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Leicester and Leicestershire Total Place Pilot

Leicester and Leicestershire Total Place Pilot. Total Place: Better for less. New national initiative looks at how a whole area i.e. ‘place’ approach to public services, can lead to ‘better services at less cost’

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Leicester and Leicestershire Total Place Pilot

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  1. Leicester and Leicestershire Total Place Pilot

  2. Total Place: Better for less • New national initiative looks at how a whole area i.e. ‘place’ approach to public services, can lead to ‘better services at less cost’ • It seeks to identify and avoid overlap and duplication between organisations – delivering a step change in both service improvement and efficiency • Enables a conversation with Government on any national or regional barriers to achievement of Total Place aims • Nationally there are 13 official pilot areas

  3. Key Components of Total Place Three complementary strands:  ‘counting’, ‘culture’ and ‘customer insight’ The Counting Process : maps public money flowing to & through the place (from central and local bodies), to identify where public money can be spent more effectively The Culture Process :looks at the way existing cultures (the way we do things) actually helps or hinders the process Customer Insight :consultation with residents and service users to ensure their views are at the heart of any improvements

  4. Leicester/Leicestershire Pilot The Two ‘culture’ themes chosen are: • Drugs and Alcohol • Access to Services

  5. Leicester/Leicestershire PilotThe Count – Key Findings • Total gross expenditure is £6bn - £4.3bn local delivery organisations - £1.7bn NDPB • Highest local spenders are: - Department of Work and Pensions £1.4bn - Leicestershire County Council £892m - Leicester City Council £846m - University of Leicester NHS Trust £615m - Leicestershire and Rutland PCT £434m (expenditure excluding acute commissioning)

  6. The Count – Key Findings • The cost of being in business (corporate management and support services) ranges from 3% to 11% for the limited organisations analysed. Average = 5% • Applying this % to local delivery organisations spend in Leicestershire = c£200m is spent on being in business • Long, complicated and expensive delivery and funding chains • Audit Commission estimates that every time funding moves through an organisation 20% of funding can be lost in that layer

  7. Drugs and Alcohol Theme Framing the Problem

  8. ‘Cost’ of Alcohol Misuse Nationally: • NHS 2.7 billion p.a. (England & Wales) to treat chronic and acute effects of drinking • 17 million days lost absent from work = cost 6.4 billion p.a. • 69% increase in hospital admissions (past 5 years) • 35% of all A & E attendance are alcohol related • 7,000 road accidents attributed specifically to alcohol • 1 in 11 children live in families with an alcohol misuser • 50% of domestic violence linked to alcohol • 1.2 million incidence of violent crime each year • 1 million prediction for hospital admissions 2011/12 alcohol primary/secondary factor • All costs: 8 – 13 billion p.a. (Home Office)

  9. Children, Young People and Alcohol Misuse Nationally: • 22% of 11-15 year olds drink on a weekly basis • 24% of young people said that they had done something as a result of drinking that they later regretted • alcohol consumption for girls aged 11-15 continues to rise • alcohol consumption for boys seems to have stabilised

  10. ‘Cost’ of Alcohol Misuse Leicester/Leicestershire • Estimated 1 in 5 adults misuse alcohol – some areas 1 in 4 • 45% of reported crime in the region is related to alcohol • Alcohol related admissions doubled from 5.2k to 10.3k (02/03 to 07/08 • City in top 10 in England for alcohol related hospital admissions • 32% of the prison population have a drink problem • City isthe most challenged area in relation to alcohol related violent crime in the East Midlands • the second most challenged in relation to sexual offences attributable to alcohol • 27th in top 50 most challenged areas in respect of NI 20 & NI 41 (Assault with less serious injury & Perceptions of drunk and rowdy behaviour) • Alcohol is linked to offending for 51% of prolific and priority offenders

  11. ‘Cost’ of Alcohol Misuse Across Leicestershire & Leicester: • Up to £16 million to Leicestershire Health Services (and 80,000 bed days) NHS costs : 05/06 = £10m estimated 09/10 = £16m • £80 Million cost of crime Plus costs family impact, clean ups, benefit costs, absenteeism, RTA’s, Safeguarding children, etc. • £120 millionlocal expenditure on alcohol every year

  12. Drug & Alcohol Theme Objectives • Reduce misuse & its impact on our Place • Reduce the costs of misuse • Improve outcomes for service users • Reduce inefficiencies in handling misuse

  13. Solution Components.. 1. Increase Focus on Prevention 2. Reduce Alcohol Availability 3. Improve Late Night Economy 4. Pilot Multi Agency ED 5. Develop Coherent Treatment Systems & Pathways 6. Access to Treatment in ‘Integrated Offender Management’ 7. Joint ‘Place’ Commissioning Structure, Budget, Performance Framework & Approach

  14. Solution Component 1: Prevention & Young People • Mainstream education & awareness to all young people • Target family/parenting programmes to ‘at risk’ families • Skill up children’s workforce around substance misuse i.e. advice & info • Reduce emphasis on ‘specialist’ treatment

  15. Solution Component 1: Prevention & Young People • Prevention better than cure? • Change perceptions & behaviours around substance use – particularly alcohol • Normative approach? • Positive influences? • Role of ‘the family’ & peers • Pilot a ‘Place’ Social Marketing Campaign targeted to young people • Supported by National ‘normative’ Campaign?

  16. Solution Component 2: Reduce Availability of Alcohol Seek Local Support for following interventions: • Sale in the Late Night Economyacross ‘Place’ • Reduce undercutting • Cessation/reduction of promotions • Minimum price for a drink • Strengthening Licensing Powers • Single approach across 8 areas • Use all available legal powers • Implement good practice i.e. density & no. of premises

  17. Solution Component 2: Reduce Availability of Alcohol Seek National Support for: • Pricing of Alcohol • Minimum price per unit • Targeting high volume low cost brands • Loss Leading • Influence supermarkets to cease/restrict loss leading on alcohol sales • Strengthening Licensing Powers • Compulsory Code of Practice for licensees? i.e. challenge 21 • Increase legal responsibility of licence holder & owner • Stronger sanctions for underage sales • Legal sanctions for sales to ‘over the limit’

  18. Solution Component 3: Improve Late Night Economy • Compare and Contrast • County and City • Map Costs Of Servicing • i.e. Policing, Licensing framework, Street Cleaning, Street Lighting, CCTV, Repairs • Explore the Role of ‘Calming’ Influences • i.e. Volunteers/ Street Pastors in clubs and pubs • Champion & Promote Good Practice in Licensed Premises • i.e. Best Bar None Awards

  19. Solution Component 4: Pilot Multi Agency ED for Alcohol Misuse Currently universal provision – 1 size fits all • Substance Misuse and urgent health need & repeat admissions? • ED & Custody Suites = Expensive? Appropriate? Disruptive? • Root cause effectively addressed currently? Pilot: safe, improved alternative with: • Range of relevant services & agencies – Multi-agency approach • Brief interventions • Referrals to treatment • Better identification & address dual diagnosis needs Aim: Improved outcomes & Reduced costs

  20. Solution Component 5: Develop Coherent Alcohol Treatment Opportunities: • Well established treatment system for ‘drugs’ • Redesign of drug treatment system across Place underway • Systems Change Pilot area (1 of 7 nationally) • Opportunities for efficiencies through redesign process & redistribution of resources • Alcohol treatment ‘Cinderella’ • Piecemeal commissioning from several organisations • National/local ‘Pooled Alcohol Budget’

  21. Solution Component 6: Integrated Offender Management Integrate access to Alcohol Pathway within Offender Management 2007 work started on IOM Integrated Offender Management Vigilance Link is to better ensure access to users System Change Total Place November 09 March 10 March 11

  22. Total Place Joint Commissioning Structure • Join up drugs and alcohol commissioning • All relevant agencies jointly commission drugs and alcohol services (PCTs, LAs, Probation) • Pooled budget & resources at the table • Subregional Commissioning Board, but retain city and county commissioning groups (Total Place not One Place) • Review performance frameworks & targets

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