Total Place delivering more for less in the Public Sector

Jayne Bench

Head of City Finance

Be Birmingham

Birmingham’s Total Place ambition

3 objectives

• Put citizens at the heart of better service delivery

• Identify efficiency savings

• Develop new collaborative leadership

Its about …• Service redesign rather than modification, doing

different things

• Prevention and early intervention rather than treating the consequences

• Being a public servant for Birmingham’s Citizens

• Developing self-reliance

• Giving the People a voice

• Moving from a factory model to a citizen focussed model

What we did• Map expenditure and investment in the city of

Birmingham

• Total of 50 partners contributed

• Identified total Public Sector spend of £7.3b in 2008/9

• Assessed the extent of aligned investment behind the community strategy

• Identified six thematic areas as part of the Total Place pilot

Top Funding sources across the CityTop Ten Funding Sources (£million)

26

50

43

105

279

239

699

1,918

3,657

0 400 800 1,200 1,600 2,000 2,400 2,800 3,200 3,600 4,000

WM Probation Service

WM Fire Services

AWM

Home and Communities Agency

LSC

WM Police

Job Centre Plus

PCTs

Birmingham City Council

`

Organisations funding ‘mapped onto’ partnerships

Spend by Partnerships (£m)

114

267

323

825

1,083

1,674

2,136

0 500 1,000 1,500 2,000 2,500 3,000

EnvironmentalPartnership

Culture Partnership

Safer BirminghamPartnership

City Housing Partnership

Economic Prospectus

Children and YoungPeople Partnership

Birmingham Health andWell-being

Where might savings come from ?• More citizen, neighbour and community reliance

• Prevention instead of cure

• Higher staff motivation

• Stopping of activities which adds little value

• Less duplication

• Reduced re-working

• Simpler delivery processes

• Lower overheads

A move towards Outcome Based budgeting ?Outcome based budgeting provides the opportunity

to:

• Obtain stakeholders input identifying concerns and needs

• Set broad goals that provide overall direction and serve as a basis for decision making

• Establish priorities assessing community needs, challenges and opportunities

Continued

• Commission costed, time limited, programmes from who ever is best to deliver them

• Budgets to be held by the core organisation for the relevant commissioned programme

• Develop a practical approach which can lock in savings for future years by focussing on outcomes rather than processes

Financial planning

• Develop a financial plan that moves towards the achievement of goals, within the constraints of available resources

• Define a budget process which:3. Incorporates a long term perspective4. Establishes linkage to broad organisational goals5. Focuses budget decisions on results and outcomes6. Involves and promotes effective communication

with stakeholders

Presenting the data…

Early intervention

With thanks to Aperia and CACI

Early intervention - principles• Invest in research proven blue chip prevention &

early intervention programmes.• Avoid investment where there is little evidence of

effectiveness.• Keep abreast of latest research findings to

determine how to use taxpayers money wisely.• Evaluate funded programmes to determine if

benefits exceed cost.• Pay attention to quality control and fidelity.

Case Example Incredible Years• Incredible Years pilots in 6 children’s centres (RCT’s)

• Cost of conduct disorder (Scott, Knapp Maugham 2001) 10X no behaviour problems plus demand on services

• Largest cost crime –US studies (Tom Dishon) adolescent delinquency £56000-£232000 & adult crime $1.2m

• Success rates of evidence based programmes for very young 75% in adolescents 25%

• Benefit realisation includes savings 2.1 over 15 years

Steve Aos Economic modelling• Early indications of benefits beyond the confines

of the LA suggest they could be over £400m over 15 years – a benefit of 6:1.

• Data from UK pilots not yet available – we need to develop different assumptions from the US model.

• Does provide an indication of the benefits which could be to communities and local and central government from a coordinated approach to implementation of evidence based interventions.

Transforming early years

Service Transformation Benefits identified Costs identified

Incredible Years 16,997,145 3,381,137

Team Around the Child 16,000,000 8,200,000Preventing Adolecent Long Term Placement 29,938,896 10,053,250

Triple P evaluation 897,000 692,600

Parenting programme roll-out 52,399,531 2,181,685

Family Nurse Partnership 1,028,376 GrantTotal: 117,260,948 24,508,672

Drugs & Alcohol

With thanks to Aperia and CACI

HealthSubstance Services

Public Services

Emergency Services

Justice

Police

BCC

Drug & Alcohol Service Providers

NHS Business Services

Hospitals

PCTs

GPs

Probation

Prison

DIP

Arrest

DAAT

Crime

Arrest Out of Hours Calls

FireIncidents

DIP Referrals

Opinion Survey

Children (CareFirst)

Housing (SX3)

WMPHO

BHWP

Needle Exchange Commissioning

Service Provider Commissioning

Case Management

Case Files

Prescribing Data

Aggregate Hospital Episodes

Monitoring NDTMS

Hospital Records

Case Files for Patients

A+E Admissions flagged for Substance

Offender Assessment

(OASys)

Accredited Programmes

(IAPS)

Prison Records

SPOC Call Centre

Revs / Bens (Northgate)

Adults (CareFirst)

Public Health Mortality Files

Courts

Sentencing Records

Mental Health Trust

Drugs and Alcoho l Data Map

Consolidated Cost Index arising from Drugs Misuse:1) Birmingham Opinion Suvey - Proportion who say

that people using/dealing drugs in the local area is a big problem

2) Police Data - Instances of Drug Possession crime3) HES Data - Inpatient Admissions for Drug Misuse

The Consolidated Demand Index arising from Drugs Misuse:

2) DAAT Needle Exchange Volumes - Pharmacy Level aggregated to Ward

3) NHS Business Authority - Spend on prescriptions relating to Opiate Dependence

4) Police Data - Drug Possession Offenders

5) Probation Service OASys - Drug Offenders with Criminogenic Need

6) Demographic Propensity - derived from ACORN profile of Drug Offenders

The Consolidated Cost Index arising from Alcohol Misuse.

1) Birmingham Opinion Suvey - Proportion who say that people being drunk or rowdy in the local area is a big problem

2) Police Data - Instances of ARV crime (Alcohol Related Violence)

3) HES Data - Inpatient Admissions for Alcohol Attributable Reasons

Drug Offenders – by Birmingham Segments

Produced by Customer Knowledge, BCC24/02/10Copyright © Experian Ltd 2010. Copyright © NAVTEQ 200 7. Based on Crown Copyright material

Birmingham Segment Group Count % BCC % Index

A 21 1.64 5.73 28.64B 17 1.33 3.74 35.52C 61 4.77 10.24 46.55D 40 3.13 2.72 114.75E 129 10.08 13.87 72.68F 399 31.17 13.28 234.73G 41 3.20 7.10 45.11H 181 14.14 11.70 120.83I 218 17.03 12.43 136.97J 145 11.33 11.59 97.76K 13 1.02 3.37 30.10L 15 1.17 4.22 27.74

Segment Group profiles

Group F

Group i

The True Cost of Drugs in Birmingham – Per Annum

Benefits

Hospit

al Adm

issio

ns

Criminal Justice System Other Spend

DAAT

£27.8m

£33m

£15m

£2.3m

£??m

Drug Treatment ProvisionPooled

Treatment

£13.1m

Drug Intervention Programme

£5.3m

Birmingham City Council

£1.3m

£3.7m

£1.08m £3.4m £15.6m £1.4m

•Police•Adult Social Services•GPs•Families•Schools•Mental Health Trust•Acute Trust•Probation•Prisons•Housing

•Single Point of Contact

•DATUS Peer-led Advocacy•DIP (BCC)•DIP (ARW)

•Needle Exchange•Outreach•Inreach

•Addaction•DIP CARAT

•Midland Heart•SADIE•KIKIT•BBV

•Community Outreach•GP Prescribing•CDT/DIP Prescribing•Swanswell•Turning Point•Safe project•EESPro•DRR•Mother & Baby

•Residential Rehab•Detox

•Structured day care

Tier 1 Tier 2 Tier 3 Tier 4

PCTs

£5.6m

Other

£357k

DoH Tier 4 Grant

£1.3m

Professional

Self

referral

Advisory

Service Journey

DannySEGEMENT:- Drug AddictGENDER:- MaleAGE GROUP:- 25-40RELIGION:- n/aSTATUS:- SingleDEPENDANTS:- 1 child

How do we measure his outcomes?

Customer Journeys

Ups

and

dow

ns o

f the

cus

tom

er e

xper

ienc

e

Key journey steps

Agency Touch-points

1991 2000 2008 2010

Suicide Attempt, A+E Admission

Relapsed upon release from hospital

Suicide Attempt, A+E Admission

Relapsed upon release from hospital

Suicide Attempt, A+E Admission; detoxed

Relapsed upon release from hospital

Medication treatment from GP

Off sick with depression

Started drinking JD with current partner who's alcohol dependant

Arrest and sent to hospital due to sickness and shakes

Forced 9 day Detox

Social Services Intervention around child

1st session; Search for activities (dance)

2nd session

Book appointment at GP for depression

Argument with Neighbours

Relapsed over weekend

Controlled drinking; Abuse from neighbours ongoing; Seeking help from Housing Seek additional

support for son

Arrange transfer meeting

Child in Need meeting with Social Worker

Depression

Unsure if employer support her

Depression – drink to cope with life Depression

Humiliated

Motivated to sort life out Worried

about son’s care

Hospital Hospital Hospital GP Police

Hospital

Alcohol Services

Social Services Social Services

Alcohol Services Alcohol Services

Social Services

EducationHousing

38 yrs old. FemaleLives with 7yr son Older 18yr son who’s left home

2005

Drank with friends at home; family drink dependent

Caught in Abusive Relationship

Argument with rowdy neighbours who stop her sleeping after night shifts

Customer Journeys

Ups

and

dow

ns o

f the

cus

tom

er e

xper

ienc

e

Key journey steps

Agency Touch-points

Apr 2008 Sept 2009 Oct 2009 Nov 2009

Breakup of relationship and lost contact with children

Starts Drinking

Starts sick leave from job as Fork Lift truck driver

GP referral to Alcohol Services

Applies for Disability Living Allowance

1st Session with RAPt

DNA 2nd Session

2nd Session;

Referral to Aquarius for detox

Lost job due to drinking

DLA Claim rejected

Paul fails to start detox with Aquarius

Appeals decision over DLA

Several DNAs so RAPt case file closed

3rd RAPt session

4th RAPt session;

GP Alcohol Services Alcohol Services Alcohol Services

36 yrs old MaleLives with Mum and Dad after partner left him and took two sons away

Depressed

Stressed and of very low mood

Motivated to engage services to keep benefits

Felt ‘rushed’ into detox

Alcohol Services

Social SecuritySocial Security

Feb 2010

Gangs

Offence Type Cost in Anticipation

of Crime

£

Cost as a Consequence

Of Crime

£

CJ Costs

£

Total Cost

£

Homicide 374 1,314,362 144,239 1,478,975

Att Murder/Serious

Wounding

1256 481,478 78,243 560,977

Criminal Use of Firearm

798 120,198 48,724 169,720

Robbery 348 4698 3298 8344

Details of criminal activities and offences has been mapped

Gang Member’s familial networks and criminal histories have been mapped

Obligate and Dynastic

Families

Criminal Justice Costs£2.7m