5. RESEARCH
INITIATIVE: QUALITY
PROTECTS
Background:
Quality Protects is a five-year programme
to support local authorities in transforming the management and
delivery of children's social services. The research initiative,
which contributes to the evaluation of the Quality Protects
programme, has a budget of £2 million over a period of four
years. 83 initial research applications were received. A team
of external referees including academic advisors, policy makers,
and service and voluntary sector representatives appraised proposals.
Eight studies were selected to address the key themes of placement
stability; children's protection from significant harm; the life
chances of children looked after, young people leaving care and
children in need; and services to disabled children and their
families.
Projects:
The projects with a central focus on outcomes
and the effectiveness of services are:
— The reunification of looked after
children with their parents: patterns, interventions and outcomes.
Provider: School for Policy Studies, University of Bristol
This study will examine reunification outcomes, patterns
of return within children's care histories and the key factors
that distinguish between successful and unsuccessful reunification.
It will also evaluate the effectiveness of interventions that
aim to reduce the negative effects of failed reunifications.
— Children placed with relatives
and friends: placement patterns and outcomes. Provider: School
for Policy Studies, University of Bristol
This study aims to compare the characteristics and
outcomes for children of all ages placed with relatives/friends
with those placed with unrelated carers. It will examine which
factors relate to the success or failure of these placements.
— Outcomes for children placed with
family and friends as a result of care proceedings
Department of Social Policy and Social Work, University
of Oxford
This study will examine outcomes for children placed
with members of their extended families or social networks, focusing
on children placed as the result of court proceedings brought
because of child protection concerns. Outcome data will be available
for between three and seven years post-proceedings.
— Participation of disabled children
and young people under "Quality Protects"
Provider: Social Policy
Research Unit, University of York
The study will investigate both the outcomes of participation,
in respect of the impact of disabled children's views on service
development and/or the tailoring of individual packages of care.
— Enhancing placement stability:
a randomised controlled trial of routine services compared with
two specific interventions with adoptive placements
The study is intended to evaluate two intervention
programmes. The primary hypothesis to be tested is that either
a cognitive behavioural parenting programme, or an educational
programme about parenting special needs children, when added to
the routine service, will be more effective at enhancing parenting
and reducing the children's problems than the routine service
alone.
6. THOMAS CORAM RESEARCH
UNIT'S NEW
DEPARTMENT OF HEALTH-SPONSORED
RESEARCH ON EFFECTIVENESS
AND OUTCOMES
Repeated use of accident and emergency (A&E)
departments
The principal aim of this study is to examine
the role and level of support offered by the health, education
and training professionals and other agencies to young people
making repeat presentations to A & E departments. It will
identify the factors that contribute to the successful take up
of services by young people. Additionally the study will investigate
the integration of the service provision to identify systems that
contribute to timely multi-agency responses. It will identify
the problems and risk factors which predict poor outcomes. The
study will inform the devising and implementation of more effective
and successful interventions, and demonstrate how new policies
aimed at improving outcomes for young people such as the Care
Programme Approach and ConneXions are impacting on the lives of
this group.
Teenage Conception among Young People Looked After
by Local Authorities: Determinants and Support for the Mother,
Father and Child
This study will explore the experiences of young
people (both male and female) looked after and recent care leavers
aged between 15-20 years who have become parents. Work will focus
on the effectiveness of service provision for young people looked
after, including sex and relationship education and access to
health care and services. The study will aim to illuminate some
of the determinants of early pregnancy among young people looked
after, and in particular to improve understanding of risk and
protective factors.
Advocacy for looked after children and children
in need: achievements and challenges
This study aims to investigate the role of advocacy
in facilitating the participation of looked after children, and
children in need in decisions concerning their care. In particular,
it will examine the practice and effectiveness of advocacy in
relation to children of different ages, disabilities, genders
and ethnic identities. The study will also explore the challenges
and dilemmas posed by advocacy in the context of different interpretations
of legislation and policy (eg the Children Act and Quality
Protects) concerning children's welfare and children's rights.
7. THE CENTRE
FOR CHILD
AND FAMILY
RESEARCH'S
NEW DEPARTMENT
OF HEALTH-SPONSORED
RESEARCH AND
DEVELOPMENT ON
EFFECTIVENESS AND
OUTCOMES
Outcomes for looked after children—transforming
data into management information
This project is designed to help local authorities
explore how data gathered in the course of social work interactions
with individual children can be aggregated and used to monitor
the effectiveness of child-care interventions, identify where
improvements can be made, and inform the planning of services.
The project includes a longitudinal cohort study which particularly
aims to identify how far the experience of being looked after
away from home influences children's psychosocial development.
A benchmarking group, composed of senior staff from the participating
local authorities, has also been set up to provide a forum for
sharing ideas on how outcome data from the cohort study can be
used within the inter-and intra-agency planning process.
Outcomes for children in need: an in-depth qualitative
study of babies who entered care or accommodation before their
first birthday and who were still looked after 12-24 months later
The aim of this related study is to explore
the decision making process that influences the experiences of
very young children who remain long looked after away from home.
After 30 to 42 months, about one in five of the babies in the
sample were placed with their parents, and some had been discharged
from care. The study examines whether with hindsight it would
have been possible to predict which children would be re-united,
and which would need to be placed for adoption.
Helping local authorities make better use of information
on children in need (Data Analysis Network for Children's Services).
This project aims to help local authorities
improve their information systems, both paper- and computer-based,
to achieve better outcomes for children in need, particularly
those who are looked after. The project examines the ways in which
information is gathered, analysed, used and compared, and to design
and test practical ways of implementing improvements.
Development of the Integrated Children's System:
linking the Looking After Children materials with those related
to the new Framework for Assessment of Children in Need and their
Families
Strategic planning within and between agencies
is required to ensure a coherent range of services is available
to all children and families. This will require clarity about
the roles and purpose of different agencies in contributing to
the achievement of agreed outcomes for children. It will also
require a shared language with which to describe children's developmental
needs and desired outcomes; and accurate information to plan services
and interventions and evaluate whether they are making a difference.
The Integrated Children's System aims to provide a structured
coherent and holistic approach to assessment, planning, intervention
and review across children's services.
4.15 Fees, Charges and Grants
4.15.1 Could the Department update Tables
5.12 providing separate figures on residential care for each client
group? Could the Department quantify the degree of variation in
domiciliary charges between authorities? Could the Department
provide a commentary? [5.12]
4.15.2 Could these figures be listed by
LA, including any differential rates?
4.15.3 Could the Department provide an analysis,
to include chart, tables and commentary, of (i) the recent national
trend in the percentage of gross expenditure on residential accommodation
for older people recouped through fees and charges and (ii) the
recent national trend in the percentage of gross expenditure on
home care/home help for all client groups recouped through fees
and charges? [5.12]
4.15.4 Could the Department provide an analysis,
to include chart, tables and commentary, of (i) the local authority
variations in the latest year in the percentage of gross expenditure
on residential accommodation for older people recouped through
fees and charges and (ii) the local authority variations in the
latest year in the percentage of gross expenditure on home care/home
help for all client groups recouped through fees and charges?
[5.12]
1. Table 4.15.1(a) updates last year's information
and provides separate figures on residential care for each client
group. Figures 4.15.1(a) and 4.15.1(b) illustrate the recent national
trends in the percentage of gross expenditure on residential accommodation
for older people recouped through sales, fees and charges and
the percentage of gross expenditure on home care/home help for
all client groups recouped through sales, fees and charges. The
charges are not a social services fixed rate.
2. The table shows that the percentage of
gross expenditure recouped in sales, fees and charges for residential
care for the elderly rose from 35 per cent in 1998-99 to 39 per
cent in 2000-01 (mainly as a result of increased use of the independent
sector where councils are able to recoup a higher proportion of
their recorded expenditure from charges). The main reason for
this is that prior to April 2002, higher rates of income support
were available to people entering independent homes compared with
council homes. The chief element of income support accounting
for the higher rate is residential allowance (which equates to
housing benefit and was introduced in 1993 to give independent
residential care an edge over council homes). Most income support
is taken into account by the means-test for residential care.
Therefore the more people entering residential care prior to 2002,
the greater the fees and charges councils would recoup—the
amount recouped rose from £1,100 million in 1998-99 to £1,388
million in 2000-01. Note that residential allowance is no longer
available to individuals entering independent care homes. Transitional
arrangements are in place to residents in receipt of the residential
allowance prior to April 2002. It will cease entirely for existing
residents from October 2003. The amount recouped for home care
and home help service also rose from £160 million in 1998-99
(representing 11 per cent of gross expenditure) to £200 million
in 2000-01 (12 per cent of gross expenditure which is about the
same as in 1998-99).
Table 4.15.1(a)
Variations in charges for domiciliary services
3. Figures 4.15.1(c) and 4.15.1(d) illustrate
the percentage of gross expenditure recovered in charges by each
local authority for home care and meals services, the two main
items of service provided in a domiciliary setting. Table 4.15.1(b)
sets out in tabular form the percentage of gross expenditure on
home care recouped through sales, fees and charges.
4. At the Local Council level, there is
a wide variation in the amounts raised in sales; fees and charges
made from domiciliary provision. Local Councils are free to decide
on whether to levy charges and upon the level of charges, provided
that guidance on assessing ability to pay is observed. Wide ranges
of charging policies are in operation ranging from flat rate charges
to income-related charges. We have considered how best to improve
the system in the light of both the Royal Commission's report
on the funding of long term care, and the Audit Commission's study
of local council charging practices (published as "Charging
with Care" in May 2000). In November 2001, we issued guidance,
"Fairer Charging Policies for Home Care and other non-residential
Social Services". The guidance should be implemented in two
phases, by 1 October 2002 and 1 April 2003.
5. There are a number of instances where
Local Authorities have reported that they raised no sales, fees
and charges income for home care services provided; at the other
extreme, some authorities reported recouping in excess of 25
per cent. Such wide variability of individual authority figures
points to issues of data quality and there is a risk that misreporting
of data by local authorities has had an effect. The current Performance
Management Framework for Best Value in Personal Social Services
will help to reinforce the message to Local Authorities that it
is important they report their PSS financial data accurately on
the central returns.
6. For England as a whole, 12 per cent of
the direct cost of the home care service was recouped in sales,
fees and charges to clients. Within authorities, the actual figures
reported varied from zero in the case of four authorities to 25
per cent or more in seven authorities. The middle 50 per cent
of authorities had recoupment rates between 8 per cent and 16
per cent compared to rates between 9 per cent and 17 per cent
for the previous year.
7. For meals services the overall England
recoupment rate was 43 per cent: LA figures range from zero in
eight authorities to over 100 per cent in one authority (four
authorities reported no expenditure). The middle 50 per cent of
authorities had recoupment rates between 32 per cent and 57 per
cent compared to rates between 29 per cent and 64 per cent for
the previous year.
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