Features

Child protection: joining up the dots

06 June 2018

Many agencies bear responsibility, but the safeguarding of children can still fall short. Are local authority cutbacks solely to blame or do other barriers prevent a fully joined-up approach between health and social services? Journalist Helen Bird investigates.

How has the landscape of children’s safeguarding changed in the last decade? A quick scan through the archives unearths some poignant examples. Flash back to 2010, for instance, when the coalition government pledged to recruit 4200 health visitors in England by the end of the parliament. ‘Many of them will work in Sure Start children’s centres to support the most vulnerable families,’ reported a news story that year, suggesting that health visitors were set for a larger role in early intervention
in the lives of vulnerable families (Griffiths, 2010).

Fast-forward eight years, and practitioner numbers continue to dwindle after the government missed its target in 2015 (NHS Digital, 2015), while recent figures showed the closure of 1000 Sure Start centres since 2009 (Smith et al, 2018). And the number of children becoming subject to a child protection plan or being added to a child protection register has risen by 39% across the UK since 2009, with the largest increase (43%) seen in England (NSPCC, 2017). Although these figures are unquestionably cause for concern, they also indicate that more work is being done to keep children safe from harm. But is it enough? And with these ever-increasing caseloads, can social workers and their frontline partners - community practitioners - protect vulnerable children sufficiently, or is a culture of firefighting creating fragmented rather than joined-up services?

 

Facing hurdles

The concept of multiprofessional-working is not a new one, particularly when it comes to safeguarding. Over the last decade, and in response to a number of high-profile cases in which vulnerable children fell through the net, many areas have set up multiagency safeguarding hubs in order to mitigate this risk. A government review found that, while this model helps professionals to ‘join the dots’, there were nonetheless barriers to effective delivery (Home Office, 2014).

These included ‘misunderstandings among professionals about what information can be shared’. The report also states: ‘Many felt that some practitioners withhold information too frequently… some felt that the risk of sharing information is perceived to be 
higher than it actually is.’

Cultural barriers and a lack of resources were among the other obstacles identified – some of which have been echoed in subsequent research. A review of school nurses carried out by the Office of the Children’s Commissioner for England (2016), for example, highlighted frustration within the profession at the ‘inaccessibility’ of children’s services, while 41% of those surveyed were unsatisfied with the outcomes of at least half of the referrals they made. Time spent on paperwork was cited as a barrier to working directly with children, which was thought to be reducing school nurses’ ability to identify children at risk of neglect or abuse. And among those who answered questions on child protection, it was felt that thresholds were too high and that a number of children in need of support were being turned away.

 

Structural vs individual

Following the 2014 Home Office review, statutory guidance was published in a bid to standardise the multiagency safeguarding of children in England and eliminate barriers (Department for Education, 2015). But shortly after came the transfer of community healthcare services – and the delivery of the Healthy Child Programme – to local authorities (Department of Health and Social Care, 2015), along with confirmation of a 3.9% real-terms cut in public health funding over the next five years (HM Treasury, 2015). It seemed the hurdles to delivering high-quality, preventative, child-centred care were being raised ever higher.

Dr Gary Walker, principal lecturer in education, childhood and early years at Leeds Beckett University and author of Working together for children (2008), says the lack of resources is only part of the problem.

‘Certainly, austerity and funding cuts won’t help, but there is a long history of tensions and barriers to effective multiagency-working that goes beyond funding,’ he explains. It’s useful to tease apart two types of barriers, 
he adds: structural and individual.

While structural factors are ‘inherent to multiagency work, not the fault of individuals and cannot be changed’, Gary explains, individualised barriers ‘are caused by personal behaviour and can be challenged or changed’. There are many structural factors: different core functions of agencies, which means they cannot always be available for multiagency work; different values, cultures and practices between agencies (‘the way different services see and think about children and parenting’); lack of clarity over who is responsible for what; and lack of clarity in decision-making.

Examples of structural barriers can be found in the recent joint inspection of multiagency responses to children living with domestic abuse carried out by Ofsted, the Care Quality Commission, HM Inspectorate of Probation and HM Inspectorate of Constabulary and Fire and Rescue Services (2017). The report calls for ‘a greater focus on perpetrators and better strategies for the prevention of domestic abuse’, and highlights instances from across the six local authorities in which information was not sufficiently shared between, or within, services.

But the individualised barriers Gary describes – including professionals ‘being awkward or unhelpful’, a lack of training or confidence in individuals, and jealousy or rivalry between agencies (‘so they “compete” to look the best’) – also appear to be evident in accounts from both health and social care staff.

 

‘Us and them’?

Lisa*, a school nurse, and John*, a child protection social worker, spoke to Community Practitioner about their experiences of working with the other’s profession on child safeguarding issues.

‘It can take weeks to get in contact with a social worker – missed calls back and forth – to follow up a concern about a family,’ says Lisa. ‘The duty social worker can’t always help with concerns.

‘Once a case has been referred, there’s a belief that social care will take responsibility and healthcare professionals will wait for feedback and to be advised on relevant action,’ she adds. ‘But no feedback is given on the outcome of referrals; and no feedback is given when social care closes cases, either.’

Lisa believes social workers are also keen to close cases early, ‘even when families need high levels of support’. But John insists the decision to close a case is always made ‘as a multiprofessional team’.

‘Sometimes there are issues within families that can be managed at a lower level, by universal services. But they don’t want to carry the risk; they want social care involved,’ he adds. ‘We [children’s services] are only for quite high-level risk, but
I find that some professionals don’t want that responsibility.’

Gary suggests that different perspectives could be at play. ‘There are definitely different understandings of ‘risk’ [between agencies] and also of what constitutes significant harm – as opposed to just harm – and where to draw the line for statutory intervention by services, as opposed to family support,’ he says.

And Lisa admits reluctance to add to an already heavy workload can be a symptom of understaffed teams. ‘Due to a lack of resources, there can be an avoidance of health professionals [to ask] too many questions when visiting a family or seeing a child in school,’ she says. ‘Questions can open up a can of worms, which can lead to weeks of additional work.’

 

Everyone’s business

But the financial and staffing pressures under which community healthcare services find themselves should not affect practitioners’ ability to safeguard children, argues Michelle Moseley, Wales chair, CPHVA Executive Committee, and undergraduate education lead and lecturer in primary care and public health nursing at Cardiff University. Speaking particularly for health visitors, Michelle, says safeguarding ‘should be their priority’.

Could it be that some community practitioners are shying away from potential child protection cases because they feel ill-equipped to deal with certain issues? ‘I certainly hope not,’ says Michelle. ‘They should all be trained to deal with recognising safeguarding issues and referring on to the local authority [social services]. If they shy away due to workload issues, this is a priority for the managers within that area and support [should be] put in place.’

Gary also believes commitment from senior leaders and managers to the process and ‘owning the belief in multiagency work’ is important, as is ‘a strong professional identity and good knowledge in your own discipline, but also a good understanding of the roles and responsibilities of others’. A focus on multiagency training can help, he says.

With a background as a lead nurse for safeguarding children, Michelle confirms there are plenty of positive examples of joint professional training across the UK. ‘I worked in an area with a proactive safeguarding children’s board, where there were multiagency training programmes in place,’ she says. ‘And within our university we have introduced interprofessional education where health visitor and social worker students sit together in neglect workshops.’

But Gary stresses that in order to be effective, professional training ‘has to be grounded in practice and real-world issues, and should not just provide rhetoric about how wonderful multiagency-working is.’ And although there is plenty of rhetoric in the literature, the advantages of joining together as a multiprofessional network for the wellbeing of vulnerable children should not be dismissed. Maris Stratulis, the British Association of Social Workers’ England manager, says the benefits surely outweigh
the barriers.

‘I certainly know of some really good experiences with practitioners from across health, social care, education and police are involved in strategy and core group meetings, and those groups have worked really well together,’ she says. ‘So I do think that for any poor experiences a professional may have had, there are many positive experiences.

‘Health visitors play a valuable and pivotal role in this, and it goes back to that central message that safeguarding is everybody’s agenda, and that we’re here for children and families.’

 

Finding solutions

An additional – and significant – challenge that emerges from both research and anecdotal evidence around multiagency-working is insufficient IT infrastructure and information-sharing systems. In April, children’s commissioner for England Anne Longfield warned all NHS trusts and local authorities to make it a ‘priority’ to introduce the new child protection information-sharing system, which sends alerts between frontline clinicians and social workers about children in care.

Michelle agrees this can be a problem. ‘Serious case reviews often mention a lack of joint working or poor information sharing,’ she says. ‘This ethos has to come from the top.’ Gary asserts that clarity is needed on the lines of communication between agencies. ‘Professionals need clear written and shared protocols for how to contact others, who to contact, how to leave messages and what the expectations are in terms of receiving a response. This should be agreed and accepted by all,’ he says.

Surely one of community practitioners’ most powerful tools – in addition to their medical expertise – is an ability to engage with families when they’re often wary of social services. Is this something that could be built upon to enhance the effectiveness of safeguarding practice?

John thinks so. ‘There’s a huge stigma around social workers: we’re seen as the ones that take people’s kids away,’ he says. ‘It’s not that we don’t build relationships [with families], it’s that there’s always going to be this stigma.’

And Charlotte Ramsden, chair of the Association of Directors of Children’s Services health, care and additional needs policy committee, agrees: ‘Health visitors and school nurses are uniquely placed to recognise early signs of children and families in need of help and support.

‘While a referral to children’s social care may not always result in social worker involvement, families can be signposted to other support services, such as parenting classes.’

She adds: ‘Local authorities, the police and health services are all under increasing pressure due to rising levels of need and falling budgets. In the future, we have to work even more closely together to break down professional barriers in order to provide seamless support to children and families at risk. We owe it to them to get this right.’


 

Resources

Royal College of Paediatrics and Child Health – Safeguarding children and young people: roles and competences for health care staff bit.ly/RCPCH_safeguarding

NICE quality standard – Early years: promoting health and wellbeing in under 5s bit.ly/NICE_early_years

HM Government – Working together to safeguard children: a guide to inter-agency working to safeguard and promote the welfare of children bit.ly/HMG_safeguarding

National guidance for child protection in Scotland bit.ly/SCT_child_protection

NI Department of Health – Co-operating to safeguard children and young people in Northern Ireland bit.ly/NI_safeguarding

Welsh Government – Safeguarding children: working together under the Children Act 2004 bit.ly/WAL_safeguarding


 

References

Children’s Commissioner for England. (2016) School nurses: children’s access to school nurses to improve wellbeing and protect them from harm. See: childrenscommissioner.gov.uk/wp-content/uploads/2017/06/School-Nurses-report-Childrens-Commissioners-Office.pdf (accessed 4 May 2018).

Department for Education. (2015) Working together to safeguard children. See: gov.uk/government/publications/working-together-to-safeguard-children--2 (accessed 4 May 2018).

Department of Health and Social Care. (2015) Services for children aged 0 to 5: transfer to local authorities. See: gov.uk/government/publications/transfer-of-0-5-childrens-public-health-commissioning-to-local-authorities (accessed 8 May 2018).

Griffiths J. (2010) Health visitors and social workers to work more closely in early intervention. See: communitycare.co.uk/2010/11/26/health-visitors-and-social-workers-to-work-more-closely-in-early-intervention/ (accessed 4 May 2018).

Home Office. (2014) Multi agency working and information sharing project: final report. See: assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/338875/MASH.pdf (accessed 4 May 2018).

HM Treasury. (2015) Spending review and autumn statement 2015. See: gov.uk/government/publications/spending-review-and-autumn-statement-2015-documents/spending-review-and-autumn-statement-2015 (accessed 8 May 2018).

NHS Digital. (2015) NHS workforce statistics – March 2015, provisional statistics. See: digital.nhs.uk/data-and-information/publications/statistical/nhs-workforce-statistics/nhs-workforce-statistics-march-2015-provisional-statistics (accessed 4 May 2018).

NSPCC. (2017) How safe are our children? See: nspcc.org.uk/globalassets/documents/research-reports/how-safe-children-2017-report.pdf (accessed 4 May 2018).

Ofsted, Care Quality Commission, HM Inspectorate of Probation, HM Inspectorate of Constabulary and Fire and Rescue Services. (2017) The multi-agency response to children living with domestic abuse: prevent, protect and repair. See: assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/680671/JTAI_domestic_abuse_18_Sept_2017.pdf (accessed 23 April 2018).

Smith G, Sylva K, Sammons P, Smith T, Omonigho A. (2018) Stop start. See: suttontrust.com/research-paper/sure-start-childrens-centres-england (accessed 4 May 2018).

Walker G. (2008) Working together for children: a critical introduction to multi-agency working. Bloomsbury: London.

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