Children's directors urge radical steps to improve residential care

Momentum for an overhaul of residential care provision in England is growing as a result of concerns over safety and standards.

The government is consulting on proposals that would see homes closed in areas deemed to be a risk, while revamped staff training requirements are also on the cards (see below).

But the Association of Directors of Children's Services (ADCS) is among a number of organisations calling for more wholesale change. Speaking at the ADCS annual conference this month, the organisation's president, Andrew Webb, called on local authorities to use their power as the primary purchaser of residential care places to influence the market and drive up standards.

Webb says provision is often geographically clustered in areas where it is cheap, but fails to deliver decent results for the children they care for. He says that providers - 75 per cent of which are in the independent sector - could be compelled by market forces to establish provision where it is requested and to a higher standard.

The ADCS's vision is that specialist provision catering for those who have faced issues such as sexual abuse or eating disorders could be commissioned on a national basis. Councils would then collaborate on a regional or sub-regional basis for more general provision.

Webb says providers with homes in areas where property is relatively cheap could be tempted to move to more expensive areas, such as London, if local authorities could broker additional support from the government. "With some engagement from the Department for Education, we could look at innovative ways of providing incentives for providers to do that," he says. "If the outcomes are better over time, it would be a huge saving to the public purse."

Webb says work is currently ongoing with the DfE and other organisations to come up with ideas – with concrete proposals expected in the autumn.

However, while more localised provision may address some of the issues around out-of-area placements, it will not improve standards on its own.

So if local authorities are to commission based on outcomes, what should these be?

New approaches

Webb says commissioning based on long-term outcomes is not feasible, but some intermediate outcomes can result in better prospects for those entering residential care. An individualised approach to issues including mental health, substance misuse and low educational achievement would compel providers to work with psychologists, drug and alcohol workers and education specialists to deliver outcomes.

"At a local level, we need to build up what the needs of the population are and commission places based on that," Webb says. "Savings would be across the entire public purse over a long period because commissioning would be linked much more to individual need."

Webb also wants Ofsted to get involved in a "meaningful discussion" about the registration requirements of children's homes.

To register, children's homes already have to produce a statement of purpose that sets out the overall aims of the children's home and the objectives for children who live there. Webb would like to see requirements strengthened, as well as an increased focus on outcomes in inspections.

"Ofsted ought to be able to say, in the same way as you can ask a school about pupils who have been there since the last inspection, what its aims for them were and whether they have been achieved. Those questions ought to be built into the inspection regime.

"We ought to put care providers under more scrutiny, with Ofsted having a much fuller picture of how well care is being delivered. The current regime is a bit too focused on compliance and regulations."

Levels of need

The Independent Children's Homes Association is in favour of commissioning by regional consortia, but its chief executive Jonathan Stanley warns that for this to work, councils must prepare a strong business case by accurately mapping predicted levels of need.

"Providers will not move without a good business case being made," he says. He adds that improving social work training is also necessary to ensure residential care is the right choice for those it is used for.

"Children in residential care have often had inadequate social work assessments," he says. "Social work training needs to include a residential care placement so they have experience of working with children with high-level needs." He adds that charting the progress of children in care should be made mandatory in national minimum standards for care homes.

John Diamond, chief executive of the Mulberry Bush School, a residential setting that supports victims of abuse, trauma and neglect, says some children's homes could face closure if local authorities become more demanding in terms of outcomes and where they are located.

"We have been able to collect evidence and show what our services can offer in terms of stability, social and emotional attainment, educational attainment, and reintegration into families and schools.

"But outcomes-based commissioning would place a lot of residential providers at risk of closure, because they couldn't evidence or meet it."

He also warns against the introduction of a payment-by-results system, whereby providers are paid a portion of the placement fee once certain achievements had been made, suggesting it would make it difficult for smaller providers to stay in business.

"It would make cash flow for organisations like ourselves very difficult," he says. "Many providers already operate within tight margins. It would also throw up potential disincentives: providers wouldn't want to take on the most difficult cases, because they would be the hardest to help."

ADCS PROPOSALS

• Local authorities should use their purchasing power to ensure good-quality care places are set up and operated where they need them
• With DfE support, councils should consider incentivising providers to set up in areas where there is a shortage of care homes
• Medium-term targets should be set for each child
• Ofsted should assess homes based on whether outcome goals identified previously have been met
  
  

GOVERNMENT PROPOSALS AND SECTOR REACTION

Changes to the way children's homes are run and regulated are already in the pipeline.

Under government plans put out for consultation last month, Ofsted will be able to refuse to let new homes open in areas deemed unsafe. Existing homes in unsafe areas will face closure if they cannot demonstrate that they can protect children.

Meanwhile, residential care workers will be required to meet a minimum-level qualification and, to improve transparency, full inspection reports of homes will be published along with details of who owns the home (unless that risks identifying the children). Homes will also be required to inform local authorities when moving children in and out of the area, and out-of-area placements that are a "significant distance from a child's home" will need to be approved by a senior local authority official.

Jill Sheldrake, director of social care at the Together Trust, says a debate needs to take place around what constitutes a "risky" area to run a children's home.

"It is difficult to set up children's homes in more affluent areas that can be considered less 'risky' because they are not always welcomed by communities.

"There needs to be more detail on exactly how these assessments will be made. If the demographics change in an area and the crime level goes up, that is not going to be the fault of the children's home.

"In principle, nobody would want children in areas considered to be a risk, but we don't want there to be a problem with sufficiency because the criteria makes it too difficult to register. The problem of out-of-area placements is largely down to a lack of sufficiency locally. This could exacerbate the problem."

Natasha Finlayson, chief executive of the Who Cares? Trust, says the proposals will not "solve the problem of poor outcomes", but are to be welcomed.

"I really believe that they are important steps forward and set us on the right path and show the government's commitment to change," she says. "They have heard loud and clear that children's homes have to improve for the sake of the children in them."

Finlayson describes new requirements on training and qualifications as "absolutely crucial".

Under the proposals, all residential care staff must attain the necessary qualifications within two years of starting work. All care staff in employment when the new regulations come into effect will be required to attain the necessary qualification by April 2017. From April 2018, candidates for appointment as a registered manager must have the necessary management qualification prior to being eligible for appointment.

"I would have preferred a shorter timeframe," Finlayson says. "But I appreciate we have to work alongside the sector and they have to be with us. There is an issue with training around the cost for providers and the risk of losing good people who do a really tough job, because they perhaps won't match up in terms of new qualifications and requirements.

"Some homes are scared of pushing those people away and don't want it to feel too onerous for them. Some small voluntary providers will feel very nervous about this."