LAC and the new Sufficiency Duty how to do it better

1. LAC and the new Sufficiency Duty � how to do it better An opportunity to consider the practice guidance and standards for commissioning practice �

2. Agenda Sufficiency duty Standards for commissioning practice Practice Guidance Discussion

3. The Sufficiency Duty The duty requires local authorities to take steps that secure, so far as is reasonably practicable, sufficient accomodation within the authority�s area which meets the needs of children that the local authority are looking after, and whose circumstances are such that it would be consistent with their welfare for them to be provided with accomodation that is in the local authority�s area.

4. The new sufficiency duty A general duty placed on a local authority (and their Children�s Trust partners) to take steps to secure accommodation for looked after children that: is within the authority�s area; and meets the needs of those children (including children �on the edge of care� �so far as is reasonably practicable The duty is set out in section 22G of the Children Act 1989. It is an amendment arising from the Children and Young Persons Act 2008, where it was set out in Section 9. The duty is placed on the local authority. However each local authority is also bound by the duty at section 10 of the Children Act to make arrangements to promote co-operation with its relevant partners with a view to improving the well-being of children in the authority�s area. In turn, section 10 also requires the relevant partners of a local authority in England to co-operate with the local authority in this regard. Therefore, the sufficiency duty places responsibilities on all relevant Children�s Trust partners It is a general duty, which means that it does not have to apply in case of each individual child or young person. The duty recognises that in some cases it will not be possible to place children and young people in their local area, because this is not consistent with their welfare or because it is not �reasonably practicable� to do. We will talk about this in more detail later. The duty is set out in section 22G of the Children Act 1989. It is an amendment arising from the Children and Young Persons Act 2008, where it was set out in Section 9. The duty is placed on the local authority. However each local authority is also bound by the duty at section 10 of the Children Act to make arrangements to promote co-operation with its relevant partners with a view to improving the well-being of children in the authority�s area. In turn, section 10 also requires the relevant partners of a local authority in England to co-operate with the local authority in this regard. Therefore, the sufficiency duty places responsibilities on all relevant Children�s Trust partners It is a general duty, which means that it does not have to apply in case of each individual child or young person. The duty recognises that in some cases it will not be possible to place children and young people in their local area, because this is not consistent with their welfare or because it is not �reasonably practicable� to do. We will talk about this in more detail later.

5. Timescales The sufficiency duty is being phased in as follows: From April 2010: if they have not already done so, local authorities should include in relevant commissioning strategies their plans for meeting the sufficiency duty. From April 2011: working with their Children�s Trust partners, local authorities must be in a position to secure, where reasonably practicable, sufficient accomodation for Looked after children in their local area.

6. Recommended action for LAs (and CTs) Review the current situation in relation to securing accomodation which meets the needs of looked after children and care leavers: Have regard to the standard for commissioning practice set out in the guidance and identify areas for improvement: Develop or enhance strategic commissioning processes so that all relevant services, including universal eservices, make a full contribution Set priorities for action until April 2011

7. Recommended action for LAs (and CTs).2 To have regard to the benefit of having: A number of accomodation providers in their area; and A range of accomodation capable of meeting different needs - A WHOLE SYSTEM APPROACH

8. Why necessary? Because we need better integration of services around looked after children, closer to home Because there are a lot of inefficiencies in the system at the moment Because children and young people want choice Because lack of choice leads to inappropriate placements which are more likely to breakdown Because of the association between placement stability and a range of better outcomes for looked after children Integration Ministers are keen that children and young people are increasingly placed within the local authority area boundary so that their full range of needs can be addressed by integrated services commissioned by the local Children�s Trust Poor placement matching� Mismatched initial placements tend to lead to a cycle of placement breakdowns, which causes inherent instability for the child / young person and significant cost to the Children's Trust. Poor placement matching occurs largely because of a lack of choice and/or ineffective needs assessment. The core assessment and the care plan need to be clear about the desired outcomes for the child or young person, so that everyone is clear about what is required from the placement. The Select Committee noted that placement choice is particularly limited for children from minority ethnic groups, in sibling groups and with complex needs. Inefficiencies in the system� Decisions about where a child or young person should be placed are still often made on an ad hoc, last minute basis. This may result in a placements being �spot purchased� � where the local authority approaches a single provider for a single placement, usually in a crisis, so there is little time for negotiation. This reduces competition between providers; often results in poor value for money; and provides no choice for the child or young person. Commissioners are not routinely involved in placement decisions, at either strategic or operational level. This means there is no one person with an overview of what is happening across the system, to spot obstacles and identify how things can be improved. Integration Ministers are keen that children and young people are increasingly placed within the local authority area boundary so that their full range of needs can be addressed by integrated services commissioned by the local Children�s Trust Poor placement matching� Mismatched initial placements tend to lead to a cycle of placement breakdowns, which causes inherent instability for the child / young person and significant cost to the Children's Trust. Poor placement matching occurs largely because of a lack of choice and/or ineffective needs assessment. The core assessment and the care plan need to be clear about the desired outcomes for the child or young person, so that everyone is clear about what is required from the placement. The Select Committee noted that placement choice is particularly limited for children from minority ethnic groups, in sibling groups and with complex needs. Inefficiencies in the system� Decisions about where a child or young person should be placed are still often made on an ad hoc, last minute basis. This may result in a placements being �spot purchased� � where the local authority approaches a single provider for a single placement, usually in a crisis, so there is little time for negotiation. This reduces competition between providers; often results in poor value for money; and provides no choice for the child or young person. Commissioners are not routinely involved in placement decisions, at either strategic or operational level. This means there is no one person with an overview of what is happening across the system, to spot obstacles and identify how things can be improved.

9. What does sufficiency look like? All children in appropriate local placements with access to the support services they need; Universal, targeted and specialist services working together; integrated Mechanisms in place to secure placements in neighbouring areas, the sub region ore region All children with adoption recommendation placed within 12 months of that recommendation Sufficient services are available in adequate quantity to respond to children, able to meet a range of needs and respond to emergencies

10. What does sufficiency look like? 2 Services available to young people who come into care at 16 and 17 and able to support the continuity of accomodation beyond the age of 18 All placement providers are linked into the wider network of services Skilled professionals Market management supported by sub-regional or regional arrangements

11. Reasonably practicable? Appropriate Friend, relative or other other person connected to the child and who is a LA foster parent Proximity to the child�s home Does not disrupt the child�s education or training Enables the child to live with accomodated siblings Within the area and suitable

12. How it can be assessed Nos of children for whom a local placement is not consistent with their needs and welfare The extent to which universal services meet needs The state of the local market for accomodation The degree to which the market is being actively managed The resources available and capabilities of accomodation providers The CTs resources, capabilities and overall budget priorities and progress in delivering their strategic plan

13. The Challenge Increased referrals and number of children in care Chief Exec savings targets for children�s services Southwark ruling Ongoing patchy performance re: placement stability + outcomes for looked after children and care leavers Concerns about market sustainability Personalisation How do we save up to 50% but still improve the lives and outcomes for our looked after children and young people?

14. Sufficiency Duty Statutory Guidance Key gaps identified by LAC commissioners and providers are addressed by statutory guidance for consultation in six sets of commissioning standards: Individual assessment Commissioning decision Strategic needs assessment Market management Regional Collaboration Securing services

15. Commissioning Commissioning is the process for deciding how to use the total resources available for children, parents and carers in order to improve outcomes in the most efficient, effective, equitable and sustainable way

16. Why use commissioning The commissioning approach is a practical alternative to top down, centrally funded models It enables the �Total Place� concepts to become realities It is being used and developed by the sector and in localities to keep a focus on outcomes for children whilst cutting resources It is suitable for whole system redesign or can be used for just one service It engages both change processes (procedures and systems) and people (emotions and behaviours) � it engages all levels

17. Sufficiency Duty Statutory Guidance Leading commissioners and providers developed the Practice Guidance to share best practice from across the country

18. Context 2 dominant and competing philosophies in commissioning for CIC: Standardising services � e.g. by specifying a child�s needs based on standard elements and using a matching engine to find the closest service which matches those elements; and Personalising services � e.g by assessing needs and expecting providers to compete to design a unique service around the child.

19. Standard 1 - Individual assessment and care planning Robust needs assessments � use of the CAF and LP Senior ownership of the assessment process Care plan including specific planned outcomes and timescales (informed by a knowledge of what works � C4EO evidence etc) Competent workforce � processes designed in consultation with providers Providers enabled to design services around the child and innovate Clear performance expectations Devon � options appraisal Essex - MAAGs

20. Standard 2 - Commissioning decision The right decision, first time after the completion of the individual assessment and care plan Clarity about desired outcomes Informed by the strategic assessment, resource analysis, individual assessment and views of the child Informed by an understanding of the cost and quality of all provision � choice Clarity about who makes decisions and when Involving the child, carer(s), appropriate professional and strategic commissioner - decisions made in isolation and with a lack of openness or competition are less likely to result in the best decision being made for the child or young person. Gloucestershire example � use of pre-qualified providers

21. Standard 2 - Commissioning decision. 2 Example - an independent team which manages the process of identifying suitable placements for each child. clear systems and tools to enable the team to project manage each referral, including strong administrative support and the ability to use electronic mailing systems effectively; referrals emailed to a range of approved providers at the same time to promote competition (in preference to phoning around) with a clear deadline given for providers to respond with potential placements that meet the criteria on the referral form; following the given deadline, the commissioner filters through offered placements and checks that they meet the criteria given information on available placements is then shared with the social worker, the social work manager, the child, and any other individuals with responsibility for appraising the options and for making the final decision on where to place; and team members who have a mix of skills � partnership, analytical, finance, contracting and sound knowledge of the market place. Evidence suggests that the role can be carried out effectively by both individuals with and without a social work qualification.

22. Standard 3 - Strategic Needs Assessment Undertaken with partners Assesses the desired outcomes and needs of all LAC, children �on the edge of care� and their families Includes short and long term timescales Predicts demand and unexpected demand Informs universal services Gloucestershire example

23. A good JSNA? Includes: Data from the wider population of vulnerable children; Individual assessments (including placement breakdown); Local targets and outcomes; User participation; GIS mapping; General information such as births and medical trends; Information from professionals and providers (including the voluntary and private sector).

24. Standard 4 - Market Management Includes resource analysis � universal as well as specialist services Effective relationships with all providers including universal services Leadership � working with providers to redesign services Workforce development

25. Standard 4 - Market Management. 2 Five topics: Resource analysis Market analysis Market management Market management in relation to complex needs Working with providers.

26. Some solutions Budgets for all looked after children and children in need at risk of care should be strategically commissioned as one category Look at all resources Budget planning over 3-5 years � highlights the benefits of early intervention and prevention Procurement techniques Building competition into the system Cost calculator; Peninsula and Harrow examples

27. User choice Improved stability Geographical redistribution Efficiency savings across the Peninsula: 2006/07 ? �540k 2007/08 ? �1019k 2008/09 ? �923k There are many emerging examples of ways in which strategic commissioning is improving outcomes for looked after children and young people. Devon has introduced an �option appraisal� model to commission individual placements. Instead of social workers having to search for a service, they now have to specify the child or young person�s needs and desired outcomes for the placement. This is sent electronically to all pre-qualified providers (both fostering and residential), who express an interest by submitting proposals for a package of support which show how they will meet needs and deliver positive outcomes. This process can be completed within 24 hours. A multi-agency team evaluates how each proposal meets the five Every Child Matters outcomes. This process follows a clear protocol and the results are summarised as a matrix. Only after options have been appraised as suitable does the price become a factor. The child or young person is involved in deciding on a placement. On average five to ten providers respond to each tender, which ensures strong competition and a range of options for improving outcomes for the child or young person. Over the first four years this has resulted in a fourfold increase in placement choice and�savings in the region of �2 million. As choice is increased so is the likelihood of finding the �right match� and Devon has�also seen a marked improvement in placement stability where this model has been used.There are many emerging examples of ways in which strategic commissioning is improving outcomes for looked after children and young people. Devon has introduced an �option appraisal� model to commission individual placements. Instead of social workers having to search for a service, they now have to specify the child or young person�s needs and desired outcomes for the placement. This is sent electronically to all pre-qualified providers (both fostering and residential), who express an interest by submitting proposals for a package of support which show how they will meet needs and deliver positive outcomes. This process can be completed within 24 hours. A multi-agency team evaluates how each proposal meets the five Every Child Matters outcomes. This process follows a clear protocol and the results are summarised as a matrix. Only after options have been appraised as suitable does the price become a factor. The child or young person is involved in deciding on a placement. On average five to ten providers respond to each tender, which ensures strong competition and a range of options for improving outcomes for the child or young person. Over the first four years this has resulted in a fourfold increase in placement choice and�savings in the region of �2 million. As choice is increased so is the likelihood of finding the �right match� and Devon has�also seen a marked improvement in placement stability where this model has been used.

28. More children being recommended for adoption All recommended children being matched within 6 months A number these being placed with concurrent carers (so no further moves for that child) 20% of eligible looked after children now adopted or in special guardianship arrangements Shared ethos between LA and Coram - permanency planning now at the core of all decision-making Delays reduced, children exiting care more speedily Harrow has commissioned Coram Family to deliver its domestic adoption services in partnership with the LA. It is the first area to do this. Coram Family has been working�with the local authority since 2007 to find adoptive families, place children�and to support social workers in planning for permanency.Coram has an annual target to find adoptive families a specified number of children. If this target is not reached, the number in subsequent years increases accordingly. Since Coram's involvement the number of children with a 'should be placed for adoption� recommendation has surpassed the target and Coram has been able to match all children within six months of the adoption recommendation. A number of the children have been placed with concurrent carers and this provides additional benefits as children have no further moves. Currently, 20% of eligible looked after children in the borough (i.e. not including asylum seekers or those looked after on a series of short breaks) are adopted or in special guardianship arrangements, increasing the number of fostering places available and reducing overall costs. The success of the project has in part been dependent on Harrow�s social care workforce strategy which has resulted in the employment of more permanent staff, a reduction in social worker caseloads and higher staff morale.� The involvement of Coram in planning and chairing meetings has ensured that permanency planning is at the core of all decision-making.�Delays have reduced and children are exiting care more speedily than previously to�be reunified, placed with kin or adopted. Harrow has commissioned Coram Family to deliver its domestic adoption services in partnership with the LA. It is the first area to do this. Coram Family has been working�with the local authority since 2007 to find adoptive families, place children�and to support social workers in planning for permanency.

29. Standard 5 - Collaboration Pooling budgets Joining up with SEN and other services Sub-regional and regional collaboration Regional needs analysis Joining up back room functions ER5 example CCRAG example

30. Standard 6 - Securing Services Use of commissioning mechanisms � outcome based contracts Spot purchasing as a last resort only Performance management options � evidence based Workforce development National contracts examples Bucks example

31. Good commissioning � why it helps Improved understanding of need + evidence base by �segments� of the population � including �CHALLENGE!� � Improved dialogue with providers throughout the commissioning cycle Attention to supply management / stimulating the market around key need areas (e.g. particular forms of placements / recruitment of carers) Better understanding of impact + VFM of all kinds of provision

32. Shifts we�re seeing nationally Radical revision of commissioning processes to promote choice / efficiency / sufficiency / and individualised packages of support Development of robust enhanced foster care models including wrap around support delivered: Including �off the peg� (e.g. MDTFC) and other models Including social learning and therapeutic models Delivered �in house� or by other providers Use of residential care only for children and young people who really need it + generally using smaller �units�

33. CSP support Capability building around commissioning: Programme for senior commissioners in CTs Accredited Commissioning Skills Training Commissioning Development Materials Regional events, action learning and SIGs Access to on-line resources and support Bespoke consultancy support for Children�s Trusts based on Self Analysis and Planning

34. CSP www.commissioningsupport.org.uk Claire.lazarus@commissioningsupport.org.uk 07880 787190