Archived Transcript for 26 April 2002: Pages 1 to 50

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1 26th April 2002

2 THE CHAIRMAN: Good morning, ladies and gentlemen. My name

3 is Herbert Laming. I am very pleased to welcome you to

4 this fifth seminar in Phase II of the Victoria Climbie

5 Inquiry. I apologise to those who have their backs to

6 me, but it will only be for a very few moments.

7 You recall that in our terms of reference, you each

8 have them in the small pack, not the big blue one, the

9 terms of reference include these words: that the Inquiry

10 is to reach conclusions as to the circumstances leading

11 to Victoria Climbie's death and to make recommendations

12 to the Secretary of State for Health and to the

13 Secretary of State for the Home Department as to how

14 such an event may as far as possible be avoided in the

15 future.

16 It is that latter bit of how we might prevent

17 terrible events of this kind in the future that this

18 series of seminars is directed to addressing. I am

19 extremely grateful -- all my colleagues join me in

20 this -- for the interest that you have shown in this

21 part of the Inquiry, and of the thought that you have

22 already devoted to the issues that we are considering.

23 I have no doubt that because of your efforts already and

24 also what you are going to contribute today that the

25 work of this Inquiry will be that much better informed.

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1 I am very grateful indeed that Counsel to the Inquiry,

2 Neil Garnham QC, who I hope you have all had the chance

3 of meeting, has kindly agreed to chair each of these

4 seminars.

5 Before we begin, may I formally introduce the

6 colleagues who are sitting with me and who have been

7 with me throughout the Inquiry. On my immediate right

8 is Dr Adjaye, who is a consultant paediatrician with

9 special interests in community child health services,

10 currently working in the Maidstone and Tunbridge Wells

11 NHS Trust.

12 On Dr Adjaye's right is Mr Fox, who is a detective

13 superintendent with the Hampshire Constabulary, and has

14 played a significant role not only in investigating

15 child protection issues at a local level but in working

16 with both the Home Office and the Department of Health

17 on these matters.

18 On my left is Mrs Kinnair, who is a qualified nurse

19 and health visitor and more recently a senior nurse

20 manager for the Lambeth, Southwark and Lewisham Health

21 Authorities Children's Services. Like each of my

22 colleagues, she has vast practical experience in

23 managing child protection services.

24 On Mrs Kinnair's left is Mr Richardson, who is the

25 Assistant Director Children and Families Services for

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1 North Lincolnshire Council and is the Vice Chairman of

2 his local Area Child Protection Committee. Like each of

3 my colleagues, he also has made a major contribution on

4 the national scene.

5 I can say that in what seems to have been a very

6 long time that we have been together, I could not be

7 blessed by a more able, more committed and hard-working

8 group of colleagues.

9 Inevitably an inquiry of this kind attracts a wide

10 range of responses, and each of them no doubt in their

11 own way is important, but you will understand that not

12 all of them are relevant to the terms of reference that

13 we have been given, and we have to keep constantly

14 before us the terms of reference that actually set the

15 limits and also the opportunities of this Inquiry.

16 Issues that are beyond the scope of our terms of

17 reference, important though they may be, cannot be

18 considered.

19 As I said on an earlier date, I will be identifying

20 the contributions which we have received which seem to

21 me to be both relevant and of value to the Inquiry.

22 Those contributions will be treated as evidence to the

23 Inquiry and published on the Inquiry website. Others

24 will not be regarded as evidence to this Inquiry.

25 Perhaps I could also take this opportunity to say

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1 that I and my colleagues will be very pleased indeed to

2 join members of the seminar in the breaks and at

3 lunchtime, but it comes with a health warning, which is

4 that I must make it clear that the evidence to the

5 Inquiry must be heard in public in this room, so it is

6 better that we do not discuss with you any matters that

7 you wish to put to the Inquiry or which would be the

8 subject of debate in the seminars. I hope that will not

9 prove too inhibiting.

10 That said, the seminars so far have proved to be of

11 great value to us and the issues have been extremely

12 helpful. During this seminar, as with the others,

13 neither I nor my colleagues will play any part, we will

14 observe and listen carefully, but towards the end of the

15 afternoon some time will be left so that any one of us

16 can be free to ask any questions by way of

17 clarification.

18 Now, before I hand over to Mr Garnham, I would be

19 grateful if everybody in the room and not just the

20 seminar participants could make sure that mobile phones,

21 pagers and any other forms of distraction can be turned

22 off so that we can concentrate on the issues that are

23 before us.

24 Thank you very much indeed for being present today,

25 and now I hand over to Counsel to the Inquiry,

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1 Mr Neil Garnham.

2 MR GARNHAM: Thank you, Chairman. Can I add my welcome to

3 Lord Laming's. All of us involved in this Inquiry are

4 enormously grateful for the time that so many busy and

5 distinguished people have given up in order to be here

6 today. Thank you. Can I begin with introductions. My

7 name is Neil Garnham, counsel to this Inquiry. To my

8 left is Neil Sheldon, junior counsel to the Inquiry. To

9 my right sit, and I have checked to see she is here in

10 time, and she is, Dr Valerie Brasse and Sue Shepherd,

11 the advisers to the Inquiry on social care and health

12 issues respectively. To my far left is Mandy Jacklin,

13 secretary to the Inquiry, and to my far right our

14 stenographer who will keep a note of what is said during

15 the course of today.

16 First a few housekeeping points. We will break for

17 coffee at about 11.15 and for lunch at about quarter to

18 one. Both of those will be served in the room where

19 coffee was made available when you first arrived this

20 morning. There is a gents' loo next to the lift on this

21 floor and a ladies' on the floor below. We will aim to

22 finish this seminar by about 4.15 or shortly thereafter.

23 Now, can I go around the table, please, and ask each

24 of you to introduce yourselves to us. We have included

25 brief biographical notes in the pack that has been made

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1 available, but if you can just tell us the name by which

2 you would like to be known during the course of this

3 seminar and something of the nature of the work you have

4 been doing. Can I start with Richard Cooling.

5 MR COOLING: My name is Doctor Richard Cooling, a GP in

6 Sutton, clinical director of the Sutton and Merton

7 Primary Care Trust, which was formed on 1st April this

8 year, and prior to that clinical director of the Nelson

9 West Merton Primary Care Trust, a predecessor

10 organisation from April 2000.

11 MR HOLLIS: My name is Tim Hollis. I represent Her

12 Majesty's Inspectorate of Constabulary. I have been in

13 post since January this year. Prior to that for seven

14 and a half years I was Assistant Chief Constable in

15 South Yorkshire Police, with responsibilities for

16 operational policing, personnel issues latterly.

17 MS FRY: I am Marcia Fry, Head of Clinical Quality, Ethics

18 and Genetics in the Department of Health, and for these

19 purposes the relevant responsibilities are for the

20 clinical governance system for the NHS, patient safety

21 and the Commission for Health Improvement and the

22 current move to rationalisation of inspectorates.

23 MR LOGAN: Leroy Logan, Chief Inspector in the Metropolitan

24 Police, based at Westminster borough, and I am chair of

25 the Black Police Association, which is a support network

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1 for black person personnel in the Metropolitan Police.

2 I am suffering from deja vu having just -- I gave

3 evidence here three years ago at the Stephen Lawrence

4 Inquiry, so it is --

5 MR GARNHAM: This is much better organised.

6 MR LOGAN: No comment.

7 MS PLATT: Denise Platt, Chief Inspector, Social Services

8 Inspectorate, in England. I also have a personnel

9 responsibility at the Department of Health as director

10 of older people, children's services and social care

11 services across both health and social care policy.

12 I suspect my Inspectorate responsibilities are the

13 relevant ones for today.

14 MR FRATER: Michael Frater, Chief Executive at Telford and

15 Wrekin Council. My assumption that the reason for being

16 here is that I have done a lot of work on performance

17 management in my present authority, my previous

18 authority, a London Borough, and the one before that

19 which was a county Council.

20 MS HALLSWOTH: Kate Hallsworth, Detective Inspector with

21 Merseyside Police. I manage one of the six child

22 protection units we have on the force. I have been

23 doing that for seven years and set up the original child

24 protection unit on the force.

25 DR CONLON: Maurice Conlon, GP in Birmingham and Director of

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1 Primary Care for the NHS Clinical Governance Support

2 Team, an organisation that seeks to create an open,

3 enquiring, learning culture in which we can improve

4 quality and maintain safety.

5 MR GARNHAM: Can I go back. Normally we manage to arrange

6 this so that when attendees are late they are sitting

7 over this side. We have failed that with Bess Herbert,

8 so I will go back to Bess and first of all say welcome

9 and secondly ask you to introduce yourself.

10 MR HERBERT: Apologies for being late; I made the mistake of

11 getting a bus. I am Bess Herbert. I work at the London

12 Children's Right Commissioner, a voluntary project

13 demonstrating the value of a Children's Rights

14 Commissioner. So I have very much a children's rights

15 perspective, not so much expertise on child protection

16 services but thinking about the general promotion of

17 children's human rights.

18 MR LEADBETTER: Mike Leadbetter, President of the

19 Association of Directors of Social Services, which is

20 one of the reasons I am here. I am Director of Social

21 Services for Essex and have been a director for 16

22 years.

23 MS GRINDROD: Kathryn Grindrod, senior practitioner on

24 a family support team for Manchester social services.

25 We cover a wide variety of work with children and

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1 families from duty and family support through to child

2 protection care proceedings.

3 SIR ANDREW FOSTER: Andrew Foster, Chief Executive of the

4 Audit Commission. Earlier in my career I spent the

5 largest part of it working in social services

6 departments and was Director of Social Services of

7 a London authority and of a county council. And then

8 I worked in the health service for quite a long time and

9 was Deputy Chief Executive of the Health Service prior

10 to doing this job, which I have done for the last nine

11 years, and I like to be called Andrew.

12 MR GRANGE: Terence Grange, Chief Constable Dyfed Powys

13 police. I have responsibility for policing two-thirds of

14 Wales. The add-on job, I am the lead for the

15 association of chief police officers on personal crime,

16 which runs from homicide through domestic violence,

17 rape, sexual crime and I take personal responsibility

18 for child protection and the management of sex offenders

19 and development of policy strategy and investigation.

20 MS RENOULF: I am Christine Renouf, Director of Inspection

21 Services with the NSPCC. Most of my working career was

22 spent with the probation service where I had

23 responsibility for child protection and work with sex

24 offenders, and I moved into inspection six years ago,

25 initially with the HMI Inspectorate of Probation, now

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1 with the NSPCC.

2 MR DONKOR: Elvis Donkor. I have a background in general

3 medicine, public health and clinical audits, presently

4 responsible for clinical governance at the Lewisham

5 Health Care Trust, and I presume that is why I have been

6 invited here.

7 MS ROBERTSON: I am Daryl Robertson, Assistant Director of

8 Strategy and Development for Kent and Medway Strategic

9 Health Authority, previously worked for West Kent Health

10 Authority. We changed at the beginning of April and

11 I have a lead for children's services including child

12 protection, and up until 31st March was lead officer for

13 child protection for the health authority.

14 PROFESSOR AYNSLEY-GREEN: Al Aynsley-Green, paediatrician.

15 For the last nine years I have held the Nuffield Chair

16 for Child Health at Great Ormond Street and I am

17 director of research at Great Ormond Street and the

18 Institute of Child Health. Last year I became Chair of

19 the Children's National Task Force and since July,

20 I have been seconded to the Department of Health to be

21 the National Clinical Director for Children.

22 MR GARNHAM: Can I ask people to speak at a reasonably

23 moderate speed.

24 MS JAMES: I am Anne James, Team Manager from Leeds. I work

25 in Chapeltown, an inner city area, running a childcare

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1 team, lots of child protection in it, and a multiracial

2 area.

3 MR PINNOCK: Mike Pinnock, Performance Manager for North

4 Lincolnshire Social and Housing Services. My

5 responsibilities cover policy development, planning and

6 performance review within social care, child welfare and

7 housing services. I am also the Chief Executive's

8 Champion for social inclusion within the authority and

9 I work part-time at the centre for child and family

10 studies and informed in research on looking at how

11 outcome information can be collected in Children's

12 Services and used to improve the planning of services.

13 MS STREET: I am Barbara Street. I am here as the Chair of

14 the Area Child Protection Committee for Bridgend, which

15 is a small unitary authority in Wales between Cardiff

16 and Swansea, in case you don't know. I am also

17 Assistant Director for Children's Services in Bridgend,

18 and previously to that I was a child protection

19 coordinator for Port Talbot Children's Services.

20 MR WEBSTER: Andrew Webster. I like to be known as Andrew.

21 I am the Director of Public Services Research at the

22 Audit Commission. Prior to that I was the Director of

23 the Audit Commission and Social Services Inspectorate's

24 Joint Review Team reviewing local authority social

25 services, and the bulk of my career has been spent in

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1 social services and health management.

2 MS ROBERTSON: I am Lily Robertson, Regional Development

3 Officer for TOPSS in Southeast England. TOPSS is the

4 training organisation for the personnel social services.

5 We are what is known as an NTO, not a training provider.

6 We work alongside employers and employment interests to

7 develop coherent strategies towards workforce

8 development. I have a national policy lead in

9 continuing professional development and management

10 development.

11 MS RIGG: Gill Rigg, head of Children's Services in

12 Lancashire, previously head of Children's Services in

13 North Yorkshire, and I have worked in children and

14 families social work for the last 25 years. I have also

15 been a member of an ACPC for the last 10 years and chair

16 of one for the last 4 years.

17 MR GARNHAM: Thank you very much. Before we begin, I want

18 to say a little about the purpose of these seminars and

19 the way in which they will operate.

20 First the purpose. It became apparent from an early

21 reading of the documents generated by Victoria's case

22 that Lord Laming was likely to have to consider making

23 recommendations of two rather different types. The

24 first type would be addressed to the particular

25 circumstances of Victoria's case and to the events that

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1 had occurred in Ealing, Brent and Haringey whilst

2 Victoria lived there, but it was recognised fairly early

3 on that there might need to be recommendations of rather

4 wider potential impact, recommendations that might

5 affect the way the three relevant services were

6 conducted across the country.

7 We are not charged with conducting a review of the

8 entire child protection system in this country, but

9 Lord Laming's brief is to make recommendations as to how

10 a tragedy like Victoria's might, so far as possible, be

11 avoided in the future. That direction recognises the

12 impossibility of guaranteeing that there will never be

13 another Victoria Climbie, but it plainly requires us to

14 consider the need for change beyond the borders of the

15 London boroughs where she happened to live.

16 Inevitably some of the recommendations are likely to

17 be to the effect that certain new steps should be

18 considered, rather than immediate changes introduced.

19 But it can be dangerous even in those circumstances to

20 move from the particular to the general.

21 In the course of Phase I we learned a great deal

22 about what was happening in certain London boroughs, but

23 it would plainly be a mistake to assume that those

24 practices and procedures were followed in a similar way

25 elsewhere in the country.

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1 Phase II of this Inquiry has been designed therefore

2 as a vehicle for exploring those wider concerns and for

3 generating and testing amongst a wider constituency

4 ideas that might serve to improve child protection

5 arrangements across the country generally.

6 There are two elements, as Lord Laming has

7 explained, to Phase II. The first is that we have

8 invited and have received written submissions from

9 members of the public, and Lord Laming has indicated how

10 we are processing that material. These seminars

11 constitute the second element of Phase II.

12 Now a word about the way in which this seminar will

13 operate. We are very grateful for all the written

14 submissions that people here have put in. As will soon

15 become apparent, they provided a prompt for many of the

16 topics on which I am going to invite discussion.

17 Together with those of the public submissions that

18 are chosen by Lord Laming, they will be treated as

19 evidence to this Inquiry and published on the Inquiry's

20 website once today's proceedings are over.

21 That means that there is no need for any of you to

22 feel that you have to speak to every issue that you

23 raised in the written submissions. We will have read

24 them and carefully considered them in any event.

25 What is said during the course of this Inquiry, this

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1 seminar, will also be treated as evidence to the

2 Inquiry. The verbatim note that our shorthand writer is

3 preparing will enable Lord Laming and his colleagues to

4 reflect on what you say in the days that follow the

5 conclusion of these seminars.

6 But that, I hope and predict, will not inhibit the

7 full and frank exchange of ideas once we get going.

8 I will be happy to receive suggestions for further

9 topics for discussion from members of the public who are

10 here. If anybody wants to put forward questions, if

11 they would complete one of the pro formas that there are

12 in the room and leave them completed in the baskets

13 provided, they will be collected up by Inquiry staff and

14 handed to me. I do not guarantee that we will take

15 every one of those questions, but we will try and build

16 in as many as we can.

17 All of you have been invited here in a personal

18 capacity. We have not invited you as representatives of

19 your employers or professional associations. What we

20 want is your honest views about how we ought to

21 recommend improving child protection arrangements in

22 this country. There are a number of topics I would like

23 to try and cover during the course of the day, and we

24 have put a document, a single page document, on the

25 table, indicating the sort of issues that we want to

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1 work through.

2 I will invite comments from various of you on each

3 of these topics as we work through them, but please feel

4 free to join in and give your views if we are covering

5 a topic on which you think you can contribute. Give me

6 a nod or raise a pen and I will catch your eye and try

7 and bring you in when I can when the discussion permits.

8 You will be sorry, I know, to know that I am not

9 here to cross-examine you, because you would have the

10 fun of knocking me into a cocked hat every time I tried,

11 but there may be occasions when I will want to put some

12 supplementary questions to some of you, particularly

13 where you are giving us information about new ideas, and

14 I hope you will permit me to do that.

15 In order to approach our task systematically, we

16 have attempted to break down the processes by which

17 children are protected into their constituent elements.

18 This, I am sad to say, is the fifth and final one of

19 these seminars. Each one has concentrated on

20 a different stage in the process of delivering services

21 to children in need. We have recognised all the way

22 through that those divisions are not watertight and that

23 some subjects discussed in one seminar are relevant to

24 topics that emerged in another.

25 I do not want to inhibit that full and frank

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1 exchange of ideas, as I mentioned earlier, by sticking

2 too dogmatically to the issues we have identified.

3 Given that the time at our disposal is limited, I am

4 sure you will understand if from time to time it is

5 necessary for me to bring us back to the central issues

6 for today's seminar.

7 Today we are seeking to discover how well we, as

8 a society, monitor performance at present, how it is

9 planned that we should monitor in the future, and

10 whether we ought to make other changes to those

11 arrangements.

12 That will necessitate us looking at the way in which

13 standards are set, the way in which internal monitoring

14 is carried out by the agencies concerned, multi-agency

15 monitoring and monitoring by external agents.

16 May we begin with the present arrangements first.

17 I imagine it is common ground -- but it will not be the

18 first time if I am corrected on that sort of

19 assumption -- that in order effectively to monitor and

20 assess performance we need to have yardsticks against

21 which we can make judgments.

22 Andrew Foster, how confident are we that we are

23 seeking to measure the right things?

24 SIR ANDREW FOSTER: I will just choose three or four main

25 points because our evidence does try and go through

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1 these issues reasonably thoroughly. Clearly measurement

2 is important, but I think it is very important to put

3 measurement in the context of the general approach that

4 is being taken. Measurement should never be about one

5 individual measure. It almost inevitably needs to be

6 a cluster of measures being taken to take an overall, an

7 overarching view of how services are being provided.

8 So for my part it is the intelligent questions that

9 sound management and good scrutiny can bring from

10 performance measures that is important, rather than

11 putting massive reliance on individual indicators. So

12 an absolutely vital point is that performance

13 measurement is part of an overall approach. It must

14 not, cannot, exist just in its own right. Neither

15 should individual measures.

16 I will say that some of the reason for that is you

17 can very easily get perverse behaviour being brought

18 around by overreliance on individual measures.

19 MR GARNHAM: Because people are trying to address those

20 particular measures to get the scores on the doors.

21 SIR ANDREW FOSTER: I will give you some examples where

22 exactly that sort of thing can happen. I do not think

23 that we are always entirely confident that the

24 information is as reliable as it should be, and so if it

25 can cause perverse behaviour, or if it can be

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1 inaccurate, if you were putting massive reliance on

2 that, as your principal response, I think you would

3 increase your chance of risk, but that is not to say

4 that this is not helpful, but it must be as part of an

5 overall approach.

6 MR GARNHAM: In your paper you say that the Department of

7 Health uses three critical performance indicators to

8 monitor child protection performance: timeliness of

9 reviews, length of stay on the CP register and

10 percentage of children returning to the register. In

11 what way are they adequate or inadequate?

12 SIR ANDREW FOSTER: I think they are quite helpful and

13 I think that they are a good starting point, but I was

14 going to indicate that there are ways that they can be

15 not always as helpful. I mean --

16 MR GARNHAM: Just give us an example.

17 SIR ANDREW FOSTER: Two examples would be if reviews happen

18 in a timely way but are not substantial, that is of no

19 use. If visits happen according to the rote but we have

20 no knowledge of what the quality or the substance of

21 them is, that is not very helpful either. That is not

22 to knock those, it is really the way of making my point

23 about how important it is to see this in a broader

24 sense.

25 I guess the things that I say later in our paper,

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1 which I think are very important, about measurement --

2 I mean, how do you measure delays for people in getting

3 help? Almost impossible. Are the right families and

4 children being seen? How would you measure that?

5 I give a range of examples.

6 MR GARNHAM: We will come back to that. Let me bring in

7 Mike Leadbetter on what has been said so far. Michael

8 Leadbetter, to what extent do individual social services

9 departments set standards based on evidence about what

10 is best practice, about how things turn out?

11 MR LEADBETTER: As we have said in our submission,

12 individual authorities up and down have different

13 standards of practice. To be parochial for a moment,

14 the sub-sets of information we collect in Essex to try

15 and dig down into the reviews, for example were children

16 prepared for the reviews, were parents' views sought,

17 how participative was the review? We operate a traffic

18 light system where information from over 40

19 indicators -- that is initial assessments, reviews, case

20 conferences, case records, supervision notes -- are

21 assessed. Information monitored, fed monthly to teams.

22 MR GARNHAM: Are you pretty confident that social services

23 departments up and down the country are getting these

24 measures right?

25 MR LEADBETTER: What do you mean by "right", Neil?

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1 MR GARNHAM: That you are identifying a sufficient range,

2 that the question is being asked with sufficient

3 intelligence to get an accurate picture about the way in

4 which performance is being achieved.

5 MR LEADBETTER: I think, as we said in our paper, there has

6 been a sea change in the last two years. Significant

7 use of IT, growing acceptance of the need for

8 performance management. Again, as we have stressed

9 throughout our papers, almost a rediscovery of the

10 crucial importance of supervision, both for setting

11 management objectives, but also for identifying training

12 needs and personal support. You combine that with the

13 effective management that flows from it with peer audit

14 and I think the peer audit needs to be alongside, not

15 punitive.

16 For example, if someone is going red in Essex we sit

17 with them in the initial stages, perhaps a team manager

18 who has got it right, work out an action plan, work out

19 some targets. The targets are not necessarily stretch

20 targets in the first place but reasonable targets so

21 they can succeed, and build on the principle of success.

22 Only later becoming a little heavier if there are still

23 intractable problems in certain teams.

24 MR GARNHAM: Can I ask about the position with the police.

25 Tim Hollis, do the police approach the measurement of

22



1 performance in the same way internally?

2 MR HOLLIS: Terry Grange has got the lead from ACPO, will

3 give you some detail. I can draw on my experience as an

4 operational officer and more recently having had command

5 responsibility for these units.

6 I think a crucial issue for the police is what the

7 police can measure in terms of police activity, and

8 obviously there are two levels: one, the responsive, the

9 reactionary police, the officers in uniform going to

10 particular calls, because that can bring some of these

11 issues to notice at an immediate level. Behind that are

12 the specialist teams of the dedicated units, with the

13 officers who are more professional in terms of their

14 expertise in particular areas of policing and the

15 important links to other agencies.

16 I think the police are the first to admit this is

17 not a policing problem; it manifests itself and there

18 are crimes in relation to it which need to be managed

19 and investigated, but the essence of it is not

20 a policing problem.

21 The challenge for police forces is to come up both

22 within a force as to what you do measure, and I

23 associate with the comments made, it is easy to measure

24 how quickly people get to something. The quality of

25 what is delivered when they get there and the training

23



1 of the officers applying to it is more difficult to

2 measure.

3 MR GARNHAM: Terence Grange, at present are there adequate

4 performance indicators in use in individual police

5 forces in order to monitor performance in relation to

6 child protection?

7 MR GRANGE: No.

8 MR GARNHAM: What is wrong with it?

9 MR GRANGE: There is an absence of performance measures that

10 target what the original priority of the exercise is,

11 and that actually starts not within the police service

12 but from Government. As I understand it, there is no

13 acknowledged Home Office priority for policing in child

14 protection. It is not mentioned in any of the Home

15 Secretary's priorities ever.

16 MR GARNHAM: We will come on to look at how it is monitored

17 nationally, but internally, inside individual police

18 forces, how good are they at getting these --

19 MR GRANGE: All they really measure is the amount of work

20 that is done, and even that I do not think is done

21 adequately in many places. I am convinced from what

22 I have seen over the last year that most police forces

23 have child protection units that work almost in absence

24 of overall management from the top. They do their thing

25 within their own area and they are managed very locally,

24



1 as best the managers can, with little or no top level

2 management oversight.

3 MR GARNHAM: Kate Hallsworth, what is your experience in

4 Liverpool?

5 MS HALLSWOTH: I think there is a massive difference between

6 performance indicators and actually managing child

7 protection. Performance indicators tend to be about

8 statistics -- same with police and social services,

9 I feel -- how many case conferences, how many children

10 are on the Child Protection Register. There is

11 a massive difference. You cannot measure how a single

12 police Child Protection Unit is working purely by

13 producing figures. It is about how that unit is working

14 individually.

15 For me the responsibility should be down to -- and

16 I have strong views on the fact that all child

17 protection units within police forces should be headed

18 by an inspector, so that they are the performance

19 managers and the people who are making sure that every

20 referral that comes in is actually managed properly.

21 Performance indicators I see as something wholly

22 different.

23 MR GARNHAM: And unrelated, or are they part of the process?

24 MS HALLSWOTH: I think it can be part of the process, but

25 you can get hung up on: how many referrals have we had

25



1 this month, how many video interviews have we done?

2 Therefore if we have done less than the other child

3 protection units we are not performing as well.

4 MR GARNHAM: I think you are echoing what Andrew Foster said

5 about how this can only be part of the process and it

6 has to be viewed intelligently.

7 MS HALLSWOTH: Yes.

8 MR GARNHAM: Mike Pinnock, what is the approach in North

9 Lincolnshire? How do you use performance indicators?

10 MR PINNOCK: What we have tried to do is concentrate on

11 developing a system of reviewing progress that is

12 appropriate to the needs and circumstances of social

13 work. I think I would have to say that the majority of

14 people do not come into social work because they are

15 concerned about performance measures and targets and so

16 on. Obviously they are concerned about improving or

17 bringing better outcomes for children and their

18 families. So what we tried to do is develop systems

19 that mean something to or speak to social workers about

20 effectiveness rather than the performance measuring. We

21 have tried to concentrate our efforts on organising

22 indicators around a set of clear desired outcomes for

23 children and families.

24 I think we have to look at the way that we can

25 understand the collective efforts of agencies by

26



1 developing some good outcome indicators that will serve

2 to demonstrate whether or not the joint or the

3 collective efforts of agencies are protecting children,

4 and at another level I think we need to look at how we

5 can develop indicators that tell us something about the

6 good management of the critical systems that each agency

7 is involved in.

8 MR GARNHAM: I want to come back to joint working later on,

9 but, Barbara Street, what is your view?

10 MS STREET: I would agree with the previous speaker.

11 I think they are not outcome based issues -- an

12 extremely important one now, we talk about quantity not

13 quality. In my experience across all the agencies

14 involved in child protection there is a huge difference

15 between working a case and monitoring a case, and that

16 is the issue. You come back to that.

17 MR GARNHAM: A difference?

18 MS STREET: Yes.

19 MR GARNHAM: Can they not be intertwined?

20 MS STREET: You can say that you have done a monitoring

21 visit, but the quality of that does not come out in what

22 you say.

23 MR GARNHAM: Is there a danger with the collection of

24 figures that the figures can mask important underlying

25 themes? I think, Mike Pinnock, you said something in

27



1 your paper about how authority-wide figures can mask

2 poor performance in relation to certain groups of

3 children.

4 MR PINNOCK: That is right.

5 MR GARNHAM: What did you have in mind?

6 MR PINNOCK: We have seen that it is possible to achieve

7 a target but it is -- if you are to disaggregate the

8 results, that overall authority-wide target might be

9 masking variations for children from particular groups

10 or children in particular types of placements or --

11 MR GARNHAM: Of different ethnic minority groups.

12 MR PINNOCK: Yes. We would agree with what people said

13 about the need to bring together both qualitative and

14 quantitative information, narrative and other sorts of

15 feedback together, to have a thoughtful, intelligent

16 conversation about whether or not an outcome is being

17 achieved, not to spend time worrying about how we

18 achieve this target and that target.

19 MR GARNHAM: Leroy Logan, is this something that concerns

20 the police, that the unintelligent use of figures can

21 mask regional differences, differences in relation to

22 different ethnic groups? Is it a concern that you have

23 had?

24 MR LOGAN: Absolutely. In fact, one of the things that we

25 put to the Lawrence Inquiry in this very room three

28



1 years ago was around the effects of institutional racism

2 in not being clear of the impact of the systems that you

3 have in place. Instead of just dealing with performance

4 indicators and outputs, you should be looking at quality

5 and the outcomes of the systems.

6 MR GARNHAM: Does that happen at the moment in the Met where

7 you are?

8 MR LOGAN: Having done some inquiries within this special

9 crime group in the Metropolitan Police, which is in

10 charge of child protection teams, there is that lack of

11 rigour and those questions are not being asked. As you

12 know, if they are not going to be asked, no one is going

13 to measure them and it is not going to get done. So

14 those sort of breakdowns are not available and of course

15 that plays out in the quality of staff that manage.

16 MR GARNHAM: I will come back to that later if I may. We

17 have touched on the way this is dealt with in social

18 services and the police. Can I ask people about health?

19 Maurice Conlon, there are a number of changes in the NHS

20 that I know we will need to explore a little later, but

21 describing, if you would, at the moment the present

22 situation as it exists on the ground, how does

23 standard-setting indicator measurement work at the

24 moment in the health service?

25 DR CONLON: Thank you. I did feel the need for health to

29



1 start talking. I am glad you invited me. The

2 measurement, it goes without saying, is an extremely

3 difficult issue and one which we are I think really only

4 at the very beginning of learning to understand, let

5 alone implement and undertake. Some of the issues that

6 have come out this morning demonstrate to me how it is

7 a generic problem, a generic challenge, if you like, for

8 all of us, not just in health, because the issues you

9 are describing are very similar to the ones we

10 experience in health.

11 Just jotting down some thoughts that have arisen

12 from what has been said, questions which have occurred

13 to me are: why are things which are written down not

14 done? Why, when they are done, are they often done

15 wrongly or incorrectly? We measure in measurement,

16 quality measurement we measure 3 things: structure,

17 process and outcome. The closer you get to outcome, the

18 more you get to what you are trying to measure but the

19 harder it is to actually measure that thing. The more

20 you measure structure, the easier your measurements but

21 the less relevant that is to what you are actually

22 trying to achieve.

23 What we are finding in the health service -- and

24 actually we are learning in the health service from

25 other organisations such as the airlines -- is that as

30



1 well as structure, process and outcome we have to try

2 and understand culture and the measurement of culture,

3 and if structure, process and outcome are difficult,

4 culture is on a different dimension in terms of

5 measurement and understanding. It is not to say: these

6 are our goals, these are our targets, this is the path

7 that we have to start.

8 And I think, yes, the measurements that people are

9 discussing in terms of their limitations and their

10 usefulness and the way that any figure can be

11 reinterpreted to a particular end does not negate the

12 validity of pursuing that, but it is the understanding

13 from my point of view -- and I think this is the

14 attitude of the Clinical Governance Support Team -- it

15 is an understanding that this is the beginning of a very

16 long, very difficult process.

17 MR GARNHAM: So at the moment in health how good are we at

18 measuring? Elvis Donkor?

19 MR DONKOR: I am glad you started with Maurice because you

20 have highlighted what we are actually trying to do. In

21 performance monitoring you can divide it into structure,

22 process and outcome. For health you have at least five

23 parameters that are given to us by the NHS; How you

24 should measure performance. Some of them are

25 concentrated on process, others on structure, others on

31



1 outcomes.

2 In some cases the outcome measures which we are

3 aiming at are not clearly identifiable, so we use proxy

4 process measures to measure outcome, and this is where

5 probably I disagree with someone who says monitoring is

6 not performance management, but monitoring in terms of

7 for instance using clinical audits becomes part of

8 performance management, and within a local NHS that is

9 the way we are pursuing, trying to measure performance

10 relating to what, for instance, commissions do, and what

11 individuals, do we encourage them to involve themselves

12 in processes like clinical audits, measuring their own

13 within the sort of area what they do, what they are

14 trying to achieve.

15 So, even though it is new, as far as the NHS is

16 concerned, it is quite difficult. There is a lot of,

17 I would say, difficulties collecting the data that is

18 valid for the measurement. I do not think we should be

19 sort of holding back and saying: we do not need to do it

20 because it is not measuring the right things. I think

21 with time we will perfect the methodology we are using

22 in order to measure the right things, but I think at

23 this stage it is a bit too early to say how far we are

24 going into -- for instance, I mean if you are asking

25 for -- the NHS is asking us now to do patient surveys as

32



1 part of the performance management. Some of the

2 questions are debatable, whether they are measuring the

3 right things, but I would say probably they are right at

4 this time because at the end of the day you perfect the

5 methodology and you will be able to measure the right

6 outcomes.

7 MR GARNHAM: Richard Cooling, with your GP hat on, if you

8 would not mind putting that on, how good at the moment

9 is the health service at measuring GPs' performance?

10 MR COOLING: I would echo what Maurice has said about the

11 performance monitoring in the NHS.

12 MR GARNHAM: We are at the beginning.

13 MR COOLING: We are very much at an early stage.

14 MR GARNHAM: Before we come on to the changes -- I want to

15 explore those in a minute -- look at it before those

16 changes are introduced. How well do we discover how GPs

17 manage their child protection responsibilities?

18 MR COOLING: The mechanism is through the clinical

19 governance arrangements that have been enacted in all

20 primary care organisations across the country. Having

21 said that, I feel that I would be fair in saying there

22 has not been a major focus on child protection issues in

23 terms of clinical governance for general practitioners

24 in our country.

25 MR GARNHAM: How does clinical governance work for general

33



1 practitioners?

2 MR COOLING: It will depend a lot upon the contract that the

3 GP is working under. There are two types of contract:

4 personal medical services and general medical services.

5 MR GARNHAM: Most in the past had general medical services.

6 MR COOLING: The vast majority are under general medical

7 services. That contract is based very much upon inputs

8 rather than outcomes and is -- a new version of the

9 contract was announced on Friday, which I will happily

10 talk about later, but it was very focused on inputs and

11 it was very much focused around people you had on your

12 list, activities that you undertook, so in relation to

13 children, for example, GPs would be remunerated for

14 providing child health surveillance.

15 MR GARNHAM: It is the amount of work the GPs do rather than

16 what the work achieves?

17 MR COOLING: Indeed, and to be registered on the child

18 health surveillance list, GPs have to undergo a brief

19 period of training, and that training usually will

20 include at least one session on child protection. Now,

21 that is a fairly minimal amount of training.

22 MR GARNHAM: And it is not compulsory.

23 MR COOLING: And it is not compulsory, but it is usually an

24 integral part of the child health surveillance training

25 courses.

34



1 MR GARNHAM: But not all GPs have child health surveillance

2 training.

3 MR COOLING: That is correct, but the majority would be

4 child health surveillance trained in the current

5 arrangements.

6 It is then beyond that and up to the individual

7 primary care organisations in their clinical governance

8 leads as to how they take forward that work. I read in

9 the medical press about a previous submission to this

10 Inquiry at a previous seminar about the difficulties

11 encountered in one part of London through setting up

12 training sessions for general practitioners, and they

13 were only able to get two GPs to come.

14 For example, in our own area we as a Primary Care

15 Trust worked with the former Merton, Sutton and

16 Wandsworth health authority, which disappeared on

17 31st March, to set up a training roadshow that went

18 around all the practices. What we felt the problem was,

19 in terms of getting general practitioners and their

20 teams out of the surgeries to places like postgraduate

21 centres for lectures, it always seems to fail.

22 MR GARNHAM: Because they are busy people.

23 MR COOLING: Yes, and it is very difficult to take the whole

24 team out. We set up a series of programmes, of visits,

25 where they would take place at the practice, usually at

35



1 lunchtime, with a bit of light refreshment provided,

2 and --

3 MR GARNHAM: Department of Health sandwiches.

4 MR COOLING: Absolutely, a bit of food always helps, and all

5 the practices, all 118 practices in Merton, Sutton and

6 Wandsworth, were visited. Out of the attendance of that

7 there were 262 GPs who went through that training, so in

8 our new organisation in Sutton and Merton Primary Care

9 Trust, we can say that over the last two years 155 out

10 of 183 of our GPs have actually been through child

11 protection training, which we feel is, we felt was,

12 a much more successful way of running training

13 programmes than this traditional way of doing it.

14 MR GARNHAM: Can I look at some of the changes that are

15 happening. There are already in the National Health

16 Service changes afoot about the way in which standards

17 are set and performance is measured. I think it is

18 right that the Department of Health have already engaged

19 on a substantial amount of work which they say is aimed

20 at raising standards. Al Aynsley-Green, your paper

21 identifies a number of vehicles for raising standards in

22 the NHS. Can we start with the national service

23 framework for children? A thumbnail sketch.

24 PROFESSOR AYNSLEY-GREEN: Thank you, chair. This is really

25 a very, very important opportunity because, as came out

36



1 in the Kennedy Inquiry, and there are many resonances

2 between that and this, until now services for children

3 have been fragmented, uncoordinated and with a low

4 priority. The creation of the NSF provides

5 opportunities to give this a much higher priority with

6 developing understandings. The key issue and difference

7 between NSF and a report is NSF produce standards that

8 have to be implemented.

9 MR GARNHAM: I saw in your paper something about them being

10 non-negotiable, which sounds terribly impressive, but

11 how do you make it non-negotiable? What is the carrot

12 and stick?

13 PROFESSOR AYNSLEY-GREEN: We are still exploring the ways of

14 doing that with respect to children, but there have been

15 a number of NSF published already, mental health,

16 elderly people, and the creation of a standard has two

17 aspects: the first is what can be delivered immediately

18 against the real constraint of workforce and resource

19 against what is the retrotravel, which over a period of

20 10 years can be implemented with milestones along the

21 way.

22 So the standard has two components, what can be

23 implemented immediately and what the direction of travel

24 is over a 10 year period of time and we are at the

25 earliest of stages of defining what those standards will

37



1 be as far as a childrens' NSF is concerned.

2 MR GARNHAM: Looking at that element, the stuff that can be

3 implemented immediately, How do you make it

4 non-negotiable? How do you eliminate the option to opt

5 out?

6 PROFESSOR AYNSLEY-GREEN: Part of it is through the

7 definition of performance indicators, and we come full

8 circle to the start of this discussion. We are engaged

9 in trying to define what those performance indicators

10 might well be for each of the components of the NSF.

11 MR GARNHAM: What happens if a clinician or a trust does not

12 measure up to those performance indicators? How do you

13 enforce?

14 PROFESSOR AYNSLEY-GREEN: We are trying to work closely with

15 CHI, for example.

16 MR GARNHAM: CHI, in case people are muddled up between CHI

17 and --

18 PROFESSOR AYNSLEY-GREEN: Commission of Health Improvement,

19 responsible for inspecting NHS establishments against

20 standards and procedures. At the moment they are

21 inspecting against the published NHF, and we very much

22 hope our standards will also be inspected as part of the

23 process.

24 MR GARNHAM: You inspect standards and inspect against those

25 standards so you can discover when people are not

38



1 reaching the standards. Then what do you do?

2 PROFESSOR AYNSLEY-GREEN: Depending on where they are

3 falling short, you engage in serious discussions how

4 they can be put right. At the end of the day there will

5 probably have to be some sanctions. Training might be

6 one important issue. If an institution is not

7 delivering appropriate training it will not be

8 accredited for training until it is put right.

9 MR GARNHAM: The NSF, as I understand it, impacts directly

10 on the National Health Service and on social services.

11 Does it also affect the police and education?

12 PROFESSOR AYNSLEY-GREEN: Yes, it does indeed.

13 MR GARNHAM: In the same way, how will it be -- I will ask

14 Terence Grange -- how will Terence Grange be affected by

15 the NSF's work on children?

16 PROFESSOR AYNSLEY-GREEN: I cannot tell you at this moment

17 in time. What I can say is that the three things we are

18 trying to change in the NSF process is first of all the

19 concept of child life. It is not just the doctoring of

20 sick children, it is not just the protection of sick

21 children, it is a total experience of the child

22 interfacing with health, social care and education and

23 the environmental (inaudible), and that is the first

24 point.

25 The second is it is a needs led approach, looking

39



1 firmly at the needs of the child and the competencies to

2 deliver those needs.

3 The third is the creation of partnerships. There

4 are various possible vehicles for that, including at

5 strategic level local children and young people in

6 strategic partnerships. Then the creation possibly for

7 service provision and commissioning children's network

8 boards that will bring together health, social care and

9 education in the local health economy. There will there

10 will be representation from police and other agencies on

11 that, and that is reflected in the structure and process

12 for our NSF. We have all these agencies represented in

13 the process.

14 MR GARNHAM: These initiatives are always terribly

15 impressive when one reads them, especially when produced

16 by the Department of Health Brochure Production Line.

17 The acid test, I suppose, is: what difference would it

18 have made to Victoria? Taking the developing NSF for

19 children, how would that actually impact on a little

20 girl who wanders into a hospital in Haringey or goes

21 into the Social Services Department in Brent? How would

22 it affect her?

23 PROFESSOR AYNSLEY-GREEN: Very, very important question.

24 I hope the first way it will impact is through the

25 culture of what we are trying to do. Part of the

40



1 difficulty has been the fragmentation, lack of

2 coordination, and this becomes a cultural issue. We

3 have the means, especially through training, to affect

4 that; that would have been something that could have

5 helped her enormously.

6 I think the other issue is performance indicators

7 and the relationship of that happening in that

8 particular patch and having early intelligence of things

9 going wrong and intervention to address that.

10 MR GARNHAM: Thank you. Denise Platt, how will the NSF

11 impact on children's social services, do you anticipate?

12 MS PLATT: What I am hoping that the NSF will do, and it is

13 still in its determination, as Al just said, is in the

14 child protection field make it clear to each agency what

15 their individual responsibility is.

16 MR GARNHAM: Do you think that is not clear at the moment?

17 MS PLATT: Yes, I think people think their responsibility is

18 to help social services deal with child protection, and

19 helping and collaborating with social services on child

20 protection is a very significant responsibility for all

21 agencies, but in doing that you can forget as

22 a particular agency what your own responsibilities are,

23 and people have their own responsibilities as doctors,

24 police or whatever, and a collaborative responsibility.

25 What I want to see in the NSF is that it will make those

41



1 agencies' responsibilities clear.

2 MR GARNHAM: How?

3 MS PLATT: It will be spelt out for a start.

4 MR GARNHAM: If they read what will doubtless be lengthy

5 documentation they will understand better?

6 MS PLATT: They should understand better. I think the NSFs

7 at the moment, which are having a lot of impact in the

8 change in services, the vitality of them is in the fact

9 that they are not just glossy documents which people are

10 actually left to implement and make up what it means.

11 There is a process of milestones and support and

12 development, which is why we have clinical directors.

13 The NSF I am familiar with is the NSF for old people

14 where the clinical director and director for primary

15 care are out on the road a lot talking to people across

16 professions and, importantly, talking to the people who

17 are on the receiving end of the services.

18 I think the other thing that I hope that the NSF

19 will emphasise, and it is a very big part of its

20 development, is that children and families are very much

21 a part of its construction. What we have not talked

22 about around performance here is actually asking people

23 on the receiving end what they think of the service and

24 what good performance in services would be for them. We

25 have had presentations from children and facilitated

42



1 sessions presented to us from very young children about

2 what is very important for them in services for

3 children.

4 So getting professionals who are very used to

5 talking to each other and adults to talk with and to

6 listen to children and to hear their contribution in a

7 different way I think is a very important part of this.

8 I think that will also have an impact on how children's

9 social services develops.

10 MR GARNHAM: Christine Renouf, I imagine three cheers from

11 your corner at that last observation. First of all, am

12 I right about that? Secondly, have you seen any

13 evidence of it so far?

14 MS RENOULF: Yes, you are right. I guess I have seen some

15 evidence, particularly in terms of the work the direct

16 reviews have done over the years where they are talking

17 to users. We have a whole range of information

18 available to us that I think we do not use that comes

19 from users. Obviously there is the direct talking to

20 them, but there is also information we may have had

21 through complaints that we do not use, so I would like

22 to see us addressing that wider span of information.

23 I guess the other thing, coming back to what people

24 were saying about is performance monitoring and

25 performance management, are they the same thing, for me

43



1 they are integral. I guess where my focus would be is:

2 okay, managers have performance monitoring information,

3 what are they doing with that? How can they demonstrate

4 that practice has changed? If it has changed, what

5 difference did it make for children and young people?

6 The only way we will know is by asking them.

7 MR GARNHAM: Terence Grange, you are familiar, are you, with

8 the national standards framework at least so far and the

9 one now being produced for children?

10 MR GRANGE: No, I am not.

11 MR GARNHAM: Have the police been involved in its production

12 thus far?

13 MR GRANGE: I have only been involved in this area for

14 a year and it has never come across my desk.

15 MR GARNHAM: Al Aynsley-Green, how are you enmeshing the

16 police in this, if you regard their contribution as

17 significant?

18 PROFESSOR AYNSLEY-GREEN: We do have police representation

19 on our external working groups.

20 MR GARNHAM: Anybody with interest in child protection.

21 PROFESSOR AYNSLEY-GREEN: Most certainly, yes, from the

22 Metropolitan Police and --

23 MR GARNHAM: From the Met.

24 PROFESSOR AYNSLEY-GREEN: Yes. How we disseminate the

25 information across all police forces is a very important

44



1 question, and that is something we need to consider

2 further.

3 MR GARNHAM: If it is not reaching the ACPO lead on child

4 protection there is some breakdown, is there not?

5 PROFESSOR AYNSLEY-GREEN: Yes. We are at the earliest stage

6 of the consultation process. It is a very important

7 prompt I picked up already.

8 MR GARNHAM: I interrupted you, Terence Grange.

9 MR GRANGE: Not at all, you have just hit the classic block.

10 A particular force is involved in this; it is therefore

11 assumed that all 43 forces are involved, and that is not

12 necessarily the case.

13 MR GARNHAM: Is ACPO the route by which somebody like

14 Al Aynsley-Green should be involving all police forces?

15 MR GRANGE: It should be and probably is. I will make the

16 point, I have been involved in this area for a year.

17 I have not seen documents relating to this. I have just

18 read Al Aynsley-Green, his submissions, I did not see

19 the word "police" in it. All I can say is that I have

20 seen nothing, though in a year I have seen that much, it

21 is vaguely possible it would have passed me by, but I do

22 not think so.

23 MR GARNHAM: Thus far what effect are these new Government

24 initiatives having on the ground, those who are actually

25 carrying out work and talking to children and families?

45



1 Kathryn Grindrod.

2 MS GRINDROD: I think it is interesting from what is being

3 said about how things get filtered down to ground level

4 really, because I think a lot of what we are talking

5 about, about collating statistics at the ground level,

6 it often feels that you do not get feedback from that.

7 You do not actually know necessarily why the statistics

8 are being collated and you do not really know what comes

9 of them either. So I think it is important that that

10 information does get filtered down a bit more really.

11 MR GARNHAM: Thank you. Gill Rigg, are you aware of how the

12 national standard framework for children is going to

13 impact on your work?

14 MS RIGG: Yes, and I think it is fair to say that none of

15 the agencies around here now are stand-alone agencies.

16 All of our targets are interrelated and dependent on

17 each other to achieve them, certainly from social

18 services within the Quality Protects initiative.

19 I think what is important is to establish good local

20 planning arrangements, strategic planning arrangements,

21 so agencies can sit down together, share the issues they

22 have, share their performance targets and look at how

23 they are going to implement those locally. Certainly

24 that is the structure I have put in place, which I think

25 helps all of us with our performance management

46



1 frameworks.

2 MR GARNHAM: Al Aynsley-Green, what is the timetable for the

3 national service framework for children? When is it

4 going to be part of the everyday life of Kate Hallsworth

5 and Gill Rigg?

6 PROFESSOR AYNSLEY-GREEN: Can I repeat that we are still at

7 the earliest of stages of development. It is not

8 entirely surprising that many people may not be aware of

9 what is going on. We are engaging in a whole series of

10 issues in the course of the next year to try to engage

11 everybody as much as possible.

12 MR GARNHAM: When will they be engaged?

13 PROFESSOR AYNSLEY-GREEN: We have a whole communications

14 programme being developed. In terms of the delivery of

15 NSF, the first milestone will be at the end of this

16 year, when you recall that the Secretary of State

17 announced in Parliament in July that he wanted one part

18 of it accelerated, and this was the acute care and

19 hospital services for children, so we have one module

20 which is expected to be available by the end of this

21 year.

22 MR GARNHAM: Is that in response to Bristol?

23 PROFESSOR AYNSLEY-GREEN: Very much driven by Bristol. The

24 rest of the NSF is still in the gift of ministers in

25 terms of when they want it to be published, but we

47



1 expect some time in the next two years. You may say why

2 is so much time being taken? We have to get it right

3 this time. This is an important opportunity and we have

4 to make sure the foundations are right. To get

5 appropriate standards and consultation is a very

6 important part of that. So within the next two years.

7 MR GARNHAM: Thank you. Maurice Conlon.

8 DR CONLON: It is interesting to me that much of my insight

9 into this comes mostly from my experience as a GP,

10 perhaps more than my corporate experience, and that

11 alludes to what Kate was getting at about things being

12 relevant to ground level.

13 Also you mentioned earlier, the question was asked:

14 what makes an NSF non-negotiable? Of course its

15 credibility with people who are implementing it is

16 a vital part of that.

17 What I as a GP -- and perhaps Richard would give

18 a view on this -- what I would like to see in terms of

19 child protection in the NSF is something very simple,

20 which is that every health professional, social services

21 professional, police professional and every other

22 relevant specialist should be able to answer the

23 question: who is your immediate point of contact for

24 issues around child protection and, b, what is their

25 telephone number because -- I think it was Kate who

48



1 mentioned earlier about clarifying who is responsible

2 for what.

3 That is good and we must know what our

4 responsibilities are, but the risk of that is that you

5 get a complex document, and GPs, as a classic example,

6 have great difficulty reading anything more than one

7 paragraph long, and anything that is over one side of A4

8 very often gets filed for later reading, and you know

9 what that means.

10 MR GARNHAM: There is a filing cabinet on the floor shaped

11 like a bin, I imagine.

12 DR CONLON: Something like that. The relevance to my

13 clinical governance role is that we seek simple rules

14 and indicators which reflect a wider remit, and for me

15 this question, if it is answered in the affirmative in

16 90 per cent of cases, then it means that there is, must

17 be, a sensible system for child protection in that

18 person's area, and that that has been disseminated down

19 to grass roots level.

20 MR GARNHAM: Richard Cooling, agreed?

21 MR COOLING: Yes, I do actually on the whole. I think one

22 of the responsibilities that primary care organisations

23 can take on in this area is to ensure that there is

24 a child protection lead in each primary health care team

25 and that that lead is well supported and empowered to be

49



1 there as a resource for all the clinicians and other

2 staff who are actually attached to that primary health

3 care team.

4 It is unrealistic to expect a GP, unless they have

5 a particular special interest, to be that lead, and in

6 most teams -- in fact in our team these exist, but

7 virtually all of them are health visitors. The

8 important thing is that they are trained to supervise

9 and empowered, and a lot of organisations have

10 established senior health visitors who do not have a

11 clinical caseload who actually act as a professional and

12 supervisory resource for those people, and then pull

13 those people together on a regular basis for training

14 and support.

15 If you go back to the issue about the GP, the GPs

16 know who they are and, as Maurice says, know who they

17 are, know their phone number, then you have a very

18 valuable resource. I would agree with a lot of the

19 comments that have come out from this session this

20 morning that the problem with child protection is not

21 that you want to have more sort of tick box indicators

22 but actually you want to improve the quality of how that

23 individual practitioner, whether they are a social care

24 or health care practitioner, is working with those

25 individual families. That is a much more difficult

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1 issue to measure.

2 MR GARNHAM: Barbara Street.

3 MS STREET: Can I commend to the Inquiry the Carlisle review

4 which took place in Wales earlier. I think this is

5 highlighting the issue that has come about, about

6 practising in different areas of the country. I do not

7 know when this is appropriate, to say things about what

8 is happening in Wales, but there are developments which

9 would be useful for you to know about.

10 For example, we are about to go on to next month All

11 Wales National Child Protection Procedures, which have

12 been developed on a multi-agency basis. They grew out

13 of the procedures that were developed on a multi-agency

14 basis in South Wales, in the South Wales police area.

15 We have a regional ACPC forum based on the four police

16 areas in Wales which work together to develop joint

17 protocols, and we have learned a lot about joint working

18 and monitoring performance. We have standards which

19 cross South Wales, for example in monitoring child

20 protection processes.

21 The Carlisle review, which has 150 recommendations

22 about child protection in the NHS, is a major document.

23 I never hear it talked about in the national press. And

24 I think that is an interesting comment on how we can

25 become isolated geographically and isolated