Council-led early intervention pilots are showing it is possible to radically rework public services so those in need get better help.
Communities and Local Government Secretary Eric Pickles announced how the pilots can save the taxpayer millions.
Over the past year, 4 Community Budget pilots in Essex, London, Manchester and Cheshire, with support from Whitehall, were given free reign to track local public expenditure to see where it was being spent and whether it was being put to best use.
The pilots discovered that a large proportion of budgets and services were focused on entrenched problems where small numbers of people were repeatedly involved in local services costing the taxpayer hundreds of millions of pounds.
The issues included how to reduce repeat offenders; how to support older people with chronic health conditions so they are less likely to end up in hospital; helping victims of domestic abuse earlier; and identifying and helping children facing disadvantage from the start.
By taking radical steps that set up better locally-integrated early intervention services between all agencies the pilots could save the 4 areas hundreds of millions over the next 5 years.
Speaking at a conference about Community Budgets to an audience of public service experts, Communities and Local Government Secretary Eric Pickles said:
“So I wasn’t looking for these pilots to patch things up, to mend and make do, to think about service improvement I wanted them to put people at the heart of the system and get to the root cause of entrenched problems even if that means throwing away the rule book and starting again.
“Instead of an average of 68 separate interventions per family, at cost to the taxpayer of up to £92,000, our pilots have discovered that if you simply follow the money you’ll usually find different cash flowing through different pipes to different agencies with different targets.
“They’ve also worked out, if you get heads together in a room. Focus on the elderly and the vulnerable, the troubled families, the reoffenders, the long-term unemployed and those with dependencies you can actually start to take dependence out the system and you can actually begin to help people recover their sense of self-worth.
“We are all on the same page now. The pilots are bringing services together with an appreciation of the real prize for getting this right and is not just savings of millions of pounds it is changing people’s lives too.”
Health and social care
In Greater Manchester it is estimated that 750,000 hospital bed days a year are occupied by older people with multiple long term conditions, costing £800 million to £1.2 billion annually. Two per cent are aged over 85 but they account for 10% of emergency admissions and 18% of all hospital bed days. They estimate that they can reduce emergency admissions and days spent in hospital beds or care homes. The 3 West London boroughs found that 20% of residents who had the highest health and social care needs accounted for nearly 80% of spend on these services. This represented almost £25,000 for a person with very high needs compared to £250 for people with very low needs. West Cheshire expect to make a £26 million saving from a similar approach.
Essex has 29,000 incidents of domestic abuse causing costs of £86 million in the county every year. Four in 5 victims visit GPs before going to police. Essex’s plan will see a single hub streamlining the current system where 1000 locations, 116 phone numbers and in excess of 80 agencies deal with domestic violence, bringing agencies together with common goals and aligned budgets. It will focus on prevention and early intervention will save over £100 million by reducing reoffending and domestic abuse, supporting 17,000 victims by creating a single contact point to help with issues like accommodation and dealing with perpetrators. West Cheshire found that almost all of the £20 million spent on dealing with its 9,000 cases of domestic abuse was reactive. They expect to save £17 million by providing earlier support for victims and dealing with perpetrators sooner.
Westminster, Kensington and Chelsea and Hammersmith and Fulham found that half of those given short sentences were likely to reoffend within a year. That group totals 9% of all offenders but two-thirds of all prison admissions and releases. They are establishing a bespoke service to co-ordinate help that is expected to save £25 million. They are cutting the time care proceedings take to go through the courts. Half of all crime in Essex is committed by someone with a record. Two thirds of boys with a convicted father go on to commit crimes themselves.
In Greater Manchester, about 40% of young children - 16,000 each year - are assessed as not school ready. Early years services are fragmented and often miss the wider factors that influence a child’s development. These services cost the area £300 million a year but we spend far more than that addressing the subsequent failure. This approach is expected to secure £215 million savings over 25 years on a cohort of children born in particular years for an investment of £38 million. West Cheshire plan to introduce a children’s investment unit and single family assessments.
Young people in Essex are not choosing vocational and skills courses that give them the best chance of a quality career with skills to offer employers. The council are making training employment led through an Employment and Skills Board to address the mismatch between skills of residents and young people and needs of businesses. Directing money in the right way will act as a catalyst for more apprenticeships, creating a more streamlined pathway from education to work and fewer NEETs (not in education, employment or training) by setting out clear choices and opportunities for young people.