Letwin attacks ‘desperately patronising’ view of social care users

On Wednesday I was delighted to be present when Oliver Letwin rubbished the notion that many users of social care are ‘incapable of making decisions about their own lives’. The Minister of State for Policy was responding to a question from an audience member following his talk on the Open Public Services White Paper. It is ‘desperately patronising and utterly wrong’ to diminish people’s capacities in this way, he said. Not that I have found mention of this among the largely negative reaction to his proposals for reforming public services. Which is a shame because it is rare you hear such an uncompromising and impassioned defence of people’s personal freedoms.

You might not be surprised to hear that I’m sympathetic with what Letwin had to say. I wrote Social Care for Free Citizens for the civil liberties group, the Manifesto Club. I’m also a member of the Personalisation Group to Revolutionise Social Care, a loose collective of social care professionals who think more can be done to really put social care users in control of their own care, and ultimately of their own lives. And the policy makers, to be fair, seem to agree with us. The Department of Health has recently published a Consultation on proposed changes to regulations for Care Quality Commission registration. Included is the proposed removal of the requirement that only CQC-licensed home care may be purchased. The ‘financial costs and the additional bureaucracy’, DH say, ‘outweighs the assurance of safety provided by regulation’. In response, a self-appointed defender of ‘vulnerable’ adults has raised the prospect of ‘perpetrators who will be willing and able to do some caring if it gets them near vulnerable adults or children‘. The vast majority of social care users – mostly older people – have undiminished mental capacity and are more than capable, with a little support, of living independent and fulfilling lives. In a society with an exaggerated sense of the prevalence of abuse, and of the vulnerability of fully grown adults, statements like this can only contribute to a limiting of the choices open to people who use social care.

The spectre of abuse should not be allowed to deny adults their autonomy or to close down debate about improving social care. As the coalition’s Vision for social care says, ‘risk is no longer an excuse to limit people’s freedom’. Which is why I am also nervous about the implications of local authorities issuing smart cards. Instead of personal budgets taking the form of direct payments into people’s bank accounts, these cards restrict what the money can be spent on and allow the council to keep tabs on people’s spending. Unless there are well-founded concerns about a person’s mental capacity, why would anybody choose to diminish the choices they are allowed to make? There are changes that can be made for the better though. A good start would be for those of us in the world of social care not to call people ‘vulnerable’ just because they are receiving a service from us. Letwin was right in his criticism of the paternalistic impulse that deprives so many so-called vulnerable adults of their independence. But we need to go much further than that and look beyond the culture of public service provision. A misplaced tendency to regard people as incredibly vulnerable and lacking the capacity to run their own lives, is fuelled by a wider fearful and risk-averse culture that affects society as a whole. If the transformation of social care is to turn ‘vulnerable’ adults into just adults, then we’ll need to get to grips with this too.

Making social care funding fairer?

Andrew Dilnot, chair of the Commission that published Fairer Care Funding, concludes that the social care funding system is ‘confusing, unfair and unsustainable’. The report argues for an eligibility and assessment regime that is universal and portable, and better aligned with the benefits system. It suggests a lifetime contribution cap to social care at £35k, a higher threshold for means-testing of £100k, and the removal of means-tests altogether for young adults with existing needs.

It makes the case for  a shift away from the uncertainty associated with care in old age, and a greater ‘awareness’ on the part of individuals of the need to plan for the future. Not just by saving for their pensions, but for their social care costs too. To this end the Commission recommends the development of a national strategy, and the establishment of a statutory information and advice duty. It assumes two things. That social care costs will continue to rise and that there will need to be a renegotiation of who pays – individuals or the state. Or more accurately, individuals or society.

Much of this is actually quite positive in as far as it is a sober assessment of a genuine problem i.e. how to deal with the challenges of an ageing population and the health and social care needs associated with it. This makes a change from the usual hysterical language about time bombs. Indeed, it reminded me of an excellent book by the economist Phil Mullan written over a decade ago now. The Imaginary Time Bomb: Why an Ageing Population is not a Social Problem (1999) says we shouldn’t panic. Indeed, as the report also says, we should be celebrating the fact that we live so much longer than we used to; and, says Mullan, in economic terms the problem could be worse. He explains that the ‘dependency ratio’ whereby the working population supports those who don’t work could be higher.

That is, it costs a lot more as a society to support children and young people, than it does to care for the elders. So an ageing society is not only a good thing in itself, but in terms of the cost borne by the working population, far preferable to one that’s getting younger. However, how those costs are administered and distributed – via the market-led financial products anticipated by Dilnot, or by the State through taxes – is actually secondary and should be up for debate. While we can more than cope with the burden on society, it is the transfer of that burden onto individuals as opposed to society as a whole, that needs to be questioned.

Abuse and neglect are not the norm

When the UK secretary of state for education, Michael Gove, announced that he would be asking Eileen Munro to conduct an independent review of child protection, there was cause for optimism. For Munro is not only a professor at the London School of Economics, she has also been one of the rare critics of the hysteria around child abuse. Maybe this was the person who would challenge those campaigners and policymakers who, in seeing child abuse everywhere, have undermined the fundamental relationship between adults and children.

And, thankfully, there is much to cheer in her initial report. For instance, she wants to redress the imbalance between social work and ‘technical solutions’ where rules, procedures and databases seem to take precedence over the very face-to-face business of good social work. Munro is also critical of the overemphasis on searching for cases of child abuse. Or as she puts it, this is a ‘skewed system that is paying so much attention to identifying cases of abuse and neglect that it is draining time and resources away from families’. And she is keen to see social workers spend more time intervening in the few cases where children are genuinely at risk of harm, rather than being preoccupied by endless investigations into often inappropriate referrals.

The scale of the problem caused by the sheer number of referrals is striking. OFSTED reported an increase in referrals to children’s social services of 11 per cent in 2009/10. That there was only a five per cent increase in child protection plans – and of these the ‘overwhelming majority’ were not even at risk of significant harm, according to Munro – only underlines the point that much of the activity that is overwhelming the social care system is driven by heightened anxieties rather than sound judgments. A parliamentary committee put the increase in cases at 34 per cent following the notorious case of Baby P in 2008. Heavy caseloads and a shortage of social workers cause delays for children caught up in the system, and in the clogged-up family court system, too. In the past year the Children and Family Court Advisory and Support Service (CAFCASS) has reported a ‘30 per cent rise in applications for care proceedings’. The National Audit Office (NAO) says that by mid-2010 for every case closed, another five were opened.

‘Protecting children from abuse and neglect has been high on the political agenda for many decades’, Munro says. While there has been a steady rise in referrals, particularly following notorious cases in the 1970s and 1980s, there has been a steeper rise more recently. Munro describes a ‘culture of fear and blame… [that is] undermining… quality of practice and public confidence in the child protection system’. And she criticises the target culture within the social services that has distracted social workers from actually doing social work. Whatever you think of social workers, it is hard to dispute that their time is better spent working with families than sat behind a computer screen.

Munro is good on where social workers get it wrong and why. She explains that where thresholds for child protection interventions are too high, so are the false negatives, which means that abuse is not always spotted. Alternately, where the thresholds are too low – typically in response to a high-profile investigation into the death of a child – there are invariably lots of false positives, that is parents wrongly accused of abusing their children. The point is that this sharp-end of social work is incredibly difficult. There are bound to be mistakes because it is all about ‘working with uncertainty’. But while all of this is undoubtedly true, the ‘damned if they do and damned if they don’t’ stance doesn’t necessarily get us anywhere. It tends to forget that social workers have considerable powers invested in them, which may result (rightly or wrongly) in their removing children from families. It is therefore right that these interventions – or the lack thereof – are subject to the greatest scrutiny.

Moreover, the focus on social work is too narrow to deal with the problem of child protection and the way society as a whole is obsessed with it. Social work doesn’t take place in a vacuum, and child protection has long since burst the banks of children’s social work teams to become a concern of society at large. This is why improving child protection isn’t just about reclaiming social work from the technocrats. Much more important a task is to challenge the preconceptions that make child protection such a defining issue of our age in the first place.

Unfortunately Munro stops short of criticising the mainstreaming of child protection. Instead, the review suggests ‘developing the expertise of universal services to support vulnerable families’ as a solution to the problem of an already overstretched system. The problem, as the review poses it, is simply that the media and public opinion are to blame for overhyping the issue. Yet while there is indeed ‘an all-pervading sense in society that social workers and the system in which they operate can prevent child abuse’, this is hardly a solely media-created phenomenon. In fact, the notion that children are at unprecedented risk, that adults should be on their guard against each others’ malevolent intents, and that the government should ‘do something’ about it, was at the heart of New Labour’s Every Child Matters reforms introduced in 2003 following the death of eight-year-old Victoria Climbié.

The Every Child Matters policy framework has been adopted wholesale by the Lib-Con coalition from their New Labour predecessors. The central problem is that ECM reorients thinking on everything from schools to youth work around the notion that children need protecting like never before from innumerable risks to their wellbeing. The suggestion of some kind of moral equivalence between cases of brutal abuse like those of Victoria Climbié and, more recently, Baby P, and the normal experience of most children and families, is breathtakingly cynical. Not only is such a formulation lacking in any perspective, it also shows the contempt in which parents and adults in general are held by the authorities. It also has very little, if anything, to do with how we might go about dealing with, never mind preventing, such rare occurences.

The answer to the child protection problem is not just better social work (though we’ll need that, too). It must also address the wider pessimism about the alleged prevalence of abuse and parental neglect in society at large. The notion of targeted child protection has given way to an all-encompassing notion of safeguarding all children. This not only generates wrongful accusations of parental child abuse, it also ends up endorsing some peculiar responses when things do go wrong.

The serious case review into the abuse of children at Little Ted’s Nursery, for instance, told us little about how to deal with the likes of the revolting Vanessa George. It did, however, tell us what’s wrong with the response to rare cases such as these. The Local Children’s Safeguarding Board concluded that regulations, training and staff supervision were poor. They questioned whether it was right that anybody should have access on their own to a room in which to change children’s nappies, or whether workers should be allowed to use mobile phones (presumably because, like George, they might use them to share child porn images). That the extreme case of a woman committing unthinkable acts on babies and toddlers has been normalised, as if to suggest that we are all capable of similar acts, is testament to the degraded view of adults held by the authories. It is this kind of mindset, not any failings on the part of the regulators or those running the nursery, that made Little Ted’s into an ‘ideal environment’ for abuse. After all, it had children in it.

One can only hope for a different response to a similar case at the start of the New Year. A former worker at the Little Stars Nursery in Birmingham has been charged with the serious sexual assault of a child in 2009 and 2010. The nursery’s temporary closure in the wake of the suspect’s arrest, and the setting up of a helpline for worried parents, doesn’t bode well.

Child protection is not confined to the world of social work. In a way, of course, it should be: the problem of abuse and neglect is a marginal one that needs targeted intervention by well-trained professionals allowed to use their judgement to respond in the appropriate way. But the bigger problem involves our political culture, a culture in which adults are routinely suspected of being potentially harmful to children. So instead of dealing with rare but often tragic child deaths in their own terms, the authorities tend to treat them as if they are the norm, not the exception. This does nothing for children genuinely at risk of abuse. Instead it diverts resources that could be better spent on supporting families struggling to bring up their children and ends up undermining everybody’s trust in each other when it comes to bringing up and caring for children.

Despite the exceptional horrors encountered by those working in child protection, most of the anxieties about children’s wellbeing are largely misplaced and the risks to their welfare invariably overstated. Ironically, and rather depressingly, it is society’s pessimistic outlook that threatens the very adult-child relationship that does protect children from the potential for harm. Social workers need to make the case for social work, but the rest of us need to make the case for the wider society of adults as the best place for safeguarding children.

http://www.spiked-online.com/index.php/site/article/10075/

Social Care for Free Citizens

A Manifesto Club Thinkpiece

In short…

Social care should support people’s autonomy and independence, allowing us to control our lives as much as possible.

The allocation of personal budgets for people to spend as they see fit is a step in the right direction.

However, the pervasive culture of suspicion which tries to nudge people to make the ‘right’ choices must be challenged.

We should not give in to the tendency to see the potential for abuse at every turn, especially when dealing with society’s most vulnerable.

Social care for free citizens must begin by defending people’s ability to choose for themselves.

The ‘personalisation’ of social care is a good example of how today’s public services can liberate people rather than simply control them. One study estimates that ‘within the next five years, 1.5 million people could be using personal budgets to commission and manage their own support.’ [1] Promoting people’s independence, choice and control (as the rhetoric goes) points the way forwards towards establishing a more fair and just social care system. It ultimately shows how a new public sector ethos can aid the creation of a society of free citizens.

It seems the public service revolution is already underway. The government is dedicated to developing a personalised welfare state. The Conservatives similarly want to allow people to spend the money allocated for their care as they see fit, and ‘give some of our most deprived citizens the opportunity to live independent and fulfilling lives.’ [2]

Indeed, it is partly the endorsement of conservative critics that lends weight to the suspicion that ‘personalisation’ is a slippery term used to disguise public services cuts and get tough on benefit claimants. Yet, despite this not entirely unreasonable nervousness, I have found myself warming to the idea.

This Thinkpiece constitutes an argument for a social care policy that truly supports people’s autonomy. We should challenge the fretful desire to nudge people into making the ‘right’ choices and impede people from truly taking control of their lives, and support a genuine personalisation of social services.

A truly active society

There is a sympathy between personalised social care and a personalised welfare system: each can help people play a more active role in society. Indeed, the idea of personalisation is most developed in the field of social care for adults, but has much wider implications for the delivery of a variety of public services.

It is true that in the current economic climate and amidst unprecedented levels of welfare dependency (real and rhetorical), political parties agree that personalisation is a good way forward. Yet whilst the economic recession is not something to be welcomed, it does present a profound challenge to the way we organise public services. It forces us to consider as a society what we, both as individuals and in our communities, can do for ourselves — and what we need from government.

The current government has its own idea of what personalisation might mean. As the Prime Minister puts it in his foreword to Putting the Frontline First: Smarter Government, personalisation means creating ‘services that are universal to all but personal to each’ and that ‘strengthen the role of citizens and civic society.’

Indeed, there is a good deal of confusion about the role of the state in our lives today. The fundamental question of when it is appropriate for the state to intervene in our lives is not even being asked, never mind answered. Despite talk of handing over control to people, whether by co-production, co-operatives or user-led organisations, there is a tendency for political parties to offer us ‘support’ whether we like it or not.

So, whilst we will soon see the introduction of personal health budgets, the prevailing health care culture has done little to promote people truly taking control of their lives. Attempts to shape people’s behaviour and nudge them towards making the ‘right choices’ about how much they drink, eat or smoke doesn’t bode well for those of us who want to help people make their own decisions – whether they are ultimately good or bad for them, and whether we like it or not.

That is a reason why these reforms are so badly needed. They could, if developed in the right way, encourage a welcome shift in our expectations of ourselves, and each other.

No suspicion

A headline early last year claimed ‘Over 50% of carers admit to elder abuse’. [3] It was based on a study which concludes that instead of suspecting paid carers of abusing older people, authorities should address the ‘taboo’ of abuse carried out by family members. However, those caring for elderly relatives with dementia were not physically beating their relatives. They were mostly shouting at them. The scary 50% in the headline was 50% of just 220 carers interviewed. A further one third admitted inflicting what they describe as ‘significant levels of abuse’ but the term ‘significant’ here was taken to mean ‘swearing often or being insulting’. Not nice maybe, but not abuse either.

This and similar studies regularly get picked up by the media, generating considerable anxiety about something that we, not least those doing the research, can only speculate about, giving legitimacy to whatever interventions are deemed necessary.

Even if those convinced we live in an abusive society concede people are not regularly beating up their grandparents, they are nevertheless, we are told, financially abusing them. Levels of theft and fraud affect ‘hundreds of thousands of older people’ involving ‘tens of millions of pounds’, according to Action on Elder Abuse. [4]

While there are no doubt instances of financial and elder abuse, although neither term is particularly helpful, these wider claims need to be challenged. Why, despite an apparent lack of evidence to support the view, are we told that elder abuse is widespread? I can only assume that those who make these claims see human relationships as inherently abusive.

The truth is that no matter how vulnerable an older person, it would be wrong to build our approach to safeguarding on a presumption of harm and vulnerability. Doing so would likely undermine those relationships with family, friends and neighbours on which so-called vulnerable adults rely.

And yet passing of the Safeguarding Vulnerable Groups Act in 2006 and setting up the Independent Safeguarding Authority to oversee the new vetting and barring arrangements, has given legislative and institutional form to the notion that we’re all vulnerable now.

Fewer safeguards

Nevertheless, responses to the consultation on the government’s adult safeguarding guidance, No Secrets, do suggest there is some concern about these developments. The use of the terms ‘vulnerable adult’ and ‘abuse’ has been questioned. There is an unease about the implicit robbing people of the dignity of being an ‘adult’, and a concern that what we really need is more support rather than suspicion of those who care for their elderly relatives.

The fact there ‘were reportedly few successful prosecutions in relation to safeguarding’, as the police responded, should be reason for optimism, not cause for alarm as lobbyists would have us believe. It suggests that elder abuse and financial abuse may be much less prevalent than we are being led to believe.

There is something of a stand-off between safeguarding and personalisation, between choice and risk. And yet there is a clear feeling from those who use services that ‘safeguarding decisions should be taken by the individual concerned’ and that ‘they wanted to retain control and make their own choices’. Too often, we learn, safeguarding is ‘experienced as safety at the expense of other qualities of life, such as self determination and the right to family life.’ [5]

While safeguards are an important consideration for those of us working with people with disabilities, mental health problems or people who may be ill or frail, the risk-averse response of the authorities is out of all proportion to the actual (and thankfully rare) incidence of abuse itself. Too often seeking to protect ‘vulnerable’ people from risk is to protect them from life itself and all it brings, both good and bad.

The proliferation of paper exercises may make us sleep safer in our beds, but there is little evidence that risk assessment matrices and safeguarding procedures do anything to prevent things going badly wrong in practice. Indeed, while these tools may have a role to play, they can also generate false positives and a wider sense of anxiety. Relying on them can only distract and inhibit care workers, keeping them from the business of caring and making it more difficult to spot abuse in those exceptional cases where it arises.

Instead of generating safeguarding referrals by promoting ‘awareness’, which seems the perverse dynamic currently at work in local authorities up and down the land; we should be generating local intelligence about the outcomes of those referrals. We should work out the real and often mundane risks people might face, such as the risk of falls for older people living alone or the risks presented by unscrupulous traders known to be operating in the local area. This is the only rational way to respond to what we actually don’t and can’t know in advance.

Taking control

As David Brindle argues in The Guardian, ‘Social care has to its surprise turned up in the vanguard of public services reform through personalisation, blazing a trail for other sectors that are now gingerly following suit.’ [6] For Charles Leadbeater (the academic most associated with the idea), personalisation is a way ‘to mobilise service users’ intelligence to find lower-cost ways to improve services.’ [7]

In a sense, the personalisation of social care takes the Community Care reforms of the 1980s to their logical conclusion. At the time, reformers were accused of putting vulnerable people (and the public) at risk, using kindly sounding rhetoric as cover for cutting services. There was some truth in this, and yet reforms helped to get ‘vulnerable’ people out of institutional care and into the community. Likewise, where local authorities are beginning to implement these changes, there are examples of how people are being given the opportunity to escape the confines of traditional services, and find better, more tailored solutions to the problems they face in their day-to-day lives.

For instance, in 2005, Cambridgeshire County Council piloted self-directed-support in their learning disabilities service. [8] By 2008, 56 of their service users were in receipt of personal budgets. In their evaluation they found people tended to spend their money on leisure pursuits, personal assistants and help at home more than anything else.

Alan, a young man with Down’s syndrome, ‘has taken up running, including completing a half-marathon, and swims at the local pool three times a week’. His mother manages his budget for him, and ‘with Alan, recruits his personal assistants’.

Alice, keen to avoid a residential or supported living arrangement, and wanting to stay close to family and friends, used her budget to pay for a place of her own under a shared ownership scheme. With her family, she arranged for a local organisation that specialised in mortgages for people with disabilities, to sort things out for her. According to the sister of Dev, a young disabled man who didn’t go out at all until his family were given control of his care, he now gets support and ‘goes out horse riding, swimming and for regular walks’. It has, she says ‘improved his quality of life immensely’, and that of his family.

The London Borough of Richmond upon Thames found that while a quarter of the service users they interviewed continued to use traditional services (ie. day care and residential care), a third paid friends and family members to support them, and half paid for transport. By far the most common use of personal budgets amongst this group of service users was for paying for help in the home, for carers and personal assistants.

One of their disabled residents, Anna, who left her teaching job to have a baby, says ‘I couldn’t even go to mother and baby groups because I needed someone else to carry my daughter when she was a baby or to help me with a pram. Just knowing I can pay someone to come with me and help me makes a big difference.’ Instead of feeling ‘trapped and resentful’ toward the limitations imposed by her disability, she is now able find new ways of dealing with old problems.

The personalisation of social care has something going for it precisely because it is at odds with so much else that officialdom does these days. It goes against the intrusive, paternalistic grain – but we also need to be on our guard. For all that personalisation promises, many enthusiasts seem oblivious to the counter-trends that threaten to undermine these changes.

Historically, on the political right, says Ken Mclaughlin, an academic and former social worker, social work has been understood as creating a dependency on welfare. On the radical left as doing ‘nothing more than supervise the deterioration of people’s lives.’ He argues that we need to understand people as capable of change.

This is something which even enthusiasts for personalisation seem to struggle with at times. They call for supporting people when they take ‘positive’ risks, but this is a misnomer. There is no getting around the fact that as we ‘allow’ people to take risks they will also have to face the consequences. But in most cases the benefits of ‘vulnerable’ people taking control of their lives far exceed the problems that come with that newfound autonomy.

We have an opportunity to renegotiate where the line is, to dispute the safety-first suspicion of events behind closed doors and assert people’s right to make their own decisions and control their own lives. Otherwise, these reforms will only be neutered by the powerful presumption of harm.

Some social workers regard personalisation as the realisation of their core values, as an opportunity to help people live their lives as normally as possible. This is not to deny the public servant’s duty of care, or the need to protect those who are genuinely vulnerable or lack capacity. It is to underline where it is legitimate for them to act on that duty of care and where it is not, or (put another way) to have a wider view of what that duty entails.

Social workers should be seeking solidarity with the people they work with. When a service user’s personal autonomy is hindered, this is at least in part a consequence of the barriers put in the way when workers could be using their discretion to support people where they need it, and to liberate them where they don’t from the dispiriting experience of dependency.

Genuine personalisation

We cannot expect the personalisation philosophy to win out on its own. Personalisation and the choice agenda more broadly have limits. The world cannot simply be reduced to our individual choices.

Our current culture undermines personal freedoms in so many ways, and is already threatening to undermine the promise of personalisation. Fears about the potential for abuse hang over debates about how we look after society’s most vulnerable. The prospect of people taking control of their budgets and choosing who to commission services from only heightens these fears. It provokes more prevention strategies, risk assessments, concerns about service users’ mental capacity, and possible ‘financial abuse’ from door-steppers and family members alike.

This is why it is important to join in what the Prime Minister recently described as the ‘biggest debate we have ever had on the future of our care system.’ [9] Having said that, despite the pre-election bickering about free personal care and funding of the proposed National Care Service, there is a broad consensus that social care (like welfare) needs reforming.

Most agree what those reforms should look like too; there should be a shift to prevention and early intervention, and an extension of choice and control for individuals, they say. And yet it is this pre-emptive aspect of the transformation of adult social care that, until recently at least, has been overshadowed by the controversy over the personalisation of services.

The worry of early intervention

The problem – in adult social care at least – is not early intervention or preventative strategies per se but the broader climate of anxiety, stoked by the proliferation of abuse scandals, in which they take place.

It is this wider culture that is such a formidable opponent for those of us who want to give so-called vulnerable people greater control over their lives. As the obsession with vetting, checks and databases makes all too clear, this isn’t just a case of changing the culture in social services; it is about challenging the assumptions held across society but given credence by politicians, commentators and policy makers.

The notion that if somebody develops dementia our first instinct should be to suspect the family of pinching their money or abusing them is despicable. But, it is the logical conclusion of an indiscriminate culture that brands us all as potential abusers, and the cared-for as potentially lacking the capacity to live their lives without official interference.

While early intervention, as an argument for more cost-effective public services and a way of avoiding long term dependency, has a lot going for it, the rhetoric of early intervention in relation to safeguarding is far more problematic, and threatens to derail reforms that have real promise for people who use social care services. There is an undeniable logic to the notion that professionals should ‘work together’ and intervene early to prevent neglect or abuse.

But we cannot know in advance what goes on ‘behind closed doors’. Sometimes we can do more harm than good by intervening. And sometimes the assumptions that underlie interventions in people’s lives are themselves problematic.

In practice, early intervention can mean an over-reliance on databases, on checks and procedures, rather than the good practice and judgement of social workers and other professionals. It can mean an obsession with ‘awareness’ campaigns and generating referrals, rather than responding to known risks in the community. This is a consequence of a culture that tends to exaggerate the extent of society’s problems. In reality, social services (and all of the other agencies involved in safeguarding) can only play a limited role in protecting people from abuse or neglect. It is primarily the role of the wider community to look after the welfare of its members.

In so many ways, we cannot afford to continue making these interventions in people’s lives. The challenge is to trust communities to get on with things, to recognise that even the most vulnerable are actually quite robust and able, and unlikely to come to significant harm; to build services that are more limited in their remit and yet more effective in their role, by focusing on supporting good practice and only making proportionate interventions.

The only way to transcend our culture of dependency is to launch a more wide-ranging assault on those who would hold people back ‘for their own good’. So yes, we need to reform our care and welfare systems to really give people the opportunity to eject the state from their lives, but we need to do more than that.

If the system is to be truly transformed and have a real impact on individuals, their families and the communities of which they are a part; then people must be able to live their lives as they see fit, and have real control over the support that they receive. Such an outlook requires we challenge the exaggerated sense of people’s vulnerability and irrational fears and prejudices about what happens when they are left to their own devices. We need to make the rhetoric of empowerment and choice meaningful by rediscovering a sense of people as autonomous and able citizens, not as dependents on an over-protective and intrusive state.

In summary, it is only by reorienting our relationship with, and our view of, ourselves as makers of our own destinies, rather than as victims of circumstance – that we can begin to open up wider possibilities for the transformation of our lives, not just the transformation of the services we receive.

We need to stop standing in people’s way, and advocate a public service model that is conducive to promoting a sense of ourselves as autonomous and robust individuals. It may seem modest in the wider scheme of things, but there is nothing more radical today than to stand up for people’s personal freedoms and to defend their capacity to run their own lives, whatever disadvantages they face.

 

Endnotes

[1] http://www.demos.co.uk/publications/at-yourservice

[2] The Conservative Party, Work for Welfare, 2008

[3] http://www.guardian.co.uk/society/2009/jan/23/

elder-abuse-dementia

[4] http://news.bbc.co.uk/1/hi/business/7601419.stm

[5] http://www.dh.gov.uk/en/Consultations/

Responsestoconsultations/DH_102764

[6] http://www.guardian.co.uk/world/2009/dec/16/

public-services-policy-review-decade

[7] http://www.guardian.co.uk/society/

joepublic/2009/dec/16/ways-to-protect-publicservices

[8] See: http://www.in-control.org.uk/

[9] http://www.number10.gov.uk/Page22402

http://www.manifestoclub.com/files/DavidClements01.pdf

Fixing ‘Broken Britain’?

In March this year, Lord Laming reported on the progress made in child protection since his own report into the death of Victoria Climbié, published in 2003. Laming, a former head of the social services inspectorate, was disappointed with the continuing failings of the system, lamenting that ‘it cannot be beyond our wit to put in place ways of identifying early those children at risk of deliberate harm, and to put in place the means of securing their safety and proper development’.

Laming added that society should ‘support children as soon as they are recognised as being “in need”, averting escalation to the point at which families are in crisis’.

Some of this is common sense. Family support is something that social services have been doing for a very long time. How well they do it and how it relates to other aspects of social work such as child protection and taking kids into care is a point for debate.

But early intervention is something else, because it suggests that we can not only foresee the risks children face – whether it be abuse or a life of crime – but that we can act early and decisively to prevent those ‘bad things’ from happening. A letter from assorted ‘experts’, politicians and children’s organisations, for instance, published in the Guardian following the Baby P case, called for a ‘long-term inquiry to examine how we can stop some of today’s children becoming the abusing parents of tomorrow’ (1). The government’s flagship extended schools, which provide additional services on top of regular schooling, and Sure Start children’s centres are built entirely on the notion that by intervening early in children’s and families’ lives, problems (and problem families) can be nipped in the bud.

But we can never intervene early enough or extensively enough to protect all children all of the time. And nor should we. The Guardian‘s Polly Toynbee asks ‘Is every child death preventable?’ She responds to her own question: ‘Possibly. But it would come at a social cost the likes of the Mail and the Sun would certainly not tolerate.’ (2) Minette Marrin, writing in The Times (London), agrees: ‘We could do something, if we as a society would accept some extreme intrusions into our personal freedom. And if we can’t tolerate such measures, then I think we have to accept there is indeed not much we can do to stop something like this happening again’ (3).

To his credit Laming recognises this. It ‘would be unreasonable to expect that the sudden and unpredictable outburst by an adult towards a child can be prevented’, but he argues that this is not the same as the ‘failure to protect a child or young person already identified as being in danger of deliberate harm’. This isn’t the prevailing view amongst the bulk of self-appointed experts in the media, in the child protection industry and in the political class.

For example, Minette Marrin makes the remarkable claim that, ‘the neglect and abuse of babies and children damage them not just in some loose psychological way, as everyone has always assumed. It also damages them physically; it permanently affects the development of their brains, leaving them with cognitive and emotional impairments that will cause grave problems to themselves and others.’

There is a very real danger that such wrong-headed and unfounded views legitimate not only an intrusion into people’s lives, with the ultimate sanction of removing children from their families, but it can also mean giving up prematurely on people with complex problems, that are not necessarily insurmountable (4). The popular notion that the clock is ticking and there is little time to prevent permanent damage creates an unnecessary pressure on social services to act. But for all the messages to the contrary, there is nothing inevitable about the continuation of dependency, or the cyclical hopelessness of apparently ‘chaotic lives’.

Martin Narey, as chief executive of Barnardos (a charity ostensibly lobbying on behalf of disadvantaged children), claimed that ‘It is children like Baby P who, due to disadvantage, neglect and abuse, could grow up to become the troubled youth of today…Had Baby P survived, given his own deprivation, he might have become unruly by the time he had reached the age of 13 or 14, and become the child that so many people refer to as “feral”, “parasites”, “yobs”.’ (5) Marrin concurs, comparing Baby P to the two young boys who tortured, sexually assaulted and left for dead two other youngsters in a quarry near Doncaster earlier this year. ‘Perhaps it might really be best if such babies were compulsorily taken away at birth and adopted. Had Baby Peter survived living with his mother, he might well have grown up to be something like the Doncaster boys, but if he’d been adopted at birth he might have grown up undamaged.’

Narey and Marrin clearly see these cases as unexceptional, but it seems more likely a projection of their own attitudes on to Britain today. As Polly Toynbee argued in the wake of the Baby P case: ‘Everyone finds in this rare horror the “proof” for whatever it is they already think about society.’ The exceedingly rare instances of depravity inflicted on Victoria Climbié, the Soham girls, Baby P, Shannon Matthews and now on the victims of the Doncaster boys are flattered with a significance they simply don’t deserve. They are treated as yet more evidence of just how ‘broken’ Britain really is.

So Narey’s belief that ‘we can’t keep trying to fix families that are completely broken’ is more than a criticism of social workers’ reluctance to ‘call it a day’ and start care proceedings. There is a defeatism about his comments (6) – something that has more do with the profound social pessimism of our times, particularly with regards to the supposedly poor wellbeing of the nation’s children and what that says about the fecklessness of the adults supposed to be looking after them.

In fact, just 55 children ‘were killed by their parents or by someone known to the child’ in 2007/08. Over the past decade, the figures have gone up and down from a low of 35 to a high of 85, bearing little (if any) relation to wider trends in society (7). Of the 11million children in England, the latest figures show there are 235,000 children in need, and in whose families there is consequently some social services involvement; 60,000 children at any one time are in the care system for a variety of reasons, the majority of them living with foster carers, and mostly for relatively short periods; and 29,000 children are subject to child protection plans – in other words, where there is a suspicion of, or thought to be a risk of, abuse or neglect, but no immediate danger to the child.

In other words, just two per cent of all children have on-going contact with social services and 0.2 per cent in families where abuse or neglect is suspected. This rather suggests that the need for early intervention is overstated.

Nevertheless, there are clearly some problems with those services that we expect to protect children and to work with those families who are struggling to look after them. That’s why for all his opportunism and his defeatism, I have some sympathy with Narey’s view that there is too much ‘fixing families that can’t be fixed’. While they are a minority of a minority, there are cases – involving prostitution, violence and drug dependency amongst other things – where the home circumstances are genuinely ‘chaotic’ and potentially very dangerous for a child. In such circumstances, sometimes the best thing to do, for all involved, is to remove the child rather than intervening with ever more intensive packages of family support.

Narey is also right to insist that social workers should be ‘brave’ and ‘courageous’, if they aren’t already, and more decisive in their interventions. It might be easy for armchair critics to say as much, but this is an incredibly important part of social work, and of child protection work in particular, and something that is too often lacking, if the conclusions of numerous investigations into avoidable child deaths are anything to go by.

There is a growing concern about the quality of social work practice itself and not just the structures and systems, and about the ‘services provided for the most vulnerable children and young people’ (8). But the neglect of these things is in large part a consequence of subsuming child protection and social work into a political agenda built on an apparent concern for ‘Every Child’ in the country (all 11million of them), and a commitment to a heavily bureaucratic approach to safeguarding them, something to which Laming, the government and its inspectors are still very much wedded.

But as even Laming acknowledges, ‘ultimately the safety of a child depends on staff having the time, knowledge and skill to understand the child or young person and their family circumstances’ and this ‘too often depends on the commitment of individual staff and sometimes this happens despite, rather than because of, the organisational arrangements’. This is why Children’s Trusts, which integrate all children’s services into one big department and which were introduced on the advice of Lord Laming after the Climbié case as part of the Every Child Matters reforms, have belatedly come in for some serious criticism. A report by the Audit Commission found: ‘On the ground, professionals are working together, often through informal arrangements outside the trust framework. Trusts get in the way.’ (9) Good working relationships across agencies and between professionals are indeed vital, but Balls and Lamings’ insistence on yet another layer of bureaucracy with the requirement to set up local multi-agency Children’s Trust Boards (10) only suggests that they aren’t learning any lessons either.

It is the social work intervention itself, based on the sound judgment of the professional(s) concerned, that is key to protecting children from abuse and neglect, and working with families who need support. As Harry Ferguson argues in the Guardian, ‘before any information can be shared, someone has to find it out. And making such inquiries inevitably pitches social workers into remarkably difficult, unpredictable and often dangerous encounters with parents and carers.’ (11).

Reportedly ‘one in seven social worker posts [are] now vacant across England’ (12). In addition, ‘one-third of those studying social work at university do not go into the profession and a further one-third leave after a year in the job.’ Huge caseloads, low morale, poor training and supervision, insufficient resources – all of these things were a fact of life before Baby P and long before Climbié too. Despite recent efforts to tackle these problems, the political pressure being put on children’s services is likely to make it even harder for social workers to do their job effectively.

The irony is that we’re worrying about what social workers do and don’t do at precisely the time when they are seemingly chained to their desks. They spend typically between 60 per cent and 80 per cent of their time at their computers rather than with their clients. One recent study confirmed the view that the focus on the completion of ‘workflows, “tasks” and forms’ and the meeting of government targets, means that social workers spend more time processing cases than doing social work. The ‘complex sense-making’ that is so important to good social work is easily lost in the churn of information (13).

But even this discussion, while important for those children and families who desperately need social services help, detracts from the probably more important one not being had about the safeguarding role played (or that, at least, ought to be played) by ordinary people in their everyday lives. For safeguarding to be truly effective, it needs to be a part of the social fabric, not an institutional response to referrals or a technical exercise in risk management.

Despite our apparent obsession with child abuse and ‘feral’ children doing unimaginable things to each other, the business of child protection itself is largely conducted behind closed doors. For all the column inches devoted to Baby P and the Doncaster case, serious case reviews – the very investigations that should tell us what goes wrong when children do ‘slip through the net’ – are conducted in private. Since Baby P, the Tories have challenged the government to make their findings publicly available (14). Those cases ‘concerning care, supervision and emergency protection of children’ that don’t reach the criminal courts are also closed to the public, and conducted without a jury. ‘In 2007’, according to the Guardian, ‘the family courts heard 20,000 cases’ (15)[15]. Yet it was only a few months ago that these courts began to open their doors to journalists – never mind the public – and even then with restrictions on what they can and can’t report, and only with the permission of the presiding judge.

This culture of secrecy needs to be challenged so that we can begin to have a sensible conversation about protecting children and promoting their welfare, and about the appropriate role of social services in people’s lives. We also need to challenge the assumptions and prejudices of those who want the state to step in earlier and more often to remove children in a vain, or at least misdirected, effort to mend ‘Broken Britain’.

http://www.spiked-online.com/index.php/site/article/7396/‏