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OP37 Narratives of change in children’s services: a qualitative study of action on the socioeconomic determinants of care entry
  1. Davara Bennett,
  2. Ben Barr,
  3. David Taylor-Robinson
  1. Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK


Background Tackling the unsustainable rise in children in out-of-home care is a policy priority in England. There is growing evidence that socioeconomic conditions, including rising child poverty and declining local authority (LA) spend on preventative children’s services, are major drivers of children entering care. Less is known about the status, in policy, of these drivers. Our aim in this study was to elicit LA policymakers’ understanding of the challenges in children’s services over the past decade, and assess how socioeconomic drivers of care entry are considered.

Methods We conducted remote, individual, semi-structured interviews with 15 policymakers across 6 LA children’s services departments in England. Purposive sampling guided recruitment of LAs heterogeneous with respect to geography, size, structure, deprivation, and trends in care entry. Within LAs, snowball sampling was used to reach relevant policymakers. Interviews were recorded, transcribed, and subjected to thematic coding in NVivo. Kingdon’s multiple streams framework guided the grouping of codes, focussing the analysis on problem recognition, policy generation, and politics relating to the socioeconomic drivers of care entry.

Results We recruited participants in a range of strategic roles, from a diverse sample of LAs with varying deprivation levels and care entry trends, across 4 Regions.

In the problem stream, financial pressures affecting service delivery were were explicitly linked to rising care entry. A set of ‘cascading problems’ could be traced back to an implicit ‘source problem’, central government cuts to LAs. In contrast, accounts of the relationship between poverty and care entry were often highly ambivalent.

Policies of decimation, closure, consolidation and targeting of services dominated the policy stream. There were examples of resourcefulness and virtuous investment cycles, but path dependency seemed to stack the deck against LAs struggling to break a vicious cycle of disinvestment in prevention.

In the political stream, participants used soft strategies to influence local leaders, or sought to capitalise on the threat of Ofsted to leverage LA resources. Participants recognised the importance of swings in elections and national mood following high-profile child deaths, but the ‘swinging pendulum’ seemed a force apart, beyond LA control.

Conclusion We identify major challenges to the consideration of policies tackling the socioeconomic determinants of care entry, rooted in each of the problem, policy and political streams. But we also identify opportunities for stronger problem definition, broader strategic policy alliances, and transformation of crises into policy windows. Limitations included recruitment challenges during the pandemic, and participants’ diplomatic reserve.

  • child health inequalities
  • qualitative
  • policy analysis

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