Chapter 3: Inequality of access to high-quality public services
53.Ryan Wise is a qualified social worker who now works in higher education, training social work students. With the Centre for Public Impact he helped facilitate a focus group of frontline social workers. Participants stressed the importance of agencies working together to ensure that users can access services. But Mr Wise recounted:
“The main reflections from what we … heard [were] about the support systems for children, and social care—the interactions with the health visitor service, with the midwifery service, and with hospitals. What we are hearing from social workers is that they are very much alone.
“I recall one anecdote. Someone phoned up a health visitor: ‘Have you visited this young child who is two? We are worried about them.’ ‘No, our policy is not to go out.’”
54.The child was unable to access the services that they needed because the pandemic meant that health visitors had stopped home visits.58
55.In this chapter we consider the underlying reasons for pre-existing inequalities of access to high-quality public services. Such reasons include a lack of integration between public services, and a failure by public services to identify the specific needs of certain groups. Since the beginning of the pandemic these inequalities have continued to prevent users from accessing the services that they depend on, making access even more unequal. Such failings have been felt particularly acutely by Black, Asian and Minority Ethnic service users, Gypsy, Roma and Traveller groups, and vulnerable children.
The consequences of poorly integrated services: vulnerable children
56.Our evidence suggested that a lack of collaboration between public services meant that even before the COVID-19 pandemic the needs of vulnerable children59 were not sufficiently met. The first lockdown widened inequalities of access to public services between vulnerable children and other groups.
Numbers of vulnerable children
57.The Children’s Commissioner’s Office (CCO) warned that in 2019 an estimated 829,000 children from a vulnerable family background were “invisible” to services. They did not have access to children’s social care or to statutory support from local authorities such as the Troubled Families Programme, which conducts targeted interventions for families experiencing multiple problems.60 An estimated 2.3 million children were classed in 2019 as “vulnerable due to their family circumstances”. The Children’s Commissioner’s Office suggested that this number was likely to have increased substantially during the first lockdown.61 More than 750,000 children were absent from school in the second week of October 2020, giving an 89.9 per cent attendance rate, compared with 95 per cent the previous autumn.62
58.The Children’s Commissioner, Anne Longfield OBE, described how vulnerability may be widespread among children:
“The emergency has … exposed … the scale of vulnerability. We are talking potentially about one in six children with significant vulnerabilities, many of which were hidden before the actual crisis and have remained hidden.”63
59.Witnesses were concerned that families who were already experiencing difficulties before the first lockdown could be pushed to “crisis point”.64 Such pressures are likely to be felt most severely in parts of the country with high levels of deprivation. For example, in Manchester 18 per cent of children live in families where one parent has a severe mental health problem; in Blackpool, 13 children in 1,000 are currently on a child protection plan; and in Hackney, over 10 per cent of children live in households where domestic abuse is occurring.65 Many such areas were recently placed under ‘local lockdowns’, which may have worsened conditions for vulnerable children living there.
60.We heard that for children experiencing abuse and serious harm, school can be a reprieve. When vulnerable children attend school, teachers and social workers can detect problems early.66 However, with most vulnerable children unable to attend school during the first lockdown, many had little support from public services.67 For Children England, school closures and the reduction in social workers’ home visits as a result of COVID-19 exacerbated vulnerable children’s existing inequalities.68
61.Before COVID-19, vulnerable children were falling through the gaps between public service providers, “invisible” to social services, the NHS and the education system. Many more have become “invisible” during the pandemic since losing contact with public services.
Inadequate integration between service providers
62.On 24 April 2020 the Government announced that just over £12 million would be spent on 14 projects across the country to tackle the increased risk to vulnerable children during the first lockdown. The money supported children at risk of abuse; community volunteers working with families; children in care and care leavers; and children’s mental health. It included £1.6 million in funding for the National Society for the Prevention of Cruelty to Children helpline, to which people can report concerns about vulnerable children.69
63.While this additional funding is welcome, we heard that a lack of integration between services and a tendency for siloed working could limit the ability of public services to protect vulnerable children. The CCO outlined how separate targets mandated by different Government departments for schools, local authority children’s social care services and NHS children’s mental health services could result in a situation where “three agencies believe they are acting in the best interests of a [vulnerable] child, but are pursuing different ends, or considering one elements of a child’s needs as both discrete and the responsibility of someone else”.70
64.The CCO highlighted areas where an existing lack of coordination between services could have a negative impact on vulnerable children. It described how services did not work together effectively when vulnerable children moved from accessing children’s to adults’ social care services, and the lack of Child and Adolescent Mental Health Services (CAMHS) professionals working in schools to identify vulnerable children. The CCO argued that in order to “identify, and then ameliorate, the broad range of risks to children”, it was “necessary to have a shared understanding of the needs of children and an integrated approach across the different partners involved”.71
65.Todd Krieble, Deputy Chief Executive of New Zealand’s Institute of Economic Research, outlined how that country had successfully encouraged the kind of cooperation that the Children’s Commissioner advocated. The New Zealand government has set up “joint ventures”. These are coordinated strategies to tackle complex social problems which do not fall within any single departmental remit.72 We describe this approach in Box 2.
Box 2: Breaking down silos: learning from New Zealand’s “joint ventures”
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The funding for joint ventures is allocated in New Zealand’s annual budget. In Budget 2020, $202.9 million was allocated to a “joint venture” on “family violence and sexual violence”.73 Responsibility for addressing family violence and sexual violence was previously distributed across at least 10 government agencies. “Family violence and sexual violence” comprised ministers from the departments of Justice, Social Development, Children and Māori Development, and a senior civil servant from each department.74 A lead minister is appointed, who decides how funding is spent. For “Family violence and sexual violence” it was the Parliamentary Under-Secretary to the Minister of Justice (Domestic and Sexual Violence). A senior civil servant acts as “chief executive” of the “joint venture”, to provide a single point of accountability and leadership. |
66.The Government should urgently develop a cross-agency strategy which would support vulnerable children in, or at risk of, crisis and ensure that public services do not lose touch with children during future crises such as the COVID-19 pandemic. As part of this strategy, the Troubled Families Programme and community services that facilitate multi-agency support for families such as children’s centres and family hubs should be extended. Schools should have Child and Adolescent Mental Health Services professionals, police liaison officers and youth workers who can collaborate to address vulnerable children’s needs.
67.The Government should study New Zealand’s “joint ventures” to understand better how central Government can encourage cross-agency collaboration on complex social problems.
Black, Asian and Minority Ethnic and Gypsy, Roma and Traveller service users
68.In May 2020 the University of Manchester Centre on Dynamics of Ethnicity and the Runnymede Trust warned that:
- BAME people’s inequalities in experiences of health care were substantial and had not changed over time;
- disparities in educational outcomes showed persistent disadvantage for Black Caribbean, Pakistani and Gypsy and Irish traveller groups, including significantly higher levels of permanent exclusion for Black and Gypsy and Irish traveller groups.75
69.Such inequalities of access have grown since the beginning of the first lockdown. Lord Woolley of Woodford, Director of Operation Black Vote, stated that while COVID-19 did not “target race or ethnicity”,76 it did target “those areas within our society that I would describe as deeply racialised. … I mean those areas in which a disproportionate number of black and minority ethnic individuals are on low pay, on zero-hours contracts, in poor housing, in overcrowded housing.”77
70.Dr Angelo Ercia told us:
“The lockdown has disabled many BAMEs to access healthcare services that are essential to help with managing and treating their health conditions. For example, a diabetic BAME patient may have not seen a dietician for weeks. Therefore, they are unable to thoroughly discuss their food intake, receive assistance with meal plans, and review their blood tests. Health education and one-on-one support is an important aspect of managing diabetes. The patient may have also experienced limited or no communication with their GP … about their diabetes and other health conditions.”78
71.Lord Woolley argued that a “COVID-19 race equality strategy” was urgently needed: “we desperately and immediately need a plan to ensure that Black, Asian and Minority Ethnic communities are not doubly, triply, devastatingly hit again.”79 Professor Claire Alexander, Associate Director of the Centre on Dynamics of Ethnicity at the University of Manchester, said that such an approach should be “led from the top”. She called for a Government race equality strategy: “There needs to be a very strong commitment from the Government to tackle this in a real way.”80
72.Sarah Mann, Director of Friends, Families and Travellers, a charity working with Gypsy Roma and Traveller groups, described how the pandemic had underscored the exclusion of GRT people from public services: “It took a long time for any guidance to get out to local authorities to remind them that they may have a duty to support Gypsy and Traveller families as they would other families in this situation.”81
73.She explained that moving education provision online during the first lockdown had caused problems for GRT families:
“Gypsy, Roma and Traveller families are more likely to be digitally excluded … and children are less likely to have literate parents within a household. Accessing remote education was virtually impossible. We had a case of a family being told that one mobile phone was sufficient access for four children to follow their education programme during lockdown.”82
74.Sarah Mann recommended “specific targeted catch-up … for Gypsy, Roma and Traveller children, who already experience the worst attainment of any group in the UK”.83
75.COVID-19 should be a wake-up call for the Government that the designers and providers of public services have paid insufficient attention to the specific needs of minority groups. The Public Sector Equality Duty has had limited success; Black, Asian and Minority Ethnic and Gypsy, Roma and Traveller groups experience significant inequalities of access. These inequalities have worsened since the beginning of the pandemic.
76.The Government should introduce a race equality strategy that would apply across public services and address inequalities of access for Black, Asian and Minority Ethnic and Gypsy, Roma and Traveller people. Such a strategy should include joint targets, shared by all relevant service providers and supported by voluntary sector organisations working directly with these groups, to tackle persistent inequalities in health and educational outcomes. The strategy should investigate the links between such inequalities.
77.Service providers should respond to race equality targets by developing clear implementation plans to meet them. The Government should set out the role of regulators in holding public services accountable for these implementation plans and targets.
58 We heard that during the pandemic health visitors and midwives had worked hard, in difficult conditions, to keep children safe. This example from the Centre for Public Impact focus group with social workers reflects a broad consensus among focus group participants that children’s services are insufficiently integrated. See written evidence from Centre for Public Impact focus group (PSR0113) and Q 155.
59 The Children’s Commissioner’s Office defines child vulnerability as being at risk from a range of difficulties, including physical or mental illness, to going hungry; being homeless or excluded from school; being at risk of neglect or abuse; or living with parents with health problems, such as mental ill health or substance abuse. See: Children’s Commissioner, We’re all in this together: local area profiles of child vulnerability (April 2020): https://www.childrenscommissioner.gov.uk/wp-content/uploads/2020/04/cco-were-all-in-this-together.pdf [accessed 10 November 2020).
60 House of Commons Library, The Troubled Families programme (England), Briefing Paper Number 07585, September 2020
62 Sian Griffiths et al, ‘Teachers search for lost children of COVID’, The Sunday Times (18 October 2020): https://www.thetimes.co.uk/article/teachers-search-for-lost-children-of-covid-bgjkbmpz5 [accessed 30 October 2020]
67 Children’s Commissioner, Childhood in the time of COVID (September 2020): https://www.childrenscommissioner.gov.uk/wp-content/uploads/2020/09/cco-childhood-in-the-time-of-covid.pdf [accessed 10 November 2020]
69 Department for Education, ‘Multi-million support for vulnerable children during COVID-19’ (24 April 2020): https://www.gov.uk/government/news/multi-million-support-for-vulnerable-children-during-covid-19 [accessed 20 October 2020]. The Government also announced that this money would be spent on better data-sharing between all safeguarding partners, to ensure that the NHS, police, social workers, school nurses and health workers had the information that they needed to protect children at risk of abuse. The role of data-sharing in keeping children safe is discussed in Chapter 8.
71 Written evidence from the Children’s Commissioner’s Office (CCO) (PSR0106). See also Local Government Association (LGA), ‘A child-centred recovery’ (10 September 2020): https://www.local.gov.uk/child-centred-recovery#executive-summary [accessed 29 October 2020]
74 Q 123; New Zealand Ministry of Justice, ‘Family violence and sexual violence work programme’, (13 August 2020): https://www.justice.govt.nz/justice-sector-policy/key-initiatives/reducing-family-and-sexual-violence/work-programme/ [accessed 21 October 2020] and Public Service Commission, ‘Machinery of Government—Organisational Forms’, (11 May 2018): https://www.publicservice.govt.nz/resources/mog-organisational-forms/ [accessed 7 November 2020]
75 University of Manchester, ‘Report highlights extent of UK’s race inequality with COVID-19 likely to worsen problem’ (4 May 2020): https://www.manchester.ac.uk/discover/news/extent-of-uks-race-inequality/ [accessed 20 October 2020]
76 Operation Black Vote, ‘Official: COVID-19 devasting impact on BAME. Now act!’ (2 June 2020) https://www.obv.org.uk/news-blogs/official-covid-19-devastating-impact-bame-now-act [accessed 20 October 2020]
80 Q 128. The Equality and Human Rights Commission (EHRC) also called for such a strategy. Written evidence from the EHRC (PSR0107)
82 Q 60. The EHRC also highlighted digital exclusion among GRT families and argued that online education provision risked widening GRT children’s education attainment gap. It wrote: “In England, In 2016/17 72.5 per cent of White British children achieved a ‘good level of development’ at Foundation Stage (as assessed by a teacher), higher than Black (69.6 per cent), Bangladeshi (67.1 per cent), Pakistani (64.3 per cent) and Other White (63.9 per cent) children. Attainment was lowest, by a large margin, for Gypsy, Roma and Irish Traveller children (33.2 per cent).” Written evidence from the Equality and Human Rights Commission (EHRC) (PSR0107).