“Telling the Story” – The Journey for People’s Services · Newport City Council “Telling...

Newport City Council

“Telling the Story” – The Journey for People’s Services

2010/11 to 2016/17

April 2017

Newport City Council “Telling the Story of People’s Services 2010/11 to 2016/17 April 2017

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Contents

1. Executive Summary ......................................................................................................................................................................................................... 3

2. Introduction .................................................................................................................................................................................................................... 9

3. Background – A History of the Transformation ............................................................................................................................................................10

4. Performance in Adults’ and Children’s Services 2012/13 to 2016/17 ..........................................................................................................................13

5. Budget Outturns in Adults’ and Children’s Services 2010/11 to 2016/17 ....................................................................................................................17

6. Social Services and Wellbeing (wales) Act Readiness – A 2017 Assessment ................................................................................................................23

7. Externally Identified Improvements in Adults’ and Children’s Services .......................................................................................................................25

8. The Transformation Journey for Adults’ and Children’s Services – Key Aspects and Critical Success Factors .............................................................29

9. Conclusion - application of learning to future transformation .....................................................................................................................................35

10. Appendix 1- Transformation Timeline ..........................................................................................................................................................................37

11. Appendix 2- Tables detailing performance in Adult’s and Children’s Service between 2010/11 and 2015/16 ...........................................................42

12. Appendix 3- Spend Comparisons with comparator authorities 2016/17 and 2017/18 ................................................................................................45


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1. EXECUTIVE SUMMARY

Performance in both Adults’ and Children’s Services in Newport has by and large been maintained, and in some areas improved, between 2010/11 and

2016/17, with Newport being better than comparator authorities on several Key Performance Indicators.

In adults, a significant area of improvement has been demand management and the success of the transformation journey in Newport can be evidenced by

the reduction in clients receiving statutory services. As highlighted in section 4 below, a 32% reduction in the rate of older people supported in the

community has been seen since 2010/11, resulting in Newport being one of the best performing authorities in Wales. Although the reduction in provision in

Newport, compares well to performance in English authorities, it is difficult to compare numbers of people supported as the differing funding rules in Wales

result in more people being supported by the local authority than in England.

Furthermore, there has been a 23% reduction in older people supported in residential care since 2010/11, which has put Newport in a good position

compared to both Welsh and English comparators and only the South East and South West of England have marginally lower rates (14.2 in the South East

and 14.6 in the South West, compared to 14.7 in Newport).

In Children’s services, although a rise in demand has been seen since 2010/11, Newport compares well to both Welsh and English comparators on Children

in Need and Child Projection, with rates being lower than the English average and English comparator regions on both measures. Furthermore, the rate of

Looked After Children is significantly lower than Welsh comparators, although slightly higher than English comparators.

These improvements in performance have been achieved despite having made financial efficiencies of circa £11m, in the MTFP achievements, since

2013/14, circa £8m of which was achieved between 2014/15 and 2016/17, the period examined later in the report.

Whilst both Adults’ and Children’s Services have overspent in the last two years, these overspends are not significant when compared with those seen in a

number of other local authorities in England and Wales. The average net percentage overspend over the 6-year period was 3.4% in Adults and 1.18% in

Children’s. Whilst growth and some additional investment has been put into both services, between the two services, savings made outweigh investment by

£3.8m. Currently Newport have the lowest budget per 10,000 of the 10 local authorities in its comparator group, see figure 1 below.


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Figure 1- – Spend Comparisons with Comparator Authorities – Budget per 10,000 Population 2017/18

Very few Councils in this period can compare with Newport’s financial position in Social Care, coupled with improving or maintaining of performance. This

would suggest that something “additional” has contributed to achieving this position. So, what is different in Newport compared to many other authorities

in Wales and England? This report seeks to examine the transformation journey that Social Care has undertaken over the last 6 years, identifying the impact

this has had from both a financial and performance perspective. It goes on to examine the critical success factors in achieving this position, but also the

learning that can hopefully be applied to future transformation /change programmes within Newport and wider.

Drivers for Change

Since 2009/10, significant transformation has occurred in both Adult and Children’s Services. This transformation has been delivered through a range of

projects, and whilst utilising different methods of support at different times, one consistent factor has been the rigor around governance, with each

programme reporting into a Transformation Board. The key drivers have varied between the different programmes, with Childrens very much focused on

improving outcomes for children in need and their families, and ASC initially focused on efficiency to steady an increasing overspend position, and later

more on improving outcomes for vulnerable people with the modernisation of service provision.


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Whilst the drivers have varied, the success of these programmes cannot be understated when you consider the following key achievements:

For Children’s Services:

An explicit and well communicated strategy which has maintained the demand in Childrens Social Care, with the aim to reduce the number of

looked after children.

A high degree of collaborative working between agencies working with children, young people and their families in Newport, delivered through the

Integrated Family Support Service.

An emphasis on the benefits of early intervention and prevention, which is maintaining demand and improving outcomes, evidenced through

performance information.

A focus on ensuring the right information and data is collected to inform robust decision-making.

For ASC:

From a position of £4m overspend at the end of 2010/11 to achievement of £7.8m efficiencies against an MTFP target of £7m, with an overall

reduction in budget for 2016/17 compared to 2010/11 of £1.4m.

Targeted prevention which is maintaining demand and reducing dependency on social care, evidenced through performance information.

Significantly reduced delayed transfers of Care achieved through the ‘in-reach’ programme.

The modernisation of service provision with a focus on independence choice and control, achieved through Active Living in Older Age and Promoting

Independence and Choice programmes.

Increased productivity and efficiency through the introduction of workflow and performance reporting.

Approach to Transformation

As well as the drivers for change being varied, the approach to transformation has also been different between Children’s and ASC. In Children’s the

majority of the transformation has been delivered by staff within Children’s services, with limited support from external consultants and the internal

Business Improvement Team (BIT). In ASC the approach has been very different, with external support a key feature through much of the transformation,

supported since early 2014 by the BIT, working alongside service managers and teams from within the Service. Although the approaches have differed,

critical success factors and learning can be taken from all the transformation programmes.


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Findings relevant to Future Transformation

Later in the report using Kotter’s well regarded 8 step change model published in 1996, we identify what are considered the critical success factors that have

contributed to Newport’s relatively strong position today, along with lessons that can be learnt and applied moving forward, summarised below.

a) Lessons Learned

Take everyone with you: As discussed below, the Consortium and subsequently the partnership with Peopletoo created a powerful coalition and a

clear vision. However, the lack of capacity in ASC at the initial stages and the changes in key personnel during the transformation journey, made it

difficult to bring everyone on the journey. What is key here is communication and strong leadership to ensure ownership and accountability

throughout the transformation journey, and sustainability post implementation.

Celebrate Success: Linked to the above and communication to the wider stakeholder group, there is little evidence of celebrating success. There

appears limited narrative around the successes achieved in Social Care, which perhaps makes it more difficult for those who haven’t been involved

from the early stages, to recognise the starting place and the extent of the journey.

Communicate the Facts: Linked to communication and celebrating success is the common narrative. Outside of Social Care there is consistent

reference to the extensive investment in the budget in 2013/14 (circa £8m), with no acknowledgement of the budget removed in proceeding years.

The net position over the last 6 years being circa £3m contribution to corporate efficiencies. There is also no reference to the performance in Social

Care, which for Childrens Services was the main driver in the transformation that took place in 2010/11, and the subsequent partnership with

Barnardos.

Communicate the Roles: The initial Consortium contract was based on ‘risk and reward’ and for its time was very innovative. There is a view that

this programme was driven too much by the financials, but in moving to supporting programmes such as Promoting Independence and Choice,

Active Living in Older Age and Integrated Older People pathway, it was evident that outside of Social Care and BIT, there was limited knowledge of

the work the external consultants had been contracted to deliver linked to managing demand and improving outcomes.


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b) Key Success factors

Clear Vision, Purpose and underpinning values: A key success has been the ability of the service to develop clear and compelling visions for change.

For example, the development of the Integrated Family Support Team (IFST) began with a well-defined vision, based on the drivers for change and

underpinned by clear values.

Strong Governance: Despite the differences in drivers for change and method of delivery, a consistent factor of the transformation in Newport has

been strong governance, with individual workstreams reporting to a Transformation Board to ensure pace is maintained and monitor delivery

against key outcomes.

A sense of pace: Supported by a clear vision and strong governance, a sense of pace has been created and maintained as a result of the key drivers

for change. In ASC, this was initially financial and in Children’s was it service improvement.

Successful coalition of change agents: Regardless of the differing approaches to transformation, whether using internal change agents or external

partnerships, a key success factor identified has been a strong coalition between partners. There has been a focus on sustainability and transfer of

skills, for example a focus on developing project management skills in Service Managers.

Bespoke Transformative Roles (moving from directive, through participative to facilitative): It is acknowledged by partners and council officers

that there has been a shift in the role of the external transformation partner over the course of the transformation journey. From directing during

the early consortium days driving significant efficiency targets, to a more facilitating role working alongside internal service leads and BIT during the

Promoting Independence and Choice and Active Living programmes, to an approach bringing innovation and capacity to projects such as Workflow

and Integrated Older People Pathway. It is apparent that some of this changing behavior has been driven by the ‘sense of urgency’, the capacity

available and the core objectives. Therefore, it could be argued that this change in behavior and approach has been critical in ensuring successful

delivery of each phase.


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Supporting culture change: One of the key successes in the transformation of Newport is the changing of practice and culture, moving away from a

paternalistic approach towards outcome focused practice to drive service improvements. This has been key in ensuring that transformation and

efficiencies made were sustainable and performance maintained.

Capturing and Applying the Learning: Throughout the transformation journey, critical success factors and key lessons learnt have been captured

and applied to future transformation projects. This report engaged with key stakeholders that have been presented throughout the transformation

journey and captures the key learning.

Having captured this learning and identified the critical success factors, it is essential that this is applied to all future transformation projects, during the

development of the brief and during the project startup phase. Furthermore, it is important to ensure that learning and reflection continues, adopting a

disciplined approach to project closure ensuring these are captured and used to inform the design and development of the next project/ programme.

Despite the success of transformation across Social Care to date, Newport like all local authorities, faces challenges going forward. For Newport, chiefly this

is that overspends have been maintained at a reasonable level by the services’ ability, (in particular ASC), to make savings. However, there is a limit to

efficiencies a service can safely deliver whilst fulfilling its statutory duty, considering increasing levels of demand and complexity, and it is unlikely given the

current financial settlements from Welsh Government, that the Council will be able to fund growth into these services in future years.


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2. INTRODUCTION

This report details the findings of research commissioned by the Director of People’s Services, undertaken jointly between Peopletoo, the BIT and Social

Services managers in March and April 2017. The brief to examine the transformation journey of Social Services over the past 5 years, to identify both the

“critical success factors” contributing to the current successful position of Newport’s Social Services, and lessons learned that can help meet the further

challenges ahead.

Key Deliverables of this work included:

Capturing reflections on life before 2010/11 for Children’s and Adult Social Services– using data and qualitative impressions from key people who

were involved from the beginning of the journey

For the period 2010/11 to 2016/17 set out the changes in budget and the financial efficiencies achieved

From a benchmark of 2010/11 set out the performance of Children and Adult services to 2016/17

Identifying key areas of improvement using evidence reports such as inspections and independent reviews

A statement of the current position in relation to readiness for the Social Services and Well Being (Wales) Act 2014

Capturing the critical success factors in driving change through partnership working, and key components of change that can act as learning points

going forward

To inform this report, interviews were undertaken with key service managers, BIT and colleagues from Finance. One challenge in undertaking this work was

that a number of those interviewed had not been employed by Newport City Council throughout the period covered by the brief. However, this does not

retract from their direct experience of transformation within Newport, and by combining all views gained throughout the process, this helps to create an

overall picture of what have been critical success factors and what would have helped the partnership approach become even more successful.

A further challenge worthy of note is that some Service Managers found it difficult to distinguish transformation that has occurred as a result of the

partnership / consortia approach, from what they felt may have happened naturally had the partnership approach not been taken. Furthermore, there was

discussion with other colleagues, in particular those in Finance, about what constitutes “success” when spend continues to rise, and the extent to which

investment has kept budgets manageable.


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Whilst respecting these positions, the benefit of working in partnership with organisations that work with a wide range of local authorities, is that a

comparison can be made between the journey from 2010/11 to the present day in Newport with that of many other Councils both in Wales and England.

We begin to explore this more in the Executive Summary, with the subsequent sections detailing performance, budget outturns and savings achievements

that appear to support the case that the partnership / consortia approach to transformation has been a critical success factor in itself, to Newport’s strong

standing against its comparators.

3. BACKGROUND – A HISTORY OF THE TRANSFORMATION

Since 2009/10, significant transformation has occurred in both Adult and Children’s Services and both service improvement and financial efficiencies have

been delivered. This transformation has been delivered through a range of projects, utilising different methods of support at different times. This section

outlines some of the transformation projects, but is by no means an exhaustive list of all the MTFP savings that have been delivered directly by the services

with BIT support, some of this activity is reflected in the budgetary impact of the MTFP savings in section 5. A more detailed timeline of the transformation

is provided in appendix 1

Transforming Services for Children in Need and their Families was a critical transformation programme that commenced in Children Services in 2010. The

key drivers for the programme were improving outcomes for children and their families and ensuring a sustainable and high performing service moving

forward. The programme saw a fundamental shift in approach and a move towards greater partnership working and investment in resources. This

programme was led by the service through several specific projects, reporting to a programme board. This was prior to the consortium being commissioned

and BIT resources being allocated to social care. Once the consortium was commissioned some joint work was undertaken around re-modelling fostering

and Children with Disabilities to build on this transformation. This programme led to the partnership with Barnardos which saw the establishment of the

Integrated Family Support Service in 2011.

The partnership approach began in October 2011 when Peopletoo, Newton Europe and Coactiva were engaged as part of a consortium to deliver the Social

Care Transformation Programme, with the aim of improving services and financial savings across Adults and Childrens Services. As illustrated by the budget

positions in section 5, this work was undertaken at a time of significant financial pressures in Adult Services. The key achievements of the programme

included:

Delivery of £12.7m in financial efficiencies against a target of £10.6m between October 2011 and March 2014

Enhancement of prevention initiatives


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Development of a robust commissioning strategy

Development alternative provision such as assistive living technology and medication management

The consortium approach was also used to support the development of the legal contract for the Integrated Family Support Service which commenced in

Children’s Services in 2011. The Service, provided by Barnado’s, focused on early intervention and prevention, and delivered significant benefits to both NCC

and the charity, including:

Maintaining significantly lower levels of Looked After Children (LAC) than regional and statistical neighbours.

Financial efficiencies of £275k achieved through a reduction in demand for statutory services

Development of an innovative, good practice model

Following these initial programmes, Peopletoo were commissioned in April 2014 to work alongside BIT and Adult Services to deliver two projects; Active

Living in Older Age and Promoting Independence and Choice Learning Disabilities. These projects delivered financial efficiencies and improved outcomes for

service users through the promotion of independence and choice. For Older People, this related to supporting people to remain in their own home for

longer, and in Learning Disability Services it related to reviewing eligibility for support and a switch from traditional day provision to outcome focused

planning of day opportunities. Key achievements of the projects included:

Delivery of £2.5m of financial efficiencies across the two projects

A switch from traditional provision of services to outcome focused practice which encouraged independence and choice

Right sizing of packages of care within Learning Disabilities

Improved efficiency and use of resources

The development of the Newport Older Person’s Pathway began in January 2014 as a partnership between NCC, Aneurin Bevan University Health Board,

Age Cymru Gwent and Care and Repair and was supported by Peopletoo. The pathway delivers targeted prevention in the form of a Stay Well Plan (SWP) to

individuals that are identified by a Risk Stratification Tool as being in the top 3-7% of people at risk of ‘tipping’ into long term care should they endure a

crisis. Care Facilitators employed by Age Cymru develop SWPs, alongside the individuals and their carers, through the use of motivational interviewing

techniques and the utilisation of low cost, no cost services. The key aims of the project are:


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To keep people living safely and independently in their own homes.

To avoid unnecessary admission into institutionalised care.

To develop effective anticipatory care planning with care wrapped around the individual.

To develop a continuum of multi-agency provision, deploying the right resources at the right time in a holistic manner.

To develop capacity for effective early prevention.

To develop outcome focused service provision within a community setting as an alternative to primary care.

The project has adopted a novel approach to evaluation adopted by developing a linked dataset of individual level data across multiple systems to monitor

how often the target cohort are accessing services, allowing for comparison between participants, those that opted out and the over 75 population. Initial

evaluation results have found the following benefits:

A significant reduction in A&E attendances and Emergency Admissions, following the intervention, in those that had a SWP, compared to those that

opted out

A significant reduction in Frailty episodes, following the intervention, in those that had a SWP, compared to those that opted out

Fewer participants accessing Social Care services than people that opted out

Increased access to benefits such as attendance allowance, allowing people to access community support independently

Between January and April 2016, Peopletoo were commissioned to carry out an assessment of readiness for the Social Services and Wellbeing Act (2014) in

Adult Services. This work identified that although plans were in place in several key areas, there were some significant gaps in readiness for some of the key

requirements. It was recommended that a more structured programme was required to support delivery of Act requirements to ensure gaps in

implementing the Act were managed in a systematic and timely manner. As a result of this work, the Act in Action programme was developed with support

provided by BIT to oversee the implementation of the Act across both Adult’s and Children’s. Additional detail about this work is provided in section 8.

Alongside the assessment of act readiness, Peopletoo also conducted a high-level analysis of demand in Adult Services in order to promote a greater

understanding of the current financial and demand pressures being placed on ASC, and identify mitigating actions that could be taken to address these

pressures.


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Following recommendations made in the act readiness and demand analysis assessments, Peopletoo were commissioned in July 2016 to support Adult

Services in the development of a standardized workflow. This work was delivered as part of the Act in Action programme, supported by the BIT lead for

Social Services. The key aims of this project were to:

Ensure a standardised and consistent process is developed and adhered to across operational teams which clearly outlines roles and responsibilities

at key stages of the customer journey.

Ensure timely and accurate information collection and performance reporting.

Support a level of culture change required to ensure consistent use of the existing Adults Information System.

Ensure an evidenced approach is undertaken by the Service in managing key areas of pressure and in undertaking performance management.

Ensure compliance with report requirements stipulated by the Social Services and Wellbeing Act (Wales) 2014.

Support preparation for the implementation of the Welsh Community Care Information System (WCCIS

The wider Act in Action work was led by the BIT lead for Social Services and consisted of several workstreams, led by Service Managers. The aim of the

programme was to ensure compliance against the Act across both Adults and Children’s Services. More detail about this approach is provided in section 6.

4. PERFORMANCE IN ADULTS’ AND CHILDREN’S SERVICES 2012/13 TO 2016/17

The following section details key findings from performance and demand management data provided by Adults’ and Children’s Services between 2010/11

and 2015/16, when the last comparator information was available. Tables detailing the performance data used care provided in appendix 2.

Given budgetary constraints that have been experienced by all local authorities, Newport’s performance across Adults’ and Children’s Services in the period

2010/11 to 2015/16 compares well with both the average Welsh authority and the Welsh comparator authorities. Some of the critical factors behind this

are explored in Section 6, but key findings specifically in relation to performance are detailed below.

Key Findings

Adults’ Services

Performance in Newport in key indicators relating to Adult Social Care between 2010/11 and 2015/16, shows a positive trend in most cases and compares

well with comparator authorities. It is particularly positive in the following areas:


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The rate of delayed transfer for social care reasons per 1000 population aged 75 or over – Despite a rise seen in 2012/13, this has since shown an

improvement year on year and Newport performs better than both the Welsh average and that of comparator authorities.

Rate of Older People (aged 65 or over) supported in Care Homes per 1000 population as of 31st March – this has decreased year on year (see

appendix 2) and performs better than both the Welsh average and that of comparator authorities as well as performing favorably against English

averages. The table below shows Newport in comparison to Welsh comparators and English averages.

Table 1: Rates of clients supported in residential/ nursing care per 1000 (65)+- Welsh and English comparators

Rate of clients supported in residential/ nursing care per

1000 (65+)

South East 14.2

South West 14.6

Newport 14.7

London 14.8

Bridgend 15.1

East Midlands 16.2

West Midlands 17.4

Wales average 18.0

Yorkshire and the Humber

18.7

North West 19.0

Torfaen 19.6

North East 22.5


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% with a care plan who should have been reviewed – this has increased year on year and performs better than both the Welsh average and that of

comparator authorities.

Rate of Older People (aged 65 or over) supported in the Community per 1000 population as of 31st March – this has slightly decreased and is now

lower than both the Welsh average and that of comparator authorities (see appendix 2). This reflects the practice change from providing traditional

care to utilising preventative and community services and indicates the success of the First Contact Team in diverting demand. As shown by the

table below, over a three-year period (2012/13-2015/16), Newport have reduced their overall Home Care provision by 8%. The rates of Older People

(65+) supported in the Community have fallen by 15.5%. During this time, the average package size has remained fairly static, remaining below the

Welsh average.

Table 2: Comparison of provision of Home Care in Newport 2012/13 and 2015/16

Where performance in Newport compares less well and requires further focus is predominantly in indicators relating to the following:

% of carers of adults who were offered an assessment or review of their needs in their own right during the year – latest figures show a decrease

in 2015/16 after an increase in the previous two years and is now lower than both the Welsh average and that of comparator authorities. Whilst it is

accepted that there was a drive to complete carer’s assessments over the last two years, this needs to be sustained. The assessment of carers in

Newport 2010/11 2015/16 %

increase/decrease

Rate of Older People (65+) supported

in the Community per 1,000 85.7 58.31 -31.9%

Number of home care clients

(snapshot during sample week) (18+) 1,156 872 -24.5 %

Number of hours provided during a

sample week (18+) 9,081 8,556.7 -5.8%


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their own right is a key requirement of the Social Services and Wellbeing Act, and therefore appropriate arrangements should be in place to ensure

this function is carried out effectively.

Children’s Services

Performance in managing demand in Children’s Services is also strong. Key points include:

Performance in Child in Need and Children on the Child Protection Register statistics have remained consistent between 2010/11 and 2015/16, with

rises in demand in the years in between but managed down to 2012/13 levels in 2015/16 (see appendix 2). The table below shows that, both of

these areas are below the average of comparator Welsh and English authorities. Rates per 10,000 of Children on the Child Protection Register are

lower than the Wales average, whilst the rate of Children in Need is slightly higher.

Looked After Children numbers have seen a slight rise since 2010/11 (see appendix 2), but the number in 2015/16 is still below the Wales average

and significantly below the average of comparator local authorities. However, it is higher than English comparators and significantly higher than the

English average.

Category Newport 2015/16

Wales Average 2015/16

Average of Welsh comparator LAs 2015/16

English Average 2015/16

North East England Average

North West England Average

Children in Need per 10,000 (2013/14)

315 300 355 337.7 441.5 308.1

Children named on the Child Protection Register 10,000

41 49 56.3 43.1 59.6 55.2

Looked After Children per 10,000

88 90 112.6 60 84 82


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Referral rates have dropped in the past three years (since 2013/14), suggesting that this demand is being met without the need for statutory

services. This may be due to the increased focus on early intervention and prevention.

5. BUDGET OUTTURNS IN ADULTS’ AND CHILDREN’S SERVICES 2010/11 TO 2016/17

The following section details the following:

Budgets, outturns and net overspends or underspends in Adults’ and Children’s Services from 2010/11 to 2016/17

The growth in budgets in Adults’ and Children’s Services between 2014/15 and 2016/17, and MTFP targets / MTFP achievement in both services 2014/15 to 2016/17, and the net difference between investment and savings

Spend in Newport on Adults’ and Children’s Services compared with other Welsh authorities.

5.1 Adults’ and Children’s Services Budgets and Outturns 2010/11 – 2016/17

Table 3 - Adults’ Services budgets and outturns 2010/11 to 2016/17Year

Year Budget Outturn/Forecast for 16/17 Underspend / Overspend Net % overspend/ underspend

2010/11 41,090,269 45,116,762 £4,026,493 overspend 9.8%

2011/12 £38,938,754 £41,263,737 £2,324,983 overspend 6.0%

2012/13 £37,344,104 £41,220,698 £3,876,594 overspend 10.4%

2013/14 £40,892,995 £40,173,814 £719,181 underspend -1.8%


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2014/15 £39,768,397 £39,340,157 £428,240 underspend -1.1%

2015/16 £38,169,030 £38,260,655 £91,225 overspend 0.23%

2016/17 £39,748,188 £39,931,181 (forecast) £182,993 overspend (forecast) 0.46%

Table 4- Children’s Services budgets and outturns 2010/11 to 2016/17

Year Budget Outturn Underspend / Overspend Net % overspend/ underspend

2010/11 17,958,906 19,532,377 £1,564,471 overspend 8.7%

2011/12 £17,961,397 £17,453,331 £508,066 underspend -2.8%

2012/13 £17,862,294 £18,036,247 £173,953 overspend 1.0%

2013/14 £19,252,253 £19,236,026 £16,237 overspend 0.1%

2014/15 £20,415,961 £20,232,989 £182,972 underspend -1.0%

2015/16 £20,468,512 £20,764,212 £295,700 overspend 1.4%

2016/17 £21,033,136 £21,214,000 £181,000 overspend 0.8%


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Key Findings

Since 2010/11, overall, the budget for Adult Services has reduced by £1.3m and the Children’s Services budget has increased by £3m. This increase

has largely been as a result of planned budget growth. However, in 2013/14 an investment of circa £8m across Social Services was made, mainly due

to unachieved savings in previous years.

The above shows that the outturns in Children’s Services decreased significantly between 2010/11 and have then increased slightly year on year

since 2011/12. The outturns show an overspend in each of the last two years.

After some variation in between, the budget and outturn for Adults’ Services are lower in 2016/17 than they were in 2010/11, but show an

overspend in the last two years (increasing between 2015/16 and 2016/17). However, these overspends are significantly smaller than those seen

between 2010/11 and 2012/13, with the net percentage overspend being 0.46% in 2016/17, compared to 9.8% in 2010/11.

Further analysis shows that in Children’s Services, these overspends are being driven by particularly challenging budget lines such as Out of

Authority placements. The service has undertaken significant work in order to try to address this issue.

5.2 Growth in Budgets, MTFP Targets and MTFP Achievement in Adults’ Services 2014/15 to 2016/17

In order to give further context to an analysis of financial management within People’s Services, the following tables highlight the level of growth allocated

to Children’s and Adults’ Services since 2014/15, the level of savings targeted and achieved and any variance. The purpose of this exercise is to consider in

particular the final column, which highlights an overall net figure between growth and savings made.

Table 5 – Growth in budgets, MTFP Targets and MTFP Achievement in Adults’ Services 2014/15 to 2016/17

Year Growth in Budget MTFP Savings Target MTFP Savings Achieved MTFP Variance Difference between Growth in Budget and MTFP Achievement (in

bold)

2014/15 £545,000 £2,286m £2,527,598 £289,598 £1,982,598 surplus


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2015/16 £565,000 £3,059m £3,358,000 £269,000 £2,793,000 surplus

2016/17 £1,869m £1.712m £1,947,797 £235,797 £78,797 projected surplus

TOTAL £2,979m £7,057m £7,833,395 £794,395 £4,854,395 surplus

Table 6 – Growth in Budgets, MTFP Targets and MTFP Achievement in Children’s Services 2014/15 to 2016/17

Year Growth in Budget MTFP Savings Target MTFP Savings Achieved MTFP Variance Difference between Growth in Budget and MTFP Achievement (in

bold)

2014/15 £936,000 £146,000 £146,000 0 £790,000invested

2015/16 £697,000 £778,000 £736,000 £42,000 shortfall £39,000 surplus

2016/17 £790,000 £467,000 £530,733 £113,733 £259,267 invested

TOTAL £2,423m £1,391m £1,412,733 £155,733 £1,010,267 invested

Key Findings

The figures below show a clear difference between Adults’ and Children’s Services. In summary:

With one small exception (Children’s Services in 2015/16) MTFP savings targets in both Adults’ and Children’s Services have either been met or

exceeded between 2014/15 and 2016/17 and both have exceeded overall across the period, which suggests that both have had a clear and realistic

view of how to achieve efficiency savings and, indeed, been able to exceed these targets.


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Growth in the budgets of both Adult’s and Children’s Services has been relatively similar in the period 2014/15 to 2016/17, (£2.9m in Adults’,

£2.423m in Children’s). However, in terms of percentage there is a difference - 11% growth in the Children’s Services budget compared to 7% in

Adults’ Services.

An investment of circa £8m was made in Social Services in 2013/14 to counter significant overspends in 2012/13. However, if we look at the figures

in tables 2 and 3, £4.2m of this was effectively what had been taken out of the budget in 2012/13, and because required efficiency savings were not

achieved and were incorporated the in the 2012/13 overspends, an investment was made to include growth to the social care budget in 2013/14.

The overall net position for social care in this period is a surplus of £3.8m

Of particular note is that there is a very clear difference between savings made by the two services and overall investment required:

The net figure above is mainly due to Adults’ Services having managed to outweigh growth in budget by making savings to produce a net saving of

£4,854,395, whereas in Children’s Services, there is a net figure of £1,010,267 growth.

The level of savings in the MTFP achieved by Adults’ Services is considerably more than that which has been achieved by Children’s Services -

£7,833,395 (6.6% of their overall budget in this period) compared to £1,432,733 (2.2% of budget). This is noted again in Section 6 when considering

critical success factors in the Newport “journey” since 2010/11.

These differences may be seen within a degree of context:

Since 2009, Children’s Services have undergone significant change in order to stabilise and improve safeguarding process to make it fit for purpose.

There has also been a significant investment in early help and prevention services which, whilst incurring spend, has contributed to keeping down

demand and the associated costs of this. Many local authorities have made their savings in Children’s Services through reducing these preventative

services but cannot cite a similar narrative to Newport to demand management.

Anecdotal evidence suggested that Adult Social Care had more potential for savings as it modernized from being quite traditional, rather

paternalistic approach to one that is focused more on commissioning and community based activity, as most obviously evidenced by the reduction

in Council run care homes and day centres. Having said this, it is still open to question whether the above fully accounts for the large difference in


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savings achieved between the two, and whether the greater input of the partnership in Adults Services than Children’s, along with the different

drivers for transformation, has contributed to this difference.

There are further considerations necessary as part of the analysis of savings and growth since 2014/15, namely:

Seen within the context of budget outturns in tables 1 and 2, where overall budgets show an overspend in the last two years, this appears to imply

the need for continued growth in budget unless this trend can be reversed.

It stands to reason that the continued growth on a year on year basis in Children’s Services may not be sustainable. This either suggests a

consideration of how the partnership approach to Adults’ Services has achieved success in efficiency savings and if this approach could successfully

be adopted in Children’s Services, or further examination of challenging budget areas and the adoption of a demand analysis that enables the

Council to set a planned, appropriate budget. However, this needs to ensure that budget is sufficient to maintain performance, evidence elsewhere

suggests that when a service falls to a point where it requires intervention, it can often lead to an acceleration of investment that is not planned or

effective.

Generally, the Council can only continue to give further growth in Social Services for a limited period of time before the sources to fund this become

depleted – i.e. when savings from ASC and other services across the Council can no longer be made or reserves are not at the level to enable this. An

analysis of potential savings in other areas of the council has not been undertaken for this report, so we cannot comment on when this is likely to

be.

Similarly, though Social Care have achieved savings targets in the last 3 years and exceeded them in the last two years, there is a limit to how much

they can continue to deliver efficiencies if demand and complexity of need increases and overspends continue in particular areas of the budget.

Whilst performance in relation to demand is good at present, the need to maintain this becomes imperative in order to manage within budget in

future years.

It is also essential that where savings have been achieved in certain budgetary lines, these savings are maintained, and that they do not start to

creep back up once the immediate pressure of an MTFP target is lifted.

5.3 Spend Comparisons with Comparator Authorities


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Despite the challenges outlined above, especially for Children’s Services, this next section shows that Newport compares well with comparator authorities

when it comes to spend and budget management. Tables comparing budget and overspend can be found in appendix 3.

Key Findings

Whilst Newport undoubtedly faces challenges in funding both Adults’ and Children’s Services, the tables in appendix 3 show that Newport compares well

with its comparator authorities in respect of the budget management, as demonstrated by:

In 2017/18, Newport has the lowest budget per 10,000 population. In 2016/17, Newport had the third lowest budget, with Torfaen and Cardiff

having marginally smaller budgets. In 2016/17 Overspend per 10,000 population Newport was 4th out of 7, and, even then, the differences between

Newport and 2 of the 3 better performing authorities were marginal. Overspends per 10,000 population in 3 of the comparators were significantly

higher.

Whilst comparators do not negate local challenges, the above comparators demonstrate that Newport is not alone in facing challenges in funding both

Adults’ and Children’s Services, but that comparatively Newport is doing relatively well in meeting this challenge. This has been achieved through the

savings delivered, especially in Adults’ Services, as shown in tables 3 and 4.

Section 8 explores the particular contribution that the partnership approach has made to this.

6. SOCIAL SERVICES AND WELLBEING (WALES) ACT READINESS – A 2017 ASSESSMENT

Significant progress has been made over the course of the last year in compliance against the Act in both Adult’s and Children’s Services. A mini Programme,

‘Act in Action’ was created, based on the Act Assessment carried out by Peopletoo in March 2016, to provide a robust governance structure to maintain

focus on specific requirements. The Programme was led by the BIT lead for Social Care and workstreams were led by Service Managers to ensure changes

were embedded as core business. This approach also enabled significant discussion around practice and professional development against the principals of

the act between Service Managers and Team Managers.


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8.1 Adults’ Services

A review of Act Readiness for Adults’ Services was most recently undertaken by Peopletoo in March 2017. Of the 35 “Key Parts of the Act”, 27 are RAG rated

as “Green”, 7 as “Amber”, and 2 as “Red”. This is a positive picture, whilst there is still work to be done to ensure full compliance, Newport are in a good

position in comparison to many other authorities, and there is a clear view by Adults Services as to where the key areas for development lie.

Key Issues and Risks

Significant progress has been made to ensure that the Information, Advice and Assistance provision continues to be up to date and that staff have

an awareness of the preventative and voluntary services that are available within the local community. The First Contact team is working well to

manage demand, with 80% of contacts being resolved with the provision of IAA and low-level preventative support. It is essential to ensure that this

provision continues and is maximized, for example, ensuring that the community connectors continue to meet regularly with teams, particularly the

Front Door is key to this.

Part 3 places a duty on local authorities to assess an individual’s (adult or child) need for care and support, and a carer’s need for support

(understanding that carers have the same right to assessment as those they care for). This exists regardless of level of need or financial resources.

The Integrated Assessment has been developed for use on the AIS system and any updated workflow should be evaluated over time to ensure

continued compliance across all areas of Adults’ Social Care as well as ensure integration of the document onto the Welsh Community Care System

(WCCIS).

Although the measure of timeliness of assessment is not defined in the Act, there is a need to performance manage to ensure waiting lists are kept

to a minimum to ensure need is identified at the earliest possible point and potential crisis is avoided.

Establishment of eligibility of need and the development of Care and Support Plans are based on the principals of the Act. However, there is work to

be done to ensure these criteria are documented. There is a risk that if a consistent eligibility criteria is not implemented that there will be

inconsistency in care and support provision across teams, which may result in lack of equity for service users and impact the budget.

Regarding working in partnership with others to investigate allegations of abuse and neglect and take action to ensure that people are protected

from harm, the availability of some partners can delay these meetings. Work is continuing to develop a compliant safeguarding pathway.


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There is a need to ensure that there is engagement with the use of the Care and Support Plan documentation and that the volume and quality of the

information inputted onto AIS remains consistent. Issues around processes in the OT team mean that they are not on target to be compliant with

the Care and Support Plans by April ‘17. There is a need to ensure that understanding of outcome focused Care and Support Planning is consistent

across teams

The number of carers assessments carried out has decreased and is lower than statistical neighbours and the Welsh average. The provision of

assessments and support planning for carers is a key requirement of the Act and therefore failure to offer assessments would class as non-

compliance. A review of the processes around carers assessments would establish the reason for the decrease in the number of assessments and

enable the service to put plans in place to improve provision if required.

8.2 Children’s Services

An external review of Act Readiness for Children’s Services has not been undertaken. Readiness for the Act has been managed through the Act in Action

workstreams, through which the majority of the requirements have been met. However, it should be ensured that a full assessment against the

requirements is undertaken before the completion of the Act in Action Programme.

7. EXTERNALLY IDENTIFIED IMPROVEMENTS IN ADULTS’ AND CHILDREN’S SERVICES

The following section summarises the key findings and learning from external evaluations or reviews in the period covered by this report.

7.1 Research for Looked After Children – Overview for Newport; Cordis Bright 2013

Cordis Bright was commissioned by the All Wales Heads of Children’s Services, the Welsh Local Government Association (WLGA) and the Association of

Directors of Social Services to undertake research to understand why local authorities with similar levels of need, have different looked after children

populations.

The research sought to explore the extent to which, beyond expected variations in the numbers and rates of looked after children across local authorities

due to the demographic and socioeconomic profile of each local authority, other aspects such as the way that local areas lead, organise and deploy their

services for vulnerable children and families impact upon these numbers and rates. The research highlighted five main areas that can contribute to local

area efforts to reduce the numbers of looked after children, for example:


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Strategy and leadership;

Prevention and early intervention;

Approach to practice;

Partnership working;

Information and intelligence about performance.

Arising from this, the research identified 23 factors that should be in place within the local area in order to increase the likelihood of reducing the numbers

and rates of looked after children. The intention of this was to help the local area understand its readiness and likelihood of success in reducing the numbers

and rates of looked after children going forward.

Newport was one of the case studies forming part of this research and the full report provides commentary against each of the 23 characteristics, using

evidence collected during fieldwork.

This report suggested that Newport had a strong and well understood strategy to reduce the numbers of Looked After Children which had the buy-in from a

number of different social care and other partners. The report also suggested that prevention and early intervention initiatives are contributing to the

reduction in numbers.

Critical success factors included:

An explicit, clearly articulated and well communicated strategy in place which aims to reduce the number of looked after children.

Visible, visionary and optimistic leadership.

A high degree of collaborative working between agencies working with children, young people and their families in Newport. Stakeholders felt that,

on the whole, people are working together to meet common objectives. A number of respondents highlighted a culture of ‘zero tolerance of

blaming each other’.

An emphasis and belief in the benefits of early intervention and prevention.

The focus on ensuring the right information and data is collected to inform robust decision-making.

7.2 CSSIW Inspection - Progress in relation to Adult Services in Newport City Council 2016

In September 2016, the Care and Social Services Inspectorate (Wales) undertook a two-day visit was to review progress made in relation to the

recommendations set out in CSSIW’s inspection of adult social services undertaken in November 2014.


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The areas of focus for the visit were the First Contact (duty and initial assessment, and hospital interface) and Managed Care (neighbourhood care network)

teams within the revised adult social services structure. The inspection also looked specifically at safeguarding.

In summary, the inspection noted that, via a renewed drive to develop and modernise ASC, the authority had made considerable progress in implementing

its action plan in response to the recommendations made in CSSIW’s previous report in 2014. In particular, significant progress had been made in setting

out a coherent ‘vision’ for adult services in general and the implementation of the older people’s pathway in particular. This had helped to engender greater

resilience and a proactive approach to problem solving. The quality of the assessments and care planning being undertaken under the new arrangements

was deemed to be improving, as well as community based preventative working via the establishment of the community connectors, working within the

three geographically located teams across Newport.

Further inspections of ASC highlighted that The Supported Living Agency “actively encourages the involvement of service users in the decision-making

processes of the agency through various forums and participation events. Individuals lacking capacity are supported to access independent advocates and

mental capacity assessors to ensure that their views on their accommodation and care are gained. The service has a robust development plan and

continually reviews best practice in regard to services for adults with learning disabilities.”

Inspectors also described the Homecare Service as “facilitating a holistic approach to people’s social and housing needs”, which means that people have

improved quality of life. The service has piloted and now instigated a rapid response falls service. This 24-hour service means that trained carers can

respond to and assess if people can be safely moved after a fall and reduces the need for frequent hospital admissions.”

7.3 Institute of Public Care Assessment of the Integrated Family Support Service 2016

An independent assessment by the Institute of Public Care of our Integrated Family Support Service identified outstanding practice, describing the service as

“One of the most consistently evidence based, genuinely preventative and complementary set of family support services evaluated to date by the

researchers involved.”

7.3 Unannounced Inspections of Residential Care Units 2015 - 2016

The three children’s residential units - Cambridge House, Forest Lodge and Oaklands - were each the subject of unannounced inspections between

December 2015 and January 2016. For context, Cambridge House provides accommodation for children in the short term, including one emergency bed.

Forest Lodge provides longer term residential accommodation. Oaklands offers short breaks for children with disabilities.


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Whilst recognising that all three units required physical maintenance, each were judged to be providing a positive experience for children. In Cambridge

House overall CSSIW found the quality of care provided to children and young people was good. All young people have a voice and have opportunities to

express their ideas and opinions. Forest Lodge was reported as a service supporting young people with considerable and complex needs in an environment

where group dynamics can be challenging and persistent.

7.4 Inspection of the Youth Offending Service 2016

Following a disappointing full joint inspection in 2014, significant improvements were noted by the re-inspection in 2016.The illustration below shows the

scale of improvement.

Figure 2- Youth Offending Service – Improvements in Performance

Dusty Kennedy, Director of Youth Justice Board (Cymru) described progress as being “The biggest turn around we've ever seen between

inspection and re-inspection. It's been earned by their hard work and dedication to doing the best for the young people they supervise

and care for.”

7.5 Welsh LGA Review of Social Services Budget 2013/14

The Welsh LGA were given the following brief:

Is the 2013/14 Budget for social care robust?

https://1.bp.blogspot.com/-Uu0QXMm1QeY/V1rGUQdRlNI/AAAAAAAAVQQ/msD09m6zkqg2E1-19Q56EvPnzwLd1DQtwCLcB/s1600/newport+scores.png


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Are the forecasting tools used in Financial Management effective?

Is good financial management firmly embedded in management behaviours?

Consider the role played by the Newton Consortium

Are the underlying assumptions in the MTFP for Social Services reasonable?

Key observations and recommendations included:

Childrens Services 2013/14 budget – it was felt that this was deliverable but held some risks, which included more robust forecasting and

monitoring of legal costs, and more visible tracking of transitions

Adult Services 2013/14 budget – the view by welsh LGA was that this was not deliverable due to capacity concerns and insufficient evidence of

political support for all of the proposed areas of efficiency.

It was felt that the performance information was good but financial management was not universal across all managers

The Welsh LGA felt that the Consortium had made a considerable contribution to achieving the financial savings in social care and would exceed

their target despite the lack of capacity from NCC, however there was confusion around cashable savings and cost avoidance.

In relation to the MTFP, the Welsh LGA felt that this was optimistic and held high risks given the capacity and capability that existed across the

Service although aided by external support, concerns over how future demand and activity was being projected, and limited robust business cases

being in place.

8. THE TRANSFORMATION JOURNEY FOR ADULTS’ AND CHILDREN’S SERVICES – KEY ASPECTS AND CRITICAL SUCCESS FACTORS

This section has been developed as a result of the analysis of performance and financial data, the interviewing of personnel involved in the transformation,

and consideration of some key external reports and reviews. Using Kotter’s well regarded 8 step change model published in 1996, we identify what are

considered the critical success factors that have contributed to the relatively strong position in respect of performance and budget management across

Adults’ and Children’s Services, and in particular the contribution that a partnership approach to transformation has made. We also consider key learning

points from this approach to help address the challenges identified going forward.

In defining the critical success factors in the transformation journey for Adults’ and Children’s Services, it is useful to recap and reflect on what these key

successes are.


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In brief, these include:

The transformation of Children Services developing a shared holistic vision for the future across partners with the emphasis being on the ‘whole

family’ ensuring the best possible outcomes.

Significant financial efficiencies delivered across ASC.

Development of robust budget management across Social Care, the development and achievement of the majority of MTFP savings

Performance maintained across Social Care despite increases in demand and complexity of cases and reduction in resources.

The management of risk at a lower level in Children Services and giving partners the confidence to do this, is seen as a key factor in reducing the

number of families needing to receive statutory intervention.

Maintaining the level of demand in Adult Services through robust gatekeeping, despite changing demographics

Social Services and Wellbeing Act ready.

Increase in workforce stability and reduction in the reliance on external agency staff within Children’s Services

A shift from a rather paternalistic approach to one of promoting independence and choice within Adult Services. This has been supported by the

development of provision such as Community Connectors, Older Person’s Pathway and third sector consortium. This approach is continuing to

develop with additional training provided to staff and consideration given to the best use of preventative resources under the Social Services and

Wellbeing Act.

Linked to the above a lower number of people supported in the community by Social Care. This provides evidence of the practice change towards

increased use of preventative services and robust gatekeeping at the Front Door, with 80% of demand being diverted away from ASC Services.

To ensure this section provides some key learning and principles for successful Transformation going forward within a clear and evidence based concept of

change management, we have used Kotter’s 8 step change model and summarised in the table below.

Key Driver of Change Elements Supporting this Driver Learning from the Newport Transformation Journey

Establish a Sense of Urgency Examine market and competitive

realities

Identify and discuss potential

crisis and opportunities

It is apparent that the financial ‘blackhole’ that ASC found itself in in 2011,

created a real sense of urgency in achieving transformation to deliver

necessary financial efficiencies.

The key driver for change in Childrens Services was improved outcomes

for children and their families, a very different environment in which to


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Create the catalyst for change deliver sustainable transformation.

Performance as well as financial was seen by Managers as creating a sense

of urgency across social care, with actions to address poor comparisons

taken as a priority.

Energising key partners in the need for change is critical in distinguishing

“transformation” from “business as usual”.

Having an overall, strategic programme management overview of the

separate transformation projects and dedicated programme management

resource, was seen as a critical in bringing project management expertise

but also the additional capacity to gain momentum, keep a clear view of

project objectives from the beginning, and maintain pace.

Form a Powerful Coalition Assemble a group with enough

power to lead a change effort

Develop strategies for achieving

that vision

Transformation works best when there is a truly joint approach and the

contribution of all is valued, capacity issues in ASC made this difficult in the

early consortium days.

Linked to the above building trust and relationships across partners and

Service Managers was seen as especially critical.

A key relationship in transformation was deemed to be that between the

Service, Finance and HR.

A clear planning and monitoring framework is seen as critical in being able

to keep a programme on track, the Boards established to support the

Transformation went some way to achieve this.

The ability of a partner to call upon subject specialism where necessary

was seen as a success factor where the partnership has worked well.

It is essential that the role of external support is communicated effectively

at all levels of the organisation and reviewed when according to the stages

of a project and the type of work required.

It was felt that there can be a risk that external support can become overly

relied upon as additional capacity for operational “business as usual” tasks

which can reduce the impact of focussed, specialist input losing the


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visibility of the “additionality” that this external input can bring.

Create a Vision Create a vision to help direct the

change effort

Develop strategies for achieving

that vision

It was felt that strong leadership with a clear vision is critical for successful

transformation, with an ability by Service Managers to manage services

within the context of strategic objectives.

It is essential that there is consistent and regular communication of the

vision in order to keep all stakeholders on board and prevent a ‘drift’ from

the brief.

It was felt that a change in team dynamic and service personnel can

impact direction and delivery of the transformation and it is important to

ensure a shared vision is continually communicated and owned by all

involved.

Communicating the Vision Use every channel and vehicle for

communication possible to

communicate the new vision and

strategies

The guiding coalition teaching

new behaviours and leading by

example

There was a feeling amongst a number of those interviewed that the

external consultants and BIT have been predominantly focussed on

achieving financial efficiency, which can lead to tension within the Service

Management team. Communicating the vision, achieving some common

ground and the recognition that both sides of this spectrum are

interdependent, is critical to the success.

An understanding by non-social care colleagues that the pressures of

managing rising demand and costs in social care are a national challenge

and not necessarily due to poor budget management or decision making

by social care professionals. Therefore, stakeholders should understand

the context of the transformation as well as performance and finance

metrics.

The benchmarking of spend and performance is an important element of

any Transformation Programme. Comparisons with other authorities can

keep these challenges in perspective and enable the authority to take

further action should they begin to compare unfavourably.


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Empowering Others to Act on the

Vision

Removing obstacles to change

Changing systems or structures

that seriously undermine the

vision

Encouraging risk taking and non -

traditional ideas, activities and

actions

Transformation works best when all partners work together to develop

the project vision, objectives, and ultimately share ownership of the

project’s outcomes. In this way, transformation is undertaken with a

culture of as something that is “doing with” collaboratively rather than

“being done to” with a sense of “compliance”, and ensures full

engagement and ownership of transformation.

Communicating the vision to ensure the willingness of the service to

engage in support offered is critical. This can be challenging as some

practitioners can feel threatened by a perceived implication that they

would be unable to achieve the same outcomes without support.

Consideration should be given to ensuring the most effective use of both

internal and external support at each different stage and component of

the transformation.

Planning for and Creating Short

Term Wins

Planning for visible performance

improvement

Recognising and rewarding

employees in these

improvements

“Quick wins” can create confidence in a programme at an early stage and

buy time to address issues that may take longer to resolve.

It is important to recognise where credit is due for successes and celebrate

the contribution of those involved.

Consolidating Improvements and

Producing Still More Change

Using increased credibility to

change systems, processes or

policies that don’t fit the vision

Hiring, promoting and developing

employees who can implement

the vision

Re-invigorating the process with

new projects, themes and change

Programmes that run over a period of time have different phases and this

may necessitate a change of approach and even different personnel with a

different skill set for particular phases, depending on the needs of the

programme at that time. Identifying this need to change approach and

personnel as appropriate can reduce the potential for a “drift” in a

programme, maintain pace and drive a renewed urgency.

Whilst there was mixed picture in terms of changing culture and it can be

difficult to quantify, where the partnership was deemed to have worked

well was in changing the culture of practice so that a legacy of a change in

approach was left after the support had come to an end. In ASC this was


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agents seen especially in the move away from a relatively paternalistic approach.

Stabilising the workforce has been a key factor in improving and

maintaining performance in Children’s Services in particular. Factors

leading to an improvement in staff retention has included not just salary

reviews but the overall support package to social workers, in particular

that given to newly qualified social workers within their first two years.

Other factors included an approach of a shared approach to decision

making.

Project Management and problem solving skills are becoming increasingly

important as part of the skills – set of social care managers. Whilst it was

felt that there had been an increase in project management skills amongst

Social Services managers, it was felt by some that both project and finance

management skills were now as important a part of a manager’s required

skills set as service specific skills, and that this should be factored in to

future job specifications and recruitment approaches.

It is important to remember that delivery of successful projects is time

consuming and often Service Managers are not given the appropriate time

to develop the project and consider strategic direction on top of their day

to day roles.

Institutionalising New

Approaches

Creating the connections

between new behaviours and

corporate successes

Developing channels to ensure

leadership development and

succession

It was felt important that a coaching /mentoring approach focussed on the

transfer of skills should be seen as a priority from the start, and not

something commenced towards the end of involvement. Although

recognising that this approach is undertaken informally as required

throughout transformation and is often not visible to all stakeholders.

Whilst a return on investment models is crucial for any change programme

there should be an appreciation that this doesn’t have to be financial.

Monitoring and tracking progress against project objectives is reliant upon

accurate data, effective tracking systems and the quality of the analysis to

inform project evaluation.


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Approaches that have led to service efficiencies need to be maintained

and not seen as an isolated achievement against a budget line in a given

year, only for spend against that budget line and budget pressures to

creep up again the following year.

9. CONCLUSION - APPLICATION OF LEARNING TO FUTURE TRANSFORMATION

As previously stated whilst not always easy to evidence the role of a partnership approach in a successful journey, the fact that very few Councils in this

period can compare with Newport’s balance of savings, overall net of overspend, and, by and large, maintenance of performance, would suggest that

something “additional” has contributed to achieving this position that could not have been achieved in its entirety through a single service approach.

However, as with all change programmes, there are some key lessons that can be learnt and applied moving forward to ensure Social Care can continue to

modernize and manage demand within a reduced financial envelope. These are summarised below:

It is evident that the Consortium and subsequently the partnership with Peopletoo created a powerful coalition, but it is questionable if it brought

everyone on the journey. The lack of capacity in ASC at the initial stages and the changes in key personnel during the transformation journey, will

have all played a significant factor in this not being achieved. What is key here is communication and strong leadership to ensure ownership and

accountability throughout the transformation journey, and sustainability post implementation.

Linked to the above and communication to the wider stakeholder group, there is little evidence of celebrating success. There appears limited

narrative around the successes achieved in Social Care, which perhaps makes it more difficult for those who haven’t been involved from the early

stages, to recognise the starting place and the extent of the journey.

Linked to communication and celebrating success is the common narrative. Outside of Social Care there is consistent reference to the extensive

investment in the budget in 2013/14 (circa £8m), with no acknowledgement of the budget removed in proceeding years. The net position over the

last 6 years being circa £3m contribution to corporate efficiencies. There is also no reference to the performance in Social Care, which for Childrens

Services was the main driver in the transformation that took place in 2010/11, and the subsequent partnership with Barnardos.


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The initial Consortium contract was based on ‘risk and reward’ and for its time was very innovative. There is a view that this programme was driven

too much by the financials, but in moving to supporting programmes such as Promoting Independence and Choice, Active Living in Older Age and

Integrated Older People pathway, it was evident that outside of Social Care and BIT, there was limited knowledge of the work the external

consultants had been contracted to deliver linked to managing demand and improving outcomes.

It is acknowledged by partners and council officers that there has been a shift in the role of the external transformation partner over the course of

the transformation journey. From directing during the early consortium days driving significant efficiency targets, to a more facilitating role working

alongside internal service leads and BIT during the Promoting Independence and Choice and Active Living programmes, to an approach bringing

innovation and capacity to projects such as Workflow and Integrated Older People Pathway. It is apparent that some of this changing behavior has

been driven by the ‘sense of urgency’, the capacity available and the core objectives. Therefore, it could be argued that this change in behavior and

approach has been critical in ensuring successful delivery of each phase.

Having captured this learning and identified the critical success factors, it is essential that this is applied to all future transformation projects, during the

development of the brief and during the project startup phase. Furthermore, it is important to ensure that learning and reflection continues, adopting a

disciplined approach to project closure ensuring these are captured and used to inform the design and development of the next project/ programme.


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10. APPENDIX 1- TRANSFORMATION TIMELINE

Transformation project and outline scope

Transformation project and outline scope Timeframe Project Achievements Resources

Childrens Services

Transforming Services for Children in Need and their Families June 2010 -

2011

Multi-agency Transformational Board established.

The key drivers for the programme were improving

outcomes for children and their families and ensuring a

sustainable and high performing service moving

forward.

Key projects included:

- Developing a commissioning framework

- Developing a Corporate Parent Strategy

- Developing an Integrated Children System

Model

- Robust QA and Business Assurance

- Developing and effective transitions

programme

- Developing an Integrated Family Support Team

Model for Transitions

- Developing a Family Contact Centre and Family

Assessment and Support Centre

Investment in resources was agreed by the Council.

Children Services

Social Care Social Care Transformation Programme

Peopletoo, Newton Europe and Coactiva were

Oct 2011 – March 2014

Delivered against a risk and reward contract, the

Consortium supported a transformation programme

that delivered total cumulative savings of £12.7m

External consortium


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engaged as part of a consortium to deliver improved services and financial savings across Adults and Childrens Services.

against a target of £10.6m over the course of the

programme.

Approx. split of savings:

£3.2m – social services restructuring and reengineering

of administrative structures

£7.3m – Directly ASC

£555k – Directly Childrens Services

This was achieved through re-engineering, restructuring,

developing and adopting a robust commissioning

strategy, enhancement of prevention initiatives and

developing alternative provision such as assistive living

technology and medication management.

Adult Services

Children Services

Finance

Children Services Integrated Family Support Service

Working with Barnado’s the DCS and the Consortium developed a set of innovative arrangements to enable a gradual transfer of resources and functions to flow between the organisations. As a result of this Barnardo’s were able to invest £200K of resource jointly with the Council to support early intervention and prevention to meet both the needs of the Council and the charity.

Dec 2010

Operational / Contractual commencement 2011

This unique arrangement enabled an innovative operational environment to be created that would enable Newport to utilise Barnado’s staff to deliver core social care functions and alongside Newport city staff. This arrangement drove both innovation and the transfer of good practice and created a stable operational environment maintaining significantly lower levels of LAC than regional and statistical neighbours.

Savings of £275k achieved through reduce demand for statutory services

Childrens Services

External Consortium

Barnardo’s

Legal

Finance


39

Adult Services Active Living in Older Age

Programme objectives included:

Improve choice and control for service users

Improve access to services

Improve staff knowledge and awareness of alternative provision

Improve efficiency and improve use of resources

Focus on preventative, rather than reactive services

April 2014 – April 2015

Changes to practice focused on promoting independence and outcomes. Supporting people to remain in their own homes for longer.

Financial savings - £1.3m

Workstreams lead by Service Managers

Business Improvement Team

Peopletoo

Finance

Adult Services Promoting Independence and Choice Learning Disabilities

Project scope included:

LD placement project

Re-Assessment of Service Users

Modernisation of Day care

Review of Transition process and outcomes

April 2014 – April 2015

Modernisation of residential and supported living care focusing on outcomes and increased independence.

Service users reviewed for both their current eligibility potential care levels if outcome focused care is adopted.

A radical rethink of Day Care that lead to increased choice and control with a move away from traditional building based Day Centres to Day Activities.

Effective management of the transition process in partnership with parents, carers and providers.

Financial savings - £1.2m

Workstreams lead by Service Managers

Business Improvement Team

Peopletoo

Finance

Adult Services Integrated Older People Pathway

To keep people living safely and independently in their own homes.

Jan 2014 – present

Development of an innovative risk stratification tool

Recognition for the project on a national basis

Adult Services

ABHB


40

To avoid unnecessary admission into institutionalised care.

To develop effective anticipatory care planning with care wrapped around the individual.

To develop a continuum of multi-agency provision, deploying the right resources at the right time in a holistic manner.

To develop capacity for effective early prevention.

To develop outcome focused service provision within a community setting as an alternative to primary care.

A significant reduction in A&E attendances and Emergency

Admissions for participants

Fewer participants accessing Social Care services than people

that opted out

Increased access to benefits such as attendance allowance,

allowing people to access community support independently

Peopletoo

Age Cymru

Care and Repair

Adult Services Social Services and Wellbeing Act (Wales) 2014 Readiness Assessment

Jan – April 2016

Identified that a more structured programme was required to

support delivery of Act requirements, to ensure gaps in

implementing the Act were managed in a systematic and

timely manner. Key recommendations included:

Re-design of roles and responsibilities at the Front

Door

Development of an amended workflow to enable

robust performance reporting and monitoring

Ensuring key services were represented within the

Front Door structure

Incorporation of a new safeguarding (POVA)

workflow to address key requirements of the Act.

Incorporation of the Integrated Assessment onto the

Adults Information System as part of the

recommended workflow.

Peopletoo

ASC

BIT

Performance


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Development of a robust set of reporting outcomes

aligned to Common Recording Requirements of the

Act.

Promote increased engagement and consistency in

system use through increased investment in training

Development of a more robust governance

arrangement including key roles and responsibilities

and oversight functions to drive implementation and

monitor compliance against the Act. As a result Act

in Action Programme was established across social

care with support from the BIT.

Adult Services Demand Analysis

Peopletoo were commissioned by Newport City Council (NCC) to undertake a high-level analysis of current demand pressures being managed by Adult Social Care (ASC).

Jan – April 2016

Establishing demand at key points of the customer journey in order to promote a greater understanding of the current financial and demand pressures being placed on ASC, and identification of mitigating actions that could be taken to address these pressures.

Peopletoo

NCC Performance

Finance

Adult Services Implementation of workflow July 2016

As part of the Act in Action programme set up to achieve compliance, implementing a standardised workflow for ASC. This enabled the service to evidence compliance and compile vital performance management data to inform practice. In addition, standardised and consistent processes were developed and adhered to across operational teams which reduced handoffs and clearly outlined roles and responsibilities at key stages of the customer journey. This reduced the reliance on administrative staff and increased operational efficiency.

In addition, it enabled the service to produce accurate demand data which will allow for the forensic analysis of spend against demand.

Peopletoo

BIT

ASC Lead


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11. APPENDIX 2- TABLES DETAILING PERFORMANCE IN ADULT’S AND CHILDREN’S SERVICE BETWEEN 2010/11 AND 2015/16

Table 1 - Adults’ Social Care Performance 2010/11 to 2015/16

Category 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16

The rate of delayed transfer for social care reasons per 1000

population aged 75 or over

4.3 5.78 11.84 11.51 5.37 4.29

Rate of Older People (aged 65 or over) supported in the Community

per 1000 population as of 31st March

85.77 77.14 68.96 63.32 61.81 58.31

Rate of Older People (aged 65 or over) supported in Care Homes per

1000 population as of 31st March

19.19 19.59 18.50 16.2 14.36 14.69

% of Adult Protection Referrals completed where the risk has been

managed

85.5 85.8 90.6 97.08 98.6 99.19

% of all clients aged 18-64 that were supported in the community

during the year

88.94 92.37 94.97 92.57 91.99 Not collected

% of all clients aged 65 or over that were supported in the

community during the year

81.71 84.34 83.38% 83.22 85.67 Not collected

% of clients with a care plan who should have been reviewed that

were reviewed during the year

72.4 67.6 64 65 77.9 86.3

% of carers of adults who were offered an assessment or review of

their needs in their own right during the year

52.5 47.3 67.3 87.9 94 72.1


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Table 2 - Performance of Adults’ Services in Newport compared with National and Comparator Authorities (2015/16)

Local Authority comparators used – Torfaen, Swansea, Neath Port Talbot, Bridgend, Cardiff and Caerphilly

Category Newport 2015/16 Wales Average

2015/16

Average of

Welsh

comparator LAs

2015/16

The rate of delayed transfer for social care reasons per 1000

population aged 75 or over

4.29 4.86 5.69

Rate of Older People (aged 65 or over) supported in the

Community per 1000 population as of 31st March

58.31 64.12 76.71

Rate of Older People (aged 65 or over) supported in Care Homes

per 1000 population as of 31st March

14.69 18.02 18.32

% of Adult Protection Referrals completed where the risk has been

managed

99.19% 96.9% 96.98%

% with a care plan who should have been reviewed 86.3% 82.9 82.08

% of carers of adults who were offered an assessment of review of

their needs in their own right during the year

72.1 91.3 91.83


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Table 3 - Children’s Social Care Performance 2010/11 – 2015/16

Category 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16

Children in Need per 10,000 310 330 315 325 335 315

Children named on the Child Protection Register per

10,000

33 33 41 58 55 41

Looked After Children per 10,000 85 83 84 86 86 88

Referral rates 3559 4304 3529 1939 1871 2018

Re-Referral Rates (% of all referrals that are re-

referrals)

1095 (31%) 1883 (44%) 1374 (39%) 604 (31%) 438 (23%) 502 (24.8%)

Table 4 - Performance of Children’s Services in Newport compared with National and Comparators Authorities

Local Authority comparators used – Torfaen, Swansea, Neath Port Talbot, Bridgend, Cardiff and Caerphilly.

Category Newport 2015/16 Wales Average

2015/16

Average of Welsh

comparator LAs

2015/16

Children in Need per 10,000 (2013/14) 315 300 355

Children named on the Child Protection Register

10,000

41 49 56.3


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Looked After Children per 10,000 88 90 112.6

12. APPENDIX 3- SPEND COMPARISONS WITH COMPARATOR AUTHORITIES 2016/17 AND 2017/18

Figure 1- – Spend Comparisons with Comparator Authorities – Budget per 10,000 Population 2017/18

Table 1 – Spend Comparisons with Comparator Authorities – Budget, Overspend, Budget and Overspend per 10,000 Population 2016/17

Table 2- Spend Comparisons with Comparator Authorities – Budget per 10,000 Population 2017/18


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Authority

Budget (k) per 10,000

population

2017/18

Newport £4,219

Bridgend £4,222

Swansea £4,290

Cardiff £4,307

Torfaen £4,341

Caerphilly £4,500

Neath Port Talbot £5,401

Authority

Budget (k) 2016/17 (nb. Excludes in-

year virements)

Projected end of year over/under

spend (k)

Population per 10,000

Budget (k) per 10,000

O/S (k) per

10,000

Caerphilly £73,404 £2,499.00 18.0 £4,078.00 £138.83

Torfaen £39,826 £474.00 9.2 £4,328.91 £51.52

Newport £60,884 £1,011.00 14.8 £4,113.78 £68.31

Cardiff £146,352 £5,581.00 35.7 £4,099.50 £156.33

Swansea £104,755 £3,382.00 24.2 £4,328.72 £139.75

Neath Port Talbot £75,138 £476.00 14.1 £5,328.94 £33.76

Bridgend £59,697 £743.00 14.2 £4,204.01 £52.32

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