Will England's children's social care review live up to its bold ambitions?

Professional Social Work magazine - 5 February, 2021

England’s review into children’s social care promises to be “bold and broad” – a “once-in-a-generation opportunity” for reform.

It takes place against a tough backdrop with Covid, years of austerity, potentially more economic hardship to come and poor mental health increasingly impacting on families and children.

Even before getting off the ground it became mired in controversy with the appointment of Josh MacAlister, chief executive of Frontline, England’s fast-track graduate training programme for children and families social workers, to lead it.

Will the review live up to its ambitions? PSW editor Shahid Naqvi looks at the seven themes outlined in the review’s terms of reference.

Care

The review asks how can the system ensure children have a “positive experience” of the care system that “prioritises stability”? This is probably the most fundamental question of the review.

For too many children, the experience of being in care has been cold, impersonal and stigmatising, with multiple professional involvement in their lives and a lack of continuity. Ask any group of care experienced people what they want from the system, and it can basically be summarised as ‘more care’.

At the Care Experienced Conference held in 2019 at Liverpool Hope University 140 people with experience of care came up with ten key messages.

Number one was a desire to see “more love in the care system, including displays of positive physical affection”. Number two was to be seen as individuals “worthy of respect much more than we are”.

The number three priority on the list was relationships – a strong desire for continuity in relationships with friends, relatives, professionals and carers. Stability and continuity, help with mental health, lifelong support, a sense of self, having a say, being aware of rights and entitlements and being listened to were the other priorities.

Similar findings came from the Our care our say survey of 163 experienced people backed by 76 more in-depth discussions carried out at the end of last year to inform the review.

It breaks down its messages into three areas – before care, in care and after care.

Before care, respondents stressed they wanted early help to prevent situations worsening and more done to support struggling families, including drawing on the resources of wider family, friends and communities.

When in care, the “overriding focus” should be on the importance of “love and stability”. Continuity and the ability to build and sustain personal relationships was seen as critical. Respondents said they did not want to feel like “being part of a process or part of a business”.

Richard Vickers, a social worker for 45 years who was made an OBE for services to children and families, emphasises the importance of stability in education: “The school experience, the friendships with staff and peers, is critical.

“But when placements are made that can lead to a change of school. More effort should be made in maintaining school stability."

In terms of after care, there was a strong feeling that stopping support at the age of 25 is wrong and that care is a “lifelong experience and therefore should attract lifelong support”.

A key government focus to achieve that stability and lifelong support for children in care has been adoption.

However, there has been disquiet among some families and social workers that this emphasis has resulted in some injustices.

In 2018 BASW published findings of a year-long enquiry into adoption which said the drive to promote adoption as “risk free” in a “happy ever after” narrative was unhelpful.

It also noted the impact of austerity was impacting on the adversities facing families in poverty and there was a danger of human rights abuses.

The review must balance this so-called ‘push to permanency’ against the need to provide better support for young parents, those with mental health or learning difficulties, and parents who grew up in care.

More recent government thinking has promoted the involvement of wider kinship networks, such as grandparents or other relatives able to provide lifelong links.

North Yorkshire’s work using the Family Finding model, developed by US-based “child protection innovator” Kevin Campbell, has attracted interest.

It seeks to find and engage other relatives when children are removed from parents in the believe that the most important factor in outcomes for children is “meaningful, lifelong connections to family”.

Kinship carer groups, however, highlight the economic hardship they face in taking on the role and children living in such homes are often among the poorest in the country.

In order for such kinship support to thrive, the review needs to consider how wider family are supported both prior and during the placement. That could mean funding them in the same way that foster carers are paid when they care for children.

Strengthening families

The review asks what can be done so children are supported to stay safely in and thrive with their families?

One obvious answer is to put more funding and resource into preventative services. A report by the Lloyds Bank Foundation in September 2018 found nearly all (97 per cent) of cuts to preventative services since 2011/12 had fallen on the fifth most deprived councils in England and Wales with the highest proportion of people in need.

Preventative funding to help children stay in their homes had fallen by 46 per cent during the period.

Meanwhile, amid more risk-adverse cultures driving by political and media scapegoating, child protection investigations increased over the last decade by 129 per cent to more than 200,000 a year by 2019/20.

The number of children on child protection plans increased by 20 per cent and the number of looked after children has risen by 22 per cent, comparing figures on 31 March 2011 and 31 March 2020.

The Department for Education launched the Strengthening families protecting children programme to help address this. It’s pumping £84 million into 20 local authorities to reduce the number of children entering care over five years.

The authorities are adopting one of three models developed by Leeds, Hertfordshire and North Yorkshire using money from the DfE’s Children’s social care innovation programme.

The Leeds model engages wider family networks and family group conferencing to promote a cultural shift to “working with families rather than doing things to them”.

The Hertfordshire model is a multidisciplinary approach to supporting families including specialist adult workers with an emphasis on a “counselling approach”.

North Yorkshire adopts a hub approach working with adolescents with complex needs bringing a range of services including housing under one team.

But embedding such approaches nationally needs resource and funding. With councils in England estimating the cost of the pandemic at between £1.1 - £2.2 billion and eight out of ten warning of bankruptcy last June, this means major investment from central government.

Delivery

The review asks what are the key enablers to implementation, such as creating a strong, stable and resilient workforce, leadership and partnerships?

A first stop might be to look at the latest findings of the Working conditions and wellbeing survey conducted by the British Association of Social Workers and the Social Workers Union in 2018.

It found nearly half of all social workers were dissatisfied with their jobs and 40 per cent were planning to leave the profession. Responses from more than 3,000 practitioners found working conditions to be worse in social work than almost all other public and private sector occupations.

Crucial to improving children’s social care will be improving the working conditions and morale of the profession that plays the biggest part in delivering it.

Professor Eileen Munro’s 2011 review of child protection in England said social workers needed to be freed from target-driven cultures, managerialism and excessive paperwork.

It’s true that some of her recommendations have been implemented, such as the creation of a principal social worker to represent the profession at a senior level in local authorities.

But the kind of system change Munro wanted is far from being achieved and too many social workers still feel dominated by a tick-box culture and form-filling.

A survey by BASW England in 2018 found in an average 45-hour week, social workers were spending only 11 hours face-to-face with children and families.

This, coupled with research from England’s Children’s Commissioner that found children felt they did not hear from their social workers enough, led to BASW England’s 80-20 campaign. Its aim is to tip the balance of time spent away from paperwork and computers to direct contact with children and families.

The physical environment many social workers work within also needs to improve. A survey of more than 600 social workers by PSW magazine in 2016 found almost two-thirds said their office was not fit for purpose.

They highlighted noisy workspaces, dodgy IT systems, poorly heated and even vermin infested offices. More than half said they had nowhere to make sensitive work-related phone calls, with some using their car or even the toilet for privacy.

Hotdesking – a practice Munro criticised – was also found to be having a negative impact, with some workers having to trawl buildings to find a workstation.

Behind this is a need to recognise social workers for the highly skilled professionals they are. An interesting question to ask is whether local authorities, with all their competing demands, are necessarily the right environment to achieve this. Might a properly funded national social care service make more sense? And would that give social workers greater freedom advocate for service users and to speak out about professional issues without being muted by their local authority political masters?

If the review is true to its word of thinking bold and broad, it might need to consider this. At the very least, it should look at how to ensure social workers get the working conditions they need to do their jobs properly.

Sustainability and accountability

The review asks what is the most sustainable and cost-effective way of delivering services and who is best placed to deliver them? It also asks what accountability arrangements are needed. These two areas are potentially the most controversial and have already set alarm bells ringing.

For when a Tory government talks about sustainable and cost-effective ways of delivery, the private sector is surely always on the table.

One might, of course, ask what is wrong with private sector involvement if it delivers the desired outcomes for children and families?

The obvious response would be that the ultimate goal of business is profit – and when profit is king, money not people tends to dominate decision-making.

Those who oppose private sector involvement will point to horror stories such as the abuse of adults with learning difficulties at the Winterbourne View private hospital. Of course, abuses also happen in state-run institutions and the private sector-versus-public sector debate can all too easily turn into one of ideology.

Vickers, who had experience of evaluating local authority contracts under New Labour’s Best Value policy, believes the key question is one of governance rather than who's providing a service.

“That brings together accountability of elected members as well as the commissioning arrangements.

“At the end of the day, from a local authority point of view regardless of who provides a service, they are still the children of that local authority and the local authority will still have corporate responsibility.”

The private sector is already heavily involved in some areas of children's social care. Nearly three out of four children’s homes are run privately or by the voluntary sector. The biggest ten providers own nearly a third of them.

Two out of five fostering placements are provided by 300 privately and voluntary-run fostering agencies in England. The largest six placed half of all children in England last year.

Last month the Local Government Association raised concern at “increasing private equity and stock market involvement in the system”. Its research shows the six largest independent providers made £219 million profit last year.

Sir Martin Narey’s 2016 review of residential care found some private sector agencies charged 92 per cent more than what local authorities spend on foster carers.

Last year Liverpool’s cabinet member for children’s services said the cost of private residential care had gone up about 30 per cent in the last three years. One placement he highlighted was costing £3,500 a week.

The LGA last year warned of the danger of private providers - six out of ten of which it claimed were running in debt - going bankrupt. It points to the fiasco of Southern Cross, Britain’s biggest care home provider, which went bust ten years ago threatening many elderly residents with homelesness.

Against this backdrop the appointment of Josh MacAlister to head up the review becomes significant.

MacAlister is the founder of Frontline, the fast-track graduate training programme for children and family social workers, an organisation with links to big business.

Among its founding partners is global management firm the Boston Consulting Group. Other corporate links include LinkedIn, international consultancy firm Gerson Lehrman Group and the KPMG Foundation, a charitable arm of the global accountancy firm.

Many in the social work sector and beyond have expressed concern that MacAlister comes with a bias toward business solutions.

MacAlister has stressed his independence, asking detractors to judge him by his actions.

But it’s easy to understand the disquiet over an ideologically pro-business government choosing MacAlister to lead this review.

Social work scholar Steve Rogowski sees the “spectre of cronyism” in MacAlister’s appointment adding: “It is no surprise some consider the review is largely going through the motions and that the government and hence the review already know many of its final thoughts and recommendations.”

As chief executive of Frontline MaAlister – who stepped down from the role to lead the review - was head of an organisation enjoying significant government support, not least funding.

Social work academic and former social services director Ray Jones asks can he be truly independent as a result? “He is within a coterie of favoured advisers close to the government and chief executive of a company which is dependent on disproportionate government funding to provide social work training,” says the emeritus professor of social work at Kingston University and St George’s, University of London.

Last month MacAlister called on the Competitions and Markets Authority to launch an investigation into the children’s social care “market”.

This could be as much about evidencing the negative impact of the marketplace, but in such a febrile environment, it’s easy to see why this caused alarm bells to ring among some.

On top of this, the Conservative government has given many indications of a desire to privatise children’s social care over the years.

As education secretary in 2013, Michael Gove launched a consultation on whether private companies should run children’s services. Changes to statutory regulations were introduced in 2014 allowing contracts to be given to not-for-profit arms of private companies to deliver statutory children’s social work services.

Two years later, in 2016, the government launched the Children and Social Work Bill, containing clauses that would allow authorities to ignore some statutory duties to “test new ways of working”.

As well as warning of the threat this posed to long-established children’s rights, campaigners such as Carolyne Willow of Article 39 believed it was motivated by a desire to make children’s social care more attractive to the regulation-hating private sector.

Outsourcing of children’s social care in the form of trusts has already happened at several local authorities as a solution to persistent “failings” – or what others might describe as persistent underfunding.

However, a leaked draft policy paper suggests the government is planning to roll back private sector involvement in the NHS scrapping the process of competitive tending for contracts. Could this signal a change of direction within government that may also impact upon social care?

If the review is to be truly independent it will have to look at all the evidence – and there is plenty around to suggest the most cost-effective and sustainable way to deliver services is not the private sector.

Safety

The review asks what can be done to ensure children who need care get it quickly and safely without being at risk of significant harm?

A Freedom of Information survey by PSW in 2017 found more than a quarter (29 per cent) of local authorities in England had placed their most vulnerable children in secure units as far away as Scotland.

There may be good reason to place highly distressed children hundreds of miles from their home – for example if they are at risk of exploitation by gangs. But often it’s simply due to a lack of local placements.

The availability of humane therapeutic-orientated centres for the most vulnerable children and young people locally needs to be looked at. Likewise the at times unnecessary use of restraint, including handcuffing, to transport distressed and vulnerable young people.

Young people in care are particularly at risk of child sexual exploitation and county lines drugs gangs, both of which have received high profile in recent years. This includes the sexual grooming of vulnerable young people on social media sites, an area of exploitation that has grown in recent years leading to tougher legislation.

A report by England’s Children’s Commissioner Anne Longfield in 2019 claimed some 27,000 children in England are at high risk of gang exploitation and are not being supported by services.

Longfield, says as many as 120,000 - one in 25 of all teenagers in England - are falling through gaps in education and social care putting them at greater risk of exploitation. She warns that figure is likely to grow in the aftermath of the Covid pandemic.

According to the Children’s Society, happiness levels among children aged ten to 15 in the UK are among the lowest in Europe and declining.

It calls childhood unhappiness a “national scandal” with its Good Childhood report highlighting discontentment with appearance, friendships, worries about the future including jobs and money, crime, the environment and school.

Addressing such broad issues may be outside the remit of the review, but it should at least acknowledge these drivers that can impact upon children and their need for social care.

Support

The review asks what support is needed to meet the needs of children who are referred or involved with social care?

Even before Covid, the mental health of children and young people was an issue. In 2017, amid rising pressures on youth, including social media, an NHS Digital survey found one in eight people aged under 19 in England had a diagnosable mental health disorder.

Almost one in four girls had a mental disorder and half of those had self-harmed or attempted suicide.

Around 75 per cent of young people with a mental health problem wait so long for a service their condition gets worse. Less than a third of 338,000 children referred to adolescent and mental health services in 2017 received treatment within a year and one in four referred by GPs or teachers were turned town.

Children in care are likely to have experienced greater levels of trauma, including abuse, than most. The Our care, our say report highlights the need for access to mental health and therapeutic services both before, in and after care.

Jennifer West*, a children and families social worker, says: “Children in care have experienced very challenging times and there is an expectation for them to function and learn in school while trying to manage trauma with limited or no additional support.

“I would want the review to look at what support can be put in place. When you put in an application for child adolescent mental health services (CAMHS) often waiting times are very lengthy - there needs to be other options.

“Children with additional needs have an education, health and care plan. Care experienced children aren’t automatically eligible for that yet they have experienced trauma that can prevent them from learning.

“Anyone who has experienced trauma should have access to therapeutic support.”

But perhaps the big elephant in the room for the review is poverty. In a climate of growing inequality and rising food insecurity, the pressure on some families is unbearable. Social work intervention, at whatever stage it occurs, can feel a bit like sticking plaster.

Research by the Child Welfare Inequality project in 2017 found children living in the UK’s poorest neighbourhoods are almost ten times more likely to be in care or on a child protection plan than those in the most affluent.

Selina Anderson, a children’s social worker in Reading who spent time in care as a child, says: “There is a lot of poverty, drug and alcohol problems, undiagnosed mental health and lack of opportunity for young people.

 “When I was younger even though it was a struggle there were opportunities. We had a youth centre, we had libraries, there were things we could go and do but with cuts to services these things have gone.

“With Covid they have just opened up clinics – if that kind of effort and resource could be put into helping our families we wouldn’t have so many children in care.”

Tackling social inequality and poverty might not be within the remit of the review, but to ignore these pernicious factors may also make it something of a sticking plaster.

Speaking at a conference about kinship care recently, England’s chief social worker for children and families Isabelle Trowler asked in relation to the review: “Has Covid created the moment when we are able to push forward toward a more welfare-orientated social care system and practice?”

Time will tell...

*Name changed on request