Commissioning: Edge of care services

The pressures on English local authorities are growing, year on year. Significant budgetary pressures, complex needs of children and families, sufficiency challenges and the personal pressures on staff to navigate this are some of the contributory factors we are currently seeing in the social care sector. More effective commissioning of edge of care and family support services form part of the solution to the current challenges facing the system.

What can an edge of care service offer?

The primary objective of an edge of care service is to prevent family breakdown, either short, medium or long term, and can be commissioned at any point in the child and family’s lives. Dependant on when the edge of care service is brought in to support the family, it may be the safest option for the child at that point to become a looked-after child. However, with the right ongoing support for the family, there are opportunities to rebuild the family unit and for the child to return to their family. This presents opportunities for commissioners to consider edge of care services as an integral part of the planning process for long term success.

Choosing the right edge of care service

It is essential that edge of care services can demonstrate the impact and effectiveness of their service to commissioners in a format that enables clarity to budget holders of efficiency savings created. This challenge is far greater than demonstrating actual savings, but to mitigate against the risk of efficiency savings not being realised going forward, it is essential that providers are freed from artificial barriers that will prevent positive outcomes being achieved. A long-term commitment is often required to enable edge of care services to work alongside families, during periods of improvement, sustainment and decline, recognising that progress is highly unlikely to be linear. This requires open and transparent conversations, timely updates and feedback from individual family members, their supporters, and professionals to get a true sense of the difference the support is making.

Challenges that can impact outcomes

Commissioned pieces that only provide a finite period for outcomes to be achieved, such as six weeks of person-centred therapy, are less likely to have a positive impact, and may significantly impact the wellbeing of a family member, if support is abruptly ended without space to create meaningful change. A co-produced joint plan, which includes therapists and family support workers within edge of care services, can look to inform commissioners of projected timeframes that are realistic for each family. Review periods will be built in to provide commissioners with reassurance of the quality of the work, and the ongoing impact it is making. A trusted relationship with open dialogue, and high-quality reporting by the edge of care service will enable commissioners to keep a careful eye on their budget and to plan ahead throughout the programme of work.

The added reassurance that edge of care services can provide to families in crisis, or if their child has been removed from their care can be invaluable in reducing anxiety, stress/depression and suicidal thoughts by knowing that with the right support and work, there are opportunities for positive change.

What does it look like?

Person-centred commissioning can offer incredible value to local authorities, not only as a preventative measure across family breakdown and wider social challenges but also adding social value in communities. Community cohesion reduces social isolation and loneliness and can improve the emotional wellbeing of our families. A community-focused service will look creatively at local assets and how these will be beneficial not just to the family, but to the local authority creating less reliance on statutory services.

Quality assuring edge of care services, many of which are not required to be regulated, should include:

• Excellent feedback from families and professionals

• Robust and comprehensive policies and procedures, of which there is clear evidence that the organisation holds accountability to these

• An outcome framework that identifies key themes that impact families on the edge of care and how the organisation will respond to and address these

• Examples of how contracts have been met in full, meeting timescales and within agreed budgets

• Creative and organic organisations who can walk alongside the family, adjusting programmes of work to meet their needs in full

• Clinical supervision that both supports the quality of the work and the emotional wellbeing of staff

• An open door to families so that at any point, the family can reach back out for help if struggling, to prevent further crisis ahead (at no further cost to the local authority)

• A service that looks at the environment and what changes may be required to give the best possible option for positive change, particularly if a child/young person is being reunified with their family

• An organisation that does not give up on the family despite the challenges they may face.

Applying the “commissioning cycle”, the following actions could prove an invaluable step forward in considering a greater utilisation of edge of care/family support services to resolve sufficiency/budgetary challenges:

• Understand the breadth of what can be offered, including client feedback and track record of mobilisation in other localities to agreed timescales.

• Plan to commission an edge of care/family support service as part of the solution to your short, medium and long-term planning for service delivery and individual families.

• Do come and talk to providers – you do not know what else they may be able to offer. For example, the voluntary sector has a board of advisors/directors, who come with a raft of knowledge across health, education, social care and business.

• Review qualitative and quantitative data – impact reporting will reassure you of the quality of our work.

A bespoke strategy prior to the delivery model, can reduce the risk of duplicity of roles and provide the basis of a strong partnership on which our services can work together. Effective risk management provides a further level of safeguarding and scrutiny which can be invaluable to busy social workers.

Examples of better outcomes includes:

• Reduction in anti-social behaviour

• Reduction in criminal activity

• Reduction in the risk of child sexual exploitation

• Reduction/cessation in missing episodes

• Reduction in knife crime

• Reduction/cessation of domestic abuse

• Improved emotional wellbeing

• Improved sense of pride (both parent and child)

• Improved sense of safety and stability (through effective boundary settings)

• Improved physical health

• Increased social return on investment in local communities.

What to avoid?

• Services that over promise on results in unrealistic timeframes

• Heavily weighted back office or management costs

• One size fits all model

• Commissioning purely for qualifications without exploring the true quality of the value the team offers, eg experts by experience.

Can it work?

The impact my organisation has made includes:

• 86% of children working with our service do not enter the care system

• 93% of all clients (children and adults) report an improved sense of wellbeing after accessing our therapeutic support

• For every £1 spent, on average £45 is saved

• A robust level of safeguarding which has prevented neglect, abuse and physical violence in more than 2,000 families since 2005.

As a commissioner, the benefits that edge of care services offer include multi-million pound efficiency savings through children either being cared for by their family, or returned to their family when safe to do so. The difference this will make to commissioners is both a reduction on the financial pressure on overstretched budgets and improved and sustained outcomes for families and communities. The benefits are not just in the investment in the child, but for the wider family and future children to come.

Next steps

It is time to think out of the box as the current market is unaffordable, expensive and failing to deliver enough provision. It fails vulnerable children. At present, there is a risk that the national shortage of places, especially for more complex children, will worsen and costs will continue to increase above inflation. Urgent short-term action and a longer-term change in approach towards models of commissioning and procurement are required. These must be based on flexible, collaborative approaches with longer term relationships, less complex more sophisticated documents, including specifications reflecting the highly regulated nature of this marketplace.