1. Embedding Early Intervention within the Commissioning Pathway Ian Curryer, Corporate Director, Children and Families Candida Brudenell, Director, Quality and Commissioning Chris Wallbanks, Programme Manager, Early Intervention and Partnerships

2. Purpose To provide an opportunity for leaders from across the region to engage with leaders from Nottingham, explore their approach and share learning from their experience.

3. Programme Nottingham as an Early Intervention City – Ian Developing the Commissioning Pathway – Candida Early Intervention within the Commissioning Pathway – Chris Considering the challenges and sharing practice – All Embedding Early Intervention – Candida Examples of shifting resources – All Next Steps - All

4. High levels of deprivation; high spending LA Strong Nottingham Plan and CYPP Ofsted Inspection of Safeguarding and Looked After Children Services December 2010 Nottingham has…an extensive and outstanding range of early intervention services, making a marked shift with vulnerable children and families Nottingham City

5. Nottingham, Early Intervention City Our aim is to break the intergenerational nature of underachievement and deprivation in Nottingham by identifying at the earliest possible opportunity those children, young people, adults and families who are likely to experience difficulty and to intervene and empower people to transform their lives and their future childrens lives Programme approach: Governance Pilot projects Learning and Evaluation Knowledge Finance

6. Learning from the EI Programme Think like a Partnership –Joined-up decisions and an integrated workforce Use the F word = Fidelity –Roll-out evidence-based programmes properly –Engage the right families Evaluate and build your evidence-base –Standards of evidence and evaluation Seek first to understand –Insight – whats really happening? Costs – know them!

7. Using EI principles to change our systems and structures Family Community Teams Family Support Strategy Workforce Core Standard - consistency CAF target groups Thinking more holistically around complex families Corporate parenting is everybodys business

8. 10 year profile of one complex family Key points: Escalation Non-engagement Inter-generational Symptom not cause Silo focus Child focus not family focus High cost but outcomes getting worse

9. Family Community Teams Local Team Delivering Universal & Additional Support Single point of access for Extensive Support Children Centres Play & Youth services Child and Adolescent Mental Health Services Family Support Teams Education Welfare Educational Psychologists Disabled Childrens Service Youth Offending Team Link to Partner Community Services Area Management Police Midwifery Health Visitors Job Centre Plus Voluntary and Community Sector Extended Schools Leisure Education Improvement Partnership

10. Early Intervention starts early as soon as potential difficulties are identified and......requires good assessment of need that should form... …a comprehensive, purposeful response to tackle problems www.mynottingham.gov.uk/familysupport Or http://www.nottinghamcity.gov.uk/ics/inde x.aspx?articleid=14713

11. Discussion In pairs, discuss what the term commissioning means to you. As a group, record your shared definition on the flip chart paper and stick to the wall or window.

12. Commissioning …means outsourcing...is about meeting your sales target …is getting someone to do some art for you...is a structured needs based approach to identify your service

13. Commissioning …is more than just about children …is the whole process of designing and resourcing service provision. Who we deliver to, how much it will cost...is about the life cycle. People often confuse it with procurement …is an urban myth About half of our senior managers had an understanding of commissioning, but thought it related to EXTERNAL services only.

14. Our Commissioning Journey…. Commissioning Framework agreed in 2010 by the Council and One Nottingham Not just the diagram! Details, tools and explanation on the website Strong collaboration between partners and in particular the Voluntary and Community Sector

15. Our Commissioning Journey…. Underpinned by principles including: Early Intervention Local Jobs for Local People Supporting a thriving 3 rd Sector During 2010 Children and Families was reconfigured to bring together Adults and Childrens Commissioning Framework translated into a pathway First set of commissioning intentions identified

16. Strategic Commissioning Intentions Strategic Commissioning Intentions – origins Improved outcomes for citizens Reduced costs Greater investment in prevention and EI Improved pathways Improved Efficiency Commissioning Pathway

18. EI within the year 1 reviews Analyse 85+ population to inc by 45% by 2030 Budget £42.3m High use of residential High placement costs People lose skills in resi Citizens feel isolated but want to remain independent Consider EI models Involve partners and citizens Establish Business Cases Agree budgets Finalise details PlanDo Procure/implem ent new models of delivery Monitor and evaluate progress quarterly Measure impact annually Adjust where appropriate Review Client group feedback Measure longer term impact Evaluate the process Inform stakeholders and the market what works and what we want more of

19. EI Phase 1 Programmes Nottingham Circle Living Support Networks Expansion of Telecare Service Reablement Gateway

20. Low cost/no cost options NeedsLow level support in community Friends and Family Equipment and telecare ReablementAlternatives to resi care (supported housing) Crisis / rapid response service Shopping Cleaning Food and drink Social Contact Personal Care Medication Parenting Financial Planning

21. Year 2 Reviews Safe from Harm Complex Families Social Exclusion

22. Discussion What do you believe to be the key challenges in driving the EI agenda through the commissioning process for Providers? Commissioners? How is your organisation meeting these challenges?

23. Embedding EI into Commissioning Base lining financial split Engaging Councillors Identifying a % shift Pump-priming, but identifying the mainstream budget Focus on clear evidence-based programmes Scale up what works

24. Discussion What examples can you share of how you are shifting resources to Early Intervention?

25. Next Steps What can Nottingham do to support you further? What can JRIEP do to support you further?

26. Thank you For further information contact chris.wallbanks@nottinghamcity.gov.uk chris.wallbanks@nottinghamcity.gov.uk Website - www.nottinghamcity.gov.uk/commissioningwww.nottinghamcity.gov.uk/commissioning