Shaping Children's Services

Chris Hanvey

• Editorial: Routledge
• Año: 2019
• ISBN:
  9781351241717
• Edición: 1
• Categoría: Medicina
• Categoría: Medicina pediatrica

This text is an authoritative analysis of current services for children and young people in the UK. Drawing upon European-wide data, this innovative book critiques the policies that have shaped today's services, argues that the current system is insufficiently joined-up and outlines a radical new model of co-located services for the integrated delivery of children's care.

Shaping Children's Services:

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• examines key indicators of children's development;

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• provides a breakdown of the economics of caring for children;

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• explores the way government initiatives such as Sure Start, Extended Schools, Total Place and the Kennedy review of children's health have shaped current policies;

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• charts the key twentieth-century developments of child welfare across health, education and social care and looks at the inter-relationships between health, social care, police, education and the voluntary sector;

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• presents both good and failing examples of children's services.

Offering a thoughtful and provocative challenge on how the present system can be better configured to meet the needs of children and young people, this book is an essential read for all those involved in working with children from a range of fields, including health, education, social care, juvenile justice and voluntary sector services.

1

INTRODUCTION

Contemporary childhood

It is the best of times; it is the worst of times. It is the age of limitless information; it is the age of borderless social media. It is the epoch of wide opportunity; it is the era of unprecedented competition. It is a century of healthier, better educated children; it is a time of disturbing sexual abuse. We have all before us and yet we inhabit a hothouse of growing social pressures. Of no age group are these factors more true than that of the young growing up both in the UK and in other European countries today.

For contemporary children and young people, one of the newest and biggest challenges is that of choice. Thirty years ago, for example, about 14% of 18–21-year-olds attended university. Today, it is closer to 30%. Between 2016 and 2017 there were 2.32 million students studying at over 160 UK higher education institutions (excluding further education colleges) in a previously unforeseen range of vocational and non-vocational subjects. Two litmus tests for the way in which higher education has been extended to a wider cross section of young people is, first, that in 2016 English pupils receiving free school meals were 78% more likely to go to university than they were as little as ten years ago. Between 2008 and 2009, 17% of state-funded pupils who received free school meals entered higher education at 19. By 2014/15 this had risen to 24%. Second, that the number of full-time undergraduates from black and minority ethnic groups rose by 38% between 2007/8 and 2015/16 (1).

Children and young people are the most likely to be what Mark Prensky defined in 2001 as “digital natives”, comfortable with new technology and quick to grasp the significance, amongst other things, of quicker, faster ways of doing things electronically. (We will later consider the downside of this.) Similarly, with advances in medicine and more attention to child safety than in the past, children’s well-being is largely better than it has ever been. Fewer children die in the UK than they did 50 years ago and the major cause of child morbidity is no longer infectious disease (2). It is also the case that, as a result of Article 12 of the 1989 United Nations Convention on the Rights of the Child – the right to be heard – young people have a stronger voice and more say in some of the decisions that affect them.

What is not always understood is that the concept of childhood – particularly in literature – is a relatively recent idea. Peter Coveney traced it back to the end of the eighteenth century when, with writers like Wordsworth and Blake, the “romantic child” with sensibilities and a unique series of views on the world was first accepted (3). Similarly, Helen Seaford argued that early fifteenth- and sixteenth-century pictures show children as mini adults, dressed in heavy, ornate costumes. It is not until the nineteenth century that they are seen differently. High levels of infant mortality meant that it was not possible to take a sentimental view of children (4).

Now childhood and children with their own legal rights and voices is firmly established in the UK, although often couched in two contradictory sets of arguments. On the one hand is a view that the period of childhood, as such, is becoming shorter; the result of earlier physical maturity and increased pressure to grow up. This is largely encouraged by social media and commercial organisations keen to take a share of young people’s growing economic power. On the other hand there is a move to heighten the age limit for children who are receiving some statutory services. The Chief Medical Officer’s 2013 report on children’s health used 25 as the cut-off date for some children’s services. The justification being, first, that many adult services don’t begin at 16 or 18 but sometimes much later than this (5). Second, that key elements of development, particularly emotional development, continue until the early 20s.

Despite the greater emphasis on children’s rights, campaigning organisations point out that there remain wide anomalies in legal triggers to achieve adulthood. So, for example, you can marry at 16, with parental consent: the same age at which you can join the armed forces. You only need to be 14 before you can get a firearms licence, 17 before you can usually drive a car and 18 before you can buy alcohol in a pub or off-licence. There is no single law that defines the age of a child across the UK. The UN Convention on the Rights of the Child ratified by the UK in 1991 states that a child “means every human being below the age of eighteen years unless, under the law applicable to the child, majority is attained earlier” (6, p. 4). In the UK specific age limits are set out in relevant laws or government guidance. There are, however, differences between the UK nations. In England, Working Together 2013 refers to children up to their 18th birthday. In Wales, for example, the All Wales Child Protection Procedures states “A child is anyone who has not reached their 18th birthday”. Children, therefore, means “children and young people” throughout (7, p. 17). The fact that a child has become 16 years of age, is living independently, is in further education, is a member of the armed forces, is in prison or a young offenders’ institution does not change their status or their entitlement to services or protection under the Children Act 1989. For the purpose of this book, therefore, children are defined as all of those children and young people who have not yet reached their 18th birthday.

The pyramid of need

Given that the main focus of this book rests on what happens to those children – and their childhoods – when services fail, it is important to begin with the assertions of success, outlined above that many children navigate a successful route between the Scylla of state health, education, recreation or social welfare services and the Charybdis of pressure from social media and the demands of twenty-first-century life. They, however, are not the book’s concern. Instead, the emphasis here is on those in need, from a variety of causes, and where the State has a duty to provide additional layers of support.

There have been numerous classifications of need, aiming either at a generic classification or that of a specific profession. It is best characterised by a simple pyramid, which is then subdivided in a range of slightly differing ways. Basic divisions are between intensive help, medium support and signposting to agencies offering some additional help. According to which model is being used, it is usually the level of “medium” support that tends to be the subject of further subdivision. So, if we provide two examples, children with significant health needs and those with mental health issues, we find that both often have a fourfold classification. A typical mental health model might begin with a simple referral through primary care, such as to a health visitor – tier 1. Tier 2 is to a specific mental health worker in primary care, say for counselling. Tier 3 relates to referrals to specialist child and adolescent workers and tier 4 referrals for specialist day or in-patient unit support. In the case of children with significant health issues, the tiers will move from support provided within primary care to Level 4 where intervention may be at the level of palliative care or for children with life-threatening conditions.

The book proposes a four-tier pyramid, where help gradually becomes more intensive. If we look at the normal distribution of children and young people across a typical population, we find that the level of need falls crudely into this four-tier pyramid. At the base of the pyramid are the majority of young people, capable of growing by accessing main stream services, such as education or health. Above, at tier 2, there is a cohort where some degree of support is necessary. They may, for example, require additional educational help because of dyslexia, speech or language difficulties or parenting programmes requiring some additional help, if only to prevent problems from escalating.

At tier 3 are those who will need some specialist services and staff. This may be because of a disability, school exclusion, issues of homelessness or because of already experienced mental health problems. At the top, tier 4, are children and young people with high dependency needs. This may be a life-threatening condition, the requirement to provide palliative care, complex educational needs or, for example, because they are looked-after children in the care of the local authority. The book’s focus is on tiers 3 and 4 and this model assumes that the high costs of intervention will lie in tiers 3 and 4. The relationship between individual assessments – by a specific profession – and the devising of an overall, generic and multi-disciplinary score will be explored in Chapter 8.

FIGURE 1.1 Pyramid of need

The protection of children

What the remainder of Chapter 1 explores is, albeit selectively, examples of failure and disconnected services from a wide range of statutory and voluntary agencies. It is an examination of what has gone wrong, in order to extract some over-arching lessons, which need addressing if services are to improve. Often, they concern children already identified as both vulnerable and requiring special help – the top tier 4 of the pyramid. The way they have been widely reported is equally important, as this helps to illustrate a central argument about the fragmentation of current services. Taking as examples the Rotherham child sexual exploitation inquiry, the deaths of Daniel Pelka, Kaiya Blake, Ben, Max and Olivia Clarence, the exclusion of very young children from schools, the 2010 Kennedy Inquiry into NHS services for children and the Children Commissioner’s 2018 Vulnerability Report, all help to illustrate not only that we face major challenges across a wide range of agencies, including health, education and social care, but that these are often exacerbated by a systemic failure of what we will come to see as non- integrated services.

The Independent Inquiry into Child Sexual Exploitation in Rotherham published in 2014 (8) revealed that between 1997 and 2013 over 1,400 children had been sexually abused by groups of mostly Asian men. The true scale of abuse is not known but included rape by multiple perpetrators, and girls trafficked to other towns and cities in the north of England, abducted, beaten and intimidated. Just over a third of those affected were previously known to services, because of issues surrounding child protection and neglect. Tangentially, this finding is confirmed by other studies that have examined the large number of children and young people in care who go missing every year. In a report recorded by Young Minds, the NSPCC estimated that in 2012, for example, more than 3,000 children went missing from care on 28,000 occasions (9).

Evidence from the subsequent Rotherham inquiry, chaired by Alexis Jay, indicated that despite the warnings of youth workers, the police in Yorkshire gave no priority to child sexual exploitation and the actions of social services to respond to the abuse allegations were largely too little and too late. There was similarly no engagement with leaders of the Pakistani heritage community, to discuss how they could best jointly address the issues. In a series of recommendations, Professor Jay stated that the authority should develop a more strategic approach to sexually exploited children and there should be much closer working arrangements between a whole range of agencies.

Subsequently, further and similar investigations for comparable alleged crimes were conducted by police forces across the country, with groups of men prosecuted for the organised sexual grooming of victims, in areas as distant and different as Oxford, Leeds, High Wycombe, Halifax and Newcastle. While wider factors have come into play, influencing the way these crimes have been understood and reported, there has been a failure to listen to the voices of young people, coupled ...