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Until now fostering agencies have been free from independent inspection and regulation. But the launch of national minimum standards last week should mean both parents and children know exactly what to expect from fostering. Alex Dobson investigates.

Setting the standards for fostering

Some time ago, the government signalled its intention to set high and non-negotiable standards across the social care sector with the introduction of new national minimum standards. The standards have been dribbling out, one by one, over the past 12 months, but the timescale is now tight and last week saw the launch of the 27 proposed new national minimum standards and draft regulations for foster care.¹

There has been concern for some time that fostering agencies have not been subject to outside inspection. But this new consultation document states, for the first time, private, public sector and voluntary agencies will be subject to inspection and regulation.

The draft standards come at a time when the proportion of looked-after children in foster care continues to rise. Around 58,000 children are currently looked-after by local authorities, with about 38,000 of those placed with foster carers. While the majority of foster care is provided directly by local authorities, there are also now 120 independent agencies offering a range of services, and some practitioners believe regulation of the whole sector is long overdue.

The standards (see below) cover key areas of fostering, including fitness to manage, recruitment and support, and suitability of premises.

Although the consultation document sets down standards, it stresses that it is not aiming for a standardised service. Nor, it says, is it intent on stifling innovation. Standards are aimed at covering a variety of different models of fostering care, and the document suggests that the standards should be seen as enabling rather than preventing individual providers developing their own approaches.

Practitioners feel it is not yet clear how the non-mandatory minimum standards will work alongside the mandatory regulations. The practical effect though, says Sue Gourvish, head of services at the National Foster Care Association, is that providers must meet minimum requirements in order to satisfy the compulsory regulations.

"The standards are based largely on what has gone before and we would expect that members could meet the requirements. Many will already be working to a higher standard. The 27 requirements are for minimum practice, not best practice," she said.

Most providers welcome proposals to standardise practice across the sector, but there are concerns over some of the long term implications of the new requirements. Many agencies are also calling for more time for the consultation - the current deadline is 16 October.

There are also fears that the registration and inspection process will push up the cost of foster care. The NCSC is intended to be a self-funding body, and under draft proposals there will be a flat fee charged for inspection plus an additional charge, depending on the size of the organisation. Fees would be increased over a period of five years. Providers themselves are likely to have to bear the costs of the new checks, inevitably meaning that costs will have to be passed on.

Andy Robinson, head of inspection and registration for children’s services at Kent Council, is launching a pilot project to assess the way that the standards will work in practice. He is optimistic that the new proposals will have a positive effect, but has concerns that the inspection process and the proposed costs may undermine the work of smaller independents.

"My fear from all of this is that smaller fostering agencies, where there may be an excellent specialist service, could be adversely affected. It seems to be directed at larger organisations and this is something that we have become aware of with the pre-inspection work for the pilot.

"I know from experience how the preparation for a social services inspection can be enormously time-consuming, and it is likely to put huge pressure on the smaller scale independents to meet the requirements and to pay for the inspection. Larger organisations are likely to be able to absorb the costs and the amount of work involved more readily."

The Partial Regulatory Impact Statement that accompanies the new minimum standards says that few fostering providers of adequate quality would have any difficulty meeting the requirements. They are already expected to meet the National Foster Care Standards 1999, and the new minimum standards are largely based on them. But there are some significant new requirements that are likely to be the main focus of the consultation process.

Jenny Hemming is a director of independent fostering agency Childcare Bureau Ltd. She welcomes the minimum standards, but is concerned about the effect that one of the regulations in particular could have.

"The whole thing holds no terrors for us - we will enter into the new procedures wholeheartedly. We do have a problem, though, with the section that talks about the non-employment of family members," she says.

"I recognise that where agencies are using members of staff to foster for them there is obviously going to be a lack of impartiality, because there are no safety measures in place for the children. There are also problems with the complaints procedure in cases like that and that is not acceptable," she admits. "But I would like clarification on exactly how the regulation will impact. Many of the independents that I know are made up of family members.

I will be writing to explain my concerns over the practical implications of this. Companies set up after April next year will be aware of this requirement but what about those already employing family members?"

Felicity Collier, chief executive of British Agencies for Adoption and Fostering, also notes the importance of the new provisions relating to family members.

"It has been a matter of concern to us that one or two of the independent fostering agencies would appear to have had managers of the service also fostering children. There are clear potential risks in that in relation to safeguarding children," she says.

"The separation of roles needs to be clear," she adds. "We would be concerned about the rigour that it is possible to exercise when managing and protecting children when you are supervising managerially members of your own family."

Collier also welcomes the establishment of fostering panels that allow thorough consideration of all the issues. She is less enthusiastic about the lack of a right of appeal for carers, contrasting it with proposals to set up an independent body to look at appeals in adoption.

"Under the minimum standards for fostering, while there is a system of review and the opportunity for foster carers to have their case looked at again, they are not proposing using any independent access to an appeals system. I can’t see the logic of extending access to an independent body in the case of adoption but not in fostering," she says. "The government needs to look again at what messages they are giving out, and there needs to be consistency in the treatment of carers."

When the standards come into being, it is not only fostering agencies and carers who will be affected. The laying down of minimum standards will mean that users, both parents and children, will know exactly what they should expect from foster care, whoever is providing it. And that, say many practitioners, is long overdue.

¹ Department of Health, Fostering Services National Minimum Standards Fostering Services Regulations, DoH, 2001. Also at http://www.doh.gov.uk/ncsc/fostering.htm

Proposed minimum standards for fostering:

1. Clear statement of the aims and objectives of the service and of what facilities and services they provide.

2. The people involved in the service possess the necessary business skills and experience of child care and fostering.

3. Those managing the service are suitable people.

4. Clear procedures are provided for monitoring and controlling the activities of the fostering service and ensuring quality performance.

5. The service is managed effectively and efficiently.

6. The service makes available foster carers who provide a safe, healthy and nurturing environment.

7. Children and their families are provided with services which value diversity and promote equality.

8. Each child placed in foster care is carefully matched with a carer capable of meeting their assessed needs.

9. The fostering service protects each child from abuse, neglect, exploitation and deprivation.

10. Each child is encouraged to maintain and develop family contacts and friendships as set out in their care plan.

11. Each child receives appropriate health care, together with information and training appropriate to their age and understanding to enable informed participation in decisions about their health needs.

12. A high priority is given to meeting the educational needs of the child.

13. Services help to develop skills, competence and knowledge necessary for adult living.

14. Any people working for the fostering service are suitable people to work with children and young people.

15. Staff are organised and managed in a way that delivers the best possible foster care service within the resources available.

16. There are an adequate number of sufficiently experienced and qualified staff.

17. Employers are fair and competent.

18. A good quality training programme is provided.

19. All staff are properly accountable and supported.

20. Employers ensure there is effective management and supervision for staff.

21. Employers provide supervision for foster carers and helps them to develop their skills.

22. Foster carers are trained in the skills required to provide high quality care.

23. An up-to-date, comprehensive case record is maintained for each child and relevant information from the case records is made available as appropriate.

24. Administrative records contain all significant information relevant to the running of the foster care service.

25. Premises are appropriate for the purpose.

26. The agency is financially viable at all times.

27. The financial processes of the agency are properly operated.

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Plans to end the role of approved social workers in consenting to a patient’s compulsory admission to hospital have provoked fears that an important safety net will be removed, Claire Laurent reports.

Safeguard under threat?

 

When the government’s Reforming the Mental Health Act white paper was omitted from the Queen’s speech, many mental health social workers and organisations breathed a sigh of relief.

They felt it gave them more time to publicise their concerns about some of the proposed changes and so give the government more time to get this piece of legislation right.

However, there is growing concern that the white paper could be discussed in the second session of this parliament, meaning that legislation could be on the statute books by 2005.

Mental health organisations are concerned that the current proposals threaten to dilute the role of social work, especially in relation to compulsory detention. At present only an approved social worker (ASW) can apply to compulsorily admit someone to hospital. Two doctors, one a consultant psychiatrist and the other a doctor known to the client, must recommend detention, but it is the job of the ASW to assess the client socially, talk to the family and look for the least restrictive alternative.

"The ASW has to ask the obvious question: ‘Are you prepared to be an informal patient and would you agree to take the medication at home?’," says Paul Jewitt, an ASW at Orchard medium secure unit in Luton, Bedfordshire. "If the person is prepared to do that, that’s where they stay. You can’t put them in hospital if they are prepared to co-operate with a less restrictive alternative."

The government proposes to remove the requirement for an ASW to be involved in sectioning. Instead, two doctors will be backed up by "a suitably trained mental health professional,".

Observers are concerned that the removal of the legal requirement for an ASW to be involved means clients’ home circumstances, family and social needs will not be given due consideration. Jewitt, who is launching a campaign against the proposed changes, says, "ASWs take a holistic view. They are independent of the health service. A consultant psychiatrist has enormous power and a nurse is vulnerable.

"If the role of the ASW is watered down, we could be in a situation where one or two doctors and a nurse are actually making decisions to lock up people against their will. I think that’s extremely dangerous."

ASWs are employed by local authorities, which reinforces their sense of independence from NHS colleagues. "The ASW role is the only independent arbiter role that exists under the Mental Health Act," says Jewitt.

Government proposals to develop advocacy services are not robust enough to protect the client and uphold the law, he argues, partly because advocates are poorly paid and not professionally trained, but also because their role is to support the client’s view whether or not the circumstances indicate that detention is necessary.

Marjorie Wallace, chief executive of mental health charity Sane, says: "It is an enormous shame that we are diminishing the role of the ASW - in a world where skill and experience are in short supply, they are performing one of the most important tasks. We feel that instead of becoming more specialised, mental health workers will become increasingly de-skilled and less able to respond to the complex needs of people with serious mental illness."

However, David Joannides, director of Dorset social services and chairperson of the Association of Directors of Social Services mental health group, says the ADSS supports the extension of the ASW role to other suitably trained professionals.

"We are not so arrogant that we believe this work can only ever be done by ASWs. The opinion in the past was that the strength of the ASW was that they were outside the clinical team so were able to carve an independent role. That argument is less sustainable because mental health teams are becoming increasingly integrated.

"The need for an independent, objective view still remains - but in future everybody is going to be part of the same team. What will be important is the rigour of the assessment when staff undertake this role. Everyone is going to have to learn to assert their own judgement."

He adds, too, that while the role of the ASW can be taken on by others it will be important that they are well trained. "What we don’t want to lose is the competence of the ASW training."

The fears of mental health groups and ASWs that their independent role is being written out of the equation could be given weight by care trust pilots.

The NHS cannot employ ASWs directly because of the need for them to be independent of medical staff. This has raised an interesting dilemma for the five pilot sites concentrating on mental health, which are in the position of being unable to employ their own ASWs. Instead they are relying on ASWs employed by local authorities - leaving mental health services split.

The danger is that ASWs will come to be seen as superfluous. It seems likely that the new mental health white paper will make ASWs optional, leaving future care trusts free to employ all three of the professionals necessary to detain someone against their will. From an organisational point of view this is nicely streamlined, but whether it’s in the interests of service users remains to be seen. 

Department of Health, Reforming the Mental Health Act, The Stationery Office, 2000