Partership members agreed we eeded to make this type of shift i approach i Croydo. Havig doe so, we decided to make our commitmet real by addressig a focused programme of activity. Total Place gave us a fatastic opportuity to do so. We wated to build o our track record of iovatio ad collaboratio, ad apply our learig i a area that we had ot tackled sufficietly i the past where we kew there would be sigificat beefits for improved outcomes ad potetial log-term savigs. We chose Early Years services for childre ad families as a ideal test-bed for such a ew approach, especially give the importace of successful collaboratio across agecies to achievig the Every Child Matters outcomes. May studies from aroud the world have show that a bad start i life has life-log cosequeces. We have set out a summary of the evidece that has iformed our approach i a later chapter. I short, whe we talk about a bad start i life we mea poor physical, social, emotioal ad or/cogitive health. Ofte, the root cause of weak early developmet is poor or iappropriate paretig, resultig i a lack of meaigful attachmet or attuemet betwee the child ad the primary care giver, ad too ofte combied with exposure to violece. The result is that too may of our childre are reachig school age with impaired empathy ad lack of emotioal cotrol. Others will be seriously overweight through sustaied poor utritio ad lack of exercise. The stark fact is that childre who grow up i homes characterised by dysfuctio, lack of love ad effective supervisio have a far higher propesity to metal ill-health, school failure, serious violece, egagig i risky behaviour ad becomig a paret themselves whilst still a teeager. Despite the weight of the evidece, public expediture is skewed away from support to families i the early years. Istead, we still sped a far greater amout seekig to address the cosequeces of poor early developmet later i youg adulthood. There is o sigle agecy that ca address this deficit o its ow. It is a area of work that, by its ature, requires professioal collaboratio. It is also a area of work that ca icetivise collaboratio because may public services beefit dow the lie from successful itervetio. There are substatial cost savigs for Police, Priso Service, Probatio, Courts Service, educatio, health ad social security amogst others. I other words, it is a area that fits perfectly with the applicatio of Total Place thikig. cotext 15

16 Backgroud to Croydo With a populatio of 342,000 people, Croydo has both the largest populatio of ay Lodo authority, ad the largest populatio of childre ad youg people aged 0 to 19, at early 90,000. Croydo is a area of diversity. There is a sigificat mixture of affluece ad deprivatio across its eighbourhoods, with some areas classified as withi the 10% most deprived i Eglad. Deprived areas are cocetrated i Croydo s major social housig estates ad i the orth of the area while wealth is maily i the south. Outcomes vary eormously: there is a 11 year gap i life expectacy. Childre i Croydo The diversity is of course reflected i our childre ad families: Birthrates: Croydo s birth rate (70 per 1000 wome) is higher tha the Lodo average of 68 ad the atioal average of 62. There are about 5,000 births per year i Croydo ad this umber is likely to rise Ethicity: May of the births i Croydo are from mothers who are members of black or miority ethic groups, as well as mothers who themselves were bor outside of the coutry. By 2026 the black ad miority ethic populatio i Croydo will be greater tha 50%, makig Croydo a miority majority borough Child poverty: Oe i four childre i Croydo grow up i poverty ad there is a relatively high percetage of loe parets who are beefit recipiets, with 3.1% of the populatio versus the Lodo average of 2.8% ad the atioal average of 1.9% Housig: Oe i six childre lives i overcrowded housig. We also kow that i Croydo there are a small umber of homes requirig safety visits from housig colleagues. I 2008/9 there were 258 households visited with childre uder five Homelessess ad temporary accommodatio: Childre are overrepreseted i families o the housig register who are classified as homeless. I October % of homeless households had childre i them ad 53% of homeless idividuals were childre. Most of these families are livig i some form of temporary accommodatio which is very trasitory ad complicates access to other services Other health idicators: Our teeage pregacy rates are higher tha the average across Lodo ad the rest of the UK. There are high rates of obesity i some wards, with more tha 25% of childre obese versus a atioal average i the low 20s (although below we set out progress 16

17 particularly for our childre age five). We are particularly cocered about our ifat mortality rate which is higher tha Lodo or Eglad, ad appears to be risig We are doig well for may childre Buildig o our foudatio of schools, Childre s Cetres ad the Childre s Trust, we have made some sigificat improvemets across our system, ad see idicatios of future promise: GCSE 5 A*-C results have icreased from 58.8% i 2007 to 72.7% i 2009 well above the atioal average Key Stage 2 results i Eglish ad mathematics have icreased from 69% i 2007 to 72% i 2009 The umber of youg people from poorer families goig ito higher educatio has improved from 12% i 2007 to 14.5% i 2009 Prevalece of breast-feedig at 6 8 weeks from birth has icreased from 53% i 2007 to 59% i 2009 The percetage of childre who are obese at age five has decreased from 12% i 2007 to 10.9% i 2009 We kow we ca do eve better To improve outcomes for all our childre ad youg people our Childre s Trust is workig towards seve priorities. These reflect areas that demad improvemet ad are agreed i the Local Area Agreemet (LAA), fidigs from ispectios ad the cosesus of key parters: Reducig teeage pregacy Promotig childre s healthy weight ad growth Keepig childre safe ad reducig bullyig Improvig educatioal opportuities Reducig youth crime ad disorder Reducig the umber of youg people ot i educatio, employmet or traiig Supportig parets ad families Croydo has the largest populatio of childre ad youg people i Lodo cotext 17

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19 2 : our approach Oe of the best thigs about this process has bee grapplig with a umber of ways of approachig the core questio; it has take us out of our comfort zoes Croydo Coucil seior leader our approach 19

20 Buildig o our successes Croydo parters already have a strog history of workig together i respose to difficult challeges. Like may places, we were creatig Total Place-style solutios before the brad was iveted. Whe Croydo had the highest icidece of domestic violece i Lodo at the tur of the milleium, we developed ad implemeted the Croydo Family Justice Cetre. Workig together across the Police, Croydo Coucil, NHS Croydo, Probatio ad our volutary ad commuity sector parters, we implemeted a ambitious ad iovative resource with co-located professioals from over 30 agecies, icludig ot oly traditioal services but faith-based services, commuity-led services ad others. The Family Justice Cetre ow serves over 500 families each moth. Our targets to reduce woudig ad commo assault, ad to icrease sactio detectios for domestic violece are all beig met. It has become a project of iteratioal reow ad sigificace. More recetly we opeed the cross-agecy Turaroud Cetre for youg people aged who were startig to get ito trouble. It provides assessmets ad solutios tailored to the idividual youg perso, ad seeks to use a wide rage of resources ad agets to eable youg people ad their families to tur their situatio roud ad start to thrive. I services for older people we have delivered a dramatic shift from high ed expesive services to prevetative itervetio that has achieved 18% savigs over the last three years with a projectio of a further 15% per year savigs over ext three years. This has ivolved a commitmet to co-desigig services with our elder citizes through our Old is Gold egagemet programme. Our Croydo Memory Service - a medium cost, high quality, high throughput assessmet ad care service for those eedig help ad their family/carers - is a atioal leader i demetia care, provided through a multi-agecy approach i ew, purpose built accommodatio that is desiged aroud the customer jourey. We have leared a lot from these ad other collaboratio projects. However, these examples are relatively boudaried: they are small systems (sub-systems) chages, rather tha radical shifts at a macro level. As we thought about early years, we were cofidet that we could go much further by takig a whole-systems approach. We kew that we had the foudatio to thik radically ad be disruptive, ad were clear that, if we sought ew ways of lookig at the challeges, listeig to citizes ad each other we would fid: 20

21 Quick wis through better ways of doig what we already do, by doig thigs more collaboratively Opportuities for sigificat service redesig Some geuie iovatios i approach to securig improved health ad wellbeig of childre, leadig to sigificatly improved outcomes ad reduced cost to the taxpayer Backgroud to our approach The recet history of public service reform demostrates that attempts to reform services dow sigle departmetal or issue-based lies have ofte give rise to uiteded cosequeces; thikig arrowly about policy solutios ca mitigate oe eed, but exacerbate others. 3 We kow that the complexity of eed - especially for those who deped heavily upo public services - ofte crosses cetrally-dictated professioal ad orgaisatioal boudaries. We believe that thikig i systems ot services is the key to shiftig public service outcomes. We also kow that makig this a day-to-day reality requires sigificat shifts i midset, culture ad behaviours. 4 We therefore set out to see Total Place as a collaborative learig experiece. We sought to develop the disciplies of a learig orgaisatio i our approach to Total Place. We reflected upo our idividual ad orgaisatioal pre-coceived models, learig to uderstad the leses through which we see the world - ad thus uderstad ad appreciate others perspectives. We have actively developed a shared perspective ad thus created a commo arrative. A key isight from systems theory is that differet idividuals ad orgaisatios will have sigificatly differet perspectives Jake Chapma i System Failure 3 Systems thikig i the Public Sector: Joh Seddo System Failure: why govermets must lear to thik differetly: Jake Chapma, Demos 2002 our approach 21

22 We are buildig o strog foudatios I Croydo, we already had strog idividual orgaisatios ad a awardwiig Local Strategic Partership, uderpied by high levels of trust. Takig a systems approach, ad seeig, perhaps for the first time, the total public sector purse for Croydo as a shared resource, has take us to a more sophisticated uderstadig of what it meas to lead a place. I preparig for the project, we explicitly set ourselves some success criteria to give us a poit of referece whe we foud the process challegig i its cotet ad structure. We believed that if we maitaied our commitmet would see: A ew relatioship betwee ourselves ad our citizes, movig from cosultatio methods to collaborative co-desig, co-productio ad solutio A further deepeig i the trust betwee orgaisatios across Croydo, particularly betwee NHS Croydo ad Croydo Coucil; ad we would see this happeig betwee multiple levels of our orgaisatios A ew way of workig takig root amog professioals actively egaged i the process; we would ot solve a problem i the old way agai A validatio of our commitmet to give specific time ad more tha ormal to shared problem framig, doig this i ew ways with ew people i the room Sigificat fiacial savigs i the short, medium ad loger terms, both for Croydo ad for the public purse as a whole. theory ito practice Oce you begi to master team learig or systems thikig, it is very difficult to play the old game of optimisig your positio at the expese of the whole. Peter Sege: The Fifth Disciplie Fieldbook 1994 [Total Place] has give us a differet way to work together that we will use i the future beyod February We are ow i a place where we ca make sigificat differeces to our services ad people s lives. Seior health leader, Croydo

23 Our Diverget/Coverget Coversatio Buildig o our commitmet to thik differetly, we decided to use a system desig approach, which required a rage of creative methodologies to secure differet types of kowledge shapig our ideas. The Desig Coucil s double diamod graphic describes well the classic diverget-coverget desig process we have used i our work (discover, defie; develop, deliver), ad the differet modes of thikig that eed to occur at each stage. Fig 1: Desig Coucil Double Diamod approach to desig discover defie develop deliver problem framig solutio creatio Stage 1 Discover: Creatio of ew iformatio ad isights Workig collaboratively across teams, orgaisatios ad sectors, we brought together deep qualitative systems thikig with traditioal iformatio gatherig to develop a uderstadig of our challeges ad opportuities. Our problem framig phase cosisted of five work-streams; crucially they operated iteratively ad i parallel, iformig ad learig from each other. We have give a overview of each below. Chapters 3, 4 ad 5 set out the more detailed evidece gaied from each of these methods ad the collective coclusios. our approach 23

24 Fig 2: Creatig ew iformatio ad isights listeig to families through customer isight listeig to frot lie ad seior leaders mappig of activity ad expediture i our Early Years system collectio ad aalysis of secodary data isights mappig the customer jourey through existig services Collectio ad aalysis of secodary data We gathered evidece from aroud the world about why early itervetio is importat, ad what works to support childre ad families. We explored both theory ad practice. We aalysed this iformatio to ascertai the commo aspects of programmes ad itervetios that were successful as well as commo aspects of those that failed. Listeig to families We listeed directly to stories from families ad childre across Croydo. We egaged i ew ad creative ways that we have ot doe before to fid out what life is really like for our families, what their experiece of beig a paret is like, what they thought of our services, what worked ad what did ot meet their eeds or expectatios. 24

25 Egagig the frotlie ad maagers together I order to egage a wide rage of colleagues i listeig to service users ad explorig our system together, we committed sigificat time to ru a series of workshops i ThePublicOffice - a iovative space which uses video ethography ad imagiative collaborative techiques to give 120+ colleagues from across more tha 20 orgaisatios a powerful, shared experiece focused o what it meas to desig services aroud the eeds of those who use them. Video stories from real families from across the coutry helped us uderstad that: There is ofte poor collaboratio betwee public services It ca be a struggle to get the right iformatio at the right time Public services are ofte poorly set up to deal with commo life evets Public services do ot respod to the eeds of both idividuals ad their families Citizes ofte have to become experts to make the system work for them We were particularly struck by the teacity ad capacity very ordiary families demostrated i tryig to secure what they eeded for their childre; ad the articulate way i which they described the effort they put i to overcome the system. It made us realise that we ofte iadvertetly treat citizes as passive recipiets of services, rather tha active ad eergetic participats i improvig outcomes. We realised that - together - we are the system which sometimes ca feel such a hidrace rather tha a help. Citizes ad their wider families should be see as sigificat cotributors to securig better outcomes. We listeed to over 60 families all across Croydo, o the street, i cafés, i libraries... our approach 25

26 Explorig these challeges together was extremely sigificat for our work. We built a shared uderstadig of the problem, ad for the first time - across all agecies - felt we had a commo startig poit, arrative ad vocabulary. We stopped thikig i our silos which represeted our particular orgaisatios views, ad started really collaboratig, appreciatig the differet perspectives ad value the iput from colleagues across the public, volutary ad private sectors. Mappig of activity ad expediture i our Early Years system We brought staff from NHS Croydo ad Croydo Coucil together o a regular basis to upick the various fudig flows related to our cohort. We mapped the jourey of the fudig from cetral govermet through to local bodies, delivery agecies ad fially families. We had ever before sought such a joit aalysis across all our orgaisatios, ad immediately saw how complicated the system was, how discoected differet spedig streams were from each other. What we foud was a focus o services, ot people. I fact, we soo realised that much of the expediture ever eve touches the people it is meat to help. We saw that there are key opportuities to obtai much greater holistic value from sped that is i the system for example, through the pre ad post atal ad early years cotacts that primary healthcare has with families. We saw how disparate all the spedig o early years is, ad how the discotiuities ad separatios could udermie geuie commitmets to work towards shared objectives ad visio. Mappig customer joureys through existig services We developed a series of case studies to idetify how our services are actually experieced by real families, ad where childre ad their parets come ito cotact with the support ad resources that are available. These case studies powerfully expressed the experieces of real families i Croydo, highlightig discotiuities ad the sometimes seredipitous ature of our resposes to some of the most difficult ad complex challeges faced as childre grow up. You will fid the Richards ad Li families joureys preseted later i this report. 26

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