Are services meeting the needs of children?
Tim Hobbs | CEO | @tim_hobbs_lab
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This is a deceptively simple question that has captivated the Dartington Service Design Lab in its various forms for decades.
Now after three decades, we are pretty confident in our response to the question, which we’re sharing in our new report, Matching Children’s Needs and Services: A Case of Three Circles. In some ways, the answer won’t surprise many. But it contains some fundamental challenges to the way that we have organised support for vulnerable children and families.
But before we get to that, why has such a simple question taken us decades to address? Why, when we spend just under £9 billion per annum on children in England, don’t we have a clear view on how this money is spent, on whom and to what end?
One important reason is that the majority of available data informing expenditure is based upon those children and families known to services: for example, those on the books of social work, special education or mental health services.
But what about those not known to services? Those trying but failing to get through the door for help, or those doing what they can to avoid being seen? Until now, we’ve simply not had good data on all but the top-level indicators of children’s health and development (largely around health and education), leaving policy-makers and commissioners operating somewhat in the dark about the wider needs and influences on child development at the local level.
New data to address an old problem
So over the last decade, we’ve sought to shed light on this dark spot. We have worked with 25 local authorities in England and Scotland and assembled data from over 38,000 children and families. For the first time, we have a valid and reliable picture of how children are developing, coming first-hand from young people and their families. This unique dataset breaks new ground by linking data on the needs of all children in local communities with the data on the services they are receiving [1].
Given that given the significant cuts to public expenditure, the level of high need and proportion of vulnerable children in the community far outstrips the capacity of services to respond to that need. We find that over one in five children have needs or risks to their development that might justify a service response, whereas targeted services have capacity to reach about half of this number. We don’t know but suspect that while this may have been exacerbated by austerity, even in times of plenty the picture would not be fundamentally different.
What is probably more surprising is that about half of those in receipt of targeted services don’t have high levels of need. Not only are services not close to meeting the volume of child need in a community; there appears to be a fundamental mismatch between those in need and some of those served.
Our report explores why this may be so, with explanations including that services may have done a good job, yet young people remain on the books. We also consider the likely impact of measurement and methodological limitations on our findings. Notwithstanding these explanations, it is likely that a ‘real’ degree of mismatch remains. We can’t dispute that need greatly outstrips the capacity of services to respond.
Anyone with knowledge of public services will have their own hunches to explain these patterns. We believe it is partly about the history and partly about the way systems behave. Public systems were never designed to meet all needs, and they have never been funded at a level that would mean they could. So, to cope with this imbalance, the systems of children’s services find their own way of restricting access to help, for example, by raising thresholds, and managing demand that is beyond their capacity to address, for example, by monitoring but not intervening.
How might local and central government respond?
In Three Circles we suggest three avenues for exploration:
First, is ‘shrinking the size of the pink circle’ by ramped-up investments in prevention and early intervention. Despite the wealth of evidence and enthusiasm for the concept, uptake and investment have been slow and patchy. Cuts to public expenditure have in many ways decimated these investments.
Second is acknowledging that despite the best intentions – and even with all the investment in the world in prevention and early intervention – if leaders of public systems don’t get a grip on the dynamics at play within their local systems, then services for children and families will continue to be misaligned to need. Poorly managed demand and dysfunctional system dynamics means that a workforce struggles, children and families most in need lose out, and limited resources get sucked into responding to crisis, when it may have been mitigated beforehand. (You can read here about how we are exploring these drivers and modelling out potential strategies in our system dynamics work in children’s social care and mental health systems.)
Third, is acknowledging the pivotal role that families and communities take in responding to children’s needs in their communities. In Three Circles we also explore this with some empirical data. Although early days, what we find is that about six out of seven people have someone they turn to when they need support, which includes the majority of those with high levels of need. This is a huge asset, which could be better supported and enhanced (in much the way that places like Barking and Dagenham are doing with Everyone One Every Day).
But there is a worrying segment of the population – we estimate about 5% in total – that have high levels of need, don’t have people to turn to, nor are they in contact with services. This is the group that keeps me awake at night.
The political and economic landscape is changing rapidly, and children with serious needs are losing out – with lifelong consequences. It’s time to test out some bolder approaches to these entrenched problems.
[1] You can read more about the methods, approach to informed consent and ethics in the report.