Commissioning and Decommissioning in York: Are we redirecting our
resources to impact more effectively on outcomes?
This brief paper summarises a range of examples of commissioning being used to
improve outcomes.
Context:
The City of York has a long history of strategic planning to improve outcomes for the
children and young people of the city. As a pathfinder Children’s Trust and in
advance of statutory requirements to have a Children and Young People’s Plan,
York had one because we wanted one. A plan based on evidence, data, analysis
and consultation which would concisely describe where improvement was needed
and how we were going to go about making that improvement. A plan which would
challenge but also celebrate achievements and give a clear, ambitious vision for the
future.
The city has now seen plans covering 2005-8, 2007-10 and 2009-12. Responsibility
for producing the plan sits with the YorOK Board (ie, the Children’s Trust) and the
Board is also responsible for monitoring progress against the plan’s priorities. To
assist with that function the Board receives quarterly monitoring reports against its
Performance Scorecard and challenging discussions take place. The Board also
receives Annual Reviews of the Plan which are again published on the YorOK
website.
To support the work of the Board the Integrated Commissioning Group (ICG) has
been established to get behind the details and to ensure that resources are
effectively targeted and that the joint ambitions of the plan are supported by
resources. The ICG comprises senior representatives from our partner organisations
but also brings into the debate work stream leads to unpick any challenges to
improvement. The ICG has also created opportunities for joint learning on
commissioning, for pooling resources and our mutual understanding of allocation
decisions, and for consultation at moments of key budget setting. A wider
commissioning network was established to benefit from the Commissioning Support
Programme of training and development. The attached framework summarises this
work.
City of York’s Children and Young People’s Plans have provided clarity of vision, a
shared analysis of progress and an agreed set of key priorities and outcomes. They
have been produced in large scale, in different formats and deliberately written in
readable English which engages the reader and as a result harnesses energy for
delivery. They have been used and cascaded by individual agencies into their own
service planning frameworks and have been used by partnership groups to provide
clarity on their role and purpose. As a result outcomes have improved.
In addition there have also been specific commissioning and decommissioning
decisions made by the partnership to enhance our collective impact. The rest of this
briefing summarises some of these examples.
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1. Commissioning services for those with severe learning difficulties and
challenging behaviour: attached are details of a relatively new service which
provides intensive one to one support for families. Families who have reached the
stage where they feel the only option is out of authority placements/care. This would
include support in unsociable hours to help develop good bedtime routines, model
responses to behaviour at the weekends and form a strong partnership with parents
that would change behaviour. We knew such a service was only required for a few
cases but the impact already is remarkable. Satisfaction is high, local solutions are
found and significant financial savings delivered.
2. Catalyst: Family Intervention Programme in York: attached are details of the
local FIP scheme known as Catalyst. It responds to our strategic challenge of
supporting families intensely within the community particularly for families on the
edge of care. It models working intensively on a whole family basis. Its impact is
clear for all to see and is well demonstrated on the attached excel document. As a
result protection has been afforded to the programme through challenging budget
rounds. We are now well placed to roll the programme out, tripling its capacity as
part of the government’s “Troubleshooter” programme.
3. The new Front Door Service – decommissioning Education Welfare: the work
to enhance the front door arrangements in York is attracting national interest. It is
based on a strong evidence base and comparative data from Professor David
Thorpe’s involvement. As part of this development we reviewed our Education
Welfare Service (EWS) – why did we need a service focusing solely on attendance
issues when we know that such issues frequently come about because of problems
in the family home that need to be addressed holistically? Attendance figures in York
are exceptionally good – so why continue to invest in a narrowly focused service
when the opportunity to deliver the wider front door was open to us? Already the new
service is achieving reductions (28%) in referrals into children’s social care,
significant reductions in caseloads for social workers, and that in turn has allowed a
doubling of the numbers of cases dealt with at core rather than initial assessment
level. In short, it has permitted more intensive time to be spent by social workers with
those that need them most. At the same time the service ensures those needing
earlier help get it, and better tracks the impact of that help. And last year’s school
attendance figures were our best ever.
4. Recommissioning Drug Services in York: We recognised that the problem of
adult drug and substance misuse was a problem which was having detrimental
impact on the lives of children and young people. Analysis showed the significance
of drug and alcohol problem in the makeup of parents of children with a Child
Protection Plan and in care. The commissioning of drug and alcohol services was
historically undertaken by a shared Drug Action team for North Yorkshire and York.
Following our insistence that team was decommissioned and a local York specific
Drug Alcohol Action Team established. The impact has been almost immediate.
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Previous providers have been decommissioned and new contracts are in place with
stronger requirements regarding both prevention and impact on known users. The
language of responsibility for safeguarding by all providers has been introduced and
communication enhanced as a result. We now see:
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2nd most improved DAAT area in our Opiate DAAT family
An improvement growth of 46% against a National average for improvement of 6%
Improvement of 46 places in the national profile for OCU’s (opiate and crack users)
Improvement of 48 places in the national profile for all adults (all drug users in
treatment)
4th overall for successful OCU completions in the Yorkshire and Humber region
1st overall for successful non OCU completions in the region
The new drug provider contract has included:
 Residential rehabilitation placements with priority given to family placements
in partnership with social care;
 The future programme of non residential placements in the city specifically
targeting hard to reach families and work closely with “troubled families”
programme – edge of care agenda;
 More robust safeguarding procedures are highlighted in the new contract
particularly where children are resident in a household where injectables are
present;
 A service which offers assistance to children of drug users.
5. Early Intervention Fund: if early intervention was the local mantra it made sense
to protect our early intervention funding but also to ensure that commissioning of
early intervention services was undertaken in a comprehensive, evidence-based
way. The process, influenced by Friedman’s work, is attached. It provides a strong
example of commissioning which seeks impact and shares best evidence for how to
achieve that impact. The third attachment then evidences the impact funded projects
had against outcomes – it also includes some powerful case examples.
6. Sure Start Portage (SSP) was the name given to a collaborative piece of work
initiated in 2004 between the York Portage Service and the Sure Start Programme to
work with two groups of vulnerable children. This was initially undertaken in the Sure
Start areas of York, becoming citywide from 2004:
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Children born low weight and pre-term (LWPT)
‘Looked After’ pre school children (LAC)
The latest annual report is attached (2011) which has rich case examples of the
impact of the service on both of these groups.
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7. CAMHS/TAMHS: contained within comprehensive local CAMHS/TAMHS
strategies are clear examples of evidence based commissioning of services eg
nurture groups which are impacting on outcomes. Attached is an example of the
work aimed at increasing pupils’ self esteem and self confidence and improving staff
awareness of where to get help. The work has been positively evaluated from both
the child and the parent perspective: work of this nature prevents a child and family
detaching from mainstream provision and ending up in edge of care/safeguarding
situations. A case study demonstrating impact is attached:
We have also made LAC a priority within the CAMHS service specifications going
forward given that LAC do have more frequent emotional health and wellbeing
issues.
8. Teenage Pregnancy: historic challenges around increasing teenage pregnancy
rates have been turned round by effective commissioning strategies which now
result in excellent local performance:
9. Commissioning Post 16 provision: whilst historically NEET levels are low we
knew we had a challenge in engaging those who were not ready for existing post 16
provision – included within this cohort were some care leavers. The attached
demonstrates impressive success. YPLA data shows that in the last 3 years the
number of 16-19 year old participants on Entry Level and Level 1 programmes has
increased by 51% (328 to 495 in terms of actual numbers) and that the proportion of
participants at this level has increased from 8% to over 11%. We have also
delivered impressive increases in Apprenticeships through the “100 Apprentices in
100 days campaign”:
10. The Safeguarding Unit of the CYSCB: when we established the Safeguarding
Board we also established a pooled budget to fund a core team. That team has now
been supplemented by an additional post funded through the school community.
This post creates excellent capacity to enhance school based safeguarding practice.
The local clinical commissioning group has also expressed interest in following this
model as they move from shadow form, as a method of effectively delivering their
statutory responsibilities.
11. Transitions in York: a key priority has been improving the transition to
adulthood for children and young people with complex needs. This cohort includes
many vulnerable young people and LAC. The attached demonstrates the major
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progress made in the city and the feedback being received from families. This
example also demonstrates our strong links to local universities.
12. In addition we can list a number of further examples of joint, outcome-focused
commissioning, including:
 Castlegate Centre – joint PCT/LA development providing effective support to
16-24 year olds;
 Retargetting of Young Peoples Service and Children centre provision in light
of funding pressures and to ensure those requiring targeted intervention can
access;
 Country Classroom: engaging those turned off by traditional curriculum offer;
 York Cares: partnership funding (CYC, University of York and local
businesses) to work with employers to promote employee volunteering and
corporate social responsibility. A specific York Cares project, known as
“Starting Blocks” was aimed at improving life chances and aspirations for
LAC, and it has attracted national recognition;
 Joint work with NSPCC to enhance early intervention, domestic violence and
interventions for children and families where sexual abuse has occurred;
 Joint work with York St John University to enhance the accredited learning
opportunities for foster carers and thereby aide retention and improvement.
For the future: the Annual Review of the Children and Young People’s plan is under
way. The Board has expressed its desire to develop a new plan but recognises that it
needs to work in the context of changing strategic planning arrangements. The JSNA
for York is advanced and we will have our first Health and Wellbeing Strategy for the
city by summer 2012. Our engagement with the new GP Commissioning Group is
excellent. The attached shows our current thinking on commissioning frameworks in
the new world with the relationship between the new Health and Wellbeing Board,
YorOK, York Education Partnership and safeguarding board included. The new
Children and Young People Plan will be able to respond to the expectation of both
the YorOK and the Health and Wellbeing Board. We are as a result confident that
these arrangements will build on rather than deflect from the progress described
above.
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