The optimum place

Rising demand coupled with shrinking budgets is leaving commissioners with a tough task to ensure placement decisions are based on best meeting the needs of children rather than cost. According to the Children and Familiy Court Advisory and Support Service (Cafcass), there was a 14 per cent increase in the number of care applications made from April 2016 to March 2017 compared with the same period the previous year.

The Local Government Association estimates that due to rising demand and cuts to central government grants to councils, children's services face a £2bn funding gap by 2020.

Care applications for the first six months of the current financial year suggest some stabilisation. Cafcass figures show there were 7,150 applications between April and September 2017, compared with 7,471 in the corresponding six months in 2016.

However, the search for value is dominating placement decisions, say providers. "Commissioning is mostly a poorly administered system looking at cost rather than about timely evidenced-based decisions," says Harvey Gallagher, chief executive of the Nationwide Association of Fostering Providers (NAFP).

Independent Children's Homes Association chief executive Jonathan Stanley concurs. He says residential care commissioning in the main involves large frameworks of providers, where "price demonstrably trumps all other factors".

Graham Baker, chief executive of residential therapeutic care provider Outcomes First Group, is sympathetic to the budgetary pressures commissioners face. But he admits that in this financial climate placements are being made that are not "necessarily in the best interest of the young person".

"There are lots of young people who are tracked for fostering as a priority over residential care even though they perhaps would be better placed in residential care for stability prior to the move to a family," he adds.

Capping of provider fees is also harming innovation, with many providers reluctant to develop enhanced costlier services, warns Gallagher.

He says: "Local authorities are getting the provision they are asking for but they need to be careful what they wish for."

Cost cutting is reducing the range of providers commissioners can call on. A survey of 100 fostering providers by NAFP in June found just under half (47 per cent) do not tender for contracts where fee caps are in place.

Another key concern raised in the survey is a lack of communication between commissioners and providers. This can lead to poor understanding of local care trends and undermines placement stability through poor matching that places a greater emphasis on spot purchasing, rather than planned care.

"It is increasingly challenging to find the most appropriate placement for each child in these circumstances. What is needed is better early planning," says Gallagher.

Nevertheless, there are examples of commissioners and providers working well together to tackle issues such as placement instability. Lancashire County Council, for example, is working with providers to look at cost and quality of referrals (see box).

Buckinghamshire County Council also recognises the importance of strong relationships between providers and commissioners and operates an extensive programme of visits to every children's home it uses.

These visits are invaluable in helping commissioners understand the market and improve the accuracy of referrals, says Simon Brown, head of Buckinghamshire children's care services: "What is the philosophy of the home manager? What are the staff like? Do they know our child? We spend around three to four hours asking these questions, talking to staff and seeing them interact with children."

PROVIDER PARTNERSHIPS

Providers are also making sure they can continue to innovate by showing commissioners they understand the financial pressures they face.

Baker explains that Outcomes First Group has put in place a fostering feasibility assessment for all young people placed in its West Midlands homes "regardless of whether it is requested by the placing authority".

This includes details of how a young person could make the move from residential to foster care if appropriate for their needs, which can save commissioners money and provide a potentially more suitable placement for children, while maintaining their school placement and therapeutic links.

Central government involvement in improving children's social care commissioning has focused on separate parts rather than the system as a whole. Over the last two years there have been reviews of adoption, and residential care, and this year a "fostering stocktake" was launched.

The residential care review and fostering stocktake, both led by Sir Martin Narey, have highlighted similar concerns about commissioning. The former highlighted that commissioners frequently regard children's homes as a last resort.

Meanwhile, a report released in July as part of the fostering stocktake said placement decisions are too often based on financial constraints rather than the best needs of children.

As recommended by Narey's residential care review, the Department for Education has promised to set up a Residential Care Leadership Board, of commissioners, academics and independent providers to advise the government on improvements. This is expected to be up and running in the new year.

Jonathan Stanley believes it is likely to provide only "a partial addressing, yet further tweaking" of challenges facing commissioning.

The Children and Social Work Act also sets out to improve commissioning through a definition of corporate parenting, which specifies that during care planning more consideration needs to be given to providing permanence and stability and tackling the long-term impact of trauma.

Again, Stanley is sceptical about whether such a legislative focus on corporate parenting will itself lead to any improvement in commissioning practice. "Parenting is observably a lesser factor in much placement making," he adds.

HOLISTIC REVIEW

Given this piecemeal approach to reviewing care, some in the children's sector are advocating a far deeper investigation, similar to a two-year review of all aspects of children's social care launched in the summer by the Scottish government.

"A wider review of care in England would enable discussions about care as a whole, and the journey of care," says Chloe Cockett, policy and research manager at children's charity Become. "Isolated reviews don't answer the big questions, like what care is, or who should it be for, or what outcomes we should be measuring." Creating clearly defined national outcomes could help ensure commissioners place children more appropriately, rather than based on cost, she adds.

The Office of the Children's Commissioner for England's stability index for children in care, could help provide such a definition of what success looks like when placing a child. This focuses on stability in three key areas of a child's life as being the most important aspects of their time in care: placement, education and social worker support.

"This has huge potential to improve commissioning," enthuses Gallagher. "We would be able to ditch every other outcome measure and just look at stability, it is that significant.

LOCAL SPOTLIGHT SOUTH LONDON COMMISSIONING PROGRAMME

Six councils in south London have come together in a bid to ensure their commissioning of looked-after children placements is both cost-effective and improves outcomes.

All those involved are part of the South London Commissioning Programme. This was set up in 2013 and involves 10 councils commissioning school placements for children with special educational needs and disabilities.

Over the coming months the London boroughs of Croydon, Merton, Sutton, Bexley, Lewisham and Greenwich will develop a shared, flexible roster of children's care providers.

Using economies of scale, this will ensure they can use a wide variety of residential and fostering providers, which would have been much costlier if used individually.

Specialist providers not on the roster will also be considered if they are identified as being the best match for some children.

"We have to be able to commission in a way that gives flexibility," says Alisa Flemming, Croydon's cabinet member for children, young people and learning.

"For example, a parent I was speaking to recently had found an organisation that could benefit her daughter who had been in a secure placement.

"This new commissioning model allows us to bring in a smaller organisation like that, which may not have been placed on the framework initially but meets the needs of a specific cohort. In Croydon we may only have one child who that provider is suitable for, but say Merton has two, Bexley has two and so on. Together that means it would be worthwhile commissioning that provider."

The new model becomes operational in 2018. It has been granted £1m from the Department for Education's Children's Social Care Innovation Fund to help its development, which includes the involvement of looked-after children in the design of the service, legal and administration costs, and evaluation. The fund is hoping that other groups of councils will be able to learn from the partnership's experience and that it will offer a "blueprint for sub-regional commissioning which is scalable across the country".

LOCAL SPOTLIGHT LANCASHIRE COUNTY COUNCIL FEES UPLIFT

While many local authorities around the country have frozen their fees to residential care providers or even reduced payments, Lancashire County Council is bucking the trend by increasing care home providers' fees.

Each year, fees for the 40 providers on its residential care framework, which launched in 2016, will increase in line with inflation. The first uplift, of 2.7 per cent, took place in August this year.

The move is part of a drive by the commissioning team to work closely with local providers and act on their concerns, such as their increasing costs around the national living wage.

"It is fair and right to include an annual uplift that recognises the cost of living and national living wage, as well as minimise cost pressures on providers and maintain quality," says the council's policy, information and commissioning manager Annette McNeil.

In this same spirit the council also asks providers to review their costs and consider waiving the annual uplift if they can find savings elsewhere. "Some have done that and decided to waive the uplift in part or in full," McNeil says.

In addition, the council meets with all providers twice a year to look at latest care trends and how they can work together to address problems.

One issue to emerge from the last meeting was how quality of referrals can be improved to ensure children are matched better with providers.

"We are going to develop training for our social workers on what a good referral looks like, with providers included to give advice," says McNeil.

Her team is also working with providers to improve placement stability. This includes identifying trigger points for what makes a placement vulnerable "and getting people around the table earlier to have a look at what needs to happen to stabilise the placement and avoid it breaking down," adds McNeil.

In addition, the council involves looked-after children in commissioning decisions, which some have done. Currently, their involvement is focused on the quality of homes' welcome packs for children.

Already, a number of providers have resubmitted improved guides following feedback from children.

This article is part of CYP Now's Children in Care supplement. Click here for more

Read the full supplement online, or download as a PDF