Care Makes Things Worse?When I left the management of the Prison and Probation Services to joinBarnardo’s in 2005 I was seized with a conviction that being taken into carewas damaging to children. In my defence, I had met so many prisoners whohad spent time in care that I might have been forgiven for concluding –however erroneously – that their care experience is what had propelled themto prison. Nevertheless, saying, as I did in August 2006, that the state, as aparent, fails [children in care] terribly was both wrong and unfair. But I washardly out of step with general opinion. That view had been long establishedand it has changed relatively little since. As recently as April of 2009, BarrySheerman, then Chair of the Select Committee on Children Schools andFamilies talked of:the perception that entering the care system is catastrophic for a child’s futureprospects.Certainly when I added my voice to those making this simplistic andfundamentally misconceived assertion, it brought only praise and aninvitation from Alan Johnson, then Secretary of State at Education to lead anindependent working group to examine the scope for reducing the numbersof those in care. I was delighted to do so and confident that the significantdrop in the numbers in care, which started in the eighties, could be givenextra impetus.A brief history of the numbers in careThe fall in the numbers of children in care in the eighties was not the first fallin recent decades. After the Second World War the number of children in carefell steadily, dropping to a little over 50,000 in the mid fifties and stayed at arelatively low figure into the sixties. But, in the seventies, the numbers beganto climb steadily as the reality of child neglect and abuse began to take hold inthe UK. By 1981 there were 92,000 children in care in England an increase ofalmost 50% or 30,000 children on the figure just twenty-five years previously.Of this 92,000, almost two thirds, about 58,000, lived in residential homes.So there were almost as many children in children’s homesin 1981 as there arein all forms of care now (that needs to be remembered when it is argued thatthe current care population is too large). Inevitably, the costs of almost 60,000children in residential care were seen as unsustainable and in any case, anumber of high-profile abuse scandals brought the residential sector intodisrepute. The large institutions began to close as the voluntary sector rapidlyabandoned its orphanages.In the working group I led for Alan Johnson I was keen to help further drivedown the numbers in care seeing that reduction, incontrovertibly, as a goodthing. No one suggested otherwise, at least not publicly. But, sometimes, inthe margins of consultation events or at conferences, front line social workerswould sidle up to me to whisper their anxiety that the direction of travel was
not as clear as I thought. The whispers grew, I became nervous about myinitial certainty, and eventually my working group concluded, almostcertainly to Ministerial disappointment, that we should not have targets forfurther reducing the numbers in care.At about this time I started to see a little more of Barnardo’s own work in thisarea. I recall a particularly fascinating day in one of our services talking toparents – or more specifically mothers – who were seeking the return of theirchildren from care. Our job was to assess their readiness to re-assume theirparenting responsibilities. What I saw made me uneasy.My practice whenever I visited a Barnardo’s service was to reflect for a day ortwo on what I had seen and then to share my thoughts with senior colleaguesand Trustees. After this visit I wrote:[I was worried that staff] seemed to be working in a context which required themnot to do what was unequivocally the best for the child, but instead one whichtasked them, whenever possible, with keeping children with their mothers. Onefamily was described to me as being guilty of the most abject neglect of theirchildren who were filthy, suffered exceptionally serious dental decay and were notattending school. Now fostered, the children, 10 and 14, were doing reasonablywell and were both at school. Meanwhile we seemed to see success in this case aseventually returning the children to a mother who, I was told, had very limitedawareness of the inadequacy of her care for her children. I wondered why on earthwe would contemplate taking such a risk and the answer that “blood was thickerthan water” certainly did not convince me.I went on to observe:Part of the problem is, I fear, that these seem such illiberal things to think, muchless write. But I left this visit seriously perturbed that staff were working in acontext, overly influenced by considerations of what a Court might opine, inwhich the interests of the child were not the overwhelming consideration theyshould be.As I began – tentatively at first – to utter publicly the view that we might haveto think about taking more, not fewer children into care, my motives wereattacked. Some correspondents said I was drumming up trade for Barnardo’sChildren’s Homes (ignoring the fact that the last one had been shut twodecades earlier). John Hemming MP dismissed my view without debateblogging, simply, ‘Martin Narey is wrong’ and there was a great deal ofoffensive comment on the internet. Meanwhile, at successive presentations tostaff from Children’s Services Departments in two northern counties, eachhost Director referred to my views, respectively as unorthodox and challenging.But amongst the abuse, letters I received convinced me that this was a debateworth having.Meg, a Social Worker with decades of experience wrote to say:
I am 57 and started my career as a child care social worker but I found myselfunable to tolerate the incredibly low standards that were tolerable within thechildcare services...Thank Goodness someone is speaking up for all those childrenwhose lives are witnessed and about whom nothing is done.I did not know it at the time but there was no shortage of very sound researchto back up my anxieties about the children we leave in neglectful and abusivehomes.The reality is that care can be much improved and the current Children’sMinister is right to be impatient about achieving such improvements. But,even as it is, care is much to be preferred to leaving a child in neglect. AsProfessor Mike Stein from the University of York has said:The simplistic view of care as failing 60,000 young people should be confinedto the dustbin.Extensive research, much of it commissioned by the Department forEducation confirm the Stein view. Very recently, in 2010, DEMOS werecommissioned by Barnardo’s to take a comprehensive look at the evidence.DEMOS confirmed that:Stigmatisation of the care system, combined with concern about the upfront costs tothe state, means that some children who might benefit from the care system do not doso.When the care system is used effectively in this way it can be a powerful tool forimproving the lives of vulnerable children and young people.The mistaken belief that care consigns all looked-after children to a lifetime ofunderachievement and poor outcomes, creates a culture of uncertainty, increasingdelay and leading to instability later on.There is now a substantial body of academic evidence that provides a longer-term andmore nuanced perspective on looked- after children’s lives, taking into account thenature of their pre- care experiences and comparing them with more appropriatecontrol groups. This evidence shows that care can be a positive intervention for manygroups of children.Some groups of children whose entry to care is delayed by indecision or drift are atrisk of experiencing a longer exposure to pre-care adversity; higher emotional andbehavioural problems; placement disruption and instabilityMore recently, and more vividly, Becky Hope’s All In A Day’s Work, published
in April of this year offers a frequently moving record of the experiences of asocial worker who has spent twenty years working in child protection. Herpreface could not be more stark when she says:Children whose basic needs for responsive loving care are not met, and who areleft to flounder, have been found to suffer clear detrimental effects to their braindevelopment long before they reach anywhere near their first birthday. It has alsobeen found that children who have experienced severe neglect as tiny babies, butare placed in long term adoptive homes before the age of six months are able tomake far greater progress overall than a child placed after that age.[But} at present this research is not infiltrating social work practice in a way thatbest supports the children who depend on us. To allow these research findings tochange our practice will require a change in the mind-set of all involved in theprocess of child protection.She captures the sad reality that too often we wait too long before removing achild from parental neglect, sometimes because of an unjustified optimismabout the capacity of parents to improve. As Jonathan Ewen the Director wholeads for adoption for Barnardo’s told me:Speeding up the decision making after a child first comes to the attention ofthe authorities is key; research shows that most parents who are going tosignificantly improve their ability to look after their child do so in the first sixmonths of the child’s life. If that doesn’t happen, then we need to be bolder –and quicker - in making the decision to remove that child permanently.It needs to be stressed here that I am not talking about cases where there isroom for doubt over whether or not a child has been neglected or the capacityof the mother to become an adequate parent. This is not to deny that mistakesare not sometimes made and that, however occasionally, decent and lovingparents suffer the horror of having their children taken from them withoutjustification. But front line practitioners know that those cases, howeverregrettable, are overshadowed by a much larger number of cases where weleave children too long and until neglect turns into abuse. I believe that mostlay people, most parents, would be deeply shocked both at the conditions inwhich we routinely leave children and at our continued consideration ofreturning a neglected child to the circumstances which led to his or her abuse.In All In A Day’s Work, Hope describes her experience with a typical casewhere a child had been physically abused, was in care, but seeing her motherregularly (known as contact) with the possibility of a future reunion. Thechild is Sarah and the mother, Julia:Over the weeks since Sarah had been taken into care, Julia was often very late forcontact meetings and a couple of times she forgot to come altogether. Sometimes itwas suspected that she was high on something, at other times there was asuspicious smell of alcohol about her person. It was a frequent event for it to bereported that she had spent her time reading a women’s magazine at contact andoften had very little time for Sarah at all, just making the very barest attempts to
interact. Sarah said little after these contact sessions but reacted silently with theinevitable wet beds, disturbed sleep and very difficult behaviour at school.Before her birthday Sarah was getting very excited about the prospect of a partyand presents and, during contact the week before, her mother had made repeatedpromises in terms of presents, building up Sarah’s hopes. Sadly, when the pre-birthday meeting with the mother took place, nothing appeared, her motherarrived both an hour late and empty-handed. The long promised bike, the puzzleand the skipping rope – all evaporated in vague excuses. Not even a card. Sarah’sbehaviour at the remainder of this contact session was of hesitation and confusedsilence, but later her hurt came out in tremendously angry outbursts andterrifying nightmares, plus some fights at school. This was the culmination ofmonths of disappointment with her mother’s disinterested behavior.Why do we allow children to be damaged in this way? Sometimes it isbecause sustained changes in parenting capacity can be and are achieved. Butthe current system is gripped by an unrealistic optimism about the capacity ofdeeply inadequate parents to change. Making the birth family successfulshould be our first option, and I am not arguing that mothers should not begiven a second or even a third chance, just not a fourth, fifth and sixth.This unjustified optimism in the capacity of deeply inadequate andsometimes uncaring parents to change condemns children to a childhood ofneglect and sometimes abuse and damages their chances of leading asuccessful life in adulthood. We should and do help parents to change andwhen that is successful that is a great achievement. But we have to tackle thenaïve optimism that paralyses the system. And we have to stop lettingchildren down by returning them to parents only for them to be neglectedonce again. This is not simply my view. Research supports it. In Casemanagement and outcomes for neglected children returned to their parents: a fiveyear follow-up study (2010), Professor Elaine Farmer followed the fortunes of138 children who had been taken into care and then returned to their parents.She discovered that:[There was] a tendency over time for abuse and neglect to be minimised so thatreferrals about harm to children [did] not lead to sufficient action to protect them.Plans made during care proceedings did not work out in three fifths of cases, oftenwhen children were returned to parents because of an over-optimistic view of thepossibility of parental change by guardians and expert assessors, in the face of longhistories suggesting the contrary.And, most troublingly, she found that two years after those children had beenreturned to their parents three in every five (59%) had been abused orneglected once again. We cannot let children down in this way.
Findings from a University of York study (Jim Wade, Nina Biehal, NicolaFarrelly and Ian Sinclair) also published last year echo Professor Farmer’sfindings. This study compared the progress and outcomes of a sample ofmaltreated children some of whom were returned home from care with thosewho remained in care. It was found that outcomes for the children whoremained looked after were better than for those who went home with respectboth to stability and well-being.Judicial opinionWe shall not see many more adoptions, and significantly we shall not seemore of the most successful adoptions, until we begin, as a society, includingsocial work professionals, the courts, the media and politicians, to accept that,however well intentioned, we leave some children, too long in neglect. As Ihave argued here, a frequent reason for this is this strongly held butmisconceived belief that however bad things are at home, care will makethings worse. It is vital that Judges appreciate that this is not so. But in twopresentations to Family Court Judges last year there was bemusement at mysuggestion that care made things better, not worse, for neglected children.This is hardly surprising when shortly after his appointment as President ofThe Family Division, the most senior Family Law Judge, the much respectedLord Justice Wall said:What social workers do not appear to understand is that the public perceptionof their role in care proceedings is not a happy one. They are perceived bymany as arrogant and enthusiastic removers of children from their parentsinto an unsatisfactory care systemSocial workers may sometimes get it wrong. I accept entirely that there maybe cases where intervention is inappropriate and unnecessary (althoughsometimes, those who are concerned about such cases jump to the conclusionthat such errors mean all interventions are unnecessary). But it is very clearthat generally children are not removed from their parental home unless thereis the clearest evidence of their abuse and neglect. Even in the wake of BabyPeter when applications for care increased significantly and there was somespeculation about social worker over reaction, research from CAFCASS foundthat none of the additional interventions were premature.The reality of care is best captured in an article published in the Journal ofSocial Policy in 2009. Forrester, Goodman, Cocker, Binnie and Jenschreviewed all British research since 1991. Their conclusion was that:The studies consistently found that children entering care tended to haveserious problems but that in general their welfare improved over time. Thisfinding is consistent with international literature. It has important policyimplications. Most significantly it suggests that attempts to reduce the use ofpublic care are misguided and may place more children at risk of serious harm.
Judges must understand the truth of those simple sentences.