Some members of the Care Review Evidence Group reflect on the risks of reforming in haste and repenting at leisure.

Wednesday, December 7, 2022

Category: Blog

Co-authored by: Professor Leon Feinstein, Professor Geraldine MacDonald, Professor Paul Bywaters, Dr John Simmonds, Professor Karen Broadhurst, Professor Donald Forrester, Dez Holmes

A reflection on evidence and implementation

As members of the Evidence Group supporting the Independent Review of Children’s Social Care (IRCSC), a number of us have received requests to share our views on the evidence base underpinning the Review’s recommendations. In responding to these requests, our intention here is to offer a high-level and constructive perspective for those now tasked with thinking about implementation.

The first thing that should be clarified is that the Review is not a systematic review of all research evidence that might be relevant, it is a framework for policy and practice reform. Though informed by evidence, the recommendations are not all tightly linked to research evidence of intervention effectiveness – as might be the case when producing, say, NICE Guidelines. This is not a criticism. There are many types of review and it is entirely usual for policy and/or practice reforms to draw on multiple sources of knowledge (for example, from research, practitioners, families and individuals) and for the evidence base to be incomplete and/or contested. As such, the Review drew on multiple types of knowledge and evidence. Those now focused on implementation will need to consider some of the complications this approach brings.

There is much to welcome in the Review, and many have called for urgent action to ensure reforms are not delayed. The need for improvement in services and positive change for children, young people and families is widely recognised and so there is an understandable drive to ‘do something’. Given the scale of reform proposed, there is an equally strong argument for thinking carefully about a number of the issues raised before progressing at pace. The Review was undertaken in a relatively short time-scale, working to a very broad scope and with an ambitious goal of system change. Implementation colleagues will need to recognise and grapple with the risks that result from ambiguous, conjectural or partial evidence. Taking time to interrogate the wider evidence base not reflected in the Review, to consider unintended consequences and manage interdependencies, would be time well spent. As with so many important decisions, one might approach in haste and repent at leisure.

For example, the structural reforms proposed in relation to Regional Care Cooperatives is an area where implementation colleagues will find very limited evidence to draw upon. The creation of Regional Adoption Agencies might be somewhat comparable, and the DfE-funded evaluation to date presents ‘a complicated picture’ with very mixed evidence of success against intended outcomes[1]. Given the Review’s intention to strengthen leadership and accountability, care will need to be taken that these structural reforms do not dilute local accountability mechanisms. With ever-increasing pressure on the care system, it is unclear that the mechanisms proposed have the capacity to resolve the issues within the ‘market’, as it is often referred to. As with all structural change, and particularly in light of learning from NHS reorganisation, implementation of RCCs – if this idea is progressed – will need to ensure that this does not become an expensive distraction[2]. The proposed reforms to inspection will require similar attention; much of what is presented as unpopular or unhelpful within the Review can equally be seen as essential checks and balances that are necessary within a system that exerts immense power over citizens’ lives.

The Review’s emphasis on family help is in the spirit of the 1989 Children Act and welcome to many who recognise that families in contact with children’s services too often describe a punitive approach to their difficulties[3]. As was explored in the first report from the review team, there is firm evidence of the socio-economic drivers which are associated with family involvement in child protection services[4]. Colleagues involved in implementation activity will be acutely aware that achieving a responsive and effective family help system depends less on restructuring children’s services and more on radical efforts by national government to reduce poverty, improve health, education and other services and reduce inequalities in living standards. At present, the foundational economy which is vital for family wellbeing is stretched beyond capacity. Moreover, restructuring alone, without fundamental consideration of the mission of children’s social care and changes in the power dynamic between families and services, is unlikely to bring the required change.

The proposed bringing together of Early Help with Child in Need and Child Protection is not wholly illogical; after all, support and protection are not neatly delineated. However, there are potential consequences that must be avoided: such a proposal could pull resources, expertise and the focus of attention away from family support; it could create confusion regarding existing legal thresholds and drive inconsistent practice with families. The proposals will also concern those who remember Munro’s commentary on the previous Information Commissioner’s query that “When looking for a needle in a haystack, is it necessary to keep building bigger haystacks?”[5]  Against a backdrop of concerns that professionals are missing children facing serious risk[6], could this proposal inadvertently exacerbate the situation? It might lead to an ever-widening investigative net, with decreasing resources available to do the kind of work required to develop trusting and purposeful relationships to support families. These are just some of the issues that implementation colleagues will need to grapple with.

The Review makes a number of recommendations regarding workforce, and few would argue that skilled, knowledgeable practitioners are essential to a functioning system. The proposals to develop an Early Career Framework do not have a wealth of research evidence to draw upon, and there are potential risks of creating a separate system for early career child and family social workers and adult social workers. There are some insights from the evaluation[7] of the recently disbanded National Assessment and Accreditation System, which sought many of the same benefits as the ECF.  In attending to training and practice guides we must not overlook the wider evidence that training has limited impact on practice without accompanying efforts in relation to organisational context and climate[8]. There is limited evidence that issuing prescriptive guidance has a positive causal effect on practice quality (put simply, we wouldn’t need these reforms if guidance to date had been effective), and the significant influence of supervision, leadership and culture deserve equal attention.

In the current political context, there is a risk that the kind of long-term sustainable resource needed to achieve whole system change will not be forthcoming – and so implementation could become focused on what can be done with what resource is available. Without attention to the wider interdependencies, this risks fragmenting the system further, and could lead to some recommendations being progressed with limited effect (or worse, negative consequences). What is required is not temporary support or piecemeal funding of boutique initiatives, but long-term investment. Government must act as a whole system itself if it desires system change for children and families; this requires government departments to share ownership of complex and intersecting social issues and ensure the wider infrastructure which supports family life does not further decline.

Ultimately, evidence can only address so many issues. For the Review to achieve its intentions of improving the experiences and outcomes of children, young people and adults who encounter social care, it will be vital in our view that rigorous attention be paid to rights. Many of those with current, or with previous, experience of social care services represent some of the most marginalised and simultaneously scrutinised in society; people whose voices and preferences have been overlooked for too long and for whom there has been a high degree of surveillance but not enough support. Proposed reforms, included those relating to the use of data, should be subject to assessment of their impact on equalities so that they do not inadvertently erode or undermine rights of children and adults.

Lastly, colleagues focused on implementing the Review’s recommendations may be interested in recent research focused on the implementation of policies and practices within health systems, which identified that trusting relationships – those characterised by empathy, authenticity and collaboration – seem to be key to effective implementation[9]. This suggests that to successfully lead the proposed change, government must position itself as an enabler to the sector, exercising humility and a collaborative spirit. Policy reform, like good social work, requires more than passion for change. It requires critical thinking, skill, judicious use of evidence, and is something can only be ‘done with’ and ‘not done to’ those it is seeking to influence.

 

[1] https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1057530/Evaluation_of_regional_adoption_agencies_-_final_report.pdf

[2] Walshe (2010) Reorganisation of the NHS in England. BMJ. 341:c3843

[3] See for example, Featherstone, B., Gupta, A., Morris, K. & White, S. (2018) Protecting Children: A Social Model. Bristol: Policy Press.

[4] See for example, Bywaters, P. and Skinner, G. (2022). The Relationship Between Poverty and Child Abuse and Neglect: New Evidence. Nuffield Foundation.

[5] Information Commissioner (2005) Evidence Given to Select Committee for Education and Skills, House of Commons, London.

[6] Child Safeguarding Practice Review Panel (2022). Child Protection in England. HM Government. Available: https://www.gov.uk/government/publications/national-review-into-the-murders-of-arthur-labinjo-hughes-and-star-hobson

[7] https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/938083/NAAS_delivery_evaluation_of_phases_1_and_2.pdf

[8] Burke, L. A., & Hutchins, H. M. (2007). Training transfer: An integrative literature review. Human resource development review, 6(3).

[9] Metz, A., et al. (2022) ‘Building trusting relationships to support implementation: A proposed theoretical model’ Frontiers in Health Services. Vol 2.  https://www.frontiersin.org/articles/10.3389/frhs.2022.894599