An update on the
Early Years Collaborative
Leith Pioneer Site
Graham Mackenzie
Consultant in Public Health Medicine
NHS Lothian
7 October 2015
@gmacscotland
#gethealthystart
/GetHealthyStart
Acknowledgements
• Thanks to Angela Dougall, Andrew Massie,
Lyndsey Good, Diane McInally, Jane Stafford,
Lesley Fraser and all the teams across Lothian,
Simita Kumar, Jen Irvine and many others
• Granton Information Centre and partners
involved in the Tackling Money Worries work
• Scottish Legal Aid Board for their Tackling
Money Worries grant
Learning outcomes
• Work to reduce impact of maternal and
child poverty in Lothian
– Healthy Start
– welfare rights advice
• Introduction to some tools for health
improvement
• Reflections about how improvement
science can be used with front line staff
Child poverty in context
¼ children live in poverty
Child poverty has a huge
impact on health and
wellbeing and long term
outcomes
In comparison
– 1 child in 10 has speech and
language delay
– 1-2 children in 100 children
have fine or gross motor skill
delay
Healthy Start
• Food and vitamin vouchers
• Low income families
• Pregnant women (from 10 weeks
gestation) and children under 4
• £3.10 per week food vouchers
Initial aim
To increase uptake of Healthy Start (food and
vitamin voucher scheme) to 90% of eligible
participants (benefits recipients, child tax credit
recipients and pregnant women under 18 years
old) in north east Edinburgh by March 2015
“£250,000 into the pockets of families in north
east Edinburgh”
Focused on staff and women’s knowledge of scheme
and registration overall rather than vitamins.
Note – this is addressing the consequences of
deprivation; still need to work on addressing the causes
of deprivation.
Current sign up for Healthy Start in Lothian
75% (women and children)
What we did… testing and spread
5) We kept testing – e.g. reaching new populations, support
for women to complete the form, other services and beyond
pregnancy…. work that continues…
1) We worked with one midwife to
understand the process of signing a
woman up for Healthy Start by week
10 of pregnancy (Mar 2014)
4) We shared the recommendations and data with team
leads, for cascade, and started visiting the other teams (May
to Nov 2014).
2) Once we had identified a simpler
and faster process to sign up we
surveyed other midwives in the same
team, neighbouring team then the
whole of Lothian (Apr – May 2014)
3) We put the lessons into a simple recommendation sheet
and flow chart for pregnant women and their midwife (May
2014).
@gmacscotland
/GetHealthyStart
Tool number 1) Project Driver Diagram
Would add in retailer factors
here now, and are testing
ideas with a supermarket and
pharmacy
“Drivers” and influences on data
Starting point
Family factors
Staff factors
Staff factors
Community factors
Results
Introducing run charts, statistical
process control charts, Pareto
charts and more
Process
Process
Process
Outcome
Jan 2014

Jul 2015
Outcome
Aug 2013

Jul 2015
@gmacscotland
weeks)
early (7
Applied too
DoH
back from
Not heard
interpretation
Language/
at booking
was eligible
Didn't think
turned down
Application
completed
not posted/
Application
Number of women
6
5
4
60%
3
50%
2
40%
30%
1
20%
10%
0
0%
Reasons for not receiving voucher by 16 week antenatal appointment
/GetHealthyStart
Cumulative %
Reasons for not receiving vouchers
Pareto Chart
100%
90%
80%
70%
Team level data
(team 3)
This is for illustrative purposes, showing the
level of sophistication we can obtain using
monthly small-area data. Data need to be
interpreted with caution
* Would be good to ask all women – ie aiming for 100% for these measures
# Aim for these measures depends on local population and capacity of local WRA
services. Remember that it’s not just lowest income women who may benefit.
Team 3
*
*
#
#
Documentation of Healthy Start good, with some fluctuations with new staff.
Eligibility for Healthy Start increased early on, before slight fall.
Documentation of offer of welfare rights advice, and % of women accepting that offer
(+), has increased very substantially (highest in Lothian) and is reaping dividends for
these women.
Number of women receiving Healthy Start
vouchers, Aug13-Aug15 TEAM 3
% eligible w&c in receipt of vouchers (team 3)
Team 3: Children <1 in receipt of vouchers
Team 3: Children >1 in receipt of vouchers
“Drivers” and influences on data
Starting point
Family factors
Staff factors
Staff factors
Community factors
Welfare rights advice
Work with Granton Information Centre in north east
Edinburgh, with Citadel, Fort EYC, Dr Bell’s Family Centre,
midwives, health visitors, Edinburgh Community Food and
many others
Scottish Legal Aid Board funded
Process
Initial results
Worked with families not usually
referred for welfare rights advice
What do you think impact has been on
these families?
Conclusions
• Huge impact of this work on family
finances in north east Edinburgh
particularly
• Has required relentless focus, front line
work, sharing data at team and small area
level
• Sharing results with all teams, with hope of
repeating success across Lothian and
Scotland