Presentation on theme: "CPFT – Children’s Services"— Presentation transcript:
1 Russell Norman General Manager - Children’s Services Cumbria Partnership NHS Foundation Trust
2 CPFT – Children’s Services Health VisitingSchool NursingChildren’s Community NursingCAMHSPhysiotherapyOccupational TherapyChildren’s Learning Disability NursesAudiologyPodiatryCommunity PaediatricsTeam 400+(and other services)
3 Is Child Poverty an Issue ? Children from poor families are 5 times more likely to die from unintentional injuriesChildren from poor families are 5 times more likely to die as a pedestrianChildren from poor families are 16 times more likely to die in a house fireChildren 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 familiesHDA 2005
4 Is Child Poverty an Issue ? Children from poorer families believe that:Health is a matter of luckSmoking cigarettes is not dangerousChildren from poorer families are more likely to:Play truant from schoolLeave school at 16Not want to be a parent or marryHave low self esteemBecome pregnant at an early agePerform poorly in educationDWP 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 outcomesGap between groups is wideningChildren in poverty more likely to:Under achieveGet pregnant earlyBe affected by domestic violenceBe involved in alcohol and drug misuseDie younger, suffer health problemsBe a cost to society, not just in financial terms
9 Not intervening early is expensive…. Cost per child / familySeverity of needCostFamily Intervention Projects – £8-20,000 per family per yearFamily Nurse Partnerships – £3000 per family a yearChild looked after in children’s home – £125,000 per year placement costsChild looked after in foster care – £25,000 per year placement costsSchools - £5,400 per pupilChildren’s Centres - around £600 per userCosts increase as children get olderMulti-dimensional Treatment Foster Care – £68,000 per year for total package of supportChild looked after in secure accommodation – £134,000 per year placement costsParenting programme (e.g. Triple P) – £900-1,000 per familyPEIP – £1, ,000 per parentMulti-Systemic Therapy – £7-10,000 per yearBy 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 Services1Education - £580mChild benefits - £110mGP/NHS costs - £30m£0.7bn universal spend/yr46,000families…and specialist services, (often repeatedly for many years) Targeted Services2Welfare benefits - £750mMental health treatment - £20mParenting support - £50mDrug misuse treatment - £10m£0.8bntargeted spend/yrbut family breakdown and crises still leads to very poor and costly outcomesReactive spend3Children 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/yr1 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 difficultDfEHOMoJDHCLGDWPLAPoliceYJBCCGHousingauthoritiesJCPVCSPrisonsYOS workerYoung carersupport workerCAMHS/ Mental Health WorkerPolice officerDrug and alcohol teamHousing link workerEmployment Personal advisersFamily supportworkersSchoolsSurestart Children’s CentreIntensive family intervention worker/ parenting practitioner11
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 chancesAround 120,000 families in England experience multiple social, health and economic problems. 46,000 of those experience ‘problem’ child behaviourAccount 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 protectionContribute to a wide range of social problemsFamilies with multiple problems make significant financial demands on a wide range of local servicesThe 117,000 families are often targeted by a number of different professionals each dealing with a different family member and a different problem46,000 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 strengthsUsing incentives / rewards / consequences and flexibility to use resources creativelySupport not time-limited for support (average months) and available ‘out of hours’Effective multi-agency working and information sharingFamily intervention costs £14K1 per family per year, making savings of around £50K2 per family per yearEvidence Based Parenting ProgrammesMulti-systemic Therapy, Evidence-based parenting programmes, Family Group Conferencing, Family Nurse PartnershipsPEIP Interim report: shows significant improvements to parent and child outcomesWhat doesn’t work: Families targeted by different professionals each dealing with a different family member and a different problem1Steve Parrott and Christine Godfrey, Department of Health Sciences, University of York April 20082calculated using the DfE Family Savings Calculator https://registration.livegroup.co.uk/fip/with data collected from 17 LAs13
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 aspectof 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 childrenand young people. Through our joint commitment and efforts we are determined to:• reduce child deaths through evidence based public health measures and by providing theright care at the right time;• prevent ill health for children and young people and improve their opportunities forbetter long-term health by supporting families to look after their children, when they needit, 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 andmental well being and providing early and effective evidence based treatment for thosewho need it;• support and protect the most vulnerable by focusing on the social determinants of healthand providing better support to the groups that have the worst health outcomes;• provide better care for children and young people with long term conditions anddisability 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 alternativesMay AngelouWe worry about what a child will become tomorrow, yet we forget that he is someone today.Stacia Tauscher