Altogether Better: Cheshire West and Chester

Whole Place Community Budget Area

Carly Brown Head of Ellesmere Port and Strategic Lead for Troubled

Families CWAC

CONTEXT

Integration around customers and communities

Whole systems change

From symptoms to root causes

ResponsivenessOpen Public Services

The Economy

Rising demand

Disparity in opportunity

The drivers Altogether Better

•New delivery models•New financial models•Collaborative leadership

Better with less

The result

Reducing resources

Starting Well

• Families Together•Early Support :

-9 months – 5 years

Living Well

• Community empowerment

• Community delivery• Safer Communities

• Sustainable Communities

• Affordable Housing

Quick Wins:ASB integrationLocal delivery

vanguards

Working Well

• Work ready individuals

• Skills for sustainable growth

• Supporting Enterprise

Quick WinsOpportunity Centres

Social Value Procurement

Ageing Well

• Integrated prevention

• Team around the community

Quick Wins:Reablement

Assistive technology

Investment agreements

Smarter services

CustomerInsight

New Delivery Models

StrategicCommissioning

Assets

The Projects• Families together: New approach to supporting

families who have the most needs resulting in greatest demand on public services (Project Lead – Carly Brown)

• Early support: Developing the case for joined up early support primarily at levels 2 & 3 on the continuum of need. Priority emerging for focus on -9 months to 5 years

(Project Lead - Val Sturgess)

Getting there

Jan-Feb 2012Scope development and programme set up

March- April 2012Assess:-As is-Discovery workshops-Opportunity definition

May-July 2012-New delivery Model-Customer Insight-Stakeholder Engagement

August- October 2012Draft specifications & operational plan

November-December 2012

Approval (Local and National)

OBC

FBC

Ownership

The Case for Change• Emphasis on Early Support , Foundation 0-5

(Marmot, Allen, Tickell, Field)• Troubled Families• Transformed Service Models e.g. Health

Visitors• Sustainability in context of contracting

budgets

The Case for Change• Latest Health profile for CW&C (March 2012) indicates

a number of issues where performance is significantly below the England average e.g.– Children achieving a good rate of development aged

5 (with respect to the Early Years Foundation Stage Profile)

– Teenage mothers (age under 18 years)– Hospital admissions due to alcohol specific

conditions • Estimated 525 Troubled Families in West Cheshire

footprint (CLG) with direct costs to the public purse of £39.4 million

Where do we want to be? (October)• Route map for improvement to priority outcomes:• As-is analysis (cost, quality, customer experience)• Integrated delivery models tackling root causes• New approaches to delivery• Evidence based interventions at scale• Cashable savings route map/Joint Investment Agreement• Decommissioning plan• Clear pathways for levels 1 to 4 on Continuum of Need (step

up, step down)• Effective multi-agency governance and commissioning

arrangements

‘Families Together’• Consolidate approaches and governance

- DCLG Troubled Families - ESF /DWP Complex Families- DOH Multi Systemic Therapy (MST)

• Advocate the need for whole system reform• Integrate the myriad of ‘People’ initiatives to improve

service delivery• Develop a ‘core offer’ of support and unlock potential

within families

Families Together - Concept• The development of a ‘Families Together’ pledge• Partners who commit services as part of the pledge –

prioritisation & responsiveness• A core offer of services with the agility to tailor• 24/7 provision to meet customer need• Personalisation• A family assessment rather than individual or multiple

assessments

What does ‘success’ look like…• Families know how to access appropriate services at the right time• Families live a housing of ‘good’ condition• Families demonstrate and respect neighbourly qualities – participation

in the community• Families make positive lifestyle choices• Children brought up in a warm, stable supportive parental

environment• Children meet age appropriate development indicators• Strong financial literacy, awareness and not dependent on benefits• Adults are work ready for local industries/markets• Minimal interventions from agencies outside of the core offer

What constitutes an eligible ‘family’…

• A household that has dependent(s) up to the age of 19 (subject to exceptional circumstances)

• A family that is experiencing difficulties in achieving 3 or more of the determinants of success and;

• A family that is referred through partnership channels that cause disruption to their communities

How can we identify families that require help…

• DCLG Troubled Families Unit Figures correlated with ‘local’ analysis

• ‘Bottom Up’ referrals generated from ESF / DWP Families process and other existing referral processes

• A Partner Conference • Local discretion

TAF assessment

Family Budget

Key worker

Triggers/Flags identify Family

Fast Track referral

Contract with consequences

Evidence based interventions

Service User Payback

Who is involved analysis?

Cost

School Absence/exclusion

Crime

Intervention for as long as it takes?

Other services ‘back off’

Or for a set time?

Appointments synchronised

Top of the queue?

Funded by the £ saved by each

agency?

Worklessness

How do we know when to end?

Clear step up step down approach

Expected?

How do we review?

Filter Do we filter?

How many pathways?

For every family?

Do we weight this data?

Under development?Who completes?Costs included?

When is this best done?

Who is best to commission and provide?

One size fits all or a tailored approach?

Process

Ap

pro

ach

What delivery models?

Across which agencies?

Which IT System?

Dat

aA

nal

ysis

Acti

on

Do all families get all the menu on the right hand side?

Rewired money?Which ones?

How long for?

The same as Westminster?

Costs?

Key worker through the process?

Chosen by Family?

Contracted to 3rd Sector?

Swindon LIFE model?

Do we commission only evidence based interventions?

No handover?

Families Together - the offer• A menu of support options / interventions for our Key

Workers and Families to ‘contract’ to• One Key Worker: One Family• A customised, 6 month, Family Action Plan• Five key areas they want to improve with inspired

targets• A Celebration of Achievement designed by the Family

for the Family

Families Together – delivery

• Integrated and co-located teams in the 4 new localities supported by the Area Head of Service

• Performance, intelligence and support centrally provided

• A strong, unique Team Identity • A single assessment and referral process

appropriately branded

So where do we start???

Families Together – what are we trying to answer?

Which Families?‘shared cohort’

How are we working with

them now?

What impact is this having?

What and who is it costing?

Costs /benefits of a new

delivery model?

Which agencies spend and gain?

Distribution?

‘Whole system’ viewPlanned services?Reactive response?Assessments?Coordination?1 year timeline/usage pattern?

Outputs?Outcomes?Behavioural change?Neighbourhood effects?Impact on services/staff?

Planned Service costs?Reactive Service costs?Wider system/support costs?Wider/Long term costs?Distribution?

Outputs?Outcomes?Behavioural change?Neighbourhood effects?Impact on services/staff?

Building the evidence base

for Joint Investment

Who are our families?- Service data- Local knowledge- Cross matching

Families Together – A whole system approach

3.Assessments & baselines

3.Assessments & baselines

2. Family I/D & Referral

2. Family I/D & Referral

5. Joint Investment and service redesign5. Joint Investment and service redesign

1. Partner Engagement

1. Partner Engagement

4. Family plans & coordination

4. Family plans & coordination

6. Performance, Evaluation and Cost Benefit Analysis

6. Performance, Evaluation and Cost Benefit Analysis

Detailed programme

delivery plan. CLG agreement on

PbR.

Ongoing evaluation

Detailed programme

delivery plan. CLG agreement on

PbR.

Ongoing evaluation

Mobilisation Plan

• One single action plan to enable the programme to be effective

• One ‘route map’ referencing collective and key milestones

• One assessment process

• One evidence base

• One ambition to do something different

Programme GovernancePublic Services BoardPublic Services Board

Operational Steering GroupOperational Steering Group

Families Together Board Families Together Board

Multi Systemic Therapy

Multi Systemic Therapy

ESF Complex Families

ESF Complex Families Early SupportEarly Support

Work stream 1Work stream 1

Work stream 2Work stream 2

Work stream 3Work stream 3

Starting Well Thematic

Group

Starting Well Thematic

Group

Families Together – Next Steps

• Continue to develop the Families Together Concept• Conduct planning session (20 April) and continue

weekly sessions with ABC team• Deliver the actions required for DCLG by 30 April • Produce options for Services and Partners to discuss

regarding an integrated delivery team• Deliver ESF / DWP Families Targets