An effective workforce for Early Help Delivery
Nuala O’RourkeWigan Council
Confident Place, Confident People.
The drive to integration
• Total Place• Community budgets• Public service reform• DH drive for Health and Care
Integration• Movement of Public Health into
Local Authorities• Commissioning of Health
Visitors moving to Local Authorities
Confident Place, Confident People.
The drive to integration
• Total Place lessons– People at the heart of
service design– Reducing dependency /
enabling self reliance– Pooling budgets– Reducing bureaucracy
Confident Place, Confident People.
The Public Service Reform Challenge• GM Priority: Growth and reform
• Total tax intake in GM £17bn• Total public spending in GM £22bn
• £5bn gap
Confident Place, Confident People.
DfE
Multiple funding and accountability structures make coordinating support for families very difficult
Intensive family intervention worker/
parenting practitioner
DH
LA YJB CCGPolice
Surestart
Parent support advisers/Schools
Police officer
YOS workerCAMHS/
Mental Health Worker
Drug and alcohol team
DWP
JCP
Employment Personal advisers
VCS
Young carer support worker
Prisons
Family support workers
CLG
Housingauthorities
Housing link worker
MoJHO
Confident Place, Confident People.
Known Interactions Nov. 09 to Oct. 10
Confident Place, Confident People.
What does integration mean• Many different models
– Co-located– Aligned– Fully integrated under single line
management
Confident Place, Confident People.
Integration in Wigan
• Integrated Safeguarding and Public Protection team
• Integrated Health team
• LIFE team
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Integrated Safeguarding and Public Protection team
• A partnership response to domestic abuse• A coordinated community response model• A co-located team including
– Police, Children’s social care, Probation, Housing, Independent Domestic Violence Advocates, Drug and Alcohol outreach, Young person’s violence advocate
• With daily input from– Health Economy– Adult Social Care
• Process overseen by and approved by CAADA
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Delivery Model
• Daily meetings which respond to domestic abuse incidents
• All agencies share their knowledge of the whole family
• A joint action plan is jointly agreed and implemented immediately
• Individual agencies take ownership of on going activity with the family
• Taking MARAC principles to a daily meeting• Launched in March 2013
Confident Place, Confident People.
Integrated Health Support Team• An integrated targeted intervention and support
service to vulnerable pregnant women and their families.
• Works with top 2% most vulnerable pregnant women in the Borough (circa 75) and their families to reduce the risk of children becoming looked after and / or suffering significant harm.
• Team consists of Public Health midwives, Midwifery Support, specialist Speech and Language therapist and a targeted Speech and Language therapist, Family Support Worker
• Won 2 national awards from RCM & BJM.
Confident Place, Confident People.
Delivery Model
• Joint assessments• Joint team meetings• Shared case notes• Joint visits• Shared family plan
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The Life Programme
• A long term attachment rooted service where families are invited to take part and work intensively with a range of workers
• A team of workers with a range of skills including police, social care, early intervention, health and housing.
• Located in a local building which operates as a drop in centre for family members
Confident Place, Confident People.
Delivery Model
• All workers support families and share their expertise with the team
• Staff have specialist areas – but all members of the team carry a case load and act as a keyworker for the family – or members of the family
• Small case load – 12 families on each site – but as this includes the extended family it adds up to nearly 100 individuals.
• Staff work with families for a period of up to two years with a defined exit plan seeing a step down in the level of support over an extended period of time
Confident Place, Confident People.
Learning – Aligned Integration• Working in a co-located team can blur the lines
between professions and need all involved to have a flexible approach
• The benefits are not shared equally across all agencies and without shared budgets the cost can outweigh the benefit to some partners
• Relationships and engagement are critical to success and the timeliness of appropriate interventions is key to delivering and sustaining change.
Confident Place, Confident People.
Learning – Single team• All staff need adopt a person centred approach to family work with a
single family assessment built into the centre of the approach so that we ensure that the child’s needs are paramount and services wrapped around the family
• Having all professionals managed within one team enables the change process to be managed, removes competing agendas and prevents the family from playing off professionals
• This means that team members are team members first and carry their professional skills on their shoulder to be used as and when needed by family members or other team members.
Confident Place, Confident People.
What helps develop the single team• Having a job role outline that defined the role of the team member.• Some common competencies that tied the team together,• Common statements that outlined the primary task that we were all working together to achieve• A set of fundamental principles that set out the way that we worked with families.• An acknowledgement that as a team we had different sets of value bases and motivation for the
work that we do. • Embedding the fundamentals within the IPA process so that we could measure our journey.• Providing daily debriefing sessions in the early days of integration supported by a manager. • Understanding that t he team moved from roles where they had been seen as the expert in their
specialism working with a particular cohort to working outside their comfort zone. Staff need support to understand that they don’t need to know all the answers, its ok to say I'm not sure but we can find out.
• Recognising each individual team member as a consultant from their specialist area. • Being open to share working practices. • Involving the team in the development of the service.• Providing high quality supervision and support to enable team members to manage the change in
the way of working.
Confident Place, Confident People.
Learning• We are asking our new integrated teams to support families into
behaviour change which the public sector has been struggling to achieve for many years
• Need a workforce than understands– We need to take an asset based approach with families– Families and individuals need to be encouraged to take responsibility for
their behaviour and understand the impact in order to be willing to change.– Behaviour change takes time and families often relapse and need further
motivation and support
Confident Place, Confident People.
Confident Place, Confident People.
Aim in Wigan
• To develop and begin to implement by 2015/2016 an approach to full integration of early help including Health Visitors and our Early Help team.– Locality based model– Single line management of staff
Confident Place, Confident People.
What are the challenges we have identified
Communication:• Need for an agreed shared vision and
understanding with clear communications strategy:– Strategic partners / management– Workforce– Public
• Accountability / governance / clear leadership.
Confident Place, Confident People.
What are the challenges we have identified
• Accountability • Governance • Need for clear leadership• Ability of organisations to let go
Confident Place, Confident People.
What are the practical challenges we have identified
Systems:• Fragmented commissioning• Range of assessment processes and paperwork
to be agreed• Data: systems / sets / sharing• Working models e.g. key working / corporate
caseload• Accommodation
Confident Place, Confident People.
What are the challenges we have identified
Workforce:• Workforce sign-up.• Workforce competency• Workforce culture• Change management• HR / Pensions / TUPE
Confident Place, Confident People.
Discussion topics
• What type of integration are delegates developing in their locality?
• Do we all share the same challenges?• What do we see as the benefits of
integration?• How will we measure our success?
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