Beyond Places of Safety

Application fort a Department of Health Grant 2017-18

Application for Funding Template Part 1A
Local Crisis Care Concordat (CCC) Group - Contact Details
Bids must come from a local Crisis Care Concordat group, with evidence that it has been developed and agreed by that group as a whole and reflects local partnerships and joint planning arrangements. Bids must be made jointly on behalf of organisations within your local CCC group. Bids must involve local CCGs and be supported and sponsored by local STP groups. All bidding organisations must complete parts 1A, 1B, 1Cand 1D of this application form. If the bid includes funding for any non-statutory organisation (Charities, Social Enterprises or Civil Society Organisations) then part 2 of the application form must also be completed. For practical purposes, payment must be made, and the resulting asset owned, by one lead organisation. You will be asked to provide details of this organisation below. Please also enter a word count at the end of each completed section where asked to do so. Answers breaching the word count will not be considered. Bidders must not in any other way amend,reorder or reformat this application form.
Within the CCC group, one organisation must be nominated to receive funds, with the agreement that it will own the asset when completed or improved. This organisation must demonstrate the agreement of its Chief Executive or Director of Finance to receive the funding.
Lead organisation name (i.e. the organisation to receive funding and own the asset)
Lead organisation address:
Nominated Single Point of Contact (within the lead organisation)
Name / Email / Telephone number
Project Director Contact Details
Name / Email / Telephone number
Finance Director Contact Details
Name / Email / Telephone number
Project Sponsor Contact Details ( e.g. CEO of a VCS organisation or appropriate Director of Finance)
Name / Email / Telephone number
By signing this application you are confirming that this capital award will be utilised only for the project described in this application, and by no later than 31 March 2020. Bidders are also confirming their willingness to report on project outcomes and share learning from the project. This will include, but may not be limited to, a final report twelve months from the date funding was awarded
Bid validated by CCG representative on CCC [100 words maximum]
Word count:
Submission signed by CCG representative on CCC:
Name: / Signature: / Role in organisation: / Date:
Bid supported and sponsored by STP [100 words maximum]
Word count:
Submission signed by STP Sponsor:
Name: / Signature: / Role in organisation: / Date:
Submission signed by Lead organisation Sponsor or Finance Director:
Name: / Signature: / Role in organisation: / Date:
Project Details
Project Title:
Main Project Address:
Note: For projects with multiple addresses please include all address by inserting additional project address rows. e.g. Project Address1, Project Address2 etc.
Concise summary highlighting the key aspects of the proposal [400 words maximum]
Word count:
Detail total amount of capital required and spending profile up to 31/03/2019
(please indicate amounts required for 2018/19 and 2019/20 respectively)
Confirm total amount of capital funding required: £
Application for Funding Template - Part 1B
Describe how your proposal satisfies the funding evaluation criteria
Please read the supporting guidance documentation before completing the application funding template. Add response to all the evaluation criteria listed below.
Criteria: / Bidder Response:
Partnership Working and Joint Planning:
Please describe in brief the joint working arrangements between local Crisis Care Concordat members delivering care to people vulnerable to, experiencing or recovering from a mental health crisis. / Maximum 200 words
Word count:
Please describe how the project has been developed and agreed by the CCC group as a whole and how it reflects or builds on local partnership and joint planning arrangements for urgent and emergency mental health care, including wider STP plans. / Maximum 200 words
Word count:
Legislation:
Describe the steps taken to ensure that the project will comply with all relevant legislation (e.g. Planning law, the Public Sector Equality Duty, Health and Safety legislation and the Mental Health Act). You may attach further accompanying evidence alongside your bid. / Maximum 300 words
Word count:
Demand
The bid should indicate the level of demand locally and how the proposal will help to meet this. This might include:
  • How the project will help to meet a shortfall in local capacity for supporting people who are vulnerable to, experiencing or recovering from a crisis.
  • How the project will reduce the incidence of detentions under sections 135 or 136 of the Mental Health Act
  • How the project will reduce the inappropriate use of police cells for those detained under the Act.
  • How the project will reduce attendances at (or use of) A&E Departments by people experiencing a mental health crisis.
  • How the project will reduce use of inpatient acute mental health beds.
/ Maximum 350 words
Word count:
Sustainability: As only capital funding is available through this scheme, proposals that require revenue funding (e.g. for staffing) will also need to set out the agreed local sources for revenue funding on a sustainable basis. If this service requires staffing, please briefly set out the staffing arrangements needed and how this will be funded?
Do commitments exist to provide an on-going funding stream for a sustained service that will remain fully operational after the capital funded project completes? Please provide a brief summary. / Maximum 200 words
Word count:
Delivery:
Please describe how the following criteria will be fulfilled.
  • The project will be delivered by 31st March 2020 at the latest.
  • The plan includes how qualitative and quantitative data will be collected to measure the impact of the project.
/ Maximum 200 words – project plans with timelines for delivery may be attached alongside your application.
Word count:
Is any of your requested budget attributed to communications/digital activities in any given year?
 Yes
 No
If your requested budget includes an element for communications/digital activities in any given year please explain why the relevant outcomes cannot be reached through methods other than paid for communications/ digital activities. For the purpose of the controls 'digital' has been defined as: "Any external facing service delivered through the internet to citizens, businesses, civil society or non-government organisations". The restrictions cover areas such as changing the functionality of an existing website, such as having a new menu. However, creating new content on an existing website would not be covered. For further guidance please contact the
Maximum 350 words
Word count:
Application for Funding Template - Part 1C
Describe how your proposal satisfies the Funding Evaluation Criteria
Note: Please read the supporting guidance documentation before completing the application funding template. Add response to all the evaluation criteria listed below. If you cannot respond to any of the criteria please put a N/A into the relevant bidder response box. Failing to respond to the listed criteria may have a negative impact on your application.
Criteria: / Bidder Response:
Improved access and quality of care (bids must demonstrate how they will improve access to crisis care for children and young people, or adults or both)
If your project will improve access and/or quality of care for children and young people please describe how? You may wish to consider some of the following within your answer.
  • Having considered the special additional needs of children and young people requiring support (social, developmental, peer support).
  • How the facility will support management of behaviour that makes a person unsafe to themselves or others.
  • Consideration of some of the special logistical and legal challenges associated with providing care to CYPs (e.g. parental/carer consent, safeguarding, escorting)
  • Willingness to accommodate CYPs who may be under the influence of alcohol or drugs.
  • Consideration of CYPs with additional needs (e.g. disability, physical health needs, special communication or language requirements etc...)
  • Consideration of equalities in relation to protected characteristics and the need to help service users from all backgrounds feel included
  • Numbers of CYP expected to benefit from the project and the basis for these estimates.
/ Maximum 400words
You may leave blank if your proposal does not relate to children and young people
Word count:
If your project will improve access and/or quality of care for adults and older adults please describe how? You may wish to consider some of the following within your answer.
  • Having considered the needs of adults who may be prone to a crisis, in crisis or recovering from a crisis (social, developmental, peer support).
  • How the facility will support management of adults in crisis including management of behaviour that makes a person unsafe to themselves or others.
  • Willingness to support adults who may be under the influence of alcohol or drugs.
  • Consideration of adults with additional needs (e.g. disability, physical health needs, special access requirements or additional needs relating to older adults etc...)
  • Consideration of equalities in relation to protected characteristics and the need to help service users feel included.
  • Numbers of adults expected to benefit from the project and the basis for these estimates.
/ Maximum 400 words
You may leave blank if your proposal does not relate to adults
Word count:
Evidence base supporting approach
Please provide a summary of evidence available to support the effectiveness of the proposed approach to be supported by this investment. In particular
  • Evidence in support of efficacy of proposed service/approach to supporting people who are vulnerable to, experiencing or recovering from a mental health crisis.
  • Evidence of the project’s alignment with local and national priorities.
  • Evidence of the numbers of the target population for this funding already supported by the bidding organisation within the CCC.
  • A clear description for how the organisation will measure and monitor service user outcomes and experiences and follow up on users to demonstrate efficacy and the impact of the approach.
You may refer the evaluation panel to external links but these must be in addition to, not instead of, a summary description. / Maximum 350 words
Word count:
Detail of specific plans
Applicants should demonstrate that their bids are fully costed and provide details of quotes obtained from contractors as part of the application. In particular
  • Details for how the costs have been worked up and arrived at.
  • Details for how funding will be spent to deliver the project.
  • What steps CCC partners have undertaken to assure themselves that the project will meet the needs of service users.
Additional evidence, such as quotes from contractors, and a project plan spreadsheet can be attached to the email alongside this completed application form. / Maximum 350 words
Word count:
Expected longevity
Please give details for how long facilities funded by the capital investment are expected to last and brief rationale. / Maximum 100 words
Word count:
Application for Funding Template - Part 1D
Commitment to fund any discrepancy in project costs
The Department of Health (DH) will not be held liable for any discrepancy between the total capital requested at Section 1A of this application form and the actual final costs of the project. However DH will also not contribute to a project that cannot be completed due to lack available resources. We are, therefore, looking for a commitment from a partner (or partners) within the CCC group to fund any shortfall between the bid costs and the actual final costs of the project. Please ensure the section below is completed by the CEO of any VCS organisation and/or appropriate Finance Director(s) of any NHS or wider public sector organisations who are part of this bid to confirm this commitment. If the commitment to fund any shortfall is being drawn up between multiple organisations within the CCC group then all partners need to confirm this commitment and detail the percentage of any shortfall for which they will be liable. If more space is required for signatures then an additional form can be included alongside your bid.
VCS CEO or Finance Director Contact Details
Name and position / Email / Telephone number
Extent to which your organisation will be liable for ensuring completion of the project (please give details)
[Maximum 200 words]
Word count:
Signature: / Date:
VCS CEO or Finance Director Contact Details
Name and position / Email / Telephone number
Extent to which your organisation will be liable for ensuring completion of the project (please give details)
[Maximum 200 words]
Word count:
Signature: / Date:
VCS CEO or Finance Director Contact Details
Name and position / Email / Telephone number
Extent to which your organisation will be liable for ensuring completion of the project (please give details)
[Maximum 200 words]
Word count:
Signature: / Date:

Application for Funding Template Part 2:

Non-Statutory Organisations

All of the sections below should be completed if the lead organisation to receive funding is a non-statutory organisation (Charity, Social Enterprise, Faith Based or Civil Society Organisation)

Organisation Details
Organisation Name:
Charity No. or Companies House Registration No.
Project Title:
Summary of the aims and objectives of your organisation [maximum 350 words]
What is your Annual Income as shown in your most recent audited accounts?
Since 2015/16, has your organisation been in receipt of other grant funding from the Department of Health
If so, please give details of what that is for, the time period it covers and the DH team you liaised with.
DH Funding Source / Details / Period / DH Team you liaised with
Social Enterprise Investment Fund
Health & Social Care Volunteering Fund
Innovation, Excellence, Strategic Developments Fund
Strategic Partner Programme
Other
Is a member of the Board of Trustees/ Directors aware and content for this proposal to be made?
Please provide his/ her contact details
Have you applied to, or do you plan to apply to, other funding sources to obtain support for this proposal? If so, please give details of the funding source(s), the application dates, and the amount(s) applied for. Have funding decisions been made? If not, when do you expect to be notified?

2. Section 2 – Eligibility

Is your organisation carrying out activities that involve “providing a service similar to a service provided by the National Health Service or by local authority social services, promoting, publicising or providing advice to do with providing either a national health or local authority social service or a similar service?”
Will the activity be delivered solely in England?
Is your organisation a non-profit making organisation?
(that is, carrying out not-for-profit activities but is not a public or local authority)? If your organisation is not a registered charity (e.g. Company Limited by Guarentee, CIC) we may need to check your governing documents to assure ourselves that you are a non-profit making organisation.
Please state the legal structure of your organisation (Delete as appropriate)
A Charity registered on the Charity Commission website
A Corporate body – company limited by guarantee (registered at Companies House)
A Community Interest Company (registered at Companies House or CIC regulator)
A co-operative (we will need to see your govering documents)
An Independent Provident Society (we will need to see your governing documents)
New Charitable Incorporated Organisation (CIO)
None of the above, but the organisation has a formal constitution (set of rules) or governing document which shows its objectives and management structure
None of the above (please provide details)

3. Section 3 – Senior Sponsorship

Statement of support from VCS organisation senior sponsor (400 words maximum)
By signing below you are confirming that this capital award will be utilised only for the project described in this application, and by (date to be no later than 31 March 2019).
Name: / Signature: / Role in organisation: / Date: