Integrated Service Delivery Model for Children and Young People in Suffolk

Themes this local practice example relates to:

  • General resources
  • Local area early intervention strategies

Basic details

Organisation submitting example

Suffolk County Council

Local authority/local area:

Suffolk


The context and rationale

In April 2009, Suffolk County Council's Cabinet and the Children’s Trust Board endorsed Suffolk’s Early Intervention and Prevention Strategy for Children and Young People. The overall aim of the strategy was to improve early intervention, preventative approaches and integration of services to promote professional collaboration and reduce duplication. 

The strategy would build on preventative approaches and joint working arrangements already being developed in Suffolk to bring about further improvements, in particular, the strategy would:

• Lead to a more targeted approach to deliver services to those families in Suffolk who would benefit from additional information, advice and support, but who are not gaining access to services now.
• Develop new ways of working to ensure that the right response can be given to children, young people and families at the first point of need by building on the strength of families and local communities.
• Develop a shared understanding of preventative priorities between partners to make sure that, in future, existing resources and new investment are targeted more effectively within the Children’s Trust Partnership’s joint commissioning approach.
• Develop joint commissioning in support of shared preventative priorities which would more clearly define the important role the voluntary and community sector can play in contributing to early intervention and prevention.
• Build on good practice, improve consistency and avoid duplication across all service delivery within the Children’s Trust Partnership.
• Ensure a clearer understanding of how universal services, schools and primary health services in particular are central to successful preventative work.
• Strengthen the impact of the existing Children and Young People’s Workforce Development Strategy.
• Ensure the co-ordinated development of systems and processes that are intended to support and enable the delivery of preventative approaches and early interventions, such as the Common Assessment Framework, and bringing teams and services together at local level through Community Clusters.

The practice

Work had already begun on implementing aspects of the Early Intervention and Prevention Strategy through, for example, the ‘early adopter’ phase of the Integrated Access Team, when the additional need to deliver services within significantly constrained resources led to the decision to establish a Programme Board in 2010 to take the strategy forward as a coherent programme for service re-design. More than 2,000 staff and budgets of £70m were in the scope of the programme.

To manage the change programme, in addition to the Programme Board, a number of workstreams were established. The Board and workstreams included service leads for youth services, early years and childcare, children’s social care, youth offending services, special educational needs/disability services; and both commissioners and service providers for health services, corporate parenting and safeguarding services and schools. 

The Change Programme, led by the Programme Board reporting to the Directorate Management Team, ran from April 2010 to the point at which the new operating model was implemented in July 2011.

The Service Design

The core purpose of the new operating model was to provide a range of universal, targeted and specialist services to children and families proportionate to their needs. This included a range of statutory duties in relation to the safety and welfare of children and young people. The overall aim of the new operating model was to make best use of available resources to enable early, more effective assessment and intervention to reduce the need for more costly specialist interventions.

The restructured service has three key elements:

1. A single point of customer access through an Integrated Access Team, working alongside Customer First, the Families Information Service co-located with the Police Central Referral and Tasking Unit. This plays a key role in supporting families and practitioners to make full use of universal services, community services and self-support. 

2. Early intervention for children and young people with additional needs, but who do not meet the children ’in need’ threshold for Specialist Services. This is delivered by age banded Integrated Teams using the Common Assessment Framework (CAF) as the key early intervention tool, and a multi-disciplinary ‘Team Around the Child’ approach drawing on services provided from a range of sources including Children’s Centres, Youth Support Services and Community Health resources. A key element of the integrated service model are the 196 full-time equivalent Community Health posts, including Health Visitors and School Nurses, which have transferred to the County Council and form part of Integrated Teams. 

3. Streamlined Specialist Services, with the number of Social Care teams reduced from 27 to 20 providing statutory services to children ‘in need’, those at risk of significant harm and children who are ‘looked after’. The reduction in the number of teams is intended to create bigger, more resilient teams to better withstand the impact of staff vacancies and peaks and troughs in demand. Specialist Services also include Corporate Parenting, Safeguarding and Youth Offending services.

Integrated Teams and Specialist Teams work to the same geographical boundaries to ensure safe and seamless collaborative working in respect of children whose needs change over time and may require different levels of intervention. The overall aim is to shift resources to Integrated Services over time, based on a gradual reduction in the demand for more costly Specialist Services

The management structure for the new operating model includes three posts at Assistant Director level, a reduction from five in the previous structure. The model complies with the corporate standard of no more than five tiers of management from service director to practitioner. 


Further details of the model for programme governance; of the key areas of work completed within the governance of the programme; and a detailed diagrammatical representation of the model and the management structure are available by contacting the C4EO team at the NFER.

Achievements so far

• Full implementation of the new operating model on 1st July 2011.
• Completing the transfer of 196 full-time equivalent Community Health staff, including Health Visitors and School Nurses, from the Primary Care Trust to the County Council to become part of integrated teams.
• Alignment of the Workforce Development Strategy with the new operating model to embed an integrated, outcome based approach. 
• A formal 90-day consultation process with all staff, trade unions and partners, indicating broad agreement with the service redesign and identifying constructive adjustments to be made prior to implementation. 
• A Human Resources programme to manage staffing changes to the organisational structure and based, where possible, on staff preferences for new roles and teams.
• Implementation of new budget codes to align with the new organisational structure and provide for effective financial control.
• Completion of changes to all customer databases to reflect the changed team structures and geographical boundaries within the new operation model.
• Completing the co-location of staff in Integrated Teams and aligning integrated and specialist teams with shared geographical boundaries in the same buildings where achievable. 
• Developing and agreeing a revised strategic governance and operational management of the new operating model.
• Development of an outcome based Single Performance Framework to quality assure the new operating model, identifying key performance indicators, qualitative measures and methodologies for customer feedback.
• The Integrated Access Team was implemented in 2010 on an ‘early adopter’ basis by one area of the county. This enabled an incremental approach towards full county-wide implementation on 1st July 2011 as part of the new operating model. Data indicates that the team is now diverting 70% of initial contacts, that would previously have been dealt with by Social Care Teams, towards other, more proportionate responses.
• Since the early adopter phase of the Integrated Access Team began, the number of new CAFs per month has increased by an average of 60 to 200 per month. With the full implementation of the new operating model, this figures, along with the number of children supported through ‘team around the child’ interventions in Integrated Teams, is expected to increase significantly over the next year. 

The changes brought about during the development of, and the full implementation of, the new operating model during 2010/11 and 2011/12 have resulted in savings of £7m for the Children and Young People’s Directorate.

Replication

Cost
Eastern Safeguarding Project funding over two years has provided £95k for programme support and management. In addition, programme support and specialist Human Resources, Finance and ICT services were provided by Customer Service Direct. 

Savings required of the Directorate over the next two years amount to a further £3.5m. A new operating model is designed to realise efficiencies, primarily through reducing the need for high cost interventions. It intended that the majority of this saving will be delivered through such efficiencies over the next two years. 

Learning from experience:

• There is a need for a properly constituted and supported programme to drive the planning, decision making and implementation of change and an adequate level of dedicated programme support.
• The nature of the change in Suffolk has been evolutionary, beginning with the implementation of integrated customer access arrangements. The analysis undertaken and inefficiencies identified through this process, combined with the need to make significant savings provided the catalyst for a positive approach to change.
• Service redesign was undertaken within the framework of an Early Intervention and Prevention Strategy that had the support of Suffolk County Council's Cabinet and the Children’s Trust Board. The approach to change was, therefore, based on sound principles and priorities, rather than being driven solely by financial imperatives, and had formal and explicit commitment at the highest level. 
• The programme identified options for change, a preferred model and consulted fully with staff before considering the strategic governance and operational management arrangements required to deliver it. This approach was a helpful factor in engaging staff in the debate about service redesign. 

Key leadership behaviour characteristics
Suffolk identified the following core behaviours as key to the transformation of their service. (These behaviours link to those identified by the National College and C4EO as the 
eight core behaviours of resourceful leaders
)

Openness to possibilities 
Within each work stream several options for service design were explored and proposed to the Programme Board whose responsibility it was to decide on the most effective and compatible options. Further changes were identified and implemented through the formal 90-day staff consultation. 

Ability to collaborate
A founding principle of the new operating model was that of integration, in particular the transfer of almost 200 full-time equivalent Community Health staff from the Primary Care Trust to the County Council. A high level of trust and collaboration was required to achieve this.

Demonstrating a belief in team and people
Each work stream was given autonomy to evaluate where change was required and to develop new approaches, within commonly understood parameters, based on their findings. The implementation phase required a high degree of trust and confidence in the Human Resources Team.

Personal resilience and tenacity
Some elements of the proposed model were subject to a degree of scepticism within the workforce. Particularly where these elements were interdependent with others, this required a high degree of resolve to influence and persuade in favour of specific proposals, where possible based on evidence.

Ability to create and sustain commitment across a system
The success of the new operating model was based on the full integration of a range of professional disciplines. Whilst staff were signed up in principle to integration, they still retained a degree of concern for their own professional status. The approach had support at a strategic level through Suffolk County Council Cabinet and The Children’s Trust Partnership Board’s endorsement of Suffolk’s Early Intervention and Prevention Strategy. This provided the basis for promoting overall commitment to what needed to be achieved.

Focusing on results
A comprehensive analysis of the strengths, weaknesses and overall performance of the previous model and clear articulation of the benefits and outcomes of the new operating model were key elements of the change process. 

Ability to simplify
The new operating model was founded on three basic components - integrated customer access, integrated services, and specialist services. Its primary aims are to deliver earlier and more effective intervention through preventative approaches. This is in the context of a need for financial savings. The opportunity to articulate the need for, and purpose of, change through these basic elements was fundamental to gaining consensus.

Ability to learn continuously
The programme retained a commitment to exploring alternative approaches, taking staff consultation seriously and to look outward at how other local authorities were tackling the need for change. Eight months into the new operating model Suffolk is to undergo a Peer Review (March 2012). The timing of the Peer Review is intended to provide an opportunity to gain an external perspective on where the new operating model is working well and where further change and adjustment might be required. As the anticipated pressures on public services continue so will the need to learn and adjust.

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