Those who raise safety concerns must be treated with consideration and respect

According to the BBC (http://www.bbc.co.uk/news/health-22252425) a survey suggests that about a quarter of nurses who raise alarms about patient safety are warned off by managers. Some whistle-blowers said they were belittled or bullied. The Royal College of Nursing (RCN) is reported as talking of a ‘climate of fear’. To his credit the Health Minister Dr Dan Poulter has said that those who speak should be listened to and protected from reprisals.

Organisations that do not have open reporting cultures are NOT safe. A culture of fear is the greatest enemy of safety. It is a ‘no-brainer’ really. If people are frightened of saying something when they see things that are not right – or even dangerous – then those ‘error traps’ will remain hidden out of sight, until they cause an accident and somebody gets hurt.

Where managers discourage members of staff from reporting safety concerns they are also doing themselves no favours. They just end up trying to manage an unsafe organisation that they do not understand. It’s a good example of Hans Christian Andersen’s tale of the king’s new clothes.

This recent survey gives us some information about the way things are in nursing, but what happens in other professions such as social care, the police and education? There may be no surveys in these fields but I think many people do not feel comfortable with whistle-blowing. An experienced child protection manager recently told a committee of MPs how dedicated members of her staff lived with “… an ongoing culture of fear … they do fear telling the truth and losing their jobs. They don’t feel whistle-blowing works.” http://chrismillsblog.blogspot.co.uk/2012/12/a-culture-of-overwork-and-fear.html   

And an article by Amelia Hill in the Guardian powerfully recounts the stories of some social care practitioners who have blown the whistle and suffered as a result.

Effectively protecting and safeguarding children requires professionals and organisations involved to practice safely and to address safety concerns. Organisations need to make strong clear statements encouraging staff to report their concerns without fear. Then they must practice what they preach and ensure that staff members who raise concerns are treated with consideration and respect.

Some interesting ideas from the Care Quality Commission

The Care Quality Commission (CQC) is the independent regulator of health and social care services in England, with the exception of children’s social care, which is inspected by Ofsted.

The history of the CQC includes its missing some hospitals and care homes that were failing very badly, even disastrously. So it is by no means an icon of perfection.

Now under new management it has laid out its new strategy to address some of the problems it has experienced in the past. And some parts of this seem very good.   

I particularly liked the following aspiration:

To “… ask the following five questions when inspecting services - are they safe, effective, caring, well led and responsive to people's needs?”

I thought that puts it very neatly and could be applied very well to children’s services. And I also liked plans to involve services users as experts in inspections. That seemed part of an overall intention to listen better to people’s views and experiences of care. Listening to people who use services is never easy and can easily descend into tokenism. Organisations need clear plans about how they will undertake this sort of work and ensure its quality.

I would like to see Ofsted laying out its stall in a similar manner. It could do a lot worse than to adopt the CQC’s five questions as they stand.

I’ve always thought that inspection is a blunt tool, which is not a very direct path to quality. But at least the CQC appears to be doing some interesting thinking about how to move forward. Ofsted should take note.

Emotional neglect and the criminal law

I was sorry to hear - on this morning’s BBC Radio 4’s Today programme  - consultant child psychiatrist Dr Eileen Vizard apparently supporting the charity Action for Children in calling for the criminal law relating to child neglect in England and Wales to be changed.

The argument is that it should be made easier to prosecute parents for emotional neglect. It is set out in great detail on the Action forChildren website 

As I have said before, I cannot see what all the fuss is about. There is no problem at all with the civil law (the Children Act 1989), which allows local authorities to intervene in all cases where there is a likelihood of significant harm to a child, whether caused by physical or emotional abuse or neglect. So the only issue appears to be an aspiration to prosecute and punish parents, who may currently be difficult to bring within the ambit of the criminal law.  

I simply can’t see what added value doing that would have. The proposed changes do not make it easier to intervene to protect a child and do not make it any more likely that intervention would be successful. And, I believe, they make it more likely that some inappropriate cases would come before the criminal courts, where the parents concerned turn out to be more deserving of help than of prosecution and possible imprisonment.

Delays in implementing joint inspections

It’s hard to understand what is going on with child protection inspection at Ofsted. 

This week Children and Young People Now reports that plans for joint inspections of child protection are being put on hold. Eileen Munro recommended* this type of inspection which would involve health, police, probation and prison inspectorates working together with Ofsted.

Joint inspections would surely be an improvement on present arrangements – so why not just do it?

Footnote

* The Munro Review, Final Report Recommendation 2: "The inspection framework should examine the effectiveness of the contributions of all local services, including health, education, police, probation and the justice system to the protection of children."

Increase in number of care proceedings – no end in sight

The relentless increase in the number of care proceedings in England continues unabated. The latest figures from Cafcass show an 11.5% increase in the number of proceedings in February 2013, compared with February 2012, with each of the monthly totals in the period, except those for June 2012, being the highest ever recorded by Cafcass.

For details see the Cafcass website or Children and Young People Now 

There needs to be a plan about what to do to deal with this situation. It is no good the government appearing to stand aside and allow events to take their course, because, if the trend continues, the resource shortfalls will become unsupportable.

But, before we can have a plan, we need much better information about what is happening and a coherent account of why. Speculating about the causes is not wise. Facts are required.

How it feels to be accused

It is hard not to feel sad reading the account of a family on the wrong end of child sex abuse allegations that have proved to be false. Unlike some of the cases reported in the tabloid press, which often have puzzling or incomplete information, this account in the Guardian has the ring of truth.

http://www.guardian.co.uk/lifeandstyle/2013/apr/06/accused-of-child-abuse-police

Of course it is a counsel of perfection to urge that child abuse investigations will always be painless. It is simply not possible to make the process anything less than stressful and unpleasant.

But professionals charged with conducting child abuse enquiries always need to be aware of how horrible it is to be accused of heinous crime, especially if you happen to be innocent.

One of the process objectives we should have for these investigations is that they should do the least collateral damage possible. Every organisation involved should have plans to try to achieve this end.

How do we solve a problem like ... Ofsted?

Looking back over the blog in recent months I think I might be accused of being a bit negative about Ofsted. So I am resolved to try to be more positive in future.

So, how do we solve a problem like Ofsted? Abolish it!!

No only kidding, not quite, but nearly.

I think the time has come to create a completely separate inspectorate of child safeguarding and children’s social care. In fact I would make it more than an inspectorate and give it some powers to conduct research, sponsor safety initiatives and disseminate safety knowledge. I’d also give it some clear responsibility for quality, which, of course, goes hand-in-hand with safety. And I'd make it responsible for overseeing SCRs and organising its own investigations in very serious cases.

And I wouldn't ask it to do inspections that are process-focused, tick-box, poorly focused and judgmental; or to label a third of its 'customers' inadequate without giving a good account of why they are inadequate!!

It might be a little more expensive than having children’s services inspected by Ofsted, as at present, but not that much more. And I’m sure one of the benefits would be that overall costs would fall as quality and safety improves – the costs of low quality and poor safety are quite high.

We could call it (succinctly!) the Office for Quality, Safety, Learning and Improvement in Child Safeguarding and Children’s Social Care (maybe QualSaf for short). Its responsibilities would be to:

·       Conduct inspections of service including unannounced inspections

·       Conduct thematic inspections and supporting research

·       Conduct or commission research relevant to quality and safety in children’s services

·       Conduct or oversee enquiries into child deaths and other disasters

·       Fund and promote a confidential human factors reporting programme for child protection and safeguarding

·       Be a repository of knowledge about quality and safety in children’s services

·       Sponsor the dissemination of relevant knowledge through publication, conferences etc., including regular safety bulletins, briefings etc.

·       Promote safer practice and foster a reporting culture in children’s services

·       Contribute to and inform relevant policy discussions

·       Advise the Secretary of State on all matters relating to the safety and quality of child safeguarding

I’m going to write to my MP and to Michael Gove, the Secretary of State for Education, suggesting it. Why not join me? (But write to your own MP, not mine!)