Embedding Early Intervention
within the Commissioning
Pathway
Ian Curryer, Corporate Director, Children and Families
Candida Brudenell, Director, Quality and Commissioning
Chris Wallbanks, Programme Manager, Early Intervention and
Partnerships
Purpose
‘To provide an opportunity for leaders
from across the region to engage with
leaders from Nottingham, explore their
approach and share learning from their
experience.’
Programme
• Nottingham as an Early Intervention City –
Ian
• Developing the Commissioning Pathway –
Candida
• Early Intervention within the Commissioning
Pathway – Chris
• Considering the challenges and sharing
practice – All
• Embedding Early Intervention – Candida
• Examples of shifting resources – All
• Next Steps - All
Nottingham City
• High levels of deprivation; high spending LA
• Strong Nottingham Plan and CYPP
• Ofsted Inspection of Safeguarding and Looked After
Children Services December 2010
Nottingham has…’an extensive and outstanding
range of early intervention services, making a
marked shift with vulnerable children and
families’
Nottingham,
‘Our aim is to break the
Early
intergenerational nature of
Intervention City underachievement and
deprivation in Nottingham
Programme approach: by identifying at the
earliest possible
Governance
opportunity those children,
Pilot projects
young people, adults and
families who are likely to
Learning and
experience difficulty and to
Evaluation
intervene and empower
Knowledge
people to transform their
Finance
lives and their future
children’s lives’
Learning from the EI
Programme
• Think like a Partnership
– Joined-up decisions and an integrated workforce
• Use the ‘F’ word = Fidelity
– Roll-out evidence-based programmes properly
– Engage the right families
• Evaluate and build your evidence-base
– Standards of evidence and evaluation
• Seek first to understand
– Insight – what’s really happening?
• Costs – know them!
Using EI principles to change
our systems and structures
•
•
•
•
•
Family Community Teams
Family Support Strategy
Workforce Core Standard - consistency
CAF target groups
Thinking more holistically around
complex families
• Corporate parenting is everybody’s
business
10 year profile of one complex family
10 Year FIP Family Timeline
Key points:
Chld 7 = 3 recorded injuries during 1999
Chld 7 attends A&E
with fractured femur referred to social
services
S47 on Chld 10 end Services No evidence of
abuse/neglect
Chld 6 referred to Paediatrician 4 times
Chld 7 falls - head
injuries
Chld 7 falls head injuries
2000
2001
2002
Escalation
Social Worker Enquiry Chld 7 in care of Chld 1, at
time of the injury
Fathers Criminal History - Common Assault, Criminal Damage, Actual Bodily Harm, Breach of Community Service Order, Obtaining Property by Deception, Theft, Theft from Dwelling, Failing to Surrender to Bail, Taking Conveyance without Authority, Domestic Violence, Suspected Arson (Family Home)
Social services monitor provision for Chld, 1, 2, 4,
5, 6, 7, 8, 9, 10
Police arrest Dad. Call from Chld
allegation of violence to Chld 3 1
when drunk
Chld 9 attends A&E 4 times
Chld 9 hearing referral - Mum FTA numerous
appointments
Chld 8 referred to
Speech Therapy
Health Visitor suspects
Emotional Neglect
2003
IA conducted for Chld 6,
8, 9 & 10
- Chld 3 reprimand
criminal damage, final
warning
IA conducted for
Chld 2, 5, 9 & 10
Mum FTA school meetings regarding Chld 5
exclusion as well as reintroduction meeting
Mum FTA several Health reviews for Chld 8 eventually seen without mum
Police attend address - DV
incident - Dad threatens to
kill Mum/children. Police
,suspect child neglect
house unhygienic and
overcrowded
Dad now moved down
to live in London
School contact Social services concerns neglect, FTA's violence and
Police involvement
Social services
monitor provision
for all children
Chld 5 violent & racist at school excluded for 5 days
Mum complains to Police - teacher used unreasonable
.force on Chld 5. Doctor concludes wasn't unreasonable
Strategy discussion about bruising on Chld 5 & Health
Visitor contacts Child Protection
Mum cancels Social Services
visit - they do not visit again.
Multi Agency meeting regarding
non cooperation
2006
Inter-generational
2005
Chld 5 Permanent
Exclusion Education Action
Plan meeting Mum FTA
2 x CAMHS
appointments for Chld
6 - FTA
Police contact Duty Team - Dad
spending all money on alcohol and
four kids going without food
IA for Chld 1, 2, 4, 5,
6, 8, 9 & 10
Chld 1 reporting DV
between parents & chld threatening to run away
CA for Chld 3 & S47 Chld 3
Enquiry/Assessment - No case
conference - S17 services - Risk
unlikely to recur
2 boys referred to Paediatrician FTA, 2 PRU meetings FTA, 10 school
meetings FTA, 4 BST worker meetings FTA
Chld 4 shoplifting - Mum
attends as appropriate
adult - Drunk
School Nurse request
for info - concerns on
house overcrowding
- Chld 4 reprimand
shoplifting
,Several reports of Mum being drunk
Mum complains of youths hanging
around
School contact Social
Services - Mum
appears not to be
living at home
School Nurse contact
Duty Team Chld 2
covered in bruises,
suspects DV - suggest
initiating a CAF- Mum not
cooperative
Housing contact Duty
Team - Mum not
living at home - told
refer to police as
missing person
Health Visitor contact Duty Team Makes CP referral - concerned about
family - children dirty, home a
disgrace. Explained involvement of
YIP & MALT - Mum struggling
YIP/MALT attend
arranged meeting Mum not home
School Nurse refers
Chld 9 to opticians &
Speech Language
YIP/MALT attend
2nd meeting for
CAF - Mum
retracts consent
2007
Plan & Family
Contract set up
IA & CA for all
children
Senior Practitioner
reports Neglect
concern - High risk of
DV - inadequate home
for family
Multi Agency meeting
chaired by Social
Services and
unplanned visit - Did
not meet thresholds
IA and CA
completed for
Chld 5
CA for Chld 2, 3, 4,
7, 9, 10
Multi Agency
completed - case
closed to Social
Services - Mum not
cooperating - no
outcome
IA for Chld 2, 3, 4,
7, 9 & 10
No ASB complaints
Housing Fire safety checkhigh risk; Environmental
Health Inspection - Cat 1
Hazard - represents risk to
inhabitants safety,
overcrowding serious
issue, re-housing urgent
issue
Mum engaged with APAS - no alcohol issues
Chld 6 successful transition to Bulwell Academy
Family have their first day out
together and go the park
Arrears of £3k discovered
on previous property held
with partner
Chld 2 discloses
Mums alcohol intake
dropped, but Chld 3
smoking cannabis
Risk assessment for
house in Bulwell deemed inappropriate too close to Chld 5's
previous arson offence
Jack bailed for
alleged robbery
Mum, Chld 1 & 2 attend
Freedom Programme
Mum continues
ISVA & APAS
work - Chld 3
stopped smoking
cannabis
Chld 2, 3 & 4 referred
to Connexions
Chld 3 starts
construction
course at college
Ex City Council laptop
provided to Chld 5 to
help with his work
Chld 5 narrowly avoids permanent
exclusion - has to attend Fill The Gap
until Sep 2010 when he will be
reintegrated into mainstream
CAMHs Initial
Assessment for Chld
5 completed and
work begins
Mum tells BST
to go away
Police contact Duty Team - Mum
presents at police station criminal damage by boyfriend Police reviewed: long history of
multi agency support
FIP request for
gardening equipment
provided by Salvation
Army - addresses
complaints about state of
house outside
ABC for
Chld 5
Negotiations
mean BST work
can continue Mum re-engages
Parenting
programme
Risk assessment of
new property in Clifton inappropriate
Mum's MARAC meeting
takes place - Mum still
engaging with ISVA
Chld 4 attendance improving,
Chld 3 still not attending and
staying out overnight
Letter sent from
Parenting about further
engagment - no
reponse, case closed
Chld 3 TWOC 3 month referral
to YOT
Chld 5 bruises noticed - fighting brother
Further bruises noticed - fighting sister
Further bruise on face - no explanation
ASB Case against
address
Chld 5 sets fire to house
c60k of damage - YOT
final warning
BST close case due to
lack of engagment
Chld 5 cut head, no school
uniform, bruises on body & arm IEP's not returned to school
CAF completed for Chld 7
and allocated lead
professional as part of
handover/exit strategy
2010
Chld 4 Social Care
referral - thrown out
the house living with
a friend
Home maintenance improved
as family take responsibility doors put back on by NCH significant improvement
Fire safety risk
assessment on
new property
FIP secure tenancy on
new property behaviour contract
attached to tenancy to
ensure compliance
Chld 2 sporadic attendance college. Chld 3
passed final exam - starts college Sep. Mum
attends meeting at school - Chld 4 65%
attendance. Chld 6 got reward for improved
attendance. Chld 7 concerns re behaviour
Chld 7 referred to
Catch 22
Family move to
the new 4 bed
property
Multi Agency risk
assessment conducted
prior to house move
Alcohol Assessment
showing improvement
for Mum
Chld 1 & partner move into
own property under Housing
Aid bond scheme (supported
by FIP and NCH)
Chld 1 has a baby girl
Multi Agency team agrees that FIP
Tenancy and Behaviour contract
worked and NCH agree to turn the
tenancy into an introductory tenancy
Chld 3 charged with Supply of
Class B Drug - 6 month referral
order and has to pay costs
Chld 4 accepted to
study retail at college in
Sept 2010 after
completing school
Chld 3 progresses
onto Year 2 of his
construction course
at college
IA for Chld 2, 3, 4,
5, 6, 7, 8, & 10
Police Incident, Mum
drunk - further police
reports of Mum drunk
School contact Mum - benefits
stopped for school meals.
Despite attempts no contact
from mum, no renewal
Connexions worker confirms
Chld 2 has progressed onto
Level 2 childcare
apprenticeship at Happy
Days Day nursery
2nd school referral to
Social Services
School refer to Social
Services - children no
lunch despite letters
Vaccs & Imms
organised for
children
ASB complaint against
children & Mum drunk
Mum FTA parenting
programme - hungover
Chld 5 referred to
MALT- not taken on
Mum on Triple P
Parenting course
Stronger Families referral
Demotion Order (Housing Order)
Chld 10 now
attends Nursery
Chld 3 in Court - Breach
of YOT order
Chld 10 not
attending Nursery
Bus passes for all
children to go to school
Chld 5 discloses mums
boyfriend smokes crack Chld 7 unsure if true
Action Owner Key:
Police
Health
Social Care
Housing
School
Court
Voluntary
Comm Protecion
MALT
FIP
Family
Mum
Dad
Chld 1
Chld 2
Chld 3
Chld 4
Chld 5
Chld 6
Chld 7
Chld 8
Chld 9
Chld 10
D.O.B
January 1970
July 1965
January 1990
August 1991
February 1993
January 1994
December 1996
May 1998
May 1999
July 2001
October 2002
April 2004
Parenting contract
in place
Mum attends first
APAS session
Notice Seeking Possession
ASB - also rent arrears
Chld 7 - SENCO &
Speech Therapist
support
Chld 5 shoplifting Police give Youth
Restoritive disposal
Whole family go on a
Narrow Boat so FIP can
do an assessment of
interaction
FIP
involvement
in family
begins
Chld 5 referred
to CAMHS
2009
Chld 6 referred to BST poor school behaviour
Chld 5 referred to Family
Care for therapeutic work
around DV
DV still evident
in family
Mum attacked by
partner - goes on
drinking binge
Beds provided
by FIP
Mum engages with
ISVA for DV
Housing & FIP discuss
manual offer for new
property
Chld 4 & 5 found walking from
Aspley to Bulwell by Police Mum drunk at boyfriends
Review of home overcrowding, no doors as
closed doors associated with
violence, few beds
Symptom not cause
Chld 3 - ASB
in Lenton
Leisure cards for family
2008
Chld 7 CP referral injured thumb
Mum aggressive with
Parenting worker case left open
CAF completed for Chld 5
and allocated lead
professional as part of
handover/exit strategy
Dad sets fire to the house family moved to the Meadows
Mum attends benefits/welfare advice
- plan put in place for arrears, other
finances put in place. Wasn't getting
all her entitlement - all bills now paid
Health visitor
organised for
younger children
Letter from Health to
Social Services concerns not
followed up - referral
closed and weren't
informed
Presented at VPP
S47 for All Children No case conference Sect. 17 Services Significant Evidence of
abuse/risk to Child
Non-engagement
Court orders preparation of S7
report concerning all children parents now separated - issues
over custody and previous DV
IA for Chld 8 &
Chld 5
Chld 8 attends A&E Sunburn
2004
Duty Team contacted by Health. Mum
refusing immunisations for children. She
said willing to kill herself and been
violent to partner in front of children
Dad accused of raping
Mum - found not guilty
Social Services review
services & provision
Silo focus
Child focus not
family focus
Mum exhibiting
MH issues
Chld 5 now
attending secondary
school
Glossary of terms & abbreviations:
S47 = Section 47 Child Protection assessment
FTA = Failed To Arrive
S17 = Section 17 Child in Needs assessment
PRU = Pupil Referral Unit
IA = Initial Assessment
YIP = Youth Inclusion Project
CA = Core Assessment
CP = Child Protection
Perm Exc = Permanent Exclusion
DV = Domestic Violence
BST = Behaviour Support Team
TWOC = Taken Without Owners Consent
NSP = Notice Seeking Posession
IEP = Individual Education Plan
MALT = Multi Agency Locality Team
CAF = Common Assessment Framework
APAS = Alcohol Prevention Advice Service
ISVA = Independent Sexual Violence Advisor
VPP = Vulnerable Person Panel
High cost but
outcomes getting
worse
Family Community Teams
Local Team
Delivering
Universal & Additional
Support
Single point of access for
Extensive
Support
Link to Partner
Community
Services
Children Centres
Child and Adolescent Mental
Health Services
•Area Management
•Police
•Midwifery
•Health Visitors
•Job Centre Plus
•Voluntary and
Community Sector
•Extended Schools
•Leisure
•Education
Improvement
Partnership
Play & Youth services
Family Support Teams
Education Welfare
Educational Psychologists
Disabled Children’s Service
Youth Offending Team
Early Intervention
starts early
as soon as
potential
difficulties are
identified and...
...requires
good assessment
of need
that should form...
www.mynottingham.gov.uk/familysupport
Or
http://www.nottinghamcity.gov.uk/ics/inde
x.aspx?articleid=14713
…a
comprehensive,
purposeful
response to
tackle
problems
Discussion
• In pairs, discuss what the term
‘commissioning’ means to you.
• As a group, record your shared
definition on the flip chart paper and
stick to the wall or window.
Commissioning
“…means outsourcing”
“ ...is about meeting your sales target”
“…is getting someone to do some art for
you”
“ ...is a structured needs based approach
to identify your service”
Commissioning
“…is more than just about children”
“…is the whole process of designing and
resourcing service provision. Who we deliver
to, how much it will cost”
“...is about the life cycle. People often confuse it
with procurement”
“…is an urban myth”
About half of our senior managers had an
understanding of commissioning, but thought it
related to EXTERNAL services only.
Our Commissioning Journey….
 Commissioning
Framework agreed Commissioning
Model
in 2010 by the
Council and One
Nottingham
 Not just the diagram!
Details, tools and
explanation on the
website
 Strong collaboration between partners and in
particular the Voluntary and Community
Sector
Commissioning
Legislation and
statutory
guidance
Gaps?
Plan
Set priorities and outcomes
Analyse
Purchasing/
Contracting
Existing provision/
service
Agree Commissioning
Strategy
Understand the
market
Data and feedback
on needs
Assess individual
needs
Analyse market
Review user/
citizen outcomes
Learning – to
feed into
‘Analyse’
APPLY
GUIDING
PRINCIPLES
AT EVERY
STAGE
Review contract/SLA/
service outcomes
Manage contract /
SLA/ service
Review
Review:
- delivery
- outcomes
Gather feedback
- users
- Councillors
- others
Develop
procurement plans
Develop service
specification
Agree best way to
deliver (take
account of impact
on market)
Secure the service
(tender, grant or in
house)
Let outcome based
contract/ SLA
Manage the
contract/ SLA/
service
Service is
delivered
Manage and build
the market
Manage
relationships
Do
Our Commissioning Journey….
 Underpinned by principles including:
 Early Intervention
 Local Jobs for Local People
 Supporting a thriving 3rd Sector
 During 2010 Children and Families was
reconfigured to bring together Adults and
Children’s Commissioning
 Framework translated into a ‘pathway’
 First set of commissioning intentions
identified
Strategic Commissioning Intentions – origins
Improved
outcomes
for citizens
Commissioning Pathway
A Preventative Strategy: Building a Capable Community & Supporting Choice
Version 3 – 20/05/2011
1

Strategic
Commissioning
Intentions
Strategic Direction
 Review CYPP* and VAP**
 External drivers analysed
Strategic commissioning priorities agreed by
councillors and communicated
 JSNA updated
 Investment Plan produced
 Market Development Plan produced
Close Down Review (services continues)






Priority and governance
agreed (scheduled or
right to challenge)
Business case agreed
with Portfolio Holder,
including rationale,
outcomes, timescale,
resource,
interdependencies,
strategic risks and
opportunities
Appoint project team and
sponsor
Identify expert team,
including service users
and routes to customer
and provider voice
(voluntary, independent
and community)
Develop and implement
Communications Plan
Timescale set
Pathway initiation date:



DRAFT Commissioning
Pathway
Decision on resource with Portfolio Holder
Pre-Pathway
Reduced
costs
Preferred options and decision on spend with councillors
Analyse
Identify:
 Current and future need
(JSNA, provider and
service user feedback)
 Current market position
and future business
plans
 Current spend
 Outcomes required
 Gap analysis
 Research evidence-base
(national and local) and
current costs
 Market development
needs
 Risks/opportunities
Learning / strategic issues / opportunities
Recommendations for other priority areas
Outcomes / direction of travel summary
Plan






Review
Do
Options appraisal,
ensuring balance of;
- quick wins / longterm outcomes
- evidence-based
programmes/
innovation and coproduction with service
users/providers
- early intervention
- projected savings
- Equality Impact
Assessments
Resource
Budget plan/strategy
Joint commissioning
Workforce implications
Evaluation/monitoring
plan
4 - 8 weeks
5- 10 weeks
Phase completion date:
Phase completion date:






Procurement process in
place, involving service
users
Communication and
consultation process in
place as appropriate
Incentivisation where
appropriate
Contracts agreed
- Outcomes focused
Implementation of
services
Monitoring/evaluation
undertaken (including
user voice)







Cost/impact analysis
Outcomes summarised
Evaluation/evidencebase summarised
(involve service users)
Cashable savings
identified
Re-investment plan
Learning and
recommendations
discussed/shared
De-commissioning/recommissioning
recommendations
outlined
6-12 months procurement
12 months minimum
implementation
4 weeks
Phase completion date:
Phase completion date:
Greater
investment
in
prevention
and EI
12 months – 2.5 years
Analyse
* Children and Young People’s Plan
** Vulnerable Adults Plan
Plan
Do
Review
Improved
pathways
Improved
Efficiency
Commissioning Pathway
Strategic Direction
Review CYPP* and VAP**
External drivers analysed
Strategic commissioning priorities agreed by
councillors and communicated
JSNA updated
Investment Plan produced
Market Development Plan produced
Pre-Pathway
Priority and governance
agreed (scheduled or
right to challenge)
Business case agreed
with Portfolio Holder,
including rationale,
outcomes, timescale,
resource,
interdependencies,
strategic risks and
opportunities
Appoint project team and
sponsor
Identify expert team,
including service users
and routes to customer
and provider voice
(voluntary, independent
and community)
Develop and implement
Communications Plan
Timescale set
Pathway initiation date:
* Children and Young People’s Plan
** Vulnerable Adults Plan
th
Agreed EBCS-C 13 July 2011
Close Down Review (services continues)
Learning / strategic issues / opportunities
Recommendations for other priority areas
Outcomes / direction of travel summary
Commissioning
Pathway
Analyse
Identify:
Current and future need
(JSNA, provider and
service user feedback)
Current market position
and future business
plans
Current spend
Outcomes required
Gap analysis
Research evidence-base
(national and local) and
current costs
Market development
needs
Risks/opportunities
Plan
Do
Options appraisal,
ensuring balance of;
- quick wins / longterm outcomes
- evidence-based
programmes/
innovation and coproduction with service
users/providers
- early intervention
- projected savings
- Equality Impact
Assessments
Resource
Budget plan/strategy
Joint commissioning
Workforce implications
Evaluation/monitoring
plan
Procurement process in
place, involving service
users
Communication and
consultation process in
place as appropriate
Incentivisation where
appropriate
Contracts agreed
- Outcomes focused
Implementation of
services
Monitoring/evaluation
undertaken (including
user voice)
4 - 8 weeks
5- 10 weeks
6-12 months procurement
12 months minimum
implementation
Phase completion date:
Phase completion date:
Phase completion date:
Review
Cost/impact analysis
Outcomes summarised
Evaluation/evidencebase summarised
(involve service users)
Cashable savings
identified
Re-investment plan
Learning and
recommendations
discussed/shared
De-commissioning/recommissioning
recommendations
outlined
4 weeks
Phase completion date:
12 months – 2.5 years
Analyse
Plan
Do
Review
EI within the year 1 reviews
Analyse
• 85+ population
to inc by 45%
by 2030
Plan
• Consider EI
models
• Budget £42.3m
• Involve partners
and citizens
• High use of
residential
• Establish
Business Cases
• High placement
costs
• Agree budgets
• People lose
skills in resi
• Citizens feel
isolated but
want to remain
independent
• Finalise details
Do
• Procure/implem
ent new models
of delivery
• Monitor and
evaluate
progress
quarterly
• Measure impact
annually
• Adjust where
appropriate
Review
• Client group
feedback
• Measure longer
term impact
• Evaluate the
process
• Inform
stakeholders
and the market
what works and
what we want
more of
EI Phase 1 Programmes
• Nottingham Circle
• Living Support
Networks
• Expansion of Telecare
Service
• Reablement Gateway
Low cost/no cost options
Needs
Shopping
Cleaning
Food and
drink
Social
Contact
Personal
Care
Medication
Parenting
Financial
Planning
Low level
support in
community
Friends and
Family
Equipment
and telecare
Reablement
Alternatives
to resi care
(supported
housing)
Crisis / rapid
response
service
Year 2 Reviews
• Safe from Harm
• Complex Families
• Social Exclusion
Discussion
• What do you believe to be the key
challenges in driving the EI agenda
through the commissioning process for
• Providers?
• Commissioners?
• How is your organisation meeting these
challenges?
Embedding EI into
Commissioning
•
•
•
•
Base lining financial split
Engaging Councillors
Identifying a % shift
Pump-priming, but identifying the
mainstream budget
• Focus on clear evidence-based
programmes
• Scale up what works
Discussion
• What examples can you share of how
you are shifting resources to Early
Intervention?
Next Steps
• What can Nottingham do to support you
further?
• What can JRIEP do to support you
further?
Thank you
For further information contact
chris.wallbanks@nottinghamcity.gov.uk
Website - www.nottinghamcity.gov.uk/commissioning