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Patrick MyersDorset County Council

*Change Matters

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*Key drivers for change

*Deficit reduction

*Public sector reform

*Transforming

*New models and practice

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*What is commissioning?

*Put simply, we “commission” in order to achieve outcomes for citizens, communities and society as a whole; based on knowing their needs, wants, aspirations and experience.

*Use an integrated approach to better understanding citizens and communities and using this insight to work more effectively in order to secure better outcomes and allocate resources.

*What is commissioning?

*The approach also acknowledges the whole-system and interdependencies between citizens, communities, organisations and services.

*The focus must be on commissioning FOR outcomes rather than simple commissioning OF services

*The challenge

*The challenges to public funding mean transforming the delivery of public services is more important than ever; joint commissioning, fostering innovation, systems thinking, co-production and co-design with service users are key to finding greater efficiencies and better productivity.

*New Spectrum and Model

Present Policy   A model that includesFocus on Deficiencies

  Focus on Assets

Reactive response   Opportunity Identification

Charity Orientation Investment OrientationGrants and contracts to agencies

  Grants, loans , investments, leverage

More Services   Fewer Services High emphasis on agencies

  Emphasis on associations

Focus on individuals Focus on communities and neighbourhoods

Maintenance   Development

See people as Clients

  See people as Citizens and Co producers

Fix people   Develop potential Programmes are the answer

  People are the answer

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*Currency of Outcomes is Change

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*Fixations

Value

QualityOutcome

Maximum ValueRight OutcomesBuilt on quality

Service User Experience

*Value

*Value

*VFM (outcomes linked)

*User value

*Value to wider group

*Political value

*Social value

*Environmental value

*Outcomes

*Change

*Skills

*Knowledge

*Attitude

*Behaviour

*Circumstance

User valueValue to wider groupPolitical valueSocial valueEnvironmental value

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*More than one

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*Parenting

*Peep

*Incredible Years

*Triple P

*Strengthening Families

* and………..

*IMPACT

*Background • 3 to 16 years• Parent , child/young person & teacher

completion• Explores: conduct problems,

hyperactivity/inattention, peer relationships, pro-social behaviour

• Vaild, reliable, effective in measuring outcomes

• Can help identify issues and inform goals

Strengths & Difficulties

Questionnaire (SDQ)

• Any age child/young person• Parent completion• Explores: child development, parenting

capacity, family and environmental factors

• Valid, reliable and effective in measuring outcomes

• Enables setting and measurement of personal & family goals

Parent Concerns

Questionnaire (PCQ)

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*Methodology

Pilot for 1 year

Automated calculation

toolkit

Pre and post programme completion

4 month follow up

Central collation &

analysis

*Results

Christchurch

East Dorset

North Dorset

Purbeck West Dorset

Weymouth & Portland

1 1 3 1 3 2

The Participants (110)

Number of Programmes (11)

*Results – levels of difficulty

*Results – types of issues

*Results – completion rates

-60.0% -40.0% -20.0% 0.0% 20.0% 40.0% 60.0%

Emotional Symptoms

Conduct Problems

Hyperactivity

Peer Problems

Pro-social Behaviour

Significant Borderline Normal

*Results – impact of programmes

*Results- snapshot

82% •Reduction in total difficulties

57% •Reduction emotional symptoms

70% •Reduction in conduct problems

59% •Reduction in peer problems

61% •Increase in pro-social behaviour

80% •Reduction in stress

44% •More fun with child

46% •More confidence child will do as asked

45% •Felt good about child more often

39% •Child seemed happy more often

*Results - overall

76% •Improvement in problem situations

91% •Improvements in child’s problems

93% •Found course extremely or very helpful

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*Message

*Change Matters

*Value for money matters

*Impact Talks

*Investment Orientation

*Sustained Change

*`Proximal and Distal Outcomes

*Make the case for your theory of change

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*Questions?

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*Cost Avoidance

*Theory of Change

*Measuring Prevention

*Outcomes- Yes again

*Maximising Value

*Making the case-saving money

*Information- what it looks like

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*Why?

*Making Life Better

*Beneficiaries

*Releasing Resource

*Enabling me to do more with what I have

*Moral Purpose

User valueValue to wider groupPolitical valueSocial valueEnvironmental value

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What if?

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*Family Intervention

Calculator

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*Database of Costs

Economic pay-offs per £1 investment NHS

Other public sector

Non-public sector

Total

Early identification and intervention as soon as mental disorder arises

Early intervention for conduct disorder 1.08 1.78 5.03 7.89

Health visitor interventions to reduce postnatal depression 0.40 - 0.40 0.80

Early intervention for depression in diabetes 0.19 0 0.14 0.33

Early intervention for medically unexplained symptoms 1.01 0 0.74 1.75

Early diagnosis and treatment of depression at work 0.51 - 4.52 5.03

Early detection of psychosis 2.62 0.79 6.85 10.27

Early intervention in psychosis 9.68 0.27 8.02 17.97

Screening for alcohol misuse 2.24 0.93 8.57 11.75

Suicide training courses provided to all GPs 0.08 0.05 43.86 43.99

Suicide prevention through bridge safety barriers 1.75 1.31 51.39 54.45

Promotion of mental health and prevention of mental disorder

Prevention of conduct disorder through social and emotional learning programmes 9.42 17.02 57.29 83.73

School-based interventions to reduce bullying 0 0 14.35 14.35

Workplace health promotion programmes - - 9.69 9.69

Addressing social determinants and consequences of mental disorder

Debt advice services 0.34 0.58 2.63 3.55

Befriending for older adults 0.44 - - 0.44

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*Narrative

*Headlines

*Stories behind the headlines

*Sustained Change- checking

*Logic Models

*Systematic and robust

*Performance Orientation

*Knowing your theory of change

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*It’s all about people