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Why are we letting the market commodify care?

There is a crisis in the care system according to the latest Children’s Commissioner report ‘The children who no one knows what to do with’ - November 2020.

Those of who work within the system know that resources are stretched, and that austerity and the pandemic have exacerbated the issues. There is some fantastic work going on at school and virtual school level, but pressures on foster placements and lack of vision at local or central government level has created a system where demand for placement outstrips supply, and quality of care varies across and within counties. The Children’s Commissioner’s report highlights an insidious commodification of care, where legislative duties have been converted into a private market, to the detriment of the children who are our most vulnerable.

The report was the result of 3 years of research undertaken by the Children’s Commissioner and links to other reports such as the yearly Stability Index which detail the number of placement and school moves children in the care system experience.

There are 6,570 children in children’s homes in England. The children placed in residential accommodation are there because they have complex needs, are older children who are reluctant to be fostered in a family or are children who should be in foster care, but for whom the lack of available carers means they need to be accommodated for short or longer periods while waiting for a home. Some of these children have complex physical or mental health needs, have experienced abuse or are at risk of serious harm from criminal exploitation. The rise in criminal exploitation has also forced a need for accommodating some children out of county, away from potential contact with their exploiters.

The standard of care received by these children is variable - there are good homes where care is welcoming and warm and where staff are well trained and experienced. Some local authorities have seen the need for better post 16 provision, for short term care to support families in crisis and for joined up work between departments. But the report points to the fact that too many residential placements are unregulated, and no one has oversight of who owns or runs these homes.

Unregulated provision is allowed by law and is most common in supported living accommodation for children over the age of 16 or in some cases for unaccompanied children and young people. Ofsted do not need to regulate this type of provision. It is up to local authorities to ensure this provision is suitable. Many supported living providers do a great job, however a BBC report earlier this year flagged concerns about risks for children living in these placements.

Unregistered provision is when a setting is providing both care and accommodation but has not registered as a children’s home. This is illegal. The line between care and accommodation is not always clear. Supported living accommodation may be providing lodgings but not care, so these homes don’t register. This is a grey area. Some providers are not registering by choice. Providing short term care necessitates registering with Ofsted. There is no regulatory body that has oversight of the quality of unregistered homes as the market has expanded and the legal definitions around what care is specifically, allow loopholes in the system.

1 in 8 children in the care system have spent time in unregulated accommodation. Some of this accommodation is institutional and sterile, poor in standard, run by agency staff who work shifts and are who are often poorly trained. The accommodation is sometimes found at the last hour by social workers ringing round seeking whatever might be available for their children in a crisis. Demand outstrips supply and often different councils are bidding for the same places. The residential option available may be far from home and overpriced, but lack of capacity is driving local authorities to make compromised choices.

Stability is a huge protective factor for children. Sadly, for children in England’s care system, too many children have had 2 or up to 4 placement moves in a year. Foster placements do break down but there are issues with privately run children’s homes giving notice to children with little warning. Stability affects education. Children who have frequent home moves often have to leave their school or college. Social workers and virtual school leads work very hard trying to find a suitable school or college place for a child as quickly as they can, because they know that time out of education puts the child in an even more vulnerable position.

Sometimes finding a suitable school place is hard, especially for year 11 pupils or pupils with significant SEN. Schools should offer places to children in care, over roll number, but there are sometimes inevitable delays. Schools vary in their approachability to admissions mid-year. Children need to be in school or college to develop sustained relationships and to feel a sense of belonging. Moving schools is disruptive to education and each time a child moves, it’s harder to build trust and invest in learning. In some cases, older children, and children with EHCPs are left waiting months for a school place. Being out of education can out further pressure on the placement and risk a possible move. Delays to school admission further damage children’s self-worth as they feel no one wants them.

The cost of care for a small number of children requiring secure and specialist residential homes has put pressure on Local Authority budgets. On top of this, SEN systems are at breaking point and there is a severe shortage of specialized settings - educational and/or residential - for children with EHCPs. 55.9% of children in the care system have an identified SEN. SENCos will know that even having received a hard won EHCP, getting an appropriate special school if needed, is far from guaranteed. Schools vary in their inclusivity. Exclusion rates are higher for children in care compared to other children and this can place additional strain on foster placements, which can add to the overall stability issues experienced by many children.

Why is the system so catastrophically letting these children down?

The bureaucracy is hard to navigate, but the Children’s Commissioner report points to some key issues.

1. Councils have a statutory duty to ensure there are enough local placements for children but mostly this hasn’t been delivered.

2. The Department of Education has responsibility for providing councils with necessary resources and have failed to do so.

3. The number of children coming into care has increased - particularly in the 12-15 years old cohort. There are more children needing specialized, secure and therapeutic care.

4. Ofsted have judged 82% of children’s home as good or outstanding. The lack of training was flagged by Ofsted in weaker performing homes.

5. There has been an increase in unregulated and unregistered accommodation which isn’t covered by Ofsted.

6. There has been sustained criticism of the current system by the National Audit office, Housing, communities and Local Government Select Committee and several high court judges.

It seems that the system is one of unmet need and strain. Government departments are not working effectively together and local authorities have for whatever reason, not planned effectively for the long-term needs of their children. Privately owned businesses have stepped in to cover the shortfall of places and we are now reliant on them. The quality and costs of these homes is variable, and children are falling through the gaps. Most people wouldn’t recognize the difference between regulated and unregulated provision and at the moment there is no sanction for councils placing children in unregulated provision. Ad hoc commissioning of care to private companies is normal practice because there are simply not enough regulated provisions. Strains across SEN, mental health and care provision amplify the issues for particular councils.

The 3 year long root and branch care review in Scotland culminated with a promise which sets out how changes will be made. Talk of a care review in England has been rumbling on since December 2019. The government has pledged that it will carry out a care review ‘imminently’. Some big thinking is needed. Untangling the role of different government departments in the care system, alongside the complex umbrella of legislation, is not going to be easy. I hope that the voices of children are going to be heard. I hope they don’t delay any further. I hope that profit margin and children in care don't appear in the same sentence.

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