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

2. 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

3. 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.

4. 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 Currently there is a £5bn per year gap between total tax take in GM (estimated £17bn) and total public spending (£22bn).

5. 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

6. Known Interactions Nov. 09 to Oct. 10

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

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

9. 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.

10. 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

11. 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

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

13. 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

14. 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

15. 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.

16. 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

17. 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.

18. 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

20. 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

21. 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.

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

23. 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

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

25. 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?

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