Select Committee on Children, Schools and Families Written Evidence

Memorandum submitted by the National Children's Bureau (NCB)


  NCB promotes the voices, interests and well-being of all children and young people across every aspect of their lives. As an umbrella body for the children's sector in England and Northern Ireland, we provide essential information on policy, research and best practice for our members and other partners. NCB has over 20 years of experience in research, policy and practice development relating to looked-after children and young people. We host the National Centre for Excellence in Residential Care, a two-year project, funded by the Department for Children, Schools and Families (DCSF), to improve standards of practice and outcomes for children and young people in residential child care in England. NCB also leads the Healthy Care Programme, another DCSF-funded project, which has developed tools to help local authorities and their partners to provide healthy environments for children and young people in care.

  NCB welcomes the opportunity to provide our views on the Bill to the House of Commons Children, Schools and Families Select Committee. We welcome the Children and Young Persons Bill, which introduces some welcome measures for the children in care population. We were surprised, however, that measures in the Bill required legislation when many should be a matter of good practice—such as a local authority representative visiting a child looked-after by the authority (clause 13); or placing a child in-authority where this is consistent with the child's needs (clause 8).

  We are concerned, however, that some gaps in the legislative framework underpinning the delivery of services and support to these children do still remain. During the Bill's passage through the House of Lords, we have been briefing Peers on:

    —  Looked-after children in the youth justice system—seeking assurances that regulations under clause 13 will include specific requirements in relation to visits to looked-after children in custody to ensure continuity of support when these children enter custody, during their time in detention and during their resettlement into the community.

    —  The health of looked-after children—seeking amendments to strengthen the legislative framework underpinning the delivery of assessments and care to improve the physical, mental and emotional health outcomes of looked-after children.

  NCB will be submitting a more detailed briefing on looked-after children and the youth justice system in the context of the wider Care Matters reforms. The Healthy Care Programme, funded by the Department for Children, Schools and Families and led by NCB, will also submit a more detailed briefing on improving health outcomes for looked-after children and young people.

Looked-after children in the youth justice system

  Children in care are over represented in the secure estate population, approximately 40% to 49% of children and young people in custody have been in local authority care at some point and about 18% are still on statutory Care Orders.i These are a particularly vulnerable group of children and are those most likely to experience resettlement problems on their release. Through its work within the youth justice system, NCB has identified a welfare/justice divide, which creates barriers to the delivery of much-needed educational, health and welfare services to young people involved in the youth justice system, and especially to those who are looked-after by a local authority. Practitioners within the different services operate under separate pieces of legislation which can lead to young people falling through the gaps. They work within separate teams, to conflicting targets, using different databases, assessment systems and interventions. The links between Youth Offending Teams (YOTs)—which were initially established as multi-disciplinary teams containing staff from a number of sectors—and their staff members' "home" agencies are becoming blurred over time, with YOT members becoming specialist youth justice practitioners. In addition, it is unclear how the responsibilities of the YOT fit with those of other agencies.

  Clause 13 of the Children and Young Persons Bill places a duty on local authorities to arrange for a representative of that local authority to visit a child it looks after. These provisions will apply to a looked-after child who enters custody—including a child voluntarily accommodated under section 20 of the Children Act 1989 who loses his or her "looked-after" status upon entering custody. However, unless it is specified who is to be this representative, it could be a YOT or other local authority worker and fail to ensure that social services continues to maintain its contact with the child for whom it is responsible. While we welcome this provision, during Grand Committee NCB supported amendments which set out specific requirements relating to the qualifications and training of the local authority representative and requiring that (except in exceptional circumstances) he or she is known to the child.

  While the Minister provided an assurance that guidance under clause 13 would state that in good practice the local authority visitor to any looked-after child would be known to him or her, NCB is still seeking further commitments relating to the qualifications and training that will be required of a local authority visitor, and in particular those visiting a looked-after child in custody. At Report Stage, we will therefore be supporting an amendment to require that the local authority visitor to a detained looked-after child is a registered children and families social worker. This should apply to: children who are subject to a care order under section 31 of the Children Act 1989; children who were accommodated under section 20 of that Act prior to entering custody; and children and young people who are eligible for care leaver support under the Children (Leaving Care) Act 2000. The purpose of the amendment is to seek assurances that:

    —  regulations under clause 13 will set out a number of requirements relating to the frequency and purpose of visits to looked-after children remanded or sentenced to a period in custody to ensure that they receive continued support from their social worker—including assessment and care planning—on entering custody, during their period in detention and when returning to the community; and

    —  this visiting requirement is over and above any statutory duties that the Youth Offending Team may have.

The health of looked-after children

  Looked-after children and young people are often disproportionately affected by physical and mental health problems when compared with their peers. National research has found that:

    —  Two thirds of all looked-after children were reported to have at least one physical health complaint—most commonly eye and/or sight problems, speech and language problems, difficulty in coordination and asthma. ii

    —  45% of looked-after children and young people aged five to 17 were assessed as having at least one mental health disorder, compared to 10% of the general child and young person population. iii

    —  Looked-after children and young people exhibit high rates of self-harm and high-risk behaviour, particularly in secure accommodation. iv

    —  Some studies have shown higher levels of substance misuse, including smoking, among looked-after children and young people, when compared to the non-care population, however, research in this area is limited.v

  In particular, these figures demonstrate the significant needs of looked-after children in terms of their mental health and emotional well-being—which may be rooted in experiences of trauma due to abuse or neglect, and/or feelings of bereavement or loss. Health problems may also be amplified for vulnerable groups who may have particularly complex health needs or who experience discrimination within the care system—such as children with disabilities or those from black and minority ethnic groups.

  Since the Children Act 1989, a number of measures have been introduced that should provide the necessary legislative impetus for local authorities to work with health bodies to improve the health of looked-after children. Section 27 of the Children Act 1989 requires health bodies to comply with requests from local authorities to help it carry out its functions to support children and families, and section 10 of the Children Act 2004 provides the legislative framework for children's trusts, where partners such as health bodies must cooperate with local authorities to promote the well-being of children in the area. Regulations under the Children Act 1989 provide for the provision of health assessments and services to looked-after children, placing explicit duties on the local authority and social worker to ensure that assessments take place and a health plan is prepared and reviewed for each child. vi Promoting the Health of Looked After Children guidance was published in 2002 on a statutory basis for local authorities but not for Primary Care Trusts (PCTs).

  Despite these provisions to support partnership working, it is clear that more is clearly needed to improve the delivery of health assessments and care to looked-after children. Anecdotal evidence gathered through work carried out by both the NSPCC and NCB's Healthy Care Programmevii suggests that barriers to the proactive engagement of health bodies, such as PCTs, in assessing and meeting the health needs of looked-after children significantly contribute to the current state of affairs. We therefore welcomed the Minster's confirmation, during Committee, of the Government's commitment to place guidance on the health of looked-after children on a statutory footing for Primary Care Trusts (PCTs), under sections 10 and 11 of the Children Act 1989. We are concerned however that guidance to which PCTs must "have regard" will not provide a sufficiently enforceable framework with which to ensure that PCTs and local authorities work in cooperation to meet looked-after children's health needs. In addition, current regulations state only that the medical practitioner carrying out a health assessment must "have regard" to the child's physical, mental and emotional health; there is no requirement that the latter two aspects—mental and emotional health—be addressed. Guidance states that practitioners who carry out health assessments should have training in the early identification of mental health difficulties, and should link into CAMHS for advice and consultation. However, this guidance is not always followed through, and there is no corresponding requirement in regulations.

  At Report Stage, NCB is therefore supporting an amendment to:

    —  place an explicit duty on PCTs to co-operate with local authorities in the provision of physical, mental and emotional health assessments and care to looked-after children; and

    —  introduce new regulations to make clear that both bodies are jointly responsible for improving health outcomes for children in care. Regulations must:

    —  contain provisions that ensure that the healthcare professionals who assess looked-after children and young people have the relevant qualifications and experience to undertake that assessment. This could include a requirement that the professional has the necessary training to identify potential mental health or emotional issues and to refer the child to the appropriate specialist;

    —  specify how soon an assessment must take place after a child enters care; and

    —  provide for the inclusion in the child's care plan of joint arrangements made by the relevant local authority and PCT for the physical, mental and emotional health care of the child. There should be a clear expectation that appropriate support for children young people and carers—including therapeutic support or mental health services—will be provided for children who have experienced abuse and neglect and have been assessed as needing it.

  It is evident that further research is needed to understand why there are challenges, and geographical differences, in terms of the levels of quality achieved in the delivery of health services to looked-after children. We will therefore be seeking assurance from Government that the implementation of the revised statutory guidance on the health of looked-after children will be rigorously monitored and its impact assessed. This should be for the purpose of identifying whether changes to the status and content of the guidance have had an impact and, if not, identifying other approaches in terms of both legislation and practice.

February 2008


i  Youth Justice Board (2005) Youth Resettlement: A Framework for action. London YJB.

ii  Meltzer and others (2003) The Mental Health of Young People Looked After by Local Authorities in England. London: The Stationery Office.

iii  Department for Education and Skills (2007) Care Matters: Time for Change. Cm 7137.

iv  Richardson, J and Joughin, C (2000) Mental Health Needs of Looked After Children. London: Gaskell.

v  Meltzer and others 2003 op cit; Williams, J and others (2001) "Case-control study of the health of those looked-after by local authorities", Archives of Disease in Childhood, 85, 280-85; Department of Health (1997) Substance Misuse and Young People. London: Department of Health.

vi  Arrangements for Placement of Children (General) Regulations 1991 and Review of Children's Cases Regulations 1991, as amended by Children Act (Miscellaneous Amendments) (England) Regulations 2002.

vii  Funded by the DCSF, and developed by NCB, the Healthy Care programme aims to improve outcomes for children and young people in care through: the development of good practice in multi-agency partnership working; policy development; and the participation of looked-after children and young people themselves. There are currently about 90 local authorities delivering the programme via local multi-agency Healthy Care partnerships.

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2008
Prepared 20 March 2008