#KeepThePromise, Scotland’s Care Review

We recently invited Fiona Duncan, Chair at The Promise, to join us at Transitions and share her story.

Dominic Campbell: I can quite honestly say, despite all of the travelling I do and all of the people I meet from government around the world, our next guest is probably the person who’s has the most significant and possibly most visceral impact on the way I think about the work we all do. How I see what’s achievable and how you can truly bring people together and a really unbelievable level of change across a system to tackle the biggest possible challenges in our society.

I’m sure she’ll really thank me for that welcome, as that’s put a bit of pressure on Fiona. But I mean every word of it and I’m so grateful that she’s able to join us today to share her story.

I want to thank you for inviting me to speak today and I’m going to start with a picture that was taken in October 2016. And for those of you who follow Scottish politics, you’ll see right at the very front we have Scotland’s First Minister. This picture was taken at the October 2016 Scottish National Party conference where the First Minister made a promise to a group of care experienced children and young people.

I want to thank you for inviting me to speak today and I’m going to start with a picture that was taken in October 2016. And for those of you who follow Scottish politics, you’ll see right at the very front we have Scotland’s First Minister. This picture was taken at the October 2016 Scottish National Party conference where the First Minister made a promise to a group of care experienced children and young people.

You can see them clustered around her, and you can also see them holding paper hearts. I’d like you to look at some of their faces and I’d like to think of the symbolism of that heart, because you’re going to see it again later on.

Through the incredible work of the organisation Who Cares? Scotland, the First Minister in advance of that conference had been spending time with young people who were growing up in care, or who had grown up in care. They had told her their stories. Some filled with hope and love, but many more about their struggles with mental health, homelessness, poverty and the justice system. Many talked about not having support networks or good relationships, some feeling they didn’t know how to love or be love, and many felt they hadn’t achieved their potential. They talked about the role of the ‘care system’ in this. How it hadn’t given them a sense of family, belonging or love.

At the party conference, the First Minister promised there would be an independent root and branch review of the care system that would look at legislation, practices, culture and ethos. Watching a video from the BBC of the First Minister making her speech, you’ll hear the emotion in her voice. She also promised on that day that the care review will be driven by those who had experienced care, and she acknowledged that this wasn’t something that any country had ever done before.

Where the Care Review started

When I was appointed as the chair of the Care Review in February 2017, I capitalised on this lack of a ‘template’ and made sure the Care Review was unlike any other typical government-sponsored review.

We carried out a virtual workshop with children, young people to ask them what it was they wanted from the review. We asked them to help us create a brand for the review and they came up with beautiful colours, energies and shapes. But they also told us what language they wanted the Care Review to use. They told us what they expected from us, they expected us to be bold, fearless and they expected us to champion them. This was an explicit, very early signal for me that, from the outset, the Care Review’s purpose was to serve the care community.

There had been six previous reviews in Scotland, into aspects of the care system. They were all led by different custodians of the care system and had very limited involvement of the care community, which meant that typically and understandably they came up with changes to the care system that individuals around the table knew were required.

My view is very clear; the promise has been made to children and young people. And children and young people shouldn’t have to change shape to fit into Scotland’s care system. So the Care Review was not only going to look unlike a typical review, it was also going to:

1. Be governed by members of the care community, not custodians of the system
2. Focus on all of the things that mattered to children and young people in care
3. Seek to focus on creating change

If Scotland was to get this right, the outcome had to be an entirely new approach that worked primarily for children, young people and their families.

And this is my first hope for a big, significant transition.

If a review into the future of public services doesn’t have at its very centre, guiding all of the conversations, the needs of those people, representatives from those groups of people the public service is intended to meet, what chance does it ever have of getting it right?

The Care Review was governed by the care community and The Promise; a succession organisation would also be governed by the care community. The wording that The Promise has come up with, the principle report by the Care Review is unequivocal. Scotland should never again ask children and young people to share their most intimate and traumatic stories in order to figure out what has to change.

I was clear from the outset that this time, Scotland had to change. This is the scale of the Care Review. Over the course of three years, we heard over five and half thousand experiences of the care system.

These were mainly from children and young people and care-experienced adults, as well as their families. We also met and spent time with the paid and unpaid workforce. We deliberately sought out people that are described by the care system in Scotland as ‘Scotland’s most expensive child protection case’, or the families who have had multiple children removed, in order to really understand what they needed from the future of care.

We took the roots and branches of the First Minister’s speech incredibly seriously, it connected not just with all the custodians of the care system all across Scotland, but also with all of its adjacencies.

We pulled together over 943 research sources. We also commissioned some of our research, we looked for gaps in Scotland’s understanding of what matters to the care community. This included things like the conflation of poverty and neglect; you’re twenty times more likely to be removed if you live in a poorer part of Scotland. We also looked at transgenerational patterns of care. We knew there were families and young mums who were care-experienced whose children had been removed, and we wanted to understand why those things were happening.

We touched all of the different parts of this big thing we call the care system. As we were steered by the care community we wanted to make sure that we were looking at the things that mattered to children and young people. We wanted to also identify the things that didn’t matter, particularly to the care system.

And as I said earlier, the focus of all of this was seeking solutions on how Scotland can get this right. This approach is the opposite of what many reviews do, which is admire the problem. What Scotland didn’t need to push out was another report into what Scotland was getting wrong.

And this was also my second hope for a transition.

It would have been so much easier for the Care Review to take a backwards look into past failings and to apportion blame. But that approach doesn’t look forward to what we want from the nation we live in. Care Reviews don’t typically create a vision that takes hope with us, which is what was desperately needed.

The branding showed you that the Care Review took place over four phases, the second phase included a discovery group which was 50 per cent care experienced. The third phase, we had a journey group, which was over 50 per cent care experienced.

During the journey stage, we took deep dives into some of the areas I mentioned a moment ago, and we had 150 volunteers taking part in all of those conversations, and over 50 per cent of them were care experienced. We were interested in the system, but we were also really interested in the experience of the system.

Publishing the reports

On the fifth of February 2020, The Care Review published seven reports, and all of these reports are available on our website.

The first report was called The Promise, which had over eighty calls to action based on five foundations painting a vision of what Scotland has to do to change. We produced a version of The Promise called the Pinky Promise, which is the child-friendly version of the principle report. It was always intended that The Care Review existed for children and young people, and we were really conscious that we didn’t want to produce something that was only accessible to adults.

The Promise is based on five foundations and there are eighty plus calls to action. But those are based on five really simple things.

1. Children and young people must be listened to and meaningfully involved
2. When living with a family is not possible, children must stay with their brothers and sisters
3. Whenever children are safe in their families and feel loved, they must stay
4. All of the people involved in the care of children must be supported to develop relationships with them, and those children must also be supported to develop relationships with the wider community
5. We need an infrastructure and system around all of this that’s responsive and accountable

The Promise has been designed to reflect the heart of the children and young people, and the story of The Care Review explains how these foundations were developed.

Our principal findings

Next are the principal findings of a piece of work that we did to follow the money. When I was appointed, I was met with comments on why the review would just be like every other Care Review, and that its conclusions wouldn’t necessarily be accepted or implemented. And one of those was that there would be an argument that Scotland couldn’t afford it.

So we did work to follow the money in the care system. We identified that Scotland’s spend on its care system, as you can see from this image, is £942 million. But it also spent £875 million in meeting the failures of the care system, which includes things like the disproportionate numbers of children and young people who find themselves homeless or in the justice system. That also includes some £132 million of unrealised monies into the system, that Scotland would have if care experienced children had been given more chances to education and work.

The money report talks about how that investment could be met in a different way from a wellbeing economy, which fits with many of the principles that Scotland’s already committed to.

When I refer to this thing we call a care ‘system’, it is in fact a labyrinth of bureaucracy which equals 44 different pieces of legislation and 19 pieces of secondary legislation. In this labyrinth system, childhoods can get lost.

Next, I’ll tell you a little bit about the plan; in order for Scotland to achieve the new vision and resolve the outlined problems we needed a completely new approach to service design and service delivery. The Care Review took a different approach to reviews and the next stage is to get a completely different review to delivering that. What Scotland needs is one co-owned, cross-sector multi-agency plan that lifts the 80 plus calls to action included in The Promise. It’s a way of working that we’ve never done before, fortunately, at the moment there’s still a huge commitment to doing that.

The other important mention is a thank you to all of the people who have got involved. All of the reports are available on our website, and if you would like hard copies of the reports email [email protected] and we’ll send you a pack, they are beautiful.

Sharing children’s stories

The Care Review’s conclusions were narrated by twelve composite stories. We made a promise to every single child, young person and family right at the very beginning to protect their right to confidentiality and their anonymity so we could tell their stories.

The thousands and thousands of experiences that were shared with us were carefully reviewed for recurring patterns and themes, and then they were rewritten into these composite stories. A huge amount of care was taken when doing that.

For example, the second on the far left, there’s a story about Olivia. When the team checked the National Records of Scotland for the most popular girls name 10 years ago, Olivia was number 13. So the 10-year-old girl is called Olivia. And that’s true for all of those stories that reflect all children.

We took these composite stories back to a group of children and young people to check them before animating them; we wanted to make sure that we had all their stories right. And they changed them. So one of the stories is about a boy called James, in the first generation we said James’ mum was struggling with her mental health, drugs and alcohol. And the children basically said ‘we don’t see our mum struggling with her mental health, we go to school and our mum is not well’. So the language has changed to reflect what children and young people say.

We also sent the animations back out to children to be checked, which were then changed. One of the children’s parents is in prison, so bars were added to the window of the prison, because ‘if you go to jail, there are bars on the window’.

When we asked children what they thought about us retelling their stories, they said they recognised themselves here and they could see from these other stories that they weren’t alone. They could recognise their friends. All 12 stories are available on YouTube if you want to watch them.

This approach to how the Care Review narrated what mattered, challenged many charities who are increasingly waking up to the realisation that their campaigning and fundraising approaches can inadvertently reinforce societal stigma around their beneficiaries or the groups they exist to support.

This is my third hope for significant transition.

That we can build new compassionate narratives for how we tell other people’s stories and how we tell other people’s stories to each other.

One of the composite stories is about a young girl called Isla, and before I move into what happened next, I just want to show you a typical week in Isla’s life.

You’ll see from this, that the system around Isla all operates in its own way to support its own ends, it doesn’t operate in and around Isla’s life. If Scotland can transition from policy silos into an approach that prioritises children and families over the needs of the system, this map will look very different. That’s really what the ultimate transition hope is for the Care Review.

Where are we now?

Here we are on the 5th February this year in Bute house, Scotland’s 10 Downing St for the Care Review’s conclusion.

You’ll see the First Minister and Deputy First Minister. This group of folk are exclusively care experienced people who were hugely involved in shaping the Care Review; this is their review. Which is one of the reasons the Care Review’s conclusions are called The Promise and not the Duncan Review. It doesn’t belong to me. It belongs to the children, young people and families that shaped it.

Hopefully, you’ll recognise some of the faces here from the faces you saw in the picture taken in 2017. This was very deliberate, the initial promise the First Minister made, she made to young people in the care community. It was absolutely critical that The Promise was kept to that group.

Another deliberate aspect of that day was the planning that went around the launch event. It was important that the conclusions of the Care Review were bigger than the announcement of The Care Review. I’m sure most people here know, typically, the decision to commission a review makes news headlines. That’s the day that the government accepts the need to do something different, and often hands the responsibility off to do that thing differently. And very often, the conclusions or the recommendations may come to light on a news report, followed by a statement that they will be considered by government. That was never the plan. That was never the intention for the Care Review.

I think that it’s absolutely critical that if we’re going to hold governments and others to account, that my next hope for a significant transition is that we don’t let governments hide. That we do hold them to account for the changes needed to Keep The Promise.

It’s clear that there can never be another review like this in Scotland. Therefore, the day of the launch event was absolutely huge. Later that day the First Minister made a statement in Parliament accepting the Care Review’s conclusions in its entirety. These are some of the things she said, and she commends the Care Review to Parliament on that day.

None of us expected her to make this speech and none of us expected her to agree with everything in its entirety. Her statement that day secured cross-party support. Throughout the day, #KeepThePromise was trending on Twitter, which was a real reflection of the outpouring support of the Care Review’s conclusions from all across Scotland.

This supports the many thousands and thousands of people who had made sure that the review reflected what they wanted but also from the many hundreds of custodians of the care system — we had their commitment to do things differently.

This is the picture of cross-party support on the stairs of Parliament. And you can see here the hearts of the Care Review.

So on this day, Scotland made a promise to its children and families, that there would be a radical change and the way they would look after them and support them from here on would never look the same. It also made clear that Scotland recognised the potential of its children and families, including those who struggle, if supported differently.

We were ready to start. We knew the task would be tough but we had an army of people supporting a radical change programme, accepting that had to happen and accepting our plan.

I’m just going to conclude with COVID-19. The global pandemic has changed all the plans for transition. Apart from the very obvious delay in moving from a review into implementation. The people who needed to change shape simply weren’t available to plan or do what we needed them to do in order to understand how they were going to operate differently. They were also exhausted, the workforce in particular. Frontline social workers had been battling a global pandemic for months.

The global pandemic also reinforced that public services are not fit for purpose. Some families have reported that for the first time due to the reduction in state intervention they have space to be together and focus on what matters to them, and are doing better as a result.

And the other big learning from the pandemic is that historically, there’s been a divide between those responsible for designing and delivering services and those responsible for receiving services.

COVID-19 has changed us, there’s greater compassion and empathy because we’re all impacted. Communities who have often been left behind are stepping up and stepping in, blurring the boundaries between the service delivery and the service recipient.

There’s an update on the plans that we’ve got at the moment on The Promise website. The Promise, the Care Review’s succession organisation will also be governed by the care community with at least 50 per cent of the spaces on its Oversight Board ringfenced for members of the care community.

I’d like to thank you for asking me to come and talk to you today.