Rethinking children's services

The basic children's services model was founded in the 1940s welfare reforms. It has aged well, but previous columns have demonstrated how systems thinking is leading to new solutions. The 70-year-old approach now often leads to rationing scarce state resources to vulnerable people. Austerity bites and the cracks are beginning to show.

However, necessity being the mother of invention, local authorities and partners across the country are developing and testing new service designs in three key ways:

• Understand and anticipate — New data sources and big data analytics are creating a step-change in our understanding of children's needs and outcomes. Better under-standing increases the accuracy of predicted need and offer help much earlier.
• A compassionate system — Professionals working in public services are compassionate, but our systems are not. Families often have long waiting times and are offered services that don't fit their needs. There is now an economically viable alternative to reach out and support citizens earlier - a compassionate public sector system.
• Integrate to control demand — Integration is critical to control where demand is met; to build trust between providers; and manage how the statutory, community, universal and digital resources are all used to support families. Inevitably funding will move from expensive statutory services to real early help, increasing the volume of demand but reducing overall costs.

These three approaches will now be analysed in detail.

Understand and anticipate

The first challenge is to better understand and anticipate the needs of local residents - enabling much more responsive and cost-effective forms of support. Intelligence is being integrated to create a single view of the child, including a wide variety of partner data (including from education, social, care, health, benefits, housing, marketing and social media).

But this intelligence is insufficient - for instance, the needs of children are barely known until they escalate - which gives practitioners little time to be proactive. New measures, such as annual surveys of children's outcomes and real-time measurement of patients' health using wearable technology (so patients can stay at home rather than in a precautionary hospital bed), will become widely used. Predictive analytics is starting to change service delivery. For example, the Behavioural Insights Team project which analysed social worker case notes to identify children who will be re-referred. Or the Essex University work to identify risk and protective factors for re-offending enabling the youth offending team to target those most at risk.

Better intelligence allows commissioners to do three things:

• Build the science behind services, based on local evaluation of the longitudinal impact of interventions, so investment is targeted at solutions that work. It may be that traditional services don't deliver the most sustainable outcomes, but family and friends, the community, schools and local economy might.
• Commission for outcomes and not services by giving responsibility to providers for improving the mental health of children and young people. For example, rather than paying for entry to services or a number of sessions.
• Anticipate and predict the needs (including hidden needs) of every family and offer targeted and tailored early help.

A compassionate system

Public service failure is often institutional, obscured by layers of history and culture. The teenager with special educational needs whose complex needs do not fit into the boxes on offer, the hidden children where 24 per cent of a class has a mental health need but only three per cent have services, waiting time targets that are gamed by institutions and used to manage demand, or the thresholds that say we can only help if you are really ill.

Staff working in the public sector are compassionate, but can be let down by processes and pathways.

Now some children's services are dismantling their thresholds, for example the multi-agency safeguarding hub in Leeds. Often in safeguarding services there is a process of triage with a quick assessment against thresholds. If the need is below the threshold then there is no further action, reducing demand to expensive social care services.

Logically this makes sense, but it also pushes children away until their needs escalate and lives become worse. Now some local areas such as Leeds are removing this stage and offering appropriate help for all referrals - using the wide range of community and public services to help families and intervene early.

What a public sector system allows commissioners to do is move away from cuts and statutory minimum services to a compassionate design - one that understands citizens and hidden need, and reaches out to help them. It's a simple choice: demand is either managed by ignoring it, or because children, young people and families are helped earlier.

What is defined as a service is changing. Intelligence moves interventions from reactive to proactive giving time for different types of support to be more effective. However, there is currently a vacuum of interventions in this new tier, so innovation is needed. At the same time, traditional services are blending with community resource (for example, social pre-scribing), blending with universal services (schools delivering family support), and blending with digital delivery (apps for peers to support each other's mental health). It is unclear what this new tier of support will look like, but it is likely to grow rapidly, and it won't feel like a normal public service.

Examples of future services might include: volunteers shoulder-to-shoulder with professionals; service users recognised for their assets and asked to support others; self-help and a culture of local compassion seeded by the state; teachers doing a little more with target families; pharmacies, gas engineers, taxi drivers or other local businesses supporting resilience by looking out for vulnerable residents; online training and guidance to democratise professional knowledge; or digitally pushing a tailored list of local community groups to parents through social media, based on analysis of their future needs.

Many local areas such as Wigan are recognising the importance of social capital and deliberately creating a new relationship with the community - to encourage connections, self-help, and neighbours and families to help each other a little more.

Integrate to control demand

It feels uneasy to talk about control in the same breath as compassion. But control will be a defining characteristic of the public sector system - so that children and young people get the help they need from the many different services and types of innovative support. Demand must be met in the most cost-effective part of the system instead of the de facto maze of current pathways.

Single points of access will make the public system easier to navigate and show where more support is needed to reduce demand to expensive statutory services - for example, improving access to mental health services, or increasing capacity in primary care through digital consultations.

The new public system is dependent on trust between commissioners - to stop cost-shunting, share risks and use the total resource in the system. Integration will help to improve efficiency and create this trust, through arrangements such as alliances that give a legal basis to risk sharing. These new providers will be incentivised to grow innovative services blended with community, universal and digital resource that promote resilience and reach out to families.

Alliances however cannot be the sole solution. As with any part of the government it operates in layers. National governance and policy, regional combined authorities, hospital level alliances, local service integration around populations of 50,000 citizens, and voluntary and community based support at street level. Too much focus on one layer to the exclusion of another will be inefficient.

Commissioning will also integrate and scale up to manage these competing providers. A combined authority model gives the right sort of integrated governance between health and care enabling the move to outcome based commissioning and making best use of all public services and resources. Commissioners' aim will be to pursue population outcomes, but also push growth and resilience, and crucially to shift funding from acute to early help.

Shaping the future

Every area is evolving and reshaping services - responding to austerity and continuing to safeguard children and families. If commissioners join the dots, a picture emerges that goes beyond the welfare reforms of the past, towards a more compassionate public system. Children's services must work together to test, share, learn and craft a new compassionate public system.

IMPLICATIONS FOR SECTORS

While themes that describe the future of children's services are emerging, it's more difficult to say how these will affect organisations and professions, as there are more variables, so take the following as a best guess.

• Local authorities - Public services are likely to integrate, which could lead to fewer two-tier authorities, joint commissioning with health, and potentially more formal integration. Some local authorities are externalising their services. Funding for local authorities is changing to be more dependent on business rates, so expect more initiatives and a clearer focus on employment, education and productivity.
• Commissioning - Commissioners will integrate and potentially move up a tier to sub-regional arrangements. Commissioners will be looking for population outcomes more than micro-managing providers. Joint Strategic Needs Assessments could be replaced by local evaluation and named lists of children and families to help. Commissioning will be quicker with artificial intelligence supporting decisions, based on detailed local evaluations.
• Social care - Social care could become smaller and more acute, it may be externalised, or could be moved into a health delivery model like in Trafford. We're likely to use more computer-based analysis of needs, and have much better information on families before we get a referral.
• Schools - As other parts of the state shrink, schools will do more to support the child, and to also support families more. Perhaps acting as case-holding professionals to co-ordinate the help from a range of statutory and community services, or simply building good relationships with families. Services are likely to be delivered through integrated locality hubs - schools have the potential to be at the centre of these hubs.
• Voluntary sector - Large charities are likely to be part of the fabric of public sector delivery, through alliances or partnerships with local authorities. Small voluntary and community services have a great opportunity to grow by offering targeted support to vulnerable residents for a low unit cost - supported by predictive analytics which identify these residents much earlier. But medium-size voluntary organisations have a difficult choice between these extremes.
• Families - Over time the relationship between families and communities and the state should improve. Residents will expect professionals to know about them, and to interact digitally as well as face-to-face. Support will be provided much earlier to prevent a need escalating.
  
  

Richard Selwyn is a member of the Association of Directors of Children's Services resources and sustainability policy committee @rjselwyn