Examination of Witnesses (Questions 240-246)
CELIA ATHERTON,
JANE HAYWOOD,
PROFESSOR JULIAN
LE GRAND
AND STEVE
TITCOMBE
12 MAY 2008
Q240 Chairman: Is that common practice?
Jane Haywood: I do not know.
Chairman: It sounded horrific to me.
Steve Titcombe: Children's experience
of being in care is not determined only by continuity of social
worker. I had a recent all-staff conference up in Rochdale featuring
all the staff employed by my service. We watched a fantastic DVD
about three children in the same long-term care for four years.
They were saying goodbye to their social worker, who had done
a good job and they had already been introduced to their new social
worker. They were not unhappy about this. The really important
issues in those children's lives were related to the quality of
care that they received from their long-term foster carers and
their very positive contact with family, brothers and sisters.
I just wanted to make that point.
Q241 Chairman: Continuity is what
we are all talking about though, is it not?
Steve Titcombe: Yes. I entirely
agree that the problems with the continuity of social workers
can sometimes be a big problem for children.
Celia Atherton: When you started
on this particular line of questioning, you asked about whether
we could not learn now. I would put that together with something
that Jane said about the workforce being the beginning and the
end of it. The bit of the jigsaw that we are missing is that we
should ensure that the workforce are constant learners. I shall
give two examples. Very recently, another Government report came
out, on building brighter futures. Nothing in the body of the
report mentioned the workforce being a learning workforce, the
use of research or developing the ability to reflect on what they
do. It is mentioned once in an annexe on the values of the children's
workforce network. That is all. However, the document published
on the same day about managing and leading children's services
says a lot about reflective practice and using research evidence.
It is as if, so long as people at the top know what the research
evidence is, the workforce will follow. People at the top know
that children want to know that the same person they saw last
week will be there next week and in six months' time. But we have
to get to a position where front-line workers are hungry to learn
that for themselves—they should feel it for themselves instead
of being asked to believe that other people know what they are
doing and what is being put in place for them. It seems to me
that unless we do that, we will not create people who are constantly
reflecting and constantly learning and who are enabled to do some
of those things that, as suggested, are not rocket science or
terribly difficult, but quite straightforward.
Professor Le Grand: Exactly. It
is not rocket science, which makes one ask what is going on and
what are the incentives in the system, which means that we do
not have continuity. The reason why we do not have continuity
is at least partly because of massive problems over recruitment
and retention, as we heard. Social workers move on, and they do
so very fast. There are reasons for that, which we have all articulated.
I know that I am always banging on about incentives, but in some
sense it is about getting the incentives right. It is not enough
simply to say that it ought not to happen. We have to work out
why it is happening or not happening, and how we can structure
the incentives so that it works.
Q242 Mr Chaytor: Scepticism about
social work practices being the solution is based on the fact
that the model on which they are based is that of GP practices.
Over the past 60 years, they been very effective in building up
practices and building up the status of doctors, but not terribly
effective in doing anything about health inequalities, giving
personalised service to patients or building a seamless approach
to the rest of the national health service. That is what concerns
some of us. The typical GP practice does not do anything of what
we want from social work practices. Is there a model elsewhere,
outside the UK, that gives a stronger evidence base for social
work practices than the history of GP practices in the UK?
Chairman: I think that one is for you,
Julian.
Professor Le Grand: We discuss
international evidence at the back of the document, but there
was not any. That is one reason why we want pilots—
Q243 Mr Chaytor: You run pilots,
but you are not allowing time to evaluate them before launching
them nationwide.
Professor Le Grand: Oh no.
Q244 Mr Chaytor: What happens if
the pilots prove to be totally disastrous?
Professor Le Grand: We discuss
the decom- missioning.
Q245 Mr Chaytor: The legislation
assumes that there will not be disasters and that you can quickly
move from the completion of pilots to roll-out.
Professor Le Grand: This is important:
there is no presumption at all that this is a preliminary to rolling
it out nationally. We try to make that clear. In fact, we discussed
what happens if the pilots do not work. For instance, if some
social workers in a social work practice have children being looked
after by those social workers, how do we decommission the pilots
effectively to return to the previous system? We talk about that
quite a bit, which indicates that we really were not presuming
that there will be an evaluation—simply nodding to the idea
of evaluation and then rolling it out nationally. I am very keen,
when talking to the relevant people, to impress it on them that
that is not the idea. What you had to say about GPs was interesting.
When people from abroad look at our GP service they think it is
remarkable—for all the things you were saying that you did
not think it did. They think it is extraordinary that it provides
a personal service and that it acts as an integration device,
because there is a central person who looks after the care of
the patient. I suppose that it may be a glass that is half full
or half empty. I would have said that GPs are remarkably effective
in providing continuity—we have all these troubles and we
know that there are to-ings and fro-ings on the hours and the
rest of it, but when you look at it in the round and compare it
internationally with the total absence of continuous primary care
that seems to characterise most health systems, I believe that
primary care is remarkable.
Q246 Mr Chaytor: France?
Professor Le Grand: You do not
get continuity in France; you get people shifting very rapidly.
The GPs get very upset about it—
Mr Chaytor: That is the patient's choice,
surely.
Chairman: I am afraid that this is developing
into a discussion that I am sure most of us would love to pursue,
but we must get the second bank of witnesses in. I thank you all;
Jane is staying with us. I am glad that Lancashire and Yorkshire
did not come to blows. I was not prejudiced against you at all,
Steve, even though Rochdale claims to have founded co-operatives
in 1844. That is total nonsense, because they started in Huddersfield
about 30 years previously. Apart from that, the evidence has been
excellent all round. Will you maintain contact with us. We get
best value out of you only if you come back to us and say, "There
is something that never came up when we were discussing this."
We write good reports not by making things up, but by listening
to our evidence. We got a lot out of that. Thank you.
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