House of Commons - Health

Select Committee on Health Second Report

CHILDREN LOOKED AFTER BY LOCAL AUTHORITIES

Residential Care

154. There were 1,232 homes in England accommodating children at 31 March 1997 which were either "community homes", for which the local authority has responsibility, or were registered with the local authority or the DoH. Of these, 838 were community homes, 62 were voluntary children's homes, 221 were registered private children's homes, and 98 were registered residential care homes.[171] Most homes (91%) provided accommodation for both boys and girls.[172]

155. Approximately 70% of children in residential care accommodation in 1995-96 were in council-run community homes, with 7% in voluntary homes, 8% in private homes and 9% in schools and associated homes and hostels. The remainder were in family centres, mother and baby homes, medical or nursing facilities, young offender institutions and youth treatment centres.[173] The total number of places in all local authority and registered homes was 10,869, an average of 8.8 places per home. The most common size of home had six places (253 homes). Only 46 homes had the capacity to accommodate more than 20 children.[174] The DoH notes a trend towards the use of smaller homes to provide for children who cannot remain with their parents and for whom fostering is not an appropriate arrangement. This, in combination with the reduction in overall numbers in residential accommodation, has led to the closure of many of the larger residential units.[175]

156. As at 31 March 1996, about 6,000 children and young people in England, amounting to some 12% of the looked-after population, were living in residential accommodation. As we have seen, this represents a steep decline both in absolute and relative terms over the past 20 years: the comparable figure for 1976 was 38,000 children, amounting to some 40% of those in care.[176]

157. We have discussed in paragraphs 103 to 105 above some of the reasons for this shift away from residential and towards foster care. In recent years, awareness of the dangers of physical and sexual abuse in children's homes has been an important factor in tarnishing the image of such homes in general. The horrors that can ensue if a group of paedophiles acting in concert gains control of a children's home are now widely appreciated, and evidence continues to accumulate as to past cases of organised abuse. The fact that, even allowing for recent revelations, the number of homes in which such enormities took place remains a very small proportion of the overall number does nothing to diminish the sense of public outrage, or the consequent public suspicion of the concept of children's homes.

158. Despite the seriousness of the crimes which took place in some homes, it was generally accepted by our witnesses that residential care is desirable for some children. BASW stated that "there is no doubt that residential care continues to be an essential part of the child care service. There is no evidence to support a view that local authorities could look after children without it."[177] BAAF argued that

"residential care continues to provide a valuable role and placement of choice for many young people, particularly as a bridge to a future family placement following a painful foster home breakdown. It is vital that such care is not devalued because of recent abuse inquiries."[178]

159. Adolescents in particular will in some cases positively opt for the greater degree of personal independence offered by residential as opposed to foster care.[179] Mr Keith Bilton of BASW told us that the kind of children likely to profit from residential care are "young people who have their own strong views in wanting residential care or not wanting to live in a foster home". They may want to be with brothers and sisters, or need intensive specialist care, or simply "on past experiences of family life feel that they just cannot cope with it at the moment".[180] Mr Paul Kefford, looking back on his experience of residential care, said that "I could not have thought of anything worse than going into another family situation after the situation I found myself in—the care home was exactly what I wanted".[181]

160. A less positive reason why continuing residential capacity is needed is that some young people will evince behavioural problems so severe that foster carers are not able to cope with them. Councillor Arthur Keefe of the ACC told us that "the children in residential care generally are the children who are the most difficult, the most challenging, the most disturbed, and many of them have gone through the foster care system and it has been unable to contain them".[182] The reduction in provision of residential care has led to an increasing concentration of such children in the remaining homes.

161. Back in 1984, the Social Services Committee commented that "the mixture in residential homes of children in care because of their home circumstances and children who may be in care as a result of delinquency can create problems".[183] The trend towards foster care has exacerbated these problems. Mr Rob Hutchinson of the ADSS told us that the reduction in the number of children's homes had led to "a reduction of choice and flexibility" and to "problems of mix", with "a greater concentration of very difficult children all put in together ... it seems so often that there is a potentially volatile situation always in existence".[184] BASW commented that

"local reception and assessment centres have virtually disappeared, and most local children's homes have become 'general purpose', with a mix of long and short stay residents displaying a range (and from time to time an explosive cocktail) of different needs and problems".[185]

Ms Rosie Kett of UNISON said that children's homes were sometimes used as "a dumping ground" for children for whom other more suitable resources were not available.[186]

162. The reduction in residential provision has also led to an increasing trend for specialist provision to be purchased for children with complex needs outside the boundaries of their own local authority. In a joint submission, the ACC/AMA told us that "placing children outside their home area has significant repercussions for the child in terms of discontinuity of education, health care and rehabilitation back to the family home", and drew our attention also to the resource implications of such placements and the ensuing need for greater liaison between the authorities concerned.[187]

163. The Parliamentary Under-Secretary, Mr Boateng, described this as

"an area of very real concern to me and to the Department. There is increasing evidence of children being put in a position in which all too often the fear is that they are out of sight, out of mind. There are on occasion good reasons where specialist facilities or special skills which a particular foster parent, for instance, might have, those can provide good reasons why a placement should take place some distance away from the home authority, but in the main, I view with increasing concern a tendency to place children a long way away from a local authority which is their home. It produces all sorts of problems ... in terms of effective management and supervision of the placement."[188]

164. The Chief Inspector of Social Services, Sir Herbert Laming, commented that children should not be sent many miles away from their familiar surroundings unless there were very strong reasons to do so in terms of the child's own welfare. He said that:

"the idea that a local authority can fulfil its parental responsibilities with an annual visit is also rank, bad and unacceptable practice. ... A local authority should be expected to act as a good parent and a good parent does not put their child in a car and send them 100 miles away and have a visit once a year."[189]

165. The DoH told us that although figures were available for the number of foster children in placements outside their home authorities (5,300 as at 31 March 1996, amounting to 16% of all foster placements), equivalent figures for children in residential care are not collected, nor are details of the reasons for out-of-area placement.[190] This means that it is not possible to quantify the extent of the problem.

166. A number of our witnesses commented on the extent to which provision of residential care varied between authorities. Councillor Eve Brook of the AMA said that "across the country there is an enormous variation in the extent to which local authorities do or do not continue to provide residential care. ... I do not think we actually know what the appropriate level of residential care should be within a particular locality for a particular child population".[191]

167. The view was widespread amongst our witnesses that the pendulum has swung too far away from residential provision. BASW claimed that "this process has gone too far: ... the closure of too many homes has put too much pressure on fostering services and has resulted in inappropriate placements; similarly, within the residential sector, appropriate placements are hard to find".[192] This conclusion was supported by Sir William Utting. His report states that "it is probable that residential child care has shrunk as a national service to a level below that at which a reasonable choice of placement is possible for any child".[193]

168. The Parliamentary Under-Secretary, Mr Boateng, told us that he was not complacent about residential care capacity. He said that "there are real worries about the extent to which local authorities are in a position realistically to make choices in relation to the placement of children", and he undertook that the Ministerial task force would examine this issue. However, he said that he wished to caution against a "knee-jerk reaction that says therefore local authorities individually must have spare capacity", because he thought it feasible that in future local authorities could come together in consortia to make suitable residential provision for children. He added that he was thinking in terms of contiguous authorities making such arrangements within a limited local area: in other words, it might be sensible for Camden, Islington and Hackney to come together in a consortium, but it clearly would not be for, say, Brent and Powys.[194]

169. The evidence we have taken on provision of residential care leads us to two conclusions. Firstly, that it is not realistic to suppose that the trend towards foster care can be continued to the point at which residential care becomes unnecessary. There will always be a significant minority of children and young people, particularly in the older age ranges, for whom—because of their behavioural problems, as a matter of personal preference, or in other circumstances—residential care is the better option.

170. Secondly, the reduction in residential home capacity has gone too far. There is a clear need for an increase in the number of children's homes countrywide, to enable local authorities to make appropriate placements, to reduce problems arising within homes from an inappropriate 'mix' of children, and to relieve pressure on the fostering service. In order for the desirable choice of placements to be available, it will be necessary to plan on the assumption that each home will normally contain some spare capacity. We support Sir William Utting's recommendation that the DoH should "establish and resource a dedicated group to develop and implement a national strategy for residential child care", which should "extend to the volume and nature of service needed, with plans for securing provision to the standards required".[195]

171. We were disquieted to hear about the increasing trend towards placements outside the home authority. We share the concern expressed by the Minister and by the Chief Inspector of Social Services about this development. We recommend that the Government should take steps, through the Social Services Inspectorate, to establish the extent of the problem; it is unsatisfactory that the DoH does not collect statistics on this. The Government should issue instructions to local authorities that such placements should only be made when they are in the clear interests of the child's welfare. The Government must ensure that sufficient resources are available to enable local authorities to make appropriate placements within or very close to their own area, other than in cases where children have exceptional needs (such as severe disability or behavioural difficulties) and specialist facilities are required. Local authorities should be required by regulations, when a child is placed out of their area, to communicate effectively with the authority in which he or she resides prior to placement and during placement, and to agree arrangements for the effective monitoring of his or her progress. The SSI should issue guidance on how this monitoring and communication should be carried out.

172. We recognise that in many cases cross-authority arrangements may be desirable. However, we are sceptical about the extent to which the current shortfall in residential capacity can be addressed by local authorities acting in consortia. This may be a helpful option in a limited number of inner-city areas, or between immediately neighbouring authorities, where geographical distances are not great, and for particular specialist services, but across most of the country and for most placements we believe that it would run counter to the general principle that children should not be sent to reside far away from their own familiar surroundings. We reiterate our view that local authorities should be resourced to provide or have access to all necessary non-specialist residential and foster care facilities within or very close to their own areas.

SMALL PRIVATE CHILDREN'S HOMES

173. We have commented adversely in paragraph 136 above on the failure to regulate independent fostering agencies. There is another omission in the current regulatory regime which needs to be remedied. At present, private children's homes caring for three or less children are not required to be registered under the Children's Act. DoH figures show that during the year ending 31 March 1997 local authorities had made use of 89 such homes to accommodate children.[196] These homes provide similar services to those provided in larger homes, and cater for the same kind of children and young people, but they are not subject to the scrutiny and supervision exercised over larger homes. There is no planned and co-ordinated inspection and oversight of the quality of care, of the kind and number of staff who are appointed, or the mix of children and young people living in each home. This situation is not only undesirable in itself, it creates an incentive for proprietors wishing to evade the regulatory regime to establish groups of units in which there are never more than four children in each unit.[197] Some local authorities have a policy of not using these homes, because of the lack of regulation.[198]

174. The DoH has accepted in principle that statutory regulation should be extended to these small homes and "will introduce the necessary changes in legislation as soon as practicable".[199] We recommend that the Government make a public commitment to introducing legislation in the next Session of Parliament. The legislation should require small private children's homes to be registered and subject to supervision and inspection in exactly the same way as larger homes.

171 DoH, Children's Homes at 31 March 1997, England (January 1998), p 2. Back

172 Ibid. Back

173 Better Value for Money in Social Services, para 3.7. Back

174 DoH, Children's Homes at 31 March 1997, England (January 1998), p 3. Back

175 Better Value for Money in Social Services, para 3.7. Back

176 Ev p 145. Back

177 Ev p 95. Back

178 Ev p 72. Back

179 Q254. Back

180 Q254. Back

181 Q779. Back

182 Q18. Back