Keeping the promise: one year on from the care review
We’re now one year on from the high-profile care review, which was intended to be the review that finally changes the care system for good, and not much has been heard about it since.
After the publication of the seven review reports on 5 February last year, the care review morphed into The Promise, a ten-year programme that will run from 2020 to 2030 to implement the action points of the review. Then came COVID.
But while we might not have heard much about it, plenty has been going on behind the scenes.
“I suppose we haven’t been shouting an awful lot about the things we’ve been doing because we’re really conscious that folk are in the middle of a global pandemic,” says Fiona Duncan, who chaired the care review and is now heading up The Promise.
“And also, I think we want to say something when there’s something useful to say … We didn’t want to give a narration of The Promise’s life, but we’ve been busy.”
This has included winding up the care review, setting up The Promise team, running engagement sessions – it has had 100 people sign up to its webinars, over 100 submissions from different organisations and around 100 applications for the oversight board, which will oversee the implementation of the review.
It has put together The Plan, which will set out what will happen over the next three years, as well as a change programme, which details who is responsible and when.
The oversight board, half of whose members have experience of the care system, met for the first time last week and at its next meeting it will look at The Plan and the change programme.
All going well and assuming the oversight board is happy with The Plan, it will be published in March, setting out what will happen over years two to four of The Promise.
The Promise Partnership fund, which will support increased capacity in the system and new initiatives, launched this week.
They have also been planning The Promise Design School, which will train those with experience of care, and others, in the Scottish Approach to Service Design so that they can think like service designers in planning changes to services.
Alongside this is the Pinky Promise Design School, which will bring together younger children with experience of care to ensure their wishes are not missed out.
Duncan says she’s “more excited about [that] than anything else ever,” and one council has even been so brave as to promise that whatever the children ask for, it will do.
The care review has 80 different action points, but Duncan underlines that these are not called ‘recommendations’ and they were deliberately not numbered so as not to suggest that some are more important than others.
All must be implemented. She points out that a recommendation “feels entirely optional”, such as when you recommend a restaurant.
The order and timescale of implementation are not about importance but about sequence, based on what needs to be in place before something else can be done.
She likens it to setting up dominoes where you knock down one and it hits two more or to making a cup of tea: “Just because the first thing I do is put the kettle on or put water in the kettle, that doesn’t mean that that’s the most important.”
“We’re basically saying even if something has to happen later, it is still of critical importance. So it’s comprehensive,” she adds.
Duncan won’t be drawn at this stage on what will be in The Plan, since it is still to be approved by the board, but early actions are likely to include work to improve holistic care around children, young people and families.
Preventing children being taken into care is one of the aims of The Promise, as well as improving care for those who are taken into care.
And work has begun on this already. Thomas Carlton, who is The Promise’s implementation lead, says that councils are already thinking about how they can do things differently.
“A number of local authorities are telling us and demonstrating what they are trying to do to build on some of the stop-go commitments that they’ve made, and then begin to understand where they can begin to consider how they will be able to keep The Promise in more of its entirety.
“So some local authorities have done some great things in relation to the real challenge that Scotland has about keeping siblings together, and also beginning to understand how they continue to support children within their care but offer a level of support that is more joined up for their parents.
“That is a shift that I feel has happened following the conclusion of the review, when actually children and family services are beginning to accept the fact that even when they have the child solely in their care, that there is a responsibility there as well to the family of origin to which that child may return to at one point, but [the child] also benefits from knowing that their family’s taken better care of.”
Better data has also been highlighted as important to the success of the care review, with not enough at the moment showing whether services are actually successful from the child’s point of view, while more work will also need to be done on funding that centres around the child rather than individual services with their own silos.
This fits in with work the Scottish Government’s been doing to budget around wellbeing, children’s rights and different financial models.
Duncan says they were “really taken aback” at the cross-party support and the outpouring which trended under people making a commitment to keep the promise and since then the Promise team has been “working really hard to turn that vision into a reality”.
Duncan says: “A chief exec tweeting, ‘I’m going to keep the promise and we were glad to be part of the care review’ means nothing unless they do keep the promise.
“So we’ve been trying to continue to hold people to account to make sure that they do that, but in a way that reflects what the care community said.”
Scotland often has an implementation gap between intention and reality.
The care review is one of several since the creation of the Scottish Parliament and Duncan asked previous review chairs why their reviews hadn’t stuck.
She got a long list of reasons, but among them was that people didn’t know how to implement the recommendations, so The Promise will have a key role in supporting organisations in planning what action to take, which is where Carlton’s team comes in.
Duncan says that from the response they’ve had so far it’s clear that some organisations are not sure where to start, but both Duncan and Carlton are convinced that the will for change really is there, even with the challenges of the COVID pandemic.
“I think that what we’re seeing in the information that’s come back from places is quite a mixed bag,” says Duncan.
“And I think it’s fair to say that some organisations/local authorities maybe haven’t had the time or capacity to dedicate to coming up with a great articulation of their ambition, and in fact some of them are really beautifully articulated, but actually possibly aren’t as full of activity, others are full of activity and not that beautifully articulated.
“Some of them, I think it’s fair to say, they don’t know what they should be doing … So we’re trying to do that thing where we’re building communities of interest and creating conversations around achieving things.
“But what I don’t think we’ve seen is a lack of commitment.”
The pandemic might have been expected to hamper progress in implementing the review, and certainly it’s created more poverty, which increases the risk of more children being taken into care and puts more pressure on services, but Duncan also finds some positives that she believes might in fact speed up the rate of change.
“I think COVID has also shown that things that were previously impossible to do are now possible, so it could challenge the pace of change in a positive way, increase the change.
“I think the other thing that has struck me around the pandemic is that, again, this is maybe a bit reductive, but typically the people who were delivering the service didn’t have a great empathy or understanding of the person who was in receipt of the service.
“And I think COVID has [created a situation where] we’re all in this together, we’re all worried about somebody in our family or in our friendship group who’s got a health condition, or folk are concerned about home schooling, we’re all worried about this.
“It’s not a, ‘Oh, I’m doing this to you because your circumstances are challenging and mine are fine’.”
But while there is widespread commitment to implementing the actions of the care review now, one of the challenges for the team is keeping the commitment going for the ten years it’s going to take to make all the changes – after which Duncan intends that The Promise will have made itself obsolete.
A decade is not a long time to implement a complete system change, as Duncan points out, but it is a long time in the life of a child and the intention is to frontload as much action as possible. But the emphasis within the Promise team is on getting it done, however long that takes.
Carlton says: “I would hate for this to become very reductive in saying, ‘Oh, we’ll put in this timescale,’ because I think it would miss the opportunity of this country beginning to actually get it right for its most disadvantaged population, historically and currently.”