Select Committee on Health Memoranda



  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.


  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.


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.


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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Prepared 17 February 2003