bradford - total place summit masterclass presentation
Post on 30-Nov-2014
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Bradford’s Total Place Experience
What we've learnt about the importance of interconnectedness of the public service around
the customer
Strategic Director – Mary Weastell
Contents
• Our Approach• Customer Insight• Barriers - Changes• Forging The Future - New Ways of
Working
Scoping Our Approach• LSP agreed theme of
supporting vulnerable groups at point of entry/re-entry into community, through a “Gateway to Integrated Services”
• Aligned to priorities and
outcome focused
• Address concerns about current ways of working, VFM and barriers to improving service delivery
• Focus on reduction in crime, enhancing of social capital and more productive use of public services
• Three key sub-themes:– Young people leaving care– Offenders over 18 leaving
prison – Older people with mental
health problems leaving hospital
Determine Joint
Leads
Phase 3 – Forging the
Future
Identify Key
Stakehol-ders
Phase 2 – Customer Insights
Phase 1 –Discovery
and Develop-
ment
Offline Work to
Consolidate Outputs
Design New
Pathways & Develop business
cases
Agree Scope
Facilitated by Leads
Facilitated by Providers , VS & Leads
Facilitated by Leads
InvolvingService Providers & Voluntary Sectors stakeholders
InvolvingServiceUsers
Involving Service ProvidersVoluntary SectorService Users
Gateway to Integrated Services – Methodology
Different approach to Community Engagement and Consultation?
• Phase 1 - Discovery and Development:– service providers defining current
situation
– understanding dependencies and inter-dependencies
– recognising problems associated with current level of service delivery
• Phase 2 - Customer Insight: – creative ways to capture real life
experiences of services users
– obtained greater degree of insight of impact of wider family
• Phase 3 - Forging the Future:– bringing together service
users and service providers work on new pathways
– Giving freedom to think creatively, beyond current boundaries, and design transformational changes
Customer Insight
• Research approach - going beyond current engagement models, customer evaluation and feedback
• Service Users’ interviewing each other and Providers
• Experiences of the impact on the wider family• Variety of tools - videos, drawings, art work• Space for creative thinking & joint solutions
Insights from Care Leavers
Three things: better support, assistance with money and more ambition – my carers were great and had such high hopes for me but my friends carers did not encourage as much
I cannot continue studies at College, and been
discouraged from enrolling this year, due to
being pregnant. I am frustrated, it stops me
making progress. I would be able to study at home. I want to go to university
and this will stop me
I was living with my landlord from 16 to 18 with a rent agreed. When I reached 18 the DWP wouldn’t pay the agreed level of rent so I had to leave his “home”
Insights from Older People and their Carers
Insights from Older People and Carers
I am old…I was admitted to the hospital and moved to eleven
different wards when I was there. I was very
confused
My mum has psychosis, went to hospital. No one
checked her support package. Community MH Team not aware.
Discharged with extra medication, no
explanation. She took double which meant she couldn’t function. CPN was not informed she
was sent home
An elderly man, known to Mental Health team, was discharged from hospital at night dressed in pyjamas. His wife, with mental illness had undergone surgery and not well enough to look after him, was told of his discharge whilst visiting him and told Social Services would be contacted next day.
Insights from Offenders and their Families
I was in remand prison halfway into a course, then
transferred to another prison. I go through
induction process again, placed on education
waiting list, and released before completing course
or getting qualification
I’ve been 21 years in and out of
institutions - from the age of 20 to 46 years. Each time I get little
support, have no money and can’t get
ahead so I get arrested again.Children in care
I was released from prison on 13 July and still there an hour later, no-one had
collected me. I was wandering up and down
the road
Key Challenges – Care Leavers• Challenge 1
– Local fragmented service - emotional health not assessed in timely way, access to support and treatment difficult. Lack of supported housing for the most vulnerable
• Challenge 2– A cohort of young people are NEET from an early age
who are dependent on benefits • Challenge 3
– National benefits system complex and difficult to navigate
Key Challenges – Older People• Challenge 1
– Entering acute hospitals with physical problems may have secondary mental health issues or may acquire them during their stay
• Challenge 2– Mental health needs may not be addressed leading to
prolonged stay in hospital and disjointed discharge process• Challenge 3:
– Double Financial Cost • additional cost of extended stays in acute hospital • Longer stay in hospital, greater likelihood of discharge to
care home
Key Challenges – Adult Offenders
Challenge 1 – Breaking reconviction cycle – custody sentences of less than a year
do not undergo any supervision after release – 46.5% re-conviction rate
Challenge 2– Offenders who serve shorter sentences often in prison long enough to
lose all social support structures but not long enough to gain level of support offered to long term prisoners
Challenge 3– The collection of information and assessments designed to serve the
needs of agencies and providers rather than the individualChallenge 4
– System not designed to meet needs of women prisoners or families and has multi generation impact as consequence – esp in relation to mental health
National• Complicated benefits system that is complex, difficult to access and can be a disincentive to young people to access training and apprenticeships
Local – Change• Tailored approach to Entry 2 Employment support for the most challenging young people • Supported housing in decent areas ending any reliance on inappropriate hostels and B&B
Local – Change• Improved integrated approach to care leavers from all partners• Commitment of corporate parenting responsibility of the Local Strategic Partnership
Changing the whole system - Care Leavers
National• The compatibility of IT systems can have a profound effect on good clinical assessment
Local – Change• A key and consistent message from our workshops has been that the whole approach to treating and working with people with dementia and their carers requires a complete overhaul
Local – Change• Multi agency training approach - Training that currently exists on working with older people with mental health tends to be organisation specific.
Changing the whole system - Older People
National• No case management of any adult offender with a sentence of <12 months custody exists and the relevant justice services and supporting agencies are not resourced for such a role
Local - change•Interventions with selected non-convicted offenders•Housing Commissioners / Providers to adjust approaches to homelessness, social housing allocations and tenancy management
Local – Change• Transform the approach to offender management by increasing the intervention at the point of arrest
Changing the whole system - Adult Offenders
Invest to Save vs Benefits and Efficiencies
Resource realignment – predicted gross savings / efficiency gains – Realigning £880k could realise c£670k resource costs
and up to £3.9m benefits for 45 care leavers who are NEET
– Realigning £270k could realise c£4.1m p.a. processing cost across whole offender pathway in preventing re-offending
– Realigning £1.2m could realise c£2m through improved discharge planning and support to avoid direct discharge into residential care and readmissions
Removal of Barriers / Freedoms
• Aligned thinking, nationally and locally, on priorities for “place”– Prioritisation/Realignment of resources– Performance Frameworks
• National policy change to deliver desired outcomes e.g. – Offender management policies changes in partnership
with MoJ, Home Office, NOMS– Cross agency Dementia Training for staff with DoH
• Lack of Flexibility of Benefits System (across three sub themes)– Interim and Transitional Benefits proposals
Redesigning Solutions Together
Learning - Future service redesignCare LeaversWide consensus on “gold
standard” service areas– emotional health and well
being– Employment, education,
training– finance and benefits and– Accommodation
Offender Management• 5 key interventions to transform
offender management pathway – Offender Management at Arrest– Passported Assessments– Reformed Early Conditional
Release– Case Management for Everyone– Focus on Families
Older peopleInitial focus on planning of discharge and post-discharge support, now admission and in-patient processes also included – work will be focussed to secure a complete redesign of the pathway
New Ways of Working• Significantly improve life
chances / living conditions for people through– Co-design and delivery with
service users • Community Leadership at the
highest level– Joint accountability/Political
leadership– Challenging the established
barriers to local decision making
– Improved Scrutiny
• Constant dialogue local and central government– Co-designed policy making– Influencing role
• Realigned budget and resource arrangements– “Place” based funding and
resourcing – Shared risk and reward
Some Thoughts
• How effective are your current engagement models with citizens?
• Could this learning change your mindset about a whole system approach to joint service delivery in your area?
• How ready are you to act on removing local barriers to Transformational Improvement?
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