Getting Our Priorities right - Consultation Analysis

EXECUTIVE SUMMARY

Introduction

This report provides an analysis of responses to the Scottish Government's Consultation on the refreshed "Getting Our Priorities Right" (GOPR) guidance for practitioners working with children and families affected by substance misuse.

The Scottish Government originally issued the "Getting Our Priorities Right" guidance in 2003. It was produced as part of a package of support to help improve the lives of children affected by substance misuse.

Over the past decade, the landscape in which practitioners work to support children and families affected by substance misuse has changed considerably. There have been a number of policy developments which strongly emphasise the need for early intervention, joined up working and a 'whole family' approach to working with children. Importantly, the policy framework "Getting it Right for Every Child" (GIRFEC) now sets out Scotland's aims for children and young people as successful learners, confident individuals, responsible citizens and effective contributors.

As the "Getting Our Priorities Right" practice guidance requires to be up to date with the policy, legal and practical context in which practitioners operate, officials and practitioners have been working to update the guidance since 2011. The consultation on the refreshed guidance ran from July to September 2012.

Summary of Responses

The Scottish Government received a total of 77 responses to the consultation. Of these, four were duplicate responses - identical in wording to another response, and submitted either by the same organisation or group of organisations. These were removed from analysis, leaving 73 responses. A further two responses were very similar to another response received, but not identical. These were included in the analysis. A full list of respondents is included as Appendix One.

For analysis, respondents were categorised as either 'public' or 'voluntary/ other' organisations. Most responses (71%) were from the public sector. Public sector organisations included partnerships led by the public sector - including Community Health Partnerships and Alcohol and Drug Partnerships - which may also include voluntary sector partners. Due to the relatively small number of responses, it was not felt appropriate to break down the categories further for analysis.

Guidance Style and Presentation

Generally, respondents recognised the effort which had been made to refresh guidance in this significant and complex area. However, most raised issues about the style and presentation of the guidance. Many felt that it was too long and "unwieldy". There were particular concerns about repetition; overlap or lack of consistency with guidance contained elsewhere; and difficulties with referencing and indexing within the document. Many had concerns about the style of writing, which was felt to vary but tended to be academic rather than practical. And many felt that there were contradictions, ambiguous statements and a lack of clarity in defining some key concepts. Many felt that these challenges meant that the guidance was not accessible.

Many respondents felt that there was a need to help different audiences to navigate the document more easily. Suggestions included:

• producing a stand-alone document or section for operational staff (many found the concluding summaries very useful and felt these could act as a 'pull out note for practitioners);
• refocusing entirely on key practice issues;
• producing a 'pocket version' of the guidance highlighting key points;
• referring and signposting to guidance and policy rather than reiterating it;
• providing quick links to key information in an online version of the guidance;
• being clear about the audience and consistently writing in a style with this audience in mind; and
• streamlining the use of summaries and chapter introductions.

Evidence Base

Just over half of those who provided a view felt that the evidence base and research outlined in GOPR helped. It was seen as providing a relevant context, and a clearer rationale for policy and procedures. Some were concerned that some of the evidence sources were not current, not well referenced and academic rather than practical in style. Many suggested that better organisation of the document, clearer referencing and hosting the document online and regularly updating it would help to address these challenges.

Getting it Right for Every Child (GIRFEC)

There were varied views about the links with GIRFEC. Some felt that the guidance recognised and integrated GIRFEC processes well. However, many felt that GIRFEC could be more clearly embedded within the guidance; and terminology could be more consistent between the two pieces of guidance. A minority suggested that there was a need to consider whether stand alone GOPR guidance was required, and suggested that it could potentially be incorporated into GIRFEC and other existing relevant policy and practice guidance. However others felt that a separate document on GOPR was necessary, particularly as professionals largely working with adults may not be familiar with GIRFEC.

Taking Account of Children's and Parent's Views

Most of those who provided a view felt that the document sufficiently highlighted the importance of ensuring that children's and parents' views were taken into account. Some highlighted a need for more guidance on how to balance the views of children and parents, and how to make sure that practitioners' expertise could also be taken into account - to ensure that decisions are in the best interests of the child. While some felt more could be done to prioritise children's rights, others felt that adults' rights were insufficiently covered.

Multi Agency Working, Roles and Responsibilities

Respondents felt that the guidance balanced national guidance and local practice well, making good links with local structures such as Alcohol and Drugs Partnerships and Child Protection Committees. Respondents also felt that the discussion of 'Named Person' and 'Lead Professional' roles was useful, and that the guidance made a clear effort to bring children's and adult's services together. However, some respondents sought more clarification over the role of the 'Named Person'. Some were concerned about the guidance appearing to suggest that adult service providers should take more responsibility for children's welfare. And some felt more generally that there was a need for further clarification over staff and organisational roles and responsibilities, and systems of accountability.

Many felt that the guidance would better help them to determine 'what to do' in different situations if it had more detail on best practice partnership working, including signposting, inter-agency protocols, information sharing, confidentiality and consent. Some also felt that it should be clearer that there is a real expectation that practitioners follow the guidance, rather than it being seen as optional.

Information Sharing

Views on the information sharing section were mixed. Some respondents felt that it was useful and straightforward, and an improvement on previous guidance. However, others felt that it was confusing and required:

• more guidance on confidentiality, consent, escalation and accountability;
• recognition of the challenges of sharing information due to IT systems; and
• greater consideration of the roles played by voluntary and third sector organisations.

Substance Misuse

Some respondents felt that a strength of the guidance was that it was more explicit on issues around alcohol misuse. However, many mentioned that reference to substance misuse could be strengthened through:

• clearer distinction between drug and alcohol misuse;
• more background on the prevalence and harm caused by alcohol misuse;
• more up to date guidance on alcohol and drugs misuse - set in the context of related issues such as mental health, sexual offences and gender-based violence;
• reference to all types of substance misuse - including cannabis, legal highs and tobacco;
• more reference to young people's own substance misuse; and
• more guidance around early intervention in the prenatal and early years stages.

Workforce Development

Some respondents felt that the section on workforce development could be further enhanced through:

• more guidance on dealing with hostile situations, overdose awareness and prevention and early identification of vulnerability;
• greater consistency with GIRFEC recommendations in relation to workforce development;
• reference to the 'Common Core' concept helping to define the required skills of the children's workforce across all agencies at a national level;
• more emphasis on the importance of the consistency of workforce training at both national and local levels; and
• more clarity about the audience for this section.

Prevention and Early Intervention

Many respondents gave no definitive answer to whether the guidance accurately described and reflected earlier intervention and prevention. The guidance was seen to help promote earlier intervention through links with GIRFEC, an emphasis on 'whole family' recovery, and recognition of the need for multi-agency working. However, the most common criticism was that the document lacked clarity and was confusing in how it described early intervention. Some felt concerned that the guidance appeared to suggest that early intervention would prevent the enactment of child protection procedures, and felt that early intervention should not necessarily aim to reduce child protection action. Many felt that there was a need to emphasise early intervention in relation to preventing unplanned pregnancy.

National Guidance on Child Protection

Most respondents felt that the GOPR refreshed guidance complemented the National Guidance on Child Protection - reinforcing the close collaboration required between Alcohol and Drug Partnerships and Child Protection Committees; providing more detail than the National Guidance on Child Protection in many areas (such as drug and alcohol misuse, information sharing, risk assessment, confidentiality and consent); and providing useful tools to illustrate child protection and information sharing. However, some felt that there was too much duplication and overlap between the two - and that this could be addressed through better signposting and referencing. Others suggested a need for more consistent and mutually reinforcing messages between the two guidance documents, with consistent terminology and definitions.

Equality Impact Assessment

Very few respondents provided a view on equality impact assessment - with only eight out of 73 respondents providing comments. Respondents felt that the guidance could better reflect and represent the needs of all families, and focus more on minority ethnic people and minority faith groups, travelling families, families affected by disability, mental health and learning disabilities and looked after children.

A small number of respondents felt that the guidance would effectively challenge stigma and would make families better aware of the support available. Almost all respondents felt that the GOPR guidance would not have a disproportionately negative impact on particular groups of people. However:

• Two respondents felt that there should be more recognition of parents misusing drugs or alcohol, including emphasising that people with substance misuse problems are not automatically bad parents.
• One respondent felt that there was a need to ensure that there were no negative connotations in the guidance in relation to blood borne viruses.
• One respondent felt that the lack of reference to independent advocacy would negatively impact anyone who faces a communication barrier.
• One respondent felt that the guidance may encourage professionals to make judgements about families when they are not qualified to do so.

A small number of respondents called for more consultation with particular groups of people, and their involvement in developing the GOPR guidance.