PhD Studentship: The Right Child in the Right Place

Reducing the use, and cost, of inappropriate placements for Plymouth’s looked-after children

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Background

There is a national shortage of foster carers as new carers are not being recruited at the same rate as those who are leaving, resulting in looked-after children being placed far from home with many local authorities paying exorbitant costs for their care.1 More than a fifth of all looked after children in England are now living more than 20 miles from home, a rise of 62% since 2013.2 A recent Barnardo’s report3 documented the decline being due to “the impact of the pandemic, the cost of living crisis, biological children staying at home for longer and spare rooms being used as home offices”.4 In addition to personal reasons deterrents from becoming foster carers included not being able to afford to and not having suitable accommodation.3 The declining number of foster care places means that more children are being placed in private care, often at a distance from their family, siblings and community, and at a considerably increased cost. Children living far away are likely to have more complicated and fragmented histories and there can be legitimate reasons for a distant placement – e.g., to keep a child safe from exploitation. Against this, being moved can disrupt a child’s education, life outcomes and relationships – including with brothers and sisters who might live miles away. Disconnection from their local community increases risks of feeling lonely, isolated and stigmatised – creating additional trauma for children who have already had difficult upbringings.
The decreased number of foster care placements means that children whose needs could be met within a budget of around £1000 a week are being placed in private care places designed for more complex needs which cost around £6000 a week per child in a group residential home, around £12 00 a week for an individual placement and £9 800 a week for a 28 day respite/breaker placement. Retainers which were previously charged at 50% are now being charged at 100% due to the high demand across Local Authorities.
In 2023, 25% of the 500 children under the case of Plymouth City Council (PCC) were placed over 20 miles from home, compared to a national average of 21%.5 On 30 September 2024 there were 517 children in the care of Plymouth City Council of which only 356 (68.9%) were in foster placements.6 The Children, Young People and Families (CYP&F) Directorate of Plymouth City Council have the highest level of statutory requirements in the Local Authority, making innovation particularly challenging during a climate of increasing austerity. The majority of their work focuses on children identified as being in need, protection plans and those in care and accounts for 29% of the overall PCC revenue budget. In a recent research prioritisation process undertaken by PHDRC (see below) addressing this issue of ‘more appropriate placements’ and ‘reduction in associated overspend’ was prioritised as the most important research issue for Plymouth City Council.
Plymouth City Council have undertaken a substantial review of the situation, the challenges and opportunities, to support achieving their Children and Young People’s Plan for the city7 which is summarised in their ‘Homes for our Children and Young People’6 report which they have kindly shared with us ahead of publication. Some initiatives are already underway including enhanced payment for foster carers, use of the ‘Mockingbird’ technique where more experienced foster carers support newer ones, a strategic collaboration to encourage and support foster care across the region and encouraging private care organisations to deliver care in the city (reducing associated travel and subsistence costs for social workers and families and retaining and strengthening local ties). Other initiatives have been identified and are in the early stages such as the setting up of homes run in and by the city and further needs have been pinpointed for which solutions are yet to be identified, particularly for children with higher level more complex needs. This review was heavily informed by listening to the needs of Children and Young People who contributed their experiences of being placed away from Plymouth. In addressing their financial issues and statutory responsibilities PCC does not have the resource to undertake substantive research on evidence informed potential solutions to the issues identified or to evaluate those being implemented.
 

Research question:

How can Plymouth City Council, and other Local Authorities, place ‘the right child in the right place’ to provide the best possible local care and reduce unsustainable costs?

Aims:

1. Conduct a Realist Synthesis of what has, and hasn’t, worked in other areas to produce evidence informed solutions for the areas where these have not yet been identified in the ‘Homes for our children and Young People’ report.6
2. Develop a ‘Programme Theory’ of how Plymouth City Council intend to reduce both out of area and institutional care for looked-after children and reduce associated inappropriate spending.
3. Conduct a Realist Evaluation of Plymouth City Council’s innovations for looked-after children.
4. Feedback local learning and generate recommendations with national applicability.
 

Methodology

The issue under study is a complex problem, as defined by the Medical Research Council, consisting of a series of interventions with interacting components.8 The greatest challenge for such studies is to make them simple enough to study, without loosing the richness and value added of their component parts. This will be achieved by breaking down the study into the four overlapping, but sequential, aims and making the ‘unit of study’ the individual looked after children rather than the services, reinforcing a focus on their needs. A Realist Evaluation methodology will be employed to seek to understand not only ‘if’ something is working how it does so. Realist Evaluation seeks to produce applicable findings that will make a difference in the real world through a process of progressively reducing uncertainty and establishing ‘Who, When, What , Why and Where’ something is working, rather than presuming because an intervention has worked once it will do so in another place and time.9,10
  • Conduct a ‘Realist synthesis’ (academic literature, grey literature, case studies; supplementing with case study based interviews where no published literature exists) to interrogate what has and hasn’t worked in other settings (UK and abroad) to address the service needs identified in the ‘Homes for our Children and Young People’ report (Aim 1). The findings will be fed back to and discussed with PCC staff and commissioners, to gain their perspective on their applicability to Plymouth and inform their practice and delivery (Aim 4).
  • Undertake documentary review, realist (theory building) interviews and field visits to develop a ‘Programme Theory’ or ‘Theory of Change’, and associated logic model, to explain how a programme of interventions are understood to contribute to a chain of results that produce the intended or actual impacts (Aim 2).
  • Carry out a Realist Evaluation, informed by the ‘Programme Theory’, of what parts and/or combinations of the component interventions are ‘working’ for ‘Who, When, What, Why and Where’. Data collection will include realist interviews with commissioners, practitioners and children, young people and their families, field observations of service delivery, documentary analysis of council reports and other documents and financial costs data. Data collection may also extended into innovations and service developments which are aimed at preventing children becoming formally looked after by Plymouth City Council, such as support for kinship care arrangements. The analysis process will not only consider what is working well, but what is not working so well and why and will be sensitive to unanticipated consequences. (Aim 3).
  • Feedback and discuss findings to inform local service development and decision making throughout. Discussions, including focused workshops, will be used to gain a more nuanced understanding of the findings and their applicability. This will help to develop recommendations not only for local application but also for areas throughout the country working towards similar aims and challenges. (Aim 4).
While carrying out the more formal research methods the student will also be exploring, testing and developing the best ways to work with a Local Authority Directorate who have a high level of statutory responsibilities in a context of increasing austerity, building on CPCRG and PHDRC’s knowledge and experience of embedded research.11 This, subsidiary, work will be recorded in a reflexive fieldwork diary which will be used to produce guidance for others working in similar areas, particularly in other HDRCs.
 

Timeline

Timetable
The writing of the PhD will be undertaken throughout.

Relevance and significance

This studentship proposal will produce high impact, high quality academic publications of national significance because it is addressing an area of high national need, producing not only cost saving but also care improving recommendations in a field which usually has little time or resource to find evidence based solutions and evaluate them.
The research topic has been prioritised not from a desk based exercise but by the service itself. They have demonstrated their ongoing commitment not only to interact with the results of the research but also to facilitate access to data and people, activities and relationship building that can often take up much of the first year of a PhD student’s time, leaving more time towards the end of the PhD for dissemination. The commitment of Plymouth City Council has already been demonstrated not only in the joint funding but also the list of other support detailed in the application and their willingness to trust the Supervisory team with operationally sensitive data (understandably not shared here) and to allow us to refer to documents before they are publicly available. This ongoing commitment will not only to allow access to data but also to work towards implementing the findings mean that this studentship is likely to produce outputs suitable for a REF Impact case study in the future, either on it’s own or as part of a wider PHDRC submission.
The national roll out of National Institute of Health Research (NIHR) Health Determinants Research Collaborations,12 in which Plymouth was successful being funded in the first wave and of which there are now 30, are already demonstrating the advantages of bringing research informed culture and decision making to the heart of local government. Much of this early success has been with Directorates such as Public Health who already have a strong tradition in this area. There is, as yet, little guidance on how to work with Directorates such as CYP&F who while welcoming the idea of research informed decision making have little time or resource to engage with it particularly when austerity driven shrinking budgets mean they are sometimes able to implement improvements for which there is an established evidence base. This studentship would produce guidance on how to work in this area and would help to spread the culture of collaboration between the University and the Local Authority.
The wider scale implementation and testing of the recommendations produced (Aim 4) will form the basis of a post-doctoral funding application for the student. Positively promoting the benefits of research and critically exploring ways to conduct and apply research with PCC, supported by PHDRC, could and should lead to other funding applications.
 

Supervisory team

Director of Studies: Dr Cath Quinn

Senior Research Fellow, evaluation and methodological development lead, Plymouth Health Determinants Research Collaboration.
As Director of Studies Dr Quinn will bring her methodological expertise of leading and delivering Realist Evaluations for complex interventions and developing embedded researcher roles. As the Evaluation and Methodological developments lead for PHDRC she will provide support for the student in making contacts in PCC and problem solving for applied research. As a member of the CPCRG Senior Management Team she will link the student to the support and opportunities available within the group, including other PhD students.
Cath Quinn, Health Services Researcher
Dr Cath Quinn

Second Supervisor: Dr Oliver Beer

Dr Beer will contribute his research informed knowledge of the needs, priorities, stresses and strains of the social care workforce, particularly the health and well-being of the child protection workforce. He will provide a complementary counter-foil to Professor Asthana’s strategic perspective and necessary practical insight into the application of the findings.
Oliver Beer
Dr Oliver Beer

Third Supervisor: Professor Sheena Asthana

In addition to strategic support and insight Professor Asthana will be able to provide as Academic Lead for PHDRC, she will provide experience and support for the student how to complete their PhD and deliver the papers and other outputs necessary for the development of their career. She will also provide knowledge of the commissioning process and quantitative analysis relating to finance.
Sheena Asthana
Professor Sheena Asthana
 

Training opportunities

In addition to the training offered by the University Graduate School and access to Plymouth City Council Staff Development training the student will be given a range of training opportunities for both the specific needs of the PhD and their ongoing career development needs.
A tailored induction programme will introduce the student to Plymouth City Council staff and working practices. A number of data processing related staff and commissioners have already expressed their enthusiasm and willingness to show the student how they work and how they can access the PCC owned information they require. Being part of the PHDRC team will allow the student to learn from weekly meetings about the challenges, and solutions, to conducting research within PCC, it will also provide a supportive space to ask questions about any issues they might be experiencing. These meetings are also attended by Local Authority staff who can facilitate access to other people. The PHDRC Researchers in Residence will provide ‘field training’, this is the main method by which embedded research techniques are learnt. They will also be linked to a local and a national Researcher in Residence support network.
DoS Quinn will provide most of the applied training on Realist Evaluation techniques, some of it by involvement in the PHDRC Evaluation. Additional knowledge and training will be gained and accessed through the national Realist Research network (RAMESES). Supervisor Beer will provide knowledge and identify any training required relating to social worker practice, which will be dependent on the background of the student. Supervisor Asthana will contribute training/knowledge of strategic commissioning and will identify any statistical training requirements.
Community and Primary Care Research Group (CPCRG) , within which the student will be located, has further expertise in Realist methods, embedded research and other PhD students who will give the student an alternative perspective, offer shadowing opportunities if required and give career development advice. The CPCRG seminar series will provide exposure to a wider range of applied health research methods and provide a supportive environment to share their early findings, including the opportunity to practice conference presentations before delivering them.
 
 
 

References

1. Levelling Up, Housing and Communities Committee. Financial distress in local authorities. House of Commons, 2024.
2. Become. Still too Far. London, Become, 2024. https://becomecharity.org.uk/content/uploads/2024/08/Still-Too-Far-report-FINAL-v1.pdf Accessed 22/12/2024.
6. Strategic Co-operative Commissioning, ‘Homes for our Children and Young People. Placement Sufficiency Statement 2023-2028’, Plymouth City Council, shared prior to publication. Now updated and published as ‘Homes for our Children and Young People. Placement Sufficiency Statement 2025-2029’, Plymouth City Council, January 2025. https://www.plymouth.gov.uk/sites/default/files/2025-04/Childrens-Placement-report-Homes-for-our-children.pdf. Accessed 09/07/2025.
7. CYP Bright Futures. ‘A Bright Future 2021-2026’, Plymouth City Council, May 2021.
8. Skivington, K et al. ‘A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance’. BMJ 2021;374:n2061
9. Pawson, Ray. The Science of Evaluation. A Realist Manifesto. Sage. 2013.
10. Pawson, Ray. How to think like a Realist. A methodology for Social Science. Edward Elgar. 2024.
11. Gradinger F, Elston J, Asthana S et al. Reflections on the Researcher-in-Residence model co-producing knowledge for action in an Integrated Care Organisation: a mixed methods case study using an impact survey and field notes. Evid Policy 2019;15(2):197–215