Squaring the Circle in Essex. Wendi Ogle Welbourn Director of Commissioning Schools, Children & Families
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1 Squaring the Circle in Essex Wendi Ogle Welbourn Director of Commissioning Schools, Children & Families
2 The Essex Context Second most highly populated county in England; 415,600 children and young people 12 Districts and Boroughs; 5 Primary Care Trusts (two clusters) Geographically diverse rural, coastal, new towns, historic old towns Contrast of areas of affluence and deprivation Estimated 41,000 children living in poverty
3 The Essex Context Cont. Diminishing number of in house foster carers since 2004 Poor social care assessments, decision making & large backlog of unallocated cases unearthed Notice to Improve 2009 Growth in CLA population budget has not kept pace High spend on independent residential care/schools and IFA placements steadily increasing since 2004 Lack of BESD & ASD provision No investment for SGO s/ro s as alternatives to care Insufficient investment on preventative services and lack of strategic approach to planning, commissioning and delivery Poor financial commitment systems and controls Vicious circle -:
4 The Vicious Circle Ineffective support services Overspent budgets Poor assessment and care planning Growing numbers in care Crisis admissions to care
5 The Essex Context Cont. Shadow Health and Wellbeing Board in place Social Impact Bond Edge of Care Residential to treatment foster care Community Based Budget pilot: Essex Family One of 16 nationwide Dual focus on chaotic families and early intervention - 9 month 5 Pathway end of life Re-commissioning of children s centres NWOW Advocacy, Advice, Information and Support Health Visiting workforce development Transformation programme towards Essex County Council becoming a predominantly commissioning organisation rather than a provider of services: CIN, CLA, CWD, School Improvement and SEN, Youth Services
6 The Partnership Landscape Enactment of strong commitment to joint working arrangements to improve outcomes for children, young people and families Focus on (joint/aligned) commissioning, including creation of Child Health and Wellbeing Joint Commissioning hub Five Local Children s Commissioning and Delivery Boards accountable for all outcomes for children and young people in their area
7 Essex Joint Working Arrangements for Children PCT Boards/ GP consortia Health & Wellbeing Board Safer Essex Essex Safeguarding Children Board Scrutiny Challenge and Support Strategic Joint Commissioning Group Infrastructure Group Executive Joint Commissioning hub One Childrens Workforce Group Gateways Child Protection Looked After Children JAP ART Gateways MAAGs North East Local Children s Commissioning & Delivery Board Mid Local Children s Commissioning & Delivery Board South East Local Children s Commissioning & Delivery Board South West Local Children s Commissioning & Delivery Board West Local Children s Commissioning & Delivery Board Stay Safe sub-group Stay Safe sub-group Stay Safe sub-group Stay Safe sub-group Stay Safe sub-group Districts / Communities
8 Early Intervention and Prevention Strategy Principles: Clear understanding of and focus on early intervention and prevention (not just early years) Partnership, placebased approach
9 Early Intervention and Prevention Strategy Vision: Strategic joint commissioning of a tapestry of evidence-based interventions Individual joint commissioning of service packages to meet assessed needs
10 Early Intervention and Prevention Strategy Tapestry model: Based on shared understanding of the four levels of need Founded on new approach to integrated care pathways
11 Local Priority Fund programmes Tapestry of evidence-based interventions Integrated care pathway (-9 months 19 years). Provision of Universal services Level 1 Universal Children with No Additional Needs Early Learning and education Childcare Open access advocacy, advice, information ant support Statutory health services Transition to adulthood / adult services Early intervention - Vulnerable Level 2 Vulnerable Children with Additional Needs Interventions at Complex level Level 3 Complex Children with Complex Needs Level 4 Acute Children where needs are prolonged, specialist and Critical Statutory assessment / intervention High level interventions
12 Integrated care pathways A new approach to the design, specification and commissioning of services and interventions Starts from the child and family s view, focusing on their journey through universal, statutory services (that should be) available to all Generates a clear view of the elements that come together to deliver for children and families Forces a detachment from what s delivered now and by whom
13 Starting Point up to 5 years Development of an integrated care pathway from maternity through to five years of age Bringing together: Early learning; Childcare; Open access advocacy, advice, information and support; Maternity and paternity rights information and benefits; Statutory health services; Parental engagement and support Using Healthy Child Programme and Childcare Act duties as key references Showing the links to assessment and referral processes and links to more specialist pathways, including pathways to intensive interventions for complex families and into social care Showing the way back along the pathway Step Down
14 Universal integrated care pathway: -9 months 5 years
15 Key points that emerge Majority of contacts in the earliest years are with primary healthcare Number of points at which the majority of children and families will access any service is very limited Vitally important that all opportunities are taken to pick up and act upon the early signs of need / risk / vulnerability (particularly at 28 week antenatal assessment stage) Importance of a workforce with the skills and confidence to assess need, hold and support children and families in universal services and support access and referral to targeted support as the Lead Professional
16 A developing whole life pathway Development of 5 19 integrated care pathway: Extending the -9 months 5 years integrated care pathway Show transitions into adulthood / adult services Exploring the development of whole life pathway (from 9 months to end of life)
17 Integrated Care pathway (-9 months to 19 years old)
18 Making Tough Choices Together Local Children s Commissioning and Delivery Boards have used the Early Intervention and Prevention Strategy model as the framework for: Gathering local needs analysis and evidence of impact of services and priority setting Development of local tapestry designs Decisions about which services should be cut from April 2011and where to re-invest Development of local joint commissioning plans using joint resource envelopes
19 Making Tough Choices Together Cont. Local Boards plans used as the basis of business cases to access Early Intervention Grant and devolve CAMHS funding, inform children s centre specifications, local priority fund commissioning Development of Essex Family (community budget project) Development of Social Imapact Bond Integrated care pathways being used to: Redesign early childhood services Re-specify and re-commission children s centres from April 2012 Influence commissioning of child health and maternity services now Drive integrated working and shape the children s workforce of the future
20 Thank-you
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