It is indisputable that children’s services face huge challenges. A report earlier this year from Parliament’s housing, communities and local government committee described children’s services in England as being at breaking point. While more funding was a necessary condition of tackling the challenge, it was insufficient; children’s services also needed reform and systemic change, MPs argued.
In my view, the single biggest challenge facing children’s social care is the lack of integration between all of the various agencies. In relation to older people, the argument seems to have been won that health and social care need to work more closely, if only because the alternative leads to hospital beds being blocked and, consequently, other inpatient services being affected.
For children and young people it is less clear cut, because there are more agencies involved. Look no further than the tragic deaths of Ben, Max and Olivia Clarence (all with spinal muscular atrophy) in 2014 at the hands of their mother, who had mental health problems. A serious case review found there were about 60 professionals involved in the children’s care, including social workers, GPs, a designated nurse, nine health organisations, schools and a charity, and the family felt inundated, despite practitioners’ best efforts to co-ordinate visits.
What is not needed to put the present situation right is large-scale structural change: it paralyses organisations for months and years and consumes huge amounts of wasted energy required to keep organisations going. But there are two “green shoots” which point the way towards creating a more coherent, integrated children’s service; and they come from different directions.
Building on MASH
The first of these is the multi-agency safeguarding hubs (MASHs), which were first developed in 2011 and now operate in many areas of England. Although the model has evolved differently, to suit local circumstances, all MASHs have at their core the bringing together of a range of disciplines to protect children experiencing or at risk of abuse or neglect.
Since staff are seconded, there is no widespread reorganisation of services as disciplines as varied as social care, the police and education retain their own identity. Some encouraging research indicates that the corporate culture which MASH staff assume, when members of this inter-disciplinary team, is greater and different from that of any one discipline.
The second “green shoot” is the development of integrated care systems, which bring together NHS commissioners and providers and local authorities to plan and commission care across their areas. To some extent, the starting point was, again, bringing together health and social care for older people but they also embrace care for children and young people.
In Cornwall and the Isles of Scilly, for example, integrated services for children have looked at how childhood obesity can be tackled across health and social care and secondly new models of planned mental health services, linking up mental health practitioners, GPs, social workers and the voluntary sector.
Taking integration further
There is a growing movement to ensure that the idea of “wraparound services” for children ceases to be a slogan and becomes a reality. But to go further, we should test the establishment of children’s service teams (CSTs), to which staff from a range of disciplines would be seconded. In some ways these would operate like the MASH model, but would extend across the whole range of children’s issues, from mental health to disability, youth justice to services involved in tackling childhood deprivation. To work successfully the teams would need to embrace not only health and social care but education, the voluntary sector, housing and income support.
Each CST would consist of two groups of staff: those seconded full-time to the team, such as social workers and community paediatricians, for example, and those who are part-time members, representing larger groupings – such as teaching staff, GPs or representatives from housing and leisure services. The onus on these representatives will be on making sure that information on children is shared with say, relevant schools or GP practices.
To make this work we would need some pump-priming from government to test the establishment of CSTs in a few areas. The present system is not sustainable long-term. MASHs and the push towards integrated care systems point a way forward for bringing staff together to deal, holistically, with children’s needs in new inter-disciplinary teams. Nothing could be more important for our future.
Dr Chris Hanvey is author of Shaping Children’s Services (Routledge, 2019) and formerly chief executive of the Royal College of Paediatrics and Child Health and deputy chief executive of Barnardo’s.