Social work: political football

Yesterday the labour group in the scottish parliament sought to make political capital out of the death of a child. This is wearyingly common, and to be honest I am entirely sick of it. For example the BBC reports a scottish labour MSP as saying " "This independent report paints a shocking picture of failure and of staff in health and social work, including at senior management level, being unaware of proper process and untrained in their responsibilities." The headline of that report states that the serious case review identified 16 areas for improvement: and so it did. As is usual it focuses on more procedures and better communication: entirely missing the point that the former tends to undermine the latter. More importantly it omits the wider context which would enable people to better understand what is going on here. Once again there is an implication that if all of the "procedures" were perfect; and all of the staff implemented them perfectly, no child would die: which is not what the report says and not what it means, so I am not criticising the review itself: I am criticising the use made of it by these self serving politicians. The leader of the labour group in the scottish parliament raised this at questions for the first minister: and her sole purpose was to suggest that Mr Salmond was complacent about a child protection system which she characterised as rubbish. Her aim was nothing to do with child protection and it never is when this happens.

So I want to make a couple of points about this case. I have no direct knowledge of it: but I do know how departments work and I do know something of the historical background and development of this area of work.


1. There are already special steps which are taken when a woman known to abuse drugs or alcohol becomes pregnant, or has the care of young children. Services for substance abusers are woefully inadequate across the whole of Scotland: but when a substance abuser is pregnant or has responsibility for small children they do get some priority. Nonetheless the help is not really there: and the focus on those women is not perceived as helpful, for the most part, when child protection workers are involved: it is seen as policing. So it is. That is not actually what I came into this job to do: but it is the role I am increasingly forced into. The reason for that is that I have no power to access services on the basis of assessed need: they don't exist. Instead I am required to visit regularly and when things become worrying all I can really do is remove the child from the situation. People are not stupid: they know that. Yet in another part of the forest I am required to work in "partnership" with families. I do not mean to suggest that is impossible: but it must be obvious how difficult it is to wear these two hats.

2. The whole thrust of policy in recent years has been on "evidence based" practice. That does not just apply to social work: it is across the board of public service. One of the things which bedevils the whole idea is confusion about what that means. Are we talking about evidence meaning research findings? Or about evidence in the legal sense of what will stand in court? It is not clear. What is clear is that there is no good evidence of the sort normally understood as being based on research. There cannot be: because what is statistically true for a whole population does not, and cannot, help with the assessment of the individual. Doctors know this and have made a very clear distinction between what one can gain from epidemiology and what must, perforce, depend on clinical judgement. That is, a reasonable individual judgement about an individual's condition, based on the expertise which comes from training. Such judgements are sometimes wrong: that does not indicate systemic failure, nor does it indicate individual failure, by itself. When my doctor failed to identify that my shoulder was broken I accepted that he did his best and that mistakes will happen. Such pragmatism does not exist in social work: every death of a child is seen as preventable. That is just not true. It is absolutely true that the death of a child is more serious than a broken shoulder: but doctors also make mistakes which result in avoidable deaths: yet we do not see this hysteria in those cases either. Time the public, press, and politicians grew up.

3. If we take "evidence" to mean what will stand legally we face a number of problems. In the case under discussion a major focus was on the fact that the mother of the child did not engage with services: she missed a great many appointments and presented plausible excuses for doing so. Those appointments were primarily with health visitors and with drugs workers. It may not be obvious to those who read the press reports, but there is no requirement legally to keep such appointments. None at all. It is true that a person who is subject to a drug treatment order through the courts may be compelled to engage with the drugs services: but that is normally imposed because the person has been convicted of a criminal offence, and it is part of the sentence. There was no such order in place in this case. Since the mother was known to abuse heroin one might ask why there was no charge and no conviction. Presumably there was insufficient evidence to lead to that outcome: one can be convicted of a drugs offence because of possession; or intent to supply; or driving under the influence; etc. I do not know if the police have power to arrest and charge on the basis of reasonable suspicion that a person has heroin in their body: I have never heard of such a case and it is difficult to see how it could be done. Reasonable suspicion might do it: in practice it doesn't. Charges arise from objective evidence of an offence of the sort noted: there are strict rules about taking bodily samples, and in any case being under the influence of a drug does not, of itself, constitute a crime, so far as I know. maybe that should change: but only for pregnant women? Or do we wish to extend surveillance to the extent that implies? There are obvious problems with either approach.

4. GOPR
www.scotland.gov.uk/Publications/2003/02/16469/18716

is not an unreasonable document, just so long as you completely ignore resources. In fact it is really quite in keeping with standards of practice I take pretty much for granted. Unfortunately the aspiration is impossible because of the pressure on all of the professionals involved in this work: and the cuts we have been experiencing do not help. Morale amongst social workers in Scotland is said to be better than that in the uk as a whole: and I well believe that. I do honestly think that our system is better, on the whole. Unfortunately there is some push to change it more in the direction of the english system: I would regret that, and I hope it will be resisted. But even at present morale is low: there is widespread distrust of management and deep frustration with the paperwork as well as the computer systems and the physical working conditions. Work loads have risen to the extent that it is impossible, in most places, to meet the demands. The service to the group under discussion here is not worse than the service to other groups, IMO. To provide the quite obvious level of support/policing which GOPR envisages is just not realistic.

Let me put some numbers on that, from the document itself. In the year 2001/2 10,798 people with drug problems made contact with services and were entered on the database. A third of those people were women and 19% of the total were living with dependent children. There is no information about how many of that 19% were women: it is not unreasonable to suppose that they represent the majority but let us assume that men and women are represented in that group the same way as they are in the total. In that case there are about 700 new referrals of women with responsibility for children. Information specifically related to neonates is available: in 2000/2001 there were 228 cases where the mother had a diagnosis of drug misuse: and, curiously, there were 326 newborns discharged where there was the same diagnosis in the same year.These mothers must give birth to a lot of twins, presumably.

Although alcohol is the bigger problem in this country there are no national statistics of the sort kept for drug misuse. Nevertheless the document reports that 26% of all women drank more than twice the benchmark safe level on their heaviest drinking day in the year 2000. The proportion of women aged 16-44 drinking more than the recommended weekly limit stood at 15% in the year 1998. No more recent figures are provided.

These are clearly figures for those who have been identified, and therefore are very likely to be a serious underestimate of the scale of the problem.

Research in particular areas is also referred to and the report states that it is estimated that between 120,000 and 160,000 children are adversely affected by parental substance misuse in Scotland: and every single one of them is at risk of neglect or worse.

In 2009 there was a record number of social workers in Scotland: 5,235 full time equivalent staff. That was an increase of 35% over what there was a decade earlier. The announcement of this improvement said nothing about the amount of time which is devoted to paperwork, nor anything about how that had changed in the same period: but it is well known in another part of the forest that that has significantly increased. There is no information about how many of those social workers work in children and families' teams: the figure includes all qualified social workers and therefore covers those who work in adult care; the voluntary and private sector; specialist teams for disabled clients; hospital based workers; criminal justice workers; and many other areas. In 2003 16% of total social work staff provided services for children: but there is no information available for qualified social workers alone. Nonetheless it is obvious that the proportion for all staff must bear some relation to the numbers of qualified staff, I suggest. It is likely that the numbers in residential care of the elderly are high within the numbers for adult care: and so I am prepared to be generous and assume that 32% of qualified social workers work in children's services. Say 1675 for the whole of scotland. There is an average of about 5% vacancies. Those social workers have to provide services to children in foster care and in local authority care; they have to find and assess prospective adopters; they must deal with children who are committing offences and children who are disabled (though in some authorities these are dealt with through separate teams, that is not universally true); they must deal with all reports of child abuse and neglect from whatever source. And they have to do this in 32 different local authorities of very different size and geographic composition. I trust you see the problem?

No more time: will continue later

Edited by FionaK - 21/5/2012, 10:24

5. In 2000/2001 there were 51,165 babies born in Scotland. Health visitors and midwives are universal services. For the first 10 days after birth the midwife is responsible for visiting the mother and child at home: and then the health visitor takes over, until the child goes to school

In 2009 the health select committee had this to say:


Unite ( the biggest union in this field) conducted a survey which showed that the number of whole time equivalent health visitors fell by an average of 13.5% between 2004 and 2008. In 2008 40% of health visitors reported that they had responsibility for more than 500 children. 69.2% said they did not have the capacity to respond to the needs of the most vulnerable children.

http://www.unitetheunion.org/pdf/The%20Cri...g%202009-05.pdf

I work very closely with health visitors and the relationship is usually good. They, too, have a range of responsibilities and they tell me that they also have to make very difficult decisions about priorities simply because of the pressure of work. They are responsible for immunising every child; for routine health checks at fixed intervals for every child; and for monitoring and supporting the health of young children in the community as a front line service. They are also part of any team around a child identified as being at risk.

Health visitors are more demoralised than any other group of workers in the health service, according to a report from the Royal College of Nursing. Like many public services they have undergone a huge amount of reorganisation, none of which has produced a better service. As with social work, they get more responsibilities and fewer resources: and more paperwork. This is a profession in crisi,s which a quick google will easily demonstrate.

In the review under discussion much of the criticism revolved around the health visitor. Again there is nothing wrong with the remarks if you completely ignore the actual situation. But the fact is that they have to make judgements about where to concentrate their efforts. The report makes sense if you consider the situation of this mother as very unusual, and the "risk indicators" as rare and certain: they are not, as the GOPR figures for substance misuse amply demonstrate. What is in play here is a logical fallacy which is not immediately obvious, perhaps. There is no consideration at all of the numbers of people with very similar profiles who do NOT go on to kill their child. But all of us who work in this field know many. I suspect that for the general public the profile presented looks shocking and unusual; and they find it hard to understand how professionals could miss such indicators: but it is our daily diet. The outcomes for children who live in such circumstances are not good, and all of us would like to intervene in every such case. There is not the resource to do it and there is not the legal backing either.

6. Let us now look at the failures in procedure which were identified.

a) the mother in this case was correctly identified as someone who presented some risks, and was therefore subject to the procedures in place for substance abusing mother- to -be.

b)In those circumstances there should be an initial meeting; that happened. The health visitor was not invited to that meeting. That is noted in the report, though the significance of the omission is not immediately obvious to me. The health visitor is not involved with a family until 10 days after birth: the midwife is. So long as the midwife was there she would have any information available: and should pass it on at handover. The health visitor was invited to the post birth meeting. There is no clear reason why that is not acceptable: it is not in line with procedure, to be sure. But the fact is that procedures are there to make sure that if there is a problem it is always possible to blame the staff: or so it often seems. Think about your own work: do you always follow procedure to the letter? Or do you sometimes do things in a rather more practical way? I seem to remember that when staff "work to rule" things grind to a halt: and the public and management are outraged: but of course that is in another part of the forest.

The initial meeting did its job. It was noted that the mother was known to misuse drugs and she had a history of not cooperating with voluntary services: she was homeless with little family support and she did not prepare properly for the birth. She was evasive about her drug use (that is not unusual; drug use is illegal: and even if the problem is alcohol misuse there is a tendency to be evasive on account of the fact that people assume we are likely to take their children away from them, if they are honest: a risk very few will run). But the basic problems were identified and all the services were aware of them

b. There should be a pre-birth meeting. That also happened, and again the health visitor was not invited. Another omission happened at this stage: there was no "Parental Substance Abuse Report" available to the meeting. Again a failure to follow procedure. But this is a piece of paper. The drugs workers involved with the mother were at the meeting. Their assessment was therefore available to it: even though no piece of paper was on the table. I fully accept that written documentation has a value: but I also know that every one of us is drowning in paper and every hour spent writing reports is an hour not spent with families. Bits of paper do very little in the scheme of things: and sometimes they get in the way of actual cooperation. I have no idea whether that is true in this case: but the report does not address that question: there was no piece of paper and so there was a failing. That is true: whether it is trivial is another question.

c. There was a post birth meeting too, and the health visitor was invited to that. That meeting produced a "care plan" described as "sketchy" and it did not set a formal review date. These, too, are failures, according to the report. But let us look at that a little more closely.

It is absolutely true that the risk indicators noted at the first meeting were known: and it is also true that by the time of the post birth meeting many of them had been addressed. Look at the list outlined above:

i. Mother was homeless:: by the time of the post birth meeting she had been allocated a temporary tenancy: but she did not want to move into it and instead went to live with her parents
ii. She had little family support: see above
iii. She had avoided contact with ante-natal services: by the time of the post birth meeting she was regulary seeing the health visitor and keeping appointments with the drugs service
iv. she had not made preparation for the coming baby : by the time the baby was born she had all she needed
v. she did not display any understanding of the needs of a new-born baby : staff who were working with her observed that she was a loving mother who cared for the child well. Bear in mind this was her first child: many young mothers do not talk well before the birth yet rise to the responsibility when the child comes.

This is the problem with "evidence based practice": it forces you to be factual. A moment's reflection shows that if you set out specific risks in this way you cannot then move the goal posts. The fact is that this kind of practice is counter productive. You know, and I know, that the report is correct in saying that all of these changes were insufficient because they were very new and flew in the face of the history: but that is not how evidence based decision making works: when you reduce things to a set of objective facts then when those facts change you must make your decision on the basis of that. It is one of the things which makes my job more difficult: I may have a view that this is not safe: but I can't prove it. Evidence based practice means that that knowledge and experience carry no weight at all. I find that hard but it is what we are told to do: then they cut up rough if we do it and things go tragically wrong.

7. The baby was born in April. According to the report the mother got badly drunk, once, in June. There is no indication that the baby came to any harm and at this point the mother was living with her parents. She had a history of drug and alcohol misuse: lapses are not uncommon and on the whole her care of the child was good. The report consders that should have been a trigger for re-assessing the situation: but the incident was known and was recorded. Those who are involved at the time obviously did consider the implications: they took the view it was not of itself a reason to question her care in general. The report seeks to suggest that it was ignored but it obviously wasn't: hindsight is a wonderful thing but, again, this ignores the fact that almost all substance misusers lapse: are we to presume that every such episode is grounds for radical action, when on the whole things seem to be going welll? There is not enough information in the report to say what actually happened: I have faced that situation many times. The fact of an episode of drunkeness does not tell me very much: if the baby is in the care of gran, or a responsible baby sitter, for example, I do not see I am in a position to intervene: not unless all mothers are to live lives commensurate with being in closed order of nuns. I will put my hands up: I have myself put in place care plans which involved regular care for a child by a relative precisely so that a young mother can go out on the lash once a week. I think that is a pragmatic approach which keeps everybody safe by acknowledging what is going to happen anyway. It is a bit like sex education: it doesn't work to say to young people just don't do it: it is far better to make sure they have contraception. Or so I think. The "myth of motherhood" is a profoundly sentimental and destructive force in our society: yet I don't see much else here.

8. The case was open till August: and apart from that one episode it was going well. So the social work department closed it. As the report notes the closure summary says that the GOPR assessment had been completed (including the precious piece of paper omitted earlier) and "no child care concerns were noted" That is also the objective fact which arises from the way this work is now done. Let me explain that a bit. In the past when I made an assessment I wrote a narrative report starting with a blank sheet of paper. This allowed me to include the concens I might have which were not directly related to the current facts. The form it took was useful because it started with as complete a history as I could discover, and therefore patterns emerged of the sort which were crucial in this case. That is not to say there was no "evidence": I always try to back up my conclusions with "evidence" though that "evidence" might be historic. But if you focus on the kinds of things identified at the meetings now required; and fill in the paperwork as it is set out, there is very little place for that kind of thing. Current paper work places the emphasis elsewhere, as a quick look at the check list at Appendix II of GOPR shows.

www.scotland.gov.uk/Publications/2003/02/16469/18715

This mother passed all of the checks contained in that "good practice guide". But when it comes to tragedy that does not matter. Of course it doesn't. They have almost nothing to do with a case like this: they are too specific and too time limited. Despite what government bean counters think they are of very little help. But as noted, we must prioritise and the case was open for several months during all of which time, on these objective tests, there was no obvious problem. We cannot keep cases open forever: but I no longer have the autonomy to act on my experience: I need to "evidence" my recommendation in these terms: I could not have done it in this case.

9. So far as the child care part of social work was concerned that was the end of the matter: there was no further involvement, though there should have been. Attention now shifts to the health visitor and the drugs service.

Which I will come to

One of the omissions which is recorded in the review is that there was no inter-disciplinary meeting before the decision to close the case to social work was taken. Again that is against procedure: but it does not mean that the workers involved were not talking to each other. Nobody was expressing serious concerns, at least as I read the review. The social worker saw mother and baby at the baby's grandparents house and all was well: the baby was growing as expected and routine health checks had been carried out. The only actual incident referred to in the report, was the incident in June.

From August the family support worker continues to be involved. Note the name: a family support worker is a unqualified worker who is there to support families who are in need of help in caring for their children. This is often an enormously helpful role: family support workers cannot take your children off you: so they are seen as more helpful than social workers often. But there is this: involvement with them is entirely voluntary. Some people just don't want folk interfering in their lives, and they have a perfect right to refuse to engage with such a service. In this case both the family support worker and the drugs worker had difficulty in making contact with the baby's mother.

One thing that is often a feature is that people find involvement with such workers stigmatising. That is much less usual when you are talking about universal services such as GP's and Health visitors: because everybody sees them. It is also true that those who misuse drugs or alcohol often have quite chaotic lives, and are not reliable in keeping appointments. The mother gave plausible explanations for not keeping appointments. This lack of engagement is made much of in the review; but again, it is easy with hindsight. If people do not see any value in engaging with a voluntary service why on earth should they? It is a difficult position for these workers: they have the services they have and people have a choice. Yet when they exercise that choice it seems the review expects workers to take that as evidence that they should take action. I mentioned above that we are to work "in partnership" with people: so long as they do what they are told, apparently: by workers who are in a support role, offered as a service and entirely voluntary.

It is arguable that the engagement should not be voluntary: but at this stage what grounds have there been for any compulsion be imposed? In Scotland we have a fairly flexible system, compared to that which exists in England: but we still have to have grounds for statutory intervention. The grounds of referral to a children's hearing are fairly clear and are contained in the Children (Scotland) Act 1995. The only possible ground is S 52 (2 (c) which says that the child:


What evidence is there for that? At the point the case was closed to social work the majority of the objective causes for concern were gone. So as far as I can see there is no possibility of formal measures at that point. Thereafter the support workers are not getting in to see the mother and baby. But she is going to the clinic because she is on a methadone programme and will not get her script if she does not. She is still seeing the health visitor, so far as I can tell from the review. Babies get checks at 14 days, and at between 6 and 8 weeks: they get immunisations at 8 weeks, 3 months and 4 months:and they get a full review before they are a year old. All of those checks are done. The review also notes that the Health Visitor visits monthly, though there was no visit in October and none planned, apparently. It is true that the health visitor did not succeed in seeing mother and baby in November, as planned, and that the next visit also fails on 3rd December: But the baby is seen by the GP on 11th December and nothing of concern is noted.

It is quite a stretch to make a successful referral to child protection social workers in these circumstances. The review makes much of the fact that risk factors are not mentioned in the health visitor's records: so what? Again there is a touching reliance on paper: what are workers expected to do? Write down that this is a single mother with a history of substance misuse every time they visit? How will that help?

The review notes again that the risk factors are not mentioned when the health visitor does the "wider world" assessment in July. This is what that assessment looks like (though this particular example is from Lanarkshire, they are all much the same)

http://www.girfecinlanarkshire.co.uk/girfe...20Part%20II.pdf

Those facts should have been entered, obviously. It keeps the paperwork tidy. What else does it do? I have absolutely no idea. In my experience it sits on a file. In this case it would not have told them anything not already known. And the situation did appear to be improving. But this is the kind of thing which is to be done on the basis of the leading strategy for children in Scotland: which is called "Getting it right for every child" Imagine doing that for a case load of 500 children: when would you ever get out of the office?

In December the mother is referred to a different service called Family Matters, and they take over from the drugs workers in January 2009. One of the things which is well recognised is that continuity is helpful and that families value it. But by now this mother and child are on to their 2rd health visitor and their second drugs service. It is true that Family Matters have been involved in supplying the methadone: but that is quite a different kind of service from a family role. Despite the name, the service offered in this case was support for mother's detox, so the focus was largely on her. That meant that no social worker was involved, and that is quite usual for that service.Their remit is described as


Once again there is an immediate problem. At the outset, for this service, there is normally a meeting involving staff from Family Matters; the referrer; and the client. The aim is to sign a "Support Agreement". In this case the mother did not turn up for the meeting; so this piece of paper is not completed until April. It is clear from the outset that the mother does not want to engage with this service because she avoids mich contact with them. The allocated worker sees her but not the baby, and she therefore asks the health visitor, in February, to see the child, and she does. Mother and baby are fine.

One significance of this is that it is clear evidence that the professionals were communicating and cooperating. But that positive is not really emphasised in the review: it prefers to focus on the pieces of paper. For myself I would probably have piggy backed on the health visitor's visit: sometimes if you are being avoided it helps if a known worker introduces you, and that can make a difference. Doesn't always work, and I have no idea what other priorities might have been in play. I am a children and families worker so that is natural to me: but this person was a drugs worker and at this point had no reason to be particularly concerned about the baby. In any case the review notes that the Family Matters worker accompanied the mother to the GP on 6th March, and that the health visitor had seen mother and child on that date.

Both the health visitor and the drugs worker seem to me to have done a good job. The drugs worker, in particular, starts to be concerned about mother's possible alcohol abuse and she reports this to the GP and the health visitor in March. At this point the health visitor is about to move to another job, and this is concerning because she is the only person regularly seeing this child.

Throughout April the mother does not make herself available to the drugs worker and this is duly reported to her supervisor: they decide to try unplanned visits but these are not successful either. The review notes that a referral should have been made to the children and families social work team at this point: this is based on the GOPR guidlines: which were not in play. Nevertheless the safeguard of regular contact with the health visitor was not now in place and nobody was seeing this child. The review takes the view that there was by now clear evidence of risk: I don't see it myself: I think that is more hindisght. But it is open to debate. From my point of view there was growing concern and a lot of reasonable actions taken given what was known at the time.

Two staff from Family Matters do make contact towards the end of April: and this visit gives the first concrete evidence of risk, that I can see. The condition of the house had deteriorated and the child was unresponsive. Once again they ask a Health visitor to call: but the only health visitor available is the one who left: and now she only works on Fridays in that practice. She asks the mother to bring the child to the clinic, but she does not do that and there is no further record of health visitor action until August. Not surprising since the child is not actually anyone's responsibility in health visiting terms by now.

Family matters staff continue to work with the mother as best they can in the circumstances but they do not see the child: by August mother is off methadone and this is the point that service normally withdraws. The case can be transferred to the social work children and families team if either there are statutory measures in place; there are child protection procedures in place; or if she agrees The baby's mother made it plain she did not want a referral to social work services for further support, and the case was therefore closed in the absence of either of the other two conditions.

It should be noted that the health visitor who knew them had left: and the senior social worker at Family Matters had also now left: this may well have contributed to the fact that the case was closed without further review. The allocated drugs worker telephoned the new health visitor who was in post by august. She advised they were closing the case and asked the third health visitor to monitor the baby. This does not go at all well and the upshot is that there is no agreement between them: once again the importance of continuity is seen: and that is also a resourcing problem, not an individual failing.

The third health visitor took up her post on 3rd August. Despite the difficult exchange noted above she did attempt to visit twice that month without success: and in September a neighbour told her that the family were staying with the mother's parents (she had moved into her own tenancy the previous September).Further failed appointments are noted and there are telephone contacts during which mother explains that she has been staying with her father in England. Turns out neither of those are true: but that does not emerge until much later, after the child is dead.

The health visitor eventually contacts the social work team the following March.They make two failed visits and decide to close the case. Grandparents then find the baby dead on 30th March: and he has been dead for a long time

In face of all this there are a number of recommendations made by the review: I will consider those tomorrow.

The recommendations are these:


Fair enough. This might address a problem in some other case. But in this case the mother's substance misuse was known to the maternity services from the outset: that is why she was being dealt with through the "Special Needs in Pregnancy" (SNIPS) team. She did not engage with those services during the early months of her pregnancy: but a pro-forma referral sheet would not have made any difference to that at all. As soon as the SNIPS team did manage to engage her they referred her to the drug service, who instituted a methadone programme and an associated support programme. A referral form would not have made any difference to this at all, so far as I can see.


This is odd. The review notes that there is a difficult interface between the GOPR procedure and the Child Protection procedure: so there is. This recommendation essentially means that there should be two sets of meetings in every case: yet it is at odds with the clear recognition that


( From the National Guidance for Child Protection in Scotland)

A Child Protection Case Conference is described in the National Guidance


That is also what GOPR meetings are for. The same people attend both meetings: they consider the same information: is it likely they would have reached a different conclusion? Perhaps it is. But they did decide that child protection action was not required. The review assumes that an initial child protection conference would have judged the same information differently, and I do not see the logic in that. The justification in the review is that a child protection case conference would have raised the profile of this child. It recognises that there may well have been a decision not to register, yet asserts it would have "almost certainly" led to the ongoing involvement of a social worker and a "process of reassessment and review". If the conference decided that there was not sufficient risk to formally register I do not see why that follows. In fact I think it is very unlikely indeed. Nor do I see all these "risk factors" they keep asserting were present. Substance misuse, as is repeatedly asserted in GOPR and the other government document,s does not of itself guarantee harm. It follows that it is a possible outcome of an Initial CP conference that there is no need for intervention: or that the intervention should not be under the auspices of child protection, but rather in the form of a support plan: that is what we got

So what this recommendation means is either that we abandon the GOPR process altogether: or we run both processes simultaneously: two meetings; two sets of reports; two minutes; two plans. How will that help?

'
I have partially covered this in an earlier post: but there is an underlying point to this. In terms of the support for families the fact that the midwife is there should be enough to ensure information from the meeting is passed on to the health visitor when she takes over: but the omission for the meeting is the information held by the GP and which may be very relevant. GP's refuse to attend any multi agency meetings simply on the basis that they have the professional status to do that: they don't go to CP conferences either. Since nobody will take them on, the work around is to have the HV there instead, in the hope that she can pass on the medical information. So I do not object to that recommendation. The more information the better


That is all predicated on the meeting taking the view that there is high risk and that the plan is required to mitigate that risk. It is not a bad idea where that is the conclusion: but it doesn't apply in this case. I reiterate: there was no obligation on this mother to cooperate with any service: making rules you can't enforce is not usually a good idea. It was the view of the meeting that the actual risk was not demonstrated. This is the nonsense of risk assessment as a concept. I will say more about that later


Again, not a bad idea: but in this case the child was seen, at least in the first year of his life. No concerns were noted. So that would not have helped either. The fact is that the person who had been seeing the child, and who is the natural person to do that, was the Health Visitor: she left around the time the child was a year old and was not replaced till August. A protocol won't help if nobody is trying to see the child: it is true that the worker from Family Matters was concerned, and there is scope for a protocol to have helped there.


Fair enough: but it was closed under GOPR in August 2008 and at that time any review would have been informed that the child had been seen and that all was going well. Mother was sticking to her methadone programme and the child was progressing as he should. Can't see how that would help. Again there is the assertion that there were clear indications of risk: but I don't see them. The only thing speficied in the review is the one incident of alcohol misuse in June: I do not think it is unreasonable to place that in the context of what has actually been observed wrt the child's development and the care and interaction between mother and child which was reported to be good by both Health Visitor and Social Worker. That is what "evidence based" practice is supposed to be about. On this reasoning one should ignore all positives and act only on a single negative: yet we are told (again in all the documentation and guidance from the scottish government) that we should balance the two, because it leads to false conclusions if you only look at one side: and that seems right to me.


More bits of paper. If all reports are top priority none of them are: that is why Child Protection reports are treated differently in this respect. But hey, why not make everything of equal importance: it is not like we are short of time or anything. In this case the Full Assessment report was late: and it didn't come to any different conclusion than the meeting reached when it did arrive.


Information about what was contained in the medical records in this cases is redacted: so Ihave no idea how important it might have been. I suspect not very. The Health Visitor would have that information, so although it would not have been available for the first meetings it was available to the post birth meeting: it made no difference at all. It is possible that inclusion of that information at an early stage might have changed the developing view of the situation: but if it was that significant I think it likely it would have had an impact when it was presented at the post birth conference. Might be wrong


More paper and more time not doing your job: but fair enough. Training is always good, arguably.


This is based on the problem which arose when Family Matters closed the case and asked the Health Visitor to monitor the baby. There was miscommunication perhaps: not sure about that. What the review says is that the Health Visitor took the view that if the worker felt there was risk then this request was not appropriate and that referral to social work was the right way forward: I think she was right. If they did not think there was risk then the usual pattern of visit would be sufficient and therefore the request made no sense. This is a sledge hammer to crack the wrong nut. But there is nothing intrinsically wrong with it as an idea: why not?


So in a service where there are not enough staff and where someone leaves in May and is not replaced until August, they are going to find resource to allow "shadowing" when a new staff member arrives? when they are already covering a huge number of cases including the cases of absent staff? Dream on ..ll. Note how the management failure to provide adequate resource is nothing to do with any of this: it is all the fault of the workers and their obstinate ignorance.


This is just an insult combined with "all the better to know who to blame". If there is no-one to hand over to you cannot date the handover. Sheesh! Health visitors in my experience keep very good records: but like social workers they would keep better records if they had the time: if you do it properly you will never see any families: and will be pilloried for it: if you don't you will be pilloried for that. An example from my own work: recently I left a job. The manager and I agreed it was time to part: on Friday afternoon at 2:45 which is when she scheduled the meeting. She asked me if I wished to leave that day. Since I neeeded to write handover summaries I said no: it did not appear to have occurred to her that was important. Matter of priorities. They shift a lot


Translation: less autonomy and more managers. Don't know if they realise this but the NHS is cutting back room staff in favour of front line workers: or so they say. But yes, lets have more managers, even if there is no evidence at all that would have changed the situation in this case. I think this one is "off the shelf" and included in every such review.


Same again. Don't know if this group of staff see any value in that at all: it is a fairly isolating job. The review does not say if they are asking for this: though it is a central principle, eg in working with clients, that their views should be sought and recorded. But don't do as I do....


No idea if they are not familiar: don't see what difference it could have made in this case, either. There is nothing in the review suggesting that the GP did not carry out their function. But it may be there was a failure somewhere: bound to be given a GP is a member or staff, even if a high status one


This is because all hospital based staff deal with ill people mostly: the vast majority of social workers in that setting are involved with care of the elderly and so the management structure reflects that. This might be a good idea or it might not: again I would like to hear from the staff involved before making a judgment.

That is all of the recommendations: and I do not think they would have made a bit of difference. I will say why but have no more time at present

Edited by Vninect - 22/5/2012, 15:39