Select Committee on Home Affairs Written Evidence

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 this area.

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 July 2005.

  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 patients.

  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 the service.

  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 and forms.

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 and adolescents;

    —  all staff working within CAMHS are sensitive to the needs of children and young people from different BME groups;

    —  training is available for staff to work effectively with families from specific BME groups within their community;

    —  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 are available.

  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 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).

  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 are underrepresented in terms of use of CAMHS which focus on early intervention.

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).

Table 1


Ethnic category code
Age categories

Census categories
Other White
White and Black Caribbean
White and Black African
White and Asian
Other Mixed
Other Asian
Other Black
Other ethnic group

  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

Hazardous drinking

  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."

Harmful drinking

  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 = 2.9-4.0)

  Those aged 16-24 years are at the highest risk of harmful drinking. The White-BME ratio was 6.8:1.

Binge drinking

  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 million—6.6 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)
From the General Household Survey
Hazardous drinkers (22-49 units/week)
Harmful drinkers (50+ units/week)
Binge drinkers (8+ units/day)

Teenage pregnancy?

  There is evidence that suggests young people from some ethnic groups are much more or less likely to experience teenage pregnancy than others—even 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 ethnic make-up.

  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[157] 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[158] 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,[159] 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 rates—especially 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 recruitment.

  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 data shortly.

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 background.

  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 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 Skills Council.

  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 activity.

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.

July 2006

157   Data quality and small numbers do not permit a more detailed disaggregation of "Black" ethnicity. Back

158   Research with East London Adolescents Community Health Survey (RELACHS), 2004, UCL, City University and Queen Mary, University of London. Back

159   Testa A and Coleman L (2006), Sexual Health Knowledge, Attitudes and Behaviours among Black and Minority Ethnic Youth in London. Trust. Back

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