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GM Whole Place Community Budget Summary of approach Objectives and priorities The Greater Manchester strategy focuses on reducing dependency on public services through public sector reform and supporting economic growth through greater workforce productivity, reduced worklessness and improved skills. The Whole Place community Budget is at the very heart of this, taking a radical view on service delivery models that will reduce dependency and failure demand whilst promoting independence resulting in a fundamentally different relationship between public services and citizens. Our experience shows that current public services are often fragmented and uncoordinated, addressing symptoms not causes resulting in poor outcomes at high costs. The Greater Manchester pilot aims to move away from this unplanned reactive and high cost spend towards a more transformational reduction in demand whilst moving the most challenging people and places towards self-reliance. Essential to success will be breaking into the cycle of high cost demand and dependency at the earliest stages of intervention and prevention. The Greater Manchester concept of a community budget is one that involves joint investment and resources supporting a range of new delivery models, delivered through new investment agreements where partners achieve a return on investment based on robust evidence and evaluation. Successful implementation of the Greater Manchester pilot will largely be dependent on the level of ambition and innovation demonstrated locally and the ability to develop propositions that gain the support of Government Ministers. Thematic areas within the Greater Manchester pilot Four key thematic areas are being progressed through the Greater Manchester pilot: Taking troubled families out of dependency through joint agency working and integrated commissioning, identifying effective sequencing, prioritisation and integration of support. Improving Early years provision focused on school readiness to deliver longterm increases in earnings and workforce productivity and short-term benefits on cost avoidance from reduced demand on services and potential reduction in looked after children. Transforming justice and reducing re-offending working across criminal justice agencies, health and local authorities, building on small-scale exemplars such as intensive alternatives to custody and greater use of conditional discharge. The focus of health and social care is of meeting the needs of vulnerable people, promoting independence, reducing demand, and ensuring good quality, financially sustainable services Each theme is explored in more detail in the annexes attached. Underpinning the delivery of whole scale reform within these areas are cross-cutting themes developing new investment models, delivery models, workforce skills and culture. A further workstream is taking a whole place view of Greater Manchester, identifying demands on public services across the whole geographic areas and informing the most appropriate level for service design and delivery. New Delivery Models Each exemplar area is developing their own approaches to service delivery. To ensure optimum benefit from this work we are also exploring whole systems approaches to new ways of working that cut across all theme areas. These will incorporate transformational approaches, shifting from models where professionals work within their organisational fields and organisations to new models incorporating hybrids of existing roles and delivery streams. Key Timeline Phase 1: March – June 2012: Phase 2: May – October 2012: Phase 3: Post October 2012: Develop a clear plan Route-map that Develop a number of for reducing defines which working working examples of dependency and examples of Community Budgets supporting growth Community Budgets across the four across Greater and other products will workstreams that Engagement Manchester. Scaling be implemented when, operate at different Engagement will form a key element of the delivery of the pilot inupparticular to informing what works based during 12/13 and in spatial levels. an understanding of what currently works and in helping to shape the development of on evaluation future years new delivery models. Existing intelligence from partner agenciesevidence and service users will of tracking be crucial in the successful delivery of our objectives and will beoutcomes draw together to form a wide picture of customer experience and expectations. Specific opportunities will arise to undertake more specific engagement activities during the development stages of the pilot work which will inform the development of future service delivery models. Governance arrangement The delivery of the pilot is overseen by the Public Service Reform Executive, comprising Chief Executives and senior officers from partner organisations across Greater Manchester. As part of their role the executive is responsible for providing strategic direction and challenge to the thematic areas of work and the pilot overall. They are themselves responsible to the AGMA wider Leadership Team and Leaders through the AGMA Executive and Greater Manchester combined Authority. The Greater Manchester pilot will also report in to the overall national governance arrangements for the four pilot areas. To ensure alignment with the Deal for Cities work, the Greater Manchester Community Budget will reporting in to their governance structures. In addition the troubled families workstream will engage effectively with the Troubled Families Unit to secure maximum benefit and alignment. Project team A core team of officer has been established to drive the delivers of the pilot, incorporating both local officers and government officials working together, bringing together Local Authorities, Health, Police, Probation, Community and Voluntary sectors. From the core team leads for each for the thematic groups have been identified and are directly responsible to the Programme Director. Each team will deliver an agreed project plan which will identify what currently works well, what could be scaled up across the GM area and how new delivery models could be implemented. Further information Further information is available from Vicky Sharrock at [email protected] Annex A: Troubled Families The aim of this workstream is to take troubled families out of dependency, to connect to opportunities for growth across the conurbation, scaling up existing work in neighbourhoods and districts. There is now an even greater national focus on troubled families, given the Government’s announcement of £448m of for local authorities to drive progress on turning round the 120,000 most troubled families over the life of this Parliament. This will be primarily on a Payment by Results basis, with Government funding 40% of the costs and local partners expected to find the remaining 60%. Government estimates there are around 8,090 troubled families in GM, and wants to take all of these families out of dependency in the lifetime of this Parliament. Success could generate significant savings and contributions to GM growth. For example, Manchester City Council estimates taking 4,000 families out of dependency could save £50m across the public sector. This work will look at the scope of greater GM level of working on troubled families across the conurbation. This workstream should establish new investment models in which partners see a return on joint investments for troubled families. In particular, ensure all partners have the ability and freedom to jointly invest in multi-agency investment funds, underpinned by investment agreements – to ensure all the benefits of working in this way can be captured by upfront investment. These investment models will be based on locally-specific new delivery models that integrate commissioning and delivery across all the partners that support troubled families. The work should ensure all partners have the operational freedoms to adopt these new delivery models, including effective sequencing, prioritisation and integration of support across agencies. Robust evaluation evidence should be produced that show the incremental financial and non-financial benefits of new delivery models over business as usual. The workstream will also need to engage effectively with the Troubled Families Unit to secure maximum upfront investment, recognising the particular challenges in cities and boroughs with high concentrations of troubled families. Those cities will have to invest significantly greater resources in new delivery models that are as yet unproven. Upfront financing will be required to share the risk, for example through enhanced attachment fees. Work with Government will need to include agreement about how the proceeds of success are apportioned. Links to worklessness There is clear overlap between reducing worklessness in GM and turning round troubled families given the clearest route out of dependency is through work, which may well require action to improve skills. There will be significant overlap here with the Deal for Cities agenda and this project will ensure effective connections are made to make progress on both fronts. Many troubled families have inter-generational worklessness, nobody working in the household, few if any formal qualifications and low levels of aspiration and resilience. There are strong incentives for the connections to be made with: - JCP districts, who are measured by their ability to move people off benefits and back into work quickly, particularly within 12 months – JCP districts can refer troubled family cases to these new delivery models and have greater financial flexibility to invest in shared local priorities - Work Programme primes, who receive PBR funding from DWP when they support people back into work, and who receive referrals from JCP – primes could refer troubled family cases to these new delivery models as a basis for joint delivery and investment models - European Social Fund (ESF) providers, who also receive PBR funding from DWP for supporting individuals within complex families back into work, and achieving prework outcomes – representing additional capacity within districts and across GM that needs to be integrated with these new delivery models - GM work on a stronger local element to skills commissioning alongside the Deal for Cities process, including work led by New Economy to bid for ‘Employer Ownership of Skills’ pilot status Annex B: Early Years The aim of this workstream is to improve school readiness, to support the MIER and GMS priorities of improving long-term earnings and workforce productivity. This is essential to supporting long-term growth across GM. Longer-term effects should be manifest in shorter-term improvements to early years indicators, school attainment, and school attendance. There may also be short-term benefits from reducing the incidence of children taken into care, which would avoid significant costs for GM districts and their partners. This will build on the work of the existing GM high-level task and finish group, to - develop a joint outcomes framework, incorporating GMS indicators - identify scalability factors that support investment, and - create an enabling workforce. New delivery models and investment models will be developed for specific early years interventions that have a strong evidence base (e.g. speech and language therapy, parenting courses) that are closely linked to those for troubled families and transforming justice. We will also examine the evidence base for interventions that improve aspirations and enhance resilience. This workstream will involve close working with Government to increase the pace of progress, and to ensure all the GM organisations involved have the freedoms to invest in new investment models and the organisational flexibility to embrace the new delivery models developed. We estimate that raising long-term average earnings of GM residents to the national average could boost GVA by £340m p.a. or more, and short-term cashable savings of £2m p.a. could accrue to local authorities for every 1% reduction in the number of Looked After Children. Annex C: Transforming Justice This work aims to reduce reoffending, and reduce demand across criminal justice agencies, health, housing and local authorities. The aim set out in the CB bid to Government is to achieve a 30-40% reduction in the reoffending rates of priority groups who have the biggest impact on individuals and communities. This will mean generating evidence-based new delivery models for point of arrest, point of sentence and point of release, building on small-scale exemplars such as intensive alternatives to custody and greater use of conditional discharge. There is significant latitude within this high-level target to define cohort, timescales and baselines. Multi-agency investment funds will be developed across the full range of partners that benefit from reduced demand on the criminal justice system, underpinned by investment agreements. We will work with Government to overcome blockages to joint investment and effective multi-agency delivery models from local partners, and aim to scale up the 30-40% reductions demonstrated in neighbourhood pilots across GM. This work will need to maintain the fidelity of the MoJ’s evaluation of its Financial Incentive Model, which is one of two national Justice Reinvestment pilots that rewards places for reductions in demands on the criminal justice system. The Community Budgets work will build on the GM FIM to drive progress at a much greater scale, setting out how to invest in transforming justice interventions that reduce demand across the whole public sector, not just within criminal justice. Annex D: Health and Social Care The aim of this theme is to support the development of new investment models and new delivery models that help meet the health and social care sectors’ Public Service Reform objectives. In particular, meeting the needs of vulnerable people, promoting independence, reducing demand, and ensuring good quality, financially sustainable services. The context is the very high costs of poor health in GM, significant cost pressures in the system, a lack of coherence and join up across the health system and the local authority social care system, overlaid with rising demand pressures amidst year on year reductions in spend. Continuing ‘as is’ is simply not an option. A key output of the work will be creating the system leadership conditions that enable fundamental and transformative approaches to health and social care integration from the perspective of the citizen. To develop new delivery and investment models, the theme will: 1. State the Case for Change in Greater Manchester Detail a granular picture of the current costs and activity across the separate health and social care systems at the two spatial levels of local and Greater Manchester wide, set against the demographic and financial challenges facing Greater Manchester. This will provide a compelling case for change for partners across GM and to inform the national picture of the urgent need for new delivery and investment models in health and social care. 2. Articulate the Future Model of Integrated Health and Social Care in Greater Manchester State the Vision for health and social care in Greater Manchester; the Principles of integrated health and social care; the role of the citizen, and how they will be empowered through new delivery models. We will, using worked examples, highlight the priorities for long term preventative action and wellbeing promotion to reduce long term demand; create new delivery models for integrated health and social care provision for older people, people with long term conditions, people with disabilities, mental health provision and urgent care. We will state the forecast allocation of spending across the health and social care spectrum as a result of the future integrated model, showing for example, the move in proportion of spend from hospital and acute services to community based provision. 3. Provide the Roadmap to the Future Highlight and scale up good quality existing reform initiatives operating across Greater Manchester at a local level which are already contributing to new ways of working to deliver a better service at lower cost. We will develop new Community Budget Exemplars, with Investment Agreements between different partners that align incentives and share the benefits of new delivery models. This will include co-designing funding and incentive systems with government based on outcomes rather than activity, and agree how the proceeds of success are shared between Government and GM. We will identify the blockers to reform and articulate the solutions, at a local, GM and Whitehall level. The roadmap to the future will detail system level changes required to deliver high quality, integrated health and social care, using specific Exemplars to illustrate where and how a Community Budget approach can make a discernable impact. This will include for example, population level activity supporting improved health and well being; Early Diagnosis / Case finding / Targeted upstream services; Integrated Self Care including Telecare / telehealth;