Pick ‘n’ mix hits the spot

The island of Guernsey sits just 80 miles south of the English coast, but when it comes to the structure of its social services it may as well be a world away.

For Guernsey – far from following the Every Child Matters agenda of the mainland – has joined its children’s services with health, not education. Moreover, it is taking ideas from around the world in a pick ’n’ mix approach to policy.

Until May 2004, Guernsey had a separate children’s board (children’s social services) and a board of health (health services and some adult social services), which were then merged into one joint health and social services department. This is split into three directorates: children and young people; acute adult services; and continuing and community care services. However, changes are afoot (see below).

Traditionally, the links between health and social services in Guernsey are closer than those with education, which explains why the English model was disregarded.

David Hughes, chief officer of health and social services, says: “They are both 24-hour, 365-day services while education is restricted to school hours and term time. So the close working partnerships needed to be between social workers and health professionals. That doesn’t mean that we don’t have to work closely with education and we are working towards that.”

Guernsey has 12,500 people aged 0-18. Every child is seen by the health and social services department through contact with midwives, health visitors and school nurses, instead of only being known to social services because of a problem, as happens in the UK.

For Janet Gaggs, director of services for children and young people, this is one of the benefits of merging health with social services. “The first five years are crucial in a child’s life and it means we have the opportunity to get in early,” she says. “Every child has a developmental screening by the health visitors at three years old which brings in a number of services, including paediatrics, if necessary, speech and language therapy, dental services and orthoptics. We can pick up on vulnerable children early either because they may have special health or developmental needs or because of their social circumstances.”

Guernsey has never experienced deaths of children on the child protection register or after abuse. “We haven’t, but anyone would be foolish to say something would never happen,” says Gaggs. “In a small community such as this it would be more difficult for a child to be lost in the system, given the small numbers we are dealing with and inter-agency working. It is difficult for someone to have a child on the island that no one is seeing.”

Every Child Matters stemmed from Lord Laming’s inquiry into Victoria Climbié’s death and, although Guernsey does not have to adhere to the mainland’s Children Act 2004, it has been working with an English solicitor for three years on new children’s legislation. The result is The Children (Bailiwick of Guernsey) Law which will update 1967 legislation and be brought in in 2007. The new law is based on experiences from around the world, resembling a pick ’n’ mix of legislation from England, Scotland, other parts of Europe, New Zealand and Canada.

Key to the legislation is the decision to go down the road of Scotland’s children’s hearing system and establish a child and youth community tribunal to deal with most children who are in trouble or troubled (see, panel, below, for other measures).

Gaggs says: “The attraction was that it is very much the community taking responsibility and becoming directly involved in what happens to children and young people. We visited small isolated Scottish islands to see how it works and felt it would work here.”

Their are myriad differences between the UK and Guernsey when it comes to children’s services. The island has no young offender institutions; instead, the state prison has a wing to hold them. The one small secure unit is used for children mainly on welfare rather than criminal grounds. There are no plans for a children’s trust – with such proximity between departments it is felt that they do not need the more complex structures of bigger places which have to address a wider range of problems.

In addition, there is no long-stay residential care provision, as children and young people either return home, are fostered or adopted or move into semi-independent living. There is no statutory duty to provide leaving care services, although this has been recognised and will be addressed next year. At the moment the department helps 19- to 20-year-olds in further education and it has a joint venture with children’s charity NCH to provide supported accommodation.

Perhaps it is because there isn’t the same level of violence and serious crime as on the British mainland that Guernsey has found no need for antisocial behaviour orders or parenting orders, although the court does have the power to impose curfew orders.

But there are some similarities. Just as UK social services are struggling with data protection legislation and its implications, Guernsey is looking to see what comes out of the English information-sharing and assessment pilots. It is hoping to establish an electronic health and social care record but, says Gaggs, “we need much greater clarity on that and the issues on sharing that information with other departments, for example, education”.

Guernsey has an area child protection committee but it may be replaced by a local safeguarding children’s board. And Gaggs thinks the question of a single qualification framework for staff is worth considering for management and senior management levels. She says: “Within my senior management team I have two from a social services background and one from health, all three managing health and social services. So at this level the key qualification is seen as a management one together with a relevant professional one.”

To iron out tensions from health professionals worried about being managed by social workers – and vice versa – the role of head of profession was created. The post holders are responsible for professional supervision and professional issues, while operational managers, who may have a different professional background from those they are managing, are responsible for the day-to-day running of services.

Social workers on Guernsey, half of whom are from England, are registered with the General Social Care Council, so if they return to the mainland they can still work. And many do because, unless they are from the island or rich, the only way they can live and work legally there is if they are classed as an essential worker. This entitles them to a work permit and a five-year essential housing licence. But it results in a continuous turnover of staff, presenting Guernsey with the same recruitment and retention problems as the UK.

Richard Burrows, senior manager responsible for accommodation and long-term services in the children and young people directorate, says: “Retention is an issue that is framed by the length of someone’s licence. There’s a view that this is not the best way to go about getting the best outcomes for children.”

The seniority of his post gives Burrows a 15-year licence, but for him it is not a permanent move, “it’s about the job in hand”. He came to Guernsey for an interim consultancy job after six years working for the Children’s Society and 20 years’ local authority experience.

The island’s potential was what made him stay. “There are three things that make it happen here: the size of the population; the tradition people have of working together; and the intention and thinking behind the forming of this department.”

So where does education fit into all this? The health and social services department is beginning to co-locate some services in schools, particularly for children with special needs. And there is a programme to develop three special schools: one for juniors, which has just opened, one for seniors and one for children with challenging behaviour. “We are committed to being in each one,” says Burrows. “Education already has a policy of integration. There are a large number of children with special needs who are in mainstream schools. The intention is that children will move in and out of a special school and a mainstream school during the week, which is something that can be done on an island this size.”

He adds: “Some of the thinking is like extended schools, with community rooms, football pitches and therapy pools. These are local solutions drawing on national models.”

Putting health and social services together is logical to Burrows, even as a relative newcomer from the mainland. “It’s about what makes sense for children and young people. The opportunities to have an impact on healthy growth and healthy living probably make it right to put health and social services together. We have more freedom here to create a new paradigm.”
Gaggs adds: “We say to new staff that you can never underestimate the stretch of water between here and the mainland. We may be just off the south coast but it’s a very different culture. After six months they realise that.”

Changing structures
When one of the directorate heads retires at the end of the year two of the directorates will be merged, leaving children and young people and services for adults. Both will include health and social services.

David Hughes, chief officer of health and social services, explains the thinking: “It wasn’t clear-cut as to what went into the acute adult services and continuing and community care directorates, especially when you’re talking about areas like assessment and rehabilitation for older people. Is that acute services or continuing care?”

Changing law
The Children (Bailiwick of Guernsey) Law will introduce new measures to update current legislation. They include: