Select Committee on Health Second Report


The Present Situation


23. "Children looked after by local authorities" are those children and young persons for whom local authorities, primarily through their Social Services Departments, provide accommodation and care. This includes children subject to compulsory care orders as well as those accommodated by voluntary agreement with their parents. (Only children in the former category are technically known as "children in care", although use of the term is widespread to refer to all looked-after children.) The Children Act 1989 imposes an obligation on local authorities to provide accommodation for any child who appears to require it for one of the following reasons: because there is no person who has parental responsibility for the child; because the child is lost or abandoned; because the person who has been providing care has been prevented from doing so; or because they consider the welfare of a child over 16 is likely to be prejudiced without accommodation.[19]

24. Local authorities are responsible as corporate parents for the welfare of looked-after children. They are required to support children and their families and, where possible, take measures to prevent the necessity arising for children to leave home. Since 1996 it has been mandatory for local authorities to assess the level of need for children's care services in their area and draw up a Children's Service Plan, prepared by the SSD in liaison with the health and education authorities, certain voluntary organisations, the police, probation service and other relevant bodies. The plan should reflect a medium-term strategic planning process by projecting ahead three years, being reviewed regularly in the interim.[20]

25. The Association of Directors of Social Services (ADSS) summed up the reasons why children tend to be taken into care:

"Most commonly children are 'looked after' because parents are having difficulty providing adequate care and control. Most looked-after children will return to their families after a relatively short period, whilst some, generally younger children with weak family ties, may be placed for adoption. A significant number, however, will be looked after for a substantial period of their childhood. The challenge for public services with these often extremely disadvantaged children is to compensate for the loss of the advantages that normally come from being brought up by one's birth family and the stigma associated with being in care."[21]

26. The Who Cares? Trust pointed out to us that "the vast majority of the young people being looked after are in care through no fault of their own. They may be being looked after because of bereavement, physical or sexual abuse, neglect or other traumatic reasons associated with family breakdown."[22]

27. Somerset County Council has drawn up a list of reasons for entering care, expressed in simple language as part of their "Words of Welcome" for children who find themselves in this situation:

"Why Do I Need To Be Away From Home?

There are lots of different reasons why young people need to live away from home. Here are some of them:

(1)  Perhaps someone's ill

(2)  You might be very fed up and need a break away from home

(3)  You might have missed too much school

(4)  You may have been getting into trouble

(5)  It may not be safe for you to be at home at present

(6)  Someone at home might be falling out very badly with you

(7)  You may need special help

(8)  You may have asked to live away from home."[23]

28. The principles underlying the legal framework set up by the Children Act 1989, and by its associated regulations and guidance, remain widely supported, although some criticisms were made by our witnesses as to the way in which it is being implemented—we deal with these matters in paragraphs 60 to 68 below.

29. The Children Act requires that the DoH should submit an annual report to Parliament on the working of the Act. Reports were duly submitted relating to 1992, 1993 and 1994, the first three full years after the coming into force of the Act. We asked the DoH why no reports have been submitted since then. The Parliamentary Clerk at the DoH replied as follows:

"All the material which was produced in previous Reports has been put in the public domain and submitted to Parliament in other forms, such as the Department's Statistical Tables and the Chief Inspector's Annual Report and Inspection Reports. However, the Department recognises that it has failed to comply with the requirement in Section 83(6) to provide an overall consolidated report over this period. I am assured the Department will be producing a Children Act Report this year and for future years as required by Section 83(6)."[24]

30. We were very disturbed to learn that the DoH has over a number of years simply disregarded the statutory requirement that it submit an annual report to Parliament on the working of the Children Act. It should not have been necessary for us to remind the DoH of its duty to obey the law. This does not inspire confidence in the DoH's ability to monitor and enforce local compliance with statutory provisions. It is particularly regrettable in the light of the fact that, back in 1994, the existence of an annual report to Parliament was referred to by the Government in its first report to the UN Committee on the Rights of the Child as evidence that "the operation of the Children Act and its effect on children is subject to regular and public scrutiny".[25]


31. No statistics are collected centrally on the number of children determined by local authorities to be "in need". Research commissioned by the DoH suggests an estimate of around 400,000 in 1996. The DoH comments that "very few statistics are collected on services provided to children in need, beyond numbers on the protection register, and numbers looked after".[26] The number of children on child protection registers (some but not many of whom will be "looked after") declined from 38,600 in 1992 to 32,400 in 1997.[27]

32. As at 31 March 1996, there were about 51,000 children and young people looked after in England. Just over 20,000 of these (40%) were looked after by voluntary arrangement with their families, and some 30,000 (57%) were subject to various forms of care order.[28] A breakdown by type of placement shows that about 33,200 children and young people (65%) were living with foster carers, about 6,800 (13.3%) were living in residential accommodation, 4,700 (9.2%) were living with their parents (usually for a trial period as part of a plan leading to the discharge of a care order), 2,300 (4.5%) were placed for adoption, 1,400 (2.7%) were in lodgings or living independently, and 2,700 (5.3%) were otherwise placed.[29]

33. The following table and graph show how the total number of children looked after has declined over the last 20 years, and how the proportion of children looked after who are fostered has increased significantly over that period, from 33% in 1976 to 65% in 1996, while the proportion in residential homes has declined from 40% to 12%. The decrease in the number of looked-after children may now have bottomed out, as the figures for the two most recent years in the table show a slight increase.[30]


34. There is a great deal of variation between local authorities in the use they make of different types of placement. Although in England taken as a whole, 65% of children looked after in 1995-96 were in foster care, one local authority (Trafford) had as few as 38% of its children in foster homes, whilst another (Norfolk) has as many as 85%.[31] Differences in size and socio-economic circumstances between authorities, of course, mean that a significant degree of variation is to be expected.

35. A breakdown by reason for being looked after (see chart below) shows that the most common reason for starting to look after a child during the year ending 31 March 1996 was to give relief to the parents or family (29%). The other most commonly cited reasons were abuse or neglect (20%), parent's health (14%) and concern for the child's welfare (8%).[32]

36. There has been a trend towards reduction in the average age of children looked after. The average age of such children at 31 March 1996 was 10 years 11 months compared with 11 years 10 months in 1986. At 31 March 1996 there were 20,000 children looked after aged under 10 (39%); the proportion in this age group in 1986 was 29%. The percentage aged 16 and over was 19% in 1996 compared with 27% in 1986.[33]

37. There were more boys looked after (54%) than girls at 31 March 1996, a slightly higher proportion than in earlier years. The proportion of boys has been largely constant since 1991, having fallen from 57% in 1986. In 1995 boys were estimated to account for 51% of the total population aged under 18.[34]

38. One significant change has been in the number of admissions and discharges from care that take place within a year. These have been rising for some years. Children move in and out of care for many different reasons and stay for periods ranging from a few weeks to three or four years. Since the introduction of the Children Act, there has been a gradual reduction in the average overall length of time for which children are looked after, from 610 days in the 1992-93 (the first full year after the Act came into force) to 500 days in 1995-96. This reduction is largely a consequence of a decline in the proportion of children who are in care for long periods: only 19% of children who left care in 1995-96 had been looked after for more than two years, compared with 26% in 1992-93.[35]

39. The average duration of individual placements has also been declining. The average length of placements ceasing during 1995-96 was 210 days, compared with 360 days in 1992-93. This decline has occurred both in residential and foster placements. In 1995-96 over half of all placements lasted for less than eight weeks, and only 6% lasted for two years or more.[36]


40. The DoH estimates that the average gross expenditure per week on services for children in local authority maintained homes in 1995-96 (the most recent year for which figures are available) was £1,100 per child, or over £57,000 per annum, and on children looked after by foster parents £159, or over £8,000 per annum.[37]

41. Prior to 1998 these figures were supplied in the DoH Annual Report, but in this year's report they were omitted "in line with the Department's policy to produce a more concise report" and we had specifically to request them from the DoH.[38] It seems to us that the average costs to the public purse of caring for looked-after children are a matter of legitimate public interest. We recommend that this information be re-instated in future editions of the Annual Report.

42. The figure cited above for residential homes is calculated by the DoH from local authorities' personal social services returns. These give a figure for gross current expenditure on each maintained residential home in the authority: the DoH adds together these figures to produce a total for England, then divides this by the number of children in residential homes to produce the average figure per child per week.[39] The Education and Employment Committee, commenting on this figure in its recent report, states that "given the method by which the DoH arrives at this figure, we have some concern about the extent to which it accurately reflects the actual cost of provision in a typical residential home. However, we accept that it is the only figure available and gives a reasonable indication of the sums of money involved."[40]

43. The Social Services Committee in its 1984 report noted that "the care of children separated from their families is an expensive service".[41] The trend has been for it to become even more expensive since those words were written. Weekly unit costs for a child in a local authority maintained home rose from £606 in 1984-85 to £712 in 1989-90, and then leapt sharply upwards to £1,100 in 1995-96 (at 1995-96 prices, after taking account of the rise in prices met by local authorities for social services staff and other inputs). The average weekly unit costs for fostering nearly doubled over the same decade, from £83 in 1984-85 to £159 in 1995-96.[42]

44. The DoH attributes these increases in unit costs largely to changes in the pattern of placement:

"Many children that in the past might have been provided with residential care services are now being fostered, whilst some who in the past might have been fostered are now being provided with services within their own families. Thus, in each service area, the concentration of children with behavioural problems or requiring closer supervision or more intensive support might increase. Unit costs of care in each area might tend to rise, while overall cost-effectiveness would be improved."[43]

However, the DoH adds that it is not possible fully to establish the reasons for the increases in unit costs, and as a result "it is therefore uncertain that all the cost rises are justified".[44]

45. One reason for the high cost of looking after children in maintained homes is the high staff/child ratio in such homes. In 1994-95 this stood at almost two members of staff for each child. The number of staff members per child has nearly doubled since 1984-85. This is no doubt partly at least attributable to the increasing concentration of children with severe behavioural problems in residential care. The DoH adds that "an increase in the staff/child ratio may also indicate an improvement in the quality of service".[45] It is worth noting that if staff cover in residential care is to be provided 24 hours a day, 365 days a year, it is necessary to employ between 3.5 and 4 whole time equivalent staff in order to have one staff member on duty at a time. A staff/child ratio of two members of staff per child, therefore, represents one staff member per two children actually on duty at any given time.


46. Any improvements in the quality of service do not seem to be reflected in outcomes. The Who Cares? Trust supplied us with a useful summary of research findings over the past two decades which illustrate the extent to which care leavers underperform and are disadvantaged (with dates of publication of research in brackets):

Education: between 50% and 75% of care leavers complete their schooling with no formal qualifications compared with only 6% of the general population (1992, 1995)

Further education: between 12% and 19% of care leavers go on to further education compared with 68% of the general population (1994, 1995)

Employment: between 50% and 80% of care leavers are unemployed (1986)

Offending: 23% of adult prisoners and 38% of young prisoners have been in care (1991)

Parenthood: at least one in seven young women leaving care are pregnant or already mothers (1986)

Homelessness: 30% of young, single homeless people have been in care (1981)

Poverty: one in ten 16-17 year old claimants of DSS severe hardship payments have been in care (1993).[46]

47. Other recent research suggests that up to 50% of children looked after may be in need of some form of health intervention, that up to 30% may have special educational needs, and that 67% may experience psychiatric disorders compared with 15% in the general population.[47]

48. The fact that looked-after children perform considerably less well, by all these different measures, than the general child population does not necessarily indicate that the care system is failing them. It is important to remember that outcomes for looked-after children will always be poorer than those for children at large to some extent, because of the personal and family problems and unhappy experiences which have led them into care in the first place. This was a point made by Professor David Berridge of the University of Luton:

" Most children looked after by local authorities have very very severe problems. There are not many children looked after unnecessarily at all. The level of deprivation, damage, injury, abuse, humiliation that those children have suffered, which we as researchers come into contact with on a regular basis is absolutely horrendous. Unless one realises the depth of damage that these children have experienced we cannot begin to conceive how to put a framework of services into place to deal with that. It is clear that Social Services on their own cannot begin to tackle the major problems that these children have got ... ."[48]

Professor Berridge added that:

"I think we have to bear in mind that it is not necessarily the care system that creates these problems. Children arrive in residential and foster care with acute problems and in the research that we have done about half the group of residents in children's homes have been there less than six months. So you are not going to turn round quite acute problems that are built up over 15 or 16 years within a very short period."[49]

49. Another witness, Professor Dorothy Whitaker, formerly of the University of York, stressed how difficult it was fairly to assess outcomes:

"Criteria such as school attendance or school performance, or getting a job after leaving school, are readily measurable, but may be seriously misleading unless judged in the light of other information which distinguished a specific case. For example, a desperately grieving child may perform poorly at school, and if school performance is used as a criterion will seem to be achieving little. Yet this same child may have achieved a great deal through having overcome the worst of his sense of personal loss. Whether an outcome is 'good' or not needs to be judged against each child's start state."[50]

50. These are sensible points, which we endorse. Nonetheless, the extent to which the outcomes of looked-after children fall short of those of their peers in the general population is very worrying, and it is difficult to resist the conclusion that the system itself is under-performing. In the field of education, for instance, as we shall see,[51] the failure to provide adequate support and opportunities to looked-after children is scandalous. Some strong and talented individuals—like the young people who gave oral evidence to us—survive the system and do well, but the horrendous statistics we cite in paragraph 46 above indicate that the odds are stacked against the majority of those who enter care. It would be a betrayal of looked-after children to suppose that significant improvements cannot be made with regard to outcomes. In the remainder of this report we examine ways in which this aim might be achieved.

19  Ev pp 1, 9. Back

20  The Children's Act 1989 (Amendment) (Children's Service Planning) Order 1996, explanatory note; HC (1996-97) 307-III, Ev p 223, Q15. Back

21  Ev p 9. Back

22  Who Cares? Trust [with Barnado's and other agencies], Too Much, Too Young: The Failure of Social Policy in Meeting the Needs of Care Leavers (1996), p 2. Back

23  Somerset County Council SSD, Living Away From Home (1993), p 8. Back

24  Ev p 396 (Appendix 20). Back

25  The UN Convention on the Rights of the Child: The UK's First Report to the UN Committee on the Rights of the Child (HMSO, 1994), p 5. Back

26  DoH, Better Value for Money in Social Services: A Review of Performance Trends in Social Services in England (February 1997), para 3.2. Back

27  Cm 3912, Figure 5.8. Back

28  DoH, Children Looked After by Local Authorities: Year Ending 31 March 1996, England (1997), Table 3 and p 5. Back

29  Ibid., Table 4; ev p 94; ev (2) p 145. Back

30  See also Q1-4. Back

31  DoH, Children Looked After by Local Authorities: Year Ending 31 March 1996, England (1997), p 16. Back

32  Ibid., Table 10 and p 14. Back

33  Ibid., p 11. Back

34  Ibid., p 12. Back

35  Ibid., p 14. Back

36  Ibid., pp 14-15. Back

37  Ev p 398 (Appendix 20), Tables 5.19, 5.20. Back

38  Ibid., p 2. Back

39  HC (1997-98) 498-I, para 3, footnote 8. Back

40  HC (1997-98) 498-I, para 83, footnote 159. Back

41  HC (1983-84) 360-I, para 6. Back

42   Annex B (Appendix 22). Back

43  Ibid., para 3.10. Back

44  Id. Back

45  Ibid., para 10, figure 8. Back

46  Ev pp 41, 44. Back

47  Ev p 8. Back

48  Q422. Back

49  Q424. Back

50  Ev p 33. Back

51  In paragraphs 273 to 303 below. Back

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