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GM Public Service ReformComplex Dependency

April 2014

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Complex Dependency Priority

• Tackling issues of complex dependency is a key reform priority for GM. This involves:- – Scaling up PSR principles to a broader cohort (e.g. those

leaving the Work Programme, offenders, those involved in organised crime, and those with complex health needs) and a deeper cohort (e.g. families at risk of becoming troubled; those in low pay, no pay cycles that may also have complex needs).

• Complex Dependency will have a sharper focus on employment and skills progression.

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2014-15 Commitments

Already working intensively with subsets of complex dependency cohort:• Troubled Families (worklessness, truancy, crime/ASB)• Intensive Community Orders (18-25 yo offenders)• Work Programme Leavers (ESA claimants)• Health & social care (working age adults with complex health needs)• Families linked with organised crime

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GM co-design with Government

• Early adopter for next phase of Troubled Families• Improved mental health offer for workless residents• Test impact of Universal Credit prior to roll out• Supporting those in cycles of low pay, no pay – based on

more flexible skills offer• Match mainstream adult skills budget with GM ESF at

source – establish robust tracking mechanism

All underpinned by longer term place based settlement, with shared risk & reward for investing in reform.Aim to inform future options for Work Programme contracts.

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Complex Dependency Cohorts

Work to date to define the cohort suggests that issues associated with complex dependency fall into four broad areas:

• Employment and low skills (e.g. Worklessness, Low pay, no pay, Low skills)

• Crime and offending (e.g. Repeat offending, Domestic Abuse, Organised Crime)

• Health (e.g. Mental health, Long term conditions, Drug & Alcohol misuse)

• Children and young people (Children in Need, Child Protection Plans, Looked After Children, Early Years, School attendance)

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Cohort Overlap (Manchester)

10% of probation cases are from Troubled Families

43,000Workless Families

30,000Families with Children Aged

0-5

11,000 Offender Families (inc 2,000 ASB families)

8,000-10,000 At-Risk Families

25% of Troubled Families have children aged 0-5

80% of Troubled Families with children aged 0-5 are also workless

Workless Troubled Families:- 25% families claiming JSA (1,052 people from 925 families)

- 32% families claiming ESA (1,383 people from 1,292 families)- 27% families claiming IS

(1,142 people from 1,104 families)- 15% families claiming CA

(629 people from 607 families)

80% of offender families due to offences by adults only

4,000 Troubled Families

2-5% of individuals with suspected links to organised crime are from

Troubled Families

3,200 Children with Child in Need Status

(550 are in Troubled Families)

All Out of Work Benefit Claimants:31% claimants claiming JSA 53% families claiming ESA12% families claiming IS

(Based on 59,700 individuals/claimants)

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Cohort Needs

Total complex dependency cohort in GM expected to be in excess of 100,000 individuals. Segments of the population will include those who:

a) create the highest demands and costs, including many of the first phase Troubled Families;

b) have medium levels of need;c) are at risk of having complex needs in the future; andd) do not require support beyond universal services.

Most complex cases will be relatively straightforward to identify through intelligence and systems. More difficult to identify less complex, involving complex assessments of risk and need.

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New Delivery Models

• co-designed with partners, based on PSR principles and Troubled Families ways of working:– integration, sequencing and prioritisation of public services

to form bespoke packages of support, coordinated by key workers;

– deploying interventions with a strong evidence base;– integration of services on a whole family basis, not just for

individuals.Supported by:- workforce development, information & intelligence, sanctions & conditionality, joined up commissioning across GM.

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Customer Journey

REFERRALS FROM RANGE OF AGENCIES

INITIAL ASSESSMENT OF LEVEL OF NEED BY INTEGRATED TEAM OF PUBLIC SERVICES

LEAD KEY WORKER ALLOCATED. COMMON ASSESSMENT OF WHOLE FAMILY

INTENSITY OF KEY WORKER SUPPORT WILL VARY. KEY WORKERS MAY BE SPECIALISED

KEY WORKER DEVELOPS ACTION PLAN WITH FAMILY. KEY WORKER CREATES BESPOKE PACKAGE OF SUPPORT. MANAGES INTEGRATED AND SEQUENCED ‘TIER 2’ INTERVENTIONS, E.G. DRUG AND ALCOHOL

MISUSE, MENTAL HEALTH, DEBT, EMPLOYMENT, PARENTING. INCLUDES COMMUNITY ASSETS

ONGOING MANAGEMENT OF CASES. OPTIONS TO STEP UP/DOWN SUPPORT. ONLY CLOSE CASE WHEN CHANGE SUSTAINED

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Asks of Government

• Continue process of co-design.• Support laying foundations for more radical reform:-

– Multi-year budgets– Devolved accountability

• Work on national enablers of reform, removing barriers:-– Data sharing (particularly employment & health)– Place-based systems for regulation and inspection.

Encourage partners to deal with whole families, rather than single issues.

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Complex Dependency in Salford

• Given this context we need to understand:-– the needs and assets of our city, people and communities; – which services deliver most impact – how we manage access to those services given our reduced

budget• We now have a unique opportunity to bring together the

GM PSR work, Salford’s Joint Strategic Needs Assessment (JSNA) refresh and the developing Financial Strategy for the City into a design that incorporates our key learning to date from PSR.

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Understanding Needs & Assets

• Robust intelligence is fundamental to enable long term planning and decision making that will support innovation and sustain outcomes for the city.

• The JSNA will be Salford’s ‘single version of the truth’ and should provide the evidence for intelligence led decisions about where to invest or reduce spending to improve the well-being of our individuals and communities.

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Evidence Based Interventions

• Ensuring that the services and interventions we deliver and commission have a strong evidence base will give us the confidence that we are investing in those things that have the greatest impact.

• New interventions should be chosen on the strength of the best available evidence but will also require a review of the ability of existing interventions and services to meet the needs of people and communities

JSNA

• Understanding the needs and assets of our city, people and communities

• Defining key cohorts

Single front door with clear thresholds

• Co-ordinated access to targeted and specialist ‘People’ services

• Resource allocation based on assessment of risk

• Clear service thresholds that reflect the nature of complex dependency

Integrated delivery

• Integrated, co-ordinated and sequenced support at the right time, in the right order

• Family based approach

• Interventions chosen on strength of evidence base

Strategy and Change Function (Enabling Hub):Data analysis including: Define Cohort, Spatial Analysis, Family Stratification, Modelling and Demographic Projections, Impact Evaluation, Financial Analysis

Design and Delivery Team:Informs, supports and quality assures the work of the Enabling Hub. Plus delivery of specific products: Service Gap Analysis, Process Design, Service Design, Specification Development, Financial Analysis

Salford’s Approach

Workforce reform / ICT

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Ask of Partners

• Support design and delivery team to develop a proposition & specification for this work.– Feed into the evidence gathering required to understand

needs and assets in the city– Provide support and resources for a single front door– Help define service access thresholds – broader than social

care– Integrate delivery resources for Team around the Family– Share examples of best practice / impact evaluation / costs