Select Committee on Health Memoranda

Memorandum by the Department of Health


Table 5.9.1


  5.9b  Could the Department comment on the outcome for personal social services of the Capital Challenge Pilot Fund scheme?

  2.  The Capital Challenge Pilot Fund scheme was launched in 1996 and is no longer in operation. The Department has nothing further to add to its reply in 1998.

  5.9c  Could the Department provide an update on PFI projects currently supported, or being considered by the Departments, and state its criteria for supporting such projects?

  3.  The Department's criteria for supporting PFI projects remains unchanged: the Department is seeking to support innovative approaches to the problems associated with social exclusion. This can apply to any client group—older people, children, people with mental health needs or learning disabilities. Evidence of projects growing out of long term strategic service thinking, evidence of VFM and evidence of flexibility are all required.

  4.  The following PFI projects have been approved to date:

DudleyHealth and Social Care Centre
EnfieldResource centre for older people with cognitive impairment
GreenwichNeighbourhood Resources Centre for older people
Hammersmith & FulhamNursing care + extra care housing for older people
HarrowServices for older people
HarrowLearning disability / mental health services.
KentIntegrated social and health care service
NorthamptonSpecialist care services for older people
PortsmouthLearning Disability services
RichmondCare Services for older people
StaffordshireChildrens Homes
SurreyServices for Older People
WestminsterServices for Older People

  5.  Two further Outline Business Cases have been received, from the London Borough of Ealing and Kent County Council, and these are being assessed.

  6.  Social services PFI is increasing steadily, particularly in relation to services for older people. Much of the demand is in response to LAs' long term strategic reviews and Best Value reviews of their residential care, nursing care and sheltered accommodation. Joint working with health, in relation to social services PFI, is well established.

  5.9d  Could the Department compare actual capital spend by social services departments with the funding provided through credit approvals and capital grants?

  7.  Table 5.9.2 compares actual capital spend by social services departments with the funding provided through credit approvals and capital grants. The table shows that central government capital funding is only one source of capital for LAs. LAs can fund their capital requirements in other ways, through capital receipts, joint funding, EC funding and through the Private Finance Initiative.

Table 5.9.2


5.10  Changes to PSS Statistical Information

  Could the Department provide details of any forthcoming changes to statistical information the Department collects on personal social services?


Social services workforce—gender and ethnic data

  1.  In agreement with the ADSS, DH has been collecting gender data on local authority social services staff from September 1999, and collected ethnic data on staff from September 2000.


Children in Need Census

  2.  This project grew out of the fact that whilst there is well established data on the children who are looked after by local authorities there is little information on children in need who are not formally looked after. Prior to the CiN census there was no reliable information on the number of children in need who are living with their families or independently and who are receiving assistance from social services departments. Nor was there sufficient information on their needs, the services they receive or the costs of those services.

  3.  The new Children in Need census plugs this gap. It is designed as a database which links needs, services and costs of provision made by Local authority social services departments to all children known to them as being in need. The database therefore fulfils the dual function of providing management information to local authorities and summary data on activity resources and costs to DH. The first survey was for a week in February 2000. The figures at an England and LA level have been published on the internet at

Referrals and assessments of children in need

  4.  Starting in 2001-2002, a new collection will take place of data on referrals & assessments of children in need, including data on child protection. The details of the collection have still to be finalized.

Outcome indicators for looked after children and care leavers

  5.  A new statistical collection on outcome indicators for looked after children has been introduced to cover the year from 1 October 1999. Local authorities will provide aggregate data on educational attainment in the Key Stage tests and at GCSE, school attendance, school exclusions, offending rates, and the health care received by these children. The collection will help to support a range of indicators under the Quality Protects Programme including some of the Performance Assessment Framework series. The first data was published in May 2001.

  6.  In addition, local authorities will also be asked to provide data about the occupation and accommodation of their care leavers after they have left care. Starting in April 1999 this scheme required councils to keep in touch with young people leaving care aged 16 and provide data on a proportion of them when they reach 19 years old. Data collection will begin in 2001-02.

PSS user satisfaction survey

  7.  Local authorities will be required to undertake user satisfaction surveys for the first time in 2000-01 in the context of Best Value, including a social services user satisfaction survey. Information from these will be collected by DH, producing two of the indicators in the Performance Assessment Framework (users who said they got help quickly following assessment and users who said that matters relating to race, culture or religion were noted during assessment). Local authorities will include additional questions in their surveys for their own use. To minimise the burden on councils, only new users assessed during November will be surveyed.

RAP (Referrals, Assessments and Packages of care) project

  8.  This major statistical development project in the adults and elderly area provides a framework for defining and collecting aggregated person-based information on the main aspects of the community care provision and assessment process. After passing through successive "dress rehearsal" stages, the full implementation of this annual collection took place from 1 April 2000 to 31 March 2001 with a report of findings expected to be published in Autumn 2001. The report will provide some information on waiting times (with "dress rehearsal status") and on information relating to the ethnic group of clients with completes assessments and receiving services. RAP information to be collected for the 2001-02 collection year is little changed from the previous year.

Workload and performance of registration and inspection units

  9.  The Registration and Inspection survey has been repeated this year and a report will be published in Autumn 2001. It is not certain whether the National Care Standards Commission will want to retain it in its current form.

Ethnic origin data

  10.  As the committee was advised last year, such data in future will be collected on a basis consistent with the 2001 census categories; with a transition period for datasets where ethnic data are already being collected in whatever form (generally based on 1991 census categories, or variants of them). The first dataset to report ethnic data on the new basis is the Children in Need census.

Internet Data Collection (IDC) Facility for PSS Returns

  11.  This facility is not strictly a data collection but is a key development as part of DHs contribution to the e-government initiative.

  12.  This year DH has made most social services returns available in electronic format over the Internet—either as downloadable Excel spreadsheets or as part of the IDC system. This is consistent with the E-Govt initiative for handling returns electronically. These returns will have the advantage of including validations that will enable data providers to check on the accuracy of the data provided, at source. The following returns are currently included in the IDC facility:

    Outcome Indicators for looked-after Children (OC2)

    Adoptions from Care (AD1)

    Number of homes and places in residential care homes (RA Form A, Parts 1,2 3)

    Independent sector nursing care homes registered under Section 23 of the Registered Homes Act 1984 (RH(N) Summary, Parts A/1to A/3)

    Local authority supported residents (SR1)

    Register of Deaf or hard of hearing (SSDA910)

    Personal Social Services Expenditure (PSS EX1)

    Key statistics (KS1)

    Home help/home care services (HH1)

  The following returns are bring revised and will subsequently be available within the IDC facility:

    Children on Child Protection Registers (CPR3)

    Annual PSS Staffing return (SSDS001)

  A separate initiative is under way to add the Referrals, Assessments and Packages of care (RAP) set of statistical returns for 2001-02 to the list of forms available electronically. The RAP returns are quite complex and putting these on the internet is a significant block of work.

Personal Social Services Expenditure and Unit Costs

  13.  A new return (PSS EX1) was introduced for 2000-01 to collect detailed expenditure data formerly collected by DTLR on RO3 (RO3 has been slimmed down to eight summary lines plus a total), PAF cost indicator data formerly collected on the Key Statistics return (KS1) and data collected on the CIPFA Actuals return (which has now been discontinued). The expenditure categories on PSS EX1 match those in the CIPFA Service Expenditure Analysis for Social Services.

  Note:  examples of the returns and the publications referred to above can be viewed on the DH Internet site:

5.11  Research on outcomes and effectiveness of social care

  Could the Department provide details of any research work currently being sponsored by the Department on the outcomes and effectiveness of social care?



  1.  A programme of studies has recently begun to investigate key questions relating to the costs and effectiveness of different child care services. Thirteen studies have been commissioned. The studies cover the following important areas of service provision: non-infant adoption, children's homes, adolescent support teams for children at risk, foster care, an intervention with sexually abused children, mental health services through the child protection system, leaving care services, and aspects of family support. One aim of the research programme is to clarify the basis on which costs of services are derived and to develop guidelines for both research and services. Professor Ian Sinclair of York University is the academic co-ordinator for the programme. Details of studies are provided at Paragraphs 6 to 48.


  2.  Thirteen projects were funded under this programme, together with a related programme of projects at the Social Policy Research Unit, University of York. The overall aim was to see whether services were meeting policy objectives by delivering the desired service outputs and user outcomes. Considered overall, the projects were concerned with the full range of adult client groups, and addressed the following themes:

    —  Assessing the effectiveness of services.

    —  Comparing costs and outcomes.

    —  Evaluating and reviewing the evidence base.

  3.  The findings and key implications for policy and practice drawn from across the programme will be pulled together in an "overview report" which is currently in preparation. Many of the individual studies have already reported Melanie Henwood and Eileen Waddington of Nuffield Institute of Health are the academic co-ordinators. Details of studies are provided at Table 1 and Paragraphs 49 to 64


  4.  An important element of work at one of the Departments long-term funded units is to explore the relationship costs, effectiveness and performance. Two continuing streams of work focus on this area, as follows:

  4.1  Commissioning and Performance Programme

  The aim of the Commissioning and Performance Programme (C&PP),

formerly known as the Mixed Economy of Care Programme, is to evaluate how different commissioning approaches, and different commissioned services, can enhance the performance of social care services in delivering quality care and improving user quality of life.

  4.2  Costs and Outcome Programme

  The Unit Costs programme draws together information about unit costs of a wide variety of services in a format that is transparent and easily adapted.

  5.  Details of the PSSRU and these streams of work are provided at Paragraphs 65 to **.


  6.   Introducing the Initiative: the Department of Health's research initiative Costs and Effectiveness of Services for Children in Need. The first project to be commissioned under this initiative began in January 2000 and the last in April 2001.

  7.   Where did the idea come from? The Initiative is the second in the Department's current series on children and reflects current preoccupations. A range of terms ("Comprehensive Spending Review, `Quality Protects', `Quality Strategy', `Beacon Councils', `Social Care Institute of Excellence'") reflect the concern of both Central and Local Government with producing good and effective services at an appropriate cost. The interest is understandable. Notoriously there is never enough money to go round—preventive work, for example, often appears to lose out financially to services for children who are looked after. There are unexplained variations in costs both within and between local authorities. Why, for example, have past CIPFA figures shown a place in a children's home as costing £18,000 per year in one authority and £80,000 per year in another? And how is it possible to commission services in a way that takes account of both cost and effectiveness?

  8.  This background helps to explain the current emphasis on "best value" and on the need to justify expenditure with evidence that it is being spent wisely. It also provides the rationale for the research Initiative.

  9.   The aim of the Initiative is therefore to address some of these issues by investigating the costs and effectiveness of services. It seeks to tackle a variety of questions. Do some ways of running a service produce better outcomes at no greater cost than others (or, alternatively, similar outcomes at lower costs)? Are some services or combination of services more effective than others (and how do they compare on costs)? What is the relationship between cost and the infrastructure of services? For example, is the comparative generosity of an authority's foster care allowances reflected in higher recruitment and retention rates for foster carers? And why do some authorities have much higher unit costs than others?


List of Projects

  Children in the community

  1.  A structured approach to the assessment of family capacities and children's needs

  2.  Home visiting in the primary prevention of abuse and maltreatment

  3.  Family support for vulnerable families with young children

  4.  The mental health needs of children in the child protection system

  5.  Costs and effectiveness of adolescent support teams

  6.  Costs and outcomes of different interventions for sexually abused children

  Children in the care system or adoption

  7.  Costs and outcomes of non-infant adoptions

  8.  Consequence of different types of child care provision

  9.  Leadership, resources and efficiency in children's homes

  10.  Services for troubled adolescents: costs and consequences

  11.  Transitional support for care leavers: an evaluation of costs and outcomes

  Studies of resource use

  12.  Remuneration and performance in foster care

  13.  Childcare costs: variations and unit costs




  Hedy Cleaver and Steven Walker, Royal Holloway, University of London

  Pamela Meadows, National Institute of Economic and Social Research

  10.  An effective and flexible assessment and evaluation system for children in need does not currently exist. In the context of the Framework for the Assessment of Children in Need and their Families (Department of Health et al, 2000) the study aims to explore:

    —  whether the records support assessments under the Assessment Framework

    —  the experience of parents and children

    —  the role of the records in management systems

    —  if the system results in identified objectives and a plan for the child in need

    —  the costs implications of carrying out core assessments

  11.  A prototype electronic version of the recording forms will be developed; the team will act as consultants on devising the specification for an electronic system for the Integrated Children's System's data.

  12.  The study is in two parts, the first of which involved introducing and supporting local authorities to implement the Assessment Framework. The second part focuses on information gathering through: auditing the assessment records at two points in time, qualitative interviews with parents, young people, social workers and other key professional, postal questionnaires to relevant professionals, and a costing exercise.

  13.  The study will provide important information on the effectiveness and costs of the assessment records in ensuring children in need and their families receive appropriate and timely services which address identified needs.

  Start date: November 1999

  End date: March 2002



  Sarah Stewart-Brown, Jane Barlow and Emma McIntosh, University of Oxford

  14.  There is currently much interest in how best to meet the needs of children who come from deprived families where parenting skills are poor, social and environmental risk factors are high, and there is a significant risk of maltreatment. Home-visiting programmes are seen as a useful method of improving parenting and preventing child maltreatment.

  15.  The aim of the research is to evaluate the cost and effectiveness of such a programme.

  16.  Mothers/parents at risk of poor parenting or child maltreatment were identified prenatally and includes families who require Child Protection Services or Family Support Services.

  17.  With their consent the families have been randomly allocated to an intervention (n=130) and a standard treatment control group (n=130). The intervention group receives structured, weekly visits from a home visitor trained in counselling, child development, and parenting, for a total of eighteen months, beginning antenatally. Parents in both the control and intervention groups continue to receive the standard help that is currently available to such families from the health and social services departments.

  18.  Interim and final assessments will be undertaken immediately post-intervention and at one-year follow-up, using a range of standardized outcome measures to assess the effectiveness of the intervention on infant health and parental well-being.

  Start date: January 2001

  End date: December 2003



  John Carpenter, Jill Dutton, Justine Schneider and Jan Slade, University of Durham

  Jeni Beecham, University of Kent at Canterbury

  19.  Family Support is a broad term covering a wide range of interventions with families. The research evaluates the cost effectiveness of support interventions for vulnerable families with multiple needs arising from unemployment, unsuitable housing, poor health and education, and are identified as having "children in need". The therapeutic interventions under scrutiny are those provided by social services and, with varying degrees of joint working, the voluntary sector.

  20.  The key variables in this study are:

    —  types of service delivery and methods;

    —  types of population and needs; and

    —  outcomes and costs.

  21.  Study locations represent a range of partnerships between local authorities and voluntary organisations. Also present within these locations are differences in the range of intervention (from child protection to family support) and the services provided by both social services and voluntary sector present.

  22.  Sample projects in these locations have been selected to represent up to four different models of therapeutic family support defined according to key dimensions of focus, location, method, contact and staffing. Sample sizes are sufficient to compare outcomes of models.

  23.  The goals of the research include:

    —  Determining the role of family support services.

    —  The measurement of family characteristics and service use.

    —  The definition and measurement of family support interventions.

    —  Evaluation of outcomes.

    —  Assessment of costs.

  Start date: January 2001

  End date: December 2002



  Ann Hagell, Deborah Ghate and Sunita Bhabra, Policy Research Bureau

  Jeni Beecham, University of Kent at Canterbury

  Richard Harrington, Royal Manchester Children's Hospital

  Susan Bailey, Mental Health Services of Salford NHS Trust

  24.  There are a number of disturbing estimates for the overlap between child protection issues and mental health problems. While the child protection system may be a child's first point of contact with services, a proportion will need additional specialist services and input over and above those usually provided by child protection agencies.

  25.  This project addresses a range of important and timely questions concerning the processes and outcomes for children with mental health needs who are entering the child protection system. We are tracking how multi disciplinary teams dealing with at-risk young people identify needs and refer on to appropriate services. Services will be costed, and costings of different models of provision will be compared within and between a selection of local authorities. The project will describe or develop models for good and cost effective practice in providing "joined up" services for young people, and follow-up samples of approximately 600 young people to describe their needs, the services they receive, the relative costs of different options, and their outcomes over a period of one year.

  Start date: ?

  End date: ?



  Nina Biehal, Sarah Ellison, Helen Weatherly, University of York

  Sarah Byford, Institute of Psychiatry

  26.  This study aims to evaluate the effectiveness and cost effectiveness of adolescent support teams in achieving positive outcomes for young people at risk of care or accommodation, as compared to mainstream services. It also aims to compare outcomes for young people admitted to care or accommodation with those for young people who are not.

  27.  A prospective, comparative study is being carried out in eight local authorities, six of which have adolescent support teams. A quasi-experimental study is complemented by a qualitative study. The experimental group comprises all referrals to adolescent support teams which include a request for care or accommodation, while the comparison group includes all such referrals to mainstream services for young people age 11 or over. Baseline data and measures of outcome will be collected on first contact with specialist/ mainstream workers and follow up data on interventions, outcomes and costs will be collected six months later. Outcomes for a sub-sample admitted to substitute care will be compared to outcomes for a matched sample of young people for whom accommodation has been avoided. The qualitative study will carry out depth interviews with 30 young people receiving the specialist service matched with 30 receiving mainstream services. It will explore how, why and in what circumstances particular interventions come to be associated with particular outcomes.

  Start date: March 2000

  End date: October 2002



  Tara Weeramanthri, Paul McCrone and others, Institute of Psychiatry

  28.  The Tavistock/Maudsley outcome study of psychotherapy for sexually abused children, funded by the Department of Health and the Mental Health Foundation, ran from 1993 to 1998. Girls aged 6-14 and their carers were assessed at baseline and treated on two main sites, the Tavistock Clinic and Camberwell Child and Adolescent Service.

  29.  81 sexually abused girls and their carers were assessed, and 71 girls entered treatment. They were randomly allocated to time-limited individual or group treatments—psycho dynamic psychotherapy and psycho-educational group therapy. Follow-up assessments were carried out one and two years after treatment commenced. At final follow-up, over two-thirds of the girls had improved on a range of measures, including psychiatric diagnoses, co-morbidity, symptoms of post-traumatic stress disorder, general functioning, educational achievement and carer views of outcome. There were few significant differences in outcome between individual and group treatments.

  30.  It is the intention in this small follow-up study to collect and analyse costs. Cost-minimisation and cost-consequences comparisons will be conducted between the two intervention groups.

  Start date: ?

  End date: ?



  Julie Selwyn, Wendy Sturgess, David Quinton and Kate Baxter, University of Bristol

  31.  This study examines the care costs and psycho-social outcomes of a complete epidemiologically based sample of children who underwent medical assessment prior to adoption. The children were aged between 3-10 at assessment and at follow up will be 12-19 years of age. Carers are being traced and interviewed to establish the type and length of contact with all agencies since the medical. Estimates of sample size yield approx 90 adoptive placements and a further 45 children who were never placed for adoption. The latter group are being used to determine why some children are adopted and some not as well as providing some comparison with the adopted group by mapping routes and outcomes through the care system.

  32.  Psycho social outcomes for the children are measured using questionnaires following the seven dimensions of the Looking After Children system. Other measures include SATS results and involvement with the criminal justice system. Psycho social costs and benefits for the adoptive parents are also measured. In addition, the financial cost of delay, disruption and support will be calculated. The use of post adoption support services, formal and informal, and their contribution to placement stability is a central feature of this study.

  Start date: January 2000

  End date: July 2002



  Harriet Ward, University of Loughborough

  Jean Soper, University of Leicester

  33.  The research aims to assess how far variations in the costs of different provision for children looked after is reflected in the quality of care and in impact on developmental progress. A prospective longitudinal study is being undertaken in six local authorities, matched for similarities in the extent of deprivation and differences in the costs of placement. Six hundred children aged 10 and over, looked after away from home in these authorities are being followed for two years.

  34.  The study assesses how far placements of different costs meet the needs of subsets of children who display evidence of educational difficulty, behavioural problems, health concerns and/or significant disability, as demonstrated both by the quality of care experienced and their developmental progress. Qualitative data from interviews with about fifty children with significant disability further informs the analysis. A decision analysis model is used to estimate the different probabilities of outcome for children with different needs and histories who receive placements of different costs and quality.

  35.  Outputs include a fully developed computer application for estimating the probable costs and consequences of various types of provision.

  Start date: ?

  End date: ?



  Leslie Hicks, Ian Gibbs and Helen Weatherly, University of York

  Sarah Byford, Institute of Psychiatry

  36.  Residential homes are a key, albeit expensive and often criticised, part of the provision for "looked after" children. Among a number of recent studies two in particular have suggested that, while the heads played a key role in the success their homes, staffing ratios appeared of less consequence. Following on this work the current research aims:

    —  to describe (and, where appropriate, measure) the practice of heads of homes, explore their use of resources and carry out an economic evaluation of their costs

    —  to assess the impact of heads of home on:

            a)  the morale and unity of the staff group

            b)  the quality of the residential environment

            c)  changes in the residents over one year

    —  to assess the conclusions in terms of their relevance to practice and to the experience of staff and heads

  37.  The project involves a quantitative study of 45 homes and a qualitative study of a sub-sample of eight homes selected to present contrasts in resource use and leadership style. All the homes and a sample of residents in them will be described at two points in time. Information about the young people and the homes at these two points will be related to variations in costs, size, the approach of the heads of homes and other factors likely to affect performance.

  Start Date: April 2000

  End Date: September 2002



  David Berridge, Isabelle Brodie and Virginia MacNeill, University of Luton

  Jeni Beecham, University of Kent at Canterbury

  Martin Knapp, London School of Economics

  Harry Daniels and Ted Cole, University of Birmingham

  38.  This exploratory research focuses on services for adolescents living in children's homes, (specialist) foster homes and residential special schools for young people with emotional and behavioural difficulties ("EBD"). The specific objectives are:

    —  To develop a profile of the differences and similarities amongst samples of young people living in children's homes, (specialist) foster homes and residential special schools.

    —  To compare and contrast key factors relating to the organisation of these different settings, including information on costs.

    —  To develop measures of "quality of care" which will permit comparison of services for adolescents living in these settings.

    —  To highlight key policy and practice issues in the care of adolescents.

    —  Development of hypotheses for further research.

  39.  The research is based in four, geographically diverse, local authorities. Data regarding the three most frequently used children's homes and EBD schools as well as by the users of these services are being collected via interviews with managers and keyworkers. For the fostering group, examination of up to 50 case records is taking place. In the next stage, case studies will be undertaken involving qualitative, semi-structured interviews with young people, parents, social workers/educational psychologists, carers, and teachers. As far as possible, integrated research tools are being developed which can be applied to these different forms of provision and groups of young people.

  Start date: June 2000

  End date: June 2001



   Jim Wade, Jo Dixon and Helen Weatherly, University of York

  Sarah Byford, Institute of Psychiatry

  40.  Leaving care is a difficult challenge for young people, especially when they lack the guiding hand and support of parents. The study will investigate the plans and support for young people aged 16-19 leaving the care of seven local authorities. The study aims to:

    —  evaluate the outcomes achieved by young people across a range of dimensions

    —  evaluate the costs associated with packages of support of different types and in different local authority contexts

    —  identify the constituent elements of "good" supported transitions

    —  relate the outcomes and costs of these packages to the strengths and weaknesses of different organisational frameworks for delivering leaving care services.

  41.  The primary unit of analysis is the care and post care careers of individual young people. The study comprises two elements:

  42.  Extensive study: Statistical data will be collected through questionnaires to approximately 200 young people and their personal advisors. Baseline data and outcome measures will be collected soon after leaving care (T1) and followed up 9 months later (T2) to gather information on interventions, outcomes and the costs of services provided by social services and other agencies.

  43.  Intensive study: A sub-sample of 80 young people will be selected for interview at T2. Semi-structured interviews will be conducted with them and their personal advisors to provide a depth focus on their histories, the processes associated with transitional support and to understand how, why and in what contexts particular forms of support achieve the outcomes that they do.

  Start date: March 2001

  End date: December 2003

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2002
Prepared 17 January 2002