How can councils help recruit more foster carers and adoptive parents?

What can councils do to help children waiting for adoption find a new home? Photograph: Tim Gainey / Alamy/Alamy

In May, the Fostering Network forecast that 9,000 new fostering families would be needed over the coming year and in January the Department for Education estimated that 4,600 children were waiting for adoption in March 2012.

Through various initiatives, central and local government have made some positive progress in this area and in April the association of directors of children's services pointed to a 45% increase in adoption placements over the year to March 2013.

However, the reality is that the number of children requiring foster care or adoption continues to grow and budgets continue to shrink. The government's recent one-off £150m adoption reform grant is clearly helping to reduce the adoption "backlog" this year, but what of next year and thereafter? How can councils find enough placements to provide for children in the future?

I believe the answer lies in recognising the "customer" aspect of fostering and adoption services and reforming the service accordingly. In other words, services must become better at knowing what turns a prospective foster carer or adopter on or off and responding to those needs.

After doing work with a number of councils, the Department for Education and the Fostering Network, I am convinced things are now moving in the right direction.

The relationship between fostering and adoption teams and those applying and approved to be foster carers or adopters is a deeply human one, with a unique and complex mix of compliance, assurance and customer service. Improving these relationships is central to finding more loving homes for vulnerable children.

To aid this, we help teams understand what their current and future foster carers and adopters want and their values. We surveyed foster carers, asking questions like: are you looking for rules and belonging, for example? Or outward indicators of success? Or do you have another goal?

We use a values segmentation system, a way of categorising groups according to their values, to show what motivations are driving these customers and how they are best engaged. When this is combined with local feedback about a service, it is hugely powerful.

During our research, we found that up to 80% of foster carers we spoke to – compared to a national average of 40% – have a specific set of common values which is characterised by the need and confidence to help the local community.

They want to help recruit and support other foster carers for instance. What they value most highly is advocacy and support from other foster carers. Pioneers don't want a big book to read or an impersonal edict to follow, they look for questions and discussion. A lot of them believe they can cope with whatever comes their way.

This tells us much about how services can attract and support these people. Since then, colleagues in local government have been working hard to turn this insight into practical improvements.

From recruitment methods and messages to the way in which support is provided, this simple piece of insight helps provide a completely new perspective on how to allocate resources.

The government's analysis of the adoption challenge includes a specific reference to gaining greater "customer insight" and these findings demonstrate what an opportunity this presents.

Whitehall has set out clear expectations on the nature and scale of change needed in adoption and has provided funding to support it. It is now up to councils to take up the challenge and reach out for new and different thinking. I believe this must start with a better understanding of customers and will only end with improved relationships.

Jeremy Cooper is director at Impower.

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Councils are developing coherent, long-term public health strategies

Local authorities can now relate to the Beatles' Ringo Starr when he sang 'How do I feel by the end of the day?' Photograph: Jon Super/AP

Now councils have a major new role in public health, they once again have the chance, as Ringo Starr didn't quite put it, to help their residents feel better at the end of the day.

The report I have written for Localis clearly shows councils exploring new and innovative ways to tackle the wider social, cultural and environmental determinants of health, following April's switch of £2.7bn of public health funding from NHS control to the hands of local authorities. New health and wellbeing boards were created, enhancing the role of councils in the planning and oversight of all local health services.

With NHS acute treatment costs on a seemingly unsustainable, upwards trajectory, this shift in emphasis towards prevention and tackling the "causes of the causes" of poor health could not be more timely.

Housing, transport, children's services, leisure services and employment (among others) have all been demonstrably linked to health outcomes. It is refreshing, then, to see councils showing real innovation in pushing through short-term public health projects with the potential to deliver instant benefits. Barnet borough council told us that this year it has rolled out green gyms, "forging a closer integration between public health and leisure providers".

Alongside such "quick wins", it is inspiring to see councils developing coherent, long-term public health strategies. A mass of evidence links employment to a person's health and wellbeing, and Kent county council's long-running apprenticeships programme offers businesses grants of up to £2,000 to take on an unemployed 18-24 year-old as an apprentice.

Critics argue that the £2.7bn public health budget transferred to local authority could prove a little leaky, accusing councils of using the money to fill in holes in their budgets. But as Public Health England chief executive Duncan Selbie rightly observes, "ultimately these are local decisions".

Selbie is right to caution, however, that this approach should not be taken too far, offering reassurance that if money was spent on things "completely outside any reasonable view about what constitutes health then of course we'd have to be addressing that".

And where existing, traditional public health themes are demonstrably working, councils are continuing to support such measures. Persistent problems like smoking cessation, healthy eating, drugs, alcohol services and sexual health, are – quite rightly – still absorbing the overwhelming majority of public health budgets.

The return of public health responsibilities to the town hall is a golden opportunity to do things differently. But, crucially, restoring public health to the heart of local government requires fostering links and synergies with wider local government functions.

And to do this, councils will need more than a little help from their friends.

Gwilym Tudor Jones is a research fellow at thinktank Localis.

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Councils need to build on their successes in integrated health care

A new report assesses joined-up health and social care and local government's growing role in providing such services. Photograph: Shannon Fagan/Getty Images

Another week, and another report provides a reminder of how local government is changing. The report In Sickness and in Health from the independent thinktank Localis reflects the growing recognition of local government's role – working hand-in-hand with health commissioners, healthcare providers and local communities – in driving better health outcomes.

However, the report also recognises many of the difficulties faced by those responsible for making this work in practice. To understand the opportunities and the challenges involved, it is important to understand the broader context within which these changes are happening.

Well over a year since Barnet's "graph of doom", councils face a further round of budget cuts and council tax freezes. Meanwhile, as demands on local health and social services grow, so do questions about whether patients and service users are receiving the quality of care they deserve.

Not surprisingly, the mantra that only radical transformation will do has become the meme of public service reform, echoing around council chambers, conference halls and management boards. But talk to those at the frontline and there are few better places to start than the interfaces – or, perhaps more accurately, the gaps – around how care is delivered.

The concept of better co-ordinated services, centred on the needs of individuals, isn't new. The Local Government Association suggested that rolling out whole place community budgets could save between £9bn and £21bn over five years. The fund for joint NHS and local authority commissioning is set to be £3.8bn by 2015-16. And there is comfort in what one Localis researcher, Gwilym Tudor, Jones said earlier this year about the "near feverish excitement" around uniting health and social care services. But questions remain as to why it has taken so long already and what will happen next.

The story of health and social care in England is often written as one of crisis, but it's important to remember how much of this is driven by another story – one of success.

Between 2001-02 and 2011-12 net NHS expenditure increased from £49bn to £104bn.At the same time, gross expenditure on adult social care increased to £17bn, a 33% rise over the same period.

The benefit of bringing these services together is an area of almost complete political agreement. But the reality is that the closer we get to integration, the clearer both the opportunities and challenges become.

Take away considerations of politics and funding and we are still left with organisations with cultures, practices and infrastructure that are as separate as their objectives are shared.

Health and wellbeing boards will be crucial to fixing this, providing the one vital place where the right people come together with a view across the whole and the remit to make change.

This summer saw the launch of the Local Government Association's support for health and wellbeing boards seeking to integrate care at scale. Working with partners, including NHS England, Monitor, the Department of Health and Integrating Care, this is about providing practical help to identify opportunities, overcome barriers and implement the new models of working that promise the biggest improvements for service users and organisations alike.

At the heart of the association's work is the recognition that many local authorities and their partners have already made good progress in bringing together services. Learning from what has been achieved, and making it the norm, is our best chance of meeting the challenges ahead.

Simon Morioka is managing director at PPL and senior adviser at Integrating Care.

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Councils must face difficult decisions on NHS with leadership, not hyperbole

Councils are becoming increasingly aggressive in their opposition to hospital trust moves such as changing an accident and emergency unit. Photograph: Leon Neal/AFP/Getty Images

Councils are becoming increasingly aggressive in their opposition to hospital trust moves, such as changing an accident and emergency unit into a more modest urgent care centre.

In the high court, Lewisham council won a major victory, blocking changes to their local hospital that were part of a plan to save the imploding South London Healthcare Trust.

In west London, Ealing is objecting to changes to A&E services, while down the M4 Windsor and Maidenhead is fighting a plan to move a minor injuries unit to Bracknell and close a birth unit. Trafford council has voted unanimously to fight the closure of the A&E unit at Trafford general hospital, which at peak times see seven patients an hour according to the Department of Health, and expand services nearby.

Councils are taking these actions while they themselves are making similar difficult decisions – closing, downgrading or sharing services, and sometimes handing them over to someone who is doing it better – such as Hampshire county council taking over Isle of Wight's children's services. Is there a whiff of hypocrisy?

Local governments scrutiny of the NHS is often the service's only effective democratic oversight. Foundation trusts have a fig leaf of public accountability through their membership schemes, but there are few trusts who can seriously claim members make much difference.

But councils' local mandate should not be an excuse for hysterical overstatement about what is being proposed. When the high court blocked Ealing's attempt to judicially review the west London accident and emergency reorganisation the council described the GP-led plans as "monstrous", with leader Julian Bell claiming: "The NHS want to treat the people of Ealing as guinea pigs in the largest experiment in its history".

This sort of hyperbole is irresponsible. Spreading the idea that the NHS wants to treat an entire borough's residents in such a way is itself monstrous. It crudely plays on the fears of local people and obliterates the chance of an intelligent discussion about what is being proposed.

Ealing has faced its own tough decisions, such as changes to its services for people with learning disabilities. Surely it must know that everyone loses when debate around reforming – and sometimes simply closing – public services is reduced to invective.

Of course, councils cannot simply abdicate taking a position on something of such profound local interest. On the contrary, if community leadership is to mean anything, it needs to be a vigorous participant in the debate.

But that means actually leading, not unthinkingly following the gut reaction to oppose. It is now clear from Local Government Association analysis that the 2015-16 spending review has left councils facing cuts of up to another 16% – not the 10% that the government stated. If anyone has a vested interest in raising the quality of public debate about how to manage cuts in public services it is local government.

When it comes to their own services, councils are demonstrating a willingness to look at a radical solutions which can offer residents a better service for less money. Trafford is one of them – leading the way in redesigning adult services by championing reablement.

Councils have a duty to scrutinise, question and debate reforms to local health services. Sometimes those proposals will be found wanting – as Lewisham demonstrated. But dogmatic defence of the status quo in defiance of the best long-term interests of patients is a serious error of judgement, even if it may be superficially and tactically appealing.

These difficult discussions between councils and the NHS will be a major feature of local government for the next decade. Attempting to drag proposals through judicial review cannot be the default response. Where that happens it is an indication of failure on both sides. There are numerous examples of where councils and local NHS services have collaborated effectively to make the right, difficult decision.

As the community leaders, councils must be in at the beginning of these debates – helping shape them, questioning them, but also accepting where the evidence leads, and having the courage to support the outcome.

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