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Valuing Care Impact Update

Since February 2018, five councils have used Valuing Care to improve outcomes. This report shares some of the learning.

Executive Summary

IMPOWER exists to increase the quality of people’s lives by making meaningful and measurable improvements to local public services. We understand complex problems
and we deliver sustainable change.

By understanding children’s social care as a complex demand-led system, councils can use IMPOWER’s Valuing Care programme to achieve better outcomes for children in their care, which also costs less overall. Valuing Care’s tools, insights and metrics give Directors
of Children’s Services both the evidence and the confidence to understand and value their services.

Since February 2018, five councils have used Valuing Care to improve outcomes. This report shares some of the learning.

Published: May 7, 2019

Authors: Al Thompson

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Impact highlights

Foreword

Jenny Coles, Director of Children’s Services Hertfordshire County Council

When we were first approached about the concept of strengthening the links between needs, costs and outcomes, it just felt like the right thing to do. We are rightly proud of our work with children, young people and their families in Hertfordshire, but we recognised that like most councils, we needed an evidenced narrative about the impacts and value from our placements for looked after children. As you will have seen from the commentary and recommendations from both the National Audit Office and the Public Accounts Committee, this is a challenge consistently levelled at the sector. I believe Valuing Care is well placed to become part of our response.

Our experience with the Valuing Care programme has been genuinely transformational; we are making a difference, having a demonstrable and positive impact on the lives of children and young people, and achieving value by getting resources to the children who need them the most. We are capturing and evidencing needs in a way we never have previously, and have a comprehensive view of this at a child and system-level, to demonstrate how they are changing over time. The intelligence this is giving us is informing our current and future planning for children and young people.

Each of the councils currently involved are at different stages of their journey, and this provides fascinating yet different emphasis and insight; from social work practice improvement, through improved relationships with young people and providers, through strategic commissioning, to evidencing outcomes and value. Common to them all is a shift to a fairer system in which better outcomes cost less. We don’t want to stop there though; we want to make this way of working the standard across the whole social care journey, from the front door to all forms of permanence. We are genuinely excited about the further potential of the approach. The open and honest way in which we have shared learning with other councils has been so helpful; it genuinely feels like we are doing this together, and unlocking new ways of working across many different areas.

I am delighted with the progress and impacts we have made to date with Valuing Care, and this can be just the start. These early impacts are powerful – children’s services departments, commissioners and providers alike, have a great opportunity to get involved and help improve outcomes at scale through this pioneering programme.

The challenge

Children and young people in care achieve their best outcomes when support and interventions are tailored to meet their individual needs. Yet IMPOWER’s analysis has shown that the links between children’s needs and councils’ spending levels are weak at best. There is often no evidence that the best outcome has been achieved or that the system is fair.

There are a bewildering range of agencies, people, processes, forms and systems involved in finding the right care for looked after children, and no single person or organisation has control. As a result the young person’s story is too often reduced to labels, risks or a list of things they cannot do. Not only does this make it difficult to find the right carer or home for the young person, it also gets in the way of setting ambitious goals for the future. Any placement, often at any cost, has become good enough, and containment of risk is an acceptable outcome in itself. It is therefore no surprise that the choice of placements is insufficient to meet needs, that councils are in a daily bidding war with each other, and that one in five children in foster or residential care are now being sent to live over 20 miles away from their homes and networks.

This is clearly not intentional: it is a system problem. There is no shared language with which the team around the child can communicate the complex requirements of children and young people in care, agree goals and monitor progress. Without a common understanding of needs, there is no way to show what is being achieved, and children’s services departments cannot demonstrate value in their sizeable spend.

By March 2018, 75,420 children and young people were in the care of the state. This was an increase of 4% in just one year. Over the year to March 2018, councils spent £4.3 billion on providing this care. And while the number of looked after children rose 10% between 2014-2018, the cost of support rose by a disproportionate 39% over the same period. This represents an increase in spend per child of 26% over four years. It is therefore no surprise that, in total, councils overspent by £450 million in 2017-2018 (12% above budgeted spend).

While more resources are being directed towards children and young people in care, this has neither solved the challenges faced by the system nor addressed the pressures of rising demand. There is no correlation between the needs of the children and young people, the outcomes they achieve or the investments made. This is simply unfair for children, and opportunities to improve life chances are being missed. Something must change.

A new way of working: Valuing Care

There is an illusion that public services such as children’s social care are ‘complicated’, and that they can be controlled if the right processes are put in place. At IMPOWER, we challenge this perception as we know that public services are actually ‘complex’: non-linear systems, where responsibilities are distributed and where success depends on creating the right relationships and behaviours across and between system boundaries.

In recognising children’s social care as a complex demand-led system, councils can achieve better outcomes which cost less overall. This requires new tools, insights, skills and metrics. Our unique approach – EDGEWORK – gives Directors of Children’s Services both the evidence and the confidence to understand and value their services.

Using EDGEWORK, we developed our Valuing Care programme to navigate this complexity, and to strengthen the links between children’s needs, the outcomes being pursued, and the resources available. By better capturing and reviewing the needs of looked after children, and assessing value and outcomes rather than focussing on containment of risk, councils can make better decisions on support, placements and commissioning. They can make the system better and fairer.

What is Valuing Care?

We developed Valuing Care with a number of councils, drawing on our EDGEWORK approach. By establishing a relentless and systematic focus on what the young person needs, we have moved the emphasis from containment to ambition, and from cost to value.

By introducing a common children’s framework and language throughout the system, children services teams are able to bring all conversations back to what the young person needs to thrive and how those needs should be reducing.

The diagram below shows the journey for looked after children under the Valuing Care programme:

Setting a new inclusive ambition for the children's care system

Use, learning and impact of Valuing Care

The five councils that have been involved in developing Valuing Care are Hertfordshire County Council, Oxfordshire County Council, Norfolk County Council, Central Bedfordshire Council and North East Lincolnshire Council.

All of these councils are now working to change the culture around care by transforming the conversations between and behaviours of those involved, and by improving core processes, forms, systems and panels to enable that shift.

In addition to these core changes, each council is using Valuing Care with a slightly different focus.

Hertfordshire County Council

Hertfordshire have also used the Valuing Care approach to support the development of its local outcomes framework, the ‘Outcome Bees’ (shown below). Each of the six Outcomes Bees is aligned with two related Valuing Care needs domains. As a result, Hertfordshire can now better demonstrate that by reducing associated needs outcomes are improving overall.

Another area of focus for Hertfordshire is placement stability. In addition to using Valuing Care to flag breakdown risks in existing placements, Hertfordshire – one of the first Ofsted-led matching pilot sites – are making the most of the approach to ensure placements are carefully and evidentially selected and given the right support to meet needs in the first place. As part of this, further guidance is being developed for the team around the child to explicitly link the Valuing Care assessment, care plan and review approach to other evidence-based practice tools.

Norfolk County Council

Over the past year, the number of children accommodated by Norfolk County Council foster carers has increased by 14%, providing annual savings of approximately £1.2 million.

The Norfolk commissioning team have used Valuing Care to evidence sufficiency gaps by demonstrating how different placement support and provision will benefit young people with particular needs patterns, for example unaccompanied asylum-seeking children. This evidence has allowed them to secure funding for the development of new semi-independent, fostering and other placement support schemes.

In addition, Social Work and Placement Team Managers as well as Independent Reviewing Officers inform the needs assessments and reviews, and practitioners routinely work through cases together at team meeting team using the Valuing Care framework.

Oxfordshire County Council

As Sarah Duerden, Strengthening Placements Lead for Oxfordshire, explains:

“The first step in the process has been to develop profiles of each child or young person in a consistent way that also produces a well-rounded picture of each individual, including strengths and ambitions. We have used the Valuing Care needs assessment approach to do this and also to provide the agenda for profiling meetings. These meetings are attended by the child’s social worker, their key worker from the residential home and other relevant professionals involved with the child. The approach enables an informed and holistic discussion about each individual, and allows professionals to highlight areas of need and to consider the strengths and challenges faced when caring for this individual.

“I have been surprised by how rich these conversations can be, even though the approach itself is simple. It gives structure to our discussions but is straightforward enough for practitioners from a range of agencies to pick up, meaning that we get all parties contributing.

“Out of 20 children and young people we have profiled in this way we are actively searching for 10 foster placements. For the remaining 10 young people, the process provided the evidence to either say they were appropriately placed or that joint funding with health or education needed to be explored.

“To ensure children also play a part in this process, they are encouraged to write their own personal profile which we attach to the placement request form. For each child, we then plan what support would be needed when they move to a family setting and set out the child’s goals for the immediate and distant future.

“The next step, which is a new method of searching for a placement, has been to invite providers of placements along to an event, where they can learn more about some of the children we are searching for placements for. This approach gave us a way to share the ‘softer’ information about each child with providers. The key worker from their residential home and their social worker were again involved, and could talk about what it was like to care for the child on a day-to-day basis.

“So far we have managed to step down five of the ten young people, with another three placements in the process of being agreed.”

In Oxfordshire’s recent Ofsted report, the Valuing Care approach was an important way to demonstrate the progress of children in care, and the framework is now included in all provider placement agreements.

The council is now working with providers to explore the potential for outcomes-based arrangements in which a level of payment is linked directly to needs reduction.
As well as better outcomes for the young people involved, the council currently estimates this work alone will provide savings of up to £1.6 million over 2019/20, with further benefits anticipated from other work that Valuing Care enables, such as reunification.

Central Bedfordshire and North East Lincolnshire Councils

What are those involved saying about their involvement in Valuing Care?

“The young people we showed the new placement referral forms to really liked them. They felt that the tone was so much better, because they include young people’s positive characteristics and the young person’s voice. Most agreed that it was so much better to talk about needs than risks, and to include the positives too.”

Children in Care Council

“It’s a great framework for our social workers to think about, and record, the needs of their children and we are starting to run reports which give us a ‘needs profile’ across our care population, something we have never been able to do – previously we had to rely on anecdotes about complex needs. The assessment is also now the referral.”

Service Director

“Providers are consistently sharing positive feedback about our newly adapted Placement Referral Form [which contains the Needs and Outcomes Profiling Tool]. They like the language, the consistency of information and the snappy way it is delivered.”

Placements Manager

“Long term it will help commissioners’ relationship with the market.” “It will help a discussion about price by developing a common language.” “You’re starting to understand the child more, [and] foster carers are more at ease and confident to take the placement.” “This will help us with Ofsted. It’ll give an extra layer of evidence.”

Providers

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