Bundle contents: policy; funding; resources; political priorities; structure change

National, state, and local polices that impact health

  • Structure change in the child welfare system
  • Interventions that increase/decrease a family’s finances


Children's social care cost pressures and variations in unit costs.
Holmes., L 2021

This report brings together findings from a recent data collection template completed by 13 local authorities in England (termed here the cost pressures survey) and existing research evidence to explore the unit costs of providing children’s social care services. The findings from existing research are focused on the use of a bottom-up unit costing methodology to explore different parts of the children’s social care system and to identify, and account for variations, based on qualitative responses from the cost pressures survey. The focus of this report is on all children in need, including those who are looked after. The findings are also positioned within the wider evidence base covering issues related to demand and expenditure on children’s social care.

Children's Social Care Innovation Programme
Fitzsimmons & McCraken 2020

This report provides an overview of key findings from evaluations of the Department for Education’s Children’s Social Care Innovation Programme as well as drawing in some overall conclusions and suggestions recommendations for children’s services based on the body of evidence as a whole.

Children’s Social Care Innovation Programme Final evaluation report
Sebba, J., Luke, N., McNeish, D., & Rees, A. 2017

We study the relationship between a key early intervention policy designed to support families with children up to the age of four and the rate at which children are taken into social care. The gradual build-up of over 3,600 Sure Start Children’s Centres (SSCC), operated by Local Authorities across England, created large spatial and cohort variation in the provision of a range of services that include childcare, early education, health and parenting support. Local Authorities are also responsible for the safeguarding of children and about 25 children per 10,000 are taken into social care annually, in the majority of cases to protect them from abuse and neglect. We find that SSCC provision is associated with a higher rate of entry into care for children aged 0-4, but a lower rate of entry for children aged 5-9. The findings are consistent with the policy improving longer-term outcomes while identifying cases in urgent need of care.

Costing and outline CBA of the Independent Review of Children’s Social Care recommendations: Modelling assumptions
Alma Economics 2021

Alma Economics worked with the Independent Review of Children’s Social Care (the Review) to investigate the outcomes of children who need a social worker and related costs, as well as to estimate the costs and benefits of proposed recommendations to reform children’s social care. This research project comprised two phases. Phase 1 documented the lifetime cost to individuals, the state and society of adverse outcomes of children with a social worker. Phase 2 estimated the impact on public finances and produced an outline Cost-Benefit Analysis of the Review’s recommendations.This technical note is part of Phase 2. It provides more information on the modelling approach and it accompanies the model outputs.Estimates of the impact on public finances capture costs and savings to the public sector. The outline CBA takes a wider approach and reflects costs and benefits to society, following HM Treasury Green Book guidance. The frameworks used for estimating each type of cost are detailed below.Each recommendation is approached on a stand-alone basis – in other words, estimates do not directly take into account the interaction between different recommendations.

Edge of Care Cost Calculator: Change Project report
Bowyer, S., Gillson, D., Holmes, L., Preston, O., & Trivedi, H. 2018

Introduction: In 2017 a Research in Practice (RiP) Change Project, conducted with RiP Partners from 19 local authorities in England, explored the development of a tool for calculating the financial costs of delivering services for young people who are on the ‘edge of care’.The Change Project method applies an action research approach to developing evidence-informed, practical resources by bringing together experts from across practice and research. You can read more about this methodology and other Change Projects at This project was a collaboration between RiP, North Yorkshire Children’s Services, and academics at the Centre for Child and Family Research (CCFR), Loughborough University (Lisa Holmes and Helen Trivedi, now based at the Rees Centre, University of Oxford).

Estimating Children’s Services spending on vulnerable children
The Children’s Commissioner Office 2019

This report provides new estimates of how much is spent on children in specific categories of need and vulnerability across a sample of local authority children’s services departments.The Children’s Commissioner’s Office visited over a dozen LAs between November 2018 and February 2019 to gather evidence from Directors of Children’s Services, elected council members, heads of finance and programme managers on local pressures on children’s services budgets, specifically budgets for high needs and early intervention. The Children’s Commissioner Office then worked closely with nine local authorities to develop a methodology to allocate financial data and produce a set of estimates.The work does not provide a nationally representative picture of demand and spend intended to benefit children in England. The aim was to get a better understanding of the current cost pressures facing councils and then work with local authority children’s services to co-create a common framework and methodology for mapping the level of support and spend on children and to work with a small sample of LAs to use this framework to obtain comparable data.In the absence of a full national dataset on where money goes this study provides an important contribution to the debate on the efficiency, effectiveness and fairness of current funding.

Improving the effectiveness of child protection system: a review of literature
Barlow, J. & Schrader-Mcmillan, A. 2017

The objective of the review was also to identify effective programmes, as well as evidence regarding effective methods of assessment and engagement, and practitioner training, working and management. Where possible the analysis aimed to identify the reliability of the evidence, scale of impact, and evidence of potential to reduce costs or mitigate the need for increased spending on children’s services and other parts of the child protection system

Making Sense: Understanding the drivers of variation in spend on Children’s services.
Local Government Association (LGA). 2018

Nationally reported data for each local authority reveals that spend on children’s services per child varies significantly between authorities, from £292 to £1,254 (based on revenue outturn returns for FY16/17 and the local population aged 0-25). Standardising for similar outcomes, spend per child still varies from £299 to £805. This work, commissioned by the Local Government Association (LGA) and undertaken by Newton, seeks to shed light on the factors driving variation of spend on children’s services, establishing why some authorities spend significantly more than others, whilst achieving similar levels of outcome.The work comprises two major projects. The first involves a review and analysis of national demographic, geographic and economic data for all councils in the country, to identify correlations with children’s services spend. The second project, a detailed, on-the-ground study of the factors influencing spend which could not be quantified through national data alone, was completed with a sample of eight councils. The factors identified included analysis of financial reporting and the influence of council and partner organisation practice. Through correlation analysis of 18 demographic, economic and geographic measures, it has been possible to identify a set of five factors that explain approximately half of the variation in spend seen nationally across all authorities. These factors are largely outside of the control of councils, and certainly sit outside the control of children’s services. As a consequence, variation in what authorities spend on children’s services (per head of child population) is inevitable. It is not logical to expect authorities to converge on a single ‘right’ value of spend. Of the five drivers of variation, the IDACI measure of deprivation was found to be the single most significant factor. Alone, it explains 31% of variation. When combined with the other four factors (size of population aged 0-25, amount of disposable household income, levels of unemployment and levels of crime) the resulting model describes just over 50% of spend variation. Analysis of reported spend, according to the revenue outturn financial returns, echoes previous research that has shown variation in the accuracy of how these returns are compiled. This makes it difficult to draw a like-for-like comparison of spend between councils. The treatment of grants, coding of spend to areas of the revenue outturn and allocation of central overheads were the three key areas of inaccuracy identified. The complexity is compounded by the fact that the guidelines for the returns do not permit a like-for-like comparison of spend between authorities, specifically around how spend on asylum-seeking children is set out. In the sample of authorities with whom in-depth analysis of the financial returns was completed, the overall contribution of this factor to spend variation was small. However, this is not necessarily representative of the broader national picture since examples were seen where individual council spend changed by up to 12%. Nationally, spend on looked after children and safeguarding children and families (which covers core spend on statutory child in need and child protection social work) are both the largest areas of spend and also the areas where spend varies most between authorities. Study of these areas across the sample authorities identified that taking the right local steps to achieve the best possible outcomes for children, young people and families could reduce spend variation between the sample group of councils by 13%. The changes required to achieve this consistently, whilst more in the control of councils than other local partners, are nonetheless complex, potentially costly and challenging to achieve, with no ‘one size fits all’ solution across authorities. Opportunities exist to explore the role of partnership working and practice consistency further to assist authorities in developing local improvement plans. Spend on other areas of children’s services outside of looked after children and safeguarding children and families makes up 30% of spend on average but presented a source of variation between the sample of authorities. In one authority the figure was 22%, whilst in another it was 56%. Within this, different approaches to early help and preventative services were identified. The methods employed in this study were not designed to identify a correlation between spend on early help / preventative services and lower spend at higher tiers. It was noticeable that councils spending more on these services tended to do so primarily as a result of political or strategic commitment to the importance of providing help early. Greater engagement in the building of the evidence-base around early help and preventative services, at a time when such spend is coming under pressure, is likely to be important if funding for them is to be maintained. By taking two different approaches this work has described some of the drivers behind up to 50% of the variation in spend on children’s services. More importantly perhaps, the work also re-emphasises that we should expect to see some degree of variation driven by wider economic and geographical factors; our modelling suggests that a range from £334-£883 could be expected as the result of five factors alone. This coupled with variation in financial reporting practices means that caution needs to be taken when comparing one authority with another. Rather; the narrative around spend needs to be based on local system understanding and the appropriate cost of achieving the ideal outcomes for children and families. The scope of this work, looking specifically at factors driving variation in spend on children’s services between councils, is one of many questions and challenges facing the sector. Further work in this area is required to address the next logical questions around factors driving increases in demand and the future funding arrangements for children’s services, including the total quantum of spend.

Mapping the evidence about what works to safely reduce the entry of children and young people into statutory care: A systematic scoping review protocol
Brand, S. L., Morgan, F., Stabler, L., Weightman, A. L., Willis, S., Searchfield, L., ... & Evans, R. E. 2019

Introduction:The increasing number of children and young people entering statutory care in the UK is a significant social, health and educational priority. Development of effective approaches to safely reduce this number remains a complex but critical issue. Despite a proliferation in interventions, evidence summaries are limited. The present protocol outlines a scoping review of research evidence to identify what works in safely reducing the number of children and young people (aged ≤18 years) entering statutory social care. The mapping of evidence gaps, clusters and uncertainties will inform the research programme of the newly funded Department for Education’s What Works Centre for Children’s Social Care. Methods and analysis The review uses Arksey and O’Malley’s scoping review methodology. Electronic database and website searches will identify studies targeting reduction of care entry, reduction of care re-entry and increase in post-care reunification. Supplementary searching techniques will include international expert consultation. Abstracts and full-text studies will be independently screened by two reviewers. Ten percent of data abstraction will be independently conducted by two reviewers, with the remainder being extracted and then verified by a second reviewer. Descriptive numerical summaries and a thematic qualitative synthesis will be generated. Evidence will be synthesised according to primary outcome, intervention point (mapped across socio ecological domains) and the realist EMMIE categorisation of evidence type (Effectiveness; Mechanisms of change; Moderators; Implementation; Economic evaluation). Ethics and dissemination Outputs will be a conceptual evidence map, a descriptive table quantitatively summarising evidence and a qualitative narrative summary. Results will be disseminated through a peer- reviewed publication, conference presentations, the What Works Centre website, and knowledge translation events with policy-makers and practitioners. Findings will inform the primary research programme of the What Works Centre for Children’s Social Care and the subsequent suite

Mapping the evidence about what works to safely reduce the number of children and young people in statutory care: a systematic scoping review
Brand, S., Morgan, F., Stabler, L., Weightman, A. L., Willis, S., Searchfield, L., ... & Evans, R 2018

The increasing number of children and young people entering statutory care in the UK is a significant social, health and educational priority. Development of effective approaches to safely reduce this number remains a complex but critical issue. Despite an increase in interventions, evidence summaries are limited. This study is a scoping review; using systematic searching methods to map published evidence in the area of what works in safely reducing the number of children and young people, under the age of 18 years, entering statutory social care. Including exploring the clusters and gaps of research evidence in this area.

On Estimating the Fiscal Benefits of Early Intervention.
Feinstein, L., Chowdry, H., & Asmussen, K. 2020

In this paper we explain some of the difficulties of providing forecasts of the financial benefits of early intervention programmes, focussing on those delivered during the early childhood period. We highlight the diversity of early intervention, and the complexity and multiplicity of outcomes. We summarise recent work at the Early Intervention Foundation to assess the evidence on the impacts of early intervention, recognising the diversity of approaches to delivery and the importance of innovation and local practice as well as of rigorous approaches to evaluating causal effects. We also describe new ways of assessing accurately the local fiscal costs of late intervention and consider the implications of this for addressing the well-established barriers to investment in prevention. Our analysis brings to the fore gaps in the evidence from which even the most rigorous ‘gold-standard’ research is not immune. These limitations prevent the production of an accurate and realistic cost-benefit ratio or net present value for the majority of programmes as delivered in practice. We suggest some paths towards a firmer foundation of evidence and a better alignment of evidence and policy.

Protocol for the economic evaluation of a complex intervention to improve the mental health of maltreated infants and children in foster care in the UK (The BeST? services trial)
Deidda, M., Boyd, K. A., Minnis, H., Donaldson, J., Brown, K., Boyer, N. R., & McIntosh, E. 2018

Introduction: Children who have experienced abuse and neglect are at increased risk of mental and physical health problems throughout life. This places an enormous burden on individuals, families and society in terms of health services, education, social care and judiciary sectors. Evidence suggests that early intervention can mitigate the negative consequences of child maltreatment, exerting long-term positive effects on the health of maltreated children entering foster care. However, evidence on cost- effectiveness of such complex interventions is limited. This protocol describes the first economic evaluation of its kind in the UK.Methods and analysis An economic evaluation alongside the Best Services Trial (BeST?) has been prospectively designed to identify, measure and value key resource and outcome impacts arising from the New Orleans intervention model (NIM) (an infant mental health service) compared with case management (CM) (enhanced social work services as usual). A within-trial economic evaluation and long-term model from a National Health Service/ Personal Social Service and a broader societal perspective will be undertaken alongside the National Institute for Health Research (NIHR)–Public Health Research Unit (PHRU)-funded randomised multicentre BeST?. BeST? aims to evaluate NIM compared with CM for maltreated children entering foster care in a UK context. Collection of Paediatric Quality of Life Inventory (PedsQL) and the recent mapping of PedsQL to EuroQol-5-Dimensions (EQ-5D) will facilitate the estimation of quality-adjusted life years specific to the infant population for a cost–utility analysis. Other effectiveness outcomes will be incorporated into a cost-effectiveness analysis (CEA) and cost-consequences analysis (CCA). A long-term economic model and multiple economic evaluation frameworks will provide decision- makers with a comprehensive, multiperspective guide regarding cost-effectiveness of NIM. The long-term population health economic model will be developed to synthesise trial data with routine linked data and key government sector parameters informed by literature. Methods guidance for population health economic evaluation will be adopted (lifetime horizon, 1.5% discount rate for costs and benefits, CCA framework, multisector perspective).

Spending on Late Intervention: How we can do better for less
Chowdry, H., & Oppenheim, C. 2015

This report focuses on the immediate and short-run fiscal costs of ‘late intervention’: the acute, statutory and essential benefits and services that are required when children and young people experience significant difficulties in life, many of which might have been prevented.

Stable Homes, Built on Love: Implementation Strategy and Consultation Children’s Social Care Reform 2023
Department of Education 2023

Every child deserves to grow up in a safe, stable and loving home. Last year, 3 independent reviews looked at the changes that are needed to achieve this.1 Between them they looked at the full breadth of children’s social care and heard from thousands of people with lived experience of these services or who work in them. We agree with their problem analysis and vision for change. This vision is underpinned by the fundamental principle of the Children Act 1989 that children’s welfare is paramount. The best way of promoting children’s welfare is very often by supporting children’s families and the loving relationships around them. To achieve this vision, we need to rebalance children’s social care away from costly crisis intervention to more meaningful and effective help for families, so that it achieves the outcomes children deserve. Achieving this will require a major reset that puts love and stable relationships at the heart of what children’s social care does. We will take ambitious action across six pillars to transform children’s social care. These are set out below. We will reform in phases. Over the next two years, we will invest £200 million 2 addressing urgent issues facing children and families now, laying the foundations for whole system reform and setting national direction for change. After two years, we will refresh this strategy, scaling up the new approaches we have tested and developed, and bringing forward new legislation (subject to parliamentary time).

Supporting children and families returning home from care
Holmes, L. 2014

In early 2014, NSPCC commissioned the Centre for Child and Family Research (CCFR) at Loughborough University to provide evidence to inform debates about the cost effectiveness and potential long term savings, or costs avoided, of providing appropriate assessment, support and services to families on return home from care (reunification). The aim of the work was to estimate the costs to the public purse if services to support successful reunification are provided to all children and families following a care episode, based on their assessed needs, and to compare these costs with the costs associated with re-entry to care. This report explains the context for focusing on reunification practice, describes the methodology and provides the evidence base used to estimate the costs.

The cost of late intervention: EIF analysis 2016
Chowdry, H., & Fitzsimons, P. 2016

The Cost of Late Intervention: EIF Analysis 2016 calculates how much the public sector in England and Wales spends on late intervention for children and young people, responding to the more severe problems that they experience. It updates our previous analysis from 2015. Knowing how much is spent on late intervention is useful because it also illustrates a potential ‘fiscal prize’ from early intervention although we do not argue that all of the demand for late intervention can be prevented. Our analysis also provides transparency at a local and national level about how much is spent and by which departments or agencies. This can help stimulate cooperation and new approaches to tackle the demand for late intervention.

The independent review of children's social care: final report
McAllister J. 2022

This moment is a once in a generation opportunity to reset children’s social care. What we need is a system that provides intensive help to families in crisis, acts decisively in response to abuse, unlocks the potential of wider family networks to raise children, puts lifelong loving relationships at the heart of the care system and lays the foundations for a good life for those who have been in care. What we have currently is a system increasingly skewed to crisis intervention, with outcomes for children that continue to be unacceptably poor and costs that continue to rise. For these reasons, a radical reset is now unavoidable.Achieving this reset starts with recognising that it is loving relationships that hold the solutions for children and families overcoming adversity. While relationships are rich and organic, children’s social care can be rigid and linear. Rather than drawing on and supporting family and community, the system too often tries to replace organic bonds and relationships with professionals and services. Without a dramatic whole system reset, outcomes for children and families will remain stubbornly poor and by this time next decade there will be approaching 100,000 children in care (up from 80,000 today) and a flawed system will cost over £15 billion per year (up from £10 billion now).1 Together, the changes we recommend will shift these trends and would mean 30,000 more children living safely and thriving with their families by 2032 compared to the current trajectory.

The price is rights!: Cost benefit analysis and the resourcing of children's services.
Stalford, H. 2019

This paper reflects on the impact of a decade of austerity measures on children in the UK, with a particular focus on the growing emphasis on cost benefit analysis (CBA) as a public rationing device. The argument points to the dangers of the now widespread use of this mechanism in the context of resourcing children’s services, not just by state bodies, but by civil society organisations and others charged with the protection of children’s rights. It considers why CBA is so appealing, and points to its potential in creating persuasive economic arguments in favour of investment in children; but it also points to the need for more principled, critical engagement with this device to prevent some of the mischiefs for which it has been used to date. The discussion proposes that a more robust rights-based approach, grounded firmly in the UN Convention on the Rights of the Child, would help to achieve a more fruitful correspondence between economic and children’s rights-related objectives.

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