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Delivering on a promise: the Independent Care Review

Independent Care Review Fiona Duncan (far right) launching the report. Image credit: Care Review / Gold Visuals

Delivering on a promise: the Independent Care Review

Pink paper hearts were thrust into the air and First Minister Nicola Sturgeon’s voice trembled as she delivered an emotional announcement: “Every young person deserves to be loved, so let’s come together and make this commitment to love our most vulnerable children and give them the childhood they deserve.

“Children don’t need a system that stops things happening to them, they need a system that makes things happen for them.”

This was the moment, at the 2016 autumn SNP conference, that the FM announced an “independent root and branch review of the care system”, driven by care experienced people. “This is not something that any country has done before, we will do it here in Scotland first,” she said.

After three years, the Independent Care Review has delivered its verdict on Scotland’s care system.

Five and a half thousand people from across the care system were spoken to as part of the expansive review, 2,500 of those being children and young people with lived experience in care.

The Scottish Government awarded more than £5m to the review to complete the work, with half of that budget spent on participation and engagement.

The review is damning in its condemnation of the current system, and extensive in its recommendations for the future of care. It found that care in Scotland is “fractured, bureaucratic and unfeeling” and does not “adequately value the voices and experiences of those in it”.

The review’s six reports contain five “foundations for change”: voice, family, care, people and scaffolding, with 80 specific changes to “transform how Scotland cares for children and families”.

When announced as chair of the review, Fiona Duncan, Corra Foundation chief executive and herself care experienced, said: “I paused”.

“In the seven preceding years, there had been six reviews into how Scotland cares for its children,” she writes in the review’s foreword.

“Wise people had already documented the problems with the current ‘care system’ and worked hard to establish what needed to change. Yet their recommendations, based on a wealth of knowledge and understanding, did not lead to wholesale change.

The Care Review had to be different, starting with an unwavering commitment to make sure the care-experienced community would be at its very heart

Holyrood meets Duncan inside a busy café near the Scottish Parliament, a few days before the review’s findings are publicly released.

“What we did was look at what matters to children and young people throughout their lives, before care, in care, after care, in order to understand how this operating environment has to change to fit children, rather than how children have to change to fit in,” Duncan explains.

“We’re proposing a completely new apparatus in Scotland to pull together the Scottish Government, local authorities, charities, national bodies, to build one sequenced time-bound plan.

“And that plan has some urgency about it. It will probably take ten years for this change to happen, but that doesn’t mean that folk can sit on their arses in years one to nine and then make the change in year ten. We’re losing childhoods, so we have to do this quickly.”

So, Holyrood asks Duncan, is this really the “review to end all reviews?”

“It would be really glib of me to respond to that in any other way than – I honestly think it would be morally reprehensible to do this again,” she replies. “I think we have to do it this time, I don’t think that we can have another review in five years’ time.”

The review’s six reports consist of ‘The Promise’: setting out specific examples of problems and then recommendations to fix those problems; ‘The Pinky Promise’: a child-friendly version of those recommendations; ‘Follow The Money’ and ‘The Money’: the human and financial costs of the care system and future investment; ‘The Rules’: how the legislation and system must change; and ‘The Plan’: what must happen now that the review is coming to an end.

Among the review’s “calls to action” is one for the Care Inspectorate and Scottish Social Services Council to 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. A new framework must be totally focused on children’s experiences and their ability to find and sustain safe and nurturing relationships,” ‘The Promise’ report states.

The review recommends that Scotland should move towards early intervention and prevention services, and that “acute and crisis care services must be phased out”.

“As the number of children and families requiring a service reduces, the service must become obsolete or be refined so that it meets current and future need. The approach must be that care meets the needs of the child and their family.”

The care system is currently underpinned by 44 pieces of legislation, 19 pieces of secondary legislation, three international conventions and straddles six out of nine Scottish policy areas which, the review said, makes “cohesive operation impossible and creates disconnects into which children, young adults and their families can fall”.

Duncan tells Holyrood: “All of these bureaucracies, all of these decision makers, with all of their language and all of the acronyms and all of their different settings...result in families getting lost in bureaucracy.”

On legislation, the review recommends that Scotland creates “a clear legislative enabling environment that supports families to stay together and protects and allows relationships to flourish”, with the UN Convention on the Rights of the Child to be used as the “bedrock upon which legislation is based”.

Further, it recommends the creation of “an accredited legal specialism to set standards for legal professionals representing children” which will uphold children’s rights and understand trauma.

Several changes are proposed around the Children’s Hearing System (CHS), which is heavily reliant on volunteers. Children and families told the review about inconsistencies in terms of panel members and decisions taken, and the pain suffered around retelling difficult stories. Panel members themselves said they felt unsupported and inexperienced to manage the cases before them.

The review recommends the CHS should “plan to shrink and to specialise”. “Full and proper consideration of implications for the operating model, including the dependency on volunteers, must be integral to this planning.” It recommends everyone involved in the CHS is properly trained on the impact of trauma, childhood development, neurodiversity and children’s rights.

Care experienced children and adults must have “the right and access to independent advocacy at all stages of their experience of care and beyond”.

Secure care must be “fundamentally” rethought, with more alternatives for community-based support and monitoring, to ensure that some children spend less time in secure care, with the review finding: “Children must not be held in secure care because there are inadequate options for them within the community.”

Specific residential, therapeutic settings for girls who have been sexually abused or exploited must be developed, and 16 and 17-year-olds must be accommodated in secure care rather than young offenders’ institutes.

Children’s voices must be listened to and they should be “meaningfully and appropriately involved in decision-making about their care”.

Children should be able to live with their siblings if they so choose, and “brothers and sisters” must be understood to include half, step and adoptive siblings, accompanied by a “strong legal framework that acknowledges, protects and promotes brother and sister relationships” including the right to time together, participation in decision-making about their siblings and clear rights to appeal.

Care should not be “monetised or marketised” and how Scotland commissions its services must change. Duncan says there are “significant challenges around how we commission services”.

At the moment, we’ve got an approach where we are awarding contracts to the lowest bidder. What does that say about how we value children and how can we expect that organisation to deliver high-quality care if they’re doing it on a shoestring?

On financial investment, economist Dr Katherine Trebeck, who helped build ‘The Money’ section of the review, told the launch event: “So much of current investment, fiscal expenditure, goes into trying to put sticky plasters on the damage.” She added that the review’s proposals are “absolutely possible” if the way that money goes in and out of the system is reassessed.

The review proposes creating an independent oversight body “with at least 50 per cent of its members being care experienced including its chair”. That group will establish “a fit-for-purpose governance structure to hold to account those responsible for making change” to the care system, with a report annually submitted to the Scottish Parliament. A timeline has been attached to this, as has a request for “significant investment” in the beginning.

Before the review concludes at the end of March, a planning meeting will be held with responsible agencies to lay out the schedule to produce ‘The Plan’ proposed by the review. “It will also identify the changes which must happen nationally and those that can happen locally and be incorporated effectively into local planning arrangements,” the review states.

The review says the Scottish Government will resource ‘The Plan’ by establishing a team of planners, public service designers and systems-change experts including care experienced people to oversee its development. Before November 2020, the planning team should have produced “one cross-sector multi-agency, collectively-owned plan” outlining how to realise calls to action, with an agreed timeframe no later than 2030.

A blueprint on the remaining nine years of ‘The Plan’ lists its “headline” priorities: from April 2021 to March 2024, early intervention and prevention are to become standard “with obsolescence of crisis services commenced”; necessary legislative reform should be underway; and a practice and culture change programme should be embedded.

From April 2024 to March 2027, a “midpoint review” of ‘The Plan’s’ progress is recommended “to ensure pace and performance is on track”, and the recommendations in ‘The Promise’ should be realised. From April 2027 to March 2030, “all targets will be achieved” with the majority of crisis services having become obsolete, ‘The Promise’ will have been delivered and the independent oversight body will cease to exist, “giving way to a new standard of care”.

Just hours after the review was released, Sturgeon announced her commitment to implementing the review’s recommendations.

She told the parliament it was “one of the most important moments in my tenure as First Minister so far”.

“We will act straight away to implement ‘The Plan’ section of the report. There are two key immediate elements to this, the first is the establishment of a team to take the report and turn it quickly into a detailed delivery plan. The second is the creation of an independent oversight body. I can confirm that both groups will include people with experience of care.

The responsibility that we owe to people in care is a very special one. Today’s report makes the need for action overwhelmingly clear.

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