Swindon Council’s services were felt to be fragmented. But by pooling budgets – to the extent that it has been announced as one of the pilots for the much vaunted community budgets – it has transformed performance. Ben Willis reports
(picture: Swindon’s integrated team: Simon Kitson, senior educational psychologoist; Ali Hayward CAF/TAC co-ordinator; Louise Campion, integrated service manager, and Leona Black, educational psychologist)
● Project name: Swindon integrated services for children and young people and services for disabled children.
● Aims and objectives: To bring together the services for children and young people and disabled children offered by Swindon Council and Swindon Primary Care Trust through pooling of budgets and setting up of joint staff teams.
● Number of service users: 46,000 children and young people are supported by universal services. Targeted services support 700 children a year and 200 disabled children.
● Cost of project: £28m pooled budget, £10,000 set-up costs
● Timescale: A permanent arrangement since April 2008, no end date.
In 2005, Swindon Council was struggling to contend with some worrying trends within its child and youth population. According to Sue Wald, the authority’s director of strategy and commissioning, teenage pregnancy, the number of children in care and the rate of young people not in education or employment (Neet) were all on the increase.
At the same time, young people and their families complained they found the support services offered by the authority and local primary care trust confusing. “They were saying our services were very fragmented and that every time they came across a service, they would be asked the same questions again and again,” says Wald. “What they wanted was a single lead professional to work with them without having to be passed around a lot of different people.”
The council and the local primary care trust began discussions on how to tackle these problems. They needed to improve the co-ordination and effectiveness of services for children and obtain maximum impact from the money spent by both bodies on these services.
Various options were discussed, the simplest being co-location of council and NHS staff in the same building. But Wald says the feedback from staff on this option was that it would not go far enough, and that full integration of management from the two bodies would be preferable.
Eventually, it was decided to make use of a provision in the 2006 NHS Act known as a section 75 agreement. This enables local authorities and NHS bodies to combine budgets or staff to jointly deliver overlapping health-related services, and, says Wald, meant there was a strong governance framework to underpin the process of integration.
The council and PCT agreed to instigate three separate section 75 agreements. The first allowed the two bodies to align and eventually pool the budgets they both spent on commissioning services for children and young people. Overall the council put £20m into the partnership, covering all the money it spent on areas such as social work, education welfare and vulnerable and disabled children. The PCT put in the £8m it spent on community health services for children.
“The advantage of it is that it forces you to agree the common priorities and outcomes across the two agencies, so everyone is very clearly signed up to those,” says Wald.
The council and PCT instigated two more section 75 agreements to provide integrated services for children and disabled children respectively. Both agreements enable the two organisations to combine their staff, with 200 NHS employees seconded to one of four ‘integrated locality teams’ set up to run services in four geographical areas of Swindon. Each team combines council and NHS staff from a range of disciplines, such as education welfare officers, speech and language therapists and youth workers.
A key tool in the integration process is the common assessment framework (CAF), used to gauge a child or young person’s specific problems or needs. Each professional on the team is trained to use the CAF, and may decide to deploy it if they feel that a child referred to them for a specific problem has wider needs.
Once a family has been through the CAF process, they then take part in a “team around the child” meeting. This allows the lead professional looking after a specific case to gather together a group of members from other disciplines to decide the support required by the child and its family.
Louise Campion, manager of the Central South Swindon integrated locality team, says this has been a successful approach. “People really appreciate that one point of contact. If you’re a family with three or four children and there are lots of different workers, it can be very overwhelming and confusing.”
It also appears to be having noticeable effects on outcomes. For example, Campion says the Neet count in her patch has fallen from around 9% last year to 6% this year while across Swindon, obesity rates for children in year six fell from 19% in 2008 to 16.5% a year later.
Swindon’s experiences with integration will hold it in good stead as the government looks for more authorities to pool a number of strands of government funding in order to help needy families. It has asked 16 councils to pilot “community budgets” of which Swindon is one.
“It will be very helpful having done this work already,” Wald agrees. “We’ll be able to take into this the learning from our work on the section 75 agreements and do this relatively easily.”
CASE STUDY: ‘I’ve got more scope to progress my development’
Marilyn Thompson is an education welfare officer in the Central South Swindon integrated locality team. She is responsible for supporting home-taught children and is assigned to one of the pupil referral units that caters for vulnerable children and young people in Swindon.
Thompson says she has already noticed the benefits resulting from integration, particularly the easy access it allows her to a broad range of specialist professionals. “Previously you would have to fill out the individual referral form for an agency, whereas now you can get those agencies around a table with the parent and child,” Thompson says. “From a parent’s point of view that’s pretty good; they know there’s going to be a review in six weeks, and they know those same people are going to be around the table.”
Thompson says the new CAF-led system also means her own job has become more stimulating: “Obviously as education welfare officers we’ve got our job to do, but it seems that we’re doing more from a CAF point of view and getting involved in a lot of different things. So that gives you scope to progress your own development.”
Tips on pooling budgets
● Establish clear outcomes for what you want to achieve through pooling. “That will then give you the rationale for what you do,” says Wald. “The bit about how you set budgets, share risk and so on you can do afterwards.”
● Ensure each party fully understands how the other’s budget works before aligning or pooling.
● When establishing integrated teams, ensure staff are involved in deciding the culture and values underpinning integrated teams. “The principles on which the teams operate becomes very important in establishing a clear identity and common purpose,” says Wald.
● Seek to identify what common skills and core competencies everybody in the team needs to be trained in at the same time as maintaining their specialist expertise and knowledge.
Published in Community Care 24 February 2011 under headline ‘Unifying Forces’
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