Great article on Working Together

What an excellent article by Allan Norman in Community Care about Working Together 2013. He incisively analyses the mess that is the new document and draws attention to the subtle way in which human rights have been circumvented. 

It is spot on!!

I do not propose to summarise it – it is too good for that. I urge you to read it for yourselves:

http://www.communitycare.co.uk/articles/25/04/2013/119131/working-together-2013-ignores-human-rights-and-we-must-act-on-this.htm

What happens to the children of immigration detainees?

The charity BID (Bail for Immigration Detainees) reports that it has found that “(t)he UK Border Agency (UKBA) repeatedly failed to safeguard children when detaining their parents, with appalling consequences for the children concerned”. 

http://www.biduk.org/848/news/first-uk-study-finds-200-children-split-from-parents-in-immigration-detention.html 

The parents in the study were detained without time limit, for an average of 270 days. In 92 out of 111 cases, they were eventually released. The charity concludes that their detention  apparently served no purpose. 

Meanwhile some of the children lost weight, had nightmares, suffered from insomnia, cried frequently and became extremely isolated. Some children were reported to have moved between unstable care arrangements. The charity argues that some of the children were neglected and placed at risk of serious harm.

A spokesperson for BID said:

“Children … described their despair and misery at not knowing if or when they would see their parents again.”

“The Border Agency displayed a callous indifference in continuing to detain parents, in some cases despite having clear evidence that children were in wholly unsuitable care arrangements.”

This research is extremely worrying. UKBA has some questions to answer.

The Future of Children’s Homes

All credit to Children’s Minister, Edward Timpson, for aspiring to improve the quality of care in children’s homes, but I found the drift of his recent Daily Telegraph article (http://www.telegraph.co.uk/comment/10013169/Time-for-radical-changes-to-our-shameful-system-of-child-protection.html) a bit too much rule-focused and a bit short on ideas about how quality will actually be improved, other than a bit about training; and, of course, ordering people to do it.

Some of the new rules are:

• “… a decision to place a child in care far from their home can only be made by a senior official….”
• “… a requirement for the council to consult with the local area before they place a child in a home, to satisfy themselves about the quality and location of the home….”
• “… a duty on homes to notify local councils when children move in from other local authority areas and when they leave the home.”
• “… a requirement for children’s homes providers to carry out a risk assessment of an area, with the police and local council, before opening a home, with registration being refused or suspended where the area is deemed unsafe.”
• “… strengthen(ing) the current rules, requiring existing staff in homes to have completed minimum qualifications within a set period of time ….”

For a minister in a government which not so long ago wholeheartedly agreed with Eileen Munro that there are too many rules relating to child protection, Mr Timpson is certainly doing his utmost to demonstrate that the exception proves the .... rule!!

It’s a pity really, because I agree with so much of what he says about the shortfalls in residential care for children and young people, and I applaud his desire to do something about it; but more procedures are not the solution.

You don’t need to read many pages of an introductory textbook on quality management to understand that the quality of complex services is never likely to be improved by throwing the rulebook at it. The quality of the service children receive is a function of the dedication and motivation of the people who care for them. And motivation and dedication do not come out of procedural manuals  - they come from commitment and inspiration.

Those who raise safety concerns must be treated with consideration and respect

According to the BBC (http://www.bbc.co.uk/news/health-22252425) a survey suggests that about a quarter of nurses who raise alarms about patient safety are warned off by managers. Some whistle-blowers said they were belittled or bullied. The Royal College of Nursing (RCN) is reported as talking of a ‘climate of fear’. To his credit the Health Minister Dr Dan Poulter has said that those who speak should be listened to and protected from reprisals.

Organisations that do not have open reporting cultures are NOT safe. A culture of fear is the greatest enemy of safety. It is a ‘no-brainer’ really. If people are frightened of saying something when they see things that are not right – or even dangerous – then those ‘error traps’ will remain hidden out of sight, until they cause an accident and somebody gets hurt.

Where managers discourage members of staff from reporting safety concerns they are also doing themselves no favours. They just end up trying to manage an unsafe organisation that they do not understand. It’s a good example of Hans Christian Andersen’s tale of the king’s new clothes.

This recent survey gives us some information about the way things are in nursing, but what happens in other professions such as social care, the police and education? There may be no surveys in these fields but I think many people do not feel comfortable with whistle-blowing. An experienced child protection manager recently told a committee of MPs how dedicated members of her staff lived with “… an ongoing culture of fear … they do fear telling the truth and losing their jobs. They don’t feel whistle-blowing works.” http://chrismillsblog.blogspot.co.uk/2012/12/a-culture-of-overwork-and-fear.html   

And an article by Amelia Hill in the Guardian powerfully recounts the stories of some social care practitioners who have blown the whistle and suffered as a result.

Effectively protecting and safeguarding children requires professionals and organisations involved to practice safely and to address safety concerns. Organisations need to make strong clear statements encouraging staff to report their concerns without fear. Then they must practice what they preach and ensure that staff members who raise concerns are treated with consideration and respect.

Some interesting ideas from the Care Quality Commission

The Care Quality Commission (CQC) is the independent regulator of health and social care services in England, with the exception of children’s social care, which is inspected by Ofsted.

The history of the CQC includes its missing some hospitals and care homes that were failing very badly, even disastrously. So it is by no means an icon of perfection.

Now under new management it has laid out its new strategy to address some of the problems it has experienced in the past. And some parts of this seem very good.   

I particularly liked the following aspiration:

To “… ask the following five questions when inspecting services - are they safe, effective, caring, well led and responsive to people's needs?”

I thought that puts it very neatly and could be applied very well to children’s services. And I also liked plans to involve services users as experts in inspections. That seemed part of an overall intention to listen better to people’s views and experiences of care. Listening to people who use services is never easy and can easily descend into tokenism. Organisations need clear plans about how they will undertake this sort of work and ensure its quality.

I would like to see Ofsted laying out its stall in a similar manner. It could do a lot worse than to adopt the CQC’s five questions as they stand.

I’ve always thought that inspection is a blunt tool, which is not a very direct path to quality. But at least the CQC appears to be doing some interesting thinking about how to move forward. Ofsted should take note.

Emotional neglect and the criminal law

I was sorry to hear - on this morning’s BBC Radio 4’s Today programme  - consultant child psychiatrist Dr Eileen Vizard apparently supporting the charity Action for Children in calling for the criminal law relating to child neglect in England and Wales to be changed.

The argument is that it should be made easier to prosecute parents for emotional neglect. It is set out in great detail on the Action forChildren website 

As I have said before, I cannot see what all the fuss is about. There is no problem at all with the civil law (the Children Act 1989), which allows local authorities to intervene in all cases where there is a likelihood of significant harm to a child, whether caused by physical or emotional abuse or neglect. So the only issue appears to be an aspiration to prosecute and punish parents, who may currently be difficult to bring within the ambit of the criminal law.  

I simply can’t see what added value doing that would have. The proposed changes do not make it easier to intervene to protect a child and do not make it any more likely that intervention would be successful. And, I believe, they make it more likely that some inappropriate cases would come before the criminal courts, where the parents concerned turn out to be more deserving of help than of prosecution and possible imprisonment.

Delays in implementing joint inspections

It’s hard to understand what is going on with child protection inspection at Ofsted. 

This week Children and Young People Now reports that plans for joint inspections of child protection are being put on hold. Eileen Munro recommended* this type of inspection which would involve health, police, probation and prison inspectorates working together with Ofsted.

Joint inspections would surely be an improvement on present arrangements – so why not just do it?

Footnote

* The Munro Review, Final Report Recommendation 2: "The inspection framework should examine the effectiveness of the contributions of all local services, including health, education, police, probation and the justice system to the protection of children."