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

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)

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

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 158 2001

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).

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

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 – £1,200 - 3,000 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

Disproportionate costs on services Can be as much as £250,000-330,000 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 2010-11 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

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

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

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 12-18 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 https://registration.livegroup.co.uk/fip/ with data collected from 17 LAs 13

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

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)

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.

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.

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

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