An effective workforce
for Early Help Delivery
Nuala O’Rourke
Wigan Council
The drive to integration
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Total Place
Community budgets
Public service reform
DH drive for Health and Care
Integration
• Movement of Public Health into
Local Authorities
• Commissioning of Health
Visitors moving to Local
Authorities
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The drive to integration
• Total Place lessons
– People at the heart of
service design
– Reducing dependency /
enabling self reliance
– Pooling budgets
– Reducing bureaucracy
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The Public Service Reform
Challenge
• GM Priority: Growth and reform
• Total tax intake in GM £17bn
• Total public spending in GM £22bn
• £5bn gap
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Multiple funding and accountability
structures make coordinating support
for families very difficult
DfE
HO
LA
MoJ
YJB
Police
VCS
DH
CLG
DWP
CCG
Housing
authorities
JCP
Housing link
worker
Employment
Personal advisers
Prisons
YOS worker
Young carer
support worker
Parent support
advisers/Schools
Police officer
Family support
workers
CAMHS/
Mental Health Drug and
alcohol team
Worker
Surestart
Intensive family
intervention worker/
parenting practitioner
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Known Interactions Nov. 09 to Oct. 10
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What does integration
mean
• Many different models
– Co-located
– Aligned
– Fully integrated under single line
management
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Integration in Wigan
• Integrated Safeguarding and Public
Protection team
• Integrated Health team
• LIFE team
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Integrated Safeguarding and
Public Protection team
• A partnership response to domestic abuse
• A coordinated community response model
• A co-located team including
– Police, Children’s social care, Probation, Housing,
Independent Domestic Violence Advocates, Drug and
Alcohol outreach, Young person’s violence advocate
• With daily input from
– Health Economy
– Adult Social Care
• Process overseen by and approved by CAADA
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Delivery Model
• Daily meetings which respond to domestic
abuse incidents
• All agencies share their knowledge of the
whole family
• A joint action plan is jointly agreed and
implemented immediately
• Individual agencies take ownership of on
going activity with the family
• Taking MARAC principles to a daily meeting
• Launched in March 2013
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Integrated Health Support
Team
• An integrated targeted intervention and support
service to vulnerable pregnant women and their
families.
• Works with top 2% most vulnerable pregnant
women in the Borough (circa 75) and their families
to reduce the risk of children becoming looked
after and / or suffering significant harm.
• Team consists of Public Health midwives,
Midwifery Support, specialist Speech and
Language therapist and a targeted Speech and
Language therapist, Family Support Worker
• Won 2 national awards from RCM & BJM.
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Delivery Model
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Joint assessments
Joint team meetings
Shared case notes
Joint visits
Shared family plan
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The Life Programme
• A long term attachment rooted service where
families are invited to take part and work
intensively with a range of workers
• A team of workers with a range of skills
including police, social care, early
intervention, health and housing.
• Located in a local building which operates as a
drop in centre for family members
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Delivery Model
• All workers support families and share their expertise
with the team
• Staff have specialist areas – but all members of the
team carry a case load and act as a keyworker for the
family – or members of the family
• Small case load – 12 families on each site – but as this
includes the extended family it adds up to nearly 100
individuals.
• Staff work with families for a period of up to two years
with a defined exit plan seeing a step down in the level
of support over an extended period of time
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Learning – Aligned
Integration
• Working in a co-located team can blur the
lines between professions and need all
involved to have a flexible approach
• The benefits are not shared equally across all
agencies and without shared budgets the
cost can outweigh the benefit to some
partners
• Relationships and engagement are critical to
success and the timeliness of appropriate
interventions is key to delivering and
sustaining change.
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Learning – Single team
• All staff need adopt a person centred approach to family work with a
single family assessment built into the centre of the approach so that
we ensure that the child’s needs are paramount and services wrapped
around the family
• Having all professionals managed within one team enables the change
process to be managed, removes competing agendas and prevents the
family from playing off professionals
• This means that team members are team members first and carry their
professional skills on their shoulder to be used as and when needed by
family members or other team members.
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What helps develop the
single team
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Having a job role outline that defined the role of the team member.
Some common competencies that tied the team together,
Common statements that outlined the primary task that we were all working together to achieve
A set of fundamental principles that set out the way that we worked with families.
An acknowledgement that as a team we had different sets of value bases and motivation for the
work that we do.
Embedding the fundamentals within the IPA process so that we could measure our journey.
Providing daily debriefing sessions in the early days of integration supported by a manager.
Understanding that t he team moved from roles where they had been seen as the expert in their
specialism working with a particular cohort to working outside their comfort zone. Staff need
support to understand that they don’t need to know all the answers, its ok to say I'm not sure but
we can find out.
Recognising each individual team member as a consultant from their specialist area.
Being open to share working practices.
Involving the team in the development of the service.
Providing high quality supervision and support to enable team members to manage the change in
the way of working.
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Learning
• We are asking our new integrated teams to support families into
behaviour change which the public sector has been struggling to
achieve for many years
• Need a workforce than understands
– We need to take an asset based approach with families
– Families and individuals need to be encouraged to take responsibility for
their behaviour and understand the impact in order to be willing to change.
– Behaviour change takes time and families often relapse and need further
motivation and support
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Aim in Wigan
• To develop and begin to implement by
2015/2016 an approach to full integration
of early help including Health Visitors and
our Early Help team.
– Locality based model
– Single line management of staff
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What are the challenges we have
identified
Communication:
• Need for an agreed shared vision and
understanding with clear communications
strategy:
– Strategic partners / management
– Workforce
– Public
• Accountability / governance / clear leadership.
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What are the challenges we have
identified
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Accountability
Governance
Need for clear leadership
Ability of organisations to let go
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What are the practical challenges we
have identified
Systems:
• Fragmented commissioning
• Range of assessment processes and paperwork
to be agreed
• Data: systems / sets / sharing
• Working models e.g. key working / corporate
caseload
• Accommodation
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What are the challenges we have
identified
Workforce:
• Workforce sign-up.
• Workforce competency
• Workforce culture
• Change management
• HR / Pensions / TUPE
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Discussion topics
• What type of integration are delegates
developing in their locality?
• Do we all share the same challenges?
• What do we see as the benefits of
integration?
• How will we measure our success?
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Nuala O’Rourke
n.o’rourke@wigan.gov.uk
07525 657 140
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