Stafford and Surrounds’ Health and Wellbeing Group

Commissioned Projects 2015/16

Impact Report (May 2016)

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Contents Page Page

Executive Summary

Context

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4

Introduction 4

The Process and Applicants 6

Delivery and Outcomes 9

Investment and Costs 19

Process Review 20

Future Direction

Conclusion and Recommendations

22

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Appendix A Selection of Promotional Materials

Appendix B Project Scoring System

Appendix C Project Performance Data

This report was produced by Stafford District Public Health Development Officer; Kate Harrold with support from providers and Stafford Borough Council Housing and Health Policy and Performance Officer; Chris Swetmore (June 2016)

Participants from Engage in Nature

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Executive Summary

In November 2014 the Stafford and Surrounds Health and Wellbeing Group launched their second Commissioning Prospectus with the priority areas of; Safe, Supportive, and Healthy Living Environments; Obesity; Emotional Wellbeing; and Frail Elderly. Public Sector commissioners brought 6 funding streams together to create a joint pot of £398,000.00. In total 57 project proposals were received by providers requesting £1.3 million investment in health and wellbeing locally. Of the 57 project proposals 28 were shortlisted, and 10 projects were commissioned at a total investment of £301,568.00 (including co-ordination and monitoring costs). Between April 2015 and May 2016 these projects worked collaboratively across 26 organisations to engage 12,040 individuals, and recruit 533 new volunteers for the Borough. Of those individuals supported 86% reported increased physical activity levels, 85% increased emotional wellbeing, and 87% had a reduced feeling of isolation or loneliness.

Moving forwards with reducing public sector funds, there is a need to change the existing model and do things differently. There is no longer the money to invest in projects, and the focus now must be on environments which promote healthy behaviours and influencing individuals and communities to take control of their own health, and empowering others to do the same.

Therefore the following recommendations have been made to support locality commissioning in the future:

1. With reducing budgets further work is required to engage more partners to ensure locality commissioning is sustainable and continues to deliver the benefits of economies of scale and shared outcomes.

2. Significant work is needed to support development of the marketplace to ensure there is sufficient capacity and skills within the community to facilitate partnership work, support sustainability, and aid joint funding bids.

3. The co-ordination of the commissioning process and paperwork needs to be

improved to enable economies of scale, and support providers working across more than one District.

4. Short term investment does not facilitate sustainability therefore medium to long term commissioning plans are required to enable providers to invest in the infrastructure required to provide sustainable interventions with the capacity to provide outcomes at scale.

5. A new model for prevention and early intervention is needed which facilitates

communities and individuals to build capacity and provide local support responses to local need.

Participants from Feel Good Food

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Context

The Stafford and Surrounds’ Health and Wellbeing Group was established in 2012 as a local response to the National Public Health reforms to ensure district level need and assets were not over looked at a County level. The Group is Chaired by the Stafford and Surrounds’ Clinical Commissioning Group and also has representatives from; Stafford Borough Council, Staffordshire County Council, Health Watch/Engaging Communities Staffordshire, Voluntary Action Staffordshire and Stoke on Trent, Support Staffordshire, Stafford and Rural Homes, Staffordshire University and Stafford Borough Cabinet.

The Group was delegated commissioning rights for health and wellbeing by the Stafford Borough Strategic Partnership Board in February 2015. The 2015 Commissioning Prospectus was the second produced and delivered by the Group after publishing their first Prospectus in 2014 which had a focus on mental wellbeing.

Introduction

Partners need to rethink their traditional responsibilities to consider the wider strategic needs of the population, and how they can work in a cohesive and integrated way. We need new solutions that are built upon the foundations of prevention and early intervention in order to decrease the demand on services with a focus on treatment. (Commissioning Prospectus 2015 Key Principles)

The Stafford and Surrounds’ Commissioning Prospectus was launched by Andrew Donald (Chief Officer Stafford and Surrounds Commissioning Group) at the Group’s Health and Wellbeing Summit in November 2014, which was attended by 156 stakeholders.

It was the first time public sector commissioners had brought their funding streams together and worked in a collaborative way to focus on commissioning projects which addressed prevention and early intervention.

In Stafford the following funding streams were agreed:

Stafford and Surrounds’ Clinical Commissioning Group £90k Staffordshire County Council; Building Resilient Families £50k, Isolation and Loneliness

£17.5k, Public Health £202k, Mental Health £13.5K Office for Police and Crime Commissioner £15k

Sports Across Staffordshire and Stoke on Trent also agreed to potentially match fund up to £10k if projects met the Sportivate criteria

The Borough Council also made in kind contributions of £30k through the District Public Health Officer role who coordinated and managed the locality commissioning process, and the Health and Housing Performance Officer post who monitored project progress.

Total value available £398,000 (£30k of this went towards co-ordination and monitoring

software (Upshot) costs) which makes the total amount available to spend £368,000.00

The Stafford and Surrounds’ Health and Wellbeing Group and Locality Commissioning Hub agreed four priority areas to commit the Prospectus resources against, they were:

Safe, supportive, and healthy living environments Obesity Emotional Wellbeing Frail elderly

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The commissioners stated they were looking for innovative and new ways of working to tackle the priority areas. A number of cross cutting principles were identified which supported the Stafford and Surrounds’ Health and Wellbeing Partnership Pledge which partners signed up to at the Health and Wellbeing Summit, the commissioners would expect to see these principles addressed and evidenced in project proposals, the Principles are shown below;

Stafford and Surrounds Commissioning Prospectus Principles:

1. To make a positive difference and improvement to the quality of life for people living within Stafford and Surrounds

2. To promote and help people and communities take control of their own health and wellbeing and to support them remain independent

3. To work together in new ways to add scale and value 4. To focus on local need and priorities 5. To deliver outcome focussed projects which are cost efficient, and can demonstrate a

measurable improvement 6. To provide a robust line of accountability, and work in a transparent way

Left Andrew Donald (Chief Officer CCG) opening the

Commissioning Prospectus at the Stafford and

Surrounds Health and Wellbeing Summit November

2014

Below right The ‘Demonstrating Outcomes’

workshop ran by Mike Calverley and Rachel Caswell

of Staffordshire Public Health for providers at the

Summit November 2014

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The Process and Applicants

For the first time, rather than asking provider organisations to complete multiple funding applications for the different funding pots, this ‘locality commissioning’ approach allowed applicants to use a single process. This approach also allowed public sector commissioners to co-ordinate decisions, work collaboratively, increase transparency, and reduce duplication.

The Stage 1 process is shown in figure 1 below:

Figure 1 Stage One Commissioning Process

There were no minimum or maximum funding amounts; the commissioners just requested providers developed proposals which involved partners working together in innovative ways to tackle the key areas identified, and were able to demonstrate outcomes in terms of the activities delivered and the return on investment. A guide was provided in the Prospectus as shown below in table 1 below:

Table 1 Stafford and Surrounds Commissioning Prospectus 2015 Guidance For Providers on Funding Amounts

Applications under £10,000 Applications over £10,000

Led by community need with a clear target group, and a qualitative baseline

One off innovative or pilot projects

Have clear measurable outcomes

Demonstrate a collaborative approach to development and delivery

Demonstrate community engagement in project need

Have clearly defined outcomes with measurable improvements

Have a robust financial model

Demonstrate sustainability and long term impact

Stafford received 57 project proposals for the Prospectus requiring a total investment of just over £1.3 million, of these 33% were from the private sector, 21% were from the public sector, and 46% were from the community and voluntary sector. The largest number of proposals focused on Obesity (58%) emotional wellbeing was highlighted in 31% of proposals, Safe and Supportive and Alcohol received 7%, and Frail Elderly received just 4% of proposals.

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Of the 57 applications, 28 were shortlisted and presented to the Commissioning Hub to evaluate, the members of the Hub were; Kate Harrold (Stafford Borough Council), Mike Calverley (Staffordshire County Council), Jonathan Bletcher (Clinical Commissioning Group), Nicky Bromage (Staffordshire County Council), Tracy Redpath (Stafford Borough Council), Harriet Sumerfield (Staffordshire County Council), Narinder Reehal (Staffordshire County Council), and Hester Parsons (Health Watch). The District Commissioning Lead for Stafford Borough Wayne Coombe Chaired the Hub.

The applications were scored across seven areas which were; About you and your organisation; Project need; Outcomes and impact; Added value; Project costings; Sustainability, and About your project. The scoring criteria can be found in appendix B. Across all 28 applications only four proposals were given the highest possible mark. Commissioners felt submissions were generally of a low standard and there were obvious gaps in knowledge with regards to; partnerships, capacity building, sustainability, insight, and demonstrating impact. As a result the minimum scoring threshold was lowered from 65% to 60% and six proposals where identified to progress to the second stage of provider interviews. These project proposals are shown in the table two below:

Table 2 Projects with the highest scores after Stage 1

Organisation Project Name Hub Score Total Cost Funding stream

1 Stafford and Rural Homes

Growing Health

88% £38,340 Public Health, Emotional Wellbeing, OPCC, Isolation and Loneliness SCC

2 Staffs Athletics Network

Be Active groups

66% £11,267 Public Health

3 Stafford and Rural Homes

Branching Out Befriending

66% £37,004 Building Resilient Families, Isolation and Loneliness SCC

4 Staffs Wildlife Trust

Engage in nature

63% £10,000 Public Health, Emotional Wellbeing

5 Home-Start Home-Start; New Futures

63% £42,092 Building Resilient Families, Emotional Wellbeing, Public Health, OPCC

6 Stafford Borough

Walking for health

63% £25,800 Public Health

Total £164,503

The Stafford and Surrounds’ Health and Wellbeing Group approved the process and recommendations of the Commissioning Hub at their meeting in January 2015 agreeing to fund the six highest scoring projects. The Commissioning Hub were also delegated rights to commission the remaining money and asked to carry out the following duties:

Revisit the remaining applications which focused on the Obesity priority with a view to working with providers to develop their proposals to meet the required standard, and if needed develop a new project specification for the Public Health investment

Revisit the frail elderly requirements and develop a project specification

Following the Group’s request the Commissioning Hub went into a second stage of commissioning, which involved working to enhance two proposals and develop an expression of interest for a community nutrition project. They also identified that before any projects for older people could be commissioned there was a need to assess current community provision and needs. This led to the development of an expression of interest for a frail elderly needs assessment. The process is outlined in figure two below;

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Figure 2 Stage 2 Commissioning Process

Following this process, the projects outlined in table three below were also commissioned taking the total of projects commissioned by the Stafford and Surrounds’ Health and Wellbeing Group in 2015/16 to 10. The South Staffordshire Network for Mental Health, which was commissioned by the Group in 2014 to deliver the Mental Health Toolbox in Stafford for £8999 reported an underspend at this time and was also extended until December 2016 and included in monitoring data, increasing the project total to 11 .The total investment on projects during 2015 was £271,568. A full breakdown of cost can be found on page 19. Table three below outlines the additional project spend. Table 3 Projects Commissioned in Stage 2 Organisation Project Name Total

Cost Funding stream

1 Stafford Borough Council Wheels Around Stafford £31,410 Public Health

2 Stafford Borough Council NEET1s Football £16,883 Public Health, OPCC

3 Stafford and Rural Homes Feel Good Food £18,050 Public Health

4 Staffordshire University/ Stafford Borough Council/ Stafford and Rural Homes

Frail Elderly Needs Assessment and Sit Stand Intervention

£40,722 Clinical Commissioning Group

Total £107,065

1 Not in Education, Employment or Training

15 Jan six highest scoring projects

approved by Group

15 Feb two further PH projects

commissioned following

interview and development

15 Mar

Community Nutrition EOI

15 Mar

Frail Elderly

EOI

£271,568k invested

Nordic Walking

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Delivery and Outcomes

We are looking for innovative and evidence based proposals for investments to deliver measurable achievements in the key areas of focus detailed. Projects will need to aim to identify future replicable or sustainable service models that build social value; maximising the impact of public expenditure, and considering more than just financial transaction by including aspects of happiness, wellbeing, health, inclusion and empowerment. (Commissioning Prospectus 2015 Foreword)

The 11 projects monitored during 2015/16 delivered the following achievements:

• 12,040 people were engaged including 2093 supported on an individual basis, totalling 70,110 participant contact hours

• £19.79 invested on each person engaged across all the projects

• 86% increased physical activity levels (of 5232 participants), 85% increased emotional wellbeing (of 449 participants), 87% had a reduced feeling of isolation or loneliness (of 368 participants)

• 1337 sessions delivered totalling 2243 delivery hours

• 533 new volunteers engaged and trained contributing 193 volunteer delivery hours providing a social return on investment of £9,957 (based on minimum wage for 7. 7 hours volunteering per week www.timebank.org.uk)

• 26 organisations working in partnership to support the 8 providers in delivery of the projects

• 72% of monitoring indicators achieved green 80+% (81% achieved amber or green)

• 89% of engagement targets in grant agreements were met by providers

• 150% of session targets in grant agreements were met by providers

• 207% of volunteer targets in grant agreements were met by providers

• The Growing for Health Project delivered by Stafford and Rural Homes and Stafford Borough Council won the regional TPAS award for Excellence in Community Action and will be entered to the National Awards in July 2016.

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To support the Prospectus Principles the projects were mainly focused on providing support for those in need, so most of the projects were targeted at the areas of deprivation across the Borough, Figures three, four and five below show the overall participants mapped against the areas of multiple deprivation (the areas shown in dark brown are the most deprived).

Figure 3 Overall demographic of project participants set against areas of poor health and deprivation (Upshot 2016)

Figure 4 Demographic of project participants in Stafford Town set against areas of poor health and deprivation (Upshot 2016)

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Figure 5 demographic of project participants in Stone Town set against areas of poor health and deprivation (Upshot 2016)

Looking at the Public Health Outcomes data (www.phoutcomes.info) although data for 2014/15 is not yet available the health inequality gap in Stafford Borough has shown improvement during the term of the Stafford and Surrounds’ Health and Wellbeing Group in 2012-14 the health inequality gap value droped from 7.7 to 5.2 for men as shown below in figure 6, but there was no statisical difference for women (7.5 to 7.9).

Figure 6 PH Outcomes Data Men

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Table 4 below shows the individual projects and what they have delivered and achieved in 12 months (April 2015-May 2016). Table 4 Individual project delivery and outcomes

Project Name and Provider

Delivery Outcomes Added Value

Walking for Health

13 weekly health walks (+ development of new walks)

Walking Festival

Door Step Walk maps

Volunteer Walk Leader training

5150 people engaged

53 new walkers

5 new walks developed

33 new volunteers trained

SWEMWBS score improved by 3 points (26 baseline to 29)

Walkers reported an increase in physical activity by 50 mins per week

(* of 53 new walkers)

Joint work with 12 organisations

There are now 602 registered regular walkers in Stafford Borough. There are also 46 volunteer walk leaders registered and trained in the Borough.

In 2015 the Walking Festival included Community Clean Up Walks. Litter pickers and collection bags were provided to parishes. There was also a themed history walk for early years and nursey children at Stafford Castle where children dressed in armour and robes to walk the Castle grounds.

Mental Health Toolbox

62 one to one sessions

(including 2-3 with young carers)

3 training sessions to local businesses

1 full days training session for providers

574 engaged (46 individuals)

Post intervention

60% felt more self-empowered

75% reported a good or excellent awareness of mental wellbeing support services

(*out of 12 participants surveyed)

This grant funding was used in a pilot approach to demonstrate achievable outcomes and SSNMH have now gone on to secure Big Lottery funding for 4 years starting in September 2016.

Wheels Around Stafford

7 8 week Bike Benefit courses

4 Led Rides

2 Maintenance courses

1 Ride Leader course

295 people engaged (59 unique to sessions)

This project supports the Stafford Town Sustainable Transport scheme through a series of courses and pilots projects to promote cycling as a travel choice.

Approximately 2000 children are trained annually in Stafford Borough through a range of cycling programmes including Bikeability. However there was no support for adults, and with the Sky rides coming to Stafford it provided an opportunity to upskill adults to cycle with their children and increase activity for the whole family.

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Nordic Walking

10 weekly sessions (6 week course)

232 sessions delivered

861 contact hours

261 session hours

764 participant attendances (75 individuals)

85 people continuing to walk after the intervention

21% reduction in stress

100% increased physical activity

87% feel their fitness levels have improved

79% have improved emotional wellbeing

72% increased social interaction

44% reduced feeling of isolation/ loneliness

90% increased knowledge of health benefits

(*of 34 participants surveyed)

With the equipment, and interest generated through this pilot the project is now sustainable and continues to run across the Borough.

This project had noted success in the media for support a registered blind man to achieve sustained weight loss and increase his physical activity levels.

A celebration event for all the participants was organised with over 30 people attending on a rainy Saturday morning for a walk at Rowley Park.

Homestart – New Futures

Session hours delivered 773

238 individuals engaged (61 families engaged, 21 supported on a 1:1 basis) 21 families registered to Family Support group 11 families regularly attending Family group 21 volunteers trained 3 parents have returned to work as family life has become manageable. 6 families have addressed health concerns and volunteers have accompanied them to GP appointments. 7 families now accessing playgroups or mums and tots groups who were not using these groups previously 5 families received support on healthy eating with volunteers using the Home-Start ‘Eating well in the first 5 years’ resource pack. (*out of 21 families supported)

Volunteers engaged 19

Volunteer hours 97

Home-start was no longer operating in Stafford, this funding has enabled the project to re-establish itself. They at based in ‘The Hub’ in Eastgate Street and have been able to secure further funding to support more families especially the MOD families moving into the area who are adjusting to less strucured lives.

Growing For Health

4 allotment sites developed

51 growing sessions delivered

42 healthy lifestyle sessions

Session hours

408 people directly engaged 950 indirectly engaged 97% increased physical activity 100% have increased knowledge and understanding 96% have changed shopping

9 organisations working together

4 community groups engaged

144 volunteers

A learning disability youth group (WhyCH) who support socially isolated young people participated and as a result of the project have

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delivered 236

habits 97% have improved their mental wellbeing 100% have improved general health and wellbeing 100% have improved confidence in preparing meals 92% now cook meals from scratch 100% will continue to grow fresh fruit and vegetables next year 83% have improved fruit and veg consumption 91% now do more family activities together 94% feel closer to their neighbours (* from 36 plot holders)

reported individuals have built confidence, developed communication skills, and learnt to work as a team. They said that working on the project has improved mental health and improved behaviour and mood. And that they feel proud to be part of such a facility.

The project is also the winner of the Central Region TPAS award

Branching Out Befriending

Total session hours 224

Overall total Participant contact hours 27,760

Total number of sessions and courses delivered 65

9 active volunteers

45 volunteers trained

15 NEETS engaged

18 parents engaged (2 gaining actual employment)

Of the 18 there were 8 lone parents engaged (3 gaining actual employment)

16 Parents enter further education, training or volunteering

93% of lone parents/parents improved their SWEMWBS score (18 parents)

Of the 15 NEETS engaged:

87% improved their SWEMWBS score

(*out of 18 parents engaged)

72 volunteer training hours

Feel Good Food

25 sessions delivered including; A Healthy You, Teenage Pregnancy Group, Cooking Sessions and Breakfast Club

Engaged with 505 people in total (109 at promotional events, 119 at volunteer recruitment, 277 engaged with at other events)

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Engage in Nature

Number of sessions delivered 73

54 local events delivered inspiring local people to benefit from enjoying and exploring the wild spaces of Stafford

Number of people attending event 574 (46 unique)

92% now visit more green spaces

92% increased mental wellbeing

86% improved health and wellbeing

67% reduced BMI

Warwick-Edinburgh Scale

Average score before event 23.8

Average score after event 25.6

(*out of 30 participants)

Overall regular participants burnt over 228,000

calories, with on average 250 calories being burnt per session.

Also the Engage in Nature Wildlife Walkers walked over 40 kilometres and each took over 60,000 steps to a fitter lifestyle.

83,000 steps taken by participants

Over 100,000 calories burnt by participants

Partnerships, Stafford and Rodbaston college, Northfield Centre, Aspire Housing, Stafford Stroke Club

Be Active

25 sessions delivered

41 people engaged (23 surveyed)

100% increased confidence

23% felt a sense of belonging

100% felt more connected to local community

100% were physically active 7 days after the programme

13% feel less isolated

3 run leaders are trained and continue to lead beginner running courses in the community

Frail Elderly Needs Assessment and Sit Stand Intervention

Frail Elderly Needs Assessment Published Sept 15

83 organisations identified providing 212 services as ‘events’ to the over 75s in Stafford and Surrounds.

qualitative investigation carried out with 19 focus groups (involving >156 participants) 105 one-to-one telephone interviews

Sit Stand Intervention

261 engaged, 35 participants completed the intervention

Number of stands achieved during 30-s Sit-stand test baseline; 7.97 (±3.6) Post intervention8.25 (±4.5)

Proportion of people who used assistance used during sit-stand Baseline 56.7% Post intervention 23.3%

SWEMWBS score (/35) Baseline 24.84 (±5.5) Post intervention 26.09 (±4.5)

(*of 30 participants surveyed)

The Frail Elderly Needs Assessment has been used to support develop the priorities of the Age Well Focus Area of the Stafford and Surrounds Health and Wellbeing Strategy and prioritise projects for its action plan. It has also been used to support to work of the Public health insight team at Staffordshire County Council.

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Outcome Snapshots; below are Here are some examples of project outcomes:

Engage in Nature One off event Questionnaire (average score/10) I have enjoyed the event and met new people 8.5

This event has made me happier in myself 8.6

This event has made me more physically active today 8.2 I feel more confident to explore local wild places on my own and with others 8.6 Warwick-Edinburgh Scale one off events

Average score before event 23.8 Average score after event 25.6

Growing for Health

Nordic Walking

Mental Health Toolbox

Feel Good Food

42% yes

Have you altered your weekly food shopping habits (thinking how you budget

and plan)?

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Case Studies and Feedback

Below are some quotes from project participants:

Mental Health Toolbox “I feel so much better knowing I’m not the only one. I’m going to try a recovery service now and give it a go. I didn’t know all these things existed and I’m so pleased I came” “It felt really great to have someone to talk to and chat about how I felt. I felt so much better after talking about how I feel.” “It’s been so lovely, I’ve really enjoyed it. I feel better now I’ve had a little cry and it’s been really nice to be listened to.”

Walking for Health “This is ‘me’ time and I can switch off from what is happening at home as I am a carer. The I love the surroundings and the group as there are other carers who walk as part of this group, it is nice to catch up and share stories which helps me feel like I am not on my own.” “When I joined, it saved my life. I never really went out to socialise or meet people. But since I started with the group, my stamina and health has improved and I loved the social side of the walking. I did the walk leader training and now I back mark, it means so much to me.”

Nordic Walking

His superb teaching method, his enthusiasm, encouragement and patience has inspired me, and also made it great fun. On the social side, meeting different people, of all ages and abilities, and seeing how they coped with their disabilities through Nordic walking was most enlightening. We have decided to take it up because it is the perfect exercise using the whole body, not just your legs, so that it can be really aerobic, and gives the added bonus of burning up those extra calories. The poles give you stability, and help with balance, which is so important as you get older, and develop joint problems. The fact that you are in the fresh air, and that great "feel good factor" after a good walk is another bonus. It has certainly made a difference to us, and enthused us to take up Nordic walking on a regular basis; the perfect exercise; everyone can have a go and reach their potential.

Growing for Health

“As far back as I remember, people have fly tipped the area. It’s always been dark where nothing positive ever happens”

“The project has helped my Uncle a great deal already. He drank a lot and was isolated in his flat. The project has got him out working in the fresh air with something to focus on”

“I live in a flat with no garden, the space will be ideal for us and it will be great getting our son involved”

Engage in Nature

The individual aged 74 regularly attends the Engage in Nature walks in Stafford. The participant indicated from the consultation she had been an avid walker but was suffering from pains in her back so she wanted to get involved with the ‘Engage in Nature’ walks as they were ‘low impact’ and they also got to find out about local wild spaces. The participant also stated that they had learnt a great deal from the project regarding local fauna and flora and as there were new to the area the project had given them a great opportunity to visit local wild spaces and meet new people. Their response to the questionnaire also highlighted that during their time with the project they feel a great deal healthier and do more walking. In regards their mental well-being since joining the project they said: “I definitely feel uplifted, being in the fresh air and chatting to people makes any problems smaller.” They are continuing to increase the amount of walking they do away from the project and have recently signed up to 12 months of Gymophobics with the fitness levels increasing due to engagement in the project.

Feel Good Food

Danni aged 27 is a single mom with two children, one has severe learning difficulties. Danni is a healthy weight but wanted to eat more regularly as she was only having one meal per day. Her anxiety issues around being in a large supermarket also meant that she didn’t shop regularly enough and had trouble planning meals. Having attended the group for 9 weeks she has made changes to her habits and is now eating breakfast regularly and has been shopping to a larger supermarket. Danni has even entered ‘Race for Life’ in June and hopes to continue making the changes needed in order to complete the 5km run. Danni said “I feel proud that I have been shopping on my own and can shop for me and my children”. “I want people to come and watch me finish the race, and I feel I have more energy” to do it now”.

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Some pictures from the projects:

Investment and Costings

Growing For Health

Walking for Health

Feel Good Food

Nordic Walking

Feel Good Food

Engage in Nature

Engage in Nature

Walking for Health

Wheels Around Stafford

Growing For Health

Nordic Walking

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Investment and Costings As noted earlier in the report the total amount available to spend on a locality commissioning model in Stafford and Surrounds was £398,000.00 however we were only able to commission 10 projects at a total of £301,568.00 (including £30k co-ordination and monitoring costs). There is not a pooled commissioning approach adopted in Stafford and Surrounds so the £86,432.00 of unspent money remained with the partners to commit elsewhere. Projects were commissioned on a performance by results model and received 60% of funding amounts up front, then 30% at 6 months, and 10% on completion of the final project report, the Group agreed in January 2016 that projects could only receive their total funding amount if all agreed project indicators and outcomes were achieved by a minimum of 80% (this is also stated in provider grant agreements). Table 5 below outlines the actual investment amount at the end of project delivery. Table 5 Project Investment Amounts Project Name and Provider

Initial Project Cost

Final investment

Comments

Be-Active Staffordshire Athletics Network

£11,267 £10,140.30 The project was deducted 10% due to under achieving

Branching Out Befriending Stafford and Rural Homes/ Support Staffordshire

£37,004 £33,303.60 The project was deducted 10% due to under achieving

Engage in Nature Staffordshire Wildlife Trust

£10,000 £10,000 N/A

Feel Good Food Stafford and Rural Homes

£18,050 £16,245 The project was deducted 10% due to under achieving

Frail Elderly Needs Assessment and Sit Stand Intervention Staffordshire University, Stafford and Rural Homes, Stafford Borough Council

£40,722 £40,722 N/A

Growing for Health Stafford and Rural Homes, Stafford Borough Council

£38,340 £28,813.36 One of the sites in the proposal could not be developed and included so the costs were revised

Home Start Stafford District

£42,092 £37,883 The project was deducted 10% due to under achieving

NEETs Football Stafford Borough Council

£16,883 £7154 The project was decommissioned in December 2015 due to low numbers

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Nordic Walking, British Nordic Walking

£8917 £8070 Nordic Walking was included in the Walking for Health project proposal, the total cost for both was £25,800

Walking for Health Stafford Borough Council

£17,730 £17,730

Wheels Around Stafford Staffordshire County Council, Stafford Borough Council

£31,410 £28,269 The project was deducted 10% due to under achieving

Total £271,568.00 £238,330.26 £33,238.00 in reserves

Process Review It was clear through the commissioning process that although support was offered through workshops, online guidance, and individual meetings by the Council and Volunteer Action Staffordshire and Stoke on Trent (VAST), local providers in both private and voluntary sector struggled to work collaboratively in an innovative way to develop proposals which met the Prospectus Principles. In response to this VAST ran a consultation with voluntary sector organisations across Staffordshire during April 2015 (there were 6 respondents in Stafford) a summary of their findings for Staffordshire were: Timescales were too tight, particularly for the development of any new partnership

bids, which were actively encouraged by many localities. There was a lack of consistency across application forms, which placed a large

burden on resources particularly for smaller organisations who wished to operate across Districts.

Providers identified a failure to recognise funding interdependencies’ when bidding for service funding into more than one District.

In some Districts there was a lack of clarity around what commissioners were looking for, and providers asked for clearer guidance.

There was a lack of understanding of the inequalities agenda i.e how are the more vulnerable groups in society supported? This was particularly highlighted when previous funding pots which had addressed this agenda were incorporated into the prospectuses without any apparent consideration of the impact to service users of the withdrawal of those services that would no longer be funded due to the changed focus.

In December 2015 the Stafford and Surrounds Commissioning Hub met to reflect and review on the process. A summary of their findings is shown below:

There was inconsistency in the way commissioners provided funding for the process, with some comfortable with funds going into a genuine pooled budget and others insisting on a ring fence (often due to external funding conditions).

It was recognised that without long term (3 year) funding commitment from all commissioners it would be hard for providers to demonstrate long term impacts and sustainable models which is particularly unattractive to the voluntary sector.

Many commissioners on the Hub were also involved in panels elsewhere in the County and reported that different application questions and different scoring methods were being used which was unnecessary, and made the job of evaluating bids more difficult and produced an inconsistent approach for providers.

Commissioning across localities may attract the larger voluntary sector organisations.

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Project outcomes could not be compared equally as some were targeted at hard to reach groups whilst others were to general populations.

Projects were targeting the same groups and creating fatigue in the market especially around volunteers

Many projects had similarities and more work was needed to join projects and providers together to increase scale and efficiency.

Better outcomes might be achieved by investing in few projects at scale as opposed to a larger number of small projects

Further work was needed to support providers demonstrate outcomes and develop the infrastructure needed to support project development

Further work was required to bring other locality grants and commissioning processes into this approach before commissioning could be delivered in a joint and pooled way.

During this commissioning process a monitoring tool called Upshot www.upshot.org.uk was used at an investment of £10,000.The tool was proven to be successful at South Staffordshire District Council where it has been used for a number of years, and Lichfield District Council had also adopted it. All providers were invited to a one day training workshop held by Upshot to support them use the system and also had access to telephone and online support, the providers were asked to complete an evaluation in December 2015 so the Group could review its effectiveness at their January meeting, some of the feedback received from providers is shown below: Positives of the Upshot monitoring tool

Upshot staff supportive and dealt with queries or problems when approached. The system is clear and fairly easy to use, it provides a "live" method of recording

attendance. Great to be able to press a button and print out a report Good that only the 'basics'

need to be entered to log volunteers so they are not bombarded with paper work on their first interaction with the project.

Nice calendar layout for sessions Great to be able to pull up register from previous events, especially when working with regular groups

Negatives of the Upshot monitoring tool

Did not capture the full picture for families to show the distance travelled, for example 12 week reviews

Not clear when linking activities to outcomes and impact. Unable to compare surveys within the programme, has to be exported to excel then imported back in as media.

Not clear, when adding media, to link to activities/sessions It doesn't show social value The system is targeted at sports projects and not suited to the kind of projects we are

working on In March 2016 the Group decided not to continue investing in Upshot they felt it was not the best use of resources given their reducing budgets, they also felt it did not support providers to deliver the monitoring they required to demonstrate difference made at quarterly intervals, and they felt there was some duplication because many providers had their own monitoring systems.

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Future Direction During 2015 The Stafford and Surrounds’ Health and Wellbeing Strategy was reviewed and re-prioritised, the refreshed Strategy runs for 5 years until 2020 and looks to address the primary causes of poor health and wellbeing through a ‘person centred’ approach. It states project delivery will work in a holistic way to identify root cause and address unhealthy behaviours by addressing wider issues, and empowering individuals and communities to engage with service providers and commissioners and take control of their own health and wellbeing. The refreshed priorities as shown below in figure five below align the Strategy with the priorities of the Commissioning Hub which will allow projects commissioned in the future to directly support delivery of the Strategy. Figure 5: Stafford and Surrounds Health and Wellbeing Strategy 2015-20 Focus Areas

The delivery model for the Strategy is based on Focus Groups with Chairs who will work collaboratively with partners to develop action plans and provide commissioning recommendations to the Group. The Strategy Minimum Standards which are shown below have also been amended to reflect local need:

1. To raise awareness and understanding of local assets and support services available

within communities 2. To add value to service delivery through enabling and facilitating joint work between

organisations 3. To enable effective delivery by working with providers to review and shape services 4. To build capacity in communities through supporting individuals, and/or groups to

develop the confidence, understanding, and skills required to engage with providers and influence service provision and delivery

5. People of all ages suffering from low level mental health problems are enabled to manage their condition through supportive community environments

There are two themes running through the Strategy which are; mental wellbeing and community capacity building, this reflects the approach taken by the County Council who are working with the Cabinet Office and the New Economics Foundation (a national think-tank

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who developed the 5 ways to wellbeing) to develop a Staffordshire Strategy for Social Action.

In December 2015 the Group were informed their budgets would be reduced by 51% for 2016/17 and Staffordshire County Council stated no further investment would be made in locality commissioning due to their own reducing budgets and deficit, meaning the Group would expect a further 50% reduction in 2017/18 as shown in table six below. The cut in funding forced the Group to decommission all the projects and a meeting was held in March 2016 to discuss a sustainability plan going forward. The Focus Group Chairs presented their recommendations, and following discussions it was agreed that the projects based on a community development model (Walking for Health, Mental Health Toolbox, Growing for Health and Home-Start) which had been proven to be successful and addressed local needs would be recommissioned for 2016/17 but on a reduced budget. The Focus Groups are also working to develop further commissioning recommendations and project specifications which they will present to the Group for approval during 2016/17.

Table 6 Commissioning Funding 2013 to 2017 2014/15 2015/16 2016/17 2017/18 SCC Public Health £30000* £202000* £81000* 0 SCC Mental Health £10000 £13500 0 0 SCC Building Resilient Families & Communities

£50000 £35000 0**

SCC Isolation & Loneliness

£17500 0 0

CCG £90000 £81000 £71000 OPCC £15000 0** 0** SASSOT £10000 0** 0** TOTAL £40,000 £398,000 £196,000 £71000 *includes £20k contribution for District Public Health Development Officer

** Funding relies on national grants and previous performance and cannot be committed in advance

Wheels Around Stafford

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Conclusion and Recommendations

In conclusion, the commissioning round has achieved significant outcomes for the groups targeted, and the majority of projects have been successful meeting 89% of engagement targets and over exceeded the session and volunteer targets by 150% and 207% respectively. The locality commissioning process has brought a number of commissioners together and established the principle of joint commissioning and pooled budgets. However further work is needed to refine the process so it works well across Staffordshire and supports providers working across District boundaries. There is also a clear gap between commissioner expectations and provider ability to present innovative and outcomes led project proposals and more work is needed to upskill the market place. Moving forwards with reducing public sector funds requires a change to the existing model to maximise impact and return on investment, there is a need to expand partnerships and utilise other existing funding steams and commissioning arrangements such as Voluntary, Community and Social Enterprise (VCSE) infrastructure small grants, and the Community Foundation which is the vehicle used for the Police and Crime Commissioner grants. There is no longer the money to invest solely in projects, and the focus now must be on influencing environments which promote healthy behaviours and facilitating individuals and communities to take control of their own health, and supporting them to empower others to do the same. The following recommendations have been made to support locality commissioning in the future:

1. With reducing budgets further work is required to engage more partners to ensure locality commissioning is sustainable and continues to deliver the benefits of economies of scale and shared outcomes.

2. Significant work is needed to support development of the marketplace to ensure there is sufficient capacity and skills within the community to facilitate partnership work, support sustainability, and aid joint funding bids.

3. The co-ordination of the commissioning process and paperwork needs to be

improved to support providers working across more than one district.

4. Short term investment does not facilitate sustainability therefore medium to long term commissioning plans are required to enable providers to invest in the infrastructure required to provide sustainable interventions with the capacity to provide outcomes at scale.

5. A new model for prevention and early intervention is needed which facilitates

communities and individuals to build capacity and provide local support responses to local need.

Walking for Health

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Appendix A: A selection of promotional materials from the projects

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Appendix B: Project Scoring System

How will your application be scored? Each question will be scored in turn. Once all questions have been scored they will be weighted as per the following tables:

Question Number

Points will be awarded to applications that achieve / provide the following information:

Weighting %

1 About you and your organisation 0 3 Project need 20 7 Outcomes and impact 30 6 Added Value 15 4 Project costings 10 8 Sustainability 10 2 About your project 5 5 Project plan 10

Total Score and Weighting: 100%

The scoring matrix that will be used to answer each question is as follows:

Category Definition Score Unacceptable No response to the question or the response is highly

inadequate/inappropriate/incorrect/ irrelevant. Insufficient information. Does not meet the service specification.

0

Poor Limited response provided or one that only partially addresses the question with a lack of detail. Limited experience. No additionality to current service provision. Meets only certain elements of the service specification/criteria.

1

Satisfactory/Good An acceptable response submitted in terms of the level of detail, accuracy and relevance. Meets the service specification/criteria to the required standard. The response is good but there are some omissions of important factors. Good experience.

2

Excellent A comprehensive response submitted in terms of detail and relevance. Good evidence provided. Clearly meets or exceeds the service specification/criteria and required standard. Provides added value and includes innovative ideas.

3

Please note, any applications scoring a ‘0’ in any question will not be considered for funding by the appraisal panel as the application will be regarded as incomplete/unacceptable a Minimum total score MUST equate to at least 65% to be considered for funding

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Appendix C: Project Performance Table

Scale Key for projects commissioned until May 2016: Green 80%+ achieved, Amber 50% achieved, Red less than 50% achieved

Scale Key for projects commissioned until March 31st 2016 - achieved: Yes / No Strategy Commissioned Projects as of 05.06.16 Organisation

Project Output targets

Current No Scale (on track)

Additional data

Progress Comments

Major Outcomes with participants

Stafford and Rural Homes

Branching out befriending 56 directly engaged (unique participants) 3806 Indirectly engaged

24 vols 24 vols trained NEETs engaged 15 20 Parents and 5 Lone parents gaining employment Parents enter further education, training or volunteering 40

9 45 15 18 parents engaged (2 gaining actual employment)Of the 18 there were 8 lone parents engaged (3 gaining actual employment) 16

Red Green Green Red

Total session hours 224 Overall total Participant contact hours 27,760 Total number of sessions and courses delivered 65 72 volunteer training hours

SARH did not start the project until June as they were unable to recruit a suitable co-ordinator, there have been issues recruiting volunteers and have received no referrals from partners

Out of the 18 parents/lone parents: 93% of lone parents/parents improved their swemwbs score (18 parents) Of the 15 NEETS engaged: 87% improved their swemwbs score

Stafford and Rural Homes/ SBC

Growing for health 36 plot holders across all of the sites

408 people directly engaged 950 indirectly engaged 144 volunteers 4 community groups 4 allotment sites developed 42 healthy lifestyle sessions and mentoring sessions

520 1142 444 3 4 49

Green Green Green Green Green Green

Partipant contact hours 3582 Session hours delivered 236 51 sessions

One site included in the project proposal (littleworth) is not going ahead, therefore the outcomes and targets have been adjusted

36 plot holders: 97% increased physical activity 100% have increased knowledge and understanding 96% have changed shopping habits 97% have improved their mental wellbeing 100% have improved general health and wellbeing 100% have improved confidence in preparing meals 92% now cook

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meals from scratch 100% will continue to grow fresh fruit and vegetables next year 83% have improved fruit and veg consumption 91% now do more family activities together 94% feel closer to their neighbours

Stafford and Rural Homes

Feel good food 376 directly engaged 579 indirectly engaged Unique participants 56

30 volunteers trained 100 service users 60 events

8 349 70

Red Green Green

Participant contact hours 2275 Session hours delivered 95 Volunteer hours 24 2 participants moved into employment

SARH did not start the project until June as they were commissioned via EOI

Out of 56 participants: 98% now have a better understanding of what is meant by a ‘balanced diet’ 97% dietary behaviours have improved 75% have now positively altered their shopping habits 57% have increased the time they spend at mealtimes with family 75% had a reduction in BMI 59% now eat wider varieties of foods

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Staffs Wildlife Trust

Engage in nature 574 engaged 46 unique participants

Number of people attending event 400 Number of sessions delivered 40

574 73

Green Green

Participant contact hours 2967 Session hours delivered 256

Out of 30 participants: 92% now visit more green spaces 92% increased mental wellbeing 86% improved health and wellbeing 67% reduced BMI Warwick-Edinburgh Scale Average score before event 23.8 Average score after event 25.6

South Staffs Mental Health Network

Stafford Toolbox 96 engaged

52 people engaged 2 volunteers in place 1 key worker in place

67 2 1

Green Green Green

This project is not using the UPSHOT software

This project was originally commissioned in the first round in May but due to under expendature has been extended. The project is not on UPSHOT.

Out of 12 participants: 60% felt more self-empowered 50% had a good awareness of services with 25% having excellent awareness

Home Start Stafford and District

Home start; new futures

238

individuals

engaged (61

families,

supported 20

with 8 on

waiting list

for support)

Number of families supported 37

Number of volunteers trained 25

20

21

Amber

Green

Participant contact hours 2451

Session hours delivered 773

Volunteers engaged 19

Volunteer hours 97

The start of the project was delayed because the volunteers needed full training not refresh as orgininally thought

Out of 21 families:

3 parents have returned to work as family life has become manageable.

6 families have addressed health concerns and volunteers have accompanied them to GP appointments.

7 families are now accessing playgroups, twins groups or mums and tots groups who were not

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using these groups previously

5 families received support on healthy eating with volunteers using the Home-Start ‘Eating well in the first 5 years’ resource pack.

Stafford Borough Council

NEETS football – now over 50’s football

100 engaged

76 (total number from the sessions delivered not individuals)

Red

Despite working with the police, BRFC, Families First and Youth Offenders only 2 NEETs engaged with the project, project now widened out to different groups including over 50’s but still low engagement (7 per week)

Project decommissioned Dec 15 when the engagement figure was 7 people

Stafford Borough Council

Walking for health

Total

engaged

5150

Nordic

6800 engaged

5 new walks

600 registered walkers

15 trained volunteers

40 Registered volunteers

Number of attendances

5150

5

602

33

46

Amber

Green

Green

Green

Green

Participant contact hours 29,595

Session hours delivered 276

Participant

There have been issues obtaining data from the Walking for Health national database which went down over the summer and lost client data.

SWEMWBS score improved by 3 points (26 baseline to 29)

Walkers reported an increase in physical activity by 50 mins per week

Out of 34 participants:

21% reduction in stress

100% increased physical activity

87% feel their fitness levels have

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walking

184 unique

participants

350

Number of unique attendees completing training 25

Number of unique attendees taking up Nordic walking 30

764

75

85

Green

Green

Green

contact hours 861

Session hours delivered 261

Total sessions 232

improved

79% have improved emotional wellbeing

72% increased social interaction

44% reduced feeling of isolation/ loneliness

90% increased knowledge of health benefits

Stafford Borough Council

Wheels around Stafford

Total

engaged 295

355 people engaged

15 events/sessions

295 (59 unique to sessions)

15

Amber

Green

Participant contact hours 619

Session hours delivered 122

295 people have engaged sessions (some have been to one or more sessions) 60 individuals in total (unique)

Withheld 10% for under performance

Staffs Athletics Network

Be active

Total

engaged 41

225 engaged though promotion

10 run leaders trained

41

3

Red

Red

There have been issues engaging people in the targeted areas, and with finding leaders from existing running clubs to support

From 23 participants surveyed;

100% increased confidence

23% felt a sense of belonging

100% felt more connected to local community

100% were physically active 7 days after the programme

13% feel less isolated

Withheld 10% for under performance

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