Individual Commissioning for Children and

Young People with Complex Needs

in Gloucestershire

Chris Sands: Head of Individual Commissioning

Children and Young People’s Directorate

Placements

OutcomesSupport Services

Budget HoldingLead Professional Pilot (Children in

Care)

Learning Points

Feedback

Special Educational

Needs

Children and young people with Complex Needs

……have a number of discrete needs –

• e.g. relating to their health, education, welfare, development, home environment

• Require additional support from more than one agency / service sector / system.

•Their needs are often chronic and may be life-long.

•These different needs tend to interact, exacerbating their impact on the child's development and well-being.

Typically, they may have…..• A spectrum of need which has been sustained for at least 6

months (and is likely to be ongoing);• Needs falling at the severe/profound end of a spectrum of

intensity;• Needs falling across at least two of the areas below:

– Acute and/or chronic medical difficulties, – Multiple and profound physical and/or sensory impairments, – Behaviour problems which are often challenging,– Significant Learning and/or Language difficulties, and/or

disabilities,– Parenting and/or attachment/social needs.

• Intensive ongoing involvement of at least two agencies / service sectors, usually drawn from:– Therapy services – Specialist Educational Services – Nursing and Medical Services – Social Care Services (core teams or specialist personnel) – Mental Health Services

•Poor outcomes

•Escalating spend

•Inefficient processes

•Lack of customer focus

•Future predictions

The Complex Needs Strategy

Where we were……a bit of history…

Revise and redesign the commissioning process in order to improve processes and

decision-making, broaden choice of placement options, ensure an outcomes-focussed approach based on individual

needs, and ensure that these needs are met by effective quality providers at reduced

levels of cost.

Since then……………

Complex Needs Strategy (excerpt)

Commissioning has really taken off…. Why?

to

Clear direction from DCSF, the CSP + Ofsted Inspections

Move away from ‘what we have/always had’

what we and our customers need/planning for the

future/trends/patterns etc

…..Its our framework for planning all services for dynamic future proofing

Commissioning Cycle

Analysing Planning(e.g. OPS; CYPP NA; (e.g. CYPP;

CommissioningCommissioning Plans NA) Plans; evidence/’research’)

Reviewing Doing(e.g. CYPP; Contracts/SLAs) (e.g. Tendering/Contracting

Service Improvement &/or

Development Plans)

(DCSF) (CSP)

Different levels of commissioning

•Strategic

•Local

•IndividualSounds simple...

My focustoday

GLOUCESTERSHIRECONFERENCE

GLOUCESTERSHIRECONFERENCE

GSPGloucestershire

StrategicPartnership

GSPGloucestershire

StrategicPartnership

DISTRICTS NETWORK(Chairs of the 6 LSP CYP Thematic sub groups and

district officers)

DISTRICTS NETWORK(Chairs of the 6 LSP CYP Thematic sub groups and

district officers)

CYPSP BOARD and

EXECUTIVE GROUP

CYPSP BOARD and

EXECUTIVE GROUP

COMMISSIONING BOARD

COMMISSIONING BOARD

CYP Local Strategic Partnerships

CYP Local Strategic Partnerships

Schools

Forum

Schools

Forum

6 LSPS(Local Strategic Partnerships)

6 LSPS(Local Strategic Partnerships)

Extended services clusters

Extended services clusters

CYP ‘hubs’CYP ‘hubs’

keyCountywide strategic commissioners

Countywide strategic commissionersDistrict/locality commissionersDistrict/locality commissioners

Officer supportOfficer support

Commissioning family/individual level

Commissioning family/individual level

money

need

Commissioning teamCommissioning team

Locality ManagersLocality Managers

Countywide strategic

commission

ers eg PCT and GCC

Countywide strategic

commission

ers eg PCT and GCC

Individualised budgets through Lead Professionals

Individualised budgets through Lead Professionals

Providers of services

Providers of services

Children and families in GloucestershireChildren and families in Gloucestershire

Levels of commissioning

Professional Filter – what happens now

Individual CommissioningIndividual Commissioning

Moving from this

Where we’re going -Citizenship Model

Individual CommissioningIndividual Commissioning

To this

Resource Allocation System……

Individual CommissioningKey Features/principles of the

Gloucestershire Commissioning Model

Individual CommissioningKey Features/principles of the

Gloucestershire Commissioning Model

Needs led, outcome focused

Transparency,clear processes and timescales

Accountability and review

Creativity, flexibility

Value for money Empowers and

engages yp, their families/carers

Local services

Promotes choice

Objectives: Improved, managed outcomes relating to ECM

Improved stability and placement choice

Effectively commissioned services through pre-qualified lists

(fostering, residential, SEN)

Increased local service provision

Increased accountability for service outcomes

Empowerment of young people and carers in decision making

processes

Reduced bureaucratic processes and release time back into

frontline working

Link with and build upon experiences of individual budgets for

children in care and children and young people with disabilities

Join up the commissioning and individual budget processes (BHLP and the Resource Allocation

System)

Objectives: Improved, managed outcomes relating to ECM

Improved stability and placement choice

Effectively commissioned services through pre-qualified lists

(fostering, residential, SEN)

Increased local service provision

Increased accountability for service outcomes

Empowerment of young people and carers in decision making

processes

Reduced bureaucratic processes and release time back into

frontline working

Link with and build upon experiences of individual budgets for

children in care and children and young people with disabilities

Join up the commissioning and individual budget processes (BHLP and the Resource Allocation

System)

Where we are up to…….•Individual Commissioning Services Team

•Mainstream Children’s Homes….closed – all children’s homes services individually commissioned

•Fostering:•Service of excellence•Business model•Level playing field (12+)•28 day contract•Target for 85% in fostering placements

•Special School and SEN process trials

•Budget Holding Lead Professionals pilots

•Support Services accreditation Process examples

Individual outcome focused commissioning profile completed (with

parents and yp)

ICST Quality Assurance function Anonymised data

ICST screen against priorities

Expressions of Interest from Partner Providers

(pre-qualified providers)

5 working day turnaround

Social Worker/Lead Professional grades (with parents and yp)

Negotiation with partner providers ranked 1&2

Contracts based on clear service/outcomes provision

Needs/Outcomes form part of YP’s review

Needs/outcomes to IRO Service

Service Commissioning

Tribunals 7 Parental pref….

X

Special Educational Needs Trial

Stat assessment request or review indicates complex

needs

Multi-agency outcomes meeting held: identifies and agrees

need, outcomes and challenges

Commissioning form completed by LP,

agreed by parents and professionals

Review of outcomes

Decision re. extra resources/external

placement

LP, professionals and parents grade responses and undertake

visits

Contract issued and placement

begins

Aims of the BHLP pilots The BHLP pilots aim to:

Involve young people and parents in decisions about what they need and how best to support them

Ensure children, young people and families get the services they need when they need them.

Reduce overlap and inconsistency and poor engagement, thus reducing the costs per “episode” of intervention.

BHLP Children in Care Pilot

Workstreams:

•Children waiting permanency

•Educational achievement

•Young people with substance misuse issues

•Yp in our children’s homes

•Children and young people’s participation

BHLPs - How they work……

Common Assessment (CAF) Analysis/PEP completed with parent, young person,

relevant professionals

Allocate budget if required

Review outcomesComplete support plan with

young person/parents

Agree Lead Professional if not already identified

Access existing services or commission direct

Needs and outcomes identified

One of our big questions and challenges…

Why go out of county?

What more could we do in-county?

How can we make better use of our own resources?

Special School TrialsEmerging needs…..

Use BHLP principles

Costs inevitable…

Not just ‘education’

Creative & Flexible

approach

Local support services

Accreditation of

‘non-trad’ providers

Individual Commissioning:

Have we got it right?Proof of the pudding…….

Benefits RealisationImproved

stability/choice/matching

Increased involvement in decisions and process

Promotes roll out of BHLP

Reduction in yp placed out of

county

Reduced overall costs

compared with pre-ICST

Improved Market

engagement

Increased Local

provision

Increased accountability

Sufficiency

Commissioning Learning Points and feedback

IFAs: - comprehensive information - able to meet timescales - ECM framework helpful in matching - outcomes led supports matching - a plan already to roll - positive way forward - 100% good/very good/excellent

SWs: - takes more time than want to spend - QA function presents a challenge - timescales difficult to determine re outcomes - difficult if not know child (when an

emergency) - ECM focus good - 55.5% good/excellent. 33% average. 11.5%

poor

BHLP (Children in Care Learning Points)

Social work practice issues:

•Raises questions about what the role of the social worker is – commissioner a new concept

•Meaningful relationships with young people

•Challenges the culture of the ‘expert’ model

•Moving from systems and process approach to needs led

•Corporate parenting aspirations

BHLP (Children in Care Learning Points) cont..

Engagement with young people issues:

•Greater participation in the care planning process•To feel they are important and that they matter•A chance to talk about their day to day needs with someone with whom they have a meaningful relationship

Commissioning feedbackYoung People:

quite an achievement!

successful

yes: definitely

yes: happy and settled in placement

my choices were

considered

offered choice of two placements

two intros and enough

notice

Choice?

Right Choice

?

Placement move?

‘Just wanted to say that the processran very sweetly. Many thanks to everyone for their part in findingthe right placement. I have been impressed by the professionalcourtesy and support along the way. The process is a vast improvement (topast experiences) and really does helpto focus on my child’s needs and outcomes’

…..we’re still learning and working on it!

Individual Commissioning:

Have we got it right?