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Looked After Children

Introduction

 

This chapter of the JSNA considers the needs of children who have become looked after as a result of a legal order or who have been accommodated on a voluntary basis in agreement with their parents/carers

Looked After Children (LAC) are one of the most vulnerable groups in society.  The majority of children who remain in care are there because they have suffered abuse or neglect. It is recognised that children in care have significantly higher levels of health needs than children and young people from comparable socio-economic backgrounds who have not been looked after. 

 

Their life opportunities and outcomes are also often much poorer and poor health is a factor in this.  Past experiences, poor start in life, care processes, placement moves and many transitions mean that these children are often at risk of having inequitable access to health services, both universal and specialist

 

The local authority’s duty to meet the social care needs of looked after children is set out in the 1989 Children Act and subsequent amendments.  The local authority has specific duties:

  • To receive a child who is the subject of a care order into care and to continue to look after them while the care order is in force;
  • To safeguard and promote the welfare of looked after children - finding out the wishes and feelings of child/parents before making any decision, and giving due consideration to those wishes and feelings and to the child's background;
  • To promote the educational attainment of children in its care;
  • To regularly review the needs and circumstances of a child in care and to appoint independent reviewing officers to do this;
  • To provide appropriate advocates for children in its care;
  • To continue to support young people after they have left the authority’s care.


The duty to meet the health needs of Looked After Children for both the NHS and local authorities are clearly laid out in ‘Statutory Guidance on Promoting the Health and Wellbeing of Looked After Children’.

  • The NHS is required to make arrangements to secure appropriate health services for the child, in accordance with the health assessment and the child’s health plan and need to understand the current flows of looked after children both in and out of the CCG area and ensure that services are commissioned to meet the needs of all Looked After Children.
  • All children in care are subject to a health plan.  Health assessments must be undertaken twice a year for children under 5 years, and annually for children and young people aged 5 years and over

 

What do we know?

Facts, figures and trends

 

There has been a clear upward trend within Bedford Borough Council for numbers of Looked After Children.  As at 31 March 2014 there were 268 children looked after by Bedford Borough Council, this represents a 61% increase since to 31 March 2010.

 

Table 1: Looked After children in Bedford Borough

 

March

2010

March

2011

March

2012

March

2013

March

2014

Looked After Children)

166

164

215

247

268

Bedford Borough Rate per

10,000 children aged 0  - 17

47.1

46.6

60.4

68.4

72.9

Statistical Neighbour Average

(rate per 10,000)

56.6

59.9

61.6

58.5

57.9

National Average

(rate per 10,000)

58.5

59.3

59.0

60.0

60.0

Chart 1 - 5 year trend analysis chart

LAC1 2015

 

Table 1 and chart 1 above shows that in 2010 Bedford Borough had lower numbers compared to both national and statistical neighbour averages. Since 2010 the rate of children Looked After has risen significantly in Bedford Borough (61% rise) and it is now higher than both the statistical neighbour and national averages.  Between 2010 and 2014 both statistical neighbours and national averages were relatively stable. Bedford Borough is benchmarking thresholds for children entering care and exploring best practice across the country, to review practice ensuring the number of children entering care is appropriate.

Chart 2 – Ethnicity of Looked After Children (as at 31st March)

LAC2 2015

Between March 2013 and March 2014 the percentage of looked after children from BME groups increased from 36% to 38%, this compares against 35% in the general Bedford Borough child population (2011 Census).  This increase is largely due to an increase in the percentage of children with mixed ethnic background from 20% (49 children) to 22% (59 children), this is significantly higher compared to 14% of the general population.  Children from Asian / Asian British backgrounds are significantly lower than the general population (7% compared to 15%).

Chart 3 – Age of Looked After Children (as at 31st March)

LAC3 2015

Between March 2013 and March 2014 the number looked after children in both the 5 to 10 and 11 to 15 age ranges have increased significantly, across both age groups there has been a total rise of 24 children looked after.  Other age groups in 2014 remain similar to that of 2013; however trends since 2011 show significant increase in all age groups.

 

Projected LAC population

Based on the projected demographic growth of children aged 0-19 years in Bedford Borough, (at 0.8%), it is projected that there will be a year on year incremental growth in LAC  Chart 4 provides data for the projected increase over the next 3 years.

Chart4: Projected Looked After Child population based on expected population growth of approx. 0.8% a year increase

LAC42015

 

Current Placement Mix and Cost

 

As of March 2014 the Council had 268 children placed in care. Table 2 and chart 5 below shows the breakdown of where children were placed

 

Chart 5 – LAC by placement type

 

LAC5 2015

 

Table 2– LAC by placement type

 

Date

In-House

Commissioned Foster Care

Placed with Parents

Placed for Adoption

Residential

Independent Living

Other Placements

Total

Foster Care

31st March 2010

70

41

12

7

20

13

3

166

31st March 2011

67

55

10

4

24

3

1

164

31st March 2012

93

78

10

5

22

4

4

216

31st March 2013

79

116

4

6

31

7

4

247

31st March 2014

78

113

2

26

33

14

2

268

Fostering

Bedford Borough is committed to the use of fostering as a first option for young people who come into the care system, including the use of connected person foster care. This option reduces the risk of placement moves, is known to maximise the outcome potential for young people and allows us to minimise overall placement costs.

Foster placements can be sourced from:

 

  • Within the child’s existing network under connected person arrangements
  • Foster Carers approved by the Local Authority
  • Independent Fostering Agencies (IFA’s)

 

All three of the above options may provide a placement in or near the young person’s home community.  Although this is not guaranteed, Bedford Council makes every effort to place children close to their home area and avoid further disruption to their schooling, support networks etc where it is safe to do so.

All three of the above options may provide a placement in or near the young person’s home community.  Although this is not guaranteed, Bedford Council makes every effort to place children close to their home area and avoid further disruption to their schooling, support networks etc where it is safe to do so.

When a child becomes looked-after or there is a plan to do so, full exploration is made of Family and Friends (otherwise termed as Connected Persons), to ascertain if the child can be safely and suitably placed with a Connected Person.

Fostering continues to be mixed market, with a level of dependency on IFA’s providing some of the placements we require. Analysis shows that the ratio of in-house placements to IFA placements needs to be addressed given the current ratio’s. As of the 31st March 2014 there were 78 (41%) young people placed with in-house carers (which include Connected Persons approved as foster carers), in comparison to 113 (59%) young people placed with IFA carers. 

During 2010-11 Bedford Borough Council joined in partnership with Luton Borough Council and Central Bedfordshire Council to develop a Framework Agreement for the provision of independent fostering agency placements. It was recognised by the partners that a more systematic and holistic approach was required to provide a consistent quality assurance framework, to reduce negotiation times and to provide a better understanding of and control over the pricing structures of placements.

The contract commenced on 1st November 2011 by tendering a framework agreement with 18 independent fostering agencies. Since its implementation the framework has resulted in both an improvement in the quality of provision and a reduction in the costs of placements. For example, as at 31st March 2014 out, of the 113 young people with Independent Fostering Agencies, 90 (79.6%) were with agencies aligned to the IFA framework provision. The approximate cost of these placements was £741.41 per week per child. In comparison, there were 23 young people in non IFA framework provision at an average cost of £884.60 per week. The potential savings if all children were included in the framework equates to £143.19 per week per young person (£3,293 per week in total)

 

Residential Provision

Residential provision is required for children with the most complex needs. Where health and education services are provided in the placement, contributions are received from these agencies. These arrangements are managed through the Multi-Agency Panel (MAP)

Where it is identified that the needs of young people can be fully met and managed locally, this is provided by our in house residential provision, which is currently commissioned from and managed by the St. Christopher’s Fellowship, a voluntary organisation. The Service Level Agreement with St. Christopher’s Fellowship runs until November 2014. The unit cost of this provision, run by St. Christopher’s Fellowship is £2,340 per week compared to an approximate average of £3,975 per week for an independent specialist provider.

 

16+ Accommodation

Bedford Borough has analysed the need for 16+ accommodation based on the number and individual needs of children within the care system. This has demonstrated that there is a wide gap in the availability of semi-independent and fully independent accommodation for young people leaving care.

Bedford Borough Council, as of the 31st March 2014 had 55 looked after children aged 16-17.

  • Of these, 47% (number = 26) were looked after under Full Care Orders and would require accommodation until their eighteenth birthday.
  • 1 was placed with family and 28 were fostered. These young people may require semi-independent accommodation if they choose not to remain looked after under the Staying Put arrangements.
  • 9 were looked after in residential homes/hostels, 4 were in “Independent Living” provision and 3 were Unaccompanied Asylum-Seeking Children. These young people are likely to require more independent/ permanent accommodation.

 

A review of the characteristics of this cohort informs us that any contractors providing these services will also need to take into account the cultural and religious needs of a significant number of these young people

A finer analysis of trends informs us that approximately 28 young people aged 16 plus leave care each year within Bedford Borough. However local and national trends indicate that not all of these will require semi-independent accommodation.  National trends indicate that 26% of 16 year olds, 39% of 17 year olds and 36% of 18 years old move into semi independent accommodation. We therefore anticipate that approximately 12 care leavers will require semi independent accommodation each year.

There is currently a shortage of this form of placement across the area and the Council will therefore need to commence reviewing current arrangements and explore the benefits of different commissioning approaches to improve the quantity and quality of accommodation for care leavers.


Chart 6 – Location of Looked After Children Placed Out of Borough as at 31stMarch 2014

LAC62015

Of 268 Looked After Children 97 (36%) were placed within Bedford Borough, the remaining 171 (64%) were placed outside the Borough.  Central Bedford and Luton had a total of 69 (26%) children; this means that 62% of Looked After Children by Bedford Borough Council were placed within Bedfordshire County.

Future placement mix and cost

Chart 7 below shows that we predict there will be an increase in numbers of children placed in care. This prediction is based upon the known growth of the LAC population within Bedford Borough. The table also shows that we predict there will be a significant increase in the demand for foster care placements to meet the increased need for this type of placement.

As of the 31st March 2014 there were 33 young people residing in residential care. Of those, 8 (24%) were aged 12-14 years, 6 (18%) were aged 15-16 years and 7 (21%) were aged 17 years. In terms of characteristics, 21(64%) were male and 10 (33%) were diagnosed as a child with a disability. To minimise the need for residential care as a placement option, the Council will continue to intervene early as a means of improving young people’s life chances.

The number of children placed with adoptive parents, or with parents has grown from 7 in 2010, to 26 in 2014. We anticipate that the demand for this placement will further grow to 29 (12 %) within the next financial year. Further work therefore is planned to increase the amount of suitable adopters available.

Chart 7– Projections of Looked After Children by placement

LAC72015

 

Using the projections of Looked after Children in chart 7 and table 3 below Bedford Borough anticipates there will be increased costs and demands for placements if we continue accommodating children at current levels.

Based on historic growth and demand for placements, we can predict that foster carer placements will continue to be more frequently required than the other placement options. Locally we anticipate potential shortages in house carers in the next year. This shortage will either be met through the use of independent fostering agencies (which has on going financial implications), or will be managed through the recruitment of 30 new in house carers within the next 3 years

 

Table 3 – Comparative costs of placement types

 

Description

Actuals

Actuals

Actuals

Actuals

Forecast

 Budget year

2010 - 2011

2011 - 2012

2012 - 2013

2013 - 2014

2014-15

Residential Care Home Placements

£3,067,775

£2,154,811

£1,907,011

£2,511,233

 £2,317,100

Independent Foster Care

£1,904,727

£2,733,731

£4,240,260

£4,962,802

 £4,699,440

In House Fostering Allowances

 

 

 

£1,165,357

 £1,619,160

 

HEALTH OF LOOKED AFTER CHILDREN

Health Assessments

During 2013-14 86.7% of children looked after for 12 months or more had at least one health assessments (children under 5 had two) during the year.

Chart 8 : Health Assessments for Looked After Children

LAC8 2015

 

Dental visits

During 2013-14 88.4% of children looked after for 12 months or more had at least one dental check during the year.

 

Chart 9 Looked After Children dental visits

LAC9 2015

 

Immunisations

Children looked after for 12 months or more with all their immunisations up-to-date have increased and at 31st March 2014 stands at 92.8%.

Chart 10  - Looked After Children immunisations:

LAC 102015

 

Emotional Wellbeing of Looked After Children

The emotional wellbeing of Looked after Children is measure using a Strengths and Difficulties Questionnaire (SDQ). This figure is measured and any score of over 14 is then referred to CAMHS. These scores are returned to the Department of Education as part of statutory returns using  average scores for children who have been looked after for more than 1 year and are aged between 4 and 16 years old. The average score has returned to the level seen in 2011/12 and at 15.3 slightly down compared to 2012/13.

Chart 11  SDQ Average scores

LAC11 2015

 

Chart 12  Looked After Children Child Protection history:

 

LAC12 2015

 

National & Local Strategies (Current best practices)

Children’s’ Services have re-organised and developed services to improve working together to provide help at an earlier stage in a child’s journey through services and shortening that journey.  Bedford Borough l recognises the need to put children and young people at the heart of all decision making directly related to them, as outlined within the Department of Education (2010) care planning guidance. In response to this, we ensure that every young person (pending age and understanding) is given the opportunity to express their wishes and feelings including children with specific needs. Children and young people’s views are always discussed with their assigned social worker, recorded and given due consideration before a placement decision is made. They are also collated at every review meeting and at case conferences. The possibilities and options identified are then explained, discussed and, if necessary, reassessed in the light of the child’s views.

The Council has a responsibility to try and keep children in their local communities if they can not live with their family. Children and young people’s views are therefore key to finding the right placements for them.  If the child or young person is not happy with the decision, the Council ensures they have access to an independent advocacy service to support them. For example, we commissioned a service that responded to 69 referrals for children and young people to access an independent advocate in the period 2012-13, 90 referrals in 2013-(14) and 53 referrals in the first 6 months of 2014-(15)

For further information about the way the Council has agreed to work with Children in Care, please see the Council’s Corporate Parenting Strategy. Primarily this sets out the Council’s pledge to children in care and emphasises its commitment to work in partnership with young people when making decisions, which impact upon them. It also stresses that the Council will take necessary actions to enable LAC to consistently achieve positive outcomes related to their physical, mental and economic wellbeing

Whilst every effort is made to ensure that children inform their care plans, it is recognised that there is a need to embed a more systemic way of collecting the views of children and young people to inform future service design. In the coming year we therefore intend to complete a more in depth analysis of young peoples’ views.  This will commence with young people placed in residential care to ascertain how happy and safe they feel in their current placement and to identify if there are any notable trends which we can use to inform our future commissioning intentions.

 MANAGING DEMAND

The Council directly delivers and commissions a variety of services that aim to minimise the need for children coming into the care system, to improve outcomes for the cohort in care and to return children to their family of origin where assessed as appropriate.

The provision of early help services can reduce the number of children and young people reaching the threshold for coming into care, avoid repeat entry into care or support them to return safely to their families in a timely manner. Our early help services recognise the crucial role that all family members (i.e. not just mothers and fathers, but step parents, grandparents, siblings and other extended family members and carers) play in influencing children’s experiences and achievements.

Targeted services focus on children, young people and families who may need support either through a single service or through an integrated multi-agency response. They work with families where there are signs that without support a child may not achieve good outcomes and fulfil their potential. Targeted services are also critical in preventing escalation into specialist services, at  the end of March 2014 there were 277 Common Assessment Frameworks (CAFs).


What are the unmet needs/ service gaps?

 

FUTURE COMMISSIONING INTENTIONS AND DEVELOPMENTS

Bedford Borough recognises the need to constantly review the supply of appropriate placements for children. The demand for placements changes constantly and therefore it is vital that the Council’s commissioning approach is flexible and allows the opportunity to respond to changes in demand.

 

Recommendations

 

At present it is clear that the Council needs to:

  • Explore methods to increase the recruitment of in house foster carers by a minimum of 30 carers over a 3 year period
  • Identify 87 additional adoption household over a 3 year period
  • Re-commission existing specialist residential placements within the local area
  • Secure semi independent and independent accommodation for approximately 28 care leavers per annum
  • Increase the amount of high quality places to meet the increasing demand for places within 20 miles of children’s homes.

 

The Council’s overarching intention is to continue to collaborate with a range of providers to secure the broadest range of placements possible in the most effective and cost efficient way to meet the needs of our looked after children.

 

References


National Children’s Bureau, (2012)  Tackling health inequalities among children and young people National Children’s Bureau public policy priority 2012-13.  Available at:

http://www.ncb.org.uk/media/775150/ncb_policy_priority_health_inequalities_-_2012-13.pdf

 

The Munro Review of Child Protection: final report, A child centred system (2011), Department for Education, The Stationery Office.  Available at: http://www.official-documents.gov.uk/document/cm80/8062/8062.pdf

 

Working Together to Safeguard Children (2013), Department for Education.  Available at:  http://www.education.gov.uk/aboutdfe/statutory/g00213160/working-together-to-safeguard-children

 

Care Proceedings Reform (2013), Ministry of Justice.  Available at: http://webarchive.nationalarchives.gov.uk/20130128112038/http://www.justice.gov.uk/protecting-the-vulnerable/care-proceedings-reform


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