Examination of Witnesses (Questions 100-119)
MARGARET DILLON,
MARY MACLEOD,
ANNE SCARBOROUGH
AND PROFESSOR
JANE TUNSTILL
26 MARCH 2008
Q100 Mr Slaughter: I am very sorry
for making a flying visit to the Committee, but I have fallen
on my feet by arriving for the part that I wanted to be here for.
Chairman: You have been watching it on
television.
Mr Slaughter: I want to pick up on earlier
comments about finance. I appreciate that there are different
types of provision and local circumstances, but I am concerned
about consistency across the country. I was not aware of that
issue with regard to family support. I was aware of it in other
areas of social care—domiciliary care, for example, where
there are huge differences in how and what is provided and things
such as charges. I am also aware that we had a good level of care
in my locality, but now that seems to be changing; there is less
provision, or provision is charged for. How much of a factor is
that? Are you concerned that there may be areas in the country
where there is a lack of provision, expertise or sharing of good
practice? Within that, how widespread is charging, and how much
is it a factor?
Professor Tunstill: During my
national evaluation of SureStart research, charging seemed to
be a significant deterrent to the use of day care. I imagine that
in the area of children and families, the major negative way in
which charges might impact would be in day care. We know that
being able to use day care is associated with a range of positive
outcomes for children and parents. Anecdotally, some people might
worry that there are children's centres which are being effectively
"taken over" by the more affluent middle classes. That
will lead to a vicious circle, as not only can the less affluent
people in that area not afford it, there is also a deterrent and
a stigmatising effect. I work very closely with ATD Fourth World,
which is hugely conscious of people living in poor conditions.
Those people will feel very uncomfortable going into a children's
centre where a charging policy has accidentally skewed the profile
of the service users.
Q101 Mr Slaughter: It is an area
that I am becoming familiar with—charging for things like
counselling and respite and matters of that kind seems, to give
a personal view, to be rather counter-productive. If we are dealing
with families who are on the edge, it is a barrier which, apart
from any moral considerations, might cost the state more in the
long run. How prevalent is that?
Professor Tunstill: I suspect
that it is not very prevalent. It is that paradox of the universal
services being high-quality services and being good enough at
Level 1 to attract the likes of most people in this room. The
danger is that as you go up the continuum, a range of other things
kick in—the offer that you cannot refuse or the fear that
you might lose your child. I do not think that charging is the
problem at that point, but we could do more about capitalising
on the money that comes in from parents who are happy to pay for
high-quality day care because they have well-paid jobs to go to—I
have no idea what happens in Calderdale. However, the issue is
inextricably linked with the local employment situation.
Chairman: I am conscious of the time
and there are quite a few sectors, so one more answer to Andy
and we will then move on. Does anyone else want to come in on
that?
Q102 Mr Slaughter: I am not necessarily
asking you to name names, but are there areas of the country that
you have concerns about, simply because of the lack of provision
or the lack of quality in provision?
Margaret Dillon: There is a variability
of provision, which is one of the challenges. Where local authorities
choose to put their resources, in terms of the services that they
are shaping and delivering, will look very different, and that
is because needs vary across the country as well.
Q103 Mrs Hodgson: I have just a couple
of quick points to round off the section. You mentioned the pilots
that we are moving away from for the seven to 11s and teenagers.
Fiona asked this question: if the money is there and local authorities
have it, is it all skewed towards children's centres and early
intervention rather than towards teenagers and adolescents because
of the Government's emphasis on early intervention? I will round
in the second part of my question to save time. Fiona asked about
it being harder for teenagers and adolescents to hook into the
system—how many of those teenagers trying to get into the
system are above the radar for the first time? Have they at various
points dipped in and out and are therefore not totally unknown
to the system, or do you get teenagers—with whom there is
no history of intervention—who hit 13 and all of a sudden
require help?
Professor Tunstill: I suspect
that there is deficit in knowledge on the part of parents about
parenting older children. All the handbooks are about parenting
but parents lack confidence. In the papers all this week it has
been obvious—at the NUT conference or wherever—that
parents are rather iffy about parenting adolescents, that they
are frightened of saying no and a whole range of other things.
All the evidence shows that youth offender teams work very well
because they have been purposefully put together. They are multidisciplinary
teams, working with that particular age group in local authorities
but, ironically, only of course when they are triggered because
adolescents come into contact with the youth offending system.
There are some perverse linkages, where you get a really good
service but only at the point where you have hit the spot. I am
on the management board of Cafcass. We have family support workers
who do a supremely good job resolving family conflicts, but you
only have a chance of getting one of them at the point at which
a court order has been made. It may not have gone through the
court hearing, but it is hitting the high spot thing. I am not
quite sure where I am taking us on this one, but it is a combination
of parents' confidence and systems that perversely reward bad
or tricky behaviour and do not offer a service early enough to
those who are merely still at the stressed stage.
Mary MacLeod: What we find is
that when children are coming into the age group called tweenies,
it begins to become apparent that things have not been wonderful
at home. We have been talking about early prevention and the importance
of that, but there are a great many more problem families—or
families with problems—that are impacting on children than
we are picking up. So yes, children do end up hitting the radar
because their acting-out behaviour is a response to things that
are happening at home that nobody has—
Q104 Mrs Hodgson: It was not picked
up?
Mary MacLeod: It was not picked
up and nobody knew about it. I would not be too blaming about
that, because it can be very difficult. One of the studies that
I did when I was at ChildLine was about calls from children about
parental misuse of alcohol in particular. Children are very frightened
of what will happen if they ask for help. They are aware that
a juggernaut could hit the family and that then everything would
be out of control. Therefore, they involve themselves in ways
of managing what is going on in the family that is not good for
them, for example, by going to see their auntie at the weekend
when things are very bad, or whatever. So, there can be families
in which the children have been in quite dire straits, but where
it has not been obvious. Behaviour such as running away or getting
into trouble is then the first sign of what has happened.
Q105 Mrs Hodgson: The flash point
often occurs in adolescence, I would imagine.
Mary MacLeod: Yes.
Q106 Mrs Hodgson: Is the emphasis
on more early intervention Government-led, in your opinion? Are
we encouraging that? Personally, I think it is right that we should
focus on early intervention.
Mary MacLeod: I think it is quite
driven by Government picking up on the importance of the early
years. However, children and families can be worked with later,
and it would be a great pity if what you are talking about as
one batch of funding and resource was to shift there from here,
rather than deciding what is needed across the board.
Chairman: Okay. Sharon, take us on to
the relationship of family support to care thresholds.
Q107 Mrs. Hodgson: It follows on
nicely, actually. Is family support primarily a measure to prevent
children being taken into care? If that is so, does it not polarise
the sort of families who receive that support? So the "children
in need" category gets the support rather than the wider
group of vulnerable children.
Chairman: There are lots of shaking heads.
Who will start? Anne?
Anne Scarborough: I go back to
my former point that family support is a complex area. It encompasses
a lot of different things, so it is needed at many different levels.
It is for every family, but the challenge is getting families
to understand what support there is for them. There is probably
a difference between family support and parenting support. We
have talked about the two, and I think that there is a difference
between them. As we have just discussed, parenting support for
an adolescent is very different to that for a nought to three-year-old.
We have found that the gap in numerous services is between the
ages of five and 10. That period is crucial in a child's life,
from when they are at primary school, but also supporting their
transition to secondary school. The points of transition for families
and parents are crucial to how they parent and how they support
their children. The nought-to-three period is when SureStart and
children's centres are provided, normally in connection with health
services, because that is when you receive a lot of support for
health. In the transition to the next phase, the information and
intelligence about families at risk needs to be passed on. Hence,
I refer back to pathways and transitions. Passing on the intelligence
is the important bit. When a child gets to 11, let us say, and
goes off the rails, there is probably, as Mary alluded to, a whole
history behind it, but it is only just starting to manifest itself
in a particular form of behaviour.
Professor Tunstill: It is awfully
important not to see merely keeping children out of care as an
achievement. Care needs to be seen as part of the package of things
that help us enhance outcomes for all children. A seminal piece
of research done by Jean Packman back in the 1960s and 1970s showed
that when parents went with difficulties to what was then social
services they were asking for reception into care of often slightly
older, more difficult children and were refused it, but not offered
anything else. That was a profoundly important study because it
showed how valuable a short-term period of planned respite care
could be at that point, and that if you were going to avoid it,
you needed to offer other things. It is a great sadness that other
European countries see things slightly differently, and do not
regard it as a badge of failure if a child goes into care. For
some children, a care period might be the right thing for them.
However, given the other concepts of shared care that we have
talked about, care does not need to mean wrapping-up a red spotted
handkerchief and going off for ever, but a range of partnerships.
The emphasis should not be on keeping out of care per se,
but on approaching children on the basis of their individual needs.
Margaret Dillon: I support that.
Packages of family support can include shared care with a foster
carer. Parents often say when they have received that package
that the foster carer was immensely helpful in enabling them to
understand their child better, and helping them with techniques
to manage the child's behaviour back in the birth family setting.
That would have been at the request of a parent who said, "I
don't think that I can quite cope with Johnny and Jane at the
moment. Is there a possibility?" That is voluntary accommodation.
We see that as part of the package of support to the family. Unfortunately,
a great stigma is associated with the concept of in-care.
Mary MacLeod: Family support should
not only be targeting families who are very troubled or whom we
are anxious about. It is important that families whose relationships
could be improved can have access to family support. At the moment,
you can do that if you have money. You can have counselling for
family problems but, unless you have a big problem, it is much
harder if you do not have money. It is a big resource issue.
Q108 Chairman: Is not that one of
the problems that we have not talked about today? Is it not the
responsibility of the health sector to provide? The amendment
to the present Bill that was discussed in the House of Lords was
about a duty on health providers to provide the crucial therapeutic
care that so many young people need at the time that they need
it, rather than just at a crisis point. Is health a failing partner?
Professor Tunstill: The children's
trust evaluation showed that joint commissioning between social
care and health was the most complex. The best commissioning partnership
was social care and education. Often health is the missing partner.
It might play a part in some of the centres that are funded by
everyone else, but it needs a much more robust engagement. Services
such as child and adolescent mental health services might be the
patchiest of any that we have talked about.
Mary MacLeod: But there are good
examples. You might be interested in finding out about the Marlborough
Family Service, which is funded jointly by three London authorities
across education, health and children's services. It deals with
very troubled families, but goes out to schools. It is a beacon
service in the country and I am sure that it would be of interest
to you. It is in Maida Vale, surprisingly.
Chairman: Any suggestions of things that
we should look at are gratefully received.
Q109 Mrs Hodgson: Taking into account
what Anne said about family support, it is not about just preventing
children from going into care. Andy Slaughter spoke about the
varying provision of family support across the country. We have
looked at the number of children in care. Is there any correlation
between those two statistics? Where are good family support services
and which local authorities have reduced the number of children
in care?
Margaret Dillon: I am looking
for the detail. We, in the Vale of Glamorgan, deliver a crisis
intervention service that was targeted specifically on preventing
children from coming into care. It commenced in April 2004 and,
in nine months to the end of December, 15 successful interventions
were made. At that point they had 200 children in care in the
vale, and the average length of time for the children being looked
after in the Vale of Glamorgan was just over three years. We did
a cost benefit analysis of the savings on those 15 children who
would otherwise have been accommodated and looked after. The Vale
of Glamorgan could see the cost benefit of investing in the intervention
service, which reduced the costs of the looked-after population.
We have a number of such services giving that evidence—we
have a similar one in Merton at the moment.
Chairman: We have 15 minutes to wrap
up the last questions. Is that okay? The people I want are Fiona,
Graham and then Annette.
Q110 Fiona Mactaggart: We talked
a bit about commissioning, but a bit sideways. I am just wondering
what outcomes commissioning bodies look for from family support
services. What are they looking for? Are they asking for the right
outcomes when they commission family support services?
Professor Tunstill: I do not think
that I can answer that.
Margaret Dillon: In our experience,
in the last two to two and a half years, local authorities have
become more able to be specific about the outcomes that they are
seeking. What is problematic is that that tends to be numbers-counting
things rather than qualitative measurements about improvements
to children's well-being. It remains a complex area to measure
the outcomes being sought. With our intensive family support services
around antisocial behaviour, you can see more specifically what
the outcomes are as a result of those services. They are much
more measurable: maintenance of tenancies, reduced complaints
from neighbours, improved school attendance from children. Those
are much more tangible, whereas a range of other family support
services are often much harder to capture in measurements of what
you are seeking and in evidence for successful outcomes.
Q111 Fiona Mactaggart: But things
have not got worse. How do you ensure that?
Anne Scarborough: I would say
the same really. If we go out to commission, we would have a fairly
rigid contract with whoever we were commissioning. There would
be outcomes on it. One of the issues that we have probably not
discussed today is the qualitative one, which is the information
from the families themselves. When we were commissioning things
for children and young people, we asked their views. We certainly
did that for our parenting strategy, and got qualitative information.
However, it is normally the harder information that we are tasked
with—our performance indicators.
Professor Tunstill: Harking back
to the big, university of East Anglia, Government-funded study,
commissioning is incredibly influenced by the nature of pre-existing
partnerships. In a sense, it holds up a mirror to what the cross-departmental
and agency partnerships were like in that local authority. In
a sense, it is a sort of virtuous, or unvirtuous, circle. There
is a huge tendency for commissioning to be around the targeted—in
theory, more countable—bits of the system, rather than about,
as we have been labouring to tease out this morning, the need
for this broad-based menu of easily accessible services at each
level.
Margaret Dillon: One of the challenges
with commissioning is that there has been a phenomenal level of
investment in a commissioning structure within local authorities,
and within a set of processes and procedures. It is incredibly
complex, particularly for the voluntary sector, in terms of delivering
pre-qualification tender documentation with incredibly tight timetables.
We find that the commissioning arm of the local authority is not
necessarily having the right conversations with the referrers
to the services—the operational arm—be they health,
education or children's social care services. There is a slight
and sometimes major disconnect between what is commissioned and
what the operations arm of the local authority perceives as the
needs in reality. Anne is nodding. There are some challenges with
that issue.
Anne Scarborough: It is a really
difficult area. Most authorities are at the starting blocks with
commissioning. One of the tensions is about releasing the funding
for commissioning. To do that, you have to decommission or decide
which of the services you really want. Decommissioning local authority
services creates a tension in itself.
Mary MacLeod: I am not sure whether
users—children or parents—are involved in commissioning
processes.
Anne Scarborough: We do ask parents.
Mary MacLeod: You do.
Q112 Fiona Mactaggart: There are
guidelines in Every Parent Matters about having a commissioning
strategy and about a single commissioner for priority services
in local authorities. It does not sound to me as though that has
made much difference to anything. It sounds like it is the same
old story of struggling through and making choices, but sometimes
not making them in a way that fits with what is happening on the
ground. What recommendation should we make to shift that, apart
from engaging children and families and assessing whether things
work, which I have heard about?
Mary MacLeod: Give it time.
Margaret Dillon: Yes, give it
time and share the better practice. Have the right players at
the table when understanding the needs of a community and the
families within it. Do not have siloed thinking, but have a more
holistic approach. Gather the information from all players within
the local authority. Anne made a very good point that that should
include housing workers, who are often excluded from the social
children's welfare agenda.
Anne Scarborough: It should really
come back to the children's trust. Our children and young people's
management group is very well versed in knowing exactly what is
available in each of the areas within what is the quite diverse,
small area of Calderdale. We have that information and we rely
on it. It will now go forward into commissioning. Councils are
at very early stages on commissioning. For instance, we commission
organisations such as Home Start and the Pre-School Learning Alliance
and have done for quite a long time. I would say that perhaps
our commissioning processes have not been as robust and rigorous
as they need to be. Again, this is not about creating a bureaucratic
nightmare for people who want to take on contracts. It is about
creating a process that gets the service that will deliver for
the people.
Professor Tunstill: It would be
a great shame if the commissioning process got into an unhealthy
relationship with what I call the "what works agenda".
The Government are rightly concerned with a knowledge base for
practice, but some things are not amenable to random control trials
and evaluation in the most positivist, experimental sense of the
word. It would be a great shame—this is very germane to
supporting families—if local authorities got to the point
of being allowed to commission only services and interventions
that have been subjected to random control trials and evaluations.
(One example is the Webster-Stratton programme, which is very
important in its own right). These are often manualised programmes
because, by definition, those are the easiest to evaluate and
they appear to produce the magic answer. I am just cautioning
that whatever the guidance on commissioning, it must take account
of the commissioning of the broad menu and not just the narrow
number of programmes that have been subject to what some researchers
feel is the only gold standard of rigorous evaluation. It is not
the same as the National Institute for Health and Clinical Excellence.
Q113 Fiona Mactaggart: I am hearing
a difficult tension. One of the things that I think all of you
said earlier was that you need some expert, quality services that
are tried and trusted and that might reach beyond a single authority.
You probably need that to be centrally directed to some degree.
The system now has a lot of flexibility around how a local authority
can decide to spend its money. You talked about bringing people
round the table and working it out together, and the system seems
to meet that. I wonder whether you want both of those things?
Do you want one more than the other? I am not sure that I know.
Mary MacLeod: I would say both.
You lose a lot of knowledge if you do not support the national
services. A lot of those services are voluntary sector or third
sector and there must be some central discussion and thinking
about how that support is delivered alongside a localist agenda.
With regard to the parenting strategies and services commissioners,
it is very early days. They have just been set up and parenting
strategies are only now being developed. It is too early to say
that it is not working; with help, it will work and it will deliver
more and better than was previously the case.
Chairman: We are running out of time,
so I will call Graham and Annette. Unfortunately, Prime Minister's
questions is close upon us.
Q114 Mr Stuart: Margaret, you touched
on some work in Glamorgan. Do we need more economic analysis of
the impacts of different local authority approaches?
Margaret Dillon: Yes, absolutely.
Mary MacLeod: May I draw your
attention to one piece of economic analysis by Leon Feinstein?
He looked at the outcomes of children's offending in a number
of authorities. Some had only the educational maintenance grant,
but some had particular youth offending support. He found that
where both were present in authorities, there was a better outcome
for children—fewer children were offending and they were
getting out of offending more quickly. That kind of analysis would
be hugely helpful to local authorities in planning services. We
need to look at the impact of a number of different interventions
that seem to be disparate, but might actually work together to
give a better outcome.
Professor Tunstill: Just a point
of information: there is a large review called The Costs
and Consequences of Child Abuse, which is being set in train
at the National Institute of Economic and Social Research. It
will try to pull together all the different bodies of knowledge
and show the short, medium and long-term consequences of what
not addressing problems in families leads to down the line.
It is under a range of headings—housing, the economy, everything
in the world.
Q115 Mr Stuart: What is the right
ratio for spending on children in care and family support?
Mary MacLeod: It depends where
you are. If you start off by aiming for prevention, once you begin
to provide good preventive services, you begin to find those children
that we were talking about—the ones that we get to only
in adolescence. For a period of time, you have to invest very
heavily in both before you see the reduction in spending on children
in care that you would hope to achieve by increasing preventive
services.
Q116 Mr Stuart: So where do you aim
to get to? You said that it depends where you are, okay, but what
is the end point? What should the ratio be?
Mary MacLeod: I would like to
see more family support.
Mr Stuart: At the moment the average
is three to one or, in some places, 10 to one.
Professor Tunstill: Yes, there
has to be more support. Mary is right; there needs to be an interim
period of double-track funding. We tried hard with the last Government
in the '90s to argue that we needed some short-term, double-track
funding for what we were doing. Yes, if push comes to shove, that
is where the emphasis must be, but I do not think that it is as
mutually exclusive as we may think.
Q117 Mr Stuart: The economic analysis
in my previous question is what will be needed to convince people.
I have one last question. I am going off at a tangent, but should
the same assessment that is used before removing a child from
the parents, namely that of safety, be used for grandparents,
uncles, aunts and those in the immediate family, in accordance
with the presumption that, if children cannot be with the parents
because of a safety issue, they should be with immediate family
members rather than having the decision about what is in their
best interests in the broadest sense handed over to the social
worker?
Mary MacLeod: If you are asking
whether we should be doing more about kinship care, the answer
is yes we should. I think that most people would say that that
is where you start. You would start looking there, and a way of
doing that is through family group conferencing. Kin who do take
on that responsibility are often poor, and get different allowances
from what is provided to foster parents, and that is a huge disincentive,
particularly for the grandparents who did not ever think that
they would be parenting their grandchildren. They will need more
support and we cannot just wash our hands and say, "Well
that is the family and that is fine."
Q118 Mr Stuart: What about the threshold,
because grandparents could be willing to take the child on, but
the social worker's opinion might be that that is not the best
place for the welfare of the child? Should we create a higher
threshold that they need to be in danger before the presumption
is that they are put with kin, rather than wherever else the social
worker wants to put them?
Professor Tunstill: That is a
terrible trick question. However, there has to be an assumption,
subject to all the financial caveats that Mary has just laid out,
that a different threshold would be incorporated within one's
wider kinship network, but that is not to say that the local services
should forgo all their responsibility. Although I am not yet a
grandmother, I guess that I would come down on the side of expecting
to be seen as the first port of call to look after any grandchild
who happened to get to the point of being formally taken into
care, without having every aspect of my life combed over.
Q119 Mr Stuart: Is that a yes?
Professor Tunstill: I think it
is a yes. I think that I am on your side and that it is a lower
threshold.
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