It’s risky out there – the Care Review and its existential risk to Residential Child Care
An existential risk is posed to Residential Child Care by the Care Review.
- Context – considerations of the Care Review Case for Change
On page 62 the Case for Change asks “a broader question about whether children’s homes are the right long-term option for children in care and the extent to which they should play a role in our long-term vision for care”. It is asked again on page 72. It is not a slip but signals an intention.
Though it seeks “the right homes in the right places with the right support” the role of residential child care is left open, “What role should residential and secure homes have in the future?” (71).
So, a future, but one that is, at best, uncertain.
There is one positive evaluation of Residential Child Care included from the (previous) Children’s Commissioner; “Good children’s homes do exist in England…. homes which children have told us they experience as loving and supportive and the best place for them to be; homes that engage and involve children’s families; homes that provide therapeutic care, access to a good education and experience of the wider world.”
This is followed by “Unfortunately, too many children do not get this experience” and descriptions.” This is the pattern of the Case for Change when addressing Residential Child Care, any positive is followed by a negative; it could be called balanced reporting, “The quality of homes continue to be raised with the review and whilst some point to the high proportion that receive a good or outstanding Ofsted rating (95% of inspection outcomes – NCERCC addition), others have questioned whether these ratings are linked enough to children’s experience”.
These equivocal highpoints are within an environment of a publication that is not supportive of Residential Child Care, where it is repeatedly not seen in its own right but only in comparison and then only to assert its detriment. “At a time of wider budgetary pressures, local authorities trying to balance their books are increasingly stuck in a cycle of spending more on short-term reactive interventions, including the most drastic measure of moving children away from their family to live in a residential home, at the cost of the preventative work that could lead to better long-term outcomes for children and families (73) … Throughout the system there are opportunities for things to both work better as well as cost less – avoiding parents having repeat removals, taking fewer children into care by supporting families where possible, making better use of kinship arrangements, avoiding children entering costly residential and secure placements, curbing profit and reducing the number of agency social workers. (73)
The Care Review has not undertaken a cultural review or adopted a social constructionist view of children’s social care and especially so when throughout it takes and uncritical understanding of the uniquely English ‘last resort’ use of Residential Child Care. In few countries is Residential Child Care used as a last resort, access by sequential placement breakdowns, choice of care setting achieved hierarchically. How is it that we have made the use of Residential Child Care this way? A way that others in the world do not use it.
For some years NCERCC has been stating that England has had the lowest number of residential places in history and that there was a need for more. NCERCC termed the phrase ‘right homes in the right places at the right time for the right child’ over a decade ago. It is only recently that other people have realised there is the need for more residential child care places. The Care Review sees it too, “There are not enough homes in the right places with the right support” (58). NCERCC has explained some strategies that could be helpful, we have said as the Care Review now says, “Fixing this in the long term will take bold and focused action, however, we cannot ignore the current issues and the impact they are having daily on the lives of children.” (58)
“The review is concerned about the cost, profit, and financial health of providers and the impact of the current system on children. We want a pragmatic re-think given the urgent problems, the complexity of the issues and the fragility of the current system”. (58)
The Care Review has much to do to add to its knowledge and understanding of Residential Child Care.
It has to be absolutely certain that it is does not create an existential risk to Residential Child Care. It needs a strategy that starts from a granular needs analysis the plan for the future starts from needs.
I had it explained to me that the reason why sufficiency and not a needs analysis is the current expectation is because a needs analysis would show the need for more settings to meet high level and complex needs. It would require more residential resources. It would require more funding for children’s services.
This is why the Care Review has to challenge its terms of reference and propose more funding.
In the Case for Change the current spending on for profit Residential Child Care is subtlely presented as the solution for all of children’s services funding woes. It isn’t. It isn’t in the amount spent. It isn’t because if the idea is to move to local authority homes these cost about 33% more than the independent sector according the PSSRU Unit Costs report. Funding is choice, but to move from where we are to where you would want to be requires a plan, a plan requires funding. If you wish to end private social care it will require funding that will enable a disinvestment whilst continuing the services. This is not only about finance, or morals, or ethics, but real life. Occupancy is key to any home for the equilibrium viability of its finances, but importantly also its the culture and dynamics. This is the case no matter the organisation that is the provider, LA or private or voluntary organisation. It is not a case of the local state taking over the running of children’s homes. This will require legislation. We have no legal means to take over the running of homes. NCERCC has repeatedly issued reminders. (For the record, NCERCC position is that care should be definancialised and a National Children’s Care Service established, nationally and regionally planned, locally delivered and accountable. We hold no banner for any of the 3 current types of ownership).
The Case for Change describes the care system as Jenga with Sellotape (NCERCC has often used the Jenga analogy). Removing any piece requires thinking about what might happen. Removing the Residential Child Care piece might have devastating effects. The role and function of Residential Child Care is well researched, well documented. The Care Review needs to adopt a role and function approach that meets needs. It appears to be redefining needs and finding approaches to fit.
As it currently constituted the Care Review and its Case for Change pose an existential risk to Residential Child Care. It is not too late. A climate change is needed.
NCERCC has also published a NCERCC easy guide.
What does the Care review Case for Change say about Residential Child Care?
Extracts of all entries + page numbers from the Case for Change
1.1 Context – what others have been saying about Residential Child Care
Charlotte Ramsden ADCS presidential speech April 2021
ADCS_Presidential_address_CR_FINAL_for_publication.pdf
“ …we need better residential care, with placements that meet children’s actual needs. We can achieve this though better commissioning, child-centred practice and regulation that works’.
Stuart Carlton ADCS North Yorkshire June 2021
Who loves this child? | CYP Now
I don’t want children in residential care, the long-term outcomes as evidenced support my position. (Stuart continues, ‘Adults who lived in foster and residential care during childhood had a 40 per cent chance of very poor health 10 years later. This rose to 85 per cent over the following two decades. Those who grew up with a relative saw their chances of reporting very ill health range from 21 per cent to 43 per cent over the same 30-year period’. NCERCC This is what the research tells us. However Residential Child Care is not then causal agent. Residential Child Care allows us to observe the corelation of factors).
LGA various 2021
Councils have been reporting increasing difficulty in finding suitable places for children in care, particularly for older children and those with more complex or challenging needs. They have also identified some placement costs rising far beyond inflation, putting pressure on budgets that are already at breaking point.
Rising demand means that despite increasing budgets, councils still overspent on children’s social care by more than £3 billion over the past five years…
The Department for Education has launched an independent review of children’s social care which councils say is an important opportunity to consider how we can ensure that we have the right homes for all children in care, and that money spent on those placements is improving outcomes for children.
Cllr Judith Blake, Chair of the LGA’s Children and Young People Board, said:
Providers should also not be making excessive profit from providing placements for children. What matters most is that children feel safe, loved and supported, in placements that best suit their needs.
“Councils, providers, central government and Ofsted all have a role to play in developing a diverse market that makes sure we have the homes children need.
“The Government’s review of the children’s social care system is a positive step. It must consider how to support councils and independent providers to deliver the homes our children in care need, how the current market is impacting on children’s experiences, and how we can make sure children get the support they need to thrive.”
Report = Profit making and Risk in Independent Children’s Social Care Placement Providers.
‘…this model of ownership and financing, properly monitored, appears not to be extracting significant funds from operating cashflows’.
Local Government Association Children’s Homes Research
Childrens Homes Research – Newgate.pdf (local.gov.uk)
LGA commissioned research makes a balanced assessment and says what many have said for many years from a completely new and independent viewpoint.
“A variety of inter-related barriers to establishing residential children’s care provision were identified that impacted local authorities and smaller independent providers across both the private and voluntary sector. These included:
- The perceived role of children’s residential care as an option of last resort due the negative stigma that surrounds children’s homes, comparatively worse outcomes for those children and young people that have been supported within these homes (often having come through multiple failed placements beforehand), and the significantly higher cost for residential places
- Challenges making a robust business case for investing in children’s residential care due to the high capital expenditure required for setup and the lack of predictability in the flow of placements
- Difficulties finding the right property and staff (in particular a registered Manager), and having these in place in advance of being given licence to operate by Ofsted, all of which require significant time and resource investment
- The complexity and severity of children and young people’s presenting needs can make it difficult to make a placement (due to the need to manage the dynamics of homes as much as the challenging behaviours themselves) and homes can feel overly restricted in managing challenging behaviours due to stringent regulatory requirements and the need for appropriate matching
- A perceived lack of co-ordinated and strategic commissioning”
- It’s risky out there – the Care Review and its existential risk to Residential Child Care
Developed using the thinking in the paper: Existential Risks: Analysing Human Extinction Scenarios and Related Hazards
Nick Bostrom, Professor, Faculty of Philosophy, Oxford University. Published in the Journal of Evolution and Technology, Vol. 9, No. 1 (2002). (First version: 2001) Existential Risks: Analyzing Human Extinction Scenarios (nickbostrom.com)
Abstract
The Care Review is intended to move children’s services to a critical phase of development. The attraction of radical transformation brings opportunity and risk. A better understanding of whatever the transition will bring is needed. Of particular importance is to know where the pitfalls are: the ways in which things could go terminally wrong through existential risks. There is an existential risk in the Care Review for Residential Child Care. As yet the threats have not been recognised. Existential risks have a cluster of features that make ordinary risk management ineffective. A final section of this paper discusses several ethical and policy implications. A clearer understanding of the threat picture will enable us to formulate better strategies.
Setting the magnitude of a risk: scope, intensity, and probability.
- Scope = the size of the group of people that are at risk.
- Intensity = how badly each individual in the group would be affected.
- Probability = the best current subjective estimate of the probability of the adverse outcome
Distinguishing 6 qualitatively distinct types of risks based on their scope and intensity, with probability being superimposed on the two dimensions plotted in the figure.
Other things equal, a risk is more serious if it has a substantial probability and if actions can make that probability significantly greater or smaller.
| Global | ||
| Local | ||
| Personal | ||
| Endurable | Terminal |
Existential risk = where an adverse outcome would either annihilate or permanently and drastically curtail its potential. It is very serious.
In the Care Review there are 3 observable existential risks: threat to diversity of RCC (the right sort of RCC = ADCS comments), recession (CMA referrals and imploring by leader of CR to reduce fees), cultural bias against use (the focus on family).
Local terminal risk can come from frameworks that are solely on the terms on the LAs. It has happened before Warwickshire and Kent. More recently No Wrong Door is a critique of fostering and RCC.
Even where the whole of RCC was not imperilled it would still have major adverse consequences for all RCC that remained.
For there to be a risk, given the knowledge and understanding available, it suffices that there is some probability of an adverse outcome. It may later turn there was no risk.
In the current situation with the Care Review, we do not know if what is being proposed is risky or not. (What we do know is the current situation already has risk e.g., here are not enough intensive and expensive high level complex places).
We know too that there is a continual attrition on RCC; professionally and financially it held in negative regard no matter that the evidence base does not support this evaluation). The attrition on RCC is observable over many years. (See Stanley, A political economy of RCC that identifies the decline in the Approved School/CHEs and the factors involved).
It is only strong evidenced advocacy that has enabled the sector to sustain itself. This was taken by the local and national state to be ‘combative’ which indeed it was necessarily so. Compare this to the current collaborative stance and leadership of RCC. Many years ago, NCERCC explained that it was necessary to avoid implosion of the sector. This is exactly what the Care Review designs for RCC. It is the very ‘crumpling’ that was described.
The approach to existential risk cannot be one of trial-and-error. There is no opportunity to learn from errors. The reactive approach – see what happens, limit damages, and learn from experience – is unworkable. Rather, we must take a proactive approach. This requires foresight to anticipate new types of threats and a willingness to take decisive preventive action and to bear the costs (moral and economic) of such actions.
Clearly RCC cannot rely on the institutions to defend it as this is where the threat is coming from. An existential risk is different than local, the frameworks that have been avoided by spot purchasing. Risks have been eluded and elided. So far the local risks have been reduced. An existential risk is quantitatively and qualitatively of a different order. There is no hiding place from the magnitude of the risk.
The thinking and organisation to address and overcome an existential risk may be in short supply. Those holding the existential risk are not thinking that what they are thinking, saying, doing is a risk. Currently RCC may not see the risk. However, neither position is not a reason not to act as though there is a risk. Here’s one reason, what is the effect on other children’s services if RCC is not available? Swe know the answer because it is the situation now! Ther are benefits of RCC but these are not being seen and if seen not articulated. RCC has been made to be a ‘folk devil’ and the features of a moral panic are observable.
If the care system is ‘Jenga with Sellotape’ (NCERCC also wrote before the Care review using the Jenga analogy) then it is surprising how little systematic work has been done.
In the place of systemic work has been the Innovation Programme. This is designed to take selected projects and create a rapid evidence and evaluation base as the foundation for future investment and roll out. Critique of the projects was not invested in, and so it is in abeyance.
Part of the reason for the Innovation Programme was to present future ‘technologies’ (manualised, scalable) against mounting interdisciplinary and speculative analyses. The Innovation Programme cannot be seen as a sober look at the situation before us, and we do not know if it has created responsible strategies. In place of strategy we have a series of propositions, that the Care Review now tries to sew together. The tradition of English ad hoc social care legislative development in the event of a tragedy is alive and operational.
Classification of existential risks
Bangs (often accidental rather than deliberate)
- Misuse of research findings e.g., research with different internal and external factors compared (as apparent in the NICE evidence base e.g., MDTFC and RCC
- Explosive policy e.g. CMA, Select Committee
- Machine learning applied to social work/care esp. for high level complex needs knowing the granular difference that can lead to formulation and diagnosis is crucial. Its application requires that complex input and use. There is nothing to suggest it is designed to work at this level of complexity.
- An uncontained idea of rectifying immediate issues leads to longer term loss of abilities.
- The attrition continues – who knows where the tipping point is?
- Unforeseen – a wide scale safeguarding concern. Consider the potential difference of there being in children’s homes the daily abuse of young women in schools as recently identified by Ofsted.
- If it is taken as the premise that it would be better to be without RCC then it is better that it occurs with full cognisance and preparation of how children’s services will operate in a situation that have never in all of human history before. Is there anything that suggests that this is now the time in human development that residential care can be done without? If so, what is it?
Crunches
- Resource depletion – workforce gaps
- Fundamentalist policy – no RCC use allowed.
- Time limited evidenced manualised programmes
- Charismatic leaders offering solutions.
- Adoption, kinship, and fostering develop in numbers, knowledge and expertise to the degree that RCC is not needed. Is there anything that suggests that this is currently present? The Care Review suggests it is the case. Given there does not seem to be the evidence: Is the Care Review proposing an experiment?
Shrieks – the future is attained but it is an extremely narrow band of what is possible and desirable.
- Superintelligence – Potentially machine learning allows all that is to be known to be applied to an individual’s situation by use of a taxonomy of need and outcome. However, in reality and practice, the algorithm is designed by a small group of people who also usually also selected the policy goals.
Whimpers – the physical limits of children’s services (workforce, financial) are encountered to the degree that there is the complete disappearance of the things we value or to a state where those things are realised to only a minuscule degree of what could have been achieved.
- Reduction in resources
- Depletion of resources
- Core values are eroded to the degree that some services are dispensed with
- Core values are redesignated.
Assessing the probability of existential risks
Direct
Assign probabilities, subtract the sum of these disaster-probabilities from one to get the success-probability. In doing so, we would benefit from a detailed understanding of how the underlying causal factors will play out: How much harder is it to put into real life a designed model of assured children’s services as in the Care Review? What are the estimates of existential risks, given that we have not encountered them before?
Indirect
Create a theoretical model. Allow critique. Take time. There is no discussion of simulation of probability among hypotheses, the consequences becoming visible and aiding decision making where we should put our efforts.
Both, in reality, rely on making a lot of guesses, probabilistic evidence for or against various hypotheses.
How would we deal with bias? It is inevitable there is systematic bias when estimating prospects or risks.
The best options we have developed to date might be seen as operating as a resilient environment for resilient services. That requires a degree of planning that is not envisaged by the Care Review. Rather than such an informed container it seems to be suggesting the removal of all containment beyond the personal lives of families.
If we want what other countries have got then what other factors are present that make them possible? Children’s services policy and practice is contextual. Even inside England Signs of Safety and NWD are implemented in diverse ways such that the fidelity of the original and of any comparisons is compromised.
Implications for policy and ethics
Existential risks have a cluster of features that make it useful to identify them as a special category: the extreme magnitude of the harm that would come from an existential disaster; the futility of the trial-and-error approach; the lack of evolved coping methods; the fact that existential risk dilution is a public good; the shared stakeholder ship of all future generations; the interdependency of many of the required countermeasures; the necessarily highly speculative and multidisciplinary nature of the topic; the subtle and diverse methodological problems involved in assessing the probability of existential risks; and the comparative neglect of the whole area.
So, what do we do?
1. Raise the profile of existential risks.
The Care Review asks for solutions. This is the wrong request for this time.
We need more research into existential risks – detailed studies of particular aspects of specific risks as well as more general investigations of associated ethical, methodological, security and policy issues. Public awareness should also be built up so that constructive political debate about possible countermeasures becomes possible.
- We need to ask not what works, but what can go wrong.
- A system that leads to the provision of existential risk reduction in something approaching optimal amounts should be attempted.
If none of the above is applicable to the current situation what is to be done?
- The only option is to take action to prevent the proliferation of the proposals using all legal means necessary until such a time as reliable countermeasures are able to be deployed.
Each intervention should be decisive enough to reduce threat to an acceptable level, but it should be no greater than is necessary to achieve this aim.
Waiting is not an option; it might be the start of the slippery slope of existential risk.
- Use existing powers to increase or reduce items in the current system.
What we do have the power to effect changes. Isn’t this what we have always done? What is the push for the radicalism that is being applied?
The adoption of the Common Pool Resourcing approach by Ostrom would bring into operation some helpful checks and balances.
We should choose actions that have the greatest benefit under the assumption of impending existential threat.
- Adopt the default option of doing what Scotland do.
Given they are going about things differently and towards a different destination we have to option to bail out and adopt their measures.
