Memorandum submitted by the National Children's
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 practicesuch 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
Looked-after children in the youth
justice systemseeking 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 childrenseeking
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 sectorsand 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 custodyincluding
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 workerincluding assessment and care planningon
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
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 complaintmost
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-beingwhich 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 systemsuch 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 aspectsmental and emotional healthbe
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
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
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 carersincluding therapeutic
support or mental health serviceswill 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.
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.