Funding for preventative Children’s Services and rates of children becoming looked after : a natural experiment using longitudinal area-level data in England

Background Children in care face adverse health outcomes, throughout the life-course, relative to the general population. In England, over the last decade, the rate of children entering care has increased. The rate of change differs markedly for older and younger children, who may also experience different preventative services. These services have been subject to inequitable spending reductions due to fiscal policies trailing the 2008 recession. Objective To assess the impact of cuts to prevention on rates of preschool children and adolescents entering care between 2012 and 2019. Participants and Setting Children aged 1–4 and 16–17 years, across 150 English upper-tier local authorities. Methods Our outcomes were annual rates of children entering care, aged 1–4 and 16–17. Our exposures were Children’s Services prevention spend per child under 5, and per child over 12. Regression models were used to quantify, within areas, associations between trends in prevention spend and trends in rates of children entering care, controlling for employment and child poverty rates. Results We found no association between changes in prevention spend per child under 5 and changes in care entry for 1–4-year-olds. However, spending reductions per child over 12 were associated with rising rates of 16–17-year-olds entering care. Every £10 per child decrease in prevention spend was associated with an estimated additional 1.9 per 100,000 children aged 16–17 entering care the following year (95% CI 0.7 to 2.9), equivalent to 1 in 25 care entries in this age group between 2012 and 2019. Conclusion This study offers evidence that rising rates of older children entering care has partly been driven by cuts to prevention services catering to their needs. Policies to tackle adverse trends should promote reinvestment in youth services, placing ordinary help on a robust statutory footing