Saturday, 28 June 2014

Do we need to redesign child protection services?

I’m still reading the CSJ report - it's over 400 pages! 

I have some mixed feelings about what I've read so far.  Much of the case material has the ring of truth to it, but it's difficult to generalise from it. Clearly there are children who are seriously failed by the system - any one who works in the sector knows that – but the issue is why. And so far I have found that the report tends to make quite a lot of assumptions about why, resulting in acall for ‘redesign’ which may be unhelpful. Let me explain.    

It seems to me that the kind of quality problems that the report illustrates may be caused by one or more factors, such as:
  • Chronic underfunding of services 
  • Poor allocation of resources 
  •  Crucial skills gaps / staff shortages 
  • Poor systems for assuring quality 
  • Failure to learn and adapt 
  • Distractions, such as bureaucracy or imposed change or target stetting 
  • Strategic confusions, such as being required by government to prioritise one thing at the expense of others 
  • Chronic low morale resulting from some or all of the above 
  • Poor service design
Some of these factors do not require top-to-bottom ‘redesign’ of services to remedy them. For example government can choose to reduce bureaucracy or increase funding quite easily. Staff shortages or skills gaps can sometimes be remedied by more resources or by introducing incentives.

Failure to learn and adapt is a very fundamental failing. It is not addressed by redesigning services, so much as by changing the culture. People have to be allowed and encouraged and rewarded for seeking to learn and adapt, which at present they are not.

I get worried when people start talking about ‘fundamental re-design’, because that usually unpicks as letting the politicians and spin-doctors and the editors of the tabloid papers, and who ever else happens to be around, pitch in with their ideas and issues, no matter how well informed, or ill-informed. A wide public debate sounds very open and constructive, but more often than not those who shout loudest will be those who are heard, not those with the most sensible ideas. And the resulting re-design is likely to look like it was re-designed by a committee – or even worse by a group of tabloid journalists.

I understand the temptation to want to think in terms of clean slates but it is very hard to design a viable service from scratch. And the last thing we want, I think, is an EveryChild Matters Mk II because in 10 years time we'll be back to where we started from, again.

Children’s services are very complex. They depend on a complex legal framework and they try to meet complex needs in a variety of complex ways. It is very difficult to understand the extent and nature of the services, and their effects, let alone redesign them. As the architects of Every Child Matters found, “it just ain’t that simple”. There are no quick fixes.

The crucial thing for me is changing the culture to accommodate and embrace continuous learning and improvement, based on the insights and experience of those who do the work and those who receive the services. In other words a bottom-up approach - not having rooms full of well intentioned (or in some cases not so well intentioned), and not necessarily well informed, people redesigning services on the backs of cigarette packets. And, as I have already said, that is about changing the culture, not the detail of how services operate. Doing things in this way starts from where we are now; and goes slowly in the direction of where we want to be.

I would start by trying to get a very clear vision of what we want. I don’t think that is too hard – services that meet the needs of vulnerable children and young people, that keep them safe, that treat them with respect and which promote their rights and welfare.

Then I’d concentrate on making three important changes.

Firstly I’d set up systems to collect reliable data from children and young people and their families who experience the services. They would be asked not only for their experiences but also for their ideas about how to improve services. A lot of this data could be collected through a single national system, so it would not be too expensive.

I would ensure that this data was used in the planning and design of services and in monitoring the quality of service provision.

Secondly I would introduce systems and incentives for all people employed in children’s social care to engage in activities of continuous improvement. People should be made to understand that they are not just employed to do their jobs, but to improve the way in which the work is undertaken. And managers should be made to understand that their primary role is to support staff in gathering data about quality and making suggestions about how to improve services.

I would ensure that this data is used frequently to make small but significant improvements to every aspect of the service.

Thirdly I’d set up reliable systems to collect data about service failures and errors. A national confidential critical incident system would be a very good idea. And I would help staff to develop their understanding of error through a human factors approach.  I would encourage them to incorporate thinking about error, and how to mitigate or avoid it, as a central part of their professional activity. Information about error would be used to make improvements that would result in safer services.