In Harmony Liverpool Year 5 Evaluation Health and Well-Being Report by Liverpool Philharmonic

Contents: Preface

Executive Summary

Introduction

Shifting Political Context

Policy Overview

o o o o o o o o o

Health Inequalities Heath Inequalities in West Everton Determinants of Health and Well-Being Educational Inequality Inequality and Well-Being Importance of Early Years Resilience Importance of the Arts and Participation in Health and Well Being Community Well-Being

In Harmony Liverpool: Impact

Key Findings

Recommendations

Appendices 1. 2. 3. 4. 5.

Definitions Well-Being Measures Note on Health Data Summary: Interim Evaluation Year 5 Analysis of responses to well-being surveys over life of programme

Preface In Harmony Liverpoolâ&#x20AC;&#x2122;s aim is to transform communities through music. It is an intensive, immersive and daily orchestral music programme benefiting the West Everton community, with children and young people 0-16 making music for up to 10 hours every week. Established by the Royal Liverpool Philharmonic in 2009 as part of a Government-led national pilot, there is strong evidence, through longitudinal evaluation, that In Harmony Liverpool is making a positive impact on educational achievement, school attendance, personal, social and emotional well-being of children, with wider impacts on stronger family relationships, increased pride, well-being, aspiration and empowerment in the community. At both a local and national level, there is a strong interest in assessing the actual and potential long term impact of the In Harmony activities on the health and well-being of children and families in disadvantaged communities. Recent policy and structural changes in health and educational provision render this more pertinent and urgent. As part of the ongoing evaluation of the In Harmony Liverpool programme, we have sought to understand and evaluate the impact on the health and well-being of participating young people and the wider community. This special report has been produced to focus on the specific dimension of the impact on health and well-being of the In Harmony Liverpool programme on participant children and the wider community in West Everton. It seeks to outline what we know and what we donâ&#x20AC;&#x2122;t know, and contextualises this within policy changes and trends. It is intended as a focus to stimulate further debate, to support the continuing development of an active working partnership with health and other public sector agencies, and to galvanise further cross sector working at both a local and national level in this crucial area of work.

Susanne Burns and Paul Bewick December 2014

Executive Summary – In Harmony Liverpool Year Five 1.

Since the start of the In Harmony programme in West Everton the well-being of participant children and the wider community, and consequent impact on health trends, has been a key area of focus for the evaluation process. This report presents headline findings from the fifth year of longitudinal evaluation data from In Harmony Liverpool and has a specific focus on impact on health and well-being, drawing on key policy areas, case studies and evaluation data to produce findings and recommendations.

It includes a summary of the impact evaluation data gathered in its fifth year. (See Appendix Four). Unlike previous years, we are not publishing a full interim report as we have decided instead to focus on a special report on health and well-being. However, the data contained within this summary seeks to maintain the data sets and ensure that the evaluation continues to inform the ongoing management and development of the programme.

The summary data and the report demonstrate that In Harmony Liverpool continues to progress well against targets in relation to reach, academic and musical attainment and wellbeing and community engagement. Importantly, it maintains the data sets that have been gathered since the beginning of the programme in 2009, providing evidence of long term impact: Reach In Harmony Liverpool has engaged a total of 360 children and young people aged 016 in West Everton between February 2009 and July 2014. Children and young people are making music for up to 10 hours every week both in and out of school. From January 2015, In Harmony is engaging more than 500 children aged 0-16 each week. Academic and Musical Attainment In Harmony Liverpool has been a catalyst for improvements in children’s academic progress and attendance across the Faith Primary School population since 2009.    

 

Two thirds of the school are entitled to Free School Meals, one third has Special Educational Needs and for 18% of children, English is not their first language The proportion of Faith Primary School children exceeding expected progress in Maths and Reading has nearly doubled between 2009 and 2014, from 35% to 69% in Maths, and 36% to 68% in Reading The proportion of Faith Primary School children making good progress in Maths has increased from 40% in 2010 to 82% in 2014 Evidence from the Head Teacher, school data, school teachers, parents, musicians and Ofsted school inspections highlights contributing factors including: o Improvements in the culture of school as a ‘learning community’ through children and adults learning instruments and performing in orchestras together o The development of cognitive skills through music o Improved motivation to learn, enhanced concentration and focus in children. In Harmony Liverpool has achieved expectations in relation to musical attainment with 92% of children leaving Faith Primary School at Grade 2 or 3 equivalent Two thirds of children continue music making on transition to secondary school.

Attendance at Faith Primary School School attendance has increased 2.5% between 2008 and 2014 from 91.2% to 93.7% Well-being of children and young people Well-being outcomes remain encouraging with evidence of:  enhanced confidence, teamwork, aspiration, cooperation and enjoyment  increased resilience  a sense of belonging  greater maturity and focus  application to learning  positive views of future prospects.

Community Engagement  Community engagement continues to develop as the programme becomes more established with evidence that self-determination and social capital are building within the community and In Harmony Liverpool has played a key role in enabling and supporting this. The community feels a strong sense of ownership over ‘their orchestra’ and In Harmony Liverpool as a programme.  Community members report increased civic pride, hope and enthusiasm, positive relationships with children, increased well-being and confidence in the future, and increased involvement with the community as a result of In Harmony.  Music is linking key events in families’ lives and becoming a normal part of life within the community. There is evidence of increased parental engagement with school and children’s’ learning and evidence that music is playing an increasingly important part in the lives of families and extended networks. Parents report improved relationships with their children. They are proud of their children and young people in a collective way as well as individually. 4.

A brief survey of the policy context places our learning and the evidence in context and reveals key areas within which In Harmony Liverpool can (and does) directly and indirectly contribute to impact on educational attainment, health and well-being, resilience, community well-being and positive outcomes for families. We present evidence of impact to date drawing on data collected over a five year period which suggests that In Harmony Liverpool impacts on:      

The children, the school and its culture, thus creating an environment where positive outcomes are more likely to be achieved Early years development The family environment, sibling relationships and extended networks which appear to be creating positive outcomes for children, families and the community and where engagement with music is becoming a part of everyday life Home school relationships with evidence of growing parental engagement Choice and self-determination in both the children and the family networks Increasing resilience in intrinsic and extrinsic domains that appears to demonstrate that security, self-sufficiency and self-worth have been enhanced and secure attachments and enhanced support networks are valued

These are important claims but are supported through evidence and, whilst we recognise that more can be done to ensure that the evidence base becomes more robust and that we learn more about attribution and the actual mechanics of how this is occurring, we are confident that the programme is working well in many dimensions and that this can have a long term impact on inequality and community development and cohesion. 5.

The report ends with a series of headline recommendations which include this need for more in depth research using the In Harmony Liverpool site as a live action research site. It is our contention that much could be learned about how the desired outcomes of many public agencies (as well as cultural organisations who work at the intersection between art and communities) can work together to achieve social outcomes.

We make recommendations about actions that could be taken in three key areas:   

Partnership Development Research and Dissemination Understanding the Importance of Long Term Interventions

It will be important moving forward that:   

a greater in depth focus on health and well-being research is developed in partnership with other agencies that includes the quantitative measurement of health outcomes socio economic impacts for families and community are examined to generate hard data on return on investment impact and evidence is shared and disseminated at local and national levels and that this is used to encourage debate and inform policy on health, well-being and community development.

Introduction:

1.1.

In Harmony Liverpool began in February 2009 and has therefore now been running for five years. The initial outcomes of the two year pilot programme were as follows:

1.2.

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All children attending Faith Primary School, The Shewsy and Everton Children’s Centre to have the opportunity for daily instrumental and vocal music making (over 130 children over the life of the programme)

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An improvement in levels of achievement and attendance at Faith Primary School

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A significant increase in reported levels of self-esteem, self-confidence and increased well-being amongst West Everton children, measured using qualitative evaluations with children, families, community organisations, schools and teachers

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A significant proportion of family and community members from West Everton reporting improved well-being through engagement in music making and live music performance

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A community that feels ‘music is a normal part of our life’

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Increases in take up of Further and Higher Education by people from West Everton (a key part of Government’s Widening Participation agenda. Target is 50%, Currently 27% in Liverpool and significantly less in West Everton)

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A vision for sustained music development in West Everton beyond 2011

In Harmony Liverpool was always envisaged as a social/ community development programme: Our vision is a healthier, inspired and higher achieving West Everton, empowered to celebrate the community through music. The programme, like El Sistema which inspired it, seeks to effect change at a community level through music. This is premised on a belief that there are links between educational attainment, participation in cultural activity and social development. In Harmony Liverpool adopted a holistic approach and worked in a cross sector/ multi agency way to achieve its aspired-for outcomes. “In Harmony Liverpool provides compelling evidence of a holistic and enriching musical education resulting in a positive impact on the personal, social, emotional and educational development of children and young people.” (Burns & Bewick 2013)

1.3.

Health and well-being were always envisaged as aspired-for outcomes of the programme and have been measured alongside other indicators throughout the five years to date in a range of different ways. At the onset of In Harmony Liverpool, we noted: “Arts and health initiatives are a rapidly growing area of interest for the Primary Care Trust (PCT) and there are major opportunities to engage more strategically with this sector in relation to the ongoing assessment of impact in areas of community and individual wellbeing.” (Burns & Bewick, 2009) In the 2009 Baseline Report it was noted that overall, the indicators for health for people living within the Liverpool Primary Care Trust (PCT) area show poorer health than the national average. Liverpool people lived three years less than the national average. The two Super Output Areas (SOAs) in which the majority of pupils attending Faith Primary live, were then the 2nd and 20th most deprived areas in the country. At the beginning of the programme in 2009, Everton Ward statistics were stark and remain so today (Source: http://liverpool.gov.uk/media/120892/everton.pdf):

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The current worklessness rate is 37.3% . This is almost twice the Liverpool average and more than three times the national rate (11.2%)

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Average household income in 2013 was £22,100, the lowest of all 30 Liverpool wards, compared with £30,100 in Liverpool and £36,400 in the UK

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Incapacity benefit claimants (May 2013 DWP): 23.1% more than twice the Liverpool average (11%) and almost four times the national average (6.2%)

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Job Seekers Allowance rate (November 2013 DWP): 8.3% (fourth highest in the City)

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41.7%of all households contain someone with a long term health problem or disability – higher than all other Liverpool wards

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1 in 2 adults (47.3%) have no formal qualification, the highest proportion in the City)

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The proportion of BME residents in Everton is 11.4%, 9th highest of all Liverpool wards

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In the Index of Multiple Deprivation (IMD) 2010 Everton shows a high level of overall deprivation with almost the whole ward (97.6%) falling into the most deprived 5% nationally. More than four fifths of the ward (84.5%) is in the most deprived 1% of areas nationally

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Over half (50.8%) of all children living in Everton ward are classed as living in poverty, significantly higher than the Liverpool average of 32.5% and over two and a half times the national average (20.1%)

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The ward was ranked 1st (ie highest) out of all 30 Liverpool wards for Cardiovascular Disease (CVD), 2nd highest for cancer and 4th highest for respiratory disease.

1.4.

Initial dialogue with the Liverpool Primary Care Trust led to an investment into the In Harmony Liverpool programme premised on a shared belief that the programme could have a major impact on the health and well-being of the children. Liverpool PCT was at this stage commissioning and prioritising arts and health interventions that would assist in developing well-being and this synergy was timely and led to partnership working and shared dialogue. It also allowed for some initial research into health impact that is summarised in section four.

1.5.

In a briefing to local government in September 2013 NICE (National Institute for Health and Care Excellence) highlighted that: ‘Social and emotional well-being creates the foundations for healthy behaviours and educational attainment. It also helps prevent behavioural problems (including substance misuse) and mental health problems. That’s why it is important to focus on the social and emotional well-being of children and young people…… Well-being includes: emotional well-being; psychological well-being; and social well-being’….. Social and emotional wellbeing provides personal competencies (such as emotional resilience, self-esteem and interpersonal skills) that help to protect against risks relating to social disadvantage, family disruption and other adversity in life. Such competencies provide building blocks for personal development which will enable children and young people to take advantage of life chances.’ The briefing further highlighted that improved social and emotional well-being:    

Reduces mental health problems in children and young people Improves social and economic outcomes Reduces demand on services Promotes educational attainment and reduces bullying and risk taking behaviour among pupils

Since the start of the In Harmony programme in West Everton the well-being of participant children and the wider community, and consequent impact on health trends, has been a key area of focus for the evaluation process, and has more recently been given increasing importance by the programme delivery team. This is now seen as a potential major area of impact of the In Harmony programme. 1.6.

This special report seeks to outline what we know about the impact of In Harmony Liverpool in these key dimensions and contextualises this within policy changes and trends. It seeks to use data that has been gathered throughout the five years with a view to highlighting key evidence, both qualitative and quantitative, that demonstrates how the intervention has impacted on health and well-being at an individual as well as a community level. It contains case studies that tell individual stories and seeks to provide a focus for this specific area of the evaluation programme at this critical stage in the development of the In Harmony model and at a critical time in policy and political development.

Shifting Political Context

2.1.

In this section of the report we outline the shifting political context within which In Harmony Liverpool has developed.

2.2

The austerity agenda and public sector and benefit cuts have impacted on the overall economic environment and the resulting impact this has on growing inequality is still emerging but there is no doubt that it is affecting areas of deprivation significantly. The community within which In Harmony Liverpool exists has been affected badly by cuts and there is no sign that things are about to get better. In this context, social interventions that can support resilience and health and well-being within the community are critical. Additionally, Funding for the arts typically diminishes in times of economic recession and political change and yet in times of austerity, it is arguable that the role of the arts has its greatest relevance.

2.3.

At the onset of In Harmony in 2009, the baseline report noted: “Recent policy and strategy developments indicate a clear desire from Government to deal with children and young people in a more holistic way. Not just in terms of improved interagency working and cooperation, but also in terms of the individual child. Emotional, physical and social well-being are now recognised as being central to learning and achievement.” (Burns & Bewick, 2009)

2.4.

When In Harmony was launched in 2008 by the Labour Government it was in a the context of Every Child Matters: Change for Children, introduced in 2004. This framework ensured that the health of children and young people was placed at the forefront of all service providers’ interventions. It reflected the belief that a healthy child will get the best out of their life, and was seen as a key move to help promote the well-being of children and young people in a cross sector and agency way. Its main aims were, for every child, whatever their background or circumstances, to have the support they need to:     

Stay Safe Be Healthy Enjoy and achieve Achieve economic well-being Make a positive contribution

A similar model Getting it Right for Every Child was the equivalent approach in Scotland. 2.5.

When the Coalition government came to power in May 2010, there was a quiet but definite shift in priorities. The day after the coalition was formed, the Department for Children, Schools and Families was renamed the Department for Education (DfE). The Coalition also quietly pushed a shift from well-being to achievement. Schools no longer had a statutory right to promote children’s spiritual, social and emotional well-being, and Ofsted would no longer grade them on this but should “consider” it.1 “Judging the quality of a school 104. Inspectors must judge the quality of education provided in the school. This is the overarching judgement. 105. In order to make a judgement about the quality of education provided in the school, inspectors must first make four key judgements. These are:    

the achievement of pupils at the school the quality of teaching in the school the behaviour and safety of pupils at the school. the quality of leadership in, and management of, the school.

Under Ofsted’s new inspection framework, the number of points that schools are graded on has been reduced

106. In addition, inspectors must also consider:  

the spiritual, moral, social and cultural development of pupils at the school the extent to which the education provided by the school meets the needs of the range of pupils at the school, and in particular the needs of:

 pupils who have a disability for the purposes of the Equality Act 2010  pupils who have special educational needs.” The DfE immediately replaced the values of 'Every Child Matters' and the 'Five Outcomes' with 'help children achieve more'. The Children and Families Bill 2013 takes forward the Coalition Government’s commitments to improve services for vulnerable children and support strong families. It underpins wider reforms to ensure that all children and young people can succeed, no matter what their background. The bill will reform the systems for adoption, looked after children, family justice and special educational needs. It will encourage growth in the childcare sector, introduce a new system of shared parental leave and ensure children in England have a strong advocate for their rights. 2.6.

Alongside this, the introduction of the Health and Social Care Act 2012 brought the most wide-ranging reforms of the NHS since it was founded in 1948. On 1 April 2013 the main changes set out in the Act came into force, and most parts of the NHS were affected in some way. The Primary Care Trusts were disbanded and responsibility for public health shifted to the Local Authority with Clinical Commissioning Groups taking responsibility for primary health care. Health and well-being boards are central to the government’s vision of a more integrated approach to health and social care. Established and hosted by local authorities, health and well-being boards bring together the NHS, public health, adult social care and children’s services, including elected representatives and Local Healthwatch, to plan how best to meet the needs of their local population and tackle local inequalities in health. To date they have been the one feature of the Health and Social Care Act that has received overwhelming support. Clinical commissioning groups (CCGs) are the cornerstone of the new health system. Each of the 8,000 GP practices in England is now part of a CCG. There are 211 CCGs altogether, each commissioning care for an average of 226,000 people. CCGs will commission the majority of health services, including emergency care, elective hospital care, maternity services, and community and mental health services. In 2013/14 they will be responsible for a budget of £65 billion, around 60 per cent of the total NHS budget.

2.7.

So, under the coalition we could say that the link between health and well-being and education has been somewhat weakened with the DfE and Department of Health (DoH) implementing different policy priorities and little or no cross referencing apparently occurring. For example, a Department of Health Factsheet on Well-being – Why it Matters to Health states: “Children’s ratings of their well-being appear to be most strongly influenced by relationships with family members and with their peers.” There is no direct mention of schools or of the influence of teachers and significant other adults. And yet we know that education and health and well-being are closely interrelated: poor health works against educational success, and educational attainment strongly affects social and economic prospects and choices about health. This lack of recognition of the interdependency of some of the key goals of both the education and the health sectors is of major concern.

2.8.

At local government level, the political and policy shifts that have occurred have seen local government assuming responsibility for public health since the demise of the PCTs along with their existing responsibility for education, creating an opportunity at a local level to

connect the two crucial policy and service delivery areas. As we move forward with this transfer of responsibility for public health and health improvement from the NHS to local government it is vital that a whole council approach to addressing the social determinants of health is delivered. In Liverpool, it would appear that at this stage, this policy context and the structural changes around health and education are beginning to translate into a consistency in message around improving outcomes and life chances for children:   

2.9.

We need more long term, early interventions that are at child, family and community level Children’s emotional well-being and resilience is central to their future achievement, adult life and happiness Educational achievement is critical to improving health outcomes.

This complex context where the current government has separated educational policy from health policy, where health policy has created structural separation from public and clinical health delivery and where fiscal policy has generated growing inequality resulting from public sector cuts and austerity measures provide some serious challenges to dealing with inequality. In this context, the links between education, health and well-being are rendered more difficult in the operational delivery of interventions. However, we are living in times where these links are critical to addressing the growing inequalities within society. While schools can’t change the economic and social circumstances within which children grow up, they can address issues of equality, well-being, and resilience and research tells us that this will affect the long term health of the individual child and arguably the community within which that child lives.

Policy Overview

3.1.

In this section of the report we consider the policy context within which In Harmony Liverpool exists and consider the implications of this for the development of the programme and the evidence gathering around impact that has already generated and could continue to generate moving forward.

3.2.

Heath Inequalities Health is a sensitive indicator of societal structures, economic conditions and political priorities and an equally sensitive indicator of the physical and social fabric of our communities. Health and health outcomes are affected by a series of complex and interrelated factors: Genetics, economic conditions, income, environmental factors, physical characteristics of neighbourhoods, housing, education, social structures and individual behaviour are just some of these factors. The disparity in determinants of health therefore means that inequalities emerge and those living in disadvantage are liable to experience disproportionate levels of illness, disease and reduced life expectancy than those living in comparative advantage. Given the wide range of factors that affect health, it is clear that any improvement of health in a community must therefore involve a variety of sectors, skills and inputs. Collective action and approaches are crucial in any attempt to address health inequality.

Figure One: Determinants of Health and Well-Being2

The Dahlgren and Whitehead model (1991) shows the factors that affect our health. To improve health action is required not just at the individual level but also in communities and through the work and living environment. 2

3.3.

Health Inequalities in West Everton The West Everton community makes up part of the larger Everton ward and, geographically, is on the edge of Liverpool City Centre. The ward has been the focus of many regeneration initiatives in recent years and yet, the recently published ward profile states: “..it is clear that there remain considerable housing, health and community safety and worklessness issues in the ward requiring long term solutions.” Liverpool is recognised by the Government as the most deprived Local Authority in England and Everton ward is one of the most deprived in the city. 84.5% of the ward is in the most deprived 1% of areas nationally, compared with a city wide average of 12.7%. 3 Everton Ward statistics are stark with a high level of overall deprivation as almost the entire ward (97.6%) falls into the most deprived 5% of neighbourhoods nationally. With a population of 14,734 people, average household income is the lowest of all 30 Liverpool wards. Child poverty levels in the ward are high with over half the ward living in poverty. This is the second highest child poverty rate of all Liverpool wards. Worklessness is, at 37.3%, the highest in the City, almost twice the Liverpool average and over three times the national rate. The area also has a high proportion of its workless population who are lone parents, a significant issue affecting child and family poverty levels in the area. Crime rates are higher than the city average and incidents of crime have increased between 2011/12 and 2012/13. Life expectancy is 4.9 years lower than the England average. The ward’s standardised mortality rate is the 4th highest of all Liverpool wards with mortality rates for cancer, cardio vascular disease and respiratory disease amongst the highest in the city. Child obesity and alcohol related hospital admission levels are also high, as too is the teenage pregnancy rate. 4 In 2012/13, Faith Primary had 68% take up of free school meals and 27% on the special needs register (at the beginning of In Harmony in 2007/08 the figure was 40.9%). Improving attendance remains a challenge for the school. The challenging environment within which the school operates has an inevitable impact on the children’s learning and well-being.

3.4.

Determinants of Health and Well-Being If we relate this to what we know about the determinants of health and well-being it is clear that there are significant health inequalities being faced that are likely to impact on the health of the community as a whole and particularly on the children living within it. Changes in factors detrimental to health have brought new and complex challenges. Sociobehavioural diseases such as obesity, heart disease, depression, anxiety, stress and addictions have a disproportionate grip on disadvantaged communities and are often embedded in social class, social behaviours and often social exclusion. Poverty and income inequality are fundamentally linked in the research to diminished access to care and services, neglect, poor parenting and neglect, disease, violence, poor diet, poor housing, lower attendance and attainment at school, exposure to harmful substances such as tobacco, drugs and alcohol. Attempts to address such social determinants have often been social regeneration interventions – action within communities to develop cohesion, and address exclusion – however these tend to get less attention than more tangible measures of physical and economic regeneration.

It was noted in the Baseline Report (2009) that:

3 4

IMD 2010 http://liverpool.gov.uk/media/120892/everton.pdf

“Approaches to transforming neighbourhoods have to date primarily focussed on physical infrastructure. Significant investment has been made in the area since 2003. Much of this has been infrastructure based including CCTV, alley-gating and housing maintenance alongside private developer led projects. New investment includes: 

Project Jennifer – £150million housing, industrial and retail development

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City Point – a £3million office development

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West Everton Health Centre – a £3million PCT development

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Plans for a new West Everton Community Centre

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Everton Green Homes – phased development of new housing with Plus Dane Group/ LCC and HCA

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North Liverpool Academy - £37 million development due to open in 2010

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Private sector housing development to include almost 200 new apartments

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Liverpool Hope University Creative and Performing Arts Centre

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Liverpool Philharmonic at the Friary (the rehearsal and education centre at the former St Mary of the Angel’s Church in West Everton)

This project has the potential to supplement this approach.” 3.5.

Educational Inequality Health Inequalities connect to educational inequality. A major review of the most effective evidence-based strategies for addressing health inequalities was conducted by a team under the leadership of Professor Sir Michael Marmot. In its report, published in February 2010, the Marmot Review Team confirmed the extent of health inequalities and found a "social gradient" in health (meaning that "the lower a person's social position, the worse his or her health"). It recommended action to reduce the gradient by seeking to improve health throughout society "but with a scale and intensity that is proportionate to the level of disadvantage" (an approach it called "proportionate universalism"). Since health inequalities resulted from social inequalities, action was needed "across all the social determinants of health". The review also recommended the adoption of the "life course approach" to improving public health. Six specific policy objectives were recommended:      

Give every child the best start in life Enable all children, young people and adults to maximise their capabilities and have control over their lives Create fair employment and good work for all Ensure healthy standard of living for all Create and develop healthy and sustainable places and communities Strengthen the role and impact of ill health prevention.

The Government responded with the white paper, Healthy Lives, Healthy People. It pledged in that White Paper to apply proportionate universalism, by improving the health of all whilst "improving the health of the poorest, fastest"; and to take the life course approach, addressing "the wider factors that affect people at different stages and key transition points in their lives". What is clear from the Marmot review is that ‘health’ no longer simply means an absence of disease, rather it is an incredibly complex, multi-dimensional concept. Health is not solely related to the body and the mind in terms of illness and mental health, but is far more pervasive. This breadth calls into question how such recommendations could be adequately

implemented, despite the fact that the Department of Health is one of the most well funded government departments. Many of the recommendations of the Marmot review are multidisciplinary in the sense that they seek to act on aspects of society as a whole through diverse channels at multiple levels. In research, there is a well known, large, and persistent association between education and health. This has been observed in many countries and time periods, and for a wide variety of health measures. “The differences between the more and the less educated are significant: in 1999, the ageadjusted mortality rate of high school dropouts ages 25 to 64 was more than twice as large as the mortality rate of those with some college.” “There are multiple reasons for these associations, although it is likely that these health differences are in part the result of differences in behavior across education groups. In terms of the relation between education and various health risk factors - smoking, drinking, diet/exercise, use of illegal drugs, household safety, use of preventive medical care, and care for hypertension and diabetes - overall the results suggest very strong gradients where the better educated have healthier behaviors along virtually every margin, although some of these behaviors may also reflect differential access to care. Those with more years of schooling are less likely to smoke, to drink heavily, to be overweight or obese, or to use illegal drugs.” (National Bureau of Economic Research: The Effects of Education on Health)5 A recent consultation response from a group of academics from Liverpool University to proposed budget cuts in Early Years support and Education in the city highlighted the direct correlation between child poverty and GCSE results, with Everton being one of the areas with the lowest GCSE attainment and the highest levels of child poverty. 3.6.

Inequality and well-being Similarly, the link between emotional well-being and learning is well researched. Without well-being children cannot flourish and reach their potential. The UK does not perform well in Unicef assessments of well-being. In 2007, An Overview of Child Well-being in Rich Countries placed the UK at the bottom of the child well-being league table. 6 The six dimensions measured were:      

Material well-being Health and safety Educational well-being Family and peer relationships Behaviours and risks Subjective well-being.

Further research carried out by Ipsos Mori for Unicef (2011) paid particular attention to the role of materialism and inequality in children’s well-being, as there is a growing consensus in the literature that these three concepts are inextricably linked – materialism is thought to be a cause, as well as an effect of negative well-being, and countries that have higher levels of inequality are known to score lower on subjective well-being indicators. 7 The Coalition Government initiated an Office of National Statistics (ONS) programme that sought to measure well-being. The, so called, ‘happiness index’ is intended to complement other measures of the state of the UK such as GDP: “ONS is developing new measures of national well-being. The aim is to provide a fuller picture of how society is doing by supplementing existing economic, social and environmental measures.”8

http://www.nber.org/digest/mar07/w12352.html http://www.unicef.org/media/files/ChildPovertyReport.pdf 7 http://www.unicef.org.uk/Documents/Publications/IPSOS_UNICEF_ChildWellBeingreport.pdf 8 http://www.ons.gov.uk/ons/guide-method/user-guidance/well-being/index.html 6

Ten indicators of well-being, including health, education, income, work and trust in politicians are contained within the index and in 2012 the first survey was published. The rationale has been presented as a ‘commitment to developing wider measures of wellbeing so that government policies can be more tailored to the things that matter.’ Arguably, a wider and more systematic consideration of well-being has the potential to lead to better decisions by government, markets and the public but it is also the case that more joined up working across government departments would facilitate this and there is little evidence in 2014 of that occurring. 3.7.

Importance of Early Years Evidence from international research supports the view that the early years are the key life stage during which future health is determined. Interventions include those with a focus on parenting, quality pre-school provision and action to promote health-promoting behaviours. The first five years of a child's life are fundamentally important. They are the foundation that shapes a child's future health, happiness, growth, development and learning achievement at school, in the family and community, and in life in general. Recent research confirms that the first five years are particularly important for the development of the child's brain, and the first three years are the most critical in shaping the child's brain architecture. Early experiences provide the base for the brain's organisational development and functioning throughout life. They have a direct impact on how children develop learning skills as well as social and emotional abilities and stability. We also know that children learn more quickly during their early years than at any other time in life and that this learning will be facilitated when the child is loved, given attention and encouragement and is protected. The Convention on the Rights of the Child (CRC) is the most rapidly and widely ratified international human rights treaty in history. 9 After 25 years, significant progress has been made in changing the way children are viewed and treated as human beings with a distinct set of rights instead of as passive objects of care. The CRC outlines the rights of all children to be raised in a family and to have access to quality health care, good nutrition, education, play and protection from harm, abuse and discrimination. Children have the right to grow up in an environment in which they are enabled to reach their full potential in life. Unicef state: “A good foundation in the early years makes a difference through adulthood and even gives the next generation a better start. Educated and healthy people participate in, and contribute to, the financial and social wealth of their societies……There is consistent and strong evidence which shows that:  



Brain development is most rapid in the early years of life. When the quality of stimulation, support and nurturance is deficient, child development is seriously affected. The effects of early disadvantage on children can be reduced. Early interventions for disadvantaged children lead to improvements in children’s survival, health, growth, and cognitive and social development. Children who receive assistance in their early years achieve more success at school. As adults they have higher employment and earnings, better health, and lower levels of welfare dependence and crime rates than those who don’t have these early opportunities.

Efforts to improve early child development are an investment, not a cost. Available costbenefit ratios of early intervention indicate that for every dollar spent on improving early child development, returns can be on average 4 to 5 times the amount invested, and in some cases, much higher.” Early years interventions create value for money through return on investment. It is worth citing a pre-school programme from Michigan, High Scope Perry. A longitudinal evaluation carried out on this programme highlighted positive effects on test scores, grades, graduation 9

http://www.unicef.org/crc/

from high school, home ownership and earnings, reduced crime rates and welfare use. It was estimated that the programme generated a seven fold return on investment at age 27 and at age 40, a more recent follow up study showed a thirteen fold return on investment primarily attributed to reduced criminality and imprisonment. Since its inception In Harmony Liverpool has incorporated early years provision in the overall programme (Tots in Harmony, Faith Primary School and The Beacon CE Primary School) and this is now an element of provision that is set to grow with the introduction of the In Harmony Liverpool Nursery School at Everton Nursery School and Family Centre in 2015. This work will form an important part of the overall evaluation of the programme moving forward and will bring a new dimension to the learning accruing through the overall programme. 3.8.

Resilience The recent emphasis on the notion of resilience is a further important dimension. The International Resilience Project defined resilience as “a universal capacity which allows a person, group or community to prevent, minimize or overcome the damaging effects of adversity.” In 2014, as the full extent of the welfare reforms is being realised – the benefit cap and the bedroom tax amongst others - the numbers of children and young people facing substantially increased deprivation and poverty is rising steeply, with problems such as increased risk of neglect, risk of emotional and physical abuse. The resilience of parents is more likely to be affected by poverty, mental health problems, lack of educational attainment and fewer life chances amongst other significant complex, interconnected problems. Health inequalities in England are getting wider, made worse by the economic climate and by welfare reforms. Thus, the combination of recession and austerity is likely to widen health inequalities considerably. Recent research has highlighted the inequitable distribution of the local authority budget cuts in England, showing areas of the country with the sickest populations are being affected most by the cuts. (Taylor-Robinson et al BMJ 2013) In this context, there has been much discussion in community and social development contexts around resilience. However, in public policy terms we see the above split between health and education in policy again being reflected. A Government Report published in 2011 that reflected back on the UK Resilience Project, a DfE initiative of the previous Labour government, was prefaced with the following comment: “This research report was commissioned before the new UK Government took office on 11 May 2010. As a result the content may not reflect current Government policy and may make reference to the Department for Children, Schools and Families (DCSF) which has now been replaced by the Department for Education (DFE).”10 In her Guide to Promoting Resilience in Children, Edith Grotberg11 identifies three sources of resilience:   

what we have what we are what we can do.

This “I have, I am and I can” model suggests numerous actions that children and caring adults can take to promote resilience. Grotberg explains that children need to be helped gently to shift their reliance on support from outside (I have) to their own internal skills (I can), while building their own personal attitudes and feelings (I am). It is helpful to focus on resilience in terms of the areas or ‘domains’ of a child’s life that can be manipulated or changed. A useful framework for describing this is provided by Brigid Daniel and Sally Wassell who split resilience into intrinsic and extrinsic factors. The intrinsic factors are building blocks that are necessary for resilience: 10 11

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/182419/DFE-RR097.pdf http://resilnet.uiuc.edu/library/grotb95b.html



a secure base – the child feels a sense of belonging and security



a sense of self-efficacy – a sense of mastery and control, along with an accurate understanding of personal strengths and limitations



self-esteem – an internal sense of worth and competence.

The extrinsic factors are: 

at least one secure attachment relationship



access to wider supports such as extended family and friends



positive nursery, school and/or community experiences.

This building block framework provides a useful basis for informing assessments of children, and designing and implementing targeted interventions and is one that we return to later when summarising In Harmony findings. 12 3.9.

Importance of the Arts and Participation in Health and Well-being In recent years we have seen an increasing emphasis on the arts as a vehicle for driving social regeneration, strengthening and improving communities and enhancing social capital and employability. There is now a considerable and growing evidence of the effectiveness of arts interventions in healthcare and in promoting well-being. In the Arts Council England publication Arts in health: a review of medical literature, there is a broad spectrum of evidence to show how the arts achieve positive outcomes for patients, for staff, for the patient-staff relationship, for hospitals, in mental health services and in the health of the general population. There is widespread recognition that choosing a healthy lifestyle, rather than simply dealing with illness as it occurs, is key to improving health in the longer term. The arts play a hugely valuable role in engaging excluded or hard-to-reach groups or communities who may not respond to traditional methods of health promotion. The arts are also powerful in the ability to engage, focus and galvanise communities in a common purpose that can inspire renewed confidence and self-esteem, build social capital and develop local resilience in areas where more traditional services have struggled to make any impact. In 2013, Liverpool NHS Primary Care Trust, who were significant funding partners to In Harmony Liverpool prior to the changes in delivery structures, evaluated their long term interventions in this area of work in 2013. The evaluation stated: “The work commissioned by the PCT from 2010 – 2013 has created a body of evidence to support the case for investment in arts and culturally based well-being interventions. It has demonstrated that modest investment can create innovative healthcare solutions that are effective, value for money and replicable. Specifically, it has demonstrated that: o o o o o o o

Arts and cultural activity is a mechanism for developing social skills Arts and cultural activity is a mechanism for developing new skills that will support employability Arts and cultural activity can impact on general health behaviours by increasing motivation and developing coping mechanisms Arts and cultural activity can increase confidence Arts and cultural activity can provide the opportunity to express emotions Arts and cultural activity can help people to feel safe and respected in a healthcare setting Arts and cultural activity connects people and increases a sense of relatedness

Daniel, B and Wassell, S (2002) The School Years: Assessing and Promoting Resilience in Vulnerable Children. Jessica Kingsley Publishing, London 12

o o

Artists can play a unique role in promoting health and well-being through carefully planned activity Arts and Cultural activity is a powerful mechanism for community engagement and social interaction.” (Source: Burns & Cox, 2013)

More recently, an All Party Parliamentary Group (APPG) for Arts, Health and Well-being was launched in January 2014. Peers and MPs with a shared interest in the field of arts and health come together for regular events to hear about and discuss the latest developments relevant to current policy priorities. In July 2014, the Officers of the APPG met with the Secretary of State for Health to present the case for arts and health. As a result of this meeting Jeremy Hunt has asked Public Health England (PHE) to prepare him a briefing on the evidence base. A recent report, Well-being in Four Policy Areas, recommended that the Department for Culture, Media & Sport (DCMS), and the arts sector more generally, should use well-being analysis to help make the case for arts and cultural spending; that government should use well-being analysis to help set strategic priorities for spending on arts and culture. For example, spending should give greater priority to participatory arts; that arts funding bodies should seek to evaluate the well-being impacts of their grants, either individually or by using well-being evidence to inform their evaluation frameworks; that in the light of evidence on the links between the arts and health, central government (DCMS, the Department of Health and the Department for Communities and Local Government) should work with relevant agencies, including Arts Council England and PHE, to maximise the beneficial impact on well-being of available budgets. Local authorities should consider how cultural commissioning might contribute to priorities identified in their Health and Wellbeing Strategies; and that government should seek to ensure that the benefits of arts spending reach those with the lowest well-being, including communities with high deprivation. 13 In specific relation to music and impact on health and well-being there is a significant body of research that links participation in music to health outcomes as well as to an individual’s intellectual, social and personal development. For example, recent technological advances in the ways that we study the workings of the brain have enabled us to enhance our understanding of how music influences other areas of development. Hallam, S. (2010) highlights the impact of music on the intellectual, social and personal development of young people:    

  

Music has a positive impact on the development of perceptual, language and literacy skills Learning an instrument has an impact on intellectual development, particularly spatial reckoning There is a consistent relationship between active engagement in music and general attainment Music participation enhances personal and social development, creating: a sense of achievement; increased self esteem; increased confidence; persistence; self-discipline; and a means of self-expression; as well as promoting: social skills; team work; cooperation; responsibility and commitment Active engagement with music can have a considerable impact on motor skills and has positive health benefits Particular health benefits can be derived from singing which can have a positive impact on the functioning of the immune system, breathing, adopting good posture, improved mood, and stress reduction Increasing the amount of classroom music within the curriculum can increase social cohesion within class, and lead to greater self-reliance, better social adjustment and more positive attitudes, particularly in low ability, disaffected pupils.

http://b.3cdn.net/nefoundation/ccdf9782b6d8700f7c_lcm6i2ed7.pdf

Importantly for In Harmony, the role of the arts in the early years of an individual’s development is increasingly recognised as a powerful catalyst to the development of creative thinking: ‘The importance of nurturing creativity in the care and education of children under six has now been recognised. It is endorsed by government frameworks and publications such as the Curriculum guidance for the foundation stage (Qualifications and Curriculum Authority, 2000) and Birth to Three Matters (Sure Start 2003). Many individual artists and arts organisations have begun to work in early years settings, collaborating with early years practitioners to embed creative learning opportunities through the arts.’ (Arts Council England) Early years arts experiences can impact positively on confidence, self-esteem, personal, social, emotional development and behavioural health, breaking down language barriers, cultural prejudices or societal differences, and leading to decreased social problems, reduced inequality and increased creativity. 14 As we have stated, considering the complexity and diversity of mechanisms which effect health, it is clear that improving population health and reducing health inequalities must involve a variety of sectors and partners and incorporate a wider range of skills and inputs beyond that of health professionals and the NHS alone. The relatively neutral space occupied by cultural organisations, where they are not seen as part of mainstream clinical health provision, provides a powerful opportunity to engage children and young people in a variety of ways that will directly contribute to their positive social and emotional development and subsequent improved health profile in later life. Arts and cultural activity can therefore play a powerful role within a health context. 3.10.

Community Well-being Lack of income, inappropriate housing, unsafe workplaces and poor access to healthcare are some of the factors that affect the health of individuals and communities. Similarly, good education, inspired public planning and support for healthy living can all contribute to healthier communities. Arguably all public sector agencies have a crucial role to play in helping individuals and communities to develop social capital. There is growing recognition that although disadvantaged social groups and communities have a range of complex and inter-related needs, they also have assets at the social and community level that can help improve health, and strengthen resilience to health problems. A person’s social networks can have a significant impact on their health. One large-scale international study showed that over seven years, those with adequate social relationships had a 50 per cent greater survival rate compared with individuals with poor social relationships (Holt-Lunstad et al 2010). Social networks have been shown to be as powerful predictors of mortality as common lifestyle and clinical risks such as moderate smoking, excessive alcohol consumption, obesity and high cholesterol and blood pressure (Pantell et al 2013; HoltLunstad et al 2010). Timely and targeted intervention at a local level can have a direct positive impact on community well-being through increased engagement, enhanced confidence and self-esteem, shared belief and purpose, and increasing self-determination that underpins increased local resilience and is a precursor to building local social capital. This in turn can yield positive returns in terms of improved health outcomes and a reduced burden on the state.

3.11.

This brief survey of the policy context reveals key areas within which In Harmony Liverpool can directly and indirectly contribute to impact on health and well-being, educational attainment, inequality, early years provision, resilience and community well-being. We go on to consider this evidence in the next section of the report.

3.12.

It is clear that the In Harmony Liverpool programme has worked consistently to develop a more connected and holistic approach to addressing some of the more apparently intractable social issues in the West Everton area, in partnership with a range of public sector agencies

National Children’s bureau (2010), Scottish Consultative Council on the Curriculum (1999), Barnett, S. and Ackerman, D. (2006)

and service provider partners. There is a significant opportunity to develop new active partnerships and to grow the understanding of the determinates of local health issues, as well as developing new approaches to measuring and assessing impact on health and well-being indices in a local area that will enable shared data gathering and analysis that will be of benefit to all partners. In our view, In Harmony Liverpool provides a lens through which much can be learned locally, regionally and nationally about the role that arts and culture can play in strengthening individuals and communities. It shines light on many public policy agendas and demonstrates how a timely and targeted intervention at a local level can have a direct positive impact on community well-being through increased engagement, enhanced confidence and self-esteem, shared belief and purpose, and increasing selfdetermination that underpins increased local resilience and is a precursor to building local social capital. This in turn can yield positive returns in terms of improved health outcomes and a reduced burden on the state.

In Harmony Liverpool: Impact

4.1.

As stated earlier in the report, In Harmony Liverpool represents a significant opportunity to examine the impact of a cultural intervention over an extended period of time on the wellbeing and physical health of a clearly defined population in one of the most socially challenging neighbourhoods of the UK. In this section we consider the evidence of impact to date drawing on data collected over a five year period. We highlight impact on educational attainment, health and wellbeing, resilience, community well-being and positive outcomes for families.

4.2.

Throughout the five years that In Harmony Liverpool has been evaluated we have monitored a small group of children through termly interviews. We have also interviewed teachers on a termly basis and parents on an annual basis and this data has allowed us to track children and highlight individual stories and journeys. Collectively and individually, they demonstrate the impact of participation in In Harmony Liverpool on health and wellbeing, resilience of children, families and the community. Thus, in addition to presenting summary data in this section, we illustrate some of the impact through snapshots of children and families in order to highlight specific outcomes for children, families and the community relating to health and well-being, resilience and social determinants of health. The snapshots have been chosen to demonstrate examples of a wider trend captured through the longitudinal evaluation. In 2014, further research was commissioned by Liverpool Philharmonic from Professor Jude Robinson at University of Liverpool which aimed to research the experience of family members of children who participate in In Harmony Liverpool, and so begin to capture the wider impact of the programme on the lives of families and communities as well as on their children. The findings of this research, carried out using participatory methodology through interviews, drawing, recordings and photography, largely correlate and support the findings of the longitudinal evaluation. Robinsonâ&#x20AC;&#x2122;s research highlights many important themes but, importantly, it sheds light on the growing sense of value and self-worth in parents as well as the children and on the importance of networks. Some of the content in the snapshots is drawn from this research.

4.3.

Educational Attainment: We know that In Harmony Liverpool has a positive impact on educational attainment of the children in Faith Primary. Appendix Four summarises the data sets to date in full. The following table and graph highlight the number of pupils in each year group that have progressed by two sub levels or more in one academic year (which exceeds expectations of 3 sublevels over a 2 year period therefore 1.5 sublevels each year) . The significant improvements across the Faith School population remain in Reading and Maths when comparing annual figures to 2013/14 from the baseline of 2008/9 academic year, although there has been no significant change compared to 2012/13.

Years: 1 - 6

Writing

Reading

Maths

2008 / 09

56%

36%

35%

2009 / 10

59%

84%

75%

2010 / 11

48%

47%

48%

2011 / 12

61%

69%

71%

2012 / 13

68%

66%

2013 â&#x20AC;&#x201C; 14

59%

68%

69%

The table shows the proportion of the school population exceeding expected progress in reading has increased from 36% in 2009 to 68% in 2014; and in maths from 35% in 2009 to 69% in 2014. In writing, although there is no significant change compared to the 2008/9 baseline, there has been a decrease compared to 2012/13. This is demonstrated in the graph below showing the percentage of children who have progressed by two sublevels or more in Writing, Reading and Maths

90% 80% 70% 60% 50%

Writing

40%

Reading Maths

30% 20% 10% 0% 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14

Whole school trends however do not tell the stories of individual children and the following case study features a particular child who has made significant academic progress whilst also demonstrating growth in confidence, focus and aspiration. The emphasis that both the school and In Harmony Liverpool place on the holistic development of the individual child is evidenced strongly in this particular snapshot.

Child B: Child B has been playing violin with In Harmony since year one and is now in year four. She is an only child living with both parents. The change in child B over the past four years has been dramatic…. Her mother comments: ‘(she) wouldn’t even speak to the men in our family... when she was a kid she was dead timid, dead shy... And I think the only man she ever spoke to was my brother… it’s a confidence thing... And the majority of the music teachers in there (In Harmony) are men, male, like Rod and that, and it’s, oh she has a fantastic relationship with them... and she comes in and she goes, such and such a one’s partner’s just had a baby… the bond they’ve made and the relationship is unbelievable … it is, it’s unbelievable. And you can, you know that you could trust them. And the bond that they’ve got as well is, every single year when they go, they move up a year, they then have to have a new teacher for their class. Now, with the music, they’re there from beginning to end. And I think that’s what she likes about it, it’s not always changing. It’s progressing them, do you know what I mean? And it’s like they know, they’ve known her since a little girl and they’re watching her grow up and playing her music and … So they know what she used to not be able to do, to what she can do now. The difference to what a school teacher can do. Because it’s hard for a school teacher to know what they did last year…’ (Robinson, 2014) There is a very real sense from her mother that child B has learned or acquired new skills through music that have had a direct impact on other areas of her life, in particular her greatly

increased confidence levels. This has resulted in child B becoming more involved in other activities that she previously would not have had the confidence to do. When asked directly if In Harmony has changed things she replies: ‘Oh my God, unbelievable. Oh … it’s a fantastic thing! … I don’t think she would have had the confidence [to do gymnastics], and that’s the truth, that. And I think since her playing the music, she’s started becoming a rhythm and everything and it’s built her confidence up a lot. Because (she) was a shy and timid kid and stood back. And now the determination in her is unbelievable. And even Rod, the music teacher, has even noticed it, the concentration in her is like from, on a scale, from 3 to 10’. (Robinson, 2014) In Harmony has been a powerful catalyst for child B creating a positive spiral of development which created the confidence for her to become involved in gymnastics. She is now rated the second best for her age group in the North West and now has her sights on the 2020 Olympics. In turn this newly found confidence has directly affected her levels of concentration, focus and hopes for the future as her mother reports: .... it’s started to come a bit like, ‘This is where I want to go’ and … ‘This is what I want to do’… It’s a big step, it’s like she’s grew up overnight.’(Robinson, 2014) The combination of after school In Harmony rehearsals and gymnastics training sessions involves child B and her family in a complex logistical timetable on most weekday evenings and Saturdays, using taxis to get from one session to the next when activities take place on the same evening. ‘But I’m willing to do that for her, to keep music in her life.’ (Interview, Mother) The previous Headteacher of Faith Primary stated: ‘ Two years ago she had a lot of problems making friends, she has come on in leaps and bounds. She was talent spotted by a gymnastics club and is, it seems very talented and I know is going two or three times a week and travelling the country. This to me shows amazing commitment - I never thought she would keep it up but both her and her family see it as really important to commit to. This I think is a result of In Harmony - to see that in order to succeed one has to practice and that commitment to the team is really important.’ (Interview with Headteacher) Child B’s involvement in In Harmony, and her developing interest in music, has also resulted in her mother listening to more music and re-engaging with other forgotten aspects of her life: There has therefore been a significant ripple effect in the impact that child B’s involvement in In Harmony has had on her wider family and the community: ‘There is a lot of pride in our community now…. Speaking to people in the community they are all amazed because other schools don’t have it. There is so much pride when others talk about - our In Harmony, our orchestra.’ (Mother, Interview) The impact of In Harmony on child B, and her achievements, are clearly apparent in the comments from the In Harmony team: ‘(child B) continues to make excellent progress on her violin, and is excellent at reading music and learns new pieces quickly, pushing herself to be one of the top students in her year group. In orchestra she tends to play parts between a Grade 1-2 level, and has an excellent attitude and enthusiasm for music making. Having taken part in many exciting performance opportunities already, it will be great to see this develop further as (she) moves into the upper end of the school.’ (In Harmony Artistic Director)

We also know that In Harmony Liverpool has had a significant impact on the culture and relationships within and beyond the school and we feel that this is likely to have impacted on the improvements in educational attainment. The case study of a teacher highlights the impact on personal well-being and the power of engaging with music. It is perhaps a universal truth that it is important to ensure that good teachers remain within the teaching profession and that they are also motivated to remain

within communities in challenging areas such as West Everton. The experience of In Harmony has refocused this particular teacher’s career:

Teacher A: Teacher A has been a class teacher in Faith Primary school since 2007, two years prior to the In Harmony Liverpool programme being introduced to the school in 2009. She is one of the younger members of the teaching staff and has experience of teaching in the upper end of the school (years 5 and 6). She has been a committed learner and performer within the In Harmony programme from the outset and has volunteered and been involved in many extra-curricular parts of In Harmony, where she has supported the children during trips away from school. As a valued member of the teaching staff at Faith school she also accompanied the In Harmony Artistic Director on a visit to El Sistema in Venezuela. ‘She has always been keen to maximise her involvement in the In Harmony programme, including attending out of school sessions with West Everton Super Strings (WESS) and taking her instrument home to practice and progress. Her commitment and passion for music has led to her recently taking lessons/sectional rehearsals as a musician and teacher. As a musician, she has progressed from being a committed viola player to now focusing on the flute and becoming a founder member of the new Everton Youth Philharmonic Wind Section.’ (In Harmony Artistic Director) Whilst being interviewed early in the evaluation of In Harmony (July 2010), she reported that she was experiencing greatly improved job satisfaction as a direct consequence of the introduction of the programme to Faith Primary: ‘I always wanted to play an instrument. I have huge job satisfaction now. In Harmony has saved my career. 18 months ago I knew I needed a career change. I couldn’t handle it. I was waking up at night worrying about work. I couldn’t do the work with the pupils that I wanted, I couldn’t get them to do what I wanted because they couldn’t concentrate and they were so hard to manage. They had bad behaviour and poor motivation. I was going to leave teaching. There has been a huge improvement because of In Harmony. Now I look forward to work and doing music in school. I have great pride in the school I work for and I’m proud to be part of it.’(Teacher Interview) She has since consistently commented on the improvement in the attitude, behaviour and attainment of the pupils, and on the increasing involvement of parents in the school and the positive impact on the wider community: ‘Behaviour is much better across the board, the children are far more tolerant now. I can now do maths and english in the afternoon – that would never have happened before. The children have better concentration and energy levels. Shake Up and Sing is very positive – it gets children ready to learn with a positive attitude. Listening skills and confidence have definitely improved. Pupils have more respect for each other and will listen when others are speaking – they are not just waiting their turn to speak. The school feels more part of the community, we are more connected to the parents now.’(Teacher, Interview) She had the opportunity to travel to Venezuela to observe the work of El Sistema directly: ‘One of the clearest messages I received, from all the people that we spoke with, was of the relationship between the musical excellence and the impact it has on social welfare’. She has subsequently introduced more team work, group reward schemes, and aims to develop clearer pathways for pupils to promote young leadership skills. She is deeply engaged in the In Harmony programme and has directly contributed to the positive changes seen in the In Harmony programme in recent years. She provides a clear role model for the children in pursuing her own learning alongside them. Importantly, as we have pointed out in previous evaluation reports, the In Harmony programme has supported the development of the teacher-pupil relationship within the school through their shared experiences of learning to play instruments and playing together in the orchestra.

4.4.

Health and Well-Being The Marmot Review in 2010 suggested that ‘health’ cannot be viewed simply as an absence of disease. Rather, it pointed to the complexity of it as multi-dimensional concept requiring multi-disciplinary approaches. In Harmony Liverpool is demonstrably contributing to the policy objectives which were recommended in that it is helping to “Give every child the best start in life” and is assisting to “Enable all children, young people and adults to maximise their capabilities and have control over their lives.” In 2007, Unicef measured six dimensions of well-being:      

Material well-being Health and safety Educational well-being Family and peer relationships Behaviours and risks Subjective well-being.

There is strong evidence to suggest that In Harmony Liverpool is making a significant and direct contribution to the educational and subjective well-being of the children through the data we have gathered. There is also strong evidence that it is contributing to enhanced family and peer relationships. We also believe that it is contributing to improved behaviour and mitigating risk. The following snapshot is an important example of a particular child who was in difficult and risky circumstances and whose life has now been deeply affected by participation in In Harmony. The sense of aspiration that is emerging from this study seems to demonstrate that life chances can be changed and control can be regained by the child: Child D: Child D comes from a challenging family background. She is the youngest of four siblings with an older brother and two older sisters. Affected by drug and alcohol abuse, the siblings now live with their grandparents who remain their principal guardians. Initially, finding it hard to settle in school, Child D was on the verge of exclusion on a number of occasions because of serious behavioural difficulties. Her confidence was low. The Headteacher believes that In Harmony has given her “new confidence and a real belief in herself. It has raised her aspirations and given her real ambition for the future and there would now seem to be no limit on what she can achieve. She now wants to be a professional musician. Behaviour is far more consistent and she is doing well academically. She still has some insecurities but is outwardly far more confident. In Harmony has given her an avenue to explore her creative side.” (Headteacher Interview). Other observations from teachers and carers support the belief that Child D has gained from a sense of achievement from taking part and that this has helped to control her behaviour and given a focus, aided concentration and a provided a purpose and sense of aspiration. She loves music and looks forward to it but more importantly wants it to be part of her life as she grows up. Her ambition to become a professional musician and to run her own orchestra has been expressed in interviews with the evaluation team and she has expressed her desire to become a violin teacher to the In Harmony team. This sense of aspiration and ambition, given the problematic start in life, is testimony to the potential power of the In Harmony intervention. The importance of ongoing support, consistency and continuity is apparent for this child as teachers and carers both comment on the fact that In Harmony has provided this child with a “safe place to go that is consistent over time”. She clearly feels supported and safe: “I made a mistake on Friday but no one noticed because I was being backed up.” (Child D in interview)

This sense of being part of something appears to be supporting Child D in her transition to secondary school as there are still clear links between In Harmony, home and school providing triangulation to continue to support her. She continues to attend In Harmony rehearsals after school and is now a part of Everton Youth Philharmonic. “She has a memory box that she has made, all about In Harmony, and she keeps all the things in it to do with In Harmony – she is so proud of it all. It’s something to show her children in the future.’ (Grandmother) In broader terms we have gathered data over the five years of the project using a bespoke well-being measure that was applied across the school. 15 Well-being surveys have been undertaken by the evaluation team with the case study pupils on ten occasions since In Harmony began: February, July and November 2010; February, June and December 2011; March and November 2012; July and December 2013; and July 2014 (Detailed scores are available). There has additionally been a termly whole-school wellbeing survey undertaken since July 2012. Tracking of the impact on community well-being to date has included:     

Regular well-being surveys (Dec ’09, Mar ’10, Jan ’11, Mar ’12, July ’13) Parent carer focus groups Community focus groups In Harmony at Home feedback Parent and babies/toddlers group feedback

Data on pupils’ emotional well-being demonstrates a continuing positive trend and, since 2013, this can now be compared to data gathered from other In Harmony programmes through the Arts Council England commissioned NFER national evaluation. The data tells us that: 

Children report improved self-confidence, teamwork, aspirations, cooperation and enjoyment of school and music, and a sense of belonging, captured through focus group and case study interviews and termly online well-being surveys



Children demonstrate improved behaviour, confidence, listening, reflection and awareness, greater sharing and support of fellow pupils, with strong evidence that greater maturity and focus is emerging as reported by teachers, musicians and parents, and apparent in evaluation focus groups.

In fact, pupil well-being scores have continued to improve overall during the life of the programme to date, most notably in relation to trying hard with schoolwork and wanting to do well. The case study pupils’ aggregate responses indicate that for the majority of the areas questioned, a more positive response continues to be reported as the programme progresses, which may well suggest a general improvement in pupil well-being. More recently a generally more positive response to ‘I help other people’, ‘I try hard with my school work’, and ‘I want to do well’ has been recorded across all age groups of case study children. This change in aspiration and cooperation is strongly supported by the views of all teaching staff and parents, and by improvement in reported levels of concentration and recorded attainment.

Rather than using an ‘off the shelf’ measure of well-being such as the Leuven Scale or the WarwickEdinburgh Mental Well-Being Scale (WEMWBS), which were felt to be too narrow or impractical, a local well-being scale and questionnaire was developed drawing on questions from: The Ofsted Tellus Survey; The Place Survey; Local Government Local Area Agreement Performance Indicators; Emotional Literacy Survey. These were supplemented with a number of locally developed questions focussing on music. From a long list of 40 questions a final questionnaire was developed, in consultation with clinical psychologists at Priority Research, containing 14 key questions. This is contained in Appendix Two.

Additionally a whole-school well-being survey is undertaken termly with all children and young people participating in the programme (Jul ’12, Dec ’12, Mar ’13, July ’13, Oct ’13, Mar ’14, Jul ’14). The latest data from the whole-school survey (July 2014) continues to show improvements with positive increases across all critical inputs from July 2012 to date. In the last term there have been three exceptionally high percentages for:   

I help other people 93.3% I try hard with my school work 94.6% I want to do well 98.7%

100

90 Jul-12 Dec-12 85

Mar-13 Jul-12 Oct-13

Mar-14 Jul-14 75

70 I help other people

I carry on trying I try hard with I want to do well I feel happy at even if I find my school work school something hard

Further evidence comes from a national study that benchmarks In Harmony Liverpool against the other In Harmony programmes. A national evaluation commissioned by Arts Council England with NFER in 2013 mainly focuses on the newly established In Harmony programmes in Leeds, Newcastle, Nottingham and Telford & Stoke. However, some interesting comparisons were observed between children in new and established programmes (Lambeth and Liverpool) in NFER’s baseline report in 2013. Children in established programmes scored significantly higher than children in new programmes in two areas: application of self to learning, and view of future prospects. However, NFER reported even greater differences between established In Harmony programmes compared with control schools not involved in In Harmony: “Further analysis showed that the more established In Harmony areas scored significantly higher than comparison schools on three of the social factors: application of self to learning, self assurance, security and happiness and view of future prospects. This also suggests that

In Harmony may be having some of its desired impacts, and particularly around children’s well-being as young, confident learners with clearer future aspirations.” 16 This benchmarking of Faith Primary School against the other schools surveyed show a significant difference between Faith Primary and the average across the other schools in several key areas and triangulate our own findings:      

90% of Faith Primary School pupils stated that they tried hard at school in comparison to 66% average across the other schools surveyed 100% of Faith Primary School pupils want to get a job (against 69% average) 92% think they will have a happy life (against 85%) 72% always do well at school (against 49%) 69% are a happy person (against 54%) 92% carry on learning (against 85%)

The following case study demonstrates the impact of participation on attainment, confidence, well-being and resilience, communication, concentration, aspiration, friendships and networks whilst also demonstrating the impact this has on the family and the parents’ confidence, networks and sense of worth.

Child C: Child C started at Faith Primary in the September following the start of In Harmony. Her parents specifically enrolled her at Faith because of In Harmony taking place in the school. They believed “this is a great school” and her mother had learned about In Harmony as part of her work in pre-school care. They felt that she was innately musical. This was a complex commitment for the parents but one they wished to make as they felt their daughter would benefit greatly from it. There was a strong sense from the parents at the onset of the programme that they felt this was a unique opportunity for their daughter: “The Royal Liverpool Philharmonic (RLP) is dead big. I like showing off at work about it. It’s like a Liverpool FC player came in to teach you football.” (Father, Focus Group, 2010) “She is coming on leaps and bounds – she can name instruments from their sounds when she hears them on TV.” (Mother, Focus Group 2010) Child C had no previous experience of school without In Harmony and on a number of occasions she has expressed her surprise that not all schools have it. She has a genuine and deep love of music and this reflects in her musical attainment: “Child C has a real love for music and continues to make excellent progress on her cello. She has a very good ear and picks up new pieces quickly, often seizing on musical ideas and performing with control, panache and commitment to detail. She generally performs parts at a Grade 2 level in orchestra, and her parents are interested in supporting her this year to see where she may be able to get to by the end of her time at Primary School. As well as many performances as part of the Children’s Orchestra, she has also performed in more intimate surroundings, including a duet performance alongside her teacher as part of her parents wedding ceremony.” (In Harmony Artistic Director) Child C is also doing well academically and the parental support appears to be critical to this. She remains happy in school and has always scored highly on well-being indicators such as ‘I help other people’, ‘I try hard with my school work’ and ‘I want to do well’.

NFER, Evaluation of In Harmony Year 1 Interim Report, 2013 http://www.nfer.ac.uk/publications/ACII01/ACII01.pdf 16

“seeing how well she’s doing and how good, how much she’s come on leaps and bounds, then now we know we can encourage her even more, then she’s going to be even better isn’t she, so …?” (Robinson, 2014) Robinson’s research (2014) also highlights the impact of In Harmony on the wider family network: “They played at our wedding and she played with them... and obviously a lot of our friends and family knew that she obviously plays it and that was the first time that most of them had seen her do it and they were talking about her more than they were talking about our wedding.” (Robinson, 2014) “I mean I get actually dead proud, me, when I say to people like friends in work and stuff, I go, oh yeah my daughter plays like the ‘cello with In Harmony, part of the Liverpool Philharmonic Orchestra. They go what? And I go, and I explain to them, they go but you’re from Liverpool, you’re a Scouser you know, that’s, they’re not meant to be playing the ‘cello! And I’m like what?! And I had the ‘cello in my van before and the guy said to me, what’s that? He actually asked me if it was a guitar. I said, no, it’s a ‘cello, I said my daughter plays. It’s a good thing, it makes you feel proud as well, so it’s good.” (Robinson, 2014) The parents also report the impact music is having on them personally: “ I mean I’ve definitely been to see the concerts and seen people walking in and they’re like, they don’t look too pleased walking in, walking out they look, they feel great, they feel like you know just had a makeover, you know inspired, it does inspire people, it gives them a whole set of different … well it gives everyone different feelings doesn’t it?” (Robinson, 2014) Mum – “I mean the Philharmonic Orchestra … the Philharmonic, you wouldn’t have … I would never have associated myself with the Philharmonic before … Dad - … She got involved with the In Harmony, I would never probably … I knew the building, I knew of it obviously. But the very first thing, the very first time we went to watch her, we were like, oh my God, this is amazing. And then, we won tickets to go to see, was it John Williams, is it John Williams? He plays all the musicals, the soundtracks to all the films. Mum - And we went to watch that and that was the most amazing … one of the most amazing things I’ve ever heard in my life.” (Robinson, 2014)

4.5.

Resilience We outlined the Daniel and Wassell (2002) domains in section three and suggested that these might provide a framework for understanding how In Harmony Liverpool appears to be working. It was argued that the domains or building blocks identified through their research as being essential to resilience were able to be manipulated and changed and it is worth summarising how In Harmony Liverpool appears to be succeeding in doing this.

INTRINSIC A secure base – the child feels a sense of belonging and security

Evidence Parents have commented on the In Harmony musicians’ complete belief in the children and their potential, the unconditional support for the children and the sense of belonging that children feel in the orchestra. Children, staff and parents all refer to the orchestra as a team, that there are children (and staff) of mixed ages and abilities in each section of the orchestra, all working together towards common goals and shared achievement. Parental support of pupils within the school has grown markedly

A sense of self-efficacy – a sense of mastery and control, along with an accurate understanding of personal strengths and limitations

There is strong evidence of:

Self-esteem – an internal sense of worth and competence.

There is strong evidence of children displaying a sense of achievement and worth through their growing confidence.

       

Musical mastery and creativity The development of transferable skills that can be applied in education and life Determination in children to achieve Concentration and focus Ambition and aspiration Discipline Hunger to develop new skills Educational achievement

There is a real sense, and recognition, of personal achievement amongst pupils, staff and parents. Improved educational and musical achievement has all had a reported direct bearing on increased self-worth, belief and value. Travel has given confidence through growing independence and parents and teachers evidence growing maturity and independence. Evidence of growing ambition and aspiration and taking greater control of the future. EXTRINSIC At least one secure attachment relationship

Children have strong relationships with the In Harmony team and in some cases we have evidenced attachment to the instruments and bows as well as to people. The phenomenon of the Orchestra as team and the security that affords. The reported change in the learning culture within Faith School and the positive change in teacher/pupil relationships through teachers learning alongside children. Increased parental support and engagement and improved relationships with children and school as evidenced in recent school parental survey.

Access to wider supports such as extended family and friends

Parents and teachers have commented on how the team provide positive role models. The bond between musicians and children is also evidenced throughout the research both by teachers and parents. The wider support provided by the orchestra environment is also reported. In Harmony provides a wider community programme (in and out of school, across age range 0-16, with families and community, as well as community based secondary aged provision, developing and supporting friendships / networks). Being part of the national In Harmony programme provides numerous opportunities for joint activities and performances locally, regionally and nationally.

Being part of the Liverpool Philharmonic provides a unique range of opportunities for the pupils, staff, parents and wider community (Side by side performances with the Royal Liverpool Philharmonic Orchestra, attendance at concerts, master classes with world class musicians, performances at Liverpool Philharmonic Hall and in the local community). Parents have commented on the importance of the musicians supporting children’s progression over the long term, and on how relationships with In Harmony staff have had a fundamental positive impact on children. Positive nursery, school and/or community experiences.

All parties report on the importance of the musical experience as positive and diversionary. Children are learning about life, travelling and experiencing new places and cultures. The change in the school culture as learning environment National events and performances (e.g. BBC Proms at Royal Albert Hall, Southbank Nucleo weekends).

The case of Child A highlights the importance of networks and sibling groups in generating greater aspiration and well-being. Child A is one of the eldest to have engaged with In Harmony Liverpool over the five years and has developed leadership skills that have made him a positive role model for other children, and especially for his younger sibling. As the programme moves forward, it highlights the need for further research into the journeys of children once they leave primary school.

Child A: Child A was in Year 6 when In Harmony Liverpool started yet, despite only having lessons for 1 term in school, he chose to reengage with West Everton Super Strings once he had left Faith Primary, and continues to be a member of Everton Youth Philharmonic. He successfully completed his GCSEs in summer 2014 and is now in college with aspirations to become a teacher. He is one of three siblings, with the youngest attending Tots in Harmony and the middle sibling attending Faith Primary. He has been one of the most committed of all the children and young people of In Harmony Liverpool. “His list of achievements as part of the programme are extensive, having performed many times leading the cellos in WESS, West Everton Children’s Orchestra (WECO) and side by side performances with professionals and other In Harmony programmes alike. He has also given many chamber performances as part of the West Everton String Quartet, where he has performed in master classes given by esteemed quartets such as the Libertadores String Quartet from Venezuela. He is an extremely committed performer, who will always give his all in a performance and strives to continually do his best. His commitment and achievements continue to serve as an excellent role model for his brother, who has recently joined as part of the Bass section in Everton Youth Philharmonic, and he has also accompanied his pre-school sibling to our Tots In Harmony sessions. He continues to exemplify what is expected from this older age group of young musicians, and through studying for his Silver Arts Award alongside 4 other young people, he played a crucial role in the planning and delivery of this year’s In Harmony Summer School for primary aged peers, and continues to be a valued voice in the progression and expansion of Everton Youth Philharmonic.” (In Harmony Artistic Director) His middle sibling was in reception when In Harmony commenced and progressed to learning Double Bass as he moved up the school. He is now in Year 5 and his confidence has grown as the programme has progressed and he is now a mature and articulate young man with a

strong sense of what might be possible in life. He was accepted by Liverpool Football Club into the youth academy and is self-motivated with strong aspirations: “It has shown me that you’ve got a ladder. You can do things. You don’t have to stay the same in life. I don’t know if I want to be a musician but I know that I can do stuff ….” There is no doubt that the role model provided by Child A has supported and spurred on this child as he has progressed through primary school. 4.6.

Community well-being From its inception the In Harmony programme was trailed as being fundamentally a community development programme using music to bring positive change to the lives of young people in some of the most deprived and challenging areas of England, as well as delivering significant benefits across the wider community. From the outset of the evaluation programme, tracking the impact on the wider community was highlighted as a key element of the evaluation process. The evaluation team has consistently highlighted the potential of the In Harmony programme as a catalyst for community engagement and as a potential model to ultimately underpin and drive local determination and civic renewal. This is particularly apposite in the context of the shifting political and policy context referred to earlier in this report. Community well-being surveys have been undertaken regularly over the life of the programme and recorded responses have continued to return increasingly positive responses since the baseline survey in 2009. Most notable, in terms of the changing health and well-being of the West Everton community, have been increasingly positive responses to the statements:        

‘I feel part of the West Everton community’ ‘Through the In Harmony project I feel more involved in the community’ ‘I feel I have the ability to change my life’ ‘I feel my health is generally good’ ‘I feel hopeful about the future of the West Everton community’ ‘The In Harmony project has given me a more positive relationship with my children‘ ‘The In Harmony project has given me a more positive relationship with Faith Primary’ ‘The In Harmony project has made me feel more positive about myself and the future’.

Overall, since the initial survey in 2009, respondents are increasingly reporting feeling more involved in the community as a direct consequence of In Harmony. They are reporting more positive relations with their children and the school, as well as feelings of improved well-being and more recently, feelings of positive self-determination and confidence in the future. These observations from the community well-being surveys are supported and amplified by statements from community focus groups and parent focus groups:         

‘It has brought the community together and given us real hope and pride’ ‘Someone thinks we matter ….. people will see us in a different way’ ‘In Harmony has got us more involved …. We have a better relationship with the kids, we understand them more’ ‘It gives us a lot more in common with the kids than we had before’ ‘We can see a change in our kids, in their approach to the environment and to other people’ ‘They have learned to take instruction, and what they learn in music transfers into home life’ ‘The kids are more mature, more grown up and more confident and that makes them easier to get on with’ ‘It is a nice way to learn, the approach is right, but they still have to knuckle down because music is complicated too – like maths’ ‘The school is great – it’s not too formal – the school seems more relaxed’

       

‘We are really proud when others talk about our school/our In Harmony – there is a lot of pride in the community – we can all hold our heads up round here’ ‘People are always talking about it in the shops and it just brings everyone together’ ‘I know loads of people who want to live here now so that they can get involved’ ‘Everyone just seems to feel full of hope for the future’ ‘It feels like we could do anything now’ ‘What better start to life than In Harmony’ ‘I think it makes you realise that there are always choices in life that can affect what you experience and achieve – the kids certainly get that’ ‘I think we all have more belief in ourselves now’.

There is an increasing perception amongst parents and within the wider community that the involvement of the community in In Harmony has affected a sense of choice and selfdetermination, and this seems directly related to the affect that observing the impact on the children has on the wider community – a virtuous cycle of change is clearly evident. 4.8.

Positive outcomes for families Additional research was undertaken in association with the University of Liverpool involving a more in-depth focus on the impact of In Harmony on the families of pupils and in particular on the change in intra-family relationships. This report is to be published separately but we have drawn on some of the research in this report. The case of Family A further demonstrates the impact of the programme on a sibling group and a family. It highlights the importance of family support and encouragement, early years interventions, parental engagement which has generated new experiences for them and sibling support creating aspiration, a growing sense of value and worth as well as family pride. This will also in time contribute directly to the development of stronger families and contribute to stronger home-school links and engagement in, and consequent resilience of, the local community.

Family A Family A have been involved with In Harmony Liverpool since the outset, and have been very committed to supporting their three children through the programme. The mother has been a regular attender at events and performances and has regularly contributed to the evaluation of the programme through attending Focus Groups. In a focus group held in February 2010, she stated: “This is a chance in a lifetime for our kids. We couldn’t afford to do this for them. At first I thought it might have been a flash in the pan, you know, something starts and then it ends, but it is here to stay and we’ve got something that others want and that makes us proud.” (Mother, Focus Group) The eldest sibling was in Year 3 when the programme commenced, the middle sibling was in Reception and the youngest was brought along to the early Parent and Tots classes: “What better start in life than In Harmony?” (Mother in Focus Group) Tracking the siblings through the five years of the programme has evidenced growing maturity, confidence and tenacity in the two older siblings. At the onset the mother said of the eldest child: “He wouldn’t do stuff in the past – easily embarrassed you know – but he has come out of himself and it has done him the world of good bringing him out of his shell.” (Mother in Focus Group) Of the pre-school child she commented that she had seen an increase in attention span from attending the tots sessions and as the programme progressed, she constantly pointed to improvements in behaviour, attention, confidence and increased maturity: “They have learned to breathe, listen and take instruction. What they learn in music transfers to home

life. They are more mature at home – more grown up and confident. I don’t get so much backchat.” (Mother Focus Group 2013) Unfortunately, the eldest child did not continue with his instrument on transferring to secondary school in 2013, largely due to peer pressure but he did attend Liverpool Philharmonic’s Royal Albert Hall BBC Proms concert with his mother in September 2013 and was clearly moved by the experience, proud of his younger sister and enthusiastic about the music. This connects to several themes that have emerged from Jude Robinson’s 2014 research with families that evidences music now playing an important part in family life as families do things together, experience new things together and share a sense of pride in their collective community achievements. “Seeing the kids on stage just chokes you up. We all get so proud. Everyone is proud. The kids are recognized as a group. When I was in Home Bargains recently, the check out woman said to me aren’t your kids in the orchestra and they are going to London to play soon ….?” (Mother in Focus Group) Musically, the siblings are high achievers: “The eldest child progressed very quickly on the Double Bass, and by the time he finished primary school was one of the highest achieving musicians in the orchestra. The middle sibling started In Harmony strongly, and was one of the most committed in the early stages, attending practice clubs nearly every day in the early stages of the programme. This focus and determination has ebbed and flowed over time, but she has since progressed on to specialising in Percussion, and is proving to be an excellent role model for the other children in her section. For the youngest, it is obvious to see the influence of his elder brother’s engagement with In Harmony in the choice of instrument and focus that he gives in lessons, and although in the early stages of his learning, he picks concepts up quickly and performs confidently on his Double Bass.” (In Harmony Artistic Director) The impact of the programme on this family appears to have been representative of many other experiences reported within different family groups (Robinson, 2014) with sibling support creating aspiration, parental engagement generating new experiences for them and a growing sense of value and worth as well as family pride.

This snapshot points to the importance of early years provision. It was noted by the nursery and reception teacher in Faith Primary School in 2014 that: “At the end of last term 82% of children reached the ‘expected level’ for “forming positive relationships” and this is the highest percentage recorded in the Early Years Department at Faith School to date.” (Summer 2014) For this reason, Liverpool Philharmonic has worked with Everton Nursery and Family Centre to develop a new nursery school programme which will start in early 2015. The partnership is not a new one as Liverpool Philharmonic has worked with the centre through the targeted Tuning In to Children early years programme. The Nursery School will expand the In Harmony Liverpool programme, involving every 0-5 year old and families in Everton Nursery School and Family Centre, developing musicianship, creativity, school readiness and improved well-being of young children. The programme stems from the belief that In Harmony needs to develop a deeper, immersive and innovative model with under 5s and their parents/carers throughout Everton, building upon and widening the reach of existing In Harmony early years provision in Faith Primary School, The Beacon CE Primary School and through the drop in Tots In Harmony sessions for parents and children. This in turn has the potential to address a longstanding challenge in Everton of many children beginning primary school already being behind in terms of child development, achievement and well-being. The aims are: 1.

To improve the personal, social and emotional development of young children through participation in creative musical activity.

2. To improve the school readiness of young children, including musical and creative development, listening, concentration, physical coordination and preparation for formal learning.

3. To develop, test and disseminate learning from an In Harmony Nursery School and Children's Centre model, applying the immersive El Sistema philosophy for early years, working across an entire nursery school population of under 5s and their families through musical excellence. Through the Centre’s weekly reach to over 200 children in Everton, and commitment of the leadership and staff team, Liverpool Philharmonic believes this is the setting to build upon learning and evaluation, devise, test and deliver a new innovative In Harmony Nursery School model. Everton is one of only three early years National Teaching Schools, leading the North Liverpool Teaching School Alliance and providing opportunities to share the curriculum, practice and model with other providers through professional development, locally, nationally and internationally. This provides a significant opportunity to work in partnership to generate robust evaluation and data that will test assumptions about the importance of early years’ interventions. Moreover, it will be interesting to continue to monitor and evaluate potential impact at school entry. 4.8.

The Interaction between the individual, the family and the community – a virtuous circle: The baseline study for the evaluation stated: There is a strong sense of aspiration for the community within the plans for the In Harmony programme. This is shared within the community. There is a view that if In Harmony is linked to the wider community projects and development plans, that music can lie at the core of community regeneration as a catalyst for enhanced well-being and community confidence. This is ambitious. The challenge for the evaluation of the project is to measure this impact in a way which is robust and quantifiable as well as qualitative. The potential power of In Harmony to unleash the potential of the community to empower itself is already evident from the baseline interviews. The impact on the school, community and neighbourhood may provide a model for measuring how communities can work and how they can be empowered. Even before the project began, the community already appeared to be feeling better about itself: “Someone thinks we matter, so now it is up to us to make the most of the opportunity.” We noted in the Year One Evaluation Report (Burns & Bewick, 2010) that as the children became more confident, more focussed and happier, teachers grew in confidence and learning was enhanced. As this occurs parents become more confident and pride grows. This virtuous cycle of change appeared to be significant and has remained a recurring theme.

Change in Children

Teachers/ Carers becoming more confident and teaching/ parenting affected

Confidence and pride grows within the school and community

Attainment improves

Importantly, data from the community and the annual well-being surveys continues to indicate a further virtuous circle of community identity, pride, trust and ownership. As the community begins to own the programme more, their pride in it, and their trust in the partners with whom they are working, grows. This positively affects identity and they begin to feel more empowered and more open to participation in networks beyond their own community.

Ownership community actively engaged in finding solutions to challenges

Trust in partnerships and networks as community gains attention of others

Pride a positive vision of the community and greater meaning

Identity as experiences are viewed constructively

The evaluation process to date has revealed:     

Improving community well-being Evidence of a changing narrative in the more positive way that the community is described, and describes itself, in press and media A transition in language from talking about ‘receiving’ the programme, as if the community was a bystander in the process, to a different language set that implies engagement and ownership, “our orchestra” Evidence showing increasing attendance at Liverpool Philharmonic Hall for performances and events such as community choirs and orchestras Evidence of increased volunteering within the community.

In previous reports we have asked whether the community is changing because the children were, or were the children changing because the school and the community were? In some senses, it doesn’t matter. The change is occurring and the community is reportedly becoming more resilient and its social capital is being greatly strengthened. The opportunity now exists to harvest more quantitative data through partner organisations to quantify, in particular, the scale of impact on community health and well-being. 4.9.

One of the key messages to emerge from the Marmot Review 2010 was: ‘Health inequalities result from social inequalities. Action on health inequalities requires action across all the social determinants of health’. In recognition of this, the In Harmony Liverpool programme has worked consistently to develop a holistic approach to addressing some of the more apparently intractable social issues in the West Everton area and has involved a range of public sector agencies and service provider partners. There is a significant opportunity for partners to work together to directly inform local, regional and national policy development by demonstrating through evidence, the impact of the approach on improved health, enhanced well-being and renewed community confidence that results in communities becoming healthier, more resilient, more self-determining and ultimately less dependent.

Key Findings

5.1.

As stated above, In Harmony Liverpool exists within a complex context where educational and health policy have become less connected, where health policy exists in structural separation from public and clinical health delivery, where fiscal policy has generated growing inequality resulting from public sector cuts and where austerity measures provide some serious challenges to dealing with inequality.

5.2.

In Harmony Liverpool was always, and continues to be, envisaged as a social/community development programme: Our vision is a healthier, inspired and higher achieving West Everton, empowered to celebrate the community through music (Liverpool Philharmonic 2008). The programme, inspired by El Sistema, seeks to effect change at a community level through music. This is premised on a belief that there are links between educational attainment, health and well-being, participation in cultural activity and social development. In Harmony Liverpool has therefore adopted a holistic approach and worked in a cross sector/multi agency way to achieve its aspired-for outcomes. Addressing growing inequality requires this multi-agency approach and the importance of the In Harmony Liverpool programme and the Liverpool Philharmonic as a cultural organisation with a role in civil society is critical.

5.3.

Importantly, we have seen that In Harmony Liverpool can play an important role in public health provision, clinical health services, educational attainment, developing well-being at individual and community levels and in families. We believe the programme is generating important outcomes and life chances for children and families. We know that to do this we need long term, committed and consistent, early interventions that are at child, family and community level. We also know that the interventions need to support the development of children’s emotional well-being and resilience because this is central to their future achievement, adult life and happiness.

5.4.

The evidence supports claims that In Harmony Liverpool can impact positively on:     

5.5.

Educational Attainment Health and well-being Resilience Community well-being Families

The Importance of Cross Sector Working In the same way that it is clear that health and well-being are determined by a complex set of factors, so it is clear that positive impact on this will require the involvement of a variety of sectors, skills and inputs if we are to address inequality in any community. Importantly, In Harmony Liverpool demonstrates the crucial role that a cultural organisation can play within civic society. After five years of working within and with a community, the In Harmony team and Liverpool Philharmonic are now perceived as a part of that community, not an outside benefactor bringing resources to it, but a part of it, ‘ours’. Language is very telling and the evidence is clear that trust and ownership are creating a climate that, over time, will build social capital and community strength. In Harmony is no longer seen as just a school’s programme with some additional community benefit, but as a community owned, and increasingly community driven, programme that has grown and evolved organically. In many ways In Harmony transcends individual institutions and is effectively a whole community of 0-16s, children and young people, their families, teachers, and wider community engagement and open to any child living in the West Everton community. It is a

programme with demonstrable long term commitment to working with children across age groups, within and beyond schools, and at family and community level. 5.6.

Social Capital Importantly, this embedding of a major cultural institution in a local community is assisting in building both cultural and social capital. The evaluation of In Harmony Liverpool has provided strong and compelling evidence that self-determination and social capital are building within the West Everton community and we have identified a cycle of change that is compelling.

5.7.

Families It is clear that In Harmony Liverpool has impacted on families in many different ways. Both our own evaluation and Robinson’s research has highlighted that it has:        

Supported children and families to engage with music Generated strong parental support and encouragement of their children Supported both family and civic pride Created emotional experiences for families and community at performances Generated a sense of value and self-worth in parents Created new experiences for parents. For example, connecting with Liverpool Philharmonic when they had not done so previously Had a positive effect through networks. For example, aspiration in siblings and cousins Increased parental engagement with music and established music as part of family life and integral to social context and networks.

A recent survey carried out by Faith Primary School asked three key questions of families in relation to In Harmony and the results bear out the evidence that the programme is impacting on relationships with children and the school as well as the community. The In Harmony Programme has helped me have a positive relationship with my children Strongly Agree 65%

Agree 31%

Disagree 2%

Strongly Disagree 2%

The In Harmony Programme has given me a positive relationship with Faith Primary school Strongly Agree 77%

Agree 20%

Disagree 0

Strongly Disagree 2%

I am involved in the West Everton community as a result of In Harmony Strongly Agree 36%

5.8.

Agree 24%

Disagree 21%

Strongly Disagree 17%

Importance of Early Years We know that In Harmony Liverpool has the potential to make a significant contribution to the early years provision and what has been done to date has clearly generated impact. As a result of this, the programme will expand to encompass an In Harmony Liverpool Nursery School from 2015.

The critical importance of incorporating the evaluation of this new area of the programme in the longitudinal evaluation cannot be underestimated as this could provide significant evidence of the impact of music in early years interventions. 5.9.

Finance, Value for Money and Leverage In Harmony Liverpool has demonstrated a mixed economy financial model since 2013, securing an additional £2.30 for every £1 invested jointly by Department for Education and Arts Council England. £200,000 of Government funding between 2013-2015 leveraged an additional £460,000 cash match funding from other sources raised by Liverpool Philharmonic. Between 2015-2018, with a projected £150,000 annual funding jointly from Department for Education and Arts Council England, Liverpool Philharmonic anticipates securing an additional £250,000 per year from philanthropic, corporate, public and charitable sources to expand the programme. In Harmony Liverpool has also evolved from a relatively high unit cost per child at its inception to one that demonstrates efficiencies of scale and value for money. From £2,111 per child in 2009/10 the programme costed £1,204 per child in 2014/15 and is projected to cost £587 per child from 2015/16, further reducing to £546 per child by 2018 when it will engage over 700 children and young people aged 0-18, their families and the wider Everton community. This is an important message for potential commissioners. Arts and cultural institutions are independent and have leverage ability that can at least double the value of initial investment. Imaginative commissioning could create added value that will bring benefits to all agencies by generating cross sector working, knowledge exchange and a stronger evidence base.

5.10.

We have presented evidence of impact to date drawing on data collected over a five year period which suggests that In Harmony Liverpool impacts on:      

In Harmony Liverpool is a multi-layered social intervention through music. It is critically important that it uses music as the vehicle for the many reasons outlined and evidenced above. There is no doubt that it is achieving good musical outcomes for the children, evidenced through musical outputs and observations by music educationalists and Ofsted. However, without compromising musical excellence and standards, the programme has worked consistently to develop a more connected approach to addressing some of the social issues in the West Everton area, through working in partnership with a range of public sector agencies and service provider partners.

It is an increasingly cost effective model (and one that can be scaled up) that delivers outcomes in key policy areas and which has the potential to do more. It has the potential to grow and evolve and will do so in 2015 with the development of the new Nursery programme. It works because it is focussed on music and involves the collective ensemble experience of the orchestra at the heart. It works because it is immersive and is delivered with full commitment from the partner schools and community organisations and it works because it engages and provides a neutral intervention that is not associated with other forms of social intervention. It is an example of complex, cross sector working that supports a holistic approach to the health and well-being of individuals and communities and in the times that we live in, it is one that could continue to address social, educational, health and economic inequalities into the longer term. In our view, In Harmony Liverpool provides a lens through which much can be learned locally, regionally and nationally about the role that arts and culture can play in strengthening communities It shines light on many public policy agendas and demonstrates how a timely and targeted intervention at a local level can have a direct positive impact on community wellbeing through increased engagement, enhanced confidence and self-esteem, shared belief and purpose, and increasing self-determination that underpins increased local resilience and is a precursor to building local social capital. This in turn can yield positive returns in terms of improved health outcomes and a reduced burden on the state.

Recommendations

6.1.

The report highlights the need for more in depth research using the In Harmony Liverpool site as a live action research site. It is our contention that much could be learned about how the desired outcomes of many public agencies (as well as cultural organisations who work at the intersection between art and communities) can work together to achieve social outcomes. We therefore make recommendations about actions that could be taken in three key areas:   

6.2.

Partnership Development Research and Dissemination Understanding the Importance of Long Term Interventions.

Partnership Development It is recommended that: 

 



6.3.

More work needs to be done to explore and better understand the important role played by a cultural organisation within wider society and their role as a community partner working in partnership with other services to generate cross sector solutions to social problems. New partnerships can be developed with commissioners that are premised on recognition of the fact that a cultural institution can deliver value for money services that are neutral and that meet the needs of service users in creative and innovative ways. As the programme moves forward there is a real opportunity to develop partnerships and approaches which will assist in measuring and assessing impact in ways which meet the needs of commissioners for evidence related to outcomes. In the area of health and wellbeing there are specific opportunities to work with the Clinical Commissioning Groups (CCGs) to develop systems that will enable data sharing and analysis that will be of benefit to all partners. This process has already started. Partnerships with the CCGs continue to be developed that will explore commissioning models that integrate provision in mainstream health care, generate value for money delivery and maximises the neutrality of the cultural organisation in the delivery of health services and outcomes.

Research and Dissemination It is recommended that: 



  

Opportunities for dissemination and debate are actively encouraged and cross learning between the In Harmony programmes nationally might inform research funding bids that could build on learning. The national In Harmony programme should be consulted with a view to extending the learning and considering whether this lens can be applied across the programme. As suggested above there is a significant opportunity for partners to work together to directly inform local, regional and national policy development by demonstrating the impact of the approach on improved health, enhanced well-being and renewed community confidence that results in communities becoming healthier, more resilient, more self-determining and ultimately less dependent. Opportunities to collaborate to collectively pool learning and evidence to inform policy should be sought. The programme potentially represents a new model of cross-agency working that could inform regional and national cross sector debate. Further research partnerships be explored that will support the ongoing learning and scale up what can be achieved within the evaluation. The evaluation process must encompass the new strands of early years work as the evaluation moves forward and it is suggested that after five years it may be timely to consider emerging priorities for the ongoing evaluation whilst maintaining existing data sets to ensure longitudinal consistency.

6.4.

Understanding the Importance of Long Term Interventions The work being undertaken is not a quick win. The evidence is that after five years we are starting to see interesting results and outcomes but programmes like this will only demonstrate long term impact over an individual’s lifetime. This is a message that must be communicated widely and across sectors. The long term nature of seeing the return on investment in economic and social terms must be understood by all parties. It is recommended that:   

More work is undertaken to understand, evaluate and quantify the wider socio-economic benefits of the programme on children and families over an extended timeframe perhaps using a Social Return on Investment model. The evaluation work encompasses a more in depth analysis of the children who move on to secondary schools in order to track their progress and the impact taking part may have on their lives as they move through school and into employment and training. A greater understanding of the broader health and socio-economic impacts on families and the wider community is developed through active longitudinal cross-partner collaboration

Appendices

Appendix One: Definitions Well-being is a complex term and one that appears to be interpreted in many different ways. Essentially it is the ability of individuals to have the psychological, social and physical resources they need to meet a particular psychological, social and/or physical challenge. When individuals have more challenges than resources or more resources than challenges their well-being dips. Broadly, well-being has been defined from two perspectives. The clinical perspective defines wellbeing as the absence of negative conditions and the psychological perspective defines well-being as the prevalence of positive attributes. Positive psychological definitions of well-being generally include some of six general characteristics. The six characteristics of well-being most prevalent in definitions of well-being are:      

the active pursuit of well-being a balance of attributes positive affect or life satisfaction prosocial behaviour multiple dimensions personal optimisation.

Much thinking around well-being focuses and links to quality of life. For example, The Five Ways to Well-being is a set of evidence-based actions that promote people’s well-being. They are: Connect, Be Active, Take Notice, Keep Learning and Give. These activities are simple things individuals can do in their everyday lives. The Five Ways to Well-being were developed by the New Economics Forum (NEF) from evidence gathered in the UK government’s Foresight Project on Mental Capital and Well-being. The Project, published in 2008, drew on state-of-the-art research about mental capital and mental well-being through life. It asked NEF to develop the Five Ways to Well-being to communicate its key findings. The Five Ways have been used by health organisations, schools and community projects across the UK and around the world to help people take action to improve their well-being. They’ve been used in lots of different ways, for example to get people to start thinking about well-being, to develop organisational strategy, to measure impact, to assess need, for staff development, and to help people to incorporate more well-being-promoting activities into their lives. Emotional well-being is one of the most commonly used concepts to talk about overall mental health and well-being for children and young people and their later life outcomes. In turn, it is seen as a key factor to the overall health and success of individuals and society as a whole. Love et al see it as: ‘The ability to develop psychologically, socially, emotionally, intellectually and spiritually. Secondly, this ability was “functional” in that it allowed individuals to recognise, understand, manage and express emotions. Finally, such activity was purposeful, in that it was directed at satisfying both personal and social goals.’(Love et al, 2005) Emotional well-being is a composite concept, comprising concepts that are either used in conjunction or are seen to some extent as interchangeable. These include emotional intelligence, emotional literacy, and social and emotional competence. Resilience can be seen as a component of emotional well-being. Some children exposed to severe adversity go on to prosper and ‘succeed’ as adults. The study of the concept revolves around understanding why this happens; that is to say, which behaviours and competencies are associated with resilient behaviour. The study of resilience also involves trying to understand how these behaviours may be encouraged or promoted, often through public service interventions of one sort or another. Increasingly, the concept of ‘resilience’ is being talked about as an additional and useful indicator of overall well-being, and emotional well-being in particular. Current interest in resilience and identification of the need to build up an evidence base of interventions that are designed to boost it has the potential to help policy makers understand and replicate the things that help young people deal with adversity. Resilient behaviours in children may be encouraged through reducing exposure to risk factors (eg income poverty, poor maternal health, divorce and parental discord) and the promotion of protective factors (eg educational achievement, self-efficacy, strong internal locus of control, positive relationships with

supportive adults). It follows, therefore, that policy makers are likely to be interested in interventions that do one or both of these. â&#x20AC;&#x2DC;Resilience is characterised by the presence of good outcomes despite adversity, sustained competence under stress or recovery from trauma.â&#x20AC;&#x2122; (Masten and Coatsworth, 1998) Werner and Smith (1988) concluded that most children seem to have self-righting tendencies and that competence, confidence and caring can flourish even under adverse circumstances. They noted that positive relationships rather than specific risk factors seemed to have a more profound impact on the direction that individual lives take and that it appears that it is never too late to change a life trajectory.

Appendix Two: In Harmony Liverpool Wellâ&#x20AC;&#x201C;Being Measures Children I help other people I carry on trying even if I find something hard I try hard with my school work I find it easy to pay attention in class I like coming to school I work quietly in class I want to do well I feel safe in school I feel happy in school I feel happy at home I like doing music at school I like singing at school I like listening to music I like doing music out of school

Community I feel part of the West Everton Community I feel involved in the local community I am satisfied with West Everton as a place to live I can influence decisions affecting my local area I feel people in West Everton treat each other with respect and consideration I feel positive about the future I feel pride in the West Everton Community I feel people from outside West Everton see the area in a positive way I have a positive relationship with Faith Primary School I have seen an improvement in the behaviour of children attending Faith Primary School I feel I have the ability to change my life I feel hopeful about the future I feel hopeful about the future of the West Everton community I feel stressed or anxious I feel my health is generally good

I have a sense of contentment and well-being I give unpaid/voluntary help to a group, club or organisation in the local area I am a member of a group that makes decisions that affect my local area I feel, people from different backgrounds get on well in West Everton I think parents take enough responsibility for the behaviour of their children in West Everton Through the In Harmony Project I feel more involved in the West Everton community The In Harmony Project has given me a more positive relationship with Faith Primary The In Harmony Project has given me a more positive relationship with my children The In Harmony Project has made me feel more positive about myself and the future I think the Liverpool Philharmonic at the Friary is a good opportunity for West Everton I have attended a concert by the Royal Liverpool Philharmonic Orchestra I have attended the Philharmonic Hall for a concert or performance I listen to classical music I have bought classical music I have attended other cultural activities

Appendix Three: A Note on Health Data Assessing the potential impact on pupil and community health has become a clearer priority as the programme has matured. A significant amount of work has been undertaken previously with the Primary Care Trust (PCT), and more lately with the recently established Clinical Commissioning Group (CCG) to develop data collection processes for using patient level health data from GP practices as well as data from secondary care (A&E and hospital admissions). The purpose was to begin to track and assess any health impacts of the In Harmony programme on the pupils at Faith school and on the wider West Everton community. In order to assess any impact on pupils’ health the number of GP visits and number of prescriptions issued was initially identified in 2009 as a potential impact measure for In Harmony. The associated data collection initially proved a significant challenge, as there was no existing system to directly abstract patient level data from GP practices for a defined local population (in this case the pupils attending Faith Primary School). Whilst proving a significant challenge to partners’ data collection systems In Harmony also provided a unique opportunity to explore and develop health data collection systems across a number of agencies. A partnership was created with the PCT, Social Services and Children’s Services to develop a new model of localised GP data collection and information sharing using In Harmony as a working practical test bed to trial approaches. Previously no shared approaches existed, and the experience of collecting data on the number of GP visits and prescription rates has highlighted a number of fundamental issues, including information governance and standards, that were resolved as a consequence of using In Harmony as a live working model. Traditional approaches to joint agency working were shortcut and the learning used as a model for future more effective joint working across the agencies involved. This was the first time that data of this nature had been collected on a whole school population and tracked over time to assess the impact of a local intervention such as In Harmony:    

Data was collected from a total of 26 GP practices 102 children were identified by the information facilitators in practice Of the 102 children identified, 30 were found to have long term conditions, multiple prescriptions, or multiple attendances at the practice Long term conditions included: Eczema, Asthma, Atopic Dermatitis, Psoriasis.

Data was subsequently manually collected from all GP surgeries by members of the Aiming High for Disabled Children (AHDC) team within the PCT for 6 x six month periods covering April 2008 – March 2011 The Year Two Report in March 2011 highlighted that “It is still too early to draw any firm conclusions from the data as more longitudinal analysis will be required to establish patterns of change over a wider timeframe. Data will continue to be collected over the life of the pilot phase of the In Harmony project and beyond to track and highlight any emerging trends.” (Burns &Bewick, 2011) However the disestablishment of the PCT, effective from April 2013, and the subsequent establishment of the Liverpool CCG, with all the accompanying structural and personnel changes, resulted in data no longer being available. Now that the CCG is established a number of meetings have taken place in recent months to revisit the evaluation approach to health and well-being data collection and the assessment of impact of the In Harmony programme on health indices and well-being of pupils attending Faith Primary School and of the wider community. This has involved beginning to generate new knowledge and exploring opportunities to build new partnerships that will enable shared data gathering and analysis that will be of benefit to all partners and will also assist in identifying any measures, trends and impacts of the In Harmony programme on the health and well-being of West Everton. An initial ‘think tank’ was held, involving Liverpool NHS Clinical Commissioning Group, Liverpool City Council’s Public Health Team, Mersey Care NHS Trust, University of Liverpool, Liverpool Philharmonic and the Evaluation Team, to contribute to the development of the approach to assessing impacts on health and well-being, and to begin to identify relevant health and well-being indices and appropriate data streams, to inform the future development of the In Harmony programme. Subsequent meetings were held with the CCG, Informatics Merseyside and data analysts within the CCG.

Recent changes in governance and protocols within the NHS, and the CCG within that, have resulted in a far less direct access to GP data than was the case with the PCT. Previously the PCT were able to access patient data from GPs directly, albeit manually, and then share aggregated anonymous data sets with organisations outwith the NHS. Current information governance protocols involve a divide between the data accessible within the NHS and that accessible within, and to, the CCG. Currently the CCG are not able to access any personal patient data and are required to submit lists of name, date of birth and postcode for each individual in a study group to central operations in the NHS who then produce a list of corresponding NHS number. These numbers are then used by data analysts within the CCG to extract details electronically from GP records for the individual in the study group. Aggregated anonymous data can then be shared with external organisations. Additionally changes to thresholds of access to patient data within the NHS/CCG now mean that all individual members of a study group have to give express permission for their medical records to be accessed by the CCG even if the data is anonymised and contains no individually identifiable information. Consent forms have consequently been sent to the parent/guardian of each child currently involved with In Harmony at Faith Primary School. Once consents are obtained data analysts at the CCG will build the search into the information management system and subsequent data will be processed and shared with the In Harmony evaluation team.

Appendix Four: Summary: Interim Evaluation Year 5.

In Harmony Liverpool Summary Interim Report: Year Five September 2013 – August 2014 1.

As In Harmony Liverpool enters its sixth year of operation in West Everton, this report is a summary of the impact evaluation data gathered in its fifth year. Unlike previous years, we are not publishing a full interim report as we have decided instead to focus on a special report on health and well-being. However, the data contained within this summary seeks to maintain the data sets and ensure that the evaluation continues to inform the management of the programme.

In Harmony Liverpool continues to be evaluated against the outcomes and outputs outlined in the original programme document submitted to the Department for Education (then known as Department for Children, Schools and Families) in autumn 2008, as well as indicators that have been identified as the programme has progressed. This report focusses on the educational attainment, progression and well-being of the children and young people, the attendance and reach of the programme, and the impact of In Harmony in the West Everton Community.

In summary, the programme continues to perform well against targets in relation to reach, academic and musical attainment, well-being and community engagement. In Harmony Liverpool has engaged a total of 360 children and young people aged 0-16 and their families in Everton between February 2009 and July 2014. Children and young people are making music for up to 10 hours every week in and out of school through In Harmony. Subject to funding, future expansion includes an entire second primary school and establishing an In Harmony Nursery School with Everton Nursery School and family Centre, a Department for Education National Teaching School (lead school for the North Liverpool Teaching School Partnership) and the national lead for Early Years Hubs. In Harmony Liverpool has been a catalyst for improvements in children’s academic progress and attendance across the Faith Primary School population since 2009.    

Two thirds of the school are entitled to Free School Meals, one third has Special Educational Needs and for 18% of children, English is not their first language. The proportion of Faith Primary School children exceeding expected progress in Maths and Reading has nearly doubled between 2009 and 2014, from 35% to 69% in Maths, and 36% to 68% in Reading. The proportion of Faith Primary School children making good progress in Maths has increased from 40% in 2010 to 82% in 2014. Evidence from the Head Teacher, school data, school teachers, parents, musicians and Ofsted school inspections highlights contributing factors including: The development of cognitive skills through music; Improved motivation to learn, enhanced concentration and focus in children; Improvements in the culture of school as a ‘learning community’ through children and adults learning instruments and performing in orchestras together. School attendance at Faith Primary School has increased 2.5% between 2008 and 2014 from 91.2% to 93.7% In Harmony Liverpool has achieved its expectations in relation to musical attainment: o o o

 

92% of children leave Faith Primary School at Grade 2 or 3 equivalent, with a future ambition that all children will be minimum Grade 3 equivalent and many up to Grade 5 standard (Grade 4-5 is GCSE level equivalent on musical instruments). Two thirds of children continue music making on transition to secondary school. However, by the time children reach the end of primary school year 6, their overall musical development will have included:

        

Performing in 20+ events, including high profile, prestigious concerts in Liverpool Philharmonic Hall and nationally at venues such as the Southbank Centre, the Royal Albert Hall and the Sage Gateshead taking part in over 150 orchestra and ensemble rehearsals singing in ensembles every school day developing high levels of musicianship composing and performing their own music and collaborating with other young musicians regularly working with local, national and international world class musicians achieving excellent musical knowledge and understanding through attending frequent live performances by visiting professional artists, ensembles and the Royal Liverpool Philharmonic Orchestra completion of Arts Award Explore.

Well-being outcomes remain encouraging and an emphasis in this year on establishing closer relationships with the Liverpool Clinical Commissioning Group (CCG) will assist in gathering health data in future years. o o

Children report improved self-confidence, teamwork, future aspirations, cooperation, resilience, enjoyment of school and music, and a sense of belonging. Children demonstrate improved behaviour, confidence, listening, reflection and awareness, with strong evidence that greater maturity and focus is emerging as reported by teachers, musicians and parents, and apparent in evaluation focus groups. Arts Council England and Department for Education commissioned research by NFER demonstrates the effect of In Harmony over the medium term in comparison to control schools not involved with In Harmony: “Further analysis showed that the more established In Harmony areas scored significantly higher than comparison schools on three of the social factors: application of self to learning; self-assurance, security and happiness; and view of future prospects. This also suggests that In Harmony may be having some of its desired impacts, and particularly around children’s well-being as young, confident learners with clearer future aspirations.” (NFER, Evaluation of In Harmony Year 1 Interim Report, 2013) http://www.nfer.ac.uk/publications/ACII01/ACII01.pdf



Community Engagement continues to develop as the programme becomes more established. o o o

Parental engagement with school and children’s learning is accelerating and deepening. Music is linking key events in families’ lives and becoming a normal part of life within the community. Parents report improved relationships with their children. They are proud of their children and young people in a collective way as well as individually. Community members report increased civic pride, hope and enthusiasm, positive relationships with children, increased well-being and confidence in the future, and increased involvement with the community as a result of In Harmony. Self-determination and social capital are building within the community and In Harmony Liverpool has played a key role in enabling and supporting this. The community feels a strong sense of ownership over ‘their orchestra’ and In Harmony Liverpool as a programme.

Faith Primary School in West Everton remains at the centre of In Harmony Liverpool, with every child taking part. Provision also extends to secondary school age young people (currently up to 16 years) through community based after school activity at Liverpool Philharmonic at the Friary, other primary age children living in the West Everton postcode boundary, and early years activity for very young children and parents/carers. 

 

The programme has expanded the age range of child participants and in 2013/14 academic year engaged 234 children and young people aged 0 – 16 years and their families. This represents a 278% increase in scope and reach within the programme since the first year in 2009. With planned growth, this figure is expected to reach a total of 355 children and young people from September 2014 and more than 500 children and young people from January 2015. In Harmony Liverpool has engaged with a total of 360 children, young people and their families between February 2009 and July 2014. Whilst all primary school aged school children at Faith Primary School are accessing up to 4.5 hours per week of music making in curriculum time, 58% of those children participated in after school provision including wind, brass, percussion and chamber ensembles – participating in up to 10 hours per week. A total audience of 9,362 people from West Everton, Liverpool and beyond attended a total of 23 In Harmony Liverpool performances throughout 2013/14. Data on educational attainment and well-being continues to evidence a sustained improvement in children’s academic performance in numeracy, literacy and music and child well-being.

Children and Young People 2013/14 – Academic Attainment Attendance, engagement, progression and attainment within the programme continue to see sustained improvements. The number of children on roll at Faith Primary has historically been small. There are some existing small classes (11 pupils in Year 6, 12 pupils in Year 5) and therefore statistical comparisons must be taken in context. Pupil numbers are however growing in the school and the reach of In Harmony therefore continues to grow. The children and families live in an area that is situated within the most deprived area of Liverpool. Many children enter the school at levels below the national average. Faith Primary 2013/14  65.35% of the children on roll were entitled to free school meals against a sector average (based on Liverpool City Council data 2010/ 2011) of 33.16%  31.81% of children on roll were assessed as having Special Educational Needs (School Action, School Action Plus, Statement)  18% of children on roll do not have English as a first language

Faith Primary School Pupil Statistics Baseline 2008 / 09 2009 / 10 Total number of pupils on roll

No. 93

No. 94

No. 104

Free School Meals

2010 / 11

2011 / 12

No. 118

No. 110

66.3

68.2

2012 / 13 No. % 132

2013 / 14 No. 168

65.35

Pupils with Statements / SEN or supported at School Action Plus

4.3

8.7

9.3

11.8

31.81

Pupils with SEN supports at School Action

36.6

26.6

26.9

24.7

31.81

Total SEN

40.9

43.6

35.6

32.3

36.5

31.81

Attainment and Progression A significant increase in levels of educational attainment was observed in 2009 / 10, which was the first full academic year of In Harmony in the school (having begun in February 2009). Whilst this significant improvement has not been replicated, the improvements in attainment have been sustained and remain consistently higher than 2008 / 09. The sample size is small (98 pupils) and the size of the Year One class (28 children and therefore 29% of the sample) has a strong influence on the overall statistics and it is worth noting that in Year One, out of 28 children:  14 children started the academic year below / very below the national expected average for writing  13 children started the academic year below / very below the national expected average for reading  16 children started the academic year below / very below the national expected average for maths

Teacher Set Targets Around half of the children are meeting and/or exceeding teacher targets across all subject areas. Writing % Surpassed teacher set target

2013 / 2014 20%

% Met teacher set target

24%

% Didn’t meet teacher set target

56%

Reading % Surpassed teacher set target

28%

% Met teacher set target

24%

% Didn’t meet teacher set target

48%

Maths % Surpassed teacher set target

16%

% Met teacher set target

45%

% Didn’t meet teacher set target

39%

Percentage of Children in whole school that met teacher targets for all three areas (reading, writing and numeracy) 2008 / 09 12%

2009 / 10 55%

2010 / 11 42%

2011 / 12 39%

2012 / 13 36%

2013 / 14 30%

3 / 26 children

29 / 53 children

36 / 86 children

29 / 75 children

28 / 77 children

29 / 96 children

National Measures of Progress and Achievement at Faith Primary School The following three tables provide a breakdown of percentages of children making good progress (according to national curriculum points and sub level systems) and percentages attaining national expectations. Good progress is defined as 4 points in a year for Key Stage 1 (years 1-2), 3 points in a year for Key Stage 2 (years 3-6) and three sublevels over a two year period. National Expectations are:  Achieving 11 points or sub level 1A at the end of Year 1  Achieving 15 points or sublevel 2B at the end of Year 2  Achieving 18 points of sub level 3C at the end of Year 3  Achieving 21 points or sub level 3B at the end of Year 4  Achieving 24 points or sub level 4C at the end of Year 5  Achieving 27 points of sub level 4B at the end of Year 6

Proportion of Children making good progress and achieving national expectations on attainment Writing

Whole School Averages % making Good Progress (sub level system over two years)

% meeting National expectations on attainment level achieved

2009 / 10*

% making Good Progress (points system over one year) 71

2010 / 11**

2011 / 12

2012 / 13

2013 / 14

*Source: Faith Primary School data supplied by Head Teacher **Source: Faith Primary School Pupil Tracker Database (2010 - 2014) Progress and results in writing show no significant change.

Reading

Whole School Averages % making Good Progress (sub level system over two years)

% meeting National expectations on attainment level achieved

2009 / 10*

% making Good Progress (points system over one year) 87

2010 / 11**

2011 / 12

2012 / 13

2013 / 14

Progress in reading demonstrates an improvement in the proportion of the school population making good progress from 70% in 2010 to 92% in 2014. This includes a small improvement since 2013. Maths

Whole School Averages % making Good Progress (sub level system over two years)

% meeting National expectations on attainment level achieved

2009 / 10*

% making Good Progress (points system over one year) 76

2010 / 11**

2011 / 12

2012 / 13

2013 / 14

Progress in maths demonstrates a significant increase in the proportion of the school population making good progress from 40% in 2010 to 82% in 2014. This shows minimal change in progress since 2013, with a small year on year decrease in the proportion of school population achieving national expectations on attainment.

Proportion of Faith School Population Exceeding Expected Progress and Attainment The following table and graph highlight the number of pupils in each year group that have progressed by two sub levels or more in one academic year (which exceeds expectations of 3 sublevels over a 2 year period therefore 1.5 sublevels each year) . The significant improvements across the Faith School population remain in Reading and Maths when comparing annual figures to 2013/14 from the baseline of 2008/9 academic year, although there has been no significant change compared to 2012/13. Years: 1 - 6 2008 / 09

Writing 56%

Reading 36%

Maths 35%

2009 / 10

59%

84%

75%

2010 / 11

48%

47%

48%

2011 / 12

61%

69%

71%

2012 / 13

68%

66%

2013 â&#x20AC;&#x201C; 14

59%

68%

69%

The table shows the proportion of the school population exceeding expected progress in reading has increased from 36% in 2009 to 68% in 2014; and in maths from 35% in 2009 to 69% in 2014. In writing, although there is no significant change compared to the 2008/9 baseline, there has been a decrease compared to 2012/13. This is demonstrated in the graph below. Percentage of children who have progressed by two sublevels or more in Writing, Reading and Maths 90% 80% 70% 60% 50%

Writing

40%

Reading Maths

30% 20% 10% 0% 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14

Children and Young People 2013/14 – Musical Attainment In assessing musical progress, the team has maintained a detailed database of technical progression on instruments by children, however overall musical progression includes the following: 



Musician assessment of individual children against ABRSM (Associated Board of the Royal Schools of Music) music medals and individual graded instrument examinations. (Please note this is teacher assessment and no formal external examinations have been completed.) Qualitative assessment of orchestra and ensembles, singing and creative progress by the In Harmony Liverpool Artistic Director.

Percentage of Year 3 Children Achieving Levels (assessed at end of 2013 – 2014)

Music Medal Level

ABRSM grade approximate equivalent

Pre-copper stage 33%

Copper Level

67%

Bronze Level

Preparatory Test

This shows that the majority of children playing at a Bronze level by the end of Year 3. The medium term aim of the programme is that a majority would be at the silver level by the end of Year 3, in order to push on to the higher levels in the later years of the programme. Assessment at end of Year 3 coincides with children’s transition from In Harmony Year 2/3 Orchestra into the full West Everton Children’s Orchestra from Year 4. Percentage of Year 6 Children Achieving Levels (assessed at end of 2013 – 2014)

Music Medal Level

ABRSM grade approximate equivalent

Copper Level 8%*

Bronze Level

Preparatory Test

Silver Level

Grade 1

46%

Gold Level

Grade 2

46%

Platinum Level

Grade 3

This cohort is a small, with only 13 children in Year 6 across the programme, but they have shown excellent progress with 92% playing at Grade 2 or 3 level. This was assessed at the end of the academic year with the children preparing an individual piece from the Music Medals / Grade Exam repertoire. This was then performed to their peers and their In Harmony teacher, and was also recorded via iPad for evaluation purposes. In Harmony Liverpool Ambition for Musical Outcomes at end of Year 6 The ambition for the programme is to push the overall levels of musical progression so that children are playing at a Grade 3 level equivalent by the end of Year 6, with some exceptional young musicians playing at a level as high as Grade 5 ABRSM by the time they leave Primary School. More than this however, by the time children reach the end of year 6, their overall musical development will have included:

       

involvement in 20+ performances, including high profile, prestigious concerts in Liverpool Philharmonic Hall and nationally at venues such as the Southbank Centre, the Royal Albert Hall and the Sage Gateshead taking part in over 150 orchestra and ensemble rehearsals singing in ensembles every school day developing high levels of musicianship through their lessons, rehearsals and musicianship classes composing and performing their own music and collaborating with other young musicians regularly working with local, national and international world class musicians achieving excellent musical knowledge and understanding through attending frequent live performances by visiting professional artists, ensembles and the Royal Liverpool Philharmonic Orchestra completion of Arts Award Explore.

It is these experiences as much as their individual progress that set In Harmony Liverpool apart, creating a rich musical education that delivers In Harmony’s social objectives. In 2014/15, the In Harmony team will set out similar ambitions at higher levels for young people continuing with In Harmony Liverpool to 16 years of age that also includes opportunities to participate in Arts Award up to silver and gold level. Historically the In Harmony Liverpool team have developed their own levels and sublevels to keep track of the young musicians’ progress in the programme. Whilst this has been useful in tracking technical development on instruments, it has had limited benefit in terms of assessing individual musical progression and levels of attainment. Ofsted HMI for Music Robin Hammerton also issued guidance in June 2014 regarding musical assessment: “… using levels and sub levels to try to prove pupils’ ongoing progress in music doesn’t work, as Ofsted has pointed out many times. It is usually superficial, time wasting and neither reliable nor valid. It is most certainly not any kind of ‘Ofsted requirement’. To be absolutely clear, our inspectors do not expect to see it. There are no, and never were, sub levels in music anyway, for good reason.” Published by Ofsted, 16 June, 2014 online at TES Connect As part of the ongoing reflection of the programme, the In Harmony team discussed current and alternative ways of assessing progress. This included more opportunities to record individuals/classes as well as more opportunities for solo performance at periodic intervals where environments similar to Music Medal or Grade Examinations could be created. The In Harmony team will trial, evaluate and refine this process throughout the 2014/15 academic year. Arts Award Five young musicians (aged 13 – 16) are in the process of completing their ‘Silver Arts’ Award. As part of the Arts Award the young musicians developed the In Harmony Summer School: generating the theme, approving repertoire, mentoring students, taking a role in teaching younger children, organising activities, recruiting volunteers, managing logistics, communication and planning. Their contribution was invaluable and central to the success of the Summer School and is a great example of how a music ensemble generates learning beyond musical attainment and the power of youth leadership within the programme.

Children and Young People 2013/14 – Well-being Throughout the year, well-being surveys have been undertaken with In Harmony children. These surveys are conducted with children from Faith Primary school, Beacon Primary School and West Everton Super Strings musicians. The following surveys have been undertaken this year:   

October 2013 – a total of 65 responses from children in Years 2 – 6 March 2014 – a total of 64 responses from children in Years 2 – 6 June 2014 – a total of 75 responses from children in Years 2 – 6 and a further 6 responses from secondary aged young people.

The well-being surveys have been conducted in this format since July 2012 and therefore comparable data and analysis is only available from this date. The key components that have been identified as critical inputs to well-being are:     

I help other people I carry on trying even if I find something hard I try hard with my school work I want to do well I feel happy at school.

The following statistics are percentages of children answering positively (response ‘Strongly agree’ or ‘agree’) from the total number of responses. I help other people I carry on trying even if I find something hard I try hard with my school work

Jul-12

Dec-12

Mar-13

Jul-12

Oct-13

Mar-14

Jul-14

87.3

83.8

79.4

89.2

92.2

93.3

69.6

76.4

75.7

76.3

81.5

82.8

82.7

91.1

80.9

85.1

86.6

91.7

90.8

94.6

89.9

89.2

92.8

91.7

96.8

98.7

74.2

75.7

80.4

86.4

85.9

83.8

I want to do well I feel happy at school

The latest data (July 2014) continues to show improvements with positive increases across all critical inputs from July 2012 to date. All ‘highest percentages’ are in the last academic year. In the summer term 2014 there have been three exceptionally high percentages for:   

I help other people 93.3% I try hard with my school work 94.6% I want to do well 98.7%

100

90 Jul-12 Dec-12 85

Mar-13 Jul-12 Oct-13

Mar-14 Jul-14

70 I help other people

I carry on trying I try hard with I want to do even if I find my school work well something hard

I feel happy at school

There has been a similar positive direction for children responding positively to the question “I like doing In Harmony at school”. This question has been part of the well-being survey since March 2013. The below responses are an average score of all responses (where 1 = Strongly Disagree, 5 = Strongly agree)

I like doing In Harmony at School

Mar-13 3.74

Jul-13 3.47

Oct-13 4.23

Mar-14 4.23

Jul-14 4.04

Consistently the three questions with the lowest average scores (across the last three sets of data October 2013, March 2014, and July 2014) are:

I like singing at school

Oct-13 4

Mar-14 3.68

Jul-14 3.57

I work quietly in class

3.87

3.62

3.68

I find it easy to pay attention

4.05

3.82

3.86

With regards to singing it is worth noting that although this a lower score there are considerably more children who ‘Strongly agree’ with the statement “I enjoy singing at school” compared to those ‘Strongly disagree’ with the statement. It has therefore been agreed to trial a school choir with In Harmony, School staff and children in the new academic year.

Children and Young People 2013/14 – Pupil Attendance at Faith Primary School Attendance is 2.5% higher than reported attendance in the Baseline Report in 2008.

Year

2007 / 08

2008 / 09

2009 / 10

2010 / 11

2011 / 12

2012 / 13

2013 / 14

Attendance

91.2%

92.06%

91.02%

92.7%

94.1%

93.5%

93.7%

Absence

8.8%

7.94%

8.98%

7.3%

5.91%

6.5%

6.3%

Source: Faith Primary School The Programme’s Reach and Attendance Since the programme began in February 2009, In Harmony has engaged a total of 360 children and young people in West Everton from Early Years to age 16. The children engaged in the orchestral programme (139 in total) are predominantly drawn from Faith Primary (109 pupils), however the orchestral programme continues to extend its reach to children in West Everton via the Beacon Primary school and Secondary Schools in the area. Number of Children Involved in the Comprehensive Orchestral Programme Number of children currently from: Faith Primary School

109

The Beacon Church of England Primary School

Other Primary Schools

North Liverpool Academy

Notre Dame Catholic College

Other Secondary Schools

Total

139

In addition to the number of children playing an instrument (Year 1 and above) the In Harmony programme has a broader reach through performances, the In Harmony Summer School, links with local community organisations, In Harmony at Home, parental engagement and the Tots In Harmony programme.     

In the last 12 months Tots in Harmony has engaged with 27 children under 3 and their parents/carers In Harmony at Home has engaged with 22 children and their families Over the last 12 months, 26 volunteers and student placements have been completed from the University of Liverpool, Hope University, RNCM, the Liverpool Youth Philharmonic Orchestra and Youth Choir the local West Everton community 12 members of Faith Primary School Staff remain engaged on the programme, learning an instrument and playing alongside children in the West Everton Children’s Orchestra The In Harmony programme has reached an estimated 9,362 people through our performances.

Involvement in In Harmony Performances Percentage of children:

2012 - 2013

2013 â&#x20AC;&#x201C; 2014

Taking part in at least 3 performances this year

100%

Taking part in 5 or more performances this year

77%

57%

Taking part in 7 or more performances this year

34%

26%

Taking part in 9 or more performances this year

30%

11%

All primary and secondary children on In Harmony Liverpool have taken part in a minimum of 3 public performances, with 83% of children performing in 5-7 events in 2013/14. Faith Primary School

09/10

10/11

11/12

12/13

13/14

Number of sessions available to eligible children per week, in school time (Key Stage 1 and Key Stage 2)

Total number of eligible children for out of school sessions

N/A

% of eligible children on average attending after school provision (Yr 2 /3 Mini Strings, Wind, Brass, Percussion, West Everton Super Strings)

N/A

64%

45%

62%

58%

Frequency of attendance at after school sessions (% of available sessions)

16%

46%

55%

75%

74%

This demonstrates that 58% of eligible primary children at taking part in after school provision in addition to the 4.5 hours per week of in-school curriculum time. Commitment by children to attending after school sessions has remained broadly consistent with 2012/13 levels at 74%.

10/11 (graduating 2010)

11/12 (graduating 2011)

12/13 (graduating 2012)

13/14 (graduating 2013)

Number of children moved up from Year 6 into Year 7 whilst involved with In Harmony in given year

Number of secondary aged children continuing with music with In harmony in given year (as at March 31st in given year)

6 children

15 children

13 children

6 children

Number as a percentage

60%

71%

81%

67%

Number of eligible secondary aged children continuing with music with In Harmony

7 children

22 children

23 children

17 children

39%

56%

42%

35%

69%

54%

78%

73%

Number as a percentage Average attendance of regular secondary aged WESS attenders

Continuation of music making on transition to secondary school remains at high levels. Whilst many young people then continue with music at secondary school or elect to follow other interests, nearly half of young people remain involved with In Harmony Liverpool, demonstrating good commitment similar to 2012/13 levels. 9.

Community Engagement Reach of In Harmony Liverpool Performances and reach through audience attendance: West Everton Children’s Orchestra – BBC Prom 66, Royal Albert Hall, London September West Everton Super Strings – Liverpool Philharmonic Hall Open Day, September

5000 + radio/online audience 300

West Everton Super Strings, Junior Strings, Bass Ensemble, Friary Ensemble – In Harmony Chamber Concert, Capstone Theatre, November West Everton String Quarter - Residential Performance, Buxton, November

Year 1 Orchestra, Year 2 Orchestra, Nursery/Reception Choir – Key Stage One Showcase, Faith Primary, December

West Everton Children’s Orchestra – In Harmony Christmas Concert, Notre Dame Catholic College, December Children from Years 4,5 & 6 at Faith – Royal Liverpool Hospital, December

200

West Everton Super Strings – Performance with Christian Lindberg, Friary, March

West Everton Super Strings – Performance alongside Richard Holloway lecture, St George's Hall, March West Everton Super Strings and West Everton Children’s Orchestra – 5th Birthday Concert, Philharmonic Hall, March West Everton Super Strings – Incorporated Society of Musicians Conference, Adrian Boult Hall, Birmingham, April West Everton Super Strings – Performance at Liverpool Central Library, May

263

100

1385 150 120

West Everton Super Strings – Performance at Southbank Nucleo Weekend, June

400

Year 1,2 & 3 Orchestra – End of term performance at the Friary, July

Year 4, 5 & 6 Orchestra – End of term performance at the Friary, July

170

Ministrings, Concert Band and Cast of Joseph – Out of the Blue Festival, Everton Park, July 3 Performances of Joseph and Amazing Technicolor Dream coat – July

200

Year 3 Mini-strings performance at Everton Nursery School and Children’s Centre – July

200

West Everton Super Strings – End of term performance at Faith Primary School – July

Year 4,5 & 6 strings – Performance for Sister Moira’s Leaving Mass, SFX Church, Everton – July West Everton Children’s Orchestra and West Everton Super Strings – End of Summer School performance – 1 August Total

170

300

62 9,362

The In Harmony concerts are always regularly well attended by family members and community representatives. In Harmony is an integral part of the West Everton community and as such is central to community events such as the annual Out of the Blue Festival. In addition to the In Harmony Concerts, we are seeing a continued involvement with the Liverpool Philharmonic Hall events. Attendance at concerts facilitated by In Harmony Liverpool Attendance at concerts facilitated by In Harmony (tickets and transport provided) 2013 - 2014 Date 6 Dec, 2013

Numbers 49

Event Key Stage Two Schools Concert, Royal Liverpool Philharmonic Orchestra

21 Dec, 2013

Rudolph Family Concert, Royal Liverpool Philharmonic Orchestra

2 March, 2014

Fire and Ice, Royal Liverpool Philharmonic Orchestra

23 March, 2014

Liverpool Philharmonic Youth Orchestra with Christian Lindberg

30 March, 2014

Simon Bolivar National Youth Choir of Venezuela

Faith Primary

8 May, 2014

Key Stage One Schools Concert, Royal Liverpool Philharmonic Orchestra

All children in Key Stage One at Faith Primary

22 May, 2014

Percussion workshop facilitated by Stewart Copeland

Children learning percussion

23 May, 2014

Children learning percussion

6 June, 2014

‘ Bringing Down the House’ performance, Royal Liverpool Philharmonic Orchestra, Royal Liverpool Philharmonic Choir and Liverpool Philharmonic Youth Choir Teresa Carreno Youth Orchestra of Venezuela, Southbank Centre

Total

Attendees Faith Primary School, Teachers and Teaching Assistants Competition winners from Faith and their families Young musicians from West Everton Super Strings Brass musicians

Children from West Everton Super Strings

201

Appendix Five: Analysis of responses to well-being surveys over life of programme

Number surveyed?

Average response

N/A

3.54

N/A

Feb-10

Case Study Pupils (25)

3.85

N/A

4.36

N/A

4.06

N/A

3.95

N/A

3.17

N/A

2.87

2.21

2.94

3.86

4.19

3.31

3.00

3.28

Jul-10

Case Study Pupils (21)

4.2

N/A

3.16

N/A

3.66

N/A

3.52

N/A

3.46

3.6

3.48

4.26

4.86

3.94

3.38

3.44

Nov-10

Case Study Pupils (21)

4.42

N/A

3.66

N/A

3.96

N/A

4.56

N/A

4.38

N/A

3.26

3.5

3.16

3.98

3.7

3.2

2.78

3.36

Feb-11

Case Study Pupils (17)

4.84

N/A

4.18

N/A

3.88

N/A

4.86

N/A

3.82

N/A

2.58

3.1

2.74

3.52

4.2

4.1

2.88

3.18

Jun-11

Case Study Pupils (17)

3.92

N/A

3.06

N/A

3.94

N/A

4.74

N/A

4.04

N/A

2.38

2.16

3.46

4.6

3.42

2.70

3.92

Dec-11

Case Study Pupils (14)

4.63

N/A

4.5

N/A

4.88

N/A

4.88

N/A

3.88

3.5

2.63

4.5

3.88

3.63

3.00

Mar-12

Case Study Pupils (18)

4.54

N/A

4.22

N/A

4.84

N/A

4.52

N/A

3.56

N/A

3.78

3.04

3.16

3.84

4.8

3.04

2.28

4.24

% of children surveyed responding positively

Average response

% of children surveyed responding positively

Average response

I want to do well

I try hard with my school work % of children surveyed responding positively

Average response

% of children surveyed responding positively

Average response

% of children surveyed responding positively

Average response

I like doing music at home

Average response

N/A

I like singing at school

Average response

N/A

I like doing In Harmony in school

N/A

I feel happy at home Average response

4.15

I feel safe in school Average response

N/A

I work quietly in class Average response

3.69

I like coming to school Average response

N/A

to pay attention in class

4.08

I feel happy in Ischool find it easy

Year 5 and 6 Faith Primary (13)

Mar-09

I carry on trying even if I find something hard

Average response to question, across all participants. 1 = Strongly disagree and 5 = Strongly Agree I help other people

Group surveyed?

Average response

Date of survey

Jul-12

All participants (all schools and ages from Year 2 upwards) (79)

3.95

87.3%

3.69

69.6%

4.1

91.1%

4.36

89.9%

4.09

81.0%

3.53

3.63

3.25

4.18

4.32

3.62

3.27

3.47

Dec-12

All participants (all schools and ages from Year 2 upwards) (89)

4.36

82.0%

4.24

76.4%

4.35

80.9%

4.69

91.0%

4.2

74.2%

3.96

3.99

3.48

4.4

4.68

3.82

3.53

3.72

Mar-13

All participants (all schools and ages from Year 3 upwards) (74)

4.14

83.8%

4.15

75.7%

4.33

85.1%

4.58

89.2%

4.24

75.7%

3.75

4.15

3.7

4.47

4.76

3.74

3.56

3.75

Jun-13

All participants (all schools and ages from Year 1 upwards) (97)

4.11

79.4%

4.02

76.3%

4.27

86.6%

4.65

92.8%

4.04

80.4%

3.51

3.76

3.42

4.23

4.37

3.47

2.89

3.79

Oct â&#x20AC;&#x201C; 13

All participants (all schools and ages from Year 2 upwards) (65)

4.4

89.2%

4.17

81.5%

4.48

91.7%

4.75

91.7%

4.39

86.4%

4.05

4.13

3.87

4.61

4.76

4.23

4.00

4.06

Mar-14

All participants (all schools and ages from Year 2 upwards) (65)

4.45

92.2%

4.28

82.8%

4.54

90.8%

4.76

96.8%

4.31

85.9%

3.82

3.85

3.62

4.45

4.82

4.06

3.68

4.15

July-14

All participants (all schools and ages from Year 1 upwards) (79)

4.56

93.3%

4.27

82.7%

4.65

94.6%

4.83

98.7%

4.39

83.8%

3.86

4.10

3.68

4.63

4.79

4.04

3.57

3.94