Children’s Services Understanding Cost and Outcomes

1. Children’s ServicesUnderstanding Cost and Outcomes Improving strategic commissioning information

2. Are we really doing the strategic bit? Strategic Commissioning

3. Not according to.... • NRCCI (2009) • SWIA (2011) • Audit Scotland (2012) • All identified important areas for improvement in terms of how councils plan and commission services for children • Key areas of weakness in information about local needs, effectiveness of services and determining the actual cost of internal and external services

4. Knowns, Unknowns and Known Unknowns • How much do different services cost? • Are services matched to individual need? • Are services effective? Value for money? • Are ‘expensive’ services ever worth it? • Do early interventions work? • Do ‘intensive’ or ‘therapeutic’ services work? • Are we measuring the right outcomes?

5. Do we have the right tools?

6. Effective Strategic Commissioning Requires... • Robust information about: • the needs profiles and characteristics of LAC • trends and frequency of need • the full costs of services - £££ and resources • outcomes achieved for particular groups of LAC by different services • outcomes for children and performance of services over time • care pathways and impact of timing of interventions and combination of services

7. Strategic Commissioning - Challenges • Weak information about the needs profiles of LAC – local and national recording • Reliance on administrative data • Care pathways not being tracked • Inconsistent outcomes specification and measurement • What works? What’s best value? • Inconsistent costing methodologies and preconceptions about cost & value • Lack of longitudinal information

9. Loughborough Cost Calculator • Based on more than a decade of research by the Centre for Child and Family Research (CCFR) at Loughborough University • Calculates costs from the ‘bottom up’ • Individual costs based on the actual care history of each child • Relates costs to children’s needs • Uses longitudinal data to track costs incurred throughout care pathways of children • Presents results for any child, group of children or type of placement by any time period • Analyses costs by outcomes

10. The Cost Calculator • What goes in: • Unit costs of social care staff time based on 8 case management processes: • Real data, using national statistical returns and local collection, re child placements and care pathways: • Child need categories • Placements and service types • Activities and events undertaken to support the child 1. Decide child needs to be looked after 2. Care planning 3. Maintaining the placement 4. Leaving care/ return home 5. Find a subsequent placement 6. Review 7. Legal processes 8. Transition to leaving care services

11. The Cost Calculator • In addition to administrative & CLAS data: • Reliable information about the psycho-social wellbeing of LAC – SDQ scores • Categories of need for LAC eg. emotional and behavioural difficulties; mental health support, Record of Need, offender, school exclusion, disability. • Categorisation of service or placement type eg. specialist foster care, mainstream foster care, therapeutic service etc

12. The Cost Calculator – what comes out? • Quality data in --- quality data out • <6 months - unit costs of services • <1 year -output reports highlight ‘outliers’ • 3-5 years – progress data • Longitudinal data takes time (!) • ‘see the future’ – development of costed care pathways for LAC with different needs • Identification of the drivers of high cost • ‘what if?’ analyses – comparison of relative value of different services – estimation of potential cost/benefit

13. Next Steps... • Proof of concept pilot across small group of LAs • Initial scoping work by Loughborough – 1 month • Loughborough academics map social care process information – 3-6 months • LAs agree additional data collection to support Cost Calculator • Development of Cost Calculator specifically tailored for Scotland and for the in participating councils • Develop knowledge and support amongst stakeholders