Sunday, 24 March 2013

Working Together – some improvement, but could do better!

At long last the new version of Working Together – nattily titled Working Together to Safeguard Children: A guide to inter-agency working to safeguard and promote the welfare of children – has been published. 

For those not familiar with the British scene, I should explain that in England Working Together is the main document of guidance on child protection practice issued by the Government. Scotland, Wales and Northern Ireland each have their own separate documents.

The first version of Working Together appeared in the late 1980s and every subsequent version, until the present one, has been longer, reaching a mammoth 393 pages by 2010.

From the point of view length the 2013 edition is definitely a lot better – only 97 pages. A lot of the verbiage of previous editions has been radically excised.

And there are some good bits to the guidance that must be warmly welcomed, but there is still a lot which to my mind is poor quality and some of which is just plain silly. I’ll deal with each of these in turn. 

The good bits – what I liked 

There are good clear statements (not always presented in the most logical order) about the need for a child-centred approach, such as:

“…for services to be effective they should be based on a clear understanding of the needs and views of children.” (paragraph 8, page 8)

“… the child’s needs are paramount, and the needs and wishes of each child, be they a baby or infant, or an older child, should be put first, so that every child receives the support they need before a problem escalates….” (paragraph 6, p 7)

“Children want to be respected, their views to be heard, to have stable relationships with professionals built on trust and for consistent support provided for their individual needs. This should guide the behaviour of professionals. Anyone working with children should see and speak to the child; listen to what they say; take their views seriously; and work with them collaboratively when deciding how to support their needs.” (paragraph 15, page 9) 

“Failings in safeguarding systems are too often the result of losing sight of the needs and views of the children within them, or placing the interests of adults ahead of the needs of children.” (paragraph 13, p 9)

I can certainly sign up to that and I hope that everyone will recognise how important it is to articulate clearly, and to follow, the child-centred principle. 

There was also a recognition in the document that continuous improvement is a responsibility of all those involved in safeguarding children. The document says:

“… there should be a culture of continuous learning and improvement across the organisations that work together to safeguard and promote the welfare of children, identifying opportunities to draw on what works and promote good practice….” (paragraph 9, p 66)

Sadly the document contains no suggestions about how this might be achieved.

Another important positive - the need for a just reporting culture - is also acknowledged. The document says:

“... professionals must be involved fully in reviews and invited to contribute their perspectives without fear of being blamed for actions they took in good faith….” (paragraph 9. P 66)

I was especially pleased to see this paragraph, because I suggested something like it in my response to the consultation on the document. I only wish it could have been writ larger! There is little that is more important than establishing a just, reporting culture in child-protection. 

Poor Quality – what could have been better 

I felt that throughout the document there was a need for a keener focus. To my mind it still fights shy of focusing on abuse and neglect – the definitions of which are relegated to a glossary – and the document does not offer any guidance or direction on the issue of recognising abuse and neglect, nor on the related issue of thresholds.

In case I am misunderstood here I should make it clear that I don’t think the document – or practice for that matter - should ignore children’s other needs; far from it. It should, however, make it clear that the gears shift when a child is being abused or neglected (or is otherwise at risk of significant harm) and that different rules apply.

Then there is the issue of language. I suppose that I shouldn’t be surprised that it still reads like a government document; it is one! But given the importance of the subject matter I do wish more attention had been given to readability and user-friendliness. A document designed to be easy to use shouldn’t be beyond the reach of the group that wrote this – but at the moment it seems it still is.

That brings me to the vexed issue of diagrams. The flow diagrams contained in the guidance (pages 27, 29, 32, 35, 83 and 84) are to my mind amateurish and hard work to read. I am not against using diagrams like this per se but I think that they need to be more carefully crafted and should adopt the standard conventions for flow diagrams, especially to distinguish between activities and decisions. 

There seems to be more on information sharing in this document than there was in the consultation draft. And most of it refers back to the dire guidance Information Sharing: Guidance for practitioners and managers issued by government in 2008. 

I say this information-sharing guidance was dire because, long as it is, it really doesn’t help, relying, as it does, on asking professionals to weigh the ‘public interest’ in sharing information without consent.

My own view is that the guidance would have better enjoined practitioners to follow that part of the Data Protection Act 1998 that directs that information can be shared without consent  when it ‘ … is necessary to protect the individual’s “vital interests”’. [1] To my mind that makes it clear that information can be shared without consent to protect a child from abuse or neglect, or injury or death. 

Just Plain Silly – needs a serious rethink 

One of the saddest omissions from the new Working Together, I felt, was the absence of a robust direction to adopt a systems approach in undertaking Serious Case Reviews and other forms of corporate learning. The relevant paragraph couldn’t be much weaker: 

“LSCBs may use any learning model which is consistent with the principles in this guidance, including the systems methodology recommended by Professor Munro.” (paragraph 11, p. 67) 

Eileen Munro did not recommend the adoption of what she calls the ‘systems approach’ [2] because it is interesting, fashionable, clever or fun. She recommended it because it is essential to learning constructively from error. As she says: “Human error is taken as the starting point not the conclusion and the investigation tries to understand why the mistake was made, by studying interacting factors in the practitioners, the resources available, and the organisational context”. [3]

If SCRs are not doing that then I think there is very little hope for them. But the Government clearly feels it should be optional! One suspects that there is a lobby somewhere trying to kick Munro’s report [4] into the long grass.

More generally I was also saddened to see that the ‘learning and improvement’ section of Working Together concentrated on the Serious Case Review and did not make much mention of other forms of corporate and professional learning.

Serious Case Reviews, I believe, have become a bit of a fetish, with the vain hope that somehow they will result in huge strides towards greater safety. But they are expensive, slow and cumbersome and the learning from them is difficult to share and absorb. A report from the Care and Social Services Inspectorate Wales got it about right a few years ago saying that: "...huge amounts of time and resources (are) spent in conducting these reviews ... with little clear evidence to show how they are leading to improvements in systems and practice ...." The report concludes: "Time and again serious case reviews identify the same issues as contributing to not protecting children, yet still the problems keep recurring." [5]

I would have liked to have seen the new Working Together grasp this nettle and to have called upon agencies to develop specific approaches to workplace learning. Of course that would be as part of a continuous improvement culture, but specifically I believe that practitioners require the tools, and the time, to learn daily, not sporadically, about how to improve services. Systems such as Kaizen (in which workers contribute suggestions for improvement) or frequent de-briefing following significant pieces of work would be a start. More safety focused supervision sessions, including peer-group supervision, might also form part of such an approach.

And making practitioners aware of the insights of a human factors approach to error and safety should have been a part of the document. In aviation they made human factors training mandatory.

The government has signalled its belief that child safeguarding should embrace a continuous improvement ideology. Practitioners are enjoined to practice more safely. But Government has not provided any real guidance about how these outcomes could be achieved.

Also very firmly in the ‘silly’ box is the way in which the new Working Together deals with assessment.

In the first place, I think that throughout the document there is too much focus on assessment and too little focus on services that meet children’s needs. It seems so easy for policy makers and civil servants to focus on assessment. Assessment costs less than services and doesn’t require so much thought and hard work.

So focusing on assessment is apparently an easy option. But, in doing so, we have to look at services through a distorting mirror. Doctors, nurses, early years providers, teachers and social workers do not spend most of their working days assessing children. Most of the time they are focused on providing children and their families with complex services, of which assessment is only a minor part.

In recent years a myth seems to have grown-up that more assessment is what we need. The Common Assessment Framework [6] and the Framework for Assessment of Children in Need [7] have been pedalled as comprehensive tools for reducing risk, but so far as I know there is no empirical evidence to suggest that such frameworks, with their tick boxes and checklists, actually work to make children safer or to enhance their welfare.

And, of course, there are downsides to such frameworks. They can be distracting, or even misleading, and they can use up scarce resources that would be better put to the delivery of a service. And sometimes they can delay the provision of the help and care that a child or family desperately needs.

Munro recognises this in her report [4]. That is why she recommended getting away from the straightjacket of conducting both ‘initial’ and ‘core’ assessments every time a child was referred to children’s social care. She recognised that such an approach was inflexible and bureaucratic and actually got in the way of providing services to protect a child.

So it is surprising that in the post-Munro era we find government guidance still so wedded to assessment. Reading the first chapter of Working Together one could be forgiven for thinking that the whole of this guidance is about assessment, especially since the promise of the second part of the chapter’s title (“Assessing need and providing help”) is not delivered.

Frankly I have now come to the view that the whole of Chapter 1 should be torn up and started again. To me the issue is not ‘assessment’ but how a professional or other practitioner, in the course of delivering a service to a child or family, should respond if they come to believe that a child is at risk of significant harm. I know that my view may not be popular in some parts of the children’s services establishment. However, I believe that it is wholly wrong to pretend that child protection concerns invariably arise from performing assessments, when in reality they arise in a variety of different, and sometimes surprising, ways.

Last year, when I responded to the consultation on Working Together [8], I seem to remember wondering who had ever suggested trying to combine guidance on child safeguarding with guidance on assessment. It was, of course, none other than Lord Laming in his report on the death of Victoria Climbié [9]. In this, as in some other things, he was wrong. Of course social workers, medics, police officers and others have to ‘assess’ a situation in which it is believed that a child has been abused or neglected, and social workers have to assess the welfare of a child, but assessment frameworks are only tools that may, or may not, help depending on the circumstances. They should not become central to safeguarding; and discussion of assessment frameworks should not be central to child safeguarding guidance.

If making assessment so prominent in this guidance was silly then proposing the development of ‘local assessment frameworks’ was very silly. I have struggled to think of a worse idea.

Eileen Munro has convinced us all, including the government, that convoluted guidance on child protection is a bad idea. So why produce guidance that risks reintroducing the very worst features of the system which Munro declaims as unsafe, but at local level so that not only is guidance convoluted, but it differs randomly depending on postcode? Maybe I’ve just misunderstood what local frameworks on assessment will be, or maybe I’m just a pessimist, but I need some convincing that when the time comes the worst elements of local government bureaucracy won’t get hold of this one and produce voluminous manuals full of totally idiosyncratic gobbledegook. Very silly indeed.

[1] See the Information Commissioner’s Office website at: 
[2] See Munro, E. “A systems approach to investigating child abuse deaths” British Journal of Social Work, 35 (4) pp 531-546, 2005