Meeting documents

Contributor:

Iain Campbell, Safeguarding Lead Commissioner, Access to Resource Team, Children’s Services, Joint Commissioning Unit

 

Purpose:

Iain Campbell will give a perspective on cross-regional commissioning placements, monitoring, contracting and costs.

 

Background papers:

·         Access to Resources – team description

Iain Campbell, Safeguarding Lead Commissioner, Access to Resource Team (IC), and Simon Brown, Operations Manager, Commissioning (SB), were w

welcomed to the meeting.

 

SB had a background in placements and had been in post since September 2009.

 

IC told members the following:

 

IC had worked for Buckinghamshire County Council (BCC) for 25 years. IC had managed all the BCC Children’s homes and had an MA in therapeutic childcare. 

 

The Access to Resources Team (ART) was formed about 3 years ago. The Local Authority used to rely on Ofsted reports but now also made visits.

 

ART was used across the UK, particularly in the London boroughs.  Olga Sullivan and IC had been brought together to form ART. 

The ART Team had started with 200+ educational placements with external providers.  The Team dealt with all external placements for SEN, fostering and mother and baby placements, when a placement could not be provided in-house.

The placements were monitored every year. 

BCC was part of a cross-regional group, and also part of Pan-London, to ensure that fostering placements were monitored thoroughly.

 

The Commissioning Strategy aim was not to place children away from home where possible, and to keep the placement local. 

 

The current figures for placements in the County were as follows:

 

45 children in 52-week residential placements/special schools (LAC)

4 children in mother & baby units (where assessment is needed around the parenting capacity of the mother)

 

The cost of these placements started from £1,300 per week and a 12-week residential placement could cost £40,000.  Residential placements cost £2,000 - £4,600 per child per week.

 

There were currently no placements abroad.

 

Mother and Baby placements - some of the families were very vulnerable, with previous children having been removed.  The process took about 12 weeks, and consisted of monitoring and training. More and more responsibility was passed to the mother in a safe environment.  Where drugs and alcohol were involved, the recovery often depended on the mother staying away from her partner, which could be a very complex issue.

 

SB explained that he had undertaken research in mother and baby placements. Based upon 6 years’ worth of data, he had found that only 1 in 3 mothers and babies stayed together following the assessment and a year after the assessment, 1 in 3 of that number were still together.

 

In the first year of ART there had been a saving of £0.5m.  In the current year there had been a zero percentage increase to providers. For 2010-11 the Pan London Consortium was recommending a -2% decrease.  ART negotiated with the providers re: price on individual placements.  The number of children needing placements was increasing and they were staying longer in placements (longer Court processes).

 

There were still issues - some units had been found to be sub standard, with problems not picked up by Ofsted.  This is monitored very carefully.

 

Benjamin UK had four units in Buckinghamshire.  They provided residential placements in a Therapeutic Community for young people who were at risk of offending, as well as those with a history of criminal tendencies and severe or mild behavioural difficulties. They also offered specialist placements for unaccompanied asylum seekers.

 

A member suggested that it would be useful for the Group to visit one of the units. A member said it would be interesting to see a breakdown of the total cost of a placement, from beginning to end.

 

Members then asked questions, which are summarised below.

 

Also, with Pan London, do the tariffs differ i.e. will a placement in Buckinghamshire cost more than a placement in Uxbridge?  How do you reconcile this and do you end up subsidising the cost of the placement?

All the members of PAN London pay the same cost for placements.

There are very few specialist Children’s homes in London.  They are mostly high volume, low cost homes.  The placement price is higher, the lower the volume of a home.

In London prices have been driven down.  Staff have been lost but quality is also being lost as well.  London still places children in Aylesbury etc.

 

The Loughborough cost calculator tool looks at the cost of looked after children. It may show that for a child entering care within Local Authority Foster Care on the 1^st April, and staying in the placement for a whole year,  this may cost £27,000. 

 

With regards to individual administration costs, how does this fit into the tariff?

We are currently running last year’s data through the Loughborough cost calculator.  We will know the real cost following that.  In April we will run the 2009/10 figures and will have benchmarking figures.

If we use a private provider, there is a profit element for the provider of around 10%.  We are also paying for vacancies so the provider mitigates against the risk of making a loss.  This is hidden in the costs and that is how providers manage the risk.

 

A project with other local authorities had been started 2 years earlier.  There were currently six local authorities who all had the same issues, aiming to manage the market and to bring the provider to the middle of the region. 

It had been decided the previous Friday that this was going to be taken as a Cabinet Member decision.  It was proposed that there would be a five year contract and that there would be five places allocated for Buckinghamshire. 

 

Under the contract, a school would also provide day care facilities.  Significant savings would be made by not sending the children further afield. 

 

The location of the homes was not yet clear but a building in Hertfordshire would be included in the agreement.  It would be part of the provider’s responsibility to ensure that the children could get to school. 

 

The school would be a behavioural, emotional and social difficulties (BESD) school and it would ideally be near to Aylesbury. 

The contract would state that the school had to be located within an hour of each home. 

£3,500 was the current average cost per week per child. However through working with other authorities, this had been reduced to nearer £3,000 per week per child.  It is likely that the children being placed under the contract would be at the more challenging end and cost substantially higher than the average cost.

All the short-listed tenders were from high quality providers, and the tender would be awarded to a national provider.

 

Members then asked questions, which are summarised below.

 

Why do we need to use a private provider? 

There were no in-house bids received for the tender.

 

We already have a very good provision of special schools.  Why do we need further provision?

We have had long conversations with Wendover House and other special schools.  Prestwood Lodge has recently removed its residential provision.  The children who will be placed under the contract are those who cannot be managed locally.

The Verney Unit at High Wycombe has been developed to work with a very small number of complex children.  We want to develop more of this kind of unit and to keep our young people as local as possible.

 

As local authorities can now commission schools, can they not build them?

We can invest in our own services but we have recently invested a lot in advertising for fostering placements.  Unfortunately this has not been very successful and we have had to use external providers.

The key for this contract was to include therapeutic care and therapeutic schools so that the same philosophy is in place for the whole of the child’s day.  That may have put off bids from other local authorities as they do not provide this.

 

With costs being so high, is it not better to buy people with the expertise required rather than go external?

Some schools do that. Young people are excluded for a number of reasons, and Social Care and Education need to work better together. Children’s Centres etc may help with this.

 

How do children who need help become known by Children’s Centres?

Families who are hard to engage do not tend to attend Children’s Centres, so we need more than one way of engaging with them.  We also have to go out to the families.  Professionals can quickly pick up if a child has issues.

The longer a child is in Chiltern View etc, the harder it is for them to go home. 

 

How do you measure outcomes?

When a Social Worker wants a placement for a child, it needs to be very clear what the outcome should be.  Currently the main concern is the day to day safety of the child.

One of the changes is that ART will now be doing individual commissioning for children.  They will also be looking at the outcomes very carefully (outcomes may change and develop both short term and long term).

 

Target setting within the Pan London contract will raise the quality of the providers on the ground - not just day to day survival. Experienced staff and ongoing training will be a requirement in the new unit.

 

Will we always have problems with staffing?

Finding good quality staff is always a problem.

All changes are welcome financially but quality of care is very important.

 

Are there monitoring/controls in place for external placements?

Regional monitoring is always an issue.  We have done some training so that there is a standard approach.  We check that all staff have a CRB, insurance documentation etc. 

We look at all the files, complaints and restraints.  This information is covered in a standard form and is evidence-based.  If any issues are found then we look deeper into the matter. 

There are annual checks and we can also carry out checks ourselves such as spot checks on new providers or local providers.  The providers value the things that we pick up.  Regulation 33 visits are also carried out to internal homes too and special schools.

 

An Independent Reviewing Officer (IRO) goes to the homes three to four times a year and talks to the child.  Social Worker visits meet the minimum requirement which is part of ICS.  There are also family visits and the child can contact us as well.

 

In the future we are aiming for ART to go to the provider to look at the care being supplied and to see how this can be improved.

 

We use a national contract and the Pan London contract.  They are very similar and are both for top quality services.

 

Do you have budget ‘brick walls’?  How do you prioritise?

A whole range of services are provided for families, including preventative work to save money later.  When a young person comes into care, the decisions are based on the needs and safety of the child, not on cost alone.

 

For any child to be placed externally, you have to consider the following:

 

1. If it is safe to keep the child in the current environment?
2. Have we got any vacant foster placements? (not always cheaper than external placements).
3. The Social Worker, Team Manager, Operations Manager and Heather Clarke all have to agree to an external placement.

 

A placement can be found very quickly if necessary.  If the request is agreed then it comes to ART.  The options are given to the Social Work team for their decision.  If funding is not there (from Heather Clarke) we don’t even look for a placement.

This means that the Social Worker will try everything else before asking for an external placement.  The success rate of finding a placement for some of these young people is very high and some of their lives have been saved.

 

There is concern about the transition once a young person leaves our

service.  What happens when they leave residential placements?

There are new DCSF regulations coming into force.  There has to be a plan built in for all young people in care (any age).  We have employed transition workers in the past.

 

Where is the ‘black hole’ of provision?

Many looked after children do not have parents who advocate on their behalf.  We have advocates to support young people and there has been a move forward through the Transition and Leaving Care teams. 

We have commissioned some flats for young people to use after they leave residential care.  This has been done through Paradigm Housing at a cost of around £1m.

 

The Chairman thanked IC and SB and said that it had been very helpful to hear their views and questions.

 

SB told members that they had had a meeting the previous week with eight local authorities to look at fostering as a partnership (BCC would take the lead).  There were 12 local authorities who wanted to be involved and who all had the same issues with recruitment.  It was hoped that overheads could be reduced, e.g. expertise could be ‘shared’ across a region.

For instance, currently the adoption/fostering panels took place in every authority, costing a lot to run, and the possibility of these being joined together would be looked at. This could also reduce delays.

 

A Member said that whatever happened, the quality of service should not be reduced.