Download - Russell Norman General Manager - Children’s Services Cumbria Partnership NHS Foundation Trust
Cumbria Partnership Foundation Trust
Russell NormanGeneral Manager - Children’s Services
Cumbria Partnership NHS Foundation Trust
Cumbria Partnership Foundation TrustCPFT – Children’s Services
Health Visiting School Nursing Children’s Community Nursing CAMHS Physiotherapy Occupational Therapy Children’s Learning Disability Nurses Audiology Podiatry Community Paediatrics Team 400+(and other services)
Cumbria Partnership Foundation TrustIs Child Poverty an Issue ?
•Children from poor families are 5 times more likely to die from unintentional injuries
HDA 2005
•Children from poor families are 5 times more likely to die as a pedestrian
•Children from poor families are 16 times more likely to die in a house fire•Children from poor families are more likely to suffer injuries that require hospital admission and when they are admitted their injuries are likely to be more serious than those experienced by children from affluent families
Cumbria Partnership Foundation TrustIs Child Poverty an Issue ?Children from poorer families believe that:
DWP Research Report 158 2001
•Health is a matter of luck
•Smoking cigarettes is not dangerous
Children from poorer families are more likely to:•Play truant from school
•Leave school at 16
•Not want to be a parent or marry
•Have low self esteem
•Become pregnant at an early age
•Perform poorly in education
Cumbria Partnership Foundation TrustHow do we measure up?
‘The true measure of a nation’s standing is how well it attends to its children – their health and safety, their material security, their education and socialization, and their sense of being loved, valued, and included in the families and societies into which they are born’ (UNICEF, 2007: 1).
Cumbria Partnership Foundation TrustPartnership Boards and Sub-groups serving Children and Young People in Cumbria
Children’s Trust
Board LSCB Board
Shadow Health & Wellbeing
Board
Care Stream Board
Joint Commissioning
Board
DDG Carlisle & Eden
DDG Allerdale & Copeland
CTB Impact & Evaluation Group
(CIEG)
DDG Barrow & S Lakeland
Health Builders
Foundation Years Programme
Childhood & Adolescent Programme
Acute & LTC Programme
Vulnerable Child Programme
SERG Allerdale & Copeland
SERG Carlisle & Eden
SERG Barrow & S Lakeland
Children’s Workforce Strategy Group
Policies & Procedures Group
LSCB Impact & Evaluation Group
Child Death Overview Panel
Health Safeguarding Network Group
CCG’s x 6 Named Children’s Services GP x 6 Named Safeguarding GP x 6
MALAP
Governing Body - Virtual Schools
Corporate Parenting Panel
Children in Care Council
CLA Health & Wellbeing Group
Cumbria Partnership Foundation TrustResilience?
Living in poverty is the single most important determinant for children’s outcomes
Gap between groups is widening Children in poverty more likely to:
Under achieve Get pregnant early Be affected by domestic violence Be involved in alcohol and drug misuse Die younger, suffer health problems Be a cost to society, not just in financial terms
Cumbria Partnership Foundation TrustNot intervening early is expensive….
Cos
t per
chi
ld /
fam
ily
Severity of need
Cost
Family Intervention Projects – £8-20,000 per family per year
Family Nurse Partnerships – £3000 per family a year
Child looked after in children’s home – £125,000 per year placement costs
Child looked after in foster care – £25,000 per year placement costs
Schools - £5,400 per pupil
Children’s Centres - around £600 per user
Costs increase as children get older
Multi-dimensional Treatment Foster Care – £68,000 per year for total package of support
Child looked after in secure accommodation – £134,000 per year placement costs
Parenting programme (e.g. Triple P) – £900-1,000 per family
PEIP – £1,200 - 3,000 per parent
Multi-Systemic Therapy – £7-10,000 per year
Cumbria Partnership Foundation Trust
Universal Services1
Education - £580m
Child benefits - £110m
GP/NHS costs - £30m
Targeted Services2
Welfare benefits - £750m
Mental health treatment - £20m
Parenting support - £50m
Drug misuse treatment - £10m
£0.7bn universal spend/yr
£0.8bntargeted spend/yrReactive spend3
Children going into care, hoax fire calls, nuisance behaviour costs, juvenile criminality costs, truancy costs, alternative education costs, vandalism, evictions due to ASB
£2.5bn reactive spend/yr
46,000families
All of these families access universal services…
…and specialist services, (often repeatedly for many years)
but family breakdown and crises still leads to very poor and costly outcomes
NOTE: INDICATIVE COSTS ONLY - do not include costs of criminal justice services pending further analysis by MoJ.
Disproportionate costs on services
Can be as much as £250,000-330,000 per family per year……
Cumbria Partnership Foundation Trust
DfE
Multiple funding and accountability structures make coordinating support for the families with the greatest needs very difficult
Intensive family intervention worker/
parenting practitioner
DH
LA YJB CCGPolice
Surestart Children’s Centre
Schools
Police officer
YOS workerCAMHS/ Mental Health Worker
Drug and
alcohol team
DWP
JCP
Employment Personal advisers
VCS
Young carer support worker
Prisons
Family support workers
CLG
Housingauthorities
Housing link worker
MoJHO
Cumbria Partnership Foundation TrustFamilies with Multiple Problems
• Growing up in a family with significant, social, health, economic and behavioural problems has lasting and inter-generational impact on a child’s life chances
• Around 120,000 families in England experience multiple social, health and economic problems. 46,000 of those experience ‘problem’ child behaviour
• Account for a large number of school exclusions, 1 in 5 youth offences, parents 34 times more likely to need drug treatment and 8 times more likely to need alcohol treatment and a third are subject to child protection
• Contribute to a wide range of social problems
Cumbria Partnership Foundation Trust
What works?
High quality key workers working with low caseloads (4-6 families per worker)
Respectful and persistent whole family working that empowers and builds on family strengths
Using incentives / rewards / consequences and flexibility to use resources creatively
Support not time-limited for support (average 12-18 months) and available ‘out of hours’
Effective multi-agency working and information sharing Family intervention costs £14K1 per family per year, making savings of
around £50K2 per family per year Evidence Based Parenting Programmes
1Steve Parrott and Christine Godfrey, Department of Health Sciences, University of York April 2008 2calculated using the DfE Family Savings Calculator https://registration.livegroup.co.uk/fip/with data collected from 17 LAs
Cumbria Partnership Foundation Trust
“the socialized mind is an adequate order of complexity to meet the demands of a traditionalist world, in which a fairly homogeneous set of definitions of how one should live is
constantly promulgated by the cohesive arrangements, models, and external regulations of the community or tribe. (However) Modern society is
characterized by ever-expanding pluralism, multiplicity, and competition for loyalty to a given way of living. It requires the development of an internal authority which can
“write upon” existing social and psychological productions rather than be “written by” them.
R Kagan 1991
RSA: Beyond the Big SocietyPsychological Foundations
of Active Citizenship Jan 2012
Cumbria Partnership Foundation Trust
Better health outcomesfor children and young people
The foundations for virtually every aspectof human development – physical, intellectual,
and emotional – are laid in early childhood.
(Marmot)
Cumbria Partnership Foundation Trust
Better health outcomesfor children and young people
1. Children, young people and their families will be at the heart of decision-making,with the health outcomes that matter most to them taking priority.
2. Services, from pregnancy through to adolescence and beyond, will be high quality, evidence based and safe, delivered at the right time, in the right place,by a properly planned, educated and trained workforce.
3. Good mental and physical health and early interventions, including for children and young people with long term conditions, will be of equal importance to caring for those who become acutely unwell.
4. Services will be integrated and care will be coordinated around the individual,with an optimal experience of transition to adult services for those young people who require ongoing health and care in adult life.
5. There will be clear leadership, accountability and assurance and organisations will work in partnership for the benefit of children and young people.
Cumbria Partnership Foundation Trust
Better health outcomesfor children and young people
We all have a part to play in promoting the importance of the health of our childrenand young people. Through our joint commitment and efforts we are determined to:
• reduce child deaths through evidence based public health measures and by providing theright care at the right time;
• prevent ill health for children and young people and improve their opportunities forbetter long-term health by supporting families to look after their children, when they needit, and helping children and young people and their families to prioritise healthy behaviour;
• improve the mental health of our children and young people by promoting resilience andmental well being and providing early and effective evidence based treatment for thosewho need it;
• support and protect the most vulnerable by focusing on the social determinants of healthand providing better support to the groups that have the worst health outcomes;
• provide better care for children and young people with long term conditions anddisability and increase life expectancy of those with life limiting conditions.
Cumbria Partnership Foundation Trust
Better health outcomesfor children and young people
Because• the all-cause mortality rate for children aged 0 – 14 years has moved from the
average to amongst the worst in Europe
• 26% of children’s deaths showed ‘identifiable failure in the child’s direct care’
• more than 8 out of 10 adults who have ever smoked regularly started before 19
• more than 30% of 2 to 15 year olds are overweight or obese
• half of life time mental illness starts by the age of 14
• nearly half of looked after children have a mental health disorder and two thirds have at least one physical health complaint
• about 75% of hospital admissions of children with asthma could have been prevented in primary care