Organisation submitting example
London Borough of Enfield
Local authority/local area:
London Borough of Enfield
The context and rationale
The London Borough of Enfield developed a Commissioning Strategy for Looked After Children which had the reduction in the number of children placed in residential care as one of its aims. The implementation of this strategy has been effective in this aim, reducing the numbers of Looked After Children in residential placements from 17 per cent in 2004 to 6.5 per cent in 2010. This required an holistic approach and the coordinated implementation of a number of strategies.
The reduction in these placements was achieved within the context of an increasingly challenging population of Looked After Children and has ensured that more of the most complex young people can benefit from a family setting. The financial efficiencies achieved have been reinvested into preventive services to allow more children and young people to be cared for within their own families.
In Enfield during 2003-4, it was recognised that spending on young people in care was high and the outcomes for them were poor. As a result, a commissioning strategy was developed that identified the following factors showing that:
• Children placed in family settings were more likely to have better emotional well-being and educational achievement and less involvement in crime, substance misuse and teenage pregnancy.
• The unit cost of residential care was very high, particularly in light of the poor outcomes this achieved for the majority of young people.
• By developing the resources of the Council’s fostering service to meet a wider range of need, the need to use residential care would be reduced.
• Through the provision of more local placements, children could benefit from local health and education services.
• The capacity to work constructively with the Independent Fostering Agency (IFA) market could be improved so that IFAs would take children who would previously have been deemed ‘unable to foster’.
• Rreducing the cost of services for looked after children, would release resources to be invested in a range of family support services in order to reduce the number of children needing to be accommodated.
• A more focused approach to the external residential placements for looked after children could lead to better quality and greater efficiencies and savings.
The overall aim of the strategy was to improve the standard of care for looked after children while reducing the costs. This has been achieved through a number of mechanisms including:
• Significant investment in the Council fostering service - increased staffing capacity, dynamic recruitment activity, enhanced fees to carers, excellent multi- agency support to carers and children, robust finance policies, development of a specialist therapeutic scheme.
• A partnership project with an IFA to deliver a number of therapeutic foster placements for children who would otherwise be in costly residential therapeutic communities.
• Partnership building with the local market to secure preferential referral processes for the London Borough of Enfield
• Joint working between the fostering service and the joint service for disabled children to develop family-based care for disabled children unable to live with their families.
• Development of local semi-independent provision to include more intensive resources allowing care for the more vulnerable/challenging ‘16 plus’ young people unable to live in a family setting, and who previously would have required residential care.
• Joint commissioning of a specialist resource for young people with significant mental health issues which enables them to life in a safe environment and prevents escalation to residential care.
• The weekly Placements Panel which oversees all admissions to care and ensures that children are given family-based placements wherever possible.
• Closure of the Council’s own residential unit due to lack of demand for this type of general residential provision and high unit costs.
• Improved commissioning of family support services, including the use of Family Group Conferences to reduce the number of children and young people requiring care.
Responses to an earlier service user questionnaire had identified that a number of families whose children were in care felt that improved family support services would have helped to prevent family breakdown.
The rationale for our approach was to improve the care pathway and thereby the outcomes for looked after children. Pre-existing out of borough placements have been maintained where they are clearly meeting children’s needs and their wish to remain in these placements.
The strategy to reduce the usage of residential care has relied on an holistic approach across Children’s Services. The placements panel, the fostering service, the commissioning service and the work of the children in need service have all contributed to its success.
Enfield’s looked after children’s commissioning practice has been incorporated into the national Looked After Children Sufficiency guidance as an example of best practice.
The low number of children in residential care has attracted the attention of other local authorities who have visited the Borough to observe practice and who have adopted elements of our strategy in their own boroughs/authorities.
The successful partnership with the external IFA is believed to have been the first of its kind in London.
Support and training to foster carers has increased, as has our expectation of the types of challenging behaviour that they are able to cope with.
Achievements so far are shown below.
• Reduction in the numbers of children in residential care from 17 per cent March 2004 to only 6.5 per cent in January 2010.
• The reductions achieved in the Care Purchasing budgets have demonstrated the financial success of the strategy, with over three million pounds being saved over a five-year period.
• Between 2004-5 and 2010-11, reductions of over a million pounds were made in the residential costs centres (external and in-house service). In the same period, £622,000 was invested to increase the capacity of the in-house fostering service and some of the remaining efficiencies were used to increase the range of preventive services on offer.
• Where residential care is used as a medium or long term care plan, this is now the result of a considered multi-agency Care Plan, where a young person has been assessed as requiring specialist residential care as a positive choice. Where such placements are made, these are now jointly funded as appropriate by Children’s Services, NHS Enfield and SEN. These placements tend to be expensive, given their specialist nature.
• The success of both the external and in-house therapeutic fostering schemes has allowed approximately ten children and young people at any one time to live in family settings despite their complex needs and very challenging behaviour. Prior to these commissioning projects, these children would have been placed in very costly specialist residential provision and have been denied the experience of family life.
Case Study Example
One female child had been previously placed in a specialist residential establishment for the victims of sexual abuse at a cost of £4,000 per week, and over £200,000 per annum. Following careful preparatory work, this child was placed in one of the partnership therapeutic foster placements at a cost of £1,500 per week, saving over £122,000 each year. The saving on this one child has funded the entire partnership project which delivered five specialist foster placements, each representing very significant efficiencies. A number of children have been diverted from similarly high cost residential unit placements and, in addition, have benefited from family-based care, achieving more positive outcomes than would have been likely in residential settings.
• The HEART team (Health and Education Access and Resource Team for looked after children) provide a comprehensive programme of support for children in care.
• A formal post-18 fostering policy clearly sets out the criteria which allow young people to remain in foster care beyond the age of 18.
• An 18 Plus finance policy has been developed to integrate with the Adolescent and Leaving Care Service to complement this transition into adulthood and enable carers/providers to maintain placements to support the young people either into council or independent tenancies or into higher education.
• There has been a full integration of the asylum services to give good quality of care and semi-independent provision. The specialist asylum workers are now part of the Leaving Care service.
The mechanisms outlined above are now fully embedded within Children’s Services.
The fostering service has developed its own therapeutic placement scheme and this is being further extended to increase the number and range of options available. Again, this scheme has successfully diverted a number of children from residential care and has provided a very cost-effective solution to meeting complex needs.
As the nature of the looked after population becomes ever more complex, there will always be a small number of children who are unable to manage family life and for whom high quality residential care is the most supportive option. However, the ongoing commitment to allow as many looked after children as possible to be placed in family-type settings is shared across Children’s Services.
Key leadership behaviour characteristics
The following core behaviours have been identified as successful elements of leadership (see National College for Leadership of Schools and Children’s Services/C4EO (2011). Resourceful leadership: how directors of children’s services improve outcomes for children. Full report. Nottingham: NCSL see http://www.nationalcollege.org.uk/docinfo?id=144732&filename=resourceful-leadership-dcs.pdf).
London Borough of Enfield identified the following behaviours as key to the transformation of their service:
openness to possibilities
The innovative partnership with an Independent Fostering Agency required pump priming with initial investment by the Council. Securing approval for this investment required senior stakeholders to be convinced of the potential possibilities, both financial and operational, of the venture. A business case was developed to demonstrate the anticipated outcomes.
the ability to collaborate
Partnership working was essential to the success of this strategy. Collaboration with a commercial organisation involved a new skill set which was further consolidated by the market-shaping initiatives.
demonstrating a belief in team and people
Following the successful implementation of the specialist fostering scheme with an external partner, the decision was taken to replicate this model in-house, recruiting skilled carers and utilising the expertise of CAMHS and education colleagues. Alongside this initiative, significant investment was made in the Council’s own fostering service to allow a greater number of children and young people to be placed in-house.
personal resilience and tenacity
Refocusing a service delivery model is challenging and resilience and tenacity were required to drive forward this programme. Negotiating and influencing skills were particularly important, as was the shared vision
the ability to create and sustain commitment across a system
Crucially this redesign relied on the commitment of all members of the senior management team. The number of coordinated strategies required whole system change, from robust management of admissions to care, increased expectations of in-house services and targeted commissioning practices, to a change in culture and practice. The interdependent nature of the implementation required sign-up from all stakeholders
focusing on results
The ability to measure the outcomes of work to reduce the numbers of children in residential care in an unambiguous fashion allowed early successes to be identified and momentum maintained
the ability to simplify
While the aim of the strategy was clear and simple, the mechanisms to achieve this were complex and coordinated.
the ability to learn continuously
Valuable lessons were learned during the implementation processes which informed future service design and delivery. The practice of placing challenging young people, who would previously have been in expensive residential care, into family settings has now become embedded in culture and practice. Given the difficulties of this group of children, it is understandable that some of them will still struggle to manage in a substitute family and for these, high quality residential care remains the option of choice. However, for the majority of children, the opportunity to experience settled family life, at a turbulent time in their own history, has a positive impact on a range of short and longer term outcomes.
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