Individual
Commissioning for Children and
Young People with Complex
Needs
in
Gloucestershire
Chris Sands: Head of Individual
Commissioning
Children and Young People’s Directorate
Placements
Feedback
Special
Educational
Needs
Support
Services
Learning
Points
Budget Holding
Lead Professional
Pilot (Children in
Care)
Outcomes
Children and young people with
Complex Needs
……have a number of discrete needs –
• e.g. relating to their health, education, welfare,
development, home environment
• Require additional support from more than one agency /
service sector / system.
•Their needs are often chronic and may be life-long.
•These different needs tend to interact, exacerbating
their impact on the child's development and well-being.
Typically, they may have…..
•
A spectrum of need which has been sustained for at least 6
months (and is likely to be ongoing);
• Needs falling at the severe/profound end of a spectrum of
intensity;
• Needs falling across at least two of the areas below:
– Acute and/or chronic medical difficulties,
– Multiple and profound physical and/or sensory impairments,
– Behaviour problems which are often challenging,
– Significant Learning and/or Language difficulties, and/or
disabilities,
– Parenting and/or attachment/social needs.
• Intensive ongoing involvement of at least two agencies / service
sectors, usually drawn from:
– Therapy services
– Specialist Educational Services
– Nursing and Medical Services
– Social Care Services (core teams or specialist personnel)
– Mental Health Services
Where we were……a bit of history…
•Poor outcomes
•Escalating spend
•Inefficient processes
•Lack of customer focus
•Future predictions
The
Complex
Needs
Strategy
Complex Needs Strategy
(excerpt)
Revise and redesign the commissioning
process in order to improve processes and
decision-making, broaden choice of
placement options, ensure an outcomesfocussed approach based on individual
needs, and ensure that these needs are met
by effective quality providers at reduced
levels of cost.
Since then……………
Commissioning has really taken off….
Why?
Clear direction from DCSF, the
CSP + Ofsted Inspections
Move away from ‘what we
have/always
had’
to
what we and our customers
need/planning for the
future/trends/patterns etc
…..Its our framework for
planning all services for
dynamic future proofing
Commissioning Cycle
Analysing
Planning
(e.g. OPS; CYPP NA;
(e.g. CYPP; Commissioning
Commissioning Plans NA) Plans; evidence/’research’)
Reviewing
Doing
(e.g. CYPP; Contracts/SLAs) (e.g. Tendering/Contracting
Service Improvement &/or
Development Plans)
(DCSF)
(CSP)
Different levels of commissioning
•Strategic
•Local
My focus
today
•Individual
Sounds simple...
Levels of commissioning
GLOUCESTERSHIRE
CONFERENCE
GSP
Gloucestershire
Strategic
Partnership
CYPSP BOARD and
EXECUTIVE
GROUP
Countywide
strategic
commissioners
eg PCT and
GCC
COMMISSIONING
BOARD
Schools
Forum
Commissioning team
DISTRICTS
NETWORK
(Chairs of the 6 LSP CYP
Thematic sub groups and
district officers)
6 LSPS
(Local Strategic Partnerships)
CYP Local Strategic
Partnerships
key
Countywide
strategic
commissioners
District/locality
commissioners
Extended
services
clusters
CYP ‘hubs’
Locality Managers
Individualised budgets
through Lead Professionals
Providers of services
Children and families in Gloucestershire
Commissioning
family/individual
level
Officer
support
money
need
Individual Commissioning
Professional Filter – what happens now
Moving from this
Individual Commissioning
Where we’re going -Citizenship Model
To this
Resource Allocation System……
Individual Commissioning
Key Features/principles of the Gloucestershire
Commissioning Model
Needs led,
outcome
focused
Promotes
choice
Accountability
and review
Local services
Creativity,
flexibility
Transparency,
clear processes
and timescales
Value for
money
Empowers and
engages yp, their
families/carers
Objectives:
 Improved, managed outcomes relating to ECM
 Improved stability and placement choice
 Effectively commissioned services through pre-qualified lists
(fostering, residential, SEN)
 Increased local service provision
 Increased accountability for service outcomes
 Empowerment of young people and carers in decision making
processes
 Reduced bureaucratic processes and release time back into
frontline working
 Link with and build upon experiences of individual budgets for
children in care and children and young people with
disabilities
 Join up the commissioning and individual
budget processes (BHLP and the Resource Allocation System)
Where we are up to…….
•Individual Commissioning Services Team
•Mainstream Children’s Homes….closed – all children’s homes services
individually commissioned
•Fostering:
•Service of excellence
•Business model
•Level playing field (12+)
•28 day contract
•Target for 85% in fostering placements
•Special School and SEN process trials
•Budget Holding Lead Professionals pilots
•Support Services accreditation
Process examples
Service Commissioning
Individual outcome
focused commissioning
profile completed (with
parents and yp)
ICST screen against
priorities
ICST Quality Assurance
function
Expressions of Interest
from Partner Providers
(pre-qualified providers)
Anonymised data
5 working day
turnaround
X
Tribunals 7
Parental pref….
Social Worker/Lead
Professional grades (with
parents and yp)
Negotiation with partner
providers ranked 1&2
Needs/Outcomes form
part of YP’s review
Contracts based on clear
service/outcomes
provision
Needs/outcomes to IRO
Service
Special Educational Needs Trial
Stat assessment
request or review
indicates complex
needs
Multi-agency outcomes meeting
held: identifies and agrees
need, outcomes and challenges
Commissioning form
completed by LP, agreed
by parents and
professionals
Decision re. extra
resources/external
placement
LP, professionals and parents
grade responses and undertake
visits
Contract issued
and placement
begins
Review of
outcomes
Aims of the BHLP pilots
 The BHLP pilots aim to:
 Involve young people and parents in
decisions about what they need and how
best to support them
 Ensure children, young people and families
get the services they need when they
need them.
 Reduce overlap and inconsistency and poor
engagement, thus reducing the costs per
“episode” of intervention.
BHLP Children in Care Pilot
Workstreams:
•Children waiting permanency
•Educational achievement
•Young people with substance misuse
issues
•Yp in our children’s homes
•Children and young people’s
participation
BHLPs - How they work……
Common Assessment (CAF) Analysis/PEP
completed with parent, young person,
relevant professionals
Allocate budget if required
Complete support plan with
young person/parents
Needs and outcomes
identified
Agree Lead Professional if
not already identified
Access existing services or
commission direct
Review outcomes
One of our big questions and challenges…
Why go out of
county?
What more could
we do in-county?
How can we make
better use of our
own resources?
Special School Trials
Emerging
needs…..
Creative &
Flexible
approach
Not just
‘education’
Costs
inevitable…
Accreditation
of
‘non-trad’
providers
Use BHLP
principles
Local support
services
Individual Commissioning:
Have we got it right?
Proof of the pudding…….
Benefits Realisation
Improved
stability/choice/
matching
Reduction in yp
placed out of
county
Increased
Local
provision
Increased
involvement in
decisions and
process
Sufficiency
Promotes roll
out of BHLP
Improved
Market
engagement
Reduced
overall costs
compared with
pre-ICST
Increased
accountability
Commissioning Learning Points and feedback
IFAs:
-
comprehensive information
able to meet timescales
ECM framework helpful in matching
outcomes led supports matching
a plan already to roll
positive way forward
100% good/very good/excellent
SWs:
-
takes more time than want to spend
QA function presents a challenge
timescales difficult to determine re outcomes
difficult if not know child (when an emergency)
ECM focus good
55.5% good/excellent. 33% average. 11.5% poor
BHLP (Children in Care Learning Points)
Social work practice issues:
•Raises questions about what the role of the social
worker is – commissioner a new concept
•Meaningful relationships with young people
•Challenges the culture of the ‘expert’ model
•Moving from systems and process approach to
needs led
•Corporate parenting aspirations
BHLP (Children in Care Learning Points) cont..
Engagement with young people issues:
•Greater participation in the care planning
process
•To feel they are important and that they
matter
•A chance to talk about their day to day
needs with someone with whom they have
a meaningful relationship
Commissioning feedback
Young People:
my choices
were
considered
yes:
definitely
successful
Right
Choice?
Choice?
offered
choice of two
placements
yes: happy and
settled in
placement
two intros
and enough
notice
Placement
move?
quite an
achievement!
‘Just wanted to say that the process
ran very sweetly. Many thanks
to everyone for their part in finding
the right placement. I have been
impressed by the professional
courtesy and support along the way.
The process is a vast improvement (to
past experiences) and really does help
to focus on my child’s needs and outcomes’
Individual Commissioning:
Have we got it right?
…..we’re still learning and working
on it!