In Greater Manchester, the first years of a child’s life are recognized as some of the most important, from speech development to motor skills. Until recently, the systems supporting these formative years were fragmented and paper-based, making it difficult for health visitors, nursery staff, and parents to share vital information or coordinate care.

To bridge these gaps, the Greater Manchester Combined Authority (GMCA) – a local government body bringing together 10 local councils – launched a digital transformation focused on “Early Years” services.

The GMCA team developed the Early Years App with Accenture and Mendix, using a low-code development platform supplied by Mendix. The App digitizes and streamlines child developmental assessment forms for children aged zero to five across the region.

For professionals, this means more time with families and less time spent on administrative tasks. For parents and carers, it means a more connected, consistent experience, no matter where they live in Greater Manchester.

The Data Dilemma in Early Years Services

A child’s journey through Early Years services touches many hands, beginning with midwives, followed by health visitors, then onto nursery staff and, eventually, schools. But behind the scenes, that journey was even more fragmented. Each of the GMCA’s 10 council areas operated its own systems, assessments, and protocols – some digital, many still paper-based.

As a result, critical developmental information was trapped in silos. Teams couldn’t easily share data across services or hand off between professionals. This meant assessments were delayed or duplicated, and children risked falling through the cracks.

“The result was a very stalled assessment process when it came to children getting older and moving from health to nursery settings. There were barriers to sharing that information,” said Kieran Smith, GMCA’s Head of Digital Transformation.

Health visiting teams wanted to ensure families received timely development reviews and support. GMCA needed a platform that could operate across a highly complex, multi-agency landscape and enable secure, seamless collaboration while respecting each council’s autonomy.

Transforming Ways of Working

GMCA’s multi-layered structure and varying levels of digital maturity in localities made traditional IT solutions inefficient and inflexible.

Low-code development emerged as the best fit for GMCA’s needs. Following a competitive procurement process, Mendix stood out for its speed, adaptability, and user-friendly interface – key features in a public sector environment where frontline workers often have limited time or technical experience.

“The platform was more established and had stronger relationships with partners that possessed the necessary skills to develop the applications,” Smith shared.

GMCA started working with Mendix and Accenture in 2019 to create the Early Years App and developed a minimum viable product (MVP) in six months.

Yet, speed alone wasn’t enough. The app also had to win the trust of those using it.

To ensure adoption, the team took a deliberate approach: rather than focusing on drastic change, they mirrored familiar, paper-based assessment workflows while improving areas like appointment scheduling and data entry.

This co-creation model was critical. Health visitors and council representatives were involved from day one. They trialed the system, provided feedback in workshops, and collaborated with developers to iterate quickly.

This process didn’t just build better software, but also buy-in.

Modernizing Early Childhood Support

Today, GMCA has built a digital system used by a range of health practitioners, parents, and carers to manage developmental milestones through Ages and Stages Questionnaires (ASQs) and other developmental assessment forms.

The Early Years App has rolled out across Rochdale, Bury, and Stockport, with plans to expand across all of Greater Manchester. It’s already delivering wide-reaching benefits for clinicians, families, and most importantly, the children.

Streamlining Workflows for Health Visitors 

Health visitors can now access records in real time, reducing unnecessary travel and paperwork. In Stockport, this digital transformation has led to numerous benefits, as measured for one team:

• 98% completion of 2-year ASQs
• 59% reduction in clinical time spent delivering 2-year assessments

“Previously, health visitors would have gone back to the office, printed off another form, and sent it out to make an appointment. The parent would then wait to receive it, fill it in, and send it back. The Early Years App has massively reduced that timeframe – it’s a leaner way of doing things,” said Ginny Awan, Digital and Data Lead for Public Health Nursing in Stockport.

Before visits, health staff can review information in advance, arriving better prepared to address concerns. If a child isn’t meeting developmental milestones, the app allows staff to instantly flag follow-up support, avoiding delays caused by letters or repeat appointments. The app helps to ensure continuity of care and enables faster interventions when needed.

“The Early Years App has enabled us to start understanding that on a deeper level,” Awan explained.

More Time, More Impact

The ability to prepare in advance has also made appointments more effective. If a parent flags a specific concern – like a behavioral issue – staff can arrive ready with tailored resources or guidance, creating more meaningful interactions and faster support.

This smarter, more flexible approach enables:

• Faster access for children who need extra support
• Shorter wait times across the board
• More proactive care, rather than reactive scheduling

Ultimately, time saved from routine appointments is now reinvested in families with greater needs, improving both the efficiency and equity of early years support across Greater Manchester.

The switch to digital has also produced broader benefits:

• An estimated 232 kgCO₂e reduction in annual emissions in Stockport, by cutting travel and postal delivery
• Lower operational costs by eliminating paper and recorded delivery fees

Improving the Experience for Families

The Early Years App places families at the center of the child’s development journey. For the first time, assessments, records, and updates now move with the child rather than resetting with every new service or professional.

Parents and carers now have real-time access to assessments and support, and can complete forms online at a time that suits them, often from the comfort of their own home.

“They feel empowered to complete assessments via the application themselves. It was a bit of a challenge to begin with, but we’ve overcome that and it’s going in the right direction,” said Smith.

One parent noted, “It’s so much easier than paper forms I had to do with my first. Can complete whilst feeding!”

The app has also led to a drop in missed appointments (DNAs) in Stockport. In the past, fixed clinic times sent by letter often clashed with work or family schedules, resulting in cancellations or no-shows. Now, families can choose and book appointments online using Eventbrite, improving attendance and ensuring more children receive the support they need.

Targeting Support, When and Where It’s Needed

One of the most significant gains from the Early Years App in Stockport has been in “Turning Two” developmental reviews – a key milestone for identifying a child’s progress and any emerging needs.

Before the app’s rollout, every two-year-old was automatically offered a one-hour in-person appointment to complete a paper-based assessment. This one-size-fits-all approach consumed valuable time and resources.

Now, health visitors can review questionnaire responses in advance and triage families based on need. Children showing typical development can attend a group session instead of a one-on-one visit, freeing up time and staff capacity.

These sessions, delivered by just two professionals, allow health visitors to:

• Speak directly with parents
• Share health and development advice
• Complete assessments for up to six children at once

“We’ve spoken to other trusts, and they’re not completing their two-year development checks until nearly two years and five months. That can happen sometimes due to staffing challenges and backlogs,” said Sam Stewart, Team Leader at Start Well Stockport.

Scaling Innovation for Greater Impact

The Early Years App is not only meeting, but exceeding GMCA’s ambitions of increasing productivity and improving outcomes for children and families. Reception from parents has been overwhelmingly positive, with many calling it “very straightforward” and saying they “definitely prefer the digital offer.”

GMCA uses the Greater Manchester identity service, GM Identity, to authenticate users, enhance security, and streamline service delivery. Work is also underway to expand the capabilities of the Early Years App, through:

• Integration with clinical systems such as EMIS to automatically push assessments into a child’s Electronic Patient Record (EPR)
• Expanded data reporting capabilities, with Power BI dashboards for real-time insights across services
• Digitizing more of the Early Years journey, including elements of the Personal Child Health Record (PCHR). This would give families a central place to access all assessments, track progress, and access resources within a single, user-friendly platform.

Their advice to others exploring low-code?

“If you have complex stakeholders, rapid application development is great for making sure your use cases work. It’s about starting small and building out from there,” Smith concluded.