'Hokey cokey' policy lets children down

Chris Hanvey
Friday, September 16, 2011

I was recently struck by what might be described as the "hokey cokey" nature of child care. First, we put things in. Then, we take them out. And then we shake them all about and invariably start again with no reference to what has gone before.

I have always been keen to emphasise the natural link between delivery of health services and social care, given that the two are so clearly connected as to be inseparable.

The importance of this link was vividly brought home to me on a recent visit to one of the few Accident and Emergency units in the UK uniquely for children and young people, run by an inspiring senior paediatrician.

Not only had he ensured that the unit was child-friendly (regularly inviting in local schools to learn first aid), and as unthreatening as twenty-first century medicine can be. But he knew all too well that the unit was often responding to social problems.

So, one of his biggest groups of referrals were children with repeat respiratory problems, who came from some of the most deprived inner city areas. And, readers of CYP Now will be all too able to fill in other pieces of the jigsaw of these children's lives.

Their problems might well be caused by poor housing and the fact that few local play areas existed for them. Sleepless nights, as a result of their health problems, might well lead to poor school performance and therefore reduced life chances and, given that these are deprived areas, there is also likely to be low income and reduced social mobility.

For each dedicated professional group, working often independently with these children, there is the missing link of joining up the services.

So what has this to do with hokey cokey child care? Well, the last attempt at co-ordinated services was initiated by the Labour government, linking education and social care into one central government department.

The logic was impeccable. Those children needing the most support would be the same children known to social services and education.

Since education is a universal service, the thinking went that it would be less stigmatising to provide social care support through schools. Furthermore, by extending the school day, children's social care needs could also be addressed.

If education and social care were linked in Whitehall, as well as in local authority departments, there would be some hope that problems could be tackled more holistically. This, of course, led to the creation of the Department for Children, Schools and Families.

But, as history revealed, the present Secretary of State for Education chose to take social care out of the education department, shake it all about and remove the rainbow banners in his headquarters at Sanctuary Buildings in Westminster.

Similarly, in those sections of the Health and Social Care Bill that deal with children, it is not envisaged that there will be any further attempts at integration with other professions. And, of course, there are always sound reasons for not making widespread structural changes. Reorganisations can be diverting, if not really needed, and can be a distraction from, rather than a solution to serious problems, where the answer lies more in performance management.

What is needed is a more holistic approach to children's welfare, which recognises the huge duplication in expenditure of separate professional groups, but finds new ways of working closer together.

If we don't begin with viewing children in the round, we will endlessly be putting things in and taking them out while producing little measurable improvement to the lives of children.

Chris Hanvey is chief executive of the Royal College of Paediatrics in Child Health

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