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Impacts of Changes to Child Care Services in the UK

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Discuss how the changes to children’s services currently being promoted by the government are likely to impact on the lives of children in need, their families and social workers undertaking their statutory duties.

An Essay

This essay is effectively in two parts. In the first part we shall discuss and delineate the measures that the government are currently promoting and then, having done that we shall critically assess how they impact on the various subsections outlined in the title.

The Measures:

There are many measures that have been introduced in the recent past and therefore are currently being promoted by the government. Perhaps one of the most important is the National Service Framework for children, young people and maternity services (NSF 2004). This was published in Sept 2004 after a long period of consultation. It was arguably triggered by a number of events which highlighted the need for some form of central policy document to help to guide the various professional agencies in their efforts to provide a seamless service for the child in need. (Zeigler et al 2005) (Meadow 1995)

Perhaps the defining trigger to the evolution of this document was the tragic death of Victoria Climbie, whose case in 2000 highlighted the deficiencies in the ability of the various agencies involved to effectively communicate and share vital information which might have averted the tragedy that subsequently overtook the 8 yr. old girl. (Saraswat 2005) This coincided with the publication of the NHS plan in July 2000

The subsequent Laming enquiry identified 108 separate areas where improvements could be made. This was followed up by the announcement by the Secretary of State for Health, Alan Milburn, announcing the inception of the National Service Framework. This was expedited further by the problems that arose as a result of the Bristol Royal Infirmary’s Heart Surgery policies. The Kennedy report (2002) again made a number of recommendations which became encapsulated in the National Service Framework – hospital care for children.

In 2002, the government announced that it was commissioning a major review of the Child and Adolescent Mental Health Service which it anticipated being completed by the end of 2006, which clearly may well have items of major importance to the welfare of the child in need. (Benger et al 2002)

The Green Paper “Children at Risk” was announced by the Minister of State for Children, Margaret Hodge, in 2003. It was intended to be a discussion document which encompassed the areas of childcare provision, children’s services generally and the identification and procedures pertaining to “children at risk”. The major policy shift that accompanied this move was the transfer of responsibility for children’s Social Services from the Department of Health to the Department for Education and Skills. This also coincided with another Green Paper entitled “Every Child Matters”. Its main theme was the provision of reform measures for children’s care and protection.

At about the same time the Specific Performance Service Targets were issued (2004). These covered primarily health issues and many were targeted specifically at children. Very shortly after this, the National Standards, Local Action : Health and Social Care Standards and Planning Framework 2005/6-2007/8 was published in July of the same year (2004) which was an umbrella publication covering both the NHS and all the Social Service Agencies. It covered guidance on policy, finance and targets to be met.

The Children’s Bill went before Parliament in March 2004 which brought together the major features of the preceding Green Papers. At about the same time the Child Poverty Review (Aug 2004) was also published which contained some major recommendations for action to minimise the effects of Child poverty in the UK. Its professed goal was, after reviewing the changes in policy and welfare that were required, to halve the level of child poverty by 2010 and eradicating it by 2020. In the specific context of this essay, one of its major targets was to put in place welfare support to encourage those parents who could work, to get back to work and to provide a degree of financial stability where that was not possible.

The effects

One of the major goals in the government’s policy (Treasury Child Poverty Review 2004) is to bring about social reform by improving a child’s life chances. It aims to do this by two major strategies. Firstly to improve the general standard of health of children and secondly to improve their financial stability ( by tackling material deprivation). Clearly the NHS reforms are primarily aimed at the various health issues and the National Standards are aimed more at the social problems.

It is a key feature of these measures that co-operation and multidisciplinary teamworking are the preferred mechanisms that will achieve the stated goals. (Little et al 2005) This is the nub of the major changes that will impact on the workers in the various caring disciplines.

If the government is successful in implementing all of the strategies that are covered by all the above programmes it could produce a major shift in the emphasis that is currently placed on child care and child safety and protection issues. (Pheby 2000)

As far as the Children’s Bill is concerned, it gives all children potential access to the Social Services and those children who have specific identified needs should find it easier to get targeted help for those needs. As far as the actual Social Workers and, for that matter healthcare professionals in general, are concerned, the theory is that the children’s services are now envisaged as an almost completely integrated service, where planning, facilitation and implementation is done on a multidisciplinary basis. It is hoped that this will cut down on duplication and thereby improve efficiency. Accountability is also an essential feature of many of these measures.

As far as the most socially vulnerable children as concerned, the key responsibility for their welfare still rests with the Social Services, as their responsibility, as defined by the Children Act (1989) is essentially unchanged. The major difference with the current legislation is that the Social Services will head a multidisciplinary team approach to try to close the gap between the outcomes in this group and the outcome for the average child.

Another major change will be the setting up of a database that will be shared across all relevant agencies that have a legitimate interest in a child’s welfare. This should allow all interested parties to share “intelligence” and information that may be helpful in framing a response to a particular child with a particular problem.

Most of what we have refered to thus far is theory and expectation. Perhaps this should be contrasted with the reality of the situation. Brandon (et al 2005) produced a review document covering an assessment of the last 20 serious case reviews in Wales, they highlighted a number of process failures in the methods of service delivery. It was a useful document in so far as it was able to pin-point the areas where the service is “less than seamless”. Specifically it found deficiencies in aspects of training and also the actions and role activity of the lead professional in many cases. The authors produced a very pertinent statement as part of their conclusion which is worth quoting verbatim:

Consultation could often be used prior to, or in place of referral. The barrier to the collation and analysis of relevant information often appeared to be a failure to recognise and understand expertise rather than a lack of communication as often postulated in review reports. Skilled use of expertise and consultation in a co-ordinated manner could result in more rigorous assessments and promote greater professional trust, confidence and challenge.

In that short paragraph is encapsulated the practical difference between the government’s rhetoric and good intention and the actual reality as the grass root workers try to adjust to the processes of reform.

Mercifully, we should observe that the majority of the legislation that we have presented here is actually empowering and enabling rather than prescriptive or mandatory. Perhaps we should therefore expect something of a learning curve from all parties as it slowly works its way into common practice.

References

Benger and Pearce 2002 Quality improvement report: Simple intervention to improve detection of child abuse in emergency departments BMJ, Mar 2002; 324: 780 - 782.

Brandon, Dodsworth, Rumball 2005

Serious case reviews: learning to use expertise

Child Abuse Review May 2005, vol. 14, no. 3, pp. 160-176(17)

Child Poverty Review 2004

HM. Treasury

HMSO: August 2004

Children Act 1989.

A Government Bill 1989

Children at Risk 2003

Green Paper

HMSO 2003

Children’s Bill 2004

Hansard: March 2004

Every Child Matters 2003

Green Paper

HMSO: Oct 2003

Kennedy report into Heart Surgery at the Bristol Royal Infirmary 2002

“Learning from Bristol”

HMSO: January 2002.

Laming enquiry 2003

Death of Victoria Climbie:

HMSO: 28 January 2003

Little M, Kohm A, Thompson R. 2005

The impact of residential placement on child development: research and policy implications

Int J Soc Welfare 2005: 14: 200–209

Meadow 1995 Parental Perspectives in Cases of Suspected Child Abuse BMJ, Sep 1995; 311: 697.

National Service Framework for Children, Young People and Maternity Services 2004

HMSO: 15th September 2004,

National Standards, 2004

Local Action: Health and Social Care Standards and Planning Framework 2005/06–2007/08

HMSO: July 2004

NHS Plan

HMSO: July 2000

NHS Specific Performance Service Targets 2004

NHS National Publication

HMSO: June 2004

Pheby, Carl Henshall, Deborah Henshall, Brian Morgan, and Simon Wessely 2000 Diagnose and be damned BMJ, Apr 2000; 320: 1004.

Saraswat 2005 Child abuse and trichotillomania BMJ, Jan 2005; 330: 83 - 84.

Ziegler. Sammut. Piper 2005

Assessment and follow-up of suspected child abuse in pre-school children

Journal of Paediatrics and Child Health, May 2005, vol. 41, no. 5-6, pp. 251-255(5)

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