Too much information?

Following the Laming Report into the death of Victoria Climbiè, few people dispute the need for better communication between agencies working with children and young people. But the proposal for a universal children’s index, allowing designated professionals to track the services that young people are involved with, is causing concern. Lindsey Darking talks to practitioners about the issues while Bob Hudson outlines how information sharing might work.

Lucy Ruddy can access information about every child in East Sussex. As the identification, referral and tracking manager, she has helped to develop an index of all the county’s under-18 year olds. It can tell her where they go to school, who their doctor is, and whether they use specialist services such as speech therapy.

East Sussex is one of the government’s 10 trailblazer pilots of councils tasked with developing new ways of information-sharing and multi-agency working.

“Practitioners are encouraged to check the index when they receive a referral, or when they are concerned about the child or young person. It shows them who else is involved and who to contact for further information. By doing this they should automatically think in more of a multi-agency way.”

East Sussex has tried to build confidence in the Children Index with multi-agency training and an information campaign for parents, young people and professionals.  Consent is assumed for the basic services but has to be obtained from parents for the more specialist services such as speech therapy.

“The index is just a tool, and we still place a lot of emphasis on practitioner responsibility,” says Ruddy. “But the best thing to come out of this is that we are building a culture where practitioners talk to each other and reflect on how they share information.”

The 10 trailblazers were each given £1m to test new ways of multi-agency working, including information-sharing systems. To date, nine trailblazers have established some sort of index, although research carried out by Royal Holloway, University of London for the Department for Education and Skills has concluded that there were still many technical issues to overcome. The DfES says the trailblazer experience will continue to inform both the development of an information-sharing index and multi-agency working in general. 

Some people have serious concerns about the database proposals. There are worries about sensitive services such as sexual and mental health services, and there are also questions about the importance of obtaining consent from young people and families. Government consultation on these issues has now ended, with results expected in the Spring.

“An index may be a suitable tool for the protection of children, but it might not be as appropriate for young people,” said Barbara Rayment, director of Youth Access, an organisation for young people’s information, advice, counselling and support services. “Unless they have special needs or are vulnerable, 16 year olds are more able to talk about how they can keep safe and who might be involved in that process. It’s a very different scenario for a three year old.”

Youth Access believes that the government’s emphasis on youth participation is at odds with the idea of an index containing personal information about which young people may not have been consulted. The subject of young people’s privacy was hardly addressed at all in the recent consultation document, says Rayment.

Voluntary sector advice and counselling services may also be used more often by hard-to-reach young people, sometimes anonymously, she says. If such services were included in a children’s index or were required to obtain consent, this could interfere with the delicate relationship between practitioner and client.

Sexual health charity Brook is a case in point. It fears many young people may be put off obtaining advice if they suspect the information may be disclosed to other practitioners.

“Confidentiality is one of the main concerns of young people using sexual health services, particularly those under 16,” says head of Brook, Jan Barlow. “Almost all the young people we asked about these proposals said they would be less likely to use services like ours if they knew their details would be recorded on a database. There is a real risk that proposals intended to protect young people from harm could end up having the opposite effect, if young people are deterred from seeking help when they need it most.”

Confidentiality is also fundamental to the effectiveness of HIV services. HIV charities point out that many young people using HIV services are not informed of their own or their parents’ HIV status, and may be told they are being treated for a different condition. To include a child’s contact with HIV services on any index could not only run the risk of prejudicing the way the child is dealt with at school or elsewhere but could also lead to the possibility of inappropriate disclosure, with negative consequences for the child. 

The Family Policy Alliance, which represents the views of parents’ organisations, believes that trust and good working relationships could also be compromised if practitioners have to record information without parents’ consent. FPA spokesperson Leonie Jordan points out that an index could cost a great deal, yet may not lead to better services for children.

“Many social services departments only operate at crisis intervention levels, so a flag of concern or a record of a child’s needs

on a database won’t necessarily lead to the kind of early positive intervention that parents might welcome. The problem with an

index is that there is no duty on agencies to provide support or to take action.”  

Registering concerns

According to the Laming inquiry, Victoria Climbie’s death five years ago might have been avoided if practitioners from different agencies had been willing to communicate with each other at an earlier stage, writes Bob Hudson. As a result, under the Children Act 2004, councils must set up a database containing basic details on each child living in the area, allowing any professional coming into contact with a child to flag a concern on the system that would be visible to the next agency or practitioner coming into contact with the child.

The proposals might be expected to receive a warm welcome as a serious attempt to address long-standing matters of life and death. But they have turned out to be controversial for three reasons:

Security of the database

Safeguards have been built into the system to try to ensure the database is accessed only by those entitled to use it. Individuals will be required to have Criminal Records Bureau clearance; they will have to sign a practitioner protocol and they will have to undertake training on the safe and secure use of the system including compliance with the Data Protection Act 1998 and Human Rights Act 1988. Concerns nevertheless persist. Potentially, many organisations and their employees will have access not only to contact details for all children in England but also to any cause for concern indicator and the details of services being provided, and improper access could be damaging to children. Barnardo’s, for example, has suggested that schools could use the database to avoid admitting children who appear to be “in trouble”.

The cause for concern clause
This clause has no threshold criteria, and since professional groups work to different definitions and laws there is unlikely to be a consensus. Practitioners may simply add a “concern” as a defensive measure to ensure they are legally covered, which could cause unnecessary work, and intrusions into children’s lives. 

The Every Child Matters green paper proposed designating a lead professional responsible for acting upon information placed on the proposed databases. They would act as a gatekeeper for information-sharing systems, decide whether intervention was merited, and co-ordinate any service responses.

It is not clear who will undertake the role or what authority they will have to co-ordinate support and services. The government has suggested it should be someone from the agency with the most day-to-day contact with the child, but for most children this is their teacher and so far the teaching profession has shown little enthusiasm for taking on the job.

Children and young people apparently take a pragmatic view of the reforms, accepting that information about them should be shared between agencies if it will help them gain the services they need. However, they do want to be consulted before such information is shared, to know with whom it is being shared, and to be reassured that the information is accurate, will be used properly and be kept safe.

But if the measures are to prove more robust than previous reforms introduced in the wake of a child’s violent death in avoidable circumstances, they will also need the support of those charged with making it work.

·                     Bob Hudson is visiting professor of partnership studies, School of Applied Social Sciences, University of Durham

Child Protection Online (CPoL)

Tilly Jones is full of enthusiasm for Child Protection Online (CPoL), an online database that allows her to check if children in hospital accident and emergency departments are on the child protection registers of local authorities.

“It’s fantastic,” says Jones, who is now the named nurse for vulnerable children at Liverpool and South Sefton Primary Care Trust.

“If you have a child in hospital who you’re concerned about, you normally have to find out which social worker from all the neighbouring local authorities you need to call, and then ring to see if they have the child on file. You might have trouble getting through or have to wait for them to check the details and call back.

“But with CPoL it’s instant. Within a few minutes you know if the child is on a child protection register, why they are on it, the name of the local authority, the key worker concerned and their phone number. A secure e-mail is automatically sent to social services and you can follow it up from there.”

CPoL, part of the NHS organisation the South East London Shared Services Partnership, differs from the universal children’s index enshrined in the Children Act in that it currently only covers hospital A&E departments and social services, and only includes basic information on child protection, such as whether a child is on a CP register, the category the child is registered under, and practitioner details. It is not one of the Trailblazer pilots but nevertheless allows social care workers to receive secure communications from health professionals 24 hours a day, 365 days a year.

It has numerous safeguards built in, such as encrypted e-mails, automatic information updates, restricted access, and audit trails. Hospitals and social services departments in Merseyside and parts of south London subscribe to the service, although the aim is to extend to other areas over time. However, feedback has been so positive that North Mersey will soon become the first area to roll out CPoL to primary health and community services such as GP surgeries, health visitors and school nursing teams.

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  see cpol.nhs.uk and dfes.gov.uk/ISA/

Flags are flying

Information sharing proposals

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  The database will contain only the child’s name, address, gender, date of birth, a unique identifying number, plus the name and contact details of any person with parental responsibility or day-to-day care of the child, education provider and primary care provider.
  
  
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  A flag will indicate that a professional working with a child has a cause for concern. The nature of any practitioner’s concern would not be described on the system.
  
  
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  All children and young people up to the age of 19 who reside in the area will be included on the database.