Individual Commissioning for Children and Young People with Complex Needs in Gloucestershire

1. Individual Commissioning for Children and Young People with Complex Needs in Gloucestershire Chris Sands: Head of Individual Commissioning Children and Young People’s Directorate

2. Placements • Feedback • Special Educational Needs • Learning Points • Support Services • Budget Holding • Lead Professional Pilot (Children in Care) • Outcomes

3. Children and young people with Complex Needs • ……have a number of discrete needs – • e.g. relating to their health, education, welfare, • development, home environment • Require additional support from more than one agency / • service sector / system. • Their needs are often chronic and may be life-long. • These different needs tend to interact, exacerbating • their impact on the child's development and well-being.

4. Typically, they may have….. • A spectrum of need which has been sustained for at least 6 months (and is likely to be ongoing); • Needs falling at the severe/profound end of a spectrum of intensity; • Needs falling across at least two of the areas below: • Acute and/or chronic medical difficulties, • Multiple and profound physical and/or sensory impairments, • Behaviour problems which are often challenging, • Significant Learning and/or Language difficulties, and/or disabilities, • Parenting and/or attachment/social needs. • Intensive ongoing involvement of at least two agencies / service sectors, usually drawn from: • Therapy services • Specialist Educational Services • Nursing and Medical Services • Social Care Services (core teams or specialist personnel) • Mental Health Services

5. Where we were……a bit of history… • Poor outcomes • Escalating spend • Inefficient processes • Lack of customer focus • Future predictions • The • Complex • Needs • Strategy

6. Complex Needs Strategy (excerpt) • Revise and redesign the commissioning process in order to improve processes and decision-making, broaden choice of placement options, ensure an outcomes-focussed approach based on individual needs, and ensure that these needs are met by effective qualityproviders at reduced levels of cost. • Since then……………

7. Commissioning has really taken off…. Why? • to • Clear direction from DCSF, the CSP + Ofsted Inspections • Move away from ‘what we have/always had’ • what we and our customers need/planning for the • future/trends/patterns etc

8. …..Its our framework for planning all services for dynamic future proofing Commissioning Cycle Analysing Planning (e.g. OPS; CYPP NA; (e.g. CYPP; Commissioning Commissioning Plans NA) Plans; evidence/’research’) Reviewing Doing (e.g. CYPP; Contracts/SLAs) (e.g. Tendering/Contracting Service Improvement &/or Development Plans) (CSP) (DCSF)

9. Different levels of commissioning • Strategic • Local • Individual My focus today Sounds simple...

10. Countywidestrategic commissioners egPCTand GCC CYPSP BOARD and EXECUTIVE GROUP GLOUCESTERSHIRE CONFERENCE Levels of commissioning GSP Gloucestershire Strategic Partnership Schools Forum key COMMISSIONING BOARD Countywide strategic commissioners Commissioning team District/locality commissioners DISTRICTS NETWORK (Chairs of the 6 LSP CYP Thematic sub groups and district officers) CYP Local Strategic Partnerships Extended services clusters Commissioning family/individual level CYP ‘hubs’ Officer support Locality Managers 6 LSPS (Local Strategic Partnerships) money Individualised budgets through Lead Professionals need Providers of services Children and families in Gloucestershire

11. Professional Filter – what happens now Individual Commissioning Moving from this

12. Where we’re going -Citizenship Model Individual Commissioning To this Resource Allocation System……

13. Individual Commissioning Key Features/principles of the Gloucestershire Commissioning Model Promotes choice Needs led, outcome focused Accountability and review Local services Creativity, flexibility Value for money Empowers and engages yp, their families/carers Transparency, clear processes and timescales

14. Objectives: • Improved, managed outcomes relating to ECM • Improved stability and placement choice • Effectively commissioned services through pre-qualified lists (fostering, residential, SEN) • Increased local service provision • Increased accountability for service outcomes • Empowerment of young people and carers in decision making processes • Reduced bureaucratic processes and release time back into frontline working • Link with and build upon experiences of individual budgets for children in care and children and young people with disabilities • Join up the commissioning and individual budget processes (BHLP and the Resource Allocation System)

15. Where we are up to……. • Individual Commissioning Services Team • Mainstream Children’s Homes….closed – all children’s homes services • individually commissioned • Fostering: • Service of excellence • Business model • Level playing field (12+) • 28 day contract • Target for 85% in fostering placements • Special School and SEN process trials • Budget Holding Lead Professionals pilots • Support Services accreditation • Process examples

16. Service Commissioning Individual outcome focused commissioning profile completed (with parents and yp) ICST Quality Assurance function Anonymised data ICST screen against priorities Expressions of Interest from Partner Providers (pre-qualified providers) 5 working day turnaround X Tribunals 7 Parental pref…. Social Worker/Lead Professional grades (with parents and yp) • Negotiation with partner providers ranked 1&2 Contracts based on clear service/outcomes provision Needs/Outcomes form part of YP’s review Needs/outcomes to IRO Service

17. Special Educational Needs Trial Stat assessment request or review indicates complex needs Multi-agency outcomes meeting held: identifies and agrees need, outcomes and challenges Commissioning form completed by LP, agreed by parents and professionals Decision re. extra resources/external placement LP, professionals and parents grade responses and undertake visits Contract issued and placement begins Review of outcomes

18. Aims of the BHLP pilots • The BHLP pilots aim to: • Involve young people and parents in decisions about what they need and how best to support them • Ensure children, young people and families get the services they need when they need them. • Reduce overlap and inconsistency and poor engagement, thus reducing the costs per “episode” of intervention.

19. BHLP Children in Care Pilot • Workstreams: • Children waiting permanency • Educational achievement • Young people with substance misuse • issues • Yp in our children’s homes • Children and young people’s • participation

20. BHLPs - How they work…… Common Assessment (CAF) Analysis/PEP completed with parent, young person, relevant professionals Needs and outcomes identified Allocate budget if required Agree Lead Professional if not already identified Complete support plan with young person/parents Access existing services or commission direct Review outcomes

21. One of our big questions and challenges… What more could we do in-county? Why go out of county? How can we make better use of our own resources?

22. Special School Trials Emerging needs….. Costs inevitable… Accreditation of ‘non-trad’ providers Creative & Flexible approach Use BHLP principles Not just ‘education’ Local support services

23. Individual Commissioning: Have we got it right? Proof of the pudding…….

24. Benefits Realisation Improved stability/choice/matching Reduction in yp placed out of county Increased Local provision Sufficiency Increased involvement in decisions and process Promotes roll out of BHLP Increased accountability Reduced overall costs compared with pre-ICST Improved Market engagement

25. Commissioning Learning Points and feedback IFAs: - comprehensive information - able to meet timescales - ECM framework helpful in matching - outcomes led supports matching - a plan already to roll - positive way forward - 100% good/very good/excellent SWs: - takes more time than want to spend - QA function presents a challenge - timescales difficult to determine re outcomes - difficult if not know child (when an emergency) - ECM focus good - 55.5% good/excellent. 33% average. 11.5% poor

26. BHLP (Children in Care Learning Points) • Social work practice issues: • Raises questions about what the role of the social • worker is – commissioner a new concept • Meaningful relationships with young people • Challenges the culture of the ‘expert’ model • Moving from systems and process approach to • needs led • Corporate parenting aspirations

27. BHLP (Children in Care Learning Points) cont.. • Engagement with young people issues: • Greater participation in the care planning • process • To feel they are important and that they • matter • A chance to talk about their day to day • needs with someone with whom they have • a meaningful relationship

28. Commissioning feedback Young People: my choices were considered offered choice of two placements Choice? yes: definitely yes: happy and settled in placement Right Choice? two intros and enough notice successful Placement move? quite an achievement!

29. ‘Just wanted to say that the process ran very sweetly. Many thanks to everyone for their part in finding the right placement. I have been impressed by the professional courtesy and support along the way. The process is a vast improvement (to past experiences) and really does help to focus on my child’s needs and outcomes’

30. Individual Commissioning: Have we got it right? …..we’re still learning and working on it!