An NCERCC easy guide – What does the Care review Case for Change say about Residential Child Care?

Extracts of all entries + page numbers from the Case for Change

Page 26

In Northern Ireland, strong family and community ties seem to play a role in rates of foster and residential care by strangers being lower than you may expect from the levels of social disadvantage.

Page 58

There are not enough homes in the right places with the right support

… increasing the number of families that can stay together safely will not happen overnight and there are urgent challenges in providing homes for children in care… the care system as it is currently designed breaks relationships…. We have heard that too often homes for children are chosen based on availability and price and not on what the child needs…  In recent years both foster care and residential care have been subject to detailed reviews but change has been slow. Fixing this in the long term will take bold and focused action, however, we cannot ignore the current issues and the impact they are having daily on the lives of children.

Page 58-59

The “market for care” and the role of commissioning

…. The ‘market for care’ and local authority commissioning and matching are not working. While local authorities have a duty to ensure there is sufficient provision in their area to meet the needs of the children in their care, it is increasingly the case that they are operating in a national market where providers are able to set the terms of engagement. In this environment, local authorities struggle to shape their market; individually they lack the ability due to the relatively small number of children they are each responsible for placing, and providers are able to fill their provision with ‘easier to manage’ children from across England and set whatever price they choose. Local authorities bid against each other and drive up the price…

Across both fostering and residential care it is impossible to ignore the increasing role of private provision. 78% of children’s homes are provided by private providers and 41% approved fostering places are provided by independent fostering agencies (Ofsted, 2021a, p. 20). The average reported price per child for a place in an independent children’s home in England in 2018/19 was around £4,000 per week (more than £200,000 annualised), representing an increase of 40% on prices in 2012/13 (Rome, 2020b). Across the largest twenty providers this amounts to a profit estimated at £265 million or a profit margin of 17.2% (Rome, 2020a). Supply is not meeting demand, the overall number of looked-after children at 31 March increased by over 24% between 2009/10 and 2019/20, but the number of children’s home places grew by just 8% in the years 2011/12-2019/20 (Department for Education, 2021e).

The review is concerned about the cost, profit, and financial health of providers and the impact of the current system on children. We want a pragmatic re-think given the urgent problems, the complexity of the issues and the fragility of the current system. We are pleased the CMA are undertaking a market study in this area and are working closely together, within the bounds of the CMA’s legal powers and obligations and respecting the independence of both pieces of work. There is an active debate in the sector about whether incremental improvement of commissioning or radical rethinking of the care marketplace is needed to ensure that children receive the care that they need. This review will consider all options. We have also asked the What Works Centre for Children’s Social Care to work with the Government Outcomes Lab at Oxford University to look at effective models of commissioning that could be applied to children’s social care.

Page 60

The result of this is that relationships with communities and siblings are broken and that children who might be able to thrive in fostering, end up in residential care.

Page 61- 62

Residential care

Residential children’s homes provide a home for some of the most vulnerable children in care. As at 31st March 2015, 97% of children in children’s homes were aged 10 or over (Department for Education, 2016). Older children in care are also more likely to have complex needs. In 2018, teenagers in care were 50% more likely (compared to children in care aged under 13) to have an Education, Health and Care Plan (EHCP) or a statement of special educational needs, and 10 times more likely to have been attending a pupil referral unit (PRU) (Children’s Commissioner, 2020c).

The number of children placed in children’s homes has increased by 34% since 2009/10, with 6,780 children looked after in children’s homes as at 31st March 2020 (Department for Education, 2021e). The challenges in the children’s home market described above and the increasing number of children who social workers are placing in these homes, means that residential care is dominating local authorities budgets, with spending on residential care increasing by 42% in real terms between 2012/13 and 2019/20 and reaching £1.6 billion in 2019/20 (Department for Education, 2021b). Do we really believe this is offering the sort of care we aspire to for all children?

We have also heard that the cost of these homes and the lack of suitable foster carers means children are often placed in foster homes that do not meet their needs, and it is only after multiple home breakdowns that a residential home is sought or approved. It also means some children are forced to leave their children’s home and enter independent or semi independent accommodation before they’re ready.

As the Office for the Children’s Commissioner set out:

“Good children’s homes do exist in England…. homes which children have told us they experience as loving and supportive and the best place for them to be; homes that engage and involve children’s families; homes that provide therapeutic care, access to a good education and experience of the wider world…. Unfortunately, too many children do not get this experience…. children being placed far away from home, friends and family; struggles accessing healthcare, education or fun activities; and homes which feel overly institutional, sterile or even filthy” (Children’s Commissioner, 2020d).

The quality of homes continue to be raised with the review and whilst some point to the high proportion that receive a good or outstanding Ofsted rating, others have questioned whether these ratings are linked enough to children’s experience.

Recruitment, training and support of staff has also been raised with the review. The most recent census found over half of managers found it hard to recruit, with finding staff with the right experience (91%) and qualifications (52%) being the main barrier (Thornton et al., 2015). Ofsted report that at any one time, around 10% of children’s homes do not have a registered manager in place (Ofsted, 2021b).Residential care is still first and foremost a child’s home, and a stable team who understand this and are equipped to meet children’s needs are essential to creating a loving environment. The Independent Inquiry into Child Sexual Abuse (IICSA) also recommended in the 2019 interim report that registration is introduced for children’s home staff to maintain standards of training and conduct, although the DfE have not yet responded to the consultation on this.

There is a broader question about whether children’s homes are the right long term option for children in care and the extent to which they should play a role in our long term vision for care. We would welcome views, particularly from children and care experienced adults, on this question.

Page 64

From those referred to secure but placed in alternative accommodation, nearly half of the children were placed in a children’s residential home.

Page 69

Children in residential care currently do not have an equivalent legal entitlement to Staying Put and can be forced out of their children’s home far too early. DfE continues to pilot Staying Close, as an alternative for children in residential care. It is welcome that the Government has committed £6m to roll this out further but for many this will remain out of reach. It is important that children are not forced to leave their children’s homes before they are 18 into semi-independent accommodation if this is not right for them.

Page 71

What changes do we need to make to ensure we have the right homes in the right places with the right support? What role should residential and secure homes have in the future?

Page 73

At a time of wider budgetary pressures, local authorities trying to balance their books are increasingly stuck in a cycle of spending more on short-term reactive interventions, including the most drastic measure of moving children away from their family to live in a residential home, at the cost of the preventative work that could lead to better long-term outcomes for children and families. For example, by 2019 the average cost of a residential placement had reached almost £4,000 per week, which equates to an average cost of over £200,000 each year per child (Rome, 2020b).

… Throughout the system there are opportunities for things to both work better as well as cost less – avoiding parents having repeat removals, taking fewer children into care by supporting families where possible, making better use of kinship arrangements, avoiding children entering costly residential and secure placements, curbing profit and reducing the number of agency social workers.

Page 80-81

Others have been more targeted at specific parts of the system, such as the Children in Need Review, Care Leaver and Adoption Strategies, Chapter five 81 Wood Review of Safeguarding Arrangements, Narey Reviews of Foster and Residential Care and the Social Work Taskforce. A very significant amount of the problems we are diagnosing in this document have been exposed and described again and again with sensible and considered recommendations for change. Yet actually achieving change that improves the lives of children and families has been stubbornly difficult.

Page 81

This is why this document asks some very big questions, such as how to address the tensions between protection and help or what is the role of residential care. These debates may be uncomfortable for many working in the system, but ultimately asking these questions is what is needed to consider recommendations that will improve children and families’ lives.