Tom Jefford is CEO of Family Psychology Mutual and GO Lab Fellow of Practice. He was involved in the first children’s SIB in Essex and shares his reflections. This blog responds to an earlier post from Tanya Gillett, giving her perspective of this SIB as a Head of Service at Essex County Council.
I was asked to join the board as Non-Executive Director of the special purpose vehicle created for the SIB which was going to hold the contract between the parties: Essex County Council, Action for Children who were appointed as the provider and investors, co-ordinated by Social Finance.
As the mobilisation began it was clear that the management of the service and the scrutiny under which it would operate would be different to anything I had experienced. The project was building on an evidence based intervention, known as Multi Systemic Therapy (MST) with an edge of care population rather than youth justice.
Success was not guaranteed and the project held risks, yet there were high expectations. Whilst I had great confidence in the model, the new team were not going to produce their best work immediately. They would need to get to grips with a new way of working within an operational system which was in some places ambivalent about this intervention.
An alternative local service had developed into the space which was intended for MST teams. Pressures on social care meant that Essex could not wait for the long promised service so they developed a crisis response adolescent service to reduce demand on care placements. This caused difficulties within the bandwidth of the adolescent service offer and was set to cause long term issues between the two services, requiring careful management to resolve. We had not anticipated a battle between the insider developed service and the externally appointed one.
Holding on to the early anxieties of the board was a challenge I felt was mine to contain. I had discussions regarding child protection and explaining that the threshold for intervention was much higher than the board expected. We discussed risks but it was only later I realised that risk had different meanings for me and the investors. We identified a gap in knowledge and arranged child protection training for the board which was very useful. We also sat with an experienced MST team for the afternoon for their consultation which gave insight into the types of cases with which the Essex MST service engaged.
One safeguard of note was the decision to place a young person in care always remained with Essex social care. Action for Children were paid a fee for service so were paid regardless of outcomes achieved and so perverse incentives were mitigated. If risk demanded it, a care placement would always follow, unhindered by payment issues.
The first four cases entered care. This was an early moment when confidence was shaken and there was a slower than anticipated rate of referrals. The board held its nerve. The system was new, the service was finding its feet. The way forward was to pay attention to the operational system. The SIB Director, working with Action for Children, gradually made progress with the operational leadership and Council teams to generate referrals.
The greatest operational stride forward was probably the introduction of a Programme Manager with a clinical background who could support both the MST teams and the operational system to find the most effective means of managing the throughput of appropriate cases. As social workers changed, the system had to be refreshed so that the service was well known an understood.
There were innovations such as a ‘therapist in waiting’ that was created to reduce the void period between MST therapist staff as they turned over. Whilst not a perfect solution it significantly foreshortened the period with reduced staff capacity and helped the stability of the teams. In my view, a private sector solution to a public sector problem.
What impressed me more than anything was the rigour and attention paid to performance management by the board which was unlike anything that I had seen in the public sector. The project was never allowed to drift and interest never waned. As capital was at risk the investors were as interested on day one as they were at the end of the 5 year operational period. The focus on outcomes for young people and families was resolute and the feet of all parties were kept to the fire throughout.
The eventual success in exceeding the target of opened cases (388 families over five years) was achieved through the determination of the board to manage the system strongly and effectively. This included a robust staff retention policy right throughout to ensure viable capacity was secured. Data was driving performance management as well as attention to relational and contractual aspects. The board remained engaged and consistent throughout which I consider to have been a hidden strength. They showed admiration for the efforts of the MST teams and were genuine in their desire to reward and thank them.
From my perspective this contract was not the baby of Essex County Council leadership team but was managed efficiently with good grace by senior and operational leaders. However, in my view it was neither coveted nor celebrated as it might have been, not least as it was successful in achieving the stated outcomes. Essex has made great progress in their children’s social care over five years but this was in parallel to the MST teams.
An odd quirk of how the money flowed is that in the initial period Essex paid nothing so the service felt ‘free’. However as outcomes were achieved as cases closed the money began to be paid out at a rate which certainly piqued Essex’s interest until the payment cap was reached. Beyond this cap, only when high achievement of outcomes was reached, Essex continued to gain efficiencies at no cost to themselves. There were also expressed concerns of rigidity of the MST model although I would contend that it largely achieved what it said on the tin.
There are many perspectives on this SIB and lessons for those which will come after. I think it was less about money and more about performance management. It was less about the terms of the contract and more about relationships between parties to solve problems and resolve differences. The stability of the investors, Social Finance and the board chair coupled with their determination to see this through made a difference too.
My own learning has been immense and I hope I have maintained balance between public and private sector. It encouraged me and gave me confidence to follow a different career path towards a social enterprise underpinned by social investment. Evidence based practices such as MST get mixed reviews across the spectrum. However, the outcomes achieved are by any objective measure, substantial and that is the prize which was reached for families, for Essex and for the investors after the considerable efforts of many.