Tuesday, 27 November 2012

Rochdale to discipline staff?

It appears that as many as twelve Rochdale Council staff, who were involved with child protection failings associated with the child exploitation scandal, are to face disciplinary proceedings.

I begin to despair because these things always seem to pan out in the same way. Disciplinary action against staff (usually junior staff) seems to be a knee-jerk response. Nobody seems to consider the impact that a punitive management stance has on child safety in general.

Punishing usually well-intentioned, but erring, employees is likely to result in fewer of them in future feeling able to confess their errors.  That results in less, not more, safety.

All senior managers in children's services, and their political bosses, should read Sidney Dekker's book Just Culture: balancing safety and accountability (Ashgate 2007).
What was it Michael Gove said not so long ago? 

“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.


Should more children be taken into care?

In this post I want to look at some more of the failings identified by Michael Gove.

I had planned to tackle ‘Failing No 1’ next, because it seems to me that the issue of too many local authorities not meeting acceptable standards for child safeguarding is very fundamental.

However, because of recent letters published in the press, which will be discussed below, I think I had better say something first about Failings 2, 4 and 5.

2.    Too many children are left too long in homes where they are exposed to neglect and      abuse

4.     Intervention is often too late

5.     Children are often returned prematurely to abusive homes

Let’s begin by discussing the last of these, Failing No. 5.

The available empirical evidence strongly supports the claim that in Britain children are often returned prematurely to abusive homes or left in them following some intervention. Brandon and Thoburn [1] found that 57% of the children that they studied, who were subject to a child protection intervention, experienced re-abuse. Farmer [2] reports that in almost half the cases she studied, where children returned home from care, they were neglected or abused during the return.

These are grim and disturbing findings.

Reducing the likelihood of re-abuse following intervention should be a major aim of child protection policy and practice. The very last outcome for which any of us would wish is for a child to be left in, or returned to, a home where abuse will continue to occur. But it is amazing that in all the mire of UK child abuse statistics there appears to be no routine collection of data directly relevant to the issue of re-abuse. This needs to be urgently addressed.

Nor does there seem to be a sufficiently high level of organisational awareness about the frequency and nature of re-abuse following intervention. At the very least I would hope that all cases of re-abuse should be treated as critical incidents. They need to be examined and investigated and any factors that might have been predictive of re-abuse identified. The characteristics of the child, the family and the case need to be scrutinised and careful aggregation of data needs to take place to build-up an ever improving picture of the circumstances – both familial and organisational - in which re-abuse occurs. This corporate learning should form the basis of service improvements designed to reduce the incidence of re-abuse. Such high levels are unlikely to reduce rapidly, so this is a long-term strategy and an ongoing piece of work.

Michael Gove asserts (Failing No. 2) that too many children are left too long in homes where they are exposed to neglect and abuse. The very high rates of re-abuse identified in the UK literature support a conclusion that at least some of the re-abused children should have been placed or remained in care. But - and this is the important point - it does not automatically imply that more children per se should be in care, only that more of the right children should be in care.

Martin Narey (the former head of children’s charity Barnardos and Government ‘adoption tsar’), who has clearly influenced Gove, is famously quoted as saying: “We just need to take more children into care if we really want to put the interests of the child first”. [3]

But I think this oversimplifies the issue greatly. It’s not a matter of more children across the board being taken into care, but more – the right more – being taken into care early on.

So I agree with Gove that intervention is often too late (Failing No. 3) and I would argue that any discussion of numbers of children coming into care has to take place in the context of a discussion of when they come into care.

A child who is removed from an abusive or neglectful home at a very early age suffers less long-term damage than a child who is allowed to spend her or his toddler years being abused and neglected. Indeed arguably many of the whole life ‘sequellae’ of child abuse and neglect, such as mental illness and educational underperformance, would be reduced in severity or avoided completely. Not only that, but a child who is removed early can often be more easily adopted and so the costs of care are usually substantially less. Plus there is a reduction in overall intervention costs, such as those of family support. The child benefits from a loving and a safe home at the earliest opportunity. And, of course, a child who has been made the subject of a care order early in life does not become a new care case later in childhood.

So the issue is the right number of children at the right time – not simply an issue of numbers more or less. It is a question of 'doing it right first time' which not only results in higher quality (better outcomes for children) but also lower costs [4].

My view is that a central question in child protection, with which we should all be preoccupied, is how we can shift the age of intervention earlier and earlier while at the same time making more and more accurate decisions about which children require care. ‘Early intervention’ is a phrase that is often used to describe preventative work; something I think is very important, but which is quite different. I am talking about ‘early intervention’ in the sense of interrupting abuse and neglect at an earlier stage in a child’s life.

Of course our knowledge of how to succeed with this sort of early intervention is very partial. It will certainly help greatly if academic research, in future, is much more focused on this area; and children’s social care information systems should be adapted to produce much more relevant improvement information. A key focus of study should be the characteristics and circumstances of those children who were considered marginal for care proceedings at a very young age, but who were, in the event, left at home with support until subsequently care proceedings became inevitable. Research here also needs to address the legal, business and professional processes that resulted in these cases being dealt with in this way. At present we know very little but that should not deter us from trying to learn more. “A journey of a thousand miles starts with a single step”, as the Chinese philosopher Lao Tzu said long ago.

You will probably not be surprised to hear that I find it a bit sad that this debate about care and numbers already seems to be polarising around the ‘mores’ (like Martin Narey and Michael Gove) and the ‘fewers’, such as a plethora of social work (and social policy) professors who wrote to the Guardian newspaper the other day [5].

I take no issue with the professors’ concerns that Government welfare benefit policies are likely to have a negative impact on the lives of many families with children at risk, increasing the number of ‘stressors’ which disadvantaged families face. That is not right and in my view not sensible. But it is difficult to see welfare benefits as a direct alternative to care. That is a bit like arguing that resources should be diverted from the ambulance service to road safety campaigns, rather than arguing that ambulance service costs will fall if road safety campaigns succeed in reducing accidents! Indeed the more the preventative service fails the more the emergency response is required.

And the professors seem willing to concede that  ‘… research … reveals a pattern of "too little for too long and too much too late" ‘ (letter from Brid Featherstone et al) and “… that abused and neglected children tend to do better if they remain looked after by the local authority than if they return home” (letter from Harriet Ward). So there may be more common ground than the tone of the letters implies.

My advice to Michael Gove would be to engage with the research community, including the professors who have signed these letters, and to make some resources available for research into the issue of how care can become an early option rather than a backstop. I would also advise him to take note of their concerns about the impact of the so-called ‘welfare reforms’.

And my advice to the professors would be to try to separate, rather than conflate, the issue of the early use of care and issues of welfare benefits policy. Attention to this problem should not be neglected simply because it comes from a government which pursues welfare benefits policies which are wrong-headed. Rather academics need to devise some creative, novel and helpful research to inform how we can get more of the right children into care at the earliest possible moment.

[1] Brandon, M. and Thoburn, J. (2008) “Safeguarding children in the UK: a longitudinal study of services to children suffering or likely to suffer significant harm” Child and Family Social Work 2008, 13, pp 365–377

[2] Farmer, E R G (2009). "Reunification with birth families", in Schofield, G and Simmonds, J (Eds.) The child placement handbook. London, BAAF.

[3] See

[4] The phrase 'doing it right first time' is associated with Philip Crosby - see his book  Quality is Free. New York: McGraw-Hill (1979). 

Wednesday, 21 November 2012

How many children and young people are sexually exploited by gangs and groups in England?

A study by the Office of the Children's Commissioner, published today, says there were 2,409 children and young people sexually exploited by gangs and groups in England during the 14 months to October 2011.

That’s an estimate that strikes me as being a realistic minimum. It is, of course, 2,409 more cases than anybody would want.

However, I began to lose track of the methodology outlined in the report (which can be downloaded at http://www.childrenscommissioner.gov.uk/ ) when it came to the authors identifying a further 16,500 children who were said to be at "high risk of sexual exploitation" in 2010-11. The definition of ‘high risk’ offered in the report seemed to me to be rather vague. It involved identifying children who showed a minimum of three factors, from a list of eleven characteristics. However any of these could be accounted for by other forms of abuse, neglect, stress, misfortune and deprivation.

So I ended up not being able to get my head around what the authors meant by 'being at high risk of sexual exploitation'. And I can see how this lack of clarity might lead some commentators to be concerned that the extent of the problem may have been overstated in the report.

It is of vital importance, for the sake of victims, that we respond appropriately to the phenomenon of child sexual exploitation. We need a careful, measured and effective response, not a moral panic. Having an accurate picture of prevalence and incidence is essential and I am saddened that the report appears to muddy the waters in this regard.

My belief is that central to protecting sexually exploited children and young people is the provision of services which they can trust and which listen to them. Sexually exploited children and young people are frequently fearful of the consequences of disclosure. They are often fearful of their parents or carers discovering what has happened. Frequently abusers intimidate and threaten exploited children to try to ensure their silence. Some children and young people are convinced by their abusers that they themselves will also be punished if the abuse comes to light.

My view is that the urgent priority must be to devise more effective ways of encouraging victims to disclose. Disclosure must be made easier and safer.  And a consequence of higher levels of disclosure will be that more accurate estimates of the incidence and prevalence of sexual exploitation will be made possible.

Tuesday, 20 November 2012

Organisational and Professional Learning

Michael Gove outlines two failures in child protection in the UK (numbers 7 and 8 in my list) concerning learning. He says:
  • We are not transparent about the mistakes that were made when things go wrong
  • We do not learn properly from what went wrong to improve matters in the future
A failure to learn is fundamental. Organisations which do not learn are doomed to fail. If we cannot learn how to protect abused and neglected children better, then we should despair.

Gove does not tell us what he thinks inhibits learning, but by saying that we are not transparent about mistakes he drops a heavy hint. Lack of transparency is usually due to a surfeit of fear. If people fear that their errors will have dire consequences for them personally they will not confess them, they will try to hide them. Their errors will remain secret. No corrections will be made. Errors will continue to happen. Safety will be compromised. Children will continue to die.

Back in the 1980s the airlines in Europe and the USA realised this. They realised that a jet engine technician who had lost a spanner on the job was a valuable asset if s/he confessed to the error, but a dire liability if s/he didn't. What was better, to threaten erring technicians with severe punishment, and to risk losing airliners, or to deal with most errors non-punitively and promote openness? It was a no-brainer.

Of course in practice, it may not be quite that simple, but the basic principal holds - unjust blame inhibits safety.

Swedish academic, Professor Sidney Dekker, has written extensively on these issues [1]. His book, entitled Just Culture: balancing safety and accountability, is essential reading for anyone working in a safety critical industry, like child protection. It deals with how to promote openness while not tolerating everything. That takes a lot of thought but it is relatively easy to see how it might work out. A 'just culture' is not 'a no blame culture'. Sabotage, recklessness and seeking personal gain at the expense of realising organisational and professional goals (such as the best interests of a child) should still be disciplinary matters. But errors which are committed in good faith, no matter how dire the consequences, should not attract punishment.

To achieve transparency the people at the top have to work very hard to promulgate a 'just culture'. It is easy to say that genuine errors will not be punished, but a great deal harder to do when the tabloid press is baying for blood. Politicians, civil servants and senior children's services managers need to work hard at developing a just culture and demonstrating that they embrace it. They need to have in place clear agreements not to wilt at the first sign of pressure. Promises must be kept.

Having a just culture is the start, not the end, of developing a learning culture.  We need to be clear about the nature and scope of learning. 

It is a fundamental mistake to prescribe learning too closely. We can learn to hit targets, achieve performance objectives, implement procedures or pass Ofsted inspections - but none of that matters if we are still not doing the right things to protect children. Real learning is about a deeper understanding of what we are dealing with (child abuse and neglect) and ever expanding our knowledge of how to deal with it more effectively. 
Chris Argyris and Donald Schön [2], who were professors at Harvard and MIT respectively, call this second type of learning 'double-loop' learning. They define double loop learning as follows:
When the error detected and corrected permits the organization to carry on its present policies or achieve its presents objectives, then that error-and-correction process is single-loop learning. Single-loop learning is like a thermostat that learns when it is too hot or too cold and turns the heat on or off. The thermostat can perform this task because it can receive information (the temperature of the room) and take corrective action. Double-loop learning occurs when error is detected and corrected in ways that involve the modification of an organization’s underlying norms, policies and objectives. [3]
Double-loop learning has a consequence which may be unwelcome to some policy-makers and managers: they have to give up some control of the service to the learning process which is often mediated, not by those who direct, but by those that do the work. Workplace learning in airline safety, for example, has uncovered commercial pressures, long hours and tiredness, the careless exercise of authority and the arrogance of command as key human factors that increase risk. Some airline executives may not like this type of conclusion but they have been driven to accept it.

In child protection double loop learning might result in challenging some of the assumptions of how services are currently designed and delivered. Are top-down bureaucracies suitable organisations for the task? To what extent should government, or the courts, seek to influence professional practice? Can services be delivered by over-worked and underpaid individuals? How can children and young people have more say and more control? To what extent should the civil and criminal law play a part? How far can professional boundaries be crossed?

Another fundamental mistake is to assume that there are just a few ways in which learning can come about. Recent discussions in England have been excessively influenced by the identification of the Serious Case Review (SCR) as the main tool of learning. But the SCR is probably not a very effective tool. It is cumbersome, slow and may obscure vital information. It is hard to circulate and publish the learning from an SCR. It takes a long-time to prepare an SCR. Despite its ubiquitous presence since 1991 the SCR has not resulted in reducing the same kind of mistakes happening again and again [4]. 

The primary need is for what I call 'workplace' learning. That is learning that takes place day-in and day-out at the point at which the service is delivered, usually conducted and mediated by front-line staff. The aim should be that tomorrow all those delivering the service are better placed to do so - if only a little bit - than they were today. Experience from manufacturing industry is that the cumulative effects of regular and frequent workplace learning can be dramatic [5]. I am convinced that similar dramatic results can be achieved in child protection, if only we embrace workplace learning seriously.

There are three tools of suitable for workplace learning which seem to me to be relatively easy to understand and fairly straightforward to implement initially, although the trick comes in sustaining them in the longer term. They are:
  • Debriefing
  • Kaizen
  • Critical Incident Reports
Debriefing is the simple idea that every significant piece of work concludes with a short review by all those who have been involved in it. The idea is to identify what went well and what went badly. How can the work be done better next time? Do any important issues need to be escalated for management to address? You will find that the flight crew of your holiday airliner carry out a debriefing at the end of every flight.The other side of the coin, of course, is briefing which takes places before significant pieces of work and in which the messages from previous debriefings are taken forward.

Kaizen is the Japanese idea of 'continuous improvement'. Now common in manufacturing industries across the world Kaizen places a responsibility on all employees, not just for doing the work but for improving the way in which the work is done. The emphasis is on identifying small, cumulative changes which over time amount to significant improvements in service or manufacturing processes.  Employees who recognise opportunities for improvement in a process communicate their ideas to managers, who investigate the suggestion and implement it, if it is feasible. It is vital that management take all suggestions for improvement seriously and respect the fact that front line workers will usually have a better understanding of business and professional processes than they do.

Critical Incident Reporting dates from the 1950s when it was developed to improve safety in aviation. It has subsequently extended into other transport industries and into medicine. The idea is that when a near-miss (a 'critical incident') occurs it is reported on an anonymous basis to an independent reviewer for analysis and publication. Aggregate summaries of critical incidents are provided regularly to inform safety management and to identify weaknesses in organisational defences.  As Professor James Reason puts it: ‘Without a detailed analysis of mishaps, incidents, near misses, and “free lessons,” we have no way of uncovering recurrent error traps or of knowing where the “edge” is until we fall over it.’ [6]

I believe the introduction of these three techniques, with accompanying culture changes, would make a significant difference to learning in child protection. They would result in streams of information flowing from the bottom-up, instead of the top-down flows which have traditionally predominated. They would provide the raw material of learning - relevant data - and they would involve all those involved in providing services the opportunity to contribute constructively to bringing about change and ultimately better, safer services.

[1] Dekker, S (2007) Just Culture: balancing safety and accountabilityAshgate
[2] Chris Argyris and Donald Schön (1974) Theory in practice: Increasing professional effectiveness, San Francisco: Jossey-Bass
[3]  Argyris, C., and Schön, D. (1978) Organizational learning: A theory of action perspective, Reading, Mass: Addison Wesley, pp 2-3
[4]  Care and Social Services Inspectorate Wales Annual Report 2008-2009 - see http://chrismillsblog.blogspot.co.uk/2009/12/serious-case-reviews-poor-tool-for.html
[5] Imai, Masaaki (1986). Kaizen: The Key to Japan's Competitive Success. New York: Random House. 
[6] Reason, J 'Human error: models and management'  British Medical Journal  volume 320 18 March 2000

Looking in more depth at the '15 failings'

In 2012 Michael Gove, the UK's Secretary of State for Education, identified 15 key failings of child protection in Britain.

I think he has been particularly incisive in crafting his list.

Over the next few weeks I am going to examine and discuss the failings Gove outlines, each in turn. I’m not going to follow the order he adopted in his speech, but rather the order that I think best reflects the importance of each failing.

I am starting this week with failings seven and eight, taken together. These concern organisational and professional learning. They appear to me to be fundamental. The next post explains why.

Saturday, 17 November 2012

Michael Gove identifies fifteen key failures of child protection

The gloves have come off – and Michael Gove has come out fighting. The Secretary of State for Education, and the most senior minister in the British Government with direct responsibilities for child protection, has probably shocked more than a few people with his combative speech to the Institute of Public Policy Research.

While there are a number of things in the speech with which I disagree (and which will be the subjects of subsequent posts), I have no real argument with Gove’s analysis. Indeed I think it is excellent and should form the basis of a long-term agenda for change.

Gove talks of “the failure of our current child protection system” and admits that the “… state is currently failing in its duty to keep our children safe”.

He identifies of fifteen key failures:

1.    Too many local authorities do not meet acceptable standards for child safeguarding

2.    Too many children are left too long in homes where they are exposed to neglect and abuse

3.    The rights of biological parents are often put ahead of those of vulnerable children

4.    Intervention is often too late

5.    Children are often returned prematurely to abusive homes

6.    There is a preoccupation with the smaller risk of stranger danger, resulting in an intrusive and inefficient bureaucracy that creates a false feeling of security

7.    We are not transparent about the mistakes that were made when things go wrong

8.    We do not learn properly from what went wrong to improve matters in the future

9.    We do not support the social work profession properly, nor have we modernised its ways of working in line with other professions

10. When children are taken into care we take too long to find them a secure and loving home

11. We don’t recruit enough foster parents for children with very challenging needs

12. We don't recruit enough adoptive parents – and treat those who do wish to adopt poorly

13. Children who are placed in residential care homes are not provided with sufficient support and security

14. Abused and neglected teenagers are not given enough respect or protection

15. Care leavers are not provided with a sufficiently clear and secure path to the future

In the past I have not infrequently disagreed with Michael Gove. On this occasion, however, I think his fifteen ‘failures’ are a most concise and accurate analysis of the key things that we should all be trying to change.

Carlisle on Doncaster - a disappointment?

Lord Carlisle’s review of Doncaster Council’s handling of the Edlington Case has just been published.

For a brief summary see the Independent’s account.

I think I agree with some of his recommendations.

I like Recommendation 17, “… that further attention be given to developing a good national standard for school nurse provision.” However, I would have preferred him to say that he recommended the provision of a good national school nurse service. That would have been clearer.

I also liked Recommendation 16, “… that annual medical examinations at school be introduced for every child up to and including year 11”.

But I think it would have been better to have said that every child has a right to a good school medical service. However, an annual check-up at which a child is weighed and examined is part of that. 

Recommendation 3 says that “…the links between children’s services generally and CAMHS (Child and Adolescent Mental Health Services) should be developed to achieve the best potential effect of full assessments of conduct disorder and the use of available treatment.” 

That sounds OK, but I think the issue is primarily one of properly resourcing CAMHS.

I also found some of his recommendations puzzling and difficult to accept.

Recommendation 4 is one such. He writes:

“I recommend that Ministers and local authorities consider steps to ensure that the knowledge held by housing providers becomes a standard part of developing intelligent systems for dealing with casework and is recognised by other agencies as an important source of early warning information about families facing problems.”

What does that mean? Are housing associations going to be expected to routinely pass information to local authorities concerning some of their tenants who have children? How will they select which tenants and how can such ‘spying’ be reconciled with the Data Protection Act? 

At present anybody who believes a child is at risk of significant harm should alert the local authority (or the police or the NSPCC). That is clear and justifiable. But it is a lot less easy to identify reasonable ‘early warning information’ and to justify sharing it without permission. Indeed many people who have years of training and experience in childcare find identifying reliable early warning information difficult to do. This recommendation reminds me of the ‘cause for concern’ indicators in ContactPoint - for an excellent discussion of information sharing see Eileen Munro's article on the subject at http://eprints.lse.ac.uk/4403/

I think Carlisle's discussion here is naïve.

I found Recommendation 5 very difficult to understand. Carlisle says:

"I recommend that a radical look be taken at the way interventions are assessed and dealt with. For example, for cases where there have been three police reports of criminal behaviour (or comparable trigger events) on the part of a child in a given period, consideration should be given to placing the burden on the parents and the child’s legal representatives in any ensuing Court proceedings to show that the child’s welfare and best interests are served by leaving him/her in the family home."

This seems very confused to me. Does it mean that the three reports of crime (or ‘comparable trigger events’ – whatever they are) will result in care proceedings? I certainly hope not. But if there are otherwise good grounds for care proceedings, why reverse the burden of proof for a particular group? And why say ‘three police reports of criminal behaviour’? Why not two or four? And what if these are very minor? Or what about a child who has a single very serious conviction? Reports of crime are not convictions – a spiteful neighbour might have reported a child three or more times and the police have taken no action, because the reports are malicious. Surely that should have no impact on the burden of proof in care proceedings?

Clearly this proposal does not make much sense. And, I think, it is very dangerous to meddle with the basis of the Children Act 1989 unless you are absolutely clear about the effects of the meddling. As far as I can see this recommendation will result in some children coming into care who do not need to, taking resources from some who do need to be in care. As it stands it is a sloppy and dangerous proposal.

I wasn’t ecstatic about Recommendation 10 either. Carlisle recommends “… that steps be taken urgently to ensure that Doncaster councillors are given far more opportunity to understand and scrutinise those services”. 

I find it hard to believe that if services in Doncaster haven’t improved with the Department for Education and Ofsted heavily scrutinising what is going on, that giving some group of people who probably understand very little about children’s services, family law or child abuse and neglect the opportunity to take names and kick arse, will have any positive effect at all.  

There were some other recommendations that tried my patience, but I’m running out of energy at this point, so won’t go into detail. In short I was saddened to find so much in the report to argue with and I wasn’t impressed by what seemed to me to be a return to the ways of some of the bad old enquiry reports of the past – get in a QC (lawyer) and let him or her produce a list of unworkable or naïve recommendations which will do nothing to improve services and quite a lot to distract those at the front line who are just trying to do a decent job.

Friday, 16 November 2012


It is very sad to read that child protection services in Doncaster are still struggling.

What seems to me to be totally unacceptable is that three years after the Edlington tragedy, and special measures being put in to ‘turn-around’ Doncaster, the council still seems to be failing with high case loads, shortages of experienced staff and too much administration.

The Department for Education and Ofsted have been involved in trying to improve services in Doncaster since 2009. How can it take so long to make a difference?

Can we get rid of unnecessary guidance?

Liz Davies is both right and wrong in her analysis of the draft of the revised Working Together guidance - http://www.guardian.co.uk/social-care-network/2012/nov/09/child-protection-guidance-under-threat

She is absolutely right to be concerned that specialist multi-agency child protection teams have been disbanded. She writes:

Police and social work teams which had conducted comprehensive investigations and exposed organised and institutional abuse networks across the country are no longer in place and they rarely train together. These specialist teams, which had developed highly refined skills in the investigation of abuse and investigative interviewing of children and survivors, were lost through restructuring of services into a response to children in need in a far more general sense and the word safeguarding replaced the word protection in much government guidance.

But she is in error to confuse this problem with the issue of slimming down guidance. Indeed the decline of specialist teams, as Liz herself points out, dates from central government guidance in the 1990s which sought to refocus services on assessing need rather than investigating abuse.

And I think she has a roseate view of the WorkingTogether guidance in its traditional format. She says:

Working Together forms the basis of legal proceedings, family law, disciplinary hearings, professional training programmes and professional practice – the list is endless.

I think that it is a huge, confused and inaccessible confusion of some nuggets of wisdom, some vagueness and quite a lot of arbitrary rules. Some-one had to do something about it before it developed into a multi-volume work to rival Encyclopaedia Britannica.

However, Liz is quite right to be concerned that there is a danger that each local safeguarding children board may now decide to invent their own local guidance. That will lead to chaos.

The problem, I think, is not the length of guidance but its quality. The real problem is that the proposed guidance to replace Working Together is badly drafted and foolishly seeks to combine guidance on child protection with the framework for assessment.

I remain convinced that short, clear and useful guidance could have been drafted, although sadly now the opportunity may have been missed.

Eileen Munro was absolutely right to identify the problem of every enquiry making recommendations that were subsequently turned into procedures and guidance, resulting in the capacious volumes of procedures with which child protection professionals were supposed to work. In calling for them to be swept away she challenges us to think for ourselves, rather than looking it up in the manual.

The problem I fear may now be developing is that a lot of us are not ready for this change. There are too many people asking, “How shall we think for ourselves?”

Silly Me !!!

In my response to the Government's consultation on the safeguarding guidance I wrote the following concerning the volume entitled : "Managing Individual Cases: the Framework for the Assessment of Children in Need and their Families":
Generally I am perplexed about why anyone thought it a good idea to try to subsume guidance concerning the Framework of Assessment of Children in Need into guidance on child protection. I see nothing in the Munro report to suggest that such a mishmash of guidance would result in better services.

It was only the other day that I remembered who first made this proposal. It was none other than Lord Laming in the Victoria Climbie Enquiry. Recommendation 13 of the Laming Report states: 
The Department of Health should amalgamate the current Working Together and the National Assessment Framework documents into one simplified document.(http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4008654 page 373)
Not remembering that it was Laming who made this suggestion left me feeling just a little bit foolish ... but not as silly as the suggestion itself!!

Friday, 9 November 2012

Child abuse hurts everybody

What a sad illustration of how child sex abuse hurts not just its direct victims but bystanders, commentators and innocent members of the public as well.

The North Wales children’s home scandal rumbles on bringing more and more pain to more and more people; boys (now men) who were cruelly abused and never properly listened to, and who have grown-up in fear, a man who has been wrongly accused through no fault of his own, and journalists who may face libel proceedings, maybe because they were afraid that they might be accused of a cover-up if they did not publish.


Thursday, 8 November 2012

Reader Feedback

The blog suddenly seems to be generating more international traffic with a marked increase in interest, much apparently from Japan.

Assuming that these readership statistics are not just a misleading consequence of some electronic malfunction in the blogosphere, it would be of interest to me to know what features of the blog are of interest, particularly to those accessing it from Japan but also from any new readers elsewhere.

If you can spare a few minutes why not email me with your thoughts or comments on:


Good-one Frank!

There’s a very good post in the Guardian today by some-one called Frank who is a child protection social worker in England with 30 years experience.

Frank argues cogently and eloquently that “… (s)ocial workers' jobs are made harder by constant attacks on their profession, increased workload and deep budget cuts”. He says that in 30 years he has never seen it so bad.

In particular he complains of:

  • Shrinking resources with which to do preventative work
  • “Laborious and unwieldy” data-collection systems
  • Being “chained to the desk” by poor IT and huge levels of administration
  • High caseloads and workloads

That all sounds very reasonable and very accurate to me. If you wanted to create an environment in which people find it difficult to work effectively, and where it is easy to make mistakes, Frank describes the blueprint of it very well. That’s the reality of lots of ‘children’s social care’ workplaces in modern Britain (and I expect elsewhere as well).

I hope politicians and senior managers listen to people like Frank. He knows what he’s talking about. Which is more than can be said for some (but not all) of those who entered comments on Frank’s post. Take a look - the ignorance (and nastiness) of some people is frightening.

Wednesday, 7 November 2012

The Blame Game again

How sad to witness the continuing ramifications of the blame culture with the senior management of Rochdale Council, the town where serious sexual exploitation of vulnerable adolescents took place, denying before the House of Commons Home Office Select Committee culpability for the Council’s failings.

And it’s all too easy for blame to cascade down an organisation to those at the frontline who are often least able to defend themselves.

As Sidney Dekker [1] tells us the ‘few bad apples’ argument is a convenient explanation that is invariably unhelpful in improving safety. The few-bad-apples approach seals lips and discourages safety reporting. It creates a climate of fear in which self-preservation is the only response. That results in organisations which do not learn and which are consequently less safe.

The first response of all those involved in a tragedy such as that which occurred in Rochdale should be to seek an objective understanding of what went wrong. Naming, blaming and shaming makes this much more difficult.

[1] Dekker, S. Just Culture: Balancing Safety and Accountability (Ashgate 2007)

MPs say: “(Care) thresholds need to be lower.”

BBC News takes a different perspective on the Education Select Committee’s report. The focus here is on the issue of some children not being taken into care, when it would be in their best interests to be removed from their birth families.

The Committee’s report states that thresholds for care proceedings are not set too low but too high:

'… there is a growing body of evidence to suggest that thresholds need to be lower. Witnesses from the courts found little or no evidence of inappropriate removal of children and many instances where earlier removal would have been appropriate…. This is backed by academic research: Professor Ward noted that "there is substantial evidence that many children remain for too long with or are returned to abusive and neglectful families with insufficient support".' [Paragraph 205]

In support of this the report cites research by Professor Elaine Farmer at the Centre for Family Policy and Child Welfare at Bristol University. This found that in almost half the cases where children returned home from care, particularly over the age of 10, they were neglected or abused during the return [1].

These observations are, of course, a welcome counterblast to the likes of Christopher Booker (see http://chrismillsblog.blogspot.co.uk/2012/10/at-it-again.html ) who implausibly argue that social workers and the courts are trigger happy.

But much more analysis is required of cases where the decision-making process fails a child in this way. My own sense is that babies and very young children are particularly prone to be left in neglectful and abusive situations, in which huge amounts of long-term damage occur, while professionals give a new mum and dad a second, third and fourth chance to get their act together. The long-term consequences of emotional neglect alone can be momentous (see http://www.childwelfare.gov/pubs/issue_briefs/brain_development/).

Very careful thought needs to go into making it easier to intervene earlier when there may be an absence of tangible evidence of the current impact of maltreatment, but where there is a justifiable prognosis of the likelihood of significant harm in the medium-to-long-term.

[1] Farmer, E R G (2009). "Reunification with birth families", in Schofield, G and Simmonds, J (Eds.) The child placement handbook. London, BAAF.

Committee finds that child protection is failing adolescents

I very much welcome the emphasis on the needs of adolescents in the report of the House of Commons Education Committee on child protection.

The inquiry found a worrying picture of the how the system fails to provide protection and support to those in the 14-18 age group. The report identifies:

  • A lack of services for adolescents
  • A failure to look beyond behavioural problems
  • A lack of recognition of the signs of neglect and abuse in teenagers
  • A lack of understanding about the long-term impact of maltreatment on young people

The Guardian quotes committee chairman, Graham Stuart as saying:

"Care for older children is not good enough. They are let down too often, frequently ignored or not listened to, can be pushed out of care too young and insufficiently prepared and supported. This has to change.

"In all cases, these children must be treated as children first, and not just as either criminals or immigration cases. To ensure this happens, we want the Department for Education to take responsibility for the welfare of all children."

Recognising this problem is an important step forward, but one thing that has to be accepted is that service improvements are seldom cost free. Protection and care for adolescents must be improved, but it should not be improved at the cost of safeguarding services for other children. Extra resources will be required.

If the Government is serious about prioritising services for vulnerable children and young people, it needs to look at transferring resources from other services. If it is more important to meet children's needs for safety than to pursue them as 'criminals' or 'immigration offenders', then resources need to be diverted from the police and the UK Borders Agency to local authorities and children's health services. It's not rocket science.