Inconvenient truths

Regular readers will probably remember the ongoing saga of the Integrated Children’s System (ICS) evaluation. ICS is the new electronic system intended to hold social work records. Each local authority is expected to introduce it, but the process has been fraught with delays and difficulties.

In 2004 the government commissioned an evaluation of ICS from academics at York University. Over the next two years the academic team studied four local authorities as they attempted to get ICS up and running. Their report was submitted in September 2006 – and promptly disappeared. In the following 18 months, shadow children’s minister Tim Loughton twice asked when it would be published.

Finally, two months ago, the government published its own document which they said was based on the evaluation report. We are told that they did not consult the report’s authors before producing this (though we’re happy to be corrected if we’re wrong).

The government’s version said that the report identified these problems:

The unanticipated scale of organisational change which the implementation of a complex system such as ICS brought about.

The need for improvements in social work training to ensure that qualified workers are knowledgeable about the research and conceptual base of the ICS, and are enabled to develop their analytical skills.

The need for greater support for social workers to use the system appropriately with disabled children

It also included the now-familiar response to reports that don’t say the right sort of thing:

There was coherence to the data from the different data sources… However, the research does not provide a sound basis on which to judge the potential value of the ICS

We FOI’d a copy of the original report, but had great difficulty in reconciling it with the government’s summary. While the report’s authors generally believe that a move to electronic records could be a positive one, they say:

However, our evaluation raises serious reservations about the design and use of ICS in its present form and we believe that the ICS has yet to demonstrate the degree to which and how it is fit for purpose.

While optimism about the system’s potential prevailed over time and some early sources of negativity were resolved, other negative attitudes crystallized and hardened. Social workers with longer experience of ICS were not more positive towards it than those who had relatively recent contact with it.

The concerns expressed included (a) the increased time demands which were “associated with ‘paperwork’ rather than any significant shift in orientation to social work“:

The time required for assessment, planning and review is very considerable and could easily come to absorb the great bulk of social work time. The demands of ‘data entry’ are also considerable and, in ordinary initial and core assessments, take up slightly more time than direct contact with the family or child.

(b) The prescriptive nature of the system:

The ICS was seen by the majority of members of the focus groups in the process and audit studies as being too prescriptive, too long, and repetitive and divided unhelpfully into chunks. There was concern that since the exemplars insisted on similarity, they failed to ask questions that were relevant to some children while asking of others questions that were irrelevant. Practitioners were also concerned that the records were not suitable for use with children and families, and that some, such as the core exemplar, were inappropriate for use with children with disabilities.

(c) The inflexible and standardised format which made it “difficult to grasp the key features of a case or to track its coherence“. While the authors say that the assessment framework encourages social workers to think systematically about a case,

The difficulty arises because problems do not come divided up in the way in which the exemplars are structured. Linked to this, the system cannot easily encompass the logic of analyzing a case. Essentially it adopts an actuarial approach by asking for information which, in a large sample of cases, predicts negative or positive outcomes. This is a sensible approach for management purposes, but an individual case requires a more individual and flexible approach

Far from the problem being one of social workers’ failure to understand the system, as the government’s version of events suggests, or their underdeveloped ‘analytical skills’, it is pretty clear that the fly in the ointment is the system itself. A shame, then, that the government didn’t find out more about the ‘conceptual base’ of social work to begin with, and a disgrace that they prefer to suppress criticism rather than deal with the problems.

There’s more in Community Care and a bit in the Sunday Times – the article also deals with eCAF.


16 Responses to Inconvenient truths

  1. Carlotta says:

    Having worked with a similar, if much, much smaller and presumably less cumbersome pilot database system back in my days as a Practice Nurse, (over 12 years ago now), I can well imagine how useless such a system could be. It took ages to input data, typing stuff in could get in the way of direct patient care, cos one was constantly torn between trying to type stuff in at the time and actually looking after the patient. The database was extremely insensitive to individual patient’s needs and didn’t give you anything back of any use whatsoever.

    That was a tiny pilot study, way back then. Most of the nurses, including myself, voted with our fingers, and just stopped using the system, but only after a reasonble amount of money had been invested in buying us all laptops and setting up a centralising database system.

    Did anyone bother to learn from this experience? Did they, ****!

  2. Carlotta says:

    I meant to ask…is there any chance of seeing the full report from York University?

  3. Ruth says:

    Yes, publish it. Let the information be free 🙂

  4. archrights says:

    Unfortunately I can’t publish it, but you can obtain a copy by sending your own FOI request to:
    Something like “under the Freedom of Information Act I should like to request a copy of the following report: ‘The Integrated Children’s System: An Evaluation of the Practice, Process and Consequences of the ICS in CSSRs’ submitted to DfES in September 2006.”

  5. Carlotta says:

    Thanks for the tip.

  6. Steve Horsfield says:

    What do you mean by ‘social work records’? Are these not the records of the Department of Children’s Services? How are these records related or not to other records held by the Department of Children’s Services? In particular what, if any, are the relationships between these records and records held by schools?

    If we are going to insist that there are social work records of children which are in some sense separate and distinct, what on earth was the point of creating departments of children’s services?

  7. David Ellis says:

    Could you tell us why you are not allowed to publish it ? It seems a mite paradoxical that a report be ,made available under FOI and yet cannot be disseminated thereafter.

  8. archrights says:

    @Steve: I mean the records that social workers hold for children assessed as ‘in need’ under s19 of the Children Act 1989 or ‘at risk’ under s47. You’re right to raise the issue of where the boundaries are. Yes, social care is now a subdivision within the overall children’s services directorate.

    Social workers are bound by their own professional duty of confidentiality, but it’s a matter of concern to us that social work is now called ‘social care’ because this has potentially wider definition. Will other staff who are not bound by the same duty come to have access to these records? It’s also worth noting the ultimate aim of linking health and social care records. See eg:

  9. archrights says:

    @David: It’s a bit of a minefield because it’s not our intellectual property. I’ve taken advice from several people, and we’re all equally confused. Given the day-to-day battles we already have, adding this to the mix is one we could do without. (It’s also a huge report and would probably create bandwith problems on our fairly small website.) I would guess that if DCSF is repeatedly asked for FOI copies, they may find it easier simply to publish it themselves.

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  11. Carlotta says:

    I’ve just sent my own FOI for the report.

  12. Steve Horsfield says:

    I think your response raises far more questions than it answers. If social care (children’s social care, surely) exists as a sub-division within CS, why have we just carried out the (non)-integration. If we are going to create integrated departments and then re-subdivide along existing lines, I’ve got a much cheaper solution.

    While wouldn’t challenge your description of the facts about social workers duty of confidentiality, I would simply say, so what? Implicitly the data clerks managing the data aren’t. When I phone my doctor’s surgery the receptionist very clearly reads from my medical records. That receptionist isn’t bound by any professional code and I can’t accept that a code that applies to one set of individuals who are party to the management of the data is of value. An obvious solution is a data confidentiality obligation which is contractually binding on all Children’s Services Staff.

    One of the dangers of sustaining our reliance on the professional ethos of social workers and others is that we also sustain the long standing barmy asymmetry as to responsibility and confidentiality. if the child is damaged or dies because the teacher or headteacher omits to pass on information to social services that is wholly reprehensible, but if the child is damaged or dies because the doctor or social worker failed to warn the school that’s confidentiality.

    I think the ISA consultation was unduly biased in favour of professional confidentiality. The question should not have been, “what are the circumstances under which professionals can disclose?” That is a very nineteenth century question. The question should have been, “under what circumstances can professionals withhold?”

    Far too often it is not the disclosure of data that is the problem. You won’t prevent a Victoria Climbie by withholding data, you might prevent it by disclosure. The professional ethos under these circumstances looks much more like the problem than the solution.

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