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There is a further point on which the Children’s Commissioner and several departmental Ministers may be able to be helpful. Teachers and social workers who are the subject of allegations against them by children have defined processes of investigation. These are absolutely necessary because, as we all know, children can fantasise and often lie. Foster parents have, apparently, no such protection, and can be left in limbo with loss of pay and allowances.
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I conclude by repeating that foster parents are in the front line of care. Therefore, we should ensure that they are properly recognised and cease to be a Cinderella service.
12.50 pm
Baroness Howe of Idlicote: My Lords, I join others in thanking my noble friend Lord Listowel for this debate and for the tenacity that he has shown in keeping the quality and effectiveness of social care high on your Lordships’ priority agenda. I agree with everything that the noble Lord, Lord Hylton, said about fostering. Foster parents are an incredibly valuable and much underrated resource in this country, and I hope that the Minister will take into account what he said.
My noble friend Lord Listowel rightly reminded us that the subject of our discussion today is a crucial workforce—those involved in both statutory and voluntary roles in the basic social care services. We shall all be dependent on social care of one kind or another at different stages of our lives, most particularly at the beginning and the end. The noble Baroness, Lady Shephard, gave an apt and important warning for us all to think carefully about.
One vital group of workers is those who have responsibility for helping those from deprived backgrounds. They help the most vulnerable and often the most difficult to help within our society. They face the task of making it possible for these children to grow into responsible citizens and achieve their full individual potential, for their own and the community's benefit. For a number of reasons, not least the relentless number of new initiatives under way, these social services, the people who work in them and the resources for the work they do, are under constant pressure, and never more so than now. Adequate finance for new schemes has always been in doubt, and training, as we have heard again and again today, is inadequate. Pressure, not least from the Treasury, grows for ever better outcomes from services for families and children at risk of becoming locked into what used to be called the cycle of deprivation and has now apparently been renamed the cycle of low achievement.
Like other noble Lords, I cannot help thinking what it must be like to be a social worker in these fields. They are hardly among the best paid in the economy and their work is hugely important for community cohesion, yet they are subject to constant criticism in the press and elsewhere about the results not being good enough, whether in education, health, social services or the Probation Service. Noble Lords should imagine the effect of that on staff morale. Social workers also need to absorb and adapt to continual change and increasing bureaucracy. One ends up with a profession which is highly unlikely to attract much needed new recruits. We have heard that emphasised already.
Those pressures and problems prompt me to ask a more fundamental question about our entire system of taking children into care. Have we got it right, or are there real alternatives that deserve to be considered?
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We have heard examples of that in past debates, so I shall not go into too much detail. However, with something like 6,000 looked-after children leaving care every year—6,000 of the 60,000—more than half of them, she predicts, will have no educational qualifications at all. Within two years, 3,000 will be unemployed, 2,000 will either be mothers or pregnant and 1,200 will be homeless. Are we really doing the right thing by taking so many children into care, when the numbers and costs of so doing are growing considerably? Court hearings have apparently risen by 14 per cent during the past five years and their cost by an astonishing 62 per cent. Each case takes between 42 and 51 weeks to complete and costs, I understand, an average of £25,000 in legal aid. As we know, funds for legal aid are drying up fast.
These results are tragic not just for the individuals, almost all of whom are victims of their own abusive, violent backgrounds. Harriet Sergeant argues that a successful system of care would,
- “empty a third of our prisons, and shift half of all prisoners under 25 out of the criminal justice system”—
which is much needed at a time when prisons are pretty well overflowing—
All this may be a little utopian, but these are real issues.
As my noble friend Lord Listowel has already said, Hilary Armstrong, who is the Minister for Social Exclusion and is contributing substantially to the government White Paper, has found that some countries spend less per looked-after child and get better outcomes. No doubt we shall see that White Paper soon.
Meanwhile, how should we assess what has been happening here? Perhaps I may look back on the Government’s agenda when they took office 10 years ago. Specifically, they prioritised education and pledged to end child poverty within 21 years. We should acknowledge what has been achieved. Their interim target of cutting the numbers of children in poverty by a quarter by 2005 may not have been reached, but an impressive 700,000 children have been lifted out of poverty, helped no doubt by a combination of family support and flexible opportunities for single parents to join or rejoin the workforce. But Britain still has one of the highest child poverty rates in developed countries. So a lot remains to be done.
How about the Government’s education target? That is an area where change has been continuous. There have been more than 10 Education Acts. The pattern of constant change must be even more bewildering for teachers and social workers than for the rest of us. However, I am glad to say that the picture looks a little brighter in some respects. At the nursery education level, for example, the increased nursery provision entitlement that has been granted for all children will certainly have helped towards the
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I shall not say all that I intended to say, but I hope that we will hear answers to many of the questions that have been raised.
12.58 pm
Lord Northbourne: My Lords, I congratulate the noble Earl on securing this debate, and I congratulate the Government on the publication of the Green Paper entitled Care Matters. It is very much to be welcomed. I congratulate the Government also on addressing a whole range of problems that many of us have been worried about for some time. The closing date for the consultation on the Green Paper was on Sunday. I hope that the Minister will make an exception and allow the speeches in this debate to be considered when the consultation is taking place.
The Green Paper is about children in care, and it is about children in care that I shall speak. As a society we should have the utmost compassion for children who are in care, who are at risk, or who have been taken into care because their parents have failed them. They are victims through no fault of their own. Along with their parents, we as a society are largely responsible for a variety of reasons, one of which is that we as a society do not respect and support parents and families enough. These are the damaged children whom we ask our social services to look after, and then to deliver back to us as adults who are emotionally secure and well-educated citizens. We must constantly remember that this is an exceedingly difficult and often thankless task.
I should have liked to speak at length about all the good things in the Green Paper but I do not have time. I intend to talk about only three issues which the Green Paper has missed: the case for a larger proportion of any available resources to be devoted to prevention; the case for paying more attention to attachment theory; and where the resources, human and financial, will come from.
First, although the Green Paper addresses prevention, it does not look back far enough into the life of the child. The bulk of it is about administrative changes and earlier intervention. However, the time when real results could be achieved in reducing the care population would be much earlier, at the birth of the child and in the first two years afterwards. Recent research in the USA has shown that a very high proportion—above 85 per cent—of unmarried parents, both fathers and mothers, want, at the time when their first child is born, to be good parents. Why do they fail? Very often it is not their fault. They have left school without adequate preparation for adult
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I should like to give two examples of action that can be taken because people often put up their hands and say, “What can we do about it?”. Two years ago I came across a project in Florida that arranges with ante-natal clinics to offer to every first-time mother, at about the sixth month of pregnancy, a free screening to see whether she might be entitled to free services after the birth. As one might imagine, there is a good take-up. Any mother who might have problems is offered free weekly visits by a trained visitor for the first year of the child’s life and longer if necessary. Visitors are supervised and follow a child-development-led programme. Because it is non-stigmatising, the programme is popular and successful.
My second example is that in this country young single mothers with a first baby have to wait many months, often years, to get a home of their own. For young couples the situation is even worse. If we genuinely want fewer children in care, we should make the investment necessary to ensure that every first-time family, whether a couple or a single parent, is offered appropriate and affordable housing within a matter of weeks of the birth of their first child. I have no time to give any more examples. If only we could reduce the number of children who need to be taken into care, we could do the job much better for those for whom care is the only alternative.
My second point relates to secure attachment, which ties in with what my noble friend Lord Hylton said. I should stress the fundamental importance of secure attachment and a warm supportive family life for every child, especially those who have experienced family breakdown. What can we do to increase the chances of more children in care settings getting the start in life that they need?
Ongoing research studying outcomes for Romanian and Bulgarian children who spent their early years in communist state-owned orphanages has confirmed Bowlby’s theories about the importance of early attachment—or, in those cases, the lack of it. Children who have been abused or abandoned by parents whom they trusted are emotionally wounded. Some recover and some do not. The research on Romanian children also showed that when they were subsequently placed in a secure and loving family environment through adoption, the time needed to recover from abuse or neglect tended to increase with the length of time the child was subject to abuse or neglect.
Surely a priority for children who have been taken into care should be to ensure that the period of abuse is shorter by placing them as quickly as possible in a new family that is secure, caring and, as far as is possible, permanent. Successful adoption should achieve that objective. However, if foster care is the only option or is to be the placement, then the Government’s yardstick for adequacy in foster care
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I was, finally, going to talk about resources. Happily, however, I have run out of time, and many noble Lords have already discussed the subject at considerable length. I support them. I have just one question for the Government. When they come back with a White Paper on this subject, will they put some figures to it? That would only be fair. No one in business offers a proposal of this magnitude without giving the board of directors a chance to know what the figures are. I hope the Government will listen to what I have said.
1.06 pm
Baroness Greengross: My Lords, I add my congratulations to the noble Earl, Lord Listowel, on initiating this very important debate. Like the noble Baroness, Lady Shephard, I shall concentrate on the care of older people. I want to focus on paid care workers but not exclusively on those working in care homes, as many of them also work in the community.
The Minister knows very well the difficulty in differentiating clearly between health and social care in these circumstances. Many people in care homes are primarily cared for not by nurses or qualified care workers but by care assistants, many of whom are faced with hugely difficult tasks—for which training is essential, but from which they certainly have not benefited. As the noble Baroness, Lady Barker, pointed out, many workers in such care homes, perhaps most, work in the private and voluntary sector. But in all sectors it is often said that although old people, particularly the frail and vulnerable, are able to receive health and social care services, they rarely receive professional health and professional social care. Other groups are more likely to receive such qualified and trained care.
There is also some excellent news. We all know that people are living longer and healthier lives and that they are benefiting from policies, on which we congratulate the Government, to enhance independent living. The result has been that the care needs of those entering care homes and nursing homes have appeared much later in life than was formerly the case. Their needs are, however, much more complex and difficult to meet. The care director for BUPA has talked about an epidemic of dementia. As we know, those caring for people with dementia have a terribly difficult task. We have to balance the needs of that very vulnerable group of people with the tremendous needs of the staff trying to do their best in extraordinarily difficult circumstances. The costs of caring for some 75 per cent of those whom
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Care needs—co-morbidity, really—are increasingly complex. People get all sorts of conditions together, including diabetes, cardiovascular conditions and dementia. We need a more skilled and better trained care workforce and a professional structure, which does not yet exist. That would deliver care which is far more appropriate and tailored to users and would help to address the acute problems of recruitment and retention of nursing staff and care assistants in all sectors. The Wanless report acknowledged that we need to formalise qualifications for care staff. Unless those deficiencies and gaps are tackled we will continue to place unwarranted pressure on families and informal carers such as friends. We know that. The fact that so many people leave care assistant jobs to work in Tesco is quite understandable; there is a better social life and better pay at Tesco. That is what is happening.
Taking people from abroad to do these jobs, stripping assets in the form of better-qualified people from many developing countries, is another problem. Those countries need these people. The people come here because of better—albeit still low—pay and easy access to jobs. We need to do something about that, otherwise we will also affect the family life of people in those workers’ home countries. We know that many who come to take up jobs as care workers and care assistants get on to adaptation courses that enable them to move from the independent sector into the NHS.
I would like to draw noble Lords’ attention to some studies being carried out by the University of Surrey Healthcare Workforce Research Centre. I was privileged to chair the first meeting of a group that is looking at these issues. Another meeting will be held shortly. We had representatives from the Department of Health, the voluntary sector and the care home sector. The meeting was initiated by an organisation called Friends of the Elderly. The idea is to enhance the role of those being trained to enable them to reach NVQ Level 2. These are the people who provide most of the hands-on care.
The enhancement would be achieved by creating the role of specialist care assistants, perhaps working under the supervision of qualified nursing staff. Training in vital clinical skills relevant to specific long-term conditions would be provided and serve as a bridge between the basic care function and nursing. Some functions currently carried out by nurses could be delegated to suitably trained assistants, who would benefit from having such qualifications. That would free up nursing staff for greater managerial tasks and greater responsibility and allow them to take on specialist gerontological nursing qualifications. It would pave the way to developing better domiciliary care, perhaps following the model of community matrons mooted by the Department of Health.
I hope the Minister will consider those developments and ask his officials to follow up that initiative. I doubt whether it is the only such initiative in the country. It is very important to raise the status
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1.13 pm
Lord Ramsbotham: My Lords, I, too, congratulate the noble Earl, Lord Listowel, on once again demonstrating his tireless care for people in care, particularly children, on whom I want to concentrate my remarks. There are advantages and disadvantages to having what one might call the sweeper’s position on the speakers’ list. With such an array of talent and experience speaking before you, most of the issues you might wish to raise have already been covered, leaving you in danger of merely replicating.
However, I want to do a little “so-whatting” and remind the House of the “so-what” of getting this wrong, which I have seen all too often in the prisons, the secure training centres and the local secure homes around this country. I looked at this White Paper with considerable interest, because I hoped that—bearing in mind all the people who had served on the board, many of whom I had spoken to and the experience they represented—the board would have listened to the experiences of the people who had been through the system, and were therefore the “so what” of it, in all that they did. I was very heartened by the first message from one of the board members, Mr Peter Beresford, chair of Shaping Our Lives, who said:
“For service users, the most important person in social care is the person who works face-to-face with them. Their influence for good or ill can be enormous”.
That needs to be shouted aloud and said in spades. I was therefore delighted to hear the noble Baroness, Lady Barker, say that consistency in this person was absolutely essential if good was to be achieved. She gave us the disturbing number of people who did not come from the resident social services organisations, but from agencies and others. This is not to disparage their motivation or contribution in any way, but merely to comment on it.
I feel like this because I paid a visit to a local secure home called Orchard Lodge, the only place in the country to be detailed and originally staffed to look after children with mental health problems. This House has heard this week about the problems posed by the increasing number of children with various mental health problems. It is extremely disturbing that there is only one local secure home in the country capable of taking them. Orchard Lodge is near Crystal Palace, but when I went there, far from finding that people came from the south-east, I found children from Manchester, Cardiff, Newcastle and other places. They were far away from their homes and the continuous support that is so essential in continuing whatever was begun there.
Another thing concerned me about this place. At the time it was being run, quite admirably, by Southwark council. The average tenure of staff members was 11 years. That told hugely in the relationship between staff and children, and their understanding of the sort of problems to be found there. I was disturbed to find the population being changed by increasing numbers of asylum seekers and immigrant children being brought
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