The Care Review: Putting our money where our heart is
Maxwell Murphy
‘It means ensuring Scotland has a more holistic understanding of risk that includes the risk to the child of removing them from the family. There must be a shift in focus from the risk of possible harm to the risk of not having stable, long term loving relationships.’
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In January the Independent Care Review published its findings from a four-year analysis of the ‘care system’ in Scotland, synthesising the experiences of thousands of individuals who are ‘care experienced’ or who have come into contact with the care system in some way throughout their lives. The findings set out the need for radical and immediate systems change - including changing the system’s values to those of compassion and genuine implementation of child rights, supported by a broader suite of legislative and practical changes. Underpinning these changes is a rethinking of our understanding of 'risk’ and how the impact of care and an individual’s wellbeing can be meaningfully appraised and mitigated. When the first minister presented these findings and pledged support to the enactment of the care review’s suggestions, the cross-party support generated a feeling that something special has started to happen in Scotland. But are we truly ready for this? Lab researcher Max Murphy explores…
There was a lot of information in the Care Review. ‘The Promise’. lays out all aspects of state care that can negatively affect the wellbeing of individuals who are taken into, released from, or have a professional role within it. Given the breadth and depth of their research and the suite of recommendations, I’ve condensed the findings and recommendations as far as possible into two broad mechanisms of change.
Two Mechanisms of Change
Balancing power dynamics within the care system: Many of the recommendations highlight that care is often done to children in a manner that is alienating and doesn’t properly enshrine their rights to be an active agent in decisions which affect their life. In addition, many parents find the system opaque and difficult to navigate. In response to this, a number of recommendations are made that aim to redress the power imbalance between the ‘care system’ and those who interact with it:
- The Environment of Decision Making: The environments in which important decisions are made regarding children and families care is often intimidating and alien to them. When important care decisions are made, there is not adequate emotional preparation for children and families to manage these transitions.
- Improving Procedural Transparency: Removing professional jargon, uncertainties and inconsistencies by creating more accessible processes for decision making. This includes allowing young people greater control of their own data, being transparent with them on why data is collected and what it will be used for. This also extends to the consistency of staff and hearing members.
- Embedding Child Rights: Central to the effectiveness of many of the proposed changes within the Independent Care Review is the meaningful implementation of child rights as outlined in the UNCRC. This includes reducing the criminalisation of children (under 18s) and not placing children in environments and situations wherein their desires, trauma and vulnerability are not fully and equally considered.
Changing the goals of the system: At its core, the Independent Care Review seeks to embed compassion and warmth into every aspect of care. This re-appraises how risk is conceptualised with care, so that the chance of children growing up without warmth and compassion is recognised as a serious threat to a person’s wellbeing from childhood through to adulthood.
This means removing the barriers and constraints that many who work within the care system are faced with when trying to do the best for the young people within their care. This compassion-centric approach also means long term care for the many adults who have faced challenging life circumstances when their care network has ended as they transition into adulthood:
- Re-appraising risk: learning from evidence that the risk of growing up through trauma without adequate emotional support and warm / loving relationships within an alienating and disempowering process of state care presents a much larger real risk to young people than what care standards presently cover within their appraisal of risk.
- Changing professional definitions: The report is conscious that, whilst many are harmed by experiences of state care, there are many dedicated workers who feel confined by their roles and the standards by which performance is evaluated. This reinforces the formality of the system and its lack of warmth. The Independent Care Review proposes a shift to a values-based system where an individual’s role within a care experienced person’s life is not determined solely by their qualifications but by the quality of the relationship with that person.
- It is emphasised that this is not something that can be measured. Rather, individuals must be given the space to enact those new values.
- Broader legislative changes: This is focussed on longer-term changes in legislation relating to state care which will place children’s rights and warm, caring, relationships as its goals. At present the varied pieces of legislation underpinning state care result in inconsistent processes, adversarial approaches in enforcement, and a system that lacks transparency to those most affected.
One Big Idea
Underneath the proposals outlined by the Independent Care Review, is an exciting and powerful idea (albeit not a new one): that to truly mitigate risk to an individual, we also need to maximise wellbeing for that individual over the long term. The way in which risk is presently appraised doesn’t represent the full reality of risks experienced by individuals entering and leaving the care system. This is not to say that a short-term conceptualisation of risk relating to physical harm and death is not of paramount importance.
This remains rightfully in place - but the Independent Care Review makes the case that the fundamental goal of the care system should be the long term wellbeing of children who come into a contact with it. By putting too narrow a frame on what wellbeing looks like, it currently gives a false account of the harm it causes.
The steps taken in the coming months to implement the Care Review’s recommendations could form the first systems-level example of a wellbeing agenda enacted at a national scale within Scotland. But the care system operates within a wider system which we know rarely provides the time and resource needed to practice compassion, and prioritise wellbeing. The care system, and its practitioners, may strive for, and achieve change for vulnerable children and families – but it will continue to come under great pressure itself from high needs and insufficient resource. To be successful, the system really does need to put its money where its heart is.