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I have a couple of observations to make. First, on the prison estate, we must consider carefully that if we had nothing and were starting from scratch with a purpose-built estate, we would produce what is needed at less cost and more effectively. The trouble is that we are using a lot of money in constantly trying to patch up a system that is not designed for the purpose. At some point we must wrest ourselves free of this treadmill and say that it is insane and that we must have a new strategic approach.

Secondly, when I served on the Joint Committee on Human Rights, and we were discussing deaths in custody, we encountered exactly the kind of highly professional, dedicated, imaginative, caring prison officers to whom the noble Lord, Lord Ramsbotham, referred. They would get angry with us parliamentarians and ask, “What are you trying to get us to do? You are trying to get us to do jobs for which we are not professionally trained or properly equipped in premises that are not right, and are making a bad situation worse. Instead of improving it, we are contributing to the deterioration, and we are very angry about that”. They are good people to whom we should listen.

I spent nine years as honorary president of the YMCA in England. Some of the work that I admired the most, done by a very fine crowd of people who were in the front line of social action, was that going on in prisons and detention centres. The stories that were told to friends in the YMCA, and which I was told when I made visits there, are a challenge to every Member of this House. Some of the experiences that the young people who became offenders had been through were horrific. In some cases it would have been an absolute miracle had they not shown delinquent behaviour of one form or another. That is a challenge to us all.

Sometimes it is said that it is soft or wet to talk about the social conditioning of these youngsters and their experiences, and that we should be tough with them and then things will come right. All the evidence is that the tough thing to do is to take those realities

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into account and to recognise that many of these youngsters have never been loved or cared for in their lives. We talked about that in more specific detail at earlier stages of the Bill.

I welcome my noble friend’s endeavour to leave the door ajar. It is right to say that the Minister probably sympathises 99.9 per cent with all we are saying but does not have the deciding influence in some of these key areas. We encourage him to speak in our name in the deliberations to which he is a party. We will work at opening the door that is ajar but at this stage, without, I hope, becoming the Duke of York, I consider that is appropriate to beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 30 not moved.]

Lord Adonis moved Amendment No. 31:

(c) to assist individuals who provide care for such children to continue to do so, or to do so more effectively, by giving them breaks from caring.”

The noble Lord said: My Lords, I wish to speak also to Amendments Nos. 54, 55, 57, 58, 60 and 64. These amendments deal with the provision of short breaks for disabled children and their families. They follow our debate on this issue in Grand Committee and are a further response by the Government to concerns expressed by noble Lords. I pay particular tribute to the noble Lord, Lord Rix, who has pressed the cause of disabled children and their families over many years in this House and who is deeply sorry that he is unable to be with us this evening.

Amendment No. 31 adds the provision of short breaks for parents and others caring for disabled children to the range of services that local authorities must provide for families and in doing so puts these services on an express statutory footing. The new duty will ensure that short break services lose their Cinderella status and become an essential local authority service, thereby reflecting the importance attached to them by the families of disabled children.

The new duty makes it clear that short breaks should not be provided just to those carers struggling to maintain their caring role but to those for whom a break would improve the quality of the care they can offer. Short breaks should not be used just as crisis intervention but should help carers to maintain and improve the quality of care they want to, and can, provide. However, I should make clear for the record that the new duty does not create an individually enforceable right to short breaks.

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It is hard to overemphasise the importance of short breaks to the families of severely disabled children. Without these services many parents would go without any relief from constant caring responsibilities. I am in no doubt that without short break provision, the care population would grow considerably and with it the cost to the taxpayer. But we should also not forget the wider benefits of short break provision beyond relieving parents. Any parent will be able to testify that it is beneficial and healthy for their child to gain positive experiences away from their parents whether it is time spent with another trusted adult, or in leisure or youth work-based activities where disabled children and young people can mix with peers of their own age. Such activities are immensely worthwhile and provide an important means of social development. They reduce the isolation felt by many disabled children and young people and can play an important role in enabling disabled young people to make a successful transition to adulthood. This should be and is our ambition for short break provision.

The Government have put significant resource behind the provision of short breaks; £359 million will be provided to local authorities in England alongside further funding to healthcare bodies to enable a combined approach over the next three years. We estimate that by 2010-11, local government expenditure on short break provision in England will have doubled and in some areas will have increased by up to five times. This major investment would combine with the proposed new duty to create a significant force for change and would be coupled to high expectations for service transformation. We would use both statutory guidance and regulations to make clear our expectations and requirements. We would envisage laying the first formal requirements on local authorities under the powers in the amendments in 2011.

As the Minister with responsibility for disabled children, I see this as a decisive moment in improving services for this important group in our society. I commend the amendments to the House. I beg to move.

10 pm

Baroness Walmsley: My Lords, I congratulate the Minister on being so positively responsive to the concerns expressed by the House. I also congratulate, in his absence, the noble Lord, Lord Rix, on his persistence and determination to achieve the desired outcome. What will be done to ensure that the short breaks that are offered will be of a sufficiently specific type and quality for the young person concerned? For example, for a child on the autism spectrum, will the short break that is offered be autism-specific? Will it have care from people with the right level of experience, so that the parent can be sure that the young person is in the right sort of care with the right level of understanding? That would give them complete peace of mind while they have a short break from their caring responsibilities.

Baroness Morris of Bolton: My Lords, this is a very welcome amendment. As the Minister said, it is a tribute to the noble Lord, Lord Rix, who has campaigned

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for so long on this issue, and it is a tribute to the Minister for taking on board this very important issue. Like the noble Baroness, Lady Walmsley, I would like some assurance that the short breaks will be appropriate. A year or so ago, I met a group of parents with children across the range of the autism spectrum who were very wary of any sort of respite care. They had come back from it and their children had been so distressed that it almost was not worth having the care. They very much hoped that they might be able to club together to provide their own care, because they understand the children.

I hate to appear churlish, but the regulations will not be rolled out until 2011. What might happen in the mean time? As these short breaks are essential, surely some provision should be made for the interim. Why the delay? Would it not be worth putting in place a temporary system and adjusting it according to the lessons learnt from the AHDC programme, as the Minister said in his letter of 4 March?

Lord Adonis: My Lords, I am grateful for the welcome given to the new provisions by both noble Baronesses. The reason for specifying 2011 is that for the first two years of the investment that I set out, we are building up pathfinder programmes. We recently announced the 21 short break pathfinder areas, and based on the experience of those areas we will introduce national coverage in short break provision in the third year of the Comprehensive Spending Review, which is 2010-11. It is on the basis of the provision that we are able to make in that third year that the regulations will be framed. So there is a reason for 2011; we are not dragging our feet but until we have seen those pathfinders through, we will not be in a position to know what it is appropriate to specify in the regulations.

Those pathfinder authorities will pilot and seek to develop a range of different sorts of short break provision meeting the whole spectrum of the needs of parents with disabled children, including those groups mentioned by the noble Baroness, Lady Walmsley. We are mindful of the fact that there is a wide diversity of needs in the disabled children community, and we want to see how those needs can best be met before we either make the national rollout in 2010-11 or specify the regulations under which all local authorities will then be obliged to act.

On Question, amendment agreed to.

Baroness Meacher moved Amendment No. 32:

“Health assessments and care

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(a) the qualifications and experience of an individual undertaking a health assessment;(b) the length of time after a child starts to be looked after by a local authority by which a health assessment must take place; and(c) the inclusion of details in the care plan of the arrangements made jointly by the local authority and PCT, or, if there is no PCT, the Health Authority, for the area in which the child is living for the physical, emotional and mental health care of the child.””

The noble Baroness said: My Lords, I propose the insertion of two new clauses after Clause 29. I had it in mind to cut my speech down because it is very late, but a lot of people are relying on me to put some points here, so I hope that the House will bear with me. The amendments provide for health assessments and care for looked-after children and young people, and evidence-based therapeutic interventions. I shall focus first on health assessments in Amendment No. 32.

The purpose of the amendment is to strengthen arrangements between primary care trusts and local authorities to assess and meet the physical, emotional and mental health needs of children in care. The aims are to ensure the provision of those services, and that the practitioner conducting the health assessments has the required qualifications and experience. That is simply not the case at present, I am told. The amendment also aims to ensure that the health assessments take place within a reasonable period after the child enters care. I understand from the Bill team that we have no idea how many of the children have the assessments within a reasonable period. Finally, the amendment provides 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 that care.

The amendment is strongly supported by the NSPCC, the Who Cares? Trust, the LGA, the National Children's Bureau and others. They wanted me to emphasise that it reinforces the Care Matters White Paper and other significant government policies, as the Minister will be well aware. The Minister assured the Grand Committee that the Government would fulfil their commitment to place the relevant guidance on health assessments on a statutory footing. He also referred to the statutory authority for such assessments being in Sections 10 and 11 of the Children Act 2004. The Bill team explained to me that a raft of guidance would be produced on these issues.

The reason for bringing the amendment to the House is that I—along with the NSPCC, the Who Cares? Trust, the LGA, the NCB and others—believe that the current legislation, even with all those assurances, does not ensure that children and young people will receive timely health assessments, including mental health assessments. The amendment would fill the gaps in the legislative framework. The disproportionately poor health outcomes of looked-after children were well rehearsed in Committee and I want to make only one of the points now, which is

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that 45 per cent of looked-after children and young people aged 5 to 17—27,000 in all—have an emotional or mental health disorder. However, only about a third of those—9,500—receive any support from the child and adolescent mental health services. Ofsted found that only one local authority had a 100 per cent achievement of initial assessments. The poorest performing authority achieves only 48 per cent, but only if those assessments are undertaken can we know the demand for services. Only then will services be provided at a satisfactory level for those children. The amendment is the building block on which there may be some hope at some point of having the services available.

In relation to the amendment, I hope that the Minister will be willing to give a number of assurances to the House. First, the Staying Safe: Action Plan states that the Government will work,

Will that include measures relating to the health of looked-after children, and could the Minister provide some details of that? Secondly, will issues around the physical, emotional and mental health and well-being of children in care be included in the Government's forthcoming children and young people's health strategy, referred to in the children's plan, and, again, could he provide details? Incidentally, I provided all this information to the Bill team, so I hope that the Minister may have some information available.

Thirdly, current regulations state only that the medical practitioner carrying out a health assessment must “have regard” to their mental and emotional health. Will the revised regulations under the 1989 Act specifically address the emotional and mental health needs of looked-after children who have been abused?

Fourthly, and finally, what plans does the Minister have to monitor the implementation of the revised statutory guidance and to assess its impact on the health of looked-after children?

I acknowledge that the Government are committed to placing guidance on the health of looked-after children, as I have made clear, and I very much welcome the Minister’s initiatives on all these issues. The fact remains, however, that the provisions will still be only guidance to which PCTs must have regard. That is my understanding. If that is the case, we know what will happen or, rather, we know what will not happen, from my experience. We believe, therefore, that this amendment would make a substantial difference in reducing the number of looked-after children with ongoing unresolved serious emotional and mental health problems, and would ultimately vastly cut the criminal justice bill.

I turn briefly to Amendment No. 33, which proposes that where a family court has recommended the provision of evidence-based therapeutic intervention, it should be the duty of the local authority to make such provision. The aim here is to try to ensure that, wherever possible, the appropriate intensive therapeutic work is undertaken at an early stage with the whole family of a child at risk of being taken into care, in order to try to avoid the need for that child to be taken into care.

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Since our earlier debate on this issue, I have had a very helpful meeting with the Bill team, as happened regarding my other amendments. It pointed out that the Government are piloting a number of different therapeutic interventions including, for example, functional family therapy, multisystemic family therapy, multidimensional treatment in foster care—which was developed in Oregon, with very promising results—and several other approaches. In the light of that discussion, I have revised my Committee stage amendment to take full account of the likelihood that, over time, the evidence will clarify those interventions that are most effective in different situations or in relation to different family circumstances.

The important point, which I hope will persuade the Minister to take this amendment seriously, is that there is now good international evidence in support of therapeutic family interventions. I understand that there is good evidence within the UK of the success of such interventions with young people in the youth justice system. I trust that the Minister will not argue against this amendment on the grounds that we do not yet have the final results of all the evaluations of pilots, particularly bearing in mind, perhaps, the social work practices situation within this legislation. This amendment is carefully worded to take account of the need for flexibility and research findings.

I do not wish to repeat any of the arguments that I put during our earlier deliberations. I would remind the House only that I have personal experience of the remarkable results for children’s health, emotional and mental, of intensive family therapeutic interventions. But far more important than my experience is the international and national evidence of the cost-effectiveness of those interventions.

I hope that the Minister will respond favourably to both of my amendments. I beg to move.

Lord Judd: My Lords, yet again, the noble Baroness has demonstrated how fortunate we are to have her in our midst. Her practical approach, reasonableness and experience are invaluable assets for us all.

Perhaps I may make a couple of observations. The first is that the noble Baroness referred to the organisations that have been making representations. All of them without exception said at the outset of our deliberations on the Bill how much they welcomed it. Therefore, they are not at all speaking from a position of hostility to the Bill. They are speaking with a commitment to it and a desire to see it made as effective as possible. I am sure that my noble friend would agree that that increases the responsibility of the Government seriously to consider what their position is.

10.15 pm

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