Willing…but able?

     

    BOB HUDSON is honorary professor of partnership studies at the
    Health Services Management Centre, University of Birmingham. He has
    written and researched on partnership issues for the past 20 years,
    and is a specialist adviser to the House of Commons education and
    skills select committee on partnership issues.

    The government’s reforms on children’s services began as a
    response to the Victoria Climbi’ tragedy but now involve policy and
    service responses that go well beyond the field of child
    protection. Good as far as it goes, but needing to go further was a
    key message coming out of the last national conference held by the
    Integrated Care Network (ICN).

    The green paper consultation indicated that the range of core
    partners needed to be wider. In particular, there were concerns
    that the voluntary and community sector, schools, police and
    probation seemed too peripheral. The government’s response has been
    to widen the number of “relevant partners” that will be under a new
    duty to co-operate to improve outcomes for children, and an
    extension of the number of agencies able to pool their budgets to
    achieve this.

    The conference supported this need for a wide breadth of outlook.
    The contributions analysed the dimensions of a whole system; the
    nature of children’s trusts and the Serving Children Well model and
    other policies; and several examples of partnership working in
    practice from Essex, Liverpool, Telford and London.

    Working across a whole system implies making connections between
    what goes on at operational and external levels. This can be
    difficult, for often there is inconsistency within and between
    these two levels, which can hinder progress.

    The operational agenda constitutes a huge challenge, including the
    creation of multi-disciplinary teams, co-location, extended
    schools, local safeguarding children’s boards, a lead professional,
    a common assessment framework and ground-breaking systems of
    information sharing. Some places are already making inroads into
    this tough agenda. Several made presentations at the conference:
    Telford, with its links between education and social care;
    Liverpool, with its children’s community index and single point of
    access and referral; Portsmouth and North Lincolnshire, with their
    use of key outcomes to drive development.

    But few delegates doubted the complexity of these challenges, and
    the difficulties in addressing them. The broad goal in relation to
    front-line working is to have multi-disciplinary teams in places
    where many children spend much of their time, such as Sure Start
    children’s centres and schools. In such settings, it is expected
    that information will be shared freely and assessments jointly
    undertaken. Although few question the desirability of these sorts
    of arrangements, in themselves they are no guarantee of effective
    teamwork.

    Several assumptions underpin the operational level proposals, and
    it is important to unpick them and consider the extent to which
    they can be taken as read. First, the extent to which there is
    clarity regarding the role and scope of each agency and profession.
    Second, the extent to which there is agreement about the nature of
    the tasks faced, and the most appropriate way of addressing them.
    And finally, the extent to which one profession or agency
    positively regards the contribution from another agency or
    profession.

    None of these assumptions can be taken for granted, especially in a
    field spanning social care, education and health where, typically,
    relationships have been under-developed. Co-ordinated working
    patterns will be problematic where there is confusion or
    disagreement about the contribution each partner brings to the
    relationship. Moreover, social policy and professional practice is
    littered with competing ideas about social problems and how they
    should be resolved. It is important that any differences are
    addressed, otherwise the basis for progress will be flawed.

    Friendly environment.

    Even if goodwill and commitment is evident at operational level, an
    effective whole-systems approach also needs a friendly external
    environment. First, there needs to be an appropriate degree of
    compatibility between front-line partnerships and their parent
    bodies in social care, health, education and elsewhere. This is not
    always evident across the core partners – indeed the green paper
    itself acknowledged that “an underlying cause of local
    fragmentation is conflicting messages and incentives at national
    level”.

    The most evident difficulties relate to the main ways in which NHS
    and education bodies are judged. In the case of the former it is
    targets geared to adults in the acute sector – notably waiting
    lists, waiting times and delayed discharges. With the latter it is
    academic attainment through national tests and examinations.
    Getting health and education agencies to give a higher priority to
    a whole-systems approach rooted in preventive work does not lie
    easily with this situation. It implies the need for central
    government to give greater performance management priority to
    evidence of good partnership working. Much is riding here on the
    extent to which the pending Integrated Inspection Framework can
    reconcile these and other tensions.

    A second external factor is the extent to which operational
    arrangements are underpinned by an orderly and predictable flow of
    resources. This is not just a matter of finances, but also staffing
    and information flows. However, partnership working is motivated by
    access to new financial resources. Notwithstanding the chancellor’s
    generosity in his recent budget, the reforms do not come with much
    more money, so success depends on the possibility of doing things
    differently with existing funding.

    Pooled budgets.

    Education secretary Charles Clarke has referred to “the
    benefits of getting one funding stream as opposed to many”. This
    could mean two things. First, the widespread use of pooled budgets
    among the statutory bodies with the aim of squeezing extra value
    for money out of expenditures. Second, some rationalisation of the
    monies going into several pots, such as the Children’s Fund, Sure
    Start, extended schools, Connexions partnerships and others.

    A final external factor involves the extent to which the separate
    partners retain a commitment to their own established ways of doing
    things, as opposed to the new culture that will be required of a
    whole-system imperative. This is a difficult thing to pin down, but
    already there is some evidence of turf wars breaking out as the
    implications of the changes unfold. Within the core partnership,
    for example, there is jousting between social services directors
    and chief education officers over who will get the new director of
    children’s services positions, while in education there are
    reservations about the impact on the drive to improve school
    standards.

    The extent to which these problems can be addressed will depend
    partly on the willingness of key partners at local level to put
    children, young people and their families at the centre of events –
    in effect, to behave altruistically rather than self-interestedly.
    But it will also depend on the extent to which new integrating
    mechanisms can bring about radical change. There are four
    mechanisms proposed: a duty of partnerships to require co-operation
    between councils and other public and non-public sector bodies; the
    creation and roll-out of children’s trusts; the appointment of
    directors of children’s services; and – already in place – the
    creation of a children’s minister.

    It is, of course, too early to determine how far these changes will
    have the desired effect. But what was clear from the conference was
    a widespread willingness to make a decisive break with the past.
    Every Child Matters had a generally warm response, and, post-bill,
    that goodwill still seems to be around. As ever, the tricky bit is
    the implementation process that lies ahead.

    Abstract: This article reports on the proceedings
    and papers discussed at an event on the children’s services reforms
    held under the auspices of the Integrated Care Network. It is
    suggested that the wide nature of the desired outcomes underpinning
    the Every Child Matters reforms requires a whole-systems response
    that goes beyond traditional forms of ad hoc co-ordination.
    Although there is much support for the changes, implementation will
    be difficult.

    Further information:

    • Presentations and papers relating to the ICN event are
      available on the website: www.integratedcare
      network.gov.uk
    • Details of all official publications relating to Every Child
      Matters can be found on the DfES website: www.dfes.gov.uk/
      everychildmatters/downloads.cfm
    • Details of the Serving Children Well model are on the website
      of the Local Government Association: www.lga.gov.uk  The author can be
      contacted on:  bob@bobhudsonconsulting.com

    Contact the author:

    The author can be contacted on: bob@bobhudsonconsulting.com

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