There is a lack of knowledge around child development, attachment, domestic abuse, family dynamics, and little understanding of what might constitute a risk of harm to a child. There is often a lack of curiosity and over reliance on what seems, at first glance, most apparent. And where there is clear indication of likely harm – at times this is not identified, and rarely is a referral made to safeguarding services.
I am not alone in these concerns; they are not new. They go back more than 30 years. “The lack of understanding of child development and family dynamics can result in an adult view rather than a child-centred one.” Such concerns, in addition to others around the interviewing of children, determining “genuine” views and potential “severe consequences on the child’s psychological state and social environment” led to recommendations for improvements and reform234 . Nearly 10 years later, these concerns have yet to be addressed.
Following graduation from undergraduate medical school, there are a number of points along the ‘pipeline’ for psychiatrists where potential supply can be lost:
• Not enough newly qualified doctors choosing/able to train in psychiatry. In 2016, only
349 of the advertised 417 Core Psychiatry Training places were filled by a trainee (83%). The percentage of unfilled training posts in psychiatry is consistently higher than any other specialty. Doctors in postgraduate training programmes contribute significantly to the service by delivering care, as well as getting trained. The impact of poorly filled training programmes therefore directly affects care today as well as risking care tomorrow if too few consultants are produced.
• Low direct transition rates from Core to Higher Specialty Training. Historically, for every 100 psychiatrists recruited into core psychiatry, 60 will complete core training and then proceed directly to complete higher psychiatry training. For UK medical graduates, the figure is significantly higher than overseas medical graduates. Trainees may temporarily or permanently step out of training at this transition point to work as locum or nonconsultant, non-training grade doctors.
• Recruitment into higher psychiatry is therefore reliant on non-UK doctors in training
and augmentation from beyond the pool of former core trainees. As many as 48% of
higher specialty trainees in psychiatry have non-UK Primary Medical Qualifications. 67% of our medical staff in mental health services are British (10% EU, 17% non-EU) compared to 75% of all medical staff (9% EU, 16% non-EU). The contribution of overseas doctors to the NHS is highly valued and it is essential that we retain their skills whilst also ensuring we have a sustainable ’homegrown‘ future workforce.
• A quarter of recently qualified consultant psychiatrists do not go on to be employed
substantively by the NHS (although they may be providing NHS-funded services in other settings or working as a locum for the NHS). This figure rises to a third within five years of registering. The GMC annual report2 shows over 8000 psychiatrists on the Specialist Register (across the whole of the UK), but the NHS in England employs fewer than 5000
• The psychiatric workforce also relies heavily on non-consultant, non-training grade
(SASG) doctors (24% of the psychiatric workforce). This staff group is unplanned and
therefore does not have a secure supply pipeline, but are a vital and valued part of
specialist medical care. The Five Year Forward View for Mental Health and this Workforce Plan identify the need for significant additional psychiatrists to be employed, if these services are delivered using current service models. This is in addition to filling the high levels of vacancies in current services.
Stepping forward to 202021 – The mental health workforce plan for england
Social workers are among the largest group of professionals in the mental health workforce and play a key role in the assessment of mental health, addictions and suicide. Most social workers provide services to individuals with mental health concerns, yet there are gaps in research on social work education and training programmes. The objective of this scoping review is to examine literature on social work education and training in mental health, addictions and suicide.
So why do they get it so wrong!
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Further additional provisions relevant to relocation:
13.5 Where the subject matter of the dispute includes an issue as to the permanent relocation of any child to any of the jurisdictions identified in Art.2.2(c), the arbitrator, after liaising with the parties to the arbitration, shall identify in the determination the steps necessary to give full effect to the terms of the relocation in the proposed jurisdiction including, in particular, contact with the party remaining in the jurisdiction. Such steps may include (following the appointment of an independent social worker to assist in ascertaining the wishes and feelings of the child concerned) recording the wishes and feelings of the child concerned by an appropriate finding in the determination. If a determination is made concerning a proposed relocation to which the Brussels IIA Regulation applies, the arbitrator shall attach to the determination a certificate in the form of and complying with Annexe III to the Regulation.
These provisions mirror closely the ambit of enquiries that would be undertaken by the Court in a relocation case through the Cafcass officer. Instead, in the arbitration they will be undertaken by an independent social worker jointly instructed by the parties. As in the court process, the arbitrator will also need to consider contact to the absent parent and anticipate enforcement issues.
… and finally, a change to the Disclosure Checks
17.1.1 Prior to the commencement of the arbitration (see Art.4.5) each party shall have a duty: (a) to provide accurate information regarding safeguarding and protection from harm in their Form ARB1CS and Safeguarding Questionnaire; (b) to obtain a Basic Disclosure from the Disclosure and Barring Service or from Disclosure Scotland, as appropriate, and promptly send it to the arbitrator and to every other party; or alternatively, to provide an up to date CAFCASS report or Schedule 2 letter prepared in current proceedings concerning the safeguarding and welfare of the child(ren), if applicable;
Previously safeguarding checks could only be obtained from Disclosure Scotland. This has changed and the Disclosure and Barring Service in England & Wales now permits application from private individuals. Article 17 enables checks to now be sought by either service.
Shiva Ancliffe, barrister Coram Chambers
1 HHJ Tolson QC on the 6th April 2016
2 Article 13.4
3 Emphasis added to identify the amended clause
Continue reading “Further additional provisions relevant to relocation:”