On 1 October Ecorys, ATQ and Big Lottery Fund hosted the first of a number of mini-conferences designed to help applicants to the CBO Fund develop their ideas through learning from others with similar experiences. This presentation covers the Developing Business Cases workshop. Delegates heard how Newham Council had worked with Advance, a provider of positive support to adults with learning difficulties to develop an innovative SIB model that will enable such adults to live better lives in the community and also reduce housing and care costs for commissioners.

1. London Borough of Newham
SIB Business Case Development

2. 2
Introductions
• Lee Salmon, Commissioner (Learning Disabilities lead) in the Adults Commissioning
Team
• Edward Hickman, Director, ATQ Consultants

3. 3
Background
• Provider led SIB development proposition
• Application to the CBO Fund for development grant
~ Advance Housing and Support along with ATQ
• London Boroughs of Newham and Haringey approached by Advance to see
whether they would be interested in developing a social investment business case
for ‘positive behaviour support’ services for Adults with Learning Disabilities
• A key issue for Local Authorities in responding to the Winterbourne View
Concordat
~ Challenge to find suitable community based provision for Adults with LD and
especially those presenting with challenging behaviours
• Both Newham and Haringey have been involved in developing the Business Case

4. 4
Developing the Business Case
• First question – are there ‘cashable’ or ‘avoided cost’ savings?
• So where to start?
• Firstly with analysis of the number of service user clients (or in business case
terminology the “cohort”)
~ Number of Adults with LD in care including those in Transition age range
~ In Borough or out of county
~ Community or residential provision
• Secondly, analysis of spend per week and numbers at each level of spend
~ Because of the involvement of our provider, we had an indicative cost model
for a positive behaviour support service as a base line to compare against
• The outcome of the analysis phase showed that there was a sufficiently large
cohort of Adults with LD that either currently cost or would cost well in excess of
the baseline
• Various volume and cost savings scenarios created in a Financial model which
show a potential 40% saving but more realistically an expectation of +/-20%

5. 5
Outcomes and PbR
• The starting premise of this business case is that Newham knew that it had many
high cost placements where the outcomes for service users were static
~ Broadly containment of challenging behaviours rather than improvement
• Newham has been systematically addressing its high cost placements over the last
three years but wants to go further
• The real attraction of the social investment business modelling is that it has
allowed Newham to look at the outcomes it would like to see for service users and
specify these in the commissioning of individual support packages
• The fact that there are savings, potential for co-commissioning payments from
CBO Fund etc. are a bonus on top of the chance to improve the lives of service
users
• NEWHAM’s KEY MESSAGE TO COMMISSIONERS is focus on defining the
outcomes that you wish to see
~ All the rest follows ….

6. 6
Newham outcomes and payment model
• Two outcomes categories that Newham will pay for
~ A) Successful transition to community based setting
~ B) Basket of ‘quality of life’ outcomes
• Reduction in the number and severity of challenging behaviour incidents
• Delivery of the Health Action Plan
• Improvements in social integration
• Payment model
~ 80% on A) sustained transition to community setting
~ 20% on B) achievement of basket of quality of life outcomes
• Social investment
~ Newham will pay a fixed fee rate over seven year contract period
~ Provider support costs will be higher in first two years than payments
received, which creates the scope for social investment financing
~ May also be social investor interest in providing bespoke properties but this is
further off

7. 7
Newham’s proposed commissioning strategy
• Letting of a Framework to identify 3 to 5 quality specialist Positive Behaviour
Support providers
~ Intention to work closely on a ‘partnership’ basis as the service users require
lifelong care arrangements
~ Quality of provider base to be managed by Newham
• Individual referrals will be based on a mini-competition to ensure price tension
• Seven year contracts underneath the framework
• Other LAs invited to use the framework
• Mayoral proceedings underway now (October 2015)
~ Internal approval requirements for letting a Framework