Birth of a children’s trust

After the inquiry into the death of Victoria Climbie, Alan
Milburn, then health secretary, suggested that agencies responsible
for the welfare of children should consider setting up children’s
trusts, multi-agency bodies that would be responsible for
delivering children’s services.

Given the deeply unenthusiastic response social services have given
to care trusts – another of the government’s pilot schemes – it is
perhaps surprising that so many local authorities are falling over
themselves to set up those for children. So far 44 have applied to
be pilots, of which 14 are expected to be approved this summer.
Successful bidders will receive “pump-priming” funding of between
£60,000 and £100,000 a year. Yet enthusiasm is such that
many of the bidders look likely to go ahead with their own version,
even if it is not given formal pilot status.

The appeal of children’s trusts is obvious. Milburn made it clear
that there was no set model to which trusts would have to
subscribe. Basically, if a trust integrated services and addressed
local issues the government would back it. And trusts could cover
as many – or as few – services as was thought appropriate locally.
As a result the plans for children’s trusts are as varied as the
authorities themselves.

Hammersmith and Fulham in west London is one of the councils that
submitted a bid to the Department of Health to become a pilot
trust. But whatever the result of the application, which is
expected soon, the council and its partners have decided that the
trust is the way forward. The radical restructuring of services
will present logistical difficulties and may incur financial costs.
So who stands to benefit?

With about 165,500 people, Hammersmith and Fulham is one of
London’s smallest boroughs. More than 130 languages are spoken and
22 per cent of residents describe themselves as from an ethnic
minority, including a significant proportion of asylum seekers.
About 20 per cent of the population are younger than 19. The
borough is an area of social and economic extremes between those
residents who are well housed and in paid employment and those who
are socially excluded.

Hammersmith and Fulham is served by one primary care trust, two
hospital trusts and two mental health trusts. Children’s social
work is organised into specialist services: referral and
assessment, child protection and family support, looked-after
children and services for disabled children.

So what difference would a children’s trust make?

The vision for the children’s trust in Hammersmith and Fulham is
that the needs of children and young people will be at the centre
of service planning to ensure better co-ordinated services that
share information more efficiently and are less frustrating for
service users.

Michael, aged one, has a severe brain injury. There are at least 10
professionals involved with him and his family, including a social
worker, health visitor, surgeon, paediatrician, speech and language
therapist, physiotherapist and paediatric dietician. The family
attend numerous appointments and Michael has already undergone many
assessments.

With a children’s trust, Michael would have a key worker to
co-ordinate involvement of all the professionals and be someone
Michael’s family could speak about to about his care. At least some
of the professionals working with Michael would be sitting in the
same office – improving communication and information-sharing – and
Michael would be subject to a single assessment process.

Amy, aged three, is the first child of Angela, a young single
mother with depression who feels isolated. The health visitor has
raised concerns with social services about safety in the home.
Social services assessed the case but it was not a high enough
priority for allocation. The health visitor found she could not
speak to any social worker that has met the family. Soon
afterwards, Amy arrived at nursery with bruises on her neck, and a
child protection investigation followed.

The trust’s vision for Amy is that her health visitor and social
worker would be located in the same team and would discuss the
details of her case. They would carry out a joint visit and it
would be clear that her mother was not coping and needed
significant support. Angela would have a good relationship with the
health visitor and would respond well to the family support package
that the two workers put together.

The borough has a good record of partnership work at a strategic
and operational level. These experiences show that inter-agency
working can be successful in Hammersmith and Fulham and have
already established the relationships that will make this possible.
Other partnership initiatives include:

• Assist: a joint mental health and social services team to
  provide a multi-agency assessment of need for 11-16 year olds at
  risk of being taken into care.
• Sure Start: multi-disciplinary family support teams are being
  established in the borough’s three Sure Starts.
• Behaviour and education support teams: multi-agency team based
  at two secondary schools working with their feeder primary schools
  to catch emotional and behavioural problems in the early
  stages.
• The youth offending team: a successful, established example of
  bringing together social services, police, probation, education,
  health and housing. The team has also commissioned partnership
  projects including restorative justice in schools and an early
  intervention project.

These examples of multi-agency working in Hammersmith and Fulham
have been innovative and have made a tangible impact. But parents
still tell us they are faced with going to different agencies for
different services, often telling the same story over and again. On
a national level, Lord Laming has highlighted concerns about the
effectiveness of children’s services. This wish to do better, and
pride in the achievements of local agency co-operation, has
encouraged the borough to go a step further and bring about a fully
integrated service for vulnerable children.

There are dangers with radical organisational change. Children
could be put at risk and the turnover of staff could increase, a
particularly important factor to consider in a climate of
recruitment and retention difficulties. This is why the development
of the children’s trust in Hammersmith and Fulham will be
evolutionary. Services will be linked gradually by building on
existing relationships rather than attempting an overhaul. The
launch of the children’s trust is planned for this September and
work has already begun on the plan for an integrated team for
disabled children.

The trust has the enthusiastic support of the council and the
primary care trust. Its development is being overseen by a steering
group, chaired by Andrew Christie, assistant director of children’s
services. The group is made up of senior managers from the local
primary care trust, social services, education, the mental health
trust and the two hospital trusts. Two project managers have been
seconded to the development of the trust, one from the primary care
trust and one from social services.

A sense of expectation is widely shared. At the first meeting of
the steering group Christie said: “This is the first time in my
five years in the borough that all the senior players in the key
agencies have sat down together at the table and talked about how
we might take a joint strategic approach to service development. At
this meeting and a recent planning day held with staff, there was a
real buzz of excitement about the prospect of a much better way of
working.”

– All cases in this article are fictional scenarios.

Theresa Salter is Hammersmith and Fulham Council’s
children’s trust project manager.

Project timetable

March 2003 Borough’s bid to become a pilot
children’s trust. Consultation programme with staff across agencies
and service areas.

May 2003 Work begins on a pilot integrated team
for disabled children as a model for developing other
services.

Children’s trust project managers seconded from primary care trust
and social services department. Consultation and communication
strategy put in place.

Work begins on defining levels of need and thresholds for trust
services.

September 2003 Launch of the children’s trust.
Joint review and quality assurance unit and joint commissioning
unit in place.

January 2004 Integrated team for disabled children
in place.

April 2004 Pilot multi-agency child protection and
family support service established.

2004-5 Year of consolidation. By the end of 2005,
all child protection and family support services are incorporated
into the children’s trust along with services for looked-after
children, family placement and leaving care.

2005-6 Year of achievement. Services are fully
integrated. Single assessment and identification, referral and
tracking initiative are established. Resources are realigned to
improve outcomes for children.

Model for the future

A review of services for disabled children highlighted the
frustrations of parents and carers who often deal with many
different professionals and therapists.  

A steering group was established to make recommendations about
an integrated team for disabled children. This multi-agency
partnership will form a model for the development of the children’s
trust throughout children’s services. 

As part of this process, a consultation day was held for staff
to discuss the issues arising from the plans for integration. This
was the first of a series of consultation events for staff that
will be organised for the different work streams of the trust’s
development.  

The day was attended by about 60 professionals, including
physiotherapists, social workers, special educational needs
co-ordinators, health visitors and school nurses who spoke about
how integration might work.

Several themes emerged. 

• The importance of meeting professionals in related fields and
  finding out more about their roles. 
• Difficulties with terminology. Terms such as “review” and “key
  worker” mean different things to different people. 
• Resource issues. Enough resources will be needed to support the
  changes. 
• An integrated service should address rather than exacerbate the
  problems of high staff turnover. 
• Structures that are established must reflect the needs of
  children.  
• Multi-agency workers would need specialist training and the
  local authority to make things happen.