Social work: political football

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?

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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