Abstract
When a student many years ago I was given the job of serving drinks at a reception for a world famous scientist. In this scholarly gathering, I kept a low profile but at one point found myself topping up the glass of the great man himself. To my surprise he was utterly charming and asked me what I did. When I said social sciences, I expected a speedy rebuff but at that time there were concerns about the moral implications of new discoveries by scientists left to their own devices ‒ nuclear weapons, chemical warfare, etc. To my surprise, he acknowledged these worries and admitted being terrified that his research might be grotesquely misused. He added, ‘Scientists aren’t very good at social things. When they grow old, they often become right wing or religious; it’s the search for order you know’, at which point his hosts whisked him away to more prestigious company.
This observation has stayed with me and now that I am old myself, a bit of self-questioning seems appropriate as each day I hear about crises in the social care system. Christmas joy was tarnished by Gordon Brown’s distress that he ‘never thought he would see child poverty again in his lifetime’. Then, early into the New Year, we learned that as the number of children looked after in England continues to rise (by 12% between March 2012 and March 2018), most local authorities (88%) are struggling to cope. Shortly afterwards, The Fostering Network warned that variations in support for carers were leading to compassion fatigue, trauma and resignations and a week later, government figures revealed how looked after children in Birmingham had a disproportionately high rate (5%) of cautions or convictions for criminal offences. 1 And all of this reinforced the alarm bells sounded last year by Baginski and colleagues, Neary and Owens and the Care Crisis Review. 2
It is difficult to know whether things are really getting worse or are as bad as portrayed because those making these claims might have other agendas. Often the local scene is encouraging with deeply committed people doing all they can for the children in their charge, but this does not necessarily mean that all is well with the wider system. The children’s departments I first encountered in the 1960s had dozens of devoted practitioners and passionate reformers but services were poor by modern standards. What are we to make of these gloomy messages?
It is inevitable that older people will feel that the world they knew is disappearing and that ‘everything seems to be collapsing’. So reports that things have got worse are subconsciously reassuring. But without more detail, it is difficult to interpret what the evidence actually means. For example, what is the comparison with a few years ago when there was more money about or the days of my childhood when children were beaten, institutionalised and died from polio? And what about the good news? The teenage pregnancy rate, seen by some as an indicator of the nation’s moral state, is at a record low and the number of deaths of 0‒15-year-olds in road accidents has fallen by 60% over the last ten years. Indeed, it is possible to enact a pantomime sketch with cheers and boos for each statement. For example, does the increase in care admissions mean that more children are being moved from abuse to safety (cheers) or does it reflect the collapse of preventive services, necessitating more extreme measures that can break up families and wreck childhoods (boos)? Does reduced support for foster carers mean that they are becoming more capable (cheers) or that they are being left to cope (boos)? Does the higher rate of offending mean that young miscreants are benefiting from a touch of welfare (cheers) or that they are impaired because they are looked after (boos)?
While it is easy to cast doubt, I have to admit that I do feel that UK society is struggling at the moment due to a combination of factors, most of which are beyond the remit of this journal. There does seem to be a real crisis in every public service and an increase in problematic behaviour and social problems, all leading to widespread malaise, uncertainty about the future and deteriorating mood ‒ and no one seems to have a quick solution. One option is to support the Nobel Laureate’s peers in their ‘search for order’ but I guess journal readers would prefer something more moderate: a transformation that unites people’s social concerns, enhances the welfare state and creates a fairer society. But the problem is that in these broader debates the cheers and boos are likely to muddle as responses will reflect people’s wider political and social beliefs which, it has to be said, are fairly disparate at present.
All of this raises the famous question posed by Beethoven on the score of his last string quartet: Must it be? While philosophers have spent 200 years arguing about what he meant, for children’s services the answer is simple – ‘no’. As John Simmonds writes in the Coram-BAAF response to The Fostering Network’s State of the Nation Report, ‘The consequences should not be beyond the bounds of human endeavour to design and deliver a fostering system that resolves these issues. They are neither new nor do we lack research evidence. And we currently spend a very large amount of money on the system.’ 3
So how do we go about doing this? One method is top-down reform: this takes what is there, tweaks it to accommodate new problems, modifies the legislation, adds a few extras and refigures the balance between different types of providers. But it means forcing individuals into existing systems which may not be fit for purpose and may well creak. So, building from the bottom seems a better approach although the task is enormous. A short editorial cannot do more than outline a possible process.
The initial requirement is to establish a moral baseline. A good starting point is rights and, here, the 1989 United Nation Convention on the Rights of the Child establishes what under-18s should expect in terms of civil, political, economic, social, health and cultural rights. The exercise can then move on to the principles that underpin practice and in England, the Children Act 1989 effectively links these and provides clear definitions of the fundamental concepts. More extensive applications of these ideas appeared in the 2003 publication, Every Child Matters, which specifies that every child, whatever their background or circumstances, should have the support they need to stay safe, be healthy, enjoy and achieve, make a positive contribution and achieve economic well-being. 4
Once rights and principles are agreed, attention can turn to the services themselves. I would suggest that their essential structural features include: serving all children in need and not just the poor; a balance between prevention, early intervention, treatment and social prevention; and interventions that demonstrably improve the quality of life and prevent impairment and social exclusion rather than rely on process and outputs. In terms of characteristics, they would be needs led as opposed to service led, evidence based and outcomes focused, with clear thresholds for receiving services, and based on a single process leading to a continuum of interventions. In addition, there would be practical support to complement procedures, greater use of national and local evidence bases and services designed with users rather than for them. All of this would be supported by an integrated team approach.
Once this framework is in place, the specific details of the services and the range required can be charted. One way of doing this is to begin by identifying the needs of children perceived as requiring help, cluster their needs into distinct groups, agree the outcomes desired for each of these, design services most likely to achieve them and set up the support structures to make them work. 5 The advantages of this approach are that it indicates what people need to do, and why, and views administrative issues like organisation and training as facilitators rather than as ends in themselves.
But the child care world is fast changing and each month agencies are faced with new problems and escalating old ones. Two recent publications are helpful in keeping the focus on the current national and international situation. The first is ‘The future of children’s social work’, a special edition of the Journal of Children's Services edited by David Shemmings and Michael Little (2017), which comprises 25 contributions by distinguished authors indicating ways forward for child care policy and practice. Among the topics discussed are refocusing, training, recruitment, supervision, co-operation, outcomes, safeguarding, system reform and making social work more relational and people focused.
Then in February this year came Chris Hanvey’s book Shaping Children’s Services. It is based on his experience in local authorities, leading charities and a Royal College and is reviewed in this edition by Tim Hobbs. 6 Hanvey draws upon European-wide data to argue that the current system in the UK is insufficiently joined up and a radical new model of co-located services for the integrated delivery of children’s care is needed. As situations differ across communities, he proposes that each locality should have a multi-disciplinary children’s services team and explains how they should be organised to produce maximum effect.
But confounding all these good intentions is the perennial spectre of economic reality. A decade of austerity in the UK means that there are simply not enough resources to do everything needed, and this is likely to remain the case for the foreseeable future. So there will almost certainly be a growing emphasis on identifying and applying interventions likely to produce maximum effect and deciding who should receive them. This process has been well developed by the National Institute for Clinical Excellence (NICE) for approving new NHS treatments and, although there is unease about applying these methods to child welfare, it seems inevitable that they will infiltrate services as demand increasingly outruns resources.
I do not know whether these ideas will ease or compound John Simmonds’s frustration but they seek to offer a ‘kindly light amid the encircling gloom’. 7