Adults with Complex Needs Richard Thake Executive Member for Community Safety and Waste Management Jamie Sutterby Assistant Director, Health and Social Care Integration Hertfordshire County Council

Where did it start…… Established in April 2014 Build on existing partnerships Improve outcomes Reduce costs Make best use of resources

Context A largely rural county with areas of inequality and a vast mix of services Frontline awareness of a group of individuals with complex needs, whose needs were not always met Troubled ‘Thriving’ Families model has had some success, but a recognition that partnership was not always working

Hypothesis “If agencies in Hertfordshire pool resources and work more closely together to identify and deliver services to adults with complex needs and chaotic lifestyles, they will be able to achieve a more cost effective service, and deliver interventions, solutions or improvements which are more customer focussed and effective.”

Who are we talking about? They experience several problems at the same time They have ineffective contact with services They live chaotic lives Some may be homeless or in poor, unstable housing

Building support

Practitioner engagement Multiagency practitioner workshop Practitioners wanted: More multi-agency case conferences Better sharing of information between partners A focus on high cost people with long standing problems To share what has been tried before and formulate new approaches

Service user engagement Interviews with service users Service users wanted: Consistent Trusted Adult Choice – when, where and how they receive support To create their own package of care Support at points of transition – e.g. moving from Hospital or Prison back in to the community or leaving care

Client Group Data Analysis 20 clients identified on ‘Super Wednesday’ Transactional analysis and tariff of costs Overall system cost, not including rent

2 Year costs for Lisa = £136,574

2 Year Costs for Mark = £84,359

2 Year Cost for Sarah - £55,817 (now deceased)

Top Ten by Chaos in Each Area Rank2 Year Cost Hertsmere2 Year Costs Three Rivers 1 £136,584£124,277 2 £129,654£84,359 3 £90,434£67,111 4 £85,921£64,674 5 £83,371£57,900 6 £79,263£51,570 7 £70,566£48,407 8 £70,061£43,552 9 £59,910£33, £57,327£26,404 Total £863,092£601,397 Cost per week £8,298.97£5,782.66

What did we conclude? High cost - £1.46 million Poor outcomes Big client group, particularly in urban areas A wide range of services are used –disconnected in 3 ways –Information sharing between agencies –Capturing cost and outcomes data on people of shared interest –Providing consistent, long-term support

Next Steps

Forming a Sponsor group Made up of executive level representatives from: - Police and Crime Commissioners office - Hertfordshire Constabulary - Herts Valley Clinical Commissioning Group - West Herts Hospital Trust - HPFT Mental Health trust - Job Centre Plus - Housing Associations - District and Borough Councils - County Councils

Service Principles Multi disciplinary, consistent, key workers Flexible budgets to provide bespoke support Practical and personal with a focus on goals, not problems Community Support – long term solutions Senior level buy-in to ensure progress Multi-agency panels and case conferencing (information sharing) Long term support - able to manage transition points No eligibility criteria

Pilot delivery Financed using existing budgets of our partners 2 Year Pilots – Hertsmere and Three Rivers July 2015 – July 2017 Provided by Resolving Chaos Third Party Evaluator

Evaluation Evaluation to demonstrate success or failure of pilot Proof of concept – does this approach work Improved outcomes for clients Saved money for partners Success of the project

Summary Developed, funded and led entirely within Hertfordshire Grass-roots partnership of providers, determined to try something different Personalised, intensive model of care – which is a better use of public money Desire to change commissioning cycles locally to be more preventative and proactive

What happens next? Sustainable outcomes Efficiency savings Greater preventative spend More partnership working Share learning Demonstrate economic benefits of prevention Continue partnership working Extend pilots across county Proof of concept Short termLong term National policy developments

Autumn Statement 2014 suggested expanding Troubled Families to include other chaotic and costly individuals Update due 25 November 2015 Hertfordshire project has received national attention: –innovative approach to funding –user-led approach to service design

We would like to hear from you…. Any similar examples? How can we develop this type of model when budgets are controlled nationally? What benefits are to be had? How can we improve data sharing practices?

Thank you for your time Executive Member for Community Safety and Waste Management Assistant Director, Health Integration, Herts County