Readers will be aware that this report was published on 10 May 2011. It has stimulated much debate since that time. Whilst the focus of the report is in relation to improving social work practice, there are important issues raised for the NHS.

The report is the third and final report of Professor Munro. It should be read in conjunction with her two interim reports. Professor Munro’s ‘Systems Analysis’ can be found here, and her interim report here.

Readers are reminded that the first report, published in October 2010, analysed why problems had come about in the child protection system and why previous reforms had unforeseen consequences. The second report, published in February 2011, considered the child’s journey through the protection system (from needing to receiving help) to show how the system could be improved. We commented on this in February’s Health Legal Update.

The final report focuses on the fact that the effectiveness of help and the experiences of children, young people and families are central to her recommendations for reform.

Professor Munro has made 15 recommendations. She has stated that she hopes that this shifts the child protection system from being “over-bureaucratised and concerned with compliance” to one that keeps a focus on whether children are being effectively helped and protected.

Key themes to come through for the NHS include:  

  • A child centred, as opposed to bureaucratic, approach is required.
  • The need to recognise that professionals have a skills base and that they should be encouraged to use their judgment.
  • The role of Designated Professionals is recognised and endorsed.
  • That there are inherent risks to children and young people who require safeguarding and that these cannot always be eradicated but rather the focus should be on minimising them. This runs alongside the principle that the family is usually the best place for bringing up children and young people.
  • Local areas should have more freedom to design their own child protection services (as recently seen in the Health Visitor Implementation Plan published by the government in February 2011).
  • Government and local authorities to operate in an open culture, continually learning from what has happened in the past, as opposed to operating in a blame culture.
  • Government and local authorities to trust professionals to use their judgment.
  • Professionals involved in child protection be given the best possible training.
  • The importance of adult services in child protection and the need for joined up thinking.  

The next step in the process will be for the Government to consider Professor Munro’s report and give a full response to her recommendations. Mills & Reeve understand that the response has been scheduled for July 2011.

Key recommendations for health practitioners

Recommendation 1

The Government should revise the statutory guidance, Working Together to Safeguard Children, the Framework for the Assessment of Children in Need and their Families and their associated policies.  

  • Distinguish the rules that are essential for effective working together, from guidance that informs professional judgment.
  • Remove the distinction between initial and core assessments and replace them with the decisions made by qualified social workers.
  • Require local attention to be given to:
    • timeliness in the identification of children’s needs and the provision of help;
    • the quality of the assessment to inform next steps to safeguard and promote children’s welfare; and
    • the effectiveness of the help provided.
  • Give local areas the responsibility to draw on research and theoretical models to inform local practice; and
  • Remove constraints to local innovation and professional judgment that are created by prescribing or endorsing particular approaches, for example, nationally designed assessment forms, national performance indicators associated with assessment or nationally prescribed approaches to IT systems.  

In relation to Recommendation 1, Professor Munro points to varying practice in the Health Sector in relation to IT systems and flagging up at risk children. She is of the view that the arguments for and against a national database, to give easy access to information about whether a child is the subject of a child protection plan, are finely balanced and she concludes that there is no compelling case to recommend one. However, she comments that the current system could be improved by local authorities operating a more efficient 24 hour access service so that people who had concerns were more ready to phone and check. This would resolve some of the problems which were reported overall in the review.

Recommendation 2

  • The inspection framework should examine the effectiveness of the contributions of all local services, including health, education, police, probation and the justice system to the protection of children.  

Recommendation 4

 

  • Local authorities and their partners should use a combination of nationally collected and locally published performance information to help benchmark performance, facilitate improvement and promote accountability. It is crucial that performance information is not treated as an unambiguous measure of good or bad performance as performance indicators tend to be.  

Recommendation 5

 

  • The existing statutory requirements for each Local Safeguarding Children Board (LSCB) to produce and publish an annual report for the Children’s Trust Board should be amended, to require its submission instead to the Chief Executive and Leader of the Council, and, subject to the passage of legislation, to the local Police and Crime Commissioner and the Chair of the Health and Wellbeing Board.

Recommendation 6

  • The statutory guidance, Working Together to Safeguard Children, should be amended to state that when monitoring and evaluating local arrangements, LSCBs should, taking account of local need, include an assessment of the effectiveness of the help being provided to children and families (including the effectiveness and value for money of early help services, including early years provision), and the effectiveness of multi-agency training to safeguard and promote the welfare of children and young people.  

Mills & Reeve offers training in relation to inter-agency working and are happy to discuss our services to readers.

Recommendation 8

  • The Government should work collaboratively with the Royal College of Paediatrics and Child Health, the Royal College of General Practitioners, local authorities and others to research the impact of health reorganisation on effective partnership arrangements and the ability to provide effective help for children who are suffering, or likely to suffer, significant harm.

This is particularly apt given the current health reforms.

The College has already produced a response to the report, which can be found at the following link: http://www.rcpch.ac.uk/news/rcpch-response-munro-child-protection-review

Recommendation 9  

  • The Government should require LSCBs to use systems methodology when undertaking Serious Case Reviews (SCRs) and to, over the coming year, work with the sector to develop national resources to:
    • provide accredited, skilled and independent reviewers to jointly work with LSCBs on each SCR;
    • promote the development of a variety of systems-based methodologies to learn from practice;
    • initiate the development of a typology of the problems that contribute to adverse outcomes to facilitate national learning; and
    • disseminate learning nationally to improve practice and inform the work of the Chief Social Worker (a new post recommended by Professor Munro).

It is envisaged by commentators that Working Together will be generally revised with an aim that it be a slim line version of the current format, focusing on statutory requirements. In relation to the SCR process, the intention of the changes is to move from what is perceived as a blame based culture to understanding professional practice.

Recommendation 10  

  • The Government should place a duty on local authorities and statutory partners (including health) to secure the sufficient provision of local early help services for children, young people and families. The arrangements setting out how they should do this includes:
    • specify the range of professional help available to local children, young people and families, through statutory, voluntary and community services, against the local profile of need set out in the local Joint Strategic Needs Analysis (JSNA);
    • specify how they will identify children who are suffering or who are likely to suffer significant harm, including the availability of social work expertise to all professionals working with children, young people and families who are not being supported by children’s social care services and specify the training available locally to support professionals working at the frontline of universal services;
    • set out the local resourcing of the early help services for children, young people and families; and, most importantly
    • lead to the identification of the early help that is needed by a particular child and their family, and to the provision of an “early help offer” where their needs do not meet the criteria for receiving children’s social care services.

Readers will note a shift in the language used in some areas. For example, Professor Munro has used the phrase ‘early help’ as opposed to ‘early intervention’ throughout the report. She intends this to apply to all children and young people who come to the attention of services, as opposed to meaning only those who are very young. The key message is acting when an issue relating to a child/young person’s welfare becomes apparent. This underpins a general attempt within the report to move away from descriptions or processes which may appear to place a judgment on the individuals or issues concerned and focus on problem solving and informing future practice.

‘Health’ is referred to in a generic way throughout the report. It is hoped that more specific guidance, which recognises the commissioner/provider split, along with expected changes involving GP consortia and care provision generally, will be provided by the government in its response. The RCPCH, in its response, has welcomed the opportunity to work with the government in the response period and we understand that response teams within the Department for Education and other relevant Departments are being assembled currently.