The message they just don’t seem to hear …

The NSPCC has once again raised the important issue of the shortfall in mental health services for children who have been sexually abused. A survey of more than 1,000 professionals in the UK, (social workers, doctors, psychologists, teachers etc.) found that nearly all believed that there was not enough help. And nearly 80% believed the situation was getting worse, with many children having to wait for more than five months to get any help.

The NSPCC chief executive Peter Wanless is absolutely right to say that this is a situation that "shames the nation".  It is a situation that has just gone on and on, without any kind of satisfactory progress. In this blog in 2009 (six years ago) I welcomed research on this topic from the NSPCC and the University of Edinburgh and pointed out that practitioners had been aware for years before of the large gaps in these types of services.

It seems nothing changes. British governments of various political complexions seem incapable of grabbing hold of this issue. It appears they just stand-by while children and young people suffer.

I believe that this type of chronic penny-pinching is a false economy, because children and young people who fail to get the therapeutic services they require can develop life-long problems ranging from anxiety and depression to post traumatic stress disorder and psychotic illnesses. Studies by Prevent Child Abuse America have estimated that the daily cost of long term mental illness resulting from maltreatment during childhood was nearly $13 million in the USA in 2001.

As I said in 2009: “A humane child protection system must also deal promptly with the consequences of the abuse and do all that can be done to mitigate them. Spending adequate sums of money on therapeutic services for maltreated children is not only the right thing to do; it is also financially prudent if it reduces the need to continue providing mental health care for adult survivors of abuse.”

Sadly that needs saying as much today as it did then.

Risk and Innovation – sloppy drafting, sloppy thinking?

There is a very sloppy paragraph at the top of page 7 of the UK government’s recent document (Children’s social care reform: a vision for change January 2016)

It blithely states:

“But we see far less genuine innovation in children’s social care than in comparable services, with most areas feeling unable to take measured risks in the interests of children for fear of falling foul of prescribed approaches. This must change.”

With only a little thought, this paragraph unravels as you read it! What do they mean by ‘genuine innovation’ (presumably to be contrasted with innovations which are not genuine, whatever they might be)? What are these 'comparable services' and how have they innovated? And what do they mean by ‘measured risks’ (how are they measured and by whom)? Then there’s the issue of to whom the risk applies (those taking it or those on the receiving end of services). Shockingly that's not made clear. Finally there is the implicit claim that innovation requires risk taking, which is by no means self-evident and is probably not even true because there are many examples of how innovation actually reduces risk - for example new rules on the number of lifeboats ships carried after the sinking of the Titanic.

Just as there are ‘urban myths’, so there are ‘policy myths’. This paragraph has all the hallmarks of policy mythology - slippery arguments and sweeping statements for which there is no evidence but which superficially sound plausible and which could have big implications. The extent to which the paragraph can do damage is already becoming apparent. Children and Young People Now’s headline proclaims: “DfE to encourage children’s social care providers to ‘take risks’”.

And the magazine goes on to report that there are already discussions taking place with Ofsted about what kinds of risks people can take. The Chief Social Worker for children and families has apparently stressed on Twitter that they are only concerned with measured risks, not just any risks. But we are not given any guidance about how to recognise a 'measured risk' if we saw one; or how to measure it.

For my part I wonder if some people know very much about risk taking and innovation. I only hope that nobody makes the crass mistake of thinking that in order to be ‘innovative’ (and so please the government) you need to put the welfare and safety of a child at risk. That would be really stupid.

Getting it wrong about making mistakes: flaws in the government’s vision for children’s social work

I have been reading the British Government’s latest document about children’s social work in England - Children’s social care reform: a vision for change 

 

I should say that there is quite a lot I don’t like in this document, so my spirits picked up when I noticed what promised to be an encouraging paragraph on page 7. Talking of practice and systems it says:

“Learn when things go wrong. The system is still too often characterised by repeating the same mistakes. We need a deeper and more sophisticated understanding of why mistakes occur and how the system can learn to avoid them. This requires overhauling the serious case review process.”

There is so much to agree with in this paragraph other than its conclusion! We must learn from things going wrong, the same mistakes do keep happening and we need a better understanding of how they happen and how to avoid and mitigate them. But we don’t want to spend a lot of time reforming the serious case review process. There are better ways.

I have held forth before about serious case reviews and I have now come to the view that they cannot be made to work. They are costly, time consuming and disruptive. They are often very slow to report. They are nearly always descriptive rather than being analytical. They are unrepresentative, because they concern mostly fatal or near fatal incidents. And they don’t get at the truth, often because the people involved in the incident have something to gain by not being open with those conducting the review. In short there is so much wrong with serious case reviews that the prospect of an overhaul is not just daunting, it is overwhelmingly dispiriting.

Instead what we should be doing is building a just and responsive reporting culture, in which everybody, but perhaps most importantly those that work on the front line, feel confident about reporting, discussing and analysing what goes wrong in everyday practice and how to put it right. Such a reporting culture would be based on a widespread understanding of human factors in the workplace, supported by systems which encourage openness and reporting, such as confidential near miss reporting, and underpinned by an ethic which values, respects and protects those who raise safety concerns.

What kind of new body is the government proposing for social work?

Children and Young People Now reports that the UK government is set to create a new organisation that they say will try to give social workers similar professional status to doctors and lawyers. The organisation will, it is said, be tasked with driving-up standards in children’s and adults’ social work practice, education and training.

My first reaction is that all this sounds rather familiar – a College of Social Work Mk 2 perhaps? If so why did the Government let the Mk1 College go down the pan? I dare say we can ponder that puzzle ad infinitum and be no wiser. There are wheels within wheels, as they say.

My second reaction is that this proposed new body will never confer on social work similar professional status to medicine and law unless it is owned and governed by members of the social work profession. The medical royal colleges and the equivalent legal professional bodies – the Bar Council and the Law Society – are run and controlled, respectively, by doctors and lawyers. From the scant amount of information currently available, the new social work body looks like it will be some sort offshoot of government, combining the functions of a regulator in addition to professional development. The nightmare scenario is that it will be run by civil servants and government advisers and regularly interfered with by politicians – a dire prospect.

I only hope I am wrong, because if the government is creating the kind of malign behemoth I fear, that will effectively block the achievement of full professional status for social workers for the foreseeable future.

Between a rock and a hard place?

The decision by Cardiff Council to end a ‘market supplement’ paid to some of its child protection social workers is likely to result in some people moving on and others not joining the council.

http://www.walesonline.co.uk/news/wales-news/cardiff-council-under-fire-over-10679583

The reason is simple enough – supply of qualified social workers (not enough), demand for qualified social workers (too much).

On the other hand it is hard not to have some sympathy with councillors who are arguing that they cannot find cuts to meet their austerity budget in any other way.

They do, however, need to be careful to avoid the trap of creating vacancies, which they cannot fill, and then having to rely on expensive agency staff to cover the service. The consequence could easily be the worst of all worlds – losing valued permanent members of staff and having higher costs!

The truth of the matter is that real world economics matters for public services just as much as it does for private businesses. If you cannot recruit people to do a job, you need to think of some incentive to redress the balance, whether that is a market supplement or other enhanced terms and conditions. And you cannot cut people’s wages, when they can get better paid jobs elsewhere, and expect to retain them.  You cannot square circles.

Inevitably making cuts in public spending eventually has a negative impact on the extent and quality of services.  It’s as simple as that.