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
