1. Joint Commissioning and New Governance Arrangements Leicestershire Together Board 14 th March 2011

2. Content Why discuss change? Recommendations Integrated Service Planning (commissioning) Families with Complex Needs Governance

3. Why Change?

4. National Context  About 19% less public expenditure on average.  More to be spent on the frontline  More emphasis on prevention  More emphasis on people and communities helping themselves (Big Society)  More decisions to be made locally:  GP Commissioning  More independent schools  Elected police commissioners  Councils to have greater co-ordinating role

5. The Alcohol System

6. Leicestershire Substance Misuse Improvement Framework (Target Operating Model v0.9) Vision: Working together to make Leicestershire a healthier and safer place by reducing the harm and inequalities caused by substance misuse, in a sustainable and cost-effective way 4 Key Outcomes: 1.Reduce substance related crime & disorder 2.To minimise the negative impact on children and families of substance misuse 3.To improve health and well-being for all substance users 4.Reduce public service costs by optimisation of all interventions and service delivery Citizens Licensing & Night Time Economy Offender Management Pathway Prevention Strategy Improve Health & Well Being

7. What we learnt from Total Place  Total Place and other initiatives show better outcomes can be achieved at lower cost by co- ordinated action across agencies.  Traditional partnership work helps but its slow and inefficient.  Major budget reductions require a more decisive approach.  Silo based cuts will lead to major failures in outcomes – a different approach is needed.

8. In September 2010, the LT Executive agreed that a radical change in the way LT partners work together was required, based on a pooled budget joint commissioning model the LT Board were informed of a proposal for a redesigned partnership based on around 6 thematic commissioning hubs In November 2010, the LT Executive established a working group with representation from the county council, a district council, the voluntary sector and the police to develop a new approach to prioritising, designing and co-ordinating services across partner organisations In February 2011, the Leicestershire Together Executive agreed that, outside of the community budget, we should seek wider agreement on the redesign of the Partnership and hold a conference in the summer of 2011 to communicate more widely the changes proposed to the Partnership What decisions have been taken?

9. Recommendations 1. New Terms of Reference considered by theme groups and proposals for locality management and Governance developed 2. General consultation with stakeholders 3. Executive to consider and make recommendations for final structure 4. Partnership-wide Conference in June 5. Sub group of Chair, District, PCT, VCS and Police to agree new arrangements/timetable prior to Board

10. Integrating service planning and enabling redesign (effective commissioning)

11. What does ‘commissioning’ mean? It’s a process to ensure services meet need. We already do it for individual services. It’s a culture as much as a process to ensure services are designed around evidence of need, procured cost effectively and performance reviewed.

12. What’s different then? Putting blocks of activity/service/budget together to allow a Total Place approach to service redesign a better overview of relationships between services from user perspective better decisions about what works lower cost solutions for lower priority activities to be chosen a move to prevention more manageable relationships with potential suppliers e.g. VCS Joining up support services for a level playing field single set of priority outcomes joined up performance monitoring joined up engagement single evidence base

13. How can we reach agreement on change? By testing what should be designed or co- ordinated together and at what geographic level.

14. County wide prioritisation & service design Locality prioritisation & Service design Locality service coordination A Model for Seamless Services for Leicestershire? Joint Co-ordination Joint Service Planning/ Redesign County wide service coordination Joint Countywide Governance Joint Locality Governance

15. ANTI-SOCIAL BEHAVIOUR County wide prioritisation & service designLocality prioritisation & service design Locality service coordinationCounty wide service coordination Youth Offending Service Youth Services Diversionary/Mentoring Tiered approach to ASB Licensing Educating Young People Neighbourhood Management Customer Insight/evidence base Family Support/ Intervention Teams (delivery) Trading Standards Children CentresNoise Pollution Dealing with repeat /nuisance calls Mental Health (personality disorders) Animal nuisance Common Assessment Framework Vulnerable victims/perps Environmental & Criminal Damage Substance misuse Street drinking Neighbour disputes Young People hanging around? Hate crime – race, homophobia, disability Common Assessment Framework Animal nuisance = Is required Mental Health (personality disorders) Family Support/ Intervention Teams (design) Family Support/ Intervention Teams (allocation) Family Support/ Intervention Teams (resources) Manage perceptions of ASB ASB intelligence (eg calls) Noise Pollution Vulnerable victims/perps Environmental & Criminal Damage School/Community agency interface Youth Services Youth Offending Service Hate crime – disability, race & homophobia Street drinking Young People hanging around? Neighbour disputes Young People hanging around LA/Social Housing = Design/co-ordinate alongside LA/Social Housing ASB Co-ordination Youth Services Licensing Probation Integrated offender management Integrated offender mgmt Integrated Offender Management Tiered approach to ASB Diversionary/Mentoring Neighbourhood Management Customer Insight/evidence base Hate crime – disability, race & homophobia = mainstream activity = is required alongside & at this level KEY LA/Social Housing

16. TOBACCO CONTROL County wide prioritisation & service designLocality prioritisation & service design Locality service coordination County wide service coordination NHS Stop Smoking Services – Specialist & Enhanced Schools Programme Pacesetters (community) Brief Intervention training (i.e., children’s centres) Secondary Care Programme Trading Standards – illicit, untaxed Pacesetters (community) Locality targeted anti smoking Community Midwifery School Nursing Community Midwifery Health Visiting Trading Standards – sales u-18 Trading Standards – enforcement Environmental Health Youth Services Sports Coaching Marketing Customer contact (see brief intervention) Fire Service Trading Standards – sales u-18 Secondary Care Programme = Design/co-ordinate alongside= mainstream activity

17. TACKLING OBESITY/HEALTHY WEIGHT County wide prioritisation & service designLocality prioritisation & service design Locality service coordinationCounty wide service coordination Adult Weight Management Service Child Weight Management Service Active Together Programme Breastfeeding Support Food environment Physical environment Bariatric Services Marketing Active Together Programme Cycle/Walking ways Adult Weight Management Service Child Weight Management Service Breastfeeding Support Food Packaging Marketing Multi-faceted nudge Leisure Services Sport/PE/Leisure Travel Planning Nutritionists Planning Travel Planning Children’s Centres Volunteering Adult Weight Management Service Active Together Programme Physical environment Multi-faceted nudge = Design/co-ordinate alongside= mainstream activity Healthy Schools Programme

18. Further workshops planned on: Domestic Abuse (March 15 th ) Anti-social behaviour (March 17 th ) Natural & Historic Environment (tba) A series of Health, Social Care and Children’s workshops (March, 7 th, 10 th, 17th) Physical Activity (March/April) Sport & Culture (April 1 st ) This process should help us arrive: at groups of services with potential to be redesigned at a view of what form commissioning could take in localities Service Redesign: What next

19. The Community Budget

20. Community Budget - Background Community Budgets = rebranded Total Place Total Place = an ‘approach’ to achieve better outcomes for citizens at lower public service cost Approach : Citizen at heart Whole system overview Whole place approach by public services Opportunity to identify national barriers to government

21. Families with complex needs J Bloggs  Offending  Unemployment  Depression  Alcoholism  Homeless  Probation / CJS  Benefits / JCP  M H Substance Misuse Services  Housing Support  D A Services  Housing Services  Benefits / JCP  School CYP Services  YOS  Adult Social Care Partner  Domestic Abuse  Family Breakdown  Unemployed  Homeless Children  Truancy  ASB  Drugs  Low level crime Mother  Early stages of dementia Prison Acute Health Youth Justice System Children in Care Residential Care ProblemSeparate Service Response High Cost Service Required £££££

22. Overview of Proposal - Families with Complex Needs Leicestershire 1 of 16 places Theme selected by Whitehall Proposal submitted to Whitehall 28 Feb Whitehall governance same as for Total Place Total investment committed by LCC = £4m 3 phase programme to 2013 Programme governance includes partners and reps Agreement to pool budgets Work will be based on learning from existing families with complex needs and practitioners in Leics, as well as evidenced based practice from other places

23. Principles of Community Budget ‘Place’ and ‘citizens’ before ‘organisation’ Place shared vision, objectives and services Pro-active co-design between partners in the place and between the place & Whitehall Prevention by early and earlier intervention Better outcomes at less cost Fully understand the problem before defining a solution Ambitious & if appropriate ‘radical’ local innovation’ Build on good practice /initiatives i.e. Integrated Offender Model, Children’s Centres, YOS, Systems Change, many others Decommission & reprioritise services when required Pooled /aligned budgets around the theme/place

24. Programme will focus on… 1. Identifying with FCN and Practitioners / Services what is needed 2. Developing an improved place model for providing required services 3. Taking a whole systems approach to address root problems not just ‘presenting’ problem i.e. housing, substance misuse, parenting skills, mental health, learning disabilities 4. An integrated and coordinated approach to service delivery - voluntary sector & communities integral element 5. Early / earlier intervention to reduce vulnerable families from developing complex needs - identification of key trigger points and earlier support Delivering improved outcomes for FCN and Communities at lower cost through:

25. Vision & Shaping (Strategy) Phase High Level Design Phase Delivery / Implementation Phase Programme Infrastructure - Resources - Budget - Governance Develop PID Undertake Gateway Check Establish Programme Monitoring (i.e. Prince 2) - Risk Log - Lessons Learned - Reporting Framework - Communication Plan Develop Programme / Project Plans Embed Change / Operationalise Appoint / Select Design Team Citizen & Community involvement key Undertake design phase - Analysis & document current model/customer journey/costs - Review evidence &insight & commission gaps - Identify barriers & address - Design new ‘Operating Model(s) & ‘Option Appraisal’ Framework - Test “smart” interventions - Deliver proof of concepts - Develop stakeholder engagement plan - Develop cost/benefit & benefits model Submit ‘Options Appraisal’ & business case for decision Approval for New Operating Model & budget Develop & Handover Design Blue Print Opportunity definition & high level scope (High Level Business Case) Engage leadership & key stakeholders (map stakeholders power/position) Undertake: - ‘Problem definition’ } - ‘Core’ Q } Scoping - Fundamental objectives } Define shared strategic vision Agree strategic outcomes & performance framework Propose governance Propose and coordinate member involvement Propose budgets Recommend Champion and identify key change agents Propose and establish design methodology Define solution principles, culture and key skills Draft V0.2 Strategic Transformation Model Leicestershire Together Executive/Exec Board Mandate for Transformation Key Decisions/Cabinet recommendations Strategic Vision Pooled/Aligned budget agreement Commissioning governance approval Core Transformation Competencies Induction & development programme Transformation group assure design principles within implementation & service delivery via board membership Identify early opportunities Agree Customer Insight Framework

26. Pooling of Budgets Proposed by Government for pooling: Safer and Stronger Communities Fund (to become Community Safety Fund) Early Intervention Grant Drugs Intervention Programme Drugs Pooled Treatment Budget Job Centre Plus Discretionary Funding Work Programme Funding European Social Fund Youth Justice Grant Probation/NOMS interventions funding Family Nurse Partnership funding/health visitor services 'A number are still looking to align budgets, which are unlikely to unlock the full range of flexibilities promised by pooling’.

27. Governance Clarity and Accountability vital to success in a new world of collaboration and cooperation Buy in essential from ALL partners

28. New forms of governance Moving from soft ‘direction of travel partnerships’ to ‘hard’ decision making partnerships Small number of Boards Commissioners only on Boards Support groups to include stakeholders There will be overlaps

29. Governance

31. Progress to date

32. Locality Close to Different Communities/Neighbourhoods Could be District(s) or Sub-District Build of LPG Exemplars Local Accountability for Activities Prevent New Silos Change/Make things happen

33. For example

34. Recommendations 1. New Terms of Reference considered by theme groups and proposals for locality management and Governance developed 2. General consultation with stakeholders 3. Executive to consider and make recommendations for final structure 4. Partnership-wide Conference in June 5. Sub group of Chair, District, PCT, VCS and Police to agree new arrangements/timetable prior to Board