Stockport Council budget business cases 2015-17

8/11/2019 Stockport Council budget business cases 2015-17

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IIS workstream Delivery Programme Directorate Project Lead

Investing in Preventionat a Population Level

1 Preventative Commissioning Strategy

People

Terry Dafter / DonnaSager

2 IPS Children and Family Services Chris McLoughlin

Targeted prevention,early help and the

provision of specialistservices

3 Integrated Care Adult Social Care and Health Terry Dafter

4 0-25 SEND ReviewChris McLoughlin /PhilBeswick

5 Learning Disability Review Terry Dafter

Alternative ServiceDelivery Models

6 Leisure Facilities

Place

Peter Ashworth7 Museum and Cultural Attractions

8 Highways and Engineering Megan Black

9 New Model for Regulation Ian ODonnell

Locality OperatingModel 10 Locality Operating Model Janet Wood

Commissioning Review 11 Solutions SK Operating ModelMegan Black / MichaelCullen

Investing in Growth 12 Facilitating Accelerated Growth Andy Kippax

Cross-cutting13 Information, Advice and Guidance All

Alison Blount /Geraldine Gerrard

14 Corporate and Support Services CSS Andrea Stewart

Index of the Investing in Stockport Projects


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Page 1 of 20Prevention Commissioning Strategy 4 th August 2014

Investing in Stockport - Business Case

IIS Programme:

IIS Board SRO: Andrew Webb IIS Project Lead: Terry Dafter, Donna Sager Portfolio: Adult Care Service and Health and Wellbeing Project Name: Preventative Commissioning Strategy

Project Board / Team Members

Donna SagerSarah NewsamVince FragaNick DixonGill WatersJo Lancaster

INVESTINGIN REFORM


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1. Project Overview

This project forms part of a strategic review of preventative commissioning in Stockport and seeks to achieve awhole-system change in the way that preventative services are commissioned and provided. It will include therecommissioning of some preventative services that are provided by a range of partners including the not forprofit sector, voluntary and community organisations and NHS providers.

The Council will lead the development of a single, evidence based, integrated prevention strategy for peoplewho are vulnerable or at risk. At its core this strategy will incorporate a number of the Councils statutoryduties in respect of public health, adult social care, supported living and support to vulnerable children andtheir families. The strategy will focus on building community capacity, increasing personal and communityresilience and supporting action to improve health and wellbeing across the community and for the individual.Over time, commissioning will need to move from its current, service specific approach to one that is outcomesled. In order to achieve this shift the Council will actively re-appraise the impact on outcomes of all preventiveactivity and will lead to a realignment of Public Health services and those currently managed in Adults andChildrens Social Care Services.


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2. Regulation and Statutory Considerations

The Care Act 2014 requires that Local Authorities ensure the provision of or arrangement of services, facilitiesor resources to help prevent, delay or reduce the development of needs for care and support for all people inits area, regardless of whether they have care and support needs. This applies to adults and carers.

The purpose of preventative services must be to intervene early to support individuals, help people retain orregain their skills and confidence, and prevent need or delay deterioration wherever possible. The Care Actdraft guidance suggests that preventative support should build on and grow the resources within localcommunities.

The aims of this project are consistent with the requirements currently set out in the draft guidance and LocalAuthorities appear to be given freedom as to how to implement the preventing, reducing and delaying needduty in the Act.


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3. Investment Profile

The overall investment across these services currently stands at 18.8m. We anticipate that the future(2016/17) in investment in this area will be 16.6m In order to achieve this ambitious programme of change,the total investment can be summarised as follows:

PooledBudget

Baseline 15/16 16/17

17.0 M 15.8 M 14.6 M

Year 000sBaseline 17.0 M2015/16 15.8 M

2016/17 14.6 MBeyond To be determined


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4. A Description of the New Service

This project described in this business case will be achieved through the large-scale recommissioning of servicescurrently regarded as preventative, including those funded by Adult Social Care, Supporting People, some ofthose funded by Public Health and to a much lesser (and still to be determined) extent services for Children andYoung People. Many of these services are provided by the not for profit sector, voluntary and communityorganisations and some NHS providers. The project will focus on remodelling three dimensions of preventionwhich are:

Information, advice and supported signposting a generic service, which offers a more intensive and tailoredservice for people whose needs are greater and who require more support to find solutions or make positivechange on their own.

Vulnerable people often individuals or families with multiple, complex issues and dependencies which couldinclude lifestyle/risk-taking, drugs and alcohol, domestic abuse, offending, people with mental health needs,homelessness, care leavers, people at risk, autism.

Support for independence - people who need support to have a good quality of life & live independently withgood social and emotional wellbeing and supported to age healthily e.g. older people, people living with long-term health conditions such as dementia, stroke, diabetes; people at risk of falls, loneliness and social isolation;and carers.

A key aim of the project is to develop new, innovative and more effective ways of delivering local preventativeservices which target adults who are already experiencing circumstances which may make them vulnerable (asdescribed above).

The project goal is to remodel and refocus preventative services to ensure that the people who need supportmost, are quickly enabled to find solutions. The individual will be at the heart of the process and they will besupported to identify their needs and aspirations in the round and be encouraged to consider the assets andadvantages they already have or could benefit from. A spects of most peoples circumstances can be met at acommunity level, through friends, family and community resources and w hen this natural help isnt availableto someone, preventative services will be offered, or a referral into statutory services could be made.

In summary, the fundamental aims of the project are to:

re-shape local preventative services for adults in Stockport to ensure that preventative support makes atargeted contribution to identifying and supporting vulnerable people, providing effective interventionsearlier, and alleviating and delaying demand on the wider care, health, homelessness and criminal justicesystem;

build community capacity and support for social action into our commissioning and adopt an approach thatseeks to increase personal and community resilience through natural assets;

move to a more outcomes-led approach in our commissioning which focuses on support which maintainsindependence, promotes self-care and self-maintenance, which ultimately enables people to live well intheir own homes and communities for as long as possible;

assure the Council of value for money in the deployment of public funds committed to preventing, reducingand delaying need

show a return on investment in terms of improved outcomes, contributing to a reduction in demand andwider community engagement. The options for exploring this may include new contracting arrangementssuch as payment by results and other ways to ensure that benefits are captured.


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In addition the Public Health Grant is being redirected to deliver on a programme of evidence basedinterventions that are designed to prevent, delay and deflect activity in areas of high costs in the LocalAuthority and the NHS. Some of the savings which address NHS budgets are predicated on the development ofan integrated health and social care resource strategy.

Spending within Public Health grant is also being reviewed to identify opportunities for savings that can bemade without damaging the preventative programmes upon which the achievement of the challenging targetsset for health and social care integration will depend. Savings made will be accounted for in the health promisecontracts therefore benefitting the Council cash limit.

We are exploring the possibility of recommissioning and redesigning some services that are currently providedby the Stockport NHS Foundation Trust. This would enable further integration and alignment of these serviceswith some of the new Public health commissioning responsibilities.

In addition to those services where there are benefits for recommissioning, there are also some services wherefinancial savings can only be made at the expense of partners organisations, these may not be required if atotal social care and health resource strategy is achieved.

Overall the purpose of the project is to create a series of remodelled preventative services which are capable ofsupporting and enabling tangible and positive change in an individuals circumstances and which make the bestpossible use of available Council and wider public funds.

To understand the context for this project, the Council has funded for many years services and support forpeople who would not normally be able to access public funding. These services often assist with simple or lowto moderate care and support needs e.g. handy-help services, social rehabilitation, peer support for peoplewith low-level mental health problems, befriending, home/environmental assessments to limit falls, breaks forcarers, housing related support, generic wellbeing services etc. This wide range of activities makes acontribution to preventing some of our more vulnerable residents from deteriorating and needing successivelymore complex, intensive and expensive support.

However, many of these services have been in place on a long-standing basis, and have not all been subject tocompetitive recommissioning processes or a strategic review of preventative commissioning priorities. There isnow a pressing need to ensure that preventative services in Stockport are fit for purpose going forward, whensocial care and NHS budgets will be under significant pressure and the population is ageing. The Care Act alsoexpects Councils to ensure that support is in place to prevent, reduce or delay the need for care and support.External commentators have reflected back to us that, given the overall picture for ASC and the local healtheconomy, current preventative provision needs to make a much more tangible impact than it is currently.

Other boroughs around the country have already undertaken this type of remodelling and/or recommissioningexercise to refine and refocus local preventative support. This is what this project now seeks to achieve for

Stockport.

This project will also explore the notion of self-management greater use of personalisation and individualbudgets so individuals can make their own arrangements and determine relevant outcomes. This is alsorelevant for individuals being able to manage their own long-term conditions through better information andnetworks of peer support, for instance people with dementia. There are also opportunities for personalisedcommissioning and personal budgets, building on experiences in health and social care and transferring theprinciple to other settings (e.g. skills, weight management, environmental improvement, transport).

This is a detailed, challenging and complex exercise which needs to achieve multiple objectives and will include:

a root and branch review of current preventative commissioning within the scope of this project refocusing future commissioning on the groups, issues and methods for which there is good evidence of


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impact (i.e. which prevent, reduce or delay need) redesigning both how people access preventative support and what they have access to the aim is to

improve both, making it easier and offering more integrated support achieve a culture change in which service providers enable, support and facilitate service users to become

self-sustaining and independent in the medium to long-term, which challenges the idea of them asproviders of services

encouraging greater collaboration within and between the local voluntary and community sectors growing the reciprocal or natural support available within communities, for and by communities,

neighbours, friends, families and volunteers To develop both a universal and targeted offer to prevent needs escalating and reduce demand on services Be based on agreed outcomes and an evidence base that covers a range of needs and at risk groups

What will the new serviceprovide?

A person-centred preventative service (or series of services) which isdelivered in a collaborative way so that individuals benefit from an(informal) rounded assessment which identifies their needs and willsupport them to find solutions - in doing so preventing furtherdeterioration of the individuals circumstances.

What hours will it operate? Services will need to be accessible Monday to Friday during normalworking hours. However, the Government expects that health andcare services will increasingly be available across a 7 day workingweek. Preventative services will need to mirror this working patternwhich will mean that the new service will have to provide access orcover over 7 days. However, this could be on the basis of an out-ofhours / emergency call-out function.

What staff will be required? This is still to be determined and may not emerge until the financialenvelope has been agreed and the tender / contracting process isunderway.

Does it involve a multi-agency or integratedapproach?

Yes. The objective is to design preventative services which areintegrated. For instance, a person experiencing housing problemscould expect to receive a rounded and consistent assessment of theirneeds (an informal and conversational assessment), which could resultin the individual receiving support with rehousing, but also a benefitscheck, an appointment with a health trainer and a referral to anemployment support advisor.

Will there be any change tocurrent levels of service?

This is a difficult assessment to make at this stage, as somepreventative services may not continue to be provided in the sameway or at the same scale, but there may be genuine alternativesalready available to individuals within their own communities andfamily circles. The intention is to support the growth of localvolunteer and community activities which make local informal supportmore readily available.

Will customers notice anychange to the current serviceprovision?

As the purpose of the project is to remodel current provision andideally improve upon our current approach, there will inevitably be achange in the way that services are delivered. The change that serviceusers are most likely to experience is that their needs will not beassessed and met in isolation (a positive) and they will be assisted tofind community-level solutions to problems they are experiencing,rather than always being offered a service. The approach will focuson enabling people to be as self-sufficient as possible.

sources, prom ote community solutions and assure intelligent information sharing at the front door.


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5. How we will achieve this

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Preparation / description of preventative commissioning strategy, newservice models and outcomes to be delivered

July Oct 14

Consideration of and decisions regarding most appropriate contractualmechanisms

July Sept 14

Communications, change management and engagement support providedto the voluntary sector through GMCVO

July 14 April 15

Discussions with 3 rd sector organisations to review business models July Oct 14

Consultation with service users e.g.. Older people, people with disabilitiesand those with physical, emotional and wellbeing difficulties.

August September 14

Completion of Equality Impact Assessment September 14

Final Business case September 14

Information provided to wider partners about the process Sept/Oct 14

Implementation of the recommissioning process Sept 14 April 15

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Provide on-going support to adapt to changing requirements and buildpositive relationships with and between providers working under the newarrangements via GMCVO

April 15 onwards

Frequent and on-going review by commissioning partners of newcontractual mechanisms, and delivery arrangements between providers, toconsolidate the new arrangements

April 15 onwards

Potentially complete / undertake preventative commissioning processes notfinalised by April 2015

April Oct 15

Review public health expenditure April 15 onwards

16/17

Full implementation of the new preventative commissioning strategy. Estimated by April 16

Detail are set out in:

- Appendix 1 Activity and Impact Schedule- Appendix 4 Project milestones


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6. Impact on current service model

As the proposal is to remodel existing provision, it is difficult to predict exactly what the actual impact will be,compared to the intended impact, and there will initially need to be flexibility on the part of the newlycommissioned services and support to adapt and respond to service user needs.

The following are the intended or likely impacts of the changes:

There will be a reduction in the total number and breadth of not for profit and formal voluntary sectorservices being commissioned and therefore on offer to residents, as our commissioning will be morefocused and prioritised

The development of the community sector is intended to off-set this reduction in preventative supportprovided by the not for profit and formal voluntary sector

Other preventative services may be remodelled or decommissioned in response to these wider changes Not for profit and voluntary sector providers will be required to work in a more collaborative way - sharing

expertise, premises, information and intelligence, assessment processes, and co-managing staff and widerresources etc

Preventative services will be much more integrated from the service users point of view and peoplesneeds will be assessed more consistently and effectively

Service users wishing to access services in person may have to adapt to using new premises or venues;existing contact numbers may change; and they may have to adapt to being supported in different wayswhere trusted contacts and relationships may be disrupted in the early stages of changes

Existing preventative services which have a track record of failure / under-performance will bedecommissioned

Duplication in commissioning will be removed, resulting in some services being decommissioned Some more established organisations will not be able to adapt to the changes whilst maintaining their

current form and will develop new business models and approaches accordingly Reductions in grant or contract values for some organisations may limit their ability to lever in other

funding sources


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7. Interdependencies

This project cannot be viewed in isolation and is linked to a number of cross cutting IIS themes:

Outcome Sub-OutcomeA) People are able to make

informed choices and look afterthemselves

Peoples needs are met People live well

B) People who need support get it People are supported so that their needs can be metPeople are supported to live well

This project is aligned with the evolving integrated health and social care model, delivering the prevention,independence and self- care work stream and supporting the targeted prevention work stream. In the new

joint governance arrangements, this pro ject contributes most directly to the Proactive Care theme.

It has also drawn funding support from the Centre for Social Action Innovation Fund awarded by the Cabinetoffice, a key milestone of which is to explore the application of more innovative contractual approaches withexternal providers.

Given that one of the preventative dimensions described above is to commission information, advice andsupported signposting, this project will need to interface closely with the same corporate IiS theme, and thedigital theme. However, new legislation in both the childrens and adults social care arena is explicit thatlegislative duties covering information, advice and guidance will not be met through the use of digital channelsalone.


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9. Consultation and Engagement

There will need to be proportionate consultation which gathers the views of people who may already useexisting preventative services and those who could have a dual interest. Preventative services are meant to beuniversal but we will also target specifically those people most likely to need help. Key groups will be a crosssection of vulnerable people/existing service users, older people and people who need support to remain living

independently. The recommissioning exercise will commence September 2014.

The aim of the consultation will be to gain the views of how the participants think the new service could work.The new approach and the reasons for the new service will firstly be explained followed by a simplepresentation of the theory of the new preventative service model. We will be looking to find out theparticipants ideas for what it must include, what benefits or problems it could have and what would encouragepeople to use the service.

Throughout the consultative process the objective will be to understand the impact the model could have onservice users and more vulnerable groups, many of whom are covered by the Equality Act, 2010.

APPENDICES

1. Activity and Impact2. Consultation Plan3. EIA4. Project Milestones


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APPENDIX 1

ACTIVITY AND IMPACT SCHEDULE

Year Activity Potential Impact

2014/15

Discussions with 3 rd sector organisations to review businessmodels.

Some organisations are more vulnerable and relationshipswith the voluntary and community sector may bechallenging.

Intensive collaboration which will encourage the sector toconceive new solutions and approaches

Potential for greater opportunities within local market forvoluntary and community sector organisations.

Capacity and skills to deliver such complex change acrossmultiple organisations

The project plan requires intensive and fast-paced change-management, which not all partners and providers may beable to adapt to in a timely way. Some organisations maynot have the existing skills or capacity to adapt.

Consultation with service users e.g.. Older people, people with

disabilities and those with physical, emotional and wellbeingdifficulties. EIA significant.

People understand the overall aim of the changes and whythis is important. Feedback is actively considered as part ofthe commissioning and development of new services,including the service user experience dimension.

Some public health services may be brought back in-house to Service transition may lead to temporary disruption in


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avoid management overheads. service provision

2015/16

The Council may have new providers that it will need to builda relationship with

Some providers may lose their Council contract.

Additional time and effort is needed to foster positiverelationships, support an understanding of Stockport, andenable providers to become quickly effective

Skills, expertise and organisations could be lost to the localeconomy

Requirement for radical rethinking of public healthexpenditure.

Could lead to a revised model of local public healthcommissioning and delivery

Reduction in the range of services available to the public dueto more focussed commissioning.

People may no longer be able to access services they havepreviously used in the same way, but alternatives will be inplace which target those most in need of support.

Refocus and greater use of personalisation End users have greater choice and control but are requiredto be more independent in their decision-making, with thesupport of family and carers (and professional support whererequired).

2016/17

Full implementation of the new preventative commissioningstrategy.

The new commissioning model has been implemented andthere is a comprehensive but more focused localpreventative programme in place across Stockport, which ismaking an effective and tangible contribution to individualand community wellbeing by preventing, reducing and


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delaying the need for intensive health and care services.


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APPENDIX 2

CONSULTATION PLAN

Please indicate if you need toconsult internally and/ orexternally

There will need to be proportionate consultation which gathersthe views of people who may already use existing preventativeservices and those who could have a dual interest e.g. on behalf

of others and themselves, such as carers

Details of who you intend toconsult and whether there will bea geographical focus

No explicit need to take a geographical focus although efforts willbe made to encourage people from more socio-economicallydisadvantaged backgrounds to take part. Preventative servicesare meant to be universal i.e. for the whole population, but alsotargeted specifically at those people most likely to need help.This will steer the consultation exercise, but gathering the viewsof existing service users and carers will be prioritised.

Key groups will be a cross section of vulnerable people / existing

service users, older people and people who need support toremain living independently e.g. people with physical, sensory orlearning difficulties.

What you intend to ask them orthe aim of the consultation

The new approach and the reasons for it will be explained,followed by a simple presentation of the theory of the newpreventative service model (as described throughout thisbusiness case). Views will be sought on how the participantsthink it could work, their ideas for what it must include, whatbenefits or problems it could have and what would encouragepeople to use the services.

Throughout the consultative process, the objective will be tounderstand the impact the new model could have on serviceusers and more vulnerable groups, many of whom are covered bythe Equality Act. It will therefore inform the EIA.

What methods of consultation willbe used

Largely face to face methods, as the subject matter is toocomplex to deal with via written methods.

The team that will be carrying outthe consultation

Colleagues in Adult Social Care, Supporting People and publichealth.

Period of consultation Commence mid-August through to mid-September, during whichtime a number of focus groups will be convened.

What form the feedback will take This will largely be through summary discussion at the eventsthemselves, as the methods used allow for all participants toshare and understand the key messages.


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APPENDIX 3

EQUALITY IMPACT ASSESSMENT

Title: Preventative Commissioning Date: 22/07/2014

Stage: consultation

Lead Officer: Sarah Newsam

Stage 1: Do you need to complete an Equality Impact Assessment (EIA)?

An EIA will be undertaken as this involves a change to existing contracts and commissionedservices which work with many existing and potential service users groups are covered bythe Equality Act.

This EIA will require further development to analyse the impact on Voluntary andCommunity Sector organisations (e.g. any indirect equality implications), current clientgroups and their carers (e.g. engagement feedback and service user breakdown) and widerimplications in line with the health and social care integration and the care act.

Stage 2: What do you know?

Further analysis is required to inform a current picture of the service, data that will be

considered includes: Analysis of current clients; Analysis of existing service provision; Analysis of need (building on the JSNA) Best practice and national or sub-regional analysis; Analysis of current Voluntary and Community Sector market; Feedback from any previous or existing consultation or engagement activity; Identification of gaps; Identification of any emerging impacts; Next steps for further data analysis (e.g. consultation)

Stage 2a: Further Data and Consultation

This section will be completed upon analysis undertaken at stage.2.

At stage.2 any gaps identified will be explored further in this stage. This section willtherefore include the outcomes of any consultation and engagement activity.

Stage 3: Results and Measures


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This section will be completed to reflect and build on the learning within section.2

Stage 4: Decision Stage

This EIA is a live document and will accompany the decision at all points throughout the

process.


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APPENDIX 4

Potential milestones

Project Milestone Project TargetDate

Preparation / description of preventative commissioning strategy, new service models andoutcomes to be delivered

July Sept 14

Consideration of and decisions regarding most appropriate contractual mechanisms July Sept 14

Communications, change management and engagement support provided to the voluntarysector through GMCVO

July 14 April15

Consultation with service users August Sept14

Final business case Sept

Information provided to wider partners about the process Sept/Oct 14

Implementation of the recommissioning process Sept 14 April15


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Page 1 of 20 Integrated Prevention and Safeguarding Children and Family Service 4 th August 14


Safeguarding/Childrens Social Care /Integrated Childrens Services

IIS Programme: Investing In Prevention at a Population LevelIIS Board SRO: Andrew WebbIIS Project Lead: Chris McLoughlinPortfolio: Children and Young PeopleDirectorate: Peoples Project Name: Integrated Prevention and Safeguarding Children and Family Service


Deborah Woodcock Head of Service, Childrens Social Care

Kate Fitzhugh Supporting Families Senior LeadViki Packman Head of the Integrated Childrens Service Claire Woodford Head of Childrens Services, NHS Foundation Trust Susan Claydon Service Manager, Supporting Families Pathway/ProgrammeGed Sweeney Safeguarding Manager, Childrens Social Care Heidi Shaw Deputy Head of Integrated Childrens Service , Substance Misuse and SfYP LeadHelen Woolard Commissioning SupportJane Connolly Head of Service, Child Protection, Staff and Workforce DevelopmentJeanette Warburton Service Manager, Childrens Social Care Mark Hancock Service Manager, Education PsychologyRebecca Key Deputy YOS Manager

Sarah Leah CAMHSStephen Dawson Service Mana ger, Childrens Social Care Sue Westwood Service Manager, Fostering and AdoptionGill Dixon Management AccountantGeraldine Gerrard CSS Head of Business Support, Peoples Directorate Amanda Carbery CSS Project ManagerLouise Chadderton CSS Project Manager1. Project Overview

The aim of the project is to establish an Integrated Prevention and Safeguarding Children and Family Servicethat provides the highest quality support to Stockports most vulnerable children and families.

The ambition is to redesign and align the current Childrens Social Care system with the Integrated ChildrensService. This will start with a pilot project in 2014/15 to transform the way we support and meet the needs ofStockports most vulnerable children and families.

The Council has been on a journey over the past 3 years to transform the way it works with children andfamilies via the development of the Supporting Families Pathway/Multi-Agency Safeguarding Hub and thedevelopment of the Integrated Childrens Service which has established joint service delivery with StockportNHS Foundation Trust. This has changed the way Stockport identifies need and strengthened integratedworking by making sure that everyone supporting children and families, work together effectively to put thechild and the family at the centre, to meet their needs and improve their lives. This work underpins the nextstage of our transformation programme.

INVESTINGIN REFORM


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The vision is that by 2017 the initiative will lead to a 20% reduction in the numbers of Looked After Childrenand those subject to child protection plans at level 4 (see levels of need diagram below) as well as significantand sustained reduction i n people needing repeat support leading to a reduction in the wider childrensworkforce.

It is vital the approach is underpinned with early identification and prevention to stop children and families need escalating in the first place and requires joint service delivery with wider partners in the public, privateand voluntary sector.


In presenting this vision for the future the Service is mindful of the following regulatory and statutoryconsiderations:

Children Act 1989Children Act 2004Children and Families Act 2014Care Standards Act 2000Care Planning, Placement and Review Regulations 2010Planning Transition to Adulthood for Care Leavers regulations 2010Fostering Services regulations and Minimum Standards 2011

Childrens Homes National Minimum Standards 2011Promoting the health and well-being of looked after children Statutory Guidance


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Local Safeguarding Children Boards Regulations 2006Working Together to Safeguard Children - A guide to inter-agency working to safeguard and promote thewelfare of childrenLocal Government Act 2000Crime and Disorder Act 1998Apprenticeships , Skills, Children and Learning Act 2009


The overall investment across these services currently stands at 25M. We anticipate that the futureinvestment in this area will be 23M in 15/16 and 20M in 16/17. In order to achieve this ambitiousprogramme of change, the total investment can be summarised as follows:

Year Safeguarding andSocial Care

Integrated ChildrensService

Combined

Baseline 17,000,000 8,000,000 25,000,0002015/16 15,500,000 (1.5) 7,500,000 (0.5) 23,000,0002016/17 13,500,000 (3.5) 6,500,000 (1.5) 20,000,000Beyond To be determined

In 15/16 the reduction in spend by 2M will be achieved as follows:-

Review of social work processes and thresholds for individual interventions, and evaluate the potential impactof introducing a number of evidenced- informed programmesReducing the number of placements by:-

Reviewing high cost, low outcome placements and all external placements: 600K Developing alternative provision with Stockport Homes for care leavers aged 16 plus: 100K Review edge of care non statutory operational costs including a review of the Supported Lodgings

Team, Short Breaks Team and Community Outreach Team and work more intensively with childrenboth on the edge of care as well as those that are received into care to avoid necessity for placement orensure those placed are provided effective rehabilitation to shorten time in care whereappropriate: 700K

Develop the revenue stream generated within the interagency adoption fee budget area: 100KReview of early education funding formula for 2,3 and 4 year olds: 140KRenegotiation with schools of SLAs to support schools in meeting statutory responsibilities: 125KReview with schools the targeted support provided for substance misuse work: 20KReview of operational budgets across the services comprising Integrated C hildrens Service (including ChildrensCentres), to benefit from efficiencies achieved by integration: 125KReview of Childrens Centre provision and staffing redesign potentially 5 FTE 90k

In 16/17 the reduction in spend by 3M will be achieved as follows:-

After close scrutiny of the new service model and detailed financial modelling and projections in 15/16 it isanticipated that the 16/17 reduction will be able to be met as there will be significantly fewer children andyoung people reaching child protection levels and placed into care. This reduction in demand will lead toreduced placement costs and a reduction in the wider childrens workforce. A further business case will bepresented to the Executive in Summer 2015 to evidence the reductions in Council spend in 16/17.


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4. A Description of the New Service

The new Integrated Prevention and Safeguarding Children and Family Service will ensure that Children andFamilies in Stockport receive an intensive seamless service at the point at which they need it. The Service willhave responsive, skilled, fully integrated teams that cover the four Clinical Commissioning Group (CCG) localityareas in Stockport. The service will have a strong locality approach with a key focus on working closely with allcritical partners especially schools, employment and skills, GPs, local policing teams, and other neighbourhoodresources to serve children and young people more effectively. By integrating universal and targeted servicesaround localities the service will reduce barriers to timely and effective work.

The new service will be easier for families to navigate, families in need will not have to repeat their story tomultiple professionals, information will be readily available to families - to enable those who are able to do so,to self-serve and will provide intensive support to the most vulnerable families to help them regain theirindependence as quickly as possible.

The Project will ensure that families with complex needs have a Lead Professional (key worker) working withthem who can build a trusting and effective relationship to address issues, rather than referring families tomultiple agencies and departments. The Common Assessment Framework and the Team around the Child and

Family approach will be embedded across all agencies. The Common Assessment Framework links preventionand early intervention to more specialist services. Our commitment to the Lead Professional (key worker)model will ensure that services are coordinated around the needs of the child and family.

The core aim is to improve outcomes for families, children and young people at risk of:

Poor attendance, exclusion from school, antisocial behaviour, child sexual exploitation, reception into careand not making a successful transition into adult life

Not being able to maximise their capacity for independent living

Adopting and sustaining risky and poor health behaviours that could lead to a reduced life expectancy

Poor early years outcomes

Unemployment and economic disadvantage

The service will ensure a strong focus on safeguarding, prevention and early identification of needs with clearpackages of support to children and families by radically re-thinking how prevention services are configuredand delivered. This is an aspirational approach that does not stop in 2017.

Community solutions underpin this approach; intensively supporting the most vulnerable people to deal withemerging problems and regain their independence as quickly as possible.

If the pilot carried out in 15/16 is successful, the aim will be to use the learning to inform how it will be rolledout across the Borough this will be subject to a further business case in Summer 2015.

, promote community solutions and assure intelligent information sharing at the front door.


The Council with Partners will radically re-think how prevention services and safeguarding services areconfigured and delivered.

The Troubled Families programme/Supporting Families Pathway/Multi Agency Safeguarding Hub will remaincentral to this work and will facilitate further exploration of the full range of delivery models in existence acrossthe public, private and voluntary sector to understand commonality and duplication. This will include theexamination of existing/parallel structures and performance frameworks that have shared outcomese.g. Neighbourhood management structures; Community Safety structure; Support and Pathways into work;

Training and Skills offer; Life Leisure; Adult Services, Supporting People, Stockport Homes; Public Health, 0-25SEND and Inclusion Support Services; Private and Voluntary sector provision and the available resources used


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by schools.

In order to achieve the ambitious programme of change the Council and its partners will:

1. Review 10% (30 placements) of the high cost, low outcome placements by end of September 2014,followed by a review of all external placements by December 2014. The review will be supported bycolleagues across the system who can deliver skilled interventions with children and families to achieveidentified care plans for young people.

2. Undertake an in depth multi-systemic review of five high cost placements of young people 10-13 thatlooks at their trajectory into the care system by December 2014. Care plans and the actions againstthem will be evaluated to determine whether there is any efficiency that can be identified that mayrequire a re-working of priorities, the unblocking of potential solutions or additional resource toachieve a speedier resolution. We will look at how the cases came into C hildrens Social Care and howwe might have done things differently. This work will inform the way in which we shape, model andsustain services, going forward.

3. Undertake detailed modelling and tracking in 2014 to identify and support children at greatest risk of

coming into care as adolescents and to use this information to re-design key aspects of childrens socialwork. This work is to be completed by December 2014

4. Carry out an integrated pilot, to test new ways of working, which will commence by December 2014;this will release a C hildrens Social Care team manager and Social Work resource into one of theIntegrated Childrens Service locality areas to test delivering services differently, to a cohort of complexfamilies and children and young people on the edge of care. Core elements will include:

A resource of Social Workers from both Childrens Social Care (CSC) and the Integrated ChildrensService (ICS) will hold potentially high cost, low outcome cases in the locality.

The Safeguarding Unit will underpin the work by providing support to all key agencies ensuring children

are safeguarded and that Looked after Childrens care and social work practice is of high quality. AnIndependent Reviewing Officer will be seconded to the pilot to test new ways of working.

The work will facilitate the modelling of the future integration with ICS at scale The locality area chosen will be freed up to take a creative and flexible approach to case management,

including wider flexibilities within the current Section 17 budget to be used to avoid higher costplacements.

The locality will trial the delivery of systematic support and resource to reduce the risk of reception intocare and to develop a rigorous model of rehabilitation activity where placement is not in the bestinterest of the child/young person.

The pilot will develop different approaches to Child Protection, including a strengths based model.This will include an investigation of the Signs of Safety approach looking at best practice around

strength based methodology. It is proposed that the changes will allow for better use of expertise and evidence, and mean

professionals spend more time with children and families. The pilot will act as a blueprint for further changes to social work services and other areas focused on

practice, rather than process. The pilot will inform the Troubled Families workforce development strategy at a Greater Manchester

level.

5. Virtually Align Child rens Social Care with the four ICS locality areas by December 2014 and scale upsuccessful new ways of working.

Undertake a review of non statutory edge of care operational costs and delivery models by March 2015

6. Implement a workforce development programme at scale to develop an approach which would engagethe whole workforce to deliver a Stockport approach using a strengths based model delivered across the


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broad range of family issues. This will start in September 2014 with ambition to be fully implemented bySeptember 2015.

7. Undertake a review and renegotiation of our current service level agreements with schools and theSchools Forum to discuss with Headteachers the most effective role for the council in supporting schoolsto fulfil their legal responsibilities, but ensuring full cost recovery to the council where appropriate. Thiswill be completed by March 2015.

8. Review the level of funding for Early Education and Childcare across all providers, undertakingconsultation with key stakeholders to ensure that there is a fair balance to support sustainability acrossthe sector, and the funding is most ef fective. The focus will be consistent with the Councils key role inproviding information advice and guidance to parents to enable them to make informed choices for theirchildren, and working with the sector to support the Councils overall priorities. This will be implementedby March 2015.

9. Building on the establishment of the Integrated Childrens Service during 2014, we will review thecurrent early years and childrens c entre provision across Stockport to enable the most effective serviceto children and families within the available resources, and that this is prioritised to those most in need.

We will consult with all key stakeholders to investigate a range of options for Childrens Centres ,including redesigning to become Children and Families Centres. This will be completed by August toDecember 2014 with an ambition to implement by April to September 2015

10. Redesignate the offer to children and families in line with the Greater Manchester Public Service ReformProgramme this will require different roles, functions, processes, practices and skill base. This may leadto a reduction in the workforce by 2016.

11. Supporting Families Pathway/Multi Agency Safeguarding Hub we will develop the front door digital ininterface to incorporate an easy to use one public service approach that builds on the SupportingFamilies Pathway/Multi agency Safeguarding Hub and has the service user at the heart by September

2015.

12. The Troubled Families cost calculator evaluation tool will be used to build in an understanding of thecosts and the benefits of investment in early intervention will inform commissioning anddecommissioning in relation to Stockports Prevention and Early Help offer, particularly investment inservices which have an evidence base that prevent the escalation of need. This work will commence inSeptember 2014 and run for the duration of the transformation programme.

13. Review the delivery model of accommodation for young people 16 plus with input from StockportHomes by March 2015.

14. Ensure that skilled business support is deployed to enable social workers to focus on delivering highquality support and interventions to children and families by March 2105.

Appendix 4 outlines the project milestones.


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The proposal will radically re-think how we deliver services to children and families - the core aim is to providebetter services that respond to the level of need and/or risk faced by the child that enables better outcomes forchildren and families.

The impact of changing the current service model is outlined below:

Employees (Council and health)

o Input and support will be required from:o Estates and Asset Management regarding relocation and colocation of staff as well as

appropriate meeting and interview rooms,o Information and Communications regarding development of the ICT infrastructure to

enable both Council and Partner agencies online access to case managementdocumentation, and marketing and communications support,

o People and Organisational Development support for Workforce Development and HRadvice,

o Business Support for administrative support for the project itself as well as the collocatedteams. In addition, advice and guidance on Information Governance issues,

o Legal advice for any litigation queries,o Financial support for modelling and cost benefit analysis,o STaR regarding any contractual negotiations and savings or efficiencies that could benefit

the service.o Longer term vision of the programme is that this should increase efficiency across the integrated

workforce, freeing up time to enable the workforce to work intensively with vulnerable familieswith significant needs

o The proposal requires systemic cultural and behavioural change for service providers. The systemwill only change when people think and see in new ways, therefore the proposal is reliant on beingable to influence, persuade and negotiate changes to front-line processes and practice; a significantproportion of which are not under the control of the services leading the work .

o This will require very clear communication and access to materials/resource to support staff,managers and organisations to understand the changing landscape and what is expected from theirarea of work as well as that of others.

Children and Families

o More joined up service less duplication people telling their story onceo Consistency in service provision - one key worker co-ordinating their supporto The proposal requires cultural and behavioural change for service users greater emphasis on

individuals taking control shaping and articulating their needs, desired outcomes and supportrequirements .

o Families will know where to get support and navigate the system easier

Voluntary and Community Sector

o The need to grow capacity and develop skills and knowledge to meet the needs of the newservice model

Independent Sector


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- There will be opportunities for the redesign of some service areas that will be explored with arange of partners including the Independent Sector.

Healtho There will be further discussions with Stockport NHS Foundation Trust to ensure sound

financial planning and to agree the implications for proportionate share of the savings.

Government agencieso Negotiation with the Department for Education will be a priority to clearly communicate the

Stockport approach, to ensure an understanding of the benefits of the proposed integration, atall levels, to meet the needs of Stockpor ts Children and Families.

o There is a risk of capital claw back by the DFE for sites ceasing to be Childrens Centres. This willbe addressed by ensuring that all statutory Childrens Centre Services continue to be deliveredfrom Children and Family Centres. With the establishment of the Integrated Childrens Servicethere is joint management by Council and health staff of integrated teams.

Appendix 2 explains the core activities of the project and what the impact will be.

An equality impact assessment will be considered and carried out as part of the process to ensure that actionsare put in place to mitigate any disproportionate impact on equality groups. See Appendix 4 for details.(currently being prepared )


This project cannot be viewed in isolation and is linked to a number of cross cutting Investing in Stockportthemes:

Information, Advice and Guidance

Fundamental to the new system is accurate, appropriate and timely advice, information and guidance.Universal through to targeted and specialist services will require knowledge of all provision available to localresidents. We will require providers of services to be able to access details of service provision, self-referral orreferral routes and named contacts. The information should be digital by design. Service users should be ableto access information advice and guidance on local services, eligibility (and possible passport to otherservices/benefits) and referral routes through both digital media and face to face for the more vulnerablegroups.

Digital by Design

The new model relies heavily on the use of digital media and other ICT developments, including:

Integrated and aligned systems launch of the eCommon Assessment Framework (CAF) givingaccessibility to a number of trusted and trained support organisations including schools as well asaligned systems where we are not yet able to integrate e.g. Police systems

The development if the Stockport Health Record where health and social care information will beaccessible to health and local authority professional staff

Developing a central web presence to support both front-line staff and service users in identifying whatsupport is available and how to access or refer to more specialist support and assistance.

The project also closely relates to and incorporates other projects or work including:

Prevention Services Strategy and re-commissioning Project


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Health and Well-Being Strategy Public Service Reform Programme Supporting Families Programme Domestic Abuse Strategy Greater Manchester Early Years PSR Programme Prevention and Early Help Strategy New Belongings Pilot (Care Leavers) Children and Young P eoples Strategic Plan Stockport Safeguarding Board Strategy 0-25 Education Health and Care Plan Strategy Joint Strategic Needs Assessment (JSNA)


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8. Stakeholders

This Business Case cannot be achieved alone and will require the support of a wide range of stakeholders. TheManagement Team are working with a range of stakeholders to shape and progress this proposal. Theseinclude:Children in care

Staff Integrated Childrens Services and Supporting Families Pathway ParentsChildrens Safeguarding Board Childrens Trust Children in Care CouncilSchoolsEarly Education and Childcare providersElected MembersCorporate parenting groupVoluntary and Community SectorChildrens Homes

Stockport NHS Foundation TrustStockport HomesGreater Manchester PoliceStockport Clinical Commissioning GroupCollegesHealth PartnersAdult social careEmployment and skills servicesIndependent providersCorporate and Support Services

9. Consultation and Engagement

This Project will require formal consultation and engagement as it involves the development of a new deliverymodel which will lead to the reconfiguration of existing staffing arrangements.

A Consultation Plan is attached at Appendix 1.


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APPENDICES

1. Consultation Plan (attached)2. Activity and Impact (attached)3. EIA (attached)4. Project Milestones (attached)


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Appendix 1

Consultation

Please provide a rationale for choosing whether to consult or inform

If you intend to consult, please complete the table below:

Please indicate if you need toconsult internally and/ orexternally

Consultation internally and externally

Details of who you intend toconsult and whether there will bea geographical focus

Consultation with:- Staff- Parents- Local communities - Early Years and Childcare providers

- Head teachers- Partners- Elected Members

What you intend to ask them orthe aim of the consultation

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Reviewing the current early years and childrens centre provision consultation with stakeholders to investigate a range of optionsincluding reviewing the use of children centre sites and re-designing them to become Children and Families Centres. (Augustto December 14)

Consultation with key stakeholders to review the level of fundingfor early education and childcare across all providers to ensurefunding is most effective and there is a fair balance to supportsustainability across the sector.(August to December 2014)

Engagement/consultation on the pilot to be carried out in 15/16

15/16Engaging and consulting with stakeholders on the proposed newintegrated service model

What methods of consultation willbe used

Focus groupsOnline questionnairePaper questionnaire

The team that will be carrying outthe consultation

Officers in the Integrated Childrens Service with support fromPolicy, Performance and Reform

Period of consultation August 2014 onwards

What form the feedback will take Meetings, written, reports, verbal


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APPENDIX 2



2014/15

Pilot integrated delivery model to test new ways of working inone locality to a cohort of complex families and children andyoung people on the edge of care and use this learning toinform the roll out to a Stockport-wide model

Cohort of families in the Pilot have their needs identifiedearlier and are provided with intensive support to stop needsescalating further.

Learning from the Pilot will be used for the rollout across theBorough

Reduction in the number of children and young peoplereaching child protection levels and placed into care.

Review and re-commission 10% of high cost-low outcome carepackages and all externally placed Looked after Children.

A reduction in external placements

Review 5 high cost placements of young people aged 10-13

Efficiencies identified, re-working of priorities, unblocking ofpotential solutions/additional resource to achieve a speediersolution.

Virtually align Childrens Social Care with the four ICS localityLearning from the Pilot will be used for the rollout across theBorough Learning from the Pilot will be used for the rollout


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Scale up successful new ways of working Learning from the Pilot and reviews will be used to shapepractice across the Borough, and inform increased integratedworking with all partners

Review Accommodation options for looked after youngpeople aged 16 plus with input from Stockport Homes

Improved accommodation offer for Care Leavers aged 16plus

Detailed negotiation with universal and targeted servicesInformed workforce who are able to contribute to thedevelopment of the new service model

Communication, support, guidance and training for front linepractitioners in the new ways of working

Skilled workforce to meet the needs of the new servicemodel

Consultation on the Proposal to re-designate some or all ofthe Childrens Centre provision to re -align available resourcesto support children and families more ho listically

Redefining of Childrens Centres to become children and

family centres, with the potential change of use for someChildrens Centre Sites , ensuring the essential universal andpriority work is delivered

Consultation with Early Years sector on funding formula for Transfer of current council costs for administering payments


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early education for early education to be covered by the government grantto the Council in line with most other local authorities

Review current service level agreements with schoolsEnsure the most effective role for the Council in supportingschools to fulfil their legal responsibilities

2015/16

Implement the full integration of Integrated C hildrens Service

and Childrens Social Care

Longer term vision of the programme is this should increase

efficiency across the integrated workforce

Implement a workforce development programme at scale todeliver a Stockport approach using a strengths based deliverymodel.

Skilled workforce

Review the current early years and childrens centre provision Potential closure of some Childrens Centres sites

Review process, practices and performance on reducing levelsof child protection plans and Looked after Children toinclude feedback from service users and providers

Looked after children are supported better through theintroduction of effective processes and practices.

Develop the front door digital interface building on theSFP/MASH

Intelligent information sharing systems in place acrosspartners

Re-designate the offer to children and families This will require different roles, functions, processes andskills base this could lead to a reduction in the workforceby 2016.


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Appendix 3

Title: Integrated Prevention andSafeguarding Children and FamilyService

Date: 28 July 2014

Stage: consultation/ draft/ final

(delete as applicable)

Lead Officer: Kate Fitzhugh/DeborahWoodcock/Viki Packman

Stage 1: Do you need to complete an Equality Impact Assessment (EIA)?

Not all policies will require an EIA: these key questions will help you to decidewhether you need to conduct an EIA (see guidance notes at the end of this form).

An EIA is required for this Project as it involves a service re-design. The project aims tospecifically support the Councils following Equality Objectives:

(#1) Improving life chances, opportunities and aspirations for all by tacklinginequalities across our borough specifically looking at inequalities for vulnerablechildren and families and Looked after children.

(#3) Improving access to information about services and public spaces by increasing

the clarity of what we do, how we do it and how it can be accessed specificallythrough the Supporting Families Pathway and workforce development.

(#4) Giving the people of Stockport equal opportunities to identify & voice their needsand participate in developing and delivering services through co-producing a newmodel of service for vulnerable children and families.

However, it is anticipated that the Project will impact on the following ProtectedCharacteristics:

Disability ; (in relation to people accessing services)

Age; (in relation to people accessing services) Gender; (in relation to existing staffing demographics)

As well as the protected characteristics outlined above the following group has also beenidentified as potentially being impacted upon due to the implementation of a newintegrated service:

Socio-economic (in relation to client and staffing demographics) - Professionalassumptions understand that social deprivation and low income cuts across anumber of protected characteristics, for example women are proportionally morelikely to be in part-time or low paid work.


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Analysis of emerging learning from the suggested pilot alongside feedback from engagementwill deepen our understanding of the nature of this impact and seek to understandappropriate mitigating measures, including the way the new integrated service is designedand developed.

Stage 2: What do you know?

An EIA should be based upon robust evidence. This stage will guide you through potential sources of information and how to interpret it. Understanding the currentcontext is a key stage in all policy making and planning (see guidance notes at the endof this form).

Data sources that will be considered include:

Profiling Stockport Diversity and Equality Annual Report Ethnic diversity service data Performance data Staff data profiles Service user profile data Financial data Pilot projects JSNA data hub.

Specific areas that will be looked at include:

Analysis of current looked after children Analysis of vulnerable families; Analysis of existing support/interventions available; Best practice and national or sub-regional analysis; Staff profile and skills mix; Analysis of current market; Feedback from any previous or existing consultation or engagement activity; Identification of gaps; Identification of any emerging impacts;

Next steps for further data analysis (e.g. consultation)

We will be identifying data sources available in relation to the above; where there are gaps

identified we will be considering what consultation /data gathering will be required.


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Stage 2a: Further Data and Consultation

If you feel that the data and past consultation feedback you have is not sufficient to properly consider the impact before a decision is made then you may wish tosupplement your evidence base with more data or further consultation. This shouldbe proportionate to the scale of the decision and will depend on the gaps in yourcurrent understanding (see guidance notes at the end of this form).

This section will be completed upon analysis undertaken at stage.2.

At stage 2 any gaps identified will be explored further in this stage. This section willtherefore include the outcomes of any consultation and engagement activity.

Stage 3: Results and Measures

As a result of what you have learned in Stage 2 what will you do to ensure that no

group is unfairly and unlawfully impacted upon as a result of the proposedchange(s)? (see guidance notes at the end of this form)

This section will be completed to reflect and build on the learning within section.2

Stage 4: Decision Stage

Once your plan/policy is fully developed it will need to go through the correct scrutinyand approval channels: the EIA should be included as part of this (see guidance notesat the end of this form) .

This EIA is a live document and will accompany the decision at all points throughout theprocess.


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Page 1 of 20 Integrated Health and Social Care 4 th August 14


IIS Programme:

IIS Board SRO: Andrew Webb IIS Project Lead: Terry Dafter Portfolio: Adult Care Services; Health and Wellbeing Project Name: Integrated Health and Social Care


Terry DafterSally WilsonJoan BeresfordRoger Roberts (CCG)

Michelle Lee (FT)Elaine WhittakerHolly Rae

This will also include representation from the Voluntary and Community Sector and GP Federation.

INVESTINGIN REFORM


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1. Project Overview

The vision is for an integrated and joined up service health and care service with one pathway into serviceswrapped around the individual. Building on the lessons from Stockport One the aim will be to have oneassessment, one care record, one key worker and one integrated team of professionals from all backgrounds.

The model is predicated on integrated teams based around four General Practice locality hubs. These will formthe focus for all general community health and social care services. The programme is currently developing the

customer journey, pathways and locations for the services that form part of the hub as well as those linked andaligned to the hub.

The ambition is that locality hubs will offer a broad range of services, including; community health and socialcare services, pro-active identification and management of people who are at high risk of readmission tohospital, rapid response, co-ordinated management of people with complex needs, information and advice,peer support, outpatient services, tests and investigations. The intention is to offer a comprehensive approachto the whole of the local population including the community and voluntary sector and access to universalservices. As such self-care will be a fundamental principle.

A draft Equality Impact Assessment for this project is attached at Appendix 3 and will be further developed in

line with consultation.


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The following pieces of legislation, statute and national policy direction have a direct impact on the design andsustainability of any new integrated Health and Social Care model:

Care Act 2014 :o Finance medium to longer term costs resulting from deferred payments and payments cap. o

Activity potential increase in assessment and care management activity around carers andself-funders. This is particularly an issue in the short-term and likely to have an impact on multi-disciplinary teams.

o Finance medium to longer term costs resulting from deferred payments and care accountswhich will result in a payments cap. Expected increase in requirement for financialassessments.

o Activity anticipated increase in assessment requests linked to potential changes in eligibility,self-funders and carers. Models of assessment may need to be reviewed to respond to theethos of the Act and likely demand. This is likely to have an impact on multi-disciplinary teams.

o Information, advice, advocacy increased expectations of the range of information and adviceavailable, including financial advice. A diversity of formats for information and advice to meet

individual needs including disability and ethnicity. Advocacy services to be available for peoplethroughout the process of having contact with the local authority where services and support isbeing requested.

o Community support emphasis on the development of asset based community support. Linkswith the requirement to prevent, reduce, and delay needs.

o Carers new responsibilities for offering advice, services and support to carers including whenthe cared for person is not eligible for services

o Personalisation good practice linked to self-directed support now a requirement, withexpectations of giving people control throughout the process, transparent sharing of personalbudgets, support planning and Reviews linked to achievement of well-being outcomes.Expectations of having a single holistic plan which brings together health and social care. Linkwith the introduction of personal health budgets.

o Transition expectations for children transiting to adult services; linked to statutory changesaffecting childrens services

o Commissioning, market development and market failure changes in commissioning behaviourto develop a diversity of provision avai lable for people to choose. Changes to top uparrangements for care home and community services. New requirement to step in, in the caseof provider failure to ensure continuity of care.

o Safeguarding parity of esteem with Childrens Safeguarding will bring further operationalpressures

Healthier Together reconfiguration of hospitals across Greater Manchester part of a national drive toreduce increasing costs within the acute sector;

Existing Health and Adult Social Care legislation and frameworks which determine the Councilsstatutory responsibilities with regards to service provision and client groups.

Further interdependencies are outlined below including links to related projects.


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The overall investment across these services currently stands at 45.5m. We anticipate that the future(2016/17) in investment in this area will be 29.9m. In order to achieve this ambitious programme of change,the total investment can be summarised as follows:

Year 000sBaseline 45.5m2015/16 37.7m (7.8m reduction)2016/17 29.9m (15.6m aggregated reduction)Beyond TBC


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Operational Hours 7 Day Working will operate. The exact details of this (andhours) are still to be determined.

Staff Requirements Outlined within the staffing section.Multi-agency or IntegratedApproach?

Both, an integrated locality team is a fundamental aspect tothe model. However, for this model to be sustainable, clearerlinks and routes need to be made to teams or services

(including independent providers) outside of the localityteam.

Will there be any change to currentlevels of service?

The vision of the programme is to reduce serviceconsumption within the acute sector and affect demand forhigh cost adult social care by enabling individuals to self-careand access low level support within the community. As suchthe longer term would see a reduction in service levels.

Will customers notice any change tothe current service provision?

Not a change in level of service, but a change in who they arereceiving support from (e.g. Independence workers or otherlocality team members)


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To achieve a new integrated service delivery model, this project will involve a review of existing spend toenable a shift of resources from the acute (i.e. Hospital) sector to community based services and a review andreconfiguration of staffing across key provider partners into an integrated service with a greater emphasis andinvestment on prevention and self-care.

Headline Milestones for the Programme are outlined below:

2014/15 Phase 1: Alignment of services in first hub (Marple & Werneth)

Initial staffing alignment. There are no staffing reductions anticipated in this phase.

Phase 2: Integration of services in first hub (Marple & Werneth) Continued staffing alignment and team integration. There are no staffing reductions

anticipated in this phase.

2015/16 Phase 3: Alignment and Integration of services in 3 remaining locality hubs and borough wide review of

specialist services Staffing review and reconfiguration in order to deliver an integrated service . There are no

staffing reductions anticipated in this phase.- Saving targets set against this year are expected to be met through a 3m transfer from the

NHS (Better Care Fund) and through deflections and contribution from the wider Health andSocial Care economy to support transition to a new service. Negotiations are underway withStockport CCG regarding deflections and contributions from the acute (i.e. hospital) sectorresulting from the implementation of a new integrated locality model.

2016/17 Phase 4:

- Recommissioning exercise of existing contracts. - Outcome of staffing review and reconfiguration to be implemented. It is unclear at this stage

whether there will be any reductions in staff levels.- Negotiations are underway with Stockport CCG regarding deflections and contributions from

the acute (i.e. hospital) sector resulting from the implementation of a new integrated localitymodel.

Further detail is set out in:

- Appendix 1 Activity and Impact Schedule- Appendix 4 Project milestones


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The impact of changing the current service model is outlined below:

Employees (Council)o In the short-term there will be a need for additional capacity to transition into the new model of

delivery. This should also not be seen in isolation of other capacity requirements for social work teams

including; implications of the Care Act; implementation of the Resource Allocation System (RAS); ageingpopulation; review of safeguarding and anticipated demographic challenges, particularly in OlderPeoples Services.

o However, the longer term vision of the programme is this should increase efficiency across theintegrated workforce, freeing up time which would enable them to work with those individuals withsignificant needs who require formal health or care support.

Carers and Individualso More joined up service less duplication people telling their story once;o Greater emphasis on individuals taking control - shaping and articulating their care needs, desired

outcomes and support requirements;o

Consistency in service provision (one key worker coordinating their care)o People feel more connected to their local community

Voluntary and Community Sectoro Potential for greater opportunities within local market for voluntary and community sector

organisations.o The need to grow capacity and develop skills and knowledge to meet the challenges of the new service

model.

Independent Providerso Likely increase in demand.o

Potential for new opportunities for service developments requiring potential additional capacity, skillsand knowledge.o Greater role in shaping new model.o Potential new entrants coming into the market

Healtho Initial modelling on the financial impact surmounting from deflections from Emergency Department are

outlined below:PARR Category Cohort size Engagement

Rate Deflection Rate Combined Rate Cost Savings

Very High 1,832 100% 75% 75% 7.6 million

High 4,679 100% 75% 75% 7.5 million Moderate 14,331 80% 80% 64% 7.8 million Low 218,450 10% 15% 1.5% 92,000 Total 23 million

Further work is required to understand wider health implications from the implementation of a newintegrated model (e.g. reduced bed days)

o Similar issues for Community Health Services as outlined in the Employee (council) section with othersignificant service developments (e.g. remodelling of Community Nursing Service)

The expected timeframes for these impacts are set out in Appendix 1 Activity and Impact Schedule


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This project cannot be viewed in isolation, ultimately the sustainability of a new integrated community basedcare model is based on the following areas and programmes of work being developed and delivered alongsideeach other:

Sustainable Community Networks (i.e. developing community capacity, work on going within People

Powered Health); Appropriate Preventative Offer (i.e. review of Preventative Services contracts, review of Public Health); Sustainable Social Care model (i.e. implications of the Care Act; implementation of Resource Allocation

System (RAS); Review of other social care services including Learning Disability Services); Fit for purpose hospital provision (including any review of the Emergency Department)

Specifically, this programme links to cross-cutting IIS themes and other projects of work:

Information, Advice and Guidance Fundamental to a new integrated model will be a greater focus onprevention, independence and self-care for all individuals whether they are already in receipt of services ornot. This underpins the principle of the programme to enable people to make positive lifestyle choices and

take control of their own care. Appropriate and timely advice, information and guidance is clearly key tothis. Specifically this IIS theme will link to the following projects (which contribute to or link in with theIntegration Programme):

o Targeted Prevention (including People Powered Health)o Preventative Services

Digital by Design An element of the new model will involve capitalising on the use of digital by design andother Information Management & Technology developments, including:

o Tele-health and tele-consultation;o Integrated Health and Social Care Record;o Integrated (or aligned) systems

Preventative Services Strategy and recommissioning exercise.

Learning Disability Review 0-25 Disability Review Whole Health and Care economy transformation programme, including the following specific programmes

and projects:o Urgent Careo Reform of General Practiceo GP Cover for Care Homeso Prevention and Health Literacy

Better Care Fund single pooled fund to support integrated working. Currently undergoing a review byGovernment.

Any work or review within Public Health.

Review of Community Services within the Foundation Trust. Review of Community Mental Health Services within Pennine FT. My Place project (linked to community capacity building) Implementation of the Learning Disability Self-Assessment Framework (SAF) Adult Social Care Customer Journey programme End of Life Reconfiguration


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8. Stakeholders

This Business Case cannot be achieved alone and will require the support of a wide range of stakeholders. TheManagement Team are working with a range of stakeholders to shape and progress this proposal. Theseinclude:

Pennine Care FT Independent Providers

Client Groups Community Sector Carers Elected Members Stockport FT Stockport CCG Voluntary Sector


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APPENDIX 1



2014/15

Expand the work in the Marple and Werneth area to test out the new modelof provision at scale.

People and their CarersDevelopment of stronger community networks and support

People supported closer to home

Testing of new model in Marple and Werneth may result ininconsistency of services in the short-term

Employee

Stockport Council budget business cases 2015-17

Documents