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Leicester and Leicestershire

Total Place Pilot

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Total Place: Better for less

• New national initiative looks at how a whole area i.e. ‘place’ approach to public services, can lead to ‘better services at less cost’

• It seeks to identify and avoid overlap and duplication between organisations – delivering a step change in both service improvement and efficiency

• Enables a conversation with Government on any national or regional barriers to achievement of Total Place aims

• Nationally there are 13 official pilot areas

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Key Components of Total Place

Three complementary strands:  ‘counting’, ‘culture’ and ‘customer insight’

The Counting Process : maps public money flowing to & through the place (from central and local bodies), to identify where public money can be spent more effectively

The Culture Process : looks at the way existing cultures (the way we do things) actually helps or hinders the process

Customer Insight : consultation with residents and service users to ensure their views are at the heart of any improvements

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Leicester/Leicestershire Pilot

The Two ‘culture’ themes chosen are:

• Drugs and Alcohol

• Access to Services

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Leicester/Leicestershire PilotThe Count – Key Findings

• Total gross expenditure is £6bn

- £4.3bn local delivery organisations

- £1.7bn NDPB

• Highest local spenders are:- Department of Work and Pensions £1.4bn

- Leicestershire County Council £892m

- Leicester City Council £846m

- University of Leicester NHS Trust £615m

- Leicestershire and Rutland PCT £434m (expenditure excluding acute commissioning)

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The Count – Key Findings• The cost of being in business (corporate management and support

services) ranges from 3% to 11% for the limited organisations analysed. Average = 5%

• Applying this % to local delivery organisations spend in Leicestershire = c£200m is spent on being in business

• Long, complicated and expensive delivery and funding chains

• Audit Commission estimates that every time funding moves through an organisation 20% of funding can be lost in that layer

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Drugs and Alcohol Theme

Framing the Problem

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‘Cost’ of Alcohol MisuseNationally:

• NHS 2.7 billion p.a. (England & Wales) to treat chronic and acute effects of drinking

• 17 million days lost absent from work = cost 6.4 billion p.a.

• 69% increase in hospital admissions (past 5 years)

• 35% of all A & E attendance are alcohol related

• 7,000 road accidents attributed specifically to alcohol

• 1 in 11 children live in families with an alcohol misuser

• 50% of domestic violence linked to alcohol

• 1.2 million incidence of violent crime each year

• 1 million prediction for hospital admissions 2011/12 alcohol primary/secondary factor

• All costs: 8 – 13 billion p.a. (Home Office)

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Children, Young People and Alcohol Misuse

Nationally:

• 22% of 11-15 year olds drink on a weekly basis

• 24% of young people said that they had done something as a result of drinking that they later regretted

• alcohol consumption for girls aged 11-15 continues to rise

• alcohol consumption for boys seems to have stabilised

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‘Cost’ of Alcohol MisuseLeicester/Leicestershire

• Estimated 1 in 5 adults misuse alcohol – some areas 1 in 4

• 45% of reported crime in the region is related to alcohol

• Alcohol related admissions doubled from 5.2k to 10.3k (02/03 to 07/08

• City in top 10 in England for alcohol related hospital admissions

• 32% of the prison population have a drink problem

• City is the most challenged area in relation to alcohol related violent crime in the East Midlands

• the second most challenged in relation to sexual offences attributable to alcohol

• 27th in top 50 most challenged areas in respect of NI 20 & NI 41(Assault with less serious injury & Perceptions of drunk and rowdy behaviour)

• Alcohol is linked to offending for 51% of prolific and priority offenders

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Across Leicestershire & Leicester:

• Up to £16 million to Leicestershire Health Services (and 80,000 bed days)

NHS costs : 05/06 = £10m estimated 09/10 = £16m

• £80 Million cost of crime

Plus costs family impact, clean ups, benefit costs, absenteeism, RTA’s, Safeguarding children, etc.

• £120 million local expenditure on alcohol every year

‘Cost’ of Alcohol Misuse

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Drug & Alcohol Theme Objectives

1. Reduce misuse & its impact on our Place

2. Reduce the costs of misuse

3. Improve outcomes for service users

4. Reduce inefficiencies in handling misuse

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1. Increase Focus

on Prevention

7. Joint ‘Place’ Commissioning Structure, Budget, Performance Framework & Approach

6. Access to Treatment in‘Integrated Offender

Management’

2. ReduceAlcohol

Availability

3. ImproveLate Night Economy

5. DevelopCoherent Treatment Systems &Pathways

4. PilotMulti

Agency ED

Solution Components..

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Solution Component 1: Prevention & Young People

1. Mainstream education & awareness to all young people2. Target family/parenting programmes to ‘at risk’ families3. Skill up children’s workforce around substance misuse i.e. advice &

info 4. Reduce emphasis on ‘specialist’ treatment

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Solution Component 1: Prevention & Young People

• Prevention better than cure?

• Change perceptions & behaviours around substance use – particularly alcohol– Normative approach?– Positive influences?– Role of ‘the family’ & peers

• Pilot a ‘Place’ Social Marketing Campaign targeted to young people– Supported by National ‘normative’ Campaign?

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Solution Component 2: Reduce Availability of Alcohol

Seek Local Support for following interventions:

• Sale in the Late Night Economy across ‘Place’– Reduce undercutting – Cessation/reduction of promotions– Minimum price for a drink

• Strengthening Licensing Powers– Single approach across 8 areas– Use all available legal powers– Implement good practice i.e. density & no. of premises

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Solution Component 2: Reduce Availability of Alcohol

Seek National Support for:

• Pricing of Alcohol– Minimum price per unit – Targeting high volume low cost brands

• Loss Leading– Influence supermarkets to cease/restrict loss leading on alcohol sales

• Strengthening Licensing Powers– Compulsory Code of Practice for licensees? i.e. challenge 21– Increase legal responsibility of licence holder & owner – Stronger sanctions for underage sales– Legal sanctions for sales to ‘over the limit’

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Solution Component 3: Improve Late Night Economy

• Compare and Contrast– County and City– Map Costs Of Servicing– i.e. Policing, Licensing framework, Street Cleaning, Street

Lighting, CCTV, Repairs

• Explore the Role of ‘Calming’ Influences– i.e. Volunteers/ Street Pastors in clubs and pubs

• Champion & Promote Good Practice in Licensed Premises– i.e. Best Bar None Awards

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Solution Component 4: Pilot Multi Agency ED for Alcohol Misuse

Currently universal provision – 1 size fits all

• Substance Misuse and urgent health need & repeat admissions?• ED & Custody Suites = Expensive? Appropriate? Disruptive?• Root cause effectively addressed currently?

Pilot: safe, improved alternative with:• Range of relevant services & agencies – Multi-agency approach• Brief interventions• Referrals to treatment• Better identification & address dual diagnosis needsAim: Improved outcomes & Reduced costs

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Solution Component 5: Develop Coherent Alcohol Treatment

Opportunities:• Well established treatment system for ‘drugs’• Redesign of drug treatment system across Place underway• Systems Change Pilot area (1 of 7 nationally)• Opportunities for efficiencies through redesign process &

redistribution of resources • Alcohol treatment ‘Cinderella’ • Piecemeal commissioning from several organisations• National/local ‘Pooled Alcohol Budget’

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Solution Component 6: Integrated Offender Management

2007 work started on IOM

March 11March 10November 09

Integrated Offender Management

Vigilance

System Change

Total PlaceLi

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Integrate access to Alcohol Pathway within Offender Management

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Total Place Joint Commissioning Structure

• Join up drugs and alcohol commissioning • All relevant agencies jointly commission drugs

and alcohol services (PCTs, LAs, Probation)• Pooled budget & resources at the table• Subregional Commissioning Board, but retain

city and county commissioning groups

(Total Place not One Place)

• Review performance frameworks & targets

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Drug & Alcohol Barriers Localor National

Different performance management frameworks with different KPI’s across key organisations

National

Funding for Drug & Alcohol is managed by different departments centrally which impacts at local level

Ring fenced pooled substance misuse treatment budget excludes alcohol unless a dual drug & alcohol misuser & restricted to Class ‘A’ use

National

Drug treatment can be mandatory as part of criminal justice but alcohol treatment tends to be voluntary

National

Focus on negative media messages of young people rather than promoting positive behaviours sought

Local & National

Role of supermarkets and ‘loss leading promotions’ in increased consumption & subsequent problems for communities, families & individuals

National

Protocol for decision making where movement of resources required between organisations

Local

Under use of local licensing powers & inconsistency of approach & enforcement across areas

Local