UNCORRECTED TRANSCRIPT OF ORAL EVIDENCE To be published as HC 111-i

HOUSE OF COMMONS

MINUTES OF EVIDENCE

TAKEN BEFORE THE

CHILDREN, SCHOOLS AND FAMILIES COMMITTEE

 

LOOKED-AFTER CHILDREN

WEDNESDAY 17 DECEMBER 2008

COLIN GREEN, HENRIETTA HEAWOOD, PROFESSOR JUDITH MASSON and DR. ROSALYN PROOPS

 

Evidence heard in Public

Questions 581 - 665

 

USE OF THE TRANSCRIPT

1.	This is an uncorrected transcript of evidence taken in public and reported to the House. The transcript has been placed on the internet on the authority of the Committee, and copies have been made available by the Vote Office for the use of Members and others.
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Oral Evidence

Taken before the Children, Schools and Families Committee

on Wednesday 17 December 2008

Members present:

Mr. Barry Sheerman (Chairman)

Mr. David Chaytor

Mr. John Heppell

Mrs. Sharon Hodgson

Paul Holmes

Fiona Mactaggart

Mr. Graham Stuart

 

Examination of Witnesses

Witnesses: Colin Green, Safeguarding spokesman, Association of Directors of Children's Services, Henrietta Heawood, British Association of Social Workers, Professor Judith Masson, Professor of Socio-legal Studies, University of Bristol, and Dr. Rosalyn Proops, Officer for Child Protection, Royal College of Paediatrics and Child Health, gave evidence.

 

 

Q581 Chairman: I welcome our witnesses: Dr. Rosalyn Proops, Professor Judith Masson, Colin Green and Henrietta Heawood. It is a pleasure to have you here. This session is an add-on to an inquiry into looked-after children and children in care that we had been pursuing already. As I explained to you outside, the events surrounding the Haringey Baby P case convinced us that we had not paid enough attention to the relationship between vulnerable children and children at risk, and the care system.

We are very grateful that you are here, because you are the experts and we want to learn from your expertise. It is nearly Christmas, and the House rises tomorrow, and if you do not mind, we will not use titles but first names. I hope that today's session will be reasonably informal. Rosalyn, what is the relationship between what we have been inquiring into in some depth-children in care and the decision on whether to take a child into care-and the decision that a child is at risk and to put them on a special register, but not into care?

Dr. Proops: Thank you for this opportunity. I shall approach that question from the perspective of paediatrics and health, and I am sure that my colleagues will fill in from their perspectives. Paediatricians are in a position to identify children who might be at risk or harmed in a number of different ways-often opportunistically, as those children come through clinics or are referred by general practitioners with different problems, and sometimes more directly through referrals from children's social care, police and education. It is noticeable, however, that health sees only a minority of the children identified as at risk. Education sees many more. Initially, health sees only a minority of those children deemed to be at risk.

Our role is to help to identify, to help to assess, and then to work with the multi-agency team to consider what might need to happen next. I hope that we see our role as being part of that multi-agency team in helping to analyse the degree of risk-whether it is a child or a family that needs additional help, or a child for whom another action might need to be taken. We are not directly responsible for making decisions on whether the child should be removed; we are very much part of the team. It works mostly well, sometimes variably, and at other times not as well as one might hope. Health has a key role in the process, but not a primary role in the sense of your question-the link between those who are vulnerable and those who may be taken into care. We are part of the team that will consider the matter.

 

Q582 Chairman: When we were making our visits, and as we were taking evidence, there was a small voice-it was not strong-saying that health was identified as being the quieter in the partnership. Historically, I always thought that the health visitor was on the front line when picking up on children who might be at risk or who needed to be in care, or whatever. You sometimes pick up that GPs do not play as active a role in children's centres as some of the other partners would like. Does that strike a chord, or do you think that that is not right?

Dr. Proops: Some of those comments do-certainly, health visitors are absolutely key; the universal health visiting service is extremely important, and as a health professional, I would be sad to see it diminish. There are some indications of changes to the health service provision, and that is regrettable. Health visitors are the key to identifying and supporting families with pre-school children. I am sure that we would all wish to see that reinforced.

I cannot speak directly for general practitioners. It is variable. There are primary care systems that work extremely well, and others that perhaps are slightly less engaged. I am not in a position to say any more about that.

 

Q583 Chairman: Are the health visitors in danger at the moment? Is the universal health visitor provision being nibbled or munched away?

Dr. Proops: Yes.

 

Q584 Chairman: By the Government?

Dr. Proops: By the changes that are happening; by the reorganisation that is happening within health. We have the grounds and the basis for an extremely good universal service, but over the past 10 years or so it has begun to change. When I first started in paediatrics a number of years ago, pre-school children would be routinely visited by the health visitor on a number of occasions. Those routine visits have lessened. I am not saying that routine visits are the answer, but some form of surveillance as well as targeted support is vital for families, particularly those with young children. If I had a health visitor colleague sitting next to me, they would be saying, "Yes, there are some concerns about the provision of universal and targeted services, particularly for pre-school children."

 

Q585 Chairman: Is it the Department of Health that is causing this diminution of the service?

Dr. Proops: It is something to do with how the services are set up. It is something to do with the performance targets that are required of health. It is something to do with the rearrangement of PCTs-things in that area.

 

Q586 Chairman: But would it be fair to say that some PCTs are maintaining a good health visitor service and that others are not?

Dr. Proops: There is variability. The only thing that it would be reasonable to say at this stage is that when organisations are changing there is a potential danger of losing some of the impetus in service provision.

 

Q587 Fiona Mactaggart: The change that I see in the health visitor service is that it has become more targeted. Is there evidence that the broad-brush universal service picked up more children at risk of neglect or abuse than the targeted service, which is focused on the families more at risk?

Dr. Proops: You are correct about that. Professor David Hall's reports on child surveillance looked at the evidence base for the particular surveillance systems that were in operation. For many of them there was not a great deal of good evidence. So you are correct that health visiting is much more targeted, but it is much narrower now. There is a body of opinion that suggests it may be too narrow.

 

Q588 Fiona Mactaggart: Is any research being done to look at the difference between the risks and advantages of a universal service and the risks and advantages of a targeted service?

Dr. Proops: I will be able to report back on that. I do not have that with me at the moment.

 

Q589 Chairman: What happens if you withdraw the universal service? A more focused service may concentrate on poor families and families in greater need, but if you look at the relationship between child, lack of success and post-natal depression, for example, post natal-depression is no respecter of class and income, is it?

Dr. Proops: Precisely.

 

Q590 Chairman: So you would stop picking up things like post-natal depression, would you not?

Dr. Proops: Precisely. You need both. You need confidence in your universal services as well as clarity in evidence-based targeted services.

 

Q591 Fiona Mactaggart: I wonder to what extent can you as a consultant practitioner direct the work of health visitors? I know you work with children, but if there is a parent who is showing signs of post-natal depression is there a way that the health service can brigade those resources at those families?

Dr. Proops: There are probably two ways of doing that. One is by ensuring that you have an integrated commissioning system within the locality so that the clinicians can be part of that commissioning framework and can support, advise and work with the commissioners. The other way is locally with each family. As a paediatrician, if I identify a family who I believe would benefit from some help, then yes, there are teams around me to whom I could say, "Is it possible to offer this family this piece of work? Could you do this?" Certainly, at either a practitioner or a commissioning level, I would hope that health professionals would have an involvement.

 

Q592 Chairman: Could I bring you back to the team that you are talking about? The critical members of the team are the health visitor and the local GP?

Dr. Proops: Yes.

 

Q593 Chairman: I have picked up in children's centres that some GPs are poor attenders at case conferences. Some will not come unless they are paid. Is that normal?

Dr. Proops: Speaking as a practitioner, again there is enormous variability in attendance at case conferences. Again, with my practitioner hat on, I would say that that variability has increased of late. We used to be better at attending conferences. When I say "we", I mean all shades of health professionals. Those who attend very regularly are the nurses. Almost across the country we have very strong child protection teams with a strong nursing presence. They have very good systems for ensuring that they attend case conferences with the right reports and the right information.

 

Q594 Chairman: Where do those nurses come from?

Dr. Proops: They were often practising health visitors. They now will have titles such as named nurse for child protection or lead nurse for child protection.

 

Q595 Chairman: Would they be based in children's centres?

Dr. Proops: They may be based in children's centres but they would be part of the provider system of the PCT usually or of the hospital. So they are NHS employees providing that service.

 

Q596 Chairman: But GPs are on the frontline of picking up on problems, are they not?

Dr. Proops: Yes, GPs tend to provide reports. There is a major problem with timing, and I am sure that my colleagues will address that further. When a conference is called, one sometimes does not get a great deal of notice. Conferences are complicated to put together and involve a large number of people. GPs and hospital doctors have clinics, operating lists and surgeries, and the question is whether they should cancel or postpone those. How does one work out the priority of attendance? The vast majority of professionals provide a report, and nurses attend the conferences. I would say that GPs and hospital doctors do not attend conferences as often as the system might wish, but there are practical problems in finding a way through that.

 

Q597 Chairman: Do you think that GPs and A and E doctors are trained well enough to identify not only the patient's clinical needs but possible evidence that something untoward is going on in a child's background?

Dr. Proops: I hope that my GP colleagues will forgive me for trying to answer that question on their behalf. The Royal College of General Practitioners has put an enormous amount of effort into supporting and training GPs, and has moved a long way in ensuring that GPs have training and support in a variety of ways. GPs are very much tied into the child protection teams in their provider organisations. There is some way to go, but they have made enormous strides in trying to do that.

As far as other groups of health practitioners are concerned, our college sees it as one of its responsibilities to encourage other colleges to engage in training, and we have done a number of projects with anaesthetists, dentists and A and E doctors to develop training packages and to encourage that. There is real movement in that direction. The college has made some progress, but there is some way to go.

 

Q598 Chairman: Could some good come out of the Baby P case, by raising awareness of the need for training? A particular A and E response has come out horrendously badly in that case.

Dr. Proops: Yes, I think some good can come out of it-indeed, it has already raised awareness, particularly among hospital trusts. On accountability, I feel much more confident that hospital and primary care trust boards are much clearer about their responsibilities and are checking much harder whether those things are happening. They are also following through, and checking whether people are receiving training experiences; if not, they are asking why not and what they can do to support that.

 

Q599 Chairman: I had the feeling, when I was reading the full report on the Baby P case, that if someone intended to be devious, they might, instead of going to their local GP, who has been keeping an eye on them and asking some uncomfortable questions, switch to A and E to get attention without that consistency.

Dr. Proops: Whether with or without intent, that happens, but the majority of A and Es that I know have systems in place to try to manage that. I think that all A and Es now have liaison health visitors, and all A and Es have a system of reviewing the cases of children who have come through. After their visits, a senior doctor will review those cases, and the child protection teams in hospitals keep an eye on A and E, so quite a lot has changed. However, there is room to improve.

 

Q600 Chairman: Tell the Committee a little about the child protection team in a hospital.

Dr. Proops: Such a team typically includes a named doctor, who is usually, but not always, a paediatrician. There are named doctors who are anaesthetists, neonatologists and other specialists. The team also includes a named nurse, and almost always a named midwife, as well as representatives from other parts of the hospital such as emergency services and a range of other places. It includes a senior manager and often a training officer.

 

Q601 Chairman: Does it meet regularly?

Dr. Proops: Yes.

 

Q602 Chairman: How regularly?

Dr. Proops: My local one meets every month. It meets the designated professionals and has to provide reports up to the board, which expects particular pieces of information from the child protection team.

 

Q603 Chairman: This has been so interesting that I kept asking questions; it has served the Committee. One last question before an introduction to the other members of the team: what about the role of the school nurse?

Dr. Proops: The role of the school nurse is very important. In a sense, my comments relating to school nursing would be similar to those on health visiting. Again, the caveat is that this is not my professional area, but school nursing has changed. It rather depends whether we are looking for a public health service for schools or a safeguarding service, and whether we can ask our nurses to do both. Many school nurses find that their time is directed too much down one line rather than the other, but they are certainly in a good position to support the safeguarding of children in the broadest sense. I say that on the basis of research that demonstrates that it is within the education sphere that most child protection concerns are identified, and not within health. Therefore, school nurses should be and are in a good position to support that particular part of the process.

 

Q604 Chairman: Thank you very much. Judith, you know why we are on this learning curve. How can your research and background help us?

Professor Masson: There are a number of different areas that we can look at, such as the individual decision to take a specific child into the care system. The research that I have done has been on care proceedings and emergency intervention. If we are looking at, for example, children on the child protection register, quite a lot of children who come into care proceedings or are removed in an emergency are not on the child protection register at the point when the decision to remove them is made.

 

Q605 Chairman: Why not?

Professor Masson: There is a small proportion, perhaps 10% of care cases, where the family is not previously known to social services, or they are not known to social services in the area and they have moved. There are the sudden cases, injury cases, but far more of the cases involve neglect or neglect and injuries. There may have been some social services or children's services involvement from time to time, but the case has not reached the level at which it is case-conferenced and an entry is made on the child protection register. It may have been case-conferenced but there has not been a decision to put the child on the register, and then there is a catapulting incident that leads to the child coming into the system.

That incident might be: coming to the notice of the police, being found unattended, or a domestic violence incident; it may be part of an assessment process where concerns are suddenly raised sufficiently high as to lead to the child coming into the system. Quite often, the incident that precipitates the child into the system is no worse than things that have happened in the past, but it is significant because there has been another incident. A key factor in children coming into the system through the compulsory means is lack of parental co-operation. There may have been some work with the family but the family are not seeming to co-operate; they are missing meetings and appointments and are apparently out when the social worker attends. That leads to increasing concern and then gives a trigger.

 

Q606 Chairman: Thank you. Colin, you are very experienced in this field. Tell us a little bit about the relationship between the children who are seen as at risk and are on a particular register, and those who are in care or not in care. When we went to Denmark they told us that they take twice as many children into care as we do in the UK, although that has been disputed more recently in the light of the Baby P discussions. We were impressed by the quality of the care situations into which they were taken. The fostering-certainly what we could see-was of a high order, whether it was institutional care in small numbers or foster families. Do you see it as a problem in the UK that our quality of care has no kitemark or standard that we can all rely on so we can say, "This child's going into care, but it will be good quality care"? Is that a problem?

Colin Green: May I start with your original question?

Chairman: Start with anything you like. I am just warming you up.

Colin Green: First of all, the relationship between children at risk and children who come into care is very close. In the statistics for the end of 2008 on the reasons why children are looked after, 62% were due to abuse or neglect, and a further 11% were due to family dysfunction. That is absolutely dominant in why children come into care. It is also a key reason why children in care may not do very well. It is about what happened to them before they came into care. It is a very close relationship.

Having said that, I absolutely recognise the experience that Judith described. The children are a mix. Yes, they may have child protection plans, but there is a large group of children who do not, who are known and who have been bumping along, possibly with a just acceptable level of care, until some precipitating incident leads the local authority, in consultation with the partners, to say, "We need to act to initiate care proceedings."

The second thing is that, of all the children in care, there is a group of stayers, but there is also a lot of movement in and out. The movement in and out concerns a lot of children and young people with significant issues with abuse or, more often, neglect. For adolescents, the product of neglect can lead to the breakdown of their life at home or to unacceptable behaviour at home. The relationship is very close.

On the quality of care, I think that since the initiation of the "Quality Protects" programme, a huge amount has been done to raise the quality of care and care placements. The "Care Matters" programme is a further step. The quality of care has improved significantly in both foster care and the various kinds of residential care. I have not had the benefit of going to Denmark, so I do not know what you saw, but it may well be that standards there are still significantly higher than ours.

There is clearly a view about how good the outcomes are for young people in care, and that certainly influences people's view of the best way to make a difference to a child's life. You are balancing what may not be a very satisfactory standard of life at home with what can feel like quite a risky journey in care. You also need to distinguish between the benefits of care for very young children and for those entering during adolescence. Overall, the research shows that generally, the longer children are in care, the better they do, but it can take quite a long time for children to recover and make progress within the care system.

Chairman: Thank you for that, Colin. Henrietta, last but not least.

Henrietta Heawood: From the point of view of social workers, who actually carry out the work, they are key professionals in terms of identifying children, but the multi-agency process is also absolutely crucial. I do not know whether you want me to tell you about the multi-agency processes from the social worker's point of view or comment on what the other speakers have said.

 

Q607 Chairman: Do either. Start with the first, and then go on to the others.

Henrietta Heawood: Okay. Identifying children at risk is something that happens-the targeted part of the child population. When referrals come in to local authority children's social care services, they come in in vast numbers, which is something that local authority social workers have to deal with. I have been told that there might be half a million referrals a year in England. From that, a process filters out the ones who are most acutely in need of detailed services.

 

Q608 Chairman: If you are a social worker, how is that flagged up to you? Where does it come from?

Henrietta Heawood: Do you mean where does the referral come from?

Chairman: Yes.

Henrietta Heawood: Referrals come to social work teams from other professionals, members of the public and other family members-mostly, a child will disclose themselves. They can ring a helpline or turn up at the office. Professionals who make referrals include the police, people from education and health services and occasionally the ambulance service. Referrals from the general public will include neighbours-we get quite a lot of referrals from concerned neighbours-and extended family members. Grandparents and other such people will say, "We are worried about these children, can you have a look?" From then on, the system kicks in. There are detailed processes that would take me ages to explain. I can explain them all if you want, but it would take some time.

Chairman: The rest of the team are eager to start their questioning. I will hand over to Fiona to look at identifying children at risk.

 

Q609 Fiona Mactaggart: A number of you have referred to the proportion of children who are at risk from harm whom you do not know about. That is obviously something that we need to consider, to see if there is a better way of finding out about them. I have also looked at a series of articles in The Lancet. I was profoundly shocked by the suggestion that between 5 and 10% of girls and up to 5% of boys are exposed to penetrative sexual abuse. I do not know how well founded such figures are. One of the compelling things about this series of articles was the conclusion that, in the long term, neglect is at least as damaging as physical or sexual abuse. It occurred to me that in some of these discussions, we are not looking carefully enough at neglect and how to identify it. A child is not likely to know that they are neglected in quite the same way that they know if they are hit. Judith described cases that come to the notice of the authorities after domestic violence incidents. That is not an uncommon way for cases to come into the system. I wonder whether there are good systems for identifying neglectful families.

Henrietta Heawood: May I just tell you about a couple of early identification models that I happen to know exist in a couple of hospitals in Sheffield and Grimsby? Protocols were set up to identify pregnant women who were drug users. When they delivered their babies, a protocol was set up to establish whether they were co-operating with A, B and C. It is a multi-agency plan with social workers and the hospital staff. Therefore, that is a proactive rather than reactive scheme. In Sheffield, such a scheme resulted in a lot of care proceedings because the level of risk was judged to be still very great. At least it was a system, rather than waiting for something dreadful to happen. Professionals might say, "This is what we have got and we will assess it now because we recognise that these are risk factors."

Fiona Mactaggart: But you sound as though that is an exception.

Henrietta Heawood: I hope that it is across the country. There are things in place. People are trying to say, "We know that this is going to be a risk."

Dr. Proops: May I try to answer the question in two parts? First, let me look at the figures and, secondly, at the consequences of neglect. I have some copies of The Lancet article with me that I would be delighted to give to the Committee. The reason why the figures appear both discrepant and worrying is that we have to understand how they are measured, and it is not straightforward. There are three types of studies. Two of the studies are retrospective. One group asks the children themselves whether they are old enough and another group asks the parents. The third type is drawn from official statistics, which is why one gets these apparently rather discrepant and worrying figures. If one asks retrospectively, the number who say that they have been harmed in a variety of ways is much greater than the numbers collected prospectively from official statistics. For example, physical abuse ranges between 4% and 16%, and neglect ranges between 1% and 15% depending on which study one looks at.

The other point about the Lancet series and where those data come from is that that looked only at high-income countries. The figures will be rather different if one looks at much broader, worldwide research. It is not entirely fair to give the figure of one in 10 children, because that merges all the different types of study together. One has to have some sense of where the figures come from and whether it was a retrospective or prospective study. Nevertheless, whichever way one looks at it, the numbers are rather large.

The second point about neglect is that in its full picture, it is profoundly harmful to babies, pre-school children and older children. There are some clear physiological consequences-it harms the brain, as it fails to grow properly and nerve cells do not connect properly, and permanent damage can ensue. You will read in all sorts of papers about the importance of protecting children under the age of two in particular, and certainly those under the age of three. After that, one's chances of making good are much less. Colin made the point earlier about the different approaches and actions that may be needed for the very young child and for the older child.

As a practitioner, I would say that other than a child who is severely physically abused, a chronically neglected child is the saddest child. Neglect affects all aspects of their being, from their physical growth to their emotional and psychological development and their educational attainment-everything. Neglect is a very severe insult to all children. As I said, we have good physiological evidence. You can compare the brain scans of a neglected 18-month-old with those of a healthy, sociable 18-month-old, and they look different.

 

Q610 Fiona Mactaggart: This seems to point out that we should focus more comprehensively on the families that are at risk of neglecting their children, and that we should do so through intervention. We should be prepared to be more active about putting in place protective services around their children. Too often, our care system seems to be triggered by an episode, an event, or a drama. What Rosalyn is saying, and what the Lancet research seems to be saying, is that if we could focus more effectively on the continuing appallingness, we would protect children better.

Colin Green: I absolutely agree with that, and I think that it is true to say that neglect is quite corrosive, which I think is what Rosalyn is saying. At the heart of identifying that is the quality of assessment and people having time to spend with families, potentially as a multidisciplinary team, to understand what is happening in a family and the relationship between the child and the parents and to get underneath the child's experience of living in that family. We are then in a much better position to make a decision. Without that depth, we end up responding to an incident that is evidentially much easier to present in court than trying to describe the impact of neglect over a period of time. In some ways, it is a more skilled job to describe the impact of that on a child's development than to present an injury of some kind. The other thing that I would say is that in the case of many of the children who are physically injured, and certainly those who are sexually abused, there is inherently neglect and those injuries occur within very neglectful circumstances.

Henrietta Heawood: I challenge a little bit the idea that the courts cannot deal with chronic neglect, because there have been a lot of conferences for judges and so on about research on brain development. It is widely known, and experts speak about it in court quite a lot, so courts should be able to deal with the effects of chronic neglect. However, the research is new.

Colin Green: I think that, with regard to dealing with it in court, is about the confidence of local authorities to present this somewhat more difficult evidence and gather those kind of chronologies, and their ability to present the child's experience of living there in a way that has a sharpness in court. It is just that that it somewhat more difficult. What do you think, Judith?

Professor Masson: There are a lot of neglect cases in court, and the evidence presented is very rarely this sort of brain information. It is much more likely that there will be a psychiatric assessment of the child and various sorts of evidence about the state of the home, the presence of the parents and what the parents have done, such as whether they have visited the child when he or she was in foster care. Neglect cases are neglected in court, but there is a lot of this attitude of expecting the parents to do better while the proceedings are going on and suggesting, "Let us see if the parents can do better" or "It is only neglect, and the parents are trying very hard. What more would you expect of them in these circumstances?" There is a kind of rule of optimism. Many people in the system have low expectations and take the view that taking children into care is so draconian an intervention that merely neglecting children is insufficient to justify-I use the phrase I hear around the system-taking the children away. The suggestion is that parents have been shown not to be bad, but to be rather feckless.

That is about recognition in the community, the legal community and elsewhere that neglect is what might be expected from families in those circumstances. That means that those families do not get triggered into the legal system at an early stage, and when they eventually do, they spend quite a long time in the system before people realise that the parents cannot do any better. Therefore, those cases might go on for more than a year, even though an expert who deals with this work all the time may, from their point of view, question why the order cannot be made within three or five months.

 

Q611 Fiona Mactaggart: As Dr. Proops has pointed out, that really makes a difference to the child's future.

Professor Masson: Yes, and what is more, the courts have recently become very concerned about removing children during the course of proceedings. Five or 10 years ago, proceedings would generally have started with the children being separated from their parents under an interim care order, which was often not contested. If the parents improved, they might get their child back at the end of the proceedings. Now, following various decisions by the High Court and the Court of Appeal, the courts are saying that to remove the child we really need to have proof and a proper hearing for finding the facts. Therefore, there is an emphasis on local authorities not applying for an interim care order and more of an incentive on parents to contest an interim care application if one is made, and children may stay at home with their parents until the end of the hearing when all the assessments have taken place. As those proceedings take about a year, there is potentially an extra year of damage. Or, one could say, "That is how the system should work, because otherwise these cases are being pre-judged." The judiciary have taken the view that removing children at the start of proceedings is pre-judging.

 

Q612 Fiona Mactaggart: One of the things that has struck the Committee is the evidence about the number of child deaths. Initially it looked as if there was about one child death a week connected with abuse, maltreatment or neglect, or a little more than that, but more recent figures from Ofsted suggest that that number is more like four a week. Having listened to the issue about neglect, it sounds to me that, if the court procedure is so complicated and laborious, perhaps we ought to put in place other interventions at an early stage, perhaps while those proceedings are ongoing.

I was looking at The Lancet articles that assessed various programmes and said that lots of them did not have a research basis. One said that "the effectiveness of most of the programmes is unknown. Two specific home-visiting programmes-the Nurse-Family Partnership (best evidence) and Early Start-have been shown to prevent child maltreatment." While trying to bring those children into public care, should we not be putting in place programmes to protect them more effectively during the proceedings? It sounds to me as if these things operate on different planets and do not coalesce enough. Am I right?

Dr. Proops: There are a couple of points. When looking at interventions, as the paper described, we must be clear about which programmes are set up to prevent occurrence, and which are set up to prevent reoccurrence. You are talking about the latter. There is some evidence that some of those programmes work, but from the point of view of an everyday practitioner, I wholeheartedly agree with you.

There could be a family that is struggling and has three school-age children. Evidence might suggest that the children are not functioning well, have behavioural problems at school, and that their educational attainment is poor and limited. The pre-school child might not be developing properly, and although the parents are trying within their means, perhaps their means are not good enough. In those circumstances we must provide support. I have seen evidence of very good support, but it must be provided for more than an hour three times a week and sadly, sometimes that is all that is available.

Without wishing to say that we need more resources, in some areas we do. We need clarity about what types of support are more likely to produce a positive outcome and be effective. We must carry out research in that area and put those programmes into place. Removing many of those children might not be the right answer, yet they are living in an impoverished home, not achieving their potential and so harm accrues. There is plenty of room for further research to look at the evidential value of certain programmes, and we would then need the resources to implement them. It is resource heavy, but not as resource heavy as removing children.

Colin Green: I just want to ask about the figures. I was interested in the figures that Ofsted gave the Committee last week, and I hope that we can have a full breakdown so that we can fully understand what is being counted. The figures are much higher than the figures from the NSPCC, which I would generally regard as the most authoritative, given that it has tracked this issue for a long time. I hope that we will get full backing from Ofsted.

There are good programmes, particularly the family-nurse partnership which looks very promising. I return to the discussion about health visiting, which shows a way forward for that kind of intensive programme. We need more evidence-based interventions that are focused with clarity of plan. There is too much monitoring. People talk about monitoring and support, but those things can be empty vessels. The issue is about what people can do in a more programmed way. Some of that could involve setting targets against which to measure progress, whether for the child or the adults in the family, and carrying that through properly.

As part of the social work role, the practitioner must be able to lead all the people working with that family-including the family-in their journey of change. They must find out whether people can actually change. We need a more active approach based on mobilising change and finding out what we need to do to make life better for that child.

Professor Masson: We have to bear in mind the fact that a key factor in the cases that come to proceedings is parental non-co-operation. Although evidence suggests that services are often not offered, sometimes those that have been offered are not accepted. There is non-compliance and non-acceptance of services, and there is false compliance where people appear to comply with services, but in reality do not do so.

In that context, we have to take account of the very high levels of domestic violence and drug and alcohol misuse in such families. The mother may wish to comply, for example, but she may not be a free agent. She may be a depleted person because of the violent atmosphere in which she lives. That domestic violence may be known-there is much more recognition of domestic violence than there was 10 or 15 years ago-but she may well not be disclosing what is going on. She might appear to be complying, or trying her best, but a picture of what is going on in that family might be completely different from the one that the professionals appear to acknowledge at the beginning.

I would question the idea that we can provide a service, even an evaluated service, that will make a difference in many of those families. I would focus on the cases that go to court. There is a greater group of children on the edge of care. There may be more opportunity to make a positive difference for that group, but once we set the thresholds very high, as we have done for care proceedings, it is less easy to see that change can be achieved easily for that very difficult group.

 

Q613Fiona Mactaggart: Even now, Judith, your final remark made me want to ask whether you think the threshold is too high. I also wonder whether we have a good enough risk assessment at an early enough stage to ensure that we are focusing preventive services as effectively as possible. As far as I can see from what you have been saying to me, the characteristics of a large proportion of the families with children at risk include mental ill-health, drug abuse, domestic violence. Can we tell who is most at risk, and can we target what we do more effectively to protect their children and prevent abuse? Can we intervene earlier to protect those children?

Professor Masson: That is not a question for me.

 

Q614 Fiona Mactaggart: No, my question for you is how high we should put the threshold.

Chairman: We will start with Colin, then go to Judith.

Colin Green: Certainly we can. The tools that we have are reasonably good. The assessment framework is a good tool; the issue is being able to use it effectively, which requires very sophisticated training, understanding and competence. That relates to the work force issues that you have previously considered. We have some good tools, but we need to apply them much better. They should help us identify the families that need earlier intervention. We are talking about going to court, but that is not very early. There is quite a lot of confusion about early intervention. Does it mean focusing on nought to threes? Is it early in that sense, or early in the development of difficulties? We might need to do both.

There has been a lot of investment in universal services of various kinds. Schools are much stronger, and children's centres provide a lot more support for under-fives. We need more investment in the bit in the middle between those and the very high-threshold services characterised primarily as social care, in order to work with those families, who are quite resistant and need an assertive approach. To make that more concrete, I read a number of serious case reviews when I was a civil servant, and I would always ask, "Where was Sure Start?" One would find that the families may have been in a Sure Start area, but they did not engage. An assertive enough approach was not taken with them. Some of the disengagement may have been due to lack of motivation, but some of it may have resulted from the fact that someone with four children under five found that the sheer logistics of getting out of the house defeated them.

Professor Masson: There are two issues, really. In relation to assertive engagement, there is a whole issue about what people are expected to do. Children's services such as Sure Start are all voluntary. There is quite a negative approach among some sections of the community about children's social care-"the social are coming to take your children away"-and there is a rejection of the service, rather than seeing it as a positive, helpful service. I think that the demonisation of children's social care that we see through baby P, etc., does not help that at all. Children's social care is not viewed within our community in a positive light. That is another distinction between ourselves and some countries in mainland Europe.

I want to move on to the issue of thresholds. Thresholds are very high, in that it is not just a question of, "Can we satisfy the 'significant harm' element?" It is also a question of what is being offered and what is the alternative plan if a child comes into the care system. We view children's social care negatively and we view what being looked after means for children and the outcomes of being looked after as poor, which tends to push the threshold up.

Then there is the notion that intervention must be proportional. So if something can be done through compulsory services without using a care intervention, or through encouraging the use of services in any way, whether it is through a supervision order or just getting the parents to engage, then obviously getting the parents to engage is the right response. In many cases, that leads to a delayed intervention, because there is an attempt to get the parents on board before you go through the legal process. So you get this period of neglect before cases can enter the system.

Henrietta Heawood: I do not know if we will go on to talk about the public law outline and the changes in care proceedings at some later point this morning.

Chairman: We are going to come on to that in a little while.

Henrietta Heawood: I brought you a copy of the flow chart of the public law outline, which explains all the stages that must be gone through before people can go to court. It is a quite interesting visual aid. As you can see, it is enormous.

Chairman: Excellent. We will drill down on it in a moment.

 

Q615 Mrs. Hodgson: I just want to give you my analysis of what we are talking about, to see if you agree with it. We now know-there is evidence, as Rosalyn pointed out, and I have seen evidence myself-about the impact of what happens between nought to three on the brain, emotional development and empathy, and how damaging that impact can be later in life. If we know that to be true, why are we not quicker to remove children in the first three years than we are later? There should be no benefit of the doubt. I wrote down what Judith said about "just neglect", or "merely neglect". We know how damaging that neglect is.

I think that the peak in the number of children in care is normally around the adolescent age range-that is, later down the time line of the child's life. With what we know, should that peak not be a lot sooner: between nought and three, on the basis that, when those children go back to their parents, the neglect that they might then suffer will not be as damaging? In the short term, we might end up with two peaks, but in the long term, if this evidence is right, that later peak will drop. You would have the earlier peak and then there would be just a trailing-off, because we would not have all these damaged children later on.

Dr. Proops: May I answer part of that? Then perhaps Judith could talk about the numbers. I say that because I think that that question links with an earlier one.

In a sense, two of the pieces that are missing, or certainly not as complete as they should be, are related to the inter-agency analysis of a problem. Colin hinted at that. So the information and the tools might be there, but we are not as good as we could and should be at analysing the information in front of us. That is partly to do with training and partly to do with the methodology. So I think that that is something that we ought to look at.

The other point comes back to the evidence base. We are at the very beginning of having the research to give us the evidence base of what might or might not be the better outcome. When I say the beginning, I mean the beginning for both health and social care. We rarely get together seriously, as health and social care, with any research to look at the evidence base for some of these things. So the point that you made is absolutely spot on. However, we would come at the issue in different ways to explain why we think something should happen. One of the things that we do need is a serious, joint health and social care research programme that truly looks at the evidence for some of the things that you suggested.

Professor Masson: As far as the numbers are concerned, over 50% of the children who come into the care system compulsorily come in before the age of five. There is little use of care proceedings for children over the age of 12. It used to be the case that many teenagers were brought into the care system compulsorily, but that hardly happens at all now, for a variety of reasons that we could go into.

Many children are removed at birth. They are often removed using compulsory measures-emergency protection orders or police protection orders-or their mothers are encouraged to have them accommodated under section 20 and then care proceedings are brought. Probably between one fifth and one quarter of care proceedings relate to children who are removed within the first three months of birth.

So the peak, if we look at the care data, is to do with what happens to the children in the care system. By and large, children who are removed at birth are adopted. Children removed under the age of three are most likely to leave care by being adopted. Children who come into the care system at five and above are likely to stay in it until 16 or older, and children who come in in their teens stay until adulthood.

 

Q616 Mrs. Hodgson: Those are the children Colin was referring to when he said that it is a question not of what happens to them from age five to 16 in the care system but what happened to them in the first few years of life. Can we not rescue such children sooner, for those important years, and then perhaps they could go back to their families for the years when they would normally be in the care system?

Colin Green: You could take that approach. We could take what I would call a more ruthless approach. Even for the children Judith talked about, where a second child or a first child is removed on a care order, the court process can still be substantial. Parents will often say, "Things have changed. I have a new partner. It will be different this time. I am no longer on drugs," and so on, so there is still quite an elaborate and rigorous court process. The recent judgments-Judith has expertise on this-made it clear that the judiciary sees removal of a child at birth as a truly draconian step, even on a second application. Considerable weight is given to that. We need to look at each case carefully-we should always do that-but we are still expected to go through a rigorous process. Doing otherwise would require sanctioning a shift in what society is able to tolerate.

Of course, the other side of that is that then there will be increased concern that children are being removed from their parents unnecessarily-parents who could have succeeded-and that there is permanent removal into adoption, which severs the legal ties. That is one of the most, if not the most, draconian things that the state can do to an individual. Getting a balance requires a much wider debate. We must think about that.

 

Q617 Mrs. Hodgson: It almost seems that we need to change how we think about the whole process of taking children into care at birth and having them adopted, so that in those early years the parents do not get the child back. Instead, parents could be given help during the stage when it is so important that the child is not neglected, but with a view to their getting the child back when he or she is older.

Colin Green: I do not take that view. Children need parents who are absolutely committed to them for their lifetime. If you are removing children at that age, it is for adoption or some permanent solution away from the parents. The parent does not get a second chance if you do that, if I have understood you correctly.

 

Q618 Mrs. Hodgson: No, but the parents might be totally capable of looking after a child from three onwards. They just need help earlier.

Professor Masson: They will not have a relationship with the child. There will be none of the development, bonding and all those things. Neglect is about a failure of bonding, to put it crudely. Children cannot be put like books back on the shelf in the library. It is a different child when it is three. It is not the same book.

 

Q619 Chairman: Just a quick question for you, Colin. Where does the common assessment framework come from? Who wrote it?

Colin Green: It came from the DCSF. But it was developed as a cross-Government programme.

 

Q620 Chairman: How long has it been in existence?

Colin Green: It was being developed from 2005.

Professor Masson: The original assessment came from the Department of Health in 2000.

Colin Green: That is the assessment framework. But the common assessment was in 2005. It was in development.

 

Q621 Chairman: So it was inter-agency? You all got together to write this.

Colin Green: It was led by the DCSF.

 

Q622 Chairman: So it is post DCSF? It was not Department for Education and Skills-

Colin Green: It was the DFES. Sorry, it was a DFES-led initiative, but Every Child Matters is a cross-Government programme so there was significant involvement.

 

Q623 Chairman: So the common assessment framework comes along at the same time as Every Child Matters?

Colin Green: Yes. It is part of that.

 

Q624 Chairman: I wanted to get that as a matter of fact. We have to move on, but before we do, one of the things that we picked up in the course of the inquiry is the relative scarcity of psychologists and psychological assessment for children. It is particularly worrying for me. How do you know about neglect? You can see if a child has a physical bruise-hopefully you can-but mental scarring and psychological ill-treatment are much more difficult to pick up. In my view, mental cruelty is as damaging, if not more damaging, than physical cruelty. Is the common assessment framework sensitive enough and do you have enough psychological expertise to judge that?

Colin Green: I think the framework is sensitive enough, but it is an initial overview ideally done by bringing a number of different professionals together-it is not an in-depth assessment. I would expect the school to bring up such things as attendance, response in class and behaviour with other students. At the common assessment framework stage, hypotheses might be reasonably descriptive about why that might be a problem for a particular child, but that should then lead to questions about whether the child needs a more comprehensive assessment with greater expertise. It is partly designed to get an understanding of the child's needs and to work with the parents to address the problems. It has been successfully used in that way but it should also help to identify children who have more substantial difficulties and need more expertise and more depth.

 

Q625 Chairman: So when is this common framework assessment administered? Is it to every child?

Colin Green: No. All local authorities are in a process of trying to develop their implementation of this. The idea is that it should be used for children and young people who have been identified by the universal services as having significant additional needs or as being particularly vulnerable. Some authorities say that when a child has been excluded from school, or has been excluded a number of times and is going to enter a pupil referral unit, there should be a common assessment framework because almost certainly that young person or child has a variety of difficulties. In my authority we are trying to see whether we should use it with all those children with poor school attendance, so it is not just with the education welfare service. We are taking a look at why the child is not attending school. That is a key indicator of neglect.

Henrietta Heawood: The common assessment framework was well intentioned to give other professionals, not social workers, a means of clarifying what the concerns were and linking services up to provide a better service for children. I do not know whether any research has been done into how it is working in practice. Judith might know.

Professor Masson: No, I do not.

Henrietta Heawood: It is early days yet. There have been pilot projects and I do not know whether it is entirely universal across the country yet.

 

Q626 Chairman: That is very interesting. You have a common assessment framework, but no one knows if it is working.

Henrietta Heawood: It is very new.

Colin Green: There has been research done on its implementation, because it was piloted in a number of local authorities. That tells you things like whether it has been well received. There are lots of case studies that say that it has made a substantial difference to children and their families. It has been well received by families. It has made a difference to some of the softer stuff about the work force having a common language, which is very helpful, and giving people a common framework to work within. But you have not got population outcomes that would say whether it has had a particular impact on a particular outcome.

Henrietta Heawood: And we do not know how many children who have been subject to the common assessment framework process have then moved higher up into targeted services.

Chairman: We have to press on, and Colin is only with us until 11.30 anyway. Paul, over to you.

 

Q627 Paul Holmes: This is probably a question for Colin and Henrietta. What is the typical composition of a child protection team? Is there such a thing, or does it vary in every part of the country?

Henrietta Heawood: A child may be subject to a child protection plan, which is what we used to call "on the register", but there is new terminology since the most recent "Working Together" document. I have brought it as a visual aid.

 

Q628 Chairman: We are not allowed to have visual aids, as Hansard cannot pick up on them.

Henrietta Heawood: Suppose that a child has been made subject to a child protection plan; there is a multi-agency conference and something called a core group is established. It is likely that the core group will include the social worker as the key professional-the local authority children's social care social worker. Correct me if I have got that wrong, Colin, but that is normally the case. Her manager will probably be part of the group too, so the immediate line manager is likely to attend the meetings. The health visitor or school nurse will be invited to be part of that core group, as will somebody from school, if it is a school-age child, and representatives from any other services that are being provided, for example if there is a family support worker or the family are attending a special parenting scheme or accessing drug and alcohol services. The idea is that a plan is thrashed out quite carefully to look at what progress needs to be made and what needs to change for the child not to be subject to the child protection plan. It is monitored with regular meetings of the group and reviewed in a review case conference after three months.

Colin Green: I do not quite agree. It should be everyone who has a part to play in implementing the child protection plan, and that would normally include the parents and the child, if they were of sufficient age and understanding. Certainly, you would want to involve adolescents in a plan about them.

Henrietta Heawood: So the parents attend the meetings of the core group and then may see all the workers in it individually at different times and in different settings.

 

Q629 Paul Holmes: As for health visitors, Rosalyn, you said in your opening comments that the number of health visitors or the number of visits that they could make to parents was declining. That could be quite dangerous because they are not going to pick up on signs of neglect early on.

Dr. Proops: I think that I may have phrased it slightly differently. Health visitors' practice has changed markedly. They offer a targeted service and are very involved with safeguarding and child protection. I would have thought that, more or less universally, you would find nurses, usually health visitors, at case conferences and involved in the child protection plan. When children reach that threshold, my experience is that health visitors are involved.

 

Q630 Paul Holmes: When a child is born, health visitors are not attending every home in the first year or so in the way that they used to.

Dr. Proops: They are key people all the way through from the beginning. Without a doubt, they are key people at the beginning. They often have a process in place locally to establish a relationship with the midwives to pick up on those families or mothers that they may wish to see early. I would not for a moment want to suggest that they are not key to picking up on a targeted group of people who need their support. I suspect that if they were sitting next to me they would say that there is plenty more that they would like to do and that some of the new systems in place restrict them, in part.

 

Q631 Paul Holmes: But has there been a decline in the number of visits that they do in the first 12 months after the baby is born?

Dr. Proops: As far as the universal service is concerned, yes.

 

Q632 Paul Holmes: But presumably that must mean that there is less chance of them picking up on early signs of problems.

Dr. Proops: We are not good at evidence in that area, because there are more targeted practices, policies and services around, albeit less universal visiting.

 

Q633 Paul Holmes: When we were in Denmark, the various professions we talked to said that they take twice as many into care as anyone else in western Europe, and there was discussion as to whether it should be more. They were confident that they were doing the right thing, partly because health visitors visit every child on a regular basis in its first year, and because child care is available for every child, with workers who are graduates, well paid and well trained. All that is very different to what we have in this country. They were confident that they should intervene more aggressively earlier on because they could pick up the signs much earlier.

Dr. Proops: If you look at our child population, the pre-schoolers receive fewer routine visits now than some years ago. If you look at the numbers of children who are identified through health, a certain percentage of children have consistently been identified in that way, but not as many as others. Whether we are missing them is more difficult to say.

Colin Green: I just want to comment on this, because in the new world that we are trying to create in children's services, it is important to focus on the wider responsibility for child health promotion. As a director of children's services, I carry responsibilities in that area. The Department of Health issued guidance, earlier this year, on the child health promotion programme. That guidance is good and describes how the system is meant to work, through a combination of universal services for all children and more targeted services for those in need.

The way I would like the system to work-this is what I am working towards in Coventry-is for the health visitor to work with the children's centre team. Part of the way in which they reach every child is through how the children's centre works. It is not about very experienced and well-trained health visitors going around and seeing everyone. They influence practice in the children's centre, so that its staff can offer a lot of basic health promotion advice to all parents and will also have the skills to pick up where there are difficulties and bring those issues to the health visitor, as an expert practitioner. It is not just about the health visitor; it is about the health visitor's place in a wider set of services for under-fives, for which children's centres are absolutely key. There has been huge investment in that, and we ought to make more of that investment.

 

Q634 Paul Holmes: But as you said earlier, one problem with Sure Start and children's centres is that it presupposes that parents take their children there in the first place.

Colin Green: But that is part of what we, and I, need to work on-changing how children's centres work, so that they are much more conscious of the total population for whom they are responsible and whom they are not reaching. For example, we could put similar effort into identifying who does not take up the three and four-year-old offer as we put into identifying who is not in post-16 education, employment or training.

 

Q635 Paul Holmes: After the Victoria Climbié inquiry, an integrated children's system was set up. That computerised system was intended to ensure that all the different agencies could pick up on what was going on and talk to one another. There is now a lot of evidence on that issue. According to a University of Lancaster study, many social work practitioners said that 80% of their day was spent in front of a computer filling in tick boxes, rather than doing child protection work. Is that true?

Colin Green: First, the integrated children's system is not a computer system: it is a practice system.

 

Q636 Paul Holmes: It is not a computer system?

Colin Green: Let me try to make this very important distinction. What the system integrated was the assessment framework, which is a very sound framework for assessing and understanding children's needs, and a set of records for looked-after children. That is what it integrated so that there was a whole end-to-end way-from a child being referred to social care, right through to their being looked after or having time in care-of assessing needs, planning for that child, looking at how to take forward implementation, and reviewing that, in a comprehensive set of records. That system was to be supported by electronic means, which is where the computer system comes in. I just want to make the distinction that that was the practice system describing how social care was to do the job and its implementation through ICT.

I want to say three things about this. First, the ICT implementation has clearly been hugely problematic for many local authorities and their practitioners. The systems are clunky and difficult to operate and have a number of significant flaws. Secondly, the practice system is complex. There are issues about how far it is over-complex, but it essentially replicated the expectations set out in the Government guidance. When we drill down into some of the information requirements, particularly for children in care, which is where the greatest body of information is required, we can see that it is stuff that any parent should know, but because they are in public care we need to make a written record of all those dental appointments and the medical history that parents might carry around in their heads. That creates a significant administrative load. Those are two key distinctions.

Thirdly, we need to distinguish between what is administration and what is proper, accurate recording that enables us to understand what is happening. We have heard about the importance of chronologies and of being able to look at events in a family over time, but we can only do that if we have a decent record.

Chairman: It should not take 80% of your time.

Colin Green: No, but I caution against saying that we do not need sophisticated recording systems for those very complex cases. My final point is that that came out because the evidence from inquiries over the past 20 years showed that people were often unable to use their records to inform assessment and judgment in hearings, partly because they were faced with a four-volume-or-more paper file, often not very well kept, out of which they could extract very little detail.

 

Q637 Paul Holmes: Before I put a question to Henrietta, I would like to mention that Professor Sue White of Lancaster University has reported that all the practitioners she interviewed expressed frustration at the amount of time they spend at the computer, claiming that the system regularly took up 80% of their day. The British Association of Social Workers issued a press release on 21 November in which it criticised the systemic obsession with inputting information into a database at the expense of time spent with children at risk.

Henrietta Heawood: Exactly, and having to spend so much time using an unwieldy system is a very real concern for our members. You referred to Sue White's research, and she offered two arguments. Is it because the system is new and difficult to implement, or is it a design fault in the whole thing, and is it fit for purpose for child protection? We are just not sure. It is very time consuming, and glitches in software really frustrate people. I have heard stories of people inputting data into the system for an entire morning, only to discover that they were not able to save it, because the document was on a shared network system and was opened by an administrator who was doing some other work to it. Only the first person who opened the document could save anything. The social worker was not aware that it was a read-only version and did not realise that they were wasting an entire morning. That is an anecdote, but that is what it is like, and that is why people get so frustrated.

The worry is that the system is in many ways a useful management tool because it gives managers all sorts of information about who is doing what. Is that really becoming the overriding intention, rather than developing a better understanding of the lives of children, which is what I thought it was originally meant for? It is not entirely bad if it is there to help support practice, analysis and assessment and bring things together. It is quite prescriptive, so different types of assessment in different parts of the country would perhaps disappear more if everyone were looking for the same things. However, social workers tell us that it is so prescriptive that they cannot think, because they do not have any space to use their professional judgment. They have to fill in those boxes all the time, and working out whether children have been to the dentist may not be what they should be doing.

The IROs-independent reviewing officers-also have to input data into those forms electronically. The social worker's line manager is meant to sign off the bits that have been done by the social worker, but that is not always done, because the line managers do not have time.

Chairman: It looks as if you did not agree with all of that, Colin.

Colin Green: I think that we have to be cautious about it and that there is a relationship between that and two other things. One is the development of the work force so that they understand the tools that they are using. I absolutely agree that we have been driven down a rather technical approach to practice, which gets translated into a tick-box approach rather than something that allows people to look at it as a tool to be used in their work with children and to pick and choose to some extent what to do within it. The second thing is that performance indicators are part of what is being collected. In a sense, the pressure on local authorities to collect that information and perform in relation to it can become over-dominant. The indicators, certainly in some areas, are not outcome-focused; they are about how well certain processes have been done.

 

Q638 Paul Holmes: Christine Gilbert, the head of Ofsted, appeared before the Committee last Wednesday, and said that Ofsted had done a paper-based assessment of Haringey that said that it was an excellent council on children's services and all the rest of it. It turned out that that data was either a lie or filled in completely inaccurately; take your pick. Is that linked to the obsession with filling in tick boxes rather than looking after children?

Colin Green: I do not know whether the Association of Directors of Children's Services or the Local Government Association commented. So much for local authorities rides on what can be quite fine gradations of performance on some indicators, so of course there is organisational pressure to perform in a particular way. They are only indicators-that is all they are. They do not tell you the outcomes for the children. They need to be used with care, not in a deterministic way, as a means of judging how local authorities are doing.

 

Q639 Paul Holmes: I think that Henrietta said-it might have been you, Colin-that there were cases in which the social work manager had signed off on something to say that it had been done when it had not been. Haringey had excellent paperwork saying what a great job was being done, but when the proper inquiry was done recently, it was a disaster area. It was the exact opposite of what the tick boxes said.

Colin Green: In an ideal world-in the places where I have worked, we have tried to do this-if people do the right things to try to improve what they achieve for children and young people, their performance indicators should follow behind. What can happen under pressure is that they end up chasing the indicator, not focusing on the outcomes for children and young people.

Henrietta Heawood: Something has gone wrong along the way. Performance management becomes the absolute thing to strive after, rather than quality assuring. The quality of the work being done is not in the boxes being ticked; it is in how well people have done it. Social workers must have enough emotional and physical space in their heads and lives, if they are to work with child abuse and difficult, dangerous families, to cope with the work. They do not want to be crying into their tea because they cannot cope with the computer. It sounds ridiculous, but that is how people feel-bullied and pressured to meet the targets-for the reasons that Colin gave.

It is important that a local authority manages to meet its targets, and we are not unsympathetic to the position in which managers find themselves. They are stuck between a rock and a hard place. They want to support their staff but, equally, they have to try to meet the targets. That is very difficult. Social workers at the bottom are the people who have to produce the work and do the things that meet the targets. They also have to interact with families who neglect, abuse or sexually abuse their children. It is tough, demanding, emotional work. They need the space to do it, and they need good supervision, not supervision along the lines of "Have you done this or that within seven days?" .

Models for supervision are promoted by Tony Morrison, who is a wonderful child care expert. I do not know whether the Committee has heard from him, but he has developed a model for staff supervision when working in child abuse. He is a long-term ex-NSPCC person, and has developed a very good model for supervision that staff need. Chairman: We would like to feed that into our inquiry.

 

Q640 Mr. Stuart: Following Haringey, the chief inspector said that she was writing to the chief executive of the council to ask them to promise further that they had reviewed the data and they were all accurate. However, you are saying that distortion of data is systemic and that, because of overwhelming pressure to meet the targets, people will at the very least tend to do it.

Colin Green: I am not saying that. I am saying that what can be measured gets measured, and that is what we are performance-managed on. That, of course, affects the behaviour of the organisation. People do respond and complete honestly the returns that these are based on. However, the fact that they are so critical changes people's behaviour and the organisation's behaviour, because that is the message about what is important.

 

Q641 Mr. Stuart: So at best it distorts their behaviour, and at worst it tempts them to distort the data?

Colin Green: It certainly changes behaviour, because we will respond to how we are managed and performance-managed.

 

Q642 Mr. Stuart: Last week, to my astonishment, the chief inspector said when I questioned her that she did not think that there was too much bureaucracy. Other Committee members may remember, but from last week's evidence they had not found that there was, chronically, too much bureaucracy suffered by front-line social workers. Is it the evidence of the entire panel here today that that is not the case?

Colin Green: Henrietta and I are not entirely as one. Judith has looked at a lot of files.

Professor Masson: I have looked at court files, which is rather a different thing. In the dim and distant past, I looked at social work files. My experience generally, and this perhaps does not relate to the most recent practice, is that a lot of information is collected but, having been collected, not very much information is read later on. So if the social worker changes, the new social worker does not have time to read the file. All the information has been collected and it may be easily accessible, but the person needs to be given the space to access it. I do not think that the local authorities are necessarily very good at doing that.

Dr. Proops: My contribution-again, from the practitioner's perspective-is that we cannot analyse or manage these complex cases without a detailed chronology. All of us have recognised that. It takes time to develop that chronology, and perhaps rather too often the chronology is not available at the time when the multidisciplinary team needs it. So if that is an indication of either how the information is collected or how it is extracted, from a practitioner perspective, that is something that I am aware of.

 

Q643 Chairman: So if a baby is taken into A and E and the staff access the data, will the system provide all his, or her, medical records?

Dr. Proops: There are ways of getting hold of health data relatively quickly. To integrate that with other data from social care-

Chairman: I am only talking about healthcare because that came up in the Haringey case.

Dr. Proops: Children have more than one set of notes. They will have records held within primary care from their GP. If they touch any hospital, another set of notes will be opened. They will also have a community set of records. At the very least, they will have three sets of notes. Some places will have systems whereby you can access those three sets of notes relatively rapidly, but most do not. We do not do particularly well in having a good overall picture of a child's health and welfare, because the information is in a number of different places. We will fall short with the note system, as our social care colleagues will sometimes do.

 

Q644 Mr. Heppell: I am worried about this. It seems to be that one person's bureaucracy might somebody else's essential information. It seems that we are talking about data being recorded and a system. If the tick boxes are wrong because they do not give enough clarity, that suggests to me that the case notes that the social worker would have to take would have to be more extensive than the tick boxes, which would mean more time spent recording the information than would actually happen.

Has the so-called bureaucracy not evolved because somebody has realised that there is a failing in the system and said that in future, people should record this, or, in future people should make sure that they have this information? That is what this system seems to be. It seems a bit nonsensical to say, "We have devised a system of creating and collecting data," and then write it off. I can understand it from a social worker's point of view, because it gives them boundaries and it is prescriptive, but has experience not shown us that this sort of system is necessary?

Colin Green: I think that is the correct analysis. The history of this going back many years is that some of the files were incomprehensible and there was not an adequate assessment or adequate information-gathering. The issue is about the balance of that. If we had a better-trained work force they could use the tools better and there would be more confidence that they could judge which bits to do in depth and which bits to tick the box for. That is part of the issue. People sometimes look at a long form and think, "Have I got to fill in every bit of this?". If that is the message they think they have from their manager, that is probably what they will do. It may do nothing for the child. To some extent, the tools have become very complex in part to compensate for when the practitioners do not have a clear enough practice model of how they do the job as a result of their training and other developments.

 

Q645 Chairman: Colin, can I push you on this? The detail, the complexity of this, comes post-Climbié.

Colin Green: No. This comes well before Climbié. The assessment framework was launched in 2000; the looked-after children records were launched in the mid-1990s. It was those coming together that was the integrated children's system. It is a practice system. It is a description, if you like, of how the work should be done.

 

Q646Chairman: Did the Climbié tragedy have an effect on the way in which records were taken?

Colin Green: I think it probably added further to the sense of a requirement to keep very comprehensive records. We still have not quite got this right in terms of balancing how records are kept and how they are used. It is not the keeping-it is the use of them.

 

Q647Chairman: That is what I want to nail down before you go. You have just alluded to the training and the people who use it. What is coming out time and again is the quality of the training of the social workers who make this whole thing happen. That is not to criticise them, but the training, you think, could be better.

Colin Green: We have many super staff. However, they need to do this very sophisticated and complex work, understand it and present it well in court, give confidence to the judiciary in their evidence, and give confidence to parents and children as well. We do need very substantial investment in training and development. We also need to have enough people. Again, you picked up on this point. I do not think you can run a good service with substantial numbers of agency staff. You need your own staff. That point was made last week.

 

Q648Mrs. Hodgson: I am going to come on to training and experience now. The Baby P serious case review did not explicitly blame the death of Baby P on the shortage or the high turnover of staff. However, the British Association of Social Workers put out a press release saying that we should not look for scapegoats, but at the high turnover of staff in child protection social work, excessively high case loads, over-reliance on agency workers, as Colin just mentioned, and an absence of supervision of often inexperienced or non-permanent workers. Do you feel that the vacancy rate and the high turnover have an impact on work with children at risk? What are the actual and ideal case loads for a social worker? Is the answer simply to recruit more social workers?

Henrietta Heawood: The ideal case load is a difficult issue. We cannot say what is ideal. There was some research years ago that said a social worker could manage seven families at any one time-that was as much as they could cope with. There are case loads now of 25 to 30 children, which may be fewer than 25 to 30 families, but it is still quite a lot. Heavy case loads are being reported to us across the country. Often, heavy case loads are held by experienced workers, because they are the ones the managers will go to for help with a case-here is someone who can do it-so the good workers get burdened more and more.

We are also aware of local authorities being reliant on agency staff. This is a complicated matter. In the Baby P case, a number of agency staff were noted as working in Haringey at the time. Agency staff can be good social workers. People choose to work in that way and sign up to an agency, because they get more money per hour and can stop work when they do not like it. However, they are less likely to have a commitment to the particular local authority that they are with, so the continuity may go. Being an agency worker does not mean that someone is a bad social worker, but it might mean that in that department there is less loyalty and commitment to overall aims and objectives. For children, continuity is terribly important.

 

Q649 Mrs. Hodgson: So seven families is ideal?

Henrietta Heawood: That is from ages ago-it was a bit of research stating that that was what people could really cope with. That seems a very small case load from my experience.

 

Q650 Mrs. Hodgson: Do social workers constantly complain about having too heavy a case load?

Henrietta Heawood: It varies. Some local authorities are better than others and help their staff to have smaller and protected case loads. However, across the country, we are hearing of high case loads and of teams that struggle to recruit and retain experienced social workers who can help mentor and teach newcomers to the profession. That is what we need: social work and child care cannot all be taught during the initial social work qualifying course. It cannot all be learned then, so to some extent, it must be learned on the job. It is an apprenticeship, and learning on the job means that there must be experienced, good supervisors, mentors and other members of the team around to help people. If those people are not there and the whole team is made up of new recruits, there is a problem.

 

Q651 Mrs. Hodgson: You touched on the issue of retention. I was going to come on to that later, but I will mention it now. We need professional development for staff and some encouragement for them to stay in the profession. Following cases such as that of Baby P, I imagine that fewer people will want to go into social work, and that those in social work may decide to move on and do other things.

Last week, the DCSF published the 2020 children and young people's work force strategy. I have it here. One of the things it notes that social workers said, is that initial social work training programmes need to be far better and people want "better access to ongoing professional development". The Government hope to do what it says here, "attracting and retaining the brightest and best in social work", but I imagine that it is a hard time to do so.

Henrietta Heawood: That is absolutely right. The association would like some commitment from the Department to support social workers-I do not know whether you can relay our feelings on that to it. Perhaps the press section of the Department could promote positively the good work that social workers do. It is not just bad news all the time: thousands of social workers do a really hard job, day in, day out, to make the lives of children better-that is their aim. But they would like some better press, if you like, not these dreadful campaigns in The Sun and similar newspapers. It is really distressing to get that coverage when you have worked hard. Perhaps the Department could run a campaign to help.

 

Q652 Chairman: Would Judith come in on this question? We heard evidence from a deputy director for social work in Hackney-this was before the Baby P case-who said that he would not employ a British-trained social worker; he recruited them all from overseas. Is social work training that bad?

Professor Masson: No, I do not think that social work training is that bad, but there are two problems. If we recruit overseas social workers, they are used to working in a different system and we need to put a lot of resources into training them in the British system-both the social care system and the legal system. In doing legal research, I have come across people who I am sure are excellent social workers and very highly qualified in other jurisdictions, but who have had perhaps a morning or one day of training on the Children Act, and that is all they know. They are not in a good position to work with our complex legal system and the high demands of our courts.

As for training in social work in the UK, universities have a problem recruiting good students. What was done to the social work training system and the resources taken out of it in the 1980s and 1990s-the idea was that all we needed were streetwise grannies-proved a disaster for the production of social workers. We do not have students at masters level coming through. In the university system, I teach a little on social work courses, but I do not get heavily involved in the issue of how much theory and which theories are taught-I focus on legal issues. However, there is a big issue around student placements. Students all do placements on social work training courses. In the 1970s and 1980s there used to be student units in all statutory agencies, and students did at least one placement in a statutory agency. They would spend six months of a two-year course with what is now the children's social care department. It is very difficult for students to get those placements now, so they do placements in non-statutory agencies-working in nurseries, with lawyers in private practice or something like that-as those are the only placements they can get. They therefore come out without the heavily supervised student practice in a statutory agency that they would have had on good social work courses in the 1970s and early 1980s.

We do not have a proper apprenticeship system of combined training and education, and our social work courses are generally much shorter. We are taking in undergraduates and making them social workers in three years, whereas countries such as South Africa and Australia are taking students and giving them two-year masters courses after they have done general a social care, sociology or other relevant first degree. We are not doing that.

Henrietta Heawood: I can certainly add a bit on the shortage of placements. It is a concern for the British Association of Social Workers and I do not know why it is like that. I do not know why local authority children's services and social care are not providing the placements that are needed. Somebody must know why, but it is an issue.

I have been around for years, so I have seen a lot of changes in social workers coming into the profession. When I went into the profession as a young graduate a long time ago, it was a career choice for lots of people. It was a good, solid, respectable career choice. I do not see that now particularly, so the need to attract bright graduate students is there. That is to do with the conditions of work for social workers, the public perception and the low status that they are given. I think that Ed Balls has talked about trying to improve the status of social workers, as has been done for teachers. I have been listening to programmes on the radio about a scheme for prison governors-I do not whether you have heard it-that recruits bright graduates into the prison governor system, and gives them a lot of help and fast tracking. Something like that would perhaps help. It is the status of the profession that is the problem.

 

Q653 Mrs. Hodgson: That is exactly the point that I was going to come on to. We talk in the DCSF about teaching the profession at masters level, and I think that that was what Judith was alluding to as well. The status of social workers should be raised.

Something that the Committee looked at when we were in Denmark was the issue of pedagogues. In Denmark, some child care workers who work in the profession are trained as pedagogues with three-year degree-level qualifications. They are not social workers; they are just below the level of social worker, if my memory serves me right. We do not have that staff level. We have the same people doing the same jobs-I imagine that we do-but they do not have that level of training. I would imagine that if we did, and if social work became more of a masters-level profession, the whole work force would be upskilled, but would their status improve?

Henrietta Heawood: There are problems for local authorities in the staffing of their departments, and in areas where they have found that difficult they have a kind of "grow your own" system in which they sponsor family support workers and unqualified social workers to go through university programmes so that they end up with the diploma in social work. In some areas that is quite successful, but it is quite different from what we are talking about-bright graduates doing MAs.

 

Q654 Mr. Heppell: On the threshold for taking children into care under section 31, about 90% of proceedings are successful. In one respect, that is high, but in another respect, when it is about taking a kid into care, why have we got even a 10% failure rate, and what would be the reasons for refusal? I think that you have done some research on this, Judith, which shows that local authorities are responsible and do not bring cases that would be considered frivolous.

Professor Masson: There is a small proportion of cases where there is substantial improvement in the parents' care of the children-a very small proportion of cases-so that an order is no longer necessary. There is another small group of cases in which relatives are identified-perhaps a father who has been out of the child's life for 10 years-or come forward and end up with the care of the child, and no order is required. Those are really the two things. There may be a relative placement where an order is not required.

In our study, we looked at 386 cases; 21 cases were withdrawn, and they were mostly improvement cases. There was one in which the local authority failed to prove its case-I think that was partly about how the case was presented. As a lawyer, I would say that, had that case been presented to another judge, an order would have been granted, as there were various technical difficulties. It was less than 10% in our study, which was a random sample-more like 7%-and only one of those cases was a failed case. Local authorities go through rigorous procedures in determining whether proceedings should be brought. It is not just the issue of the section 31 threshold criteria, but the issue of what the care plan is and whether intervention is necessary and proportionate.

 

Q655 Mr. Heppell: I am trying to combine my questions, because we are nearly out of time. In the Haringey case, nine days before the child's death, the advice from the lawyers was that there was not sufficient to get past the threshold to go for care. What sort of advice or guidance do people receive as to what the threshold should be? Can I just tie that in with a couple of things? There is a lot of inconsistency between authorities, so do you think that any of that is to do with resources? Do people have different policies in different areas because of how much they want to spend? I know that that is a bit of a muddled question.

Professor Masson: Can I take it from the back? One of the major differences between local authorities is how much access to lawyers they have. If they have only one lawyer in-house and great limitations on using outside lawyers-this is purely hypothetical-they are going to bring very few proceedings, because they do not have the staff to bring those proceedings. So if an authority has more lawyers, they can bring more proceedings.

When the Children Act came in, in 1989 to 1991, the number of lawyers working with children in social care went up enormously. However, there are huge differentials between authorities that have four lawyers and authorities that have 10 lawyers, even though they might have quite similar populations. It tends to be partly historic, but strong legal departments might grow, and small legal departments would not, because they are too busy holding the fort, which will impact on the number of proceedings that they bring. I think that I have already indicated that most local authorities could bring more proceedings if they wanted to, and that the success rates would not go down if they brought more proceedings. So, yes, that partly takes account of the differences.

As for legal advice and decisions in individual cases, local authorities vary as to whether a social worker can directly consult a legal department for advice without management permission, or whether they have to obtain such permission. I do not know what the position is in Haringey; I have not done research there. In more local authorities than not, I would say that the social worker is able to phone the legal department and ask for advice. However, the advice they get, as in any area, depends on the question they ask.

Before the decision is taken to bring proceedings, whether emergency proceedings or an application for a care order, the lawyer would expect to have a greater opportunity to look at the available evidence, for example the case conference minute, if there is a child protection plan, or at what sort of allegations are likely to be capable of being proved, on the basis of whose testimony and what documentation you have got. It is crucial for the decision on section 31, not just as I might give it to law students as a set of facts that I have already determined, that we know what facts can be established. That is the crucial element.

If someone is phoned up nine days before and asked a question and given an account, I imagine that they might say, "That does not sound as if it has met the threshold." It is much more likely to be an issue of "What are you planning to do with the child?". If they are planning to leave the child with the parents at that point, the issue would be, "Why do you need to bring proceedings suddenly? Can we have an opportunity to look at the evidence?". It is not just what section 31 states, but very much a case of, "What are you going to do with that child, what is the care plan and what is the evidence basis on which you are doing those things?" .

 

Q656 Mr. Chaytor: May I clarify something that Judith said earlier about the proportion of children who are taken into care in the first three months of life? What was the figure?

Professor Masson: In our study of 682 children I think that that figure was around 19% or 20%, and I think that it was in that age range.

 

Q657 Mr. Chaytor: That is not because the family or the mother suddenly became incapable just after the birth?

Professor Masson: No, a high proportion of them are second children. The mothers of those who are not second children are often substance abusers, so they are born with drug or substance abuse problems.

 

Q658 Mr. Chaytor: My next question is for Rosalyn. Given that we have touched on the difficulties of identifying families that are not engaging with the children's centre services or Sure Start centres, where is the role of antenatal services in all that? There has been no discussion of that or reference to it in the briefing, as far as I can see.

Dr. Proops: There clearly is a role, so you are right. I mentioned the presence of a named midwife within a hospital trust, and it is the relationship between the named midwife and the antenatal services in the community that is so important.

 

Q659 Mr. Chaytor: Does every woman now have a named midwife?

Dr. Proops: They should do.

Professor Masson: Some of these mothers do not have any antenatal services, and if they have had no antenatal appointments, that would be one high-risk factor at birth.

 

Q660 Mr. Chaytor: How can you go through nine months of pregnancy without any contact with antenatal services?

Dr. Proops: A few people still manage to do that.

Professor Masson: Some do not even know that they are pregnant, actually, or say that they did not.

Dr. Proops: It is about having a network that functions between the local drug and alcohol abuse services, primary care, antenatal services and health visiting services. It is about that community-based network and about finding a way of sharing what we in health would see as confidential information, and a great deal of effort has gone into that, so there is a whole range of things that can happen. The drug and alcohol problem is a major one. There are some programmes to tackle it from one end and some from the other, but it is an area where we need a great deal more evidence and resource, because we know from the United States that that is the seat and area for a large proportion of the babies and pre-school children who are at very high risk and for whom we need to do something.

 

Q661 Mr. Chaytor: Is the issue of confidentiality of medical records a major blockage in the exchange of information?

Dr. Proops: It is much less so now than it used to be, and the guidance that we have is clear. The culture change is beginning to happen and we just need to keep pressing on with it. There is far more clarity about how child protection is everyone's business, how the risk to the child is important and that at times that will have to supersede confidentiality with regard to the parent. We are not yet there, and there are lots of places to go, but it is far better than it was.

 

Q662 Mr. Chaytor: With regard to the choice between keeping the child within the family and taking the child away, it always strikes me as an amazing paradox that there are many capable families who have children with special needs or serious disabilities who are desperate to get respite care. They want the state to be more interventionist and to give them a break and take their child away for a period of time. The converse is that we have large numbers of completely dysfunctional families who have fought tooth and nail to keep their kids within the family. Is that because the conventional way of looking at this is that either you keep your child or the state takes the child away from you? Is that why so many dysfunctional families are so resistant to intervention by social services and is not the concept of respite, as a point on a continuum between the child staying at home and being moved into permanent residential care, a way of cracking the problem?

Professor Masson: That does happen. The key thing about the families whose children come into the care system compulsorily is a resistance to working with children's social care. They may have respite at a point. There may be a section 20 admission, which is intended to be temporary.

 

Q663 Mr. Chaytor: Is the word "respite" used with dysfunctional families?

Professor Masson: I would not know whether that word was actually used, or was understood, but I would expect there to be a partnership agreement for temporary section 20. That is how I would see it at as a lawyer and how I have seen it discussed with parents. However, then there is an expectation that the parents will maintain contact and do X, Y and Z, and there is often a dropping off from the parents for a variety of reasons-other problems that perhaps have not been identified, or they have not disclosed.

 

Q664 Paul Holmes: The local authority initiating care proceedings used to pay £150 to the courts, but the actual cost to the Government was over £4,000, or £35 million per year, so they have given £40 million to local authorities and said, "You pay it," and there seems to have been a worrying drop in the number of court proceedings being initiated. Is that true? Is it a problem?

Professor Masson: There has been a drop in care proceedings and I have seen figures from the Family Justice Council. I am not clear that that is linked to finance, because one thing we know as legal researchers is that when you introduce a new process, there is always a drop-off in the use of the process, because it is more complicated, people do not understand it and they want to see how the land lies. The decline in proceedings in the past six months is much more likely to be related to the introduction of the public law outline than the fees.

Having said that, the fees will have a longer-term impact. We do not know how the Government will compensate local authorities in the future in relation to this. We know that it is not ring-fenced money and that the way in which the money was allocated between local authorities did not bear any resemblance to the number of proceedings that local authorities had brought. It was related to the size of the care population, and that is only partially linked to the number of proceedings brought. The size of the care population is historic and is about outflows, not about how many proceedings you take. The Government simply did not have the figures and they still do not have accurate figures for the number of sets of proceedings brought by each local authority, so they do not have a way of divvying up the money appropriately. That is not terribly helpful.

It also gives a message, and alongside the PLO are a whole series of messages from the Ministry of Justice and, to a lesser extent, from the Department for Children, Schools and Families that they do not want too many proceedings to be brought. Part of this shift was intended to discourage local authorities from bringing proceedings. I find it difficult to understand why we should charge local authorities for bringing care proceedings when we would not dream of charging the Crown Prosecution Service for prosecuting people. I cannot see the logic in saying that there is a special funding regime for protecting children, which is part of social protection, when there is not a special funding regime for criminal proceedings.

Henrietta Heawood: I totally agree with all that. We took a motion to the British Association of Social Workers annual general meeting in April about the increase in fees for care proceedings because we were so worried that it was sending quite the wrong message to local authorities.

 

Q665 Chairman: If our inquiry report should include a particular item that you think is important, what is it? Is there something that would make it a second or third-rate report if it were omitted?

Dr. Proops: A key factor is to concentrate on the evidence base behind a number of the interventions that one needs, which is an evidence base that covers health and social care. We need to try to encourage the two, at the top level, both on a research and a delivery basis, to work even closer together.

Professor Masson: Research is very important. In the 1990s, after the Children Act was implemented, the Department of Health had a substantial research programme which looked at child protection and social care issues. Since our move to the DCSF there has not been that concerted putting together of a programme that looks across the piece. We have put children's education in with their social care, but we have taken children's health away. So we have that other barrier.

The barrier is also with the Ministry of Justice and how the legal proceedings fit in. We need to have much more wide-ranging research programmes, not only on outcomes issues, but on how these processes are operating. We cannot assume that child protection processes are operating in the same way now as in the 1990s, particularly with all the changes there have been. Drugs are a much bigger issue than they were in the 1980s and 1990s.

Henrietta Heawood: I agree with that. From the point of view of the social workers on the ground, the message we would like to go back is that social workers need to be supported to do their difficult task and not constantly criticised. Support takes various forms. We would like greater resources to help them and more social workers. Even when teams are fully staffed they can be too small to cope with the demands of the work. Partly because of what Judith is saying, more and more need is being identified. There is greater awareness of the impact of domestic violence and of drugs. There have been changes in that we have to do things where before things were not noticed so much. We would like social workers to be freed up to do the jobs that they are supposed to do and not be stuck to a computer 80% of the time.

Chairman: Thank you. This has been very valuable advice. We should be grateful if you could keep in touch with the Committee as we write our report and continue to gather the last bits of evidence. Thank you for your time.