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.

http://www.communitycare.co.uk/2016/05/27/dispatches-child-protection-programme-neither-fair-constructive/

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:

http://www.channel4.com/programmes/dispatches/on-demand/62175-001

Otherwise you can read about it:

http://www.channel4.com/info/press/news/channel-4-dispatches-under-cover-in-birmingham-s-children-s-services

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.

http://www.bbc.co.uk/news/education-36398247

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

http://chrismillsblog.blogspot.co.uk/2016/01/the-message-they-just-dont-seem-to-hear.html

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.

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.

http://www.uclan.ac.uk/news/childrens-services-uclan-study.php

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.

Brum, Brum, Brum ….

‘Brum’ is the colloquial name for Birmingham, England’s second city and the largest local authority in Europe. For many years Brum’s children’s services have been rated as ‘inadequate’ by the inspectorate Ofsted, whose head has described them as a ‘national disgrace’.  BBC news provides a useful ‘timeline’ of the problems in Birmingham.

Now the city council has decided to turn over the running of its children’s services to an independent voluntary trust, a strategy which is favoured by the British government. You can read the full story in the Guardian.

http://www.theguardian.com/uk-news/2016/may/24/birmingham-childrens-services-run-trust-following-failures

I don’t think that creating a voluntary trust is any kind of panacea. And I am pleased to see that Lord Warner, who was brought in by the Government to try to sort things out in Birmingham a few years ago, agrees with me. The BBC quotes him as saying that this is a "rushed decision" because there is “no proven track record” of voluntary trusts like this being successful in bringing about change.

http://www.bbc.co.uk/news/uk-england-birmingham-36366411

The main problem as I see it is that there is no clear analysis of what is wrong in Brum. For years and years people have been trying to fix things there without really being well informed about what the causes of the difficulties are. At first senior management was the focus and people resigned and the Government put in Lord Warner as a Commissioner. He did something for three years and then he threw in the towel, complaining of slow progress. Now there seems to be a consensus that the problem is with the ‘model’ and that a voluntary body would do it better than a local authority. But nobody says why that’s true and it just isn’t clear what a voluntary trust would bring to the situation that a local authority cannot.

My guess is that poor systems and low morale in Birmingham result from a long history of change being driven from the top by people who do not really understand what is wrong. All kinds of changes are proposed, all kinds of changes are imposed, all kind of disruption is created. First we have ‘special measures’, then we have a commissioner and now we have a voluntary trust. What the people who do the work on a day-to-day basis make of all this is not known. I expect that nobody in authority has asked them. I suspect that those in authority probably don’t care.

Rather than imposing changes top-down, and crushing the morale of the workforce in the process, I believe the route to change has to be bottom-up. To understand what is wrong with an organisation which is not functioning properly you need to engage with the people who actually deliver the service, who understand where the shortfalls are actually occurring, and work with them to gain their insights about the nature of the problems and their suggestions about how they should be overcome. And you need to empower people at the frontline to implement improvements which they understand and endorse. The alternative is a confused and disorientated workforce who become progressively demotivated by being required to implement changes in which they do not believe.

A few years ago there was a children’s TV series on British TV called ‘Brum’, which was set in Birmingham. It starred a little car called ‘Brum’ who was kept in a museum but escaped each day when the curator wasn’t looking to have all sorts of adventures in the ‘big city’. But every night Brum had to creep back into his museum and resume his position in the exhibition. Although he had spent the day ‘brum, brum brumming’ all over the city he ended up back in the static display.

That’s what they have to avoid in Birmingham – having lots of adventures but ending up in the same position at the end of it all.

Preparing for Ofsted?

I am torn between disbelief and despair by an article in the Evesham Journal about Worcestershire County Council’s Children’s Services.

  

Has somebody misunderstood what is going on or are council chiefs (as the headline proclaims) really planning to stage “a series of mock inspections” of Worcestershire's child protection services in order to prepare for an upcoming visit from Ofsted?

I don’t know specifically what is happening in Worcestershire. But generally it seems to me that there is a fundamental problem with the impact of the Ofsted regime; with its judgemental approach and its narrowly graded outcomes. A good result in an inspection can become more important than actually providing a good service. Improving appearances can become more important than improving service quality. Pleasing the inspectors can become more important than meeting children’s needs.

It all adds up to just more and more pressure on services that are already pressured as a result of tight financial constraints, increasing demands and a longstanding and unremitting shortage of suitably trained and experienced staff.

To my mind it’s all part of a name and blame and shame culture. It isn’t a recipe for improvement, it’s a recipe for knocking the stuffing out of services and the people who deliver them.

Unnecessary criminalisation must stop

A new report from the Prison Reform Trust prepared by a group chaired by Lord Laming comes to eminently sensible conclusions. The Guardian reports that the main findings are that children in care are six times more likely to be cautioned or convicted of a crime than other young people and that half the children in youth custody have been in care. The main recommendation is that great care needs to be taken not unnecessarily criminalise children who are in care.

The report points to the shocking phenomenon of children who are in care being dealt by the police in trivial situations that would normally be dealt with by parents, for example when a child “steals” food from a kitchen of a care home or when a teenager trashes his own room. Lord Laming is quoted as saying: “Most families deal with this sort of challenging behaviour within the family. Once the police are called, it becomes theft or criminal damage and it goes on the child’s record.”

In recent times I have reported in this blog on two other similar reports. 

In August 2015 I drew attention to an excellent report by the Northern Ireland Human Rights Commission examining the rights of children in care. This says (page 158) that some young people in residential care are “… being penalised for offences in a way that they would not if they resided with their parents”. Police, it is said, are called out to deal with incidents that occur within residential homes, in circumstances which would never result in police action if the children were living with their parents. The report concludes that “… the practice of police involvement and potential subsequent engagement with the youth justice system (have) profound negative implications for young people’s subsequent life chances”.

Another report which I commented on in July 2015 points to similar practices occurring in England. The police regulator, Her Majesty’s Inspectorate of Constabulary, produced a report (In Harm’s Way) which concludes: “We were surprised to find examples of children who had been accused of offences such as pushing a sibling, criminal damage in their (own) children’s home, or for wasting police time by running away from home. Sometimes, children were accused of lying or perverting the course of justice when their accounts of offences against them were disbelieved.” (Page 11)

In my view the Government needs to get a grip on this issue and provide clear and unambiguous guidance to police and care agencies that the criminal law is not to be used as an easy alternative to dealing constructively with challenging behaviour. Unnecessary criminalisation of children and young people is a form of abuse; it must stop.

Thinking about Serious Case Reviews

Regular readers of the blog will know that I am no great fan of Serious Case Reviews (SCRs). I was however pleased to see that a new publication from the NSPCC goes some considerable way to introducing safety systems thinking and a human factors approach into SCR practice.

https://www.nspcc.org.uk/globalassets/documents/advice-and-info/serious-case-review-quality-markers.pdf

On page 19 of the document the authors draw attention to the "... large body of safety management literature that addresses the same problems as child protection of understanding how poor outcomes arise and how they can be reduced". A key lesson, we are told, is that practitioner errors generally arise from the interaction of several areas of weakness in the system, and not from one major mistake by an individual. So the focus of investigations, it is argued, should be on exploring how systems function routinely and on general factors which predispose to error.  The authors quote Professor Don Berwick, in his report on patient safety in the NHS, and Professor Sidney Dekker, who both argue that it is vitally important to distinguish clearly between wilful misconduct, on the one hand, and human error which is normal, and by definition unintended, on the other. Well-intentioned people who make errors at work or who are involved in systems failures need support not punishment. And unjust punishment inhibits people reporting their errors, or defects in systems, and so inhibits learning.

All this is excellent stuff. I don’t think this document will transform the Serious Case Review process into something truly useful, but I do think that it moves forward establishment thinking about how investigations into accidents and service failures in child protection investigations are undertaken and what conditions need to be in place to encourage reporting and so facilitate learning.

That could be the start of a journey towards developing approaches – such as critical incident reporting and human factors thinking - that will deliver better results than SCRs ever have.