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Demand Management in Sandwell– reinventing children’s services

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Simon WhiteDirector of Children’s Services, SMBCSimon_White@sandwell.gov.uk Leo JonesSenior Manager, iMPOWER Consultingljones@impower.co.uk07515 053534

[IL0: UNCLASSIFIED]

2 ‘

Pre and Post MASH Volumes June 2012- October 2014 (Average Monthly Rates)

100

200

300

400

500

600

700

800

900

1000

1100

1200

1300

1400

1500

1600

1700

050100150200250300350400450500550600650700750800850900950100010501100115012001250

Children in Need (excluding LAC and CP ) 1228 1254 1645 1575 1186 1030 1041 921 853

Referrals 295 312 421 320 346 165 167 134 190

Section 47's 94 113 120 78 155 90 80 55 80

ICP Cs 34 49 47 28 45 31 19 24 40

Child P rotection P lans 291 317 347 356 353 388 347 330 321

Looked After Children 593 600 601 619 618 595 563 550 538

Assessments Started (Single Assessments P ost Nov 2013) 329 351 441 339 364 188 170 150 144

October to December

2012

J anuary to March 2013

April to J une 2013

J uly to September

2013

October to December

2013

J anuary to March 2014

April to J un 2014

J uly to Sep 14 Oct-14

Safeguarding Inspection March 2013

Start of MASH November 2013

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Past and current work volumes

Monthly Numbers 31 Mar 2012 April to June 2013 (Average)

Current Numbers Oct 14

Difference June 2013 to Oct 14

Contacts 1635 1594 1747 153 more

Referrals 366 421 190 231 less

Section 47s 110 120 80 40 less

ICPCs 55 47 40 7 less

Children undergoing Assessment

227 480 173 307 less

Long Term CiN with Plans 954 1047 495 552 less

Care Leavers 243 118 185 67 more

Total Children in Need (Exc LAC and CP)

1424 1645 853 792 less

Child Protection Plans 329 347 321 26 less

Looked After Children 576 601 538 63 less

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How we “think” about demand matters

Huge variance in councils with similar deprivation We make up stories to “explain” our data Less about prevention; more about diversion Public Services create their own customers Systems are often self regulating and seek

equilibrium

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Comparative data suggests you have a choice

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IMD vs LAC

IMD vs LAC per 10,000

0

20

40

60

80

100

120

140

160

0 50 100 150 200 250 300 350

Deprivation (1 being most deprived)

LAC

per

10,0

00

LAC 2012

Linear (LAC 2012)

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A clear correlation but significant variation in Councils with similar deprivation

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IMD and CiN

IMD vs CiN per 10,000

0

100

200

300

400

500

600

700

800

900

0 50 100 150 200 250 300 350

Deprivation (1 being most deprived)

CiN

per

10,

000

CiN throughout 11/12

Linear (CiN throughout 11/12)

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Little correlation

Some of the most deprived have the least CiN casesSome of the least deprived have the most CiN cases

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Some values……

Very sceptical about the “reality” of CiN Caseloads must be manageable You must have a stable management team, and a critical

mass of permanent staff Shrink the work to fit the diameter of the pipe A well functioning MASH is central Targeted services cannot replace lead professionals and

the TAC – if schools and the NHS do not step up, we will not step in.

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…and prejudices

Thresholds are not what they are cracked up to be Audits rarely tell you much about them Adult services tend to approach cuts with more of a

sense of agency Children at risk of significant harm are rare, children in

need of services are too numerous to assess Assessments are not services If you view assessments as a “handling charge” we

spend much more arranging services rather than providing them

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Assessment Vs Intervention

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Different types of wasted work

Some work we just shouldn’t do (its not our job) Some work we do is misguided (it’s the wrong thing) Some work we do is ineffective (it’s the right thing, done

badly) Sheer volume can make most work ineffective Sometimes children are on the merry-go-round;

sometimes professionals Transition points create waste and work Some work we do is to remedy previous failure

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Universal services Early help Entry Care and

supportPermanency and exit

Universal & Universal Plus Early Help

(Targeted)Early help Entry Care and

supportPermanency and exit

Savi

ngs

Better utilising universal resources to complete early targeted work with children & families

More targeted activitiy – specifically focused on the needs that lead to children becoming ‘Looked After’

Multi-Agency to reduce inappropriate demand

Driving planning & permanency

Increase the availability of permanency options including internal placement provision

As is: Elongated child’s journey, poor outcomes and high cost to the system

To be: Emphasis on a safeguarding and early help, better outcomes, reduced cost to the system

As is =

To be =

Programme start

Programme end

Agree the ‘end game’ – the desired future state?

Changing the Children’s System

A sustainable system focused on prevention & permanence

1

[IL0: UNCLASSIFIED]

11 ‘

Workflow Analysis

Analysis of workflow showed duplicated Core Assessments Closures at ICPC after 15 days with 2nd CA opened in Care Management Performance data shows some CA’s are being opened on same day as IA’s in some

cases

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Understand your baseline2

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• What is the real function of CiN?• Being “in need” and having “additional needs”• What intervention do they get?

’Changing the Children’s System

Analysis of open CiN cases showed some interesting facts

For all cases referred before 15th July (including assessment)

Days since last visitno visit 42<20 days 27120-39 days 28140-59 days 16160-119 294120-240 177more than 240 77

Total 1303

Be prepared to think differently3

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Changing the Children’s System

It’s a whole system thing – we need to be system architects

4 Change the whole system

Re-configured Early Help Services

Multi-Agency Safeguarding

Integrate your early help services – remove handoffs and early help boundaries

Place them in localities, centred around schools & universal servicesEnsure a social work interface in early help – to reduce the need for

inappropriate referrals

Single front door through 12 agency Multi-Agency Safeguarding Hub (MASH) with 3 screening pathways (social care, DV, Early Help)

Co-located investigative team with the police to ensure quicker & more integrated assessments of risk

In essence completion of Initial Assessment in the MASHLots of feedback into the system to bed in approach

Activity Detail

Re-modelled social care

journey

£500,000 out of social care and into early help to boost capacity immediatelySimple journey with reduced handoffsReduced caseloads to focus on quicker exitPermanent staffing is key – reduction in work makes it easier to achieve

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The Sandwell Model Whole System Change

• Central to & part of ‘Early Help’• Key part of Community Operating Groups• Commissioned to complete some targeted work – or

pooling of their budgets for local, responsive commissioning

Early Help Universal Services

Community Operating

Group

Community Operating

Group

Community Operating

Group

Community Operating

Group

Community Operating

Group

Community Operating

Group

• Integrated Early Help Services with multi-agency, multi-disciplinary teams around localities

• Re-allocation of CiN activity to early help• Supported by dedicated social worker support for each locality• Targeted services based on local need with key aim of reducing demand• Supported by local commissioning budgets to allow proactive response• Strong performance & quality management focused on reducing demand

+ outcomes

Targeted Early Help

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Impact

50% less referrals into the system 50% less Child in Need cases 50% less assessments Improving re-referral rate Reduction in agency staffing from as high as 45% to

under 15% Reduction in spend on agency staffing from £5.4m to

under £1m 10% reduction in LAC with £1.6m underspend on

placements from forecast spend

[IL0: UNCLASSIFIED]