Bradford’s Total Place Experience

What we've learnt about the importance of interconnectedness of the public service around

the customer

Strategic Director – Mary Weastell

Contents

• Our Approach• Customer Insight• Barriers - Changes• Forging The Future - New Ways of

Working

Scoping Our Approach• LSP agreed theme of

supporting vulnerable groups at point of entry/re-entry into community, through a “Gateway to Integrated Services”

• Aligned to priorities and

outcome focused

• Address concerns about current ways of working, VFM and barriers to improving service delivery

• Focus on reduction in crime, enhancing of social capital and more productive use of public services

• Three key sub-themes:– Young people leaving care– Offenders over 18 leaving

prison – Older people with mental

health problems leaving hospital

Determine Joint

Leads

Phase 3 – Forging the

Future

Identify Key

Stakehol-ders

Phase 2 – Customer Insights

Phase 1 –Discovery

and Develop-

ment

Offline Work to

Consolidate Outputs

Design New

Pathways & Develop business

cases

Agree Scope

Facilitated by Leads

Facilitated by Providers , VS & Leads

Facilitated by Leads

InvolvingService Providers & Voluntary Sectors stakeholders

InvolvingServiceUsers

Involving Service ProvidersVoluntary SectorService Users

Gateway to Integrated Services – Methodology

Different approach to Community Engagement and Consultation?

• Phase 1 - Discovery and Development:– service providers defining current

situation

– understanding dependencies and inter-dependencies

– recognising problems associated with current level of service delivery

• Phase 2 - Customer Insight: – creative ways to capture real life

experiences of services users

– obtained greater degree of insight of impact of wider family

• Phase 3 - Forging the Future:– bringing together service

users and service providers work on new pathways

– Giving freedom to think creatively, beyond current boundaries, and design transformational changes

Customer Insight

• Research approach - going beyond current engagement models, customer evaluation and feedback

• Service Users’ interviewing each other and Providers

• Experiences of the impact on the wider family• Variety of tools - videos, drawings, art work• Space for creative thinking & joint solutions

Insights from Care Leavers

Three things: better support, assistance with money and more ambition – my carers were great and had such high hopes for me but my friends carers did not encourage as much

I cannot continue studies at College, and been

discouraged from enrolling this year, due to

being pregnant. I am frustrated, it stops me

making progress. I would be able to study at home. I want to go to university

and this will stop me

I was living with my landlord from 16 to 18 with a rent agreed. When I reached 18 the DWP wouldn’t pay the agreed level of rent so I had to leave his “home”

Insights from Older People and their Carers

Insights from Older People and Carers

I am old…I was admitted to the hospital and moved to eleven

different wards when I was there. I was very

confused

My mum has psychosis, went to hospital. No one

checked her support package. Community MH Team not aware.

Discharged with extra medication, no

explanation. She took double which meant she couldn’t function. CPN was not informed she

was sent home

An elderly man, known to Mental Health team, was discharged from hospital at night dressed in pyjamas. His wife, with mental illness had undergone surgery and not well enough to look after him, was told of his discharge whilst visiting him and told Social Services would be contacted next day.

Insights from Offenders and their Families

I was in remand prison halfway into a course, then

transferred to another prison. I go through

induction process again, placed on education

waiting list, and released before completing course

or getting qualification

I’ve been 21 years in and out of

institutions - from the age of 20 to 46 years. Each time I get little

support, have no money and can’t get

ahead so I get arrested again.Children in care

I was released from prison on 13 July and still there an hour later, no-one had

collected me. I was wandering up and down

the road

Key Challenges – Care Leavers• Challenge 1

– Local fragmented service - emotional health not assessed in timely way, access to support and treatment difficult. Lack of supported housing for the most vulnerable

• Challenge 2– A cohort of young people are NEET from an early age

who are dependent on benefits • Challenge 3

– National benefits system complex and difficult to navigate

Key Challenges – Older People• Challenge 1

– Entering acute hospitals with physical problems may have secondary mental health issues or may acquire them during their stay

• Challenge 2– Mental health needs may not be addressed leading to

prolonged stay in hospital and disjointed discharge process• Challenge 3:

– Double Financial Cost • additional cost of extended stays in acute hospital • Longer stay in hospital, greater likelihood of discharge to

care home

Key Challenges – Adult Offenders

Challenge 1 – Breaking reconviction cycle – custody sentences of less than a year

do not undergo any supervision after release – 46.5% re-conviction rate

Challenge 2– Offenders who serve shorter sentences often in prison long enough to

lose all social support structures but not long enough to gain level of support offered to long term prisoners

Challenge 3– The collection of information and assessments designed to serve the

needs of agencies and providers rather than the individualChallenge 4

– System not designed to meet needs of women prisoners or families and has multi generation impact as consequence – esp in relation to mental health

National• Complicated benefits system that is complex, difficult to access and can be a disincentive to young people to access training and apprenticeships

Local – Change• Tailored approach to Entry 2 Employment support for the most challenging young people • Supported housing in decent areas ending any reliance on inappropriate hostels and B&B

Local – Change• Improved integrated approach to care leavers from all partners• Commitment of corporate parenting responsibility of the Local Strategic Partnership

Changing the whole system - Care Leavers

National• The compatibility of IT systems can have a profound effect on good clinical assessment

Local – Change• A key and consistent message from our workshops has been that the whole approach to treating and working with people with dementia and their carers requires a complete overhaul

Local – Change• Multi agency training approach - Training that currently exists on working with older people with mental health tends to be organisation specific.

Changing the whole system - Older People

National• No case management of any adult offender with a sentence of <12 months custody exists and the relevant justice services and supporting agencies are not resourced for such a role

Local - change•Interventions with selected non-convicted offenders•Housing Commissioners / Providers to adjust approaches to homelessness, social housing allocations and tenancy management

Local – Change• Transform the approach to offender management by increasing the intervention at the point of arrest

Changing the whole system - Adult Offenders

Invest to Save vs Benefits and Efficiencies

Resource realignment – predicted gross savings / efficiency gains – Realigning £880k could realise c£670k resource costs

and up to £3.9m benefits for 45 care leavers who are NEET

– Realigning £270k could realise c£4.1m p.a. processing cost across whole offender pathway in preventing re-offending

– Realigning £1.2m could realise c£2m through improved discharge planning and support to avoid direct discharge into residential care and readmissions

Removal of Barriers / Freedoms

• Aligned thinking, nationally and locally, on priorities for “place”– Prioritisation/Realignment of resources– Performance Frameworks

• National policy change to deliver desired outcomes e.g. – Offender management policies changes in partnership

with MoJ, Home Office, NOMS– Cross agency Dementia Training for staff with DoH

• Lack of Flexibility of Benefits System (across three sub themes)– Interim and Transitional Benefits proposals

Redesigning Solutions Together

Learning - Future service redesignCare LeaversWide consensus on “gold

standard” service areas– emotional health and well

being– Employment, education,

training– finance and benefits and– Accommodation

Offender Management• 5 key interventions to transform

offender management pathway – Offender Management at Arrest– Passported Assessments– Reformed Early Conditional

Release– Case Management for Everyone– Focus on Families

Older peopleInitial focus on planning of discharge and post-discharge support, now admission and in-patient processes also included – work will be focussed to secure a complete redesign of the pathway

New Ways of Working• Significantly improve life

chances / living conditions for people through– Co-design and delivery with

service users • Community Leadership at the

highest level– Joint accountability/Political

leadership– Challenging the established

barriers to local decision making

– Improved Scrutiny

• Constant dialogue local and central government– Co-designed policy making– Influencing role

• Realigned budget and resource arrangements– “Place” based funding and

resourcing – Shared risk and reward

Some Thoughts

• How effective are your current engagement models with citizens?

• Could this learning change your mindset about a whole system approach to joint service delivery in your area?

• How ready are you to act on removing local barriers to Transformational Improvement?