Are regional care co-operatives the answer to care placement challenge?

    The DfE says stripping councils of responsibility for commissioning in favour of new regional bodies will tackle the issues of insufficiency, excess profits and poor outcomes. But the idea has its critics and evidence is inconclusive

    Regional policy key on keyboard
    Photo: momius/Adobe Stock

    The last few years have seen a plethora of reports about the lack of appropriate placements for children in care and the dire outcomes that have followed.

    These include children and young being placed far from loved-ones and social networks, or in unsuitable, and sometimes unlawful, accommodation, and enduring multiple placement breakdowns. Those with the most complex needs have often being the worst affected.

    These have been accompanied by concerns about councils facing spiralling costs for such placements and some – particularly large – providers making excessive profits by taking advantage of the shortage of provision and authorities’ lack of choice.

    Regional commissioning plan

    To tackle these issues, the Department for Education (DfE) has accepted the Independent Review of Children’s Social Care’s recommendation to regionalise placement commissioning, through the establishment of regional care co-operatives (RCCs).

    RCCs – of which there would be 20 following implementation – would take over their member councils’ responsibilities for placing children in care, and would be complemented by a national body supporting councils with forecasting demand and the procurement of care from providers.

    This function –  recommended by the Competition and Markets Authority in its report last year on the children’s social care market – may be folded into RCCs over time, the DfE suggested in its recently published draft strategy for the sector.

    Providing greater scale than councils

    RCCs are designed to overcome the challenge of individual councils being too small – and having too few children – to be able to meaningfully shape the services providers offer and ensure that they meet need and are value for money.

    The DfE said that, by operating at much greater scale than councils, RCCs, supported by the national body, would be much better able to forecast need, and commission sufficient placements, in the right places, to meet it.

    It would also be much easier to share learning, good practice and information about the cost and quality of providers between 20 RCCs, compared with 152 councils, improving the quality of commissioning.

    This would reduce excess profit making and improve outcomes for children by making it more likely that they would be in a placement that meets their needs, said the DfE.

    Co-operatives to face Ofsted checks

    In time, RCCs would be inspected by Ofsted, to hold them to account for providing sufficient, high-quality placements.

    As with the rest of their reforms, the DfE is not rushing ahead with implementation, but plans to establish two pathfinder RCCs next year.

    But the department is clear that this is the way forward, with the pathfinders designed to shape how RCCs are implemented, not whether.

    So what does the evidence say about their prospects?

    Mixed history 

    Councils working together across regions to commission care placements is nothing new. However, several reports have found issues with these approaches.

    A 2015 study by Oxford Brookes University for the DfE identified 35 consortia or partnerships involved in commissioning care placements, encompassing the majority of councils. Most operated framework agreements, which defined service specifications and prices for providers who signed up.

    The report found that, while consortia had generated savings for member authorities, both commissioners and providers acknowledged there was considerable scope for improvement. Procurement and monitoring activities were seen as particularly “bureaucratic and wasteful”.

    Earlier call to require regional commissioning

    A year later, Sir Martin Narey’s independent review of residential care for the DfE found councils could be obtaining “significantly greater savings” through consortia-based commissioning.

    Foreshadowing the care review’s recommendations last year, Narey recommended the department require councils “to come together into large consortia for the purpose of obtaining significant discounts from private and voluntary sector providers”.

    On the back of this, the department funded two projects, both in London, through its innovation programme, to test the benefits of regional commissioning.

    However, an evaluation of one of these projects found that fewer providers than expected had made bids to join its proposed framework agreement, and those that had had offered prices higher than the market rates. Several providers reported that their preference was to offer placements to councils through unplanned spot purchases, where they could set their own fees.

    “The findings highlight a tension between the interests of local authorities in securing in-borough, suitable and more cost effective placements, and the business interests of independent placement providers,” found the overarching evaluation of the second round of innovation programme funding, published in 2020.

    Lack of provider sign-up

    More recently, a 2022 study by What Works for Children’s Social Care found that, while most councils were part of a regional or sub-regional commissioning framework, several said these did not help them secure local placements or reduce reliance on spot purchasing. As with the innovation programme project, the key issue was lack of provider sign-up.

    And in its report on social care last year, the CMA found that councils “can struggle to collaborate successfully due to risk aversion, budgetary constraints, differences in governance, and difficulties aligning priorities and sharing costs”. It concluded this was unlikely to change without action by central government.

    One clear difference between RCCs and their predecessor regional commissioning initiatives is that they would be mandatory and universal, following their rollout. Neither councils, nor providers, would be able to opt out, and providers would have to deal with the RCC as a whole, not individual authorities.

    This should tackle at least some of the issues highlighted in past reports.

    Several years until full implementation

    However, with the two RCC pathfinders only due to start work in spring 2024 and legislation required to roll out the system to the rest of the country, full implementation is several years away. Several sector bodies have raised the question of how immediate placement pressures will be addressed in the meantime.

    While supporting the pathfinder approach to RCCs, the Local Government Association said: “We do not believe that RCCs will be able to address the issue of insufficient placements quickly, particularly for those children with the most complex needs, and therefore call on the department to work with councils and the NHS to improve sufficiency swiftly rather than waiting for RCCs to deliver results.

    “This is imperative; too many children are not living in the right home for their needs and those children cannot wait for action to be taken.”

    Proposals unlikely to tackle ‘dysfunctional market’

    Children’s charity representative body Children England questioned what action would be taken in relation to non-pathfinder areas over the coming years.

    “The fact that selected areas will be able to voluntarily form RCCs, and will receive both set-up and capital resource from central government to do so, while so many other areas of the country won’t, simply cannot be described as a decisive intervention to reform the whole dysfunctional care market,” it said.

    Fostering agency TACT, meanwhile, while supportive of RCCs as an idea, raised concerns that the pathfinders may come to nothing.

    “Any pilots must be part of a wider plan that clearly signals when the legislation needed to enact RCCs more widely will be introduced,” it said. “Too many pilots peter out, implementing pathfinders does make sense, but must be part of a wider implementation plan that makes clear the direction of travel and timescales for this.”

    More immediate measures to boost placements

    The DfE said it recognised the urgency of the need to tackle the insufficiency of placements.

    Its key measures prior to RCC implementation are the existing programme to invest £259m in building children’s homes, from 2022-25, and a £27m increase for foster care recruitment and retention, over the next two years.

    “This will boost fostering capacity and build an evidence base on how to effectively recruit and retain foster carers, building towards fostering being subsumed into RCCs across England,” it said.

    Whether these measures prove sufficient is open to question; they will also take time to have an effect on the supply of placements.

    However, besides timescales, there are more fundamental criticisms of RCCs.

    Concerns over remote decision making for children

    The DfE’s view is that RCCs’ greater ability to shape the market would result in more children being placed closer to home.

    “No matter where children are from, at the heart of this approach, it is crucial that children live close to their family, friends and school,” it said. “A regional way of working should improve, not impede, this.”

    When they were first proposed by the care review, the LGA warned about decision-making becoming more remote from children’s needs as a result.

    “Locally-led solutions, rather than structures imposed from above, allow councils to build on existing relationships and respond to local contexts,” it said.

    In a statement following the publication of the DfE strategy, it reiterated warnings about RCCs “adding an additional layer of bureaucracy to the system”.

    Similar concerns were raised in December by some members of the care review’s evidence group, a collective of academics and researchers whose remit was to advise on the evidence base for its recommendations.

    Warnings over structural change

    In a blog post, they warned that “care will need to be taken that these structural reforms do not dilute local accountability mechanisms”.

    The group also pointed to the risks inherent in structural change more generally, stressing the need to ensure RCCs do not become “an expensive distraction”.

    A model for this sort of change is provided by the creation of regional adoption agencies (RAAs) over the past seven years.

    Precedent of regional adoption agencies

    In their blog post, the care review evidence group members pointed to the 2022 evaluation of the creation of RAAs, which identified a “complicated picture” in terms of their impact.

    It found that RAAs appeared to have sped up the time taken to place a child for adoption, relative to performance by councils who were then outside regional structures.

    However there had been a decrease in the percentage of children with a placement order who were subsequently placed with an adoptive family, relative to local authority-led adoption services. The creation of RAAs, it said, had caused “short-term disruption” that had slowed down adopter recruitment, though this factor had receded over time.

    The Consortium of Voluntary Adoption Agencies (CVAA) said it was “extremely concerned” about the plan for RCCs on the basis of the experience of implementing RAAs.

    Risks of ‘loss of valuable expertise’

    In its response to the care review, it said that “one of the most concerning consequences of the RAA programme has been the removal of adoption expertise from LA social work teams into RAAs, which may be a significant factor in why fewer children are having adoption chosen as their permanency plan”.

    “There is a serious risk of RCCs following the same route as RAAs, and therefore compounding the loss of valuable expertise from their care planning teams, without an explicit plan to avoid this happening,” it added.

    On behalf of independent fostering agencies, the Nationwide Association of Fostering Providers (NAFP) also called for lessons to be learned from the implementation of RAAs in any rollout of RCCs.

    However, it voiced support, in principle, for the change.

    “Every local authority operates in different ways, even within regional consortia, and this over-complicates commissioning and introduces bureaucracy,” said NAFP. “[Choosing] from a wider range of placement options, with better matching, will contribute to better outcomes for children. We welcome the opportunity to be a part of establishing objectives and evaluation for the RCC pilots.”

    Pledge to work with sector on implementation

    The DfE appears to have recognised that the RCC idea is not universally loved, and is aiming to take the sector with it as it takes it forward.

    It said it recognised “the wide variety of views on how RCCs could operate, including those of local authorities, placement providers, foster carers and social workers”. The department pledged to work with the sector to understand how RCCs should work and how they fit into wider plans to deliver sustainable and safe places to live for children in care”.

    Contributions are coming in already, for example, from the National Centre for Excellence in Residential Child Care, which last week produced a proposed service specification for RCCs.

    The DfE will be accepting responses to its consultation on the proposals until 11 May 2023. You can contribute here.

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    8 Responses to Are regional care co-operatives the answer to care placement challenge?

    1. Harvey Campbell February 20, 2023 at 4:41 pm #

      Basically NHS Provider Collaborative model

      • Alec Fraher February 21, 2023 at 10:58 am #

        The actual history of the, say, North West and North East Providers is pretty damn shakey. The early studies into the commissioning and contracting of the first 3 pilots of RCCs were fabrications, almost works of fiction. They couldn’t be anything else because the basic data needed to make any consideration of their viability simply wasn’t available. Council workers, both social workers and contract staff fearful of going on record. The two other authors wrote what they were ‘contracted’ to say. BASW and Oxford Brookes University know this as their, then, Officers were one and the same people.

        The similarity with NHS Providers will be the enormity of energy and money these ‘economic entities’ soak up. Absorbing more than money, detracting value through needless duplication of existing statutory duties held by Councils until they become the de facto provider

        If the Children Act and LASSA, in all their incarnations, are unworkable then let’s say so and ask, why? If Councils don’t want the responsibilities and some CEOs don’t let’s say so.

    2. Alec Fraher February 20, 2023 at 6:03 pm #

      There’s a lot of legal illiteracy in use

      The language of Framework Agreements sounds as though someone actually knows what they mean let alone do. Borrowing words from high end procurement procedure that historically are only ever used in name only simply isn’t good enough.

      There’s no evidence to say what they actually do other than create a standing list of accredited providers. Which is a pretty basic requirement if truth is known.

      The idea’s are seated on utilitarian idea’s of economic preference and gains through economies of scale. The correct understanding of any Framework Agreements first requires a standardisation of what is to be framed; these are called Category Sourcing Programmes. Having framed the service standards one must then apply the principle of transitivity. Transivity means that an increase in investment in a problem specific area adds to the overall uplifting of well-being for the population as a whole. It’s called being ‘betterthan’. (For cpd see Ethics Out of Economics and Weighing Lives by John Broome)

      Crucially, these basic requirements only work in area’s of ‘extreme commensurability’ like the substitution of smoking cigarettes with vaping. They are designed for area’s of public health management, using behavioural economic strategies, like Nudge, to secure the overall direction and intent of public policy. They are longrun projects with a contract and procurement life cycle of at least 10-15 years. Any procurement process proper beginning with complete industry buy-in from all major stakeholders.

      Oxford Brookes University has repeatedly failed to learn these,and rather basic, understandings of what ‘commissioning’ actually means. Instead, an institutional illiteracy has perpetuated ‘commissioning myths’. The early ventures in this area with the, then, National Treatment Agency, which also includes passing-off work accredited to, and by, the University which wasn’t theirs to do so, was about public health management.

      There’s a world of difference between the likes of Sir Martin Narey and The Boston Consulting Group, knowing they can getting away with getting it wrong, and largely because Government Policy provides the administration shield against litigation, which includes Corporate Manslaughter. The DofE hasn’t secured the consent and consensus needed for such seismic changes. Proceeding with anything less makes the ‘Commissioning’ ideological. As such it makes a non-sense of policy intent, reducing Governments initiative to State sponsored advertising. Children deserve much, much better.

      Commissioning, as a bespoke economic activity, if done seriously requires a rathermore deliberate focus and be crafted in terms that communicate the special specificalities of the activities as a procurement procedure in it’s own right. This ain’t rocket science. Councils, for reasons of their retained responsibility, as individual Contracting Authority’s at the level of each individual child already know this. Anything, that undermines this, like, the Information Management Requirements, must be sorted out in detail before the prevailing illiteracy becomes fully institutionally normalised.

      There’s much more nuanced work to be done.

    3. Alec Fraher February 20, 2023 at 6:35 pm #

      For CPD see ‘Suffer the Little Children’ by Mary Rafferty and Eoin O’Sullivan. Here the authors usefully draw attention to the structural, cultural and psychological factors that blighted judgement. Not only denying children and their families, mainly mothers, access to redress but also how the administrative and financial environment was constructed to stifle, distort and shame those making claims made about the systemic abuse of children.

    4. Alec Fraher February 23, 2023 at 10:35 am #

      For CPD on the limitations in the use of Utilitarianism as the basis of creating a sense of having a ‘consensus’ and ‘common denominators’

      See Complex Society: In the Middle of a Middle World by Bojan Radej and Mojca Golobic (2021), especially Ch 2, Aggregation Problems and pg 81 for ease of reference.

      When there’s talk, as mentioned yesterday in CC about changing the leadership competencies of the DCS, one is really looking at the wider issues of Evaluation Methodology and the synthesis of learning and practice from this Review.

      Social Work is Mesoscopic. Occupying the middle ground between macro-economic welfare of a City or Region and the microscopic welfare of individuals, families and communities.

      So far a reliance on a dualistic either/or narratives feed a methodological reliance on Utilitarian Aggregation Trade-offs. These are clever calculations but they’re also reducible to purious notions of happiness increasingly driven by

      Sure, this seems to communicate relational qualities but they’re measured against physical characteristics. Like did the child attend their Review, is there an Education Plan, etc etc.The LAC903 returns, which were in use and may have changed, are a typical of illustration of poor commensurability.

      There’s an assumption of commensurability as a precondition of contracting when one may not exist. Worse than this a child’s participation, especially in OAPs becomes susceptible to bribery or ‘pizza pleasure’.

      It’s wrong.

      Contracts for any services require a fundamental freedom of contract. An offer and acceptance within a deterministic structure. They are logical. They are prescriptive.

      Of the 27 Councils contracting staff involved in my review ALL were at a lose knowing they’d been placed, right from the off, in a buyer-beware scenario.

      These are some of the issues. Tackling them means getting our head around the incommensurability of values and having an Evaluation Methodology in Social Work that is fit for purpose.

      The book mentioned above is dense reading but well worth the effort.

    5. Alec Fraher February 23, 2023 at 12:24 pm #

      For CPD:

      I have literally just heard that my constituency MP.

      He is sending the comments made here, and elsewhere in CC, and about the Childrens Care Review to the relevant DofE Minister for their attention and consideration.

      We can always act as informed private individuals too.

      If the construction of the consultation process is onerous or your views are cancelled out through aggregation.

      You can do the same.

      I have often wondered whether Social Work and social workers should carry a political restriction.


    6. Alec Fraher March 12, 2023 at 7:46 pm #

      There’s an adage that describes the relationship between health and social services. It’s known as, from source legislation, as the s25 Agreement which morphed into s75 and has probably been renumbered since. In essence it reads very simply:

      ‘Services by one Authority are treated, as if, the services of another Authority’

      Here the casm between health and social services are tested and fought over. Health Economics is a global business. Social Services for children are, now, and seemingly, having to follow suit.

      Here’s the rub: Social Work is Mesoscopic. By it’s very nature it’s neither entirely macro neither is it entirely micro. Issues of incommensurability and indeterminacy can’t be weighed within a Health Driven agenda’s of QUALYs or DALYs. Except, that’s the way Health is heading and has been for a decade or more.

      I first studied the emerging narrative of welfare economics 30 years ago in a little known Journal called Catalyst which provided the platform for, the late, Prof Alan Maynard on QUALYs. Fortune has it that his protégé Prof Karl Claxton at York University’s, Centre for Health Economics, an internationally renowned enterprise, is also known to me. I will be asking how the, now, DALYs and the complete reliance on digitisation will impact the s25 Agreements.

      Luckily, for me, Bojan Radej and author of Complex Society: In the Middle of a Middle World has long been dissatisfied with such metric commensurabilities, is also known to me.

      Let’s hope, eh! I was puzzled about how this Review had become so transactional in nature and narrative. Health is doing what it does best and is again riding rough shod over Local Government.

      There was no democratic determination for regionalism. The, then, Office of the Deputy Prime Minister failed to secure the mandate to move in this direction in the noughties. Health bosses of successive Governments proceeded regardless ~ it’s not new beginning in the mid 1990s.

      Brexit, and all the unfinished business in it’s wake, is Driven by the Digital Agenda for Health Economics, once within the EU and now with the US.

      Erected Members, like SW as an institution, have got to, finally speak up and actually say something. Social Work, if valued in a democratic society has to use all and every means now available to it. Once seen as a balancing-feedback against the harshness, for some and repeatedly the same groups
      of already outlasted peoples, OF competitive economic development.

      Health Economics and Welfare Economics is huge business. Is this commensurate with our Code of Ethics, nationally and internationally.

      For CPD: see Prof Karl Claxton at York University, Centre for Health Economics.

      *disclaimer I know both Karl Claxton and Bojan Radej and I have twice tried to facilitate their meeting to thrash out the issues of incommensurability and Evaluation Methodology*

      For Bojan Radej see http;// or catch him on medium and make direct contact.

    7. Alec Fraher March 14, 2023 at 1:40 am #

      Q: Is this Review being orchastrated as a Public Health Management Programme or campaign?

      It certainly feels and appears that way.

      Ethics Out Of Economics, Right?

      See John Broome for CPD