Joint Commissioning and New Governance Arrangements Leicestershire Together

Joint Commissioning and New Governance Arrangements Leicestershire Together Board 14 th 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

The Alcohol System

Leicestershire Substance Misuse Improvement Framework (Target Operating Model v 0. 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 n tio en gy ev te Pr Stra lth ea H ng e ei ov B pr ll Im We & 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 M an ag Off em en en de t. P r at hw ay ht ig N y & m g no in co ns E ce e Li Tim

What we learnt from Total Place § § 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? ¢ ¢ ¢ 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.

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 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 = is required alongside & at this level County wide prioritisation & service design Probation ANTI-SOCIAL BEHAVIOUR 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 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 Manage perceptions of ASB LA/Social Housing Trading Standards Street drinking Diversionary/Mentoring Neighbour disputes Young People hanging around? Customer Insight/evidence base Family Support/ Intervention Teams (allocation) Family Support/ Intervention Teams (delivery) Integrated Offender Management Tiered approach to ASB Co-ordination ASB intelligence (eg calls) Family Support/ Intervention Teams (resources) Integrated offender management Educating Young People Animal nuisance Integrated offender mgmt Probation Youth Services Licensing Youth Offending Service Environmental & Criminal Damage Street drinking Vulnerable victims/perps Diversionary/Mentoring Hate crime – disability, race & homophobia Common Assessment Framework LA/Social Housing Dealing with repeat /nuisance calls Noise Pollution Animal nuisance Common Assessment Framework Vulnerable victims/perps 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 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 nudge Healthy Schools Programme Active Together Programme Adult Weight Child Weight Management Service Breastfeeding Support Multi-faceted nudge Adult Weight Management Service Healthy Schools Programme Active Together Programme Physical environment Multi-faceted nudge Healthy Schools Programme Breastfeeding Support Adult Weight Management Service Active Together Programme Volunteering Children’s Centres Physical environment Travel Planning Child Weight Management Service Sport/PE/Leisure Marketing County wide service coordination Locality service coordination

Service Redesign: What next • Further workshops planned on: • • Domestic Abuse (March 15 th) Anti-social behaviour (March 17 th) Natural & Historic Environment (tba) A series of Health, Social Care and Children’s workshops (March, 7 th, 10 th, 17 th) • Physical Activity (March/April) • Sport & Culture (April 1 st) • 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 ¢ 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 Problem J Bloggs Partner Children Mother ·Offending ·Unemployment ·Depression ·Alcoholism ·Homeless Separate Service Response · · ·Domestic Abuse ·Family Breakdown ·Unemployed ·Homeless · · ·Truancy ·ASB ·Drugs ·Low level crime · ·Early stages of dementia 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 Youth Justice System Children in Care · School CYP Services YOS · Adult Social Care Residential Care ·

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 = £ 4 m 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 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 V 0. 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 Propose and establish design methodology Develop & Handover Design Blue Print Define solution principles, culture and key skills Develop PID Undertake Gateway Check Core Transformation Competencies Induction & development programme

Pooling of Budgets ¢ ¢ Proposed by Government for pooling: l Safer and Stronger Communities Fund (to become Community Safety Fund) l Early Intervention Grant l Drugs Intervention Programme l Drugs Pooled Treatment Budget l Job Centre Plus Discretionary Funding l Work Programme Funding l European Social Fund l Youth Justice Grant l Probation/NOMS interventions funding l 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. 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