Tuesday, 13 November 2018

Northamptonshire Children’s Services – in deep trouble

The BBC reports that the inspectorate, Ofsted, has condemned Northamptonshire’s children’s services as a "potential risk" and describes children’s social workers at the effectively bankrupt council as "overwhelmed" and "drowning". Services are said to have "significantly declined" since 2016.

You don’t need to be a genius to know why services in Northamptonshire are in deep trouble. The council has run out of cash and is seeking ways of further reducing spending on services which have already been cut to the bone. Nobody can provide good services to looked after children or conduct thorough enquiries into child protection concerns if there aren’t the resources to do the job. 

The BBC article mentions social work caseloads of between 30 and 50 children per social worker. If that is correct, it is far too high. Ten to fifteen cases is more the mark.

Ofsted inspectors must know that resources are the problem. Councillors and senior managers in Northamptonshire must know that too. Government ministers must know that – surely they must know that!

Carrying on trying to provide adequate services with inadequate budgets will result in only one thing: children unnecessarily put at risk or deprived of adequate care. 

Central government now needs to stump up the cash to provide proper children’s services in Northamptonshire, pending whatever reorganisation of the council eventually emerges. Wait-and-see is not an option. Vulnerable children and young people in Northamptonshire need action now.

Thursday, 8 November 2018

The Crisis in Children’s Services in England

Hard on the heels of recent discussions concerning the working conditions of children’s social workers in Britain, comes more confirmation of the dire state of children’s services in the age of austerity.

The Association of Directors of Children’s Services (ADCS) has released its sixth annual report of Safeguarding Pressures research covering the financial year 2017/18. It concludes (page 119) that over the ten year period covered by the six phases of the research, there were:
  • More initial contacts with children and families  - up by 78% 
  • More referrals - up by 22%
  • More Section 47 enquiries (investigations into concerns of significant harm to children) - up by an eye-watering 159%
  • More children being made the subjects of child protection plans - up by 87%
  • More children who are looked after by the local authority - up by 24% 
The report notes that “These increases are higher than the growth in child population alone could account for and increases in 2017/18 have been greater than the previous year.” (page 119)

Commenting on the funding position the report notes:

“Local authorities have protected and invested in children’s services despite devastating cuts to their budgets using reserves or diverting funds from other services, yet we hear that worse impacts may yet be to come. This situation is simply not tenable with many respondents and other sources stating that services can no longer be protected going forward. The tipping point has been reached.” (page 120)

As part of its coverage of these findings on 6thNovember 2018, the BBC Radio 4’s PM programme had interviews with LSE professors Eileen Munro and Martin Knapp. 

Munro said that  children’s services have had 'gigantic' funding cuts, and have more to come, and face rising caseloads. She went on to say that that in order to do good work social workers have to be able to spend time with families and they need to have time to think about what they do. That was not possible if they were overworked and under-funded.

Knapp said that there was strong research evidence that early intervention services (which have been hit hardest by spending cuts) result in considerable economic payoffs, which in the long run reduce the costs of late intervention, such as taking a child into care. However, he saw no signs that the government was willing to accept this argument and that cuts to preventative services were seen by ministers as being an easy option. The BBC interviewer, Evan Davis, summarising Knapp’s comments, described what was happening as “bonkers budgeting”. 

Interestingly no government minister was available to appear on the show.

The ADCS and people like Professors Munro and Knapp are not hysterics. They are not serial purveyors of doom or professional shroud waivers. What they say is based on hard facts and sensible analysis. And what they are saying is that there is now a crisis in children’s services. Government cannot just go on and on cutting and cutting resources while demand for services increases unremittingly. The ‘tipping point’ (to use the phrase used in the ADCS report) has been reached.

But there is no evidence that government is taking this seriously. Ministers seem to be carrying on with business as usual while the pressure cooker that is children’s services in England reaches the point of explosion. Rather than uttering platitudes and pretending that there is no crisis, ministers need to act decisively and quickly to prevent disaster.

Monday, 5 November 2018

Working Conditions

There is a lot of evidence that stressed employees do not deliver good products and services. A recent article in the Guardian makes the point that British people work longer hours than many of their counterparts in Europe and that they are less productive, as a result. It is reported that now some British companies are reducing the working week to four days in an attempt to improve the health and happiness of employees and to increase efficiency and productivity.

That news coincides with the publication of the latest UK Social Workers Working Conditions Report prepared by researchers at Bath Spa University and funded by the British Association of Social Workers and the Social Workers Union. 

Being an update on a similar publication in 2017, this report makes for even grimmer reading. It was found that social workers, including children’s social workers, experienced working conditions contributing to stress and ill-health that are worse than nearly all other UK employees in both public and private sectors, . Social workers work an average of eleven hours per week in excess of their contracted hours and sixty percent were found to be considering leaving their current jobs (compared to 52% in 2017). Nearly 40% of respondents were looking to leave the profession entirely. The main factors contributing to stress were found to be high case and administrative loads and lack of resources. Over 40% of social workers had been exposed to aggressive or physically abusive behaviours at least once a month from service users.

There is nothing new in any of this research. It just confirms a well-established and deteriorating situation. For many years children’s social workers in Britain have not been well treated well and in recent years they have had to endure hotdesking, poor office accommodation and sub-standard IT support. 

None of that bodes well for the quality of services. Overworked and over stressed people cannot provide top quality services. It is just not possible to respond to the complex human needs of a family under stress or a distressed maltreated child if you yourself are over-stretched and over-stressed.

Good child protection practice requires social workers who can work sensitively and reflectively to bring about the best possible outcomes for the children they serve. They will not be able to do that if their employers continue to subject them to poor working conditions.

If private companies believe that they can get more from their employees by treating them well - and introducing a four day week - then maybe the public sector should consider doing that for their employees too. If child protection social workers can be given less stressful working conditions - and more time and space to reflect on what is happening to a child or a family - then most likely  the right decisions would be made more often. Getting things right in the first place - working more productively - means less rework and less waste of scarce resources. So paradoxically less work can actually equal greater output. 

Local authority employers need to wake up. The current climate of stress and overwork and fear results in worse and less efficient services. Urgent change is required.

Tuesday, 23 October 2018

Health Visitors

A report by the Office of the Children’s Commissioner into vulnerable babies in England has recently been published. 

It pulls together some recent statistics in a helpful way but concludes that much of the data is missing and that only best estimates can be given of the numbers of babies living in high-risk households. The report notes that “.. very little data is collected or collated about vulnerable babies, and that the data which does exist is often reported for children in age brackets (0-4) and not broken down for babies under a year old.”

That having been said the report produces an estimate of around 15,800 babies in England under one year of age considered by local authorities to be vulnerable or highly vulnerable and still living at home on 31 March 2017. The report also estimates that there are around 100,000 young children aged 0-5 living in high risk households who are not recognised as ‘children in need’ including 14,000 babies under the age of 1. 

The report urges the government to address urgently the under resourcing of local authority children’s services departments. It notes that Health Visitors may be the only professionals to see a baby regularly in the vulnerable early months. It recommends increasing the number of mandatory health visitor visits for families where known risk factors are present, improved referral pathways from health visitors to health children’s social care services. It suggests that there needs to be “close monitoring of the adequacy of provision of health visitors now that funding for them has transferred to local authorities”.

The report is very right to recognise the importance of Health Visitors. But it is far from clear that the government does! In fact it appears that the government is presiding over swingeing cuts in services. A report by the Royal College of Nursing has found that the health visiting workforce fell from 10,309 to 8,275 between October 2015 and January 2018 and there are concerns that the future arrangements for local authority funding will see an accelerated decline in spending.  

Research suggests that Health Visitors, who were once considered essential members of every primary health care team, have now become detached and their falling numbers mean that in many areas there is only patchy contact between them and other health professionals.

Anybody who is serious about early intervention has to accept that high quality and well-resourced child health monitoring services have to be provided, especially during the first year of life and extending throughout the pre-school period. 

A government that allows such services to wither on the vine is neglecting its responsibilities to very young children, which is a disgrace.

Breaking Point

“There is compelling evidence that the services and support that children and young people rely on are at breaking point.” 

So say the heads of 120 voluntary and statutory organisations providing children’s health, education and social care services in a joint open letter to the Prime Minister and the Chancellor of the Exchequer. 

Anna Feuchtwang,  Chair of End Child Poverty and Chief Executive of the National Children’s Bureau, who is one of the signatories, is quoted in the Guardian as saying that services once taken for granted, such as family support, children’s centres and respite care for families with disabled children, have become “the privilege of the few” and that essential lifelines have been “cut to the bone”. 
It is hard to argue with such a wide range of informed and expert opinion. The Prime Minister and the Chancellor need to take this letter very seriously. Children’s services are at breaking point. If they are allowed to collapse, the consequences for many children and young people will be dire. 

Any politicians who allow that to happen will not be easily forgiven. 

Monday, 17 September 2018

Predicting Child Maltreatment – it just ain’t that simple

It is interesting to read in the Guardian that some English local authorities are working to develop a predictive model for their children’s services teams. The plan seems to be to apply algorithms to big data sets in order to predict which children and families are at risk. The Guardian article notes that these initiatives may be a response to financial pressures on local councils as a result of austerity policies. Presumably the thought is that services could be targeted more accurately.

But predictive analytics are not as straightforward as they might seem. Any attempt to predict which groups might be at risk of disease or injury or other unwanted outcomes will involve making both correct and incorrect predictions about individuals. In addition to forecasting true positives and true negatives, systems will also forecast false positives and false negatives. The trick, of course, is to devise ways of reducing the numbers of false positives and false negatives, but even fairly accurate predictors can generate quite a lot. And that raises important practical and ethical questions about how to treat ‘at risk’ groups where a sizeable proportion of members are not actually at risk. If we could be sure of predicting all and only those children who would be abused or neglected, then we could justify strong intrusive interventions to stop maltreatment occurring, but we cannot justify doing that to families who have just been caught up because a predictive system is not very accurate.

Studies of risk prediction models for child maltreatment indicate that some can be effective in identifying at risk groups, but some predictive models have been found to be much more accurate than others (Begle et al 2010). A recent meta-analysis (van der Put et al 2017) concludes that twenty seven different risk assessment instruments have been found to have “a moderate predictive accuracy”. Analysis also revealed that the instruments were better at predicting the onset of maltreatment than its recurrence. 

A New Zealand study (Vaithianathan et al, 2012) found that the use of a predictive algorithm (PRM) applied to children under age of two had fair-to-good, strength in predicting maltreatment by age five, which compared with the predictive strength of mammograms (screening) for detecting breast cancer in the general population. But the authors note that were PRM used to identify families requiring preventive treatment, twenty-seven families would need to take up a the programme in order to avoid one child experiencing maltreatment. They conclude that a full ethical evaluation of the model would be necessary before implementation. They also believe that there is a need for extreme caution before implementing mandatory policies for high risk families and that it is preferable if scores are used to engage high risk families in voluntary rather than mandatory services.

Similar points are made by Dr Art Caplan, head of the Division of Medical Ethics at the NYU School of Medicine. In addition he stresses that unless there is an effective program to help parents learn how not to be abusive, then simply forecasting the likelihood of maltreatment will bring “stigma and penalty” to the children and families involved without bringing help. He argues that it does no good  to have knowledge of a bad outcome unless something effective can be done to prevent it. 

I am not completely against developing predictive instruments, but I am completely against developing them behind closed doors and without the proper analytical and ethical scrutiny that is required to justify their use. No predictive model should be used without a public audit of its accuracy. And no predictive model should be used behind closed doors without being subject to the oversight of an ethical committee. 

Local authorities and their private sector contractors should not be allowed to spend large sums of public money on systems of this type without being prepared to demonstrate publicly that they do more good than harm. 

Monday, 27 August 2018

More fiddling while Rome burns

They say that the Roman emperor Nero played his fiddle while the city burned. The phrase ‘fiddling while Rome burns’ means doing something ineffectual at a time of great crisis. Somebody certainly seems to have been playing a fiddle while the cash-strapped Northamptonshire County Council has been edging closer to collapse. 

An article in Children and Young People Now details a sorry story of messing about with plans to establish a limited company, to be called Children's First Northamptonshire, to deliver children’s services. This idea has now been scrapped because of uncertainty about the future arrangements for local government in Northamptonshire with the possibility of two new unitary authorities being created. How much time and effort and money has been frittered away, I wonder, in planning for this outsourcing only for it all to be put on hold.

Not that putting outsourcing on hold is altogether a bad idea. I have a lot of sympathy with the Unison Northamptonshire branch secretary, Penny Smith, who is quoted by Children and Young People Now as saying that outsourcing is unpopular with staff and that adding yet another layer of responsibility is not good for the children who are receiving services.

Messing about with structures and flirting with outsourcings and privatisations can squander time and money to no good end. And it focuses attention in the wrong place. Good high quality services don’t miraculously come about because governance arrangements are altered to reflect the ideologies of leaders. They come about because careful detailed attention is given to understanding the causes of poor quality and service failures and empowering staff at all levels to make the necessary improvements. 

Big plans often end in tears. On the other hand, frequent small changes, based on the knowledge and experience of frontline workers, can cumulate quickly to improve continuously the quality of services. Let’s hope that what happens next in Northamptonshire is based on a sensible improvement strategy; not an ideological pipe dream.