Practice - commissioning placements: Creation of ‘step-down’ foster placements improvescare and saves money

• Lancashire County Council works with five private sector agencies to offer specialist fostering placements to prepare children with complex needs for mainstream fostering
• 13 placements have been enabled through the county’s Step Down into Fostering initiative since 2017
• The scheme has delivered £750,000 of savings after children were diverted from expensive and potentially unsuitable children’s home placements
  
  

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A lack of appropriate fostering placements has meant unnecessary numbers of Lancashire children are cared for in residential homes, but the situation is improving with focused, sector-led effort.

The mismatch has come at a high financial cost to the local authority – the full fee ranges from £2,500 per week for a mainstream residential placement up to £4,500 per week for a more complex package of care. This compares to £770 per week for mainstream foster care, and £1,300 for step-down care.

Spending long periods in residential care can also come at a cost for children and young people, who may become less able to adjust to a foster setting as time passes, and may be more vulnerable to exploitation.

The problem was something Annette McNeil, senior commissioning manager at Lancashire County Council, knew about through conversations with her team. But without having concrete data to hand, it proved difficult for her to put a strong case for “doing things differently” as part of commissioning.

“I was a bit like a dog with a bone for quite a few years because I knew there were significant issues with how it was working,” says McNeil. “I was relying on anecdotal feedback and people saying: ‘We’ve got way too many children in residential care who need to be in fostering and they’re there because we couldn’t find a fostering placement’.”

This remained an issue until a 2017 reorganisation brought the council’s “access to resources” team into her remit, which encompassed placement finding, contract monitoring and intelligence – including data, analysis and market insights.

The newly available data revealed that 15 children and young people had to be placed in residential care because a suitable foster placement had not been found. This was over and above the number of children who were already in residential care, who had a plan to move to a fostering placement.

McNeil recalls: “That was enough for us to say: ‘We know there’s enough young people to justify doing something different.’ It was a no-brainer.”

Providers were first consulted about the prospect of commissioning step-down care and what this might look like.

They considered a social impact bond model, which pays a weekly placement fee with a final payment made upon completion of a placement, but decided it was too complex.

McNeil says provider feedback was that rather than new mechanisms, it was about “working differently together”.

A small pilot – which led to one successful step-down placement – was carried out around this time to plug into the potential logistical demands, such as information needed from children’s social care and the kinds of extra support required by carers.

The cost of these places would be around double that of mainstream placements, but they would lead to significant savings over all. They also had the potential to bring huge benefits to children hoping to be fostered.

As part of its 2018 commissioning process for buying mainstream foster placements, Lancashire included a second procurement “lot” geared towards the step-down service.

Conversations with all 29 mainstream providers would have placed high demands on time as well as lacking focus, “so the idea of ‘lot two’ was to be able to focus our efforts and work with key providers that were up for working with us”, says McNeil.

“We invited any provider that was interested in being on the mainstream framework,” she says.

“If anyone was interested in delivering step-down fostering, we asked them specific questions mainly around how they would deliver, how they would recruit, how they would support carers and what their model looked like.

“Out of 19 providers who asked to be included on that lot, we looked at the ones who scored the highest and looked at their prices.”

One of the three winning organisations was National Fostering Group (NFG), whose step-down service is called Bridge to Foster. The group includes three independent fostering agencies (IFA) and therefore a total of five IFAs are currently involved in step-down provision, with plans to extend to seven.

It is up to the providers to decide on how they identify and match suitable foster carers, and the child’s social worker then approves the match.

These five providers were placed in “tier one” and there is a strategy to encourage proactive working.

“We tell them, ‘the seat you’re getting at this table is precious. We need you to be proactive, so if you’re not stepping up and working with us and delivering some step-down placements or at least making offers or showing willing, then your seat will be given away and you’ll move into tier two’,” McNeil explains.

She adds: “There has been some movement – some have said: ‘Actually, we can’t deliver what you’re asking us to do’.”

Across Lancashire’s step-down care, each specialist placement is structured across four phases, which have no time limit as they are dependent on a child’s needs.

The planning and introductory phase is usually between two and four weeks, with some lasting two or three months, usually costing £300-£400 a week.

The child or young person remains in the residential placement during this phase, but has been matched to the carer and they arrange days out and ways to get to know each other. Carers are given training to help them understand what behaviours to expect and how to respond.

Phase two, the most costly period, involves settling the child in, therapeutic support where necessary, and additional visits from social workers.

If anything threatens the placement’s success, such as disengagement with education, this is flagged and a solution is fast-tracked.

Phase three concerns maintaining the placement. Some of the high level of support begins to reduce, followed by a fourth phase of transitioning into a mainstream placement elsewhere, or an agreement to remain in place.

The council employs a member of staff to oversee step down into fostering on a daily basis, and they have an opposite number at the agency with whom they are in frequent contact.

Regular meetings are also held with the IFAs, attended by social workers who advocate for the children’s strengths and “bring them to life”.

Richard Woodward, NFG’s director of strategy, appreciates Lancashire’s style of engagement, and for allowing IFAs to “professionally challenge decisions”.

He says: “A direct line into commissioners enables us to solve problems swiftly as they arise – issues such as care planning drift, lack of education placement or other matters affecting the stability of the placement.”

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Since the pilot placement in 2017, there have been six placements in 2018/19 and then another six in 2019/20.

Six are still active and one successfully transitioned to a mainstream placement, with one supported to return home.

“Eight placements in our minds worked well,” says McNeil. “A 40 per cent breakdown rate is about what you’d expect to see. We’re really happy with how it’s gone.”

However, the rate of matching has not met their 10 projected placements per year.

To achieve these numbers in future, she has secured her bosses’ backing for block contracting. This means that when an ideal carer is put forward, but a suitable child is not available, they can be paid a retainer for around a month, so they are not lost to another placement.

McNeil knows from similar arrangements with children’s homes that it opens up more opportunities.

She adds: “Instead of us relying on a list of children, this is saying to children’s social care staff: ‘We have a carer, does anyone have a child who would benefit from this kind of placement?’”

Woodward appreciates the certainty that comes with this, which he says will enable the organisation to predict demand.

In turn, this “helps us to accelerate robust matching, planning and successful transition”, he adds.

Looking to the future prospects of step-down care across the UK, Woodward believes that “proper planning and collaborative working” between IFAs and local authority commissioners could open up enduring family-based placements to a “significant proportion” of those in residential care.

He suggests that other local authorities aspiring to develop a step-down model should “look carefully at Lancashire’s work in this area”.