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GM Community Budget Pilot

Rebekah SutcliffeChief Superintendent, Greater Manchester Police,Whole Place Community Budget, Troubled Families Lead

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• 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

Origins of this work

MIER

Better Life Chances

Total Place

CBA

Complex families

Whole Place CB

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• 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

Why Community Budgets?

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Phases of work

Phase 1: March – July 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

From baseline understanding of NDMs and NIMs

Phase 2: March – October 2012:

Develop a number of working examples of Community Budgets that decommission and recommission services through investment funds and investment agreementsOperating at different spatial levels, and for each of the 4 workstreams

Phase 3: Post October 2012:

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

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Early years

Troubled families and

worklessness Health and social care

Transforming justice

Health partners join up delivery of NDMs

Health partners invest / jointly commission where they receive

benefits (e.g. reduced A&E presentation)

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

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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

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Community Budgets: Reducing demand today, tomorrow & over generations

Early Years Transforming Justice Troubled Families

Reducing demand today

Reducing demand for generations

Reducing demand tomorrow

Turning off the dependency tap at

source

XBetter outcomes,

lower cost

Health & Social Care

Better outcomes, lower cost

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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

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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

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Overview of thematic areas

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Health and Social Care

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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

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H&SC Building Blocks, CB Exemplars and Macro Reform Opportunities

Safe & Sustainable Public Health Transition

GM System Leadership

Building Blocks for Radical Reform

Themes

Community BudgetExemplars: Description & Outcome by Oct-12 (notexhaustive)

PersonalisationMarket Making & Commissioning

Culture & Independence

Local Integration (vertical & horizontal)

Falls Prevention in Community

Outcome: NDM Designed

Dementia Care & Psychiatric Liaison

Outcome: Implement Scaled Up Working Example

End of Life CareOutcome: Track Outcomes & Benefits of NDM vs BAU

Alcohol & Drug Treatment

Outcome: CBA to estimate ROI and payback

Co-morbidity in Over 65s (CCGs)

Outcome: Implement Scaled Up Working Example

Co-morbidity in Over 65s (CCGs)

Outcome: Implement Scaled Up Working Example

LTCs including COPD (CCGs)

Outcome: Track Outcomes & Benefits of NDM vs BAU

Fit for Work Scheme Outcome: Implement Scaled Up Working Example

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Early Years

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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

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EY – Current delivery models

Current delivery models:

• There is some consistency in terms of delivery of EY services across GM, including:

– a mix of children’s 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’

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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

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Transforming Justice

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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

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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

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TJ: New Delivery Model

A: Point of Arrest

Police Custody Triage

Targeted screening, once

Children

Individuals come into contact with police

• Restorative justice disposals

• Other disposals at point of arrest e.g. conditional caution

B: Point of Sentence

Intensive alternatives to

short custodyCustodial sentencing

C: Point of Release

Through the Gate

• IOM in broader context than Spotlight – develop new integrated delivery models at key transition points

• Links to other workstreams e.g. troubled families (reducing flow of demand into CJS, this work focuses on stock)

• Evidence-based interventions

• Cost-effective

• CBA & evaluation

• Ambition to run across GM

• Reality could be rolling out to more districts / pairs / clusters

GMOSH

MODEL

Work Prog

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Troubled Families

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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’

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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'

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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