Sunday, 12 December 2010

A matter of procedure?

I see that the 4th edition of the London Child Protection Procedures has recently been published - The volume is 550 pages long!

When the 3rd edition came out in 2007 (a tome of similar size) I amused myself with some statistics:
  • Weight = 1.8 kilogrammes
  • Length = nearly 100,000 words
  • Hours to read (assuming a reading speed of 250 per minute) = about 6 hrs 40 mins
The authors tell us that the "... target audience is professionals (including unqualified staff and volunteers) and front-line managers who have particular responsibilities for safeguarding and promoting the welfare of children...." Quite a lot of people. If every such person in England had to read a volume like this (and the London Procedures are not untypical) and assuming a figure of 330,000 professionals (the number that was always quoted in connection with ContactPoint) then that's about 2.2 million person hours of reading time. Not cheap.

I think procedural manuals like this one have had their day. Here's why:
  • Most of the work child protection social workers and other professionals do cannot be proceduralised. There is no simple step-by-step guide to conducting a difficult inquiry or a complex assessment. Getting it right requires common sense, imagination, professional knowledge, the ability to relate well to both children and adults, being trusted, being a good listener, making sound decisions, being flexible, being persistent, being prepared to think laterally, being willing to revise an opinion. I could go on .... There is a a lot of process variability, as we say in operations management.
  • True there are some things in child protection that can be proceduralised. But these are the less interesting parts - the administration, the forms, etc.. Standardising some things may be a good idea but it should be done with three clear aims: (1) reducing unnecessary administrative labour and simplifying bureaucratic processes; (2) reducing the possibility of misunderstandings and ambiguities; (3) making sure that information is appropriately communicated and recorded.
  • Most professionals (such as teachers or GPs) do not need complex procedures. They encounter child abuse and neglect from time to time and they need to know what to do and how to do it as simply and as quickly as possible. The rest of the time they need to get on with their jobs. Having complex procedures has two downsides: (1) people don't have the time to read them and become familiar with them; (2) in an emergency people make mistakes because the procedures are too complex to remember. Having a clear set of procedures set out on one side of A4, which everybody follows if they have a concern, is the ideal.
  • Complex procedures contain "error traps" - weaknesses lurking unseen waiting to trip us up. The reason they are there is that the people who drew up the procedures are not omniscient. There's always something that will eventually happen which couldn't be foreseen. 
  • Not infrequently there is something missing from the procedures. Take section 6.5 of the London procedures, for example. This concerns referral. Nowhere in this section does it deal with the issue of what the referrer does when the local authority refuse to act on a child protection referral. I looked specifically for this because Birmingham children's services refusal to act on a referral concerning Khyra Ishaq is still fresh in my mind. And it seems that exactly the same sort of impasse could occur in following the London procedures.
  • Having big volumes of procedures can result in a false sense of security. It supports the idea that it all works like a well-oiled big machine and that all you need to do is read and understand the "operating manual". But nothing could be further from the truth. We only make child protection safer by starting off from the understanding that there are a lot of uncertainties in the work. Rather than giving people the idea that the manual "has it covered" we should be giving them tools and skills to deal with situations which no manual can cover.
There's a lot in the London procedures which I find confusing and which I expect people less familiar than I am with child protection would find baffling. Section 6 on referral is especially complex and unclear. The problems start because the authors appear to want to dovetail the Common Assessment Framework with the process of referring a child or young person about whom their are concerns of abuse and neglect. Paragraph 6.4.2 states:
"Other than in cases where it is immediately clear that a child is, or is likely to be, at risk of significant harm, professionals should complete a common assessment and discuss this with their agency’s nominated safeguarding children adviser, LA children’s social care or the police, to help them reach a decision that the concerns they have about a child are sufficiently serious for a referral to be made to LA children’s social care."
The central weakness of this paragraph is in the first sentence.  "Other than in cases where it is immediately clear that a child is, or is likely to be, at risk of significant harm ...." casts the net very wide. Suppose a seven year old boy arrives at school one morning with a classic black-eye (circular bruising around the eye) and when asked by the teacher how it happened he says: "Walked into a door, Miss". That sounds to me like a situation in which the teacher might feel she was not "immediately clear" that the child is at risk of significant harm. She probably would be very suspicious and she probably would know that it is quite hard to get a black eye from walking into a door (unless you walk into the door knob). But it is not "immediately clear" that this child is at risk of significant harm in the way in which it would be had he said: "My Dad thumped me". So what should the teacher do?

Well I think that the correct answer is that she should make a child protection referral. This is a worrying case. But the procedure leaves open the alternative of completing a common assessment. And it is just possible that in some cases that's what might happen. Not in the real world, I hear people say. Well that's exactly what happened in the Khyra Ishaq case, where the school tried to make a child protection referral but were invited by Birmingham Children's Social Care to conduct a Common Assessment instead.

Paragraph 6.4.2 goes on to pile confusion on top of uncertainty by suggesting three alternative sources of help are available to a practitioner who cannot decide, but notice that the implication is that this would only be done after a Common Assessment has been completed. And I don't think that's safe, or fair to the practitioner concerned. If people with little experience of child abuse, and no clear authority, are left to conduct a screening check on what is possibly a case of serious child abuse through the use of the crude tool of the Common Assessment, then sooner or later something will go badly amiss.

So I've got it in for procedures. I'd like to see some simple ones which don't over-step the mark and which everybody could become familiar with. A few clear things we all need to do when we suspect child abuse. But don't let's kid ourselves that voluminous manuals make practice any safer. They just waste paper and time.