Will health reforms undermine Munro’s vision?

For some, the health and education reforms are casting a shadow over Professor Eileen Munro’s intention to improve child protection, but others feel that they will enhance joint working. Molly Garboden reports

Universal services such as schools and health should take on much more early intervention work, freeing-up social worker time, the Munro review of child protection’s second report stated. In the absence of extra resources, this is the only way it will be possible to tackle the increasing numbers of referrals to child protection teams, Munro warned. The report highlighted the effectiveness of the role of a named and designated health professional or school lead for safeguarding in reducing unnecessary referrals.

It also raised concerns of a possible threat to this vision of joint working: “The coalition government has set in train structural reforms to services such as education, policing, welfare and health. Taken together these changes could dramatically change the way services interact and support children, young people and families, but they also have a continuing crucial role in preventing or responding to abuse and neglect.

“The review is considering whether, in light of the radical reforms of services, there is a need for a panel, composed of the relevant professions within the child protection system, to advise government and the professions on how the different parts of the child protection system are interacting and whether problems are emerging.”

The current focus of concerns are the NHS reforms which are being debated in parliament. Primary care trusts, all of which have a designated child protection lead, would be abolished and replaced as commissioners by GP consortia. The original White Paper made no mention of where accountability for child protection would lie in the future health service.

This raises fears on many sides. The Association of Directors of Children’s Services points out that councils have in recent years made great strides in building partnerships with PCTs to improve the joint focus on children and child protection.

Marion Davies, ADCS president, says this success had been based on a shared understanding of commissioning, funding and the decision-making process within separate organisations. But in one blow the White Paper would sweep all that away and force local authorities to start again from scratch.

Government stance

The DH is adamant the changes will not reduce the effectiveness of child protection.

It says safeguarding children will remain a responsibility for all. A spokesperson adds: “Subject to the passage of the Health and Social Care Bill, GP consortia will have statutory duties, under the Children Act 2004, to make arrangements to safeguard and promote the welfare of children, and to be members of local safeguarding children boards (LSCBs). No part of the NHS can work without a clear understanding of patient safety and safeguarding.”

But this does not address some of the logistical problems the reforms create, such as the fact that some GP consortia will have different boundaries to local authorities.

Jo Webber, deputy policy director at the NHS Confederation, says the search is now on “to use any link between local authorities and GP consortia”.

“It means we need to look at how LSCBs can engage better with health providers.”

Ray Jones, professor of social work at Kingston University and St George’s, University of London, adds that GP consortia are at the moment fairly loose networks of GPs. “There’s no obvious command and control structure, no obvious management structure, for LSCBs to connect with.”

Jones says that for the system to protect children effectively, local authorities and LSCBs would need to identify GPs within each consortium who would work to raise the profile of children’s issues and child protection within health commissioning.

Reluctant GPs

Yet GPs have in the past been the professionals least willing to take part in multi-disciplinary child protection meetings or conferences. This, according to Community Care’s GP columnist Michael Fitzpatrick, is because they are too busy and, in reality, have a very small role to play within child protection: “Because issues of child abuse come up rarely in general practice, GPs have little role to play in child protection. All contacts between GP surgeries and child protection authorities should be suspended and any concerns should be mediated through local community paediatricians.”

The British Medical Association agrees. “GPs are well aware of the need for effective child protection, but the difficulty is that child protection is a very small part of what we do,” says John Canning, chairman of the BMA’s GP contracts and regulation sub- committee. “It’s a very important part of our work, but cases that involve child protection concerns are relatively infrequent.”

For this reason there is now a move among social care and health leaders to lobby the government to amend the White Paper to shift the responsibility for child protection to the proposed health and well-being boards instead. These will be responsible for all public health policy and commissioning and will come under local authority control.

“Consideration needs to be given to whether local authorities might be better placed to take on that responsibility,” agrees Enver Solomon, director of policy at the Children’s Society. “We can’t lose sight of the fact that GP consortia are going to have several priorities and safeguarding may well not be top of their list.”

Yet Canning believes that the reforms could present an opportunity for health and social care to work much closer together than the current system allows.

“When I started as a trainee GP 30 years ago, the hospital I worked in had a social services department and we had regular meetings with social workers and health visitors,” he says. “That’s something you don’t see much anymore because we’ve had this fragmentation of services. These reforms give us, as GPs, the opportunity to get back that lifelong relationship with social care and work more like the team we used to be.”

Webber agrees: “It’s a chance to take stock of what’s working in child protection and what isn’t. This is the time – as this legislation goes through, as the Munro Review reports – to make sure all opportunities are taken to establish the best system possible.”

Freed-up schools cause joint working concern

Health is not the only area of reform causing concern around joint working within child protection and early intervention. Many are also worried about the government’s reforms to education.

The Education Bill, introduced into the House of Commons in January, frees schools from having to co-operate with local authorities in children’s trusts. The Association of Directors of Children’s Services slammed the move, saying it would undermine joint working within local authority children’s services.

ADCS vice-president Matt Dunkley says the participation of all multi-agency partners in trusts reduced costs and eased pressure on the social care system. Breaking up trusts, he warns, could lead to agencies seeing integration “as a luxury rather than a financial necessity”.

The move to set up more academies and free schools with a degree of independence from local authorities could exacerbate the problem, although this is denied by the Department for Education.

Ministers point out it is up to local authorities to forge links and systems that work locally, instead of being tied by legislation.

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