Monday, March 17, 2008

Cameron’s unsure start

David Cameron has come up with a great ‘family-friendly’ policy: redistribution to new babies and away from slightly older children. He says:

Labour are planning an increase in outreach workers at Surestart centres, as one way of supporting parents with young children. That's their idea. But money is tight and we've got to make choices. So I believe that instead of more untrained outreach workers, we need more trained professionals who really know what they're doing. They exist already. They're called health visitors.

He proposes more health visits for families, focused most regularly in the first few months of a child’s life. No doubt at all: that would be a good thing. But, as he says, money is tight, and so he wants to cut the extension of outreach services, focused across a wider age range, that will have been implemented by the time he gets to fight an election.

No doubt at all: that cut would be a bad thing.

He cavalierly waves that away as not really important, insinuating that these outreach workers aren’t “trained professionals who really know what they're doing”. Certainly, they’re not trained as health visitors, but that’s not their purpose. Their role is to make home visits to parents of young children, offering information about services available and families’ entitlements, as well as advice, advocacy and support in navigating the system. They can also refer families to more specialised professionals – such as health visitors.

A report [PDF] assessing Sure Start outreach services gives lie to the insult that these workers are bumbling amateurs:

The components of training for outreach staff are extensive, since these workers need to be prepared to respond to a whole variety of questions and needs. Typical ingredients include courses on domestic violence, child protection, first aid, confidence building, peer support/breast feeding, drugs, Islam awareness training, child and adolescent mental health, early childhood and learning, baby massage, baby yoga, speech and language, signs and symptoms of postnatal depression and general mental health.

Some of this I admit I roll my lefty eyes at: baby yoga the world could surely live without. Most of the rest seems reasonable, though – including, to my distaste, Islam awareness. But to imply that outreach staff are little use is as dishonest as would be claiming that health visitors know about nothing other than health issues.

Cameron claims that his plans to divert resources into health visiting are popular: “it's not surprising that overwhelmingly, parents say it's this kind of help and support they want”. It’s not surprising that a politician claims public support for his plans. But the truth may not be so straightforward, according to the assessment:

there are local variations in what is acceptable in the way services are delivered. Some areas report that non-professional home visitors are not acceptable, whilst professionally qualified staff are. In others the reverse is reported. In some areas professionals are considered threatening (especially if there is an association with Social Services Departments) and paraprofessionals from the local community are welcomed. Particular sensitivity is required in understanding the local context and preferences…

Exactly: letting local people shape the public services they want is what Cameron so regularly emotes about. And yet, here he is, saying that it all should work his way.

The report notes the different approaches that local programmes take:

Where local Health Visitor managers joined the Sure Start partnership at the planning stage, it was likely that the health visiting service would be the structure on which the Outreach and Home Visiting service was built. … When this happened there was unlikely to be a major input from para-professional home visitors, other than as a support resource for this health team.
Where SSLPs [Sure Start Local Providers] had a strong community development ethos the opposite model was more likely, with the outreach and home-visiting work spearheaded by community workers and para-professionals, many of them local parents, with health and other practitioners called upon where specialist input was requested by visiting parents or considered necessary by home visitors.

Why insist that that the form where the “community development ethos” predominates, and in which parents themselves play a greater role, is wrong?

Cameron claims:

Health visitors are the kind of support that parents want. Not laissez-faire: just leaving parents to get on with it. Not nanny-state: some bureaucratic system telling parents what to do. Just sensible, practical, personal support that people trust.

And yet he can’t see that he himself is being too directing and top-down in his approach. Nor does he realise that he’s not bringing any new principles to the table. Compare the sentiments in his quote with those of this, from a training pack for the Sure Start outreach workers that he wants to cut:

It is not our role to take over a family’s problems and issues. We are there to support them in doing for themselves, to present families with choices and to respect and abide by the decision made by the family.

That’s not a lofty ministerial soundbite; it’s what the front-line workers are having drilled into them.

One other thought: specialist health visitors are good, and so is the support from more generalist outreach workers. But the latter more disproportionately benefits the most socially excluded families, less aware of and able to navigate the system than the well-educated, better-off middle class. So Cameron’s policy, as well as redistributing support from youngish children to new babies, will tend to redistribute away from poorer families.

If “money is tight and we've got to make choices”, why not choose to forsake some of that inheritance tax cut?


Cassilis said...

Mmm... (my comments on your blog seem to start with that quite often..?)

First, I've been pouring over the SureStart evaluation work with a view to a more detailed post at some point - largely because Polly Toynbee bangs on about it so much. Very hard to summarise in a sentence or two but your post is actually a neat microcosm of the problem with the whole evaluation process – i.e. almost nothing there about objective outcomes.

Cameron may well be selling some outreach workers short but the important point is we don’t know whether he is or not because of the lack of objective data. You impart value to them on the basis of the variety of things they’re trained in which seems, and this is being kind, a little weak?

Chris said...

You impart value to them on the basis of the variety of things they’re trained in

But that's exactly what Cameron is doing to promote the health visitor over the outreach worker, isn't it? He mentions one report (rickets! does this mean a return of free milk?) but not by name so we can't factcheck him. Where's the percentages and graphs and objective data in favour of such high-intensity visiting in the first two weeks? Where's the explanation of why you need trained medical professionals to act as bouncers?

PS - 'Not laissez-faire: just leaving parents to get on with it.' Given what laissez-faire means (OED: 'let (people) do (as they think best)'), am I wrong in thinking this is nonsense?
PPS - 'Yes, we can get the change we really want.' It's the new Obama!

Tom Freeman said...

Better a 'mmm' than a 'grr'!

You're right that I don't offer anything in the way of an evidential argument for why the outreach workers are worthwhile (but nor do I for the health visitors - we just assume that they are beneficial).

The report I cited describes itself as one of "a series of snapshot studies", looking at "Case studies includ[ing] document searches and interviews with users and staff".

It says: "Parents expressed high levels of satisfaction with outreach and home visiting services and reported improvements in their children as a result." And I've no reason to doubt that that's true of the parents they talked to. But of course the lack of hard data means that we can't put a whole lot of weight on this. Pity.

I don't know if you've looked at this recent study, covering SS more broadly than just the outreach? I've not the time to look any more deeply than the exec summary, but there seems to be some better data there.

"SSLP children showed better social development, exhibiting more positive social behaviour and greater independence/self-regulation than their non-SSLP counterparts. Parenting showed benefits associated with living in SSLP areas, with families in SSLP areas showing less negative parenting while providing their children with a better home learning environment. The beneficial parenting effects appeared to be responsible for the higher level of positive social behaviour in children in SSLP areas. Also families in SSLP areas reported using more services designed to support child and family development than did families not in SSLP areas."

There are tables and statistical tests in part 4. But I daresay you know better than I...

One quote from Cameron that I almost used was "Instead of endlessly dreaming up extra things for the state to do, we believe in making sure the state does the things it's supposed to do, well."

But that's the thing: the outreach workers are there specifically to help people who tend not to access existing public services to get some of the benefits of these. I think that falls utterly under his criterion. (Indeed, his logic a few years back would have prevented Sure start being set up to start with.)

PS Liam I owe you an email reply. Sorry, have been a bit chaotic lately. Flat-hunting and that...

Chris, "Yes we can" - surely Obama is the new Bob the Builder!