Good news from Munro

Eileen Munro’s review seems to be developing on the right lines. On the BBC’s Today programme this morning she told John Humphrys that more rules do not make children safer and that social workers trying to protect children are often distracted by filling forms and following procedures. She argued that professionals should be spending more time working directly with children, trying to understand how they feel and what they want to happen.

These are conclusions with which it is difficult to disagree. Child protection social work must be child centred. And procedures need to support good practice, not impede it. There is mounting evidence that huge procedural manuals and data driven recording systems, such as ICS, are obstacles to getting the job done and barriers to meeting children's needs.

The BBC also reports that Munro believes that formal time scales can distract social workers from making sound decisions. (http://www.bbc.co.uk/news/education-12323806)

Again this is good common sense. Completing an assessment before some vital piece of information can be made available is actually a waste of time – because the assessment may have to be revisited. Holding a child protection conference on a date within the required timescales, but on which key participants are not available to attend, is equally counter-productive.

Child of ContactPoint?

I was pleased to read last week in Community Care about children’s minister Tim Loughton’s plans for a ContactPoint ‘replacement’.

http://www.communitycare.co.uk/Articles/2011/01/19/116133/contactpoint-replacement-could-be-tried-in-hospitals.htm

If, as reported, the plan is for a national database, to be used by hospital A&E departments, containing only the names of children who are looked after, or subject to a child protection plans or who have been the subjects of section 47 enquiries, then it has my wholehearted support.

Putting the names of such children on a database can be justified because they are known to be at risk, and making A&E medical staff the main users is sensible. The police have various national systems that let them know if a child has previously come to attention, but A&E staff frequently have to see children with puzzling or suspicious injuries who are not from the local area. Currently in such cases they can only find out if the child is subject to a child protection plan by making a child protection referral. And it might take several days to discover that the child was at risk, by which time the family is long-gone.

A simple system like this is very sensible and, unlike ContactPoint, the small restricted user-ship of professionals, bound by well-established codes of medical confidentiality, will make it much more secure.

Reducing Bureaucracy - and adding value

Eileen Munro's review has been tasked by the Government with examining ways in which bureaucracy in child protection can be reduced. The Department for Education has recently published a list of questions (http://www.education.gov.uk/munroreview/) that the review would like answered by professionals, including this one:

“What prescribed procedures and forms do you feel are unnecessary, overly time consuming or cause you to duplicate work?” 

I am apprehensive that this question might produce a rag bag of responses, targeting people's pet hates, while ignoring other work which, although unnecessary, is generally felt to be less objectionable. Ultimately a more analytic approach may be required. How might this be undertaken?

A good starting place is the concept of “adding value”. An activity is said to add value if it contributes to satisfying the needs and wants of the end-user of the service, in this case abused and neglected children. In any business or professional process some activities will add value while others will not. For example conducting an effective and sensitive interview with a child adds value by discovering the child’s needs and wants. On the other hand completing a travel claim for expenses involved in the interview adds nothing from the child’s point of view.

It is not always so easy to see whether a particular activity is value adding or not. Many activities do not provide value directly but do so by supporting an activity that does. And things are made more difficult because child protection is a very complex process that is not always easily understood.

But that should not stop us trying. The first step is to decompose processes into discrete activities. Then to ask, does this activity directly add value, and if so how? If we are unable to answer this question in the affirmative, we need to move on to consider if the activity supports another that is directly adding value. If we cannot establish that, then it is likely that the process is non-value adding and we need to look at ways in which it might be reduced or eliminated.

Many non-value adding activities are likely be found in the “back-office” in areas such as record keeping, filing, staff management and financial controls. While some of these are “necessary evils” (for example legal requirements) constant attention needs to be given to understanding how they can be simplified and their cost and impact reduced.

However, that does not mean that all client contact activities are value adding. Conducting unnecessary assessments, for example, is costly and time consuming. So is poorly focused casework. Clearly child protection social workers need to address constantly the issue of whether what they are doing adds value from the child’s perspective. But that is essentially what is meant when we talk about services being “child focused”.

Non-value adding activities are the same thing as “waste”. Some of the main causes of waste in a business or professional process are:

Waiting and delays

Transportation (e.g. of people) or transmission (e.g. of information)

Re-work

Set-up time

Downtime

Having a valuable asset like a social worker being unproductive because s/he is waiting to be called at a court hearing has a direct impact on the quality of service received by other children and young people. Similarly being stuck in a traffic jam on the way to a meeting is not a good use of a social worker’s time. Waiting to receive important information delays important decisions and disrupts the flow of the service. Having to re-do a piece of work is always wasteful, but this happens where the original piece of work was rushed and not done properly. While appropriate planning (set-up time) may make casework more successful, too much planning delays the service and diverts professionals’ effort from actually meeting the child’s needs. Downtime – such as team meetings or training events – needs to be carefully examined. If it is clear that it will improve the service, then it can be justified, but if not it is a poor use of scarce resources.

So it is not just the "back office" functions that need to be addressed in the quest for reduced "bureaucracy". Everybody who works in child protection needs to be alert for signs that an activity does not add value, and there need to be mechanisms by which workers can raise concerns that waste is occurring. Instead of organisations being attached to the way things currently work, there needs to be an understanding that children's needs will only be better met if challenging "the way we do things" ceases to be a nuisance to managers and instead becomes the hallmark of a good employee.

 












    

A matter of procedure?

I see that the 4th edition of the London Child Protection Procedures has recently been published - http://www.londonscb.gov.uk/procedures/. 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.

A system under pressure

Ofsted’s Annual Report 2009 – 2010 (www.ofsted.gov.uk/publication/annualreport0910)
has just been published.

It tells us that, between March 2009 and March 2010:

• Referrals to children’s social care services increased by 11%
• The number of initial assessments undertaken increased by 12%
• The number of core assessments increased by 17%
• The number of children subject to child protection plans increased by nearly 5%
• There was a marked increase in the complexity of referrals
• There was a 34% increase in the number of public law care cases

By any standards these are staggering statistics. Combined with chronic shortages of social workers and foster carers they point to a system which is under extreme pressure. Urgent steps need to be taken to allocate more resources to increase capacity. Failure to do so will result in more and more children not being adequately protected.

Lean thinking in Solihull

On Monday 18^th October 2010 the BBC Radio 4 Today programme had an interesting report by Andrew Hosken that detailed initiatives by Solihull Council’s to apply lean thinking to their systems for vetting foster parents.

http://news.bbc.co.uk/today/hi/today/newsid_9101000/9101255.stm

The Chief Executive of the council said that a large part of the problem of slow and inefficient vetting of foster parents was found to be caused by custom and practice. Over the years steps had been introduced into the processes which were not strictly required, but which various people at various times in the past had thought to be helpful. As a result there was repetition and waste. Instead of getting it right first time it was more a matter of getting it right in the end.

The council has been working with consultants who come from an engineering background and who are introducing council employees to key lessons from Japanese motor industry practice.  The lean approach is applied to analyse business and professional processes: look for the value-adding parts of the process and avoid activities that consume time and resources that don’t add value. The emphasis is on avoiding duplication and waste and on ensuring that things happen at the right time, so preventing downstream delays. For example it was reported that by doing CRB checks early in the process, rather than late, unnecessary work could be avoided if they come back negative.

Back in September of last year - following a conference paper which I felt had fallen mostly on deaf ears - I wrote about the lean approach in this blog. I said that 

"....Lean is the deceptively simple idea that we need to devote our energies to those business and professional processes which "add-value" rather than to those which don't. Put at its simplest this means that resources should be directed so far as possible only to those activities which are strictly necessary to satisfy the needs we are trying to meet. In child protection terms this means activities which either prevent child maltreatment or which rescue children from it and meet their resulting needs; not administration, paper-work, recording or meetings.

"In the mid 20th century Japanese manufacturing companies realised that they were wasting time and resources on non-value-adding activities such as administration, in-process inventory and re-work. They developed an abhorrence of waste and gradually moved towards a situation in which all changes to the production system were vetted for their contribution to establishing a truly lean environment. In child protection work in Britain we appear to have moved in the opposite direction by developing ever more complex procedures and time consuming recording and IT systems. The amount of time that front-line staff are engaged in administration appears to have increased dramatically. Indeed it is hard to find any evidence that the impact of changes such as new procedures, recording and assessment systems on the ability of front-line staff to practice effectively have ever been evaluated.

"Becoming lean would involve child protection services rigorously re-assessing where value is added and where it is not. Procedures, recording systems and administration need to be re-designed to maximise the time available for direct value-adding work with families and children."

I'm glad to hear that the folks in Solihull have come to similar conclusions. They are likely to end up with a better service as a result.

There are strong moral and ethical reasons why we should embrace lean methodology in children's social work. The whole business of safeguarding children and promoting their welfare, and of acting in their best interests, involves us not only in doing the right things, and not doing the wrong things, but also ensuring that all the available resources go towards doing the right things, not other things which have no value for children and young people. Ethical child protection requires us not only to do no harm, but also to ensure that we do not squander scarce and valuable resources by doing things which make no difference.

If you are interested in reading more about Lean there is a very good account of how it can be applied in the public sector - and some of the pitfalls - which has been produced by colleagues at the Warwick Business School:
http://www.scotland.gov.uk/Publications/2006/06/13162106/0 

The Lesson of the Khyra Ishaq Tragedy

Welcome opportunities for travel in September and October have kept me away from the blog. But I have done some reading, in particular looking at the Khyra Ishaq Serious Case Review Report.

A crucial and very worrying part of the report focuses on the events of 19th and 20th December 2007. What follows is my précis of pages 49 – 51 of the report.

On 19th December a child protection referral was made by the Deputy Head Teacher of the child’s school to Birmingham Children’s Social Care. The concerns expressed were that the child and a sibling had been taking food from other children’s bags and cramming food into their mouths. Both children were reported to be thin but generally clean and tidy. It was also reported that the child had been out of school following a meeting between school staff and the mother, after which the mother had been very hostile towards school staff.

The response by Children's Social Care to this referral was as follows:

• It was stated that the Children’s Social Care team manager had recommended that the school education social worker and the school nurse should deal with the matter
• It was also suggested a CAF (Common Assessment) was required, with the education social worker as the lead practitioner, even though the mother was uncooperative and hostile.

Later the same day, the Deputy Head spoke again to Children’s Social Care. Again s/he emphasised that this was a child protection referral and raised further concerns about the sibling cramming food into her/his pockets, loitering in the dining room and reporting feeling cold. S/he also stated that there had been a sudden change in the mother’s behaviour and described her as “concerned and agitated”. Again s/he was told that the recommended approach was for the education social worker to prepare a Common Assessment.

The following day, 20th December 2007, the Deputy Head again contacted Children’s Social Care, asking for an update on the referral. S/he was told that it was not being progressed and that an initial assessment would not be undertaken. Again the Deputy Head requested a home visit and was told that Children’s Social Care had decided not to proceed. The Deputy Head was not satisfied with this response and requested that the concerns be taken to the line manager. But s/he was told that the manager would not accept the referral and had suggested a CAF. The Deputy Head was told if the school remained concerned then the police could be contacted for a “Safe and Well” check. This was subsequently undertaken by West Midlands Police, who visited the home but were not admitted. Officers did however see the children on the doorstep and were reassured.

There is no doubt that crucial errors occurred at this point:

1. The failure to accept what was clearly a child protection referral
2. The ill-judged advice that a CAF should be completed, instead of a child protection assessment
3. The ill-judged recommendation that the police should be requested to perform a Safe and Well check (these are checks generally performed by the police when children who have been reported by their parents as missing subsequently return home).

The report gives some context to these failures:

• There was a history of high levels of vacancy in Birmingham Children's Social Care, with a vacancy  for qualified social workers of 14% when the report was written (June 2009).
• Social care staffing per capita was 22% lower than the national inner city average. 
• The Social Worker involved in the case had an excessive workload of 50 allocated cases.

We know generally that decision-making can be adversely affected by over-work and difficult working conditions. One can imagine - although the report provides no detail - that staff in a hard-pressed child protection team where trying to keep too many balls in the air. Any referral that could be marked "NFA" would be a welcome outcome. And we can imagine that a decision-maker in this case may have erred because s/he wanted this not to be a child protection case, looking perhaps for any details which would mean that it did not need to be allocated. The alternatives of the Common Assessment and the Safe and Well Check may have predisposed to turning down the referral.

There are two morals. The first is that over-worked teams cannot function safely. The pressure to increase referral thresholds is too great. The second is, perhaps, less obvious. While the Common Assessment Framework has been welcomed in many quarters as part of an early intervention approach, there has been too little attention given to how it operates alongside child protection inquiries. An inherent danger will always be that a CAF will be undertaken or recommended where a child protection assessment is required. Thought need to be given to how this danger can be reduced or eliminated.