Think of the children

When the state intervenes in the UK and takes a child into its care, it surely does so with all the best intentions. The intervention is instigated in response to and governed by strict rules on child welfare or ‘safeguarding’, made even tighter since the infamous, sad case of Baby Peter. It costs over £2.5 billion per annum. Yet it condemns many of these children to a life of vicious social exclusion – sacrificed by a system that refuses to join up spend and impact.

There are just under 70,000 children in care in the UK today. Around 75% of them are in foster care, at an annual cost of £1.5 billion. The remaining 25% are in residential care, costing an average of about £135,000 a year (within a range of £120,000 to £200,000), or £2,600 per week per child.

Every year 10,000 of these young people leave care. Over 30% of them will be NEET at the age of 19, i.e. not in education, employment or training, compared with 15% in the general population. Only 6% will go on to higher education, compared with the national average of 30%. They will 4 to 5 times more likely to self-harm in adulthood.

They are massively over-represented in groups that express all the worst aspects of social exclusion. Nearly one quarter of all our prisoners were once in care. Nearly three quarters of our sex workers were too.

How can it be that we spend so much and yet appear to achieve so little?

Ofsted’s latest report (June 2016) on the state of children’s services in the UK found that a quarter of children’s services departments, 21 in total, are currently rated ‘inadequate’ while 43 require improvement. Whether an area was found inadequate or not had nothing to do with size, levels of deprivation, or funding.

Ofsted suggest the quality of residential and foster care has improved, and is good in most cases. However, standards vary, and in Outer London the National Audit Office (NAO) report (November 2014) that just over half of the residential homes are rated as good or better. 43% are not.

The NAO highlight the instability of much of the care and how that erodes the children’s sense of self-worth. 34% of children in care had more than one placement during the year of their report and 11% had three or more placements. 330 children had 10 or more placements during the year.

The NAO also notes this strange disconnect between cost and quality. They report that the Department for Education is aware of the wide variation in cost between areas but can find no statistical link between expenditure and quality. “Neither the Department nor local authorities have a strong understanding of the drivers of costs.” The NAO themselves find no clear correlation between house prices in an area and the cost of residential care in that location.

It is not just cost and quality that are disconnected. Both the NAO and Ofsted identify an almost complete disconnect between children’s needs and their placements. There is a fundamental failure to link up the purchasing of services for these children and any positive outcomes, such as educational attainment or healthcare. The NAO report:

“Local authorities often base decisions on children’s placements on short-term affordability rather than on plans to best meet the child’s needs. Local authorities and providers we interviewed told us that services are often procured on the basis of cost.”

Though, perversely, this does not necessarily mean they simply place children in the cheapest places. It is a combination of cost and convenience. “Local authorities often choose to place children in their own residential or foster care because they have already committed costs and so need to fill places. They also think the cost is cheaper than private sector provision, although this may not be the case.”

It would not be difficult to change all this. The process for commissioning that starts with a line of sight between need and desired impact, and that uses purchasing to get there, is relatively straightforward. You have to:

  1. Define what it is you want to purchase in terms of outcomes and impact;
  2. Have a notion of what the service might look like that will deliver those outcomes;
  3. Have a clear, evidence-based notion of what the cost drivers are;
  4. Make some decisions about how much impact you can afford within your given budget;
  5. Commission (i.e. purchase) that service, seeking out the providers (public, private or voluntary) who demonstrate/evidence the highest levels of quality, defined as the highest chances of success in achieving as many outcomes as possible, with a fully costed model the working parts of which you can see;
  6. Consider the use of outcome-based contracting of some sort to align the incentives of the commissioner and the provider (though this does not mean price competition);
  7. Performance manage those providers against the agreed outcome targets, with further quality assurance of their delivery.

Seven steps that are relatively straightforward, and willfully avoided by our commissioners of state care for children at risk. The reason why they continue to sacrifice the lives of these young people is surely complex, or at least hard to comprehend.

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  1. […] Johnson in ‘Think of the children’ highlights some of the terrible outcomes that children in care suffer and suggests a commissioning […]

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