Council-led early intervention pilots are showing it is possible to radically rework public services so those in need get better help.
The Community Budget pilots in Essex, London, Manchester and Cheshire have evolved from the Total Place programme which was launched in 2009.
The pilots 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 findings from the original Total Place programme were confirmed. Large proportions 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 four areas hundreds of millions over the next five years.
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. It is estimated that emergency admissions and days spent in hospital beds or care homes can be substantially reduced.
Threee 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.