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Archived Transcript for 22 January 2002:
Pages 1 to 50
1
1 Tuesday, 22nd January 2002
2 (10.00 am)
3 THE CHAIRMAN: Morning ladies and gentlemen. Mr Sheldon.
4 MR SHELDON: Thank you sir, Lesley Carr please.
5 MRS LESLEY CARR (sworn)
6 MR SHELDON: Good morning Mrs Carr.
7 MRS CARR: Morning.
8 MR SHELDON: Would you confirm your full name and
9 professional address.
10 MRS CARR: My name is Lesley Carr, my professional address
11 is South Quadrant, Children, Schools and Families,
12 Hertfordshire, King's Langley.
13 MR SHELDON: Thank you. You have prepared one statement for
14 use by this Inquiry. Sir, for your note it is volume 1
15 of the green files, page 234.401. You should have
16 a copy of that in front of you. Could you have a look
17 at the last page of it, please. Is there a signature?
18 MRS CARR: Yes.
19 MR SHELDON: Is it yours?
20 MRS CARR: It is my signature, yes.
21 MR SHELDON: Before I ask you to confirm whether or not the
22 contents are true, I believe there is an amendment you
23 wish to make. Is that right?
24 MRS CARR: Yes, the amendment is to section 5 on the first
25 page. The first line should read:
2
1 "I had no direct line management responsibility ..."
2 MR SHELDON: I see. That was just a typographical mistake
3 you did not notice when you signed --
4 MRS CARR: I did not notice it, I must confess, no.
5 MR SHELDON: Your career is as set out in your statement and
6 I will not go through it with you in detail. You
7 currently work for Hertfordshire County Council?
8 MRS CARR: Yes.
9 MR SHELDON: You worked for Enfield between November 1997
10 and April 2001, correct?
11 MRS CARR: Yes.
12 MR SHELDON: During that period between July 1999 and
13 I think October 2000 you were the Intake and Assessment
14 Manager for Children and Families?
15 MRS CARR: Yes, I was.
16 MR SHELDON: Could I ask you to go to volume 41, page 408.
17 This is a letter that you would have appear to have
18 written to Carol Wilson at Haringey Social Services.
19 MRS CARR: That is correct.
20 MR SHELDON: We will come to the detail of it later on. The
21 reason I show it to you at the moment is because you
22 will see from the front page that it is dated
23 1st February 2000. But when one turns over the page,
24 one can see that you describe yourself there as the
25 Younger Children and Special Needs Resources Manager.
3
1 I understood from paragraph 4 of your statement that
2 that was a role you gave up in July 1999?
3 MRS CARR: Yes, it was. The reason for that I think is that
4 I was using a pro forma letter and what I had not
5 noticed was that on that particular one I was using the
6 out of date one rather than the new one, so I apologise
7 for that.
8 MR SHELDON: But the position as you recorded in your
9 statement is the correct one?
10 MRS CARR: That is the correct one, yes, that is my previous
11 position.
12 MR SHELDON: If we can turn in that case to try and
13 understand exactly what your role was in the position of
14 Intake and Assessment Manager for Children and Families,
15 focusing solely on the issue of Enfield social work at
16 North Middlesex Hospital, what responsibility, if any,
17 did you have in your role for the quality of service
18 provision provided by Enfield social workers at the
19 North Middlesex?
20 MRS CARR: I had no direct responsibility for the quality of
21 the service delivered. The task that I had was to
22 incorporate the Children and Families hospital social
23 workers into part of the Intake and Assessment Group
24 within the Children and Families Division. Prior to
25 that they had been managed within the adult care
4
1 services and there was a need to move the Children's
2 Service into the Children and Families Division so it
3 could be managed and the service properly administered
4 within that area. So my role was mainly consultancy in
5 terms of service delivery.
6 MR SHELDON: I see. So you were to move them under the
7 management of people within Children and Families but
8 you would not be doing the actual managing?
9 MRS CARR: Not until they moved into the division, then
10 I would take up the management.
11 MR SHELDON: I see. So at that point would you have had
12 direct line management responsibility for those social
13 work teams?
14 MRS CARR: I would have had at that point but not
15 previously.
16 MR SHELDON: When was that eventually achieved?
17 MRS CARR: My understanding was that it was achieved
18 in April 2001.
19 MR SHELDON: I see. Now you came into that post in July
20 1999?
21 MRS CARR: That is right.
22 MR SHELDON: One of your objectives was to move the
23 management of those two social work teams, was it?
24 MRS CARR: Yes, one from Chase Farm and one from North
25 Middlesex.
5
1 MR SHELDON: Move those two teams into Children and Families
2 where they, one can immediately see, might be more at
3 home than managed by Adult Division. Why did it take
4 almost two years for that to happen?
5 MRS CARR: There were a number of issues around the moving
6 of the service, whether it was moved physically out of
7 the hospitals or whether it was still based in the
8 hospital but managed at arm's length from the Edmonton
9 Centre, and there were a number of very confirmed
10 stakeholders in terms of where the responsibility for
11 line management lay but also in terms of practice
12 issues, so that -- as that actually took a fair amount
13 of time discussing and negotiating with health
14 colleagues, as well as with the social workers and the
15 team managers within the teams to bring the two
16 together.
17 MR SHELDON: So this was a move that makes, one might think,
18 basic organisational sense but it was one to which there
19 was some resistance?
20 MRS CARR: Yes, it followed a number of changes to the
21 structure in Enfield and it was the last part of the
22 separation of the generic focused social work to
23 specialist focused social work.
24 MR SHELDON: Were the children, were the social work teams
25 within North Middlesex themselves, those social workers
6
1 themselves happy to be moved under the management of
2 Children and Families or not?
3 MRS CARR: Yes, they had been doing children and families
4 focused work for the previous two years and were very
5 well aware that they were being managed through the
6 Adults Division and felt that it would be more
7 appropriate if they were managed in the Children's
8 Division.
9 MR SHELDON: So the resistance did not come from them. Was
10 the Children and Families Division happy to take on this
11 extra management responsibility?
12 MRS CARR: Yes, it made sense because it fitted with the
13 brief I had in general which was managing all the
14 immediate frontline services, so any referral to the
15 Children and Families Division would have come through
16 one of the teams I managed.
17 MR SHELDON: Was the Adults Division particularly concerned
18 about the possibility that it might lose line management
19 responsibility for those social workers?
20 MRS CARR: No, they were not worried they would lose line
21 management, but the problem was that in terms of the
22 organisational structure they were being paid and
23 services provided through the Adults Division and there
24 was a need to disaggregate budgets and to make
25 arrangements for people to be paid in a different
7
1 section out of different budgets. So that was one issue
2 for the Adults Division but no, they believed that those
3 teams should be managed in the Children's Division.
4 MR SHELDON: I see, because on the face of it in the light
5 of those answers it would seem that if the social
6 workers themselves were happy to move, the move was one
7 that made sense for the Children and Families Team
8 people to manage them and the Adults Division happy to
9 pass over that management, it is something one might
10 expect that could have happened in less than two years?
11 MRS CARR: Yes, in a very simplistic view, probably. The
12 difficulty is there were a number of changes that
13 Enfield had gone through previously and staff were
14 feeling quite anxious about change of any kind and the
15 possibility of not being based in the hospital and
16 actually being based in the Edmonton Centre was one
17 issue that needed to be resolved, and certainly for
18 health colleagues the issue of not having a social
19 worker on hand in the hospital was a difficult one.
20 When the team who were looking at the disaggregation
21 of the social workers in the hospital came together,
22 there was actually a loss of posts to the Children and
23 Families Division which meant we had less workers in the
24 hospital and we actually had no team managers who would
25 come either as part of that, so what I would be taking
8
1 over would be four and a half social workers to cover
2 both Chase Farm and North Middlesex hospitals with no
3 senior social worker and no team manager.
4 MR SHELDON: So in your consultancy role that you were
5 fulfilling at the time, you would never I take it have
6 cause to look at individual case files for example
7 generated by those social workers working at the NMH?
8 MRS CARR: That would not normally be part of my role, no.
9 MR SHELDON: You would not for example see it as part of
10 your role to dip sample their work to check whether or
11 not it was up to scratch?
12 MRS CARR: At the time I was involved that was not part of
13 my role.
14 MR SHELDON: Would you have been the person to whom those
15 social workers might come if they needed advice about
16 a particular case?
17 MRS CARR: Yes.
18 MR SHELDON: In what circumstances would that happen?
19 MRS CARR: Any circumstances where they had particular
20 concerns about a complex case or issues around child
21 protection or issues where they wanted perhaps some
22 clarity around whether or not we should be taking legal
23 proceedings.
24 MR SHELDON: We have heard evidence from some people in this
25 Inquiry called child protection advisers and at least
9
1 one aspect of their role would seem to be that which you
2 describe, that they were a resource on hand to deal with
3 particularly difficult cases or to provide advice as and
4 when required. You were filling that sort of role were
5 you for those Enfield social workers?
6 MRS CARR: I did that and I also gave individual supervision
7 to workers on cases that were particularly difficult
8 with the agreement of their managers because the
9 background and knowledge that I had was more appropriate
10 perhaps to be giving them advice.
11 MR SHELDON: So in the context of those cases and perhaps
12 those cases alone you would have cause to consider and
13 advise upon the quality of performance on an individual
14 case?
15 MRS CARR: Yes.
16 MR SHELDON: You say in your amended statement that you had
17 no line management responsibility for those workers.
18 Who did?
19 MRS CARR: Initially it was Lesley Howard who had
20 responsibility up until the beginning of August when she
21 left the department.
22 MR SHELDON: After her?
23 MRS CARR: After her it was Steve Taub who took over her
24 role as the Hospital Service Manager.
25 MR SHELDON: There are two principal matters I wish to ask
10
1 you about this morning. I will tell you what they are
2 now so you know where we are going. The first, as I am
3 sure you are aware, is the attendance of Enfield social
4 workers at the psychosocial meetings. The second is the
5 provision of services to Haringey by the Enfield social
6 workers on site. We will deal with them in that order
7 and take the psychosocial meetings first. You were
8 aware, I take it, that these meetings existed?
9 MRS CARR: Yes, I was.
10 MR SHELDON: The evidence we have had so far indicates that
11 they happened on Monday afternoons at 2 o'clock. Can
12 you help whether or not that is right?
13 MRS CARR: I understand that was the case but I was not
14 involved in attending any of the Enfield ones.
15 MR SHELDON: You were aware either as you came into the role
16 or shortly thereafter that Enfield social workers were
17 not going to those meetings?
18 MRS CARR: I went to an initial meeting with Dr Rossiter and
19 a number of other people and the child protection
20 coordinators at the hospital at the end of June before
21 I took up the role, and it was at that meeting that
22 Dr Rossiter mentioned the fact that the social workers
23 were not attending.
24 MR SHELDON: You say in paragraph 7 of your statement that
25 you believed that meetings of this kind are valuable for
11
1 the exchange of information between medical staff and
2 social workers. What sort of information would be
3 exchanged?
4 MRS CARR: In my experience, having attended psychosocial
5 meetings in other hospitals previously, the kind of
6 information that was exchanged was the slightly longer
7 term planning, medical care of a young person, where the
8 role of the parents could be significant to the
9 treatment of that child. Depending on what the medical
10 diagnosis was, there may be a role for the social worker
11 in discussing some of this with the parents, there may
12 also be a role for the social worker in supporting the
13 parents as well as the assessment information around the
14 child's condition, which was useful for social workers
15 in helping to understand the issues around the child
16 being in hospital.
17 MR SHELDON: And that sort of information exchange is
18 valuable why?
19 MRS CARR: It helps to give a more complete picture for the
20 social worker who is doing an assessment. It may be
21 that of the children in the hospital at any one time
22 there may only be two or three that may actually need
23 any kind of social work intervention. The vast majority
24 do not.
25 MR SHELDON: Do you regard that sort of face to face contact
12
1 and discussion to be preferable to for example the
2 medical staff simply jotting down their thoughts on
3 a pro forma or a bit of paper and passing it to the
4 social worker?
5 MRS CARR: I think it depends if you are talking about
6 formal referrals or if you are talking about general
7 notes of interest.
8 MR SHELDON: I appreciate the concern that was felt by
9 social workers in the sense that these meetings were
10 being used as a short cut to referrals rather than the
11 proper process being followed, and we will come to deal
12 with that when we consider why the social workers were
13 not going, but what I want to understand at the moment
14 is that aside, is this sort of face to face discussion
15 between professionals something that is valuable in
16 dealing with complex issues of child protection?
17 MRS CARR: Yes, any kind of face to face discussion is very
18 useful.
19 MR SHELDON: And you say again in your statement that in
20 your experience elsewhere it was common practice for
21 social workers to go to this sort of meeting, is that
22 right?
23 MRS CARR: Yes.
24 MR SHELDON: You were also aware, I take it, that the
25 hospital staff, the medical staff at the hospital were
13
1 not happy about the non-attendance of social workers at
2 those meetings, is that right?
3 MRS CARR: Yes.
4 MR SHELDON: As you say in your statement, their decision
5 not to go predated your coming into post so you had no
6 direct knowledge of the basis for that decision. You
7 did, as I take it, however, undertake some investigation
8 to find out what the problem was, is that right?
9 MRS CARR: Yes, I did.
10 MR SHELDON: Were you aware of when the decision was taken
11 to stop going?
12 MRS CARR: Not originally, no, that came to light later on.
13 MR SHELDON: I wonder if we can trace it through some of the
14 documents that we have and for this you will need
15 volume 26B please, page 237. Now, these are the minutes
16 of a meeting of social workers and consultants on
17 Wednesday 17th December 1997 at 10.30. We will come on
18 to consider the issues that are raised within it in
19 a bit more detail later but it would seem, if we look at
20 item 1 of the agenda, it would seem to be clear from
21 that that at that point at least social workers (a) were
22 going but (b) were not happy with the way in which the
23 meetings were being conducted. Would that seem right?
24 MRS CARR: Yes, that would be my reading of it.
25 MR SHELDON: If you could turn two pages on to page 239, we
14
1 see again the first item on the agenda of the meeting
2 this time on 11th February 1998, so about two months
3 later, was also the Monday ward meetings and if you
4 glance through that paragraph you will see that about
5 four lines down the Social Work Department decided they
6 would not attend these meetings for a couple of weeks
7 and a memo was sent to the wards accordingly. Top of
8 the next paragraph:
9 "Dr Rossiter and colleagues stated that the medical
10 staff value the social workers attending these
11 meetings."
12 So it would seem from that that the problems
13 identified in the previous meetings had not been
14 resolved. As a result, social workers were not going
15 and Dr Rossiter at least was not particularly happy with
16 that decision. Again a fair reading would you say?
17 MRS CARR: Yes.
18 MR SHELDON: It says in those minutes that the decision
19 taken by social workers was not to attend for a couple
20 of weeks. But as I understand it, they were still not
21 attending by the time you came into post, mid-1999?
22 MRS CARR: Yes, that is right.
23 MR SHELDON: Dr Rossiter said, and it is Day 20 page 159 for
24 your note sir, that the time between that meeting and
25 mid-1999 when we start to become concerned about what is
15
1 going on was a continuous period of non-attendance by
2 social workers, it was not that they were going for
3 a bit and then coming back. Was that your understanding
4 too?
5 MRS CARR: Yes, it was my understanding that they had not
6 been attending the meetings for a while.
7 MR SHELDON: Now, we see in your statement, paragraph 12,
8 that the problem was not resolved during your period in
9 post. Social workers still were not going to these
10 meetings by the time you left in October 2000, is that
11 right?
12 MRS CARR: That is correct.
13 MR SHELDON: Then if we could go to volume 43A,
14 page 354.511, this is a letter you will see from
15 Mary Rossiter to Lesley Moore dated 22nd May 2001.
16 I realise you are not even working for Enfield at
17 this stage, let alone in the capacity of dealing with
18 hospital social workers, but you will see from the first
19 line that Dr Rossiter is writing to Miss Moore that she
20 is requesting:
21 "... the attendance of a social worker at the above
22 multidisciplinary meetings held weekly as part of the
23 overall management of children and neonates. The
24 meetings are held on Monday afternoons in the children's
25 wards and Wednesday afternoons on the neonatal unit."
16
1 So it would seem from the documents that we have
2 that we are dealing with something in the order of three
3 and a half years of non-attendance at these meetings,
4 February 1998 up to 22nd May 2001 at least, and we do
5 not know quite what happened thereafter, we will have to
6 ask Miss Moore about that, but that would seem to be
7 right, would it not, three and a half years or so?
8 MRS CARR: Yes.
9 MR SHELDON: Now, you said in response to one of my earlier
10 questions that you regarded this sort of face to face
11 information exchange to be valuable and that common
12 practice was for social workers to attend. Does it
13 follow from that that you thought social workers should
14 have been at these meetings?
15 MRS CARR: Yes, I did.
16 MR SHELDON: Did you regard it to be something that was an
17 intrinsic part of their role as hospital social workers
18 or just an optional extra they could do if they felt
19 like it?
20 MRS CARR: No, it should have been part of what they were
21 doing as a matter of routine.
22 MR SHELDON: If you could have a look at volume 29 page 6,
23 you will see that the second duty listed for
24 a hospital-based social worker -- and Karen Johns
25 accepted that this was her job description -- is that
17
1 the social worker participate in multidisciplinary
2 discussions within the various units and
3 interdepartmental meetings in the hospital, presenting
4 the policy of social services and the practice of social
5 work as they affect individual clients. Number 2 on
6 their list of duties, which would accord with what you
7 said, that it was an intrinsic and important part of
8 their role.
9 MRS CARR: Yes.
10 MR SHELDON: We have had other witnesses come before us to
11 indicate that they felt also that it was an important
12 part of a social worker's job. I will put a brief
13 selection to you of what they said and you can tell us
14 if you agree with their assessment. Beatrice Norman,
15 Day 19, page 165, for example, said she regarded them as
16 very important and a critical mechanism by which
17 information is moved from the ward to the social
18 workers. Would you disagree with her in that?
19 MRS CARR: I would not say that it is a critical mechanism.
20 I think it is part of a structure but a very important
21 part of that structure.
22 MR SHELDON: Perhaps then you would prefer what Dr Rossiter
23 said about it, Day 20 page 114. She said that they were
24 an important vehicle for the exchange of information.
25 MRS CARR: Yes, I would.
18
1 MR SHELDON: Cynthia Lipworth said, Day 22, page 173, that
2 she regarded it as really unfortunate that social
3 workers were not attending those meetings. Is that
4 something you would agree with?
5 MRS CARR: No, I do not think it is unfortunate.
6 MR SHELDON: Why not?
7 MRS CARR: Because it is part of the job description, it is
8 part of my expectation that social workers would attend
9 and would exchange information. My own view would be
10 that social workers should be at that meeting, not
11 necessarily because the information that is discussed is
12 necessarily critical to any one case but it allows
13 a much wider understanding of a range of issues that are
14 going on and certainly helps the social workers to
15 understand the medical perspectives, and it also helps
16 the social worker in interpreting the medical
17 understanding for parents and for supporting other
18 parents and children whilst in hospital, because it is
19 very difficult for children particularly to be away from
20 home.
21 MR SHELDON: If it is an important vehicle for the exchange
22 of all the sort of information that you have just listed
23 and the understanding that that creates, and that it is
24 an important part of the social workers' job, surely it
25 is unfortunate that they are not going.
19
1 MRS CARR: My own view is that it should not have been left
2 to lie for such a long period of time, that where things
3 had gone wrong initially we should have been more
4 proactive in getting the meetings back on track.
5 MR SHELDON: Let us turn now to consider why this situation
6 was allowed to persist for so long and for this you will
7 need volume 26B please, page 237. We have looked at
8 this briefly already simply to note the fact that there
9 was discontent about the meetings, but if we look a bit
10 further down the page under item 1, we can see an
11 explanation of what the problem is at least as far as
12 social workers were concerned.
13 They say that the problem is or the problems include
14 derogatory remarks made about other social workers
15 whilst hospital social workers are present, that their
16 opinions are often not heard or respected, that time is
17 not always provided for social work feedback and the
18 meetings are not clearly structured enough.
19 We will come on to look at those specifically in
20 detail but you will see just above that at the top of
21 the page the note that consultants have stated that they
22 value a social work presence at the Monday meeting.
23 So at the outset can we agree that the consultants
24 throughout the period with which we are concerned never
25 said that they did not want social workers to be there?
20
1 MRS CARR: Yes, consultants wanted social workers present.
2 MR SHELDON: Exactly, they actively attempted to persuade
3 social workers to come. Would that be fair?
4 MRS CARR: I do not know. I am not in a position to comment
5 on that.
6 MR SHELDON: But they certainly came up to you and said, for
7 example, you say in paragraph 11 of your statement that
8 Dr Rossiter and Dr Naidoo came up to you and said, "We
9 value their presence and we would like them to attend"?
10 MRS CARR: Yes.
11 MR SHELDON: No consultant certainly ever said to you that
12 he or she would rather that those social workers were
13 not there?
14 MRS CARR: No.
15 MR SHELDON: Let us turn back again in that case to those
16 problems that social workers have expressed. Basically
17 it resolves to a feeling by social workers that they
18 were not getting enough respect from the medical staff.
19 The way you put it in your statement is they felt
20 devalued.
21 MRS CARR: That was the impression they gave me, that they
22 felt very deskilled and devalued and that their
23 professional expertise did not have a role within the
24 psychosocial meetings.
25 MR SHELDON: If you could go forward two pages to the
21
1 minutes that we looked at earlier for the February
2 meeting, we see again in the second paragraph
3 Dr Rossiter and colleagues stating that the medical
4 staff value the social workers attending these meetings,
5 but in the paragraph above we see what would appear to
6 be the short-term solution, which is in the last line of
7 that paragraph, a printed referral form which is to be
8 collected by the social worker covering the wards during
9 the week. How was that system supposed to work? Are
10 you able to say? Was it still in operation at the time
11 you were in post?
12 MRS CARR: No, it was not.
13 MR SHELDON: What it would seem from that meeting and those
14 minutes, and you can tell me if you agree with that
15 interpretation, is that social workers are effectively
16 saying to medical staff, "We are not talking to you any
17 more. If you want to tell us anything you can put it in
18 writing".
19 MRS CARR: I am not sure if that is the only interpretation
20 of this. What I suspect the social workers were trying
21 do was to get a written referral rather than what had
22 been made as verbal referrals previously. I think from
23 my discussions with the social workers they felt it
24 unsafe to get a verbal referral which may or may not be
25 an actual referral because of the way in which it was
22
1 put to them. I think their feeling was that something
2 in writing on a referral form in a particular format
3 would be more helpful in terms of them understanding the
4 tasks that the hospital actually wanted them to do.
5 MR SHELDON: I mean I can see or one might be able to see
6 the concern about social workers saying, "We need to be
7 clear when a referral is actually being made. It is not
8 simply for us to try and determine that from the course
9 of a discussion," and it might be thought to be lazy
10 practice on the part of medical staff to attempt to do
11 referrals that way rather than properly and formally
12 through the required processes, but it is not either, or
13 is it? You could insist upon a proper referral
14 mechanism and still have these meetings. They are
15 different purposes, are they not?
16 MRS CARR: Yes, they serve different purposes and a referral
17 process and referral structure is essential, but the
18 informal or even formal discussions at meetings is also
19 a very important part of the process.
20 MR SHELDON: So whilst one might say that the tendency by
21 medical staff to use these meetings as a short cut to
22 referrals is a problem, it does not excuse
23 non-attendance, does it? What it should prompt is an
24 insistence that the proper referral mechanisms are used?
25 MRS CARR: Yes, and in the discussions I had with the social
23
1 workers that was the view they took, that if there were
2 a formal mechanism that were followed by the hospital
3 ward, that would be a safer process than they had had up
4 until then and I think they saw it as a separate issue
5 from attendance at the psychosocial meetings.
6 MR SHELDON: Yes, because the impression that one gets from
7 your statement and the impression that we get from the
8 minutes, particularly the December 1997 minutes that we
9 just looked at, is that social workers are not going to
10 these meetings or have taken the decision not to go, not
11 principally because they are concerned about the
12 referral mechanism but principally because they feel
13 devalued and deskilled.
14 MRS CARR: I think that was part of the whole, because the
15 way that you refer something, if it appears to be
16 referred in a very casual way, is fairly undermining of
17 your professional expertise because it is not worthy of
18 a proper response and I think the whole thing is bound
19 up together which is quite difficult to separate.
20 MR SHELDON: Because if we look at the way in which you put
21 it in your statement, paragraph 7, three lines down, you
22 say:
23 "I was then made aware of the difficulties that the
24 social work staff had experienced in attending these
25 meetings in the past. They considered that the meetings
24
1 served no useful purpose as the meetings were informal,
2 unstructured and not formally minuted. The social work
3 staff expressed strong views that they felt devalued and
4 deskilled in these meetings and that their professional
5 views were not taken into account by the medical staff."
6 Then you go on to say: "In addition, the social workers
7 were concerned about this referral point."
8 But it is what we should be clear about, this at
9 least, it is not just about the referrals?
10 MRS CARR: No, it is not.
11 MR SHELDON: And the referral problem could have been sorted
12 out in another way than non-attendance?
13 MRS CARR: Yes absolutely.
14 MR SHELDON: So you are faced with this problem of
15 non-attendance when you come into post. Perhaps we can
16 turn now to consider what is done about it. In
17 considering how best to go about resolving this dispute,
18 what was your first priority?
19 MRS CARR: The first aim was to gather as much background
20 information as possible to try and understand what the
21 problem was from everybody's different perspectives to
22 be able to make an assessment for myself of the best way
23 of moving it forward.
24 MR SHELDON: But when you are approaching this problem what
25 is the key thing that you are attempting to achieve?
25
1 What is the problem you are trying to solve?
2 MRS CARR: The basic overall problem is the incorporation of
3 the social work practice from the hospital into the
4 Children and Families Division and this is a part of
5 that. Given that it was quite a big change and it had
6 a number of effects for a number of different people, it
7 was not one that I felt I could separate out easily.
8 MR SHELDON: The key priority is the safety of the children
9 concerned, is it not?
10 MRS CARR: That is very much so.
11 MR SHELDON: And that any strategy or attempt at resolution
12 of this difficulty must have that as its primary
13 objective, the interests of the children to whom you
14 offer a service?
15 MRS CARR: Yes.
16 MR SHELDON: And in order to provide the best service and to
17 best safeguard the interests of children to whom you
18 provide a service, it is important that concerns felt by
19 medical staff are properly communicated to social
20 services?
21 MRS CARR: Yes.
22 MR SHELDON: And an important vehicle, to use Dr Rossiter's
23 phrase, with which you agreed for that to be done is
24 these psychosocial meetings?
25 MRS CARR: That is one vehicle for transmitting information.
26
1 It is not the only one.
2 MR SHELDON: So why do not you just tell them to start
3 going?
4 MRS CARR: For a number of reasons, the first being that
5 I was not responsible. I was not their line manager and
6 not in a position to order staff to do that. I did
7 discuss the non-attendance with other colleagues in
8 adult care services but there were a number of what is
9 probably best to describe as difficulties within
10 personalities of the staff involved in these.
11 I think by the time I became involved, the position
12 had become pretty intractable and it was not going to be
13 solved overnight. My own view and certainly the view in
14 discussing it with other colleagues was that if we
15 ordered the staff to go, we would simply have them go
16 off sick and we would have no cover in the department at
17 all.
18 MR SHELDON: Was that a threat that was specifically made,
19 "If you make us go we will go off sick"?
20 MRS CARR: No, that was not a threat specifically made but
21 it was a response to stress in previous events.
22 MR SHELDON: Because one might think, looking at it from the
23 outside, that it is really of fairly minimal importance
24 whether social worker X does not like doctor Y. This is
25 part of their job description, it is an important part
27
1 of protecting children and quite frankly who cares
2 whether they do not like it? They are going.
3 MRS CARR: Again, I can understand the point you are trying
4 to make. All I can say is it was extremely difficult,
5 given the personalities that we had at the time, to be
6 able to get the communication happening. It is possible
7 that we may have got the social workers to go but I do
8 not actually think that would have aided communication
9 necessarily. I think we had to establish a better means
10 of communication than forcing different members of staff
11 to take part in a meeting that they saw as devaluing and
12 deskilling.
13 MR SHELDON: Because when one looks at it with the benefit
14 of the hindsight to which we can bring to these sort of
15 questions, it is relatively easy to see what the
16 potential dangers of their non-attendance might be. One
17 of the matters the Inquiry will have to consider is the
18 extent to which the fact that the hospital felt concerns
19 about Victoria that were not adequately passed to social
20 services was a factor in what happened to her. If the
21 answer is that this sort of lack of communication did
22 have an impact then it throws the conduct of those
23 social workers who were not going to these meetings in
24 a very poor light, does it not?
25 MRS CARR: Yes, though in terms of Victoria the psychosocial
28
1 meeting happening on a Monday afternoon, the hospital
2 staff would not have had the information that they later
3 had because it is my understanding that Victoria was
4 admitted fairly soon before that and was discharged
5 before the next psychosocial meeting would have taken
6 place. The psychosocial meetings tend to be of more
7 benefit for children who are in hospital for longer
8 periods of time.
9 MR SHELDON: It is perhaps not necessary to attempt to
10 analyse the precise elements of Victoria's case in order
11 to answer this question, which is a fairly general one,
12 which is if this is an important vehicle for the
13 exchange of information, if it is important that
14 hospital concerns are fed to social workers, then social
15 workers need to be going.
16 Now, I appreciate that there were difficulties and
17 personality difficulties and this had become an
18 intractable problem and we will look at that in just
19 a minute, but we can agree at the outset, can we not,
20 what the problem is and the fact that it was one that
21 needed to be solved?
22 MRS CARR: Yes, that is true, but I think also it needs to
23 be in the context of other meetings that would have
24 happened within the hospital context. Particularly with
25 child protection, the strategy meetings at the beginning
29
1 of a child protection investigation were held at the
2 hospital and I myself chaired a number of those where we
3 actually held them in the ward so that ward staff were
4 able to attend them. So the Enfield strategy meetings
5 happened in that way so that we could pick up right at
6 the very beginning the information that was available.
7 MR SHELDON: Well, whilst we are on the subject of other
8 meetings, there was also the non-accidental injury forum
9 which took place on Tuesday, was there not?
10 MRS CARR: I understand that was the case.
11 MR SHELDON: Social workers were not going to that either,
12 were they?
13 MRS CARR: Again, I am not in a position to comment on that.
14 MR SHELDON: What would it have needed, once you had
15 researched the background to the problem and the
16 personality issues and the difficulties concerned, what
17 would it have needed in order to get social workers back
18 to these meetings?
19 MRS CARR: My aim had been to work with the consultant
20 paediatricians to try and resolve the framework for the
21 meeting, because one of the issues raised was it was
22 informal, it was not minuted and those sorts of things.
23 To have put it on to a more formal footing, where the
24 possibility of people being devalued would not have
25 actually occurred because if it followed the pattern of
30
1 other multidisciplinary meetings, everybody's opinion
2 would have been sought on each case.
3 Part of the difficulty with these psychosocial
4 meetings is that they happened I think for an hour and
5 a half or two hours once a week and they looked at every
6 child in the ward, and depending on how many children
7 there were in the ward, there was actually very little
8 time to look at each individual child.
9 So the structure of the meetings was one area. The
10 way in which perhaps the consultant paediatricians and
11 the social workers interacted and were able to exchange
12 their information was another way, because there did
13 seem to be a miscommunication in terms of professional
14 understanding of each other's role. So there was some
15 work that needed to be done with both parties to get
16 them back where they would actually adequately
17 communicate with each other.
18 MR SHELDON: Because it might be possible, might it not, for
19 Dr Rossiter for example to say in response to this sort
20 of question, "What more could I do? I am down in the
21 minutes of both of the two meetings that we have looked
22 at saying I value social work presence, I want them to
23 come, we are interested and we regard their views as
24 being important." She says exactly the same in the
25 letter to Miss Moore that we see three and a half years
31
1 later.
2 So it might be possible for her to come along, might
3 it not, and say, "For three and a half years I have been
4 saying we value your views, we want you there and social
5 workers are still not prepared to come".
6 MRS CARR: I think yes, there is no doubt that Dr Rossiter
7 did value the social work attendance at the meetings,
8 but there is also no doubt that the way those meetings
9 were conducted did impact on the social workers to the
10 extent that they felt it was not professionally possible
11 for them to continue to attend, and that was part of the
12 disentangling that needed to be done which I think is
13 different people's perceptions of the same meeting and
14 different people's perceptions of what is being said and
15 communicated within those meetings.
16 MR SHELDON: The way in which you framed your answer to the
17 question before that one, namely what would need to be
18 done, and you talked about changes to the structure of
19 the meetings and possibly the length as well in order to
20 make sure that proper discussions could be had, that
21 seems like a fairly simple solution and one might be
22 surprised to find unimplemented in the year and three
23 months you were in post.
24 MRS CARR: Yes.
25 MR SHELDON: Why is that?
32
1 MRS CARR: I understand that. The basic difficulty comes
2 back as I say to the personalities involved, that the
3 resolution for the problem does seem fairly simple.
4 Actually being able to get the time to spend with people
5 who are very busy, particularly Dr Rossiter, to be able
6 to have some focused time to look at the issues clearly
7 was very difficult.
8 I did have a number of meetings I arranged with her
9 and Dr Naidoo. The meetings were occasionally cancelled
10 at short notice and because there were other things on
11 the agenda these things tended to slip down. So even
12 though on the one hand Dr Rossiter is saying that she
13 does want social work presence at the meetings, it is
14 actually quite difficult to engage in a conversation
15 around why they are not coming.
16 MR SHELDON: So in the 15 months or so that you were in
17 post, you were unable to find the suitable opportunity
18 to talk with Dr Rossiter about changing the structure of
19 the meetings to achieve what she wanted, which was
20 social work presence?
21 MRS CARR: I had a number of occasions talking with
22 Dr Rossiter looking at the changing working practice as
23 a whole. The psychosocial meetings are part of that
24 whole framework and there were other issues that
25 Dr Rossiter was more concerned about and they were that
33
1 the hospital social workers might be based in the
2 Edmonton Children's Centre rather than in the hospital
3 and that those were the issues that took up a lot of the
4 discussion time in the early days.
5 MR SHELDON: So when you said earlier that it was on the
6 face of it a fairly easy solution but the difficulties
7 are explained by the personalities involved, what you
8 meant by that and the personalities involved were
9 Dr Rossiter's lack of availability and lack of time and
10 willingness to discuss the problem with you?
11 MRS CARR: I think lack of time. I do not think there was
12 a lack of willingness. I certainly think that there
13 were pressures on her time that made it quite difficult
14 for us to get specific periods of time where we could
15 focus on the changes and there were a number of changes
16 implicit in the work we were trying to do, some of which
17 caused her more concern.
18 MR SHELDON: Why could you not have discussed it at these
19 quarterly meetings you mention in your statement at
20 paragraph 10?
21 MRS CARR: Those quarterly meetings were arranged and
22 chaired by Dr Rossiter specifically to look at the
23 interchange of child protection information between the
24 child protection coordinators in Enfield and Haringey
25 and the paediatricians. I got myself invited to the
34
1 meetings because I thought it would be a useful vehicle
2 of getting to know the people and also hearing the
3 discussions at first hand that they were involved in,
4 and looking for ways where I might use that, not that
5 forum because that was a very specific forum, but using
6 it as a vehicle to arrange other meetings, which I did.
7 MR SHELDON: The way in which you put it at paragraph 10 is
8 that:
9 "I began to attend these quarterly meetings and used
10 them as a forum to try to improve the relationship
11 between Health and Enfield social workers."
12 Two points arising out of that. Firstly, it is not
13 a case of you using them as a forum for that; that is
14 what they were set up to do in the first place, was it
15 not?
16 MRS CARR: They were set up as a forum to look at child
17 protection issues between Health and Social Services but
18 I was -- what I was wanting to do was to get to know
19 people like Dr Rossiter and the other people who
20 attended that meeting better to be able to influence
21 them in making the changes that we felt were necessary.
22 MR SHELDON: We have the minutes of one of these meetings
23 that you went to in volume 26B of our bundle at
24 page 28.501. It might be helpful first if we turn a few
25 pages back to 20.521. This would seem to be where the
35
1 purpose of these sort of meetings is set out by the
2 people that attended on that occasion, which was
3 Dr Rossiter, Petra Kitchman, Caroline Campbell,
4 Sue Paterson and Tharu Naidoo, and it is said at the
5 beginning:
6 "It was agreed that these quarterly meetings would
7 be aimed at improving liaison between Enfield and
8 Haringey Social Services and the medical team at the
9 North Middlesex Hospital."
10 So, these were meetings that were already set up and
11 running before you came on the scene and already aimed
12 at the improvement of liaison between hospitals and
13 social services?
14 MRS CARR: Yes, that is right.
15 MR SHELDON: Then if we could go back to the one you went to
16 first of all which is page 28.501, the last item on the
17 agenda or the last item in the minutes is at page 503,
18 "hospital social workers". The first entry is somewhat
19 cryptic. I wondered if you could help us. It says:
20 "will by coming under the management of the community
21 teams". Any idea what that might mean?
22 MRS CARR: I am not at all sure that I do. I attended that
23 meeting and I did not say a lot except at the end.
24 I think that we were -- what I was certainly talking
25 about was that there would be changes and that some of
36
1 these changes would be brought about by the hospital
2 social workers coming under the management of Children
3 and Families Division, but I am not sure from that
4 minute precisely what that would be.
5 MR SHELDON: I am instructed that at least one possible and
6 it seems to me eminently sensible interpretation of that
7 is that the Y in "by" should be an E for "be", so "will
8 be coming".
9 MRS CARR: That would make sense.
10 MR SHELDON: We see a reference to:
11 "Lesley [which is you I take it] will take up the
12 management of the Intake and Assessment Team and the
13 social worker roles need to be clarified."
14 Now, there is nothing there, is there, about
15 non-attendance of social workers at psychosocial
16 meetings?
17 MRS CARR: No, not within the meeting itself.
18 MR SHELDON: That was not something that Dr Rossiter chose
19 to raise for example with you during the course of the
20 meeting?
21 MRS CARR: No.
22 MR SHELDON: But there was some discussion afterwards, was
23 there, about that?
24 MRS CARR: She did raise it with me afterwards, yes.
25 MR SHELDON: You tell us how she raised it with you. What
37
1 was she raising it for?
2 MRS CARR: She simply said that the social workers had not
3 been attending the psychosocial meetings and would I be
4 able to do anything to make a difference to this.
5 MR SHELDON: And you said "I will look into it", did you?
6 MRS CARR: More or less, yes.
7 MR SHELDON: You went to other meetings like this one during
8 the course of your time in charge or in post and you
9 said that you got yourself invited and that they were on
10 a roughly quarterly basis. So you would have gone to
11 approximately another four or so?
12 MRS CARR: Yes.
13 MR SHELDON: Was the issue of social work attendance at
14 psychosocial meetings raised at those meetings? Did you
15 raise it? Did you think, "This is my ideal opportunity
16 to do something about it"?
17 MRS CARR: No, I would not have raised it in that forum
18 because it was not appropriate for it to be raised there
19 because the issues that the meeting was focusing on were
20 quite different. I was raising it in other venues, not
21 as a specific issue in its own right separate from the
22 other issues but as part of the ongoing issues of
23 changing.
24 MR SHELDON: Right. What were the arenas in which you were
25 raising it?
38
1 MRS CARR: I had a number of meetings with various medical
2 staff from both the North Middlesex and from Chase Farm
3 where we were looking at the structures of a whole range
4 of meetings that happened in both hospitals and the
5 changes we were wanting to bring about in the
6 functioning of that team when it became part of the
7 community team managed from Edmonton.
8 MR SHELDON: You will understand that our focus is
9 necessarily narrow in this Inquiry and what I am
10 principally concerned with at the moment is
11 non-attendance of Enfield social workers at North
12 Middlesex Hospital psychosocial meetings.
13 MRS CARR: Yes.
14 MR SHELDON: So what meetings did you have and with whom to
15 try and resolve that problem?
16 MRS CARR: I have actually got some diaries and some notes.
17 If that would be helpful, I can refer to those.
18 MR SHELDON: Yes, if it would answer that question it would
19 be helpful.
20 MRS CARR: It would refresh my memory because it is a while
21 ago now.
22 MR SHELDON: Do you have those with you?
23 MRS CARR: Yes.
24 MR SHELDON: Sir, I take it you have no objection for that
25 to be done.
39
1 THE CHAIRMAN: No. (Pause).
2 MR SHELDON: Is this something you have considered in
3 advance or is this going to be a case of you having to
4 go through your entire diary for 15 months --
5 MRS CARR: No, the first meeting I brought this up was
6 actually 16th August where I met with the teams, and
7 that was what I was looking for to confirm the date for
8 that.
9 MR SHELDON: You met with the social workers?
10 MRS CARR: That is right, and that was on the agenda. It
11 was one of the things that I had picked up at that
12 point. There were a number of things that we were
13 looking at and that was one of the issues that was
14 briefly discussed as part of the issues that were on the
15 agenda for the social worker and the team managers in
16 terms of what we needed to address overall.
17 MR SHELDON: So you could find out during the course of that
18 meeting what their concerns were about this?
19 MRS CARR: That is where they gave me the information about
20 how they felt and so on, yes.
21 MR SHELDON: So now you are up-to-date, what happens then?
22 MRS CARR: I then had a number of other meetings.
23 In September was the first I think with Dr Rossiter.
24 MR SHELDON: To talk about this?
25 MRS CARR: To talk in general terms about the issues raised
40
1 by the hospital social workers and the issues raised
2 around change. My recollection is that I had three or
3 four meetings scheduled, two of which took place, two of
4 which were cancelled with Dr Rossiter and Dr Naidoo.
5 One of the reasons they were cancelled was one or
6 other of them at short notice had a clinic to attend or
7 had a patient that needed urgent attention, so we did
8 not get the number of formal venues that we would have
9 liked to be able to discuss this properly.
10 MR SHELDON: But in the two meetings that you did have did
11 you raise this?
12 MRS CARR: It was part of the discussions that we had, yes.
13 MR SHELDON: And what was the outcome?
14 MRS CARR: The outcome was that Dr Rossiter was very keen
15 for the social workers to come back in and understood
16 that there were issues. As I say, earlier I had
17 commented on the fact that Dr Rossiter was more
18 concerned in those meetings with the fact that the
19 hospital social workers may be withdrawn from the
20 hospital and may actually be working from the Edmonton
21 Centre rather than being based in the hospital. She saw
22 much more difficulty around that than there was around
23 the psychosocial meetings, but clearly if the social
24 workers were withdrawn and not in the hospital at all,
25 the psychosocial meetings became even more important.
41
1 MR SHELDON: But it would seem from that that it is not
2 a case of her not being prepared to talk to you about it
3 because there she is on two occasions in one month alone
4 attending formal meetings with you at which the subject
5 was covered.
6 MRS CARR: I am sorry, the two meetings I spoke of took
7 place between August and October.
8
9 MR SHELDON: When you left.
10
11 MRS CARR: Yes. These are not two meetings --
12 MR SHELDON: Two meetings in total?
13 MRS CARR: Yes.
14 MR SHELDON: So the net effect or the sum total of what you
15 did in the 15 months or so in which you were in post to
16 resolve this problem of social work non-attendance at
17 psychosocial meetings was to raise it on two occasions
18 with Dr Rossiter as one of the items on the agenda?
19 MRS CARR: That was in one venue, yes. There were other
20 opportunities and it was discussed in a number of other
21 places at other meetings with other professionals where
22 the focus was the change as a whole.
23 MR SHELDON: Yes, to absolutely no effect.
24 MRS CARR: We were not able to make the changes I would have
25 liked to have made, no.
42
1 MR SHELDON: When we look at what you say in paragraph 12 of
2 your statement, namely that this was a live issue that
3 you actively sought to address, how should we assess
4 your performance in doing so?
5 MRS CARR: I was not able to achieve the end I had set out
6 to achieve.
7 MR SHELDON: There might be another way of looking at the
8 problem, might there not, saying instead of "how do
9 I get social workers to go to these meetings", which
10 seems to be difficult, you might say, "Well, if I cannot
11 do that how do I ensure that information is exchanged
12 effectively in other ways? What other channels of
13 communication can I open up?" Did you look at it like
14 that?
15 MRS CARR: There were a number of channels that were open
16 for social worker and hospital staff to use. As I said
17 earlier, there were the strategy meetings around the
18 child protection issues where we had a child protection
19 investigation where social workers met with the ward
20 staff in that formal structure. The social workers
21 always attended the wards on a regular basis and were
22 able to talk informally with staff and they were able to
23 pick up the information on that kind of basis.
24 As I have said previously, the psychosocial meeting
25 was not the only venue for social workers to pick up
43
1 both formally and informally information that the ward
2 wanted to pass or that social workers wanted to pass to
3 the ward. So there were a number of other avenues that
4 were available and that were actively being used.
5 MR SHELDON: Before we leave this topic and move on to the
6 second one, if I was to suggest to you that if the
7 social workers involved valued the interests of the
8 children for whom they were responsible above their own
9 concerns about feeling devalued and deskilled, they
10 would have gone to these meetings. Would that be fair?
11 MRS CARR: I think that is a very difficult judgment for me
12 to make on behalf of other people. My expectation of
13 the social workers would be that yes they should attend
14 those meetings and yes they should value any work which
15 will help protect children.
16 MR SHELDON: If I was to suggest that the failure to resolve
17 this problem over three and a half years demonstrates
18 not just managerial incompetence but also a pettiness on
19 behalf of the individuals concerned, would that be fair?
20 MRS CARR: Again, I am not in a position to comment on what
21 previously happened but certainly my view is that it
22 should have been resolved and it could have been
23 resolved right at the beginning, that having gone on so
24 long, by the time I became involved with it, it was an
25 intractable problem that became much more difficult to
44
1 resolve.
2 MR SHELDON: If I was to suggest that there is only so much
3 time during which it is appropriate for managers or
4 people charged with sorting these difficulties out to
5 devote to making sure everybody feels comfortable about
6 a situation before they eventually have to say, "Well,
7 despite your discomfort, the problem has to be solved,
8 you have to go," would you agree that that point must
9 eventually be reached?
10 MRS CARR: Absolutely, yes.
11 MR SHELDON: And in this instance it would be reached in
12 advance of three and a half years, would it not?
13 MRS CARR: It certainly should have been and the programme
14 that we originally had set would have resolved it a lot
15 sooner. We just were not able for a range of reasons,
16 as I have indicated before, to actually get that done.
17 MR SHELDON: Would you regard it as a legitimate criticism
18 of your management of this situation to suggest that
19 perhaps it was focused too much on the interests of the
20 social workers involved and not enough on the interests
21 of the children that they were looking after?
22 MRS CARR: No, I do not think so, because my focus is the
23 child. As far as I am concerned that is the bottom
24 line, that it is not acceptable for children to suffer.
25 In the absence of being able to have social workers at
45
1 the psychosocial meetings, I ensured that as much
2 information as possible was exchanged in as many other
3 places as possible to ensure maximum safety of children
4 wherever possible. Had the psychosocial meeting been
5 the only venue then that would have been entirely
6 different, but it was not the only venue and there were
7 other ways of ensuring that the children were protected
8 whilst trying to resolve it.
9 MR SHELDON: I take it from your earlier answer that you are
10 not able to help us with the non-accidental injury
11 forums that took place on Tuesday; is that right?
12 MRS CARR: It is not one that I am aware of. I certainly
13 did not attend.
14 MR SHELDON: It was not one that came up in your review of
15 other means of communication of child protection
16 concerns from hospital to social services?
17 MRS CARR: There were a number of meetings that were part of
18 the discussions. Whether that is one specifically I am
19 afraid I am not in a position to recall at the moment.
20 MR SHELDON: Moving on now to the question of the service
21 provided by Enfield social workers to Haringey Social
22 Services. You say at paragraph 10 of your statement
23 that you wrote to Haringey in February 2000 advising
24 them that there would be a change in the level of
25 service provision given by Enfield social workers at the
46
1 hospital.
2 MRS CARR: Yes.
3 MR SHELDON: If you could have volume 41, page 408 we can
4 have a look at that letter. We glanced at this letter
5 earlier on in a different context but I wonder if we can
6 look at it in a bit more detail now and understand what
7 is meant by it. Paragraph 2 you state:
8 "As the transfer from our Adult section will mean
9 a reduction in both staff and management team for this
10 group, we will no longer be able to offer Haringey any
11 service for children and families."
12 That is not quite right, is it? You were still
13 going to offer some sort of service albeit a reduced
14 one?
15 MRS CARR: Ultimately we would not be able to provide
16 a service at all but we would certainly never withdraw
17 that service to begin with without a lot of discussion
18 and a lot of consultation. So originally we were
19 offering a scaled down service.
20 MR SHELDON: Which as I understand it is set out in the
21 fifth paragraph on that page, where you say about
22 halfway down:
23 "This will mean that all Haringey cases will have an
24 initial assessment of basic information faxed to the
25 appropriate local office. We will not be in a position
47
1 to do more. With child protection cases these will be
2 passed to our Intake and Assessment Team to do the
3 preliminary work, but again the local Haringey office
4 will be informed in that they take over responsibility."
5 So that was the scaled down service, was it, that
6 you were going to offer?
7 MRS CARR: Yes.
8 MR SHELDON: In advance of withdrawing service altogether?
9 MRS CARR: Yes.
10 MR SHELDON: Were you aware at the time you wrote that
11 letter of the point at which service would be withdrawn
12 altogether?
13 MRS CARR: No, because I then had to have negotiation with
14 Haringey. The basic problem from our point of view was
15 we had a reduced number of social workers and no
16 managers being transferred to the Children and Families
17 Division but we were still doing the same levels of work
18 that we had been doing previously.
19 The negotiation with Haringey that I had subsequent
20 to this letter was along the lines if they could finance
21 a social worker post then we would maintain that within
22 our structure and we would ensure that we did more work
23 for them, but without a manager of that team separately,
24 the volume of work that was coming through, which having
25 done a statistical analysis of it, 75 per cent of our
48
1 work through the North Middlesex Hospital was actually
2 on Haringey cases, that we could not maintain that sort
3 of service level to them, given that they made no
4 financial contributions to us for doing it.
5 MR SHELDON: That is helpful and I would like to ask you
6 some more about the reasons for the cut in service in
7 just a moment but I want to make sure I have the
8 chronology set up first of all.
9 This letter of 1st February 2000 was effectively
10 says that "as of now we will be offering you a scaled
11 down service as we have just described until further
12 notice".
13 MRS CARR: Yes.
14 MR SHELDON: And the further notice will be the withdrawal
15 of that service and whatever alternative arrangements we
16 can put in place in the meantime, for example, as you
17 have indicated, Haringey funding a social worker?
18 MRS CARR: Yes.
19 MR SHELDON: Can we understand what those interim or that
20 scaled down service would actually mean in practice?
21 The first element of it would seem to be that Haringey
22 cases will have an initial assessment of basic
23 information faxed to appropriate local office. What
24 sort of basic information are you talking about?
25 MRS CARR: We are talking where it was a children and
49
1 families social worker, them collecting the basic
2 information for an initial assessment which would take
3 probably a day or two for them to do. Part of our
4 dilemma was there was a number of occasions when workers
5 were off sick and other workers were on leave and in
6 fact there were no children and families social workers
7 available in the hospital at all, and we offered cover
8 through the workers in Chase Farm and through the
9 Edmonton Centre, but ultimately, because the service
10 became quite stretched, it was the adult care services
11 social workers who were doing those initial assessments
12 and faxing the information through.
13 MR SHELDON: So an Enfield social worker would in respect of
14 a Haringey child in the hospital do a basic initial
15 assessment?
16 MRS CARR: Yes.
17 MR SHELDON: The second element of the service seems to be
18 with child protection cases they would be passed to the
19 Intake and Assessment Team to do the preliminary work.
20 What is the preliminary work?
21 MRS CARR: If we were going to do a Section 47 investigation
22 then we would be in touch with the local office to set
23 up the strategy meeting and to make sure that those
24 parts of the investigation were put in hand promptly.
25 MR SHELDON: I see. So you would be responsible at Enfield,
50
1 but would you be responsible for doing that Section 47
2 investigation?
3 MRS CARR: No, we would not have concluded the Section 47,
4 we would have started it off immediately.
5 MR SHELDON: So for children in need cases initial
6 assessment. For child protection cases an initial look
7 to see if there was going to be a Section 47
8 investigation required and if so, get the wheels in
9 motion?
10 MRS CARR: Yes.
11 MR SHELDON: How is that less than what was being provided
12 prior to the 1st February 2000?
13 MRS CARR: It was less in that as I said previously, the
14 social worker who might have been involved was an adult
15 care social worker who would not have had the same
16 background necessarily to be able to make the same sorts
17 of initial decisions. So there would be questions marks
18 about some of the information that we passed to
19 Haringey, if it was an adult care social worker. What
20 we were basically saying to Haringey was there would be
21 less information passed at the beginning and less of an
22 assessment done than we might have done previously.
23 MR SHELDON: So it is a qualitative rather than
24 a quantitative difference, is it? You are saying to
25 Haringey: "Instead of your initial basic assessment
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