Maybe it is we are asking too few questions? Reconsidering current commentary re referrals and placements

For many years the effects of the overwhelming number of referrals received by providers from Local Authorities (LAs) has been highlighted for action. The effects have been itemised, the time cost of untargeted ‘send all’ referrals leads directly to homes getting details that are inappropriate for admission, and/or lack the detail that means they cannot be matched to what a home provides.

This lack of acuity shows a lack of adherence to regulations, by LAs, in that a referral is made without referring to the Statement of Purpose of the home. It is evidentially an inappropriate referral. Quality Standards and Regulations apply to commissioners too.

There are fewer homes for high level co-occurring needs. If LAs make referrals by bulk ‘send all’ then they will be sending to always some inappropriate homes

The higher the needs the more difficult it is to have a staff team ready and able to respond, with urgent access required often there is no time to refresh/train/upskill.

In this situation a provider must refuse a referral. In order to be compliant with the Quality Standards and regulations a provider must only accept children whose needs can be met. Providers must keep the Quality Standards and regulations, even when others, maybe including LAs, and even, given the recent reported published views and comments, the regulator, are not.

There is more to the situation in which the ADCS are being critical of providers.

A breakdown of a placement might be resulting from incomplete, inadequate or erroneous information in a placement request form. This has potential.to make the placement inappropriate, in that it does not match needs to provision. In such circumstances a child best interests are to be moved to an appropriate placement. This might be hard to find, and time needed.

Does this lead to close working together? In fostering a disruption meeting would be called, and extra resources drafted in.

This support for residential providers is not common, and so termination is called. It has not been uncommon for providers to face a refusal to move the child by the LA, and face mounting incidents. There is refusal to fund staffing to bridge through a crisis.

The outfall is that providers choose not to take referrals.

Some LAs adopt a position that the independent sector ‘must take our children’ as though the homes belonged to them.

We must remember the reason for the independent sector as it is today is LA homes were not able to meet need. Many did not have the expertise necessary.

High level provision is costly to set up, and there is the volatility of children, who may need time out or CAMHS Tier 4. This volatility affects occupancy. As demand for places gets higher providers opt for full occupancy by taking lesser severe needs.

That Ofsted do not take the above view is concerning. It shows an aligning with LAs that independent homes ‘should take our children’. As explained above this is to act against the regulations they inspect.

Some years ago, when finding the independent sector not responding LAs could have taken early intervention acting together to establish a network of high-level differentiated settings in a nationally responsive service that had multidisciplinary professionals and the workforce development necessary. LAs had power to act collectively squaring cost and risk.

So, there is a diff reading of situation, that LAs have allowed a situation to develop and be sustained over years. With full cognisance of the situation and their part in it they could, but did not, act.

Questions arise.

Why did LAs not act in best interests of children and why do they not accept responsibility but project to independent sector?

With LAs opening homes will anything change?

It is abundantly clear (in care, education, health, for adults and children) an independent sector does not respond to all needs, markets don’t work for high level low incidence needs.

The inescapable conclusion is it is incumbent on a LA/LAs to source sufficient placements (in this case high level needs) – even from its own resources.

It doesn’t often happen which begs another question: How is it that this has not been a finding in Ofsted ILACCS inspections?

Which begs a new conclusion, how is it there are too few questions being asked? How is it the are all projected to providers and none/few to LAs/regulator Govt?

Maybe it isn’t we are asking too few questions?