Cumbria Partnership Foundation Trust
Russell Norman
General Manager - Children’s Services
Cumbria Partnership NHS Foundation Trust
CPFT – Children’s Services
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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 Trust
Is Child Poverty an Issue ?
Cumbria Partnership Foundation Trust
•Children from poor families are 5 times more likely to die
from unintentional injuries
•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
HDA 2005
Is Child Poverty an Issue ?
Cumbria Partnership Foundation Trust
Children from poorer families believe that:
•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
DWP Research Report 158 2001
How do we measure up?
Cumbria Partnership Foundation Trust
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‘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 Trust
Cumbria Partnership Foundation Trust
Partnership Boards and Sub-groups serving Children and Young People in Cumbria
DDG
Carlisle &
Eden
DDG
Allerdale &
Copeland
CTB Impact &
Evaluation Group
(CIEG)
Governing
Body - Virtual
Schools
Corporate
Parenting
Panel
Children in
Care Council
CLA Health
& Wellbeing
Group
SERG
Carlisle &
Eden
DDG
Barrow &
S Lakeland
MALAP
Children’s Trust
Board
Health Builders
Care Stream
Board
CCG’s x 6
Named Children’s
Services GP x 6
Named Safeguarding GP
x6
SERG
Barrow &
S Lakeland
LSCB
Board
SERG
Allerdale &
Copeland
Shadow Health
& Wellbeing
Board
Policies &
Procedures Group
Joint Commissioning
Board
Foundation
Years
Programme
Childhood &
Adolescent
Programme
LSCB
Impact &
Evaluation Group
Acute &
LTC
Programme
Vulnerable
Child
Programme
Children’s
Workforce
Strategy Group
Health
Safeguarding
Network Group
Child Death
Overview
Panel
Resilience?
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Cumbria Partnership Foundation Trust
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
Not intervening early is expensive….
Cumbria Partnership Foundation Trust
Cost per child /
family
Child looked after in
children’s home – £125,000
per year placement costs
Multi-dimensional Treatment
Foster Care – £68,000 per year
for total package of support
Child looked after in foster
care – £25,000 per year
placement costs
Family Intervention Projects –
£8-20,000 per family per year
Parenting programme
(e.g. Triple P) – £9001,000 per family
Multi-Systemic Therapy –
£7-10,000 per year
Family Nurse Partnerships –
£3000 per family a year
PEIP – £1,200 3,000 per parent
Children’s Centres - around £600 per user
Schools - £5,400 per pupil
Severity of need
Child looked after in secure
accommodation – £134,000
per year placement costs
Cost
Costs increase
as children get
older
Disproportionate costs on services
Cumbria Partnership Foundation Trust
Can be as much as £250,000-330,000 per family per year……
All of these
families
access
universal
services…
Universal Services1
£0.7bn universal
spend/yr
Education - £580m
Child benefits - £110m
GP/NHS costs - £30m
…and
specialist
services,
(often
repeatedly
for many
years)
Targeted Services2
but family
breakdown
and crises
still leads
to very
poor and
costly
outcomes
Reactive spend3
Children going into care, hoax
fire calls, nuisance behaviour
costs, juvenile criminality costs,
truancy costs, alternative
education costs, vandalism,
evictions due to ASB
Welfare benefits - £750m
Mental health treatment - £20m
Parenting support - £50m
Drug misuse treatment - £10m
£0.8bn
targeted
spend/yr
46,000
families
£2.5bn reactive
spend/yr
NOTE: INDICATIVE COSTS ONLY - do not include costs of
criminal justice services pending further analysis by MoJ.
Multiple funding and accountability structures make coordinating
support for the families with the greatest needs very difficult
Cumbria Partnership Foundation Trust
DfE
HO
LA
MoJ
YJB
Police
VCS
DH
CLG
DWP
CCG
Housing
authorities
JCP
Prisons
YOS worker
Young carer
support worker
Schools
Surestart Children’s
Centre
Intensive family
intervention worker/
parenting practitioner
Police
officer
Family support
workers
CAMHS/
Mental
Health
Worker
Drug
and
alcohol
team
Housing link
worker
Employment
Personal advisers
Families with Multiple Problems
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Cumbria Partnership Foundation Trust
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
What works?
Cumbria Partnership Foundation Trust
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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
RSA: Beyond the Big Society
Psychological Foundations of
Citizenship
Jan 2012
Active 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
Better health outcomes
for children and young people
Cumbria Partnership Foundation Trust
The foundations for virtually every aspect
of human development – physical, intellectual,
and emotional – are laid in early childhood.
(Marmot)
Better health outcomes
for children and young people
Cumbria Partnership Foundation Trust
1.
Children, young people and their families will be at the heart of decisionmaking,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.
Better health outcomes
for children and young people
Cumbria Partnership Foundation Trust
We all have a part to play in promoting the importance of the health of our children
and young people. Through our joint commitment and efforts we are determined to:
• reduce child deaths through evidence based public health measures and by providing the
right care at the right time;
• prevent ill health for children and young people and improve their opportunities for
better long-term health by supporting families to look after their children, when they need
it, 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 and
mental well being and providing early and effective evidence based treatment for those
who need it;
• support and protect the most vulnerable by focusing on the social determinants of health
and providing better support to the groups that have the worst health outcomes;
• provide better care for children and young people with long term conditions and
disability and increase life expectancy of those with life limiting conditions.
Better health outcomes
for children and young people
Cumbria Partnership Foundation Trust
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
Remember:
Cumbria Partnership Foundation Trust
Children’s talent to endure stems from their ignorance of alternatives
May Angelou
We worry about what a child will become tomorrow, yet we forget that he is
someone today.
Stacia Tauscher