In this exclusive guest blog for CYCJ, Fiona Duncan (Chair of The Promise Scotland) reflects on Scotland’s care review journey so far, the thousands of voices that shaped this and the change that is happening to make sure The Promise to our care community is kept.
“The true meaning of life is to plant trees, under whose shade you do not expect to sit.” Nelson Henderson
In October 2016, the First Minister announced ‘an independent, root and branch review of Scotland’s care system’. Speaking directly to care experienced young people she made clear their stories led to the review, their experiences would drive it, and its purpose would be to ‘help make their lives better’.
Like many countries with a ‘care system’, Scotland knows the outcomes of children and adults who experience it are not equal to their non-care experienced peers. Over the years, despite successive governments commissioning reviews, transformation has never happened.
Could the care community dare hope for something different?
In February 2017, I was appointed to Chair the Independent Care Review and work began to put the care community at its heart. This involved designing an approach, including governance, to make the Review’s primary focus the experience of care, not the system – and demonstrate publicly its principles and values. No previous review had taken this approach.
The Review created lots of opportunities and choices to get involved, aiming to be open, engaging and warm, listening carefully and lightly directing conversations to fully understand what needed to change.
In order to meet babies, infants, children, young people and families as often as was wanted and needed to build trust, and in spaces where they were comfortable, felt safe and able to speak openly, the Review travelled the length and breadth of Scotland, many times. Who Cares? Scotland had campaigned to secure the Review and was commissioned to continue its 1000 voices work.
Targets were set across age, ethnicity, gender, care setting, geography – and more – to ensure accurate representation. The uniqueness of each and every experience of care – and there were around 3,000 – was respected. The Review acknowledged that for many, their story involved the most traumatic and intimate details of their life and made sure that everyone who took part knew there was free and confidential counselling available.
By listening intently to what mattered to children and young people and their families, two things were increasingly clear:
The first was that many urgent, day-to-day changes could be made without a review: Scotland’s ‘corporate parents’ already had duties and responsibilities to fill. Who Cares? Scotland’s analysis of years of advocacy showed the persistent lag between what should be happening and what was happening.
So, from May 2018, after analysis of the stories heard over the previous 15 months, the Review created a STOP-GO programme to help make sure children and young people did not need to wait until the end of the Review to get support and services they were already entitled to. The Review worked with all of Scotland’s 32 local authorities on 34 areas of practice that either had a negative impact so must STOP, or were good so required to progress GO, or be accelerated. This allowed councils to demonstrate their intent to act, to be restorative and it began to change their focus from primarily or solely alleviating system pressures, towards the experience.
Secondly, the Review was hearing how re-traumatising and stigmatising it is to tell and re-tell your story. That led to a conclusion in the promise that: ‘Scotland must never again have to commission a review or a Judicial Inquiry on this scale because participation and listening must form part of everything within Scotland’s system of care’.
It also led to the creation of 12 composite stories. Careful analysis of every single story heard, grouping and sorting by experience and outcome led to the creation of new stories which represented everyone and no one individual, all at the same time. Huge care was taken to devise the composite stories, right through to the names selected from the National Records of Scotland ‘most popular’ lists for the years of birth of the person in the new story. Before being finalised, they were checked by care experienced young people against their real-life experiences, and those of their friends – the stories gave them ‘the feels’ and they saw themselves and others they knew in each one.
Over 2,000 members of the paid and unpaid workforce also shared their experiences with the Review, with many talking about how their personal experience had led to their professional work. A range of engagement options was developed for specific groups; like a bespoke survey to gather social workers views. Furthermore, around 500 organisations worked specifically with the Review sharing their experiences of working in and around the ‘care system.’
In addition, the Review team, which was based at Strathclyde University, analysed 943 sources of research and commissioned new research into under-understood areas including intergenerational cycles of care and the direct link between leaving care and homelessness. It also tracked and linked to the varying government commissions, inquiries and reviews with shared constituencies to establish overlap and avoid the risk of duplication of ‘consultation’ or work, and divergence of findings. This was welcomed and supported joined-up thinking. For example, the Review and the Homelessness and Rough Sleeping Action Group both recognised the disproportionate number of care experienced people in the homeless system and devised complementary conclusions on how to prevent this.
When she announced the Independent Care Review, the First Minister accepted Who Cares? Scotland’s challenge to listen to 1000 care experienced young people over the coming two years. This created an assumption that this would also be when the Review would conclude.
But hearing from everyone who wanted to be heard and closing the ‘feedback’ loop to make sure everyone knew how their story would change Scotland, took an additional year. It was critical that the Review made sure everyone was heard – whilst driving change through STOP-GO – rather than to meet an arbitrary government deadline.
It would also allow for all learning from previous reviews to be firmly embedded.
Many reviews ‘admire the problem’ and state – once again – what is wrong. Not only is that approach backwards looking, the language of ‘problem’ jarred with what the Independent Care Review heard from the care community – who had all too often been told by representatives of the ‘care system’ that they were the problem. Most previous reviews had examined only a discrete part of the ‘system’, reviewed and polished it, only to drop it back in to be swallowed and subsumed. This is not surprising when you consider that Scotland’s ‘care system’ is no system at all. Rather it is (as per the report the rules), ‘a complex, fragmented, multi-purpose and multifaceted entity’; ‘underpinned by 44 pieces of legislation, 19 pieces of secondary legislation and three international conventions and straddle six out of nine Scottish policy areas’.
All ‘roots and branches’ had to be properly and fully examined and the Review worked independently and without fear or favour; across sectors and disciplines, connecting with all relevant agencies, understanding policy silos, rigid adjacent systems, and restrictive rules.
When past review recommendations fundamentally questioned organisations or individuals’ reason for being or criticised practice and culture, typically there wouldn’t be across the board ‘buy-in’. Instead, resistance, dissent and challenge were aimed at what was seen as top-down diktats. This resulted in an unwillingness to change, which thwarted any possible progress. Even when presenting a solution that was met with an eagerness to change, very often this was matched by a lack of ability to make that change happen without the cooperation of others and/or a lack of know-how, skills and confidence.
These insights emphasised that the Review had to get those organisations and individuals who needed to change ‘on board’ (whether in agreement or not) and this was best achieved by an appreciative inquiry approach which occasionally challenged my self-regulation (and sometimes gave me an eye twitch). It also had to develop a comprehensive knowledge of all the bridges and barriers to change.
Like most reviews, an understanding of the economics was essential. In May 2018, during a GoTo Group (care experienced peer review of the Review’s intentions), a brilliant woman talked about how the lifelong cost of care is borne by the person who experienced it, not the system – yet there was no way of calculating this. From this point onwards, the Review aimed to quantify the human cost of care, including what happens when people don’t get the help they need, when they need it, throughout their life. The report follow the money details the innovative approach and the money report narrating the alternative.
Fundamental to this, was the need for the Review to fully understand and clearly articulate the lasting impact caused by the trauma of being removed from family, friends and community. This required the conversation about ‘risk’ to move beyond how to mitigate the possible risks to a child of staying in circumstances that the professional thinks may not in their best interest, and the risks to the professional’s career in terms of the decision they take.
And of course, the Review was repeatedly challenged.
By custodians of the ‘care system’ very used to having a seat at the table and holding power. By those who felt the Review was outside its ‘tramlines’ when it explored the relationship between poverty and neglect, or with the justice system, or education, or substance misuse. By those who felt that attributing the failures of the system directly to the system – and not the individual – was wrong. By those who objected to the surfacing of the structural discrimination embedded in the system. By those who felt the process was not important, was taking too long and should instead be all about the outputs.
I really could go on and on and on…
Despite the First Minister’s announcement of something no other country ‘has ever done before’ some people clearly expected a traditional review – timebound, partial, top-down, centred on the system not real life, and with little understanding of what gets in the way of change. But the challenges the Review received were all welcome, as they allowed for explanations about how it had to be different.
Also, unlike many other Reviews, draft reports were not shared for comment or edit with the Scottish Government sponsor team, and Scottish Ministers were not given sight of any developing draft, with only the First Minister and Deputy First Minister seeing the finalised printed reports.
On Wednesday, February 5, 2020 the Independent Care Review’s conclusions were accepted in full with cross party support and got a trending-on-twitter-sized outpouring of commitment to change from the ‘custodians’ of Scotland’s ‘care system’. The level of media coverage dwarfed the original announcement. More importantly, the photographs from both show the faces of the same care experienced people. They also showed all political parties who gave the Review private and public support throughout – something that stands at the time of writing with a commitment in their manifestos to #KeepThePromise.
The Promise was made.
And met with a heady mix of celebration and scepticism from the care community. Rightly so – although the conditions were set for change and some of the moving parts had started to move, there was still a long way to go.
Again, unlike a typical review, the Review’s conclusions don’t have numbered recommendations – too hierarchical, and too optional. Nor do they call for a change from ‘this to that’. That lack of specificity was not expected but was welcomed – although not universally.
The question ‘why not?’ recurred. For example, ‘why [did the Review] not increase the age of ‘eligibility to remain in a care placement’ from 21 to 23, to bring it in line with ONS data that showed people are living with their parents for longer than they used to?’
You only have to listen to those individual, unique, real-life stories to understand why not.
The Swiss psychiatrist and psychoanalyst Carl Jung put it beautifully in The Undiscovered Self, when he noted that if he’d weighed each pebble on a beach and found the average weight was 145 grams, not only would it tell him very little about the real nature of the pebbles, it might well be true that – however long someone searched – they would not find a single pebble weighing exactly that.
For the care community, that shift from 21 to 23 requires everyone to fit into the ‘care system’s’ ideal average – and to do so on their birthday. One size doesn’t fit all and as the promise makes clear, the individual and their uniqueness is more important than the system’s metrics.
Today it is the change still to come that matters, and no-one expects it to be easy, but the Review very purposefully built a coalition around a shared vision to be realised through collaborative implementation. And last month, The Promise Scotland was constituted specifically to oversee and support the change the Review demanded – another first.
In late March 2021, Plan 21-24 was published with contents derived from over 100 organisational submissions to The Promise Scotland outlining what changes they need to make to meet the ambition of the promise.
Change is happening right now – with the care community at the centre from the traditional ‘top-down’ plus the less traditional, ‘bottom up’.
In the coming months, The Promise Scotland will publish the first of nine rolling Change Programmes translating each what from Plan 21-24 into by who, by when and how.
This isn’t to build a new ‘care system’, rather it is about building a country that cares, made up of services that work to meet the needs of children and families where and when they are needed.
When Scotland lives up to its commitment ‘where children are safe in their families and feel loved they stay – and families are given support together to nurture that love and overcome the difficulties which get in the way’ then those to whom The Promise is kept will know only care and compassion, not a ‘care system’ – but may never know that transformation was powered by the generosity and selflessness of all those who shared their stories with the Independent Care Review in hope of change for people they may never meet. Those who planted that tree, knew from their experience exactly where it needed to take root, and just how far its branches needed to spread.
And for those children who can’t live with their own family and, as per UNCRC Article 20, ‘have the right to special protection and help’, the promise to them will have been kept. They will ‘stay with their brothers and sisters where safe to do so’, ‘belong to a loving home, staying there for as long as needed’, ‘be listened to and meaningfully and appropriately involved in decision-making about their care’ surrounded by ‘a compassionate, caring, decision-making culture focused on children and those they trust’. Their individuality must be cherished and nurtured.
Between now and then we must continue to be impatient for change.
[The Independent Care Review published an Evidence Framework in summer 2020 that summarises its methodology, research, the STOP-GO work etc. etc. – it is 1700 pages so let ‘control F’ be your friend. The composite stories are all on youtube]
About our blogger
As Chair for The Promise, Fiona brings significant professional experience and expertise, passion and determination to make change happen for children and young people, and personal experience and insight of the care system to the role. Fiona is the CEO of the Corra Foundation and has over 20 years’ experience working in the voluntary sector in Scotland as well overseas. Read more.