An effective workforce for Early Help Delivery Nuala O’Rourke Wigan Council

The drive to integration Total Place Community budgets Public service reform DH drive for Health and Care Integration Movement of Public Health into Local Authorities Commissioning of Health Visitors moving to Local Authorities Adds to national drivers

The drive to integration Total Place lessons People at the heart of service design Reducing dependency / enabling self reliance Pooling budgets Reducing bureaucracy Put the customer at the heart of service redesign. Enabling communities to support themselves – reducing the demand on the public sector by finding better ways to help households and communities become more self reliant. Pooling budgets – looking at all the money coming into the locality as one pot and focusing on delivering outcomes rather than services. Reduce bureaucracy through a change in the way Whitehall interacts with localities – inspection, ring fencing etc – but also through a change in the way we interact with each other and ‘lean’ thinking in how we structure ourselves across the region.

The Public Service Reform Challenge GM Priority: Growth and reform Total tax intake in GM £17bn Total public spending in GM £22bn £5bn gap The revised Greater Manchester Strategy has two priorities, sustainable economic growth, and ensuring all residents contribute to and benefit from that growth. While good progress has been made on supporting growth, there will need to be a significant increase in ambition and impact on public service reform. The aim is for GM to be a net contributor to the national public finances by 2020. Currently there is a £5bn per year gap between total tax take in GM (estimated £17bn) and total public spending (£22bn).

Intensive family intervention worker/ parenting practitioner Multiple funding and accountability structures make coordinating support for families very difficult DfE HO MoJ DH CLG DWP LA Police YJB CCG Housing authorities JCP VCS Prisons YOS worker Young carer support worker Police officer CAMHS/ Mental Health Worker Drug and alcohol team Housing link worker Employment Personal advisers Family support workers Parent support advisers/Schools Surestart Intensive family intervention worker/ parenting practitioner

Known Interactions Nov. 09 to Oct. 10

What does integration mean Many different models Co-located Aligned Fully integrated under single line management

Integration in Wigan Integrated Safeguarding and Public Protection team Integrated Health team LIFE team

Integrated Safeguarding and Public Protection team A partnership response to domestic abuse A coordinated community response model A co-located team including Police, Children’s social care, Probation, Housing, Independent Domestic Violence Advocates, Drug and Alcohol outreach, Young person’s violence advocate With daily input from Health Economy Adult Social Care Process overseen by and approved by CAADA Aligned – multiple line management Co-ordinated Action Against Domestic Abuse (CAADA) is a national charity supporting a strong multi-agency response to domestic abuse.

Delivery Model Daily meetings which respond to domestic abuse incidents All agencies share their knowledge of the whole family A joint action plan is jointly agreed and implemented immediately Individual agencies take ownership of on going activity with the family Taking MARAC principles to a daily meeting Launched in March 2013

Integrated Health Support Team An integrated targeted intervention and support service to vulnerable pregnant women and their families. Works with top 2% most vulnerable pregnant women in the Borough (circa 75) and their families to reduce the risk of children becoming looked after and / or suffering significant harm. Team consists of Public Health midwives, Midwifery Support, specialist Speech and Language therapist and a targeted Speech and Language therapist, Family Support Worker Won 2 national awards from RCM & BJM.  3 x Public Health Midwives (WWL NHS Trust) 1.2 WTE Midwifery Support Worker (WWL NHS Trust) 1 x Specialist SALT (Bridgewater NHS Trust) 0.8 x Targeted SALT 1 x Family Support Worker (Bridgewater NHS Trust) Won 2 national awards from RCM & BJM

Delivery Model Joint assessments Joint team meetings Shared case notes Joint visits Shared family plan

The Life Programme A long term attachment rooted service where families are invited to take part and work intensively with a range of workers A team of workers with a range of skills including police, social care, early intervention, health and housing. Located in a local building which operates as a drop in centre for family members

Delivery Model All workers support families and share their expertise with the team Staff have specialist areas – but all members of the team carry a case load and act as a keyworker for the family – or members of the family Small case load – 12 families on each site – but as this includes the extended family it adds up to nearly 100 individuals. Staff work with families for a period of up to two years with a defined exit plan seeing a step down in the level of support over an extended period of time

Learning – Aligned Integration Working in a co-located team can blur the lines between professions and need all involved to have a flexible approach The benefits are not shared equally across all agencies and without shared budgets the cost can outweigh the benefit to some partners Relationships and engagement are critical to success and the timeliness of appropriate interventions is key to delivering and sustaining change.

Learning – Single team All staff need adopt a person centred approach to family work with a single family assessment built into the centre of the approach so that we ensure that the child’s needs are paramount and services wrapped around the family Having all professionals managed within one team enables the change process to be managed, removes competing agendas and prevents the family from playing off professionals This means that team members are team members first and carry their professional skills on their shoulder to be used as and when needed by family members or other team members. Multi disciplinary teams are not new – but have mostly been aligned

What helps develop the single team Having a job role outline that defined the role of the team member. Some common competencies that tied the team together, Common statements that outlined the primary task that we were all working together to achieve A set of fundamental principles that set out the way that we worked with families. An acknowledgement that as a team we had different sets of value bases and motivation for the work that we do.  Embedding the fundamentals within the IPA process so that we could measure our journey. Providing daily debriefing sessions in the early days of integration supported by a manager.  Understanding that t he team moved from roles where they had been seen as the expert in their specialism working with a particular cohort to working outside their comfort zone.  Staff need support to understand that they don’t need to know all the answers, its ok to say I'm not sure but we can find out. Recognising each individual team member as a consultant from their specialist area.  Being open to share working practices.  Involving the team in the development of the service. Providing high quality supervision and support to enable team members to manage the change in the way of working.

Learning We are asking our new integrated teams to support families into behaviour change which the public sector has been struggling to achieve for many years Need a workforce than understands We need to take an asset based approach with families Families and individuals need to be encouraged to take responsibility for their behaviour and understand the impact in order to be willing to change. Behaviour change takes time and families often relapse and need further motivation and support

Aim in Wigan To develop and begin to implement by 2015/2016 an approach to full integration of early help including Health Visitors and our Early Help team. Locality based model Single line management of staff

What are the challenges we have identified Communication: Need for an agreed shared vision and understanding with clear communications strategy: Strategic partners / management Workforce Public Accountability / governance / clear leadership.

What are the challenges we have identified Accountability Governance Need for clear leadership Ability of organisations to let go

What are the practical challenges we have identified Systems: Fragmented commissioning Range of assessment processes and paperwork to be agreed Data: systems / sets / sharing Working models e.g. key working / corporate caseload Accommodation

What are the challenges we have identified Workforce: Workforce sign-up. Workforce competency Workforce culture Change management HR / Pensions / TUPE

Discussion topics What type of integration are delegates developing in their locality? Do we all share the same challenges? What do we see as the benefits of integration? How will we measure our success?

n.o’rourke@wigan.gov.uk 07525 657 140 Nuala O’Rourke n.o’rourke@wigan.gov.uk 07525 657 140