HC 1048-III Health CommitteeWritten evidence from British Association for Adoption and Fostering (PH 56)

1. Summary

Submitted by: The Health Group of British Association for Adoption and Fostering (BAAF).

Focus is on looked after children who enter care with significant burden of health inequality.

Looked after children have greater health need, and require specialised services.

Public health should be strengthened and consideration given to addressing the health of looked after children as a public health issue.

2. Introduction

2.1 This evidence is submitted to express our view on Public Health proposals within the Health and Social Care Bill and wider health reform proposals.

2.2 In 2010 British Association for Adoption and Fostering (BAAF) celebrated 30 years of supporting, advising and campaigning for better outcomes for children in care. (BAAF) is the leading charity and membership organisation for fostering and adoption in the UK. We:

promote the highest standards of child-centred policies and services;

speak out on behalf of looked after children;

influence UK-wide policy and legislation;

provide much-needed information and advice;

promote greater public understanding of adoption and fostering; and

support our members in their work.

2.3 BAAF’s main activities are the development, promotion and advocacy of best policy and practice; the provision of advice and information to our members and to the general public; training, consultancy and seminars; child placement services including Be My Parent online. We also publish a quarterly professional journal, Adoption and Fostering, books and guides for professionals, academics, parents and carers and research studies. The main users of our services are our members comprising local authorities across the UK, voluntary adoption agencies, independent fostering agencies and also individual social care, legal and health professionals, and carers.

2.4 This evidence is being submitted on behalf of the BAAF Health Group, which is also a special interest group of the Royal College of Paediatrics and Child Health (RCPCH). The Health Group was formed to support health professionals working with children in the care system, through training, the provision of practice guidance and lobbying to promote the health of these children. With over 500 members UK-wide, an elected Health Group Advisory Committee with representation from community paediatricians working as medical advisers for looked after children and adoption panels, specialist nurses for looked after children, psychologists and psychiatrists, the Health Group has considerable expertise and a wide sphere of influence.

3. General Principles Concerning the NHS

3.1 While we recognise that this enquiry is focused on public health, we must first state that BAAF believes that whatever changes may be introduced by the Health and Social Care Bill, the fundamental values and principles of the NHS must not be undermined. The NHS must remain:

a comprehensive service;

available to all;

free at the point of use; and

based on clinical need, not the ability to pay.

4. Comprehensive Health Care

4.1 The Bill should make it clear that the Secretary of State has a duty to provide, or secure provision for, a comprehensive health service throughout England, including Public Health.

5. Reforms Must Deliver for all Children

5.1 BAAF was a signatory to the Listening Exercise Children’s Sector letter to Secretary of State (attached) submitted by the children’s sector regarding the reforms to the Health and Social Care Bill needed to enhance the effectiveness of the NHS for all children. The joint statement made a number of general recommendations for children’s services. Provision for Public Health must take the unique health and social needs of childhood and adolescence into account; services should not be simply “tacked onto” adult services.

6. Looked After Children Have Unique Health Needs

6.1 Following on from the general recommendations for children’s services in the joint statement, the remainder of our comments will focus on the particularly vulnerable group of children and young people who are looked after, including those with a care plan for adoption. Additionally, within this group, there are sub- groups with particular needs, such as infants, children of black and mixed ethnicity, disabled children, unaccompanied asylum seeking refugee children, children and young people in residential homes and secure units, and care leavers. At any point in time, there are over 60,000 looked after children in England and many more will enter and leave the care system in a given year.

6.2 In order to understand the potential impact of the Health and Social Care Bill on looked after children, it is essential to appreciate that this group is significantly different from other children in a variety of ways.

7. Greater Health Need

7.1 As acknowledged in the 2009 Statutory Guidance on Promoting the Health and Well-being of Looked after Children, this group of children has significantly greater prevalence of health problems as well as more complex health needs, particularly mental, emotional and behavioural, arising from the following factors:

health inequalities on entry to care;

experience of early trauma and loss;

physical, emotional and sexual abuse;

neglect;

attachment insecurity or disorganisation;

learning difficulties;

disability;

parental misuse of substances;

experience of domestic violence; and

multiple moves within the care system.

8. Complexity of Health Provision

8.1 There are a number of factors which make health provision far more complex for looked after children than their counterparts who live with their birth families:

Lack of parental advocacy.

Corporate parenting and integrated services - social care as the corporate parent has responsibility for looked after children, and must work in partnership with health and a variety of other agencies to promote their health and wellbeing. Therefore it is essential that effective structures are in place to facilitate integration of services.

Different health needs – due to the burden of greater health need described above, looked after children are subject to statutory health assessments and will require a variety of services and interventions to address their unique health needs.

Need for specialised health services which understand their circumstances and the range and complexity of their needs.

Need for specialised mental health services which understand their backgrounds and can offer appropriate interventions.

9. Commissioning

9.1 Commissioning of health services for looked after children is a complex area and requires considerable understanding of a vulnerable group of children with above average health burden, and who lack advocacy, thus putting them at risk of occupying an unacceptable low position on the priority list. Specialised expertise is required and we are concerned this will be lacking in GP commissioning consortia.

10. Public Health

10.1 Public health is a vital, but too often neglected, aspect of the National Health Service. The current constraints on public finances make it more important than ever to limit and reduce the overall demand for NHS services by the public health goals of preventing disease, prolonging life and promoting health. At the same time, the aim of reducing health inequalities becomes ever more pressing as the burden of ill health falls in an increasingly disproportionate way on the poorest, as well as on other disadvantaged social groups.

10.2 We believe it is essential to strengthen the role of public health. At a time of fiscal constraint it would be all too easy to lose sight of the big picture of the population’s health when local and specialist services are demanding their share of funding. Public Health is well placed to develop strategies and interventions to address the root causes of health inequalities, and to lessen the impact of the postcode lottery.

10.3 At present there is an opportunity for a shift in thinking, so that the needs of certain disadvantaged sections of the population such as looked after children are seen as a public health issue. For example, the needs of looked after children are complex and straddle the full spectrum of ill-health, including physical and mental illness, and unhealthy lifestyles, such as smoking, other substance misuse and domestic violence. Over the longer term, these may be much more effectively addressed at a population level, so that ultimately significantly reduced numbers of children will enter the care system.

10.4 Increasing the presence and influence of public health within local government may work better as public health doctors need to liaise very closely with health, social care and education departments. Close working relationship within the same organisation, particularly at a strategic level, may help to address the many recognised barriers which currently interfere with effective partnership working.

June 2011

Prepared 28th November 2011