Community budgets – A new approach to service delivery: case studies
Community budgets – Overview
Community budgets are very early in their development, with many only a couple of months in to their operational phases. Even at this early stage we can see that community budgets have let councils and their partners take a genuinely different approach which is producing savings and removing people from dependency on state services.
Community budgets are the means by which a new model of public service delivery is being achieved. There is now widespread recognition that public services must break away from inefficient and fragmented delivery based on bureaucracies and silos. Community budgets stop the waste caused by multiple producer interests and bureaucracies dealing separately with clients, and allow a much more straightforward focus on the clients as people who have the potential to take responsibility for their own lives.
Community budgets are very early in their development, with many only a couple of months in to their operational phases. Even at this early stage, we can see that community budgets have let councils and their partners take a genuinely different approach which is producing savings and removing people from dependency on state services.
Case study – Manchester
Greater Manchester (GM) sees community budgets as key to supporting economic growth and reducing dependency on public services. The GM Whole Place pilot is an opportunity to scale-up small scale examples of success in neighbourhoods, by working with Government to overcome blockages to working in this way.
The districts within GM are piloting different delivery models for complex families with some commonalities – an integrated multi-agency approach, focus on individuals and the family, and use of evidence-based interventions. Manchester is piloting a new way of working with complex families in two neighbourhoods – Wythenshawe and Gorton / Longsight. Manchester is testing a ‘new delivery model' with 240 families and comparing this to a ‘business as usual' approach for 240 families. The new model involves a single virtual team (local integration team), involving the council, health, schools and work programme providers, which takes care of all referrals for complex families. Complex families have one individual to work with who agrees with the family what kind of help they need, including referrals in to other services. There are four services they can be referred in to, ranging from very intensive support for families whose children are on the verge of being taken in to care, through to work to address the financial and social problems that cause that family to place high demands on public services.
The new approach avoids the inefficient and counter-productive results of ‘business as usual'. By having just one team which deals with complex families all referrals stop duplication of effort and counter-productive results of bureaucratic silos. This leads to two key benefits.
The ability to get families the help they need when they need it (prioritisation) – previously families would be referred into services but would have join a waiting list to receive them. Complex families can now be prioritised when referred in to services across the public sector, such as mental health treatments.
Different ways of investing (new investment models) are needed for this approach to succeed. These enable partners (DWP, health, police, voluntary sector) to invest in interventions that will produce a return – the return is found through stopping (‘decommissioning') services that are no longer needed. Manchester's cost-benefit analysis suggests that applying this new approach to 240 families will result in £0.7 million of future costs being avoided over the first two years of delivery (above what would be achieved if a business as usual approach was maintained). This is equivalent to a return of 44 pence for every £1 invested in the programme compared to the estimated current return of 32 pence. Significantly greater returns are then expected in future years as complex families are supported effectively and become less dependent on public services.
Some of the greatest savings will come from helping parents back into work stopping children being taken in to care. This is felt to be achievable because a significant proportion of costs are incurred on a case-by-case basis, as opposed to being fixed. Scaling up of the approach will be done through reinvesting savings made in the pilot studies to fund a further roll out. The next stage will be to work with 1,000 families across a wider area of North Manchester from April 2012, developing the new delivery model by learning from the first two pilots. Manchester will ultimately look to tackle the estimated 2,400 families in the city and use early intervention and prevention to stop further families becoming complex.
Greater Manchester will work with Government to extend this approach to other themes – transforming justice, early years (0-5s), and integrated health and social care, through the Whole Place Community Budget pilot. And the new Troubled Families Unit to ensure there is sufficient upfront investment to work with large numbers of families before there is full evidence about how effective the new approaches are.
Case Study – Lincolnshire
Eight partners have pooled funding to develop a community budget approach worth £1 million a year. This pooled budget funds a team that provide intensive support to 50 families with complex needs. Each family has a dedicated worker, rather than having to navigate a confusing array of people across a range of organisations. Each family signs up to an agreement which gives them access to a personal budget (approx £8,000 on average per family a year). The personal budget is used to stop the family needing so many state services, help them get in to employment and address any particular problems the family have that place demand on public services – such as drug addictions. Families work within an agreed personal budget on the condition that they will not draw upon any other public sector resources. Each year the ambition is for the personal budget to be reduced.
Pooled funding and personal budgets for families makes this a markedly different approach from business as usual. Families must commit to not accessing other public services which means that councils are their partners are working in a very different way compared with the previous approaches of the state.
So far this approach is not only making savings but also having a significant impact on the families. In one case study, the approach resulted in family debt being cleared, all children being involved in education, no anti-social behaviour, the family getting on well together and parenting better. In addition to this, Lincolnshire estimates that re-occuring savings of over £38,000 were made, along with costs of £103,264 being avoided.
Case Study – Lewisham
Being one of the first phase community budget areas has let Lewisham and its partners use collective resources differently.
Joining together funding:
Better service design:
Changing working practices:
Case Study – Blackburn with Darwen's Think Family Community Budget
The approach taken has challenged existing systems and processes and tested new ways of working with complex families for whom ‘business and usual' approaches by the state have not had any success. Defining features of the new approach are:
Swindon – Life
The LIFE approach is a programme focused on developing people's capabilities and opening up new opportunities and possibilities to families in crisis. It is not about being directive, but about enabling and empowering families to open up about issues, about what they want to happen in their lives, and trying to get to the root of the problems holding them back. It is about creating a space where they can talk about what they aspire to and giving them the right support to build their capabilities and connections and to know how to access the kind of resources they need to make their aspirations real.
In the programme development stage, 12 families were involved in the initial research, four families in building the prototype, and hundreds of staff in designing the programme. The focus of the design was on:
The pilot in Swindon has demonstrated impact for families and significant cost savings for the local authority. As of July 2011 the data, based on 55 family members, shows:
In 2010, £760,000 was saved in the first year of running the pilot (£275,000 on actual, £485,000 on preventative), with a further £720,000 of further savings estimated for the second year?(£235,000 on actual, £485,000 on preventative).
Barnet – Intensive Family Focus Work (IFFW)
A group of 100 staff from all relevant council services and partners formed a core operational group to deal with information sharing protocols, referral criteria and pathways and funding arrangements. All partners agreed to share data on their top 100 families, who presented with the most complex and costly challenges, with a view to developing a collective list of families who should be prioritised for referral into the scheme. Cases which have been picked up by the IFFW are high-risk, high-cost cases who present with multiple complex needs. Issues which led to referrals included a mix of offending behaviour, drug and alcohol use, domestic violence, housing and tenancy problems, risk of care proceedings, risk of high-cost SEN placements and physical and mental health concerns.
The team has a core staff of eight workers, in addition to secondment support from Drug and Alcohol Services, Probation, and Jobcentre Plus. It is expected that when the service is fully up and running that partners will invest in it proportionately depending on the savings they expect to make. In the first year, however, it has been seed-funded through early intervention grant, community safety funding and a contribution from Barnet Homes.
Central to CBB model is the Birmingham ‘Family Common Assessment Framework' or fCAF. This innovative approach sees the existing multi-agency assessment framework used for children being developed for use with adults. For the first time, children's and adults agencies are working together to assess need and design integrated support plans around the needs of the family. fCAF is a consensual process and provision of support is based on the family's participation in developing support plans.
Support for families with complex needs is underpinned by CYPF's new operating model, which has seen the establishment of a city-wide network of 16 Integrated Family Support Teams (IFST). In the CBB FCN Shard End area the new IFST team provides support to families, particularly where there is a safeguarding concern for a child in that family. Each family has a named advocate who is responsible for coordinating support agreed with the family.
Family Common Assessment Framework – fCAF
A total of 160 frontline workers in the Shard End area have received training in the new fCAF process. Feedback is positive, with agencies welcoming the opportunity to come together with families to identify needs and support solutions. Through the appointment of a dedicated area coordinator for Shard End, local agencies are now receiving advice, guidance and practical support in carrying out the fCAF process. For agencies new to CAF, this can include dedicated top up training from the Central CAF Team, an example being training for Jobcentre Plus staff as well as dedicated briefings for adult mental health workers.
Since fCAF went live in September a total of 48 families have been engaged in the process, with a total of 70 children being supported. Adult agencies are now participating with support from the WISH project featuring in most Integrated Support Plans. Schools, IFST Teams and Shelter are the main initiators of fCAF screenings to date, but new agencies are now emerging including Jobcentre Plus, West Midlands Police and voluntary sector organisations.
Family Intervention Programme – FIP
The CBB FIP model for Shelter is profiled to work with 65 of the most complex families over a two-year period, with 3.5 (full-time equivalent) family facing project workers. It is recognised that families most in need who would benefit from a FIP, would do so over a 12 month period. Since September a total of 19 families have been referred to and have accepted support from the FIP. Early indicators from the fCAF is that the need for the FIP support is high and allocations will be subject to ongoing review to ensure the FIP is supporting families with the most complex needs. The mix of families currently supported is both those with complex needs of their own and those that present the most challenging of behaviour in the community.
Integrated Family Support Team
The Integrated Family Support Team for the East went operational on 12 September. This new multi-disciplinary team provides intensive support to families with additional needs and access to this support will come via the fCAF process. The IFST team is based in Kitts Green Children's Centre. Although a vital part of the CBB FCN model, the team prioritises cases around the needs of the most vulnerable children.
In addition to community budgeting work, evaluation of Westminster's Family Recovery Programme, which bears many of the hallmarks of a community budget approach and has influenced a number of the 16 pathfinder schemes, demonstrates the efficacy of this approach.
Case study – Westminster's Family Recovery Programme
Westminster calculated that there were around 40 families in the borough responsible for the majority of anti-social behaviour and which displayed strong criminal tendencies. In response the council launched the Family Recovery Programme (FRP) to tackle the causes of these problems. A single team was formed combining expertise from across the council and other sectors. These teams work with families, with their consent, to help them set clear goals which address the root causes of their problems. Families involved develop a contract which details their responsibilities, the consequences of not meeting them and the support the team will provide. The council works with other parts of the public sector and commissions community and voluntary organisations to help deliver the service. This helps to link families into health services to improve mental and physical health conditions, prevent child protection problems from developing and strengthen links between the family and their communities.
A key part of the approach is a live database of information of selected families' use of public services. The information desk is run by analysts who seek out information which is used when the council and its partners develop care plans to make sure that it is done in the most efficient and effective way. This also helps to provide real time information about where families are slipping in to a cycle of escalating service involvement. Preventative action can then be taken to avoid this costly scenario.
The approach costs approximately £19,500 a year per family, and results in savings of £41,000 on average per family per year in avoided costs. In total, the £975,000 spent is estimated to have saved the public purse over £2 million. For every £1 spent, the public sector avoids £2 in costs. In addition, the following benefits have been recorded for the first 50 families involved:
5 January 2015