Thursday, 11 May 2017

Consensus on cuts

If you read my last post you would have seen some scary statistics. But there’s nothing new or very original about them. They are commonly accepted.

Today the Guardian reports that the Local Government Association (LGA) has found that unremitting rises in demand for children’s services, including safeguarding and child protection, are rapidly outstripping resources as local authorities wrestle with swingeing budget cuts.

Cllr Richard Watts, chair of the LGA’s Children and Young People Board, is quoted as saying: “Services caring for and protecting vulnerable children are now, in many areas, being pushed to breaking point … the demand for children’s social care services has more than doubled and is stretching local authority resources.”

So, there isn’t much dispute about the facts. It would be nice if there was consensus about a solution. That consensus should be: services for vulnerable children and young people have to be adequately funded. Full-stop. Period. End of story.

Perhaps all the politicians currently jostling for votes in the general election campaign would like to commit to that. Simples. 

Friday, 5 May 2017

It's only statistics

According to a report in Children and Young People Now, figures published by the Children and Family Court Advisory and Support Service (Cafcass) show that the total number of care applications in England in the financial year 2016/17 was 14,544, a 13.8 % increase on the previous record year.

The Cafcass website provides these figures dating back to the financial year 2012-13 as follows:

Financial Year
Number of applications
2012-13
11,110
2013-14
10,620
2014-15
11,159
2015-16
12,792
2016-17
14,554


So, the bald fact is that there has been a 31% increase in care applications since 2012-13. It doesn’t take much thought to appreciate how much extra work and extra resources is occasioned by an increase of that sort. Initiating care proceedings is an expensive and time consuming business, involving enquiries, reports, assessments, legal briefings and, of course, court hearings. 

An increase of this size fits apiece with all the other statistics about child protection in England.

Just to remind myself of those other figures, I thought I’d arrange them in a single table.  The result is even more scary than I expected.

Year
Number of Looked-after children [1]
Child Protection Plans [2]
Initial Child Protection Conferences [2]
Section 47 Enquiries [2]
2009-10
64,470
39,100
43,900
89,300
2010-11
65,510
42,700
53,000
111,700
2011-12
67,070
42,900
56,200
124,600
2012-13
68,060
43,100
60,100
127,100
2013-14
68,800
48,300
65,200
142,500
2014-15
69,540
49,700
71,400
160,200
2015-16
70,440
50,310
73,050
172,290
% age increase, 2009-10 to 2015-16
9%
29%
66%
92%

And it gets even scarier when you begin to think about the work and resources that go into providing the services under each of the four column headings.

The number of children in care (looked-after children) has gone up modestly over the period. But the amount of time and work that has to be put into looking after a child in care is huge. So, a 9% increase is 9% of a lot. It represents a great deal of social worker, residential social worker, foster parent, manager and administrator time. And, as we all know looking after children properly is not a cheap activity. The National Audit Office [3] found that in 2012-13, the average annual amount spent on the care of an individual child in England was in the range of £29,000 to £33,000 for a foster placement; and in the range of £131,000 to £135,000 for a residential care placement.

The number of Child Protection Plans made has gone up by nearly one third over the period. Often a Child Protection Plan involves less work than a care order, but it is a heavy commitment. A social worker has to be allocated to the case and has to visit the child and family regularly. There have to be meetings with other agencies and review child protection conferences must be held. The social worker has to be managed and supported – both costly overheads. I have never seen an estimate of how much it costs to administer a Child Protection Plan, but I can tell you it won’t be cheap.

The number of Initial Child Conferences has gone up by two thirds. An Initial Child Protection Conference follows the investigation of allegations of abuse or neglect. It should be attended by representatives of all the main agencies – children’s services, police, health, education, probation, mental health, voluntary sector etc. Typically, a conference of this type lasts between one and two hours. Professionals have to travel to attend the conference and leave other tasks unattended while they participate in the meeting. The conference requires a person to chair it, who has to be a professional very experienced in child protection work. Organising a conference is a time-consuming activity. Conferences have to be minuted by a specialist note taker and the minutes have to be typed up and circulated. All of that takes up resources. Again, I don’t think anybody has worked out how much an average Initial Child Protection Conference costs. But you don’t need to be an accountant to see that the costs of each conference will be considerable.

The number of Section 47 Enquiries has nearly doubled. Section 47 of the Children Act 1989 requires English local authorities to carry out enquiries where it is believed that a child is at risk of significant harm. At least one social worker will have to be allocated to carry out each enquiry, but often more than one person is required. The family will have to be visited, the child seen and spoken to, checks made with all relevant agencies and key professionals, such as doctors or teachers, consulted. Often the police will carry out a parallel investigation into whether or not a crime, such as child neglect or an offence against the person, has been committed. So, there needs to be liaison between the police officer and the social worker. Government guidance requires that strategy meetings are held to co-ordinate activities in each case. Evidence has to be gathered and assessed and recorded. Reports have to be written and circulated. Decisions have to be taken about what to do next. Again, all that takes time and resources. Nearly double the number of Section 47 Enquiries is likely to mean big increases in the number of social workers required. More social workers mean that more managers and more administrators are required to support them.

My scary little table seems to imply scarily big requirements for more resources. So, what has happened to resources during the period 2010 – 2016? Well, it’s not easy to come up with a clear and comprehensive account of what has happened to resources, because the way in which spending is recorded is pretty dense. I’m not sure that even a super accountant could come up with a definitive answer, not least because it is always difficult in organisations with large overheads to decide how much of the overhead should be allocated to different parts of the service.

So, I am just going to stick to the big picture in the hope that it gives a reasonable ballpark guestimate of what is actually going on.

Section 251 of the Apprenticeships, Skills, Children and Learning Act 2009 requires local authorities in England to submit statements about their planned and actual expenditure on education and children’s social care. It is pretty difficult to interpret the Section 251 returns, but in July 2016 a report [4] was produced that goes some way towards making sense of trends in expenditure. On page 21 of the report a graph shows that total spending on children’s services (at 2015 prices) between 2010-11 and 2013-14 across all 152 English local councils fell by 9%. In the absence of more up-to-date information, we can only assume that since then the situation has deteriorated, as Government cuts have become more pronounced.

The scariest and most alarming part of all is that we have big and costly increases in demand for all sorts of child protection services and we have less and less resources to meet them. That trend is set to continue. You don’t have to be a financial genius to see where that is taking us. And it isn’t a nice place!

Notes

[1] Department for Education. Children looked after in England (including adoption) year ending 31 March 2016 SFR 41/2016, 29 September 2016. https://www.gov.uk/government/statistics/children-looked-after-in-england-including-adoption-2015-to-2016

[2] Department for Education. Characteristics of children in need: 2015 to 2016, 3 November 2016.

[3] National Audit Office / Department for Education. Report by the Comptroller and Auditor General. Ordered by the House of Commons to be printed on 26 November 2014 https://www.nao.org.uk/wp-content/uploads/2014/11/Children-in-care1.pdf

[4] Children’s services: spending and delivery. Research report by Aldaba and the Early Intervention Foundation. Department for Education, July 2016. https://www.gov.uk/government/publications/childrens-services-spending-and-delivery


Monday, 1 May 2017

Driverless Cars and Child Protection

There seems to be little obvious connection between driverless cars and child protection, except, perhaps, that child protection professionals of the future may use them to get to work. There is however a vitally important common thread and that is safety.

Interviewed last week  on the BBC Radio 4 Today programme (24/4/17), Professor Paul Newman of Oxford University pointed out a very simple but hugely important feature of driverless cars when it comes to road safety. If one of them has an accident it has all the data about the incident – how fast it and other vehicles were travelling, what the road conditions were like, how close other vehicles were – and it can learn from this data to try to prevent a reoccurrence. Not only that, it can share its data and its conclusions with all other driverless cars so that the learning from one car’s accident can be shared with every other car to help all cars become safer in the future.  

Of course, IT systems can process and transfer vast amounts of data much more efficiently than humans can. But the important point, from a safety perspective, is that the data is researched and that it is shared.

How often, I wonder, do things go wrong in child protection and the information about what has gone wrong, and the thinking about why it has gone wrong, remain forever unshared and undiscussed? We may not be able to send terabytes of data across the Internet at the speed of light, but we could be a great deal more focused about sharing modest amounts of information about errors and near misses, so that there could be much more thinking and discussion about how to put things right.

In aviation, they have something called CHIRP. It is a simple but vitally important system which allows all involved, not just pilots, to share information about critical incidents. It is a way of helping people to learn from the experiences, and the mistakes, of others, before they make those mistakes themselves.

Primum non nocere – first do no harm: why we need challenge.

The Latin phrase primum non nocere – in English ‘first do no harm’ - is a principal of medical ethics, sometimes called ‘the principal of non-maleficence’. Healthcare students are taught its fundamental importance during their initial training.

Primum non nocere is thrown into sharp focus by the behaviour of the English surgeon, Ian Paterson, who was convicted last week of seventeen counts of the wounding-with-intent of nine women and one man. He had subjected them to breast surgery which was wholly unnecessary. There is now talk of hundreds of other unknown victims of this man.


Primum non nocere is a principal that also applies to all child protection professionals, whether they be medically qualified or otherwise.  But there have been some notorious occasions on which it has not been followed. In 1991 children were taken into care and adults arrested in response to what turned out to be false allegations of ‘ritual’ or ‘satanic’ sexual abuse on the Orkney island of South Ronaldsay.  After five weeks, during which the parents had no contact with their children, the claims were dismissed by a judge as "completely unfounded".


In 1987 children living in Cleveland, in the North East of England were removed from their homes by social services having been diagnosed, by two paediatricians at a Middlesbrough hospital, as having been sexually abused.  The children were said to show signs of ‘reflex anal dilation’.  So many children were taken into care that there were insufficient foster places for them and some had to be housed in a hospital ward. The validity of the test used to diagnose the children was disputed by other doctors and subsequently an enquiry led by the distinguished judge, Dame Elizabeth Butler-Sloss, concluded that most of the diagnoses were incorrect. As a result, 94 of the 121 children were returned to their homes with no further action.


In 1999, paediatrician Professor Sir Roy Meadow gave expert evidence in the trial of Mrs. Sally Clark, a solicitor accused of murdering her two infant sons, in which he stated that the odds against two cot deaths occurring naturally in the same family were greater than 70 million to 1. Meadow had erroneously assumed that the two events were statistically independent, which they are not. In reality the occurrence of a previous cot death points to the existence of conditions (environmental, genetic etc.) that make the occurrence of a second more, not less, likely. Sally Clark was wrongfully convicted and spent several years in prison before her conviction was quashed in 2003. She died in 2007 having never recovered from the trauma of the deaths of two children, being unjustly convicted of their murder and being separated from her third baby as a consequence of her imprisonment.


There is a common theme connecting these events with the case of the discredited surgeon Ian Paterson. It concerns lack of challenge. For reasons which are not yet clear, Paterson was allowed to continue operating for years even though serious concerns had been expressed about his competence to do so. In a similar way, once the allegations of ‘ritual’ abuse in Orkney were taken seriously, uncritical net-widening ran amok and more and more children were sucked in to what proved to be a moral panic. In Middlesbrough, the apparent scientific basis of the diagnosis made it hard to question the mistaken opinion of the paediatricians involved. In the case of Sally Clark, nobody in the court seems to have been able to challenge an expert witness who had made a basic statistical mistake.

Challenge is one of those words which one minute sounds positive and the next threatening. If I am challenging something or someone, then that is heroic and good. But if someone is challenging me, then that is aggressive and unfair. So, we need to make sure that we get the culture of challenge right.

If we are carrying out tasks which are safety critical – ones in which people might suffer or even die if things go wrong – then challenge is not something which is an unwelcome or painful inconvenience to be avoided at all costs. Rather it is a welcome opportunity to get things right. Everybody, including the most senior manager, who works in a safety critical context needs to be taught not just to expect challenge, but to welcome it. And everybody, including the most junior employee, needs to be taught how to initiate challenge of even the most powerful and distinguished colleagues.

Failing to get challenge right is not just unfortunate. It is downright dangerous. Unchallenged practice is unsafe practice. We all need to realise that, if we are to avoid doing unnecessary harm.

Wednesday, 19 April 2017

Talking Sense in Scotland

 I was very pleased to see that Donald Henderson, the Scottish Government’s Deputy Director for Care and Protection, speaking at a recent event, is quoted as saying:

“How did the best systems learn? The best systems learn from the mistakes they make, the mistakes that were almost made, or ‘near misses’, and also from the successes. There needs to be an honesty about it.”


I only wish English civil servants and their political bosses would be as quick to acknowledge this very simple and straightforward truth. We learn from being honest about what can go wrong. And in order to allow people to speak freely about mistakes and service failures, we need to make it safe for them to do so.

In order to make child protection safer we need to develop a just reporting culture, in which practitioners are given permission and encouraged to talk about errors. We need to support and respect those who raise safety concerns and stop intimidating whistle blowers. We need to equip practitioners to talk about workplace errors and to analyse and understand how mistakes happen by providing Human Factors training like the training that pilots and other airline employees currently receive. And we need to gain a broad and accurate picture of the types and frequencies of mistakes and service failings by developing better systems – such as Confidential Near Miss Reporting - to create better quality data about the kinds of errors that occur daily in child protection practice.

The Safer Safeguarding Group campaigns on these issues. Join us in our quest for more openness and honesty about mistakes.

Top down improvements - doomed to fail

Trying to justify the Government’s ill-starred Assessment and Accreditation scheme for children’s social workers in England, Lord Nash, a junior minister in the Department for Education, told the House of Lords that:

“Almost one in four councils inspected under Ofsted’s current inspection framework has a judgment which indicates that its practice is inadequate. In the light of that startling statistic, it is critical that the ​Secretary of State is able to bring forward improvement activity that she believes will help raise the standard of social work practice by making clear what standards are expected of children and family social workers and assessing social workers against those improvement standards.
“In other professions, we might expect a professional body to undertake that work but, for now at least, there is no such body for social workers. With the distinct regulatory functions that Social Work England will rightly have, we believe the Secretary of State is in the best position to drive this improvement forward. Indeed, she is the only person who can. In doing so, she will, of course, want to work exceptionally closely with the social work profession.”


One thing his lordship failed to mention is that it was the Government which pulled the funding from the College of Social Work, effectively curtailing the development of a professional body for social work in England.

Another thing, that he might like to reflect on, is his totally unjustified assumption that local authorities get poor Ofsted reports because their social workers lack knowledge and skills. Much more plausible explanations for low standards are under-funding of services, shortages of staff, burdensome management practices, poor IT systems and the stultifying impact of the prevalent culture of fear and blame.


And why a politician like the Secretary of State, who happens to be an accountant by profession and who probably knows very little about children’s social work, is the “only person” able to drive improvement forward is a complete mystery to me. Driving improvement forward is something we should all be doing, especially those of us who deliver services day after day. They are the only people who really know what happens at the front line. The idea that a small elite of government ministers and their advisers know what’s best is a naive fallacy, the pursuit of which will only result in failure and despair.