How can my local area create a
breakthrough in primary prevention and
integration?
Resource for London, 365 Holloway Road
Monday 30th June, 2014
Key Messages
http://www.wavetrust.org/our-work/prevention-in-practice
@WAVE_Trust
Dave Hill, Essex County Council
Finding the money - 1
• You can both save money and improve the quality of services
at the same time
• We stopped many of the services that do firefighting
• 500 fewer children in the care system than 3 years ago
• How?
• We worked really hard as services to identify the earliest
signs of a problem
• Then as early as possible, intervened or supported families to
keep their children in the community
Dave Hill, Essex County Council
Finding the money - 2
• Saved £30m from children in care
• Invested £10m of that into early support and early
intervention
• Especially early years and children’s centres
• Multi-systemic Therapy funded by social finance
• Why would you do this?
• It’s actually a way of saving money
• We’re only investing in things that really make a big difference
Dave Hill, Essex County Council
Generating the will - 1
• This happens at a number of levels
• Leadership at the top, including directors, councillors,
voluntary sector, schools, health, police
• All these agencies coming together on a common agenda
• Also, leadership from the bottom
• In Essex, strong emphasis on getting people back to working
directly with children
• Changing the culture of practice important both from top and
bottom. People will get behind a shift to working with human
beings directly and changing their lives for the better
Dave Hill, Essex County Council
Generating the will - 2
• So what persuades people?
• First, hearts and minds
• You’ve got to persuade people this is the right agenda
• Secondly, get more serious about research and evaluation
– Show the evidence base for what you did and what you are doing
• Thirdly, just be incredibly persuasive about the money and
resources because the homework on prevention vs firefighting
shows it works
• Get politicians, policy makers, and health and wellbeing boards
behind this – they will understand it’s better for children to be
with their families
Bill Alexander, Highland Council
How to implement - 1
• The Highland Practice model
• Incorporated into Scottish Govt programmes for children (e.g.
GIRFEC, Getting it Right for Every Child)
• Principles
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Pathway through services with clarity of roles
Common language
Engage and empower children and families
Named person and lead professional roles
Assessment framework from birth
Assessment determines plan and service delivery
Single Child’s Plan
Fewer meetings and single Child’s Plan meeting
Bill Alexander, Highland Council
How to implement – 2
• Integrated services officer
– Joining universal and targeted services
• Early years practitioner
– Additional social work support in early years
• Children’s services worker
– Additional social work support in schools
• Health and social care teams integrated as Family Teams with
enhanced capacity to help children in the early years
• Increased budget for early years and prevention e.g. From 23
to 35 Early Years Practitioners
Bill Alexander, Highland Council
How to implement - 3
• This funding from all council budgets and supported by all
council directors
• It is making a difference
• A range of improved outcomes across the board
• More children supported, lower rates of looked after children,
fewer children at risk of significant harm, fewer re-registered
within 1 year
• Fewer children smoking, using alcohol or drugs
• Continued low persistent offending rates
• Recent Children’s Inspectorate report confirmed success
– 7 ‘Very Good’ and 2 ‘Good’ ratings
Kim Bromley-Derry,
Newham Borough Council
Generating the will – 1
• Political support and effective public, private and voluntary
partnerships key
• Also desire to innovate (acceptance that change is needed),
motivated workforce (winning their backing for wholesale
change), resident engagement
• Health and Wellbeing Board is at the core of all this
– a holistic approach is essential
Kim Bromley-Derry,
Newham Borough Council
Generating the will - 2
A) Create sustained political support
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must get over the history of false ‘invest to save’ initiatives
must be seen to deliver
B) Effective partnerships
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must all contribute to the right environment for collaboration
C) Need to engage, work in partnership with voluntary sector
D) Need to work with families, residents. Co-design essential
E) Must have a motivated workforce
– this requires engagement, communication, a lot of work
– build capacity of managers giving them space to go beyond managing the
essential reactive requirements
Kim Bromley-Derry,
Newham Borough Council
Greatest Barriers - 1
1. Fear of change
– we all know dealing with abuse, neglect, poor health costs more in the long
run than preventing them in the first place
– but whole system, e.g. Ofsted, tends to drive to traditional reactive measures
– we have to grasp these nettles
2. Fear of the future
– will we all have jobs? Will we have the services?
– if we are aiming to transform the system, we have to get over these fears and
trust that our skills are transferable
3. Will the projected savings be delivered?
– or will we add new spend while keeping the old?
Kim Bromley-Derry,
Newham Borough Council
Greatest Barriers - 2
4. How do we balance risk and reward in the system?
– difficult to show but not impossible if we have the will
– just have to get the evidence organised and the narrative right
– the evidence is there
5. Lack of enthusiasm
– to move from reaction to prevention takes enthusiasm, to drive change
– talk about improved outcomes. Focus only on cost savings kills enthusiasm
6. The economic case
– Nobel Prize winning Economist James Heckman shows investment in the
early years delivers economic efficiency, reduced spend and improved
outcomes
Kim Bromley-Derry,
Newham Borough Council
Key components for the change process
A) A compelling vision
B) A strong evidence base
C) The right narrative
– communicated differently for different audiences
e.g. health, community, local authority, voluntary, chief executives
– Newham has a narrative around resilience – individual resilience, community
resilience, economic resilience. This is communicated across agencies.
D) Champions for the work
E) Strong leadership both from the top and bottom
Kim Bromley-Derry,
Newham Borough Council
In Summary
• Prevention and integration makes sense. We know this.
• Can we do it?
– Yes – we have the evidence
– We just need to do it systematically, lobbying hard
– And we need to do it now
• If we don’t we will just cut and cut.
• Lack of money is not an argument for inaction. Delay only
means greater problems later
• We must act now
Helen Price & Simon Bilous,
Gloucestershire County Council
Finding the money - 1
• Research showed large proportion of children in care are
under 5, and in care because of abuse or neglect
• Many of these parents had substance misuse or mental health
issues
• Same pattern for children on child protection list
• Development of these children quite delayed when they hit
statutory services
• We looked for a solution with very swift assessment and
significant boost to child development through intensive
intervention
Helen Price & Simon Bilous,
Gloucestershire County Council
Finding the money - 2
• Strong preventive element including social workers, health
visitors, drug and alcohol workers, mental health workers,
speech and language therapists
• New initiatives: Family Drug and Alcohol Court, Journey into
Early Parenting (health visitor led)
• 100% engagement with the journey into positive parenting!
• Health visitor ‘know how’ has been key to the success
• Early identification of parents not able to interact positively
with their children, inc. Language, absolutely key
Helen Price & Simon Bilous,
Gloucestershire County Council
Finding the money - 3
• Strong outcomes
• Reduced numbers and period of time in care
• Reduced parental substance misuse and poor mental health
• Cash savings through fewer care proceedings and less time in
care. Placements easier because children more advanced
• Significant benefits to children – more school ready, less SEN,
better speech and language, less offending in later life
• Significant cash savings from (not) instructing experts in care
proceedings – work already done in D&A Court or by HVs
• Workforce more efficient through greater complementary
working
Helen Price & Simon Bilous,
Gloucestershire County Council
Generating the will - 1
• Be really clear about the problems you’re trying to solve and
have the evidence
• Include the problems that are relevant to the services you are
dealing with – e.g. Chronic neglect a problem for all services
• Have to address high level service needs as well as prevention.
Start at universal and work through to high end need.
• Tailor your message differently to different audiences – be
aware of their own pressures and priorities
Helen Price & Simon Bilous,
Gloucestershire County Council
How to implement - 1
• Huge gap between children doing well and those with chronic
neglect due to parental substance misuse or mental health
• Tackled other issues also but use this as an example
• Looked at convergence of needs assessment and other drivers
to get support for an integrated approach to both
commissioning and provision in the early years
• This won backing from CCG and County Council
• Extensive consultation with parents, early years practitioners,
other stakeholders
• Result: Joint Strategic Framework for commissioning in early
years
Helen Price & Simon Bilous,
Gloucestershire County Council
How to implement - 2
• Sought to get agreed outcomes and priorities across agencies
• Gathered the evidence and the narrative first so we could
make a case
• Took a very measured and long term approach – step by step
• Worked hard to align processes, timetables etc.
• Now have jointly agreed high level outcomes between
commissioners and providers with jointly agreed priorities
• Agencies have shared expectations and clear understanding of
how each contributes to the other – e.g. Children’s Centres
to health outcomes etc.
Helen Price & Simon Bilous,
Gloucestershire County Council
How to implement - 3
• So what?
• Clear organisational benefits – co-location has led to better
information sharing and mutual understanding
• New intensive support team (Turn Around for Children Service)
for children with greatest chronic neglect
• More children receiving early education offer, more vulnerable
children supported by parent champions, more parenting
programmes through health visiting and Children’s Centres,
more children achieving good level of development by school
entry, better outcomes for children on child protection plans or
looked after, increased engagement of teenage parents etc.
The Staffordshire Story
Finding the money - 1
• Big challenges, 5 CCGs, 25 major public sector organisations
• Public sector spend of £7.5bn, Children’s services £170m
• Important to create partnership of 25 public sector
organisations
• Children’s Trust  how can we spend more on prevention?
• Youth Services how can we spend more on prevention?
• Answer  Look at the £7.5bn not the £170m
The Staffordshire Story
Finding the money – 2
• Health and Wellbeing Board put early intervention and
prevention at the heart - stop problems developing
• H&WBB ideal point to influence
– E.g. Mental health services, domestic violence services – if these are
not effective we end up with children in care
• Needed to win support of 5 CCGs / GPs
• Buy-in through passion and talking as much as by evidence
• One focussed Health and Wellbeing Plan (important to get it
right)
The Staffordshire Story
Finding the money - 3
• Took £200m out of hospitals
• Paid for community care and prevention instead of putting
people into hospital
• A lot of Children’s Services too reactive (examples)
• KEY: Early Intervention and Prevention is not a project on the
side, it’s at the core of how we operate