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Managing bureaucracy in child protection services

Cheryll Adams D(Nurs) MSc BSc(Hons) RN RHV Dip Man
Independent Adviser, Nursing, Health Visiting and Community Health Policy and Practice
Honorary Senior Visiting Lecturer
City University

One of the outcomes of Eileen Munro's review of child
protection services was that efforts must be made to free up frontline social work from bureaucracy

While teaching a group of return-to-practice health visitor students about the need to assess every new mother for the possible presence of postnatal depression and the consequences of not doing so, a senior safeguarding lead stated that, where she practised, there was just not the capacity for such early preventive activity. Often, when dealing with a vulnerable family the health visitor's time was taken in recording the information four times to meet the workplace accountabilities.

How many times do we step back and look objectively at how we work and consider how we might change working practices to improve the time we can give to our clients? How often do we reflect on the economic value of preventive interventions? For example, we now know that some infants whose mothers have persistent depression during their early years will carry the personal consequences right through their adult lives, with potential effects on their social, emotional and even physical health. Could community nursing and health visiting services have an opportunity now to use Dame Eileen's wisdom and ask for their bureaucratic systems to be reviewed? Any review must be led by the clinicians whose practice is held back by being accountable to these processes.

A little while ago, public health nurses in Eire had a work to rule and stopped doing all non-clinical duties, and were staggered by how much more clinical time they found available to them. However, the concept of risk is pervasive, especially when you are holding on to very vulnerable families or older people who might once have been taken on earlier by children's social care. It makes it even more important that, when clinicians are faced with very challenging caseloads, the systems supporting them do not add to their burden. Eileen Munro called her final report A child-centred system with good reason, as she had found that the systems were driving the professionals rather than the professionals driving the systems.1 She wanted to highlight that the focus in children's social care must be the child. This seems obvious - but we must question how we have allowed management systems to take centre stage, rather than professional practice. I don't believe this is the case for all areas of community practice, but it is for health visiting in many areas.

Ministers support Dame Munro's recommendations. In a letter to Moira Gibb, Chair of the social work reform board, Tim Loughton MP states: “We need to remove the barriers which hamper high-quality social work practice and to liberate the skills and talent of professionals on the front line”. It shouldn't require an expensive report to also make the same case for some NHS services, and as clinicians you must feel empowered by the social care case to articulate your own concerns and demand a local review.

Usually, the solutions are relatively simple, once professionals have time out to think of them. Because we are so busy, we may forget that a little time out can bring real benefits to our work at the coalface. It has always worried me that many electronic systems inhibit practice. It is vital that practitioners take a lead role in designing the systems they use and that their concerns are heard.

Dame Munro called for a “radical reduction in the amount of central prescription to help professionals move from a compliance culture to a learning culture, where they have more freedom to assess need and provide the right help”.1 In the NHS the prescription is less centrally driven, but it is there nonetheless. Why not take the opportunity generated by Dame Eileen's recommendations for child protection to ask that they are considered for their applicability to NHS community nursing services? Imagine your professional world with less bureaucracy - it is definitely something worth making time for.

Reference
1. Munro E. The Munro Review of Child Protection: The Final Report. A child-centred system. London: Department of Health; 2010.