Author Archive

April 9, 2013

Race To The Bottom Commissioning

Writers are obsessed not just with words but with wordcount. That innocuous, humble figure in the drop-down menu or nestling innocently in the bottom left hand corner of your screen should be a record of achievement. Instead, too often it’s a curse, an ever-tightening straitjacket on the creative flow. Blogging at least allows me to stretch out a bit as opposed to a commissioned piece for another site or magazine, but there’s lots of evidence to show people seldom read to the end of the article or  even past the opening paragraphs. If you’ve reached this point, you might well be in the minority.

Lately I’ve been a victim of the oppression of wordcount for a very different reason. Creativity has no place in the dark murky world of contract compliance and tenders.

These form an increasing proportion of the workload of any independent provider in fostering and residential work. I understand why they have appeared. After all, I’m old enough to recall the old days when social work had no systems for measuring its effectiveness, the days when we just knew and that got us nowhere. However, the last few months have taught me that while it appears we have swung to the other extreme with compliance coming out of every orifice, not only are we no nearer to truly demonstrating effectiveness, it is stifling innovation and good practice that children and young people need more desperately than ever before.

Two weeks ago I completed a tender for an authority in the southeast. I wrote 12,098 words. As each question was limited to 500 words, you can see how much ground they wanted to cover, except that this document, clearly designed by committee, was intensely repetitive. There are only so many ways you can say you are child centred, needs-based, work in partnership and strive to keep children safe.

Anyway, there were four lots to this tender for different groups of children but the responses were similar, so that’s 48,392 words in total, half a decent novel in another world. For this sought-after tender there would be at least 40 providers going for it, which means the authority will have to read and digest 1,935,680 words. The responses  must be processed to ensure the quality threshold is achieved, graded on a scale of 1 to 5 then compared to rank the providers in a tiered system.

My 48,392 words does not include any of the policies and procedures that were requested, nor any of the considerable business, insurance and financial information. Then this whole quality exercise counts for only 40% of the tender because 60% is price. This imbalance between quality and cost is common – one tender went 70-30 in favour of price.

This modern approach to commissioning is an exercise in futility. I simply do not believe that all my words will be read, let alone systematically compared with the other 1,887,288 that have been submitted. It cannot possibly be done.

I resent the fact that quality is less significant than price. More and more, authorities are looking to the bottom line of the balance rather than good practice when it comes to children’s futures. I accept that they don’t have as much money and that the cuts are not their fault. However, this is not the most effective way of using their scarce resources to provide a child centred service.

I’ve said before how prices can be kept down in the sector – you provide a placement without extra services like contact, therapy and other forms of support. Yet carers as well as children need those packages of care as the demands of fostering are ever more complex. A price-based approach does not encourage that.

With the contract comes compliance. Fine, I understand why this is important. However, what happens in practice is that each authority wants very similar information but in a slightly different form. The 5 outcomes are the same, the info they require ever so slightly different. In passing, you can work out the problems affecting every authority by the nature of their requirements. A heavy emphasis on, say, staff checks or allegations means they’ve had a real problem in the recent past.

The lack of consistency means providers have to collect different statistics for every authority. Providers are of course inspected by Ofsted but this seems to be irrelevant when it comes to the tenders and perish the thought that Ofsted might want stats that are in any way similar to those required by authorities. Ofsted for example uses ethnic monitoring categories that do not match with any other I have come across.

All of this costs money. Providers will have to pass on the costs of extra posts and databases in one way or another, and goodness what the local authority staff costs are in processing 1,935,680 words.

Three other southeast tenders are between 3 and 5 months late because authorities are unable to reach a conclusion. Two face legal challenges because they request information that breaches data protection legislation. Some simply do not realise that having a policy for everything does not guarantee better quality. One organisation was censured for not having a child protection policy on gangs, but what do they expect. “For children and young people we do all we can to keep them safe but if they join a gang, sod ‘em.” It’s reached the stage where I would be tempted to submit that.

Forgive the ranting. It’s helped me let off a bit of steam. I’ve just spent the day on a Section 11 audit for a council in East Anglia. It’s about safeguarding and that’s important, really, I get it, but question whether this is the right way to go about it. Self-assessment. Frankly unlikely that I’m going to give a score of anything less than perfect. ‘Do you have a policy on such and such?’ Answer: “Yes I do have a policy on such and such.” It will keep them happy because this is the fourth one I have filled in and everyone has been happy with that answer so far. Doesn’t say how good this provider is or the difference good safeguarding and risk-management makes.

The Fostering Regulations require that organisations send their child protection policies to every authority they work with or could work with. I know another provider who sent out 42 responses and did not hear back from one of them, not even an acknowledgement. Utterly futile.

It has reached the point where I don’t know what piece of legislation it is Section 11 of and I’m past the point of caring. 1,974 words, if you’re interested. I’m hacked off – you can tell, can’t you – because it’s a waste, of precious resources and of my creativity and innovation as a practitioner. I have several ideas stillborn because there is simply no time. Putting them into action would improve the well-being of children in care far more than any of the compliance mechanisms do.

But if by some chance you’ve bucked the stats and reached this far, have a look at two recent pieces that are considered, definitely non-ranty but point out the consequences. “Commissioning services drives up costs” from Public Service Europe and “race to the bottom commissioning” from the Third Sector. Commissioning is important. It needs to focus on value and quality. There must be a better way. That’s 1213 words I wanted to write.

March 23, 2013

Rich Pickings In Foster Care

In January the Financial Times carried a piece about the investment potential for private companies seeking to invest in foster care. Entitled Fostering Sector Ripe For Consolidation, it begins in seductive fashion not with high finance or balance sheets but with the personal experience of carers who are clearly dedicated to the disabled child they look after. They don’t do it for the money – you couldn’t, because as they say it works out per hour at a fraction of the minimum wage. And that’s the last time children are mentioned as anything other than a commodity.

The economy of care has always been mixed and many private companies do excellent work, often with some of the most damaged children and young people. Yet the language of the balance sheet rather than the review form sticks in the craw and masks the realities of caring for vulnerable children to the standard they deserve.

Companies, including private equity, are attracted to the sector because of the potential for “cost savings” and “economies of scale”. Fostering is a “growth market” – Peter Connolly’s death and the increase in care admissions that followed becomes an investment opportunity.

Large companies from the health sector as well as private equity are gazing enviously not only at potential profits but also at the relatively high number of small to medium size firms who are ripe for a buy-out or as they call it, “consolidation”. Small-scale one or two person businesses, often started by social workers or foster carers from their spare bedroom, propelled the exponential growth in the independent fostering sector that began in earnest in the mid to late nineties. Now, IFPs care for almost 40% of children and young people in foster care.

However, many of the originals are keen to sell. Smaller providers feel pressured because of competition, the administrative tasks around Ofsted and contract compliance and the tender/contract process leaves less room for niche providers. They may also be coming toward the end of their careers and need to provide for their retirement. I’m not blaming them – these small companies led the way in the development of excellence in foster care practice in the days before and after regulation. With the big boys moving in, it’s hard to keep going.

This isn’t the world where we talk of standards of care, of healing relationships between carers and vulnerable children, not even of outcomes or aspirations. This is “the fostering space” where consolidation provides opportunities for profit, where large concerns, often multi-nationals from the health and, latterly, service sectors could invest and please their shareholders. This world has its own language: “It’s a classic private equity play. Private equity have been consolidating and investing in the fragmented domiciliary care space for the last five years and have begun to exit those investments to facilities management businesses. You can see something similar occurring in the fostering space.” I genuinely do not know what that means.

This is not new and I’ve written about it before on NSBS “Children In Care Are Big Business”, to the point where the FT article niggled away but I had not intended to go over old ground again. However, what made me write this was something I found out this week. Another private company (not the one mentioned in the piece) works at a profit margin of 30%.

That’s plain wrong. It may be irrational, it may be unusually high (although but I suspect it isn’t), for all I know I could be a wishy washy mung bean eating sandal wearing pinko liberal bleeding heart, but that’s an excessively high profit margin. As my piece from last year suggested, the best way to make money in fostering is to limit the services you provide for children and cut corners on matching, the process by which a child’s needs are matched with the capabilities of the carers. Take any placement, the money comes in and if it fails, blame the child or put it down to experience and move on to the next referral. Plain wrong.

The other way is to charge an inflated fee, which hurts cash-strapped local authorities struggling with constrained budgets precisely at the time when numbers in foster care are going up.

It chimes with other things that I have been told around and about. Carers from a private company who were told that allowances and services for children were to be cut back because local authorities were cutting their fees, when I know that company has increased the price it charges. A group of carers looking to change providers after the CEO arrived for a football match in his helicopter. Most tellingly, from my own experience on interview panels, the number of social workers seeking to move jobs because their professional standards have been compromised beyond redemption. Managers instruct them to take a placement when they know the match is not right.

I knew one of the candidates. She used to work for a small private company with a deserved reputation for long-term commitment and success with complex placements. The man who put this in place regretfully sold up after twenty years to a large national private company. Now, placement support services like therapy have been cut and she is forced to meet targets regardless of how appropriate the placement may be. That’s what is happening in the fostering space right now.

February 6, 2013

On The Ward

We the visitors tread a well-worn path from car-park to bedside. We who long ago said everything there is to say but still talk, who drink tea we don’t want as we both cling to some semblance of normality, who dash to get food from the canteen with a fraction too much enthusiasm because we can get away from bedpans and pain, drips and catheters for a few precious minutes, giddy in the stale air of the cafe, guilty that loved ones must stay where they are.

More than anything, we have time on our hands. Time to look around and seek distraction, any distraction, just something to remark upon and air fresh words together. Time on our hands when those we worry and care about are getting the most effective medicine of them all, untroubled sleep not dictated by night or day, only the body’s needs. We the visitors have time to know what’s going on.

You don’t notice for several days. To begin with, it’s busy. This tablet, that doctor, more examinations, the results will be back soon. “Feeling better? The drip’s working. The drip will work, give it time. The op is one step nearer getting out of here.” Something is happening, something to aim for, a sense of purpose. Always niggles, that’s only to be expected. The doctor forgets to call, she’ll be in again tomorrow. Late with the bedpan? The nurses are really busy, don’t know how they cope. Hospital food – we’d say something if it was decent!

It’s when the days turn into weeks that you begin to understand. When there’s nothing to do but wait for the body to rest, recover and work its magic. When the doctors try something and wait to see what happens. If they told you that they were not entirely sure, they couldn’t be certain, fine, we could cope with that, that’s reality after all. But they don’t want to tell you what they don’t know. You just find out along the way.

The orthopaedic ward has 4 bays each with 6 beds, plus 2 single rooms.  In a ward like this, most patients have restricted mobility because they’ve broken something below the waist. Many are old and are in hospital because they have fallen. They can do little for themselves and certainly can’t go to the toilet unaided. 

Over a period of three weeks, at any one time at least two patients had dementia or Altzheimers, so being somewhere unfamiliar disoriented them even more.  One woman got up from her bed, went to the door, was prevented from leaving and taken back to her bed. The cycle was repeated for 5 hours every day, on top of the fact that everyone has too much to do. It’s so busy, you don’t realise until you think about it. For 26 people there is one sister, two nurses and 4 health-care assistants. Sometimes there’s an extra nurse.

The vast majority of the staff are unfailingly cheerful but because we’ve been around for a while, long-stayers we are, they drift to our quiet corner and talk. One man gave up his art career to be a health-care assistant. He loves his job with a passion even though he’s knackered every night and can barely pay his bills. He’s here because he wants to be.

The sister breezes onto the ward, her ward, and when she’s on duty the atmosphere lifts through the sheer force of her personality. A word of encouragement here, she’ll fill in for absent staff who need to get off their feet for 5 minutes, taking the pee out of the new young doctor. The staff nurse is kind too. She’ll go to another ward to find another pillow, forbidden really in case it exceeds the two per bed rule. She plumps them up and we both no longer sag. She’s moving to out-patients next week, she’s had enough. Can’t do my job properly any more, she says forlornly.

Intensive care is curiously comfortable and reassuring. Life and death dramas are played out in a calm, purposeful atmosphere. There’s one nurse to every two beds, with cover if a patient needs one to one. The nurses (they talk to us, you see) are motivated, well-trained, work as as team and despite the pressure elect to work here because they have the support and time to do what they want to do, which is to care.

Back to the ward. It should be a sign of progress but there’s a sigh and heavy heart. The sister winks – she briskly moves a couple of beds around so our corner is free. But it’s not so quiet because now there’s one man amongst five women. He spends the evening shouting down his mobile and demonstrating that hospital gowns cover a bare minimum of his tattooed legs. 

Next to him is another new arrival, a well-spoken and apparently frail woman in her seventies who sounds nervous. Not sure of the etiquette, I leave my post and help her with the table and her drink. She’s grateful but doesn’t look me in the eye. I say my goodbyes and walk to the exit past the laminated pledge from 2009 that wards will be single-sex.

Appearences can be deceptive. Later she’s visited by two younger relatives, who spend this and subsequent evenings talking about her trips around Europe last year, about her plans for the house and a walking holiday in Italy as soon as this leg is sorted out. Indefatigable is the word. Me, I heave my paunch around with a loud sigh just because my legs ache from sitting down for an hour.

There are visitors every day but not the same ones. They don’t see what I see. She doesn’t fancy a drink because the water is warm and it’s been there all day. But that’s what she said everytime someone asked her to drink and she hasn’t drunk since morning. Not hungry tonight, don’t really fancy the sandwich, oh OK then if you insist just one bite. But that’s all she’s had. The nurse encourages her to drink, scolds her like a schoolgirl, she takes a sip then the nurse is gone. Another more pressing task. And the water jug remains full.

Isolation now. This hospital has been heavily criticised in the papers because of hygiene problems. First sign of MRSA and here we are, plastic gloves and aprons preventing the spread of germs but separating us even more. Still, it’s a room to ourselves, with a TV. This was the old private wing. More nurses too. More risk means more care. 

The ward. The bed where the old woman lies is quiet now. Her visitors are still there but she’s asleep for long periods, waking occasionally to mumble a few incoherent words. The operation has gone well, it’s not that.  On the way out, I take the plunge and catch her visitors up. I’m no doctor but… They thank me but don’t quite know what to make of this stranger. Don’t understand it, she was so active until last week.

We wait two hours for a doctor to come in response to a leg pain. It’s the houseman, on rotation. We can tell, we know what’s going on. She listens. Without a word and without pulling the curtains round the bed, she takes a felt-tip from her pocket and draws a black mark around the area that hurts. Still silent, she smiles and gets up, presumably to inform a superior about her findings.

In the corridor sits an elderly man, upright and dapper in a worn tweed jacket, tie and proud-polished shoes. He’s ready to go home but because he lives alone, there’s no one to take him. Because it’s late, there’s no hospital transport. Because they are busy, there’s no one to sort it out. Because of the cuts, there’s no hospital social work department. That evening, I leave later than normal, a tearful day so the staff kindly let me stay past the end of visiting time. At 10pm he’s still there, sitting upright, proud and patient.

Three months on and we’re not going back. Another hospital, that odd feeling again. We’re professionals now. Patiently we give the same history for the umpteenth time. They can’t find the notes (don’t worry, the file is only a foot thick), of course they can’t.

But it’s different. Nurses rush around and don’t have a lot of time for personal care but there are more of them so things get done. The doctors are dead keen, anxious to get noticed as they forge their career. There’s a drinks machine on the ward. Same plastic water jugs but ice in the water. On the ward desk there’s an admin person. He takes the calls, gives directions, sorts out the files, all things that are distracting, time-consuming yet vitally important for patients, family and staff. No one waits patiently for a lift home that will never come. 

Tests and treatment will take a week, unpleasant and who knows what the future holds. But there’s a bed by the window. We hold hands and watch the sun set over Westminster Bridge.

January 27, 2013

Adoption: Threats And Divisions As Gove Loses Patience

We’ve known for some time now that as far as working with children in care are concerned, adoption is the government’s absolute priority. A series of announcements over the past 15 months or so have focused on different aspects of the process. Last week came the latest and potentially most radical, where failing authorities could be stripped of their powers, which would be handed to the voluntary or private sector. There’s £150m purely for adoption, new resources but it’s not new money because it comes from cash previously earmarked for early intervention. Michael Gove just got serious.

The new money for adoption is £150m previously earmarked for early intervention, an area where Surestart and other preventative initiatives that aim to keep families together have already been decimated. A few days before this announcement, Eric Pickles stated he wanted to cut resources available for troubled families. The agenda could not be more stark – prevention and keeping families together is less important than adoption. With devastating irony, this most ideological of decisions uses money specifically set aside for evidence-based initiatives.

Politicians and practitioners agree that the shortage of adoptive carers has to be robustly addressed but surely not at the expense of other children in need. The government’s attempt to say that one sector in need is more important than another smacks of the way their divisive language around the welfare and employment debate tries to set working people against the unemployed, the rest against the “shirkers and skivers”. Child care is a continuum, with support for keeping families together at one end and adoption at the other. They may appear to be poles apart but in fact they are part of the same whole, far more closely related than is convenient for the governement to acknowledge.

Evidence shows that large numbers of children come in and out of care. In foster care, for example, providers have noticed that the rise in placements due to the higher numbers of children coming into care has been accompanied by an increase in the number of short-term placments, where children then return home. It is easy to forget that the original intention of section 20 of the Children Act where children and young people can be accommodated with the agreement of their parents was designed to maintain the ties between children and their families rather than close the door, and that families could use accommodation as a service, a week or two’s respite while they sort out problems with the help of their social worker so that the child can return to where they belong, in a safe, caring home. The Act became law in 1991 but sounds like ancient history. I may as well be writing in Sanskrit for all the sense those last few sentences make in 2013.

On a personal level, as someone who has worked across the whole spectrum but more recently in fostering and adoption, I feel dirty, as if I’m using money that’s been pinched from a child’s piggy bank. This is how awful this low, underhand and cold-blooded financial conjuring makes me feel.

The decision encapsulates all that is wrong in that dark, dank place where politics meets planning for children’s services. These are themes I’ve written about before. Prevention leads to better services and saves money in the long run whether it’s children in care, health and safety or gritting the roads before forecast snow falls. Yet for the government, any government not just this one, there’s little reason to invest in the long-term because another administration will reap the benefit, be it another government or perish the thought, another lot of politicians from another party. Yet we will know the success of our work with children in care only when they are well into adulthood, and anyway, even then people change as they grow older.

Adotpion czar Martin Narey, now Sir Martin, said this week that if even half the children on the waiting list are adopted, that would produce huge savings. He’s right of course, and he’s right to say that children should not have to languish in care with only the hope of a family to hang on to. Where I fundamentally disagree is that one element of the continuum should be prioritised at the expense of another. The twin goals of long-term savings and better choices for children and families for children in need of help from the state could be achieved by investment in early intervention as well as in adoption, not instead of. Also, even if the adoption backlog were cleared, there are others coming through the system in greater numbers than ever before. They too will need placements and the resources to find them. Further, adoption is not the only route to permanence. Evidence demonstrates the value of long-term fostering for many children and for their carers who receive support throughout the placement. These placements cost money but the children are worth it.

I am delighted that the government has made the welfare of children in care a priority, the first to do so in recent memory. However, it’s hard to escape the conclusion that for this long-term, complex issue they are seeking a quick win, the headline and the soundbite that goes with it.

More irony: government proposals in the pipeline won’t grab the headlines but are far more interesting and relevent for me as a practitioner because they directly address many of the problems in the existing system. Most important is the review of the court process that maintains a steadfast focus on the needs of the child within a clear timetable and minimises drift. Support for adopters will increase, with a look at personal budgets so they can decide what their family needs and how to sort out any problems. The purpose of the new national Adoption Gateway is to make it easier for prospective adopters to find out more. Changes in the inter-agency fee place the voluntary sector on the same level as authorties, thus widening the pool of adopters. Finally, there will be more organised gatherings of prospective adopters and children, sometimes called adoption parties. This is a direct result of an evidence-based study by the British Association for Adoption and Fostering that was properly researched, funded by the voluntary sector and fully evaluated. Taken together, these initiatives will do nothing but good. I fully support them. Evidence not ideology.

Every now and again any system in any organisation needs a good kick up the backsidebut in my experience, threats are far less effective than committed, considered leadership that understands a problem and sets goals for change. The government has quickly tired of what it sees as intransigence in the sector. Last week we heard that councils who do not respond will find adoption services removed entirely from them and placed in the hands of the voluntary and private sector. The appearence of the private sector is noteworthy. This requires a legislative change as private companies are not able by law to become adoption agencies.

Once more we are seeing divisions rather than partnership. The voluntary sector wants to work alongside local authority partners. Legions of dedicated, able local authority social workers want to find more adopters, not to be excluded from the whole process. We have to work closely with communities to find more adopters, for example more black adopters, rather than becoming ever more distant. Change must be accomplished by working with the sector not against it.

January 14, 2013

Normal Service Will Not Be Resumed

Listen to ministers and you could be forgiven for believing that although cuts in the public sector are necessary, services will be maintained. It’s true, change in social care isn’t just a matter of throwing money at the problem and despite resource shortages we all know that whatever area we work in, efficiencies are possible. In reality, where resource allocation filters down through layers of bureaucracy and policy to the point where workers and users meet, these assurances are worthless. Last week I came across two examples where cuts in one area will have adverse consequences in another.

Children and Young People Now reported that local authorities’ spending on child care staff training was cut by over 40% last year. Four authorities have no budget at all. I suspect this does not come as too much of a shock to anyone who works in the public sector because training budgets typically take a hit whenever savings are required. However, it comes at a time when more and better training is recommended in each and every area of social care in order to increase standards and improve the service. It’s a staple of each report, every service review, all inquiries. I’ve often heard the argument that such cuts protect frontline services. Clearly in the long run they undermine them.

Another example concerns the impact for some foster carers on the changes in eligibility for housing benefit. From April, foster carers living in social housing will not be able to claim housing benefit for bedrooms occupied by fostered children and young people. It’s sparked a frantic rush of agitated audits as local authorities work out how many placements this will affect. The context is an existing shortage of around 8,700 foster carers as estimated by the Fostering Network. This change could reduce current numbers and deter potential new recruits. It will affect inner city authorities badly – off the top of my head, Southwark for example has over 65% of its properties as social housing.

The intention behind the change is to deter under-occupation, basically to not subsidise empty rooms. This will compel many to move from homes and communities where their families have been brought up because their children have grown up and moved on. In terms of children in care, according to the HB rules, foster children are not classed as permanent members of the household. Also, between placements the room is unoccupied. Therefore, no benefit will be paid.

This is not a deliberate policy, and that’s my point. Changes made for other reasons by another department in order to meet their savings target could have serious consequences for foster care in general and for children and young people in placement in particular. If carers can’t afford to carry on, children may have to move.

The Fostering Network have campaigned on the issue and there is now a £5m discretionary fund that in theory is available to compensate for any shortfalls. Minister Edward Timpson, who grew up in a family that fostered, is genuinely sympathetic and has promised to keep highlighting the problem but the FN is concerned the cash could be swallowed up by the larger housing pot and not reach its intended target. Anyway, when the words ‘benefits’ and ‘discretionary’ are linked, forgive me if I harbour grounds for scepticism. 

There’s no conspiracy here, rather the unintended consequences of resource-led decisions. Different departments have different agendas and priorities. Yet the devil is in the detail. I’m certain that nobody planned to undermine foster carers doing vital work for the vulnerable, they just didn’t bother to look too closely at the implications of their decision-making.

This is serious. The government is trying to create a myth that decent levels of service can be maintained with inadequate resources. Sure, we can all do better, and every professional I know is determined to put everything they can into their work in 2013 on behalf of users in defiance of the cuts. However, the government has to understand this simple thing – there is a limit as to what is humanly possible. The demands on services and professionals for higher standards are greater than ever, and rightly so, but if we don’t have the tools to do our job, there’s a limit. What really hurts is, the government know the truth but carry on undaunted.  

 
November 24, 2012

Rotherham: Truth and Politics

The only time I read my local paper is at the Indian takeaway. Whilst waiting for my korahi chicken yesterday evening, I disinterestedly flicked through the familiar mix of parking problems, noisy neighbours and oversubscribed schools. I nearly skipped the article buried on page 11 about a man who died after an error from his GP, because I was pondering whether to order a popadom. Then I stopped and read it: it was my GP.

Our doctor is kind, caring and hard-working. He treats people as individuals and always makes time for them. On this occasion, the surgery computer system did not indicate that the prescriptions for the drugs his elderly patient required for a heart condition had stopped after the man was released from hospital. Several months on, he relapsed and sadly died. The coroner praised the doctor for his honesty. I can’t recall the actual verdict but the death could have been prevented.

Today’s Daily Telegraph didn’t lead with an avoidable death or for that matter any death. The case of foster carers who allegedly had children in their care removed from them because they were UKIP members has run on all media. It’s been top of 5Live news all day, for example. You would expect Nigel Farage to have an opinion but Michael Gove has swiftly weighed in too. As I write, Milliband is being quoted. Cue outrage at social work.

If UKIP membership is the only reason why these children were moved, I don’t agree with it. They should have stayed where they were. The council said on the news this morning that the children were going to move on anyway. This may be the case. However, the original Telegraph report says the boy was moved the following day and his two sisters soon after. If this is accurate, it does not sound like a planned move to me.

I qualify my remarks with ‘if accurate’ for a couple of reasons. Firstly, the report does not appear to have any corroboration from other sources. They may exist but it’s based heavily on the carers’ account. I thought journalists cross-checked, especially on a headline story, but this is different.

Secondly, it doesn’t chime with my experiences over the years. Judgments about the capabilities of  carers are never made on the basis of a single piece of information, unless of course it relates to a child protection matter or allegation, in which case prompt action must be taken to safeguard the child.

In this case, you would like to think that other evidence would have been considered, such as the history of the carers over their fostering career, the progress of the children in placement, any evidence that the actual behaviour of the carers had negatively impacted on the children (as  distinct from their membership of a political party) and the wishes and feelings of the children. Bear in mind that the Fostering Standards prohibit changes in children’s careplans without consultation unless there is a real and immediate need. If the local authority has other information, they could not possibly break confidentiality and share it publicly, which offers no protection to the storm of media outrage.

Some of the criticism is misinformed. Farage was calling for the immediate reinstatement of the carers but they are still approved carers, it’s just this placement that has ended. Also, he might think about considering the children’s needs first, which is the law after all.

However, what is most significant is why this is a story at all. My doctor will carry on practising, as he should. The competence of the medical profession has not been called into question because a man died. Yet in the case of the Rotherham foster carers, the ability of the entire social work profession has immediately become the issue. This is all the corroboration the Telegraph needed. We know social workers do this sort of thing, don’t we. Leaving aside the fact that as I have already suggested, any judgement is based on incomplete evidence, this is not about the actions of individual social workers or even the authority itself, it’s about how lousy our profession supposedly is in making these judgement.

The implication clearly is that social workers make snap judgments based on dogma and preconceived ideas. More than this, we are driven by political ideology. In much of the coverage, this deeply flawed and prejudiced perspective has not been significantly questioned. This must be the case – what other reason could there be? It shows how little the public still understand about what we do.

This may have been a carefully considered decision or something that was rushed. It could have been a wrong decision. If so, hold up our hands, but it does not prove one single thing about how social work as a whole assesses the needs of children.

You would think the minister, our minister, might at the very least inject a sense of perspective. Not so. “The wrong decision in the wrong way for the wrong reasons,” he said. I humbly suggest he cannot know that for certain. But there are bigger issues at play here and it suits him to use the profession for which he is responsible for other reasons.

Rotherham is holding a by-election. It’s Labour-held, therefore this decision is the responsibility of the Labour authority even though it would have been made by social workers, i.e. officials not politicians. The assumption that this is a political issue has not been called into question. No coincidence.

Also, the consultation period for government proposals to diminish the significance of culture and origin in decisions about adoption placements is coming to an end. This has been well-trailed over the past year – see some of my previous articles – as a way of removing what the government characterise as impediments to swifter adoption. It’s an important proposal that has considerable opposition as well as its proponents. Whichever position you take, it’s disturbing that a matter about the health and well-being of three little children and public confidence in social work becomes a chance for political points-scoring.  We might look back at this episode in future and ask if anyone truly cares.

November 12, 2012

What The BBC Can Learn From Social Work

One of the biggest problems faced by the social work profession is that everybody else thinks they know what we do, and most of them think they can do it too. Not the nasty bits like taking children away from their families, but knowing when a child is being neglected or abused. I’ve written about this before. It undermines our credibility as a profession and limits the effort people make to understand what we do because they believe they already know the answer.

I have the same relationship with the BBC. The reality is, I don’t know what’s really going on during this latest schmozzle (see how I’m avoiding the ‘c’ word there) but I’m firmly convinced that on the basis of having some contact with the corporation on virtually every day of my life thus far, I understand exactly what’s happening.

From Danny Baker to Jeremy Paxman via David Mellor, the message bellowed by anyone who has a microphone thrust in front of them is that the BBC have too many managers. The Newsnight contretemps (neatly sliding past the ‘f’ word) is full of poor practice but also raises issues that are pertinent to most organisations, about who takes decisions, how much senior managers know about any given topic, how much they need to know and how much power is delegated. Whatever is going on, those sorting out the mess would do well to pause and make considered choices about how to maintain the balance between the professional discretion that encourages creativity and the compliance that spends so much time ensuring things get done the right way, not enough gets done.

Despite Munro’s attempts to focus on practise, children’s social work remains in the grip of a risk averse culture. The waves from the so-called Baby Peter effect are slowly becoming ripples but their effects are still being felt. This manifests itself in a variety of ways. The most noticeable is the high level of care applications before the courts but it’s all around us. I’m writing this in my lunchbreak, seeking respite from a tender application for fostering provision. At this opening stage, the authority will base its decisions on just three pieces of information – the price, the training programme and the Risk Assessment Procedure. Nothing about the quality of service provided for children or outcomes. It’s a revealing insight that lays bare the authority’s current priorities and concerns.

However, the culture of compliance is deeply embedded into the very structure of child care planning. The question has to asked, is this the most efficient way of taking the best possible decisions for vulnerable children and young people?

I’m in favour of built-in checks and balances, and also of the value of independent scrutiny. However, the current system is confusing and stifles the creativity of professionals who work face to face with children, young people and their families, precisely the point where the best social work is done. The balance has to be right.

The Care Planning, Placement and Case Review Regulations in England became effective in April 2011. Reacting to long-standing problems in the planning process, they made it a requirement for foster carers and children and young people to be fully heard and responded to in reviews. They also gave the Independent Reviewing Officers (IRO) greater authority. For example, anyone with a significant interest, including the child or young person, can contact them at any time should there be a problem or implementation delay.

In principle I’m in favour of this. Note the role of the IRO has been beefed up because of perceived failings in the system with poor decisions and lack of implementation resulting in drift. Potentially, however, it creates uncertainly and a lack of clarity.

Typically, the child’s social worker has most contact with the child, their family and their carers. In the current climate, they are at best wary and at worst disempowered from taking the decisions relating to that child, deferring to their manager.

At the Review, the IRO creates the Care Plan. In my experience, team managers sometimes feel powerless. Recommendations may be made that the manager disagrees with or for resources that may not be available. The Care Plan goes back into the mix. The manager may say the resources are not available. Increasingly, the manager and social worker have to go to an eighties-style resource panel where the recommendations of the care plan are effectively reevaluated, but crucially in the absence of key participants.

Meanwhile, the IRO, who as an employee of the local authority is not as independent as their job title makes out, is now feeling undermined. One said to me last week, ‘I despair. This is the third review in as many weeks that when I’ve come back to a key decision I took 6 months ago, nothing has happened due to resource constraints.’

Being connected to but outside the whole process, people talk to me, and anyway I have a kind face. I’ve also got the time to stop and listen, unusual these days. The thing is, managers and social worker feel exactly the same – disempowered, undermined and uncertain. Who exactly takes the decision? It feels sometimes as if any decision is temporary, subject to review at any time. Children require consistency and stability. It saps morale. Managers complain about IROs, IROs grumble about standards. Disharmony where everyone should be working together.

Compliance also takes its toll at an organisatonal level. Independent residential and fostering providers are snowed under with quality assurance demands. Again, I fully accept why this is required and both authorities and children have a right to know they are getting good value for their money and that the best possible standards are in place.

However, it is astonishingly time-consuming and costly. As in any business, those costs are passed on. The unit cost of any placement increases because more backroom staff and/or systems are needed to provide the seemingly endless flow of data for tenders and compliance. And that’s not including Ofsted.

In fostering, although a National Contract exists, few use it. In consequence, all authorities require what is effectively the same information but in an ever-so-slightly different format. This is complex, draining and favours large organisations who can pay for their own compliance unit.

Let me make it perfectly clear – IROs, social workers and their managers undertake some phenomenally good work that benefits so many children. However, in a signficant number of cases that I come across, they are hindered by the system, not helped by it. The unintended effects of well-meaning processes suck up both resources and precious energy. Professional creativity and innovation are stifled. The balance has to be right. The BBC would do well to learn from social work’s mistakes.

Tags: ,
September 5, 2012

Tell Tim He’s Sacked

One cold evening a couple of years ago I went to hear Tim Loughton, the former Children’s Minister shuffled out of the pack yesterday, speak at a meeting of the All Party parliamentary group for children in care. We queued to the sound of shrill chanting and ominous bullhorns. The Comprehensive Spending Review was being debated in the House, the first indication of the true extent of the government’s spending cuts and Whitehall was closed to traffic as a protest rally gathered.

Accompanied by two young women in foster care, we dawdled through Westminster Hall and the corridors of power. It’s a privilege to be so close to government, never to be rushed. As we hung around in the lobby, the division bell sounded. Members appeared from all sides and dashed into the Commons chamber. They left the door open for a while so we could peer around the corner to see democracy in action.

Given the significance of the evening’s events he could have easily been excused but to his great credit, Loughton appeared as scheduled to address the packed committee room full of young people from all over the country. His speech was a characteristically robust endorsement of the value of foster care and the rights of children and young people in care to the same opportunities as their peers.

With the eloquence of experience, a succession of young people politely but firmly pointed out the flaws in his argument. You say education is important for children in care but you’ve just voted to do away with educational maintenance, the money that supports us. You say jobs are important but unemployment for young people is rising. You say we all deserve good foster carers but there’s a chronic shortage of resources to recruit them. Thanks for coming, though.

And that’s Tim Loughton in a nutshell. Unfashionably sticking up for children and young people in care and defending the social work profession whilst simultaneously his Cabinet eviscerated the resources he claimed were in place  to support them.

That night Loughton bobbed and weaved with the skill of an experienced politician, riding out the storm without properly satisfying anyone in his responses. Most ministers would have ducked out: he was there because he wanted to stay. Loughton is no placeholder or careerist. Shadow Children’s Minister for several years before coming to power, this is the portfolio he sought and prepared for.

The former minister is extremely well-informed about fostering, adoption and children in care. Unusually his main source was the people involved rather than his civil servants. Over an extended period he’s taken the time to understand the sector by making himself available to children, young people and carers. He created a telephone hotline, “Tell Tim”, and met regularly with organisations representing young people and carers, offering an unprecedented degree of accessibility. Last night on twitter they lined up to thank him and praise his commitment. For a group who voice is seldom heard, his willingness to listen meant an awful lot.

One of the things children and young people in care told him was that they were fed up with needing to get permission from social workers for school trips, holidays, activities and sleepovers with friends. You couldn’t mark them out as more different from their peers if you felt-tipped a red cross on their foreheads. A group of young people confronted him on television about this. Loughton shifted uneasily under the pressure, yet he delivered on his promise to respond. His first act as a minister was to write to local authorities to remind them that they had the power to give foster carers discretion on these matters. I showed a copy to one of the young women who appeared in the programme – “You did this,” I said. Now it’s enshrined in the revised Fostering Standards. The fact authorities have still not got the message is not his fault.

It’s not all so positive. He defends social work yet I’ve heard him dismiss the content and nature of assessments with the sarcastic panache of a Daily Mail leader writer. His promised fostering action plan is still to materialise. Hearing him several times subsequently, I continued to admire his grasp of the fostering task whilst growing weary of disingenuous references to the deficiencies of authorities he knew full well were tottering under the burden of  his government’s cuts.

Ultimately his departure may say less about the man and more about the government’s perception of the sector. The adoption agenda has been dominated by Gove and Cameron. Martin Narey joined the chorus of praise and regret but in terms of policy creation made him largely redundant.

They have seized the big issues, relating it to other props of Tory policy around the family and budgets cuts. In this world, an understanding of the details, of the everyday problems facing children, carers and social workers, gets in the way. The struggles with resources, with finding the right placement, with whether a child can stay with her friend this weekend, have little significance. More than this, they may actually obstruct the agenda for change because they don’t fit together with policy as neatly as the Department may wish.

Yet these are the issues that make life better for children and young people in care. For children and carers alike, nothing is more important. Gove’s distance from this awkward day-to-day reality leads to dogmatic policy. It leaves you to wonder if there is ever a place for any minister who thoroughly masters not his brief but an understanding of the people affected by it. It’s hard to understand social work. Loughton did, but in the end all it got him was the sack.

July 3, 2012

Children In Care Are Big Business

The encroachment of international venture capital into the private provision of residential and foster care for looked after children is hardly news. It’s been covered regularly over the last couple of years but yesterday’s Times revealed the full extent of what many businesspeople have known for a while now, that the sector offers rich pickings without having to wait an undue length of time for a return.

One of Britain’s biggest independent fostering providers, the National Fostering Agency (NFA) was bought by one such company in 2006 and sold to another for £130m, tripling the original investment. Another fund made a 500% return in six years. Profits are maximised, says the piece, by concentrating residential units in parts of the country where property is cheaper. Rochdale, the scene of the recent child exploitation scandal, is cited as one example. Children in care are not only big business, they are an international commodity. Acorn Care is an investment for the pension fund of Canadian teachers.

In January the Telegraph reported that NFA made £3.5m profit in the last financial year. The previous year, a Deloitte’s survey revealed an annual profit growth of 35% as they came in at number 56 in the 100 most profitable private equity backed companies. Ironically, the Thunderer itself named them as ‘One To Watch’.

As ever with these things, the blanket statements unjustly tarnish the many private concerns who work hard on behalf of children and young people. The Times article (sheltering behind a paywall so no links, I’m afraid) unfairly juxtaposes the private equity information with the Rochdale scandal by puting them on the same page but there’s no demonstrable casual link between the two even if the children lived in a private residential home. Also, the piece leaves the reader blinking at some of the fees (one placement comes in at a cool £378,000 pa) but some of the most damaged young people need the most intensive, expert care.

It’s captured more attention this time round partly because it is in the Times, hardly a refuge of pinko mungbean scoffing sandal- wearing social work types but mainly because it neatly fits the zeitgeist. We accept, or are resigned to,  firms making profits and the people owning those companies making a lot of money but the fallout from the banking crisis has revealed just how wide the disparities can be. Whether it be Jimmy Carr’s tax avoidance or Bob Diamond’s payoff, we know it goes on but there are limits. I’m not entirely sure where they are but with the provision of private equity backed care for children, it feels as if we’ve reached them. Dig deeper and there’s something profound going on – big firms selling to even bigger companies, pension funds in Canada getting fat on cash from hard pressed local authorities reeling from the very cuts that venture capital in part helped to create.

It is questionable whether local authorities are receiving the best value from the majority of providers. How do they know what the unit offers, how that compares with what other places offer, how it best meets the needs of the child or young person and how do they monitor the effectiveness of the placement? In my experience, the commissioning process is often trial and error based on factors related less to a thorough evaluation of the myriad of services on offer and more to what has worked for other children in the past or the small ads in Community Care.

Once in placement, some (not all) residential establishments are virtually impenetrable to the outside observer. Notwithstanding the complexity of some of the work undertaken, there are many places where it’s hard to grasp how the methodology or philosophy is translated into practice in terms of meeting the child’s needs in their day-to-day life, let alone challenge it. That’s of course assuming that the social worker makes more than a cursory visit. From personal experience of many fostering and residential providers, it’s unusual for children to have any sort of meaningful relationship with their social worker.

We live in a mixed economy of care. Private companies can produce excellent care, there’s no question. But venture capitalists are active in the sector because it makes them money. That’s what they do. Often they buy undervalued companies, strip out the profitable assets, let the rest go to ruin, maximise profit and get out.

Venture capitalists exist for profit. This comes at two points in the process, at the point of sale and the costs of providing a service. The sole income source is cash-strapped local authority budgets that are being squeezed beyond breaking point. For the moment, it’s a seller’s market. Outweighing the pressure on authorities to cut costs is the increased demand for places as admissions to care soar at a time when there is already a shortage of foster carers and the local authority residential sector is virtually non-existent.

There are also opportunities to cut costs by limiting the services that are available. Low pay for residential workers has been the norm since I started in the sector 30 years ago. Foster carers are paid an allowance, not a fee, and no placement means no allowance and no outgoings for the company. It’s the extra services that can rack up the costs and eat into margins. Foster carers all value the support they receive from their provider but here’s a way to cut costs. Foster care is a more complex task than ever before. The providers I work with who are most focussed on children have a ratio of supervising social workers to carers of between 1 in 10 to 1 in 14. This of course is not enough in itself to guarantee a good service but it forms a foundation because the staff have the time to focus on the children and their carers, bearing in mind that actually they have a responsibility to both. Some providers, including NFA, have a ratio of around 1 in 22 to 1 in 24 and their staff work from home, thus greatly reducing the fixed costs of office space.

The next thing to do is to push as many services that the child needs onto local health and local authority services. If the provision of, say, psychological services is rationed or not provided at all, children wait for already over-burdened CAMHS provision. The same also applies to more prosaic but vital services like transport to and from school or contact, which these days can be several days a week or every day in the case of a baby involved in court proceedings. Exclude that from the cost of a placement and the local authority picks up the bill. Include it at premium to meet a shortfall in local authority provision and the company can’t lose.

This is not a hypothetical situation. It happens every day. No wonder the sector looks so attractive. These companies aren’t interested in the long-term, or children growing up as I prefer to think of it.

And if things get rough in the placement, the firms can always play their joker. When the going gets tough, the best carers stay rock solid and consistent, knowing that trust is established precisely at these moments of greatest challenge. As one young man once said to me, quite cheerfully, ‘I kicked off for three years, then I knew they [his carers] would stick with me so I calmed down.’ For the venture capitalists, why bother? Why bother supporting a placement that will need extra resources like time, skill and extra input when you can end the placement and move on to something cheaper, because those resources cost and more cost means less profit. Blame the child. Too challenging, unacceptable behaviour, on reflection it wasn’t the right match, we were just responding to the carers, – you name it, I’ve heard it. And so it’s another disruption because the placement was taken without proper consultation. Get them in and get them out again if it’s all too much. Ofsted don’t pick this up. The companies have legions of back office staff making sure the boxes are being ticked, and if there’s one thing that Ofsted likes more than a box, it’s a ticked box. Many inspectors can’t see beyond them and the system no longer encourages it. Blame the child – it’s the perfect businessplan.

The article quotes Kevin Williams from children’s charity TACT. I’ll leave you with his words because they are the perfect summing up:

“There is a moral question about making large sums of money from children who’ve suffered abuse and neglect. If they do profit from such children, can they demonstrate that they’re delivering the best possible outcomes for those children and not simply making money through efficiency savings, by increasing workloads and reducing training and support? I would question whether they can.”

June 7, 2012

It’s Not News That Fostering Is Under Pressure

Al Murray’s news-based Sunday radio show on 5Live has a running gag where the panellists read out prominent items from the past week that are not surprising in the least. After each, he adopts an urgent cod-announcer style and bellows, ‘Not News!’ Katy Price might have a new relationship, Big Brother contestant seeks publicity, Camilla’s wearing a hideous hat: you get the picture. Shout out the catchphrase after every paragraph in this piece. Fostering Fortnight, the biggest event in fostering calendar, finished recently and frankly, nothing’s happened. It works for me.

Fostering Fortnight is a series of events to celebrate fostering and foster carers. It presents a positive view of being a carer with the dual aims of valuing those who have already discovered their vocation and attracting new recruits to fill the growing shortage of foster homes. It’s run by the Fostering Network, a charity representing the interests of carers all over the United Kingdom. This year they’ve done an excellent job, with relevant and well-timed research attracting the media’s attention alongside the heart-warming human interest stories beloved by daytime TV, climaxing with a glittering reception proudly showcasing the achievements of children and young people in care.

Children’s Minister Tim Loughton made the keynote speech. Whilst he covered a considerable amount of ground, a couple of weeks on there’s no evidence that anything much has happened. Those of us waiting for a significant initiative from the government or at the very least some leadership to take us forward were sorely disappointed. He made some eminently sensible suggestions about improving day to practice, the level at which much can be accomplished as any regular reader of my blogs will know. Reminding authorities that they should delegate more decision-taking responsibility to foster carers (something Loughton has enthusiastically supported) will improve the lives of children and young people in care, giving them the same social opportunities as their peers. Criticising the risk averse climate in decision-making is music to my ears. A drive for employers to provide fostering leave is an excellent idea and the Department are working to ensure the benefits system, including housing benefit, does not discriminate against carers. We also have familiar favourites, the ‘streamlining’ of the assessment process and introducing greater ‘flexibility’ into the placement process cuddling up to old friends like ‘unnecessary and harmful bureaucracy.’

As I say, much of this is valuable. However, the expected and trailed ‘big announcement’ did not materialise. Normally that wouldn’t unduly bother me -it’s what carers and practitioners do that counts – but fostering is facing perhaps its biggest ever challenge over the next few years and it needed a helping hand from government. In its absence, I’m left only with confirmation that fostering remains the poor relation of the care system.

Adoption has dominated the government’s agenda over the past year or so, which I’ve covered in previous posts. Loughton acknowledged as much in his speech but failed to redress the balance. The examples he gave like the Foster Carers Charter have been around for a long time and the earth hasn’t moved.

Fostering is about the skilled preparation of children and young people for the future. This can be a return to their birth family and fostering itself as well as adoption. Many young people may not wish to be adopted and also evidence shows fostering provides a successful alternative in offering stable permanence and improved life-chances, yet the perception remains that the government (not necessarily Loughton himself) sees fostering as a sort of holding area, the lounge where you rest after passing through security and checking your baggage before rushing onto the plane, the means of reaching your destination.

There are powerful reasons why the government must give a strong lead. This debate takes place within a context of the growing numbers of children and young people being taken into care outstripping the supply of new foster places, especially ones where the complexity of children’s issues can be fully addressed. I advocate an ongoing government advertising campaign for foster carers along the lines of the long-running and successful initiative to recruit teachers. Current means and methods are not enough.

Then we have inertia within hard-pressed cash-strapped local authorities. I have every sympathy but the means of change has been there for some time without there being sufficient action. Take delegated authority. It’s the jargon for enabling carers to take day to day decisions for children and young people like whether they can have a sleepover, go on a school trip, see certain friends or take part in activities where a consent form is required. Normal parenting in other words. Ask any young person in care and they would say the need to call the social worker each and every time is the single biggest impediment to being like their peers. Backed by legislation that came into force in April 2011, the decision-taking authority should now be delegated by agreement to carers and the FN have produced a spot-on format to enable this.

Nothing is happening. Not quite true, of course, but the risk averse culture is so embedded in senior management that many authorities seem hell-bent on retaining responsibility for these decisions, regardless of the fact that children are unhappy, carers exasperated and under-valued and already busy social workers embroiled in tasks others could and should take from them. In fact, the welcome legislation is nevertheless not a radical departure from the guidance that existed before April 2011. It wasn’t implemented then because of the risk averse culture and nothing significant has altered.

Finally, I’ve come across an increasing number of examples from several authorities where the much vaunted ‘streamlining’ means assessments are being rushed and the ‘flexibility’ over placements means foster homes are more crowded than ever as age and placement criteria are being stretched to fulfil demand. This is a natural consequence of fewer resources caused by spending cuts and growing demand as the threshold for coming into care shifts.

It’s not news, however, that this does not contribute to better childcare. Children are given what is available, not what they need. Carers are pressurised to go beyond their areas of preference and expertise. Carers are great, they don’t want to say ‘no’, they want to help, but to do so they require support from us professionals, which is not the case if we take shoddy resource-driven placement decisions. Above all, children’s needs are not being met. Far from addressing the problems, I fear we are merely storing up worse for the future.

Follow

Get every new post delivered to your Inbox.

Join 7,910 other followers