Improved outcomes lead to better life chances and reduce impact on high-cost services later in life – this has been evidenced through numerous scientific analyses on longitudinal studies of children across the world.

Birmingham’s Brighter Futures Transformation programme for services to children, young people and families aims to measurably improve the physical health, behaviour, emotional health, literacy and numeracy, social literacy and job skills of children. As a result, the wider system in which children’s services operate will be transformed - moving from service-led thinking to planning and delivery based on outcomes, children’s needs and evidence-based programmes.

The strategic benefits of transformation will enable the move from reactive to preventative working, and the corresponding shift of resources from high cost specialist services to early intervention that meets the needs of children and young people. Resources will be distributed more efficiently; with preventative and targeted support meeting additional need earlier and significantly reducing the numbers of children with complex needs requiring intensive and expensive specialist services.

Developing the model

The Brighter Futures transformation programme spans over ten years in terms of implementation timescales and fifteen years in terms of full benefit realisation (accumulating as the child grows up). The programme is expected to deliver cashable benefits of approximately £101.2m against an investment of £41.7m.

The financial modelling that has underpinned the development of the Brighter Futures business case has relied heavily in the use of systematic reviews of services/programmes that analyse improvements in life chances during both the 15-year developmental cycle for children but also during their later life developments into adulthood.

The originators of those evidence-based services/programmes are claiming an average cost to benefit ratio of 1:6 (invest a £1 realise a benefit of £6). Scientific research and analysis has established that full benefits are usually realised when children become adults (usually evaluated at the age 28). Furthermore, benefits are realised across a range of agencies, including the police, courts and the criminal justice system.

To address the spread of benefit realisation across time and agencies, we talked to experts that have delivered these services/programmes to develop our understanding on implementation and benefit realisation parameters. As a result, we have applied a cautious cost benefit ratio formula of 1:2.43 and have consulted the leading expert in the world on cost benefit analysis in children’s services (Steve Aos from Washington State Institute for Research) who has validated our approach.

Expanding benefit realisation on the strengths of evidence base

Current organisational structures and arrangements necessitated the development of the Brighter Futures programme to take into consideration benefit realisation exclusively affecting services delivered directly by the local authority, as budgetary control and transformation activity are inherently constrained by organisational arrangements.

This is however an artificially generated view; outcomes and need are shared across all organisations that deliver services to citizens in Birmingham. The attempt of one unit within this wider system to affect improved outcomes and realise benefits is therefore shared to some degree across all units. Besides the logic that drives this argument, all of the research carried out against impact of evidence-based programmes on outcomes and subsequent monetisation of those, has been taking into consideration a whole system approach – the monetary impact across all units.

If we were to accept a straight application of research findings, the Brighter Futures investment of £41.7m will most likely still generate (by applying the original 1:6 ratio) a total potential benefit of £250.2m across Birmingham. This would translate to £149m of monetary benefit additional to the £101.2m already provisioned for the local authority.

Evidence and research seem to suggest that there is a potentially significant opportunity for organisations to develop a common approach in understanding the impact their services will have on outcomes for their population; and attempt to join-up benefit realisation as a result of that activity. The challenge that faces leadership across the wider system relates to understanding the profile of the proposed financial benefit and in developing a system that can help identify the corresponding benefit realisation within its units.

Opportunities for further exploring whole-system benefit realisation

The majority of strategic local partnerships across England and Wales have developed joint visions as a result of their partnership arrangements. In the case of services to children, young people and families, this has been further supported by the statutory requirements placed of Children & Young People Boards. There is still however opportunity for further integration, most notably in developing our understanding of how the wider system of services operates and its impact on outcomes.
New organisational capabilities need to be developed and shared equally amongst the various units that form the system. These could include, but are not limited to:

• Development of a jointly-owned local model of need and service provision, that would allow mapping of outcomes and benefits across the wider system; including multi-level data analysis – by age, gender, ethnicity, school, neighbourhood or by need.
• Consistent and system-wide adoption of evidence-based practice, accessing and using research from around the world to inform design of services that work and are known to have a positive impact on outcomes.
• Consistent and system-wide adoption of service design principles that are common and shared across the wider system.
• Embedded evaluation of services’ impact on outcomes in order to build constantly self-improving services (continuous improvement).
• Development of a jointly-owned system for assessing impact on outcomes of services and of a common mechanism for commissioning and decommissioning services based on evidence and evaluation, aligning resources and leading to pooled budgets for appropriate services.
• Enhanced commissioning, contracting and development of new markets (to include provider development as local partnerships will need providers for radically different services), including building third sector capacity.

Author: Kostas Androulakis