Using evidence to shape better services Measurement  Evaluation  Learning Evaluating the benefit of neighbourhood community budgets Using CBA to generate evidence Dr Robert Pocock, Chief Executive, M·E·L Research

Using evidence to shape better services Measurement  Evaluation  Learning DCLG NCB Pilots 12 month pilot scheme launched in March month pilot scheme launched in March 2012 Four ‘whole place’ whole-system pilots Four ‘whole place’ whole-system pilots 12 localised ‘neighbourhood community budgeting’ pilots – areas c households 12 localised ‘neighbourhood community budgeting’ pilots – areas c households Case study example – Castle Vale, one of three linked pilots in Birmingham Case study example – Castle Vale, one of three linked pilots in Birmingham A year to prepare a different ‘operational plan’ A year to prepare a different ‘operational plan’ Intent to use CBA to evidence the difference Intent to use CBA to evidence the difference

Using evidence to shape better services Measurement  Evaluation  Learning Basic DCLG hypotheses That public money is better used if ‘pooled’ and managed as a single pot rather than service silos That public money is better used if ‘pooled’ and managed as a single pot rather than service silos  Better outcomes for the same money, or less money for the same levels of outcome That better results are obtained if residents are involved in deciding how the money is spent That better results are obtained if residents are involved in deciding how the money is spent That better results are obtained if commissioners and providers collaborate (with residents) in co- design and / or co-delivery That better results are obtained if commissioners and providers collaborate (with residents) in co- design and / or co-delivery

Using evidence to shape better services Measurement  Evaluation  Learning Five steps to NCB Operational Plan Service definition – what services are to be covered by the proposed NCB Service definition – what services are to be covered by the proposed NCB Resource mapping – what is being done under those services (resources not just ‘revenue budgets’) Resource mapping – what is being done under those services (resources not just ‘revenue budgets’) Governance – who / how are local service decisions to be made? Governance – who / how are local service decisions to be made? Community involvement – how are residents / service users going to (re)shape what is done ? Community involvement – how are residents / service users going to (re)shape what is done ? Costs and benefits – run CBA on proposed Operational Plan compared to baseline / status quo Costs and benefits – run CBA on proposed Operational Plan compared to baseline / status quo

Using evidence to shape better services Measurement  Evaluation  Learning Castle Vale Health and Wellbeing Pilot Look at everything that affects health and wellbeing (whole system neighbourhood budget) Look at everything that affects health and wellbeing (whole system neighbourhood budget) Quantify OPs for two service outcomes: Quantify OPs for two service outcomes:  Reduce smoking prevalence  Reduce levels of obesity Priority outcomes have been based on resident community health audit 2011 Priority outcomes have been based on resident community health audit 2011 NPB model based on ‘NHS reforms’ (local HWB, local Healthwatch) NPB model based on ‘NHS reforms’ (local HWB, local Healthwatch)

Using evidence to shape better services Measurement  Evaluation  Learning Baseline Spend Mapping

Using evidence to shape better services Measurement  Evaluation  Learning Future NCB Operating Models (v1)

Using evidence to shape better services Measurement  Evaluation  Learning Future NCB Operating Models (v2)

Using evidence to shape better services Measurement  Evaluation  Learning Future NCB Operating Models (v3)

Using evidence to shape better services Measurement  Evaluation  Learning The information needed for CBA requires areas to think through how they get from inputs (costs) to outcomes (benefits) NCB Pilot Area Activities – Information Needed for CBA IDENTIFY INPUTS / RESOURCES What are the costs – (capital, revenue, in kind, other) - of delivering services through the proposed intervention / NCB? What costs are incurred, by which agency, at which point in the project lifecycle? CLARIFY TARGET GROUP / ACTIVITIES For each activity and target group: What is being done and how is this different to what would have been done without the NCB? (This might be a different set of activities, or less of the same activity). BE CLEAR ABOUT RATIONALE Why is this being done? What supports the rationale? What circumstances (assumptions) is it dependent on? SPECIFY OUTPUTS What is done with these resources to the target group? PREDICT INTERMEDIATE OUTCOMES / IMPACTS Things that can be measured in the medium term. Based on the evidence of outcomes What is the likely timing? LONGER TERM OUTCOMES / IMPACTS Things that can be measured in the longer term. What is the likely timing? COSTSBENEFITS STEP 1STEP 2STEP 3STEP 4STEP 5STEP 6

Using evidence to shape better services Measurement  Evaluation  Learning Problems – Operational Plan The idea is to get services to agree a different OP which is ‘better’ than status quo The idea is to get services to agree a different OP which is ‘better’ than status quo It took several months to identify all the services that were going on (even just smoking and obesity) It took several months to identify all the services that were going on (even just smoking and obesity) NHS ‘reform / chaos’ – public health / CCG NHS ‘reform / chaos’ – public health / CCG BCC devolution – commitment from the top but budgets / control not localised BCC devolution – commitment from the top but budgets / control not localised Scepticism about the rationale / benefits Scepticism about the rationale / benefits Protectiveness especially amongst current providers Protectiveness especially amongst current providers Co-design workshops 30 th Jan / 15 th March Co-design workshops 30 th Jan / 15 th March

Using evidence to shape better services Measurement  Evaluation  Learning Problems – localised service concept LA is a place-based public service but most services managed and funded (cut!) centrally LA is a place-based public service but most services managed and funded (cut!) centrally NHS provider function has a facilities / users concept (no place-based provider budgets) NHS provider function has a facilities / users concept (no place-based provider budgets) NHS commissioner function (PCT) funds providers not places or neighbourhods NHS commissioner function (PCT) funds providers not places or neighbourhods Local area ‘budgets’ are new territory Local area ‘budgets’ are new territory Data often provider unit not spatial unit Data often provider unit not spatial unit

Using evidence to shape better services Measurement  Evaluation  Learning Problems – community involvement Role / legitimacy / competence? Role / legitimacy / competence? Created three levels: Created three levels:  Community needs – comprehensive engagement on ‘diagnosis’ of needs / JSNA input  Governance – prioritisation of issues, monitoring implementation  Expert patient – specialist designer of individual service intervention A more sophisticated concept needed cf Arnstein A more sophisticated concept needed cf Arnstein

Using evidence to shape better services Measurement  Evaluation  Learning CBA – stop-smoking NCB What needed to make a step change (DPH – “20% better”) What needed to make a step change (DPH – “20% better”) Estimated present quits (150 pa ‘deadweight)) Estimated present quits (150 pa ‘deadweight)) Estimated costs to get 20% more quits (30 pa) Estimated costs to get 20% more quits (30 pa) Estimated savings if 20% more quit Estimated savings if 20% more quit Fiscal cost benefit ratio 1: 4.7 (saving to public purse) Fiscal cost benefit ratio 1: 4.7 (saving to public purse) Social cost benefit ratio 1: 42 (mainly in financial savings to smokers, less cigs, more earnings) Social cost benefit ratio 1: 42 (mainly in financial savings to smokers, less cigs, more earnings) £550K over 5 years – extra £55k saved £2.9m £550K over 5 years – extra £55k saved £2.9m Whole system annual budget £13.5m - ?% controllable? Whole system annual budget £13.5m - ?% controllable?

Using evidence to shape better services Measurement  Evaluation  Learning Future - Five Year NCB Strategy