Ivana La Valle

Improving residential care for children in England – what can we learn from the Italian experience? 

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In 2022, the government-commissioned Independent Review of Children’s Social Care in England concluded that the country had “sleepwalked” into a dysfunctional residential childcare system, which is failing to deliver adequate provision for some of the most vulnerable children in our society. Extensive evidence was highlighted of how the system fails to provide enough residential placements where and when needed.  Consequently, many children are sent to homes far away from their community and are separated from their siblings. Placement shortages also mean that at times children are placed in unregulated accommodation, i.e. homes that are not registered and inspected by Ofsted and do not have to comply with national quality standards.

The large-scale privatisation of public services that started in the 1990s has meant that children’s homes that used to be run by local authorities and the voluntary sector are now run by private, for-profit providers, which deliver three-quarters of residential placements. This transition has resulted in a steady increase in the price of placements and profits for providers, without any evidence that rising costs have benefited children in residential care.

In 2020, the average weekly fee for a placement was £3,830, with each place generating on average a £900 profit a week. Large companies are increasingly dominating the residential care market, including private equity firms. The Competition and Markets Authority has raised concerns about the high levels of debt among some of these companies, which could lead to bankruptcies and home closures, and further destabilise a system that is already very fragile.

With support from the Churchill Fellowship scheme, my study explores what we can learn from Italian residential childcare to inform the current debate on how to improve the English residential care system. 

Responsibility for children’s social care in Italy is largely devolved to the 20 regional administrations, so residential childcare varies considerably. However, some features considered essential to support a fit-for-purpose residential system are common across Italy:

  • residential care can only be provided on a not-for-profit basis, and it is largely delivered by the third sector;  
  • residential care staff must have a relevant degree, their pay is regulated by national contracts and there are minimum levels of staff training, supervision and staff to child ratios;  
  • homes are small and offer on average 6.4 places.  

The research findings so far suggest that, although Italian residential care is facing challenges, they are not as widespread, deep rooted and extreme as they are in England. For example, I found no evidence that children are sent away from their communities due to lack of local placements, nor that local authorities must resort to unregulated provision. Italian social workers can typically choose between local homes offering different models of provision to meet children’s diverse needs. These include: children’s homes underpinned by a pedagogical approach; homes run by resident parent-figures (as well as paid staff); units for children and their parents; and therapeutic homes for children with complex health as well as social and educational needs.

But perhaps the most striking difference between the two countries is the cost: at £838 a week (£1,497 in a specialist therapeutic facility) a residential placement in Italy is much cheaper. The average fee an English local authority pays for a placement would buy 4.5 residential placements in Italy, and 2.5 placements in a highly specialised therapeutic unit.

The differences between the two systems raise two questions. First, why is residential care in England so much more expensive given that Italian residential care is delivered by a graduate workforce, the typical size of an Italian home is only slightly bigger than an English one and the costs of living in the two countries are not very different? Second, how has the third sector in Italy succeeded (to deliver residential care where and when needed), where the English residential care market has failed?

As England is looking for more effective ways of planning and delivering residential childcare and of improving the experiences of children in residential care, the study will provide learning on the mechanisms through which the Italian residential care system manages to deliver more adequate levels and cost-effective residential care provision.

I would like to thank: the Churchill Fellowship for funding the study; the Coram Group for supporting the dissemination of the research findings; those who have participated in the study; and Valerio Bellotti an academic and expert in Italian children’s social care, for all his help in guiding me through the Italian system and its stakeholders.

Ivana La Valle, visiting scholar at the University of East London.