An Introduction to Altogether Better:

A Whole Place Community Budget for West Cheshire

Iain Barr

Altogether Better

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• Known nationally as a ‘whole place community budget’

• One of four areas working with Whitehall and partners to develop:

“A plan setting out how joined-up services and joined-up funding could improve outcomes for residents, reduce duplication, and reduce demand on costly interventions”

• March to October 2012 (planning)

• Joint local-central team

• Not another total place – rigour and credibility

Why West Cheshire?

•A microcosm of the nation

•Distinct identities

•Pockets of deprivation

•Health inequalities (13 year gap in life expectancy between wards)

•Rural and urban

•Ageing population (22% pensioners) with forecast increase of over 50% in the number of residents over 85 by 2020.

•Partnership commitment that: “by working more effectively together in partnership, we can make our scarce resources go further and also achieve more for our customers.”

The breadth of the local partnership:

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Why Partners are doing this:

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Organisation Total Budget Required Savings

Police £242 million £25 million (5 years)

Fire Service £45 million £5 million (4 years)

Local Authority £780 million £48million (5 years)

West Cheshire Health Services

£1,164 million £19 million (5 years)

Altogether Better – the business case stage

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• 22 ideas

• Follow the money

• Low volume, high cost groups that cannot be supported

• March-October 2012: Development of six business plans and an operational plan (five years)

• Critique of current services; a new delivery model; cost benefit-analysis and an implementation plan

• Co-design with partners and Whitehall

Collaborative Leadership:

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Executive Leadership

Starting Well TMG (Gerald Meehan,

Cheshire West and Chester)

Living Well TMG (Angela Cossins – Probation & Steve

Jennings Weaver Vale Housing Trust )

Working Well TMG (Janet O’Connor, Job

Centre Plus)

Ageing Well TMG (Alison Lee and Simon Whitehouse, Clinical

Commissioning Groups)

Smarter Service TMG (Jeanette McCormick

Police)

Public Service Board

Elected Members Engaged through Policy Development Boards, Scrutiny Committees and Briefing Events

What did you do for 9 months?

The proposals (1)

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Project Issue Proposal

Families Together

525 families that cost £39 million per annum, and we don’t achieve improvements for investment.

•Wraparound case management for 525 troubled families•Family assessment•Family budgets•Multi-agency investment vs. short term grant

Early Support

7,000 referrals of children with “high need” (1,200 were repeats)

• Access and triage of early support• Multi-professional team based in localities• Early support specification

Safer Communities

£20m spent annually – but £19.6m on consequences.

• Case management for perpetrators and offenders•Multi-agency investment in evidence-based interventions e.g. Perpetrator programmes, recovery programmes, IOM, accommodation support, tagging, awareness programme

The proposals (2)

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Project Issue Proposal

Work-ready individuals

22,000 unemployed residents, but all with different needs.

• Co-locating employment services (employment and skills hubs)• Specialist teams for certain cohorts (ESA, WP returners, over 50s, NEETs)•Joint assessment process between agencies•New governance mechanism to ensure more locally responsive offer

Ageing Well

£19m rise in demand on services due to ageing population.

• Integrated approach to support older adult and reduce demand on acute and residential care, including:• Self care offer ; Stronger communities; Integrated care; funding and contracting model

Integrated Assets

Partners own 1,500 assets costing £40m annually.

• Place based approach to asset management to support integrated services, reduce costs and support other objectives

From Projects to Whole System. We have identified more potential to join up case management across the business cases. This reflects the ‘shared cohort’ across Early Support, Living Well, Families Together and Working Well

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Family Breakdown

Economic Dependence WorklessnessCrime and

Anti-Social Behaviour

Educational Failure and Low Skills

Debt

Under developmen

t in early years

Health Inequalities

Addiction

Unstable Housing

and Environmen

t

Early Support

Domestic abuse

(Living Well)

Families Togethe

r

Working Well

Integrated

Operating Model

The potential financial impact

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'I am amazed to say the numbers stack up‘ Rt. Hon Eric Pickles MP, 29th November 2012

Implementation planning

•From long term planning to implementation from April 2013

•The central team

•Transition and running costs (across organisations)

•Locations

•Business processes

•Technology

•Data sharing

•Training and development

•Governance

•Benefits realisation

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Delivery : Integrated Early Support: April-June testing – 150 cases

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Access Integrated Early Support Teams

Tailored and mainstream

services

Enablers

Altogether Better

• Support and advice to partners

• First point of contact for new cases

• Multi-agency information gathering and assessment

• Appropriate onward referral - to acute needs, back to agencies and into case management

• Some new interventions and scaled up interventions.

• Priority access to interventions from some mainstream services.

• Broader access to all mainstream services.

• Three integrated hubs of delivery and 140 case workers

• Planning and execution of plans for specific facilities and individuals

• Ongoing risk assessment

• Access to specialist and mainstream interventions

• Data and intelligence on demand, performance and finances

• Case management system

• More intelligent planning and management of the supply chain

Work-ready individuals – what will change

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Day One Deliverables

• A number of multi-agency ‘Work Zones’ featuring JCP, Council Employment and Skills, NCS, Housing and others

• Tailored offers for high priority cohorts

• New assessment process to drive joint working between employment and skills services

• New process to integrate work programme and JCP ‘warm’ hand over in line with DWP operations directive

• New governance structure to ensure Employment and Skills provision is linked to the locality agenda

Integrated Care Teams: Two early adopter sites (Princeway Frodsham, and Whitby Lodge Ellesmere Port) will be set-up in May. The staff that will be included in this team are from across Health and Social Care, improving partnership working, reducing repetition, referrals and double running. This will link in with work that is taking place to redesign prevention and rehabilitation services.

Stronger Community Provision: Partners will work together to develop new approaches to foster community based provision. This will include the establishment of time-bank models, telecare, and micro-enterprises around the provision of personal assistants.

Contracts and Commissioning Practice: Reviews of existing contracts and commissioning practice will take place to see how we can commission in partnership, and promote working with the voluntary and community sector.

 

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Ageing Well – What will change?

Lessons Learnt:

1. Pick a deadline and stick to it: Focus and ambition

2. Integrated where it makes sense: You can’t make one budget for place, so it’s better to target efforts.

3. Avoid new silos: If you integrate on a project by project basis, you must make sure that you retain a view of the bigger picture.

4. Collaborative Leadership: All leaders from all partners have a role to play.

5. Invest in analysis: This can't be a nice to do. To make a difference it needs to be financially sustainable. Invest in cost benefit analysis to ensure every partner is clear on their return on investment and you can evidence impact.

6. Don’t forget the community: Redesigning services and budgets only goes so far. A new settlement between citizen and state is required.

7. Keep up the momentum: Policy Commissions – Elected Members and partners identifying new solutions to future challenges

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Localism and Community Empowerment:

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An approach that focuses on communities resources, skills, talents, knowledge, and potential, rather than the old approach which tended to focus on the needs, problems and deficiencies in communities. This will be delivered through:

•Five Ward Test Beds, developing appropriate programmes for specific wards (Frodsham, Grange, Swanlow and Deane, Upton, and Hoole). These reflect the breadth of geographies within the Borough, with differing issues prevalent in each. (1st January to 31st December 2013).

•Engaging Members as “Executive Members for Place” - community boards (20k populations)

National Developments•Public Transformation Network:

• sharing the learning,

• offering support to a second wave

•Place-based settlements – ideas submitted in Spending Round submissions:

• Top-slicing departmental spend to fund prevention

• Sharing the proceeds of success

• Greater certainty over the medium term

• Cross-Departmental payment by Results

• Heseltine Review – single pots for growth and skills

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Further information

Laurence Ainsworth – Head of Change Management

laurence.ainsworth@cheshirewestandchester.gov.uk

01244 977147

www.altogetherbetterwestcheshire.org.uk

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