Northern Ireland Care Review recommends new arm’s length body to deliver services

Northern Ireland’s Care Review has concluded, warning that a ‘major fix’ is required to tackle longstanding issues within services.

Prompted by concerns about longstanding issues within the services – such as high levels of staff vacancies and many children and families not getting the help they needed – Professor Ray Jones was appointed by Robin Swann, then Minister of Health, to undertake a review of children’s social care services across Northern Ireland.

Professor Jones has found that there are more than 4,000 children on the waiting lists for assessments and help from children’s social care services provided by the region’s five Health and Social Care Trusts, with many waiting for over a year and with the longest wait being over two years.

Detailed across eighteen chapters, the review sets out only a limited number of recommendations. Writing in the foreword, Professor Jones says this is a ‘deliberate decision’ as too many proposals could mean recommendations may not get the attention they require and may get lost. Jones adds that a report which was too prescriptive would detract from the ability of senior managers to shape services to the people they work with.

“A major theme running through this Report is that there needs to be more clarity about authority and accountability. The senior managers of services need to be able to shape and own the services which they are leading, albeit whilst being informed by all who are engaging and participating with the services. This would be undermined by a Review which was heavily prescriptive with a deluge of detailed recommendations.”

The report notes Northern Ireland’s much higher rate of children being referred to children’s social care services compared with the rest of the UK and the Republic of Ireland, as well as a higher proportion of its children seen as ‘in need’ of help, a higher proportion with child protection plans, and a record number of children in care.

Poverty is more prevalent for children and families in Northern Ireland than elsewhere in the UK. As reported to the Northern Ireland Assembly, more than a third (36%) of children live in the poorest neighbourhoods, much higher than in England (24%) and Wales and Scotland (both 26%).

Jones says this poverty is a ‘major driver’ of the need and demand for children’s social care social services.

“It is highly correlated with numbers of children with child protection plans and who are in care. It is also highly correlated with ill-health including mental health concerns and drug and alcohol misuse.

“There should now be no doubt that poverty is corrosive and it is contaminating.”

Jones also argues that Northern Ireland faces its own unique ‘toxic trio’ of contextual factors adding complexity to its social care issues. Firstly, the legacy of the personal traumas of the ‘troubles’ which are recognised as being associated with the current high incidence of mental health difficulties such as anxiety and depression, the misuse of alcohol and drugs, and the incidence of domestic violence. This in addition to the contemporary threat, fear and trauma being created within Northern Ireland’s communities today, and the political vacuum created by no Executive or functioning Assembly, Jones says creates a context which has worsened services for children and families.

During the Review, which started in February 2022, Professor Jones lauded many impressive services delivered by skilled and committed workers. However, the review team also heard from children and their families that there is a high turnover of social workers, that children and families are concerned that they have not got the help they needed when they needed it, and that the help which is available is not consistent across all areas.

“What has been described to me, and what I have seen, are services provided by the Health and Social Care Trusts and by voluntary and community organisations under great pressure, and it is recognised that there are longstanding serious difficulties which span all of Northern Ireland.”

“This has had the consequences of help not being available to many families who are struggling and then with more children having child protection plans and with increasing numbers of children and young people being removed from their families and placed in care.”

“I am concerned that within the current arrangements, which were put in place fifty years ago, locating children’s social care services within very busy and pressurised health organisations, with big issues to tackle regarding, for example, hospitals, despite the best will in the world it is not possible to give the dedicated and concerted attention needed to tackle the difficulties within children’s social care services and to provide the help needed by children and families.”

“And it is getting worse. More families are struggling as poverty is increasing and deepening, and the absence of an Executive and Assembly means that urgent issues, such as the cost-of-living crisis, are not being tackled. Big cuts are now being made with services which have taken time to build, including by voluntary and community organisations, quickly being closed down and children and families left stranded.”

Professor Jones’ major recommendation is that a region-wide organisation should be created to deliver children’s social care services and to create the platform to address the significant issues which need to be tackled.

The ‘clear and firm’ recommendation for an arms-length body would include current Health and Social Care Trusts’ statutory children’s social care services along with other allied services and professions closely related to children’s social care.

It is argued this will “create the opportunity to address long-standing difficulties which are worsening and to start to refocus on helping, when necessary, families to care for their children rather than continuing down the road of more and more children being removed from their families.”

The review also recommends appointing a Minister for Children and Families to give political leadership and focus to children’s issues, as well as reintroducing the trainee social worker route to qualification.

“It will also be important to expand qualification opportunities for the larger cohort of unqualified workers by increasing the routes into social work,” the report said, adding: “Some of the longest serving social workers and managers met during this Review qualified through the trainee route. They were already well embedded with their families and in their communities which they have then continued to assist.”

Jones warned however that the recommendations and reflections in the review should not be allowed to ‘drift and delay’.

“There is an urgency to move ahead at pace. Children only have one childhood and the clock is ticking.”