Who Steers the Expensive Top End?

The expensive top end of youth care can be steered. In Ede the number of young people in residential youth care fell by a quarter between 2018 and 2022, while nationally that number stayed level. After 2022 the top end came back. The difference lay in who held control.

Background

On 30 September 2026, at the general assembly of the VNG, the Association of Netherlands Municipalities, 96.77 per cent of municipalities voted for a motion calling for a national financial safety net for exceptionally costly youth care cases.¹ The motion came from the municipality of Kaag en Braassem, backed by fourteen other municipalities. The sponsors value regional solidarity, but consider it insufficient when municipalities are under financial pressure. Moniek van Sandick, alderman in Kaag en Braassem, said that in her municipality 15 per cent of clients account for 75 per cent of youth care costs.²

The plea has a reason behind it. A small municipality is too small a risk pool, and equalisation between municipalities that are all short of money spreads a deficit without reducing it. The motion leaves one question open: who steers the cases the safety net will pay for? This case describes what happened in Ede when the municipality answered that question itself, and what happened when the people who gave the answer left.

Key figures

Between 2018 and 2022 Ede absorbed a growing youth population without its total youth care costs rising. After that they rose by a third in two years. Costs per inhabitant and residential care are shown in the charts further on; this table gives the context.

Indicator	2018	2022	2024	National 2018 → 2024
Total youth care costs, Ede (€ m)	31.0	31.3	41.9 (provisional)	per inhabitant +58% (panel)
Young people aged 0 to 17	25,538	25,906	26,294	−2.4%
Share of young people receiving youth care	10.1%	11.9%	13.3%	11.8% → 14.0%
Share of youth care pathways referred by a GP	48%	44%	41%	34% → 34%
Young people under a child protection measure	275	200	165	−15%

Ede is a municipality of just over 125,000 inhabitants. It belongs to the FoodValley youth care region, whose municipalities procure youth care jointly.³ Figures for 2025 are available only for numbers of young people, and are provisional.

What was set in motion in 2018

The core was a simple question about the costliest cases: are we professionally satisfied with what happens here? In 2018 I spent a year as director of operations for the social domain in Ede, the municipal cluster responsible for youth care, social support and income support. In that period we set up five things at once.

A top 100 judged on professional satisfaction. The data showed that 2.5 per cent of clients used a quarter of the budget, and 10 per cent used half. With an experienced team manager we agreed that the team would systematically review the hundred costliest cases. The brief was explicitly about appropriate care, with no savings target per case. A costly case is in order if the professional stands behind it. If they do not, you look for a better approach. That team manager had worked for many years on the provider side and in regional procurement. His judgement therefore had authority with care workers and with providers alike.

The municipality’s own access team as the front door. We made agreements with GPs and placed youth practice support workers in their surgeries, so that requests for help reached the municipality’s own team first. GPs have limited sight of the available services and little time to map a family’s situation. When the municipality makes the eligibility decision itself, it can see what is appropriate.

A frame of guiding principles. The principles were given names everyone could remember, such as “A child belongs at home”, “All children are normal” and “We work with providers who share our vision”. The municipal council adopted them in July 2019 in the Youth and Education Policy Plan, with the intention of making agreements with providers to prevent residential places that had been phased out from being filled again.⁴

Source: municipality of Ede, infographic of guiding principles for transformation and budget adjustments in the social domain.⁵

The frame rested on six guiding principles that the municipal executive discussed with the council in the spring of 2019, and which formed the basis for the package of measures.⁶ Ede also measured its budget cuts against these principles.⁷ Four principles concern the breadth of the system. Two on the right-hand side, “The municipality takes the lead” and “We seek partnerships with providers who share our vision”, gave the municipality the position to steer the expensive top end: to keep control itself, and to work with providers willing to go along with the phase-out of residential care.

Counting and recounting. A team of data analysts followed the work on the ground. Results were presented as a combination of hard figures and case stories. Not everything measurable is noticeable, and not everything noticeable is measurable. The policy plan adopted the phrase: “Het gaat om tellen en vertellen” (“It is about counting and recounting”), figures and trends alongside the experiences of practitioners and residents.⁴

Investing from the savings target. The social domain had a structural deficit of around 10 million euros. The deficit would grow before the interventions took effect, so the savings also had to pay for the investment. In April 2019 the municipal executive proposed 23 measures, worth 7.5 million euros, with a reinvestment of 4 million. The medium-term budget outlook (perspectiefnota) for 2020-2023 therefore lists the measures as net amounts, after deducting the cost of investment, with the investment in case control and in community-based support as a measure in its own right. Together they yield a structural 4.56 million euros from 2022 onwards.⁶

Costs: four years flat, then in step with the rest

Ede started in 2018 well above the average and was already below it by 2020. The turning point comes after 2022: from then on Ede rises at the same pace as the panel, and in 2024 slightly faster.

Residential care: the top end shrank and came back

This is the signal closest to the top 100. These numbers are counted by home address and are therefore unaffected by the change to the residence principle (see below). After 2022 Ede moved against the national decline for the first time, and in the wrong direction.

The break: who left, and when

The costs of the top follow the people who ran the approach. Most of them left within two years of the handover in 2019. The commissioning director stayed until 2022 and the team manager of the top 100 until 2023. After that, nobody was left to continue the approach.

When	Who left
2023	the team manager who ran the top 100
2022	the commissioning director
2020	three key figures from staff and line management, including the internal successor to the director of operations
2019	the interim director who set up the approach, and a data analyst

Of the five department managers in the cluster, one is still in the same post; the other four have left the municipality. Someone who moves to another internal post does not count in the turnover figures, but takes the knowledge along all the same. That is why the book holds that we are all interim managers.

What the figures do not prove

The pattern is strong, and it proves no cause. Four points deserve an honest mention.

Normalisation did not get off the ground. The share of young people in Ede receiving youth care rose from 10.1 to 13.3 per cent, faster than nationally. Part of that difference is demographic: the group aged 0 to 11 grew by 7 per cent in Ede between 2018 and 2024, while it shrank nationally. That is precisely the age at which use peaks, and funding follows such growth only years later. Even so, there remains a growth that the top 100 did not stop and was not meant to stop. The approach targeted the top end; the breadth fell outside it.

The residence principle distorts 2022. On 1 January 2022 the rule changed that decides which municipality pays for a child’s care, the residence principle (woonplaatsbeginsel).⁸ Ede has a relatively large number of specialist care providers’ locations within its boundaries.⁴ As a result, costs per young person in residential care were about a fifth lower in 2022 than in the years around it. The numbers of young people are counted by home address and are unaffected by this change. The fall in numbers is therefore the most reliable signal.

Rates rose nationally. After 2022 rates went up everywhere because of inflation and indexation under collective labour agreements; for 2023 the VNG advised municipalities to index rates by 4.74 per cent.⁹ That explains part of the cost increase in 2023 and 2024, but it does not explain why Ede rose faster than comparable municipalities in 2024, nor why the number of young people in residential care increased.

The contractual anchor cannot be traced. FoodValley did not re-procure from 2023: since 2016 the region has worked with open-ended agreements that are updated periodically. Since at least 2023, entry for new providers of residential care has been closed, except for respite care and foster care.¹⁰ Whether the agreements intended in 2019 on not refilling phased-out places were ever made does not appear from the public contract documents.

What this means for the safety net

A safety net is defensible, as long as it leaves in place the steering that keeps the top end small. Ede shows that the costliest cases are the most sensitive to control. Decisions about placement, duration and return are central there, and the municipality takes those decisions.

The motion touches two real problems. Small municipalities cannot absorb a single case costing several hundred thousand euros a year. In addition, funding follows a growing youth population only with a delay of years, as Ede itself experienced between 2018 and 2022. Risk sharing is a good answer to the first problem. A safety net for exceptional cases does not solve the second.

The design question is therefore on what conditions the safety net is introduced. Three conditions keep the steering intact:

1. Reinsurance, with an excess. The municipality pays an excess per case and, above it, a co-payment. Whoever contributes stays involved in the outcome.
2. Access through a professional test. A case qualifies only after a review with peers on whether this is the most appropriate help. That is the top 100, as a condition for every municipality and independent of the initiative of a single team.
3. Anchoring that assumes departure. In Ede the effect disappeared within a year after the last people who ran the approach had left. A safety net must therefore lay down that the review takes place, whoever leads it.

Chapter 13 of Interim Management for the Public Sector sets out the difference between the length of an assignment and the length of a change: twelve to fifteen months against three to five years. Ede shows that this difference also applies to permanent staff who move to other internal posts. A safety net that only pays relieves the deficit. A safety net that pays on condition of control also relieves the child.

Method

The comparison panel consists of the 255 municipalities that reported costs to the Statistics Netherlands (CBS) survey for every year from 2018 to 2024. Costs per inhabitant are calculated as total costs divided by the panel’s total population on 1 January.¹¹ Numbers of young people in residential care refer to youth care in kind for young people aged 0 to 23, rounded by CBS to multiples of five.¹² Costs also include personal budgets (pgb), with which families purchase care themselves, and extended youth care beyond the age of 18, so costs per young person are only an indication. The CBS series of numbers of young people has a trend break between 2020 and 2021. For 2019 and 2020 the breakdown of costs by residential care is missing. The share of young people receiving youth care is the CBS indicator. Facts checked against primary sources, as at 1 October 2026. The names of the staff involved have been deliberately omitted.

Notes

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Jacob Huibers is an interim manager with more than twenty years of experience in the Dutch public sector. He has worked as cluster manager, cluster director and kwartiermaker — brought in to stand up new organisations — at municipalities ranging from fifty thousand to over two hundred thousand inhabitants, and at regional collaborative bodies in the social and physical domains. Statecraft is his platform for strategic reflection on public-sector execution, pillar IV of House of Viridian.

Responses and counter-arguments via Statecraft.nl.

Footnotes

1. VNG, Landelijk vangnet nodig voor dure jeugdzorgcasussen (“National safety net needed for costly youth care cases”), 30 September 2026. ↩

2. Koen Enneking, VNG wil landelijk vangnet voor uitzonderlijk dure jeugdzorg (“VNG wants a national safety net for exceptionally costly youth care”), Binnenlands Bestuur, 30 September 2026. ↩

3. Jeugdhulpregio FoodValley, inkoop (“procurement”). ↩

4. Gemeente Ede, Beleidsplan Jeugd en Onderwijs 2019-2022 (“Youth and Education Policy Plan 2019-2022”), adopted 11 July 2019, in force from 27 July 2019, sections 2.3, 4.3.1 and 5. ↩ ↩² ↩³

5. Gemeente Ede, Infographic leidende principes transformatie en ombuigingen sociaal domein (“Infographic of guiding principles for transformation and budget adjustments in the social domain”). ↩

6. Gemeente Ede, Perspectiefnota 2020-2023 (medium-term budget outlook 2020-2023): Transformatie sociaal domein (“Transformation of the social domain”), Overzicht te verkennen maatregelenpakket 2.0 (“Overview of the package of measures to be explored 2.0”) and Financieel duurzaam perspectief (“Financially sustainable outlook”); see also Omroep Gelderland, Wethouders Ede willen betere zorg met minder geld (“Ede aldermen want better care with less money”), 5 April 2019. ↩ ↩²

7. Karin Sok and Lieke Salomé, Leidende principes geven richting aan het sociaal domein (“Guiding principles give direction to the social domain”), Movisie and NJi, November 2020, with Ede as a practice example. ↩

8. VNG, Woonplaatsbeginsel jeugdhulp (“The residence principle in youth care”). ↩

9. VNG, Hoe om te gaan met indexering kosten Jeugdwet en Wmo (“How to deal with cost indexation under the Youth Act and the Social Support Act (Wmo)”), 19 December 2022. ↩

10. Jeugdhulpregio FoodValley, Deelovereenkomst Verblijf (“Sub-agreement on Residential Care”), version of 16 November 2023, articles 4 and 6.1. ↩

11. CBS, Gemeentelijke kosten; jeugdzorg, regio (83454NED) (“Municipal costs; youth care, region”), realised costs 2018-2024, 2024 provisional; CBS, Bevolking; geslacht, leeftijd, burgerlijke staat en regio (03759ned) (“Population; sex, age, marital status and region”), population on 1 January. ↩

12. CBS, Jongeren met jeugdzorg en jeugdzorgtrajecten in natura; wijken (Young people with youth care and youth care pathways in kind; districts), annual tables 2018-2025 (84316NED to 86204NED), 2025 provisional; share of young people receiving youth care from 82972NED and 85098NED. ↩