GM Community Budget Pilot Rebekah Sutcliffe Chief Superintendent, Greater Manchester Police, Whole Place Community Budget, Troubled Families Lead 1 Origins of this work Manchester Independent Economic Review demonstrated strength of economy (50bn GVA), economic assets and companies, private sector growth potential Greater Manchester Strategy priorities of economic growth and reducing dependency Better Life Chances pilots in neighbourhoods Total Place mapped total GM spending at 20bn in 2008/09, around 80% of which was spent by LAs, Health and in Benefits too much on dependency
Leading Cost-Benefit Analysis developed with 10 Government departments about the whole system costs and benefits of reform GM submits place-based budgets proposal ahead of Spending Review Community Budgets for complex families announced at Spending Review 16 national pilots including Greater Manchester National Troubled Families Programme headed up by Louise Casey GM becomes one of four national pilots for Whole Place Community Budgets 2
MIER Better Life Chances Total Place CBA Complex families Whole Place CB Why Community Budgets? Public services are too often fragmented and uncoordinated, addressing symptoms not causes, particularly for the most challenging people and places Results in poor outcomes, high costs, and constraints on growth Public service reform initiatives have been supported by ad hoc funding, not been core to mainstream public services We need a transformational reduction in demand, away from unplanned,
expensive, reactive spend, moving the most challenging people and places from dependency towards self-reliance This requires new delivery models, underpinned by workforce reform and effective use of information, building on Better Life Chances pilots And new investment models that enable us to work at scale, so money can flow freely across silos with incentives for partners to invest jointly to achieve returns for the whole public sector 3 Phases of work Phase 1: March July 2012: Phase 2: March October 2012: Phase 3: Post October 2012: Route-map that defines which working examples of
Community Budgets and other products will be implemented when, during 12/13 and in future years Develop a number of working examples of Community Budgets that decommission and recommission services through investment funds and investment agreements Operating at different spatial levels, and for each of the 4 workstreams Translate the working examples into a clear plan for reducing dependency and supporting growth in
GM scaling up what works based on evaluation evidence of tracking outcomes From baseline understanding of NDMs and NIMs 4 Links between workstreams Sustained improvement in growth and dependency within places will require success across all themes, to tackle the stock and flow of problems Many of the interventions and cohort of individuals / families will be linked Health partners join up delivery of NDMs Troubled families and worklessness Early years
Health partners invest / jointly commission where they receive benefits (e.g. reduced A&E presentation) Transforming justice 5 Health and social care Case for Change and Narrative We cannot afford to continue the As Is Current models of service provision are not fit for the coming financial and quality challenge
The aggregation of a host of small scale projects is not enough to meet the funding gap pace and scale of reform is the only option We need a transformational reduction in demand for services, not just in individual services but across whole systems - significant organisational efficiencies in themselves will not be enough To move the most challenging people and places towards self-reliance Only by exploiting the potential of Community Budgets, coupled with strong system leadership and a relentless drive for personalisation, can we tackle the challenges ahead Capturing financial benefits from Community Budgets to enable re-investment
Reform needs to happen at different spatial levels the individual, community settings, districts, and GM wide 6 Community Budgets: Reducing demand today, tomorrow & over generations Reducing demand for generations Reducing demand today Transforming Justice Early Years X Troubled Families
Better outcomes, lower cost Turning off the dependency tap at source 7 Reducing demand tomorrow Health & Social Care Better outcomes, lower cost New delivery model principles The broad principles for the radical ambition relating to reform in GM revolve around shifts in culture, finance and focus (power) These shifts will form the basis of public service reform in GM providing challenge to the process for developing new delivery models
8 New delivery model principles Shift in Culture: Focus on prevention and demand reduction Moving away from dependency Shift from fix-me to self help, resilience and responsibility Shifts in Finance: Who is funding what How is funding provided How are costs shared (individuals, families and state) Different funding models including earn back, payment by results, social impact bonds and investment agreements Shift in Focus:
From focus on professions and organisations to citizens and communities Involving users in design, procurement, delivery and evaluation Creating a focus that is organisation blind Organisational design including the role of the private sector, Community and Voluntary sector as well as the role of citizen in delivery 9 Overview of thematic areas 10 Health and Social Care 11 Health and Social Care - Overview Ambition: Support the development of new investment models and new delivery models to meet reform objectives for health and Social care in particular:
Meeting the needs of vulnerable people Promoting independence Reducing demand Ensuring good quality financially sustainable services This will be achieved by: Stating the case for change in GM Articulating the future model of integrated health and social care in GM Providing a Roadmap to the future 12 H&SC Building Blocks, CB Exemplars and Macro Reform Opportunities Themes Community Budget Exemplars: Description & Outcome by Oct-12 (not
exhaustive) Local Integration (vertical & horizontal) Dementia Care & Psychiatric Liaison Outcome: Implement Scaled Up Working Example LTCs including COPD (CCGs) Outcome: Track Outcomes & Benefits of NDM vs BAU Safe & Sustainable Culture & Independence Fit for Work Scheme
Outcome: Implement Scaled Up Working Example Falls Prevention in Community Outcome: NDM Designed Market Making & Commissioning End of Life Care Outcome: Track Outcomes & Benefits of NDM vs BAU Co-morbidity in Over 65s (CCGs) Outcome: Implement Scaled Up Working Example
Public Health Transition Building Blocks for Radical Reform 13 Personalisation Alcohol & Drug Treatment Outcome: CBA to estimate ROI and payback Co-morbidity in Over 65s (CCGs) Outcome: Implement Scaled Up Working Example GM System Leadership
Early Years 14 Early Years - Overview Ambition: To improve school readiness in support of the MIER and GMS priorities for long-term earnings and workforce productivity Shorter-term improvements around school attendance and attainment and looked after children Current activity: Overview of current provision across authorities Understanding of the pilots through evaluation and peer reviews National and international evidence into the drivers for school readiness Understanding what we spend on early years across local authorities, health and directly from Whitehall Cross agency working to develop our thoughts on deliverables and what success looks like Steering group established
15 EY Current delivery models Current delivery models: There is some consistency in terms of delivery of EY services across GM, including: a mix of childrens centres and outreach workers, integration with health services and with private and voluntary sector providers; Consistency as a result of national policy drivers There has been progress on agreeing desired common outcomes for EY across GM there is a consensus that the absolute focus should be on ensuring children are school ready 16 EY Next steps Next steps: Steering group meeting 21 May, looking at; As-Is Early thoughts on deliverables What success looks like
Revised papers based on discussions at steering group Develop propositions 17 Transforming Justice 18 Transforming Justice - Overview Ambition: to reduce rates of reoffending by 30-40% among those offenders with greatest negative impact on their area Develop investment model based on whole-area impacts of offending and reoffending, not just reducing demand in the criminal justice system This will be achieved by: Co-ordinated action across criminal justice agencies and partners at key transition points of arrest, sentence and release Greater use of intensive alternatives to custody and restorative justice Scaling up smaller examples of reform, e.g. Together Women project, Tameside reoffending pilot in St Peters Looking at wider influences on offending health, drugs, alcohol, housing, families and seeking investment from agencies that benefit from reductions in offending
19 TJ: Emerging propositions 1. Whole-system reform to develop problem solving justice, to achieve headline rates of reduced reoffending: Young males aged 16-25 Women offenders Priority and prolific offenders 2. Develop investment case and CBA for individual exemplar themes Point of arrest, including Police Custody Triage for youth and women scaling up current work across most districts; youth triage is more advanced Point of sentence, expand integrated offender management and intensive alternatives to short custody, learning from Manchester and Salford pilots Point of release, e.g. through the case and choose change models at HMP Manchester and Forest Bank, Hindley resettlement Youth to adult transition, including alternative transition arrangements between GMPT and YOS, alternative remand models 20 TJ: New Delivery Model Individuals come into
contact with police Evidence-based interventions Cost-effective CBA & evaluation Ambition to run across GM A: Point of Arrest Police Custody Triage Targeted screening, once Restorative justice disposals Other disposals at point of arrest e.g. conditional caution Reality could be rolling out to more districts / pairs / clusters B: Point of Sentence Children MODEL
GMOSH Work Prog Intensive alternatives to short custody Custodial sentencing IOM in broader context than C: Point of Release Spotlight develop new integrated delivery models at key transition points Through the Gate Links to other workstreams e.g. troubled families (reducing flow of demand into CJS, this work focuses on stock)
21 Troubled Families 22 Troubled Families - Overview Ambition: To take troubled families out of dependency, to connect to opportunities for growth across the conurbation, scaling up existing work in neighbourhoods and districts. Current activity: All areas visited and assessment of progress made and plans going forward Key differences highlighted and some innovative thinking and practice Learning from good practice elsewhere Drawing on research to understand customer experiences and perspectives Focus groups with practitioners Agreement achieved over definition of families and tiered approach Difference of emphasis and clear links with other work strands Troubled families steering group established Common definition for troubled family
23 TF Current delivery models Current delivery models Delivery models at different stages of development across GM and different ways of achieving integration / coordination Commitment to Evidence Based Intervention and enthusiasm to innovate Common methods of evaluation being developed Real opportunities for improvement and savings even within the 'As Is' 24 Troubled Families - Next Steps Achieve agreement over evaluation mechanisms to lay the ground for
comparison of effectiveness and investment agreements 'Deep dive' looking across the system Identify and address dependencies with other work streams Work with parts of GM to develop new delivery models and investment agreements for Troubled Families Identify economies of scale in commissioning Evidenced Based Interventions across GM Capture and evaluate innovative thinking across GM Develop specific asks of government to enable Troubled Family work to develop at speed 25
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