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SOCIAL SERVICES NORTH WEST
MEETING TO BE HELD ON 14 SEPTEMBER AT BLACKBURN
REPORT OF THE CO-ORDINATOR
CHILDREN’S ISSUES
1. Matter for Consideration
Approaches to addressing the escalating costs being experienced in many authorities in meeting the specific needs of certain children.
2. Introduction
Members have for many years kept a close watching brief on developments across the region in services for children, and have been ready to take appropriate strategic initiatives to help member authorities to deal with challenges which face them in this field. At the last meeting of the SSNW Committee at Tameside in June 2001, serious concerns were expressed by members about the costs of meeting the needs of certain children, for whom in-house provision was not available or inappropriate. The suspicion was that independent providers may be exploiting a weak market position in local authorities, and making excessive charges. Members urged consideration of consortia of local authorities working together to make direct provision to meet some of these needs. It was agreed that an appropriate way forward would be to conduct a feasibility study to look positively at the whole issue of member authorities working jointly together, to ensure high-quality, cost effective residential placements to meet the specific needs of children and young people.
3.1 Placement choice is at the heart of the Quality Protects agenda, and recently independent providers have grasped this opportunity to develop services to meet gaps in current provision, thus creating an increasingly market-driven framework in which Children’s services operate. This, combined with the fact that budget overspends in children’s services are often - according to the Audit Commission - related to out of area placements, provides the background to members’ concerns. Out of area placements also clearly show up as an important factor in Social Services overspend according to recent surveys of financial pressures, and members are referred the report on this agenda ‘Key Service / Financial Pressures’
3.2. On key strategic issues such as this, Social Services North West has always worked closely with the North West Branch of the Association of Directors of Social Services. Accordingly, officers of SSNW have had a meeting with Anita Marsland Director of Knowsley and Regional Lead Director on children and families issues. Discussion about possible ways forward included consideration of the NCH/ADSS (NW) study ‘Understanding the External Market Place’ the principal findings of which are summarised below. It was also agreed that Best Value Reviews of children’s services, undertaken by member authorities, would be a very useful source of information and examples of good practice. It was noted that there were already a number of positive examples of effective joint working between local authorities in the region, including an ‘After Adoption’ project involving Halton, Knowsley and St Helens. Commissioning is prioritised by the North West Quality Protects Reference Group and Anita Marsland, who chairs the group, will be discussing this issue further with the Assistant Directors in both the Mersey and Greater Manchester areas during September this year. Social Services North West officers have also met recently with the Greater Manchester Children’s Contract Officers group, from which it was clear that for some time contract managers in the region have been keen to foster a closer working together approach, particularly with reference to joint commissioning of external placements. It is also apparent that many authorities are reviewing and reshaping their own direct residential provision: for example, Knowsley are moving down the path of setting up a series of smaller residential units, providing staff-intensive, high-quality alternatives to external placements.
3.3. The study ‘Understanding the External Market’ dates back to 1999 and started with the NCH Action for Children and ADSS (NW) coming together (along with research support from the University of Central Lancashire) to share information about where children are placed, and how commissioning strategies can be used to better inform the providers around the North West and beyond. It was recognised that there was a shortage of suitable places for children across the Region, and that identifying appropriate residential care is a critical and complex task. The study’s aims were to provide "data to inform the development of local and regional strategies for the planning, commissioning and purchase of residential services for looked after children and young people". The document also highlights this statement from The Audit Commission in 1999 that " joint approaches to problems that are common to several councils in an area – such as….the development of shared local services for children with special needs -…. should be explored."
3.4. The key points from the study which are most relevant to the issue being considered in this report are:
- there are areas of provision on which local authorities might wish to collaborate – either as providers or as joint commissioners for externally provided services;
- there are many innovative projects taking place in the region but the mechanisms for pooling and dissemination information tend to be informal and ad hoc;
- whilst it may not be practical for individual authorities to develop of commission services for a specific group of children, this practice could become more effective across authorities;
Types of placement in relation to which cross agency developments might be initiated are identified as:
- placements which enable sibling groups to remain together
- placement for children with disabilities
- education placements
- foster care
- placements which meet the range of child mental health needs
- emergency placements.
Main findings included:
- children in external placements represent around 11% of those looked after by North West authorities;
- most children in such placements are male and between 10 and 15 years of age, 38% have a disability;
- 55% are placed because of no in house provision being available; behavioural problems are the most common reasons for placement in the private sector.
- The voluntary and independent foster care sector would appear - according to the study - to offer the best value in that they meet multiple needs and have multiple purposes generally at lower cost than the private sector (it is not clear that this means they are therefore providing a service of better quality).
3.5. The study goes on to state that it appears local authorities are often using the external market because they have to, rather than through planned, needs led choice. It concludes that it could be advantageous for authorities to do a data collection exercise in relation to children and placements in internal provision, thus enabling the mapping of the entire Looked After Children market, and helping to decide on a more strategic use of the external market. The document includes a quote from the Department of Health ‘Quality Protects: Transforming Children’s Services 1999’ "..inter-agency strategies for joint commissioning were often underdeveloped; and work with neighbouring local authorities, which could help to rationalise competition for placement, also need development."
3.6. There is a clear market - both external and internal - for placements meeting the needs of children with behavioural or emotional difficulties and the strategic, innovative use of Child and Adolescent Mental Health Services (CAMHS) budgets could – in the opinion of the study’s authors - impact on this need. Given that a high proportion of children in external placements also have a history of abuse and neglect (this clearly relates to Quality Protects) intense support services especially CAMHS could be applied to the initial phase of the child care project process thus probably reducing later costs. The authors of the study recommend the setting up of small demonstration type projects to test and monitor this relationship. They also recommend that monitoring from the beginning of the child care process could help to chart the care careers of these children in ways that would illuminate where costs may be reduced in future.
4. Conclusion
There is clearly much work to be done, particularly in terms of gathering information about good joint working, and about Best Value reviews of children’s services in the region, and local developments regarding the development of smaller intensively staffed residential units. It is proposed that Social Services North West works jointly on these issues with ADSS North West, to produce a further report for the December meeting as to how the various strands outlined in this report can be brought together in a plan for progress on this issue.
5. Recommendations
5.1. Members are asked to note the above report
5.2. Members are asked to request a further report to the December meeting, jointly with ADSS NW to address the issues highlighted in the report and to make recommendations for progress.
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