Central government, by default, is the purveyor of cuts. What can it do to help to encourage a sensible, rationale approach to clawing back the budget deficit?

Bearing in mind the previous contribution to this blog, on the relationship between the centre and the local, four messages stand out.
 
First, government can lead by example. Judging people by what they achieve instead of what they do will play its part in getting more from limited resources. Government ministers can take more accountability for outcomes.
 
(One is reminded here of Baroness Morris of Yardley who in 2002 resigned as Education and Skills Secretary because she failed to meet a commitment given to the Shadow Secretary, David Willetts, regarding literacy and numeracy targets.)
 
Government could do much by applying some of the outcome-driven, integrated ways of thinking used in communities and local authorities -Communities that Care, Common Language and Results Based Accountability - to its own portfolio. Instead of decisions within silos, why not bring Ministers and senior policy makers from several departments together with local people and good data to think about innovation in areas like child protection, youth justice and mental health?
 
Second, government should stop telling people what to do. This blog is aimed at people working with children and the least adept parent knows that direct command is often the least effective strategy to achieve compliant behaviour.
 
Government can show the way to doing fewer things better. Even the staunchest defenders of the last administration would concede that it was hard, impossible in fact, to keep up with the initiatives driven from the centre. The fact that there is less money means less can be done. But when things are done, they need to be better thought out and reflect at least a collaboration between central and local partners.
 
Third, central government could do more in the areas where local authorities and communities could be expected to do less. Research into the causes of impairment into children’s health and development is something the centre can support much better than the local. Sharing information on innovation around the country and evidence from around the world on what works, for whom, when and why would be better supported by central government than in many different ways by many different local authorities.
 
Technical support needed by every local authority or community can be delivered more efficiently by the centre. It makes no sense to expect every local authority or GP surgery to buy licenses or provide training for proven models, or to find the most efficient monitoring systems.
 
Supporting the tools that will lead to more effective cost-beneficial interventions is again something the centre can do better than the local. Better local data, new financial instruments to diversify investment and cost-benefit models to help investors calculate their potential return are among a longer list of products that local authorities and communities need if they are to achieve better outcomes with less money.
 
(Saying that central government can support this activity better than local agencies is not akin to saying that central government should provide the activity. It can be contracted out to the third or private sector, universities or even an individual local authority. But it makes sense to support the activity from the centre.)
 
Finally, government could do more to allow experiment in local authorities, schools and communities from which others can learn. Going back to the ‘thinking the unthinkable’ section of this blog, why not give one or two local authorities permission to reduce the numbers of children in state care and evaluate the impact on child outcomes and local authority budgets? Going back to the ‘reverse RCT’ part of this blog, why not allow some police authorities to reduce greatly arrest rates and estimate the impact, probably beneficial, on anti-social behaviour? And why not release a handful of local authorities from Treasury rule and give them permission to find radical ways of achieving better or at least similar human development outcomes with existing or reduced levels of investment?

Cutting sensibly should involve some agreement between central and local forces about what should go and why. The Big Society promises a different relationship between the centre and the local. The centre here might mean Whitehall or it might mean County, City or Town Hall. Local means those places that relate to the centre - local authorities, schools, neighbourhoods and so on.

A lot of the rhetoric around the Big Society leads us to imagine a local with more say and more power. Local people must decide what is right for them. The image that follows is of devolution of accountability and responsibilities. But by another argument, in order for it to flourish, the centre should assume more not less accountability. And more not less of certain types of responsibility for local services. Tesco is not a bad place to start thinking about the relationship between central and local responsibilities. It runs about 2,500 stores and provides about a third of the nation's groceries.
 
Most of the business - recruitment, employment, management, purchasing, distribution - is driven from the centre. But to be successful, the business must accommodate variations in local tastes, purchasing power, staff competency and security in the neighbourhoods in which it situates its shops. So the stock, the staff and the buildings differ in small but important ways from locality to locality. (In all likelihood, Tesco will not think in terms of 2,500 places, but in terms of a taxonomy of 20 places where roughly similar things happen.) Tesco responds to the local with sophisticated tools like high quality data to measure demand and sophisticated stock management so that shelves are filled just in time with the things local people want to buy. The shopping chain does not leave these decisions to the local manager.
 
This particular relationship between the centre and the local is driven by accountability to the Board, held by the CEO, to make a profit. Tesco do it this way because it makes them money. What about public sector services? There are about 3,600 children’s centres in the UK, a number somewhat analogous to Tesco stores. (The comparison can also be made with the 30,000 schools in the UK.) Local people provide the money by way of taxes given to the centre. To an extent, the centre sets the standards, provides training for staff and, in the case of schools, sets the curriculum. Crucially, accountability for children’s centres is devolved to local authorities. The centre monitors success but each locality is responsible for that success. A lot of the responsibilities that Tesco keeps at the centre, such as management systems and purchasing arrangements, are devolved to local authorities. Hardly any of the data that Tesco needs to make its business successful, for example on demand and supply and to quality control local vendors, is available to children’s centres, except when the locality thinks it is important.
 
So by this comparison, greater local control could be achieved by the centre assuming more accountability, collecting better data on meeting local needs and efficiently giving the support required to make each children’s centre a success - financial management, training, materials, quality control and so on. In this model, caring about local people does not come from devolution, it comes from thinking about the best way of meeting local needs and being accountable. There are plenty of grounds by which this comparison can be judged superficial or just plain wrong. But it does act as a reminder that in times of economic downturn, it will be necessary to think creatively. We may agree on the goal - better responding to local needs - but there may be many ways of achieving that goal.

Traditional innovation involves testing a new method or idea. In children’s services this might be a new policy or programme or practice. Another type of innovation is working out happens when existing policies, programmes or practices are withdrawn. This is innovation through subtraction.

To find out if a new idea is effective, we subject it to a randomised controlled trial. Half the eligible children, selected at random, get the innovation and half do not. We compare outcomes for the two groups. Might we do that in reverse to test whether current interventions are making a difference to children’s lives? Would it be possible to remove the intervention from half of the eligible children, again selected at random, but let the other half carry on as before and then compare outcomes for the two groups?
 
In the previous contribution to this blog we suggested this approach for some of the sacred cows of public service, such as health visiting, arresting young people and taking children into state care. There is often an emotional attachment to these services, all of which are unproven and some of which may be iatrogenic or too expensive. The easy route to cutting children’s services will be to lop a percentage off every sector - health, education, social care and youth justice. An outcomes-based approach might be more ambitious but it would also be more judicious and produce some learning.
 
The first step might be to make a list of policies, programmes or other interventions that are suspected of having little beneficial impact. In each case, instead of making an across-the-board cut, half the eligible children would be directed to other interventions. Outcomes could be compared with those of children who stay with the programme. If the consequences for children’s health and development were negative, then the intervention would be saved. If child outcomes stayed the same or improved, then cuts could be made with confidence. Maybe we should give this idea a fancy name to help it catch on. How about 'evidence-based de-commissioning'? Of course, there would be ethical implications. The prospect of taking services away from children in the interests of knowledge will raise eyebrows. But in the looming economic climate the only alternative might only be swingeing, ill-considered cuts.

It is difficult to see opportunities consequent upon the dire economic outlook. What might be good for children will be bad for somebody else, whether in terms of jobs or salary or simply having to work in a different way.

Most of what we have presented to date in this series of blogs about cutting and learning have been silver linings to relatively benign clouds.
 
But thunderstorms loom. What benefit can we draw from them? Part of the challenge in children’s services in the next five years will be to think the unthinkable.
 
In an article in the journal Adoption and Fostering we have asked the question about the necessity of traditional children’s services such as foster and residential care. Could we do without them altogether? In a way the question is meant to be rhetorical, getting the reader to reflect on how much state care we really need. But maybe it could be eliminated altogether?
 
There are even stronger candidates for a radical re-think in the social care world. There is much affection for Family Group Conferences but what little outcome evidence exists suggests that they produce worse, not better, outcomes for children. Can they be supported in difficult economic times?
 
Another sacred cow could be universal health visiting for newborns. Many parents must feel an emotional connection to their health visitor. But how much value is added to the lives of competent families?
 
Perhaps it is time to try innovation through subtraction, or what we call a ‘reverse RCT’ - described more in our next contribution to this blog. Basically it is an experiment where a universal intervention is removed at random from potential beneficiaries. If the trial finds that children or parents suffer as a result of being denied a health visitor then there is proof of benefit. If not, there may be ground for diverting some of the resources elsewhere.
 
How about trying something similar with the arrest of young people? There is reasonable longitudinal evidence indicating that arrest increases anti-social behaviour in adolescence. Many young people offend. Few are caught. More of those who are caught continue their delinquency than those who evade the police. How about reducing arrest rates in some constabularies to see what happens not only to crime but to underlying patterns of anti-social behaviour?
 
A more threatening proposal still might be to select the workforce on their ability to deliver better outcomes for children. We know from studies into fidelity of implementation that there is considerable variation in practitioners’ ability to deliver a proven model such as Cognitive Behavioural Therapy or Functional Family Therapy.
 
Moreover, even when some well-trained and committed practitioners do as they are asked they still fail to achieve good outcomes. Should this evidence be taken into account in deciding on how to scale back the children’s services workforce?

In the public sector the word ‘efficiency’ has been devalued. Politicians regularly talk about efficiency as an alternative to ‘cuts’. Generally the promise outstrips the reality.

In business, efficiency is routine. A good business will continually look to deliver more product at the same cost, or the same volume of product at less cost. Annual efficiencies of less than 5% are frowned upon. Some businesses, Tesco and Toyota for example, have established reputations for their methods for finding efficiency. Kamban, an approach honed by Taiichi Ohno, is one of the core components of Toyota’s 50-year rise from sewing machine manufacturer to the world’s largest car producer. There is similar potential in the world of children’s services, as illustrated by the following three examples.

The hardest of the three is to shift resources from treatment or intervention to prevention or early intervention. Heavy-end need like conduct disorder or depression and chronic risks such as severe violence in the home greatly exceed the supply of services. For every young person in custody there will be another 40 with a conduct disorder not locked up and probably not even on the radar of children’s services. It is impossible to meet existing need with existing provision. It is also difficult to prevent high-end problems, but the ratio of success to failure will be better than trying to deal with a high-end problem once it occurs. Plus, the same money spent on prevention will buy help for more people, which helps from a political standpoint. A little easier, although not straightforward, is to find efficiencies in the referral process. Families needing help turn to schools, doctors, social workers or police officers. Education, health, social care and the police then spend a lot of time talking to one another in order to work out who should take responsibility. In most cases, no help is offered. It is a hopelessly inefficient system that causes much frustration for staff and disappointment for families. Application of the Toyota ‘Just in Time’ methodology would produce huge efficiencies. It would require workers to examine the referral process, ask what it is intended to achieve, examine why it is designed as it is, and then get it to do those things better, more quickly and with less resource. A local authority wanting to take a radical approach might turn the whole system on its head. Instead of waiting for people to knock on the door for help, education, health, social care and the police could screen a population to select families who can most benefit from support. This becomes a more attractive proposition when one reads the results of evaluations by Tom Dishion about how feedback to families on their child’s well-being improves that well-being. It is like going to the dentist for a check-up.
 
In the months following an encounter with a hygienist we brush and floss with enthusiasm. After two or three months we are less keen, but regular check-ups revitalise the process. The easiest route to efficiency, which is more or less ignored by most children’s services, is to get smarter in responding to the ‘heavy end’. Children in state care, in the youth justice system, flagged as being at highest risk of child maltreatment or with multiple special education needs have the capacity to soak up the most resource. They demand the most evidence-based approaches - those interventions most likely to produce a good outcome in the most cost-beneficial way. There are plenty of examples from which to choose. Nurse Family Partnership. Functional Family Therapy. Multi-systemic Treatment. Multi-dimensional Treatment Foster Care. KEEP, a training programme for foster carers. We could go on. Each is an example of a programme that will deliver better outcomes for a reasonable proportion of children and that will produce financial benefits greater than the costs of delivering the intervention. But for some reason, for the most part we ignore the 'what works' evidence and keep on ploughing scarce resources into traditional policies and practices that might or might not work, and may even do some harm.

Now the election is upon us in the UK, conversations about cutting public sector services will begin in earnest. These will not be happy conversations. Many children and families will receive less support. Many people will loose their jobs.

In the next few weeks we will contribute to this conversation with suggestions about how to introduce efficiencies and improve child outcomes.

But before we get to that discussion we want to encourage policy makers to invest to prevent future need. At first glance it might seem a crazy proposition. Does it make any sense to ask local authorities to make new investments at a time when they are slashing others?
 
Let us first explain the rationale. It stems from what we call the Parker-Loughran paradox. Roy Parker is Professor Emeritus at the University of Bristol and a Fellow of the Centre for Social Policy at Dartington. He and his colleague at Bristol Frank Loughran looked at the relationship between expenditure on children’s services and the economic climate over a 100 year period. As sometimes happens with well done studies answering a well thought out, simple question, the results are at the same time both hugely surprising and obvious.
 
The state spends more on disadvantaged children during economic upturns. And it spends less on disadvantaged children during economic downturn. So when there are more needy children, there is less resource available.
 
There is no reason to think it will be any different during this economic downturn. But it needn’t be the same. Let us make a proposal for local authorities wanting to take an alternative course.
 
How big will be the cuts in children’s services in each local authority? Let us pluck a figure from the air. Twenty per cent over the next five years. In other words if a local authority department of children’s services is spending £500 million per annum in this financial year, by 2015 it will have £400 million on which to call. This is the horrible truth that faces most local authorities.
 
What if the local authority were to institute a 21 per cent cut, with the extra one per cent being snipped off from year one. This would leave just £395 million to spend each year after 2015. But in the process the local authority has created a war chest to which £5 million would be added annually. Over five years that adds up to a healthy £25 million. Twenty five million doesn’t sound a lot in a world where there will be more unemployment, greater stress on families, and less support for kids in schools and the community.
 
But what if that £25 million is allocated to an invest to save portfolio of evidence based prevention, early intervention and treatment programmes? For example, £5 million spent on a school based intervention like Life Skills Training might reasonably be expected to reduce drug, alcohol and substance abuse for about 140,000 adolescents. And it would also produce savings to the local authority and state services of about £69 million. Or £5 million allocated for Family Nurse Partnership would improve parent and child outcomes for about 800 teenage mums.
 
Before we get worried about spending so much on school age parents, let us also add to the mix a saving to local and central government budgets of about £14 million. Of course, to get the real benefit the local authority children’s services will want some certainty that the money it saves will come back into the war chest for future re-investment in evidence based cost beneficial models.
 
The result will not compensate for the pain of losing £20 million each year from the overall budget. But it could make the pill easier to swallow. And it could alleviate the impact of the Parker-Loughran paradox by preventing increased need during the economic downturn, intervening early when problems first emerge and offering evidence based solutions when they solidify.
 
Plus, from a human standpoint, the strategy might create at least a small space for optimism and innovation in what promises to be a rather dismal time for children’s services policy makers, managers and practitioners.

Children’s services -health, education, social care, police and youth justice- are about to experience huge financial cut-backs. Some might argue the biggest cuts ever are upon us. 

In the UK, with a general election almost upon us, there is a temptation to see the impending challenge in party political terms. That would be a mistake. What must be faced in the UK must be faced by all economically developed nations. We still live in a Keynesian world. Governments have been investing to stave off the worst effects of recession. Now we have to repay those investments.
 
There is a lot of fear. It is not just for the future of children it is also about jobs and livelihoods. As a small charitable foundation we feel the threat as much as any other children’s services organisation. There is no certainty we will continue to exist. But we also see many opportunities for children and for children’s services in the bleak economic outlook. Maybe it is going too far to say that the huge increase in spending over the last decade has injured child well-being.
 
But it is not unreasonable to suggest that spending less can be an effective route to better child health and development.
 
Over the next few months, the Social Research Unit will be contributing ideas about how to get the best for children with less resources in a series of blogs.
 
As befits a blog we do not wish to over anticipate the way the conversation will develop. But we know we have observations on the potential for better efficiency in local government. We will talk about how central government can help and not hinder.
 
We have ideas on the way in which smarter thinking about money can produce better child outcomes and will also suggest a series of experiments to achieve the same end. We will also consider what would happen if we were to design children’s service from scratch, unencumbered with the historical legacy of existing buildings, staff, laws and procedures.
 
The idea is to sponsor a debate about the opportunities that exist in these straightened times. And to support children’s services organisations looking to turn challenges into opportunities.

Only partly tongue in cheek, the day before the U.K. General Election in May, Prevention Action published its own manifesto. Since it was prepared at a time when huge cuts in public sector services would become inevitable, whoever was elected, it seemed to make sense to offer it again here as a backdrop to this series of blogs on cutting children’s services.