Download Fulfilling Lives Guide to New Policy Environment for Multiple Needs PDF

Fulfilling Lives Guide to New Policy Environment for Multiple Needs
Name: Fulfilling Lives Guide to New Policy Environment for Multiple Needs
Pages: 38
Year: 2013
Language: English
File Size: 1.19 MB
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Contents: 1. Introduction 2. Directions of Travel 2.1 Approaches to public service reform Financial Austerity p. 5 Localism p. 6 Competition p. 6 Partnership p. 6 2.2 National Strategies and programmes Troubled families p. 7 The social justice strategy p. 8 Other national strategies p. 8 Text box: Dual diagnosis p. 9 National Outcomes Frameworks p. 10 Text box: Recovery: a key concept for multiple needs? p. 11 Welfare reform p. 12 Work Programme p. 13 Transforming Rehabilitation p. 14 3. Mapping new policy structures and bodies 3.1 National structures and initiatives NHS England p. 15 Public Health England p. 16 Text box: Public health, health inequalities and the health premium p. 16 Care Quality Commission p. 17 Healthwatch p. 18 Monitor p. 18 3.2 Local bodies and structures Health and Wellbeing Boards p. 19 Joint Strategic Needs Assessments and Health and Wellbeing Strategies p. 19 Directors of Public Health p. 20 Clinical Commissioning Groups p. 21 Police and Crime Commissioners p. 21 Police and Crime Panels/Police and Crime Plans p. 22 Integrated Offender Management p. 22 Liaison and Diversion Schemes p. 23 Drug Intervention Programme p. 24 Text box: Equalities issues, diversity and multiple needs p. 24


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1. Introduction This document has been produced by DrugScope as part of the support provided by Making Every Adult Matter (MEAM) and Revolving Doors to the Big Lottery Fulfilling Lives partnerships. The development of services for people with multiple needs in the 12 Fulfilling Lives (FL) areas in England will require the partnerships to navigate new policy structures, managing risks and taking advantage of opportunities. The purpose of this briefing is to equip the FL partnerships to navigate this emerging terrain effectively by providing: 1. An overview of relevant policy themes and initiatives (section 2); 2. Mapping of the new local (and regional) policy environment (section 3.1, 3.2); 3. Consideration of the financial context and new approaches to purchasing and commissioning of services (section 3.3); and 4. An overview of independent initiatives on multiple needs and sector specific information and resources (section 4). The briefing does not offer comment or opinion on current reforms. It does provide signposts and links to the key resources in each policy area, as well as practical suggestions on steps that the FL partnerships can take to think through the policy changes and plan and manage their activities accordingly. The four MEAM partners and Revolving Doors are also able to offer telephone advice on policy changes to the FL partnerships as part of the support package. 2. Directions of travel 2.1 Approaches to public service reform Four overarching themes of public service reform are of particular relevance: austerity, localism, competition and partnership. Financial Austerity The Spending Review 2010 announced a 28 per cent cut in the Local Government Departmental Expenditure Limit (LG DEL) over the Spending Review period up to 2014 15. The LGA estimates that Local Government has in fact experienced a 33 per cent reduction in real terms over this period, with a further 10 per cent fall expected in 2015 16. These are not the only cuts that will potentially impact on multiple needs provision. For example, there has been a fall of around a third in the Ministry of Justice"s budget since 2010, from around 9 billion to an expected 6.8 billion by


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2014 15. It has also been reported that spending on adult mental health services is falling, despite an increase in need. 1 The practical message from this is the need to consider and remain sensitive to the pressures on local decision makers and commissioners who are responsible for setting priorities and allocating resources in an environment of increasing scarcity. There is a premium on approaches to service delivery that can 'do more with less" and deliver cost savings over the longer term. Localism This refers to the processes by which policy and financial control has been devolved from national government to local decision makers in recent years. For example, the Local Government Association (LGA) explains that the aim of the Localism Act 2011 was to 'devolve more decision making powers from central Government back into the hands of individuals, communities and councils". The impact of localism includes the removal of 'ring fencing" from a range of budgets to give local government more discretion over how it allocates resources (see 3.3), as well as the creation of new structures and offices, notably Health and Wellbeing Boards and elected Police and Crime Commissioners. The benefits of localism include the potential to shape local services around local conditions and priorities and to engage and involve the community. The risks are that there could be deprioritisation and disinvestment in services for particular groups, particularly the marginalised. Competition There is an increasing emphasis on competitive market structures in determining which organisations deliver public services and a commitment to involving independent providers from both the voluntary and community and private sectors. Personal budgets and payment by results (see section 3.3) are both mechanisms for marketisation of public service provision. It means that a wider range of organisations and services are becoming involved in developing services for people with multiple needs, from large private sector companies for example, as 'prime providers" in the DWP Work Programme to small local charities. Partnership Everyone now accepts the importance of collaborative and 'joined up" approaches to service delivery. The Spending Round 2013 highlights the need to motivate and support services in local areas to work together effectively, as do key initiatives such as the introduction of Health and Wellbeing Boards (see 3.2) and Total Place Community Budgets (see 3.3). This has also been a theme for critics of public service reforms who have had concerns about the proliferation of new policy structures (national, regional and local) and the challenge of integration in a rapidly {


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changing environment. There is also a political focus on achieving more effective integration of health and social care. 2 2.2 National strategies and programmes The issue of 'multiple need" or 'multiple disadvantage" has emerged as an important policy theme in the UK in the last 5 10 years. The first significant Government initiative was New Labour"s Adults Facing Chronic Exclusion (ACE) programme (2007 to 2010). An independent evaluation published by the DCLG in 2011 concludes that the ACE pilots were 'all based on the theory of providing a consistent, trusted adult to mediate between services and clients", with evidence of positive and cost effective outcomes, particularly on housing and health and well being. There is no direct successor to ACE sponsored by central Government (partly as a result of the shift to localism), but interest in multiple needs/multiple disadvantage has continued and a number of national strategies and programmes are relevant. The final evaluation of the ACE pilots remains relevant to multiple need provision at www.gov.uk/government/uploads/system/uploads/attachment_data/file/6333/1925475.pdf Troubled Families (TF) TF is probably the highest profile initiative with an explicit focus on 'multiple problems" or 'complex need", but targeted at families. It was launched by the Prime Minister in 2011, and is overseen by a national team based in the Department of Communities and Local Government (DCLG). TF co ordinators within upper tier local authorities are responsible for developing local services. The Government has provided 448 million to local areas for three years up to 2015 to support this work on a 'payment by results" basis (see the 'Troubled Families Financial Framework"). Initially, the programme"s target is to turn around the lives of 120,000 vulnerable families (the source of this figure and the criteria for identifying 'vulnerable families" has been controversial). The Spending Round 2013 announced a further expansion of the TF programme, with an additional 200 million of Government investment to support work with a further 400,000 families. The TF initiative has been developed as part of the Total Places Community Budget pilots (see 3.3). Details of TF are at https://www.gov.uk/government/policies/helping troubled families turn their lives around The TF Financial Framework is at https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/1146 9/2117840.pdf C Y C / C I { / 9 { /b{ Y [ /C Ia ! L !


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The Social Justice strategy In 2012, the Government launched Social Justice: Transforming Lives and a Social Justice Outcomes Framework . These provide the main articulation of a Government approach to 'multiple disadvantage". A key strand is 'Supporting the most disadvantaged adults addressing homelessness, re offending, drug and alcohol dependency, mental ill health and debt" and the strategy makes a clear commitment to better coordinated services in local areas stating: 'We recognise that more can be done to support those who are least well served by current approaches. Through this strategy and the work that follows, we want to encourage local areas to design and commission interventions that are better coordinated and that deliver multiple outcomes" (paragraph 227). The Outcomes Framework includes outcomes on worklessness, drug and alcohol treatment and reducing re offending. 3 The Strategy is supported by a Cabinet Committee for Social Justice and co ordinated by a Social Justice Team at DWP. It encourages commissioning on a PbR basis and social investment (including SIBs). Social justice: transforming lives One Year On (2013) considers how initiatives across Government are contributing to Social Justice outcomes for example, Integrated Offender Management Arrangements, liaison and diversion services in police custody suites and courts, back to work support through the Work Programme and the Drug and Alcohol Recovery PbR pilots. The Social Justice Strategy is at https://www.gov.uk/government/publications/social justice transforming lives The Social Justice Outcomes Framework and One Year On are at https://www.gov.uk/government/publications/social justice transforming lives one year on The Centre for Social and Economic Inclusion is developing a Social Justice Toolkit, which when available should be accessible at http://www.cesi.org.uk/statistics/tools Other national strategies Other national strategies help to determine the focus and configuration of services for people with multiple need and in recent years there has been a growing focus on the issue of multiple needs within many of these strategies. Key documents include: Breaking the Cycle: Effective punishment, rehabilitation and sentencing of offenders, 2010 Drug Strategy 2010 Reducing demand, restricting supply, building recovery: Supporting people to live a drug free life h C L


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No Health without Mental Health (Mental Health Strategy), 2011 Vision to end rough sleeping: no second night out nationwide, 2011 Alcohol Strategy, 2012 Making every contact count: A joint approach to preventing homelessness, 2012. A number of these strategies make direct reference to multiple needs. Breaking the Cycle states that 'a significant proportion of crime is committed by offenders who have multiple problems". The Vision to end rough sleeping says that 'homeless people often have complex underlying problems that can be worsened by living on the streets or in insecure accommodation" and Making Every Contact Count highlights the importance of the MEAM initiative. Equally important are related ideas in these strategies such as 'dual diagnosis" and 'recovery" (see box) which are helping to provide the policy frameworks for developing integrated approaches locally. The Drug Strategy https://www.gov.uk/government/publications/drug strategy 2010 2 The Alcohol Strategy at https://www.gov.uk/government/publications/alcohol strategy Mental Health Strategy at https://www.gov.uk/government/publications/the mental health strategy for england Vision to End Rough Sleeping at https://www.gov.uk/government/publications/vision to end rough sleeping 2 Making Every Contact Count at https://www.gov.uk/government/publications/making every contact count a joint approach to preventing homelessness Dual diagnosis or 'co morbidity" There is a strong link between 'dual diagnosis" and the multiple needs agenda. 'Dual diagnosis" refers to co morbidity of mental health and substance misuse problems. In 2002, the Department of Health published a Dual Diagnosis Good Practice Guide, which established the principle that mental health services have lead responsibility for patients with severe mental health problems and substance misuse, and to provide integrated care. Other key documents include Turning Point (2007) Dual Diagnosis Good Practice Handbook and Department of Health (2009), Management of Dual Diagnosis in Prison. Recently there has been interest in people in drug and alcohol services experiencing 'common mental health problems" like anxiety and depression. For example, DrugScope, IAPT and the National Treatment Agency produced the IAPT positive practice guide for working with people who use drugs and alcohol (2011). Local areas may have dual diagnosis strategies and designated dual diagnosis teams, as well as dual diagnosis specialists in other teams (such as mental health outreach teams).


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See DrugScope, UKDPC and Centre for Mental Health, Dual diagnosis: a challenge for the reformed NHS and for Public Health England at http://www.drugscope.org.uk/Resources/Drugscope/Documents/PDF/Policy/DSDualDiag nosisDiscussionPaper.pdf National outcome frameworks Alongside the Social Justice Outcomes Framework, there are other national frameworks of interest for multiple needs provision; in particular The Public Health Outcomes Framework for England 2013 2016 (PHOF) Adult Social Care Outcomes Framework 2013 2014 (ASCOF) and No Health without Mental Health Implementation Framework, 2012 (MHIF).4 PHOF includes outcomes on: statutory homelessness; access to accommodation for people with disability and mental health problems; re offending; completion of drug treatment; alcohol related hospital admissions; drug treatment access for people entering prisons; under 75 mortality in adults with serious mental health problems and suicide. The ASCOF includes the outcome 'people are able to find employment when they want, maintain a family and social life and contribute to community life, and avoid loneliness and isolation". The MHIF includes recommendations for a wide range of agencies including criminal justice and housing organisations, and considers relevant outcomes, including housing and employment for people with mental health problems. It highlights 'multiple needs" and 'multiple disadvantages" in recommendations to local government and Health and Wellbeing Boards (see 3.2), including that local authorities 'should consider the use of 'whole place" or community budgets to improve the quality and efficiency of support offered to people with multiple needs including a mental health problem". In addition to these outcomes frameworks there are a range of 'payment frameworks" that set outcomes for local services as part of the payments by results agenda (see section 3.3). PHOF at https://www.gov.uk/government/publications/healthy lives healthy people improving outcomes and supporting transparency L ! I . I t I h 5 I { / L /


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