individual commissioning for children and young people with complex needs in gloucestershire chris...
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Individual Commissioning for Children and
Young People with Complex Needs
in Gloucestershire
Chris Sands: Head of Individual Commissioning
Children and Young People’s Directorate
Placements
OutcomesSupport Services
Budget HoldingLead Professional Pilot (Children in
Care)
Learning Points
Feedback
Special Educational
Needs
Children and young people with Complex Needs
……have a number of discrete needs –
• e.g. relating to their health, education, welfare, development, home environment
• Require additional support from more than one agency / service sector / system.
•Their needs are often chronic and may be life-long.
•These different needs tend to interact, exacerbating their impact on the child's development and well-being.
Typically, they may have…..• A spectrum of need which has been sustained for at least 6
months (and is likely to be ongoing);• Needs falling at the severe/profound end of a spectrum of
intensity;• Needs falling across at least two of the areas below:
– Acute and/or chronic medical difficulties, – Multiple and profound physical and/or sensory impairments, – Behaviour problems which are often challenging,– Significant Learning and/or Language difficulties, and/or
disabilities,– Parenting and/or attachment/social needs.
• Intensive ongoing involvement of at least two agencies / service sectors, usually drawn from:– Therapy services – Specialist Educational Services – Nursing and Medical Services – Social Care Services (core teams or specialist personnel) – Mental Health Services
•Poor outcomes
•Escalating spend
•Inefficient processes
•Lack of customer focus
•Future predictions
The Complex Needs Strategy
Where we were……a bit of history…
Revise and redesign the commissioning process in order to improve processes and
decision-making, broaden choice of placement options, ensure an outcomes-focussed approach based on individual
needs, and ensure that these needs are met by effective quality providers at reduced
levels of cost.
Since then……………
Complex Needs Strategy (excerpt)
Commissioning has really taken off…. Why?
to
Clear direction from DCSF, the CSP + Ofsted Inspections
Move away from ‘what we have/always had’
what we and our customers need/planning for the
future/trends/patterns etc
…..Its our framework for planning all services for dynamic future proofing
Commissioning Cycle
Analysing Planning(e.g. OPS; CYPP NA; (e.g. CYPP;
CommissioningCommissioning Plans NA) Plans; evidence/’research’)
Reviewing Doing(e.g. CYPP; Contracts/SLAs) (e.g. Tendering/Contracting
Service Improvement &/or
Development Plans)
(DCSF) (CSP)
Different levels of commissioning
•Strategic
•Local
•IndividualSounds simple...
My focustoday
GLOUCESTERSHIRECONFERENCE
GLOUCESTERSHIRECONFERENCE
GSPGloucestershire
StrategicPartnership
GSPGloucestershire
StrategicPartnership
DISTRICTS NETWORK(Chairs of the 6 LSP CYP Thematic sub groups and
district officers)
DISTRICTS NETWORK(Chairs of the 6 LSP CYP Thematic sub groups and
district officers)
CYPSP BOARD and
EXECUTIVE GROUP
CYPSP BOARD and
EXECUTIVE GROUP
COMMISSIONING BOARD
COMMISSIONING BOARD
CYP Local Strategic Partnerships
CYP Local Strategic Partnerships
Schools
Forum
Schools
Forum
6 LSPS(Local Strategic Partnerships)
6 LSPS(Local Strategic Partnerships)
Extended services clusters
Extended services clusters
CYP ‘hubs’CYP ‘hubs’
keyCountywide strategic commissioners
Countywide strategic commissionersDistrict/locality commissionersDistrict/locality commissioners
Officer supportOfficer support
Commissioning family/individual level
Commissioning family/individual level
money
need
Commissioning teamCommissioning team
Locality ManagersLocality Managers
Countywide strategic
commission
ers eg PCT and GCC
Countywide strategic
commission
ers eg PCT and GCC
Individualised budgets through Lead Professionals
Individualised budgets through Lead Professionals
Providers of services
Providers of services
Children and families in GloucestershireChildren and families in Gloucestershire
Levels of commissioning
Professional Filter – what happens now
Individual CommissioningIndividual Commissioning
Moving from this
Where we’re going -Citizenship Model
Individual CommissioningIndividual Commissioning
To this
Resource Allocation System……
Individual CommissioningKey Features/principles of the
Gloucestershire Commissioning Model
Individual CommissioningKey Features/principles of the
Gloucestershire Commissioning Model
Needs led, outcome focused
Transparency,clear processes and timescales
Accountability and review
Creativity, flexibility
Value for money Empowers and
engages yp, their families/carers
Local services
Promotes choice
Objectives: Improved, managed outcomes relating to ECM
Improved stability and placement choice
Effectively commissioned services through pre-qualified lists
(fostering, residential, SEN)
Increased local service provision
Increased accountability for service outcomes
Empowerment of young people and carers in decision making
processes
Reduced bureaucratic processes and release time back into
frontline working
Link with and build upon experiences of individual budgets for
children in care and children and young people with disabilities
Join up the commissioning and individual budget processes (BHLP and the Resource Allocation
System)
Objectives: Improved, managed outcomes relating to ECM
Improved stability and placement choice
Effectively commissioned services through pre-qualified lists
(fostering, residential, SEN)
Increased local service provision
Increased accountability for service outcomes
Empowerment of young people and carers in decision making
processes
Reduced bureaucratic processes and release time back into
frontline working
Link with and build upon experiences of individual budgets for
children in care and children and young people with disabilities
Join up the commissioning and individual budget processes (BHLP and the Resource Allocation
System)
Where we are up to…….•Individual Commissioning Services Team
•Mainstream Children’s Homes….closed – all children’s homes services individually commissioned
•Fostering:•Service of excellence•Business model•Level playing field (12+)•28 day contract•Target for 85% in fostering placements
•Special School and SEN process trials
•Budget Holding Lead Professionals pilots
•Support Services accreditation Process examples
Individual outcome focused commissioning profile completed (with
parents and yp)
ICST Quality Assurance function Anonymised data
ICST screen against priorities
Expressions of Interest from Partner Providers
(pre-qualified providers)
5 working day turnaround
Social Worker/Lead Professional grades (with parents and yp)
Negotiation with partner providers ranked 1&2
Contracts based on clear service/outcomes provision
Needs/Outcomes form part of YP’s review
Needs/outcomes to IRO Service
Service Commissioning
Tribunals 7 Parental pref….
X
Special Educational Needs Trial
Stat assessment request or review indicates complex
needs
Multi-agency outcomes meeting held: identifies and agrees
need, outcomes and challenges
Commissioning form completed by LP,
agreed by parents and professionals
Review of outcomes
Decision re. extra resources/external
placement
LP, professionals and parents grade responses and undertake
visits
Contract issued and placement
begins
Aims of the BHLP pilots The BHLP pilots aim to:
Involve young people and parents in decisions about what they need and how best to support them
Ensure children, young people and families get the services they need when they need them.
Reduce overlap and inconsistency and poor engagement, thus reducing the costs per “episode” of intervention.
BHLP Children in Care Pilot
Workstreams:
•Children waiting permanency
•Educational achievement
•Young people with substance misuse issues
•Yp in our children’s homes
•Children and young people’s participation
BHLPs - How they work……
Common Assessment (CAF) Analysis/PEP completed with parent, young person,
relevant professionals
Allocate budget if required
Review outcomesComplete support plan with
young person/parents
Agree Lead Professional if not already identified
Access existing services or commission direct
Needs and outcomes identified
One of our big questions and challenges…
Why go out of county?
What more could we do in-county?
How can we make better use of our own resources?
Special School TrialsEmerging needs…..
Use BHLP principles
Costs inevitable…
Not just ‘education’
Creative & Flexible
approach
Local support services
Accreditation of
‘non-trad’ providers
Individual Commissioning:
Have we got it right?Proof of the pudding…….
Benefits RealisationImproved
stability/choice/matching
Increased involvement in decisions and process
Promotes roll out of BHLP
Reduction in yp placed out of
county
Reduced overall costs
compared with pre-ICST
Improved Market
engagement
Increased Local
provision
Increased accountability
Sufficiency
Commissioning Learning Points and feedback
IFAs: - comprehensive information - able to meet timescales - ECM framework helpful in matching - outcomes led supports matching - a plan already to roll - positive way forward - 100% good/very good/excellent
SWs: - takes more time than want to spend - QA function presents a challenge - timescales difficult to determine re outcomes - difficult if not know child (when an
emergency) - ECM focus good - 55.5% good/excellent. 33% average. 11.5%
poor
BHLP (Children in Care Learning Points)
Social work practice issues:
•Raises questions about what the role of the social worker is – commissioner a new concept
•Meaningful relationships with young people
•Challenges the culture of the ‘expert’ model
•Moving from systems and process approach to needs led
•Corporate parenting aspirations
BHLP (Children in Care Learning Points) cont..
Engagement with young people issues:
•Greater participation in the care planning process•To feel they are important and that they matter•A chance to talk about their day to day needs with someone with whom they have a meaningful relationship
Commissioning feedbackYoung People:
quite an achievement!
successful
yes: definitely
yes: happy and settled in placement
my choices were
considered
offered choice of two placements
two intros and enough
notice
Choice?
Right Choice
?
Placement move?
‘Just wanted to say that the processran very sweetly. Many thanks to everyone for their part in findingthe right placement. I have been impressed by the professionalcourtesy and support along the way. The process is a vast improvement (topast experiences) and really does helpto focus on my child’s needs and outcomes’
…..we’re still learning and working on it!
Individual Commissioning:
Have we got it right?
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