Tuesday, 31 May 2016

The Wood Report

There were some things I liked in the Wood Report on the role and functions of Local Safeguarding Children Boards.
I liked the idea that it is the core agencies (local authority, health and police) which have to make clear their leadership role and design multi-agency arrangements for protecting children. The old arrangements (as required by Section 13 of the Children Act 2004) were unwieldy and poorly focused.

I also liked the proposal to abolish Serious Case Reviews (SCRs). They have come to the end of their lives. Wood is right to describe the SCR approach as a “a discredited model”. He is right to argue that SCRs do not result in effective learning about what has gone wrong and how it can be put right.

And I support Wood’s recommendation to establish “… an independent body at national level to oversee a new national learning framework for inquiries into child deaths and cases where children have experienced serious harm”. It is clear that what he has in mind is something like the the Health Safety Investigations Branch (HSIB) which is proposed for the National Health Service. Wood proposes that part of the remit of the new body will be to conduct its investigations in such a way as to remove the threat of individual practitioners being blamed or scapegoated, the overriding aim being to help ensure similar mistakes are avoided in future. That is to be warmly welcomed.

So far so good. But there is also a lot missing from this report. I would have liked to see much more in the report about how new arrangements can be designed so as to foster much better day-to-day learning about how to improve service safety and service quality. Although Wood has some good ideas these don’t extend to ways in which new multi-agency arrangements could equip front-line practitioners in key agencies to analyse and understand how and why everyday things go wrong and how they can be put right. Basically there is still too much top-down management thinking in Wood’s report and not enough about empowering the people who deliver the services to do a better job.

Saturday, 28 May 2016

Dispatches from Birmingham

I don’t seem to be able to raise the same righteous indignation as Professor Ray Jones in his article on the Channel 4 Dispatches Programme in Community Care.

I didn’t think it was a very good programme, but it didn’t surprise me. In fact, it told me what I expected to hear: that people working in Birmingham’s children’s services department are not well supported, are under resourced, are under too much pressure and are confronted with organisational changes that they don’t support or understand.

And it provided me with a bit of information that I didn’t know already; namely that more than 23% of Birmingham’s child protection social workers are agency staff. By any standards that’s far too high!

But the memorable moments for me were hearing staff talk about changes imposed on them from above as follows: “… coming with new ideas to change the world…” and “…learning a whole new process when you’ve just learned this process and you are told to change it again.” All that bespeaks of top-down change management which has the effect of disorientating the workforce and leaving members of staff punch-drunk. No wonder some of them want out.

The whole Birmingham saga seems to me to be one of Ofsted, SCR authors, civil servants, local politicians, senior managers, venerable experts, national politicians and anybody else on the inside, coming up with ‘smart’ (but wrong) solutions based on a poor understanding of the problems.

I say this: understand the problems and why they happen; engage the workforce in coming up with workable and credible solutions; engage with children and young people and try to gain a ‘consumer perspective’; try to understand why errors and failings occur by identifying ‘latent conditions’; don’t try to be clever, try to be right.

And forget the silly idea of turning the whole thing over to a trust. That’s just an abrogation of responsibility.  

If you live in the UK you can watch the programme at:

Otherwise you can read about it:

Too much demand, too little funding – children’s mental health services in England are failing

There’s not much more to say about the excellent report by England’s Children’s Commissioner. She details a sorry tale of the inability of children, young people and their families to get the help they require when they need it. Shockingly she found that 28% of children referred for mental health support in England in 2015 were sent away without help, some after suicide attempts.

As I said in a recent post, none of this is new.

For years and years practitioners and campaigners have been telling governments that child and adolescent mental health services are chronically underfunded. And for years and years governments have chosen not to hear. It’s a disgrace.

Friday, 27 May 2016

Too many false positives

A study by Andy Bilson and Katie Martin at the University of Central Lancashire has found that more than 20% of children born in 2009-10 were referred to children’s services in England before their fifth birthday. Half of those referred were suspected of being abused or neglected. Child protection investigations were carried out in the cases of 5% of the children.

Bilson is quoted as saying:

“Children’s services are under considerable pressure to investigate more mainly because of government, media and public responses to child deaths and an Ofsted inspection regime that is covering its back…. Social workers are swamped by this growing tide of investigative work leaving little time to support victims and help families overcome the problems leading to referral.”

The authors conclude that the scale of statutory involvement and the growing focus on early investigative interventions results in “a considerable proportion” of families suffering “high levels of suspicion, fear and shame”. And that this is done “…without evidence that the individualised, investigative approach is effective in preventing further harm.”

These findings are deeply concerning. Absence of longitudinal data (e.g. in government statistics) does not allow year on year comparison, but there must be a strong suspicion that reaction to tragedies such as Baby Peter and Khyra Ishaq, and the relentless pressure on services not to make mistakes, has resulted in unwelcome net-widening.

One of the most important performance indicators of a child protection system seems to me to be how accurately it identifies children who need to be investigated and how well it excludes those that do not. Put another way, a test of the system is how well it minimises the number of false positives. Just as medics are concerned to spare people from unnecessary operations, procedures and invasive tests, so those of us in child protection should be constantly trying to avoid unnecessary investigations.

Of course, if we do not monitor how well we are doing in this regard it is no wonder that we don’t do very well. Bilson and Martin are to be congratulated for starkly laying out the facts on this issue. Hopefully those in authority will now put in hand collecting and publishing this kind of data on a routine basis.