Designing services around people, not pathways: Lessons from newborn care proceedings

Newborn care proceedings reveal a wider challenge at the heart of public services: too often, support is designed around organisational responsibilities and service pathways rather than the lived experiences of the people who are moving through them. In this article, Luke Bevir explores why improving outcomes for babies requires a greater focus on supporting mothers before, during and after care proceedings and what this tells us about person-centred service design.

Across children's social care and family justice, there is increasing attention on newborn babies in care proceedings. The Nuffield Family Justice Observatory's (NFJO) Born into Care research highlighted a concerning rise in the number of newborn babies becoming subject to care proceedings. More recently, the Short Notice Application Group's consultation on a new protocol for public law cases involving newborn babies has shone a light on how urgent cases are managed and the need for greater fairness and consistency.

This focus is both understandable and important. Decisions involving newborn babies carry profound consequences and are often made at one of the most vulnerable moments in a family's life.

The work of the Short Notice Application Group highlighted a key question for urgent newborn cases: what happens to the parents?

It is a question that came to the fore in Mutual Ventures' work supporting local family justice boards across the country.

What newborn care proceedings can teach us about person-centred public service design

Most public services are designed with good intentions. Responsibilities are allocated, thresholds developed and pathways established. However, real people's lives rarely fit neatly within those structures.

For mothers involved in newborn care proceedings, there is a particularly stark disconnect. During pregnancy, a range of professionals may be involved, including health professionals, family support workers and social workers - but when a baby is removed from their mother's care, many of those services cease their involvement with the mother because their focus is linked to the child rather than the adult.

From the system's perspective, a process has reached a natural conclusion. From the mother's perspective, one of the most traumatic periods of her life is only just beginning.

During our work with local family justice systems, we heard examples of mothers returning from court to find that a social worker had already removed their baby from the hospital – or examples where a mother was presented with a Section 20 to sign at their hospital bed only hours after the baby was born, and not being reunited with that child until their fifth birthday. These experiences bring sharp focus to the emotional impact of separation, but also how difficult it can be for systems focused on legal processes and safeguarding decisions to fully understand the experience of the people moving through them.

This is not unique to family justice. Across public services, support often begins and ends according to organisational responsibilities and set pathways rather than personal need. Whether in housing, health, children's services or adult social care, people frequently find themselves navigating services designed independently of one another.

The cost of losing sight of the person

The NFJO found that when a mother has previously appeared in care proceedings, there is a one-in-two chance that a subsequent baby will also become subject to proceedings. Our discussions with frontline social workers highlighted that in more than one instance, multiple babies had been born while care proceedings for the first child were still live and ongoing. The NFJO also found that many women return to proceedings with the same unaddressed needs that were present during the original care proceedings.

This should prompt us to ask some difficult questions.

If the same mothers are repeatedly returning to proceedings, are we focused on support after proceedings conclude? If challenges remain unresolved, are our systems helping people make sustainable changes or simply managing points of crisis?

This does not diminish the importance of safeguarding decisions or the need to act where a child is in danger or has been harmed. Rather, it recognises that improving outcomes for children requires us to think carefully about the experiences and needs of the adults around them.

Designing support around people

Encouragingly, there are already examples of places beginning to respond differently.

In Sheffield, local partners have redesigned their approach to supporting expectant mothers where there is a possibility of care proceedings. Their work includes earlier assessments, stronger multi-agency collaboration, earlier engagement with wider family networks and more honest conversations with parents about potential outcomes.

What is striking about Sheffield's approach is that it starts by understanding the experience of mothers and families rather than the requirements of individual organisations. The question is not simply "What does the process require?" but "What does this person need?"

In response, Sheffield introduced approaches designed to improve communication, provide greater preparation and ensure there is support for mothers as well as plans for babies. These plans include conversations about what ongoing contact and connection with their baby could look like after separation, helping mothers prepare for what lies ahead while remaining supported by the professionals around them.

The debate around the new Newborn Baby Protocol has similarly highlighted questions about when assessments should be completed during pregnancy. Several areas described completing assessments earlier to provide time for support and for women to demonstrate change before birth. This approach acknowledges how it can often be more difficult for women to engage fully with services late in their pregnancy. A service that insists assessments and engagement occur at 37 weeks falls apart if the mother has already gone into labour, but 30 weeks by comparison might make all the difference to a mother’s ability to engage with services and assessments.

The underlying principle is simple: good service design starts not with organisational structures, but with an understanding of what people need at different points in their journey.

A challenge for public service leaders

While newborn care proceedings provide a powerful example, the lessons extend far beyond family justice. This challenge cannot be solved by any single organisation. Health services, local authorities, family justice professionals and the voluntary sector all hold part of the solution. Creating genuinely person-centred support requires leaders to think beyond organisational boundaries and design collectively around the experiences of families.

Across public services, leaders should be asking:

• Who loses support when responsibility transfers between services?

• How do individuals actually experience the ‘transition’ between services and pathways?

• Which people repeatedly return to services with the same unmet needs?

• Where do organisational boundaries create gaps in support?

• Are we designing services around professional structures or around human experience?

These questions sit at the heart of many current reform agendas. Whether in children's services, health, housing or adult social care, the challenge is often the same: creating systems that work with the realities of people's lives rather than expecting people to navigate the complexities of our systems.

Babies will always, and should always, remain at the centre of decisions about their safety and wellbeing. But improving outcomes for babies requires us to think equally carefully about the adults around them.

Many public service leaders would describe their organisations as person-centred, but person-centred design requires more than a mission statement. It requires us to identify where organisational boundaries create gaps in support and redesign services around people's lives rather than professional remits.

The lesson from newborn care proceedings is both simple and profound. When we design services around people rather than organisational boundaries, we create better experiences, stronger engagement and ultimately better outcomes. Supporting parents is not separate from improving outcomes for babies. In many cases, it may be one of the most important ways of achieving it.

For more information on Mutual Ventures’ work across the family justice system see our dedicated webpage. Contact luke.bevir@mutualventures.co.uk if you would like to discuss newborn care proceedings.