ANNE LONGFIELD OBE, CHILDREN’S COMMISSIONER FOR ENGLAND – WRITTEN EVIDENCE (PSR0106)

This submission is made on behalf of the Children’s Commissioner for England, Anne Longfield OBE. The position of Children’s Commissioner is created by the Children Act 2004. The primary function of the Commissioner is to ‘promote children’s interests and rights’. The submission has been prepared by Martin Lennon, Head of Public Affairs to the Children’s Commissioner.

This submission focuses on lessons from Covid-19 for public-services delivered to children and their families. This is a potentially very broad topic, so the submission is restricted to three themes related to the integration of public services. This is based on the oral evidence session on the 10th June:

•                                                  Prevention – a topic not covered in oral evidence but raised by the Chair
• Co-operation between different elements of the public-sector
•                                                  Data-sharing – in order to elaborate on the question raised by Lord Bichard

Prevention

Prevention has long been the mantra of both politicians and policy makers when it comes to harms experienced by children. That ‘prevention is better than cure’ is an idiom universally accepted. The Children’s Commissioner’s recent report on the early years[1] summarises the general case for investing in children earlier in life to prevent issues later on and shows that a wide range of academic research supports this principle – and not just in the early years.

Yet this is not feeding through into spending decisions, local or national. A report commissioned by the Children’s Commissioner from the Institute of Fiscal Studies of Government spending on children from 2000-2020 found concentration of spending on acute interventions across multiple areas of Government spending. The pattern is particularly pronounced in children’s services, where spending on youth services and children’s centres has fallen significantly while spending on child protection and children in care has been protected. The report is available here: https://www.childrenscommissioner.gov.uk/wp-content/uploads/2018/06/Public-Spending-on-Children-in-England-CCO-JUNE-2018.pdf

The Children’s Commissioner followed this up with some detailed research with 9 local authorities to understand their spending on children in a level of detail not available in national statistics. This research broke down spending across education, special educational needs and child protection. The diagram below breaks down all this spending. It demonstrates quite clearly what a small proportion of overall spending goes to what could be described as ‘preventative services’. On average, the total spend on ‘Early Help’ and ‘Troubled Families’ combined is less than a quarter of the total spend on looked after children. This is available at: https://www.childrenscommissioner.gov.uk/wp-content/uploads/2019/07/cco-vulnerability-2019-spend-report.pdf

Source: https://www.childrenscommissioner.gov.uk/wp-content/uploads/2019/07/cco-vulnerability-2019-spend-report.pdf

The gap between the stated commitment to prevention – present in local and national Government – and the reality is stark. This cannot be dismissed as the result of a few poor decisions locally or nationally. Rather it demonstrates the need to look at the systematic barriers to introducing a preventative approach to children.

This submission will focus on three of these barriers:

1. A focus only on preventing serious harm
2. A focus on responding to risks, not eliminating them
3. A failure to understand the services currently being provided.

These issues are demonstrated by the diagram below, which shows the 2.3m children who the Children’s Commissioner would classify as vulnerable due to their family circumstances. This includes: domestic violence in the home (831,000 children), parent with alcohol or drug dependency (473,000 children), both parents (or single parent) with significant mental health problems (900,000 children) or material deprivation and severe low-income (593,000 children). Of these children, about 270,000 are on a ‘Child in Need’ plan[2]; a further 270,000 are in a family that is being worked with by local authorities under the ‘Troubled Families programme[3]’.

Figure 2: Vulnerable Children in England

Source: https://www.childrenscommissioner.gov.uk/wp-content/uploads/2019/07/cco-vulnerability-2019-tech-report-1.pdf

A relatively small number of children are receiving what we term ‘intensive statutory support’. These children are in care or on a Child Protection Plans. These children have reached the statutory threshold of ‘significant harm’ (or risk of) as defined by the Children Act. ‘Preventative’ approaches are often aimed at preventing children reaching these thresholds. Hence the recent focus on ‘edge of care’ projects within the Department for Education’s Innovation Programme[4].

Such an approach has two flaws:

1)   The number of children with ‘risk factors’ is very large relative to the numbers reaching the threshold of significant harm. This makes it difficult to justify preventative programmes on the basis of costs saved from intensive innovations. This leads to a focus on the edge of care, but these children have already reached a high threshold of harm. ‘Edge of Care’ services are not a preventative approach, they are an alternative mitigation approach once a threshold has been reached.

▪         It ignores the substantial harms to children within the outer rings of this diagram. Those children in the centre may be the ones to have reached the statutory threshold of ‘significant harm’, but there are a much broader range of harms experienced by a much broader range of children. A recent study from Bristol University found that 1 in 7 children in England will need statutory social care at one point during their childhood, and whenever this point during their life (and for many it is multiple points), the disadvantage is long-term: the disadvantage gap for pupils who have ever needed a social worker is 34% at KS4.[5] This mirrors the findings of the Department of Education’s ‘Children in Need’ review which found that 1.6m children have needed a social worker in the past six years and just 17% of these children go on to pass maths and English GCSE, compared to 46% of children who have never been CIN.[6] 

In other words, all the children in the diagram above may be experiencing harm to their long-term prospects and outcomes, if not direct harm to their safety and physical health. The need is for preventative prospects which tackle these broader harms and help these children to thrive. This is why the Children’s Commissioner advocates an approach which looks to reduce the risks to children, rather than just respond to them.

School exclusions are a key example of this. There is clear evidence of a correlation between gang violence and school exclusion[7]. Ministers have argued this is simply a correlation, and therefore school exclusion is a risk indicator of knife crime and youth violence that justifies a response[8]. The Department for Education has invested millions of pounds in looking at different responses to children who have been permanently excluded[9]. However, this neglects the fact that while only some children who are excluded will go on to be involved in serious violence, all of these children will have experienced long-term harm from being excluded from school: 59% of under 14s permanently excluded from school did not return to mainstream education within 3 years; on average children who are excluded face 76 days before they are found another school place; 71% of children in PRUs are persistently absent; 4.5% pass GCSE English and Maths; 40% become NEET when they leave at 16[10]. A truly preventative approach would seek to intervene before a child reaches the point of exclusion, but there is currently very little investment from the Government at this point.

The final barrier to investment in preventative approaches is a chronic lack of national data on what services are provided, to whom, and what these services achieve for children. The graph above represents what we know at a national level about services provided to children. Within the light blue circle we can identify 761,000 children in families we know are known to local authorities. This is the population of children for whom ‘preventative’ services are needed – these children are currently facing risks, but they have not yet escalated to the point where statutory intervention has been required.

Nationally, we do not know what, if any services these children are receiving. However, the Children’s Commissioner’s work with local authorities identifies a significant range of services that are provided at local level, shown in the table below. The services we would broadly described as preventative are those highlighted in blue and light grey cells. While the local authorities that the Children’s Commissioner worked with were able to quantify the scale of this provision, there is no national data collection or spend or provision of any of these services. 

Table 1: Services delivered to children and their families and the money spent on these services[11]

A directly analogous argument could be made about children’s mental health services. Reports from the Children’s Commissioner’s Office show that while NHS England is investing heavily in specialist services, funding for community and ‘preventative’ spending remains poorly funded and fragmented, with a significant gap between what the Government acknowledges is needed and what they have committed to funding[12]. There are roughly one million children in England with a diagnosable mental health problem, a tiny fraction of whom will go on to need high-cost intensive community or in-patient care. A broad expansion of services is not justified simply by the cost savings associated with fewer high-cost mental health placements, but is justified by the broader benefits, to individual children and to society, of improved children’s mental health and well-being.

The Government’s Green Paper on Children’s Mental Health acknowledges this explicitly by recognising that preventative approaches to children’s mental health in help children live happy, fulfilling and successful lives.[13] The Children’s Commissioner wants to see a similar acknowledgement in relation to children’s social care and family support: the rationale for investment in these programmes is that they help children and their families live fulfilling, happy and successful lives.

Why is this important in relation to Covid?

We know that Covid has had a significant impact on families, and particularly those families with known risk factors. The Vulnerability Framework mentioned above identifies five major “risks” to children which exist within the family context. There is now clear evidence that all of these have been heightened because of coronavirus (all figures from CCO Vulnerability Framework unless otherwise stated):

• Domestic abuse remains the biggest risk to children in the family context. Domestic abuse is identified in about half the cases where children come into contact with children’s services.[14] The major domestic abuse charities have all reported significant increases in calls since the onset of Coronavirus[15]. The police have reported increases in call-outs,[16] sometimes below the level of criminal activity, suggesting high-levels of family conflict if not violence. All of this will have an impact on families.
• Poor parental mental health. The Royal College of Psychiatrists has warned of that corona virus is leading to “a significant increase in urgent and emergency cases.”[17]
• Alcohol or substance abuse – Since coronavirus, supermarket alcohol sales have risen by 31%. Further research suggests this is largely driven by heavy drinkers increasing their consumption, while many moderate drinkers have reduced consumption[18].
• Children who are young carers – at least 170,000 children are young carers[19] and many more children are likely to have had to take on caring responsibilities for shielding family members.
• Children in severe poverty and material deprivation – an estimated 300,000 children have been pushed into poverty since the start of Covid-19[20].

▪         There have 145,000 thousand babies born in lockdown[21], these families will have missed neo-natal classes, pre-birth midwife visits and the neo-natal health visitor check. Not only have they missed this support, all these opportunities to identify struggling families have been missed, meaning they won’t get the Health Visitor Plus, or Family Nurse Partnership support they could have received.

It is likely that we are still some months away from the full impact of Covid-19 being seen on family functioning and pressure on children’s services. Partly this will be because families have fallen out of contact with informal support networks or light-touch support such as children’s centres, so that the warning signs are less likely to be picked up early on. The return of children to school in September is almost certainly going to lead to a huge surge in referrals children’s services, something which there is no capacity to meet.

Yet this delay also provides an opportunity to put in place a plan to help families. Just as the Government has an economic recovery plan and has recently announced an educational recovery plan, the Children’s Commissioner would like to see a family support recovery plan.

In response to the last recession in 2008, public spending cuts between 2010 and 2015 and a disproportionate impact on family support services, children’s centres and youth services. We then witnessed was a decade-long increase in children coming into care, increasingly older children[22]. Today, there is broad consensus on the need for continued investment in the economy, and the dangers of reducing state investment. Exactly the same argument can be made for family support. The Children’s Commissioner would like to see the same attitude towards investment in family support programmes.

Co-operation between different elements of the public-sector

In order to identify, and then ameliorate, the broad range of risks to children outlined in the section above, it is necessary to have a shared understanding of the needs of children across the different partners involved. The risk is that silos between schools, social care and health can lead to a situation whereby the three agencies believe they are acting in the best interests of the child, but are pursuing different ends, or considering one elements of a child’s needs as both discrete and the responsibility of someone else. At present we have academic achievement, clinical health outcomes seen as separate outcomes and the responsibility of separate partners.

The ‘Every Child Matters’ agenda was an attempt to bridge these divides, but was disbanded in 2010. Since then, however, there have been two significant statutory changes which have aimed to introduce better co-operation in supporting children’s needs:

• The Children and Families Act 2014 – expanded joint-commissioning in relation to special educational needs and disabilities. It replaced local authority ‘statements of SEND support’ with ‘Education and Healthcare Plans’.
• The Children and Social Work Act 2016 – changed the oversight of safeguarding from ‘Local Children’s Safeguarding Boards’ to local safeguarding arrangements constituted as a joint responsibility between the local authority, the police and the clinical commissioning group. In so doing, the Act established the vital principle that safeguarding was a shared statutory duty.

The Children’s Commissioner strongly supports both moves, but feels there is more to do in ensuring the implementation matches the principle.

Special Educational Needs and Disabilities (SEND)

The 2014 reforms have been criticised for the costs they imposed on local authorities, and for some of the specific outcomes to have arisen from the legislation. This has been well covered in reports by the Education Select Committee[23] and the National Audit Office[24]. This submission will focus on the principle of shared delivery between the NHS and local authorities and the degree to which there is shared sense of children’s needs, and co-operation in meeting them.

The best evidence for this is the joint CQC-Ofsted inspections of SEND arrangements[25]. These are the only joint local-area inspections which have been rolled-out to all areas, and repeated[26]. The first round of inspections found that about a third warranted a ‘Written Statement of Action’ due to inadequacies in provision.

The overarching reports highlight national-level learning, but the individual local-level reports are more revealing as to what degree the system co-operates, or fails to. This report into Lancashire, for example, was particularly critical, but in no ways unique (there were about 60 similarly critical reports). It shows an entirely dysfunctional system which failed to understand children’s needs or respond to them. The inspection found:

“There are two fundamental failings in Lancashire local area. Children, young people and their families are not at the heart of the delivery of the SEND reforms and leaders have failed to work together to deliver these reforms. As a result, children’s and young people’s needs are not always being effectively identified or met and many outcomes are not improving.  The provision for children and young people who have SEN and/or disabilities has not been a priority for elected members or leaders across health, education and social care. Leaders in the local area are unable to demonstrate effective joint strategic leadership in terms of implementing the reforms. They rightly describe being late in terms of implementation, but have underestimated how far behind they are. A lack of effective strategic leadership means that there is poor joint working across education, health and care professionals. This is exacerbated by a lack of a designated clinical officer (DCO) or designated medical officer (DMO) or a clear SEN strategy.”

              Source: https://files.ofsted.gov.uk/v1/file/2748553

There is very little national data on SEND provision, or how provision is shared within local areas. To attempt to rectify this, the Children’s Commissioner undertook the first ever national data collection across local authorities and clinical commissioning groups (CCGs), looking at speech and language provision. The data-collection allowed the Commissioner to understand variation between local areas in terms of both provision and how this is shared between local authorities and CCGs:

“There was large variation between areas on reported spend, with small groups of very high spending areas overshadowing a larger proportion of low spending areas. The top 25% of areas spent at least £16.35 per child, while the bottom 25% of areas spent 58p or less per child. This variation remained even when looking at spending per child with an identified speech and language need, with the top 25% of local authorities spending at least £291.65 per child with these needs, while the bottom 25% spent £30.94. … In addition, only 50% of areas reported that health and local authorities were jointly commissioning services, even though they are expected to do so for children with identified special educational needs. Overall, the majority of spending came from health, with CCGs accounting for 69% of the total reported spend and LAs a quarter (25%).”

Source: https://www.childrenscommissioner.gov.uk/wp-content/uploads/2019/06/cco-we-need-to-talk-june-2019.pdf

Safeguarding

Unlike the SEND reforms, the safeguarding reforms have not been accompanied by a nationwide programme of inspections to understand to what degree the reforms are being implemented. The Children’s Commissioner is currently undertaking some work to evaluate the look area implementation plans.

This is particularly so in relation to the NHS. For example, in 2019 the Children’s Commissioner published a report into youth violence and criminal exploitation[27]. The research for the report included an analysis of the characteristics of 6,500 children with known gang-related risks and identified mental health and special-educational needs (especially those without an EHC plan) as key risk factors. Serious case reviews suggested that the SEND risk was often poorly identified. Moreover, the report drew on an international evidence review undertaken by the Early Intervention Foundation[28] which identified therapeutic interventions as the most important in tackling future involvement in violence. Based on this, the Commissioner wrote to NHS England under Section 2(C) of the Children Act 2004 asking them for various actions in relation to youth violence[29].

In response, NHS England explained that it was undertaking various programmes in relation to children’s mental health and special education needs. But the only specific action was for the its National Medical Director to write to all trust CEOs to “remind you of your obligations to provide monthly reports to your Community Safety Partnership in relation to treatment you have provided in relation to violent injury”[30]. This implies that NHS believes it is fully discharging its safeguarding obligations by responding to incidents it encounters, and notifying the local authority as appropriate. This is outmoded and fails to reflect the updated statutory. The NHS has a duty to contribute to the prevention of harm, not just notify the local authority when it has occurred. 

Individual CCGs have taken a much more proactive approach. For example, in Bradford, the CCG trains and funds youth workers to target young people with mental health issues who are unlikely to access services and are at risk of violence. This highlights a better way of using local health budgets to discharge safeguarding responsibilities.

Data Sharing

During the oral evidence session, Lord Bichard made the observation that behind every major safeguarding failure is normally a failure to share data. The evidence from recent serious case reviews would suggest this is still the case, particularly in relation to evolving threats to children involved in criminal exploitation and youth violence.

Below are links to two serious case reviews for young teenagers who were murdered after a long history of incidents which should have highlighted the level of risk they faced. Both serious case reviews catalogue a series of failures of agencies to co-ordinate properly and share information. The result was that both children were ‘known’ to multiple agencies, but none had properly assessed the situation of either child or taken properly responsibility.

Child C was murdered in Waltham Forest in 2019. He was 14, and was stabbed to death by 5 men. The serious case review into his death outlines numerous ‘reachable moments’ where better data sharing should have occurred, and had it done so the imminent risk Child C was under would have been realised.

Source: https://www.walthamforest.gov.uk/sites/default/files/WFSCB%20-%20SCR%20Child%20C%20May%20final_.pdf

‘Chris’ was murdered in Newham in 2017. He was also 14 and was shot at point blank range. The serious case review into his death details dozens of contact points with safeguarding partners in the years running up to his death. Together they highlight a child in rapidly escalating danger, but a failure to share this information meant that no single agency ever realised the huge risk Chris faced.

Source: https://www.newhamscp.org.uk/wp-content/uploads/2018/10/Serious-Case-Review-Chris-.pdf

The national Child Safeguarding Practice Review Panel has undertaken a systematic review into 21 serious case reviews involving children killed or seriously harmed in relation to criminal exploitation.[31] Its recent annual report identified better information exchange across agencies as a key priority that remains unresolved.[32]

These cases highlight a general reluctance to share information unless a certain statutory threshold has been reached. When the Children’s Commissioner’s team has visited local areas to understand how they respond to children at risk of criminal exploitation, they see a common pattern: agencies not sharing information until one safeguarding partner has escalated a case, at which point it is revealed that a child is known to multiple partners. A hypothetical example of how this would look in practice:

Child G (fictional) is a 14-yr old boy who has been arrested by Police in a neighbouring force. This prompts the case to be considered by the Multi-Agency Safeguarding Hub meeting. At this meeting, it is revealed that he has been excluded from school, has been referred to CAMHS, but has not attended appointments and has previously been arrested. Yet there is rarely a forum to share this information of lower-level risk until one incident prompts the case to be escalated.

Part of this is because the onus is still on the local authority to collate and then disseminate information, but in doing this they are restricted by the Children Act 1989. The Act restricts information sharing without a child’s consent unless it reaches the threshold of Section 47– where a child protection plan is being considered because the child is at risk of serious harm. Most children with a social worker are on Child in Need plans, under Section 17 of the Act, in which case information sharing needs explicit permission. The Department for Education’s 2019 review into children in need[33] found that schools were often unaware that a child was, or had been, on a Child in Need plan, even though this is a statutory child protection intervention. The review recommended schools should be informed as a matter of course when a child was placed on the ‘Child in Need’ register. This recommendation has yet to be implemented.

However, other statutory agencies are less restricted in how they share data. For example, the police force now automatically share information with schools about domestic abuse callouts. Previously, they would have automatically notified the local authority (if the local authority accepts automatic notification), who would then have to decide whether to respond. Notifications from the police to a child’s school can occur in real-time, so that the school knows what has happened before the child appears at school the next day. This approach is known as Operation Encompass: https://www.operationencompass.org/

When the Children’s Commissioner’s Office has discussed this programme with schools, their reaction has been overwhelmingly positive. It gives them three benefits:

1)      Having this information in real-time enables the school to respond immediately

2)      Often children notified to the school are those about whom the school already has some concerns, but below the threshold for a statutory referral. This added information will often lead them to re-assess and make a referral to the local authority.

3)      Schools have also reported that they have been surprised to discover at how many of their children are being exposed to domestic abuse, including children about whom they would otherwise not have had concerns.

Operation Encompass has been running throughout Covid-19 and helped ensure schools continue to reach out to the pupils who most need their support.

The relevance to Covid-19

Operation Encompass shows the benefit to children of proactive data-sharing between different parts of the public sector. It also shows what can be done within the rules by thinking creatively. Covid-19 has upended the safeguarding system with schools, youth clubs and children’s centres closed as well as health visitors and social workers curtailing their normal programme of visits. The sharing of information in this context is ever more vital. For example:

• If schools are seeing a child every day, they can monitor risks and decide when to escalate. When a child is not in school, and has only fleeting contact with a teacher, the level of concern which justifies a referral to children’s services will probably be lower.
• If health visitors are only conducting a small number of ‘essential visits’, it is vital they target these appropriately, they need all available information to do this (especially as pre-birth and neo-natal visits were suspended). It would be very helpful for them to know if a baby’s siblings had ever been known to child protection.

The Children’s Commissioner’s Office (CCO) has encountered confusion amongst local areas as to what information they can share during Covid-19, with most local areas carrying on as before in terms of information sharing and co-operation, or ‘muddling through’, but reporting that they are unsure of the legal basis. There have been some notable exceptions who have drawn together a collective safeguarding response to Covid-19, including health visitors and local authority teams.

The Children’s Commissioner has repeatedly called on the Department for Education (DfE) to include new guidance on additional data-sharing powers and duties within its their wider Covid-19 guidance on children’s social care. The CCO submission to the DfE has been published: https://www.childrenscommissioner.gov.uk/wp-content/uploads/2020/06/cco-response-to-dfe-covid-19-social-care-guidance.pdf Thus far, the DfE has not adopted this recommendation.

23rd July 2020