State abuse?

There is something deeply shocking about the proposals from the UKBA (UK Borders Agency) to take dental X-rays of asylum seeking young people in order to determine if they are children or adults. http://www.guardian.co.uk/uk/2012/mar/30/uk-border-agency-x-rays-asylum-seekers

I don't know enough about anatomy to know if the technique is reliable, but I do know that X-rays can have very harmful side effects and should be used on people only under medical supervision and if clinically strictly necessary.

I see that on this issue I am in good company. All Four UK Children's Commissioners, the medical and dental professions, the Immigration Law Practitioners' Association and the former chief medical officer, Sir Liam Donaldson, have all warned that such checks are potentially harmful and may, in fact, be an illegal violation of children and young people's rights.

The UKBA is under a statutory duty to safeguard children and promote their welfare. It is intolerable that the agency should arrogantly cast aside its responsibilities. Administering X-rays without medical supervision could be an assault, even if the person in question has 'consented' to the procedure. I would like to see any public official found to have irradiated a child or young person in this way made to face the full force of the law.

Gove on Edlington

I was quite impressed by the letter written by the Secretary of Sate for Education, Michael Gove, concerning the Serious Case Review of the Edlington tragedy. That is the case in which two boys attacked two other boys, causing serious injury.

Gove is not impressed by the overview report of the Serious Case Review, the publication of which he has ordered. I found that there was far too much redaction in the published report for me to make a sound judgement about its quality, but I do think that Gove has a point when he says: “It documents everything that happened but with insufficient analysis of why and what could have been done differently.”

That was not, however, what I found impressive. Rather the following extract from Gove’s letter seems to me to be spot on:

“I do not want these reports to be used to assign blame where terrible incidents have taken place. People working in these circumstances need to have confidence that they will be backed by their managers when they take difficult decisions with good intent and sound judgement, whatever the outcome. Publishing factual information about serious incidents helps ensure that all the lessons are learned, nationally and locally, to reduce the risk of repeating mistakes. This will not only help people working at the front line; it will also give the public greater confidence. We want an open, confident, self-regulating system where professionals are continually asking how they can improve rather than a system clouded by secrecy and fear.”

I would like to pin that up somewhere, and I only hope that when, or if, another tragedy occurs Michael Gove will stick to these ideals without flinching.

Sadly Doncaster council is reported to be taking disciplinary action against five members of staff over the Edlington affair and has referred one former employee to the General Social Care Council.  It also resisted the publication of the overview report.

Not much evidence of an end to the blame culture there!

A Procedural Bloodbath?

A ding-dong row appears to be brewing concerning the revision of the procedural document 'Working Together’. Camilla Pemberton, in Community Care reports that there are fears that a “slaughter” of procedures is about to take place, with the suggestion that the professional advisory group, charged with revising the document, and the Secretary of Sate, Michael Gove, are determined to cut the length of the present document (just less than 400 pages) to 60 or even to 10. http://www.communitycare.co.uk/Articles/28/03/2012/118112/fear-over-plans-to-slaughter-child-protection-guidance.htm

Liz Davies, of London Metropolitan University, and Nushra Mansuri, professional officer for the British Association of Social Workers (BASW), are mentioned as being opponents of such drastic pruning of 'Working Together'. Davies is quoted as saying that it would be “extremely dangerous” and Mansuri argues that “core child protection guidance” cannot be taken out.

On the other hand, I am on record as having condemned lengthy child protection procedures and I strongly believe that Working Together in its present form is little short of a disgrace. http://chrismillsblog.blogspot.co.uk/2010/12/matter-of-procedure.html

But I agree with Nushra Mansuri that using a small group of ‘experts’ and civil servants to prune the document has not been wise. And I have considerable sympathy with her view  that the practitioner voice appears to have been effectively excluded from the professional advisory group. Perhaps, with the benefit of hindsight it would have been better to have set-up an advisory group to advise the Secretary of Sate on how to reduce child protection procedures, rather than to undertake the task directly.

It seems to me that the Government may go some way to salvaging the situation by ensuring that the consultation on the revised draft is conducted in a most through-going manner, and not, as is so often the case with Government consultations, seen as an opportunity for those opposed to the proposals to blow off steam before being ignored. The Department for Education must listen and be prepared to revise the draft document extensively if it is to maintain credibility.

Whatever way forward is adopted I remain firmly of the belief that 'Working Together' can be drastically pruned. I defy anyone to read (say) Chapter Five of the document (‘Managing individual cases where there are concerns about a child’s safety and welfare”) without being immediately struck by the sheer amount of verbiage in a document that should be strictly to the point.

Take section 5.5 for instance. This takes more than two pages to say little more than that work to safeguard and promote the welfare of children should be child-centred and informed by evidence and knowledge of child development. And the section is littered with high sounding but uninformative gobbledegook, such as the paragraph on page 134 titled ‘Holistic in Approach’, which contributes very little while using up a lot of space.

There is also a lot of unnecessary stuff about the Common Assessment Framework on page 138, which could be reduced to one line: if there is any doubt concerning a child’s safety make a referral to Children’s Social Care and discontinue the Common Assessment.

Then there are the pages (141-3) on the subject of underage sexual activity, which seem to sit oddly here and which go into unnecessary detail. So that it is not until Section 32 of the Chapter (12 pages in) that any discussion of the local authority’s response to a referral begins!

This stuff is not so much ‘procedures’ as an essay! And the sad thing is that for all their wordiness these procedures do not tell you some simple and important things, for which some sort of procedure would be a good idea.

For example despite the rant on underage sex, the Section on “Responding to welfare concerns where there is or maybe an alleged crime” (pp 140-3) gives no clear steer on how to distinguish matters in which the police only need to be involved (e.g. where a child has suffered a crime at the hands of a third party). And there is nothing to say what happens if a local authority refuses to act on a referral.

My approach to rewriting Chapter 5 would be to: (1) get rid of the verbiage, (2) simplify expression and eliminate ambiguity, (3) stick to the point and not get side-tracked, (4) make sure there were no significant omissions and (5) get in someone who knows how to draw process flow diagrams and eliminate the confusing five flow charts with which the Chapter concludes.

Even if the Government has gone about the process of re-writing 'Working Together' in a ham-fisted way, I would urge everyone to stick with the vision. Munro’s ideas are absolutely right. Procedural manuals that have been amassed as a result of risk-averse responses to various enquiries are not the way to go forward. Detailed procedural manuals are appropriate in some circumstances (for example where a piece of equipment or closed system has been carefully designed) but we are deluding ourselves if we believe that they make child protection any safer. On the contrary child protection is a very uncertain sphere. It does not operate like a well-oiled machine. That makes writing the rules in advance a pointless, and sometimes a dangerous, exercise.

How to rebuild trust

I was struck by an article in the Guardian by Dr Graham Dietz of Durham University about how to rebuild trust in businesses following a variety of corporate failures.

In particular Dietz makes reference to the impact of the Baby P tragedy, observing that following a major failure of trust, it is common to overreact by introducing new strict controls. He argues that revised child protection procedures can be “… so onerous that they may make detection of vulnerable children harder, and hit recruitment into the profession”.

Dietz’s and (co-author) Gillespie’s report (Building and Restoring Organisational Trust) ought to be compulsory reading for all policy makers and senior managers in child protection.

Poor support for family and friends carers

Research by the Family Rights Group and Oxford University’s Centre for Family Law and Policy, has found significant shortfalls in support for children who are being cared for by family and friends. http://www.frg.org.uk/

Nearly 500 carers, caring for more than 750 children, were surveyed. Ninety-five in-depth interviews were also conducted. In addition local and central government data was analysed.

Some of the main findings were:

• 44% of carers surveyed said they had received no practical help from their local authority
• 95% identified at least one form of support they had needed, but had not received
• 70% rated the support they received from their local authority as ‘poor’ or ‘very poor’

In addition it was found that:

• 76% of carers surveyed felt they did not have enough understanding of the legal options to make informed decisions
• 38% of the children living with family and friends carers suffered emotional and behavioural problems
• Two thirds of the carers had raised stress levels - twice the national average 
• 38% of carers exhibited high levels of stress

Care by family and friends is often seen often as preferable to foster care because it helps retain children’s links with their families. In some circumstances it can also be an attractive alternative to formal care proceedings, especially where a court has made a Residence Order or Special Guardianship Order.

Under-resourcing care by family and friends is clearly counter-productive. Breakdowns in family and friends placements result in more expensive foster care, so creating a vicious spiral. Local authorities and central government need to take steps to ensure that financial and professional support for this important resource is properly planned for and provided at an appropriate level.

Young people still having to leave care too early

I was sorry to read that Dr. Roger Morgan (the Children’s Rights Director) has recently found that nearly 50% of looked after children and young people say they have to leave care too early. A similar proportion was found to believe that they had been badly or very badly prepared for leaving care.

http://www.ofsted.gov.uk/news/50-say-they-have-leave-care-too-early

The survey found that some young people were leaving care as young as 16 years old. Shockingly one said: 'As a 16 year old I have gone from a children’s home to a women’s refuge. I have gone from having lots of support to having none.'

There is no clearer example of a resource shortfall. Young people are not being forced to leave care too early, or being badly prepared, because someone thinks that’s the right thing to do. Nobody believes that abandoning sixteen years olds is justified. The only reason this is happening is because there are not the funds to care for these young people properly. That is shocking in a so-called ‘advanced economy’.

The Impact of Munro

The Guardian takes a look at how the Munro recommendations are being implemented. 

There is a lot in this article about new management structures and new posts but not too much about changed practices. I know it is still early days but I think the implications of the Munro Review run very deep. It is not just about designating someone ‘principal social worker’ or even reorganising your services to resemble what they do in Hackney.

My view is that the real message of Munro is that effective child protection services can only be delivered by organisations that are willing and able to learn. Learning is inhibited by centralised policies, rules and regulations and, of course, by the dead hand of bureaucracy. But it is also inhibited by ‘expertise’.

Let me explain….

There is no shortage of reports, books and articles that set out new ways in which we can protect children. They are usually written by impressively qualified experts and are very good at saying what is wrong with the child protection system. However, when it comes to saying what must change, a hint of arbitrariness usually creeps in. We are counselled that such and such a reform is necessary, but the argument is invariably tenuous and the evidence is often obscure.

Meanwhile the people who actually do the work, and recognise and understand what is happening at the front line, are effectively sidelined and marginalised by the emphasis on the contribution of experts. A small, select group knows best and the majority of practitioners are there solely to implement the reforms, not to influence them.

However, the truth of the matter is that effective child protection is too complicated - and too important - to be invented by individuals or small ‘expert’ groups – whether they be groups of senior managers, inspectors or academics. Munro’s emphasis on organisational learning and professionalism implies that it is those doing the work who need to be the learners and the changers. Why? Because they are best placed to gather the evidence and to develop improvements.

What is not so clear in Munro’s approach, but which is very clear in my own mind, is that the learning and improvement needs to be small scale and continuous, not large scale and sporadic.

The history of quality management is littered with examples of organisations that have implemented huge one-off improvements, only to find that as time goes by the impact rapidly dissipates as the organisation reverts to traditional ways of working. On the other hand, where organisations empower their members to take charge of quality issues, and embed the expectation that each and every employee will strive to make small-scale improvements on a daily basis, the cumulative effect can be breathtaking.

So my hope is that the impact of Munro will be to encourage child protection organisations to devise ways of engaging each and every member of staff in discovering how they can learn more about mistakes and successes; and in coming up with ways of empowering those members of staff to translate their learning into concrete suggestions for achieving a perpetual stream of small-scale, achievable improvements.

Putting research in context

A good example of research being taken out of context seems to be in progress.

Professor Jane Ireland of the University of Central Lancashire carried out a study of a small number (126) of reports by “psychological expert witnesses” in Family Court proceedings. She found these to be of variable quality with two-thirds being rated by independent expert assessors as being of poor quality. Perhaps of greater concern, the research found that one in five of the so-called ‘expert’ psychologists was not properly qualified to act in this capacity.

The University of Central Lancashire’s website puts this research into appropriate context by quoting from a representative of the sponsors of the research, the Family Justice Council. This speaks of “expected methodological limitations” and a “small sample” for which “no claims are made as to its representativeness”. The sponsors describe the research as “useful” and as “an excellent signpost for future work, including reflection on how research methods can be refined in providing an initial view as to the quality of submitted expert psychological reports”.

These measured words are a far cry from the Daily Mail’s headline of an article that appears to be written by Professor Ireland herself.

“Family courts and how incompetent (but highly paid) so-called experts are failing children”

http://www.dailymail.co.uk/debate/article-2114616/Family-courts-incompetent-highly-paid-called-experts-failing-children.html?ito=feeds-newsxml

This article fails to explain that psychologists are but one of many groups of experts who provide evidence in the family courts. Nor does it explain that the research did not look at the quality of the evidence given by other groups such as paediatricians, radiologists, orthopaedic surgeons, psychiatrists, pathologists, forensic dentists … etc. etc.

Sadly the casual reader of the Daily Mail article is likely to conclude that most experts reporting in the family courts are incompetent, not the truth of the matter which is that a small proportion of one group of experts, psychologists, were found, in a small scale study, to be not properly qualified.

It is, of course, not surprising that Professor Ireland’s research as been seized upon by John Hemming MP, who campaigns vociferously on family court matters. Hemming has laid down an early day motion in the House of Commons that among other things says that Ireland’s research “… raises a massive question as to whether or not the judgments of the courts in the majority of care proceedings are reliable”.

But, of course, the research does nothing of the kind. It raises concerns about the quality of some evidence and it ought to be a spur to further research in this area. Possibly, it might entail an internal review of court practice. But a qualitative study of a small number of cases cannot purport to be representative and the results should not be generalised.

So let’s get things in perspective. There are some worrying things to which this research draws attention, but it is a small-scale study the results of which must be treated with caution. It does not raise “massive” questions nor does it cast doubts on the reliability of “the majority of care proceedings”.

Now this is getting silly

While nearly everyone agrees with the Government that adoptions should take place as quickly as possible, I think most sensible people will be appalled by the silly adoption ‘score card’ scheme that the Department for Education is introducing in England. http://www.communitycare.co.uk/Articles/14/03/2012/118065/Ministers-to-launch-controversial-adoption-score-cards.htm

This scheme has got as much sophistication as a blow from a blunt instrument. And the silly and crude performance indicators risk creating all kinds of unintended consequences. It was only a couple of weeks ago that I wrote in this blog about the findings of Peter Blau in 1966. It must have been pre-cognition!

Blau found that performance measures often result in employees improving their performance on an indicator, while the desired organisational performance actually declines.

The real danger here is that, when pressurised to speed up the adoption process, local managers will be disinclined to take risks with cases which may prove problematic and time consuming. So some children who might have otherwise been put forward for adoption will languish in care. That cannot be right.

Schools-based Services

Louise Tickle has an interesting article in The Guardian this week. 

She visited a primary school that operates a team that focuses on helping neglected pupils. Team members have expertise in family support, early years and child protection. The team appears to duplicate some of the functions of the local authority, especially with respect to early intervention with families where children may be being neglected.

The school’s head argues that the team is necessary because of high local authority thresholds and the subtle nature of neglect, the evidence for which is often patchy and cumulative. Teachers are said to have been reluctant to report suspicions of neglect to the local authority, being unclear when the threshold was reached and fearing the consequences of getting it wrong.

The head teacher sings the praises of the team. Children and their families are being helped earlier and crises are being avoided.

I think that schools based social work is basically a good idea. The NSPCC pioneered school-based teams in the early 2000s but somehow the positive messages from this work never seemed to hit the headlines. It makes sense to base children’s social workers near children, rather than in remote offices, and the school is one obvious place.

That is not to say that school based services are without problems. There need to be clear understandings with the local authority about how formal referrals and emergency action are to be handled and schools-based social workers will often have to wrestle with some difficult confidentiality issues.

Schools-based teams are not an alternative to Children’s Social Care – rather they are a form of complementary provision that can result in services which are more child-focused and which facilitate early intervention.

A Head for Figures?

I’ve been spending some time working through the British Government’s “Draft of Children’s Safeguarding Performance Information for Consultation” which was published in January and relates to England. A number of statistics surrounding child protection and related activity are proposed.

The consultation closes on the 16th April 2012, so there is still plenty of time to respond. I think doing so is a really important – although it is a somewhat technical issue – because if these ‘performance indicators’ are got wrong the child protection system, and those who work in it, could suffer the consequences for years ahead. 

So if you have strong views, a talent for constructive criticism or some good ideas, I would strongly urge you to contribute to the consultation, which you can do by visiting the following http://www.education.gov.uk/consultations/index.cfm?action=consultationDetails&consultationId=1803&external=no&menu=1

It will take me sometime to prepare my response to this consultation in full, but my initial reactions are very mixed. I think that the Government has rightly accepted some of the suggestions made in the Munro Review, but  some odd additions and elaborations are being proposed, which begin to make the list look formidable. There is no point having lots of statistics if they do not relate clearly to what you want to achieve.

A deep and fundamental flaw in the whole presentation is the careless use of the word ‘performance’. In the first place there is no definition of whose performance is being referred to. And a lot of measures that are suggested do not measure any-one’s performance at all, such as the rate of violent and sexual offences against children, or the rate of attendance of children and young people at accident and emergency units for assaults, deliberate self harm and other accidents. It is vital to understand that these are important items of contextual information, but they are influenced by factors beyond any-one’s control, so they are not 'performance information'.

I think it would have helped greatly to have divided the whole lot up into four clearly demarcated areas:

• Contextual information relevant to the demand for particular kinds of services at both national and local level
• Information about inputs into locally based services, especially staffing
• Information about the local operation itself based around quality, speed and cost
• Information about outcomes, where this is available

I have also found the consultation document to be sloppily drafted. For example statistics are proposed about ‘newly qualified social worker posts’ (whatever they are?) when what is clearly intended is ‘the number of vacancies filled by newly qualified social workers’. And the authors also seem to have forgotten the word ‘children’s’ in front of the words ‘social workers’, because there is no point measuring lots to do with the health and morale of the adult social care workforce in an exercise devoted to understanding services to children.

Then there are the usual problems associated with ‘performance indicators’. I fear civil servants have still to come to terms with these difficulties. As long ago as 1966 Peter Blau*, an American expert on organisational behaviour, found that performance measures often result in behaviour that conflicts with organisational aims; employees are able to improve their performance on an indicator, while, and often as a result, organisational performance actually declines. Nearly 50 years later British civil servants still do not seem to have fully got the point!!

The dangers are perhaps greatest with indicators that measure the speed at which parts of the process are completed. Over the years there has been a pervasive failure to understand that speeding up a particular stage of a process may not result in speeding up the whole process; and in some circumstances may actually result in slowing it down. Processes run at the speed of the slowest bottleneck, so speeding up stages other than the bottleneck will have no positive effect, and, if resources are diverted away from the bottleneck, will slow the whole process down.

I will be publishing on this blog a summary of my full response to this consultation, so watch this space.

* Blau, P. M. The Dynamics of Bureaucracy, Chicago UP, 1966.