Sharing the care: interview with Fiona Duncan, chair of the independent care review

Young people giving their thoughts on the care system - Image credit: Barnardo's

Just over a year ago, in October 2016, and looking close to tears, the First Minister, Nicola Sturgeon, announced a “root and branch” review of the care system for children and young people.

Watching from the audience at the SNP autumn conference, care-experienced young people cried and waved paper hearts.

It’s not the first such review – there have been several since the Scottish Parliament’s inception – but this was to be the review to end all reviews, the one that would fundamentally change the experience of looked-after children in Scotland.

The responsibility for leading this high-profile review fell to Fiona Duncan, chief executive of the Corra Foundation and herself care experienced, who was appointed in February last year.

Almost a year on from her appointment and with the review reaching the end of the ‘discovery stage’, Holyrood asks Duncan what has been done so far and what the next stage will be.

The aim of this initial stage has been to set out what would and would not be in the review, and ask two key questions: ‘What do we mean by a root and branch review?’ and ‘What would the best care system in Scotland look like?’, and to outline a “single cohesive vision” of what it was trying to achieve.

Duncan explains: “This is a root and branch review, and if you look at the care system, or if you look at people’s perceptions of the care system, then it’s difficult to establish what are the roots and what are the branches, where does it begin and where does it end, and therefore to really create a clear articulation about what the review has to review and what aspects of the care system are less in need of a review.”

She adds: “The most critical thing in all of that was the answers to those questions had to be shaped by children and young people in care, so it was about asking questions and listening, really, to responses and then finding what looks like a settled view in all of that.”

During this phase, the review team have carried out work around the policy environment and the different legislative areas that impact on the care system, as well as looking at previous reviews, how well their recommendations have been embedded and what trends have been identified over the years.

But more importantly, they’ve engaged in conversations. Many conversations. This has so far involved speaking to 800 care-experienced children and young people and nearly 800 paid and unpaid staff.

And while the review team will talk to anybody who wants to take part, Duncan says these conversations were also targeted to ensure they were covering all 32 local authorities and hearing from children and young people from all different settings, and across ages and genders.

The review team has also worked with Who Cares? Scotland, who were commissioned to continue ‘1000 Voices’, a campaign calling on the First Minister to listen to the voices of 1,000 care-experienced people.

Duncan says they’ve been, “in a really positive way, overwhelmed” by the number of children and young people who’ve wanted to get involved, but the plan is to go further, with 1,000 voices just the start.

She says: “We always thought 1,000 voices needed to be our minimum threshold and we’re at 800 already, and that’s only in the first public phase, so that’s a good thing.”

They’ve also spoken to nearly 800 of the paid and unpaid workforce – social workers, teachers, foster carers, parents, “a whole range of people that have wanted to be involved in the conversation from a deliverer of care perspective”.

Additionally, they’ve worked with analysts to interpret what they’ve heard and to ensure that they’re banking evidence so that any recommendations can stand up to scrutiny.

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This process involves not just looking at what is wrong and right about the current system, but imagining how care could be delivered differently.

She says: “The system is made up of many component parts that don’t all comfortably fit alongside one another, or operate as one.

“There are disconnects and barriers, and different things driving decision making, all of which creates real challenges for children and young people, huge challenges.

“So the review is not solely focusing on attempting to make improvements to, or fix, the system as it is now – we are also looking at what the system could be.”

They must also recognise that the system is “not universally broken”, though, she says.

“We have found amazing things happening, and there are people who get out of their beds every day who work in the care system trying to do the best job possible.”

Having just had a two-day meeting with the discovery group that was leading the review’s first stage, they now have “some clear outputs”, but Duncan is not willing to share them until they have been checked by a group of young people.

“One of my clear commitments is that this review will be shaped very much by children and young people, so… I want to take that back to a group of children and young people for them to really rigorously test and assess and challenge it before going public with it to make sure that they’re happy and they feel that this is what we should be doing,” she explains.

For reasons of practicality, this won’t be all 800 young people they have already spoken to. However, it will involve some of those who have already contributed and some who haven’t, so that the review “has fresh views in there, really as a sort of test, a sort of challenge to ‘does this feel right?’

“I think that we need to make sure that we don’t just create an echo chamber, that we’re widening this out as far as we possibly can and we’re getting fresh thinking to question and test this, really.”

This group is “in its formation at the moment” and Duncan won’t be drawn on exactly, or even roughly, what size it is, because she doesn’t want to set a specific number and end up having to reject people who want to be involved.

“I think if we were to get too clinical and prescriptive, then we would end up saying, ‘I’m sorry, we have three 14-year-old girls and we have to reject you,’ and we don’t want to get to that stage, so we just have to make sure it’s a good mix, a good cross-section of people that have an interest.”

The young people will be able to choose how much of the review they want to be involved in: some may just contribute to this stage, some may continue, and they can pick which bits they are interested in. Duncan also recognises it may take time for some to feel able to contribute.

She says: “…it’s not easy for everybody to get to the point where they look at something and say yes or no.

“Some of this is taking time for people to find their voice and have confidence in the review and feel that they have agency.”

She adds: “And we offer people support at the session and afterwards as well, because this can be a difficult conversation for people to have.

“It’s not as straightforward as ‘we asked 100 people and they said this’; it’s more nuanced and complicated and some of the issues are much more sensitive, much more emotional.”

Duncan says the important thing is that they are mitigating the risk of “moving forward without sense checking”.

She explains: “I was very clear about that in terms of the methodology.

“I will be held to account by children and young people and I want them to do it as we go rather than wait till the end, and I want them to feel that it’s their voice.

“It’s not just a ‘Thanks very much. You’ve told me. OK, that’s it, I’m away. I’ll go and do something with that now’.

“I want to be able to say, ‘We’re in this together. Let’s continue the conversation and let me tell you what I think I’ve heard, tell me whether you think that’s right or not’.”

With everyone’s experience so individual and subjective, it might be expected that it would be hard to draw conclusions from the feedback of 1,600 people, but Duncan says there’s been “a huge amount of overlap”, not just among the children and young people, but also what the workforce wants as well.

After they have sense checked whether what they’ve got so far is genuinely what children and young people want, the next stage will be the ‘journey’ phase.

It’s a little difficult to follow what this involves, as Duncan attempts to explain what they are doing without actually giving away the initial findings ahead of sharing them with her group of young people.

But the end of the discovery stage will involve some interim outputs, as well as other areas that need what she calls a “deep dive”.

These areas for “deep dive” are “a number of areas that are related to one another, of huge importance to the care system in its entirety”, with “work done to understand possibly the scale, possibly the complexity, possibly the challenges or disconnect between the respective legislative or policy environments, possibly around culture, possibly around poverty.”

She continues: “We also recognise that once we have all of these and they’re all shaped and they’re working, there are a number of areas that we need to look at across all of them, so we need to be aware of population modelling, we need to be aware of use of digital technology in the care system, at some point we’ll have to do some economic modelling around that that this future care system needs to look like, but these things are things of huge relevance that will take longer to fully understand.”

Duncan expects this next journey phase will last at least a year, because many of the areas are complex and will take time to properly understand.

After that is concluded and the discovery phase outputs have been implemented, they will most likely pause again to check the final conclusions with the group of children and young people, before moving into the final stage, which will be the ‘destination’ stage – the final output for the review.

Given that there have been several reviews of the care system already, and expectations for this one are incredibly high, does the responsibility for making this a success weigh heavily on her?

Duncan answers: “The First Minister made a promise to children and young people and I’m keeping that promise to children and young people. My job is to keep a promise to them.

“It is the most important thing I’ve ever been asked to do in my entire life and I’m absolutely determined to do it right.

“The weight of responsibility is equal to the privilege, actually, of being able to do something like this and to truly have the opportunity to carry out the review in a way that’s very different to the other reviews that have happened.”

She says she spends “more time, probably, on a beanbag than I do behind a desk” and her team are going to where children and young people are to ensure they can truly understand what needs to happen.

She has also spent some time, “as you would expect”, understanding the previous reviews and their consequences, has met with past review chairs, and Duncan is determined this one will work.

“It is a significant responsibility, but it is an honour as well that children and young people are trusting me with this and that they’re getting involved. So it has to work,” she says.

While she herself is care experienced, having been adopted as a child, that is something she is not willing to talk further about.

“I’ve said as much as I’m willing to say about that...” she asserts. “My job is to understand what children and young people want to happen in the care system today, so that’s the relevant voice in all of this.”

The discovery stage findings will be published very soon. Duncan says she is “really hopeful” that they can produce something within a year of her appointment.

What that output might be has not yet been finalised; it may not be a report as such, but rather “a series of things that we intend to do as a consequence of what we’ve heard”.

But the timing depends on the response of the group of children and young people to the initial outcomes and whether they agree or disagree.

“If it all went beautifully smoothly, then we’ll probably be able to say, ‘Here are our areas of interest and this is what we’re going to do’. So, ideally, within about three weeks,” she says.