A focus on outcome productivity in children’s services would unequivocally deliver the step changes in understanding called for in the recent PAC report ‘Transforming Children’s Services’.
We pay more for many of our looked after children’s placements than it costs to go to Eton – why can’t we see the impact on outcomes for children?
Recent demand rises in childrens services have put severe pressures on local authorities trying to secure placements for looked after children. Arguably the market is now broken, as there are young people that cannot be placed as providers are not willing to take them on, and the rises in demand have affected local authorities’ ability to develop the market effectively. Some authorities we have been working with, have seen rises of over 50% in their Looked after children numbers in the last 3 – 4 years alone, leaving them unable to keep up with the necessary level of local placements either provided by themselves, or at least provided within their borders. Considering the fact that in 2013/14 the National Audit Office estimated that local authorities were spending £2.5 billion a year on placements for looked after children, this is big business in its broadest sense.
Whilst this level of spend is pretty staggering in itself, what strikes me more is the fact that, as a sector, we still cannot demonstrate value, impact or improvements in outcomes for these children, despite the huge sums we continue to invest in their care. This means that, whilst we are sometimes spending 9 times as much as it would cost to send a young person to Eton every year, we are unable to often demonstrate any discernible improvement in outcomes for these children in care, proportionate to this spend.
Why is this the case? It all comes down to needs!
Firstly, at the moment, we don’t have a systematic way of identifying, codifying and aggregating needs for looked after children. As surprising as it sounds, there is no standard or common methodology of capturing needs for children in care (or in social care more broadly). Needs are often lost in the narrative of a social work or early help assessment, or confused with services or risks. This means we have no baseline to measure against; no focus for our discussions with providers of placements in terms of what interventions we want them to provide to improve needs (and therefore outcomes); and no way of tracking improvements against this baseline, or interventions offered to demonstrate tangible improvements.
Secondly, we confuse needs with risk factors, which often drives up costs and leads to placements which ‘contain’ rather than ‘actively intervene’. We specify needs as ‘fire starting’ or ‘aggressive behaviour’, which leads to a conversation based on risk management rather than the help a child or young person needs to enable them to build the resilience and independence to thrive in child and adulthood.
Thirdly, some cases are increasingly complex with children displaying a variety of ‘risky’ behaviours. We don’t have the skills to properly assess them in a way that identifies either the underlying needs which cause these risks, or the best course of intervention to reduce, or improve them. Whilst I was trained in attachment theory, child development and the art of assessment as a social worker, I was never trained in diagnosing complex emotional or psychological conditions. Equally, waiting 6 months for a CAMHS assessment is not the answer, as by that time placements have broken down and costs have increased further, leading to ‘risk management’ as the only response.
Fourthly, our current approach to assessing needs can often mean the only intervention considered is a ‘placement’ – usually focused on containing risk rather than building resilience through improving needs. Even so we don’t treat it as the main intervention in a child’s life.
So how do we do ‘get a grip’ on childrens placements to enable us to demonstrate impact?
Our thought piece on children’s placements last year, ‘Getting a Grip’, advocated the creation of a Resource Allocation System (RAS) for looked after childrens placements. We believed that the only way to ‘get a grip’ was to properly understand and codify the needs of children in care. Beginning to develop a relationship between needs and costs; using this intelligence to help us in managing the market and in tracking changes to needs from an initial baseline assessment.
We have now put this into practice with a local authority and the results have been fascinating! We developed a set of 12 needs as a basis for reviewing children in placements to understand the volume and complexity of these needs in the current LAC population. Working alongside social workers and Independent Reviewing Officers, we reviewed approximately 150 children in care against these needs to give us a proper needs profile of the local LAC population. On a strategic and financial level, we found no correlation between needs and costs but this analysis enabled us to pick out ‘poor value’ placements where children had low needs scores, yet high cost packages. We can do this by creating a ‘pound per need’ score equation, demonstrating that in some cases we are paying the equivalent of a few pence per need, whilst in others this can be as much as £11 per need point!
Interestingly for me on a personal level, the social workers found the process incredibly insightful in demonstrating that at present, we don’t have a way of clearly, simply and consistently stating the needs of children and being able to use this to track changes and improvements from the support we give them. Reviewing a child they knew against the needs codification, would take the social worker 10 -15 mins. However, reviewing a child they didn’t know could take much longer as the needs aren’t currently clearly defined in this way.
The ability to codify and aggregate needs in this way is essential in being able to track improvements in the care we are providing to looked after children. We can measure progress against the baseline needs score in every review. However, just as importantly, it is also vital intelligence for local authorities in driving their sufficiency agenda. It enables them to properly understand the kind of provision they need, and the type of services they should commission around their own local placements, to support stability and local provision. It also provides them with the intelligence to properly engage with and grow the market they want for placements for children – changing the conversation from ‘unit cost’ of a placement, to ‘value’ in improving identified needs. Importantly, our engagement with providers suggests they would welcome this system and the intel it provides, enabling the development of a more mature relationship with the market. One that moves away from simply trying to reduce cost, to trying to demonstrably improve outcomes. Assessing needs more systematically in this way also allows providers to play more of an active role in the assessment and review of needs as they often know the child or young person the best at that time.
Perhaps most excitingly though is the opportunity to roll out this needs codification across the whole social care and early help cohort. Doing so would enable local authorities to forecast potential future changes in cost and demand more accurately, and have a much richer intelligence base for their broader commissioning strategy (and conversations with their Financial Director!). It seems so simple, but it is a key step in finally gripping improvements in outcomes that our looked after children deserve.