Understanding the impact of stress on error in child protection work should be a priority

In a post I made at the beginning of November, I said that there is a lot of evidence that stressed employees do not deliver good products and services.

http://chrismillsblog.blogspot.com/2018/11/working-conditions.html

I was therefore interested to read the other day that scientists at Columbia University have recently shown that during stressful times in operating theatres, surgeons make up to 66 percent more mistakes than at other times. 

https://datascience.columbia.edu/surgeons-under-stress-make-more-mistakes-in-operating-room

I don’t expect that the methodology of the Columbia study - which involved the wearing of special clothing which monitored the electrical activity of a surgeon’s heart while operating - could be easily adapted to social workers and other child protection practitioners, working as they do in community settings. However, some research into the relationship between stress and error in child protection work would be a very good idea. And I think it should also look at the impact of both long-term and short-term stress.

Surely such a study is possible. There must be academics out there who could undertake it. And there must be sources of funding that could be found. Understanding the impact of stress on error in child protection work should be a priority.

Outsourcing

I am very pleased to see that Professor Ray Jones is publishing a book on the outsourcing of children’s services. He is, of course, a well-known critic of the increasing involvement of private companies in the delivery of children’s social care.

According to an article in Community Care, Jones argument in his new book is that accountability is being lost in the burgeoning number of moves to an “alternative delivery model” in such places as Richmond-and-Kingston, Doncaster, Slough, Sandwell and Worcestershire. According to Jones, Directors of Children’s Services, in areas where outsourcing occurs, will be increasingly faced with the loss of “information and intelligence” about what is happening in those services.

He is absolutely right. And fortuitously the launch of his book coincides with news of a major public sector outsourcing fiasco in which the British Army outsourced its recruitment to a large private sector company with extremely disappointing results. The Guardian says that government officials did not understand how complex the project was before signing the deal.

If recruiting soldiers is a very complicated business, how much more complex is protecting children from abuse and neglect? And how much more complicated will the outsourcing contracts have to be in order to ensure that the outsourcers deliver what is promised? If the Army can get outsourcing a relatively straightforward service so badly wrong, how much more likely is it that local authorities will get the outsourcing of a very complex professional service (like child protection) wrong? I suggest it is very likely.

Interestingly the business literature on outsourcing does not provide much support for the kind of outsourcing deals which the government is trying to foist on children’s services in England. In a seminal work on offshoring and outsourcing, Oshri, Kotlarsky, and Willcocks* argue that activities which constitute the basis or core of an organisation’s operation (which they call ‘order winners’) should alwaysbe kept in house. On the other hand ‘necessary evils’ such as administration, payroll or facilities management are usually good candidates for outsourcing. 

The government, in contrast, propounds policies for child protection outsourcing which involve core activities being transferred lock, stock and barrel to outsourcers. And the government provides no account of why outsourcers would be any better at delivering these core activities than local authorities. The reality is that local authorities are being pressurised into adopting strategies for which there is no evidence and no clear business rationale. That does not seem sensible to me.

If the government were proposing outsourcing only back-office services, I would have some sympathy. As it is I have to agree with Ray Jones – we should be “scared” about what is happening. Even if ministers do not listen to social work academics like Jones, or to business academics or other experts, one would hope that they would at least be chastened by what is happening to government outsourcing deals in defence and other spheres and heed the warnings. But I don't expect they will.

*Ilan Oshri, Julia Kotlarsky, Professor Leslie P. Willcocks The Handbook of Global Outsourcing and Offshoring Palgrave Macmillan, 2011 https://books.google.co.uk/books?id=hYQzxD9MSR0C&dq=order+winners,+necessary+evils&source=gbs_navlinks_s

Health Visitors are essential for effective child protection

 An article in Care Appointments reports on a poll of 1,200 Health Visitors in England which reveals an over-stretched service and concerns that tragedies could occur because vulnerable children may not be identified until it is too late.

It was found that less qualified, non-registered practitioners were being used in some areas to conduct child health and development checks, so that Health Visitors could concentrate on working with children already identified as vulnerable. Another undesirable practice of providing early contacts over the phone had also arisen. Forty-three percent of the respondents to the survey reported being so stretched that they feared a tragedy could occur. 

The survey puts into dramatic focus the effects of the continuing cuts to public health budgets in England, resulting in the loss of about 25% of the health visiting workforce during the past three years, with another round of cuts due in 2019/20. 

Health visiting, which is conducted by qualified nurses and midwives who have also gained an additional health visiting qualification, has a long and distinguished tradition in Britain, dating back to the late nineteenth century. Child health and development checks, carried out by Health Visitors, play a vital role in child safeguarding and protection, often providing the kind of early warning which otherwise would not be available. Not infrequently the Health Visitor is the only professional in regular contact with families with small children.

Not funding health visiting properly is a false economy. It is self-evident that early intervention, before serious neglect or abuse occurs, is preferable to late intervention. And the more we understand about the impact of early abuse and neglect on a child’s subsequent development, the more we understand that not providing effective health support and advice services to young families - and health monitoring of children during the early years - is as foolish as it is penny-pinching.