There is also a second target by which the government have set in relation to the standard which has previously been mentioned above is to initialise key workers such as psychologists, health workers and youth workers to work with teachers within school. This is to make sure that children’s issues and problems can be sorted out swiftly, which will reduce disruption within the individuals. This scheme is called ‘full-service extended schools’ and also aims to provide the children at school with after school activities which will help maintain their needs of the children, and to support their families further, in the case of having to work late.
Objectives
There are specific objectives which relate t the targets which were set by the ‘every child matters’ scheme:
These examples all show how teachers, parents and health and social care professionals can all work together to help improve the quality of life and the learning experience of children within schools.
Who are the planners?
‘Stakeholders’ are the individuals who have the responsibility to oversee what whether the services that they represent have the resources to prove effective services. Examples of the main planners include:
- Local authorities - these ‘stakeholders’ provide finances for local community services.
- Private fund holders - these are insurance companies who provide for care.
- Voluntary and community sectors - this includes charities and support groups.
- Social service purchases - these are the representatives who are responsible for buying services.
- Patients and the public - these are the people who use the services, and who may use it.
- NHS - these are the executive members of the primary care trusts/ groups/ organisations who have the money for the purchasing of services. Under the NHS there are also three other take holders; they include the local education departments which are the providers of services within places such as the ‘sure start’ centres. There are then the GP services that purchase the services on behalf of the local GP’s. There is then finally the service users themselves.
In order for planning there is a need for it to take place for a 3 year cycle in advance. Primary care trusts/ organisations/ groups (PCTs/ PCOs/ PCGs) and local authorities are the essentials which are required to lead the community. There are expectations for the following years and the groups are required to follow the ‘local strategic partnership’ (LSPs) to prepare ‘local delivery plans’.
Due to this change, planners now have to move away from the targets which are set at a national level, and more towards the local demographical variables on different areas. They now have to make targets which are:
- More addressed towards local provision
- Where standards become the main driver for continuous improvement
- To make sure that all of the organisations play a part in the modernisation of the services.
- Aware of the incentives which are in support of the system.
The system of planning in interrogated in that it involved a planning framework, national standards are taken into account and there are payments by the results system. The ‘national service framework’ enables there to be local targets which are placed alongside the national level of targets, this therefore allows there to be more specialised care for the people in certain areas than others. The quality of service provision is supported by the ‘national service framework’ (NSF) and ‘the national institute for clinical excellence’ (NICE).
These are several principles for local planners which have to be taken into account of. The local target settings are:
- The targets are developed in partnership with others
- The targets are in line with the population needs
- The targets address the local service gaps
- The targets offer value for money
- The targets deliver and equity
- The targets are evidence based
The way in which services are commissioned
Purchasing a range of services for local communities is what is known as commissioning, there are able to purchase a range of services which will help the community, the services include those which are needed to improve health and social care within the area, there are all paid for from the unified budget. This unified budget is based around the population, which would be around 100, 00 which also includes to 50 GP’s also involved. Different levels below shows the organisation of the complex system of commissioning.
Level 1 - PCG is an advisory sub-committee of the local health authority.
Level 2 - PCG is a sub-committee that manages a budget devolved to it by the local health authority.
Level 3 - PCG is a free standing body accountable to the health authority for commissioning services for primary community health, and hospital services for its patients.
Level 4 - A free-standing body accountable to the health authority for commissioning primary community health and hospital services and for providing primary and community health services.
The commissioning of services is still part of the purchaser- provider system, whereby it is an organisation that buys, or provides good and services. This system has meant that organisations such as the health authority or local authority social services would purchase the services from those whom would provide the services. April 2004 was the year by which the ‘commissioning for health improvement (CHI) occurred; the idea behind this was to publish the reports which would present the quality of services which had been regularly monitored. This has since been changed to the ‘commission for healthcare audit and inspection’ (CHIA) who work is relatively the same in that they are re-evaluating the concept of the ‘clinical governance’. The clinical governance ‘is a system through which the NHS organisations are accountable for continuously improving the quality of their services and safeguard high standards of care by creating an environment in which excellence in clinical care can flourish’.
New financial incentives which have been introduced by the government also are paid attention to when commissioning services. This is also known as ‘payment by results’. which are also related to the ‘commissioning levers’. they also include:
- To ensure that sustainable out of hours are commissioned to meet the quality standards, appropriate contracting, monitoring and performance management arrangements needs to be available.
- Services such as the ‘general medical services’ (GMS) and the ‘personal medical services’ (PMS) are available to deliver preventative services which have high standards of care to those who suffer from chronic diseases.
- Contracts support the flow of funds to providers where patient choice demands them; flexible contracts need to be readily available for people required planning hospital care.
- Agreeing explicit criteria for referral and treatment.
All stakeholders are involved in the commissioning process fro effective budgetary management
The process of commissioning
✱Meeting of stakeholders to discuss:
- What is needed?
- Who can supply?
- When it is needed?
- Costs that can be afforded?
Then
✱Drawing up of the contract to include:
- The service required
- Specifications
- Time schedule
- Budget
- Commissioning levers/ quality assurance
Finally
Awarding the contract
The process of monitoring is the seeking of information about what is being done and recording the outcome.
Evaluation is where an investigative process to determine whether a process is cost effective or whether the objective are achieved. An evaluation involves making judgements and then therefore, leading the conclusions.
Strategic health authorities (StHAs) are the organisations which carry out the monitoring and the services . Here below is the structure of the health and social care statutory services:
✱Department of health
✱Strategic health authority (StHA) (Leadership and performance management)
✱Performance and care organisations/ trusts (Major purchases and providers)
✱NHS trusts )Providers of secondary care and specialists services in hospitals)
The ‘national institution for clinical excellence’ (NICE) can also carry out the monitoring and evaluation of services. The idea behind this organisation is to provide a rationale for the use of the resources, this therefore leads to the analysis of the resource, which helps decide what is cost effective and what is not, and what is clinically effective. The guidance from the ’national institute for clinical excellence’ is there to provide clinicians with the use of treatments which are cost effective and will have the best response from their patients.
The ’national clinical assessment authority’ (NCAA) is another source of monitoring and evaluation, this organisation was put in place in 2003. This organisation is different in that it help monitor the performance of individual doctors when PCO’s/ trusts and community trust have any issues with any single individual, therefore their work involves:
✱Providing advice
✱Carrying out assessments of an individuals work
Methods that can be used for monitoring and evaluation can include:
✱Questionnaires
✱Interviews
✱Observation
✱Statistics
Local delivery plans (LDP’s) are monitored on a regular basis and are evaluated this is to make sure that they are effective in meeting the needs the service users and the stakeholders.
The demographic which I am going to look at, which affects local planning within the region of Milton Keynes is the amount of lone parent households with dependant children, and the amount of unemployed individuals which support dependant children. The statistics which I have found were from the office for national statistics. The statistics show that the counts for all lone parent households with dependant children were 6, 281. However this number is then divided into several different categories including whether the lone parents is 734, from this amount 494 of these are in full-time employment and 40 of those are in part-time employment, therefore this suggests that the difference in numbers would be that a number of the males who are lone parents were in the in the unemployment rota, which would be approximately 200 males who are unemployed. The statistics show that the total number of households who have female lone parents is 5, 547 out of these there were 1, 476 were in full-time employment and 1, 415 were in part-time employment, therefore again the difference suggests that 2, 656 of the lone parents are unemployed. There are several reasons why many on the lone parent families with dependent children are in the unemployed category, the main reason could be that of childcare.
By looking at these figures there are many ways in which the Milton Keynes region can change provision and organise planning in order to reduce the amount of unemployed single parents. For a single parent to survive within communities they will need the help from local planning to do required to provide for. The certain services by which the unemployed single parents would require is that of nearby health care places such as doctors surgeries, dentists and other NHS specialists units, the social services by which the local area of Milton Keynes would require are nearby schools and playgroups. Other services which are required for the employed and the lone-parent families with the dependant children is that the required public transport, which will reduce the transport barriers which often many unemployed individuals may face. Also due to that possible lack of income there should also be schemes out in place for affordable housing whereby families are able to live in adequate circumstances. Below is the outline of the standard, target and the objectives which the local planners will aim to achieve in the future:
The standard which is required for the demographic of unemployment within the lone parent families of Milton Keynes is to recognise that in order for the families to function properly within their homes and within society, there needs to be an increase in the number of services which can be provided to these families, also there needs to be an increase in the education of families whereby the parents/guardians are aware of the services which can be offered to them and also to create more of an incentive for them to go out and look for work, which would be the most ideal option for all of the individuals concerned, this would then therefore reduce the number of people who are labelled as unemployed and could possible create in a way better role models for children who grow up in the families, rather than following the trends of those around them and leaving school and depending on the government.
This initiative of the local council, will recognise that children from lone-parent families may not receive all of the attention and education which may be required from those who from nuclear families, therefore they could possibly be more susceptible to illness and may possibly be in a more unsafe living area, however this is not necessarily only occurring to those in lone-parent families, although trends do suggest that it occurs more often within the inner town centres in lone parent families. The aim therefore will be to educate children of the rights and wrongs of street crime, and also to educate parents, another aim will be to help parents to be happy and content leaving their young children in the care of other while they get part-time work which will also help them to achieve economic and social well- being. So if the services were provided to them then they will able to gain independence and feel content within themselves, which will change patterns within family life, but will also take the strain off of local councils with them increase payment of state welfare.
The target for these services of education, health and social care will for it to be complete within the next 5 years, which will be around June 2015, play group centre will be offered to parents with young children between the hours of 8am and 6pm, which will be give parents/ guardians the opportunity to have several full days in employment. The council also aims that the transport network will have an increase in the journeys which it makes, and the areas that it attends, this will give the individuals more reason to try and attend work, without excuses of the transport barriers which they previously may have faced.
The target of new affordable housing schemes which will give individuals which were previously relatively dependent on the state, the opportunity to become financially dependent, with instead of the economic support from the state, they will gain social support in that they will; be given a number of hours a week of child care depending on the age of their child, they will have nearby services such as a primary school doctors surgery and dentists surgery.
The objectives are in the table below for the specific two demographic variables of the number of unemployed people and the number of lone parent families within the local Milton Keynes: