Resetting the relationship between local and national government. Read our Local Government White Paper

Lancashire's holistic approach to school readiness

Spanning 12 distinct districts, Lancashire’s health visiting service operates across a vast geographical region reaching into rural, urban, diverse and deprived areas.

View allPublic health articles

Lancashire County Council’s priority for best start in life has redefined services by integrating health visiting, early years, maternity and family hubs within a unified framework led by the Best Start in Life (BSIL) Board. This strategic shift, aimed at improving school readiness and reducing inequalities leverages collaborative governance and data-driven insights to enhance service delivery. 

Highlighting innovative solutions to speech and language therapy access and a comprehensive approach to parenting support, this case study showcases Lancashire's commitment to a holistic, equitable start for every child.

The challenge

Spanning 12 distinct districts, Lancashire’s health visiting service operates across a vast geographical region reaching into rural, urban, diverse and deprived areas. Following the pandemic, Lancashire’s education settings identified significant gaps in school readiness and delayed developmental milestones and social skills prompting the need for a service review. Like many other services, Lancashire faced workforce and recruitment challenges which have been recognised across children's services including health visiting, maternity, early years and speech and languages therapy services. This included long waiting lists for children to access speech and language support.

The solution

To address feedback from educational settings, a Best Start in Life (BSIL) board was established, bringing renewed focus and strategic governance to implement its early years strategy. This now forms a key focus piece within the Health and Wellbeing Boards priority areas. The BSIL board is dedicated to three key priority areas: infant mortality, school readiness, and adolescent mental health, with the aim of improving outcomes and reducing inequalities.

Chaired by the council’s director of public health, the board comprises a number of key strategic and operational partners from early years, maternity and children's education services who are committed to an integrated, collaborative approach to best meet the needs of its local communities. A comprehensive outcomes framework with a dashboard to monitor progress has been developed alongside a logic model using a systems approach across Lancashire.

A strategic operational group led by the regional director of HCRG Care Group, who deliver the health visiting service, oversee the work streams for the BSIL board. This includes key focus on workforce, data and intelligence and speech and language. By bringing together key stakeholders around a unified purpose, the board has set a new standard for early years' services within Lancashire. 

One of the key priority areas identified was to address the waiting lists for speech and language therapy interventions, which as of December 2022, exceeded 100 children. To begin this workt, the council piloted a targeted initiative in Hyndburn. It leveraged its existing multi-agency partnerships to facilitate close collaboration between speech and language therapists, public health officials, health visiting practitioners, and children and family wellbeing support workers to ensure children in need of speech and language therapy received timely interventions. 

The impact

The establishment of the Best Start in Life (BSIL) board significantly enhanced the direction and operational effectiveness of Lancashire's early years and health visiting services. This has been further strengthened by strategic operational group support and coordination. The impact of the BSIL board's prioritisation of school readiness can be seen in the significant increase in the local take-up of the two- and three-year-old offer. Between the summer of 2021 and the summer of 2022 there was a 16.6% increase in local take up and in spring 2022-23, nationally published data showed for the first time, that the Lancashire offer take up was above the England and North West averages.

The board's collaborative efforts led to an exceptionally positive outcome for the Hyndburn speech and therapy pilot, where the structured partnership in place helped reduce the initial backlog of over a hundred children awaiting interventions down to zero. The pilot's success has led to it being extended to four additional areas within the county.

Moving away from the traditional model of assessment to an instant, easy access partnership approach, by May 2023, all 100 children had been seen and had support in place, the backlog was cleared and all eligible children can now access services. This collaborative approach with system partners had not only reduced the waiting list but eradicated this in a few short months. The council also invested in WELLCOMM toolkits which enable practitioners and teachers to identify children needing support and refer as appropriate. 

Lancashire has proactively embedded health visiting within its family hubs and leveraged local resources to fulfil community needs. Lancashire’s approach was also commended during a recent visit by the Parliamentary Under-Secretary of State for Public Health, Start for Life and Primary Care, Dame Andrea Leadsom MP in January 2024. 

How is the new approach being sustained?

Lancashire County Council's approach to sustaining the strides made in health visiting and early years services is anchored in a robust, integrated, and system-wide strategy, spearheaded by the Best Start in Life (BSIL) board. The governance around the board, including the operational group led by HRCG’s regional director, continues to focus on workforce development, data intelligence, speech and language services and parenting support. These facilitate a forum for addressing issues, sharing best practice and driving continuous improvement across the service, feeding into the BSIL board.

The outcomes framework developed for the service aligns with key priority areas and will enable monitoring and evaluation of the impact of interventions across the health system. 

Following successful multi-agency pilots, interventions to reduce waiting times will be rolled out into other districts within Lancashire. A conscious effort to build clearer support and intervention pathways has also helped health visitors and partners signpost families needing additional support.

Lessons learned

A shared leadership approach with a unifying purpose to reduce inequalities has had a significant impact, mainly due bringing key partners together with genuine buy-in to achieve priorities. Having a best start in life approach has provided an opportunity to reshape current models. Integrating feedback from key stakeholders provided invaluable insights that help maintain a service that is fit for purpose.


Ruksana Sardar-Akram

[email protected]

Consultant in Public Health

Lancashire County Council

Michelle Lee

[email protected]

Regional Director – North West 

0-19 Public Health Nursing Service 

HCRG Care Group