Children and Families National Leadership Group Minutes - 10 September

Attendees and apologies

• Derek Brown, SOLACE 
• Matthew Sweeney, CoSLA 
• Hannah Axon, CoSLA 
• Lynda Fenton, Public Health Scotland 
• Lynne McNiven, Director of Public Health 
• Catriona Milosevic, Children Health Commissioners 
• Mike Burns, Social Work Scotland
• Jane Kelly, Care Inspectorate 
• Neil Hunter, Scottish Children's Reporter Administration 
• Graham Grant, Police Scotland 
• Tam Baillie, Child Protection Committees Scotland 
• Jude Turbyne, Children in Scotland 
• Mary Glasgow, Coalition of Care and Support Providers in Scotland
• Kathy Henwood, Children's Services Planning Strategic Leads Network 
• Claire Burns, CELICS 
• Fraser McKinlay, The Promise
• Sarah Gasden, Improvement Service 
• Emma Smith, Glasgow Health and Social Care Partnership
• Andrew Watson(co-chair), Scottish Government
• Bryony Revell, Scottish Government 
• Sara Hampson, Scottish Government
• Carolyn Wilson, Scottish Government
• Peter Donachie, Scottish Government
• Emily Aitchison, Scottish Government

Items and actions

Welcome from chair

Andrew Watson welcomed members to the meeting. Graham Grant has become Police Scotland’s member of the group, alongside Carron McKellar, following Sam Faulds’ retirement. Andrew recorded the group’s thanks and best wishes to Sam for her assistance to this group and the Covid-19 children and families collective leadership group.

Andrew highlighted the commitments on tackling child poverty and improving whole family support in the 2024/25 programme for Government published last week. As part of this and wider public sector reform, work is taking place with partners to introduce additional local flexibility in how existing budgets and services can be reconfigured in the pursuit of a whole family approach. The Scottish Government has written to Local Government and NHS Board Chief Executives setting out some further detail on this commitment. Future discussions will take place with the Leadership Group to help progress this work.

Tackling child poverty and improving health outcomes

Lynda Fenton presented the main findings from research that public health Scotland is undertaking on the interactions between child health inequalities and poverty. The research uses the Scottish index of multiple deprivation (SIMD) as a proxy indicator for poverty and deprivation. There are some limitations with this approach as SIMD is focused on areas rather than households and individuals. This risks underestimating the effects of poverty on child health outcomes at household level. Nevertheless, the adverse impacts of poverty on a range of maternal and child health outcomes are clear. These include maternal diabetes and premature birth rates; development concerns at the 27-30 month review stage; obesity risks; and dental health. There has been some narrowing of inequalities in recent years in relation to breastfeeding but significant gaps remain between the most and least deprived areas.

Many people in Scotland have incomes just above the current poverty threshold of £374 per week before housing costs but below the UK median of £623. Income levels affect a wide range of health factors including diet, housing, stress and access to education and employment. Targeted action to reduce poverty and maximise household income will therefore help to improve health outcomes.

Carolyn Wilson summarised the main elements of the joint work taking place between Scottish Government and NHS Scotland to strengthen NHS Scotland’s role in tackling child poverty. The overall approach is focusing on the main drivers of poverty reduction – income from employment; social security and other benefit payments; and addressing cost of living issues. Support is being provided under three themes: family friendly progressive fair work; supportive infrastructure; and enhancing family wellbeing and capabilities. 

Specific strategic opportunities for NHS Scotland support are leadership and accountability - leveraging health and social care leadership to maximise the sector’s influence; employment – NHS Scotland and social care as anchor institutions especially as employers; services – NHS Scotland and social care as providers and commissioners of supports and services benefitting the six priority families identified as crucial in tackling child poverty; and longer-term prevention – break intergenerational cycles of ill-health and inequalities, driven by poverty and early life disadvantage through primary prevention at a population level and whole system transformation. 

Practical work underway in relation to these strategic opportunities includes equipping staff who are most likely to come into contact with pregnant women and young families, routinely and systematically, with the tools and resources to respond to their immediate needs.

Members made the following points in discussion:

• the presentations reinforced the importance of more integrated support and services that are easier to access and firmly centred on family needs
• children's services planning are crucial in driving collaborative local whole systems approach across adult and children's services from prevention to protection. NHS Scotland Boards are key to this as co-lead agencies with local authorities and Integrated joint boards are specified service providers
• good multi-agency working requires mutual respect across providers with the third sector as an important partner. Funding provision needs to match the ambitions to tackle child poverty with greater focus on the consequences and costs of not providing sufficient resources
• overall levels of child poverty have not reduced over many years. This is also the case with health inequalities. Much stronger action is needed to make a real difference and ensure this is sustained over the long term. This should include robust evaluations to identify the initiatives, support and services that are not working well and reinvest the resources to more successful areas of activity
• there should be a renewed focus on delivering the outcomes of the Christie commission with a more decisive shift and momentum in prioritising prevention
• there is still a tendency to focus on issues from organisational perspectives. This perpetuates policy and delivery siloes and does not reflect the reality of how people are living their lives. To help address this, the voice of children, families and communities themselves need to feature more strongly in the work being planned and undertaken

Andrew Watson assured the group that the Scottish Government will work with national and local partners on more radical solutions to deliver the changes required. Greater funding flexibilities will be part of this. Further discussions will take place with the group and Andrew invited members to provide ideas and options for funding flexibilities.

Spotlight initative - where can collaborative action be taken? 

Mike Burns and Emma Smith described the multi-agency work taking place within the Glasgow City pathfinder to adapt local systems to respond more effectively to families’ immediate needs. A crucial aspect of this work is the partnership between social work services, health and social care partnership and integrated joint board to enable health visitors, family nurses and school nurses to make emergency payments to families under Section 22 of the Children (Scotland) Act 1995.

Health visitors and family nurses have well established and trusted relationships with the families involved as part of universal health provision pathways. This enables staff and families to work together to identify where short term financial support is required to help alleviate extreme, sudden hardship and how best to access longer term advice and support. Over 80% of those who received the payments said the health visitor or family nurse was the first person they had spoken to about their financial pressures.

The eligibility criteria for the emergency payments includes:

• family unable to provide food/heating
• family unable to afford transport cost to health appointments
• other supports considered and unable to provide timely appropriate support
• referral to social work otherwise not required at this point

Each emergency payment is around a maximum of £40. The payments have been used to purchase baby food, infant formula milk and nappies.  To date, a total of 276 payments have been made. 10% of families involved required repeat payments. Those receiving the payments live across Glasgow City but most payments have been made to those in SIMD 1 and 2.

The voice of families and staff has been essential in shaping the initiative.  Among the measures being considered to build on the progress made is for financial inclusion staff to join health visitors and family nurse engagement with families where appropriate and helpful. There is scope to link the initiative more closely to other areas of whole family support including those provided by the third sector.

Members expressed support for the initiative and made the following points in discussion:

• the initiative is a good example of non-stigmatising relationship-based support founded on trust and early identification of need through universal services. This demonstrates GIRFEC principles put into practicn more action needs to be taken to support babies and infants during their first two years especially to address the developmental concerns outlined earlier in the meeting. This could be linked to UNICEF's baby friendly standards. The Scottish Government provided information on the early child development transformational change programme which is providing greater oversight and better integration of policies related to pre-birth and early years
• urgent consideration needs to be given to taking forward national and local work to free up relatively small amounts of funding for direct support initiatives such as that taking place in Glasgow. This includes ensuring better equity of availability across geographical boundaries.    Eligibility criteria and thresholds for access to services are a crucial part of this. They can act as an enabler to seamless and integrated access to services or the exact opposite by fragmenting and confusing families
• consideration should also be given to the potential for other partners involved in urgent family support work such as the third sector and Police Scotland to be enabled in certain circumstances to make emergency payments to families
• the group could usefully discuss income maximisation work being undertaken by the Scottish Government and partners
• a collaborative leadership and staff culture across services is key to the success of the work in Glasgow. There are useful lessons to be learned for other areas of multi-agency working
• all the presentations provided at the meeting reinforced the need for good information and data sharing between services. This should continue to be an area of focus for the group       

Next steps 

Carolyn Wilson outlined next steps on the joint work taking place between Scottish Government and NHS Scotland to strengthen NHS Scotland’s role in tackling child poverty.  Public health Scotland have commissioned 'deep dives' into 4 board areas (Grampian, Lothian, Lanarkshire and Shetland) to better understand income maximisation pathways and financial inclusion.  Improvements in staff training at national and local levels are also being made including in relation to issues such as tackling infant food security.

Members agreed it is important to continue the discussion on what needs to happen nationally and locally to help ensure that person-centred, community-led approaches to whole family support are more strongly embedded across Scotland. The group should focus on this issue over the next few weeks.  

Any other business and date of next meeting

There was no additional business. The next meeting scheduled meeting is on 8 October from 15.05 to 16.30/ 

[this meeting was subsequently cancelled. The next meeting was held on 4 November 2024]