Joint Commissioning and New Governance Arrangements

Leicestershire Together Board 14th March 2011

Content

Why discuss change? Recommendations Integrated Service Planning

(commissioning) Families with Complex Needs Governance

Why Change?

National Context

About 19% less public expenditure on average. More to be spent on the frontline More emphasis on prevention More emphasis on people and communities

helping themselves (Big Society) More decisions to be made locally:

GP Commissioning More independent schools Elected police commissioners Councils to have greater co-ordinating role

Crime &

Disorder

Sales & Consumption

of Alcohol

Off Licensing & On Licensing

Business

Impact

of

Employee

AbsentismFamily

Breakdown

Impact onChildren

Alcohol Related Deaths

Hospital Admissions

A&EAttendances

Business/

Commercial

Impact

Family Impact

Hea

lth Im

pact

Criminal Justice

System Impact

Licen

sing

The Alcohol System

Leicestershire Substance Misuse Improvement Framework (Target Operating Model v0.9)

Vision:

Working together to make Leicestershire a healthier and safer place by reducing the harm and inequalities caused by substance misuse, in a sustainable and cost-effective way

4 Key Outcomes:

1. Reduce substance related crime & disorder

2. To minimise the negative impact on children and families of substance misuse

3. To improve health and well-being for all substance users

4. Reduce public service costs by optimisation of all interventions and service delivery

Citizens

Licensin

g & N

ight

Time E

conomyOffender

Management

Pathway

Prevention

Strategy

Impro

ve H

ealth

& Well

Bein

g

What we learnt from Total Place

Total Place and other initiatives show better outcomes can be achieved at lower cost by co-ordinated action across agencies.

Traditional partnership work helps but its slow and inefficient.

Major budget reductions require a more decisive approach.

Silo based cuts will lead to major failures in outcomes – a different approach is needed.

•In September 2010, the LT Executive agreed that a radical change in the way LT partners work together was required, based on a pooled budget joint commissioning model •the LT Board were informed of a proposal for a redesigned partnership based on around 6 thematic commissioning hubs

•In November 2010, the LT Executive established a working group with representation from the county council, a district council, the voluntary sector and the police to develop a new approach to prioritising, designing and co-ordinating services across partner organisations •In February 2011, the Leicestershire Together Executive agreed that, outside of the community budget, we should seek wider agreement on the redesign of the Partnership and hold a conference in the summer of 2011 to communicate more widely the changes proposed to the Partnership

What decisions have been taken?

Recommendations

1. New Terms of Reference considered by theme groups and proposals for locality management and Governance developed

2. General consultation with stakeholders

3. Executive to consider and make recommendations for final structure

4. Partnership-wide Conference in June

5. Sub group of Chair, District, PCT, VCS and Police to agree new arrangements/timetable prior to Board

Integrating service planning and enabling redesign (effective commissioning)

What does ‘commissioning’ mean?

It’s a process to ensure services meet need.

We already do it for individual services.

It’s a culture as much as a process to ensure services are designed around evidence of need, procured cost effectively and performance reviewed.

1. Analyse

2.Plan

3.Do

4. Review

LAA / SCSPriorities

Governance

What’s different then? Putting blocks of activity/service/budget together to allow

• a Total Place approach to service redesign• a better overview of relationships between services from user

perspective• better decisions about what works• lower cost solutions for lower priority activities to be chosen• a move to prevention• more manageable relationships with potential suppliers e.g. VCS

Joining up support services for a level playing field• single set of priority outcomes• joined up performance monitoring• joined up engagement• single evidence base

How can we reach agreement on change?

By testing what should be designed or co-ordinated together and at what geographic level.

County wideprioritisation& servicedesign

Localityprioritisation& Servicedesign

Localityservicecoordination

A Model for Seamless Services for Leicestershire?

JointCo-ordination

JointService Planning/Redesign

County wideservicecoordination

Joint Countywide Governance

Joint Locality Governance

ANTI-SOCIAL BEHAVIOUR

County wide prioritisation & service design Locality prioritisation & service design

Locality service coordinationCounty wide service coordination

Youth Offending ServiceYouth Services

Diversionary/MentoringTiered approach to ASB

Licensing

Educating Young People

Neighbourhood Management

Customer Insight/evidence base

Family Support/ Intervention Teams (delivery)

Trading Standards

Children CentresNoise Pollution

Dealing with repeat /nuisance calls

Mental Health (personality disorders)

Animal nuisance

Common Assessment Framework

Vulnerable victims/perps

Environmental & Criminal Damage

Substance misuse

Street drinking

Neighbour disputes

Young People hanging around?

Hate crime – race, homophobia, disability

Common Assessment Framework

Animal nuisance

= Is required

Mental Health (personality

disorders)

Family Support/ Intervention Teams (design)

Family Support/ Intervention Teams (allocation)

Family Support/ Intervention Teams (resources)

Manage perceptions of ASB

ASB intelligence (eg calls)

ASB intelligence (eg calls)

Noise Pollution

Vulnerable victims/perps

Vulnerable victims/perpsEnvironmental & Criminal Damage

School/Community agency interface

School/Community agency interface

Youth Services

Youth Offending Service

Youth Offending

Service

Youth Offending Service

Hate crime – disability, race & homophobia

Street drinking

Young People hanging around?

Neighbour disputes

Young People hanging around

LA/Social Housing

= Design/co-ordinate alongside

LA/Social Housing

ASB Co-ordinationASB Co-ordination

ASB Co-ordination

Youth Services

Licensing

Probation

Probation

Probation

Integrated offender management

Integrated offender management

Integrated offender mgmt

Integrated Offender Management

Tiered approach to ASB

Tiered approach to ASB

Diversionary/Mentoring

Diversionary/Mentoring

Diversionary/Mentoring

Neighbourhood Management

Customer Insight/evidence base

Hate crime – disability, race & homophobia

= mainstream activity

= is required alongside & at this levelKEY

LA/Social Housing

TOBACCO CONTROL

County wide prioritisation & service design Locality prioritisation & service design

Locality service coordinationCounty wide service coordination

NHS Stop Smoking Services – Specialist & Enhanced

Schools Programme

Pacesetters (community)

Brief Intervention training (i.e., children’s centres)

Secondary Care Programme

Trading Standards – illicit, untaxed

Pacesetters (community)

Locality targeted anti smoking

Community Midwifery

School Nursing

School Nursing

Community Midwifery

Health Visiting

Health Visiting

Trading Standards – sales u-18

Trading Standards – enforcement

Environmental Health

Youth Services

Sports Coaching

Marketing

Customer contact (see brief intervention)

Fire Service

Trading Standards – sales u-18

Secondary Care Programme

= Design/co-ordinate alongside = mainstream activity

TACKLING OBESITY/HEALTHY WEIGHT

County wide prioritisation & service design Locality prioritisation & service design

Locality service coordinationCounty wide service coordination

Adult Weight Management Service

Child Weight Management Service

Active Together Programme

Breastfeeding Support

Food environment

Physical environment

Bariatric Services

Marketing

Active Together ProgrammeCycle/Walking ways

Adult Weight Management Service

Child Weight Management Service

Breastfeeding Support

Food Packaging

Marketing

Multi-faceted nudge Multi-faceted

nudge

Leisure Services

Sport/PE/Leisure

Travel Planning

Nutritionists

Planning

Travel Planning

Children’s Centres

Volunteering

Adult Weight Management Service

Active Together Programme

Physical environment

Multi-faceted nudge

= Design/co-ordinate alongside = mainstream activity

Healthy Schools

Programme

Healthy Schools

Programme

Healthy Schools

Programme

• Further workshops planned on:• Domestic Abuse (March 15th)• Anti-social behaviour (March 17th)• Natural & Historic Environment (tba)• A series of Health, Social Care and Children’s

workshops (March, 7th, 10th, 17th)• Physical Activity (March/April)• Sport & Culture (April 1st)

• This process should help us arrive: • at groups of services with potential to be redesigned• at a view of what form commissioning could take in

localities

Service Redesign: What next

The Community Budget

Community Budget - Background

Community Budgets = rebranded Total Place Total Place = an ‘approach’ to achieve better

outcomes for citizens at lower public service cost

Approach :

• Citizen at heart• Whole system overview• Whole place approach by public services• Opportunity to identify national barriers to

government

Families with complex needs

J Bloggs OffendingUnemploymentDepressionAlcoholismHomeless

Probation / CJS Benefits / JCP M H Substance

Misuse Services Housing Support

D A Services Housing

Services Benefits / JCP

School CYP Services YOS

Adult Social Care

Partner Domestic AbuseFamily BreakdownUnemployedHomeless

Children TruancyASBDrugsLow level crime

Mother Early stages of dementia

Prison

Acute Health

Youth Justice System Children in Care

Residential Care

Problem Separate Service Response

High Cost Service Required

£££££

Overview of Proposal- Families with Complex Needs

Leicestershire 1 of 16 places Theme selected by Whitehall Proposal submitted to Whitehall 28 Feb Whitehall governance same as for Total Place Total investment committed by LCC = £4m 3 phase programme to 2013 Programme governance includes partners and reps Agreement to pool budgets Work will be based on learning from existing families with

complex needs and practitioners in Leics, as well as evidenced based practice from other places

Principles of Community Budget ‘Place’ and ‘citizens’ before ‘organisation’ Place shared vision, objectives and services Pro-active co-design between partners in the place and

between the place & Whitehall Prevention by early and earlier intervention Better outcomes at less cost Fully understand the problem before defining a solution Ambitious & if appropriate ‘radical’ local innovation’ Build on good practice /initiatives i.e. Integrated Offender

Model, Children’s Centres, YOS, Systems Change, many others

Decommission & reprioritise services when required Pooled /aligned budgets around the theme/place

Programme will focus on…

1. Identifying with FCN and Practitioners / Services what is needed

2. Developing an improved place model for providing required services

3. Taking a whole systems approach to address root problems not just ‘presenting’ problem i.e. housing, substance misuse, parenting skills, mental health, learning disabilities

4. An integrated and coordinated approach to service delivery - voluntary sector & communities integral element

5. Early / earlier intervention to reduce vulnerable families from developing complex needs - identification of key trigger points and earlier support

Delivering improved outcomes for FCN and Communities at lower cost through:

Vision & Shaping (Strategy) Phase

High Level Design Phase

Delivery / Implementation PhaseProgramme Infrastructure - Resources - Budget - Governance

Develop PID

Undertake Gateway Check

Establish Programme Monitoring(i.e. Prince 2) - Risk Log - Lessons Learned - Reporting Framework - Communication Plan

Develop Programme / Project Plans

Embed Change / Operationalise

Appoint / Select Design Team Citizen & Community involvement key

Undertake design phase- Analysis & document current model/customer journey/costs- Review evidence &insight & commission gaps- Identify barriers & address- Design new ‘Operating Model(s) & ‘Option Appraisal’ Framework- Test “smart” interventions- Deliver proof of concepts- Develop stakeholder engagement plan- Develop cost/benefit & benefits model

Submit ‘Options Appraisal’ & business case for decision

Approval for New Operating Model & budget

Develop & Handover Design Blue Print

Opportunity definition & high level scope (High Level Business Case)

Engage leadership & key stakeholders (map stakeholders power/position)

Undertake:- ‘Problem definition’ }- ‘Core’ Q } Scoping - Fundamental objectives }

Define shared strategic vision

Agree strategic outcomes & performance framework

Propose governance

Propose and coordinate member involvement

Propose budgets

Recommend Champion and identify key change agents

Propose and establish design methodology

Define solution principles, culture and key skills

Draft V0.2 Strategic Transformation Model

Leicestershire Together Executive/Exec Board

Mandate for Transformation

Key Decisions/Cabinet recommendations

Strategic Vision Pooled/Aligned budget agreement

Commissioning governance approval

Core TransformationCompetencies

Induction & developmentprogramme

Transformation groupassure design principles within

implementation & service delivery via board

membership

Identify early opportunities

Agree Customer Insight Framework

Pooling of Budgets Proposed by Government for pooling:

Safer and Stronger Communities Fund (to become Community Safety Fund)

Early Intervention Grant Drugs Intervention Programme Drugs Pooled Treatment Budget Job Centre Plus Discretionary Funding Work Programme Funding European Social Fund Youth Justice Grant Probation/NOMS interventions funding Family Nurse Partnership funding/health visitor services

'A number are still looking to align budgets, which are unlikely to unlock the full range of flexibilities promised by pooling’.

Governance

Clarity and Accountability vital to success in a new world of collaboration and cooperation

Buy in essential from ALL partners

New forms of governance

Moving from soft ‘direction of travel partnerships’ to ‘hard’ decision making partnerships

Small number of Boards Commissioners only on Boards Support groups to include stakeholders There will be overlaps

Governance

Governance

Progress to date

Locality

Close to Different Communities/Neighbourhoods

Could be District(s) or Sub-District Build of LPG Exemplars Local Accountability for Activities Prevent New Silos Change/Make things happen

For example

Recommendations

1. New Terms of Reference considered by theme groups and proposals for locality management and Governance developed

2. General consultation with stakeholders

3. Executive to consider and make recommendations for final structure

4. Partnership-wide Conference in June

5. Sub group of Chair, District, PCT, VCS and Police to agree new arrangements/timetable prior to Board