Childcare Would Be Better As A Business
The history of child-based social care is a history of poor outcomes, especially for looked after children. Yet, in general, the social workers who deal with looked after children come to the work with a moral purpose, with idealism, energy, enthusiasm and a commitment to rectifying injustice.
The persistence of the shocking outcome statistics suggests that the aggregate failure significantly to improve outcomes is less likely to be the result of individual failures of individual workers with individual children and more to a wider malaise.
Early next week, the government is due to publish a green paper on looked after children. The first task of this paper must be to ensure that intervention from the state does not worsen these children’s plight by maintaining or aggravating the factors that have contributed to their situation.
Children in care have had overwhelmingly damaging experiences before they enter care. But all too often the problems then continue without resolution. It is not surprising that many of them do not exhibit signs of successful childhoods or indeed successful adulthoods.
Lack of continuity
The fundamental problem is a lack of continuity. As Sir William Utting has said: “Corporate parenting is not ‘good enough’ on its own. Every child and young person needs at least one individual to whom she/he is ‘special’, who retains responsibility over time, who is involved in plans and decisions and who has ambitions for the child’s achievement and full development.”
But under current organisational arrangements, social workers find it enormously difficult to fulfil that role. In most areas, there is such a rapid turnover of staff that looked after children are lucky if they have the same social worker for a few months – let alone for the many years necessary to build up the requisite degrees of trust, affection and concern.
In addition, local authority hierarchies have too many people involved in decision making, most of whom do not have a personal knowledge of the child but rely on the descriptions of others or on written reports. The social worker is then left to convey and to represent decisions to a young person that they may not have personally advocated. In consequence, there is an absence both of effective authority and of a sense of responsibility.
Social workers need to have the authority to make decisions and see them implemented. This means giving the capacity to secure, on behalf of a looked after child, high quality health and education, regular family and peer contact (if appropriate) and choice of appropriate placement to the responsible worker. In short, they need to be a caring, responsible ‘parent’. So how can this be achieved?
Introducing professional practices
We propose the setting up of social care practices or partnerships along the lines of medical or legal practices. This would be a group of perhaps eight to ten professionals (social workers and community workers) who would both provide services themselves and, under contract from the local authority, control a commissioning budget
The budget would be based on capitation, with a fixed amount for each child on the practice’s list. It could be spent on ensuring that the needs of the looked after child for normal developmental opportunities, health surveillance and treatment, additional educational support, psychological therapy, appropriate contact with parents and siblings and the wider family are organised and delivered by the practice professionals themselves to the children on their list, or on commissioning specialist care as needed from provider agencies.
The caseload of each worker in the practice would need to be small enough to ensure that the worker had sufficient time to develop a relationship of trust and confidence with the child so that she was able to ensure that she adequately understood the child’s needs and enabled the child to be fully involved in all the dimensions of the assessment framework. We do not envisage that the caseloads in these practices need be very different to those that obtain in local authorities.
We are aware of the organisational costs, in terms of layers of management and administration that attach to local authority service delivery and are confident that a small practice could reduce the costs of a field work service to looked after children. The practice or partnership could be organised as a social enterprise, or, like GPs, as a small business. The social workers who are the partners in these organisations would be investing their personal time and resources both in these communities and in the looked after children within them.
As in equivalent practices in the legal and medical sectors, partners will have a different range of expertise, skill and experience. But the important component is to create a mutually dependent team in which a choice of social worker can be offered to young people in care, a choice that will be made in the knowledge that the social worker selected will be committed for the long term, not just because of the commitment to the young person but because of the worker’s commitment to the practice of which they are a member.
Long-term relationships
This would have a number of advantages over the present system. Chief among them would be encouragement for continuity of care. Because they would ‘own’ the business, have a share in its assets and have much greater powers and responsibilities within it, social workers would have a strong incentive to stay in the area, and hence to stay with their client children and families.
This contrasts with current practice in local authorities where, especially in cities, social workers move from authority to authority (or out of social work altogether) as they seek to improve their remuneration and job satisfaction. This level of job movement has a detrimental effect on looked after children who have had to invest a level of trust in the social worker whom they see as the major decision maker in their lives.
These young people have already had to come to terms with the loss of other significant adults in their lives. We need to try to ensure that the state does not compound the young person’s potential attachment problems through its inaction in addressing the issue of social worker turnover.
The partners would also have a strong incentive to do as effective and efficient a job as possible; for in that way they could generate a surplus on their budget that they could spend either on themselves, on improving their facilities or on hiring more staff. And the empowerment involved in the practice idea would, in the longer term, make social work a more attractive career, and could reverse its long-term decline as a profession.
Monitoring outcomes
With the social care practice, all funding streams would be merged into one budget. The members of the practice would have responsibility for the package of overall care provision for their clients. Being relatively small, they would have personal knowledge of and long-term contacts with their clients. They would be separated from specialist provider interests, and hence less subject to provider pressure. And they would have an incentive to provide preventive care and to economise on treatment.
In a social care practice world, local authorities would still have an important role. They would have to specify the budgets for the practices. And they would have to monitor the quality of the service being provided.
But that monitoring would be on the outcomes of the process – the welfare of the looked after children. This would be in sharp contrast to the current system, where micro-management through bureaucratic hierarchies both diffuses responsibility and demotivates front-line workers.
As professionals trusted with a budget, the social workers involved in social care practices would be empowered and energised. They would provide a more effective and efficient service. But, most importantly, they would provide caring environment for looked after children far superior to that provided under the present system.
The consequence would be happier children, growing up into more secure and more confident adults – and more fulfilled social workers.
· Julian Le Grand is professor of social policy at the London School of Economics and an ex-Downing St adviser. Alastair Pettigrew is director of children’s social care in Lewisham
