Cheshire West and Chester’s Laurence Ainsworth on Community Budgets

Cheshire West and Chester is one of the four areas in the UK working on Community Budget pilots. Programme manager Laurence Ainsworth talked about the savings the plans should bring to his area and how the pilot works.

Room 151: You have six strands the council and partners are working on: Families Together, Early Support, Work Ready Individuals, Safer Communities, Aging Well and Integrated Assets. How is it going?

Laurence Ainsworth: It is going well in terms of where we are. We submitted the six plans on October 31, 2012 and from November 1 we started with the implementation. For each of the plans we specified what the first year of delivery (2013-14) would look like. We started to get real clarity on: the staff who would be involved in any new delivery models; which agencies they came from; where they would be based; how they would be funding and how the funding would be apportioned between different partners; transition cost and the running costs

In addition we did end-to-end process redesign, which was really detailed work with practitioners to find out how cases would flow through the new system.

Room 151: It must have been an enormous piece of work?

LA: It was huge. We had to look at how much technology would be needed for common systems, sign data sharing agreements and then finally do quite a bit of work on ‘benefits realisation’ which is ensuring that the metrics and baselines are in place for us to track progress to understand what impact everything was really having. So moving away from theoretical cost-benefit analysis of the business cases through to data.

Now we have got a number of projects working. The most significant is around what we call integrated early support. This is essentially a merging together of our domestic violence proposals, our early intervention proposals for children and our troubled families proposals, into one delivery model. That happened because we realised when we were getting into the detail that we were in danger of creating new silos. So those (proposals) have all come together in one place.

Room 151: How does it work?

LA: It is an £8m delivery model with about 140 staff drawn across the whole partnership including health, local authority, police, probation and Jobcentre Plus. It gives a single front door to services; a single gateway which practitioners can refer people on to. It is a team of around nine full-time equivalents that receive the case, compare notes on it from their data systems, compare professional judgment and refer it on to one of three case management teams. Each team has around 40 staff based in three places around Chester, Elsemere Port and Northwich and Winsford.

Within the teams there is the key worker who is responsible for stepping up and stepping down the right interventions against a single plan.

We have ensured that it started from April onwards in a testing phase for the first three months with just 50 cases so we could get it right – that’s a very small number in terms of the total demand but we wanted to test how it would all flow through. Now we are into July we’re looking to scale up to the demand that is out there.

The other thing that is different is that we have gone down the route of co-location so all the different agencies involved work under one roof. National careers service, Citizen’s Advice Bureau, local authorities, employment skills and learning service and Jobcentre Plus are starting to coordinate their way into work zones. Some are based in Job Centres, some in other bits that make sense to the community. For example one of the Job Centres has outreach into a further education college, we have also got a work zone co-located into our housing benefits advice centre in Elsemere Port which makes a lot of sense, so that is where we are with the ‘worklessness’ stuff.

For our heath and social care integration proposals under the label of Aging Well, the two clinical commissioning groups have taken slightly different approaches. We have health and social care teams that are together but on a virtual basis, working together on quite complex cases with older people who have longer term conditions where they make sure interventions are in place to reduce demand on residential care. They’re up and running in the Vale Royal area.

The other clinical commissioning group, West Cheshire, is co-locating with the first team going live any day now. There is also a lot of further work to do on Aging Well because it’s about the whole joint commissioning of services across health and social care. There’s a review underway of intermediate care, the step up and step down services that are there and understanding how that could all come together in a more cost effective and patient focused way.

Also, conversations are underway about the funding and contracting model for the acute sector and what could change over the medium term to be able to move more money around the system, from crisis services to community based intervention. That one is a much longer piece of work – if you go into this too quickly you will destabilise a lot of the care economy.

Room 151: What is the role of the finance directors?

LA: The finance directors across all of the partner agencies come together on a bi-monthly basis for a meeting chaired by the local authority’s 151 officer to discuss whether we have got the right monitoring of the benefits we expect. They’re also going to interrogate the numbers when they start to come through to see if the delivery has made the impact and how that compares to our judgments in the business case.

The longer term plan is to move to a model where we have an investment agreement where every partner has real clarity about what they are putting in to this and what they are going to get out as return on investment. We’re looking for equity between those two things as well, rather than one partner subsidising the other. That you can only really crack once you have some real-time data based on delivery. That group is really engaged now that things are starting to change on the ground.

Room 151: How many people are involved in that meeting?

LA: Seven or eight people from two CCGs, police, probation, Jobcentre Plus and our housing trust.

Room 151: One strand is called Integrated Assets: how is work going there?

LA: One of the issues with this one is that if you try to make the assets more integrated before you make the services more integrated it is a little bit cart before horse. It’s always going to be slightly further behind in changes on the ground.

The business plan we set out to government is that there is the financial gain here based on a financial model of optimum floorspace and what it would look like if you joined it up across the public sector.

There has been a lot of co-location in and around children’s centres. The assets team from the council has been involved in that. The partner agencies are also working closely with the Government Property Unit within another assets group. We did have an announcement from the Cabinet Office a few months ago that the GPU would be looking at eight areas within property.

Rather than have a big bang approach we thought we would start picking off the key projects where it makes sense to work on assets. There is another one where we’re co-locating local authority and health services in an area of Chester known as Delamere Street where there’s a purpose-built facility to bring services together under one roof. We’re picking it off on a project basis like that.

Room 151: Has it been easy to get buy-in across the partners?

LA: Because we have worked with partners on this for the last 12-18 months we have built up the trust and the confidence that this is worth pursuing. Last year there was a sense that it wasn’t just the local authority telling everyone what to do because each agency had their own staff in our team to coordinate the business case and a lot of those staff are still there, seconded from health and police and so on.

The sense of trust is there and the other thing is we have governance mechanisms in place to make sure we’re talking to each other. We have a public services board that meets every two months, chaired by the chief executive and including the chief officers from the agencies who are there to sign off plans and be comfortable with progress. We have a strategy board where the political leaders come together too.

The other thing we did was make sure that each strand that we had was sponsored by a partner rather than all being sponsored by local authority. The council sponsored the early intervention and troubled families project but domestic violence was sponsored by police and probation, worklessness by Jobcentre Plus and Chambers of Commerce, the aging project was sponsored by health, so you get the buy-in that way.

‘Sponsored’ here means that they are the senior accountable officer for making sure proposals are delivered. We took the view that the partner who had the most to lose or gain would sponsor.

Room 151: Do you have any global savings figures for the Community Budget?

LA: In terms of global savings figures the business cases collectively suggested that there were potential financial benefits of around £106m gross and £51m net over the next five years. The big caveat to all of that is that it’s a forecast; it’s cost benefit analysis on the best available evidence we had at the time. It went through three rounds of treasury analysis but it is still just a forecast.

Room 151: It’s evident that it must be a big job figuring out the finances.

LA: Yes, the purpose of the business plans was not to say to all partners ‘go away and chase money out of your budget immediately’. That’s easy to do but the real purpose was to communicate that there is a financial prize available. The modelling that we did gave people some knowledge that this was more than just a nice thing to do. As well as trying to improve outcomes for vulnerable people there is a financial return involved here and I think that is what has been very different about Community Budgets.

The local authority has been relatively prudent in our view of what will fall out of our budget and when. We don’t see any very short term return, not in the first financial year or in 13-14. The bigger numbers will start to flow from 15-16.

Room 151: What about the future?

LA: We have started with six areas and there’s an aspiration to extend, potentially to learning difficulties and areas around drugs and alcohol. We started off with a lot of these ideas last year and narrowed down to six but the partners are very clear that the story shouldn’t end there because there is more potential to adopt the Community Budget approach.

Room 151: Are they the big solution then?

These aren’t a panacea for the reductions that people need to make. There are some areas that they just aren’t applicable to. They’re most applicable I think to things where you have complex issues, complex cohorts that you are trying to work with that are relatively low volume but relatively high cost.

The important thing is how you redesign the services around those high demand groups – that’s where Community Budgets have a role to play.