Examination of Witnesses (Questions 80-99)|
26 MARCH 2008
Q80 Chairman: Graham's question was
how we spread that. We know that there are local authorities with
a poor track record in that area, as well as good and average
ones. How do we spread it?
Professor Tunstill: The whole
raison d'être of the Social Care Institute for Excellence,
for example, is to disseminate the knowledge base. That includes
both research findings and the views of the people who use services
and policy information. There is a plethora of dissemination organisations,
which I am sure you make use of. Mary's organisation does a huge
amount of dissemination of good practice.
Margaret Dillon: From my perspective,
the dissemination goes to practitioners; the challenge is delivering
to the people who actually shape the servicesgetting their
understanding and ensuring that they are learning about what works,
so that they feel that they are informed, and getting what the
research tells them into the mainstream. Then, when they are looking
at how they are going to spend their resources and how to shape
services to meet the needs of their locality or their communities,
they know what works and therefore spend their money on what delivers
the best outcomes for children and their families.
Q81 Chairman: Are you talking about
Margaret Dillon: I am talking
about local leadership, which includes local councillors and politicians,
as well as senior staff within local authorities. Our experience
is that, where you have stability of leadership and of senior
personnel within local authorities, all the inspection regimes
will show that you get a degree of stability in shaping services
and in improved outcomes for children within that area. Our experience
also tells us that, where you have short-term churn and short-term
contracts, you are losing expertise, knowledge of the area and
a stable work force. In the voluntary sector, within the commissioning
and tendering environment, we experience what we could call an
unacceptable churn with services and with able, qualified staff
who have built up a knowledge base. We enter into three-year contracts;
we recruit, train and stabilise a team, who are a good group of
staff, delivering excellent services, which all the evaluations
and inspection of the contract showbut then the funding
goes, so you lose the staff and that knowledge of the community
and families. Families like to be able to return to services.
They may receive a six-week family support intervention; 18 months
later they may have another problem, and the staff group dealing
with them will be the same. They can return, receive some advice
and move on, but if there is a churn in services, it is very problematic.
Q82 Mr Stuart: You have talked about
the problem; what is the solution?
Margaret Dillon: I think that
there are challenges with effective leadership at senior level
within local authorities. I can see Anne nodding. I do not want
to fall out with my colleagues
Mr Stuart: You do not have to stick together.
Margaret Dillon: There has been
an immense change in local authorities recently with the structural
reconfigurationthe rearranging of the furniture. Things
then slip off people's agendas.
Q83 Mr Stuart: I thought that you
were also referring to the point that from a local authority point
of view, short-term pilots carried out by voluntary groups where
the money runs out after a couple of years are not much good and
can do more harm than good. The voluntary sector is like the video
game with the frog crossing the river by jumping on floating leaves;
it has to wait for another leaf to come along. The whole life
of the voluntary sector seems to be about having to reinvent itself
to fit with whatever the latest pilot is, so it can hop on board
and keep everyone in work.
Margaret Dillon: You would expect
me to lobby strongly for long-term contracts with the voluntary
sector. We can deliver leadership at local level that is supported
by effective training and delivers research into practice. What
is important is learning from what research and pilots tell us
and getting out there, delivering the services and making the
difference for children.
Q84 Mr Stuart: That is up to local
authorities, so why do they not do it? They recognise the problem
when it happens to them, but then they give out contracts to you
that do the same thing.
Margaret Dillon: Because they
are juggling. Having worked in a local authority, I know what
the challenges are. They are juggling with a complex picture of
priorities and changing needs across the local authority, not
just within the social care services that they deliver.
Q85 Mr Stuart: As we are talking
about different initiatives and whether we should make anything
compulsory, what are the circumstances in which the use of family
group conferencing should be more widespread? Is there a case
for making it mandatory?
Mary MacLeod: It certainly is
in New Zealand. I would like to see us move in that direction.
It should be not just the adults in the family and extended family
who are involved, but the children. I remember managing what at
the time was called a family network meeting for two young children
who had been in care for two years. The father was there along
with his brothers and sisters, the grandparents and the children's
cousins. From the children came the things that nobody else would
say, but it was very important that they were said. That enabled
the family to come to a decision about what was realistic. Such
things might move the whole thinking about children in care being
"in care" to care being thought of as "shared care"
in the way that we talk about family breakdowns. We should talk
about the parents sharing care. Within the children-in-care services,
it would be a good idea to think about shared care so that we
stop talking about respite care. Families can then be included
in thinking about what is the right decision. In my view, family
group conferencing is a way to reach that position.
Q86 Annette Brooke: I have been lobbied
by several academics and I hope that I do not misrepresent their
views. I suspect that you will recognise them because they have
been reported in The Guardian. The suggestion is that the
more universal preventive approach and applying the common assessment
framework to far more children mean that there are cutbacks in
child protection. Those academics suggest that there is now not
so much investigative work and there are problems with bringing
in the police and in very serious cases. Getting the balance right
between the different services is a dilemma. Do you recognise
the scenario that is described by those academics? Should we be
concerned about getting the right balance?
Professor Tunstill: Speaking as
someone who would be defined as an academic, I think we need to
see academics in the same way as we might see political parties.
I do not come to this with a completely open or empty mind. All
academics, like other people, have their own value systems and
preferences. I am not suggesting that they allow that to taint
their work, but nor am I entirely sure that the picture is accurate.
The accurate picture of which the Committee is becoming aware
is the tendency of assessment and recording to overshadow the
chances of good relationship-based social work. I believe that
the best safeguarding and the best outcomes for children and their
families are more likely to derive from face-to-face contact with
skilled social workers in a relationship-based context than what
I have seen as a researcher. I see social workers who spend, at
a conservative estimate, 70% of their week trapped in front of
a computer, entering information within the requirements of the
Integrated Children's System. I know that that is contentious.
I am aware that the Government have commissioned two studies,
neither of which was undertaken by me, the Committee will be relieved
to hear. One is positive about such work, while the other is more
critical. Face-to-face contact with social workers is an element
in the safeguarding system. Local authorities can ensure that
social workers are out there. I am sure that those social workers
whose authority is represented here, are not trapped in front
of computers, but when I took my little safeguarding SureStart
team round, and their background was not in social work, in some
of the authorities we visited, had I told the team that we were
going to a Vodafone call centre, they would have been none the
wiser. There are serried ranks of social workers whose lives are
now dominated by the Integrated Children's System. That was a
good idea when it was at the assessment level, but it has now
rather mindlessly transported some of the complexities of the
look-after-system into the children-in-the-community-system. I
am not arguing against good assessment. The common assessment
framework is hugely exciting. Having a lead professional system
that does not have to involve a social worker will help bridge
the chasm that opens up between Levels 2 and 3. We all share the
view that that is the dangerous bit, when children go down the
hole and do not come up again. I am not sure that I recognise
the picture in quite the terms that have been expressed. There
will always be social workers whose obsession is child protection
with a capital P, and preferably compulsory child removal if they
can fit it in. That was an irresponsible thing to say, and I probably
should withdraw it, but we have to be realistic about the different
ways in which people define welfare. There will be a continuum
of valuesthis I will not withdrawabout the importance
to children of their identity within their family of birth, even
if they cannot stay there and be brought up within that family.
We talked about shared care, but that does not mean that it all
has to be as though a birth family does not exist. I do not take
back the diversity of academic views any more than politicians
would claim not to have diverse views themselves.
Q87 Annette Brooke: Anne, do you
think that there has been a diminution of the investigative work
that took place a year or two ago on severe child protection issues?
Anne Scarborough: I cannot answer
that directly. We have introduced the CAF (common assessment framework)
in Calderdale and it is now beginning to bite. The key to any
assessment framework anywhere where there are professionals around
children is the sharing of information and the dialogue between
professionals. The statement of special educational needs system
became a bureaucratic nightmare before it started to come out
of the tunnel and realised that it needed to do something different.
Authorities have now taken that to the next level. With assessment
systems we always need a process through the assessmentstages
through it. We need the process by which professionals come together.
Our special educational needs moderating group is the stage before
assessment. It is made up of professionals, including schools,
and the dialogue and debate around that is phenomenal. It is of
a very high level and matters are well debated so we know that
we will have a good assessment process. That is the right place
to do that. It is not up to one person to take on work such as
child protection; it is for a group of professionals to do that.
Sometimes that does not happen as well as it should, because there
might not be an appropriate process by which it can work.
Margaret Dillon: It is important
to understand that assessment is a means to an end. What is challenging
is to stop the gathering of information and to move into analysisto
ask, "What does this tell us about what we need to do and
what we need to provide for this family to make things different
for the child in this family?" What is far more important
is the interventiondealing with the question, "Which
services are going to make this child safe again within this setting,
and when will we know that we have tried and it is not going to
work and therefore need to take another sort of action?"
There is an increasingly unhelpful over-focus on the gathering
of information at the cost of doing the analysis and then moving
on to intervention.
Annette Brooke: Not seeing the wood for
Margaret Dillon: Potentially,
Q88 Annette Brooke: We have touched
on this already, but what would you say are the greatest barriers
to families accessing the right support at the right time?
Mary MacLeod: I think that because
the network of support feels so impenetrable to families, they
do not know where to go. That is partly because of some of the
system barriersadult social care, children's social care,
health particularlybut it is also about families hitting
different thresholds when they approach services. Within social
care, the threshold in children's services might be higher than
in some voluntary organisations, and in adult social care it might
be higher again. Different services are not thinking about the
whole family, so I really welcome the social exclusion report
and its emphasis on the importance of thinking about families
as a whole. There are big issues about supporting families and
noting where difficulties might be arising in the prenatal, antenatal
and postnatal periods. There particularly, you cannot be thinking
about children's services without thinking about child health
and health visitor services. The service landscape is very complicated.
Margaret talked about services being there and then not being
there. Parents and family members get to a point where they have
to do something desperate or be in a desperate state before they
get noticed. One of the other problems about that service landscape
is that it enables responsibility shifting, so that organisations
can say, "That's not my role, I don't deal with this."
Of course that is very complicated for families, because as far
as they are concerned everything joins up inside the familyit
just does not out there.
Margaret Dillon: May I just add
to that? In our experience of working with families in crisis
where children are on the edge of care, one of the things that
families value is that we offer support 24 hours a day, seven
days a week. When families are in crisis that does not occur in
standard 9-to-5 office hours, it occurs when all the family are
together, when they have people over for the weekend, when there
is a bank holiday or when money is tight, and that is invariably
not when the service is open. Some of the intensive family support
services that we offer are there 24/7, and that makes a difference
to families, because they can reach for the phone or call for
help when they most need it.
Anne Scarborough: The continuity
and sustainability of the key worker is always important. For
some familiesthose with a disabled child, for examplethe
number of services involved is phenomenal, so they need one point
of contact who is somebody they trust, and they need to know what
is coming next. Quite often when a family is in crisisfor
example, when you have just had your baby and you suddenly find
out that it is disabledyou are at your most vulnerable
but, equally, you need to know what will happen next and what
is in front of you. I think that sometimes professionals have
not been happy to say what is in front of families, sometimes
because they do not know what will come next, but sometimes because
they feel that the family might be too vulnerable. It is important
for families to know that, because they take bits in along the
way. Among our most successful services are our services for people
who are hearing impaired and visually impaired. They pick children
up, sometimes before they are born, so that the family knows who
they are working with, and they see the family right through to
19 to 25. It might not be the same worker, but it will be the
same service. We need to build that into services. What Margaret
and Mary said is absolutely key.
Q89 Annette Brooke: There are so
many details that I would like to discuss, particularly with Mary,
on health visitors. Obviously, that is because of the report.
A burning question for me is whether services are failing in their
responsibility towards parents with learning disabilities. I know
that Margaret probably has something to say on that.
Margaret Dillon: What is critical
is your point about access. It is about having the right services
in the right place at the right time. Mary is right: there are
risks with adult services focusing on the adult and often not
thinking about whether the adult is a parent. They might be working
with a parent with learning difficulties and not necessarily understanding
that that adult has family and child care responsibilities, so
joining up provision is critical. One of the things that work
well for families where there are adults with learning difficulties
is having access to a range of support services throughout their
caring responsibilities for the child, and those who provide the
services not making assumptions that just because the person happens
to have a learning disability they will not be capable as parents.
Our experience provides evidence that, with support, families
where there is an adult with a learning difficulty can care adequately
Q90 Annette Brooke: Support for parents
with learning difficulties is obviously very patchy across the
Margaret Dillon: It is.
Q91 Annette Brooke: It is tragic
to have babies taken away when there are options. Is there some
way that we should be aiming for a more universal approach in
this area? I mean universal in the sense of across all councils.
Mary MacLeod: One of the big issues
for social workers and local authorities is anxiety about the
level of risk. Because they are frightened that something will
go wrong, social workers may rush into decisions that the family
cannot care for the child. That is bound to continue to be the
case if social workers feel that the level of support for familiesthe
24/7 call-out and all of those thingsis not there. I do
not know whether any of you have been social workers, but those
nights when you cannot get to sleep because you are worrying about
whether a baby is safe at home are terrible. I suppose that as
a nation that we have to come to a decision about the level of
support that is required. Are we prepared to put the money in?
Such services are not cheap, and they are generally required for
the life of the child. As Margaret said, children can be cared
for wonderfully and very lovingly in families where parents have
learning disabilities, but most will need support.
Chairman: I think I will have to call
Fiona now. Is that all right? All the Committee want to come in
on this section, so I remind Members that we are limited in time.
Q92 Fiona Mactaggart: I am struck
by something that I have been hearing from you. Margaret was talking
about how services have been in silos, and Mary spoke just now
about responsibility shifting. It seems to me that that is the
key to the issue. I am trying to work out in my head what the
Governmentas opposed to anyone elsecan do about
dealing with the continuum of ensuring that you do not responsibility
shift and do not operate in a silo. That is the question that
we need to be able to answer if we are going to be able to produce
a report that is of any use.
Mary MacLeod: I would love to
be really helpful and give you the answer, but I think it is a
hard oneit is tricky. The social exclusion task force report
"Think Family" that I mentioned before is a step
in the right direction. There is Government support for the current
project with local authorities called Narrowing the Gap. There
is no magic bullet, but Government obviously need to set guidance
and protocols that will say thresholds have to be the same. One
simple thing for adult social care might be noticing whether an
adult coming in for support about drug or alcohol misuse or whatever
has been asked, "Are you a father or mother?" or, "Are
you responsible for a child?"
Q93 Fiona Mactaggart: Are you saying
that that question is not automatically asked?
Mary MacLeod: It is not automatically
asked. Margaret says it is the same with adult psychiatric services.
Drawing from my own experience, as a social work student in an
adult psychiatric hospital I dealt with a father going through
a schizophrenic episode. I have to confess that the child at home,
who it emerged had anorexia, I did not see. I really did not seethat
is the kind of perspective in operation. Your perspective is that
this is your focus and you do not necessarily think more widely.
It is a matter of training and box-ticking protocols as wellbut
joint protocols. I think that there can be a shift.
Professor Tunstill: I think that
Government are doing quite a lot. There are various measures that
could be built on. The CAF is a huge step in the right direction,
putting flesh on the bones, where you actively engage, in a whole
network, a variety of workers who see themselves as sharing the
responsibilities for safeguarding, as we said earlier. I think
that safeguarding is a much more helpful concept than the narrow
one of child protection, because it is something that people can
relate to and see at various levels. I think that that is going
on and that the key challenge would be encouraging people to engage
in the CAF and not to lose their nerve just as it gets to a Level
2 or 3. How one does that, I do not know, but it is the key thing
in the frame. We have talked about the continuity of contact with
peoplewhether they are social workers, early years workers
or whoeverso that they do not immediately flunk it and
opt out, or make the wrong sort of referral at the Level 2 to
Level 3 category. Part of that is about training, part about Government
messages and I guess part about putting money into child and adult
mental health services and a whole range of things that can make
the most enormous difference at any one point in timebut
if they are not there, the differences are really negative.
Q94 Fiona Mactaggart: Does this issue
link? What you were talking aboutI have heard it in comments
the other witnesses have madeis that there is a potential
hole between Levels 2 and 3 that people can disappear into, and
we need to find ways of bridging that. I think that that is what
I am hearing, which in a way connects with the question about
a continuum of longer-term work with families and being able to
intervene in crises. That is also part of the between Levels 2
and 3 story. How can we get that continuum working better? I have
heard lots of, "That is what we need to do." I have
heard, "It's hard." I have heard that there is no magic
bullet. But you have to know better than we can know how we can
get that working better, and I have not yet quite got it.
Margaret Dillon: I could give
you a description of a family in one of our intensive family support
services. Those services work with families that are socially
excluded, are in the antisocial behaviour category or are living
on very problematic estates where there are lots of complaints
and where they might be at risk of losing their tenancies. Those
are the families who are at risk of homelessness, and the children
are at risk of being accommodated. One family who were referred
to one of our services had nearly 30 different agencies engaged
with them, but were still in that kind of mess, so the service
sat down and did what was almost a mapping exercise. It worked
out what all of the statutory professionals were doing with members
of the family, who needed to be doing what and what was the focus
of what needed to happen to allow change for the family. The service
slimmed down and identified the needs, was much clearer about
who was going to do what, delivered a range of services with the
intention of building on the family's strengths, so that the family
worked on what worked for them and were able to move forward,
stabilise their lives and tenancy and remain within the community.
We did that with a multidisciplinary team so that we could deliver
the services from a multidisciplinary group and so get the holistic
approach within the team. We did not have a range of agencies
across the locality all sending in people to deal with housing
welfare, educational welfare, special needs and the support for
children and adolescents. They were very well known, but the situation
had become intractable.
Q95 Chairman: Thirty agencies went
down to how many?
Margaret Dillon: Four.
Q96 Chairman: Could you give us a
list of those 30 agencies, because that would be very useful for
Margaret Dillon: Yes.
Q97 Fiona Mactaggart: It sounds as
though that family illustrates another issue regarding adolescents.
A lot of what we have been talking about relates to intervention
with very young children. It seems from the evidence that we have
had that there is a gap affecting adolescents and that they are
seen, as this family clearly was, to be antisocial and a social
problem for their neighbours. It sounds to me as though it is
the adolescents within that family who are at risk of criminal
Margaret Dillon: Absolutely.
Q98 Fiona Mactaggart: Did they have
services that met their needs as part of early intervention? It
seems that we are not bad at provision up to the age of seven,
but from seven onwards we seem to get worse. These young people
suddenly stop being children and start to be something elsesomething
rather feral and aggressivethat we are angry about. I wonder
whether you have any suggestions about how to deal with that.
Margaret Dillon: This goes back
to an earlier question on pilots and short-term funding, because
the funding stream for the children's funds, which will come to
an end at the end of this month and move into mainstream local
authority budgets, was very much targeted at the five to 14-year-olds;
it was deliberately intended to reach out to those groups of children
who had needs and needed support to avoid failing at school, to
get them to attend school and not to get into trouble with the
police or the community. A lot of those services are going to
the wall. We have closed a number of those services in the past
18 months because the ringfenced funding is soon to end. So, there
is a gap and we remain concerned about that.
Q99 Fiona Mactaggart: Local authorities
still have the money.
Margaret Dillon: They have the
money, but they have significant challenges about how they spend
their money, which we recognise. One of the things that NCH is
exploring with a number of partner local authorities is whether
there is a way of doing more with children's centres so that they
are not just focused on the very young. That will look at whether
a range of services and outreach work could be delivered from
within a children's centre, because the centres are in communities
and those little children who attend or are involved almost invariably
have older siblings, as families do not just come with an 18-month-old
and a three-year-old. Families come with an age range of children,
and those children come in all shapes and sizes.
Professor Tunstill: I just want
to say two things about taking away the age restriction around
children's centres. First, I think that children's centres should
be opened up, so that they take account of the fact that families
have children of different ages. Secondly, I think that very clear
messages should be given, both to professionals and parents, that
problems are likely to be episodic. It is very difficult at the
momentprofessional training has partly aggravated thisto
have a system that gives you permission to go in and out of it.
There was always an expectation that a service will deliver the
silver bullet within a particular time period; all will be well,
that is it and if it is not, either the service has failed or
the parent is deficient. One message that politicians could give
to service planners, local authorities and everybody else about
the reality of need in families, is that it is episodic. You may
go in and out of a system, but some families will need an ongoing
offer of long-term support. It is not that they will be in the
system all the time, but they need to know, as we probably know
from our own networks, that they can go and access those services
when they need them. In this country, there has been a situation,
aggravated by social work theory in some cases, where services
are "task-centred", "brief-focused" or all
of those words that somehow make it not permissible to go in and
out of the system. That is a very simple thing; I do not know
how you get the message across, but it is a powerful message.
Chairman: Mary, and then some quick ones,
because I am conscious that I have to move a little.
Mary MacLeod: I will be very quick.
Thinking about what Government can do, one thing that is really
important is cross-departmental work, because departmental agendas
can conflict. There also must be some thinking about what the
appropriate targets are, because if you are thinking of children
aged eight and above and teenagers, the world outside also has
an enormous impact on how a family copes. It is not controversial
to say that. For families raising children in social housing as
it is now, it is much more challenging to prevent children getting
into trouble, because of the housing and the local environment.
Local authorities and Government need to think about regeneration
and about the impact of housing and locality on families' capacity
just to maintain themselves and to keep their children out of
trouble. I do not think that I would argue for more structural
change. Although I come from Scotland and I think that the children's
hearing system there is a very good one and that we have a problem
in having welfare and justice divided in the way that they are
in England, if you go and look at the results in Scotland for
families I do not think that you will find that they are enormously
different to the results in England. So I do not think that structural
change will do it. However, sharing targets and sharing funding
Anne Scarborough: I was going
to add, from a practical viewpoint, that that is certainly where
most local authorities are now. One of the things said at the
beginning was the importance of having pathways, so that you know
what your continuum of support is within a local authority. You
know the families that are likely to be at risk, and therefore
you can predict what kind of services you are likely to need in
the future. You cannot predict some services that you will need,
because sometimes you have families that come into an area and
you have to do something different for them. However, if you can
achieve that continuum, you can go through the commissioning part,
which is what I think we are coming to now. In some respects,
I suppose that local authorities do not really want to build new
services as such, if those services are already out there and
they are rigorous, robust and good enough to support what they
want to do as a local authority. That is where we would be coming
from. One of my newest best friends, as it were, is housing. Housing
can give me a lot of intelligence about which families are likely
to be at risk of losing their tenancy, or which families are at
risk of costing the council enormous amounts of money because
of the way that they leave their houses. Hopefully, within the
next few years we can start to have an impact on that. We have
to look at intervention projects in housing, which will hopefully
prevent escalation. That must be sustainable because, as people
have said today, we can not just put in an intervention and hope
that it will work, because families come back. That must be built
into what we do with our budget and resources and those services
must be developed. That is where we need to be.
Chairman: I want to take a point from
Andy on this. We will come back to the issue if we have time at
the end, as we are dealing with a vitally important section. Andy,
if you would like to come in brieflySharon will lead us
on this matter, and then you can do the next section.
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