Assessing the Comparative Costs of Care
In
the recent House of Lords debate much was made of the cost of residential
care in children’s homes – four times the cost of a
place in Eton and six times a foster placement. Good residential
care is expensive, as it is intensive, needs high staffing levels
and goes on round the clock 365 days a year. Unlike Eton, children’s
homes cannot close for holidays.
The
problem is first to make accurate comparisons. Have the costs of
recruitment, training, supervision and management been built in,
for example? Do field social workers spend more time with children
in foster care than those in residential homes, for example?
Secondly,
it is important to match up the child to his/her placement properly.
There is no point sending a child who needs residential care to
one foster placement after another, failing at each in turn, simply
because the foster placement is thought to be cheaper. If you were
a zoo keeper would you feed the lions on straw because it is cheaper?
What is needed is a really good assessment of each child’s
needs, and an open mind about the type of placement to meet the
assessed needs.
The
costs might also usefully include an assessment of the life-time
expenditure if the services offered in childhood fail, and the person
needs ongoing placements in prison or mental hospital as a result.
We
were once involved in costing the impact of a family centre in which
eight families lived under 24-hour supervision by a team of five
staff. It was seen as an old-fashioned model and was shut not long
afterwards. But the money the unit saved and the unit’s impact
on people’s lives were phenomenal.
For
the children of the families in the unit another children’s
home would have been needed, marriages were sorted out, field social
workers’ time was saved, housing arrears were paid off, people
were helped into jobs or had their benefits sorted. Because there
was round-the-clock supervision, problems were dealt with on the
spot, when the husband came home drunk from the pub and started
a row, for example, rather than talking about them days later when
the social worker called.
Maybe
we should put the idea forward as an innovation.
It’s
All Been Tried Before
This
might sound like a whinge, but it is perhaps more a sigh of sad
despair.
When
the Lords advocate new ideas such as family conferencing or respite
care, they need to know it has all been tried before. One can understand
why they cast around trying to think up new ideas. It is because
children in care need better services.
‘Twas
ever thus. Children have always needed better services, and it will
continue to be a battle to provide them. This is not actually a
counsel of despair, but a realistic appraisal of the difficulty
of maintaining a committed and skilled workforce applying itself
year in year out to meet children’s needs.
A
lot of the standards developed in the past have dropped away or
been undermined by well-intentioned developments, and we then have
to seek to re-establish the standards or start all over again.
Having
had our sigh, we have to get on with the job again, because out
there a whole lot of new children are lining up, each with his or
her own particular blend of hopes, fears, problems, potential, pleasing
and irritating characteristics, and so on. And for each of them,
the child care workers involved will need to battle to help the
child and his/her family find answers to their problems that will
enable the child to enjoy his/her childhood and find fulfilment
as an adult.
The
Big Voluntaries and Residential Child Care
Two
or three decades ago a number of the big voluntary bodies decided
to pull out of residential child care. They had good reasons. Residential
care was old hat. They wanted to get into new preventive services
in the community. Local authorities used them as an overflow so
that demands were unpredictable, providing care was expensive, and
so on.
The
outcome of their decisions, though, was that there has been a real
dearth of good quality residential child care provided by altruistic
agencies for whom it is a primary task. The gap is now being filled
by the private sector. Maybe the voluntaries should think about
getting involved again.
Upending
the Argument
Comments
have been made – understandably – about the appalling
level of educational attainments of children in residential homes,
about their mental health problems and about the number of people
in prison who have been in care. These facts are all seen as an
indictment of residential care.
It
struck us that the question also needs to be turned upside down
to get a full picture. Surely, if children’s needs have been
properly assessed, those with the most acute needs are likely to
have been placed in homes. If the most damaged children are in the
homes, you would expect them to suffer higher levels of mental health
problems. Indeed, would it not be surprising if prisons were predominantly
filled with people who had had problem-free childhoods? Blaming
children’s homes for their clientele’s problems is a
bit like blaming hospices for their high death rates.
That
is not to say that we should just give up on the children. When
they have such levels of need, we should be working even harder
to solve their problems, or to help them do so. It may be a labour
of Hercules, but it should also be a labour of love that we do not
give up on. It’s just that it’s rough on the residential
services if they get the blame for the scale of the problems they
face. The real measure of success is to see how the children get
on against their likely outcomes if not in care, and that’s
hard to assess.
The
Significance of Language
We
were in a hotel in Amsterdam, and the notice, only in English, said,
Unaccompanied children must not ride in the elevator. Why was it
not in Dutch, German or French? Because Dutch, German and French
children are sensible, and do not need to be told? Note that the
instruction is in American English. Does this imply that only American
children can read, or are they the only ones who would respond to
the notice? What does that imply about English children? The possible
implications are fascinating. Perhaps it was assumed that English
children have picked up American from the movies. Or maybe it was
just that the guy who made the notice had been to New Amsterdam
for a trip.
On
the same theme, we had a cruise on a rather old liner that had been
owned by a number of different companies, and the notices around
the ship were in several languages. The only one in Spanish told
parents firmly that it was their responsibility to control their
children. There must be a story behind that too. Had some naughty
Spanish child flicked chocolate ice-cream at the Captain in his
clean white uniform?
Less
Eligible – or More?
Wandering
around a museum a few years ago, we met a man in his nineties who
had been brought up in residential care in the early twentieth century.
In his part of Leeds children taken into the local home were envied
by many. They each had a bed, they were clothed and had shoes, and
they had three meals a day. The same could not be said of many of
the other children in the area, who often shared beds, went bare-footed
and went short of food. No doubt there was a stigma with going into
care, but there were also clear advantages as well. The old man
appeared to have no regrets about having been in a children’s
home.
Interestingly,
there were times when the much maligned workhouses also offered
high levels of care, and in the 1920s, the Labour Council covering
the Poplar area was issued with a warning under the Poor Law Amendment
Act 1834 that they had made their conditions better than those found
locally and needed to make them more spartan.
As
a nation we are interestingly ambivalent about those who are worse
off. Some have always been seen as less deserving, less eligible
than others. Workshy residents in workhouses were expected to break
stones or go for tedious spells on the treadmill to earn their crust,
while the ill and the elderly were generally treated rather better.
Even
now, people who seek damages for being abused as children may be
deemed ineligible if they have a subsequent record of offending,
even if the abuse can be seen as a major trigger for their subsequent
history. We could do with a greater spirit of generosity and less
pickiness in such cases. We can never make up for the misery these
people have experienced, and even if they are given damages, it
amounts to no more than a few hours’ pay at the level which
the fat cats of society award themselves.
Did
You See? ...
...
that parents of babies whose organs were removed without their consent
might not get their promised compensation because of claims by the
NHS that they were not 'emotionally damaged' by the ordeal (Daily
Mirror 14 February 2995)? The world sometimes seems topsy-turvy.
In one sense, nothing can compensate parents for the loss of their
child; in another sense, they would presumably have been totally
unaffected by the removal of the organs if they had not happened
to learn that they had been taken without their agreement. Now it
seems that those who are visibly upset will get more than parents
who are more balanced and can cope. It is hard to see this as justice.
It
reminds us of the way that foster carers dealing with disturbed
children have sometimes been paid more than those looking after
the less damaged. It sounds fair until you try to assess degrees
of disturbance, when you find that at review time you are removing
rewards from good foster carers who manage to settle children down
and rewarding those who upset children and thus encourage disturbed
behaviour.
...
Jamie Oliver on the BBC Frost Show arguing that the Government should
allow more than 37p for a school meal? When there are said to be
a hundred restaurants in London where diners spend more than £100
on a meal (each one being enough for 270 children to have dinner),
we are appalled at the low amount allowed for school meals. We back
Jamie. The campaign is a good use of celebrity.
From
the Correspondence
Dear
Sir,
I
would like to apply for the potion of the Chief Executive.....
Couldn’t
he get it through one of those Viagra adverts that flood the Internet?
