Public Service Reform
In July 2011 Government published the Open Public Services White Paper setting out its public service reform programme, through increasing choice, opening services up to a wider range of providers, devolving decision making to the lowest appropriate level and improving transparency and accountability of public services. The models by which public services have been delivered for the last 50 years are no longer affordable. In large part this is due to reductions in public spending, but also the significant increase in demand for services and increased public expectation about the quality of services.
Councils and public sector partners are at the forefront of meeting these challenges and are driving transformational change and redesign of services, developing new partnerships and ways of integrating delivery to provide services that are fundamentally better – in terms of results, value for money and efficiency. Commissioning is increasingly a central part of the approach to redesigning services because it offers a means of joining up resources to focus on improving outcomes for citizens in the most efficient and effective way both now and into the future.
The Greater Manchester Strategy 2013-20 ‘Better Together’ sets the overarching strategic framework for Public Service Reform in Greater Manchester. It sets out a collaborative and ambitious programme with two linked aims:
- to re-design public services to build the independence and self-reliance of GM’s residents; and,
- to collaboratively invest in public service interventions to help all GM partners sustainably reduce demand for their services.
These reforms are expressly designed to encourage families, individuals and communities to lead more productive and fulfilling lives. For example, the development of an integrated health and wellbeing plan for Trafford, focussing on innovative transformation and integration of the health and social care systems, in order to redirect resources from expensive acute services to prevention, relies as much on a culture of behaviour change amongst residents, communities and service providers as it does on structural reform.
GM PSR Principles
The factors that link together public services are the people who use them and the places in which they live. Public services need to be designed around people’s needs and expectations; and be relatable to personal experiences.
- 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 wellbeing, 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.
Public Service Reform in Trafford
With such broad outcomes, as commissioning changes and services are delivered differently, so Public Service Reform (PSR) becomes simply ‘service reform’, affecting all sectors and communities.
The Trafford Partnership sets the culture and creates the environment for collaboration between organisations, across sectors and with communities. For some years we have worked together innovatively and efficiently, delivering dynamic projects and improving outcomes for local people, leading the way across Greater Manchester and nationally. Trafford has been doing ‘Public Service Reform’; collaborating, co-locating and co-producing services long before the terminology was created. Having this strong culture and leadership of partnership working puts Trafford in a very strong position to take a lead role in driving Greater Manchester’s approach to Public Service Reform, as it’s through projects and practical delivery that we see the strength, value and impact of the Trafford Partnership.
Public Service Reform Case Study: Specialist Mental Health Practitioner Pilot
A new delivery model has been piloted in Trafford since April 2014 between the Police at the Trafford Division within Greater Manchester Police (GMP) and local Health Services. The principal element of the pilot has been the introduction of a Specialist Mental Health Practitioner from Greater Manchester West Mental Health NHS Foundation Trust (GMW), to operate within the Integrated Safer Communities Team, physically co-located on the Trafford Division at Stretford Police Station. The role of the Specialist Mental Health Practitioner is to work alongside Trafford Division Police and Trafford Council staff to triage emerging risk cases and to engage with individuals who are presenting demands on services, supporting the development of a multi-agency plan of care and / or intervention. This is an innovative multi-agency model, with a focus on personal, face-to-face interaction, relationship building, problem solving and early intervention.
The project has been very successful, achieving substantial reduction in demand on not just the police but other public services including North West Ambulance Service and other health services, achieving savings estimated to be £150,000 per year. Co-locating officers enables practical brokerage between agencies and improvements to information sharing. This is replicated at a strategic leadership level, where relationships have improved leading to new projects. Above and beyond all the measurable outcomes and metrics, at the heart of the pilot has been an overriding sense that the new way of working could produce better outcomes for service users, meaning more appropriate and collaborative decision making, and a tailored, problem solving approach centred on the individual. Service users who have been asked about their experiences reflect that the new way of working introduces a personal relationship that benefits them, providing a means to interact, be listened to, and begin a supported journey that provides stability and ultimately leads towards recovery.
On 2nd March 2016 this project won a Gold Award at the national Improvement & Efficiency Social Enterprise (iESE) awards, which showcases the best examples of transformation and improvement from councils, police, fire services and public partnerships from across the UK, further evidence that Trafford leads the way in innovation through partnership working.
The Greater Manchester Public Service Reform Programme has a number of themes developing new delivery models to improve outcomes for individuals and families who place the greatest demand on public services:
- ‘Early Years’
- ‘Troubled Families’
- ‘Work & Skills’
- ‘Justice & Rehabilitation’
- ‘Health & Social Care’
Within Trafford, and across GM, significant progress has been made to improve integration and coordination of services, however it was recognised that many individuals and families do not fit neatly into these work streams and exhibited behaviours and needs that meant they required interventions to address a multiplicity of issues simultaneously; for example, requiring help to address addiction or mental health problems prior to being in a position to address offending behaviour, improve their parenting or embark upon a journey back into work. In addition, programmes of work demonstrating principles of Public Service Reform and engaging high demand or complex groups of people have developed outside the original PSR work streams. These include Phoenix (addressing Child Sexual Exploitation), Challenger (Serious and Organised Crime) and partnership interventions to tackle Domestic Abuse.
The creation of the concept of complex dependency was therefore necessary to advance Public Service Reform and give greater momentum and clarity to the strategic ambition to re- design public services, to drive forward effective information sharing, joint assessment and integration and coordination of interventions. The purpose of this was to improve outcomes for and reduce dependency of individuals and families but also, importantly, to maximise opportunities to remove waste and duplication of effort within public service organisations and across organisational boundaries.
Complex dependency involves scaling up the existing Public Service Reform ways of working that are now demonstrating evidence of success, to broader and deeper cohorts, and with a sharper focus on employment. Trafford and its partners have a good understanding of which families and individuals face issues of complex dependency, and which would benefit from an integrated, more intensive support offer. We can define and identify benefit from early intervention to prevent future dependency. Additionally all boroughs have committed to a common set of characteristics for Complex Dependency delivery models. These are captured under the GM ‘Spine’ which has been endorsed by AGMA Wider Leadership Team.
There are a number of local drivers to implementing a Trafford approach to tackling Complex Dependency:
- The Working Well pilot is transforming the lives of those who have not been able to find sustainable employment, and is forecast to support 850 individuals in Trafford.
- Stronger Families, which has used an effective whole family approach to tackling issues and aligning resources, will be expanded from 360 families over the last 3 years to 1,200 over the next 5 years.
- Trafford’s Health and Social Care Locality Plan presents the framework for an enhanced, integrated and co-commissioned health and social care offer for Trafford citizens.
- Trafford’s new All-Age Front Door will improve access and information on social care, and the new Care Co-ordination Centre will coordinate complex care pathways on behalf of the patient. In doing so these will provide a rich source of real time intelligence, which can be used to redesign services, promote health improvements through targeted marketing and support behaviour change through the provision of a comprehensive and interactive service directory.
Place Based Integration
People with complex needs live in our communities. To tackle Complex Dependency effectively depends not only on co-ordinated intervention by services but on support from the Voluntary and Community sector and local residents. Furthermore, to prevent people becoming ‘complex’ requires early co-ordinated intervention in targeted neighbourhoods to prevent duplication, deliver budget savings, reduce demand and stop escalation.
One Trafford Response is an exciting opportunity for a range of organisations across partners and local communities to work together to understand, shape and develop an integrated place based model. The Council and partners aim to redesign and improve the way we deliver frontline services to support individuals and families who are in need at the earliest possible opportunity. Trafford Partnership has agreed a phased roll-out of this neighbourhood working. Firstly, in the Stretford area, then to the whole of the north locality followed by the other three neighbourhoods/localities.
Since May 2017, partners working in the Stretford area from across the Council, housing, health, employment and police have been getting to know the place, understanding the assets and demands of the community. It has developed into some joint working opportunities and sharing of skills and knowledge. They have been based in Trafford Housing Trust offices in Stretford mall. The front-line staff have provided a co-ordinated response to families and individuals at the first point of contact whether this is through effectively linking them to community and voluntary, community and social enterprise (VCSE) support or through a keyworker approach. A keyworker acts as the main contact for an individual/family, empowers them to achieve their aspirations, and supports the coordination of agencies involved which allows residents to live their lives well without the support of services. The team working in the Stretford pilot developed the purpose and way of working.
The purpose of the model is to look at things from a resident’s perspective - “Work with me to live as well as I can”.
The model has a set of operating principles for working together around a neighbourhood:
- Doing what matters: focusing on the aspirations and personal outcomes of those we work with and the essential activities to achieve these.
- Measuring what we’ve done: evidencing that we are making a difference through hard and soft evaluation.
- Testing, learning and adapting: improving the effectiveness of the work we do and overcoming obstacles.
- Recognising and pulling in everyone’s strengths: maximising the collective assets of citizens, employees and the community.
The roll out of the One Trafford Response way of working across the north neighbourhoods will build on the work already being done with health and social care services. We will widen this to other partners by re-locating the pilot OTR team to sit alongside the north neighbourhood locality team and by expanding the number of frontline staff across the north of borough who adopt the One Trafford Response approach to their everyday work. All agencies working in the north of the borough will be invited to attend an induction briefing. The purpose is to share the model, provide opportunities to meet colleagues from a wide range of agencies and understand the north of the borough as a neighbourhood and what assets there are in the local communities.
For more information on One Trafford Response click here
Trafford’s integrated partnership governance for Public Service Reform
Trafford is leading the way across GM by being one of the first borough’s to bring together its PSR programmes into one Partnership governance and framework.
To lead, coordinate and oversee the strands of public service reform brought together under the complex dependency banner, we have established a Public Service Reform Board, made up of senior officers from across key partner agencies. The Board met for the first time in February 2016.
The vision for the board is to establish a ground-breaking multi-agency, community based approach to tackling and preventing issues of complex dependency for children, families and vulnerable adults across Trafford.
The role of the Board is to ensure the successful delivery of an integrated Public Service Reform programme using the principles of PSR in Trafford. The Board will be responsible for investment, decision making, strategy and risk for PSR in Trafford, and will report progress and challenges to the Trafford Partnership Board. The Board will:
- Identify and exploit opportunities for integrated working and joint restructure and reinvestment to ensure delivery of programme objectives;
- Adopt and deliver the principles of PSR in Trafford;
- Provide strategic steer and direction to the PSR programme;
- Oversee the delivery of the Working Well, Complex Dependency, Troubled Families, Transforming Justice and Rehabilitation and Health and Social Care Integration programmes and further PSR programmes in development such as Co-Commissioning the new Work Programme;
- Nominate named lead individuals to oversee and contribute to the delivery of specific work-streams within the overall programme;
- Request timely and regular updates and provide challenge to ensure progress is maintained and milestones are met;
- Ensure resources are allocated to enable successful project delivery;
- Drive a set of financial and non-financial benefits and efficiencies through the programme;
- Manage any risks to programme delivery and identify lessons learnt;
- Undertake key decisions and set priorities.
Underneath the Board is an Operational Group, which will bring together operational managers across the relevant partner organisations to provide leadership and drive to the PSR programme agenda in Trafford, manage change and sustainability within organisations as we move towards an integrated approach and champion, implement and integrate the PSR principles within organisations. A Peer-Support Group will also be established, bringing together front-line staff to deal with any issues or concerns that arise from service users or key workers/ case co-ordinators when delivering packages of support, offer a solution focused discussion and explore new innovative approaches and share lessons learnt and good practice.
Terms of Reference for the Trafford Public Service Reform Board
Terms of Reference for the PSR Operational Group