Transcript Effective Partnership

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
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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
The Alcohol System
Cr
im
Sy ina
ste l J
m ust
Im ice
pa
ct
He
alt
hI
mp
ac
t
A&E
Attendances
Crime
&
Disorder
Hospital
Admissions
Alcohol Related
Deaths
Off Licensing &
On Licensing
Impact on
Children
Fa
m
Family
Breakdown
ily
Im
pa
c
t
s
es
n
i
t
s
Bu pac
Im of
e
ye
o
l
p ism
Em sent
Ab
/
ss l
e
n
si ercia
u
B m t
c
m
Co Impa
Licensing
Sales &
Consumption
of Alcohol
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
What we learnt from Total Place
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Total Place and other initiatives show better
outcomes can be achieved at lower cost by coordinated 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.
What decisions have been taken?
•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
Recommendations
1.
2.
3.
4.
5.
New Terms of Reference considered by theme groups
and proposals for locality management and
Governance developed
General consultation with stakeholders
Executive to consider and make recommendations for
final structure
Partnership-wide Conference in June
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?
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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.
4.
Review
1.
Analyse
LAA / SCS
Priorities
3.
Do
Governance
2.
Plan
What’s different then?
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Putting blocks of activity/service/budget together to allow
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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
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single set of priority outcomes
joined up performance monitoring
joined up engagement
single evidence base
How can we reach agreement
on change?
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By testing what should be designed or coordinated together and at what geographic
level.
A Model for Seamless Services for
Leicestershire?
Joint Countywide
Governance
Joint
Service Planning/
Redesign
Joint
Co-ordination
County wide
prioritisation
&
service
design
County wide
service
coordination
Locality
prioritisation
&
Service
design
Locality
service
coordination
Joint Locality Governance
KEY
= Design/co-ordinate alongside
= Is required
Youth Services
= mainstream activity
ANTI-SOCIAL BEHAVIOUR
= is required alongside & at this level
County wide prioritisation & service design
Probation
Locality prioritisation & service design
ASB Co-ordination
Youth Offending Service
Youth Services
Youth Offending Service
LA/Social Housing
Family Support/ Intervention Teams (design)
Integrated offender management
Substance misuse
Tiered approach to ASB
ASB intelligence (eg calls)
Mental Health (personality
disorders)
Noise Pollution
Neighbourhood
Management
Diversionary/Mentoring
Customer
Insight/evidence base
Children Centres
Vulnerable victims/perps
Young People hanging
around?
Hate crime – race,
homophobia, disability
Probation
Licensing
School/Community agency interface
Diversionary/Mentoring
Neighbour disputes
Customer
Insight/evidence base
Young People hanging
around?
Family Support/
Intervention Teams
(allocation)
Probation
Youth Services
Licensing
Youth Offending Service
Street drinking
Integrated
offender mgmt
Manage
perceptions of
ASB
LA/Social Housing
Trading Standards
Environmental & Criminal
Damage
Family Support/ Intervention Teams (delivery)
Integrated Offender Management
Tiered approach to ASB
ASB Co-ordination
ASB Co-ordination
ASB intelligence (eg calls)
Family Support/ Intervention
Teams (resources)
Integrated offender management
Educating Young People
Animal nuisance
Street drinking
Vulnerable victims/perps
Diversionary/Mentoring
Hate crime – disability, race
& homophobia
Noise Pollution
Animal nuisance
Common
Assessment
Framework
School/Community agency interface
Young People hanging
around
Tiered approach to ASB
Neighbour disputes
Hate crime – disability, race
& homophobia
County wide service coordination
Diversionary/Mentoring
Environmental & Criminal Damage
Vulnerable victims/perps
Common Assessment Framework
LA/Social Housing
Dealing with repeat /nuisance calls
Locality service coordination
Youth
Offending
Service
Mental Health
(personality
disorders)
Neighbourhood
Management
= Design/co-ordinate alongside
= mainstream activity
County wide prioritisation & service design
Customer contact (see brief intervention)
TOBACCO CONTROL
Locality prioritisation & service design
Trading Standards – sales u-18
Marketing
Sports Coaching
Youth Services
Trading Standards –
illicit, untaxed
Community Midwifery
School Nursing
Health Visiting
NHS Stop Smoking Services
– Specialist & Enhanced
Locality targeted anti smoking
Schools Programme
Pacesetters (community)
Secondary Care Programme
Trading Standards – sales u-18
Pacesetters (community)
Secondary Care Programme
Fire Service
Trading Standards – enforcement
Environmental Health
Brief Intervention training
(i.e., children’s centres)
Health Visiting
School Nursing
Community Midwifery
County wide service coordination
Locality service coordination
= Design/co-ordinate alongside
= mainstream activity
TACKLING OBESITY/HEALTHY WEIGHT
County wide prioritisation & service design
Locality prioritisation & service design
Food environment
Bariatric Services
Marketing
Leisure Services
Travel Planning
Cycle/Walking ways
Nutritionists
Food Packaging
Multi-faceted
Healthy nudge
Schools
Programme
Active Together
Programme
Adult Weight
Child Weight
Management Service Management Service
Breastfeeding
Support
Multi-faceted
nudge
Adult Weight
Management Service
Healthy
Schools
Programme
Active Together
Programme
Physical
environment
Multi-faceted
Healthy nudge
Schools
Active Together
Programme
Programme
Breastfeeding
Support
Adult Weight
Management Service
Physical
environment
Volunteering
Children’s
Centres
Travel Planning
Planning
Child Weight Management
Service
Sport/PE/Leisure
Marketing
County wide service coordination
Locality service coordination
Service Redesign: What next
• Further workshops planned on:
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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
The Community Budget
Community Budget Background
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Community Budgets = rebranded Total Place
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Total Place = an ‘approach’ to achieve better
outcomes for citizens at lower public service
cost
Approach :
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Citizen at heart
Whole system overview
Whole place approach by public services
Opportunity to identify national barriers to
government
Families with complex needs
Problem
J Bloggs
Partner
Children
Mother
Offending
Unemployment
Depression
Alcoholism
Homeless
Separate Service
Response
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Domestic Abuse
Family Breakdown
Unemployed
Homeless
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Truancy
ASB
Drugs
Low level
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Early
crime
stages of
dementia
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Probation / CJS
Benefits / JCP
M H Substance
Misuse Services
Housing Support
High Cost Service Required
£££££
Prison
D A Services
Housing
Services
Benefits / JCP
Acute Health
School
CYP Services
YOS
Youth Justice System
Children in Care
Adult Social
Care
Residential Care
Overview of Proposal
- Families with Complex Needs
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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
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‘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.
2.
3.
4.
5.
Delivering improved outcomes for FCN and Communities
at lower cost through:
Identifying with FCN and Practitioners / Services what is
needed
Developing an improved place model for providing required
services
Taking a whole systems approach to address root
problems not just ‘presenting’ problem i.e. housing,
substance misuse, parenting skills, mental health, learning
disabilities
An integrated and coordinated approach to service
delivery - voluntary sector & communities integral element
Early / earlier intervention to reduce vulnerable families
from developing complex needs - identification of key
trigger points and earlier support
Draft V0.2 Strategic Transformation Model
Leicestershire Together Executive/Exec Board
Mandate for
Transformation
Key Decisions/Cabinet
recommendations
Pooled/Aligned budget
agreement
Strategic Vision
Opportunity definition & high level scope
(High Level Business Case)
Vision & Shaping
(Strategy) Phase
Engage leadership & key stakeholders
(map stakeholders power/position)
Undertake:
- ‘Problem definition’
}
- ‘Core’ Q
} Scoping
- Fundamental objectives }
Agree Customer Insight Framework
Identify early opportunities
Define shared strategic vision
Propose governance
Agree strategic outcomes &
performance framework
Propose budgets
Propose and coordinate
member involvement
Commissioning
governance approval
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
High Level Design
Phase
Delivery / Implementation Phase
Embed Change /
Operationalise
Programme Infrastructure
- Resources
- Budget
- Governance
Transformation group
assure design principles within
implementation & service
delivery via board
Develop Programme /
membership
Project Plans
Establish Programme Monitoring
(i.e. Prince 2)
- Risk Log
Submit ‘Options Appraisal’ &
- Lessons Learned
business case for decision
- Reporting Framework
- Communication Plan
Approval for New Operating
Model & budget
Recommend Champion and
identify key change agents
Develop & Handover
Design Blue Print
Propose and establish design
methodology
Define solution principles,
culture and key skills
Develop PID
Undertake
Gateway Check
Core Transformation
Competencies
Induction & development
programme
Pooling of Budgets
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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
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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
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For example
Recommendations
1.
2.
3.
4.
5.
New Terms of Reference considered by theme groups
and proposals for locality management and
Governance developed
General consultation with stakeholders
Executive to consider and make recommendations for
final structure
Partnership-wide Conference in June
Sub group of Chair, District, PCT, VCS and Police to
agree new arrangements/timetable prior to Board