In the run up to PACEY’s conference in York last September, I did an awful lot of research about the integrated 2 year review to see what had been happening since it was first bandied about. With tremendous optimism and anticipation, we were told to expect our local authorities to introduce support for integration as we approach its supposed implementation from September 2015. Rather surprisingly, considering talk of an integrated review had been on the go for over 4 years by this time, all I could find was this from and it didn’t look looking like anything was changing there any time soon – if ever. I did hear from participants in parts of Yorkshire although the pilot study went well there initially but it’s not been going too great since.

Now remember, this all started back on the 18th of July 2011, when the DfE and the DofH jointly published Supporting Families in the Foundation Years (FitFY) which set out their vision for the system of services to support parents, children and families in the foundation years starting from pregnancy until a child’s fifth birthday. FitFY included a commitment to “explore options for a single integrated review from 2015 when the planned increase in health visitor number should make this possible”, bringing together the Healthy Child Programme review at 2 – 2 ½ (the HPC2) and the Early Years progress check at age 2.

The idea was that the integrated review would cover the development areas in the current HPC2 review and the EYFS 2 year progress check, in a coherent, integrated way. It was not just about integrating the content of the reviews (keep this in your mind because this comes up again later) but also about drawing together the different skills and experience of the health and education practitioners working with the child – supporting information sharing and integrated working across health and education to support children’s healthy development.

This integrated review would supersede the HCP2 year review and the EYFS progress check but would build upon both of these whilst retaining the distinct elements that each offer.

The aim of the integrated review then was to provide a fuller picture of a child’s development at age two, and, where appropriate, to identify additional support to promote a child’s future healthy development; bringing the two reviews together in a coherent way will help achieve this.

We’ve been somewhat enlightened with the experiences of practice series of papers recently. In a nutshell, the Integrated Review Development Group of health and education experts, working together with pilot sites and partners nationally, trialled different models of how the Healthy Child Programme (HCP) health and development review and the EYFS Progress Check at Two might work together. In one 5 page paper we’re updated on how things have been going in Warwickshire and Islington. Those papers have been in circulation for 11 days now and I’m not convinced many people have read them. In Islington, we’ve got Practitioners reporting that from their perspective things were going well in respect of strengthening relationships with parents whilst the Health Visitors were reporting it was working less well with PVI settings. What it all boiled down to ultimately is that HVs needed to be more aware of how we observe children and we need more training on handling sensitive information. None of the papers are heavy -going, some only 2 pages in fact so they’re worth a little read.

Meanwhile, in Oxfordshire, their pilot demonstrated that the health review and the EYFS progress check simply cannot work together as a single review because they are very different in their purpose and approach. Hmmm. Their model, developed, with the health review taking place between 2 – 2 ½ and the EYFS progress check between 2 ½ – 3 years of age, has been successfully identified as the best way forward – nationally. Did you get that? That’s two separate reviews at two separate times by two separate professionals. I don’t know about you but that’s not what I was expecting. Perhaps I really am a more optimistic character than I thought I was. Who’d have known? When I think ‘integration’ I think harmony. Well, I wasn’t alone in my delusion because that’s exactly what was expressed by the Practitioners attending our LA “integrated two year review” meeting yesterday afternoon. And we were a mixed bag of school Teachers, Teaching Assistants, Nursery Managers and Nurses and two Childminders so a fair representation of Practitioners in our LA.

What I don’t think will be lost on you will be the whole irony of the situation we found ourselves in yesterday. The meeting was scheduled for 1-3pm and would be hosted/chaired by the LA and a HV. The polite bunch that we are we all arrived in a timely fashion. We were invited by our LA team to help ourselves to refreshments. We drank our tea and ate our cake. We sat with empty cups a while. We waited. We switched our phones back on to check for missed calls and messages then turned them off again. Then we started the much anticipated, much discussed integration meeting without our guest speaker. Oh the irony of it. We were told she was in anther meeting and would be here by 2pm. We reached the end of the LA section of the presentation. Everybody’s feathers were ruffled by this time because nobody could answer all of the questions everybody had for the Health Visitor – naturally. The clocked ticked on as we got ticked off then in she comes at 2.30. Well, some were having to leave in 15 minutes to assist with school runs and to pick up their own children from school and her apology “better late than never” went down like a lead balloon. What’s worse is she couldn’t really answer anybody’s questions either without having to check back when she got back to the office.

What we did learn

  1. From 2015, health visiting teams have been using an evidence-based questionnaire called the Ages & Stages Questionnaires (ASQ-3™) as part of Healthy Child Programme (HCP) reviews at age two, in order to generate data for a public health outcome measure of child development at age 2-2½. The ASQ3 is an American assessment but it was thoughtfully adapted to British English in or around 2014. I understand these were made available direct to health visiting teams towards the end of that year but our families here in Hartlepool get sent the original American 2009 version instead. I don’t know why they get this version – it just seems thoughtless and careless to me and that seems to be how everybody else there felt too. Health Visitors here have been using them and sending them out for parents of young children to complete since September 2015 and I don’t know how this makes you feel but when I’m asked for a state, province & zip code, or asked about diapers & strollers, or when asked if a child says “I do it” more than she says “Juanita do it” hardly makes me feel that this assessment is for an English audience, does it you? So how do you think our parents would feel about it? But what I want to point out here is that several Practitioners at the meeting challenged this: they have children of their own in this age range and they’ve never received any such form despite assurance that every single parent of a young child should have one by now. Oh dear.
  2. We learned that we are continuing with 2 separate reviews but they will be shared on a secure file transfer system (anycomms+) which everybody else is already registered with except – wait for it – Childminders. But it is coming to us we’re assured. All children’s ASQ3s are going to be uploaded to anycomms+ and we can download it from there. We also use anycomms+ to upload our reviews. This is going to be our integrated system. Both reviews will then be shared with the children’s schools at the appropriate time. So all this “not just about integrating the content of the reviews” is utter twaddle. (I can’t help but wonder how much all of this has been costing the tax payer over the past 4 1/2 years…).

And then we were told that HVs would like the review to be done in the family home but they haven’t enough HVs and only 3 Community Nursery Nurses in Hartlepool, which has a birth rate of 1100 to 1200 per annum. With day care settings facing redundancies in light of increases in business rates, the upcoming living wage, pensions, the 30 hour offer, reverting to ratios thereby losing vital support staff currently covering for holidays and sickness, Managers made it perfectly clear at this juncture that doing their assessment within the family home is a resounding “impossible”.


Ah well, nearly 5 years on and we’re still pretty much in the same place so, EYFS progress checks at 2 it is. As you were.

further reading Families in the Foundation Years Evidence Pack Early Years High Impact Area 6 – Health, wellbeing and development of the child age 2 – Two year old review (integrated review) and support to be ‘ready for school’