14 October 2005
It's the biggest shake-up in social care for 30 years, with seamless children's services at its core. But already boundary disputes and rows about funding are spoiling the party. Peter Hetherington reports
In the brave new world of children's services, Montagu Primary School, on a remodelled council estate near inner-city Newcastle upon Tyne, has become a pace-setter.
Last year it was transformed from a humble primary to what's known as a 'full service' establishment. Behind a high-security fence, it doubled in size with a sparkling new wing to embrace a whole range of facilities; from school to a children's-cum-family complex in one fell swoop.
As well as a Sure Start centre for young children and parents, there's a neighbourhood nursery taking babies from a few weeks old to the age of three; a conventional three-to-five nursery; a family health and community project partly funded by the charity Save the Children; a 'health-works' initiative promoting healthy lifestyles; parent support staff; a nurse practitioner; paediatrician; community development officer; community forum; daily adult classes and much more.
David Simpson, head teacher of the 200-pupil school for the past 15 years, can be forgiven for appearing breathless, given the pace of change blowing through Newcastle and other authorities charged with piloting 'seamless' children's services.
This has placed yet another burden on the school management, ie, himself and his 12 staff, although he's managed to get an extra £50,000 this year from the Neighbourhood Renewal Fund to buy in supply teachers so that his full-timers can be redeployed when necessary.
Last year, Newcastle became one of 35 national pathfinders pioneering children's trusts, which are meant to combine social and health services, education, the voluntary sector and other agencies under one administrative roof, albeit with a complexity of funding streams that can challenge the mantra of seamless delivery.
In the biggest shake-up in social care for more than 30 years, the 35 are the forerunners of a national network of trusts under the umbrella of full-blown children's departments. These are now being established, in various forms and with varying degrees of enthusiasm, in 150 county, unitary and London authorities.
The upheaval is partly in response to Lord Laming's inquiry into the death of eight-year-old Victoria Climbié, who had been repeatedly tortured and eventually murdered by her great aunt and her lover, five years ago. Laming found that social services, the police and the NHS had missed at least 12 opportunities to save the child, and called for agencies working with children to co-operate more closely.
This, in turn, prompted a government reform programme, called Every Child Matters. This was enshrined in the 2004 Children Act, which paved the way for the emerging children's departments.
As a result, broad responsibility for children's services is now passing from the Department of Health to the Department for Education and Skills, although the former still has a strong interest.
Many long-standing social work practitioners, who remember their new discipline emerging – ironically – from the rump of old town hall children's departments in the early 1970s, are aghast at the changes.
Some talk of a 'knee-jerk response' to one particularly gruelling incident – a charge strongly denied by the new social care minister in the Department of Health, Liam Byrne. He says that while the aftermath of Climbié revealed a number of 'pretty serious issues', research for Every Child Matters indicated the need to focus work on children in a much more 'holistic' way.
'The core of this is maximising our chances [of] making sure child protection is done in the best possible way,' he insists. 'It gives us a lot more opportunity about how we deliver health services to children.'
Ministers believe the case for creating strong children's departments, embracing education, social care and health, was strengthened by a joint review in July by eight government inspectorates. This revealed that some of the most vulnerable children in England are still failed by the services that should protect them.
The review found 'serious failings' in the safeguarding of children by services, including health, the justice system and councils, and concluded that many agencies working with children are 'often unclear' about how to recognise the signs of abuse and neglect.
Nevertheless, divisions over the case for change appear to be emerging between what some see as the old social services establishment and newer professionals from other disciplines, who are taking up the new directorships of children's services.
In Newcastle upon Tyne, for instance, one of the higher-rated social work authorities, the new children's director, Catherine Fitt, a former teacher turned child psychologist, finds herself dealing with 6,000 annual referrals to social services annually, one of the highest levels in the country.
For her, the case for change is strong. 'We are on the back foot,' she concedes. 'Our referral levels are incredibly high and the challenge is to work with partners on how to break this cycle. There's nothing we're doing wrong. It's the sheer volume of the cycle.' Finding the extra resources, she accepts, will be challenging.
At Montagu school, in an area of poor health and high unemployment, with a string of social ills and little sign of an economic upturn – 85% of pupils are on free school meals – Simpson is keen to make the new system work. Among parents and children, he can already see health improving. But money is a worry. While capital funding for the new facilities on the school site proved no problem, additional revenue for day-to-day running appears elusive.
'There's a great deal of capacity but no more revenue,' he laments. 'There are very high expectations… that the school will become a “catch-all” from 8am to 6pm, and quite frankly with very little (extra) funding. I cannot see where the money is, let alone where it is coming from. This is a significant change from how a school is normally run. We are certainly finding it quite challenging.'
But as the new children's directors take up their posts – many of them from the world of education, rather than social care – the reorganisation is already raising more questions than providing answers.
What, for instance, will happen to adult services, the other element of social care? Answer: a white paper is promised by the Department of Health before the end of the year to chart a way forward. However, authorities are already setting up separate departments for adults, sometimes combining them with housing and neighbourhood services.
How will social workers, who regularly cross adult-child care boundaries, divide their time between the two areas – and, crucially, how will budgets be split? Answer: unclear.
And how will the child and adult elements of primary care trusts, with their separate income streams and NHS culture, integrate into the new system? Unclear also.
Councils are nevertheless proud that they have at least managed to soften the impact of reorganisation. After intensive lobbying by the Local Government Association, the Act was revised to make structures and lines of command less prescriptive and more flexible.
But, confusingly, it is still unclear whether social services departments will be allowed to continue, in one form or another, below new directorates.
Some councils, like Newcastle upon Tyne, are proceeding cautiously. Catherine Fitt says her authority has decided not to 'waste money' on restructuring that might have to be unpicked, depending on the outcome of the adult care white paper.
Other authorities, like the inner-London borough of Camden, have opted – reluctantly, it must be said – for full reorganisation by creating a children, schools and families directorate alongside a separate neighbourhood, housing and adult directorate, headed by the current housing director.
Chief executive Moira Gibb reckons the directorate model – technically leaving departments intact below – is the least disruptive. But she cautions: 'People will have to work across boundaries. This will be essential because, in reality, most social workers… don't work with children but with the parents of children 98% of the time.'
A former director of social services in the Royal London Borough of Kensington and Chelsea, Gibb feels that many people who could identify with social care as an integrated discipline are confused by the new structure.
For Peter Gilroy, the chief executive of Kent County Council, England's largest authority in terms of population, that confusion could lead to families with 'multiple problems' having several visits from a range of professionals ('maybe eight or nine'), rather than one social worker.
Gilroy, the county's director of social services until earlier this year, is similarly aghast at the break-up of a long-established department, which, he thinks, delivered a seamless service. 'The way we provide support must be on a holistic basis and I am reserving judgement to see what happens,' he cautions. 'We're trying to do this as painlessly as possible and the front of the “business” will not change.'
But deeper financial and structural concerns are now emerging. One new housing and adult services director in the south of England predicted a 'financial spat' as authorities divide budgets between departments. He says that's because, in some councils, children's services cross-subsidise the adult sector, and vice versa.
'In my area, children are propping up the adults and when we split the department we're going to have to devise a new budget – but managing the handover and doing the cut is frankly quite tricky.'
Another concern is the crossover with primary care trusts, partners in the new children's trusts and in the emerging children's departments. As well as being rationalised to meet £250m economy targets – and, hence, breaking the coterminous link with some councils, particularly London boroughs – they're likely to become commissioners of services, and not providers, by 2008.
Exactly where child health will go is open to speculation. While some would like to see councils extending the 'democratic net', others point ominously to the 'quangoisation' of parts of the sector.
Last week, one new council children's director met his social work staff to hear of their concerns. 'I had been warned that they'd be sceptical of the new set-up but was pleasantly surprised to hear they were very positive and wanted the system to work,' he recalled. 'But their biggest fear is being swallowed up by the NHS – they see that as the big beast in the corner.'
It's a worry dismissed by social care minister Liam Byrne, who is overseeing many of the reforms. While insisting that local government is in the lead, he acknowledges: 'As with any change, there'll be a period when people try out various ways to get it right. From the Department of Health perspective, we've got to make sure that we're sending out a very clear signal to PCTs that it's extremely important they engage with it [the new structure] very seriously. We have to make sure we're monitoring events.'
Byrne acknowledges that staff need reassurance. 'We've done quite a lot of thinking about workforce issues and one of the things I was very keen to do when I arrived at the department [after the general election] was to recognise the challenge the workforce faces.
'We've around 1.2 million people working in social care. There are very high vacancy and turnover rates in parts of the country. We can't pretend the problem is not there and have to confront it. Many people go into social care because they've got a vocation and we have to make sure these people live out their potential.'
Staff morale and the acceptance of the new structure by senior council officials were identified as key issues in a recent evaluation of the 35 child trust pilot schemes by the University of East Anglia.
While noting that professionals in all sectors believe changes can be achieved if introduced with due attention to 'new ways of working and coherent training programmes' across disciplines, it cautioned that challenges remained – not least in integrating existing programmes.
'There is some lack of clarity about new roles and responsibilities and some evidence of anxiety and confusion about restructuring among frontline staff,' it added. 'Recruitment and retention… are major challenges… training is urgently needed to support new ways of working.'
Warning of further problems in creating pooled budgets, involving legal contracts, it suggested an 'informal approach' as a starting point. More ominously, it implied that some professionals – especially council chief executives – were not on board and needed to show they were 'committed to change'.
It's a charge denied by the Local Government Association. Stephen Meek, its programme director for children and young people, insists that councils, PCTs and other agencies can 'conceptually work together', although he acknowledges there is no national template. 'But I do not sense strong opinions that this is going in the wrong direction.'
But on the ground, uncertainty and confusion is palpable, from the head of Montagu Primary School in Newcastle trying to make the system work, to the chief executive's office in Camden.
Others, heading the new children's departments, are adamant that the recent report from the eight government inspectorates underlines the case for change. Worryingly, it noted that some overstretched social services departments require cases to be so serious before they act that some children in need of attention are at risk.
And because the response can be too slow, the report found that schools sometimes stop referring children to social services when concerns first emerge. 'Some families are therefore likely to be subject to avoidable pressure and children may experience preventable abuse or neglect,' it warned.
But with next year's Whitehall grant settlement for local councils likely to be considerable tighter than 2005/06, the challenge will be to find the extra resources to implement the most far-reaching reform of social care in decades.
Ministers, as ever, will stress the need for efficiency savings. Councils will assuredly respond that while these might emerge once the new structures have bedded down, greater investment will be needed initially if the new service is meet the objectives of the Children Act. That's seems to be the message from Montagu school.
Peter Hetherington writes on regeneration and community affairs