Greater Manchester Public Service Reform

Austerity Measures Shrinking Resources Reactive Services Lack of joint Problem Solving Duplication of Effort Limited Engagement from others Context Rise in demand for services from the most vulnerable in society Increase in complexity of calls for public service Early Years Work and Skills Complex Dependency Health and Social Care Justice and Rehabilitation Existing strands of Public Service Reform All thematic strands are connected to place Place-based Integration

JUSTICE & REHABILITATION GM has made significant progress in implementing reform programmes TROUBLED FAMILIES WORKING WELL JUSTICE & REHABILITATION EARLY YEARS COMPLEX DEPENDENCY PHASE 1 OUTCOMES: All targets in phase 1 of the programme achieved PHASE 2 ON COURSE: 75% (6,600) of GM TF2 allocations for early starter phase and 15/16 are engaged STRONG STRATEGIC POSITION NATIONALLY: Only sub-region to become an early adopter for phase 2 GM outcomes framework has influenced the national approach PILOT OUTCOMES: 3,700 people now attached to the programme, 132 people have moved into work EXPANSION AGREED: Expansion of the programme agreed through devolution agreement, procurement is underway and the expanded service is due to begin in February INFLUENCING NATIONAL EMPLOYMENT & SKILLS REFORM: WW approach influencing both DWP and CLG strategy on supporting those furthest from the labour market (though discussion with DWP on other areas of reform remains a challenge) EMBEDDING REFORM PRINCIPLES: Programmes to support women offenders, young offenders, and others are embedding an integrated approach to justice and rehabilitation IMPROVING OUTCOMES: Only 6.5% of women referred to centres established to support women offenders have re-offended. 561 Intensive Community Orders have now been made, re-conviction rates stand at 19.7% (compared to 32.6% for adult reoffending: GM Probation Trust) 1,512 offenders being managed through integrated offender management model NEW DELIVERY MODEL: Places implementing different elements of the new delivery model NEW STRATEGY IN DEVELOPMENT: Early Years strategy development underway, aligning with Health & Social Care reform DEVELOPMENT OF HUBS: 5-6 LAs now have integrated multi-service hubs in place PLACE-BASED INTEGRATION: Place-based integration pilots beginning in Tameside and Wigan, other places are lining up to develop their approaches shortly

We’re focusing on early intervention and prevention Working in collaboration to support GM residents and improve outcomes Housing Fire & Rescue Police Health services Local Government Thinking about cumulative impact rather than single service planning Identifying and addressing demand before it escalates Supporting individuals and families collaboratively, working across organisational boundaries Reducing demand on expensive, reactive services

Delivering our ambition: aligning reform across GM H&SC TRANSFORMATION WIDER REFORM ACROSS GM

Integrated models of reform Devolution provides GM with a unique opportunity to reconfigure our approach to local services Given the scale of the opportunity, failing to align our broader approach to reform with the health and social care change programme would be a missed opportunity. The achievement of our health and social care ambitions are also dependent on services outside these sectors: an integrated response is required GM H&SC reform Broader GM reform Early intervention and prevention strategy: Our strategy should include implementation of a single Early Years strategy, wellness offers and should tackle complex dependency (early intervention and prevention must be part of universal and specialist service plans) Ensuring GM residents and communities are supported to avoid escalation risk (equally applicable to medical and non-medical risk) Supported by effective use of data (understanding level and location of need and assets across GM) Delivering and integrating services in ways that recognise the interdependencies in outcomes (i.e. positive mental health outcomes associated with employment) Improvement & Efficiency: Identifying appropriate cross-sector (or cross-locality) back office savings through integration and collaboration Working in clusters to improve standards of service through development of sectors of excellence (e.g. approach to some elements of the Services for Children review) Implementing GM standards (not standardising) – ensuring all GM residents are able to access support shown to have positive impact Providing integrated packages of support to GM residents, requiring collaboration across sector. This should be managed proactively in localities, based on robust use of data that helps us identify risk, ensuring integration is being managed in a coordinated way.

A place-based approach to reform Our revised reform principles highlight the importance of taking a place-based approach to the delivery of reform, ensuring our reform of public services supports neighbourhoods and communities across the conurbation to contribute to and benefit from growth in GM GM REFORM PRINCIPLES A new relationship between public services and citizens, communities and businesses that enables shared decision making, democratic accountability and voice, genuine co-production and joint delivery of services. Do with, not to. An asset based approach that recognises and builds on the strengths of individuals, families and our communities rather than focussing on the deficits. Behaviour change in our communities that builds independence and supports residents to be in control A place-based approach that redefines services and places individuals, families, communities at the heart A stronger prioritisation of well being, prevention and early intervention An evidence led understanding of risk and impact to ensure the right intervention at the right time An approach that supports the development of new investment and resourcing models, enabling collaboration with a wide range of organisations.

To deliver our ambition, our workforce must develop… Working in collaboration Making use of, having access to, and sharing appropriate data to support decision making Linking people to assets in their communities Being empowered to make decisions Having new roles Having a different conversation

Those who only need universal services Public Service Reform and ‘Place’ Complex & Costly ‘At risk’ Those who only need universal services Likely to be known to a number of services and professionals Likely to be below the threshold for specialist services but have multiple issues and risk factors Demand and the role of the Neighbourhood Teams 2.7million residents across Greater Manchester The shape and size of the triangle will vary locally Reducing demand for public services relies on identifying those individuals and families who are not yet accessing specialist services but are at risk from escalating problems. It is these individuals and families who generate most demand for all agencies in neighbourhoods. Reducing the flow of demand in the neighbourhood is therefore essential to address the needs of this ‘at risk’ group.

Key findings and learning from Place-based early adopter sites

Demand Analysis 11

Receiving Specialist Service Demand Analysis Receiving Specialist Service 27% of cases 43% of demand Hyde Area 1,235 Incidents of demand Not Coping 39% of cases 40% of demand 48 Cases Well adapted 34% of cases 17% of demand The current system is set up to deal effectively with just 17% of demand The other 84% of demand requires a tailored response Just over half of this would come under ‘Specialist Service’ leaving 40% of demand not meeting threshold but in need of more than just universal service 85% known to >1 Agency 63% known to Mental Health 49% of Police demand known to Mental Health 12

System Study Findings Demand moves around or presents variably in the system Triage, assessments and referrals dictate workflow Offer interventions from a ‘menu of options’ We deal with demand as it ‘presents’ not necessarily in ‘context’ Focus on what is wrong with people Pass/escalate to specialists without truly understanding the problem Interventions are often at the point of crisis, we miss the opportunity to intervene early Silos within and across organisations

System Designed Constraints & Blockages Access to Citizens & Other Services Nationally driven Performance Indicators Approaches to Performance Management Information and Systems Job Descriptions and Functions Competencies, skills and powers limited by remit Thresholds and Organisational Priorities 14

Redesign Operating Principles 15

Redesigning Frontline Roles Understanding what is required in the redesign of frontline roles through the experiment Competencies, Skills and Powers Framework Understanding the degree to which specialist and targeted services are required at the frontline to inform commissioning strategies and deployment of resource at different spatial levels 16

Understanding and Measuring Citizen Value A performance management framework that links individual outcomes (‘citizen value’) to wider population outcomes and is used to assess system performance 17

Place-based Integration – What’s Different? Current Assumptions “Understand ‘where people are’ and what strengths and assets can help” “Measures of organisational performance based on citizens achieving ‘what matters’ to them” Evolving Assumptions Commonly Understood Elements and Recent Developments Systems Thinking Evolutions for Place-based Working Different Conversations with service users, allowing strengths and assets to be built upon. Conversations may be structured around a predetermined framework and directed from the specific professionals perspective.    “Understanding ‘what matters’, what a good life looks like, what strengths and assets can help” ‘Leading’ Measures relating to ‘what matters’ to service users and place from different conversations are linked to ‘lagging’ measures at population / agency level. Demonstrate the link between citizen value and   “Measures of achievement of purpose and ‘what matters’ to people are linked to population and agency outcomes” Multi-agency team co-located, with shared management. “Joining up what we have” Redesigned Team Roles (including leadership roles) with the knowledge, skills, expertise to help people - themselves and their place. “Designing for what is needed” Key-worker navigates around obstacles (System Conditions) in order to achieve better outcomes. “Work around the System Madness” Leaders take action on the System Conditions – obstacles to delivering purpose and ‘what matters’ to service users – making achieving better outcomes as simple as it can be. “Design out the System Madness” Demand reduction, management and triage through a multi-agency lens. “Get it to the right agency the first time or as quickly as possible” Holistic root-cause, contextual solving problem solving. “Understand the problems to solve holistically and in context. Help people to help themselves, support as required at universal level and enable specialist support when required” “Join up what we have” “Design for what is needed” “Work around the system madness” “Design out the system madness” “Get it to the right agency the first time or as quickly as possible” There is potential to have a radical impact on Service, Costs & Moral Evidence that Service is not great e.g. Needs not met Evidence that Costs are unnecessarily high e.g. Amplified demand Evidence that morale is much better when people have a clear purpose and a system that allows true value to be added to people and places “Understand and act on the problem to solve holistically in an integrated way” 18

Next steps Implementation of integrated place-based leadership The integration place-based pilots currently rolling out across GM provide an opportunity to test integrated place-based leadership at scale in 2016-17, potentially paving the way for implementation of a GM model in 2017-18. Convergence of PSR programmes Single framework for operational delivery with agreed standards developed for GM and single outcomes framework. Alignment with Health and Social Care As locality health and social care leadership and delivery models emerge, alignment with wider locality based planning will be required. Information sharing GM proposals to strengthen information sharing were approved in January and this will strengthen GM’s ability to move to a more integrated local service model.