Agenda item

Report of the Statutory Scrutiny Officer

Councillor Cheryl Barnard, Portfolio Holder for Children Young People and Education introduced the report on Children in Care Placement Sufficiency. Catherine Underwood, Corporate Director of People Services, Ailsa Barr, Director for Integrated Children’s Services, Karla Banfield, Head of Commissioning, and Roz Howie Interim Director of Adult Social Care and Commissioning attended and gave a presentation highlighting the following points:

a)  Whilst all work possible is done to prevent children coming into care, the Council has a statutory duty to provide sufficient placements for those that do. The Council uses a mix of placement types, from in-house residential provision, all rated good or outstanding by Ofsted, fostering, short term respite care and supported accommodation, as well as external residential placements where necessary.

b)  The Council works with other regional local authorities and with the D2N2 partnership to provide best value placements that focus on the best outcomes for children and young people. The Sufficiency Strategy, originally drafted in 2023 is updated annually to address the changes in demand for placements and works to ensure that placements available for children and young people are right first time.

c)  Issues around placement sufficiency are not unique to Nottingham, it is an issue recognised nationally and the need for reform is highlighted in the findings for the Competition and Markets Authority Children’s Social Care Market Study from 2022. This national completion for placements is exacerbated in Nottingham by the higher levels of deprivation seen in many parts of the city.

d)  The strategy was rewritten in 2023 updating it as the market emerged from the pandemic and the periods of lockdown and is being updated annually, taking into account market changes, partnership working, regional networks and the Voice of the Child. This is the first time that Care Leavers have been specifically included within the strategy. Colleagues within Commissioning are working closely with Children’s Services, creating an action plan and updating the strategy to best fit the current market and demand.

e)  Since the last strategy was published there has been further work around market development in Nottingham, with additional fostering placements and residential placements and specific work with health partners around placement for children with complex needs. Work with the D2N2 partnership has ensured that both Councils are able to maximise benefits of the established commissioning framework.

f)  There are a number of challenges that the strategy aims to mitigate. There are still gaps in provision, particularly for children and young people with complex needs. A number of pilots are being run and the outcomes assessed before bringing them into fulltime use. Commissioning intentions reflected in the strategy will include a drive towards quality and stability in placements to reduce demand, block commissioning through frameworks and maximising use of internal services to drive efficiencies. Commissioning colleagues are in regular dialogue with providers and will continue to do so.

During discussion the following questions were asked, and responses highlighted:

g)  Members asked how the Council would achieve best value whilst still relying on external providers for placements. There are a number of different activities undertaken to ensure that the Council balances best value with best outcomes for children and young people. Block buying through frameworks established with partners helps to drive efficiencies and provide better placements, particularly work with Health colleagues for young people with complex needs. Commissioning staff liaise with the smaller local providers around the type of provision that is needed for the City and looking to increase the level of long-term foster carers.  The challenge is to ensure the right placement for a young person, the first time.

h)  Committee members asked what work was being done with the Integrated Care Board (ICB) around increasing placements for young people with complex needs and highlighted that these placements needed to feel like “homes” rather than “beds”.  This is one of the current pilots being trialled by the City. The ICB commission the specialist placements, at present two, which are in a home setting with specialist care and wrap around support which are in a home setting. They are currently short-term placements with wrap around care and support in place which aims to stabilise the placement. This is currently a pilot scheme, due to come to an end later this year. Learning will be taken from the pilot and full consideration to a further roll out will be given.

i)  Committee members asked what was done to monitor the quality of placements which were outside the local area. The same approach is used to monitor the effectiveness of out of area placements as is used to monitor placements within the local area.

There is a dedicated contracts team that monitors the provision and placement through the frameworks. Colleagues are also regularly in touch with counterparts in the area where external placements are to ensure local information is gathered too. Ofsted ratings can be made available for the individual placements.

j)  Committee members asked how successful the drive to recruit more foster cares had been, and what work had been done to increase the retention rate. Over the last year the Council has approved nine new foster carers with further families making their way through the assessment and approval process who will go before the Foster Approval Panel in the new financial year. This is up from five additional families the previous year. A new, regional fostering recruitment hub has been launched in partnership with D2N2. The regional fostering hub is in collaboration with 4 local authorities. This pilot project is currently funded by the DfE and the benefits will be monitored for the duration of the pilot. If it is deemed successful work will take place to see how it can be sustained and expanded in future years. In terms of retention of existing foster carers there have been no “regretted” resignations since June 2023. This means that where foster carers have left the authority it is for positive reasons, such as adopting or receiving a special guardianship order for the children they are caring for. Carers report feeling more supported and significant work has gone into improving support for existing carers.

k)  Committee members asked how the sufficiency strategy took into account the aim to spend money in Nottingham to grow the Nottingham economy. The primary job of the strategy is to ensure sufficient placements are available to the Council for children and young people with as many placements as possible being local to ensure children can maintain familiar relationships where possible. The commissioning team is forming good relationships with providers who are interested to know what provision the City requires within the local area, collaborative work is underway to ensure the kind of provision that is needed is developed within the city and the local area.

l)  Committee members asked whether there were plans to extend the inhouse provision, and what the barriers to doing so would be. Providing in house provision is a balancing act between the benefit and the risk. Most local authorities have some in house provision and compared to many Nottingham City Council has a larger than average inhouse estate. The process from the decision being taken to create new inhouse provision to that provision being available for use can be around 2 years. One significant barrier can be the recruitment of a registered manager, which all authorities are struggling with nationally. The average cost of external provision is not very different to the cost of in-house provision and providing inhouse services comes with additional risk and financial investment. 

m)  Committee members asked how complexity of need impacts cost of placement, and whether inhouse or external placements were preferable in cases of most complexity. Each young person’s need is assessed and a suitable placement for need is essential. On occasion, both inhouse and externally, the correct placement can only be found by increasing staffing ratios, which usually means, for example, a two or three bed placement becomes a one bed placement. This increased the cost of the placement as the other beds are not able to be used. This is the case both inhouse and for external provision and so costs would not be reduced by using solely inhouse provision.

n)  Committee members asked whether the recent round of budget cuts had impacted the work to recruit and support foster carers. The Regional Fostering hub, set up alongside the D2N2 partnership, has DfE funding and so has not been impacted by the recent budget cuts. The current financial situation is not having a negative impact on the plans to increase inhouse fostering provision. Services still have sufficient resource to offer the therapeutic support to foster families.

o)  Members asked how the report of the CMA highlighted the significant profits of placement providers but that there was not a significant difference in cost between inhouse and external provision. The CMA report is referring to the large national providers who are making significant profit on placements. Commissioners are spending time working with local and independent placement providers to ensure the council achieves best value. These smaller and independent providers charge less on average whereas the large national providers are outliers in terms of cost.

p)  Committee members asked whether the balance of provision for the City was right. The data within the published report is the most up to date data, but does come from 2022, when the strategy was last refreshed. The old Strategy reflected the provision that was right for the City at that point, as the Country was emerging from successive lockdowns and the Covid Pandemic. The City’s need has changed and the landscape has moved on since the last strategy was published which is why the strategy is being refreshed, and will be refreshed annually to reflect the changing need of the city moving forward. Part of the work to refresh the strategy includes a deep dive into data sets to get a far better understanding of the market.

q)  Committee members asked whether the Authority used independent fostering agencies to increase fostering provision. The Council does work with independent fostering agencies. Following the pandemic there was a national reduction in the number of carers. Commissioning teams and Children’s services colleagues regularly liaise with independent foster providers around the services the Council can provide for carers, additional support offered and discussions around specific children requiring care and possible matches to carers. This market engagement has helped to improve placement availability and relationships with the independent foster providers, but there is still work to do to approach more providers that the Council has identified as ones they would like to work with.

r)  Committee members asked how the Commissioning team identified providers they wanted to work with. The team look at a variety of factors, including Ofsted ratings, how local to Nottingham they are, their reputation in the sector as well as with other local authorities. The Team have identified a small number of providers they would not work with and although there is no formal rating system other providers are welcomed to approach the Council to start dialogue.

s)  Committee members asked whether unaccompanied asylum-seeking young people had specific access to translators. Yes, translation services are available for the young people and where they are not placed with a family that speaks their language, for the placement too. Colleagues also work hard to ensure that unaccompanied asylum seekers are helped to connect with communities from their home countries when they arrive in the City. These factors are all built into the work programme behind the Sufficiency Strategy.

t)  Committee members questioned whether the Authority had an open book relationship with the larger providers in the city. The Council is looking at open book relationships with large providers across both adult and children’s social care. Work is being undertaken to look at best practice from other authorities and how that can be built into new contracts and used to hold providers to account.

The Chair thanked the Portfolio Holder for Children Young People and Education, the Corporate Director of People Services, the Director for Integrated Children’s Services, the Head of Commissioning and the Interim Director of Adult Social Care and Commissioning for attending the meeting and answering the questions that Committee members had posed.

Resolved:

1)  In respect of the quality of local provision outlined in the Strategy, that the ratings for the providers who are not located in the city are shared with the Committee.

2)  Recommends that a comparative analysis is carried out to ascertain the outcomes between internal and external provision.

3)  Recommends that when the Strategy is reviewed, work with community groups is included and expanded on.