Postcode lotteries

The NHS is intended, at least in theory, to provide a consistent level of service across the country. However, local authorities, again in theory, can set levels of service in accordance with local decisions: they can provide more services but will have to charge more council tax to fund it, or alternatively they can reduce council tax but will have to reduce services to match.

I have said 'in theory' both times because the practice is rather different. The NHS is less consistent than you might expect. Funding was controlled by Primary Care Teams until April this year when the bulk of it was handed over to new Clinical Commissioning groups. Their funding - and therefore priorities - will vary across the country.

Local authorities have, however, been moving in the opposite direction. The bulk of their funding comes not from council tax but from a central government grant. They are severely constrained by what they can raise through council tax because governments impose caps so as to control overall public spending.

The whole system is fiendishly complicated and very few people know or care about the detail. Many people do not appreciate that hospital and community health care comes from the NHS while social care such as care homes and domiciliary care from local authorities. NHS care is free at the point of delivery, apart from such things as prescription charges for those who are liable, whereas social care is chargeable and the charges can be high.

Both entitlement to social care and the charging arrangements vary across the country. This reflects the different histories and priorities of different local authorities - as well as such things as the demographic makeup, affluence or deprivation and politics. But many people feel - whether rightly or wrongly - that this is unfair, and that entitlement to services should be consistent across the country. When local authorities are hard pressed financially, they manage by reducing entitlement to services. There is a national classification for this: needs may be low, moderate, substantial or critical. Local authorities have been free to set their own eligibility thresholds for services within this scheme.

Now the government has decided there should be a national scheme, and it will be set at the level of substantial need. Most local authorities do this already but a few have set their threshold at the critical level. Will this be affordable? The government estimates it will cost £23 million a year to do this. On the other hand, it would cost £2 billion a year to lower thresholds to the moderate level.

The fact that the NHS is a separate organization - or rather a number of separate organizations - from local authorities, and their boundaries may well not coincide means that there all sorts of perverse incentives in the system. In one sentence: more social care would reduce the need for hospital care. The government has recognized this and is transferring £3.8 billion from the NHS to be jointly managed with local authorities to provide more social care. This is not new money, and local authorities have already had substanital reductions in their funding. But it will certainly help.

What I consider we really need is full integration of adult social care with the NHS, so that perverse incentives can be ironed out. I wish the big reorganization of the NHS had concentrated on this. But it is good that it is beginning to happen now.

The Jeremy Forrest case

Jeremy Forrest, the teacher who had a sexual relationship with a pupil of 15 and took her away to France, has now been convicted and sentenced. That is quite right and proper. I urge everyone interested to read the sentencing remarks of the judge, whcih are brief, clear and easily available at:
http://www.judiciary.gov.uk/Resources/JCO/Documents/Judgments/sentencing-remarks-hhj-lawson-qc-r-v-forrest.pdf

There are few points worth making about this. Firstly, the importance and value of an age of consent. Yes, those under that age may be - at least at the time - willing to enter into a sexual relationship but the age of consent makes this illegal and invalidates their consent. It is therefore a protection for them.

Then the judge, inadvertently no doubt, raised the possibility of Forrest waiting until the girl was 16. However, a sexual relationship with her would still have been illegal, as he was in a position of trust in relation to her, and in that situation the age of consent is 18. This was originally introduced in 2000 and is now in the Sexual Offences Act 2003 at Section 21. However, the offence as so defined currently only applies in the statutory sector. So a teacher or a youth worker who has such a relationship commits the offience if they are in the statutory sector but not if they are in the voluntary sector. So it is not a criminal offence in church life - although it most certainly is a disciplinary one. I think this is anomalous and that the offence should be extended to the voluntary sector and should include ministers of religion (of any faith).

Then we should consider the issue when the parties are of a comparable age. It is obviously one thing if a man of 30 has an affair with a girl of 15, but what if she has a relationship with a boyfriend who is also 15? If you are the parent of either, perhaps particularly of the girl, you would not be happy, but is it necessarily abuse? It may well not be, and the police may consider that it is not in the public interest to prosecute such cases.

As for Romeo and Juliet, the issue was not her age, which was 14 and which at one point her father thought was too young, but the fact that her preferred husband was from the other faction in Verona. Had she been willing to marry her father's choice there would have been no issue. But that takes us into the issue of arranged marriages versus love marriages and that is a quite different issue.

Disclosure and Barring Service June 2013 changes

When I was at our national safeguarding conference in January there was a fine for any time anyone said CRB instead of DBS, the Disclosure and Barring Service. Since December 2012 the DBS has combined the functions of the former CRB and the former Independent Safeguarding Authority.

Now we have a new round of changes. They were signalled a long time ago but the actual detail only came out three weeks ago - and over a Bank Holiday - which has made us scramble to come to terms with them and issue new guidance. I need to mention four of these:

Relevancy test

This affects how the job or role is described.

Filtering rules

Following a court decision the DBS will be removing details of convictions which count as 'spent' from their certificates. Some convictions, such as those for offences against children or for violence, will never count as spent for this purpose, but the rules are complicated.

Single certificate

The DBS will cease issuing two copies of each certificate and now issue only one, to the applicant. Parishes who subscribe to the ebulk service from Churches Agency for Safeguarding will receive notifications of clear certificates. Those who use the paper service will need ask the applicant to bring in their certificate so it can be logged.

Update service

When the government consulted on this, the biggest complaint came not about the need to get a DBS certificate in the first place, but the need to repeat it for other employers. This Diocese has always operated a policy of portability for volunteers but many employers did not. It was always legal but the CRB, as was, used to discourage it. The new Update service is designed to meet this need, so that those applying for new certificates can also for a fee (unless they are volunteers) register for the Update service. Subsequent employers can then check whether their certificate is clear.

Detailed guidance on all this has been sent to countersignatories, recruiters and verifiers and will shortly also be posted on the Diocesan website.

Basically . . . porn is everywhere

This is the title of the latest report from the office of the Children's Commissioner. They undertook it because it emerged in the work for their previous report, on Child Sexual Exploitation by gangs and groups, that many of the boys and young man who became involved in police enquiries had spoken of their use of pornography.

Their findings are, in summary:

1  A significant proportion of children and young people are exposed to or access pornography;

2  Children and young people’s exposure and access to pornography occur both online and offline;

3  Exposure and access to pornography appear to increase with age;

4  Exposure is more prevalent than (ostensibly) deliberate access;

5  There are gender differences in exposure and access to pornography;

 

6 Access and exposure to pornography affect children and young people’s sexual beliefs;

 

7  Access and exposure to pornography are linked to children and young people’s engagement in “risky behaviours”;

 

8  Exposure to sexualised and violent imagery affects children and young people.

Arising from this are several recommendations, mostly relating to the need for good education in sex and relationships.

I went to a conference on this subject before the report came out, and I was particularly struck by the remark of the presenter, who herself had a teenage son. He had expressed some interest in pornography, to which her response was: 'Do you really want to hand over control of your sexual life to commercial interests?' He later admitted that her remark 'had really killed it' for him.

You can see the report at http://www.childrenscommissioner.gov.uk/content/publications/content_667

Local Safeguarding Adult Boards

The Queen's speech promised an overhaul of adult safeguarding. This is the latest stage in a process of policy development which started with an excellent report by the Law Commission in 2011, followed by a draft Care and Support Bill which gave effect to many of its recommendations, and now we have an announcement in the Queen's speech. Much of the attention has rightly focused on the feasibility of improving the service to vulnerable adults at a time when local authority budgets are being considerably reduced and also on the effect of the Dilnot proposals on the funding of residential care which in reduced form are also in the Bill and the announcement.

But I want to point to another part of the changes. This is to make Local Adult Safeguarding Boards (LASBs) a statutory function. These Boards bring together statutory and voluntary providers in a single body within a local authority area. The local authority is responsible for setting them up but they are independent. It has been an anomaly that Local Safeguarding Children Boards have been a statutory function since 2004 but the same was not done for adults. There are LASBs in most if not all local authority areas already, but they are not statutory, so they cannot compel membership and command resources in the way that LSCBs can.

This mirrors the history of adult safeguarding. The multi-agency system for managing children's safeguarding goes back to 1974 and has been reviewed and strengthened several times over the years, with the 2004 legisation putting this on a statutory footing. Government guidance is revised every few years. But there was no equivalent government guidance on adult safeguarding until No Secrets came out in 2000 and a promised revision was lost with the change of government in 2010.

The issues in adult safeguarding are just as complicated as those for children - in some ways more so, since adults have legal rights and statutory action may not be available, even if professionals consider it in the best interests of the person. The LASBs will be able to pool expertise, challenge each agency and conduct Serious Case Reviews in the same way and to the same standard as is already in place for children. This is a welcome development and we most hope that it does indeed become law.

David Hope faces enquiry

David Hope, the former Archbishop of York, is now facing an enquiry by John Sentamu, the current Archbishop, into the actions he took and apparently failed to take in relation to allegations which were made to him  against Robert Waddington. Waddington had been Dean of Manchester Cathedral in the 1980s. The allegations were of abuse of two boys, one in Australia in the 1950s and another of a chorister in the 1980s. The first allegation came to David Hope in 1999; the second apparently some years later. My source is a BBC News report at: http://www.bbc.co.uk/news/uk-22498734

Apparently David Hope stopped Waddington from functioning as a priest but did not report him to the police. He is reported as saying that at the time there was 'no automatic legal obligation on the Church to refer allegations by adults to the police or social services'. Moreover, he considered that Waddington did not present a continuing risk in that he was seriously ill following surgery for cancer.

While we should wait for the enquiry report and not prejudge his actions, there are several points to make about this. First, I must declare an interest, in fact two: in one of his earlier positions, David Hope was the vicar of All Saints, Margaret Street, in London, where I worshipped towards the end of his time there and the beginning of mine. He seemed to me a good and holy man and he seems so to me still. The other interest is that I have spent far too much of my life drafting procedures and indeed led the work on the church's current child protection policy, the 2010 edition of Protecting All God's Children as well as writing the Diocese's Safeguarding Handbook.

So the points I am about to make I do with some feeling.

The adequacy of the child protection procedures, or indeed, of any procedures on any topic whatever, cannot be assumed. However carefully they are drafted, consulted on and revised, there will always be gaps and even errors. And when it comes down to it, it is not simply procedures nor even the following of them, which protects children or achieves other desirable ends but also the exercise of judgement: we may be confronted by a situation which the procedure writer did not anticipate or where the guidance is unhelpful. We should not depart from them unthinkingly but we should not follow them unthinkingly either.

Then there is the fact that knowledge develops. Some of us, including myself, have had to learn painful truths about the continuing pain of survivors of abuse. They are not well served by regarding allegations of abuse some time in the past as 'historic' and downplaying its significance now.

Then there is the need for justice. Waddington may have been - by the time the allegations reached David Hope - no longer in a position to abuse anyone. And he died in 2007. But there is still the issue of calling to him account for what he is said to have done. And the judgement of whether he was fit to plead or handle a prosecution is one which should surely be made in the context of the work of criminal justice.

And then there is the issue of mistakes made in good faith. This is a difficult area but we will all be able to think of situations where we made what seemed a reasonable decision but which turned out badly in the end. Are we responsible for the consequence or only for the intention? Did we simply misjudge something, or were we reckless? Did we take into account all that we should, consult whom we should and identify correctly and ignore irrelevant considerations? Hindsight is wonderful. I know myself, from conducting and reading Serious Case Reviews, that it is easy in retrospect to identify what turned out to be mistakes. But in the heat of the moment, with many other competing demands for our attention and decisions it is perhaps not so easy. So let us not rush to judgement on David Hope.

Jimmy Savile

Rarely can a reputation have been trashed as quickly and as comprehensively as has happened with Jimmy Savile. As I write, the police have 400 lines of enquiry, his headstone has been removed, his cottage daubed with graffiti and people are talking of removing his UK knighthood and his papal knighthood even though such honours normally die with the holder.

A number of enquiries and reviews have been launched, and I do hope the government come round to the idea proposed by Ed Miliband of a public enquiry, to tie together all the separate enquiries. There are lessons for all of us in what has happened. Here are some I have been reflecting on:

1. It can years or decades for survivors of sexual abuse to feel confident enough to speak out and to believe that they will be heard. And the difficulty is compounded many times if the abuser is rich, famous and powerful.
2. While the effects of sexual abuse can vary, they are often devastating, often resulting in an impaired ability to make normal relationships or trust people. In some cases they can lead to mental illness.
3. While there are strict rules governing young people who work as performers, there are no special ones for those who take part in one show as a member of the public.
4. One particularly odious aspect of Savile's behaviour is that he picked on girls known already to be vulnerable, because they were ill, in Leeds General Infirmary, or actually or potentially disabled, in Stoke Mandeville Hospital, or considered criminally mentally ill, in Broadmoor, or young offenders, in an approved school. In all these establishments he seems to have been given the run of the place, with his own set of keys and sometimes a flat reserved for him. This achieved through his highly public activity in fund raising. We can now see it as a cloak for his predatory sexual abuse.
5. Apparently he is on record as saying that anything wrong he did would be set against the good he did. He seems to have imagined that the one would offset the other. Now, offsetting is a normal procedure in finance, but I do not know that it is acceptable in the field of ethics. Reprehensible behaviour does not cease to be such because there is also good behaviour.
6. It also does not appear that his fund-raising cost him anything. He seems to have revelled in luxuries, of which the white Rolls-Royce can stand as the symbol.
7. It is incomprehensible that the then government put him in charge of a task force dealing with problems at Broadmoor, when he had no relevant qualifications or experience.
8. But most seriously of all, we have to question the culture of the places which allowed him free access, did not supervise him, allowed him unrestricted contact with vulnerable children and dismissed the complaints - for some were made - about his conduct. And here, sadly, the BBC is a particular culprit. They built him up as a celebrity and took no care to protect impressionable young people.

In my sheltered and protected life I had never seen his television programmes and had only just about heard the phrase 'Jim'll fix it'. So I am not a good person to comment on the impression he made before his criminal behaviour became known. But maybe we can all learn to be more vigilant and to challenge inappropriate conduct, however famous the perpetrator may be.

Stephen Barber