Education and Adoption Bill

Written evidence submitted by Coram (EAB 33)

Summary

Coram is an outstanding voluntary adoption agency which – in addition to providing some 80 placements per annum - has provided adoption services for local authorities for nine years.

Coram remains the only agency to be providing the whole LA adoption function under delegation by formation of Coram Cambridgeshire Adoption in 2014 and - as improvement partner to Kent – has delivered the highest number of adoptions ever made by any agency with a combined total of 253 in 2014-15 across all locations.

Based on this experience and its extensive involvement in other permanence pathways, Coram submits that the adoption reform programme over the last three years has been positive for adopters and for children. We also submit that there is a need for further system development to address the needs of children in respect of consistency of access to adoption and concurrent planning as an option, variation in efficiency, effectiveness and quality between local agencies in permanence planning, adoption timeliness and post adoption support.

Coram experience

For nine years Coram has recruited, assessed and approved prospective adopters for Harrow's children while also providing the adoption support after placement, securing loving families for children, in a successful partnership that is now being replicated. KPMG and the University of Bristol validated the cost benefit to the local authority of the partnership as £400k pa and some 20% children have benefitted from Concurrent Planning.

The creation of Coram Cambridgeshire Adoption in 2014 was a step further in setting up a dedicated VAA for Cambridgeshire's children offering the continuum of services working closely with children's teams at every stage of the process to deliver early permanence.  This was the culmination of a two year contract whereby Coram provided the manager to the LA function and helped to introduce concurrent planning with the result that 25% placements are now using this approach providing early placement for children and full transparency and support for birth parents and prospective adopters.

For three years Coram has been in partnership with Kent County Council. Kent has a growing population currently at 1.4 million with a LAC population of some 1,800. This equates to a ‘regional hub’ in itself. The success of operating as a hub with Coram is evidenced by 182 adoptions in 2014/15 – the highest ever achieved in one year by any agency. Improvements over three years (placements were 65 in 2012/13) have led to KCC avoiding £1.6m in costs in the three year period.

Learning from the delegation of these functions, Coram is now working with several London LAs to formalise Coram Capital Adoption as a regional agency operating on a hub and spokes model to provide adopters and related functions drawing on the best of partnership working to secure early permanence for 'harder to place children'.  These authorities are characterised by their smaller scale and a location which makes access to expertise and to staff recruitment more difficult.

In each case, there has been significant benefit to children and significant cost avoided and therefore Coram welcomes the proposal for the progressive formation of regional hubs if the drivers for formation reflect and address the issues and needs presented by current arrangements and are motivated and aligned with the pursuit of excellence not simply expediency.

Challenges to be faced

The drivers for change which need to be addressed are those which affect fairness and excellence in outcomes for children who deserve an equal chance for permanence.

The chances of a child in care securing an adoption recommendation varies by 1:7. Whilst some variation is appropriate reflecting the differing profiles of children entering care, the majority of children are known before the age of three and such wide variation does not appear to reflect their needs or profile but rather other factors and variation of agency and legal determination.

The quality of provision in local authority services is highly variable with concurrent planning and foster-to-adopt approaches still limited in use despite the powerful evidence of benefit to children. In this there is some correlation with size and no evident correlation with cost. There is therefore potential to increase effectiveness irrespective of size.

A small local authority agency may find it challenging to present all options for children and to secure access to best ongoing support and may be more associated with staff turnover, system ineffectiveness and lack of leadership focus. This is not the experience of voluntary adoption agencies, many of which are smaller but the vast majority of which are good or outstanding with significantly higher staff engagement and leadership stability.

Whilst a number of 200 placements sets an ambitious aspiration, the largest local authority agencies have not been the best performing in recent years and such a scale may leave unaddressed the challenges of local access for adopters and children and cost drivers including multiple office locations, for example.

Coram recommends that the aggregation of functions be determined by drivers for excellence, effectiveness and efficiency and that this is likely to see a range of 80-140 emerge as the optimal scale. In each case the more agencies there are involved in the development the more complexity there will be in formation, especially if the new arrangement features different IT systems. Bringing multiple weak organisations/systems together, does not in itself make a strong one.

Securing equality of opportunity for children

Coram recommends that any aggregated agency or hub should be convened/led by an agency which is good/outstanding and which can demonstrate detailed means by which permanence planning will be integrated with each of the children’s social work teams and how access to consistent excellence in the provision of adoption support will be secured.

The Coram/KCC hub has for example been characterised not just be performance improvement but by improvement of data systems and by the development of a multi-professional post adoption hub which serves the county’s children (benefiting from some £95,000 through the Adoption Support Fund in the first quarter alone). This hub can now serve other LAs and is developing the specialisms/evidence pertinent to dealing with support for other children in need.

In establishing Coram Cambridgeshire Adoption (CCA), Coram has defined a process that amalgamates the expertise in a LA and a VAA - but being separate from the LA allows for challenge and facilitation that is made possible by being independent. It is also characterised by a multi-professional hub and which features early permanence planning utilising concurrent planning supported by an advisory board including the judiciary and CAFCASS.

Coram is establishing Coram Capital Adoption by acting as a specialist centre for recruitment/ assessment and adoption support with a set of Local Authorities that complement each other and gives cost-efficient access to a diverse range of adopters for a wide range of children. This is based on effective provision of a hub and spokes model around an outstanding agency which also works on a wider geography and across additional disciplines. This enriches the availability of preventive support and access to expertise. It also supports active research and evaluation of these approaches using a common data and reporting system to strengthen performance.

Decision to Place

A suggestion in the bill is that a responsibility of regional hubs could include "decisions as to whether a particular child should be placed for adoption with a particular prospective adopter" (s13, 3(d)). In practice we would see this as a decision for the ADM on behalf of the Children Looked After service/corporate parenting responsibility rather than the adoption service. We are unclear how regional adoption hubs or a VAA could exercise such a role. We do know however that a VAA or other agency can run a Panel that recommends the match/link (as CCA does in Cambridgeshire) – it is the decision (ADM function) that cannot in our view be delegated without disassociation from the corporate parenting duty and the integrating pathway for permanence planning.

Threshold for viability

We were intrigued by the suggestion that hubs should be of sufficient size to place 200 children a year or more. We wondered about the basis of this and why a lower figure such as 100 was not thought to be more viable, as in our experience services can perform very well at this level and in a configuration more likely to be aligned to the travel distances matching children’s and adopters needs (as for example in the catchment area for special schools). The diagnostics completed by Coram for 20 LAs indicates that size does not necessarily correlate with unit cost but that variability of throughput (i.e. POs) means that smaller agencies are not as cost-effective and may find it challenging to secure specialist expertise.

A viable minimum team in general costs some £350,000 a year (with on costs etc.) and there is also £27,000 per interagency placement and a need to incorporate adoption support costs. It is therefore easy to illustrate that LAs who place under 12 children a year are not cost effective unless other assessments are delivered too.

Adoption support is a complex area of work requiring expertise in the problems that children and families face – often in the realm of formulation/problem solving rather than a diagnosis. For smaller agencies providing for this is not cost-effective and combining resources would help – especially when/where CAMHS resources are scarce. Access to a multi-professional resource also helps with matching/linking and other issues which may cause distress. A viable hub will have access to such a resource.

Principles

A move to regional adoption hubs is a more than a concentration of a set of functions to larger and more viable units; it is also a major system change and as such offers risks and rewards. Coram believes that, in order to minimise the former and maximise the latter, that movement to regional hubs should follow a set of principles that ensure that the best features of the current models are replicated and that adoption activity is enhanced. Suitable principles are as follows:

1) Each hub should include at least one agency where adoption services have been rated by Ofsted as ‘good’ or ‘outstanding’. The aim should be to replicate good practice not to concentrate less good practice.

2) Steps should be taken to ensure that not all of the agencies forming a hub have a high rate of turnover in adoption staff.

3) Each hub should contain an authority with strong legal services and case management. There should also be evidence of effective relationships with CAFCASS and arrangements should be made with the NHS so that health can work synergistically with the hub.

4) Subject to choice/preference by adopters/children, hubs should be built upon travel time by road transport in the same way as catchment areas for special schools since this will also optimise rationalisation of management and staff deployment.

5) Data collection and case tracking systems (and related performance management data) should be robust in at least one agency and these systems replicated. In order to achieve this is will be necessary to audit the data quality and reliability of current systems in the agencies that come together to form a regional hub. The bigger the agency the higher the very real possibility of children being missed.

6) The needs to be a consistent local focus so that whenever possible children are placed in areas where they have pre-existing links and can have continuity in their lives. Because of this a regional hub still needs to think locally rather than regionally. Keeping the child in mind enables a personalised service and design should enable staff to maintain this and link with other stake-holders to permanence/adoption e.g. IROs, schools, courts.

7) A focus for hubs should be the cost-effective provision of good quality adoption support services. Commissioning of adoption support by hubs offer an opportunity to move away from expensive spot contracts with small fragmented suppliers and instead to commission services of the required type, scale and quality.

8) The interface between hubs also requires attention to prevent these larger geographical units from becoming inward looking and becoming a barrier to the spread of innovation and of placement opportunities for children.

9) Any reform/reshaping should utilise and build upon the value and potential for cross-regional system support indicated by First4Adoption which has demonstrated the benefits of consistent customer service including information, agency search, and e-learning.

10) Evaluation data should be collected for replicability – there is not enough evidence of what works – and this vulnerable group of children deserve that.

11) There is evidence that adopters are consistently and significantly happier with the service provided by VAAs including the support they receive after adoption. There is also evidence that organisations with a single mission will champion that mission with passion. It is important that the development of a regional hub does not exclude VAAs and that an application includes a risk assessment if a VAAs is excluded from the hub. Monopolistic markets do not drive choice or quality and any regional hub which excludes or ‘kills’ a VAA will lead to reduced opportunities for children.

12) Any reduction in market choice needs to be resisted since quality improvement is related to choice and children deserve access to the best wherever it may come from. Any hub should ensure that adopters can choose between it and at least one other agency.

13) The benefits of greater scale infrastructure rather than agency integration has been demonstrated consistently by the Register and by First4Adoption and further consideration should be given to national investment.

Use of Power to Enforce

All of the developments advanced by local authorities in conjunction with Coram have been driven by the common goal of achieving excellence, effectiveness and efficiency. They have not required any changes of process or compulsion.

Such innovation already exists and the provision of the power provides a welcome to acceleration to an existing direction of travel in shifting the emphasis in leaders’ minds from "why should we work across boundaries?" to "why would we not come together with others and with leadership from an outstanding agency to improve our service for children?"

The proposed new power to require LAs to partner in a regional agency is therefore an additional provision which, it is submitted, should be used if and only if outcomes for children are not being achieved rather than as a structural determinant.

Whilst bigger is much more likely to be better in the sense of resilience, big is not in itself necessarily beautiful and the driver has to be to increase the overall achievement of the system to the level of the best. Government would surely wish to consider the wisdom of intervening If an agency of any size can demonstrate results in the upper quartiles of performance.

A reliance on OFSTED judgments to assess this quality is not in itself sufficient, but it is nonetheless one important guide, especially the history of judgements. Quality assessment can be complemented and linked to scorecard measures and diagnostic evidence and also to staff and leadership turnover. Lessons from implementation science show that sustained change requires system change and consistency. Any criteria should include clear evidence of system integration to underpin sustained performance improvement.

In addition there are already national systems to ensure adopters can be found country-wide including the level inter-agency fee; these should be retained and supported by each locality not mediated by a regional overlay or preference.

There is extensive evidence of higher levels of support, satisfaction and resilience in VAAs. If any Good or Outstanding voluntary adoption agency were to be put at risk by the regional reform, we would put at risk both choice and quality for children and adopters.

If the power should need to used, the Minister of State will no doubt wish to define and confirm the checks and balances and also to ensure a level playing field for all agencies, including voluntary adoption agencies, so that the post code lottery which currently affects children is addressed and the total capacity and capability of the adoption system, as a national service for the nation’s children, is secured and enhanced.

July 2015

Prepared 15th July 2015