3. Three Areas of Efficiency

In the public sector the word ‘efficiency’ has been devalued. Politicians regularly talk about efficiency as an alternative to ‘cuts’. Generally the promise outstrips the reality.

In business, efficiency is routine. A good business will continually look to deliver more product at the same cost, or the same volume of product at less cost. Annual efficiencies of less than 5% are frowned upon. Some businesses, Tesco and Toyota for example, have established reputations for their methods for finding efficiency. Kamban, an approach honed by Taiichi Ohno, is one of the core components of Toyota’s 50-year rise from sewing machine manufacturer to the world’s largest car producer. There is similar potential in the world of children’s services, as illustrated by the following three examples.
 
The hardest of the three is to shift resources from treatment or intervention to prevention or early intervention. Heavy-end need like conduct disorder or depression and chronic risks such as severe violence in the home greatly exceed the supply of services. For every young person in custody there will be another 40 with a conduct disorder not locked up and probably not even on the radar of children’s services. It is impossible to meet existing need with existing provision. It is also difficult to prevent high-end problems, but the ratio of success to failure will be better than trying to deal with a high-end problem once it occurs. Plus, the same money spent on prevention will buy help for more people, which helps from a political standpoint. A little easier, although not straightforward, is to find efficiencies in the referral process. Families needing help turn to schools, doctors, social workers or police officers. Education, health, social care and the police then spend a lot of time talking to one another in order to work out who should take responsibility. In most cases, no help is offered. It is a hopelessly inefficient system that causes much frustration for staff and disappointment for families. Application of the Toyota ‘Just in Time’ methodology would produce huge efficiencies. It would require workers to examine the referral process, ask what it is intended to achieve, examine why it is designed as it is, and then get it to do those things better, more quickly and with less resource. A local authority wanting to take a radical approach might turn the whole system on its head. Instead of waiting for people to knock on the door for help, education, health, social care and the police could screen a population to select families who can most benefit from support. This becomes a more attractive proposition when one reads the results of evaluations by Tom Dishion about how feedback to families on their child’s well-being improves that well-being. It is like going to the dentist for a check-up.
 
In the months following an encounter with a hygienist we brush and floss with enthusiasm. After two or three months we are less keen, but regular check-ups revitalise the process. The easiest route to efficiency, which is more or less ignored by most children’s services, is to get smarter in responding to the ‘heavy end’. Children in state care, in the youth justice system, flagged as being at highest risk of child maltreatment or with multiple special education needs have the capacity to soak up the most resource. They demand the most evidence-based approaches - those interventions most likely to produce a good outcome in the most cost-beneficial way. There are plenty of examples from which to choose. Nurse Family Partnership. Functional Family Therapy. Multi-systemic Treatment. Multi-dimensional Treatment Foster Care. KEEP, a training programme for foster carers. We could go on. Each is an example of a programme that will deliver better outcomes for a reasonable proportion of children and that will produce financial benefits greater than the costs of delivering the intervention. But for some reason, for the most part we ignore the 'what works' evidence and keep on ploughing scarce resources into traditional policies and practices that might or might not work, and may even do some harm.