Wales Council for Voluntary Action
Public services: co-design, co-delivery
Where we are now
1.
The Welsh Government public service improvement programme is at a critical
stage, exacerbated by the current recession. On the one hand it is committed to
public services that are more citizen-centred – responsive, flexible, more personal,
with the citizen as an active partner rather than a passive recipient. As part of this
commitment, the third sector is identified as a key member of Local Service Boards,
and it sees the third sector contributing to an increasingly mixed economy of
provision.
2.
But on the other hand, the search for efficiency savings, always a vital part of
Making the Connections, and now increasingly important in the current economic
climate, is beginning to exclude the third sector. Public bodies are seeking more
efficient approaches to procurement – cross boundary contracts, framework
contracts, amalgamating individual services. Third sector providers and social
enterprises – many of whom are small, local and citizen-led – do not always offer the
scale of delivery required.
3.
Public bodies are also seeking to increase use of new technology and in particular
use of the internet to increase efficiency and reduce costs of service transactions.
This can make very significant savings, and for many people improve access and
convenience. Of course, this has the opposite effect for people unable or unwilling
to use the internet, creating a divide between digitally included and excluded people
– and the most disadvantaged people will be disproportionately represented
amongst those who are digitally excluded unless there is support available to help
them access mainstream internet services.
4.
The small scale of most third sector providers and social enterprises may be
problematic in terms of commissioning and procurement, but it may be precisely
what citizens need in terms of personal, local, flexible and participatory service
delivery. Achieving savings at the cost of citizen and user focus will be a backward
step for public services in Wales.
5.
The current debate on the future of public services is based upon assumptions that
substantial spending cuts are coming, but there is scope to achieve significant
savings via collaborative and joint services – that ‘smarter’ ways of working can
result in improved services.
6.
A number of approaches are emerging which seek to use the existing financial
‘cake’ in smarter ways. But, there is scant evidence that ‘efficiency’ savings can
produce the level of saving required, or that even a cut down version of existing
services will produce the saving needed. The outcome of such an approach is likely
to result in a ‘bunker’ mentality, where public service providers cut all preventative
1
or non essential work, and concentrate their diminishing resource on statutory
interventions at high cost and risk.
7.
In such an approach, services are likely to be taken back in house, and staff redeployed from a variety of backgrounds. Both quantity and quality of service may
decline, and the aspiration of citizen-centred services is abandoned, in favour of a
‘gifted’ public service designed and delivered by an over-stretched and diminishing
public sector workforce. Such a strategy will not only short-change local service
users and their providers now, but has little or no chance of meeting future
demographic pressures and needs.
8.
For example, by 2020 the number of people aged over 85 will have increased by
50%, and there will be fewer than 3 working aged people for every person over 65.
The combination of demographic change, expenditure, restraint and reduction, and
aspiration of more flexible personalised services, means that current public sector
models of service delivery may no longer be sustainable.
9.
Our current service models, particularly for vulnerable people, tend to be based on a
mix of planned statutory provision, and ad hoc alternative provision. Public bodies
commission professional intervention for a smaller number of people in highest
need, often at high cost. People who are not directly supported in this way may
access help from outside the public sector – from family and carers, from voluntary
and community groups, from self-help and mutual groups, and (if they can afford it)
from self-funded private provision. Some of this may benefit from some public
sector funding, but much of it is independently organised and funded. Sometimes
this alternative support works alongside statutory provision, offering complementary
support; often, however, it operates quite independently.
10.
Services may be just about keeping pace with current demand, but there are
pressure points. There are also serious issues about people’s quality of life. We
may have been successful in helping to keep people in the community, but we have
had much less success in helping people to become part of their community. More
support does not necessarily mean a better life or more independence, and issues
of loneliness and belonging are often more critical than the quality of personal care.
People are very vulnerable to changes in their community; shops, transport,
neighbours, local groups; and the less stable these are, the more people rely on
professional agencies for belonging.
A new approach – co-design, co-delivery?
11.
There could be an alternative way of developing future public services which
creates a bigger ‘cake’ and which deploys, not just public sector staff and budgets,
but also users, families, neighbours, local third sector organisations and the wider
community in a ‘total service’ which goes beyond traditional service provision and
releases new resources, skills and energies. It means commissioned services and
self-organised support complementing each other rather than operating in isolation.
12.
We need a new equation that measures the total value of a service and benefits for
the citizen (taking account all resources deployed – employed staff time, user input,
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volunteer time, community support groups) against the public sector investment.
The prize is to use our public funding in ways that lever in additional resources – to
achieve better value for the citizen.
13.
This could mean a new approach based on co-design and co-delivery of public
services, where activities and services are designed and delivered by a wide range
of actors – bringing together the independent third sector and the public sector with
the citizen and the community at the centre. It means investing in community
capacity and initiative in order to provide mutual support that complements, and
reduces demands on, other services. The approach can involve:
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14.
This is already happening in Wales, delivering enhanced services at reduced cost.
Examples include:
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15.
Citizen-directed support
Service user led services
Community led services
Mixed volunteer and staffed services
Integrated services.
Out-of-hours transport from hospital and support for older people who are
clinically able to return to home, helping to avoid re-admissions. The saving on
the cost of re-admissions more than covered the cost of the service in 2009.
Involving volunteers in longer term support and relationships with young people
leaving care and, in turn, care leavers volunteering themselves through
Millennium Volunteers
Involving volunteers in enhancing the experience of patients in hospitals in an
organised, union approved way.
Integrating statutory and third sector services into a seamless Intermediate Care
Service.
Direct payment schemes which increase user satisfaction, independence and
control, and also produce both savings and an enhanced service.
Community alliances bringing together people needing care and support with
local groups to build formal and informal networks and structures to meet their
needs.
Examples of these and other initiatives in Wales, and examples of similar
approaches elsewhere, are provided in Appendix One.
Practical implementation
16.
If there are already good examples of this approach working in Wales, there is a
need to systematically embed the approach in commissioning practice if we want to
significantly more. There is little guidance available to commissioners on how to
stimulate mutuality in the commissioning and procurement of services, although the
recently launched Value Wales Social Care Procurement Route Planner provides a
good framework for developing this in social care.
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Whole system commissioning
17.
Innovative partnerships between commissioners, service users and providers can
focus on mutuality and co-production in service design, bringing service users
greater choice and control, and charged with achieving strategic coherence
between service level outcomes and wider social, economic and environmental
sustainability.
18.
We need to encourage more radical approaches to reviewing and designing service
delivery. A “whole system” approach to commissioning should be able to re-think
what services are required to meet the needs expressed by citizens and service
users. It would take account of all services that citizens use, which may not be only
those formally provided or procured by the public sector. Many services that
citizens use and depend on are provided outside statutory provision.
19.
Can we identify specific service areas to undertake an in-depth, whole service
review? It would be interesting to focus on one or two service areas where there
are a variety of providers, including services organised independently of public
sector funding (for example, youth provision, carers support, support for older
people). From the perspective of the best outcomes for citizens, this would explore,
across different providers:
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20.
As a result commissioners could determine:
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21.
The balance of existing provision, including relative take-up and relative costs,
and the fit between different services
The required balance between meeting short-term needs, and developing longer
term strategies for prevention and self-reliance
The value of services that could be provided, taking account of additional/nonpublic resources available
The right pattern and mix of service delivery for current and future needs
How individual services complemented and reinforced other provision
The balance between provided services and self-managed services through
personalised budgets, and support required to facilitate personalisation
What services need to be funded and how (through grants, through competitive
tendering, as appropriate)
Priorities for development
Based on this, commissioning would open up the potential to deliver any services to
all interested providers. All providers would then be then tested against their ability
to deliver the best results in terms of both cost and citizen benefits.
Service design
22.
Co-design means that commissioners and service providers work with service users
and citizens to design services. The challenges for commissioners are varied. They
include how to ensure an effective representation of the local service user
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population and utilising different approaches to engagement and co-production that
go beyond traditional consultation meetings.
23.
The process of how to engage is as vital as the methods used to engage. Effective
service user engagement requires a culture in which a commitment to
understanding the complex needs of service-users is paramount in commissioning
and delivery of services. This demands those who commission and plan services to
think and behave differently to the exisiting way of doing things.
24.
The Welsh Assembly Government is supporting Participation Cymru to extend its
work with public services, and to provide a central information and advice resource
for those responsible for public engagement. It is already working with a number
of LSB’s in their work on Citizen and Community Engagement. The strength of
partnership working in engagement work pays dividends. The overall view from
service users and the public in general is that they do not want to increase the
amount that they are consulted but rather improve the experience of the
engagement itself.
Service delivery
25.
The commissioning and procurement procedures need to build in and assess coproduction.
26.
Service specifications can be broadened to include activity that will improve
people’s well-being and quality of life, and sustain independent living. For example,
whilst an individual may have an immediate health or social care need, their longer
term independence and quality of life could be enhanced by:
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27.
Making new friends if wanted;
Exploring different experiences;
Sharing skills;
Help with accessing internet-based services;
Experiencing stimulating social, creative or physical activities;
Helping to form groups of people who share the same interests;
Developing friendship and support from groups;
Exploring options and opportunities;
Seeking solutions to problems and barriers.
We need to commission services from providers that are equipped to address
these, for example through:
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Advice, Information and Advocacy: signposting to or provision of information,
advice or advocacy on services that can meet an individual’s needs and that
support independent living. This could include where appropriate support to
individuals to help them maximise their income through benefits advice and
assistance with form completion.
Developing networks of support: identifying and working appropriately with a
service user’s own network of support;
5
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Building community links: one-to-one support to enable a person to re-engage
with their community of interest to address social isolation. This can range from
a locality based social diary outlining activities, to personal introductions into
local groups, signposting to befriending services, support to use the internet, or
confidence building to leave the home and /or use public transport
28.
Procedures should require providers to express the ways in which they would
involve service users and draw in additional support. Prospective providers should
be required to answer specific questions on service user involvement, and how they
can assist people to access a wide range of services from statutory, third and
private sector providers in accordance with the individual’s needs.
29.
Providers should be assessed against:
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How their service identifies and mobilises service users’ strengths?
How their service assists people to participate in community life and benefit from
community networks and support?
How their service supports people in finding ways to help and support others,
including fellow service users, family, neighbours and the local community
Where appropriate, how their service creates additional benefits through the
contribution and development of volunteers? (See Appendix 1 for example of
building volunteering into a service specification)
How activities and approaches meet both service level and community level
objectives and outcomes
30.
There are existing initiatives in Wales that can help to achieve this.
31.
The Value Wales Social Care Procurement Route Planner could be further
developed to embed this approach within social care procurement.
32.
In Wrexham the Partnership Liaison Group (Compact Group with NHS, Local
Authority and Voluntary Sector Membership) is developing a Third Sector
Commissioning Framework. It aims for a consistent approach to be adopted by
officers who commission or monitor third sector services and full implementation of
the Welsh Assembly Government Funding and Monitoring Code of Practice. The
Framework provides guidance on the Commissioning Cycle and the strategic role of
the third sector, and supports officers to determine if funding can be offered as a
grant or if it needs to be competitively procured. There is a recommendation that all
funding arrangements are to be for a minimum of three years where appropriate and
applicable. Guidance on proportionate monitoring and evaluation is set out in detail
through a risk management approach. Standardised third sector contractual models
are produced as appendices to support officers and third sector organisations. The
Framework has been presented to Local Members and local authority senior
managers, the CVC Trustee Board and voluntary organisations, and has received
widespread support. The local authority Executive Board is expected to sign off the
Framework in March 2010.
33.
In Merthyr Tydfil and Rhondda Cynon Taff a two-year Commissioning Policy
Development Project has been established to produce a Funding, Commissioning
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and Procurement Code of Practice for public and third sector organisations. As part
of its work it is addressing how to quantify the added value that third sector
organisations bring to service delivery. The project aims to achieve better informed
and supported public and third sector organisations in relation to commissioning,
and more citizen centred services developed on a who does what basis.
34.
In Carmarthenshire, the Local Service Board is considering the establishment of a
third sector procurement unit linked to the county voluntary council. This would
enable all LSB partners to use the unit to enhance existing procurement procedures
and to influence the design and delivery of future services. It would streamline
processes – particularly important for smaller groups – by introducing a
‘Carmarthenshire Quality Mark’, generic PQQ and ‘Carmarthenshire Document
Passport’. It would ensure that the option of third sector service delivery was
available to all LSB partners in appropriate circumstances, helping to design the
best possible public service delivery opportunities for the third sector, and
proactively develop new providers if this would meet identified public service needs.
Conclusion and recommendations
35.
Placing co-design and co-delivery at the heart of public services is wholly consistent
with the drive for citizen-centred public services. It can lead to better service
outcomes for people and communities, and build the capacity of communities to
respond to present and future demands.
36.
Our challenges are to translate this approach into commissioning procedures and
practice, and to be willing to re-think our current delivery models and traditions.
37.
If the approaches set out in this paper are considered to contribute to the
improvement of public services, especially in the context of the difficult times ahead,
the next step is to identify how to embed these in our routine planning and
commissioning arrangements. Steps towards this could include:
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Inviting the new Assembly Government Public Service Efficiency Board to
consider the co-design, co-delivery approach
Reviewing current commissioning guidance, and including measures to promote
co-design and co-delivery
Monitoring the impact of existing local third sector commissioning and
procurement initiatives, and promoting replication if appropriate
Asking Value Wales to develop further its Social Care Procurement Routeplanner to include assessment of added value through co-design and co-delivery
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Acknowledgements
This paper draws on a range of sources, and in particular:
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The Challenge of Co-Production: How Equal Partnerships Between Professionals and
the Public Are Crucial To Improving Public Services (new economics foundation, 2009)
The Commissioning Friend for Mental Health Services: Guide for Health and Social
Care Commissioners (National Mental Health Development Unit, 2009)
Commissioning Outcomes and Recovery, London Borough of Camden, October 2008
Developing a Co-operative Model for Increasing Involvement in the Delivery of Public
Service (Wales Co-operative Centre, July 2008)
Towards Sustainable Social Care - A cooperative inquiry into new ways of providing
support to people in Swansea (http://sustainable-lives.org.uk/welcome )
June 2010
WCVA
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Wales Council for Voluntary Action
Public services: co-design, co-delivery
Appendix One
Examples from Wales
1.
Integrated services: housing related support
This project established by a mental health charity provides accommodation for
seven adults who require an intensive level of support in their recovery with two
members of staff on duty 24-hours a day. It offers a stable environment for people
who have just left hospital and are working towards independent living and enables
clients to remain in their home through most episodes of crisis or relapse.
The project involved the creation of a unique set of partnerships. It brought together
the County Council Social Services Department, the housing related support
provider, the principal housing association in the area, the Local Health Board and
the NHS Trust. What is striking about the Aberystwyth project is the high quality of its
accommodation with flats that provide desirable therapeutic environments. Flats are
furnished to a high standard, have a fresh and inviting feel and provide the kind of
home in which people would actually want to live. The project not only provides the
right environment, it is also backed up by a methodical recovery plan which belongs
to the client but is supported by staff. With a ‘Whole Person Approach’, the client gets
to look at all areas of their life, it enables them to look at issues such as education,
medication, other therapies, social life, physical health and money. Most importantly
it supports the clients – even when they are very ill – in being independent as they
approach their recovery.
A client at the project said: “I have a really nice, well-equipped and modern flat here.
It’s my own space: I have privacy and independence but I know that I can access
support at any time. Having this flat has definitely helped me to recover. The project
provides a stepping stone towards independence. It acts like a bridge between being
in hospital and moving on to the next stage. For people who have been in hospital for
a long time it’s a really important step because it would be difficult to move in to a flat
on your own.”
The impact is that the project not only does this provide holistic client focused,
community based support, it has already saved the local authority significant monies
bringing clients who were based out of county back to their home area (£0.5m in the
first year). It has reduced spending on public services whilst providing client focused
services in the community. Developing community based housing related support,
bringing people home and enabling them to contribute to their communities has
benefited both the client and public service commissioners.
Source: Cymorth Cymru
9
2.
Twilight service: ‘out of hours’ home from hospital transport and risk assessment
This service aims to prevent unnecessary admission to hospital by offering transport
home from hospital for patients over 55 years old who are medically fit for discharge
from A&E at two local General Hospitals, and to prevent readmission to hospital by
risk assessments in the home and referrals to community and statutory support
organisations, thus saving NHS Trust resources and reducing human suffering.
Twilight Service staff also provide other services including: a patient befriending
service; support to NHS staff within the departments by carrying out an agreed list of
tasks.
The Twilight service is funded by health and social services and operates five days a
week, between 2pm and 10pm. Drivers, all of whom are bilingual, are available in the
two hospitals to transport patients home in a friendly manner. Each patient is
transported home, helped to settle and offered a home safety check and referral to
other activities/services if appropriate. The service has also provided a transfer
service to other hospitals, and has crossed geographical boundaries that have
prevented use of normal transport arrangements.
The impact is that older people who are clinically able to be sent home, have
previously been admitted because a) there were concerns for their safety, b) the
ambulance patient transport service was unavailable, c) transport by taxi was
inappropriate or d) because care homes did not have the staff available to collect the
older person. The service overcomes these obstacles and prevents unnecessary
admissions. The cost of these admissions, based on one night per person (though
the average stay is longer), exceeded the funding provided to the Twilight service
when monitored over a 6 month period in 2009.
In addition, the drivers are available in the two hospitals to befriend patients and do
simple errands for the staff. Service users have been referred to local social support
groups, Care and Repair, Social Services or General Practitioner. The difference
made to those who receive the service cannot be given a financial value, but includes
a sense of being looked after, valuing being put in touch with other services and relief
at not having to stay in hospital.
Lessons learnt are that where vulnerable people are discharged from A&E and
clinical decision units, there is a need for more than standard patient transport or taxi
services. Providing a link to other services, public or third sector, helps to integrate
the care system and enables be the need for low level support to be met. The
relative costs of the out-of-hours service and the normal daytime service have not
been established, but this would be useful information to identify.
Source: F Zinovieff & B Collis (2010) The Role of the Voluntary Sector in Delayed
Transfer of Care (DToC)/Hospital Discharge and Prevention of Readmission. Report
produced for Welsh Assembly Government. Contact B Collis, bcollis@wcva.org.uk
10
3.
User-led services: Barnardo’s Cymru: Involving volunteers in supporting vulnerable
young people
Barnardo’s runs a number of services in Wales which provide a range of support for
young people who are, or who have been, accommodated by the local authority, in
order that they may successfully manage the transition from leaving care to more
independent living. In one particular service of focus, volunteers work alongside paid
Young People’s Advisors.
The impact is that volunteers are seen as part of the team, providing a wider range of
experience and support to the young people. This is provided over a number of years,
building relationships, participation in group activities and trust in others. They can
bring specific skills (e.g. cooking, DIY) as well as supporting the development of life
skills in a flexible, ‘on demand’ way. Service users report volunteers as being
‘friendly, supportive and easy to talk to’ and as having a similar background which
helps the service users to relate to them. They see the support they receive
continuing beyond the time when they are no longer eligible for statutory services.
In addition, the care leavers were in turn encouraged to volunteer through the
Millennium Volunteers scheme, which further built their self confidence and life
experience. Young people linked their enthusiasm for volunteering with their
experience of being helped by a volunteer.
Lessons learnt are that volunteers can be an active ‘added value’ part of public
service provision, and bring a breadth of experience and skills which those with a
career in social care may not have. Including volunteers in service provision means
that those receiving the service get beyond ‘you are only doing this because you are
paid’ and begin to consider their own attitudes and motivations, often with positive
results.
Source: M Andrews (2009) The Impact of Volunteer Support on Service Users,
Barnardo’s Cymru. Contact melanie.andrews@barnardos.org.uk
4.
Integrated services: Lifestyle Coaches: supporting people with long term health
problems to engage in health improvement through community activities
This service has been piloted in Neath Port Talbot and Bridgend by a partnership
involving local authorities, the third sector, local health bodies, NPHS and NHS
Direct. It involved embedding a lifestyle coach in a GP surgery who went through a
simple programme of setting health improvement goals with patients referred by the
GP. These patients were then supported through developing and implementing an
action plan. This included local physical exercise, social, educational and therapeutic
activities provided by community, independent and public bodies.
Part of the pilot involved collecting details of relevant services and inputting them
onto the local services part of the NHS direct website. The coaches had an in depth
knowledge of the services available within the primary care system, the local
authority leisure facilities and local voluntary and community support groups.
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The impact is that, on average, the participating patients showed a significant
improvement in their health status, demonstrated by filling in the Euroqol EQ-5D
questionnaire. Many also reported increased physical exercise, healthier eating and
improvements in confidence. Key elements to the success were the skills of the life
coaches and the access to the local opportunities. These local opportunities were
collated by the local county voluntary council, who had the background knowledge
and contacts.
Lessons learnt are that partnership working at a local level which includes the
integration of the voluntary sector as part of the patient’s health pathway can provide
a context for innovation which would otherwise be impossible.
Source: A Simpson & M Longley (2009) Delivering Integrated Services Project – Self
Care, Prevention and Promotion: An Evaluation of the Lifestyle Coach Pilot, Welsh
Institute for Health and Social Care, University of Glamorgan
5.
Volunteers: The Robins ward volunteer scheme – adding value
Ward volunteers (known as Robins due to their red polo shirts) have been recruited to
enhance the experience of patients at Ysbyty Glan Clwyd and the community
hospitals in Denbighshire. The Robins provide basic services such as tea rounds,
getting items for patients from the shop, filling in menu cards, refreshing water for
flowers for patients, and being available for a chat in a wide range of wards. The
tasks were agreed in advance with the unions represented in the hospitals. There are
over 170 volunteers, who have been trained, matched with a ward and generally work
a 4 hour shift once a week.
The Impact is that patients appreciate that the Robins are volunteers and recognise
the ‘red robin’ uniform. They appreciate the assistance with flowers, cups of tea, filling
out menu cards, errands to the shop and opportunities to chat, especially if visitors
are infrequent or staff are very busy. Staff comment that the Robins are ‘part of the
team’ and are able to help out with basic tasks which would not otherwise be done.
They feel that Robins contribute to a friendly and welcoming atmosphere, boost
morale and can provide a different perspective on life on the ward which can be
helpful.
The Robins provide a service which improves the patient experience and are a bridge
to the local community, improving the understanding of how the hospital works. In
economic terms, Robins contribute an average of 4 hours per volunteer per week,
totalling 35,984 hours per year. Using the adult minimum wage, this equates to a total
value of £208,707. The Robins scheme is supported by staff time and a modest
budget with an estimated cost to the Trust of £62,510, resulting in a net contribution
of £146,197. Robins testify that volunteering makes a positive contribution to their
lives, giving them a sense of belonging and self esteem. The experience of hospital
life has meant that some have gone on to pursue careers in health.
Lessons learnt are that a volunteering scheme managed by staff within a public body
can provide a useful and valued part of the service. The enthusiasm of the volunteer
can be a tangible benefit for service users and staff alike.
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Source: V Russell, J Tann, B Collis & R Roberts (2010) Part of the Team, An impact
assessment of the Ward Volunteers ‘Robins’ scheme for the North Wales NHS Trust
(Central) now Betsi Cadwaladr University Health Board, WCVA. Contact:
bcollis@wcva.org.uk
6.
Integrated services: A project to develop a consortium in Conwy that links
Intermediate Care seamlessly with third sector support services.
This project has been divided into two distinct phases with phase one based around
gaining local buy in and strategic support, designing the service and securing
funding. Welsh Assembly Government funding was used to support preliminary work
around developing a project led by the Building Strong Bridges Health and Social
Care Facilitator for Conwy.
Mapping of third sector services and identification of perceived gaps in service
provision indicated that third sector organisations were an untapped resource which
could be accessed by the Conwy Intermediate Care Service (CICS). A series of joint
sessions with interested organisations (including the CICS Team and commissioners
from the LHB and Social Services) followed. These included identification of gaps in
services (by the CICS Team): presentations by third sector organisations on the
services they offer; presentation on the consortium style of service delivery with an
opportunity to ask questions and; co-planning of a new local service.
The results of the mapping exercise were used to produce both a web-based and a
paper directory of third sector services available locally. The sessions with interested
organisations informed the development of phase two of the project, the one year
pilot of a service linked to the Intermediate Care Service in Conwy. The main
elements are:
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A single point of access to services provided by a number of third sector
organisations via a service co-ordinator
A web based directory of voluntary and community services
A volunteer enabling service
A carer’s short term respite service.
A Project Team was established to ensure effective communication across sectors,
organisations and divisions and to provide a vehicle for shaping the service, defining
and refining the parameters and considering the quality aspects of the service
provided. A particularly important role for the team is to inform the potential
mainstreaming and roll out of the service provided by the consortium. Phase two of
the project commenced on 5th October 2009 with the launch of the pilot. An
Operational Group has also been established to complete the work which will be
taken forward by a consortium made up as follows:
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British Red Cross, the host organisation for the service coordinator post and
volunteers
Crossroads Care North Wales, host for the carer respite service.
Conwy Community Directory Partnership.
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Conwy Intermediate Care Service.
The potential Impact of the project will allow for the “testing out” of a model of
partnership working with the voluntary sector, the learning from which can be used
elsewhere to achieve the aspirations around jointly funded, collaborative, citizencentred service delivery, outlined in recent strategic documents such as Making the
Connections; the Beecham Review, Designed for Life and The Third Dimension. The
model will also provide a model of a framework for the procurement of services that is
workable with any number of funding agencies and any number of voluntary
organisations, and any combination of both.
Source: Assembly Government paper, Third Sector Partnership Council, November
2009
7.
Wrexham Direct Payments
Wrexham County Borough Council has been issuing individual / personal budgets as
part of their Self Directed Support (now called Citizen Directed Support) project since
April 2008. There are currently approximately 100 people with learning disabilities
who have benefitted from the flexibility and choice afforded by Self/Citizen Directed
Support. The individual should be allowed to lead the assessment process and must
be at the centre of all decisions made in relation to their support. There must be a
focus on enablement and promoting independence, concentrating on the abilities of
individuals, rather than their inabilities.
It is important to note that in organising support, the correct balance is achieved
between natural networks of support (unpaid) and support which is funded by the
local authority and/or other agencies. There are opportunities to maintain and nurture
the natural networks of the individual. Within the model, there are a number of
options for people to choose to create tailor-made package of support, which must be
outcome focussed and can include equipment and activities where appropriate.
There are also opportunities for practitioners involved in this process to work closely
with individuals and families to support them to find alternative solutions which may
meet outcomes without relying on paid services.
There are a number of options for managing the individual / personal budget, (in
addition to a Direct Payment) including an indirect payment to a family member or
trust, an individual service fund held by a provider organisation or the local authority
can manage the budget on behalf of the individual. The individual and those
important to them, eg. family members or advocate, is fully involved in writing their
support plan, which can be facilitated by whoever the person nominates, either from
within Adult Social Care or their natural network of support. There is a great deal of
support, training and information sharing available to individuals so that people
always have someone to help them through any part of the process. Research in
England strongly criticises local authorities for not providing adequate support with
the process and placing additional burdens on carers. This learning has enabled
Wrexham Council to put in place support mechanisms which make Citizen Directed
Support accessible to everyone within the learning disability service, regardless of
their abilities.
Elaine McGuire – Development Manager, 19th April 2010
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Source: Wales Alliance for Citizen Directed Support (WACDS)
8.
Self-directed support: direct payments study
There is growing interest in models of citizen or self directed support, where people
who require care support services are allocated a personalised budget which gives
them control over their money, their support and ultimately their lives. The Wales
Alliance for Citizen Directed Support is working to develop and promote a model for
Wales. It is made up of local authorities that commission services, organisations that
deliver services, and organisations that represent the people who use services.
Currently there are seven local authorities exploring how self-directed support can
operate, working with a variety of client groups.
There are a number of direct payment schemes in operation, where disabled people
receive payments to purchase and organize their own care, often supported by
independent living agencies established as social enterprises.
A cost and resource analysis of direct payments in two local authorities in Wales
provided strong support for the emerging consensus in the literature that direct
payments, if implemented effectively, need not be any more costly than traditional
services and may over time prove to be less costly. When coupled with the
increasing evidence that user satisfaction, independence and control is greatly
enhanced by, for example, providing more flexibility in when and by whom support is
provided, the case for a cost benefit of direct payments is strong.
The analysis found that there is evidence to suggest that considerable opportunity
cost savings could be achieved by the local authorities with better policy, systems,
training and procedures, along with a critical mass of users. This is consistent with
other findings which suggested that overly complex administrative procedures, a lack
of critical mass, a lack of training and experience among care managers and a lack of
effective support services hindered the take-up rate, effectiveness and efficiency of
direct payments schemes.
The data primarily reflected support to people with physical impairments, who
remained the primary users of direct payments, although use by older people, people
with learning disabilities and, to a lesser extent, persons with mental health difficulties
is increasing.
In summary, supported by the Independent Living Scheme, the direct payment
schemes studied represented a substantial improvement over traditional
arrangements from a cost and resource utilization perspective. There is strong
evidence to suggest that greater opportunity cost savings can be anticipated if
schemes become more fully integrated into practice and procedures and when
certain policy and procedural issues, noted above, are addressed.
Source: Independence pays: a cost and resource analysis of direct payments in two
local authorities (Tim Stainton, School of Social Work, University of British Columbia;
Steve Boyce National Assembly for Wales; Ceri J. Phillips Centre for Health
Economics and Policy Studies, University of Wales,Swansea, March 2009)
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9.
Community-led services: Swansea Sustainable Lives group – exploring new solutions
In Swansea, the Sustainable Lives group, involving professionals from City and
County of Swansea Social Services Department and Community Lives Consortium,
has initiated a co-operative inquiry asking “how can we collaborate to find models of
social care for Swansea which is economically, socially and environmentally
sustainable?” Based on its work over the last year it is developing a Time Together
initiative starting in 2010 on person centred support and planning, and building more
responsive mutually supportive communities. The following elements are planned:
•
•
•
•
•
•
Time Together will work in partnership with the citizen’s of Gorseinon to build a
more mutually supportive and resilient community.
This growing community will enable people who require social care and support to
work together with community groups and support agencies to build formal and
informal networks and structures that are more empowering, and are more
financially, environmentally and socially sustainable.
Create a collaborative growing Time Together Alliance of social care and support
provider organisations, commissioners, and community groups to work together to
coordinate and develop person centred support to people living in the Gorseinon
area and to maximise the collaborative use of community assets and resources.
Develop in partnership with the citizens of Gorseinon a membership based Time
Together Network within which members can contribute to the work of the project
and the social care and support of each other and are rewarded by time credits
through which they can access community activities and events and eventually
support provided by other network members.
Use the Swansea People social networking website to support equal and open
communication between agencies, citizens and community groups to support the
work of the Alliance and the Network.
Promote community actions and activities which are inspired by the principles of
One Planet Living.
10. A project to develop a consortium in Bridgend County that links 14-19 pathways work
and accredited training with Third Sector support services.
This project has recently gained local strategic support and Welsh Assembly
Government funding through both the Children and Young Peoples Partnership and
the 14-19 Pathways Network in Bridgend. The funding will support a part time post
(hosted at BAVO, the CVC) that will work with third sector youth service providers to
develop a consortium approach to providing informal and non-formal training to
young people in the County. The service will particularly target 'hard to reach' young
people, those at risk of exclusion and those Not in Education, Employment or
Training (NEETs). The third sector providers will develop a varied menu of
complementary training options that the local authority can also access and place
young people into. The aim will be to reengage young people in education, with a
focus on mainstream education where possible.
The consortium is also developing proposals to draw down European and other
funding to also support the NEETs agenda in Bridgend County, thus adding value to
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existing options and maximising external investment to develop these services in
Bridgend.
11. Co-delivery: Bridgend Street Pastors, St Johns Ambulance and SW Police (Triage
Centre's)
Street Pastors’ is an inter-denominational Church response to urban problems,
engaging with people on the streets to care, listen and support. It was pioneered in
London in January 2003 by the Ascension Trust, and introduced to Bridgend in 2007.
It has seen some remarkable results, including a reduction in crime in areas where
teams have been working.
Street Pastors engage people where they are, in terms of their thinking (i.e. their
perspective of life) and location (i.e. where they hang out - be it on the streets, in the
pubs and clubs or at parties etc). They are also used by the Community safety
Partnership (Safer Bridgend) to tackle particular hotspots where they occur.
Street pastors usually operate in Bridgend Town over the weekends from 10pm 4am. They work closely with SW Police, particularly at times of the year or at events
when acts of antisocial behaviour and alcohol issues are of particular high risk. At
times such as these, St Johns Ambulance volunteers are also involved and set up a
Triage Centre in a town centre Church. Street Pastors patrol the streets supporting
and engaging young people who may have drunk to excess and are feeling
vulnerable, emotional, angry, or may have been hurt or hurt themselves. In these
cases they are cared for by a Pastor and taken to the Triage centre for minor
treatment if appropriate.
The impact has been reduced police resources being spent on issues that are low
priority and more people keeping a watchful eye on the streets of the town resulting in
lower crime and antisocial behaviour incidents. The scheme also reduces pressure
on the limited ambulance service which was often called in to transport people to
A&E for minor drink related incidents (such cases often also involved a police officer
staying with the individual until the arrival of the ambulance), and ultimately lower
admissions to A&E at the local hospital.
This scheme has enabled the Police and health authorities to maximise their existing
resources on priority issues, reduced costs of front line health and police services
and seen lower crime and antisocial behaviour incidents. The service is also
responsive, meeting the needs of young people at the time they require it.
Volunteers
12. Embedding volunteering in procurement: community legal advice service, West
Sussex
The joint local authority/Legal Services Commission procurement process for
community legal advice in West Sussex embeds volunteering as integral part of the
service.
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The tender specification includes the following:
The West Sussex Councils are justly proud of the County's long history of
volunteering and conscious of the impressive scope of expertise available at
grass-roots level County-wide. We want the successful bidder to utilise this
valuable resource and we are therefore seeking a provider that is able to deliver a
favourable infrastructure for volunteering within the County and ensure that any
service is a centre of excellence within the County for the recruitment, training,
deployment and retention of volunteers who will assist in the delivery of generalist
advice services.
The West Sussex CLAs will have the following key aims and objectives. It will:
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Enable individuals to protect their rights and resolve legal disputes. It will do this
by increasing access to social welfare law and family law advice to assist clients
in taking positive action to exercise their legal rights;
tackle disadvantage and promote social inclusion through the delivery of
integrated social welfare law1 and family law advice which will seek to assist
individuals in exercising their rights and challenge situations that may otherwise
lead to social exclusion;
provide advice which is independent of commissioners and government;
deliver social welfare law and family law advice to local communities in West
Sussex according to a clear understanding of local needs and ensuring that
services continue to meet any emerging needs and priorities;
provide improved access to quality assured, integrated, accessible end-to-end
social welfare law advice, ranging from Triage and General Legal Advice to
Specialist Legal Advice (i.e. from basic information to representation in court),
which offers value for money and is supported by co-ordinated funding;
provide a seamless service to tackle complex, multiple problems at an early
stage to avoid escalation;
prevent legal problems from arising through effective social policy work; and
provide an infrastructure for volunteers to deliver Triage and General Legal
Advice services in West Sussex.
The Service Provider must ensure that the integrated service provides a favourable
infrastructure for volunteering within the County and is a centre of excellence for the
recruitment, training, deployment and retention of volunteers to assist in the delivery
of Triage and General Legal Advice services and thus contribute to Local Area
Agreement targets on volunteering. Volunteers should be recruited from all sections
of the community.
13. Social care Time Bank, Japan
Japan’s population structure is often talked about in crisis terms given that the
country has one of the world’s most rapidly aging populations. The fact that its social
care system is almost entirely publicly funded means ageing could put a particular
strain on public finances (OECD 2005).
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In response to this challenge Japan introduced a ‘health care currency, or hureai
kippu in 1991. This is effectively a timebank scheme which is dedicated to caring for
the elderly. People who volunteer gain credits, the number of which depends on the
time given and the type of task, with more onerous tasks earning more credits. The
credits are stored in the same way as savings – the currency is simply the hours
instead of yen (Kent 2001).
The scheme operates in the same way as a bank. This means that credits can be
banked for the future as a form of social care insurance, so when a person needs
support she or he can draw on the credits earned. Credits can also be transferred to
others. Many people provide help to an elderly person near to them, and then transfer
the credits they earn to an elderly relative living in a different part of the country. In
this way they can ensure their relatives receive support without actually moving to live
near them (Alderidge et al 2002).
The scheme has been proved to provide a high standard of care. What’s more, the
majority of elderly people actually prefer receiving support under the hureai kippu
scheme than paying by yen, because they build relationships with their carers. They
also prefer it to services provided by charities, which make them feel dependent
(Liataer 2001).
This case-study demonstrates how Japan has responded to the challenge of
providing social care by focusing on ‘everyday relationships’. Rather than innovating
services provided by the state, Japan has responded by innovating methods of
exchange and payment. These have strengthened social ties and encouraged
families and communities to play more of a role.
Wales Cooperative Centre – examples of co-operative approaches to public services
(From Developing a Co-operative Model for Increasing Involvement in the Delivery of
Public Service, Wales Co-operative Centre, July 2008)
14. Sunderland Home Care Associates
Sunderland Home Care Associates has grown out of a co-operative wholefood shop
combined with a childcare co-operative: Little Women founded in Sunderland in the
1970s. This developed into Little Women Household Services which provided
domiciliary care on behalf of social services, funded through the Additional
Requirements Payment which Little Women helped people to apply for. When the
ARP payment ended, so did Little Women, but in 1993 Sunderland Council began the
process of externalizing its care services and SHCA was set up and registered as a
workers’ co-operative. The 160 employees of Sunderland Home Care Associates
own the company, share in some of the profits and participate in the decision making
processes which affect them.
SHCA is a significant provider of social services to Sunderland City Council, including
support for elderly, frail and disabled people to stay in their own homes. The work
involves helping people get themselves up, washed and dressed, giving them
breakfast and helping them clear up afterwards. There is social support as well as the
more obvious physical support. For other clients SHCA provides services such as
19
housework, shopping and laundry. They have also expanded into providing cover for
care workers in residential homes for the elderly and for children with disabilities.
SHCA also provides services to disabled students at Sunderland university with their
academic work and with personal care.
SHCA has won an increasing number of contracts since its launch in 1994: its hours
have increased from 400 to 4,000 per week and turnover is now in excess of
£1.75million per year. In 2005 it made a pre-tax profit of £176,000. It has also passed
on 14.8 per cent of its shares to employees since 1994.
Initially, SHCA was set up as a co-operative but it has since changed its status and is
a regular company with an employee-benefit trust and a profit-sharing trust. After six
months service employees are eligible to receive shares, so long as they work at
least ten hours per week. There have been three share allocations, the first—in 1998—
based on length of service and salary and the other two based on salary with a
£12,500 ceiling.
The company has a fairly conventional management structure with a Managing
Director and seven co-ordinators of different aspects of the business. The board
(which has the same membership as the trust) has eight members including the MD
(Margaret Elliott), three care workers and two external board members. Employees
are involved in decision-making via reports of the meetings and occasional
newsletters.
The satisfaction of employees can be measured by the staff turnover rate which is
just 3.5% a year. For the 85% of staff who are women the flexible working hours are
an additional bonus.
The local authority was supportive of the SHCA providing a grant of £10,000 in the
initial stages of development as well as paying enough of the costs of its contract up
front to allow SHCA to cover its initial wage bill. SHCA also received a grant of
£11,000 from the Tyne & Wear Foundation to cover set-up costs.
SHCA has now moved beyond its Sunderland home by encouraging the sharing of
the model with HCAs in North Tyneside, Newcastle, and Manchester. These
companies employ, respectively, 30, 30 and 27 people. This has been achieved
through the establishment of CASA (Care and Share Associates) which is an
umbrelland organization established to share the model ‘to further democratize home
care services’:
‘CASA believes that if people are given the opportunity to develop through training,
and blossom from feeling valued, that they will ultimately give a better service to the
service user. The workforce participate in the decision making process, share in the
prosperity of the company by being given shares and are encouraged to put forward
ideas. We believe that this is one of the main reasons why SHCA is such a good
model. It has been shaped by the workers.’
The founder Margaret Elliot says ‘It has been our experience that these methods of
work are a very powerful tool in raising self-esteem and confidence in
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employees….Staff feel valued and have a sense of responsibility. There is no them
and us environment.’ (from Social Enterprise Coalition website).
15. The Foster Care Co-operative
The Foster Care Co-operative Limited was set up in October 1999 and has two main
offices in Malvern, Worcestershire and Cardiff, Wales. It is incorporated as a
Company Limited by Guarantee and membership includes both Foster Carers and
employees. However, the Government’s Fostering Regulations prohibit foster carers
from being directly involved in the governance or management of a foster care
agency, therefore, legally the foster carers are actually associate members of the cooperative and therefore do not have a vote.
Currently, placements are being managed for 114 children, of whom 48 are from
Wales and placed with families in Wales. However, this number tends to fluctuate
and the long-term trend is for there toy be a 50/50 split between England and Wales.
The Foster Care co-operative recruits prospective foster carers who are assessed
and trained before being recommended for approval to the Co-operative fostering
panel. Once approved their availability is made known to local authorities and, when
appropriate, a careful matching process is undertaken between the child(ren) and
carers.
There is a variable structure in terms of charges, which is dependent on the child's
age and placement type. Of the fees charged to Local Authorities, 51% are passed
on to the foster carers, 26% spent on central staffing costs (currently paying for 40
salaried staff and some freelance employees), and the balance covers other
overhead costs.
There is a national shortage of foster care placements, putting carers in a strong
bargaining position with agencies. However, there are many private and voluntary
sector agencies and in selecting providers, local authorities are largely driven by
price. Those agencies with good carers in the right locations on their books will have
a market advantage and the Foster Care Co-operative is seeking to charge mid range
fees to local authorities, but to recruit the very best carers who it hopes will choose to
work for it.
Laurie Gregory is the Executive Director and he was initially looking for an alternative
to a 'for profit' organisation and had already had a bad experience of working within a
charity. Laurie thought a Co-operative might provide the solution as there is much
sensitivity concerning those who are profiting from the difficulties experienced by
children.
Turnover for the financial year 2007-2008 was £3.4M with a surplus of around
£300,000. While the objective is not simply to make a profit, this does help to fund
expansion. The organization currently operates primarily in the West Midlands,
Wales and South Yorkshire. It aspires to develop nation-wide coverage, and would
very much like to establish an operational base in London. However the cost of
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covering start-up losses while the business there is being built up have delayed that
aspiration being realised.
16. Lincolnshire County Council Youth Service
Lincolnshire County Council is collaborating with a rural social enterprise to provide
some innovative youth services. Hill Holt Wood is an environmental organization set
in 34 acres of woodland near Norton Disney in Lincolnshire. The social enterprise,
which was founded in 2002, has a variety of projects based around the ecological
management of the woodland. These include making furniture, sustainable
construction, charcoal manufacture, and renewable energy schemes. It has a
turnover of £300,000 per year and was recently given charitable status. HHW seeks
to employ people who are generally considered hard to employ, including excluded
and at-risk young people.
Hill Holt Wood first became involved in providing social services under the New Deal
scheme. Long-term unemployed people were involved in woodland management and
creating walkways and footpaths as a means of including them in the labour-market.
The social enterprise then moved on to youth services, beginning a fruitful
partnership with LCC. Since 2001 LCC had a statutory responsibility to provide fulltime education for permanently excluded youngsters, who had been involved in antisocial behaviour. They set up a programme called Solutions 4 which ‘is about
citizenship and key messages about what is and isn’t accepted in society’. They
found the move into the countryside setting ideal for kids who had always felt
uncomfortable in the classroom environment.
When approached by the County Council, Hill Holt Wood was keen to become
involved. It had a useful grounding from the New Deal scheme but needed training in
youth work—which LCC provided. Solutions 4 schemes are not based around fixed
curricula so the council workers and the employees of HHW were able to develop
something together for the 24 students, offering education as well as vocational
training.
Solutions 4 is about settings like Hill Holt Wood, insomuch that youngsters with pent
up feelings enjoy being outside, can see immediate achievements in the work they’re
doing. It’s about opening their minds to what they could be successful with, and that’s
also where vocational achievement comes in, but you can’t replicate what’s
happening in schools and you can’t use teachers to do this work.’
Sue Fenton-Smith, Head of Emotional and Behavioural Support, LCC
The youngsters learn from skilled craftsmen, whose ability to share their practical
skill automatically gains their respect.
The site is open to visitors and HHW is also involved in various educational
programmes as well as training and employment preparation advice to excluded
schoolchildren, young offenders and other disadvantaged young people. HHW now
delivers other types of alternative education and the Learning Skills Council’s E2E
programme. Last year for the first time, together with the University of Lincoln, they
held the Woodland University—as part of the youth service’s summer schools
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programme. The arrangement with Lincolnshire County Council suits both parties
well, since the management of woodland is a labour-intensive business.
Unemployed people have time on their hands but cannot find paid employment.
Similarly, young people who have been excluded from school can find a useful and
productive role.
The collaboration between the youth services department and Hill Holt Wood has
had many successful outcomes. Attendance rates have been high and there
appears to have been a reduction in juvenile crime rates. The local policy authority
has praised the scheme for diverting young people from potentially criminal activity
and finding novel ways to engage with hard-to-reach young people. A study by New
Economics Foundation has also found a significant and positive impact on the local
economy. In addition, the youth services funding can subsidise the social and
environmental benefits that arise from a community woodland.
Hill Holt recently received planning permission for a Woodland Community Hall that
will be built sustainably by volunteers and people on social services schemes. At the
heart of the building will be a rammed-earth conference hall with framing and
cladding for the roof being sourced from local timber. The building will also have a
PV array, a biofuel microchip system for underfloor heating, rainwater harvesting,
and other reclaimed components. It will be integrated with the permaculture garden
next door. Being involved in these sorts of projects allows young people who have
often been seen as ‘part of the problem’ themselves to become part of the solution
to the most pressing problem facing humanity.
new economics foundation: examples of co-production in practice
(From The Challenge of Co-Production: How Equal Partnerships Between Professionals
and the Public Are Crucial To Improving Public Services, new economics foundation,
2009)
17. The youth justice system in the District of Columbia, USA – an area where half of the
majority black population under the age of 35 was in prison, on parole or on probation
– had been in a state of near collapse, forced to dismiss first and second offences
because of case overload. The youth court aimed to turn this around by recruiting
young offenders themselves to help combat crime. If you are a young person
arrested for the first time for a non-violent offence in Washington now, the chances
are that you will be arraigned not before a judge but in front of a jury of other
teenagers, who will question you, judge you and sentence you. The sentence will
include serving on a jury yourself. The ultimate purpose is to deliver a youth justice
system that not only helps to prevent criminal behaviour, but also changes some of
the conditions that cause it in the first place, and it does so by engaging young people
as advocates of good behaviour. In 2007, the youth court dealt with 80 per cent of all
first-time offences in Washington. The recidivism rate for youth court participants is
only 17 per cent, about half the average in the mainstream juvenile system.
18. There is a similar successful model in Jefferson County, Wisconsin. Here, each child
they deal with who is not processed through the mainstream courts saves the local
justice system $11,510. This is partly from avoiding the basic costs of going through
the official court system, but the Teen Court has a highly successful record of
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reducing re-offending (only 7 per cent compared to the usual 30 per cent) which
brings major savings to the public purse.
19. Preston in Lancashire has been developing a UK youth jury approach. In 2009, the
Nacro Centre for Restorative Justice/Preston Peer Panels won the Justice Team
award for tackling youth crime. The project started in September 2007, and already
more than 80 cases have been successfully concluded, affecting some 250 victims.
The team has now extended the project with the Street Law programme, which offers
training to young people as part of their contract, allowing them to become peer panel
members and addressing areas of concern in their own lives. Adult versions of this
approach are also beginning in the UK with the Community Justice Panel in Chard.
20. The charity Scope has been pioneering the idea in the field of disability equality.
Mind and other organisations are using the idea in the ‘Human Givens’ approach to
mental health. The Citizens Advice Bureau’s ROTA project trains prisoners to support
other prisoners. Many schools are involving parents deeply in co-producing education
(but many are not).
21. Co-production ranges from programmes that are aimed specifically at prevention, like
the Nurse-Family Partnerships, which support first-time mothers and children in low
income families by partnering them with registered nurses until the child is two, with a
core purpose of coaching them into a sense of capability and encouraging them to
support each other. Nurse-Family Partnership programmes in the US have been
evaluated over 15 years. They were found to reduce child abuse and neglect by 48
per cent, arrests of the children as teenagers by 61 per cent and ‘incorrigible
behaviour’ by 90 per cent. This would have a huge impact if taken to scale; it
translates into benefits worth five times the investment and a saving in public
spending of about $41,000 per child involved.
22. Co-production also includes programmes that give responsibility back to service
users, like KeyRing, which supports people with learning difficulties to live in their
own homes by embedding them in mutually supportive local networks. During one
week in 2007, nearly 300,000 adults in England received person-centred services
delivered by organisations in the independent sector, funded by social services. If
each of them gave back three hours support to someone else in similar
circumstances, in the way that KeyRing schemes support people to do, over the
course of one year this would generate an extra 900,000 hours of valuable peer
support, enabling professionals to deploy their time differently.
23. It also includes programmes to use the knowledge and experience of users, like the
Expert Patient schemes, where patients with long-term health conditions teach others
about the experience, so far involving 50,000 people in the UK. An analysis of the
Expert Patient programme showed that it reduced visits to GPs consultations by 7 per
cent and to A&E by 16 per cent, saving between £27 and £58 per avoided
consultation, before prescription costs, and £84 for each patient diverted from A&E.
The figures for a disadvantaged area such as Newham in south-east London are
spectacular, with half the patients reducing their visits to hospital. As many as 45 per
cent of participants reported increased confidence that symptoms would not interfere
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with their lives and 38 per cent had reduced severity of symptoms four to six months
after completing the course.
24. Or programmes to provide for mutual support, like the Shared Lives scheme (formerly
known as Adult Placement) that pair up disabled people and those with long-term
problems with families. Shared Lives has done this now for 30 years in 130 schemes
across the UK, in such a way that caring becomes a joint activity between the people
and the families they live with. Costs and outcomes can vary substantially between
individuals, but the average potential savings for a person in Shared Lives instead of
conventional supported living for people with learning difficulties can be as much as
£995 a week.
25. Co-production can work in existing structures, like the Learning to Lead programme
that began five years ago in the Blue School in Somerset, where pupils join teams
which take responsibility for aspects of running the school, or making change happen
outside it. Learning to Lead is now working in ten secondary schools and is
beginning to work in primary schools too.
26. Alternatively, it can begin to turn the existing structures upside down, as it has in Taff
Housing, a housing association with over a thousand homes in some of Cardiff’s most
disadvantaged housing estates, where tenants earn credits by volunteering time to
help deliver the services of the housing association. They can spend these credits
through a partnership which Taff have negotiated with Cardiff’s leisure services,
Cardiff Blues Rugby Club and the Gate Community Arts Centre, which accept credits
earned by tenants instead of cash to use their services.
Scotland: community-led health initiatives
(From “How does the Social Enterprise Model fit with Community-led Health Initiatives?”,
research report published by Community Health Exchange (CHEX) supported by NHS
Health Scotland, 2009).
27. Foyer Enterprise
The Aberdeen Foyer works to improve the lives of those experiencing homelessness
which includes addressing a range of mental and physical health problems. It offers
supported accommodation linked to learning and employability schemes. This is
based on need that emerged from the individuals who were assisted as part of the
accommodation services as well as through demand from the Department of Work
and Pensions which contracts them for programmes such as Training for Work and
Get Ready for Work. To promote independence and employability as well as to
contribute to sustainability, they operate a trading arm which consists of a portfolio of
businesses.
• The Foyer Restaurant and Gallery is widely acknowledged as one of the best
restaurants in Aberdeen and the Gallery is an established venue for art
exhibitions.
• Foyer Graphics is a graphic design company specialising in design for print, web
design, corporate branding and all areas of creative consultancy and
development.
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•
•
•
•
Foyer Drive offers a comprehensive range of safe driving packages to suit
individual and corporate needs, emphasising the importance of road safety.
The Ben & Jerry’s Partnership sells ice cream, coffee and waffles etc and offers
training and employment to unemployed young people.
Their new restaurant, The Foyer at HMT, opened in January 2008.
They also operate a Maintenance Team which does a variety of tasks for
Registered Social Landlords, local authority and private individuals.
The organisation also manages Foyer Health. This is based on the need that
emerged from work undertaken in core services offered to young people at risk of
homelessness. A lack of access to crucial health services especially related to mental
health. This is largely grant funded at the moment from a wide range of funders
including NHS and homelessness strategy funding. Now that that funding is coming
to an end and the need remains, the Foyer is undertaking a review of this element of
their work to see what can be commercialised to ensure the sustainability of the
health outcomes.
Though only some of the services can become commercialised products, they may
be enough to fund the bulk of the health programme. One potential product is being
called “sorted in the kitchen”, a manual to help young people eat healthily on up to
£15 per week. This product is potentially sellable but is rooted in the needs of the
beneficiaries of the organisation.
The interviewee view was that it was possible to follow markets and income
generating opportunities while still impacting on health. The vital issue is to ensure
the right balance between commercial clients and core beneficiaries. Ultimately the
services need to be funded and therefore income needs to be brought in to help it run
without adversely affecting the health and/or social purpose.
Income generating ideas should be undertaken by organisations where activity is
within their range of experience. As a result it is better if health related organisations
can commercialise services they are already good at. In addition, these are likely to
be a combination of trading and grant income to secure service delivery.
What must be taken into consideration however is the different potential fit of social
enterprise with different models of social enterprise (social firms, acquisition, cooperatives, wholly owned subsidiaries and so on). Social Firms are particularly well
geared up for mental health gain due to the model being based around the
employability of those distant from the employment market. A secure real job brings
mental health benefits. Each organisation should found all that they do on their core
purpose. If that is community-led health then social enterprise must be one tool that
achieves that end.
The benefit of social enterprise, in the experience of this organisation, was that it
gives independent income and an ability to address needs quickly and flexibly. If a
need is identified and grants need to be secure to meet certain outcomes, by the time
a bid is written, and money secured, that need can easily be a year out of date and
perhaps very different.
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28.
Opus of Aberdeen
This is a group of social enterprises run by Turning Point Scotland providing high
quality services to the general public while profits are used to support those with
mental health problems. Referrals come from Momentum and Job Centre Plus as
well as self referrals. No placement fee is paid and the enterprise pays £20 per week
to placements from their own income generation. The enterprises offer a supportive
working environment, work skills training, a choice of work settings and a real world
business approach. Supportive staff are in place to assist people to reach their
potential and cope with this working environment. A project worker assesses each
potential worker, gives regular (13 weekly) reviews and guides them to source
external mainstream training and work.
Their mission is “to promote the independence of individuals who are disadvantaged
in the labour market through the provision of training, work experience and
employment, and to reduce the enterprises dependency on funding by generating our
own income by producing and selling high quality, good value products to the general
public through our commercial outlets.”
Opus Gifts sells high quality gifts and crafts and original art work from a range of local
and international artists. Opus Picture is a framing service for all types of art work
including sports shirts and tapestries. Opus Craft Workshop offer hand made
greetings cards, bespoke wedding stationary or party invitations, a cushion making
service, hand-made bags, children’s smocks and other items. Rosies Café is a day
time community café specialising in home-made soup and cakes and scones, freshly
made daily, on the premises. Rosies-2-Go Sandwich & Buffet Service offers a service
to Aberdeen City delivering high quality good value business lunches and buffets.
The ethos of these enterprises is to move people on using a person centred approach
and the ‘recovery model’. The system of residential institutions made people
dependent because nothing was expected of them. The social enterprise model
expects a great deal and, with the right support, can genuinely make a huge impact
on the health of those who are distant from the job market. Social enterprise can act
as a kind of half way house between being a dependent service receiver to living
independently in the community.
This model of time limited placements based on the motivation to move staff on to
real jobs in the mainstream market can also be detrimental to the business. In
mainstream catering outlets (and most businesses) staff development, up-skilling and
retention is crucial to give stability to a business. Staff retention here is impossible
because as soon as they are stable and skilled, they are encouraged to move to jobs
in the mainstream market. In addition, the project spends time and resources
encouraging individuals to form relationships and create networks to allow them to
build up coping mechanisms. This again is not a relevant activity in a mainstream
business.
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All the Opus enterprises work at a loss (less than 50 % sustainable) and other
funding comes from the Big Lottery, NHS (resource transfer) and Aberdeen City
Council. This is likely to be cut by around 20% due to funding issues in the Council.
Their core purpose is to benefit long term health and well-being through
employability. There is no objective to make profit to gift aid to the core charity.
However, money needs to be made to cover a significant proportion of running costs.
Social enterprise is not the answer to all the problems of sustainability. It is highly
likely that the Opus business will always need to be subsidised.
29. The Engine Shed in Edinburgh
The Engine Shed in Edinburgh trains and employs adults with learning disabilities
with objectives focused on employability. They also operate a café and bakery that
promotes healthy eating. The Engine Shed was established in 1989 to offer people
with a range of learning disabilities a training provision that would successfully
address key areas towards helping them make the successful transition into the world
of paid work. The Engine Shed is part of the international movement of social
therapy, whose philosophy based on the work of Rudolf Steiner recognises the
interdependency of each to create a vibrant and healthy society.
The business operates a successful café, shop and bakery and is well known in
Edinburgh for its production and nationwide distribution of tofu, amongst other
products. A market has also been built around the vegetarian, healthy eating
experience and customers will keep returning as much for the quality as for the fact
that they know they are helping to support people with learning disabilities. Since the
end of substantial European funding the business has had to develop while keeping
its core values intact. It is able to offer services to those with support needs and focus
on healthy quality food while generating working profit. This is done via the café on
site, the distribution of food to quality retailers such as Harvey Nichols and by way of
outside catering and hospitality.
An interview with the Engine Shed’s manager confirmed that extra staffing ratios and
costs add pressure to the business and impacts on profitability but this sacrifice of
profit for health and social gain can attract grant subsidy.
30. Stepwell
Stepwell is a new social enterprise company operating in Inverclyde that started its
days as a fully grant funded Healthy Living Centre. When that funding was coming to
an end the manager took the bold move to establish a social enterprise and embark
on drawing in the required income from trading following an initial period of start up
funding from lottery underspend. This trading takes the form of service level
agreements and services achieved through competitive tendering as well as selling
services such as cookschools and stress management sessions to the private sector.
The experience of this enterprise is that selling to the corporate sector still enables
those on a low income who are working there to benefit from health promoting
activity. As a result income generation and health impact go hand in hand while they
also have grant or SLA funded programmes for services that are not sellable in the
open market.
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