Total Place delivering more for less in the Public Sector
Jayne Bench
Head of City Finance
Be Birmingham
Birmingham’s Total Place ambition
3 objectives
• Put citizens at the heart of better service delivery
• Identify efficiency savings
• Develop new collaborative leadership
Its about …• Service redesign rather than modification, doing
different things
• Prevention and early intervention rather than treating the consequences
• Being a public servant for Birmingham’s Citizens
• Developing self-reliance
• Giving the People a voice
• Moving from a factory model to a citizen focussed model
What we did• Map expenditure and investment in the city of
Birmingham
• Total of 50 partners contributed
• Identified total Public Sector spend of £7.3b in 2008/9
• Assessed the extent of aligned investment behind the community strategy
• Identified six thematic areas as part of the Total Place pilot
Top Funding sources across the CityTop Ten Funding Sources (£million)
26
50
43
105
279
239
699
1,918
3,657
0 400 800 1,200 1,600 2,000 2,400 2,800 3,200 3,600 4,000
WM Probation Service
WM Fire Services
AWM
Home and Communities Agency
LSC
WM Police
Job Centre Plus
PCTs
Birmingham City Council
`
Organisations funding ‘mapped onto’ partnerships
Spend by Partnerships (£m)
114
267
323
825
1,083
1,674
2,136
0 500 1,000 1,500 2,000 2,500 3,000
EnvironmentalPartnership
Culture Partnership
Safer BirminghamPartnership
City Housing Partnership
Economic Prospectus
Children and YoungPeople Partnership
Birmingham Health andWell-being
Where might savings come from ?• More citizen, neighbour and community reliance
• Prevention instead of cure
• Higher staff motivation
• Stopping of activities which adds little value
• Less duplication
• Reduced re-working
• Simpler delivery processes
• Lower overheads
A move towards Outcome Based budgeting ?Outcome based budgeting provides the opportunity
to:
• Obtain stakeholders input identifying concerns and needs
• Set broad goals that provide overall direction and serve as a basis for decision making
• Establish priorities assessing community needs, challenges and opportunities
Continued
• Commission costed, time limited, programmes from who ever is best to deliver them
• Budgets to be held by the core organisation for the relevant commissioned programme
• Develop a practical approach which can lock in savings for future years by focussing on outcomes rather than processes
Financial planning
• Develop a financial plan that moves towards the achievement of goals, within the constraints of available resources
• Define a budget process which:3. Incorporates a long term perspective4. Establishes linkage to broad organisational goals5. Focuses budget decisions on results and outcomes6. Involves and promotes effective communication
with stakeholders
Presenting the data…
Early intervention
With thanks to Aperia and CACI
Early intervention - principles• Invest in research proven blue chip prevention &
early intervention programmes.• Avoid investment where there is little evidence of
effectiveness.• Keep abreast of latest research findings to
determine how to use taxpayers money wisely.• Evaluate funded programmes to determine if
benefits exceed cost.• Pay attention to quality control and fidelity.
Case Example Incredible Years• Incredible Years pilots in 6 children’s centres (RCT’s)
• Cost of conduct disorder (Scott, Knapp Maugham 2001) 10X no behaviour problems plus demand on services
• Largest cost crime –US studies (Tom Dishon) adolescent delinquency £56000-£232000 & adult crime $1.2m
• Success rates of evidence based programmes for very young 75% in adolescents 25%
• Benefit realisation includes savings 2.1 over 15 years
Steve Aos Economic modelling• Early indications of benefits beyond the confines
of the LA suggest they could be over £400m over 15 years – a benefit of 6:1.
• Data from UK pilots not yet available – we need to develop different assumptions from the US model.
• Does provide an indication of the benefits which could be to communities and local and central government from a coordinated approach to implementation of evidence based interventions.
Transforming early years
Service Transformation Benefits identified Costs identified
Incredible Years 16,997,145 3,381,137
Team Around the Child 16,000,000 8,200,000Preventing Adolecent Long Term Placement 29,938,896 10,053,250
Triple P evaluation 897,000 692,600
Parenting programme roll-out 52,399,531 2,181,685
Family Nurse Partnership 1,028,376 GrantTotal: 117,260,948 24,508,672
Drugs & Alcohol
With thanks to Aperia and CACI
HealthSubstance Services
Public Services
Emergency Services
Justice
Police
BCC
Drug & Alcohol Service Providers
NHS Business Services
Hospitals
PCTs
GPs
Probation
Prison
DIP
Arrest
DAAT
Crime
Arrest Out of Hours Calls
FireIncidents
DIP Referrals
Opinion Survey
Children (CareFirst)
Housing (SX3)
WMPHO
BHWP
Needle Exchange Commissioning
Service Provider Commissioning
Case Management
Case Files
Prescribing Data
Aggregate Hospital Episodes
Monitoring NDTMS
Hospital Records
Case Files for Patients
A+E Admissions flagged for Substance
Offender Assessment
(OASys)
Accredited Programmes
(IAPS)
Prison Records
SPOC Call Centre
Revs / Bens (Northgate)
Adults (CareFirst)
Public Health Mortality Files
Courts
Sentencing Records
Mental Health Trust
Drugs and Alcoho l Data Map
Consolidated Cost Index arising from Drugs Misuse:1) Birmingham Opinion Suvey - Proportion who say
that people using/dealing drugs in the local area is a big problem
2) Police Data - Instances of Drug Possession crime3) HES Data - Inpatient Admissions for Drug Misuse
The Consolidated Demand Index arising from Drugs Misuse:
2) DAAT Needle Exchange Volumes - Pharmacy Level aggregated to Ward
3) NHS Business Authority - Spend on prescriptions relating to Opiate Dependence
4) Police Data - Drug Possession Offenders
5) Probation Service OASys - Drug Offenders with Criminogenic Need
6) Demographic Propensity - derived from ACORN profile of Drug Offenders
The Consolidated Cost Index arising from Alcohol Misuse.
1) Birmingham Opinion Suvey - Proportion who say that people being drunk or rowdy in the local area is a big problem
2) Police Data - Instances of ARV crime (Alcohol Related Violence)
3) HES Data - Inpatient Admissions for Alcohol Attributable Reasons
Drug Offenders – by Birmingham Segments
Produced by Customer Knowledge, BCC24/02/10Copyright © Experian Ltd 2010. Copyright © NAVTEQ 200 7. Based on Crown Copyright material
Birmingham Segment Group Count % BCC % Index
A 21 1.64 5.73 28.64B 17 1.33 3.74 35.52C 61 4.77 10.24 46.55D 40 3.13 2.72 114.75E 129 10.08 13.87 72.68F 399 31.17 13.28 234.73G 41 3.20 7.10 45.11H 181 14.14 11.70 120.83I 218 17.03 12.43 136.97J 145 11.33 11.59 97.76K 13 1.02 3.37 30.10L 15 1.17 4.22 27.74
Segment Group profiles
Group F
Group i
The True Cost of Drugs in Birmingham – Per Annum
Benefits
Hospit
al Adm
issio
ns
Criminal Justice System Other Spend
DAAT
£27.8m
£33m
£15m
£2.3m
£??m
Drug Treatment ProvisionPooled
Treatment
£13.1m
Drug Intervention Programme
£5.3m
Birmingham City Council
£1.3m
£3.7m
£1.08m £3.4m £15.6m £1.4m
•Police•Adult Social Services•GPs•Families•Schools•Mental Health Trust•Acute Trust•Probation•Prisons•Housing
•Single Point of Contact
•DATUS Peer-led Advocacy•DIP (BCC)•DIP (ARW)
•Needle Exchange•Outreach•Inreach
•Addaction•DIP CARAT
•Midland Heart•SADIE•KIKIT•BBV
•Community Outreach•GP Prescribing•CDT/DIP Prescribing•Swanswell•Turning Point•Safe project•EESPro•DRR•Mother & Baby
•Residential Rehab•Detox
•Structured day care
Tier 1 Tier 2 Tier 3 Tier 4
PCTs
£5.6m
Other
£357k
DoH Tier 4 Grant
£1.3m
Professional
Self
referral
Advisory
Service Journey
DannySEGEMENT:- Drug AddictGENDER:- MaleAGE GROUP:- 25-40RELIGION:- n/aSTATUS:- SingleDEPENDANTS:- 1 child
How do we measure his outcomes?
Customer Journeys
Ups
and
dow
ns o
f the
cus
tom
er e
xper
ienc
e
Key journey steps
Agency Touch-points
1991 2000 2008 2010
Suicide Attempt, A+E Admission
Relapsed upon release from hospital
Suicide Attempt, A+E Admission
Relapsed upon release from hospital
Suicide Attempt, A+E Admission; detoxed
Relapsed upon release from hospital
Medication treatment from GP
Off sick with depression
Started drinking JD with current partner who's alcohol dependant
Arrest and sent to hospital due to sickness and shakes
Forced 9 day Detox
Social Services Intervention around child
1st session; Search for activities (dance)
2nd session
Book appointment at GP for depression
Argument with Neighbours
Relapsed over weekend
Controlled drinking; Abuse from neighbours ongoing; Seeking help from Housing Seek additional
support for son
Arrange transfer meeting
Child in Need meeting with Social Worker
Depression
Unsure if employer support her
Depression – drink to cope with life Depression
Humiliated
Motivated to sort life out Worried
about son’s care
Hospital Hospital Hospital GP Police
Hospital
Alcohol Services
Social Services Social Services
Alcohol Services Alcohol Services
Social Services
EducationHousing
38 yrs old. FemaleLives with 7yr son Older 18yr son who’s left home
2005
Drank with friends at home; family drink dependent
Caught in Abusive Relationship
Argument with rowdy neighbours who stop her sleeping after night shifts
Customer Journeys
Ups
and
dow
ns o
f the
cus
tom
er e
xper
ienc
e
Key journey steps
Agency Touch-points
Apr 2008 Sept 2009 Oct 2009 Nov 2009
Breakup of relationship and lost contact with children
Starts Drinking
Starts sick leave from job as Fork Lift truck driver
GP referral to Alcohol Services
Applies for Disability Living Allowance
1st Session with RAPt
DNA 2nd Session
2nd Session;
Referral to Aquarius for detox
Lost job due to drinking
DLA Claim rejected
Paul fails to start detox with Aquarius
Appeals decision over DLA
Several DNAs so RAPt case file closed
3rd RAPt session
4th RAPt session;
GP Alcohol Services Alcohol Services Alcohol Services
36 yrs old MaleLives with Mum and Dad after partner left him and took two sons away
Depressed
Stressed and of very low mood
Motivated to engage services to keep benefits
Felt ‘rushed’ into detox
Alcohol Services
Social SecuritySocial Security
Feb 2010
Gangs
Offence Type Cost in Anticipation
of Crime
£
Cost as a Consequence
Of Crime
£
CJ Costs
£
Total Cost
£
Homicide 374 1,314,362 144,239 1,478,975
Att Murder/Serious
Wounding
1256 481,478 78,243 560,977
Criminal Use of Firearm
798 120,198 48,724 169,720
Robbery 348 4698 3298 8344
Details of criminal activities and offences has been mapped
Gang Member’s familial networks and criminal histories have been mapped
Obligate and Dynastic
Families
Criminal Justice Costs£2.7m