IESE_Transform_040

ISSUE 40

In print and online interactive publication | www.iese.org.uk | www.carecubed.org

Getting the right balance Local authority budgets versus provider costs CareCubed Children’s making an impact How CareCubed is helping shape a difficult market

Also inside: • Ongoing development: Version 18 launched • iESE recognises health & social care trailblazers • New staff join the CareCubed team • Where to meet us at upcoming events

C O N T E N T S

I N T R O D U C T I O N

Page 2 Introduction from Craig White, Commercial Director at iESE Innovation, CareCubed new team members.

Page 3 Version 18 updates for CareCubed, CareCubed event schedule.

Page 4-5 Striking a balance: local authority budgets versus provider costs.

Page 6-7 iESE health and social care Transformation Award winners.

Page 8 How CareCubed is helping shape the children’s market.

EDITORIAL CONTACTS TRANSFORM IS PRODUCED BY: iESE www.iese.org.uk Email: enquiries@iese.org.uk @iESELtd CREDITS: Designed by SMK Design (Aldershot) Editorial by Vicki Arnstein Views expressed within are those of the iESE editorial team. iESE Transform is distributed to companies and individuals with an interest in reviewing, remodelling and reinventing public services.

The future is bright for CareCubed is a real privilege to introduce our latest edition of Transform It following structural changes to the senior management of iESE Innovation Ltd, with myself taking up the role of Commercial Director and Sherif Attia becoming Director of Delivery & Design. This has been another hugely successful year for iESE in which we have supported more councils, Integrated Care Boards, and providers than ever before with the significant, ongoing pressures and challenges they face.

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@digitalcraigw

CareCubed has gone from strength-to-strength and is now well established as the national care costing tool of choice, with around 65 per cent of councils in England now subscribing. I am also very pleased to welcome our first Welsh authorities to our user base to support with a wide array of local, regional, and national challenges and objectives. Having a single, consistent, common currency for health & social care commissioners and care providers is crucial to allow strategic partnerships to be built and reduce the negotiation time on care packages so that more time can be spent delivering positive outcomes for residents.

There have been lots of highlights over the past 12 months, such as the move into new territories, the launch of our new CareCubed website, great success reported from our first health users of the tool, significant adoption of the children’s and young persons and older persons CareCubed modules, and two data updates to provide the very latest data to our customers. CareCubed continues to innovate and bring new functionality based on feedback from both care providers and commissioners and this has led to the tool being used in many new ways such as large-scale procurement processes, place-based regional initiatives to provide consistency across health and social care organisations, and all-age commissioning.

We are a not-for-profit for the good of the sector. Our goal remains to deliver high impact, innovative digital tools, and maximum value to the sector, and we will be releasing exciting new products and services over the coming months. We have significantly strengthened our team to underpin this next phase of growth, with a particular focus on bringing sector experience and expertise to support new and existing customers with embedding the tool and to accelerate the benefits it brings.

CareCubed is playing a crucial role in creating a fair and sustainable market and this edition will highlight innovative case study examples from across the sector. Please do get in touch if we can support in any way.

• Craig White, Commercial Director, craig.white@iese.org.uk

© Copyright iESE 2024

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Craig White, Commercial Director

M E M B E R S

iESE expands the CareCubed team Chris McColgan, Marketing Manager Chris McColgan has joined iESE as Marketing Manager, predominantly to support the CareCubed brand. He brings with him a technical skill set across marketing capabilities such as search engine optimisation (SEO), marketing infrastructure and marketing operations. “I am hoping I can really make my mark in filling that niche, which I know is something the team has wanted for a while. I’ll be helping iESE build the CareCubed brand across all digital channels. It is a varied role but hopefully a lot of technical marketing work can be done, and I can achieve a lot with it,” he said.

Prior to joining iESE, McColgan was working on a freelance basis as Head of Marketing for two different companies. One was a called Legendary Teambuilding, a company which uses Dungeons and Dragons (D&D) as a teambuilding exercise in corporate environments, and the other was also in the D&D space for an app and web-based solution provider.

He has already learnt a lot about the care sector and is looking forward to building this expertise: “A few times in my career I have switched sector to an area I’ve been curious about to see how I can apply myself to it. I think working in the social care environment will give me a great deal of job satisfaction because it has that personal element,” he added.

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Jess Hazlitt, Account Manager

Tom Burgess, UI/UX Designer Tom Burgess has joined iESE as a UI/UX Designer to work predominantly on CareCubed and related projects. He graduated from the University of Huddersfield in 2017 after gaining both a BA and a Master’s degree in Graphic Design. Since then, he has worked in graphic design for several companies, including a fireplace business, an audio-visual company and most recently an organisation in the aviation industry.

As a UI/UX Designer, he designs the look, feel and branding for web pages and this is then coded by developers. He has already started designing for the new CareCubed platform. “I am creating designs for the new look and feel of the CareCubed platform which is great. As it is a small company it is brilliant being able to see my designs translated into visuals with a quick turnaround. I am also due to start working on another new project relating to some exciting CareCubed developments to be announced soon.”

Burgess added that he was excited to start work in an industry that makes a difference to people’s lives: “My background has been varied but I am enjoying working in this sector as it is an important industry.”

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Jess Hazlitt has joined iESE as an CareCubed Account Manager. She has joined from Surrey County Council (SCC) where she first worked in adult brokerage on the disabilities team costing residential and supported living services before moving into children’s SEND commissioning. Prior to working at Surrey, Hazlitt worked for a provider in adult social care for 12 years in various roles and services, starting as a support worker and moving up through different positions.

At Surrey Hazlitt was using CareCubed daily within her first role and sees the benefits of the tool for both providers and commissioners.

“Getting the costings right to ensure sustainability for the providers and the councils is highly important because there is not an endless pot of money. CareCubed appeals to me as a tool that can bridge the gap between providers and commissioners. If we can get providers and authority users using the tool effectively it will increase transparency, improve relationships and ultimately the quality of service being provided to the those using Health and Social Care Services. I’m looking forward to helping customers get the best from CareCubed,” she said.

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N A T I O N A L

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CareCubed Version 18 launched CareCubed is updated twice annually to ensure the figures and assumptions behind the model are as accurate as possible. The most recent release, containing some important data updates and functional changes, went live on 2nd April. ne of the main data updates for Version 18 has O been to reflect the increase in National Living Wage (NLW). Sherif Attia, Director of Delivery & Design at iESE Innovation, said the two recent increases have resulted in a compression of pay rates across staff roles. “A large proportion staff in this sector are paid around the minimum rate.

When that increases it impacts the lowest paid workers but also the differentials between the roles. The two big consecutive NMW increases have resulted in a squeezing of rates into narrower band as employers contended with a higher base rate.”

Whilst children’s care sector employees have historically been paid more than those in adult care, Attia said this differential is also decreasing. “In 2020, the difference was around 5.46 per cent and in 2023 it had come down to around 2.9 per cent.

Where previously there were slightly higher rates of pay in children’s, this is now narrowing. They are still being paid more, but less than they were three years ago. This fits with the wider trend, which is where there are significant leaps in the NMW and firms are heavily exposed in terms of the proportion of their workforce being paid around the base rate, you are seeing a

compression for higher paid workers as companies struggle to maintain pay differentials.” he added.

The latest model shows a small uplift in food costs of +0.5 percent from Version 17 (released November 2023), while the cost of social activities, transport and utilities have fallen back slightly. There has been no change to phone and broadband costs and a very slight reduction in insurance (-0.2 per cent) and recruitment and staff training costs (-0.1 per cent).

Version 18 also incorporates a series of functional changes aimed at improving the tool for users.

Following a consultation with Children’s CareCubed users, we have introduced the ability to create an ‘express’ case by entering the minimum amount of information required to generate a calculation. This allows for a quicker completion of the case but does not include a comprehensive needs breakdown.

Users can easily convert an express case to a full CareCubed case quickly and simply.

Another change is the addition of a new benchmark value introduced under Support from Other Professionals for Positive Behavioural Support. This enhanced allowance is to be included where individuals have challenging behaviours and are in receipt of Positive Behavioural Support services. We will be undertaking a period of consultation and

collecting feedback on this new offering throughout the year, with a view to providing an interim update to the data model in 2024. Local Housing Allowance rates have also been introduced as an alternative means and proxy to calculate either the rental or return on capital cost components of care packages.

Updated versions of CareCubed are released twice annually. We are changing our updates and interim update schedule in line with customer feedback. The next interim update will take place late September/early October, with the annual data update in 2025 pulled forward to the start of March to allow users to make projections for the new financial year using the latest figures.

“Updates are provided at no extra cost to our customers twice a year,” explained Attia, “We work hard to ensure the benchmarks we provide are up to date and reflective of the current market so any assumptions we have set out in the model are reflective of how care is being delivered. To get involved with the consultation on Positive Behavioural Support, or to make any other requests regarding CareCubed, please contact the CareCubed team.”

• For more information about the CareCubed update visit www.carecubed.org

E V E N T S

CareCubed in action CareCubed joins must-attend events in the social care calendar throughout the year to showcase our market leading care pricing tool to commissioners and providers in adult and children’s services. See the list below of where we are visiting in the coming months. Come and find us or contact us in advance to set up a meeting.

We’d love to meet with existing and potential clients at these events to discuss your CareCubed journey.

24th – 26th April: 2024 ADASS Spring Summit This year’s Association of Directors of Adult Social Services (ADASS) Spring Summit took place between the 24th and 26th April in Bedford. The event covered a range of important and timely topics in the adult social care market, including responding to the crisis in mental health care and artificial intelligence and adult social care. CareCubed was pleased to exhibit at the event.

20th – 21st June: NCCTC Children’s Commissioners’ Conference This event, Time for Change: A New Role for Commissioning, aims to share best practice from across children’s commissioning. More than 35 separate workshops focused on improving practice are scheduled, including: Improving Foster Care Recruitment and Retention, Supported Accommodation, Best Practice Early Help and Parental Conflict, LA and provider SEND service developments and many

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more. CareCubed will be exhibiting at the event, and Northamptonshire Children’s Trust will be holding a workshop about their implementation of the tool within their organisation on Thursday 20th June.

2nd – 4th July: LGA Annual Conference and Exhibition 2024 This three-day event takes place in Harrogate. The wide range of engaging sessions and speakers aims to appeal to senior representatives working in local and central government, as well as senior colleagues from other public sector bodies, charities, and businesses. Some of the sessions taking place include: Supporting children and young people to thrive, What does a financially sustainable system that meets the needs of children and young people with SEND look like and Children’s social care reform and delivering Outstanding Services. CareCubed will be exhibiting at the event across the three days at stand number Q9.

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Under pressure: rising costs versus tight budgets It’s no secret that the care market for older and working-age adults is under pressure. Providers face rising costs, including increasing wage bills, while local authorities are struggling to meet their statutory duties with limited and shrinking funds.

ith both providers and local authorities facing W cost pressures, understanding each other’s position can help inform productive conversations. At one end of the equation, councils have a finite pot of money, at the other end are adult care providers who want to provide quality, sustainable care and still remain viable in a difficult market. In this article we speak to the representative body for the adult social care sector, Care England, to understand providers’ pressures and to Bristol City Council, a local authority which provided around 5,500-plus adults with adult social care in 2022/23, including funding around 1,400-plus care home places.

The issues in the care sector are many and complex. The cost-of-living crisis has put a squeeze on providers, with the cost of essentials such as food and fuel increasing. A further hit has come from the recent second consecutive National Living Wage (NLW) increase, which although undoubtedly positive for employees, has pushed operating costs up significantly without a commensurate change in social care budgets.

Richard Ayres, Social Care Advisor at Care England, says the biggest challenge for providers is currently pay related: “The National Living Wage moving from £10.42 to £11.44 for those aged 23 and over means care providers will need to try to respect the £1.02 uplift across the board to maintain the differential between support and senior staff. Income from local authorities does not reflect this increase. Providers would need an uplift of eight to nine per cent just to maintain

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the status quo, but we are seeing uplifts of between five and seven per cent, with some going even lower, down to zero,” he says.

Additionally, he points out that two or three years ago the cost of food per resident was around £35 per week, now it is £50. “Prices soared and have come back a bit but won’t drop back to where they were. This is the same with insurance.

Medical consumables were affected by the energy crisis and now the manufacturers are being affected by a rise in the NLW for their workers, so prices aren’t going to come down, they are just not going to increase at the rate they were previously.”

From the council’s standpoint there is a finite budget, and care must be commissioned to meet the assessed eligible needs of the population and allocated as fairly and equitably as possible.

Jonathan Wright, Strategic Commissioning Lead at Bristol City Council, says: “Most providers want to do right by the people they support and be sustainable and we should be able to buy enough care within the available budget, that’s the riddle, yet we are always up against budget pressure. It is because nothing is equitable in the current market – there are some providers charging over the odds and some charging under. We do have some providers that are trying to maximize, they aren’t always in it for the right reasons. We want to make sure everyone has what they need and that resources are used equitably across the sector.”

Wright points out that, although many providers

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come to the council and say that they are not being paid enough, external data sources such as ADASS and the Local Government Association highlight that Bristol is consistently one of the highest outliers in terms of spend. “We were working with a big provider last week with about two per cent of our market which is quite large given how fragmented the market is – around 150 people – and they were saying they were not paid enough.

In a few cases they were right, but a few were well over. It is impossible to rebase spend unless you bring down those that are above a reasonable rate. Trying to move spend equitably is not always possible.”

Ayres says he has sympathy for the local government position but believes the current levels of funding in the older age adult market are unsustainable and that these issues are even more exaggerated in the working-age adult market where there is no ability to cross subsidise with private customers.

To this point, he says Care England took part in the recent Fair Cost of Care (FCoC) exercise carried out for older persons and this found that there was a “few hundred-pound gap per week” between what was being paid and what the FCoC was being shown as. The solution, Ayres says, would be for central government to increase local government funding. He recognises this is unlikely to happen, partly because local government can show they can buy care from providers at the rate they have set personal budgets at.

“Theoretically, if every provider said ‘I am not

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taking residents at a loss anymore’ then the personal budgets would have to be raised, but unfortunately it is a market with one buyer and lots of suppliers who are all worried about the cost of empty beds. Less is perceived as better than nothing for an empty bed,” he adds, “We need money put in by central government and the NHS to fund care at the FCoC level. What local authorities need to do is pay the cost of care for older persons which could push them toward financial challenges – however, that is the only way central government is going to act. We have a huge amount of underfunding in the older persons and working-age market, however, local authorities don’t have sufficient funds to pay the FCoC which is the challenge we need to overcome.”

The situation in the working age adult market, Ayres says, is even more dire because a far greater proportion of the care is labour based: “When we see fee uplifts less than the eight or nine per cent, we need to cover pay increases then losses are even greater. We hear of a lot of working-age adult packages being handed back as they are no longer sustainable, and we are seeing more providers closing. Margins for working age is the lowest it has ever been as there is no ability to cross subsidise.”

The funding issues on both sides are clear and with no extra money in the pot, local authorities are increasingly looking at ways to work with providers to ensure sustainability and fair pay. The interlinking of commissioning of adult and children’s services is becoming a greater focus in some areas, including Bristol. “While we take a very considered view of spend, we are still subject to inherited packages of care that are way in excess of those rates. Transitions from children’s services and health funding cessation. Our commissioning models have to factor in that we inherit some cases where there are no other options for care than what is in place. As with a lot of councils, the fragility of the children’s market and the existence of predatory providers within it is a problem. Adult services in Bristol have broadly been stable in the last two years, even in these difficult times, but the overspend is still high from other areas. We will be increasingly commissioning more jointly in the coming months and years with children’s and the NHS. At the end of the day, children become adults and adult services inherit those cases,” Wright explains.

Another potential way to bridge the gap is using the CareCubed tool. Ayres recommends the solution but advises that it should be used with caution: “Local authorities and care providers need to work together. I am a big advocate of CareCubed because what we need is a common currency to allow care providers and local authorities to talk consistently using a common currency and language with respect to care provision. With 65 per cent of councils using CareCubed, we need to get providers using it too but there is a duty to ensure the tool is used correctly and not a stick to beat providers with. We need to get more providers using it, holding firm, and using it as an evidence base.”

Hugh Evans, Executive Director of the Adults and Communities Directorate at Bristol City Council, agrees: “Councils have limited budgets and a host of providers asking for uplifts. Without a tool such as CareCubed we have no way of evidencing whether requests are fair and reasonable. On the provider side, there are rising costs and that it why it is important for both parties to be using data that is up-to-date and reflects what is happening in the real world to support these conversations. Otherwise, a provider can go to the council and say the cost of ‘X’ has gone up, but the council has no way of knowing whether it should be £50 or £150 a week. It is about quantifying that and having consistency between the parties as a common currency for them to work collaboratively and get to that point of shared understanding more quickly.”

Regional snapshot of uplifts to rates of pay in your area As the UK’s leading Cost of Care Pricing tool, CareCubed is constantly collecting and collating data on the cost of care across the United Kingdom.

Because of this, we are able to offer a more regionally specific look at how the cost of care can change across the UK.

How do you compare?

We have produced a regional snapshot of uplifts to rates of pay in your area from April 2023 to April 2024, informed by Skills for Care data.

Contact us to see how your region is affected: carecubed@iese.org.uk

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The Royal Borough of Greenwich Council The Royal Borough of Greenwich has been undertaking a piece of work to improve how packages of care are delivered for young people who are transitioning from children’s social care to adult services. As part of this project, iESE consultant Diana Sherwood worked with the council between December 2022 and April 2024 to support SEND commissioners and social care staff in working together to get the right levels of care in place for children transitioning into adult care. This process involved training social workers and commissioners and using CareCubed to evidence and inform quality assurance.

With Sherwood’s support, 13 cases of children between 14-17 years old with complex needs were reviewed. Case workers gathered information from providers which was then input into CareCubed.

Jodi Mathers, Head of SEND Social Care at the Royal Borough of Greenwich, said it had been important for case workers to understand that the process was not about questioning their decision making, but about getting the right level of person-centred care.

She said: “We were very clear with the service that we are not going to be chipping away at what a child needs. If they need 1-to-1 support they should be getting 1-to-1 support. It wasn’t to challenge practitioners’ decision making or what they have assessed. I think that helped get people on board.”

She added that the initial training delivered had been well received by her team of social workers and had helped them approach care reviews with a slightly different mentality.

“Anything that pulls together commissioning with the social work team can only improve outcomes for children.

“When we have commissioners only thinking about commissioning and social workers only thinking about care, that doesn’t align what that young person gets. This is about aligning the two systems better to get the right support for those children, and it has implications both ways. What had previously sometimes happened is a level of provision was initially agreed but over time this might shift and there wasn’t necessarily that forensic looking at each line of that arrangement. For example, if we have said 2-to-1 care is required but the young person is absconding, we should be questioning whether that is still the best way to keep that young person safe,” added Mathers.

Getting the package right for the young person, who stay with the council’s SEND team until they finish education, is important for everyone involved.

Mathers added that CareCubed offered a way of documenting the needs of children in the council’s care. For example, if care is needed that restricts the liberties of an under-18-year-old the council must be able to demonstrate that this is necessary.

“Having this scrutiny and this lens and being able to justify that it is needed, evidenced in the staff logs and their care plan, helps strengthen the evidence for those restrictive measures where we need them, and equally, where we don’t need them to facilitate independence building,” she said.

While there have been savings from the review, the focus on the work has been on improving the quality of support. “This work has been about informing quality assurance. Using the CareCubed tool and this approach helps us ensure we are child centred. Whether there are efficiencies as a result or not, working with the market and being able to compare quality, cost and provision across settings strengthens our position,” Mathers added.

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I E S E

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A W A R D S

iESE recognises health and social care trailblazers This March saw the 15th anniversary of the iESE Public Sector Transformation Awards with Bronze, Silver and Gold winners across eight categories celebrated alongside individual winners for UK Fire & Rescue Service of the Year, UK Police Service of the Year and International Public Body of the Year and the overall iESE Council of the Year 2024. than 200 submissions were received from M 70orepublic sector organisations. Here, we focus on the three finalists in the Transformation in Health and Social Care category.

GOLD: Together for Children – Transformation Management Office (TMO) In just three years, Sunderland Children’s Services (SCS) and Together for Children (TfC), which deliver children’s services on behalf of Sunderland City Council (SCC), became the first ever local authority children’s service to jump from an inadequate Ofsted rating (2018) straight to an outstanding judgement (2021).

This incredible transformation was, and continues to be, strongly supported by a new department within the organisation known as the Transformation Management Office (TMO). This team, which was developed alongside and funded through the Department for Education (DfE), works in collaboration with colleagues in Early Help, Social Care and across the organisation. The team includes a strategic programme manager, one programme lead, three project managers, two project coordinators and one graduate project and change support officer, all supporting the organisation to deliver an evolving transformation programme. Its work covers four important areas: Digital, Data and Intelligence, Working Efficiently, Capacity Building (for young people) and Income Generation. The TMO has so far supported a wide portfolio of more than 40 projects which directly benefited children and families in Sunderland.

An example of a project the TMO has been fundamental to is Breathing Space, an innovative whole family initiative that provides space, time, and support for young people with additional needs and their families and carers. The project, which is now in

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its second year and has been cited in national guidance as good practice, has received £700,000 of funds to progress several exciting developments.

This includes opening a fourth short break hub in partnership with the Autism Outreach Team to run after school hubs and Early Help working directly with primary and secondary schools. The number of referrals and attendance at hubs continues to rise steadily and there has been an incredible number of positive outcomes, including 80 per cent of children/young people maintaining or improving their emotional wellbeing, young people having the chance to make friends, reducing suspension and exclusions from school, and parent and carers feeling more supported.

The TMO also fully supported the initial development of the Wear Together Edge of Care outreach team. This project has seen incredible outcomes where family situations have been stabilised through a whole family approach. The TMO has supported multi-agency relationship building, culminating in several multi-agency posts coming into the Edge of Care team, including a Speech and Language Therapist and a Police Officer.

One of the project’s non-financial aims was the prevention of children and young people becoming cared for, thus improving their outcomes and opportunities to thrive at home. More than 90 per cent of children involved with the Wear Together team remain out of care in the 12 months post involvement.

The TMO has also assisted with the leasing, set up, expansion, amendment, purchasing, and registration needs of several children’s homes and independent living accommodation properties. The team has also helped establish the Fostering Mockingbird project where one foster home becomes a hub for a further 6-10 foster care families.

As a result of the initiatives, total cared for children’s numbers have fallen from a high of 632 in February 2021 to a current 522. The projects undertaken have also helped in the reduction of children homed in costly external accommodation from a high of 52 in February 2021 to 38 in November 2023, having both a dramatic effect upon the outcomes of children and spending.

The TMO team constantly place children and young people at the heart of what they do, adding considerable value to TfC’s improvement journey.

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The team are firmly on the map in the North East for providing professional and quality programme and project management, resulting in recognition locally and nationally for its work.

Kevin Brown, Strategic Programme Manager at Together for Children Sunderland, said: “Myself and the transformation team at Together for Children were thrilled to receive the award from iESE and recognition for the part played in the incredible transformation journey that Together for Children has been on. It goes without saying that the transformation achieved would not have been possible without countless colleagues throughout the organisation and their unwavering commitment to delivering outcomes for the children and young people of Sunderland.”

SILVER: South Ayrshire Health and Social Care Partnership – Transforming Children Services In 2019, driven by a vision statement of “keeping South Ayrshire’s Children in families or family type care”, South Ayrshire Health and Social Care Partnership (HSCP) invested in a new Children Services leadership team to help enable a whole system transformation and culture change.

A Care Inspectorate report in 2016 highlighted that South Ayrshire had a disproportionate number of children in costly external care placements, a lack of early intervention services and too many children being referred to the Scottish Children’s Reporters Administration. Additionally, there were higher than average numbers of children on the Child Protection Register and the HSCP children services budget was badly overspent.

An investment of £465,000 was approved by the South Ayrshire Council Leadership Panel in early 2020 to support transformation. This included the

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introduction of the Belmont Family First Model, implemented to assist children and families at a school called Belmont Academy and its cluster primary schools. This project works in partnership with schools, health, and community partners to support families to identify strengths, assets and resources that may enhance their wellbeing and enable them to reach their own goals. The project aims to provide valued and timely support to children and their families at the earliest opportunity, empowering families to strengthen their relationships, grow together, develop resilience, and reach their full potential.

For the Family First approach to be successful, it was also imperative to address the culture of the organisation, including improving recruitment, retention, and sickness absence. It was decided that in parallel to the Family First approach, HSCP would implement Signs of Safety, a strengthsbased model to provide a framework, common language and value base which services would work collaboratively within. This required a whole system commitment from key leaders within the Council and HSCP, from Chief Executive and Elected members to frontline operational staff.

With the Signs of Safety approach, families work alongside professionals, discussing worries and concerns, identifying the things that are going well (strengths) and agreeing what needs to be done (goals). This approach allows the family to build on existing strengths and reduce their worries, with the views of children, young people, their parents, and carers central to this work.

The Family First model was developed further with South Ayrshire Education colleagues and together has transformed the way that South Ayrshire cares for and supports children and families. Through the effective use of early intervention and keeping families together in their local schools and communities, South Ayrshire can evidence a 56 per cent reduction in the number of children removed from families and placed in expensive Out with Authority (OWA) residential placements. The Belmont Family First team have diverted 28 families (37 Young Persons) away from escalation through the care system. These are young people who could have been expected to progress into external OWA residential care.

The Family First approach and Signs of Safety model has also resulted in a 79 per cent reduction in the number of children deemed to be at Risk of Significant Harm and registered on the Child Protection Register (CPR). There has also been a change in the overall balance of care, with a 53 per cent reduction in the number of children referred to the Scottish Children’s Reporters Administration in need of care and protection from 2016, as well as a 67 per cent reduction in the number of children subject to Compulsory Supervision Requirements from 2016/17 to 2022/23.

A base line audit taken in 2021 and a retest in September 2023 demonstrated a positive shift in feedback from parents and carers. For example, 64 per cent of respondents said their social worker had been clear with them about how they see the concerns within the family, compared with 27 per cent in 2021. In relation to families feeling that social workers care whether their family resolves their problems, this improved from 35 per cent in 2021 to 69 per cent in 2023.

Internal staff surveys have also found a significant decrease in differing views between staff and leadership. This is important in creating a positive climate and culture within South Ayrshire. The alignment of values between the leadership and frontline operational staff is more likely to contribute to a successful implementation and improved

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outcomes for children and families.

Mark Inglis, Head of Children's Health, Care and Justice Services, said: “We were delighted to receive this award at the iESE Public Sector Transformation Awards. This is a strong affirmation of the journey that we have been on in South Ayrshire. This was only possible through the hard work of the front line HSCP teams, specifically Social Work and the strong partnerships they have developed to improve experiences for our young people in South Ayrshire.”

“This award shines a light on the extremely positive and collaborative relationship that we have with Education and shows that when services get out of their silos and work together, we can achieve better outcomes for our children and their families, for less of the budget,” he added.

BRONZE: Rochdale Borough Council – Raising Rochdale SEND Alliance In 2021, Rochdale SEND Alliance initiated the Raising Rochdale – Supporting SEND children, young people, and families project with the aim to “make the borough a great place for all to grow up, get on and live well”. A key driver of the project was breaking down silos to ensure services for disabled children are integrated from design to evaluation.

Together, Rochdale Borough Council and the Heywood, Middleton & Rochdale Integrated Care Board and partners, including those with lived experience, created a multi-agency SEND Alliance, which includes those with lived experience and professionals, to improve support and outcomes for the 7,000-plus children and families requiring special educational needs and disabilities (SEND) support.

The Alliance mapped services to recognise gaps and patterns, developing a strong information sharing system, including creating a multi-agency, cross-system dashboard, and seven SEND outcomes co-produced with children and families.

As a result, Rochdale has gone from having no framework for children and young people with SEND to becoming a nationally recognised, exemplary model for achieving strategic change.

Developing a framework using an outcomesbased approach was a vital foundation for this project, to give different SEND services overarching goals and a common set of measurable objectives.

To do this, partners were brought together to identify how they could pivot from being outputfocused (prioritising what is delivered, irrespective of impact) to being outcomes-focused (prioritising the difference made to children’s lives).

This included the development of strategic outcomes with a multi-agency group, including children, young people, and their families.

Alongside these, a list of measurable metrics to monitor progress towards the outcomes were produced. In addition, the framework also included a vision, two spotlight priorities (children being close to home and children staying in education) and actions with improvement plans.

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Other steps taken included: Joint Strategic Needs Assessment (JSNA) – To build this, Rochdale’s senior leadership team worked closely with all agencies and the National Charity, The Council for Disabled Children, to compile data and develop a SEND-specific JSNA, enabling a shared understanding of the population, their vulnerabilities, and needs. The JSNA is used extensively for commissioning purposes and underpins all other work taking place across the system.

Mapping Early Interventions – Mapping existing early intervention allowed greater understanding of areas of strength and highlighted areas for improvement. The mapping allows responsive commissioning and has increased access to early intervention and improved the lived experience of those accessing this provision. An additional £5m has been invested into early intervention for children in the last two years, resulting in reduced waiting times for some specialist pathways.

Developing an Ordinarily Available Provision Framework – Meeting needs early is central to meeting them effectively. Schools and settings are key to this, and recent co-development of an Ordinarily Available Provision Framework has enabled stronger partnership working. All Primary Schools have now adopted this model, with secondary schools joining this journey more recently.

Improving data and information sharing – A Data Think Tank involving multiagency senior leaders runs regularly to collaboratively develop a SEND multiagency data dashboard and improve effective information collection mechanisms.

Developing strong progress and accountability measures – An audit tool was developed to support joint working between agencies to evidence the effectiveness of local SEND processes.

The initiative has already reduced waiting times for autism, Occupational Therapy, Physiotherapy and Emotional Mental Health Support. Families requiring support for Neurodiversity are reporting increased satisfaction and shorter waiting times due to the introduction of an Integrated Neurodiversity Hub. There has been a significant reduction in Mental Health crisis escalation, while parents report confidence in the leadership and children and young people report individual progress against their outcomes.

With the SEND system under scrutiny nationally and locally, Rochdale is working to ensure a stronger and more person-centred approach to SEND commissioning. This will support developments across Greater Manchester Integrated Care System and national direction.

“We are proud of the fact that support in Rochdale is gaining national recognition and for the support of the iESE Transformation Awards for recognising the efforts that our families and stakeholders have made. We are on a journey and still have lots to do but we are proud of how far we have come over the last four years and that it is beginning to make a difference for some of our families,” said Charlotte Mitchell, Assistant Director of Integration and Health, Rochdale Local Authority and Heywood Middleton and Rochdale, Integrated Care System.

• Read more about the iESE Awards winners in the special edition of Transform Magazine: https://issuu.com/ksagency.co.uk/docs/transfor m-39_iese_winners_2024?fr=xKAE9_zU1NQ • For more information about the iESE Awards, please visit: https://iese.org.uk/public-sectortransformation-awards/

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No silver bullets but CareCubed Children’s can help

No silver bullets exist for the fragile children’s care market but having CareCubed in place can help local authorities and providers start addressing the issues.

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he issues in the children’s social care market were recognised in both a Competition and Markets Authority (CMA) report last year and several independent reports over the last two years. In the past decade, the numbers of looked after children have risen from 68,000 to 83,800. Analysis carried out recently by the County Councils Network found per person spending on children’s services had doubled in the same period, with children’s and adults social care services consuming 65 per cent of the budgets of councils with social care responsibilities across England. A Local Government Association survey carried out in November 2023 found that English councils paid for more than 1,500 placements costing £10,000 per week or more in 22/23.

The CMA report highlighted several key findings around the children’s care market, one of which was the recognition that some of the largest providers of children’s placements are making higher profits and charging higher prices than expected, putting a strain on local authority budgets. In addition, it pointed to scarcity of suitable placements and high levels of debt being carried by some large providers, which could disrupt the placement of children in these provisions.

While there is no silver bullet, local authorities are recognising the benefits of using the CareCubed tool to work alongside providers and other health care partners, such as Integrated Care Boards (ICBs), to help start moving the market towards a place that is fair and sustainable.

CareCubed is a tool which enables commissioners to see the variance between ‘price’ and ‘cost’ and start to have conversations with providers about packages, outcomes, and future placements. Nik Jones is an Account Manager at iESE who works closely with clients in the children’s sector. Before joining the CareCubed team, Jones amassed 25 years’ experience in the health and social care sector, including as branch manager for a company which provides support for young adults with learning difficulties. Recently, he’s been working on a pilot programme with three local authorities on their children’s commissioning where they have looked at providers in their market and identified where they could forge strategic partnerships. The pilot has seen some encouraging results.

As part of the pilot, there has been an increased focus on joining up the commissioning processes between adult and children’s services, especially for the transition teams as children start moving

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towards exiting a service. “What we are trying to encourage, and we are starting to see, is that all age commissioning is the future to help avoid Section 114s. If you are managing budgets effectively in adults service but then hemorrhaging money in children’s, it is futile, and all that work has gone to waste,” explained Jones.

He said CareCubed makes it possible for the transition team to use CareCubed for the cohorts of children coming towards transition age to work with their strategic partners in advance. Adjacent local authorities partnering to provide services can be effective as lots of children and young people in care face contextual issues in their local area which means local placements can carry more risks than out of borough. “They can say ‘we know these young people are coming. This is the type of provision they will require to meet their needs, and this is the area or region that we need to see those services to have maximum impact’ and then they can go to the providers and say: ‘can you do this?’. By modelling a provision in CareCubed with all the details and scenarios they can set up those provisions and make sure the right people are living together with the right support. All of this could happen much earlier than it currently typically does. There is a huge benefit for everyone, both for the council and potential cost savings, but also for the young people themselves.”

As part of the pilot, iESE also worked with one local authority to help it run a joint-funded placement through CareCubed, which was jointly funded by health care partners. The authority then presented the findings to the ICB panel, leading to significant savings for both the council and the ICB. iESE hopes and expects that analysing and negotiating these type of care packages through CareCubed will become more commonplace in future. “We ran the case through CareCubed to see if we could work out a fair split. It resulted in both parties being happy that they were funding the packages correctly,” Jones added.

Another way CareCubed can assist the children’s market is through modelling in-house services, which is something local authorities are increasingly doing. “There are solutions, but these are medium to long-term, there is no silver bullet. CareCubed doesn’t fix everything, but it is a fantastic starting point. Everyone needs to be responsible for changing what is going on in the market. Currently, it is unsustainable, and many more councils will face bankruptcy if it continues,” he concluded.

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Lancashire County Council In August 2022, Lancashire County Council introduced a new role of Market / Placement Analyst into their Commissioning Service to help strengthen cost monitoring processes (through the use of CareCubed), following issues highlighted in the children's home market by the Competition and Markets Authority in an earlier independent report.

Between September and November 2022, Max Chester (Market / Placement Analyst) conducted an initial study looking at 35 offcontract placements to understand the commissioned price compared to the CareCubed price. This exercise highlighted that on average commissioned fees were higher than CareCubed benchmark ranges. Next, Chester contacted 16 off-contract providers to test engagement. “It was very conversational, introducing my role and the CareCubed tool – that was really the first stage. Due to the success of these early conversations, in December 2022, we decided to implement the tool fully into the commissioning process and this is now ongoing.”

CareCubed is now routinely being used across six areas, including where a home is being offered at £7,000 per week or more and for uplift requests, and there are plans to increasingly use the tool alongside an additional benchmarking capability developed in-house. CareCubed is also utilised to support new providers looking to open provisions in Lancashire with the aim of developing high quality homes and deliver value for money.

In the first 18 months of using CareCubed, over 400 cases were put through the tool, leading to over £500k savings/cost avoidance.

“We now have more clarity over grey areas and we are able to set expectations and increase transparency with our providers,” he explained.

While it is not all plain sailing, with some providers who do not want to engage, Chester stressed that doing nothing is not an option: “The way the market it as the moment, to do nothing isn’t a sustainable position, so over time more councils will be asking these questions. We do still have some issues of non-engagement with providers. In this case we notify the management team so we can consider whether we want to do business with those who are not transparent in the future. We want to ensure we are agreeing fair and impartial fees and supporting providers to develop sustainable provisions. CareCubed helps improve our ability to engage with the market for all-round benefits, both for the local authority but also for providers.”

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• If you would like to hear more about the use of CareCubed in Lancashire County Council, please contact craig.white@iese.org.uk to request access to our recent online webinar.

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