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					Fit for Work Service: Programme of Piloting

Selection Questionnaire Part 1

Published on the FFWS webpage 23 rd March 2009
[Based on v0.7, 23rd March 2009]

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SECTION A – INSTRUCTIONS AND GUIDANCE FOR INTERESTED PARTIES

A 1. Purpose of this document:
The purpose of this document is to provide Eligible Partnerships with a questionnaire that is the first part of a three-part open, transparent, competitive application process to become a Fit for Work Service (FFWS) Pilot. Applications can only be made by Eligible Partnerships – see MOI, Section 3 for further details on Eligible Partnerships A good understanding of the FFWS Memorandum of Information (MOI), which is also available to download from the FFWS webpage1, will help Eligible Partnerships in their application process.

A 2. Structure of this Selection Questionnaire Part 1:
This Selection Questionnaire Part 1 is structured as follows: Section A – Instructions and guidance for interested parties, including:    Instructions on completing the Questionnaire; Clarification Question process; and Timetable for completion of this Questionnaire and next steps.

Section B – The Questionnaire is split into five key areas:      Nominated Contact and Eligible Partnership details Local needs assessment Your FFWS Model Cost / funding Other relevant information

Section C – Glossary and Annexes Glossary of terms Annex A – Declaration (to be signed and returned by the Nominated Contact) Annex B – Clarification Question Template Annex C – Partnership structure diagram (to be included by the Eligible Partnership where considered appropriate)

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FFWS webpage: www.workingforhealth.gov.uk/fit-for-work/default.aspx

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A 3. Instructions on completing the Questionnaire
All interested parties should read the instructions below before submitting a response to the Selection Questionnaire Part 1: Instructions: 1. All questions must be answered. If an Eligible Partnership considers a question not applicable to them/their application, they must clearly state why. 2. Each Eligible Partnership should nominate a named Nominated Contact who is responsible for completing this Selection Questionnaire Part 1 and for being our point of contact for this application. 3. Supporting documents should only be provided with Applications where they are specifically referenced and/or where the information is relevant to the question being asked. Supplementary information not relevant to the Selection Questionnaire Part 1 will not be considered in the shortlisting process. 4. Any responses to this Selection Questionnaire Part 1 should be submitted by email. Clarification Question process: 5. Eligible Partnerships may raise Clarification Questions on the Selection Questionnaire Part 1 by emailing ffws@dh.gsi.gov.uk. All Clarification Questions must be prepared using the Clarification Question template appended as Annex B. 6. The closing date for Clarification Questions is Wednesday 15 th April 2009. 7. Responses to Clarification Questions will be anonymised, recorded and published on the FFWS webpage www.workingforhealth.gov.uk/fit-for-work at regular intervals. If any Eligible Partnership considers that a response to their Clarification Question should be treated as commercial in confidence, they should clearly state this, and the reasons why. The FFWS Delivery Team will consider in its sole discretion the request to keep this information confidential (in accordance with the Administrative Arrangements set out in the MOI, Section 6). Timeline and next steps: 8. Responses to the Selection Questionnaire Part 1 must be returned to the FFWS Delivery Team, by email to ffws@dh.gsi.gov.uk by not later than 16:00 hours on Monday 20th April 2009. 9. Applications will be assessed by the FFWS Delivery Team (comprising representatives from the Department of Health and the Department for Work and Pensions, which are jointly supporting this programme) and, where appropriate, colleagues from the Scottish Government and the Welsh Assembly Government. All applicants will be advised of the outcome of this assessment process, via email to the Nominated Contact.

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SECTION B - THE QUESTIONNAIRE
NOMINATED CONTACT DETAILS AND ELIGIBLE PARTNERSHIPS B1. Please provide the name and other required contact details of the Nominated Contact (i.e. the person that will be the point of contact for the FFWS Delivery Team for all correspondence in relation to this Application):
Nominated Contact (name of person): Organisation: Position:

Address:

Telephone: Fax: E-mail:

B2. Please complete the table below with details of each of the members that form the Eligible Partnership; Eligible Partnership Member Name Type of Organisation Registered Address (or equivalent)

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B3. Please complete the table below with details of any other partner(s) already identified for the delivery of the FFWS in your area: Type of Organisation Registered Address (or equivalent)

Partner Name

Eligible Partnerships may wish to illustrate a partnership structure by using a diagram, if appropriate (please include as Annex C). B4. Please confirm that each member of the Eligible Partnership agrees to submission of this application to become a FFWS Pilot and that each of those members has given consent for the Nominated Contact to act on their behalf.

Yes

No

B5. Please indicate which of the following classifications best describes the ‘state of readiness’ of the Eligible Partnership (please mark one box with an ‘X’): Eligible Partnership‘s ‘state of readiness’ An established partnership already running what would qualify as a FFWS An established partnership developing a FFWS model A developing partnership coming together in order to develop a FFWS model Other – please Specify Please mark with an ‘X’

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B6. It is recognised that many existing partnerships already qualify as a FFWS Eligible Partnership. If your Eligible Partnership is based on an existing partnership arrangement, please identify which it is:

Existing partnership arrangements: National Advisory & Advocacy Group (Scotland) Local Workforce Plus Partnerships (Scotland) City Strategy Partnership Local Strategic Partnership Health, Social Care and Well-being Partnership (Wales) Other – please Specify

Please mark with an ‘X’

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LOCAL NEEDS ASSESSMENT

B7. Please indicate whether a local needs assessment has already been undertaken which informs the scope of your FFWS model:

Yes

No

B8. Where a local needs assessment has already been undertaken, please summarise how the findings of that needs assessment inform your FFWS Model:

Eligible Partnerships must write their response in this box
(maximum 300 words)

B9. Please broadly describe how your FFWS model will benefit its intended clients:

Eligible Partnerships must write their response in this box
(maximum 300 words)

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FFWS SERVICE MODEL B10. Please provide an overview of the FFWS model that you intend to deliver. Your overview must including the following information: a. Confirmation that the principal focus of your FFWS model is to provide personalised back-to-work support for sickness absentees – employees off sick from work; and b. Where applicable, a description of any other client types that your FFWS model will support in addition to sickness absentees; and c. The location in which the FFWS will be delivered (name of region / town); and d. Anticipated scale of provision, including catchment area for the following populations, where identified: i. ii. iii. the general population; the working age population; and the population in employment.

Eligible Partnerships must write their response in this box
(maximum 600 words)

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B11. Please indicate which service element(s) you are planning to include as part of your FFWS by completing the table below. Please also indicate if any of the service elements are already in place and which services will need to be developed further, or procured, in order to complete your integrated FFWS model. There is scope to include additional comments about the different element(s) in your FFWS model.
Potential Service Element Is it to be included in FFWS Service? Is it already being provided? Does it need to be developed/ procured to complete your FFWS model? New services are required – but provider partners already in place Further comments if relevant

A worked e.g.: Employer Liaison Employer Liaison Case coordination Psychological therapies Physiotherapy Occupational therapy Rehabilitation care Support for fluctuating conditions e.g. Multiple Sclerosis Support for disabled people Employment advice Social support Debt counselling Housing advice Learning and skills advice Conciliation Other – please specify

Yes

No

The service is currently only provided to private sector employee funded users

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B12. Eligible Partnerships that need to develop or procure new elements for their FFWS model may wish to exchange ideas with Providers delivering such services. The FFWS Information Workshops in March 2009 identified that a broad range of service Providers are keen to make links with Eligible Partnerships to exchange ideas on how their service might contribute to achieving the objectives of the FFWS Programme of Piloting. If your Eligible Partnership has indicated in the table at B11 that it is looking to develop or procure a service element, please indicate if you are content for the FFWS Delivery Team to publish your intentions (alongside those of other Eligible Partnerships) on the FFWS webpage, so that relevant Providers can get in touch with you to exchange ideas. Please place an ‘X’ in one box: Yes, I am content for a list of the service element(s) that my Eligible Partnership will need to develop or procure to be combined with similar information provided by other Eligible Partnerships and published on the FFWS webpage. No, I would not like a list of the service element(s) that my Eligible Partnership will need to develop or procure to be published on the FFWS webpage If you have indicated ‘Yes’ in the box above, for each service element please provide details of the person(s) that interested Providers should contact. Note: In providing these details, you are consenting to them being published on the FFWS webpage.

Service element:

Contact name:

Organisation: Position:

Email/Telephone:

B13. Where appropriate, please take this opportunity to provide a brief description of your proposed FFWS model. This may expand upon the information provided in response to Question B11 above, and will help the FFWS Delivery Team achieve a better understanding of the services you propose are delivered as part of your FFWS model:

Eligible Partnerships must write their response in this box

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COST / FUNDING FFWS central development funding will be made available to FFWS Pilot sites to ‘pump-prime’ pilot activity e.g. to meet the cost of re-configuring existing services or to develop new services to achieve an innovative approach to meeting the needs of the local working-age population. The amount of funding each FFWS Pilot will receive will be dependent on how much funding is required to support applications with the greatest chance of success. To better assess how many FFWS Pilots the central funding can support, it will be helpful at this stage if Eligible Partnerships can provide an indication of how much funding they are seeking from the FFWS central development fund. It is recognised that some Eligible Partnerships are already in a position to provide detailed costings, whilst others are not. Accordingly, the responses provided here are for information only and will not form part of shortlisting criteria.

B14. Please provide an estimate of the funding being sought from the FFWS central development fund: FFWS funding being sought (£)

B15. Please provide an indication of how the funding being sought from the FFWS central development fund would be utilised:

Eligible Partnerships must write their response in this box
(maximum 300 words)

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OTHER RELEVANT INFORMATION

B16. Please confirm that the Eligible Partnership is willing to participate in the FFWS Evaluation, that will be led and managed by the FFWS Delivery Team: Yes No

B17. Where Eligible Partnerships would like to provide further relevant information on their proposed FFWS model, please take this opportunity to do so:

Eligible Partnerships may write their response in this box

(maximum 500 words)

The FFWS Delivery Team are committed to taking on feedback or suggestions on any aspect of the FFWS Programme of Piloting. If you would like to to do so, please email: ffws@dh.gsi.gov.uk

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SECTION C – GLOSSARY AND ANNEXES
GLOSSARY Please refer to MOI, Section 7 for Glossary. Additional terms are listed below: TERM Application DESCRIPTION A completed Selection Questionnaire Part 1 submitted in application to become a FFWS Pilot Questions that are raised on the Slection Questionnaire Part 1 to clarify the requirements or interpretation of requirements/questions A template provided (Annex B) for Clarification Questions to be raised and formally submitted to the FFWS Delivery Team to request a response Fit for Work Service Memorandum of Information The individual who is the point of contact for the FFWS Delivery Team in relation to this Application

Clarification Question

Clarification Question Template

FFWS MOI Nominated Contact

ANNEXES

Annex A – Declaration (to be signed and returned by the Nominated Contact with Application)

Annex B – Clarification Question Template

Annex C – Partnership structure diagram (to be included by the Eligible Partnership where considered appropriate)

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