1. Russell Norman General Manager - Children’s Services Cumbria Partnership NHS Foundation Trust

2. CPFT – Children’s Services
Health Visiting
School Nursing
Children’s Community Nursing
CAMHS
Physiotherapy
Occupational Therapy
Children’s Learning Disability Nurses
Audiology
Podiatry
Community Paediatrics
Team 400+(and other services)

3. Is Child Poverty an Issue ?
Children from poor families are 5 times more likely to die from unintentional injuries
Children from poor families are 5 times more likely to die as a pedestrian
Children from poor families are 16 times more likely to die in a house fire
Children from poor families are more likely to suffer injuries that require hospital admission and when they are admitted their injuries are likely to be more serious than those experienced by children from affluent families
HDA 2005

4. Is Child Poverty an Issue ?
Children from poorer families believe that:
Health is a matter of luck
Smoking cigarettes is not dangerous
Children from poorer families are more likely to:
Play truant from school
Leave school at 16
Not want to be a parent or marry
Have low self esteem
Become pregnant at an early age
Perform poorly in education
DWP Research Report

5. How do we measure up?
‘The true measure of a nation’s standing is how well it attends to its children – their health and safety, their material security, their education and socialization, and their sense of being loved, valued, and included in the families and societies into which they are born’
(UNICEF, 2007: 1).

8. Gap between groups is widening Children in poverty more likely to:
Resilience?
Living in poverty is the single most important determinant for children’s outcomes
Gap between groups is widening
Children in poverty more likely to:
Under achieve
Get pregnant early
Be affected by domestic violence
Be involved in alcohol and drug misuse
Die younger, suffer health problems
Be a cost to society, not just in financial terms

9. Not intervening early is expensive….
Cost per child / family
Severity of 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
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, ,000 per parent
Multi-Systemic Therapy – £7-10,000 per year
By intervening earlier with these families, before they reach crisis point, significant cost savings can be made and outcomes for families can be improved. 9

10. Disproportionate costs on services
Can be as much as £250, ,000 per family per year……
All of these families access universal services…
Universal Services1
Education - £580m
Child benefits - £110m
GP/NHS costs - £30m
£0.7bn universal spend/yr
46,000
families
…and specialist services, (often repeatedly for many years) 
Targeted Services2
Welfare benefits - £750m
Mental health treatment - £20m
Parenting support - £50m
Drug misuse treatment - £10m
£0.8bn
targeted spend/yr
but family breakdown and crises still leads to very poor and costly outcomes
Reactive spend3
Children going into care, hoax fire calls, nuisance behaviour costs, juvenile criminality costs, truancy costs, alternative education costs, vandalism, evictions due to ASB
£2.5bn reactive spend/yr
1 DfE planned pupil funding. HMRC website. NHS costs taken from NHS expenditure in England 2009.
2 Unit costs taken from the following unpublished sources: Dept of Health (drugs, alcohol & mental health treatment costs), Home Office (Welfare costs) all other unit costs from research Steve Parrott and Christine Godfrey, Family Intervention Projects: Assessing potential cost-effectiveness University of York, 2008 (unpublished).
3 Unit costs from research Steve Parrott and Christine Godfrey, Family Intervention Projects: Assessing potential cost-effectiveness University of York, 2008 (unpublished). Distribution of costs to families based on a sample of 40 families selected by 17 authorities using a standardised methodology (DfE internal analysis)
NOTE: INDICATIVE COSTS ONLY - do not include costs of criminal justice services pending further analysis by MoJ. 10

11. Multiple funding and accountability structures make coordinating support for the families with the greatest needs very difficult
DfE HO
MoJ DH
CLG
DWP LA
Police
YJB
CCG
Housing
authorities
JCP
VCS
Prisons
YOS worker
Young carer
support worker
CAMHS/ Mental Health Worker
Police officer
Drug and alcohol team
Housing link worker
Employment Personal advisers
Family support
workers
Schools
Surestart Children’s Centre
Intensive family intervention worker/ parenting practitioner 11

12. Families with Multiple Problems
Growing up in a family with significant, social, health, economic and behavioural problems has lasting and inter-generational impact on a child’s life chances
Around 120,000 families in England experience multiple social, health and economic problems. 46,000 of those experience ‘problem’ child behaviour
Account for a large number of school exclusions, 1 in 5 youth offences, parents 34 times more likely to need drug treatment and 8 times more likely to need alcohol treatment and a third are subject to child protection
Contribute to a wide range of social problems
Families with multiple problems make significant financial demands on a wide range of local services
The 117,000 families are often targeted by a number of different professionals each dealing with a different family member and a different problem
46,000 of these also experience ‘problem’ child behaviour. 12

13. What works?
High quality key workers working with low caseloads (4-6 families per worker)
Respectful and persistent whole family working that empowers and builds on family strengths
Using incentives / rewards / consequences and flexibility to use resources creatively
Support not time-limited for support (average months) and available ‘out of hours’
Effective multi-agency working and information sharing
Family intervention costs £14K1 per family per year, making savings of around £50K2 per family per year
Evidence Based Parenting Programmes
Multi-systemic Therapy, Evidence-based parenting programmes, Family Group Conferencing, Family Nurse Partnerships
PEIP Interim report: shows significant improvements to parent and child outcomes
What doesn’t work: Families targeted by different professionals each dealing with a different family member and a different problem
1Steve Parrott and Christine Godfrey, Department of Health Sciences, University of York April 2008
2calculated using the DfE Family Savings Calculator
with data collected from 17 LAs 13

14. RSA: Beyond the Big Society
Psychological Foundations of Active Citizenship Jan 2012
“the socialized mind is an adequate order of complexity to meet the demands of a traditionalist world, in which a fairly homogeneous set of definitions of how one should live is constantly promulgated by the cohesive arrangements, models, and external regulations of the community or tribe. (However) Modern society is characterized by ever-expanding pluralism, multiplicity, and competition for loyalty to a given way of living. It requires the development of an internal authority which can “write upon” existing social and psychological productions rather than be “written by” them.
R Kagan 1991

15. Better health outcomes for children and young people
The foundations for virtually every aspect
of human development – physical, intellectual, and emotional – are laid in early childhood.
(Marmot)

16. Better health outcomes for children and young people
Children, young people and their families will be at the heart of decision-making,with the health outcomes that matter most to them taking priority.
Services, from pregnancy through to adolescence and beyond, will be high quality, evidence based and safe, delivered at the right time, in the right place,by a properly planned, educated and trained workforce.
Good mental and physical health and early interventions, including for children and young people with long term conditions, will be of equal importance to caring for those who become acutely unwell.
Services will be integrated and care will be coordinated around the individual,with an optimal experience of transition to adult services for those young people who require ongoing health and care in adult life.
There will be clear leadership, accountability and assurance and organisations will work in partnership for the benefit of children and young people.

17. Better health outcomes for children and young people
We all have a part to play in promoting the importance of the health of our children
and young people. Through our joint commitment and efforts we are determined to:
• reduce child deaths through evidence based public health measures and by providing the
right care at the right time;
• prevent ill health for children and young people and improve their opportunities for
better long-term health by supporting families to look after their children, when they need
it, and helping children and young people and their families to prioritise healthy behaviour;
• improve the mental health of our children and young people by promoting resilience and
mental well being and providing early and effective evidence based treatment for those
who need it;
• support and protect the most vulnerable by focusing on the social determinants of health
and providing better support to the groups that have the worst health outcomes;
• provide better care for children and young people with long term conditions and
disability and increase life expectancy of those with life limiting conditions.

18. Better health outcomes for children and young people
Because
• the all-cause mortality rate for children aged 0 – 14 years has moved from the average to amongst the worst in Europe
• 26% of children’s deaths showed ‘identifiable failure in the child’s direct care’
• more than 8 out of 10 adults who have ever smoked regularly started before 19
• more than 30% of 2 to 15 year olds are overweight or obese
• half of life time mental illness starts by the age of 14
• nearly half of looked after children have a mental health disorder and two thirds have at least one physical health complaint
• about 75% of hospital admissions of children with asthma could have been prevented in primary care

19. Children’s talent to endure stems from their ignorance of alternatives
Remember:
Children’s talent to endure stems from their ignorance of alternatives
May Angelou
We worry about what a child will become tomorrow, yet we forget that he is someone today.
Stacia Tauscher