news analysis of new fostering standards and plans to end ASW role in compulsory admission

(It may be advisable to print this document as it is long).

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.

 ———————————————————————————————- 

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