Ofsted – Written evidence (PSC0040)

House of Lords Public Services Committee inquiry: Call for evidence – The role of public services in addressing child vulnerability

Context

The pandemic has brought difficult and stressful times. Financial hardship, loss of employment, isolation and close family proximity have all put extra pressure on families who were already struggling. For some children, the pandemic has created or exacerbated vulnerabilities.

Our evidence focuses on two key areas, the definitions of child vulnerability and how well public services address underlying causes of child vulnerability within families.

Definitions of child vulnerability

Rightly, and necessarily, different agencies and professions define child vulnerability differently. Education will look at SEND and to some extent low attainment. In health, professionals will look at ‘clinical vulnerability’ and children’s social care would normally consider vulnerable children to be those in need of intensive or specialist services using the Children Act thresholds.

Most multi-agency safeguarding partnerships (formerly Local Safeguarding Children Boards) have adopted a tiered approach usually articulating four levels of need – for example:

Universal	Additional	Intensive	Specialist
Children and young people who make good overall progress in most areas of development and receive appropriate universal services such as health care and education.	Children and young people whose needs require some extra support. A single universal or targeted service or two services are likely to be involved; these services should work together. No need for specialist services.	Children and young people whose needs are more complex in terms of range, depth or significance of the needs. A number of these indicators would need to be present to indicate need at Level 3.	Children and young people whose needs are complex and enduring and cross many domains. More than one service is normally involved, with a co-ordinated multi-agency approach and a Lead Professional, commonly in a non-statutory role. At times statutory intervention may be required.

The pandemic, however, has shifted how definitions are being used. The government has developed a new definition as the basis for deciding which children should continue to attend school during lockdowns. This definition was broader than sections 17 and 47 (significant harm) of the Children Act 1989 but still limited to those children who were already known to services – usually those already having a social worker.

A far-reaching definition of vulnerability is not helpful if it detracts from what individual children need and doesn’t help services to differentiate carefully how they prioritise who to help and how.

However, within this wider definition there are some groups that we are particularly concerned about, for example those for whom their vulnerability means they can no longer be safely cared for within their family.

COVID-19 has affected patterns of vulnerability across sectors (education, health, care), though this may only be temporary.

Increased risk to babies

Perhaps one of the most alarming increases in vulnerability that we’ve seen through the pandemic is the continuing rise in incidents of harm to the youngest of all children, the under-1s. Often, abuse is only uncovered when there’s a critical injury, or when it’s too late. Every week, we are seeing notifications from local authorities about babies that have died or been seriously harmed through abuse or neglect.

The figures are stark. Between April and October 2020, we saw over 300 serious incident notifications. A significant proportion of these – almost 40% – were about babies, over a fifth more than in the same period in the previous year. Over half of these cases – that’s 64 children – suffered non-accidental injuries. And sadly, 8 died as a result.

Violence towards babies was already a worry before COVID. Over a quarter of all incidents reported to the Child Safeguarding Practice Review Panel last year involved non-accidental injuries to babies. Children being abused, often by young parents, or other family or household members, who had very little social support.

As well as babies being intentionally harmed, we’re seeing a high number of unexpected infant deaths. Some, apparently preventable tragedies: for example, babies not being put down to sleep safely, sharing a bed or sofa with a parent who has been drinking.

Health services play a critical role in the surveillance of infants and over the past year many child health practitioners were diverted from their primary role as part of the emergency response to the pandemic.

Changes in pattern to vulnerability of children in care

We know that the vulnerabilities facing children are often the reason why they enter the care system. When children are taken into care, it reduces their vulnerability on some fronts but can increase vulnerability on others, such as:

if it takes them away from family, friends and familiar surroundings
disrupting their education, if it makes them move school, especially if there is delay in placing them in a new one

For some children in care, the impact of the pandemic, particularly lockdown, has afforded a positive opportunity to develop closer and more nurturing relationships with their carers. However, the disruptions to education, and challenges of remote learning and in some cases home schooling, has contributed to increased demands on parents and carers.

Unless placed in kinship care, once in care they are separated from their friends, families and familiar surroundings. 60% of children are placed in children’s homes that are at least 30 miles from their home area and for some it’s much further. We know this is at least in part a symptom of a widespread lack of sufficient placements delivering what children need and in the right place for children in care.

There is a serious nationwide shortage of foster carers, restricting placement choice for looked after children; kinship carers are generally undervalued and under-resourced, despite providing an important and successful route to permanence for many children; residential and secure placements are insufficient, not matched to current children’s needs and not helpfully located.

How well public services address underlying causes of child vulnerability within families

It is important to recognise that some services are designed to address the effects of vulnerability rather than the causes, for example services to address educational catch-up in response to the impact of the pandemic. The causes of vulnerability are complex deriving from the individual needs of a child or their family, from a wider social and from failure in public services, for example poor quality schooling.

We need a better needs analysis to get an improved understanding of the causes of child vulnerability. As we said in our response to the recently announced Care Review, nationally there are gaps, overlaps and mismatches of provision - there is much scope for improved planning beyond the local authority level, especially for high cost, highly specialist provision. In this provision there are highly complex children who do not necessarily have an open children’s social care case, for example in secure mental health and youth justice provision. There should be a national overview and joined up planning for all these vulnerable children.

It is critically important to adopt a whole-system approach, so that finite resources across the sectors can be used to the best effect. We hope that the Care Review can bring about changes that ease the considerable strain on the system by focusing on providing the right support at the right time, in the right place. By providing this help more children should stay safely and happily with their families and, whenever children do need to be looked after by the state, should be provided with loving, stable care, and support into adulthood for as long as they need it.

This is not just an issue for social care. Getting the right help from health, education, housing and adult services is vital to preventing harm and supporting effective care.

As an example, we recently published a report of our research into matching in foster care [1] which highlighted the serious difficulties in recruiting enough foster carers and its impact on decision-making for children.

Weaknesses in the system

Early intervention

If we focus on those vulnerable children who are at risk of harm or neglect, we know that early help for children can prevent an escalation of issues. No one agency can do this alone. All those working with and responsible for children need to play their role to the best of their ability if we are to help children in a timely and effective way. However, in our joint targeted area inspections (JTAIs) we have found that there is often insufficient focus on prevention and early intervention before children meet the current threshold for support. This can be seen in our JTAIs on children living with domestic abuse and child sexual abuse in the family environment.

We are concerned that if the definition of child vulnerability is too wide and there is an increased expectation on services, for example early help preventative services, and this will put an intolerable strain on finite resources and risk the unintended outcome of redirecting intervention away from those in greatest need.

In the recent JTAI on child mental health we found that children who had entered the criminal justice system and were receiving a service from the youth offending team were often receiving speech and language assessments for the first time. We found cases where once the specific communication needs of the child were identified the interventions could be tailored and we saw evidence of positive progress for these children. Had these issues been identified much earlier, for example in primary school, it is possible the children would have been better able to access education and might not have entered the criminal justice system at all.

Early identification can also make a difference for children who may be groomed or drawn into gang activity. We have seen evidence of work taking place in some primary schools to support children who may be at risk.

Central government join-up

There is a lack of government join-up for children and while central government cross working has been more collaborative during COVID, it remains unclear where the policy lead sits for tackling child vulnerability. Commissioning for vulnerable children and the systems of accountability are not cohesive or joined-up across central government, local government, schools and the plethora of health agencies.

However, we have seen some evidence from our Inspection of Local Authority Children Services (ILACS) focused visits of improved multi-agency working at a local level in response to COVID.

Joined-up adult and children’s services response

A joined-up response across adult and children’s services is essential if parents and children are to get the help they need. We produced a 2013 joint report with CQC called ‘What About the Children?’, which explored how well adult mental health services and drug and alcohol services considered the impact on children when their parents or carers had mental ill health and/or drug and alcohol problems. The report also considered how effectively adult and children’s services worked together to ensure that children affected by their parents’ or carers’ difficulties were supported and safe. We found too many examples of adult mental health practitioners not recognising and analysing the impact of the adult’s mental ill health on the children and this led to risks not being recognised at an early enough stage.

We found better practice in adult substance misuse services. For example,

systems of assessment of risk that included consideration of risks to children,
a recognition by the service that they had a safeguarding responsibility in respect of children,
good liaison with children’s services and
bespoke provision of support for children such as group work for children provided within and by the adult service.

In more recent JTAIs, while we do see some good practice, we continue to identify concerns about adult mental health services failing to recognise their responsibility to children. Better practice is found where adult services, such as probation, and adult mental health services, are based in the ‘front door’ to children’s social care, typically the multi-agency safeguarding hub (MASH). This often leads to better information sharing and a better response by social workers in seeking information from adult services to inform their response to referrals.

Mental Health identification and referral

Our recent JTAI on children’s mental health identified some good progress in many of the areas visited but still too many children have to wait too long to receive specialist support with their mental health. For some of the most vulnerable children, social workers were also identifying mental health issues too late meaning that problems escalated.

More positively, we did find that in many areas visited, local partners are changing their models of care and maximising opportunities for agencies to work together to improve the identification of children with mental ill health. This includes building capacity in the system through joint work between mental health specialists and professionals working with children. Having a single point of access that professionals can contact for advice and refer children for support was seen to make a positive difference.

Good knowledge of the local community, together with consultation with children and wide partnership engagement, is leading to a better understanding of children’s need for support with mental ill health, although areas need to do more to understand the needs of diverse groups, such as BAME children.

We found that children experience a more joined-up approach to meeting their needs from agencies that have had appropriate training and a shared model of practice to help professionals understand children’s mental health needs and the impact of trauma.

Some health professionals focus too much on presenting issues, problems and behaviours and do not ask the right questions to identify children’s mental ill health.

Children value the role that schools play in supporting their mental health. In order to do this, schools need support from partner agencies, and we found that children are benefiting from this joined-up approach.

We found highly variable practice by the police in identifying and responding to the children who were vulnerable due to their mental ill health. Police forces need to share good practice to drive improvements across areas so that all children get the response and care that they need.

Recognising inter-related issues

Our JTAI on criminal exploitation in 2018 illustrates the importance of professionals recognising the inter-related issues of risk in the home, such as neglect and domestic abuse, and the way these issues can result in children being at more risk outside of the home, for example from exploitation.

We found some examples of strong practice, but risks posed to children from outside the home are still a real challenge to a child protection system that was developed to focus on risk in the family. One of the considerable challenges is understanding the relationship between risk in the family and risk outside of the family. Not all children who are exploited experience risk in the family, but many do. Front line practitioners need much more support from central government to manage and understand this. Clearer statutory guidance accompanied by increased local training is needed. Currently ‘Working Together’ does not provide sufficient guidance and support to practitioners and leaders as to how to intervene and manage extra familial risk. This means there is a policy and guidance void and although many areas are developing their own approaches, they are unclear what is expected of them.

Availability of services to handle school referrals

Co-ordination of services is particularly important during the pandemic. For example, some children may struggle to adapt back into a school environment and schools should have the capacity and resources to support these children appropriately or be able to involve the right support agencies in a timely way. Areas of high deprivation and with large BAME communities are likely to have been most affected by the pandemic and resources should be targeted at these schools. Safeguarding partners should ensure that support is in place to help schools know where they can refer children for support, and central government needs to ensure that statutory and voluntary and third sector organisations are sufficiently resourced to meet need.

Top points for action

Investment in better early intervention is the single biggest opportunity. We should prioritise effective early intervention and support (including education and health services) as a cost-effective route to positive, sustainable outcomes for children and families.

An increased focus on better needs analysis. We urgently need a better national understanding of children’s needs, matched by a coherent strategy to secure the right help, at the right time, in the right place. There is also considerable scope to improve planning beyond the local authority level, especially for high-cost, specialist provision.

Greater priority in planning at national / regional level especially for high-cost specialist provision. There is currently a chronic national shortage of foster carers. Residential care provision is unevenly spread across the country and not well matched to children’s needs. If children are not placed in the right provision, in the right time, in the right place, already vulnerable children can become more vulnerable to negative outside influences.

March 2021