What does the Care Review report say?

The independent care review report has made a number of recommendations, which Nicola Sturgeon has said the government will implement to encourage a sea-change in the ethos of Scotland' care system.

Nicola Sturgeon with some of the 1000 care experienced young people she has met with over the last three years.

"The Promise", as the care review report is entitled, says the ‘care system’ is currently a "complex, fragmented, multi-purpose and multifaceted entity" underpinned by 44 pieces of legislation, 19 pieces of secondary legislation and three international conventions and straddles six out of nine Scottish policy areas. As a result, it says, this is not a "care system" but a labyrinth of legislation, policy and practice which does not reflect the needs of Scotland’s children, makes "cohesive operation impossible" and "creates disconnects into which children, young adults and their families can fall."

The report outlines a number of areas where organisations and institutions must "radically rethink" their underlying purpose and structures, including the Children’s Hearings System, foster care, residential care and secure care. The government must therefore create a "clear legislative, environment" that supports "families to stay together and protects and allows relationships to flourish".

It also states that families must be provided "with support that lasts as long as required, with the collective acceptance that for some families this will be a long-term commitment".

It says decisions about support must involve children and families with a focus on meeting their needs, as opposed to the system’s needs - and it must become much more common for families to be supported to stay together.

Overall, it says the children and young people at the heart of the system must be properly listened to and heard as there is not a single way through the system and that children must not experience unnecessary moves.

Decision making must also take account of what those closest to children report, rather than relying on a professional hierarchy. Many in the workforce who are close to children have expressed concerns that they have been ignored in decision making processes so "Scotland must challenge power dynamics within all decision making processes to achieve a balance which ensures all decisions taken are in the best interests of the child."

Other recommendations include a "collective acceptance that there will be some families who will require long term support that goes beyond what is current normative practice." That there must be "holistic family support and individualised planning with the principles of ‘one family one plan’ wraparound support for all families in and on the ‘edges’ of care."

And if children are removed from the care of their parents, Scotland must not abandon those families. Families must continue to be provided with therapeutic support, advocacy and engagement in line with principles of intensive family support.

The review also recommends that care experienced children must not be excluded from education or "reduce their timetable to such an extent that they are denied their rights to education. The formal and informal exclusion of care experienced children from school must end."

When a young person turns 18 during their time in secure care, there must not be an automatic transfer to a Young Offenders Institute and that Scotland "must strive to become a nation that does not restrain its children."

Further the use of professionalised language to describe meetings and experiences should stop. "As one example, children must not be told they are going for ‘contact’ when they see their mum or dad" as it can lead to low self-esteem and a self-stigmatisation.

Scotland must stop selling care placements to local authorities outside of Scotland which is a breach of their fundamental human rights, and the report adds the "monetisation" of the care of children must be avoided, and the government should prevent the marketisation of care.

Asylum seeking children must also be treated as "looked after" children and be placed in caring, supportive settings.

Timetable

The care review winds up in March, and before then it will host a planning meeting with agencies with responsibility for delivering the current ‘system to increase awareness and understanding of The Promise and lay out the schedule - which it calls "The Plan" to meet its aims.

It will also identify the changes which must happen nationally and those that can happen locally and be incorporated effectively into local planning arrangements.

Next it wants the Scottish Government to resource The Plan starting with establishing a team of planners, public service designers and systems-change experts that includes care experienced people to oversee its development.

A schedule of planning meetings will be sequenced with key dates, such as existing national contracts, significant procurement and commissioning arrangements, as well as local planning timeframes. It will also include the optimum date for legislative reform.

By the end of November there should be "one cross-sector, multi-agency, collectively-owned Plan" which will outline how to realise all the calls for action in The Promise, across an agreed timeframe, and no later than 2030.

The terms of reference for an independent oversight body of The Plan will be ratified and an independent Chair and its members recruited.

Years two to four would see the bedding down of change, with early intervention and prevention becoming standard and the obsolescence of crisis services started. The necessary legislative reform should also be underway to make sure a practice and culture change programme is embedded.

In years five to seven there should be consolidation and a midpoint review carried out to ensure pace and performance is on track. While in years eight to ten there should be continuous improvement and all targets achieved. The majority of crisis services will have become obsolete. "The Promise" will be delivered and the independent oversight body will cease to exist, giving way to a new standard of care.

Independent oversight body

The review has asked for the creation of an independent oversight body with at least 50 per cent of its members being care experienced including the person who chairs it, and this body will establish "a fit-for-purpose governance structure to hold to account those responsible for making change".

The new body, which will be charged with protecting the changes the review has demanded be made, will submit a report to the Scottish Parliament every year, and will develop, approve and monitor targets across the delivery timeframe.

Ultimately, however the independent oversight body will cease to exist once the realisation of "The Promise" - the report of the care review - is fully achieved.

Costs

The review says that "integral to managing the many competing demands will be appropriate allocation of resources." It says realising "The Promise" will require "diagonal budgeting" so money does not stay in silo budgets and is re-allocated to prioritise investment in services with a focus on early intervention.

It states that working to its recommendations, a model of costs over the duration of the changes, should quantify the upfront investment and subsequent savings over time.

It admits there is a need for "significant investment" at the beginning of implementing the changes to ensure there is the necessary resource to deliver the recommendations.

Between November 2020 and March 2021, the work on a budget for implementing "The Plan" 2021/22 should be undertaken with accelerator funds secured.

The report also says financial support to kinship carers must match that of foster carers.

Legal questions

According to the review, Scotland must also "consider the creation of an accredited legal specialism to set standards for legal professionals representing children. Those standards must uphold children’s rights, understand trauma and attachment and how to operate in a setting that seeks to uphold children’s well-being. There must be ready access to legal advice and representation when aspects of the ‘care system’ go wrong. There must be clarity about where care experienced children and young people can turn for legal redress.

The Care Inspectorate and the SSSC must come together with other regulators to create "a new, holistic framework that values what children and families value." That framework must apply to the totality of care experience and include aftercare and advocacy services.

Workforce

The review also tackles the thorny issue of how involved professionals should become with children and families. It states: "There are many stories of a teacher or another professional in a child’s life providing a key relationship that has helped the child to recover. These are vital relationships that must be enabled.

"The wider workforce must feel they have support and permission to connect and build unique relationships with children in their care, according to the needs and wants of each child. Too many times, notions of professionalism have got in the way of the development and maintenance of relationships

"Fear and complex bureaucracy is preventing the system from doing what children need. Individuals and organisations are fearful of what might happen when things go wrong and of being held responsible when professional guidelines or procedures have not been followed correctly. Staff can feel they are risking disciplinary action if they go above and beyond their express duties to act in kindness towards children in their care.

"There must be a complete overhaul of regulation and scrutiny that centres on listening to children about how they are cared for, their ability to flourish and thrive and that measures the things that matter to them."

It adds that midwives and health visitors work "must be well resourced and have sufficient capacity so that families can be well supported in the early days of parenthood", and that "residential care staff must be recruited on the basis of their values rather than educational levels".