Are we there yet?

The spotlight has been turned on to children’s trusts with the publication of an evaluation report into their progress. Realising Children’s Trust Arrangements (1) is a national evaluation of the first phase of the children’s trust pathfinders.

Brighton and Hove Council is one of these. David Hawker, the local authority’s director of children, schools and families, says the complexity and length of time needed to establish a children’s trust surprised the council. Much of this was put down to legal and financial factors. “We are making progress but it is a messy, slow business that is painstaking and quite frustrating,” he says. The council aims to have the necessary structural changes in place to be a children’s trust by the end of 2006 – two years ahead of the deadline. It is opening five children’s centres next April and will have integrated teams and management in these centres by next October.

One of the areas Brighton and Hove is happy to pat itself on the back for, even if only lightly, is how it involves local young people and their parents. It has already established a young people’s council and a parents’ forum, holds regular stakeholder meetings and its consultation on children’s centres received 1,200 responses.

Another children’s trust local authority keen to mark its progress is Solihull Council. Kevin Cromptom, the council’s director of education and children’s services, says one of the best things it has achieved is the creation of a team of staff who have been seconded from the health authority and local authority. The team’s background has enabled it to take a broad look at budgets for the borough, decide where they are best allocated and improve communication between the disciplines.

While these two children’s trusts have had degrees of success, the evaluation report highlighted several councils having problems with setting up children’s trusts. One difficulty relates to how practitioners deal with information-sharing on cases. The report noted that social care professionals sometimes felt that their colleagues in health were holding information back, which was leading to mistrust between the different disciplines.

The principle of patient consent is central to case work in the NHS. Gelling health professionals’ position with that of social care professionals, who favour a case management approach, is tricky, according to Hawker. He says social care staff accept the idea that information is only shared after patient consent “although it can get in the way of effective case management”.

It is a sticky subject that Crompton has also come across. He argues that the confidentiality surrounding medical records can prove problematic as this results in professionals being unsure of what exactly they can and cannot share. He adds: “I  get the impression us councils are trying to invent the same wheel. We all know the information-sharing system we want and why we want it so why can’t we develop it?”

For him, the barrier to information-sharing is systematic and not territorial: “I’ve not met one professional who has sat in their office and said ‘I’m not sharing this information because it’s mine’. It is not a wilful decision but a product of the legislation and the system.”

But not everyone agrees. Moya Sutton is Knowsley Council and Knowsley primary care trust’s assistant director of children and families. She says: “If there is a blockage over information-sharing it is down to the individual and not the agency itself.”

She adds that there are protocols agreed in the 11 information-sharing and assessment trailblazer areas across England – of which Knowsley is one – that are running at the same time, and often in the same areas, as the children’s trust pilots. She adds that she has had GPs tell her they need to understand more about why social services have requested information about a client before they give it out.

 Although not an official children’s trust pathfinder, Knowsley has successfully integrated its children’s services without having to formally change its structure.

While disagreeing on who or what may be causing the hold-up in good information sharing, all three professionals agree that national guidance is needed from the government to tackle the problem. Hawker says any national guidance must be based on a “definitive interpretation” of the Data Protection Act 1998 and the Human Rights Act 1998 in order to clear up confusion.
Sutton calls for England’s children’s commissioner Al Aynsley-Green to lead on the issue, and, locally, urges chief executive officers to promote information-sharing.

Another area the report noted children’s trusts struggled on was in meeting the needs of families with disabled children and children with complex needs. It said that this client group was “dissatisfied” and “substantially under-supported” and adds that both parents and young people highlight the difficulties in finding information about the services available to them.

So why is this the case when one of the major reasons for establishing children’s trusts in the first place was to address the needs of disabled children, a group often overlooked by services.

Sutton says it simply may relate to local authorities in the children’s trust areas having too few staff in the services that clients require. She adds: “It could be that each family wants something different for their own child and having a very individualised service might challenge an authority.”

While staff shortages may compound the problems of accessing services, Hawker says the current funding arrangements can hinder the work that is already going on with families with disabled children. Children who may have special needs and disabilities undergo multiple assessments in order to qualify for services. The funding streams for these are fragmented because the NHS pays for some services while social services cover others.

A way of overcoming this, according to Sutton, is to ensure that resources are properly pooled and budgets are aligned behind the needs of disabled children and their families within the borough.

One particular problem Solihull is facing is how to mainstream all the good work it has done so far into future services. Crompton says its £100,000 pathfinder grant – which all children’s trusts received – runs out next year and if the government wants to keep up momentum then it will have to encourage councils to mainstream their work if it is not to be lost. “Councils will want financial support to do this.”

For Hawker the problem Brighton and Hove Council is keen to tackle is how it can improve communication between agencies, managers and staff, and providers and users. “People tend to be quite insecure when they think they don’t know what is going on… and this can lead to them feeling mistrust. We need to counteract this.”

Clearly, the strategic and operational work of creating a children’s trust is painstaking. Some councils may follow Knowsley’s path and integrate children’s services without changing governance arrangements. But whatever course councils choose, their priority must be to put clients first. Crompton sums this up when he says: “There is no right way to do a children’s trust. The key thing is for all agencies to be in one room with the ambition to improve the outcomes for children from the children’s perspective.”

(1) Realising Children’s Trust Arrangement, Department for Education and Skills, September 2005

The Background
Children’s trusts are central to the government’s policy for transforming and improving children’s services by integrating and providing all services for children – health, education, social services and others – through one single agency. By 2008 the government wants each area to have its own children’s trust. It chose 35 English children’s trust pathfinders in 2003 and they started work on their mission in April 2004.