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Bradford - Total Place summit masterclass presentation
 

Bradford - Total Place summit masterclass presentation

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The presentation used for the Total Place master class: Total Place: the story and learning so far.

The presentation used for the Total Place master class: Total Place: the story and learning so far.

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  • Challenge 1: The current approach to providing the basic needs for the care leaver (e.g. housing, financial support, staying safe, education/employment/training and health care) is not always achieving the desired outcomes. The challenge is to bring together the various public, voluntary and private sector providers to ensure basic needs are met. The impact of not meeting these needs triggers a domino effect (e.g. the lack of suitable accommodation for young people leaving care will frequently exacerbate other problems e.g. lack of an address means no access to a GP resulting in serious risk of unrecognised mental health problems; delay in releasing offenders as no bail address is available).  Challenge 2: In addition to the basic material needs of young people, there is also the issue of emotional/psychological support. Unlike young people leaving stable family environments, care leavers often lack the source for ongoing support that is needed for day to day living (i.e. mum/dad). The challenge is to provide a consistent level of service whereby young people have access to services that understand their needs and dilemmas and are willing to mentor and coach the young people through their difficulties. For some young people this may be beyond the age of 21.   Challenge 3: Current legislation means that Bradford remains responsible for any young person who is originally from Bradford, even if they are living outside of the area. Although some services may be provided in the other locality, these may not include care leaving services for the young person – a young person from Bradford resident in that other area. The young person often has to rely on Bradford staff travelling to the area to provide this service. The challenge is to establish a more efficient and cost effective way of providing a consistent level of appropriate support nationally and across authority boundaries.
  • Challenge 1:   Older people are entering acute hospitals with physical problems (e.g. fractures etc.) but also may have secondary mental health related issues such as dementia or depression, or they may acquire mental health problems during their stay (e.g. delirium). Challenge 2: There is national evidence that, for a number of reasons (e.g. staff training) older patients’ mental health needs may not be addressed as well as they could be in hospital where the focus is on their physical condition and recovery. This can lead to the patient’s stay in hospital being prolonged. This problem is further exacerbated by the disjointed discharge process which often leads to additional delays. Challenge 3: Double Cost By applying the national ratios, extracted from the Alzheimer Society’s “Counting the Cost” report, to the Bradford situation, the additional financial cost of these extended stays in the acute hospital equates to £3.3 million per year. “ Counting the Cost” also demonstrates a link between the length of stay in hospital and the likely outcome for the individual. The longer the individual stays in hospital, the greater the likelihood they will be discharged to a care home.
  • Challenge 1: By using the “resources follow risk” strategy to designing the offender management process, we are in danger of under resourcing the support for women prisoners. The majority of women prisoners are assessed in the lower risk categories, yet often have more complex and significant support needs. The challenge is to establish a method of assessment, which whilst accounting for risk also considers the “whole of life” cost of managing the offender in the community and which also ensures proportionality of sentencing is maintained   Challenge 2: Offenders who serve shorter sentences (e.g. less than 12 months) are often in prison long enough to lose all their social support structures (e.g. jobs, housing etc.) but not long enough to benefit from the support services offered to long term prisoners. These prisoners are not supervised on release and because they do not benefit from the statutory framework of supervision, are often left to drift, increasing their potential to reoffend. The challenge is to provide an integrated approach to assessment and offender management for all prisoners upon release.   Challenge 3: The collection of information has been designed to serve the needs of agencies and providers at specific stages in the process, from sentencing to release. This does not provide continuity in offender management. There is a lack of sharing of this information between the different agencies. This results in wasted time for all participants as well as duplication of information. More seriously, it can mean critical information that will impact upon the success of the rehabilitation e.g. mental health issues, may well be missed. The challenge is to establish an integrated process which enables the information to be captured once and shared between all the relevant parties.

Bradford - Total Place summit masterclass presentation Bradford - Total Place summit masterclass presentation Presentation Transcript

  • 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
  • Gateway to Integrated Services – Methodology 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 Involving Service Providers & Voluntary Sectors stakeholders Involving Service Users Involving Service Providers Voluntary Sector Service Users
  • 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 individual
    • Challenge 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
  • Changing the whole system - Care Leavers
    • 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 - Older People
    • 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 - T raining that currently exists on working with older people with mental health tends to be organisation specific.
  • Changing the whole system - Adult Offenders
    • 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
  • 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 redesign
    • Care Leavers
    • Wide 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 people Initial 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?