Community Budgets

Written evidence from West Cheshire (CB 09)

1. Introduction

1.1 This response is submitted on behalf of West Cheshire public service partners.

1.2 West Cheshire was selected in December 2011 as one of four Whole Place Community Budget pilot areas. The pilot is referred to locally as Altogether Better. The objective was to produce detailed business plans setting out how local public services could be better integrated in order to improve outcomes for residents, to jointly manage demand for more costly services and to reduce costs to the public purse.

1.3 Between March and October 2012 the business plans were developed in collaboration with all local agencies, the voluntary and community sector, the private sector and Government departments.

1.4 Six plans were produced setting out a critique of current services and funding arrangements, proposals for a new delivery model and a full cost-benefit analysis (see www.altogetherbetterwestcheshire.org.uk for further details). A summary of the plans is set out below:

Plan and focus	Headline proposals	Cost-benefit analysis (cashable and non-cashable)
1. Families Together: The local response to 525 troubled families / families with complex needs.	• Dedicated family advocates responsible for supporting the family, coordinating interventions across agencies against a single plan, and enhancing family resilience. • Shifting towards family based-assessment across public services. • Introducing family budgets and a menu of interventions so that key workers can unlock local support with minimal bureaucracy. • Multi-agency investment in the new delivery model to make it sustainable and equitable.	It is estimated that this project will avoid future costs and release savings of £2m (net) over the next five years.
2. Early Support: A partnership-wide approach to early intervention for children and young people	• A single point of access for early support services. • A multi-professional team to deliver early support interventions. • A clear specification for early support services to inform joint commissioning of programmes and interventions with a strong evidence base.	It is estimated that this project will save approximately £1.5m over the next four years.
3. Work-ready Individuals: A joint approach to enhancing employment and skills.	• Introducing joint assessment and case management processes across employment and skills services • Co-locating employment services including Job Centre Plus, Local Authority Services, the Work Programme and National Careers Service. • Putting in place tailored approaches to support Employment Support Allowance claimants (ESA WRAG group); work programme returners; young people not in education, employment and training; and over 50s. • Introducing a new governance mechanism to ensure more locally responsive skills and employment offer • An economic growth programme, which seeks to boost local growth, jobs and skill levels.	- It is estimated that this proposal could result in a total saving of £18.6m (from a reduction in benefit spend – i.e. Annually Managed Expenditure) over five years by working more effectively in partnership.
4. Safer Communities: A partnership approach to tackle the causes and impact of domestic violence.	• Multi-agency case management teams for perpetrators and offenders • Multi-agency investment in evidence-based interventions e.g. Perpetrator programmes, recovery programmes, Integrated Offender Management, accommodation support, tagging, awareness programme	It is estimated that over five years this new model will release savings and avoid future costs to public services of around £7.6m (net).
5. Ageing Well Integrated approach to support older adults and reduce demand on acute and residential care.	• Integrated care: Joint health and social care teams and specialist interventions to support the management of long term conditions in communities and reduce demand on acute / residential care; • A new funding and contacting model: Examining options for a new funding and contracting model to ensure the appropriate incentives and mechanisms are in place to shift resources into prevention and community-based support. • Stronger communities: Investing at a greater scale in low-level community support such as befriending schemes, support to carers; local area coordination • Self care: Investing at a greater scale in specific interventions to support home-based support including telecare / telehealth; accommodation-related support; supporting micro-enterprise.	This project could result in net costs being reduced by £26.1m over five years but it is recognised that this still leaves a funding challenge in the context of an ageing population.
6. Integrated Assets: Delivering a cross public sector approach to asset management.	• Mapping and recording of public sector assets in one system • A local property forum to coordinate asset management • Supporting specific co-location projects	While it is difficult at this stage to identify a full list of specific opportunities for joint-asset use, financial modelling has suggested a potential reduction in building running costs of £1.7m (net) per annum if a collaborative approach was adopted.

1.5 West Cheshire welcomes the latest announcement on the national extension of Community Budgets. Based on our experience to date the points we wish to raise with the Committee are as follows:

2. Executive Summary

2.1 Whole Place Community Budgets should be seen as a key element of public service reform, particularly to address complex, cross cutting issues. They are not, however, the answer to all policy issues: In West Cheshire we did not pursue a single-pot for all local expenditure but instead focused on specific issues and options for aligning resources within these. We felt the development of a single pot for all local expenditure would not incentivise partners to work differently and engage in this service re-design process. The specific issues we focused on were chosen on the basis of the following features:

• A shared priority for local public services with clearly articulated outcomes;

• A significant and / or increasing demand on public services;

• An issue that is inherently complex and cannot be addressed by any one single agency;

• An area where current funding arrangements do not incentivise integration, prevention and early intervention.

2.2 This approach mirrors the findings of the National Audit Office Case Study on Integration which notes that, "starting with an emphasis on outcomes rather than structures or budgets appears consistent with a mature approach to managing change and cost reduction" (NAO, March 2013). Many of the proposals therefore focus on a specific cohort of individuals and families that are relatively low in number, but nevertheless experience poor outcomes and place significant demands on public services.

2.3 It is critical that as areas move away from organisational silos they avoid creating new thematic silos: West Cheshire has consciously avoided creating a range of new delivery models which create new silos. For example, there was a risk that the troubled families team that was developed was not joined up with other multi-agency responses to domestic violence or worklessness. The Whole Place pilot offered the opportunity to consider changes across the piece.

2.4 This common approach is manifesting itself on the ground in a number of ways. For example from April 2013 a multi-agency single access point for professionals seeking information, advice and guidance on a range of complex issues, from children and young people with multiple needs to troubled families and domestic abuse incidents will be operational. The single point of access will, where appropriate, feed cases into multi-agency locality teams that will manage cases relating to early support, domestic violence, complex worklessness and troubled families. These teams will be based in three defined geographic areas and will be made up of a range of partners including Cheshire Constabulary, Cheshire Probation, the Local Authority, Registered Social Landlords and DWP Jobcentre Plus. Across the three areas approximately 140 staff will be working in this joined-up way.

2.5 Genuine ‘collaborative leadership’ between partners at the local level is the key to innovation and integration: The importance of local leadership cannot be understated. It is crucial however that this leadership does not emanate from one dominant partner. All agencies have to take ownership for this agenda and be comfortable with leading across organisational boundaries. This was embedded in West Cheshire by ensuring each partner was accountable for the delivery of a key project. For example the chief officers for two Clinical Commissioning Groups are senior responsible owners for the Ageing Well project; Cheshire Police and Cheshire Probation sponsored the Safer communities project etc.

2.6 Through a collaborative leadership model between partners, including voluntary and community and private sector representatives, many barriers to public service redesign can be addressed locally without changes to national policy or legislation.

2.7 An equal relationship between Government and local partners through co-design leads to more robust proposals: The programme benefited from central government and local agencies identifying joint solutions. This avoided creating a ‘them and us’ mentality and ensured the proposals were credible. The programme of co-design work was supported by a central team made up of both local partner staff and government secondees. This joint team engaged in several stages of co-design including mapping customer journeys and flows of work through the current systems in order to pinpoint areas for improvement. The team engaged a range of stakeholders, including customers and frontline practitioners, in the re-design process. In addition access to national policy advice and technical support was valuable to the locality. One of the other key roles played by Whitehall was to act as an ‘honest broker’ across local partner agencies during discussions on the new delivery model. Discussions with Whitehall about using national financial incentives and possible place based settlements to drive change are also important. Feedback suggested this co-design process was also valuable for Whitehall Departments and chimed with the principles of Civil Service Reform.

2.8 It is essential that the principle of co-design continues with future areas interested in adopting a community budget approach. We support the development of the Public Service Transformation network to share best practice and learning, in line with the recommendation from the National Audit Office that DCLG and local areas "continue to distil and promote lessons from the work to date" (NAO, March 2013).

2.9 The costs and benefits of integrated services need to be well evidenced and well understood to drive forward change: Significant attention was devoted to forecasting the impact of the proposals on both outcomes and service costs. This financial modelling was resource intensive but was essential so that partners could understand how the proposals would impact on local residents and release potential savings. Integration therefore became a discussion about return on investment rather than relying on goodwill. It felt like the findings of Total Place moved to the next level by moving beyond mapping local spend towards an equal focus on joined-up strategy, joined-up investment, and crucially, the practical steps necessary to implement change on the ground.

2.10 West Cheshire benefited from the co-design approach with Whitehall including advice on financial modeling provided by the Technical Advisory Group (TAG). The TAG involved analysts across Whitehall and the four areas meeting on three occasions to discuss the basis of the financial models, to challenge assumptions and to signpost to any available national evidence. This process enhanced the credibility of the financial modelling both at the local and national level. In addition specialist support was provided by Government Property Unit and discussions with policy officials across Departments.

2.11 There is a shared ambition to strengthen and join-up our analytical capability across West Cheshire to be able to monitor the impact of the proposals, which will also apply in key areas like economic intelligence.

2.12 Any Community Budget approach must consider links to economic growth and welfare reform: Community Budgets are part of a broader public service landscape that cannot just focus on reducing the demand on services. Partners also need to stimulate local growth and consider links to welfare reform.

Our Community Budget approach to service delivery and our economic strategy are inextricably linked, and this is duly reflected in our Working Well theme, which deals with the links between supply and demand in the labour market.

2.13 In addition, the local response to welfare reform and the universal credit roll out in West Cheshire has clear links to the new delivery models developed under our Community Budget. Integrated, multi-disciplinary case management teams will be well placed to tackle the wider determinants of deprivation. Locally, DWP Jobcentre Plus is introducing partners to a common five stages of getting a job approach to develop a consistent response to the challenge of unemployment.

2.1 4 Ensure next steps are in place to build on the Community Budget approach : Elected Councillors at the local level have been engaged with this process on a cross-party basis through development boards. This process will continue and is symptomatic of attempts to ensure there is broad and ongoing political support for change. It is advised that all national political parties are also offered the opportunity to engage in this area of work.

2.1 5 Whole Place Community Budgets have helped lay the foundations for further discussions on place-based settlements and co-designing more innovative ways to financially incentivise public service reform. One proposal could be that a small number of areas are given a place-based settlement where all funding is allocated on a multi-year basis to localities. This is not about a single budget pot for a locality but involves providing greater visibility of resources and multi-year certainty for local partners to invest resources in new delivery models.

2.16 Another approach would be to apply a small top-slice to Government departments to create a central fund for integrated services. The fund would be net of CSR savings to ensure reductions were realised. Local areas would bid into the fund on a competitive basis if they could demonstrate a sound business case for integrated services based on available evidence, match funding from local resources, and a clear mechanism to evaluate impact and share learning. It is advised that these proposals are considered and co-designed with local areas.

2.1 7 Community Budgets have helped bolster the national evidence base that will be maintained and disseminated by networks like the Public Service Transformation Network. As our new delivery models are rolled out further, and then evaluated, findings will be fed into these mechanisms to share learning more widely.

Questions:

Question 1 – Are Community Budgets an effective approach to working with troubled families?

· Our Whole Place Community Budget has enabled us to build on the national Troubled Families approach through the development of integrated case management teams, a model known locally as Integrated Early Support.

· These teams are designed to be about more than just troubled families as per the national definition. They are cross-partner and multi-disciplinary, dealing with a wider range of underlying issues.

· Our approach goes beyond only Local Authority key workers, instead incorporating partner staff as key workers depending on the family’s circumstances. Along with the key worker, a single assessment and single family plan are developed. The local area’s support to families during the Universal Credit roll out will have strong links to this model.

· The cost-benefit work done on this area suggests the Whole Place Community Budget approach to troubled families will provide increased financial sustainability beyond the life of the national funding stream. This model is funded by the main partner organisations that stand to benefit from the proposals. It is estimated that this approach will avoid future costs and release savings of £2m (net) over the next five years.

· A multi-agency ‘deep dive’ exercise with 50 families undertaken during the Community Budget planning phase has helped us to better understand the true complexity of public service delivery for this cohort, the costs and how to improve services.

· The efficacy of interventions will be measured to inform future services that support troubled families. Customer experiences will also be evaluated to ensure a holistic view.

Question 2 – How can the success of Community Budgets (for troubled families, Total Place and neighbourhoods) be measured, and what are the prospects for models of Payment by Results?

· Evidencing improved outcomes: A suite of approaches is needed to fully measure the success of a programme as diverse as a Whole Place Community Budget. This undoubtedly needs to include measuring the customer experience and outcomes through a shared framework across partners. This outcomes framework will focus on tangible measures like employment status, the number of domestic abuse incidents and the number of children entering social care. There is also a challenge for partners to try to measure the impact these outcomes have on economic resilience. There is an ambition for both financial and non-financial benefits to be measured for a more complete picture of project efficacy.

· Detailed analysis: Deep dive analysis is a useful tool in sampling, at a given point in time, the level of engagement with, and costs incurred by public services. Control groups will also enable us to draw a direct comparison between the new delivery model and business as usual.

· Community resilience: Developing a way of monitoring the level of demand on public services and also the increase in volunteering and mentoring. For example, family-to-family support will create a richer picture of the true impact the Whole Place Community Budget has.

· Reactive versus proactive spend: Another way of measuring the success of the West Cheshire approach is to develop mechanisms for monitoring the change in spend from reactive to preventative or upstream services that reduce the demand on acute services. Turning these ambitions into reality will require an even greater and sustained level of collaboration.

· Reduction in duplication: Over time, reductions in duplicate case work between partners and the level of duplicate interventions will be measured to gauge how effective the model is.

· Prospects for PBR: The prospects for models of PBR are encouraging in the context of Whole Place Community Budgets and evidence-based interventions. Through the use of monitored interventions Government gets clearer visibility on the outcomes achieved to inform future decision making.

· PBR should not, however, reinforce silos: By working with Whitehall, Whole Place Community Budgets can help enhance the PBR approach, avoiding PBR silos that only deal with one element of a complex issue. A smarter approach could be an overarching PBR mechanism that covers a range of key outcomes for a certain cohort.

Question 3 – As a result of Community Budgets how are, and will, Whitehall’s relationship with localities operate and be changed?

· Our experience suggests Whitehall’s relationship with localities will gradually shift over time towards more co-design at an earlier stage in policy development. Through new structures like the Public Service Transformation Network, central and local partners will have better links into innovative practice on the ground, which they can use inform decisions.

· Community Budgets have been a catalyst for Whitehall to think beyond departmental silos and consider cross-departmental issues in a systematic way. There has been mutual learning at both the local and national level through forums like the Technical Advisory Group, where analysts across Whitehall departments could engage with the cost-benefit analysis.

· This process has provided West Cheshire with a mechanism to work with government on shared challenges, including economic growth. We have benefited from considerable advice and support at a time of significant change surrounding Local Enterprise Partnerships and the development of a Local Growth Plan.

Question 4 – How are public funds for Community Budgets accounted for, both locally and centrally?

· CBA leads to greater clarity on where the benefits of investment fall. Particularly, it allows partners to see where the investment of one organisation benefits another. This means partners can invest and apportion benefits in a more intelligent way.

· Clearer accountability will flow from strengthening local analytical capacity, allowing more effective monitoring of service performance versus spend over time.

· Community Budgets encourage local partners to work towards structured investment agreements. The approach does not necessarily lead to a single pot of funding for public services but does provide clarity on the outcomes expected for investment across the partnership.

· West Cheshire has begun, through its Integrated Early Support model, to jointly fund, both in-kind and in cash terms, a radical multi-agency approach.

· The total investment that has been agreed to support this new model for the financial year 2013/14 is £8.3m

· This model will grow over time as more partners join and invest in earlier intervention. Initially, the Local Authority is managing this partner funding centrally and reporting progress back to participating organisations through our Chief Officer governance – the Public Services Board.

Question 5 – How can Community Budgets maximise the use of resources through co-design and co-production of integrated services in the face of reducing resources and outdated modes of service provision?

· The development of a CBA methodology, co-designed with Government departments, has meant a better understanding of which interventions provide the best value for money. This level of financial analysis was undertaken on each of the six business plans to ensure they all met the same high standards of evidence.

· By way of an example, the Safer Communities project in West Cheshire has used this analysis to underpin a holistic suite of interventions. The new offer is commissioned jointly with contributions to costs shared based on the expected benefits. To be specific, £367,000 of new investment has been made by partners in 2013/14 to deliver these changes. Previously, these interventions would have been funded in a piecemeal way, with costs not shared equitably but the CBA has convinced partners to invest in a new approach.

Listed below are just a few examples of the new multi-agency offer:

1. Recovery programmes for children and adult victims that are proven to reduce the long term effects of domestic abuse.

2. Tagging that employs state-of-the-art technology to control domestic abuse perpetrators, whilst allowing victims to monitor these individuals. This increases victims’ confidence as it can be used as an early warning system.

3. Navigate Safer – an Integrated Offender Management service aim ed at perpetrators of domestic abuse, which includes a vo luntary perpetrator programme. This service will work alongside the Integrated Early Support teams to provide a "family" approach to tackling domestic abuse.

Question 6 - How can community place-based budgeting strengthen participatory democracy by empowering individuals and communities especially addressing processes of exclusion for specific groups?

· Whole Place Community Budgets are not just about redesigning public services, they also help move the citizen-state relationship beyond one which focuses only on levels of need. This has been described as shift away from a ‘fix me’ mindset. Practically, this means that families in West Cheshire will be involved in the selection of a key worker, and will own their family plan. Some families will also have discretionary personal budgets to help them solve their problems.

· Our approach to engaging with the community is one that focuses on assets or strengths as well as focusing on the level of need. The Community Budget ethos is one of keeping people independent and away from unnecessary interaction with public services. This shift tallies with thinking at the national level on welfare reform, and the focus on building people’s independence and resilience.

· We are supporting older people in their own homes by building community capacity. Practically, this means rolling out a range of measures upstream of more acute services, such as mutual support networks for older people and befriending schemes that prevent social isolation.

· We have developed a series of ‘test bed’ wards, which are able to trial new approaches to local services. These were selected after applications by Elected Members acting as champions on behalf of their community. The Elected Members have an enhanced role, effectively acting as an Executive Member for their geography.

· Making better use of existing physical and social assets is an underpinning principle of the Frodsham ward test bed. Plans to create a partnership service hub in the town are progressing following analysis of customer insight within the current service hub. The new facility is designed to improve access to services and enhance the customer experience with a number of services being located in one place.

Question 7 - Is it possible to use Community Budgets to reset relationships between local democratic institutions, agencies and the public?

· Community Budgets focus on more targeted approaches to addressing complex challenges, along with a focus on more citizen choice and control. Equally, Community Budgets provide a platform for partners to work together more closely on consultation with the public. For example, the Local Authority’s budget consultation events for the forthcoming financial year featured partner representatives to convey the cooperation taking place around local service delivery.

· Elected Members in West Cheshire will have enhanced opportunities for liaising with partner agencies through the roll out of Policy Commissions that will undertake multi-agency inquiries into cross-cutting issues.

Question 8 – How can Community Budgets be used as a tool to enhance local health improvement and narrow the health divide?

· Community Budgets can be used as a tool to enhance health improvement and narrow the divide through their focus on the wider determinants of health.

· The importance of this holistic approach cannot be underestimated in a health improvement context, as has been highlighted by Professor Sir Michael Marmot. The Marmot Review Fair Society Healthy Lives noted that "action on health inequalities requires action across all the social determinants of health" (Marmot, 2010). The development of Integrated Early Support teams represents just such a joined-up approach. These teams are based in centres of deprivation and will predominantly support those who find themselves on the wrong side of the health divide.

Question 9 – What role can Health and Wellbeing Boards play in facilitating community place based budgeting across all local agencies?

· Health and Wellbeing Boards are in the unique position of having the necessary broad remit to focus on the wider determinants of health. In West Cheshire, this has meant the Health and Wellbeing Board has a stake in the whole Community Budget programme, from our Starting Well theme through to Ageing Well.

· Our Whole Place Community Budget has allowed us to review our wider partnership governance and develop a structure that is both flexible enough to respond to new challenges, and robust enough to support this ambitious programme.

April 2013