Ofsted Talks

Host Mark Leech listens in to Lisa Pascoe, deputy director (regulation and social care policy), Helen Humphries (specialist adviser for residential care) and Jenny Bird (research lead) as they discuss the findings from our recent research report ‘Good decisions: children with complex needs in children’s homes’.

Read the report 'Good decisions: children with complex needs in children's homes'

Read the blogs:

Providing good experiences for children with complex needs

Children with complex needs in children's homes

Transcript

Mark: Hello and welcome to Ofsted Talks. My name is Mark Leech, and in this episode, we're going to be hearing about children with complex needs and what that means to local authorities, children's services and those working with children who live in children's homes. Earlier this year, we published a research report called good decisions children with complex needs in children's homes, and I listened in to colleagues from our social care policy and research teams as they discussed the findings.

Lisa: I'm Lisa Pascoe. I'm the Deputy Director here at Ofsted with responsibility for regulation and social care policy and I'm joined today by Helen, our specialist advisor for residential care, and Jenny, our research lead. Jenny, let's start with you. It would be really helpful to set out for people why we did this research.

Jenny: Yeah, absolutely. So, it follows on really from a piece we'd done previously, which was looking at local authorities plans for sufficiency. And from that piece of work, we could see that local authorities were really struggling to find supportive homes for children who have complex needs. So we wanted to look at that even more. We knew as well that stakeholders were concerned about children's homes not accepting referrals for children with complex needs. We'd heard some things about them holding out for children who present fewer risks and, sort of preferring to take referrals for those children. And we heard as well about some concerns around the potential impact it could have on Ofsted inspections. So we really wanted this research to look into that further and to highlight good practice that was already out there, as well as the challenges that still exist, and what action could potentially be taken, either across the sector or by ourselves.

Lisa: So how did we make it work? Jenny, what did we actually do?

Jenny: So we used a two-phase design in this research. We started off at the start of 2023 with a survey that went out to all local authority Children's Services and all registered children's homes, and we asked them things like what they think complex needs means, what happens when they try to find places or are approached with a referral, and what the facilitators and the barriers are to finding good homes for children.

Lisa: If I remember rightly, Jenny, didn't we publish something after phase one?

Jenny: We did, yeah. We published a blog in around May time to highlight the findings of that survey in more detail.

Lisa: And then we moved into phase two.

Jenny: We did, yeah. So that built on phase one, and it was made up of two parts. The main bulk of the work was case studies. We'd completed 10 case studies, which we identified through working with three different local authorities across two regions. And in those we spoke to people who were involved in making decisions about children's care or in providing the care itself, as well as children. To supplement those, we also ran some focus groups with other groups of professionals who are involved in the care of children with complex needs. So that was people from the Association for Virtual School Heads, as well as staff who work in local authority commissioning. And we also held a focus group with some of our own Ofsted inspectors as well to talk about how they experience inspections when they're going to homes where children with complex needs are living.

Lisa: I think one of the things, Helen, was about this use of the phrase complex needs, wasn't it? I mean, it camouflages what's actually happening for children.

Helen: Yes, it's a global term that I think is on unhelpful and categorizes children into this uncertainty which is complex needs, instead of actually saying this child's particular need is related to their mental health, or, because of that this is what happens and this is how their behaviour is demonstrated. It just draws children into a classification that actually isn't helpful and we'd really prefer not to have that phrase bandied about and used so much.

Lisa: Yeah, I mean, I think there was some common themes. Weren't there. There were certainly children who needed help from a variety of professionals. They needed specialist help from, you know, from health services. They needed specialist input and there was certainly some common kind of characteristics of the children Jenny, as well wasn't there in terms of children, particularly children with serious mental health needs, but also children who had needs that led to behaviours that were placing either themselves or others at risk? There was certainly some commonality there, but I think as an umbrella, it certainly masked what was actually happening for children, rather than thinking about them as individuals.

Helen: Yes, I think it stops professionals looking any further. And I would imagine that if a children's home received a referral that just described the child as having complex needs, that might be straight away, this isn't a child we can help, rather than actually looking underneath that and saying, well, actually, what are these children's needs? Is there something here that we can provide some help and support to?

Lisa: one of the things we weren't surprised at, sadly, was that there was 91% I think it was Jenny of local authorities that had difficulty finding the right homes for children.

Helen: Because of that, some children are waiting months, or in one of the examples given, they were waiting years to find that placement that could actually meet their needs, which meant that they were then moved through a variety of placements, and to a large extent, that could have made the situation and the challenges even worse.

Lisa: absolutely, and we certainly found that these were the children who were most likely to be placed out of area weren't they? As you say, Helen, experienced those unplanned moves. You're absolutely right. When children's homes were looking at those referrals, the fact they'd had those unplanned moves sort of became a bit of a self-fulfilling prophecy, and how difficult it then became to find the right place for them.

Helen: yeah, absolutely. I mean, you can't imagine what it must be like for a child living in a children's home knowing that any day, any moment, they could receive the information that they are then moving again and how that, you know, how that must make them feel.

Lisa : And, we certainly heard quite a lot from commissioners, didn't we, about how challenging it was for them to negotiate what they needed. We heard examples of bidding wars with other local authorities, about having to purchase beds in advance, sometimes buying more beds than they needed to try and secure a placement. There was a whole range of experiences from commissioners about the difficulties that they felt. But I think we must sort of counteract that with the other side as well, in terms of what the managers were telling us about the quality of the information that they got.

Helen: That's right. And when we started to look at the things and some of the factors that means that placements work? Well, it was definitely around honest communication between the local authority and the home, and with providers saying that if it was an honest referral, that actually was far better. And, that children's homes and commissioners who had built up honest, trusting relationships so that a manager of a children's home could read a referral and be confident that this was all the information that they needed, and that none of it had been exaggerated or none of it had been redacted, meant they had confidence in accepting that referral. But, also the commissioner had confidence in making that referral, that there was a likelihood that the children's home would be able to say yes, and would be honestly, be able to say yes we think we can possibly care for this child. So there was definitely, definitely something about building up honest and trusting relationships

Lisa: And as well as the referrals, it was really clear how the statement of purpose was quite important to commissioners as well, wasn't it?

Helen: Absolutely and the statement of purpose needs to clearly set out what a home can do so that the commissioners can place confidently and that placements are less likely to break down. And the and the other thing that became clear was that building on the notion of the positive and trusting relationship is that children's homes felt more confident in taking children who had a range of difficulties that they then weren't going to be sort of left with the child. That the local authority would continue to be involved in the child's life, that they would support partnership working, that they would they would support the placement, perhaps by adding in things and putting them in touch with other professionals who could support the placement. So that it really was a true partnership, and not a feeling that, well, you've got the child now, you just need to get on with it, and so that it was far more positive, far more positive outcomes.

Lisa: And that right educational placement was something else that supported stability, wasn't it?

Helen: Absolutely so that children feel more settled because they're going to school, but also that the school feels that they're working again, in partnership with the children's home and with the local authority as well. And there was also something about how the children's home had accepted the referral. They'd gone more than just reading the referral, they talked to people who knew the child well, and very often, that's when the child comes to life. Really, it's not in a written referral, it's about talking to the adults and professionals who've been involved in those children's lives can actually then bring that child to life and helps the children's home in making those decisions.

Lisa: I mean, it was great to see so much that was working well and some of those things felt relatively simple to put in place, didn't they that quality relationships with staff? I mean, that's a consistent theme for us in inspection, isn't it that we know that that's what makes the difference for children. But there are some things that worried us Helen weren't there?

Helen: Certainly, yes, absolutely. And I mean, this isn't new. This isn't a new story. We've talked about this before. We do remain concerned about the increasing number of children on orders that deprive them of their liberty. The numbers are just increasing at an alarming rate, and this really does worry us. We want to try and get underneath some of this and really understand why there's been this rapid increase of the number of children on orders. We worry again about the use of unregistered provision, particularly for children who are on those on those orders, and because actually, who's got eyes on those, on those children?

We also worry that, and we're not clear that high staff ratios always helps children in a positive way. It must feel very unnatural for a child living on their own in a small children's home then to be surrounded by four, five, we've even heard of eight members of staff, and how actually does that support children to develop their skills and their strategies in order to go forward in their adult lives. And then, just some very practical situations, where, how can a child go to the supermarket and buy food when they're surrounded by eight adults. Or how can they go out and access activities if they've if it's been determined that they need five members of staff with them at any one time, how can you go out to the to the cinema or go and do bowling, if it means that not everybody can go, because actually you can't get six members of staff in and a child in a car. So, there's some worries, there's some practical challenges, and we also worry about children in solo homes. There may be appropriate times that where a child needs to live on their own because they actually can't interact and manage to live with other children. But should that be their long term solution? Does that prepare them, then for when they move into supported accommodation, when they become when they become older? So yeah, that we retain these worries, which I know not only we have, but other organizations as well.

Lisa: Yeah, and in that unregistered children's home space, I mean, obviously, you know, we're very close to that, but commissioners are telling us that they're being forced to use those placements that they don't want to use because they can't find the right place so they can't find registered provision can they that want to offer services to these to some of these children.

Helen: That’s right and then we worry, why would the unregistered placement take the child if a registered children's home won't take the child?

Lisa: Yeah, and we also, I mean, we know, across the sector, don't we, that there's challenges in recruiting and retaining staff, and we've been talking about this for some time now, haven't we?

Yeah, the turnover, the vacancy rate for children's home managers, you know, it's really high. It's about 12% isn't it, of children's homes that don't have a manager in place that's registered, and that has got to leave a gap for children, hasn't it?

Helen: Absolutely, and the churn of staff in children's homes as well. We always know, and it's always been a challenging role, a challenging job to work in children's homes, but the churn of staff turnover is much higher than it's ever been. And providers do talk to us and do comment how difficult it is to recruit staff who want to do this work and are willing to stay and maintain those because we also know that one of the most important factors of making placements work is the relationship between staff and children, and if there's a permanent churn within the staff team, then that is extremely difficult to manage.

Lisa: Yeah, it's almost like these worries and concerns are sort of the flip side of the things that can go well, aren't they, because, you know, the same point about finding the right educational placement for children. You know, we've said, haven't we, that that's one of the things that creates stability. But we know that for some of these children, finding and maintaining a school placement is really difficult. We know that some academies are reluctant to offer places to some of these children, and all of these things make it much more difficult. I think one of the virtual school head teachers described it as being like waiting for the stars to align, to get the education and the home together.

Helen: Yeah, absolutely, it must be incredibly challenging.

Helen: but we remain anxious about comments that continually appear that homes are reluctant to take children with a range of needs because it will affect their inspection judgments. And this is something that has worried us for a number of years now and we still try to understand what we can do in respect of that, to try and get underneath that statement.

Lisa: yeah, and it feels very real to the sector. And so, you know, we can't ignore that, can we, you know. So it's really important that if people think our approach is unfair or, overly risk averse, and that's certainly something, again, that I've heard from people, then then tell us. You know, talk to your inspector, people you know. If that doesn't feel comfortable, then Helen, I really hope people do come and talk to, you know, inspection managers. You know, there is a process there that people can use to speak to us if they think we're not landing our inspection in the right place.

I know that when we've looked at the grade profiles, it's really hard to get underneath this, isn't it, because there's nothing we can see in the grade profile that supports it. But I go back to if this is how people experience it, we just can't ignore it. Can we?

Helen: We can't ignore it. There has to be something there that we're not quite getting, although our evidence is that we can't find examples of where if a home has taken a child with a range of needs that has affected their grade profile. The worry is, I think, that people think it might so therefore don't take the chance on taking the child. So, we really, really do need to any information that will help us to understand that better than we want to listen.

Lisa: And it is, we know, that there's no such thing as a perfect placement. We also know that children who have experienced trauma and abuse and neglect, you know, their progress isn't going to be linear. It isn't going to be straightforward. They live in sort of a risk environment all the time, and children's homes are constantly, aren't they, managing and reassessing that risk? And that's why, you know for us, inspection has got to focus on yes, are these children making progress, but it's also about what's the quality of their day to day experience. Is this a staff team that are sticking with this child despite everything that that's difficult and challenging, staying with them, doing all the right things, trying to improve their lives, trying to help them, you know, feel secure and have that sense of belonging so that they can start to make progress. I mean, that feels really important to me. You know that they're the messages that our inspectors have, and that's our expectation of what inspections should look like.

Helen: Yes, because we know that if children are receiving positive experiences from staff who are interested in them and they've got good relationships with them, then progress follows on from that. But, for children with a whole range of needs, that progress will move about and how they interact with staff will change and be difficult. And it's those placements that stick with children, against all those adverse actions, that then often comes through at the end and children start then to make progress.

Lisa: Yeah, in summary, really, I think we think complex isn't that helpful of a term. It camouflages a lot of what's going on. We should really focus on children's strengths and be honest about their needs, that people can do the right thing.

I genuinely think it's really important that we see residential care as a positive option for some children, because it can be, and it is, and it does make a difference, and it's really right. You know, when we see local authorities wrapping services around residential care, it can make a real difference. That multidisciplinary approach from health services, education services and care services, when everybody's doing all the best possible jobs they can for children with these multiple needs, it really can and does make such a difference.

I really want to be really clear that we want to address homes concerns and reassure them, that we really do want to focus on the progress and experiences that children make, and we do understand that people are working with risk on a daily basis.

In terms of what we've done, we have got a priority application process for homes caring for children on deprivation of liberty orders. We did publish some guidance, probably about October, November last year, making our position around the legalities around registration and deprivation of liberty really clear. And our social care common inspection framework, we continue to make adaptations to that, and we made some last year, just to keep you know making this point as clear as we can, that we really want homes to work with children with multiple needs. We really want you to stick with children, and that's what we really want to see through those progress and experiences.

Mark: Thank you, Jenny, Lisa and Helen. That was very interesting. And if you enjoyed this episode and you don't want to miss the next one, please don't forget to like and subscribe wherever you get your podcasts.

Jenny : If you are interested in reading the full research report called good decisions children with complex needs in children's homes, you can find it on the Ofsted website. On the website, you can also find other publications about this research, which is the blog outlining the findings from the survey, and a new blog post highlighting the areas of good practice we saw in the case studies.