‘why are major variations in professional decision-making being found across Northern Ireland?’

With several high profile child abuse cases drawing attention to standards in child Health and Social Care services in England, Queen’s University, has a timely report from the Institute of Child Care Research, ‘From Care to Where?’. It highlights some inconsistencies and problems across local Care Services. The booklet is the first of three to be produced as part of the Care Pathways and Outcomes study, which examines outcomes for 374 children under 5 years old who were in care on 31 March 2000.

Below are some extracts.

Children who have been in care are: 10 times more likely to be excluded from school; 12 times more likely to leave school with no qualifications; 4 times more likely to be unemployed; 60 times more likely to join the ranks of the homeless; 50 times more likely to be sent to prison; and their own children are 66 times more likely to need public care than the children of those who have not been in public care themselves (UK Joint Working Party on Foster Care, 1999; DHSSPS, 2006). Mooney, Fitzpatrick, & Hewitt (2006) indicated that in Northern Ireland, 96 (10%) of the 986 children aged over nine years old in public care were cautioned or convicted in 2002/03, compared to 1% of all children in Northern Ireland; and 9% of school age children in care were suspended from school in 2002/03, compared with 1.7% of the general school population in Northern Ireland.

Though it notes:

A difficulty is that these figures typically compare children who have been in care with the average for the whole population, rather than children from the same backgrounds who have not been in care.

Outcomes for children seem to vary based on Health Board area and may be due to ‘particular traditions’ within boards:

Higher percentages of children followed the adoption pathway in the Northern (59%) and Southern (69%) Boards, compared to the Eastern Board (33%) and the Western Board (19%). Higher percentages of children followed the non-relative (46%) and relative foster care (14%) pathways in the Western Board; and a higher percentage of children followed the birth parents (34%) pathway in the Eastern Board. In both the Northern and Southern Boards, 12% of the children in care were at home with their parents in 2000. These figures were 18% in the Eastern Board, and 9% in the Western Board area. Children from the Eastern Board, who were in foster care in 2000, were 6½ times more likely to be returned to birth parents by 2002 than those from the Northern Board. It was also found that children from the Northern Board were 2½ times more likely to be adopted by 2002 than those from the Western Board.

Such variation in decision-making in child welfare has been found in many studies and jurisdictions (Packman, 1966 and 1986; Lowe and Murch, 2002). Even where there is general agreement on what the long-term plan should be for young children who cannot return, different authorities generate very different patterns. …….(Kelly et al., 2007).


Given that statistical comparisons across multiple variables showed that the groups of children within each of the Trusts are very similar, these variations may lie in the decision-making, and particular traditions of the Boards and Trusts ….. The variation in the proportion of children returned home also needs further and careful consideration in view of the evidence of the troubled nature of the return home placements that this study has identified (see part two which deals with the parent and carer interviews).

A key question is: If the needs of the child are central to deciding on a long term placement, why are major variations in professional decision-making being found across Northern Ireland? The recent Reform of Public Administration (RPA), creating five Health and Social Care Trusts where there were previously 11, the development of Regional Policy and Procedures in relation to adoption, and the Government’s plan to regionalise elements of the adoption service, may help foster greater consistency. However, consistency will not be improved if the reasons for inconsistency stem from more deeply held values/opinions on the appropriateness of different placement paths for children and families.

On the need for support:

The percentage of children whose mother was living alone on 31st March 2000 was high (54%) compared with the average population for Northern Ireland of around 15% (Percy, Higgins, and McCrystal, 2001). This high level of lone parenting mirrors other research in this area (Kelly and McSherry, 2002; Selwyn et al., 2003). Children whose mother was living alone when the study started were 2½ times more likely to be adopted by 2002 than those whose parents were living together. This may suggest that Social Services are more likely to deem lone parents to be less able to provide long-term care for their children.


The need for a family support strategy to be developed in conjunction with the Boards and Trusts was outlined in Priorities for Action 2004/2005 (DHSSPS, 2004a), and the 20-year regional strategy (A Healthier Future) focused on the importance of family-support services (DHSSPS, 2004b). The findings presented here should encourage Heath and Social Care Trusts, and other relevant health care agencies, to review the nature and quality of supports that are currently in place for lone parents, particularly in terms of preventing children entering care


Furthermore, 20% of children under the age of one when they first entered care were still in foster care after four years. Clearly, adoption was not the only option for this age group in Northern Ireland. This appears to reflect the variation in long-term placement practices across Northern Ireland. For example, in the Southern Board area, no children who entered care before the age of one remained in foster care, whereas this figure is as high as 52% in the Western Board area.

So do these variations in outcomes indicate broader problems with standards, direction and processes? And are the Health Minister and Children’s Commissioner on the case?

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