24. Memorandum submitted by
the Department of Health (DH)
The Home Affairs Committee is holding an inquiry
into the relationship between young black people and the criminal
justice system, focusing particularly on public perceptions of
criminality among young black people and the reasons for their
overrepresentation in the system.
For the purposes of this inquiry, the Committee
will focus on young people whose cultural background is associated
with the ONS Census ethnicity category "Black or Black British",
which comprises "Caribbean", "African" and
"Any other black background".
The Committee has asked the Department of Health
to answer the six questions listed below.
As some of the questions relate to social policy
for children, this response has been compiled jointly with the
Department for Education and Skills who have responsibility for
1. How much ethnic data is available on young
people in contact with health and social services?
The Department of Health actively promotes the
collection of ethnic data for patients and service users in contact
with health and social services. Although ethnic monitoring is
common across social services, performance on ethnic data collection
is more variable in the NHS, where there are sensitivities both
for staff asking for information and for patients giving it. The
Department is committed to raising the quality of ethnicity data
of those who use NHS services and published revised guidance on
ethnicity monitoring of NHS patients and social care users in
Within the NHS the only mandatory ethnic group
collection is for in-patients, which is currently recorded in
Hospital Episode Statistics. It is good practice, although not
mandatory, to collect ethnic data in primary care settings. GP
practices are now incentivised to collect ethnic group data on
new patients through the Quality and Outcomes Framework, and the
new GP registration forms that are shortly to be introduced will
for the first time include a question on ethnic group and should
lead to comprehensive and complete data on the ethnic group of
DH will shortly be launching the "Pacesetters
Programme" working with up to five Strategic Health Authorities
on delivering equality and diversity improvements in the NHS,
including improving and using ethnicity data collections within
Social care data is available in Table 10 in
the Statistical Volume for Children in Need in 2005. This table
is at Annex A to this response. Note that these figures
provide information on all children who were in touch with social
services during a survey week during February 2005, and that the
Children Looked After figures include children in respite care.
Research by Bristol University in 1999 found
a greater degree of unmet need for disabled children in families
from minority ethnic communities. Separate research by the University
of Lancaster in 2002 found this to be particularly true of families
of South Asian origin. These pieces of research fed into the development
of the National Service Framework for Children, Young People and
Maternity Services (The Children's NSF).
The Children's NSF, which we published in 2004,
contains eleven standards against which we will judge the performance
of NHS providers increasingly over the 10 years to 2014. The research
mentioned above relates to standard 8, which deals with disability,
but standard 1 (which deals with health promotion) and standard
4 (which deals with transition to adult services) are also important.
All 11 standards of the NSF recognise that Black
and Minority Ethnic (BME) communities are less likely to access
health care and health promotion programmes. The NSF introduced
a Child Health Promotion Programme aimed at improving the health
of all children.
The NSF calls for PCTs to have strategies in
place to ensure that all children are registered with GPs and
to ensure access to health promotion programmes for children from
sections of the community less likely to access them.
The National Children's Bureau will begin a
project, with funding from the Department of Health under the
section 64 scheme, in September 2006 aimed at improving access
to health services for children from BME communities.
2. How is this data being used to monitor
equality of treatment (including access to services) and inform
policy with particular reference to young black people?
DfES monitor and publish the data nationally
to ensure that local authorities are able to take it into account
in developing policies and services locally.
The DH guidance on ethnicity monitoring of NHS
patients and social care users applies to community health and
hospital-based settings and social care, and sets out how data
should be collected and used to monitor equality of access and
treatment and inform policy. It confirms the use of ONS codes
for ethnic group as the NHS standard and includes a range of good
practice examples, including sensible and proportionate processes
3. What evidence is there for ethnic differences
with regard to:
Child protection issues?
Of children on child protection registers at
31 March 2005, 81% were White, 7% were Mixed, 5% were Black, 4%
were Asian, 1% were Other Ethnic Groups, and 1% were Unborn. This
suggests that a disproportionate number of Mixed and Black children
are on child protection registers, compared with the proportion
of the overall population made up of these groups.
The Government guidance on child protection
is very clear that, in order to make informed professional judgements
about a child's needs and parents' capacity to respond to those
needs, professionals should be sensitive to differing family patterns
and lifestyles and to child rearing patterns that vary across
different racial, ethnic and cultural groups. It also makes clear
that children from all cultures are subject to abuse and neglect;
that all children have a right to grow up safe from harm; and
that child abuse cannot be condoned for religious or cultural
reasons. (Working Together to Safeguard Children: A guide to
inter-agency working to safeguard and promote the welfare of children.
HM Government, 2006.)
Children supervised by social services or in care?
Of all children who were in touch with social
services during a survey week during February 2005: 74% were White,
6% were Mixed, 4% were Asian, 7% were Black, 2% were other Ethnic
Groups and 7% did not state their ethnicity. See Annex A.
Fostering and adoption
Figures on the number of Children Looked After
by ethnic group are available in Table H in the Statistical Volume
for Children Looked After in 2005. See attached Annex B.
Information is available about the ethnicity
of children adopted from care but because numbers are small it
has been necessary simply to compare white children with all other
ethnic identities. 17% of looked after children who were adopted
in 2005 were from ethnic groups other than white, an increase
from 13% in 2003. This compares with about 21% of all children
looked after. (Lines from the Children Act Report).
The Government's White Paper: Adoption: A
New Approach (2000) reported that:
Black children wait on average five
months longer for placement than white children.
Mixed-race children wait on average
eight weeks longer for placement than white children.
Mental health problems?
The Department of Health set out its vision
for the development of comprehensive Child and Adolescent Mental
Health Services (CAMHS) in Standard 9 of the National Service
Framework for Children, Young People and Maternity Services (September
2004). This recognised that the mental health needs of minority
groups were not always being addressed. The document set out a
number of measures to improve the position which included:
local CAMHS needs assessments should
specifically take account of the mental health needs of BME children
all staff working within CAMHS are
sensitive to the needs of children and young people from different
training is available for staff to
work effectively with families from specific BME groups within
services aim to recruit and train
professionals from the ethnic minorities for whom services are
being provided, and review the provision and training of interpreters
to ensure that best practice is achieved; and
Primary Care Trusts and Local Authorities
ensure that local directories of services for minority groups
The existence of a CAMHS needs assessment, and
its inclusion of BME requirements, is one of the elements taken
into account by the Healthcare Commission in its assessment of
PCTs' performance in improving CAMHS locally.
Data from the CAMHS mapping found that 3% of
cases dealt with by the CAMHS workforce in 2004 were from Black
and Black British communities. See www.camhsmapping.org.uk/2004/atlas/CHAPTER4.pdf
for more details.
Additionally, the ONS survey Mental Health
of children and young people in GB 2004 looked at the prevalence
of mental health disorders amongst children aged 5-16 years. The
only major difference found between ethnic groups in this survey
was that children of Indian origin had an overall prevalence rate
of 2.6% compared to between 7-10% for other ethnic groups. However
the ONS team were keen to stress that due to the numbers of different
ethnic groups within their sample they didn't want to draw any
major conclusions from this. (table 4.6 p 41). www.statistics.gov.uk
The Mental Health Act Commission report suggests
that young black men are overrepresented on adult in-patient units
(ie are more likely to be on an adult unit rather than a young
people's unit than their white counterparts). In contrast we know
from local data collected by services that some ethnic groups
Young people admitted to secure hospitals?
In January 2005, DH published Delivering Race
Equality (DRE) in Mental Health. As part of this five-year action
plan for tackling inequalities and discrimination in mental health
care, the first annual Count Me In Census was taken in March 2005
in order to better monitor the mental health service experience
of BME service users. The Count Me In: Mental Health and Ethnicity
Census, published in December 2005 will set a baseline for monitoring
progress. The 2005 census was conducted jointly by the Healthcare
Commission, the Mental Health Act Commission and the National
Institute for Mental Health (England).
We know from research and the Count Me In census
that rates of admission and detention are significantly higher
for some BME groups. They are more likely to arrive in care through
the criminal justice system, and that once in hospital some BME
patients are more likely than white British people to be subject
to measures like seclusion or restraint. This fuels the "circle
of fear" that deters many BME patients from seeking early
treatment for their illness.
The following information is taken directly
from the Count Me in (December 2005) publication
The proportion of young people was higher among
inpatients from BME groups when compared with the White British,
White Irish and Other White groups. This finding is also representative
of the general population, where members of BME groups are younger
overall. One per cent of all inpatients were younger than 17 years
and 31% were aged 65 and older. Information on age was missing
or invalid for 1.6% of inpatients (see table 1 for percentage
age and gender distribution by ethnicity).
PERCENTAGE AGE AND GENDER DISTRIBUTION BY
|Ethnic category code
|White and Black Caribbean||5.1
|White and Black African||2.8
|White and Asian||4.8
|Other ethnic group||2.8
Further findings from the Census are given in Annex C.
Drug and alcohol use?
There is information on drug and alcohol use by ethnic group
in Pages 213-15 of the 2004 School Survey, which is available
on the DH website at the following address.
The National Treatment Agency for Substance Misuse has, as
part of the Home Office Response to the Select Committee provided
on the degree of ethnic variation in ratios of drug treatment
places to drug mis-users; and the extent to which drug treatment
services vary in their effectiveness depending on the ethnicity
of the user.
Alcohol Needs Assessment Research Project (ANARP) (DH
Nov 2005): Summary Report: states "In relation to
ethnicity, BME groups have a considerably lower prevalence of
hazardous/harmful alcohol use, but a similar prevalence of alcohol
dependence compared with the white population.
Statements out of the full report include:
Psychiatric Morbidity Survey: Alcohol use disorder profile.
The prevalence of hazardous/harmful drinking in England
among those aged 16-64 years is 22.6% (95% CI = 21.6-23.7).
The estimated number of persons aged 16-64 years drinking at this
level is 7,106,908 (6,792,443-7,452,820). The male-female ratio
is 2.26:1. The White-BME ratio was 1.7:1.
General Household Survey: Alcohol use disorder profile
According to the GHS, the prevalence of hazardous drinking
in England among those aged 16-64 years is 18.6% (95% CI = 17.8-19.4).
The prevalence among men is 22.2% (95% CI = 21.0-23.4) and 7.4%
among women (95% CI = 6.6--8.2)
There is an inverse relationship between age and prevalence
of hazardous drinking. There was a consistent decline in age-specific
rates as age increased. The White-BME ratio was 3.5:1."
The prevalence of harmful drinking in England among those
aged 16-64 years is 5.3% (95% CI = 4.9-5.8). The prevalence among
men is 7.4% (95% CI = 6.6-8.2) and 3.4% among women (95% CI =
Those aged 16-24 years are at the highest risk of harmful
drinking. The White-BME ratio was 6.8:1.
The inclusion of binge drinking in this report is based on
the widely reported association between alcohol use and alcohol-related
community harm and criminal behaviour. The prevalence rate of
binge drinking in England is 20.3% (95% CI = 19.5-21.1). From
this, it can be estimated that approximately 6.4 million persons
(lower limit- upper limit: 6.1 million6.6 million) aged
between 16 and 64 years have engaged in binge drinking in the
last year. Approximately 26% (24.3%-26.7%) of men have consumed
more than 8 units of alcohol on one or more days per week in the
last year. About 15% (14.4%-16.4%) of women have consumed more
than 6 units of alcohol on one or more days per week in the last
year. The male-female ratio is 1.7:1. This ratio is lower than
that for hazardous/harmful drinking and alcohol dependence.
The inverse relationship between binge drinking prevalence
and age is similar to that observed for hazardous/harmful drinking
and alcohol dependence. The White-BME ratio for binge drinking
(4.5:1) was similar to that for alcohol dependence.
|From Psychiatric Morbidity Survey:
|Hazardous/Harmful drinkers (AUDIT 8-15)
|Dependent drinkers (AUDIT 16-40)||03.6%
|From the General Household Survey
|Hazardous drinkers (22-49 units/week)||19.6%
|Harmful drinkers (50+ units/week)||05.4%
|Binge drinkers (8+ units/day)||21.5%
There is evidence that suggests young people from some ethnic
groups are much more or less likely to experience teenage pregnancy
than otherseven after taking account of the effects of
deprivation. For example, teenage pregnancy rates vary dramatically
between London boroughs with a similar level of deprivation, but
a different ethnic composition. In some instances, a borough's
rate is double that of a similarly deprived borough with a different
Establishing the precise impact of ethnicity is difficult
because: ethnicity is not recorded at birth registration; BME
groups are overrepresented in deprived areas where high rates
would be expected; and sexual behaviour, knowledge and attitudes
may vary considerably within BME groups. Nevertheless, the available
evidence does indicate that girls and young women from some ethnic
groups are more likely to become pregnant under-18.
Data on mothers giving birth under age 19, identified from
the 2001 Census, show rates of teenage motherhood are significantly
higher among mothers of "Black Caribbean", "Mixed
White and Black Caribbean" and "Other Black" ethnicity.
"White British" mothers are also overrepresented among
teenage mothers, while all Asian ethnic groups are underrepresented.
Girls and young women of Black and Black British ethnicity
are also overrepresented among abortions under-18. In 2004, Black
ethnic groups accounted for 9% of all abortions under-18, and
in London, which has high rates of repeat abortion, 43% of all
under 18 abortions following a previous pregnancy were for young
women from Black ethnic groups.
Variation between ethnic groups in sexual activity and contraceptive
use suggest the higher rates of teenage pregnancy among some ethnic
groups are at least partly attributable to differences in behaviours
and attitudes, and not simply a result of deprivation. A survey
of adolescents in East London
showed the proportion having first sex under 16 was far higher
among Black Caribbean men (56%), compared with 30% for Black African,
28% for White and 11% for Indian and Pakistani men. For women,
around 30% of both White and Black Caribbean groups had sex under
16, compared with 12% for Black African, and less than 3% for
Indian and Pakistani women. Survey data also demonstrate variations
in contraceptive use by ethnicity. Among 16-18 year olds surveyed
in London, non-use
of contraception at first intercourse was most frequently reported
among Black African males (32%), Asian females (25%), Black African
females (24%) and Black Caribbean males (23%).
Differences in sexual behaviour and risk of teenage pregnancy
between ethnic groups demonstrate the need for local teenage pregnancy
strategies to develop culturally sensitive approaches to reducing
teenage pregnancy ratesespecially in areas with large BME
populations. These need to recognise, and address, differences
in: norms around discussing sensitive issues within families;
gender issues; religion; and accessing mainstream services.
4. What, if any, health or social services policies exist
focusing particularly on young black people?
Fostering and black and ethnic minority children:
Matching children and carers
We know how vitally important it is for children in foster
care to be found the right people to look after them. They need
carers who make them feel comfortable and supported and who help
them to develop a positive self-identity and pride in their backgrounds.
Matching children where possible with carers who share their culture
and ethnicity is an important part of this.
Local Authorities are required by law to give proper consideration
to a child's racial, religious, cultural and linguistic background
when making any decisions regarding the care of that child. (Section
22 of the Children Act 1989)
Sometimes it may be necessary to place a child with carers
who do not share his or her ethnicity or culture. In this case
our National Minimum Standards for Fostering Services (2002) require
that the responsible authority provides the foster family with
additional training, support and information to enable the child
to receive the best possible care and to develop a positive understanding
of his or her heritage.
Recruitment of carers from black and minority ethnic backgrounds
Local authorities have a duty to consider the ethnicity of
children in need in their area when recruiting foster carers.
(Schedule 2 Part 1, section 11, Children Act 1989). We do not
have the data currently to identify whether there are shortages
of carers from particular ethnic groups, although we have taken
steps to introduce new data gathering (see below). We know that
there is a general shortage of foster carers nationally (Fostering
Network estimate 8,000 in England) which inevitably can make it
more difficult to find the right carers for a child.
Action we are taking
Recruitment of foster carers from all backgrounds is a Government
priority so that the best possible carers for each individual
child can be found. We have funded a number of initiatives to
support local recruitment:
a two year grant to the Fostering Network to identify
and disseminate innovation in foster care recruitment. They have
recently produced a report about this work which provides advice
and case studies regarding the effective recruitment of foster
carers from minority ethnic groups;
a Fostering Publicity Pack designed to help local
authorities to run targeted local campaigns to recruit new foster
carers for looked after children; and
a three year grant to the Fostering Network to
support Foster Care Fortnight, which has a particular focus on
We are also improving the support available to foster carers
to improve recruitment and retention, for example we are due to
announce the first national minimum allowance for foster carers
in July and have funded Fosterline, a new free phone advice line
for foster carers.
We commissioned the design of a survey to enable us to gather
data from local authorities on the foster carer population, which
will provide national data regarding their ethnicity. This has
now been taken forward by CSCI who are due to begin gathering
Adoption and black and minority ethnic children
Action being taken
The Adoption and Children Act 2002 was implemented on 30
December 2005. The Act implements proposals in the White Paper,
and underpins the Government's drive to improve the performance
of the adoption service and promote greater use of adoption.
The Act requires adoption agencies placing a child for adoption
to give due consideration to the child's religious persuasion,
racial origin and cultural and linguistic background.
The Act contains provisions that mark a fundamental change
in adoption law, including:
Putting the needs of the child at the centre of
the adoption process by aligning adoption law with the Children
Act 1989 to make the child's welfare the paramount consideration
in all decisions to do with adoption.
Encouraging more people to adopt looked after
children by helping to ensure that the support they need is available.
Allows unmarried couples to apply to adopt jointly,
thereby widening the pool of potential adoptive parents. It will
be for adoption agencies, and ultimately the courts, to decide
whether an individual couple is suitable to adopt.
Introducing a new Special Guardianship order to
provide permanence for children who cannot return to their birth
families, but for whom adoption is not the most suitable option.
The Government has set targets to increase the numbers of
children who are adopted from care; to ensure that those children
spend less time waiting to be adopted; to achieve this without
compromising on the quality of adoptive placements; and to ensure
that adoption is considered as a placement option for all children
unable to live with their birth family and pursued effectively
when it is judged to be the most appropriate option.
Government guidance to adoption agencies is clear that, while
a child's ethnic origin, culture, language and religion are significant
factors to be taken into account when adoption agencies are considering
the most appropriate placement for a child, it is unacceptable
for a child to be denied adoptive parents solely on the grounds
that the child and adopters do not share the same racial or cultural
Placement with a family of similar ethnic origin and religion
is very often most likely to meet the child's needs as fully as
possible, safeguarding his welfare most effectively and preparing
him for life as a member of a multi-racial society. These are,
however, only some among a number of other significant factors
and should not of themselves be regarded as the decisive ones.
National Suicide Prevention Strategy
The National Suicide Prevention Strategy for England, published
in September 2002, particularly aims to reduce suicide amongst
young men, and to promote mental well-being in the wider population,
including young people and people from BME communities.
In taking forward this strategy, we have funded the three
mental health promotion pilots, in Camden, Bedfordshire and Manchester,
specifically to identify and act on the barriers which prevent
young men from using services and seeking help in times of need.
A full evaluation of that work can be found on the National Institute
for Mental Health in England website at www.nimhe.csip.org.uk.
In Camden, the project team also attempted to engage a wider range
of young men by building partnerships with organisations working
with gay young men and men from BME communities. This work highlights
some of the ways that men's mental well-being can be improved.
It provides us with evidence of effectiveness of the measures
that were adopted and highlights key lessons and policy implications.
Our task now is to build on this knowledge and experience to help
practitioners and other partners develop effective approaches
to engaging with men.
5. How, and to what extent, are DH and social service cooperating
with other key partners eg education agencies, police and YOTs
on issues affecting young black people?
NHS planning guidance emphasises the importance of partnerships
with other key partners and Local Delivery Plans include the requirement
to work through Local Strategic Partnerships, Crime and Disorder
Reduction Partnerships and Local Area Agreements (LAAs).
Local Area Agreements (LAAs) are an important new planning
process which brings health inequalities and health outcomes to
the forefront of local community planning. LAAs are agreements,
covering the area of one or more local authorities, which focus
on a collection of goals across a range of services and which
can relate to either national or local priorities. The local authority
liaises with a range of bodies with an interest in joined-up delivery
to set these priorities. In particular, the policy aims to promote
a high level of engagement of Local Strategic Partnerships. Funding
for achieving these priorities comes from the respective bodies.
Once agreement is reached, the LAA is sent to ministers in central
departments for sign-off. Of the most recent 66 LAAs that have
been agreed over 90% had outcomes relating to the public health
agenda such as reducing smoking and outcomes relating to increasing
wellbeing and choice for older people.
The Children Act 2004 requires local authorities to set up
partnership arrangements to promote cooperation to improve the
well-being of children and young people and to assess, plan and
commission services that deliver better outcomes for children
and young people. This duty, which commenced on 1 April 2006,
should result in children's trust arrangements being established
to improve outcomes for all children, young people and their families
through more integrated services, integrated strategies and processes,
including where appropriate the pooling of budgets, coordinated
staff development and capacity building, and more integrated governance
arrangements. All local authorities must have children's trust
arrangements in place by 2008 and most already do.
The Children Act 2004 specifies the bodies under the duty
to cooperate with the local authority and which are relevant partners
in the children's trust arrangements: police; probation board;
youth offending team; SHA and PCT; Connexions; and Learning and
From April 2006, the local authority must record in a single
Children and Young People's Plan (CYPP) how services should be
provided locally according to need. The Government expects the
children's trust partners to conduct a local needs analysis to
inform development of the CYPP: almost all authorities published
their CYPP by 1 April. That local needs analysis should include
the needs of young black people which in turn should be met through
integrated services part of children's trust arrangements.
The Young People's Development Programme (YPDP) is an example
of a DH and DfES funded initiative which requires strong partnership
working with a wide range of key agencies such as the youth sector,
social services, schools and youth offending teams. YPDP consists
of 27 demonstration projects in some of the country's most deprived
areas. It is testing the effectiveness of a distinctive approach
to tackling risk-taking behaviour, particularly related to teenage
pregnancy, substance misuse and educational attainment through
a holistic programme for "at risk" 13-15 year olds.
Approximately 25% of young people attending the YPDP project
are from ethnic minority communities. A number of the projects
have a particularly strong focus on young black people either
as a closed group or as part of a mixed group.
The Mandiani project in Lewisham, for example, is working
with young black men aged 13-15 to develop their self-esteem,
achievement and sense of place in their community. Work in schools
has increased significantly and young people at risk of exclusion
or failing to prosper are provided with motivational support.
This work is tailored to the experience and cultural views of
the target group.
YPDP is being evaluated and will identify and spread good
practice so that this innovative model becomes part of mainstream
6. What mechanisms does the Department of Health have in
place to use ethnic data to monitor the impact of its overall
policies on different ethnic groups and the likely impact of any
new policies, in the light of the requirement under the 2000 Race
Relations (Amendment Act) for Race Impact Assessments?
The Department of Health recognises and accepts its duties
under race relations legislation and has made a commitment in
its 2005-08 Race Equality Scheme to undertake race equality impact
assessments for new and existing policies. Race Equality issues
are also considered as a matter of course for all policy developments
subject to the Regulatory Impact Assessment.
DH has strengthened its arrangements for supporting and accounting
for, progress on race equality within the Department's mainstream
programmes and delivery plans through mechanisms set out in the
DH Race Equality Scheme, updated and published for 31 May 2005.
Key priority programmes on tackling health inequalities, improving
mental health services, reducing coronary heart disease and developing
the evidence base all make use of ethnic data to monitor the impact
of policy on different ethnic groups.
DH has established a project to strengthen current internal
arrangements equality impact assessment of emergent policies.
Several policy teams are currently engaged with this piece of
work, which is supported by an advisory panel comprising departmental
officials and external experts.
Data quality and small numbers do not permit a more detailed
disaggregation of "Black" ethnicity. Back
Research with East London Adolescents Community Health Survey
(RELACHS), 2004, UCL, City University and Queen Mary, University
of London. Back
Testa A and Coleman L (2006), Sexual Health Knowledge, Attitudes
and Behaviours among Black and Minority Ethnic Youth in London.