Thursday, 20 August 2015

Invisible Cities: The city of children

There are invisible cities in England. You can’t see them very easily, but thousands (some say millions) of people live in them, not usually by choice (they don’t tend to be holiday destinations). Here I want to give you a quick tour of the Invisible City of Children.

How many children live in the invisible city?
No-one knows quite how many children live in the city, but until recently it was probably not far off a quarter of a million children. In recent times children in the city have been vanishing, with the number of children in the biggest suburb of the city, the Emeldee district, dropping by about a quarter over the last 4 years (to around 130,000 in 2014). No-one is quite sure what’s happened to them. Although the suburbs are much smaller, the number of children in the Eseldee and Piemeldee districts is continuing to slowly increase (around 31,000 and 10,600 children respectively).

Most children in the city are boys (63%), and although some children are earmarked for life in the city from before birth, children can arrive in the city at any age; children in the Eseldee and Piemeldee districts tend to arrive at a younger age than children in the Emeldee district.
Most children bring their families to live with them in the invisible city, although in 2013 almost 4,500 children in the city were being ‘looked after’ away from their families – children in the invisible city are 3-6 times more likely to be ‘looked after’ than children living elsewhere.

Most children in the Emeldee district (88%) go to school outside the city, with just 12% of these children in the city’s ‘special’ schools. Most children in the Eseldee (78%) and Piemeldee (83%) districts stay in the city’s ‘special’ schools for their education. Over the last few years, more children in all districts are staying in the city’s schools rather than going elsewhere for their education. There is also a shadowy network of ‘special’ boarding schools, often on the outskirts of the invisible city – no-one knows how many children are in these boarding schools, but in 2011 the estimate was around 800 children (most of whom are weekly boarders, coming home to their families at weekends).

Children in the invisible city are more likely to be absent from school than children elsewhere, particularly children in the Piemeldee district who miss on average 1 out of every 8 half-day school sessions (children outside the invisible city miss on average 1 out of every 22 half-day school sessions). For children from the Piemeldee district, most of these absences (80%) are due to child illness or to attend medical appointments; this is similar for children from the Eseldee district (73%). Children from the Emeldee district are less likely to be absent from school for these reasons (57%), but are more likely to be absent from school without permission (21%).

Children in the Emeldee district are also much more likely to be temporarily excluded from school (6.3% vs 1.8% of children) or permanently excluded from school (0.2% vs 0.0% of children, that’s over 250 children in the Emeldee district permanently excluded from school every year) than children living outside the city.

Children in the invisible city are less likely than other children to say that they like school, find school interesting, or say that they are happy at school.

Only about 10% of children in the Emeldee district stay on at school after the age of 16; many more children in the Eseldee districts (62% of children) and Piemeldee districts (49% of children) stay on after the age of 16.

There is virtually no higher education in the invisible city.

The invisible city on the whole is less wealthy than the rest of England. Over 35% of families in the Emeldee and Eseldee districts are eligible for free school meals, as are over 25% of families with a child in the Piemeldee district. In the rest of the country, between 15% and 20% of families with a child are eligible for free school meals. Families in the invisible city are also more likely to stay in poverty for longer than families outside the city.

Parents of children in the invisible city (particularly as more families in the invisible city are headed by single parents) find that the family is less likely to get the support needed for parents to work, especially full-time.

Compared to houses in other parts of England, more houses in the invisible city are rented, overcrowded, in a poor state of repair, and too cold in winter. Children in the invisible city are also more likely than children in other parts of England to have been homeless at some point in their childhood.

Social life
Children in the invisible city are less likely to say they have at least one good friend than children outside the city, and are less likely to spend time with friends outside school.

Bullying and violence
Children and adolescents in the invisible city are more likely to be bullied (often by children outside the invisible city), and are more likely to experience violence from other people, compared to children and adolescents living elsewhere in England.

Children’s health
Children in the invisible city are much more likely than other children outside the city to die in infancy – 12% of people living in this or similar invisible cities as adults die before the age of 4 years, compared to less than 1% of people living outside these invisible cities.

A minority of children in the invisible city are reported by their parents to be in fair-poor health (10%), although this is still a higher level than reported by parents for children elsewhere (2%). Children in the invisible city are more likely to have eyesight problems, hearing problems or epilepsy than other children.

Children in the invisible city are less likely than other children to have breakfast or fruit every day, and at least one parent is more likely to be a smoker. Over half of children in the invisible city (56%) never do sports or exercise, compared to a quarter (25%) of children outside the city.  Children in the invisible city are more likely to be obese than other children.

A minority of children in the invisible city show signs of being distressed – again this is more likely to happen in the city than elsewhere in England. This is also the case for their parents.

The future
Unlike children in other parts of England, who typically start carving out an imagined future for themselves during their teenage years, children and families in the invisible city are discouraged from imagining their future lives as adults outside the invisible city, in terms of a job, a home of their own, travel, friendships, someone to love and be loved by, and maybe a family of their own some day. Instead, a ‘transition process’ exists to prepare teenagers and their families for a life as adults in another invisible city.

Invisible? Yes. Inevitable? No.
There is no reason why this Invisible City of Children has to be like this – none of this is inevitable for children with learning disabilities and their families. With political and social will, this invisible city could be a place where all children are well educated, families live in good housing and have enough money to live good lives, and children have great social lives and are not subject to bullying and violence. In this city, children and families would be healthier and happier, and could imagine fulfilling futures for everyone. And, perhaps, the invisible barriers that act to create this invisible city would dissolve, so children with learning disabilities and their families can fully inhabit, alongside everyone else, the real cities, towns and villages where they live.

Update: Glossary
In response to an excellent suggestion from @thekathmoss here's a brief glossary of the districts for non-city dwellers, based on the categories used in Department for Education statistics (see )
Emeldee: MLD, or children with Moderate Learning Difficulty
Eseldee: SLD, or children with Severe Learning Difficulty
Piemeldee: PMLD, or children with Profound & Multiple Learning DIfficulty

Emerson, E. (2015). The determinants of health inequities experienced by children with learning disabilities. Public Health England: London.
Emerson, E. & Hatton, C. (2014). Health Inequalities and People with Intellectual Disabilities. Cambridge: Cambridge University Press.
Hatton, C., Emerson, E., Glover, G., Robertson, J., Baines, S. & Christie, A. (2014). People with learning disabilities in England 2013. Public Health England: London.
Hatton, C. & Glover, G. (2015). Young people with learning disabilities or autistic spectrum disorder in post-compulsory state supported schools in England. Tizard Learning Disability Review, 20, 170-174.

Monday, 10 August 2015

Client contribution? that'll do nicely

This is just a quick blog containing some data I came across today while rummaging amongst the information stored by the Health and Social Information Centre's excellent NASCIS system ( ).

I hadn't noticed before that the information relating to expenditure by social services (PSS-EX1 - notice the strategic use of the hyphen to avoid embarrassment when searching for it on Google) also includes information on income from 'client contributions' (see here for more guidance on what this means ).

The graph and table below summarise the information on client contributions concerning social services for adults with learning disabilities aged 18-64 years, in England, from 2005/06 to 2013/14.

Overall, in 2013/14, client contributions for social services for working age adults with learning disabilities totalled £262.8 million. Most of this came in contributions for residential care placements (£141.4 million in 2013/14), followed by 'fairly charged' community services such as day services and home care (£62.7 million), supported/other accommodation (£31.3 million), direct payments (£13.2 million) and nursing care (£8.7 million).

Overall, the black line on the graph takes the total amount of client contributions in 2005/06 and shows what this total would be over time taking into account inflation in the costs of social services (thanks again to the Personal Social Services Research Unit and Lesley Curtis in particular for their invaluable work compiling these sorts of statistics ). As you will see, client contributions have broadly increased in line with inflation, although the 2013/14 figures might suggest client contributions beginning to rise faster than inflation.

I don't know enough about what this information means to want to make any strong comments about it at this point and I'd like to hear people's thoughts on it. £262.8 million is certainly a big chunk of money - what do people make of this amount, what client contributions are being spent on, and how this is changing over time?

Update: I've just been looking through some provisional results from the Adult Social Care Survey for 2013/14 (see here ), which included responses 'from' 13,360 adults with learning disabilities (many people are 'helped' by support workers to complete the survey, so the results have to be taken with a Lot's wife of salt). According to this survey, 22% of adults with learning disabilities said that they buy some more care and support with their own money, and 10% of people said that their family pays for some more care and support for them.