1. Cost Effective Children’s Services 1 Joint working to support local decision making October 2010

2. The Government is radically reforming the relationship between itself and local government, ending the era of top-down government by giving new freedoms and more flexibility to local councils and the communities, neighbourhoods and individuals that they serve. At the same time, the pressures on delivering children’s services are creating an even greater need to rethink the way services are delivered and improve children and young people’s outcomes cost effectively. If we are to manage the challenges and make the most of the opportunities presented by this new era, we need to develop new ways of working together

3. Pressures on children’s services The need for savings in the economic climate: current and expected financial pressures on local authorities across all their services have increased because of the pressure created by the recession. The forthcoming Comprehensive Spending Review will set out the challenge for the next four years. This pressure is exacerbated by an increase in demand on children’s services particularly, though not exclusively, in children’s social care: The case of Baby Peter has contributed to this rise in child protection but does not fully explain it. Increases can be attributed to better identification of children in need and demographic changes such as an increase in children under 5 and increased survival rates of premature babies.  Total referrals received in 09-10 were 607,500 compared to 538,500 in 07-08.  The number of children subject to a child protection plan at 31 March 2010 was 35,700 compared with 29,200 at 31 March 2008.  Between April and August 2010, Cafcass received 3,744 new applications. This figure is 3.7 % higher when compared to the same period last year and the highest ever recorded by Cafcass for these individual months. 2009-10 figures are currently provisional. There has been a change in methodology between 2007-08 and 2009-10 that may affect comparability of the numbers.

4. Recent figures show a rise over time – Q1 2007/8 - Q3 209/10 (ADCS quarterly data) Q3 08/09: Publicity around Baby P begins

5. We want to:  Develop cost effective thinking in everyone commissioning children’s services.  Provide local areas with tools that will enable them to be even more effective in improving children’s outcomes, and in doing so, reduce costs across the spectrum of need from early intervention to intensive support.  Help local authorities and others responsible for children’s services understand the characteristics of their local area, and respond better to local and nationally identified needs.  Get better at identifying, disseminating and replicating good practice. We are doing this through:  Co-production and co-ownership – this work is driven by the needs of the sector and its products developed by the sector.  The effective use of data and evidence nationally and locally to understand needs, what is already happening in response and what else can be done; how to meet them.  Streamlining and rationalising guidance issued by the Department – central government is reducing unnecessary bureaucratic burdens, thus freeing up areas to take local decisions. Cost effective children’s services

6. How can we become cost effective?  Improving children’s outcomes: there are gains to be made by delivering services more efficiently, but the real gains will come from giving children and their families early support that prevents or reduces future spending.  Local variation: the same good practice will not work everywhere, we need to support each other to apply evidence in different areas.  Hard choices: the financial situation means that we must focus on what really works.  A range of messages and tools: Cost effectiveness means looking at every opportunity, from the most ambitious to the everyday.  Looking at emerging data: establishing whether practice is cost effective takes time, especially when looking at interventions that may have a long term impact.  An ongoing commitment: we must make cost effectiveness an integral part of our collective work, including it from the start.  Leadership: having a vision, building shared commitment and tenaciously driving it through.

7. A shared analysis of the problem has helped to identify where decision makers need support  The following slides present a national picture of children’s movement through children’s services, focussing on movement and cost effective potential of improving the social care system.  Four pressure points emerge from this analysis, at which there are significant costs, and opportunities both for savings and better outcomes. These pressure points have formed the basis of our collective efforts to improve cost effectiveness.  The analysis shows how the needs of some children and young people increase, requiring more expensive and intensive support. High quality early intervention and prevention can prevent the need for repeated interventions, often at higher cost.  Local areas vary considerably. Our intention is therefore not to produce a prescriptive ‘solution’, or an idealised system. Rather, this analysis should give local areas a way of framing their thinking about children’s services in their own area, and how best to meet local needs.

8. Number of children Severity of assessed need Cost 64,400 looked after children Figures are for 2009-10 unless otherwise indicated 607,500 referrals to social services (prov.) CAF – estimated 90,000 initiated during 2009 3,200 children adopted Edge of care Children around the threshold Understanding national movement through the system Universal Services Social Care System The diagram shows the number of children at different points in the system, and how some may move through the system. Some children effectively “drop out” at each point, moving back towards the left of the “severity of need” axis, and a lower level of contact with services. Others continue to receive further, more costly support. Some of the children who have “dropped out” will return in the future, by which time their needs may have intensified.

9. Number of children Severity of assessed need Cost 607,500 referrals to social care (prov.) Estimated 90,000 CAFs initiated during 2009 390,600 initial assessments (prov.) 35,700 child protection plans (prov.) 64,400 looked after children 382,300 children in need (prov.) 141,500 core assessments (prov.) 64% of referrals lead to an initial assessment 12.3 million 0-19 year olds in total (ONS projections) 1,260 children special guardianship order made 3,200 looked after children adopted Detailed national numbers 2009-2010 27,800 children started to be looked after 25,100 children ceased to be looked after Sources: Department of Education Referrals, Assessments and Children who were the Subject of a Child Protection Plan (Children in Need Census – Provisional) Year Ending 31 March 2010, Department for Education Children looked after in England (including adoption and care levels) year ending 31 March 2010 A working version of the mapping tool to help LAs construct local versions of this model is now available on the C4EO website Around a quarter of these children had been in care more than once beforehand

10. Information services – Around £34 via telephone helpline Around £2 via digital services Cost per child / family Severity of assessed need Cost Family Intervention Projects – £8-20,000 per family per year Family Nurse Partnerships – £3000 per family a year Child looked after in children’s home – £125,000 per year placement costs Child looked after in foster care – £25,000 per year placement costs Schools - £5,400 per pupil Children’s Centres - around £600 per user Costs increase as children get older. Increasing related costs such healthcare and the criminal justice system make it clear joined up working is a core part of cost effectiveness Multi-dimensional Treatment Foster Care – £68,000 per year for total package of support Child looked after in secure accommodation – £134,000 per year placement costs Parenting programme (e.g. Triple P) – £900- 1,000 per family PEIP – £1,200 - 3,000 per parent Multi-Systemic Therapy – £7-10,000 per year This slide shows a range of services that Local authorities can commission and some approximate costs. the disparity in cost between the cheaper provision and more intensive support shows how important it is that children and young people receive the right services at the right time. The Escalating costs of intervention These figures are intended to be illustrative only. Costs have been estimated from a range of sources and will not always be directly comparable. For example, the MTFC figure includes the package of support, social workers etc. that is needed whereas the foster care figure only includes placement costs.

11. The focus of our joint work to date has been on 5 different aspects of the system ; Number of children Cost Severity of assessed need 1. Universal Services including schools and health settings, Early Intervention and use of CAF: There are 12 million children the country and while the vast majority of their families fall short of the threshold for an assessment by social services, a large number of them will need additional help and support. This means identifying needs and issues early, helping them and their families to access the right services and so preventing their problems getting both worse and more expensive. 2. Contacts and Referrals, ‘Front door practice’ Around half a million referrals are made annually (including many repeat referrals) and roughly a third of these result in no further action. The children go back into the general population but this does not mean they do not have needs, as many will be referred again in the future. Of the 547,000 referrals in 2008-2009, 127,000 (23%) were repeat referrals, made within 12 months of a previous referral. 3. Interventions with the children on the edge of care and their families: There are a number of children on the “edge of care” because of their family circumstances, or who move in and out of care. Many children only stay looked after for a short period of time – but end up back in the care system again. Work with dysfunctional families could reduce the flow of children into care and the associated costs and negative outcomes, or enable successful returns from care. 4. Care proceedings, care placements and adoption / special guardianship: Helping the 65,000 children who are looked after to find permanency as quickly as possible, whether through remaining in a suitable, stable care placement, through adoption or special guardianship, or through returning home (and recognising that increased demand means care population will increase further). 5. Enablers – Factors common to all workstrands Including issues around Workforce, Commissioning, Performance Management, Improvement

12. First products now available  Cost model around intensive family intervention projects for 10 – 15 year olds on the edge of care and a family saving cost calculator to help local authorities quantify the potential benefits of a family undergoing successful interventions.  C4EO’s Early Intervention document ‘Grasping the Nettle’ which brings together local, national and international evidence to show the ‘golden threads’ that underpin effective early intervention.  Commissioning Support Programme Outcomes and Efficiency Methodology - this is a commissioning-based methodology designed by CSP, in conjunction with local strategic commissioners, to quickly and practically redesign their services for more efficiency.  C4EO Cost Effective Template and resource bank - C4EO have developed a model that enables local authorities to cost examples of effective local practice. This model takes the form of a web-based costing template and has already been applied to a wide range of validated local practice examples i.e. interventions that have shown demonstrable improvements in outcomes. All of these products are collected on the C4EO websiteC4EO website

13. These messages form part of a wider landscape of work to reform and improve children’s servicesand local government Local Government Group Productivity and Efficiency Programme Family Justice Review Munro Review of Child Protection Review of the Vetting and Barring Scheme Frank Field Review of Poverty and Life Chances Child Poverty Strategy Tickell Review of the Early Years Foundation Stage Spending Review Graham Allen Review of Early Intervention Publication date TBA Schools White Paper October 10December 10November 10Jan 11 – March 11April 11 - June 11July 11– Sept 11 SEN & Disability Green Paper