Acknowledgements

We would like to thank everyone in the organisations who contributed to this programme: Leeds City Council, City of York Council, Stockport Metropolitan Borough Council with Greater Manchester Combined Authority, and Nesta. Throughout the programme the strength of leadership, expertise and ambition of council teams has driven projects forwards and inspired us to go further.

There are too many people to name everyone who contributed across Nesta and our local authority partners. We are hugely grateful to all of you. We would like to particularly acknowledge the project leads: Tom Symons (Nesta), Maura Appleby (Stockport), Miriam Loxham (Greater Manchester Combined Authority), Rob Newton (York), Lesley Wilkinson and Helen Binns (Leeds).

List of case studies

• How we moved from discovery to delivery in Stockport
• Using behavioural insights to increase the uptake of York's two-year health review
• Joining up midwifery and health visiting services in Stockport
• Using 'ward profiles' to target family support across York
• Building trust with families through My World Assessments
• Tackling wait times for Leeds' Speech and Language Service
• Developing Stockport's integrated enhanced maternity pathway
• Baby Talk for York
• Co-producing Stockport's integrated enhanced maternity pathway with practitioners
• Bringing together data to improve early years support in York
• Playful Learning Leeds
• Greater Manchester's adopt and adapt approach to scaling

Executive summary

The story of A Fairer Start Local

Children growing up in poverty are less likely to live a long, fulfilling and happy life than their peers. Our mission is to break the link between family background and life chances. However, our current systems of support often struggle to reach the families who need support the most, perpetuating this cycle.

Local authorities knit together the complex web of support that all families need. This spans advice on parenting techniques, high-quality early childhood education and care, health checks through pregnancy and the first years of life, access to books, resources and places to play, social connection and peer support. Local authorities are anchor institutions in a 'place'. They carry democratic accountability and perform a multitude of roles: provider, connector, funder and coordinator. They are the single most important public institution involved in efforts to close the educational disadvantage gap.

Yet, as Nesta's A Fairer Start mission started, local authorities had borne the brunt of over a decade of austerity¹. The pandemic has upended business as usual and created new service pressures. At the same time, progress to close the disadvantage gap had slowed and even begun to reverse². Frontline services were stretched to breaking point and the capacity for innovation, service development and continuous improvement was severely denuded.

The Fairer Start Local programme was designed to respond to this challenge. It sought to work in partnership with local authorities committed to closing the gap by developing, testing and scaling new ideas to support early childhood development. It combined a multidisciplinary innovation team, a structured approach to innovation, and funding support to help councils tackle the challenges that hold back their efforts to provide a fair start to local families.

The programme established three partnerships for experimentation and innovation with Leeds City Council, City of York Council, and Stockport Metropolitan Borough Council with Greater Manchester Combined Authority (GMCA).

Running from 2020 to 2024, A Fairer Start Local brought each area's depth of expertise in early years services together with Nesta's innovation capabilities in data science, service design, behavioural insights, innovation methodologies and arts-based practice. Our goal was to design and test new models of family support. Each partnership started with a discovery phase to define an area to focus on which showed promise for shifting outcomes for children. This was followed by iterative test and learn processes using co-design, real-world experiments and evaluation to test and refine the new initiatives. Partnerships also served as test-beds for scale – exploring how to assess scalability and identify mechanisms that would lead to widespread adoption of these initiatives.

5 ways innovation can build more effective early years systems

What we learned about how to innovate effectively in the early years

1. Adopt a 'test and learn' approach: foster an experimental culture, testing ideas on a small scale and using real-world feedback and data to guide adaptations. Example: Stockport used a test and learn approach to develop their integrated enhanced maternity pathway, starting with a joint visit prototype that was iteratively refined through co-design, testing and feedback, ultimately leading to a more integrated system for supporting families.

2. Effective innovation needs dedicated capacity: local innovation leads were essential to navigate local systems, convene stakeholders, and drive initiatives forward, as was bringing in specialist expertise in innovation methods. Example: Innovation leads in all three areas were critical. Effective innovation leads were collaborative and had good relationships, respected and influential within early years services, able to solve problems as they arose and were embedded across early years teams but were not in an operational role.

3. Co-design with parents and practitioners: use ethnographic, design and arts-based methods to engage families and frontline staff to ensure solutions are rooted in lived and professional experience. Example: York engaged disadvantaged families through a user-centred design process that included ethnographic research, co-design workshops, and iterative prototyping, held in community venues with creches and vouchers to make it easy for parents to participate.

4. There's no shortage of early years data – joining it up is the challenge: fragmented data, data-sharing barriers, and limited expertise hindered the effective use of data, but by focusing on existing and accessible data, early years teams gained valuable insights and improved its use. Example: We supported York to identify datasets they had access to. We used this to create a data dashboard, linked datasets, and a data tool that empowered service managers to allocate resources more proactively and better target and tailor interventions, such as working with early years settings where attendance was low.

5. Use mission-driven innovation to drive collaboration: collaboration was fostered by bringing professionals and teams together behind a common mission, which in turn helped navigate partnership challenges that arose and strengthened engagement across the system. Example: By focusing on a shared purpose to improve speech and language outcomes for disadvantaged children, Leeds were able to foster collaboration across the city and convene a unique partnership that resulted in a series of vibrant play installations in Harehills.

6. Scale starts with a solution that works in a place: balancing place-based solutions with scale can be challenging but taking an 'adopt and adapt' approach to scaling can empower local implementers to tailor evidence-based interventions to their specific contexts while maintaining fidelity to core principles. Example: GMCA is working with Stockport and three other local authorities to scale the integrated enhanced maternity pathway. They're working to identify the pathway's essential elements and support local areas to adapt the model to fit their existing context.

Recommendations for policymakers and early years funders

Achieving Nesta's mission to break the link between family background and life chances, and the Government's mission to break down barriers to opportunity, will require significant innovation in service delivery for families.

Our report shows how we can unlock that innovation. But applying this learning at scale to achieve both our mission, and the Government's long-term goals, will require strategic thinking and investment across central government, local government and third sector funders. From our work with Local Authorities through our three year innovation partnerships, we distill some key recommendations for policymakers and early years funders.

Central government should: Evolve into a present and active steward of early years innovation.

For instance, by:

• Developing and delivering a research and innovation action plan in partnership with the sector, bringing a more structured and open approach to the pursuit of early years innovation and research, that is both rigorous and creates actionable insight.
• Supporting the development of stronger networks between local authorities, supporting evidence gathering, adoption and adaptation of effective models and spreading evidence informed practice.
• Using planned test and learn work with Family Hubs as an opportunity to build innovation capacity within local authorities, for example by funding local innovation leads who can work at combined authority level to develop and spread impactful new ideas.
• Taking inspiration from the Research Schools Network (a programme to support schools, colleges, and early years settings to access, understand, and apply evidence), develop an equivalent for innovation which can identify mechanisms to scale effective place-based models.

Local authorities should: Foster a culture of innovation within early years services which seeks to develop and adopt impactful new ideas.

For instance, by:

• Harnessing central government's test and learn agenda to develop a culture that empowers service managers to responsibly experiment and try new approaches as innovation champions.
• Nurturing internal innovation capability taking opportunities to establish a dedicated innovation lead within local early years teams to coordinate and drive innovation processes.
• Partnering with families and communities by developing specific expertise and processes for family engagement that go beyond consultation.
• Working in partnership with communities and VCS organisations to leverage their latent capacity and power to form more joined-up support for families
• Leveraging opportunities to spread innovation across combined authorities, recognising the contextual similarities which can assist scaling of innovation.

Early years funders should: Support the growth of local innovation capacity,

For instance by:

• Supporting the development and testing of scalable programmes by funding and lending expertise to early years providers to build innovation capacity and adopt a test and learn approach.
• Combining their funding streams and collectively backing the most promising new ideas and impactful solutions
• Foster cross-sector collaboration by funding initiatives that support innovation and integration, such as the Thrive at Five model, as well as specific services and interventions
• Providing long-term funding to allow the development of meaningful cross-sector partnerships.

1. Introduction to our A Fairer Start innovation partnerships

1.1. Background

i. Our mission to close the early child development gap

Currently, children growing up in poverty are less likely to live a long, fulfilling and happy life than their peers. Evidence shows that with the right support during the earliest years, we can change that. However, our current systems of support often struggle to reach the families who need support the most.

Our mission, to break the link between family background and life chances, can't be achieved by any single organisation in isolation, so we work in partnership to achieve it. This report tells the story of A Fairer Start Local, an innovation partnership model created to help make sure that every baby and young child has the same opportunity to develop and thrive.

ii. A Fairer Start Local programme

A Fairer Start Local (AFSL) was a £1.5 million programme that established innovation partnerships with three local authorities – Leeds City Council, Stockport Metropolitan Borough (in partnership with GMCA), and City of York Council. Each partnership was formed around a shared mission of closing the gap in early child development for the most disadvantaged children. Over the three years, we worked with over a dozen different services across the three local authority areas and delivered 18 innovation projects.

Innovation partnerships brought together local areas' deep expertise – about their services, families, children and delivery contexts – with Nesta's capabilities and experience of public service innovation. Between 2020 and 2024, we worked together to support innovation in three early years systems. The innovation methods we used included data science, human-centred design, behavioural insights, service evaluation and arts-based approaches to design and test new solutions to place-based challenges and support local areas to evaluate what worked and what didn't.

iii. About this report

This report presents key learnings from the AFSL programme using case studies, testimonies from key partnership stakeholders and programme data.

In this report, we:

• Describe how we developed the innovation partnerships.
• Set out what we've learned about how innovation can support councils to close the child development gap.
• Share our top lessons on how to innovate in the early years.
• Provide recommendations for others working in early years innovation.

To capture learning and generate the data for the report we:

• Conducted a document review of 37 documents, such as internal reports and presentations, grant reports, and project updates and learning blogs.
• Carried out 18 semi-structured interviews with Nesta programme staff (eight) and local authority partners (ten), including partnership leads, service heads and practitioners.
• Held seven facilitated learning workshops with all local authority partners over a two-day learning event, including journey mapping, ripple effect mapping and deep dives on topics such as place-based scaling and family engagement.
• Coded qualitative data and conducted a thematic analysis to identify key learning themes. Emerging themes were then tested during the learning event with partners.

1.2. Overview of our three local partners

The three local authorities we worked with each have ambitious goals to narrow the gap in early childhood outcomes that exist in their areas, and deeply-committed expert teams willing to embrace new approaches in order to achieve this.

However, they face a challenging environment. Local authorities have seen spending power fall significantly. According to the National Audit Office, total spending power for local authorities fell by 26% between 2010/11 and 2020/21³. Meanwhile, rising levels of needs – especially since the pandemic – place additional strain on services⁴⁵.

Along with local authorities across the country, our local authority partners in Leeds, Stockport and York, are rising to the challenge by searching for ever more effective ways to deliver services. Given the space, support and funding to innovate, they have pioneered new solutions and embedded innovation methods in their ways of working.

Leeds City Council

Headline facts and figures about the area:

812,000 Population⁶ (2021)

194,000 Number of children⁷ (2021)

25% Children living in poverty⁸ (2023/24)

65% Proportion of children reaching a good level of development (GLD) at age five⁹ (2023/24)

46% Proportion of children on free school meals (FSM) reaching a GLD¹⁰ (2023/24)

23% Percentage point gap between disadvantaged and non-disadvantaged children reaching a GLD at age five¹¹ ie, those eligible for FSM or not (2023/24)

Stockport Metropolitan Borough Council

Headline facts and figures about the area:

295,000 Population¹² (2021)

65,000 Number of children¹³ (2021)

16% Children living in poverty¹⁴ (2022/23)

69% Proportion of children reaching a GLD at age five¹⁵ (2023/24)

43% Proportion of children on FSMs reaching a GLD¹⁶ (2023/24)

29% Percentage point gap between disadvantaged and non-disadvantaged children reaching a GLD at age five¹⁷ ie, those eligible for FSM or not (2023/24)

1. Introduction

City of York Council

Headline facts and figures about the area:

1.3. Mapping local innovation journeys

In total, across the three programmes, we delivered 18 projects which addressed needs identified by council officers and aligned with Nesta's mission goal. Projects were refined and prioritised throughout the course of the programme. These ranged from exploratory research and data analysis projects to implementing and evaluating innovations such as Leeds’ Playful Learning Installations, Stockport’s integrated enhanced maternity pathway, and York’s data tool. Figures 1-3. show maps of the innovation journeys for each partner, with a brief summary of each project.

2. Key ingredients of the AFSL innovation programme

2.1. Design and structure of the innovation partnerships

The AFSL programme explored how place-based innovation partnerships might contribute to closing the gap in child development outcomes. We developed long-term partnerships with each local authority, aiming to give sufficient time to explore and refine the problem space, co-produce solutions, test and learn about what was working and what wasn’t, and explore routes to scale up solutions, as well as enabling the development of effective working relationships.

Most of the £1.5 million budget took the form of an in-kind dedicated Nesta innovation team to support each partnership – bringing additional capacity and a suite of innovation expertise and methods. We also provided an annual Innovation Fund of £50k to each local authority. Each local authority used some of this fund to invest in a dedicated innovation lead to coordinate the programme a role which proved to be absolutely essential. The remaining funding was used to support engagement with families and test innovations.

i. Discovery phase

In 2020, we put out an open call to local authorities across the UK to work in partnership on an initial trial discovery project. Through this process we identified Leeds, Stockport (with GMCA), and York as local authorities that shared Nesta’s vision and could see the value of working in partnership to use innovation methods to improve their early years offer.

We conducted a rapid four-month discovery phase, involving a series of innovation sprints – short, focused cycles of work that brought a range of people together. This process helped to explore the compatibility of relationships and priorities between each partner, before committing to a longer-term partnership. The discovery projects also tested whether innovation partnerships might be an effective way to tackle the early child development gap and identify a potential focus for the partnership. Each area started with a working hypothesis, which we refined and updated as the partnerships developed.

Starting hypotheses for each local area:

Leeds: If we could better understand who is and who isn’t accessing services, we could listen to those families and learn how to better meet their needs.

Stockport: If we better understand what support parents want and how they want to access it, we could improve children’s social and emotional development.

York: If we knew the barriers to parents taking up services for two-year-olds, we could support more families and improve outcomes for two-year-olds.

ii. Test and learn approach

The programme used a test and learn approach to develop and test solutions to challenges identified during our discovery phase. Following the discovery phase, each partnership set out clear goals and outcomes for the year. Throughout the year, smaller test and learn cycles were carried out, where assumptions and initial ideas were quickly tested in real-world contexts, allowing partnerships to follow emerging insights and change direction where necessary.

This approach supported an iterative process of exploring opportunities, testing ideas, and learning about what worked and didn’t work, and then allowing that learning to shape what the partnership focused on. The approach also helped refine the design of the partnerships, for example, by moving from shared projects across all areas, which proved difficult to align, to focusing more specifically on key challenges for each local area.

As the partnerships progressed, we gradually moved from exploring and refining the problem space, to developing many potential solutions and ideas to each area, focusing on one key project by the final year. It also allowed us to work through partnership challenges and develop Nesta’s role as we learnt more about how to design and run an innovation partnership.

iii. A test-bed for scale

As promising solutions were developed and tested, designing for scale became increasingly important. Partnerships offered local test-beds for scale, where we worked with partners to develop place-based solutions to real problems in the early years and explored their potential for scale and possible mechanisms to do so. By the end of the programme, we aimed to have supported the development of a number of interventions or practice models that have significant potential for both impact locally and scale nationally.

2.2. Combining innovation and early years expertise

A core tenet of AFSL was bringing together local authorities’ deep local knowledge and early years expertise – about their services, families, children and delivery contexts – with Nesta’s capabilities and technical expertise in service innovation methods and processes.

We brought dedicated expertise in four key innovation methods – data science, service design, behavioural insights and the arts – underpinned by an overarching test and learn innovation process. These methods and processes brought additional capacity and technical expertise that gave local authority teams the space and support to explore local challenges and develop innovations.

Equally, a core strength of the innovation partnerships was the unique expertise that local authorities brought to the table. Their deep knowledge of early years systems, policy contexts, and local communities – combined with strong relationships and a commitment to innovation – was essential to developing and embedding new approaches.

3. How we used innovation to improve early years support

3.1. Using innovation methods to discover place-based challenges

The beginning of our journey with each partnership started with a dedicated discovery phase. These first projects generated insights that highlighted challenges, helped us plan how to deliver better outcomes for children and, as such, define an area of focus for each partnership²⁴.

In addition, over the first year, we conducted a series of more in-depth and focused research and analysis projects to learn more about each area’s specific context and challenges. These ranged from data analysis of attendance rates at childcare settings to in-depth engagement with families to understand barriers to support.

In all of these projects, we used innovation methods to:

• analyse patterns of inequality in child outcomes,
• engage families to understand their experiences, and
• map early years systems to understand existing service offers and build a picture of each area’s unique ecosystem of family support.

Over the course of the programme we moved from understanding the range of relevant issues in a process of discovery, to testing our assumptions and initial ideas through a series of iterative projects which allowed us to more clearly define the challenge that needed to be addressed. Following this, we developed and tested solution ideas, before moving to deliver them as part of the local authority’s service offer. This broadly followed the Design Council’s Double Diamond²⁵ design and innovation process. The final stage involved pursuing opportunities to make the solutions available at a larger scale, exploring potential for adoption and adaptation in new areas. Read more about our approach to scale in section 4.6.

How we moved from discovery to delivery in Stockport

Discovery

The team in Stockport wanted to better understand what support parents want and how they want to access it. To address this we conducted a range of exploratory research in the discovery phase, including:

• Working with service managers and practitioners to map out existing support and understand what the innovation challenges were.
• Engaging parents through interviews and co-creation workshops to understand their challenges and experiences of support.
• Using data analysis to map the impact of interventions and understand which factors influenced outcomes for children in Stockport.

Defining the challenge

This work identified health visiting as a potential opportunity, which led us to do a deep dive into health visitor practice. This involved:

• Workshops with health visitors, early years workers, Start Well coordinators and team leaders to understand challenges and explore alternative models.
• A diary study, where 13 health visitors and early years workers kept a log of their activities during a working week.
• Two days shadowing practitioners.

Developing solutions

We took the insights from the deep dive into workshops to develop ideas for solutions, and over the course of a series of design sprints we prioritised a solution, which took the form of a joint visit between health visitor and midwife as part of an integrated and enhanced maternity pathway. We developed the solution further by understanding practitioner and family perspectives, co-created and tested prototypes, and started to address the very practical issues that surrounded implementation.

Delivery

In the final phase of the partnership, we worked with Stockport Council to incrementally roll out the integrated enhanced maternity pathway to increasing numbers of families and wards within the council. We commissioned a process evaluation to ensure we maximised learning to support further rollout, and worked with GMCA to pursue the adoption and adaptation of this enhanced pathway in more councils within the combined authority.

3.2 Five ways innovation can help develop effective early systems

Innovation methods and insights from the discovery phases helped us understand the challenges early years systems faced. They also shaped how we addressed them, both laying the foundations for solutions and empowering early years leaders with the tools to develop a more effective ecosystem of family support.

In this section, we provide five examples of how innovation can improve early years support. These are:

• Improved access to and uptake of services.
• Greater collaboration and integration across services.
• Better targeted interventions and strategic decision-making.
• More trusted and family-centred support.
• Sparking a culture of innovation and transformation.

i. Improved access to and uptake of services

Public services often find it difficult to support the families who need help the most. This is sometimes referred to as the ‘inverse care law’, where the availability of high-quality support tends to vary inversely with the need for it. For example, research suggests that low-income families that stand to benefit the most from family support like childcare and early education are the least likely to access it²⁶.

We found that effective innovation has the potential to improve families’ access to support and increase the uptake of vital services, particularly among disadvantaged communities. For example, Leeds, Stockport and York have all reported increases in the number of families engaging with and receiving support. Central to these successes was the combination of our innovative methods. By leveraging data, co-designing with families, and using insights from behavioural science, local authorities have been able to improve access to services, ensuring they reach the families who need them most.

In Stockport, for instance, a renewed focus on the antenatal period through their enhanced maternity pathway led to a 45% increase in health visitor antenatal assessments. “Looking at recent data, we’ve really increased our antenatal contacts,” shared one local lead.

In Leeds, analysing data held by library services revealed opportunities to expand and better target routes for the Story Bus – a mobile library service for families with young children. As a result, library usage has increased, and staff now feel more confident using data to inform decisions. This targeted approach has made library services more accessible, bringing these services closer to disadvantaged families and encouraging them to discover resources they might not have previously used.

Using behavioural insights to increase the uptake of York's two-year health review

The local context

York’s Healthy Child Service offers every two-year old in the city a health and development review. The review is a key touchpoint for the council with families with young children – helping to assess a child’s development and providing parents with help and advice. However, at 73%, take-up was persistently below both the national and regional average..

What we did

We undertook data analysis to explore the interplay between geography, demographics and rates of take-up, which highlighted significant geographical disparities. We then worked with York to engage families directly – via interviews and a text messaging survey – to better understand the barriers to take-up and test alternative messaging. We used these insights to inform a pilot of a new service model in one area.

Applying insights from behavioural science, we changed the default for the two-year health review appointment from an ‘opt-in’ to an ‘opt-out’ model. The new ‘opt-out’ letter invited parents to a pre-booked appointment, rather than requesting they call up to arrange a time. Alongside this, communications were redesigned to re-frame the review as a health appointment with an experienced professional rather than a ‘nice to have’.

The outcome

The results were striking. Data from the pilot show that 70% of children in the pilot area attended their appointment during the trial period, compared to 43% and 18% in two comparison areas.

“We’ve improved the take-up of the two-year review. It’s better than it’s ever been. We tested in one area and rolled it out to the rest of the city and have seen a drastic increase in uptake,” York’s innovation lead noted. As a result of this scaling, attendance at the two-year health review has increased dramatically. “It was so successful, it’s in the high 80s now," shared the head of York’s Healthy Child Service.

ii. Greater collaboration and integration across services

AFSL projects brought together various professionals into multi-disciplinary, cross-service teams, fostering stronger connections that helped break down constraints of their roles and systems. Through a focus on a shared mission and a collaborative innovation process, this laid the groundwork for more integrated systems of support. As one partner reflected: “I wouldn’t have anticipated at the beginning, but the collaborative working has been a big one. It enabled us to establish relationships."

Numerous partners reported developing new relationships which unlocked new work. As one partner in Leeds described: “I’ve got closer working relationships with people than I’ve had before. Children and Families [Service] is a massive beast and it’s brought me closer to people in the Speech and Language team. That will be a relationship that will be long lasting beyond Nesta and I didn’t have a relationship with them before at all." This was described as making it easier to “hit the ground running” with other projects, as one partner described. As Nesta’s project lead observed: “They pulled together an innovative complex partnership that included the early years team, library, speech and language NHS specialist service, and public health. It made the possibilities greater for what we could do and it brought more creative thinking."

Ultimately, this helped break down silos, encouraged more collaborative ways of working and led to better integration of support for families. This is illustrated below in the case study from Stockport.

Joining up midwifery and health visiting services in Stockport

The local context

Following our initial discovery projects, joining up support for families from midwives and health visitors was identified as a key priority by Stockport.

What we did

The integrated enhanced maternity pathway project that followed exemplifies how innovation can transform service delivery through collaboration. Focused on improving integration between health visiting and midwifery during the antenatal period, the project fostered stronger working relationships between both services and resulted in a more joined-up pathway that better supports families.

A key aspect of the project was the introduction of joint visits by midwives and health visitors for families with specific identified needs, using shared assessment tools and collectively-defined criteria.

The outcome

The joint visits improved communication between midwifery and health visiting. Joint supervision of complex cases further deepened collaboration, creating a shared culture of working. “It’s increased the communication [of health visitors] with specialist maternity mental health midwives,” noted one Stockport partner.

The innovation process, alongside shared learning between teams, was instrumental in bringing these teams together and building relationships. "[The co-design] workshops have allowed us to bring all those services together," said one of the Start Well team leads. “I wouldn’t have known the midwifery team leads in the other areas, but now we’re all working together.”

iii. Better targeted interventions and strategic decisions

The AFSL programme has led to a deeper understanding of local needs, better-targeted interventions, and improved and more strategic resource allocation. As a result, councils have been able to support families more effectively, particularly those in disadvantaged communities, while supporting a culture of evidence-based decision-making.

Central to this transformation was the ability to leverage existing data more effectively. Across all areas, through improved data use, analysis and visualisation, councils developed a deeper understanding of families’ needs and identified critical gaps in support. As one partner in Leeds described: “We identified stark gaps in the provision of [speech and language] services. There were certain areas that had really high need, really high waiting lists, and poor outcomes at age five but no provision offered by the council.” Such insights allowed a more targeted approach, ensuring that support reached those who needed it most. In Leeds, for example, insights from analysis of library usage and waitlists for the speech and language service prompted the expansion of a mobile library service, increasing access to books for families in underserved communities.

The programme also supported more strategic decision-making. For instance, in Stockport, analysis of WellComm data – a screening tool for speech and language development – highlighted disparities in development by gender and socioeconomic status. This finding led to targeted efforts to expand assessments early in pregnancy, more effective triage, and greater strategic oversight of the needs of families and children from disadvantaged areas.

Using 'ward profiles' to target family support across York

The local context

In York, the development of a simple but user-friendly data visualisation has transformed the way data is used in York and gave early years teams insights needed to allocate resources more effectively.

What we did

‘Ward profiles’ summarise key data about children in each of York’s 21 wards, bringing together linked datasets from across services, including health, education and social care.

For the first time, it allowed York to access ward-level data that painted a clear picture of children’s journeys and needs. The profiles included information such as SLC outcomes, funding data, and demographic insights. Presented visually, they were easy to interpret and share, empowering service leaders and practitioners to make data-driven decisions.

Footnotes

The outcome The impact has been transformative. York's team has been able to make better-informed decisions about where to provide enhanced support. For example, York's award-winning 'Early Talk for York' programme, which supports children's SLC development, could now be implemented in a more focused way, ensuring that the areas of highest need received enhanced support. Similarly, the profiles informed the work of Raise York family hubs, enabling a localised approach that maximised the impact of limited budgets.

“York had never seen their early years data like this before,” Nesta's project lead explained. "The profiles gave managers the evidence they needed to target resources effectively.” Beyond supporting immediate interventions, the ward profiles also fostered a broader culture of data-led decision-making. They inspired discussions across services and brought early years data to the attention of senior leaders.

iv. More trusted and family-centred support

The AFSL programme enabled councils to design better tailored support for families by using data to better understand families and co-designing support around their lived experiences and needs. For example, York engaged priority communities in one ward, using in-depth engagement to build relationships and create personas to support the design of targeted interventions. In Leeds, creative, play-based community engagement was used to involve families in shaping how local spaces could better facilitate playful interactions between caregivers and children.

By engaging families in the design of support, each partner has been able to develop a more holistic, relationship-based approach to supporting families, increasing trust between families and professionals. For example, Stockport's integrated enhanced maternity pathway uses an 'epistemic trust' model to connect families with health visitors through trusted midwives. This approach has reduced scepticism among high-need families, leading to stronger, more positive relationships.

Building trust with families through My World Assessments

The local context

In Stockport, we discovered that many families did not trust the health visiting service. Assessments by health visitors were often transactional and checklist-driven, leaving families feeling scrutinised rather than supported. “Most of the families with high needs don't trust professionals,” one practitioner shared. “We needed to build those relationships and trust back up.”

Transforming how assessments are conducted has reshaped relationships between families and professionals, fostering trust and creating a more holistic approach to support.

What we did

We integrated the midwifery and health visiting service to improve families' experiences and increase their levels of trust in professionals. At the heart of this change is a joint visit during pregnancy focused on building a trusting relationship. One way this is done is through the My World Assessment, a tool adapted from Scotland's My World Triangle. This approach offers a comprehensive view of a family's situation, focusing on strengths, risks and protective factors to better understand how the child's development is shaped by their care and environment.

The theory of epistemic trust, central to this approach, has played a key role in fostering these connections. By introducing families to health visitors through midwives, a role that tends to have higher levels of trust, Stockport built bridges with families who might otherwise have been hesitant to engage. "If I introduce one of my friends to you, you are more likely to trust them,” explained a Start Well team lead. “We've really noticed change with the families and feedback on the trusted relationship. We've seen a lot more trust from families in the health visitor."

The outcome

The joint visit and My World Assessment has helped build trust with health visitors by prioritising engagement and collaboration, and ensuring families feel heard and valued. This trust building has gone hand in hand with a more nuanced understanding of risk. “Previously, risk assessments could feel overwhelming, with referrals full of red flags and no context. Now, we see the protective factors alongside the risks, allowing us to support families in a more holistic way,” Stockport's team lead noted. In addition, through the joint visits, parents understood that midwives and health visitors worked together to provide coordinated support to them.

The My World Assessment is now being used as a universal assessment for all families, and is embedded as part of an integrated enhanced maternity pathway. Ultimately, this new approach has helped move Stockport's system from a transactional model to one centred on trust, collaboration and family empowerment. As one practitioner summarised: “The most important impact is relationships – strong relationships with parents, where they feel they can say, 'I'm struggling, I need help,' and know they'll get the support they need."

v. Sparking a culture of innovation and transformation

The AFSL programme has generated a number of ripple effects across local authorities, sparking new ideas, boosting confidence in innovation processes, and driving actions beyond the original partnership scope. By embedding a culture of continuous improvement, learning and The AFSL programme has generated a number of ripple effects across local authorities, sparking new ideas, boosting confidence in innovation processes, and driving actions beyond the original partnership scope. By embedding a culture of continuous improvement, learning and experimentation, and empowering service leaders and managers, local teams have taken the lead to embedding, expanding and sustaining innovation. As one partner reflected: “It allowed us to do more, faster, than we otherwise would have been able to."

For example, in the first year of the partnership, we supported Leeds to pilot and evaluate PEEP, a programme for practitioners to facilitate stronger parent-child relationships and increased parental confidence. In subsequent years, they have expanded the programme across the city – training additional practitioners, securing new funding, and sparking broader conversations about family engagement. This work even drew interest from the Department for Education, amplifying its reach and impact.

AFSL innovation projects also helped early years leaders influence the wider system and drive the case for further transformation. “It puts our work higher up on the agenda. It's not a priority for the NHS and local government otherwise," one partner commented. For example, Stockport were able to use AFSL projects to engage senior stakeholders at a Greater Manchester level, directly contributing to strong buy-in across the region and influencing the update of the Greater Manchester Early Years Delivery Model. The GMCA has now decided to support three additional local authorities to adopt and adapt the integrated enhanced maternity pathway.

Tackling wait times for Leeds' Speech and Language Service

The local context

In Leeds, tackling long waiting lists for the local CSLT service became an urgent priority as disparities in early education take-up and communication outcomes for children in deprived areas highlighted the extent of unmet need. This is important as part of Leeds' ambition to give children in all areas of the city the best start in life and the opportunity to enjoy healthy and happy childhoods.

What we did

We analysed waiting list data from the CSLT service to better understand the barriers faced by families. The analysis uncovered critical insights: a significant proportion of referrals were discharged without care, often because families missed their first appointment. Many of these children were subsequently re-referred and returned to the waiting list. Interviews and focus groups with parents revealed widespread confusion about their place on the waitlist and a need for clearer communication and interim support.

"Really drilling down and understanding our service area, what the data was telling us, what evidence we have, was key,” Leeds' innovation lead explained. The CSLT team subsequently and independently took the findings forward to trial new approaches.

The outcome

Using these insights, the team introduced a text messaging system to remind parents and schools about upcoming appointments, improving appointment attendance. They also increased the availability of interpreters and offered city-wide group interventions for children awaiting neurodiversity assessment. These changes, though modest, have helped to ensure more children can access the support they need when they need it most.

AFSL innovation projects helped early years leaders influence the wider system and drive the case for further transformation.

4. How to do effective innovation in the early years

Innovation in the early years is hard. Strained budgets, complex and fragmented systems, reactive services and traditional ways of working all make testing new approaches challenging. Working in partnership with three local authorities, we've learned about some of the most common innovation challenges faced, as well as how to overcome them.

We've identified six key lessons about how to do innovation in the early years:

• Adopt a test and learn approach.
• Effective innovation needs dedicated capacity.
• Co-design with families and frontline staff.
• There's no shortage of early years data – joining it up is the challenge.
• Use mission-driven innovation to drive collaboration.
• Scale starts with a solution that works in place.

4.1. Adopt a test and learn approach

Throughout each innovation project, we supported partners to adopt a test and learn approach. Test and learn is an iterative approach to policy and service development focused on early and small-scale testing of assumptions, continuous refinement, and a commitment to learning from both what works and what doesn't. It combines techniques from many disciplines, and can be embedded as a way of working when developing new family support, optimising existing services, or scaling up support to more families and new places. Below we've outlined key elements of a test and learn approach and our learning on how this creates the space for innovation processes.

i. Key elements of a test and learn approach

A test and learn approach involves designing and refining solutions in real-world conditions, using feedback and data to guide adaptations (see figure 4). Key elements of the approach include:

1 Learning loops: At its simplest, a learning loop involves: 1) developing something; 2) testing it through making contact with reality; 3) learning from the results. To manage risk we want to close these learning loops as quickly, simply and safely/ethically as possible. Learning loops deviate from a linear 'waterfall' approach to programme delivery, where policy, implementation and evaluation are treated as distinct, sequential steps.

2 Assumptions testing: Start with the end outcomes in mind and work back to identify critical assumptions and uncertainties. Then, through learning loops discussed above, take small, safe-to-fail steps to build confidence. Think big and start small, growing efforts as confidence and results build.

3 Context over control: Instead of trying to control everything, we set conditions for success and shape the context so control is indirect, not absent. The key is to be clear about overall outcomes – and base accountability around this – without specifying exactly how we're going to get there.

ii. Creating the space and process for innovation

Innovation can feel daunting and messy without structure. Adapting a test and learn process involving design sprints and rapid prototyping can help provide a clear process and create dedicated time and space for teams to step outside their day jobs and focus on innovation. “Having these sprints really helped us get to the next phase,” said one participant. The facilitated sessions allowed teams to move from exploring problems to refining prototypes in focused bursts of work.

Partners also told us how the test and learn process helped frame innovation as learning, and move away from a success or failure narrative. This encouraged teams to take risks and think creatively. “Having a team behind you gave you the confidence to try something new,” noted one partner. This approach helped practitioners and leadership engage as innovation was seen as an opportunity to learn, adapt and improve rather than a potential risk.

By starting with small-scale prototyping and pilots, this approach derisks innovation, reducing the chance of costly failures when scaling interventions. As one participant noted: “Testing helps to ensure solutions work locally before scaling." While at times the pace felt uncomfortable, structured timelines and regular sprints kept teams focused and maintained momentum, even in the face of operational challenges, driving projects forward.

Developing Stockport's integrated enhanced maternity pathway

The local context

In Stockport, families often encountered fragmented care during the first 1,001 days, where midwives and health visitors worked in silos. These gaps in coordination result in unmet needs, reduced engagement, and missed opportunities to build trusting relationships early in the parenting journey.

To address these challenges, we embarked on a journey with Stockport to co-design and test a new approach that ultimately led to their new integrated enhanced maternity pathway.

What we did

A joint vision: Co-designing the prototype

The journey began with a test and learn process in early 2023. A design sprint brought together midwives, health visitors, family nurse practitioners, service leaders, and parents to identify key problems and develop initial concepts. A joint antenatal visit emerged as a promising idea. The concept was simple but impactful: midwives and health visitors would meet with expectant parents together during pregnancy, fostering trust and coordination between professionals while reducing the burden for families.

The prototype evolved through rounds of co-design and testing, incorporating insights from workshops, practitioner interviews, and parent feedback. Practitioners highlighted the importance of using motivational interviewing techniques to engage parents and moving beyond checklists to relational, trust-building conversations.

Testing the joint visit

Once Stockport were confident in how the visit should take place, we Once Stockport were confident in how the visit should take place, we supported the team to conduct multiple testing cycles of the prototype to learn if and how it could work in practice. We started with rapid 'experience prototypes', experimenting with different aspects of the visit including the information provided to practitioners and ways to discuss the visit's purpose with parents.

In autumn 2023, the joint visit prototype was then piloted over two months in three high-need areas of Stockport: Adswood, Brinnington, and Offerton. Visits were scheduled between 20-25 weeks of pregnancy, following an introduction at the 16-week clinic appointment.

Feedback mechanisms included surveys, interviews with practitioners, and calls with parents. This feedback revealed strong support for the approach. "It helped to build the relationship with parents early on when they're not sleep deprived, and are able to process information,” a health visitor shared. Parents were supportive too, with one parent noting: “Normally you have to repeat yourself a lot of the time... it was better to speak to both professionals at the same time. I didn't know they worked together."

However, the pilot also highlighted logistical challenges, including variations in how teams conducted the visits, inconsistent use of assessment tools, and difficulties in aligning plans and records between midwives and health visitors.

The outcome

From joint visit prototype to enhanced pathway

The learnings from the pilot led to the development of a more comprehensive and holistic approach: the integrated enhanced maternity pathway. While the joint visit remains central, the pathway incorporates broader systemic changes to optimise collaboration between midwifery and health visiting, including::

• Robust assessment tools to identify families who would benefit most.
• An Integrated Standard Operating Procedure agreed by both midwifery and health visiting to align levels of need and support pathways.
• Shared assessments for all families using the ‘My World' framework.
• Joint plans developed with families, shared across teams.
• Joint supervision for complex cases, facilitated by safeguarding teams.
• Shared records to streamline communication and reduce duplication.

Stockport has now rolled out the integrated enhanced maternity pathway across seven areas. Nesta commissioned an external evaluator to assess its implementation27, focusing on both process improvements and early indications of impact. Integrating health visiting and midwifery has led to:

• More families supported: a 45% increase in antenatal assessments.
• Improved engagement and trust: the introduction of health visitors during the antenatal phase fostered early relationships, reducing anxiety and encouraging continued engagement.
• Enhanced collaboration between practitioners: health visitors and midwives highlighted the benefits of joint working, with clearer role understanding and reduced duplication of efforts.
• Earlier identification of needs: the visits facilitated earlier detection of vulnerabilities, including mental health concerns and safeguarding issues.
• Positive family experiences: families reported improved understanding of child development and parenting strategies. The collaborative approach enhanced parental confidence and strengthened early attachment.
• Workforce development opportunities: health visitors and midwives gained new skills in motivational interviewing and collaborative planning, fostering a sense of shared purpose and improving job satisfaction.
• System-wide impact: the model demonstrated potential for reducing pressure on crisis services by addressing issues early.

4.2. Effective innovation needs dedicated capacity

i. Lack of local innovation capacity is one of the key barriers to early years innovation

We found that dedicated innovation capacity, alongside supportive strategic leadership, was essential to navigate local systems, convene stakeholders, and drive initiatives forward. The role of a local innovation lead, in particular, has proven indispensable in moving projects forward, fostering collaboration, and ensuring that innovations are impactful and sustainable. “Our local lead was absolutely essential," reflected one participant from York. “He was the key person and kept coordinating and pushing us all on. It wouldn't have been successful without someone having that protected time and it being part of [his] job role.” Having someone who is focused entirely on coordinating efforts meant operational leaders were freed from the burden of managing the day-to-day logistics of the innovation process, making it less onerous for other team members to engage meaningfully.

The ability to mediate between strategic goals and operational realities is another key role of local innovation leads. As one Stockport leader noted: "It's so hard for operational leaders to do the pulling together.” In York, their lead's ability to step back and ask the challenging questions helped the team stay focused and navigate difficult decisions. This connection to, but separation from, frontline service delivery roles enabled these roles to take a strategic perspective and ensure that the innovation process stayed on track, while engaging operational roles at key moments.

The value of having well-connected and respected local leads was perhaps the most important success factor for each innovation partnership. As one Nesta team member put it: "I cannot understate the importance of having project leads that were well-connected and well-respected. It's the one thing that cannot and should not change about these projects.” As one Nesta project lead summed up: “Where we have someone who has sway internally and is really efficient and bought into the work from the start, things have worked so much better."

Key traits of an effective innovation lead

1. **Connected and collaborative** An effective innovation lead builds on existing relationships and deep knowledge of local services. They should be collaborative and know who to bring to the table and how to convene a range of stakeholders, ensuring the right people are involved in the right ways. Their established trust and credibility with both senior leaders and frontline staff are key to gaining buy-in and driving progress.
2. **Respected and influential** An innovation lead needs enough clout within the system to coordinate effectively, make requests, and have them acted upon. Their ability to translate strategic goals into practical actions while addressing concerns from various stakeholders helps align efforts across the system.
3. **A problem solver** Innovation requires flexibility, and an effective lead is willing to get their hands dirty, tackle logistical challenges, and mediate between competing demands. Their ability to distil complex needs into actionable steps and balance diverse objectives and stakeholder needs is critical for success.
4. **Embedded but not operational** Ideally, the innovation lead should not be an operational role, but bring dedicated time and focus to coordinate and push work forward. An innovation lead with protected time can act as a consistent point of contact, reducing the burden on operational leaders, and allows them to balance immediate demands with strategic objectives.

iii. Bringing in innovation expertise and capacity

As mentioned, innovation in the early years often falters due to a lack of resources and expertise. To address this, we focused on bringing additional capacity and specialised knowledge that enabled councils to think differently and achieve more ambitious outcomes.

For example, our team of designers, data scientists, mixed-methods researchers, and behavioural scientists brought skills that helped unlock work that wouldn't have been possible otherwise. “We never would have achieved the things on the design work without Nesta,” said one partner.

With operational teams stretched thin, we needed to focus on building effective working relationships, demonstrating our understanding of the local context and using our capacity to take on extra work between meetings and sprints. We conducted data deep dives, developed prototypes, and tested ideas, enabling local teams to focus on implementation. “When you're delivering an operational service, you don't have the headroom to do a deep dive or think differently," one lead explained.

4.3. Co-design with parents and practitioners

Finally, taking a multidisciplinary approach, combining design expertise with data-driven insights and creative arts-based methods, allowed for more holistic solutions. This mix of methods helped local authorities tackle challenges from multiple angles and integrate qualitative and quantitative insights. One lead stated: “Having Nesta ‘around the table' when planning and progressing with projects has brought a new dimension and helped us to enhance our own skills."

i. Evidence-informed co-design

At the heart of this programme was a combination of quantitative analysis with lived experience in order to develop solutions that can meet our goal of closing the disadvantage gap. Co-designing with parents and practitioners was key to creating solutions that were not only informed by evidence of what works but also rooted in lived and professional experience. As one partner put it: "Working with parents as partners and innovators is key to the success of the programme. This was massive.”

Co-design is about designing with families and frontline staff, not just for them. By combining expertise and experience from parents and practitioners with quantitative analysis and evidence of what works, the programme developed solutions that were both data and parent-led.

However, we heard how local authorities often face challenges to doing meaningful co-design. These included reaching disadvantaged or less-engaged families, who were often sceptical of public services but were frequently the target of support. Embedding meaningful engagement practices also requires resources, time and expertise, which were frequently limited. Additionally, practitioners, though enthusiastic, were often stretched thin, which meant balancing co-design activities with their existing workloads often proved difficult.

We share our learning about how to overcome these challenges with five lessons for engaging families and practitioners.

ii. Five lessons for engaging families

1 Make it easy to take part Lowering barriers to participation is critical for meaningful family engagement. For example, setting up a creche allowed parents to participate in focus groups and co-design workshops. Sessions were held in familiar and accessible locations, such as community centers and libraries, or even in public spaces like streets for informal 'vox-pop' style engagement. Offering a range of participation methods – such as interviews, focus groups and online options – was also more inclusive.

Language barriers were also addressed thoughtfully. In Leeds, where over 150 languages are spoken, interpreters were provided, and sessions were hosted in other languages to include parents who might otherwise have been unable to participate. These practical measures ensured that engagement activities reached diverse groups and facilitated broader participation.

2 Provide incentives Financial incentives proved crucial to supporting participation. All councils allocated part of their innovation budgets to provide vouchers as a token of appreciation. York, for example, offered £30 supermarket vouchers for an hour-long session, tailoring the incentive to the supermarket in the local community. Other councils also provided food and refreshments, along with additional incentives such as vouchers. When offering incentives we considered the need to mitigate ethical issues, such as coercion, and ensured that participants understood they could withdraw from the project if they chose to, without affecting the incentive.

Incentives not only improved attendance but also signalled that parents' time and contributions were valued. As Stockport's innovation lead explained: "Offering incentives to attend workshops was crucial to engaging parents in our work and was a good use of funds."

3 Leverage local community relationships Trusted relationships are the gateway to reaching families, particularly those disengaged from public services. Councils worked closely with early years practitioners and local voluntary and community sector (VCS) organisations. In Stockport, for example, the council partnered with Empowering Parents, Empowering Communities (EPEC), a parent-led parenting programme that connects socially excluded families with support. Through EPEC, Stockport successfully engaged parents they might not have reached otherwise. “These connections have been vital to incorporating parent views,” one partner noted.

4 Take time to build trust Building trust was essential, particularly when working with families who had lower confidence in public services. Trust-building efforts created a more welcoming environment and encouraged parents to share their experiences openly.

In York, researchers immersed themselves in the community to better understand its dynamics. “We did a bit of cultural immersion to understand the community and key places,” one researcher explained. Ahead of sessions, researchers made phone calls to introduce themselves and provide details about the process. During interviews and workshops, informal chats helped create a friendly, supportive atmosphere. These efforts were particularly important for co-design sessions, where sustained participation was needed.

5 Use qualitative and creative methods Qualitative methods, such as observations and interviews, provided rich insights into parents' lives, needs and experiences. Combining these methods with creative, design-led techniques – like journey mapping, prototyping or arts-based workshops – enabled councils to translate parents' lived experiences into actionable innovation.

These approaches were particularly effective in Stockport, where design expertise brought the voice of families into the process. “Bringing design expertise and capacity helped us facilitate our learning and listen to the voice of families," one team member shared. Snowball sampling was also effective for reaching additional participants, as parents and childcare workers encouraged others in their networks to take part.

Baby Talk for York

The local context

When York set out to engage families as part of the broader Early Talk for York programme, they had one clear goal: to understand what was stopping some parents accessing support. As head of York's Healthy Child Service explained: "We have not had the capacity to work directly with communities to understand how we can make our interactions with them more useful and meaningful. This results in a broad, universal offer that further compounds inequalities in the city."

The Baby Talk for York project focused on developing concepts to enhance parent-child interactions and extending the reach of the Look, Say, Sing, Play initiative to disadvantaged families, particularly parents aged under 25 in one of York's most deprived wards. To ensure the project was grounded in real experiences, we supported York to adopt a user-centred design process that combined ethnographic research, rapid prototyping, and iterative testing.

What we did

Before diving in, the team spent time building relationships in the community, working closely with groups like Home-Start York. This initial immersion allowed them to establish trust and reach families that weren't accessing early years services. “We made sure to chat with parents first, to build rapport," one researcher shared. “We tried to be friendly and lighthearted rather than cold, detached researchers."

Sessions were held in accessible locations like the local community centres, with a choice of in-person or online formats, to lower barriers to participation.

A free creche was provided to make it easier for parents to attend, and WhatsApp became a key tool for communication, allowing families to stay connected in a way that felt natural and convenient.

Through interviews and three co-design workshops, the team gathered rich insights that reshaped their understanding of the challenges families faced and co-created five prototypes to test. Parents didn't just participate – they became genuine co-creators, selecting and improving the most popular concept, "Our Weekly Adventure". This app helps parents get out of the house with alerts about what's going on in their local area for free or low cost, alongside tips to encourage parent and child interactions. One parent even used their graphic design skills to help develop visuals for the prototypes.

The outcome

The Baby Talk for York project demonstrated how meaningful engagement with families can lead to better solutions, stronger relationships, and a deeper understanding of local needs. “We think we know what it's like for families, but listening to their struggles was incredibly valuable,” said the manager of York's Early Years and Childcare Quality Improvement Team.

While we ultimately decided to focus the partnership on developing an integrated data tool for York, the project demonstrated the power of co-design. As York's partnership lead summed up: “The work we did with families was the most significant true engagement in the early years space I've seen in York."

iii. Five lessons for engaging practitioners

1 Engage early to build trust and buy-in Involving practitioners early in the innovation process is crucial for fostering genuine collaboration. Early engagement helps avoid perceptions of a 'tick-box exercise' and ensures their input is valued. By explaining the aims of the innovation and demonstrating how it aligns with practitioners' goals, teams can create a shared vision.“You've got to bring them in early,” noted the head of York's Healthy Child Service. “They need to understand why you're doing new things, and you've got to make the links.” Showing how the process complements practitioners' goals helps to bring them on board. As one of Stockport's Start Well team leaders, who manages a team of health visitors, reflected: "If you want to do that midwife role, you want to improve things. So if you can show them the vision and how it aligns with what they want, you take them on a journey with us."

2 Choose the right moments for engagement Practitioners often have limited time, and innovation processes can feel like an added burden. Planning engagement carefully around their working patterns and creating flexible opportunities for involvement can make a significant difference.

"We've really tried to pick our moments as to when and who we engage at different points in the process,” said Stockport's partnership lead. “We had much more reach in terms of practitioners' involvement and engagement this year when compared to previous years because of the ways in which we've tried to engage this time round."

Local authority partners were able to find ways to make things work and get practitioners involved. Using strategies such as scheduling flexible workshops, shadowing practitioners, creating practitioner networks for feedback, and reprofiling work to enable frontline staff to take part, our local authority partners were able to ensure meaningful engagement without overwhelming staff.

3. Empower and value practitioners

Co-production isn't just about consultation – it's about empowering practitioners to take the lead where they can. When practitioners are given ownership of the process, it strengthens their engagement and ensures solutions are grounded in operational realities.

In York, several frontline staff were tasked with leading the implementation of a Healthy Child Service pilot to improve take-up of their two-year health review. “We wanted them to feel like they had ownership of it,” explained the head of their Healthy Child Service. “Making sure the process was being followed is much easier coming from a colleague."

Valuing practitioners' time and expertise, even with small gestures like providing lunch during workshops, can also build trust and enthusiasm. "It sounds silly, but just buying lunch helped the workforce feel valued,” shared a health visiting team leader. “It made them more willing and enthusiastic to take part."

4. Address operational challenges

Practitioners are often the best problem solvers for operational challenges. In Stockport, their input was instrumental in addressing issues like calendar sharing, simplifying templates, and creating guides for joint visits. “We have really highly skilled practitioners who know what works well and what doesn't," said Stockport's team leader. Innovations often fail because they don't pay sufficient attention to the operational details that make an innovation work, but addressing them head-on helped secure buy-in and refine implementation.

5. Communicate regularly and transparently

Practitioners don't need to be involved in every part of the process, but keeping them informed and in the loop is essential. Regular updates about progress and outcomes demonstrate respect for their contributions and build confidence and engagement in the process. “Even just a line in an email makes a difference,” said York's Healthy Child Service head. “Giving them feedback and showing the impact of their input helps them see the difference they made.”

Co-producing Stockport's integrated enhanced maternity pathway with practitioners

The local context

Our discovery projects with Stockport highlighted a need to develop more joined-up support for families. In response, Stockport knew that frontline workers would be key to developing and testing a new approach. Health visitors, midwives, and family nurse practitioners were central to the development of Stockport's integrated enhanced maternity pathway. These practitioners were involved in a range of ways throughout key moments in the process, from co-designing, to testing, to identifying challenges and improvements in the model.

What we did

The process began with a series of co-design workshops involving midwifery and health visiting teams in Brinnington and Adswood. Practitioners were invited to step into parents' shoes to view services from their perspective. Observing antenatal visits, shadowing practitioner sessions, and gathering feedback also ensured the design was grounded in real-world practice, while minimising time pressures on busy practitioners.

Frontline staff also played a hands-on role in testing the joint visit prototype. Practitioners tested and provided feedback on different visit styles, helping to refine the approach to the visit. They then piloted the joint visit with 13 families, capturing what worked and what didn't. For example, practitioners highlighted how focusing on understanding parents' concerns – rather than rushing to offer solutions – helped build trust. Simple changes, like referencing the baby or 'bump' directly, opened up deeper conversations about early attachment and family wellbeing.

The outcome

Practitioners were able to identify operational challenges that needed to be addressed for the joint visits to succeed. Issues like scheduling, record-sharing, and the practicality of aligning health visitor and midwife workloads were raised. For instance, practitioners suggested moving the visit closer to the 20-week scan to improve its feasibility and impact.

A high level of practitioner involvement also helped refine the training, templates, and tools needed for joint visits. This collaboration ensured that the final pathway met both families' and practitioners' needs, balancing structure with flexibility. “Practitioners were able to quickly identify operational challenges and specific changes to improve the visits,” noted Stockport's innovation lead. Their input streamlined processes like calendar sharing, revising assessment templates, and creating shared records – practical changes that significantly enhanced the pathway's design.

By embedding practitioners in the co-design process, Stockport created a pathway that not only improved support to families but also empowered the workforce. "We had a worry of introducing something for practitioners to say 'it's another thing on top of the work we have to do'," one of Stockport's health visiting team leaders reflected. “But we haven't really had that, which is interesting. They've really enjoyed building those relationships with midwifery.”

4.4. There's no shortage of early years data – the challenge is joining it up

Data-driven decision-making has underpinned many successful projects. It has supported local authorities to challenge existing assumptions, identify patterns of disadvantage and service gaps, and better target support and resources. However, data was also one of the most common challenges we faced.

i. Common data challenges

Local authorities faced several challenges in using data effectively to drive early years innovation, however, a lack of data wasn't one of them. A major issue was the lack of integration and interoperability across multiple, fragmented data systems. We saw how this disconnect forces teams to rely on labour-intensive workarounds, such as manually transferring data or generating numerous separate reports. In one case, we worked with practitioners who received incomplete referral information, where key details were obscured by the system and required manual verification or additional effort to fill gaps.

As a result, it becomes challenging for service leaders to gain a holistic view of local needs or evaluate the impact of interventions effectively. “The realities of the local system, like NHS data systems, held up projects and sometimes disengaged staff," one partner reflected. These challenges add to the workload of already overstretched teams and slow down innovation processes.

Data sharing was another hurdle, especially when navigating data protection requirements across different organisations. As one partner explained: "Navigating data protection was tricky but also part and parcel of collaborating across two organisations. We had some challenging conversations, but they were healthy and helped us reach common ground.”

The need for expertise and capacity also emerged as a critical issue. Many of the teams we worked with lacked the in-house data analysts and skills required to analyse and interpret complex datasets.

Together, these challenges hinder the ability of local authorities and their partners to use data as a tool for driving innovation. Addressing these barriers needs investment in interoperable systems, streamlined data sharing and information governance processes, and building local data expertise to ensure that teams can access, share and utilise data effectively.

ii. Overcoming challenges by focusing on accessible data

One way we overcame these challenges was by supporting local partners to bring together and use the data they could access in a range of different ways. For example, in York, we demonstrated new ways to use figures and statistics, typically used for staff performance and measuring KPIs, to explore issues around the uptake of the two-year health review. The team in York had not previously had the chance to explore this data with a different lens. Now, York's team is working with schools and using their data to look at where there is poor attendance in nurseries and at reception and where it varies geographically. They are using these insights to target settings to get messages out about the importance of attending settings in the early years.

In Leeds, we supported the council to combine data from two previously unconnected services – CSLT service and Leeds Libraries – revealing new insights into local needs and inequalities. By analysing ward-level data across both services, the team identified areas where children had poor speech and language outcomes but low engagement with library services, highlighting gaps in provision and opportunities for targeted support. By focusing on joining up existing data, we were able to generate a new picture about opportunities for innovation that wouldn't have been visible otherwise.

Partners highlighted how data science expertise was invaluable: “There's absolutely no way we'd have been able to pull all of that info without the data expertise Nesta brought.” This external support not only filled a skills gap but also helped local teams better understand and apply data insights to improve services, highlighting the importance of supporting and empowering early years teams to understand and act on data.

Bringing together data to improve early years support in York

The local context

When we started working together, York's early years service lacked a unified view of children's needs and outcomes. Despite collecting large amounts of data across various services, they struggled to bring it together in a way that provided a clear and actionable picture of local needs. York's innovation lead told us how the data existed but wasn't being used effectively to generate insights or drive decisions. As he explained: “We collected lots of it, but we weren't pulling it out and maximising its potential."

Data was scattered across health, education and social services, making it difficult to identify patterns or target support effectively. For example, while childcare take-up rates were high, there was little information about attendance patterns or disparities among disadvantaged children. “We had that assumption, but we hadn't gathered any data on it," explained York's head of Healthy Child Service. “We were quite shocked it wasn't as good as it could be, and there was a gap for children who were disadvantaged."

This fragmented approach limited the city's ability to understand where children were falling through the cracks or how services could better address their needs. Recognising the potential to use data more strategically, we agreed to make data a central focus of our innovation partnership.

What we did

Year 1: Building the foundations

The journey began by using insights generated from data analysis about York's two-year health review to pilot a set of changes within the Healthy Child Service that led to a noteworthy increase in attendance. To support the evaluation of these changes and empower the service to be more responsive to needs going forward, we developed a 'data dashboard'. The dashboard combines 'real time' quantitative data (such as attendance rates by geography and demographics) with qualitative data (such as reasons for changing or cancelling appointments and feedback from families after reviews).

By highlighting patterns in engagement, the dashboard helped service managers understand where resources were needed most. This early success laid the groundwork for more ambitious data projects in subsequent years.

Year 2: Linking datasets and mapping local needs

Building on the dashboard, we created a linked dataset that brought together information from health, education and social services. This dataset tracked children's journeys through the early years system, from assessments at nine months to school entry at age five, and examined how demographics impacted outcomes. For the first time, York could see a holistic picture of how children were progressing and where disparities existed.

We also developed ward profiles that summarised key data for each local area. These profiles provided service leads and practitioners with accessible insights into local needs, such as speech and language concerns, obesity rates, and housing challenges.

Year 3: Scaling and sustaining the work

In the final year, we turned our focus to developing a data tool that will allow York to better and more proactively allocate resources for speech and language needs, while also using it as an opportunity to test its potential for scale. Drawing on three years of learning, this tool allows York to make more data-informed decisions and address disparities before they become entrenched.

The outcome

York's journey highlights the transformative power of using data strategically in early years systems. By bringing together fragmented datasets, creating accessible tools, and focusing on actionable insights, the partnership unlocked new opportunities to understand needs and provide support for children and families. "This work has had a longer-term impact that's still being realised today," reflected York's innovation lead. “We've got all the data already, but it's just not brought together. Now we can see a real picture of an area or ward or even setting."

For example, York discovered that while overall childcare take-up was high, disadvantaged children had much lower attendance than their peers. This prompted action to engage families and work with early years settings to understand and address barriers to attendance. Similarly, ward profiles have allowed practitioners to tailor interventions to the specific needs of their communities.

4.5. Use mission-driven innovation to drive collaboration

The ability to drive collaboration and bring together people from across an early years system makes mission-driven innovation a powerful approach to innovation in the early years. We found a mission-driven approach to innovation helped drive collaboration in three key ways:

• Fostering strategic alignment and focus.
• Navigating partnership challenges.
• Strengthening engagement across the system.

i. Aligning stakeholders around a shared mission

Our mission helped us identify three local authorities with ambitious and shared goals to improve outcomes for disadvantaged children. By establishing a clear, shared purpose from the outset, we were able to align innovation projects towards a common, shared vision. "We're all about reducing inequalities and supporting children who have poorer outcomes and are disadvantaged,” explained one partner. “We didn't have to keep pulling it back to that. That was a given from the start." This clarity of purpose in the overarching mission facilitated open conversations about priorities and enabled partners to explore their respective goals and identify areas of alignment. As one partner advised: “Make sure you're really clear about what you're trying to achieve, and then work with others to find mutual ground that meets both ambitions and aims."

ii. Navigating partnership challenges

Mission-driven innovation also helped us to work through bumps in the road as they arose. For example, our partnership with York faced several challenges in aligning priorities and identifying the right project to take forward. Early discussions explored various options but finding consensus initially proved difficult. "There were many possible paths – parenting, home learning, or better use of data to target support,” noted one partner.

To navigate these challenges, the partnership returned to its shared innovation mission: reducing inequalities in early years outcomes. This helped resolve tensions, reach compromises and “find the sweet spot" for both parties, as their innovation lead put it. Open conversations were key, with Nesta and York sharing our priorities and collaboratively exploring where they aligned. As one Nesta team member explained: “It's been really healthy... we've come out the end of that process with a clear thing we're going to develop.”

By revisiting the overarching goal of reducing inequalities, the partnership ultimately identified data work as the most impactful area to pursue. "It's not necessarily the focus we would have chosen from the start,” explained York's innovation lead, "but we've grown to realise that's where we could get the most out of the partnership."

iii. Strengthening engagement across teams and organisations

The complexity of local early years systems presents a significant challenge to developing and embedding innovations. These systems involve a wide range of stakeholders and services, including multiple council services, local NHS services, VCS organisations, and childcare providers in a range of settings, all of which operate within distinct structures and frameworks. In Stockport, for example, system mapping revealed 24 separate interventions targeting families during the early years period as part of their Early Years Delivery Model alone.

This complexity can lead to siloed working, where different teams and organisations struggle to coordinate and collaborate effectively. “It's hard to hold both the complexity of the wider system with the specificity of what needs to happen in a particular intervention," explained one of Nesta's project leads.

While by no means a silver bullet, we saw how mission-driven innovation was able to build stronger relationships across teams and organisations. “It has been possible to get people into the room because of the work we've done in the partnership,” shared one partner.

Many partners also shared how aligning projects around a clear vision encouraged buy-in from staff. “Deep down, they wanted to do the changes but had no structure or support around them. If you can show them the vision and how it aligns with what they want, you take them on a journey,” explained a health visiting team leader.

Playful Learning Leeds

The local context

Harehills is a vibrant and diverse neighbourhood in Leeds where over 150 languages are spoken. However, it is also one of the most deprived neighbourhoods in the city, and children growing up there have some of the poorest communication and language outcomes at age five.

Like Nesta, Leeds has a bold ambition – to be the best city for children and young people to grow up in. A place where children are valued, supported, enjoy living and can look forward to a bright future a truly child-friendly city. Child Friendly Leeds has been a key part of the Leeds improvement journey since its launch in July 2012. The team have always asked themselves and others across the city: What is it like to be a child or young person in Leeds, and how can we make it better?

This goal spurs the council to continually work to address the inequalities in the city linked with deprivation levels, where nearly one in four children are living in poverty²⁷.

What we did

Data-driven approach

We analysed data on children's communication and language outcomes, as well as the take-up of the free entitlement to early education at age two, to see how this varies across the city and identified areas, such as Harehills, where engagement and outcomes are low.

We built on these initial insights by working with the local NHS CSLT service and Leeds Libraries, to understand patterns and interactions between speech and language outcomes, waitlists for the CSLT service, and gaps in CSLT and library provision. We also conducted interviews with parents to understand their experiences of speech and language and library services and how they wanted to be supported, which indicated local community spaces might offer opportunities to support child development in playful ways outside of formal services.

A partnership around a shared purpose

The AFSL programme helped engage and galvanise people, as did Child Friendly Leeds with its emphasis on partnership, knowing that no single service or organisation can bring about its mission alone. In the process, we brought together an unexpected constellation of partners across the city, all focused around improving speech and language outcomes for children from disadvantaged backgrounds.

"A big impact has been strengthening relationships across the partnership and much more integration and people talking together and working together instead of people working in silos,” explained one partner from Leeds.

These new relationships and improved collaboration laid the foundation for the work we did in year three on Playful Learning Leeds, which focused on the power of play to support fun interactions between children and their caregivers. As one partner recalls: “It took us a while but we did bring pilots together around an area in early years. It built those relationships and partnerships, which was an unintended outcome. Because those people – who care about child outcomes came together as part of a team to make the best of it".

The Playful Learning Leeds collaboration included teams from Leeds City Council, including the Children and Families Service, Public Health, Leeds Libraries, the Leeds NHS Community Trust's CSLT service, and the local Compton Centre Community Hub – working alongside Nesta and a creative team led by local play and arts specialists, Playful Anywhere and Play Explore Art.

The outcome

The result of Playful Learning Leeds was a series of vibrant play installations in Harehills designed to support early speech and language development through creativity and play. Launched in December 2024, the Play Together, Talk Together project transformed the entrance to the Compton Centre Community Hub into a space for playful learning. These installations, designed by creatives with careful consultation with local families, invite children and caregivers to engage in meaningful interactions. An in-depth qualitative evaluation showed the installations were effective in encouraging many types of communication during play. The installations that required two players were particularly effective in initiating conversation and intergenerational play, whilst certain design features, such as peep through windows and speaking tubes, frequently prompted two-way communication.

This project not only created a new resource for families but also strengthened cross-sector relationships. As one partner reflected: “Libraries are now much more integrated into children's services and a bigger part of our early help offer because of the coming together." The closer links between library services and Leeds' Early Help service contributed to a successful recent Local Government Association Peer Review.

4.6. Scale starts with a solution that works in place

i. Approaches to scaling

A core hypothesis of the programme was that effective early years innovations, when successfully developed and tested in one place, have the potential to scale to new areas. To break the link between family background and life chances, it is crucial that proven solutions reach as many people and places as possible.

Unfortunately, some of the most promising interventions fail to achieve widespread adoption²⁸. This challenge is in part due to the complexity and diversity of local systems – each a unique mix of communities, services and organisations – requiring interventions to be tailored to local contexts.

There is also a significant gap in evidence around how to scale effectively²⁹. As shown in figure 5, scaling can be viewed along a spectrum of fidelity: at one end are highly structured models requiring strict adherence, such as the Family Nurse Partnership (FNP); at the other, more flexible models that emphasise customisation for local contexts. Similarly, scaling strategies can range from top-down approaches, where government drives adoption (eg, the Healthy Child Programme), to bottom-up approaches, where local commissioners and providers independently implement interventions. Models in between may involve significant elements of flexibility within nationally structured programmes, for example the scope for community input into Sure Start local programmes between 1999 and 2003.

ii. Managing projects to address place and scale

From the outset we sought to prioritise working on projects that addressed local needs and the ambitions of each local authority, and that also had potential for scaling. As should be expected, local authority partners exist to serve their populations and therefore addressing local needs is paramount. As one partner noted: “You want to feel the work is useful [for others], but ultimately our priority was to improve outcomes in Stockport for the groups we're struggling to impact.” At the same time, Nesta as a national innovation foundation has an obligation to create the greatest possible impact across the nations we work within.

In each local authority we were able to identify projects that both tackled local challenges and showed potential for scale. We assessed potential for scale by looking for 1) to what extent the challenge being tackled exists in other local authorities, 2) how difficult or easy it may be to identify and replicate the essential ingredients of the solution and 3) whether it's likely to be possible to make the intervention low cost, or at a minimum cost effective, as it scales.

Following project selection, the test and learn approach taken in AFSL provided important information on both the effectiveness of the innovation in its original context, and the factors that could influence the potential for further scaling. For example, in York the first priority of our project in year 3 was to design a tool that effectively met York's specific needs. In doing so, we maximised local impact, but also learned important lessons on how such a tool can be adopted and integrated into local authorities' systems, which advanced our understanding of the factors to consider when scaling this tool and others like it.

Our learning from this process reinforced our view that any intervention that scales successfully must first prove effective in a local context. In other words, scaling starts with solutions that work in place.

iii. Assessing the best route to scale

Our local authority partners reinforced the importance of giving local implementers the flexibility to tailor interventions to their specific contexts an approach they referred to as 'adopt and adapt'. Although a lift-and-shift approach may work in certain circumstances, in the complex systems that these interventions reside our assessment is that a significant degree of flexibility is usually required.

This insight aligns with our broader research on scaling parenting interventions, which highlights the importance of the delivery context and need for local adaptability in order to achieve impact. As Nesta's deputy mission director put it: "People have tried a lot of scaling and found that you often don't get the desired effect size from lift-and-shift approaches because the local institutional architectures, workforces, and communities are different and not able to be recreated."

The adopt and adapt approach acknowledges that while an intervention's core principles – its 'active ingredients' – must remain intact, its implementation must be flexible enough to respond to local circumstances. Identifying the active ingredients requires working closely with local stakeholders – including commissioners, providers, practitioners, and families to learn what it takes to embed an approach in different settings.

For example, Greater Manchester is currently scaling Stockport's integrated enhanced maternity pathway using an adopt and adapt strategy. While the pathway's core components remain unchanged, flexibility is built into the process to accommodate the distinct contexts of Greater Manchester's ten boroughs. By ensuring that local areas can tailor implementation while preserving the intervention's essential elements, the programme is more likely to achieve sustainable impact at scale.

iv. Addressing tensions between place and scale

As the programme evolved, scaling became a more explicit strategic priority for Nesta. This brought about a tension through the divergence of partners' focus, with local authorities justifiably focused on improvements in their area and Nesta's focus being increasingly drawn to the application of the innovations to other areas.

Successful approaches to resolve these tensions included:

Scaling through local networks of which the partner was already a member.

The involvement of GMCA in our partnership provided a route to scale the integrated enhanced maternity pathway developed in Stockport. This was facilitated by having strong existing relationships, close proximity of the GMCA team to the early stages of innovation development, and clarity within the team on how best to spread the innovation to new areas (the aforementioned adopt and adapt approach). This is described in further detail in the case study below.

Leveraging additional resources beyond the initial location to explore routes to scale.

In York, we focused on developing a scalable data tool that could later be adopted by other local authorities. While we remained mindful of scale and broader applicability, the priority was to design a tool that effectively met York's specific needs. In later stages of the project, as Nesta's focus shifted towards opportunities for scaling, we worked with a partner organisation that already operated tools at scale across local authorities. This provided an opportunity to explore a new route to scaling the solution, that used the learning from testing in place and combined it with an opportunity to reach a wider audience.

Greater Manchester's adopt and adapt approach to scaling

In Greater Manchester, plans are underway to scale the integrated enhanced maternity pathway, building on Stockport's success. To achieve this, the GMCA is using an adopt and adapt strategy, ensuring the pathway's core components remain consistent while allowing flexibility for local adaptation.

This approach recognises the diversity across Greater Manchester's ten different boroughs. “We can't mandate this across Greater Manchester. Each locality is different,” GMCA's early years programme manager explained. “Their communities are different; their workforce is different; the organisations are different. Strategic and political buy-in varies. There are five maternity providers in Salford but just one in other areas, for example.”

The strategy emphasises collaboration and focuses on identifying willing partners: "It's about meeting the system where it's at and working collaboratively to get buy-in from commissioners and providers,” she shared.

The adopt and adapt model starts by identifying the pathway's essential elements – such as joint supervision between midwifery and health visiting teams - but builds in flexibility to the process, enabling local areas to tweak the model to fit their existing structures and context. GMCA's early years programme manager argues that it is essential that the approach to scaling is place-based: “I absolutely believe in the work in Stockport and its ability to move us forward with how to integrate early years and maternity services. But we can't have a one-size-fits-all approach. Our families and needs and assets in each place are different.”

GMCA is taking on the role of scaling partner, identifying who to work with, sharing learning and exploring how best to support local authorities to adopt the model. Particular attention is being paid to understanding the system conditions that might be barriers or enablers of effective implementation. "We need to think about the baseline level of integration,” their programme manager noted. “What's already in place? What's the appetite? What are the system priorities, and how can we speak to those?"

GMCA's strategy also acknowledges the importance of funding and strategic support to facilitate transformation. “We've got a bit of budget for scale, but we can't do it without transformation resources,” she emphasised.

5. Recommendations

5.1. Recommendations for central government

The UK Government's commitment to its Breaking Down Barriers to Opportunity mission reflects a bold, mission-driven approach to tackling inequalities. This aligns closely with the principles and aims of AFSL. Our experience demonstrates how mission-led strategies can drive meaningful action, and that cross-departmental working is essential in order to effectively support early years teams in local authorities.

To unlock effective mission-driven innovation in the early years, we recommend that the UK Government should evolve into a present and active steward of early years innovation. For instance, by:

• Developing and delivering a research and innovation action plan in partnership with the sector, bringing a more structured and open approach to the pursuit of early years innovation and research, that is both rigorous and creates actionable insight.
• Supporting the development of stronger networks between local authorities, supporting evidence gathering, adoption and adaptation of effective models and spreading evidence informed practice.
• Using planned test and learn work with Family Hubs as an opportunity to build innovation capacity within local authorities, for example by funding local innovation leads who can work at combined authority level to develop and spread impactful new ideas.
• Taking inspiration from the Research Schools Network (a programme to support schools, colleges, and early years settings to access, understand, and apply evidence), develop an equivalent for innovation which can identify mechanisms to scale effective place-based models.

5.2. Recommendations for local government

Local authorities have a unique and vital role within local systems of family support. They are the designer and deliverer of a range of essential family support, they are a steward of best practice and standards, and they can act as a leader and convenor of the local system, bringing its many actors together and mobilising them towards a shared mission. Based on the experience in AFSL our recommendation to local government is to foster a culture of innovation within early years services which seeks to develop and adopt impactful new ideas. For instance, by:

• Harnessing central government's test and learn agenda to develop a culture that empowers service managers to responsibly experiment and try new approaches as innovation champions.
• Nurturing internal innovation capability taking opportunities to establish a dedicated innovation lead within local early years teams to coordinate and drive innovation processes.
• Partnering with families and communities by developing specific expertise and processes for family engagement that go beyond consultation.
• Working in partnership with communities and VCS organisations to leverage their latent capacity and power to form more joined-up support for families
• Leveraging opportunities to spread innovation across combined authorities, recognising the contextual similarities which can assist scaling of innovation.

5.3. Recommendations for early years funders

Funders play a vital role in driving innovation and improvement in the early years, particularly by supporting the VCS organisations that provide essential support to families. Many of the lessons in this report apply equally to these organisations.

To maximise their impact and contribute to lasting change, funders of early years service innovation should support the growth of local innovation capacity, for instance by:

• Supporting the development and testing of scalable programmes by funding and lending expertise to early years providers to build innovation capacity and adopt a test and learn approach.
• Combining their funding streams and collectively backing the most promising new ideas and impactful solutions
• Foster cross-sector collaboration by funding initiatives that support innovation and integration, such as the Thrive at Five model, as well as specific services and interventions
• Providing long-term funding to allow the development of meaningful cross-sector partnerships.

Further acknowledgements

Leeds

• Anna Salaman
• Charlotte Derry
• Clare Holding
• Designed by Duo
• Emma Bearman
• Helen Binns
• Jen Rutherford
• Jo Graham
• Julie Longworth
• Leslie Wilkinson
• Nicola Waddington
• Rachel Ingle-Teare
• Sharon House
• Stephanie Jefferies
• Tim Mileusnic
• Vicky Fuggles
• Zoe White
• Special thanks to the team at the Compton Centre
• Ivan Lambert
• John Newman
• LJ Woodward
• Louise Burns
• Maura Appleby
• Sara Jackson
• Special thanks to all the midwifery and health visiting Start Well Team Leaders

Stockport

• Christine McLoughlin
• Emma McDonough
• Ginny Awan
• Hayley Rowen

Greater Manchester

• Andrea Morales Reyes
• Huw Spencer
• Laura Knight
• Miriam Loxham

York

• Barbara Mands
• Ian Cunningham
• Jenny Dearing
• Jo Suggitt-Richardson
• Jodie Farquharson
• Maxine Squire
• Nicola Sawyer
• Rob Newton
• Tina Wynne

FURTHER ACKNOWLEDGEMENTS

Nesta

• Alex Porter
• Anna Landreth Strong
• Benton Ching
• Dalia Ben-Galim
• Dave Wilson
• Emma Dixon
• Emma McFarland
• Fede Andreis
• Fionnuala O'Reilly
• Helen Wales
• Hessy Elliott
• Imran Nazerali
• Irene Knowles
• Jack Sheeran
• Jenny Gibson
• Jess Gillam
• Kat Zscharnagk
• Kyra Kocis
• Lizzie Ingram
• Louise Bazalgette
• Nazli Durusut
• Rachael Glover
• Rachel Wilcock
• Raj Chande
• Sarah Cattan
• Stefan Kelly
• Suraj Vadgama
• Tim Shakespeare
• Toby Baker
• Tom Symons

Endnotes

1The Guardian, 2021, ‘Fewer UK children 'school ready' after Covid nursery closures', www.theguardian.com/education/2021/jan/18/fewer-uk-children-school-ready-after-covid-nursery-closures 2IFS, 2024, ‘How have English councils' funding and spending changed? 2010 to 2024', ifs.org.uk/publications/how-have-english-councils-funding-and-spending-changed-2010-2024 3Davies, G. 2021, The local government finance system in England: overview and challenges, National Audit Office. www.nao.org.uk/reports/the-local-government-finance-system-in-england-overview-and-challenges/?nab=0 4Van Herwegen, J. 2022, 'Why has there been a rise in number of SEN children, especially in the early years?', Centre for Educational Neuroscience. www.educationalneuroscience.org.uk/2022/04/01/why-has-there-been-a-rise-in-number-of-sen-children-especially-in-the-early-years/ 5Nesta, 2023, 'Early-years sector needs 27,500 staff to meet 46% rise in hours spent in childcare for toddlers', www.nesta.org.uk/press-release/early-years-sector-needs-27500-staff-to-meet-46-rise-in-hours-spent-in-childcare/ 6Office for National Statistics, 2023, 'How life has changed in Leeds: Census 2021', Census 2021. www.ons.gov.uk/visualisations/censusareachanges/E08000035/ 7Office for Health Improvement and Disparities, 2023, 'Child Health Profile: Leeds', accessed via Public Health England's Fingertips database. fingertips.phe.org.uk/static-reports/child-health-profiles/2023/E08000035.html?area-name=Leeds 8ibid. 9Department for Education, 2024, Early years foundation stage profile results, explore-education-statistics.service.gov.uk/find-statistics/early-years-foundation-stage-profile-results 10ibid. 11ibid. 12Office for National Statistics, 2023, ‘How life has changed in Stockport: Census 2021', Census 2021. www.ons.gov.uk/visualisations/censusareachanges/E08000007/ 13Stockport Metropolitan Borough Council, 2025, Children in Poverty Report, Report to the Children and Families Scrutiny Committee. 14ibid. 15Department for Education, 2024, Early years foundation stage profile results, explore-education-statistics.service.gov.uk/find-statistics/early-years-foundation-stage-profile-results 16ibid. 17ibid. 18Office for National Statistics, 2023, ‘How life has changed in York: Census 2021', Census 2021. www.ons.gov.uk/visualisations/censusareachanges/E06000014/ 19ibid. 20City of York Council, 2023, 'One City, for all: City of York's Council Plan 2023-2027', www.york.gov.uk/council-plan-1/one-city-2023-2027/6 21Department for Education, 2024, Early years foundation stage profile results, explore-education-statistics.service.gov.uk/find-statistics/early-years-foundation-stage-profile-results 22ibid. 23ibid. 24Nesta, 2021, Fairer Start Local: Learning from rapid discovery projects, www.nesta.org.uk/report/fairer-start-local-report/introduction/ 25Design Council, 2003, ‘The Double Diamond: A universally accepted depiction of the design process', www.designcouncil.org.uk/our-resources/the-double-diamond/ 26Speight, S., Smith, R., Lloyd, E., and Coshall, C. 'Families Experiencing Multiple Disadvantage: Their Use of and Views on Childcare Provision', Research Report, Department for Children, Schools and Families, 2010. repository.uel.ac.uk/item/86297 27Apteligen, 2025, An evaluation of the Stockport health visiting and midwifery joint visits service innovation: Executive Summary. media.nesta.org.uk/documents/An_evaluation_of_the_Stockport_health_visiting_and_midwifery_joint_visits_service_innovation_YVExXck.pdf 28Office for Health Improvement and Disparities, 2023, 'Child Health Profile: Leeds', accessed via Public Health England's Fingertips database. fingertips.phe.org.uk/static-reports/child-health-profiles/2023/E08000035.html?area-name=Leeds 29Beszterczey, A. & Sanguino, I. 2024, Enablers for effectively scaling parenting interventions, report by Behavioural Insights Team, commissioned by Nesta. www.nesta.org.uk/report/enablers-for-effectively-scaling-parenting-interventions/ 30ibid.

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