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Chapter 5: Building a better future for children and families

225.The Children and Families Act 2014 cuts across a wide range of policy areas and government departments. In reviewing its implementation and effect, common themes emerged.

Mental health

226.As discussed in Chapter 1, our mandate is also to consider areas which were notably absent from the Act. The first was a policy area which the Act does not refer to, but which relates closely to many of its provisions—and to its overarching aim of improving the lives of children and families: young people’s mental health.

227.Rates of probable mental disorders increased between 2017 and 2021. One in six children aged 6–16 had a probable mental disorder, whereas the rate had been one in nine. One in six teenagers aged 17–19 had a probable mental disorder, an increase from one in ten.283

228.According to the Local Government Association, children and young people are more likely to have poor mental health if they experience some form of adversity, such as living in poverty, parental separation or financial crisis, where there is a problem with the way their family functions or if their parents already have poor mental health.284

229.We asked experts why the prevalence of mental ill health has increased. Dr Elaine Lockhart, Chair of the Royal College of Psychiatrists in Scotland’s Child and Adolescent Faculty, found the increase shocking but not surprising. She cited the effect of COVID-19 lockdowns, including school closures.285 Participants in our engagement session added that lockdowns had left young people feeling like they lack control over their lives and depriving them of vital social interaction and community support networks.286

230.A psychiatrist we spoke to working in children and adolescents’ mental health services (CAMHS) suggested that greater awareness was a factor in the increased number of diagnoses, with misbehaviour now more likely to be seen as a sign of an unmet mental health need.287 However, Dr Lockhart noted that there is a risk of medicalising normal reactions to difficult experiences.288

231.Increased prevalence of mental ill health has put strain on services. Between April and June 2021, 190,271 under-18s were referred to children and young people’s mental health services. This compares with 81,170 in the same period in 2020 and 97,342 in 2019.289

232.The average waiting time for children and young people to access mental health services in 2020/21 was 32 days, but this varies significantly across England. One proxy used for entering treatment is children receiving two contacts within the year. In 2020/21, only 40% of children received two contacts within a year. Furthermore, only 29% of children referred entered treatment within six weeks, and 37% of children accepted onto waiting lists were still waiting for their treatment to begin as of 2020/21.290

233.In our online survey, we asked how effective mental health support is. One respondent told us: “Bad. Lethal. I have a dead child. And 2 legal judgments of systemic failure for the 2 others.” Several others disputed the premise of the question that there was any support at all.291 Box 12 sets out some of the other responses we had.

Box 12: Responses to our survey

Source: Appendix 6

234.Al Coates, founder of the Adoption and Fostering Podcast and adoptive parent, told us: “I have a friend whose child made a viable attempt at suicide. They were put on an emergency referral to CAMHS—six months. That is an emergency referral.”292

235.During our visit to Barnet, several students told us that they had experienced waits of two to three years for mental health support from CAMHS—suffering from anxiety, depression and panic attacks while waiting to receive a diagnosis and treatment, which affected their education. Some students had received private care but acknowledged that they were fortunate that their parents could afford this.293

236.The same pressures on services which lead to long wait times can also impact on the time available to dedicate to children and young people when they finally access care. During our visit to CAMHS at the Maudsley Hospital, parents and children generally felt that, although many of the clinicians they had worked with were excellent, long waiting lists meant that help didn’t last as long as they would have liked because the clinician had to move onto the next patient. Some felt that decisions are too often based on paperwork without spending time with a child.294

237.We received similar accounts from staff at another school. They reported multiple suicide attempts on the school site, with long waits for an ambulance and little follow-up support given—the local CAMHS service having a
12–18 month waiting list.295

238.The pressure on CAMHS is felt in many areas. Dame Christine Lenehan, Director of the National Children’s Bureau, described addressing the intersection of mental health and special educational needs as “key” to improving SEND provision.296

239.In oral evidence on adoption, Dr Carol Homden, Chief Executive of Coram, lamented how what she called the “broad and general insufficiency of the child and adolescent mental health services across the UK” affects adopted children who need help to overcome trauma.297 We heard that there are long waiting lists for post-adoption trauma support and post-adoption teams are asking untrained school counsellors to do life story work with children, which they do not feel qualified to do.298 Looked after children are four times more likely to experience mental health issues than their peers.299

240.Hannah Markham KC, Chair of the Family Law Bar Association and Chair of Women in Family Law, also encountered the effect of CAMHS waiting lists in her work in the family courts, telling us: “CAMHS is in crisis. The mental health support for children is in dire straits at the moment across Great Britain.”300 This was echoed by members of the Family Justice Young People’s Board. Several members of the group spoke of having been, or being, on long waiting lists. One had waited four years to see a counsellor and their education had suffered in the meantime. They complained that children do not become eligible for support until after proceedings have ended, even though it is often needed much earlier.301

241.We are deeply concerned by the state of children and adolescents’ mental health services. They are in crisis. This is a grave threat both to the success of individual provisions of the Act and to its overarching aim of enhancing the lives of children and their families. The Government, in allowing services to deteriorate to this level, has shown it has not grasped the importance and severity of this problem.

Early intervention

242.In many policy areas, contributors to our inquiry stressed the need for early intervention. Most obviously, it is a key part of the rationale for strengthening paternity leave rights. The OECD found: “Fathers who care for children early tend to stay more involved as children grow up. Where fathers participate more in childcare and family life, children enjoy higher cognitive and emotional outcomes and physical health.”302

243.In Oxford, members of the local Family Justice Board told us that it is often the same people having children taken removed from their care every couple of years and that they do not receive sufficient help in the interim to become capable of looking after a child. They saw early intervention as crucial to breaking this cycle.303 We also heard from adoptive parents that children’s underlying trauma is too often left untreated until it manifests in serious harm.304

244.Early intervention is not always seen as a priority. In relation to SEND, Dame Christine Lenehan described how “a sort of collapse in early intervention services in local authorities made the ambitions of the reforms, which were the right ones, almost look like a pipe dream.” She stressed that “Most children’s needs should and still could be addressed by good early intervention: good quality teaching, differentiation and good conversations between parents and schools and everyone else.” 305 Imogen Jolley, Director of Public Law, Simpson Millar Solicitors, highlighted that early intervention reduces the likelihood of a situation devolving into a crisis situation.306

245.Anne Longfield CBE, former Children’s Commissioner and Chair of the Commission on Young Lives, argued:

“Treasury approaches do not work with children’s lives. They are not long term. They do not look at long-term investment in the way they need to. The long-term investment of something like early intervention just has not been able to get through the Treasury decision-making, because it looks at five years at a time, or less, or three years at a time. Actually, if you look at a child’s life, of the disadvantage gap at 16, 40% of it has already happened by the time the child steps into school at five.”307

246.Jacky Tiotto highlighted the value of early intervention in family justice through early legal advice and mediation, which she say as the only way to reduce demands on the family justice system. However, she noted that early intervention does not solve the problems of those already in the system, saying “… we would have to double-run the system. We would have to fund it so that help was there for new applicants while we were dealing with the backlog that we have now, which also needs resourcing.”308

247.A particularly striking example of how timely interventions can save money, as well as improving lives, was the case of a young person who waited more than a year for an ADHD diagnosis. Without a diagnosis or treatment, their behaviour deteriorated, and they were expelled from school. They ultimately had to have two live-in support workers, at significant cost to the local authority.309

248.Early intervention saves money and saves lives. It results in better outcomes for children and young people and reduces the need for high-cost interventions later in the cycle for those already at crisis point. Despite the clear value of early intervention in many areas covered by the Act, it remained absent across many of the areas we looked at, threatening the stability of families and the health of children and young people. It is clear to us that the Government need fully to grasp this fact across many areas of the Act.

Avoiding ‘one size fits all’ approaches

249.We heard complaints about ‘one size fits all’ policies which fail to cater for individual children’s needs.

250.In relation to mental health, Dr Matt Woolgar, Consultant Clinical Psychologist at the National Adoption and Fostering Service South London & Maudsley NHS Trust told us:

“With more complex presentations, it is much harder for a stressed system to have the resources to look at the variety and diversity of presentations in those complex kids. That will stress any system. One way people try to cope with those problems is to simplify the services, and that means, again, that some of those more risky, complex children get squeezed out and do not get ready access.”310

251.Participants in our discussion about mental health services at the Maudsley Hospital expressed similar concern about “box ticking exercises” taking precedence over individual needs.311

252.In relation to SEND, a clear manifestation of the problem with one size fits all approaches was education, health and care plans. Our evidence suggests that they work well for parents with high levels of education and resources but leave others struggling. Moreover, we heard that EHCPs could be ‘all or nothing’ with those who have special needs which fall short of the threshold for a plan left without adequate support.312

253.However, the variety in different types of families and their needs can pose serious challenges to establishing consistent and fair support mechanisms. Kinship care serves as a salient example. Although we criticise disparities between the support available for adoptive parents and that which is provided to kinship carers with special guardianship orders (SGOs), many kinship carers do not have a formal legal arrangement of this sort. The informal and often flexible and changing nature of such arrangements militate against legal definition, making it hard for the State to provide support.

Coherence and innovation in government

254.Many concerns put to us related to systems in the public sector being fragmented and with limited mechanisms to learn from and collaborate with the third sector.

255.Dr Woolgar explained the importance of agencies having a shared understanding of children’s needs, telling us: “We often find there are silos or narratives around children’s mental health that exist within different stakeholders and do not link together. Trying to get linked-up services when you believe different things about a child is incredibly difficult.”313 During our visit to CAMHS at the Maudsley Hospital, the young people and parents we spoke to suggested that they had received excellent care, but this was because of excellent practitioners and in spite of the systems and processes in which they must operate. Families told us they often felt like they were being passed between different siloes, each of which was required to engage in a series of box-ticking exercises rather than tailoring support for the child as much as they might have.314

256.Calls for coherence of care extended to social care. Our witnesses raised concern that children and their families don’t receive continuity of care, undergoing numerous changes in their social workers.315 Al Coates, told us: “It should not be that social workers dip in and dip out, but that there is continuity across a child’s lifetime.”316

257.This is consistent with the repeated complaints we heard about the disconnect between education, health and care professionals supporting children with SEND, despite the intent of EHCPs having been to bring coherence. A respondent to our survey explained:

“Education and health are not joined up at all. Despite wanting to, education professionals are not able to work with health colleagues in too many cases due to … Education and social care can work together but often it is not effective due to social workers’ high caseloads which prevent the levels of engagement needed to actually make a difference.”317

One parent we spoke to in Barnet had had to co-ordinate support 36 staff supporting their child who did not necessarily speak to each other.318

258.Such problems extend to policymaking in government. Anne Longfield recounted how she found “silos within silos”, saying: “I have spent most of my time joining dots between different departments and different policy areas—some in the same department. I spent a lot of time making the case in different rooms. It would have been good if someone else had been doing that at the time.”319

259.High turnover rates amongst those in positions of power, including Ministers and officials, can hamper efforts to deliver consistent and high-quality services. Sir Andrew McFarlane criticised the high rate of ministerial turnover, saying that for the Family Justice Board “quite often it is never the same two chairs from one meeting to the next.”320 Professor Rosemary Hunter noted that high turnover impedes lesson learning, saying: “external research is absorbed, taken on board and dealt with, and then there are changes in Civil Service, or changes in Ministers, and then we are all back to square one again.”321 In the 4 years since 2018, there have been 7 Children and Families Ministers (or equivalent), 8 Parliamentary Under-Secretaries of State for Justice, and 7 Parliamentary Under-Secretaries of State for Small Business, Consumers and Labour Markets.

260.We were impressed by the work the third sector does. Kadra Abdinasir, Associate Director of Children & Young People’s Mental Health at the Centre for Medical Health, argued: “there has definitely been lots of learning from the voluntary and community sector and the private sector, which we consistently try to take to the State in order to show examples of good practice, and many of these things are affordable”.322

261.Charities can support communities where the state can or will not help. Anne Longfield noted “how sceptical a lot of local communities, especially marginalised communities, are about statutory services.”323 She explained that charities “stick with people for the long term”.324 Birth parents whose children had been adopted told us that while they had not felt adequately supported by the State during or after adoption proceedings, they were lucky to have found charities which offered counselling, mentoring and training.325

The need to embrace technology and better use of data

262.A common theme of our inquiry was the need to embrace technology and make better use of data. Our witnesses felt that many current systems are insufficiently modern which hampers their effectiveness.

263.We have heard about a chronic lack of data about many areas of public life, from the effectiveness of mediation to the number of discretionary adoption pay payments made to self-employed adopters.326 Contributors to our inquiry were roundly critical of this, noting that without adequate data, the Government cannot be confident that its policies are being implemented or working well.327 PAUSE, an organisation which works with women who have had multiple children removed from their care, said:

“Data collection and accountability often drive changes in systems. Currently, data on women who’ve experienced removals of children from their care is not collected routinely which means that it is difficult to learn lessons and improve support for women.”328

264.Similarly, the Women’s Resource Centre, told us:

“Data is not collated or collected by family court to review good or poor practice or outcomes for women and their children. Secrecy and silencing with regard to court processes and decisions hampers monitoring and improvement.”329

One contributor deemed the lack of data and transparency in the family justice system a “dire situation”.330

265.We are conscious that digitisation of public services can place strain on systems while they undergo a transition away from paper-based record keeping. Sir Andrew McFarlane, President of the Family Division of the High Court of England and Wales and Chair of the Family Justice Council, told us:

266. “We are coping with all the problems you are hearing about at the same time as engaging with new technology, which is coming through the reform programme throughout the court. In the course of five or six years, we are going from a wholly paper-driven system to a completely digital system. That leads to judges, who have to input information to the system, undertaking more administrative tasks than they ought to be doing.”331

267.Similarly, staff working at the Oxford Combined Court Centre told us that while virtual proceedings, introduced during the pandemic, had saved lawyers time and resources, they placed an additional burden on administrative staff.332

268.However, our witnesses were clear about the benefits of new technologies, including improved data collection and analytics, in improving outcomes across public services. Dame Rachel de Souza, the Children’s Commissioner for England, told us:

“Getting decent data sharing would help services and government to understand better what is happening with children… I go to counties where the police have a list of children not in school, which is not talking to the health list or the education list. One of the real things we could do is set up proper data sharing. So that is a biggie.”333

269.Without proper mechanisms for data collection, sharing and analysis, the Government is flying blind and is unable to track the implementation and effectiveness of its policies. Improved use of data across public services is crucial to ensure good outcomes for service users, help identify problems as they arise, and seek value for money.

Communication with children and families

270.We heard that parents and young people would often benefit from improved communication. Sometimes, they feel overwhelmed by information which is not easily comprehensible. For example, in relation to the family courts, Professor Rosemary Hunter, Professor of Law and Socio-Legal Studies at the University of Kent, told us: “If you go on the web you are absolutely drowning. There is masses of information out there but it is almost impossible for anybody to filter it, or for a lay person to understand what is authoritative or even whether it is in the right jurisdiction.”334

271.We were also told about how hard it is for parents and employers to understand the shared parental leave system and for parents to navigate bureaucracy relating to support for children with special educational needs and disabilities or to understand the process by which their child might be taken into care or adopted.335

272.One study found: “clear systems wide communication and transparency failures in relation to the overall process to obtain the relevant SEND provision for children. These failures ranged from examples of the school and Local Authorities misinforming parents, not responding to phone calls and emails to instances whereby communication between parents and the school and/or local authority had either broken down or was severely strained.”336

273.It was noted that it tends to be middle class, highly educated parents with access to resources who can navigate complex systems whereas others are left struggling.337

274.There was praise for peer mentoring schemes in the context of adoption and mental health support, but a feeling that these could not be a replacement for communication from official channels.338 Phone lines could also offer valuable support but need more investment and to be better publicised.339

The voice of the child and the Children’s Commissioner

275.There was a consensus that it is essential that children’s wishes be taken into account. This is true in decisions relating to who a child is cared by, as we discuss in chapters 2 and 3. One young person in the care system told us that social workers had often been dismissive and hard to get hold of—not taking their wishes seriously until they were well into their teens. They had seldom been asked for feedback on the support they were receiving.340

276.The voice of the child must be heard at the highest level of policymaking too. We were greatly impressed by the members of the Family Justice Young People’s Board we met. In their discussion with us and through their other work, they have drawn on their personal—and often highly sensitive—experiences to provide advice on how the system can be improved for those who come after them.341 We were also encouraged to hear from Andre Imich, SEN and Disability Professional Adviser at the Department for Education, that the Government runs ‘SEND improvement boards’ with young people.342

277.The Children’s Commissioner has a special responsibility with their primary function promoting and protecting the rights of children in England, including promoting awareness of the views and interests of children. They must have particular regard for the rights of children living away from home or receiving social care, and other at-risk groups and must take reasonable steps to involve children in their work. Dame Rachel de Souza, the current postholder, explained that the role “is about children, and families, and bringing their views to policymakers and the Government to make sure that they are heard. If I felt that I was not being listened to or heard, I probably would call for more powers, but I have good cut-through, and no Minister or parliamentarian has turned me away.”343

278.However, Anne Longfield, her predecessor, was critical of a lack of consultation by the Government during the COVID-19 pandemic. She said: “There were a number of times where decisions were made, where I might have been given something to garner my view from, but I do not think there was a strong enough appreciation of the protection that these children needed during that time.”344

279.Children need a strong voice at the highest level of government to advocate for their views and needs, providing advocacy which lasts beyond the cycle of a Ministerial appointment. The Children’s Commissioner is a powerful advocate with critical powers, and it is critical that the Government continues to heed them and to consider how best the voice of children is represented at the most senior levels of government.

280.Throughout our inquiry, we have sought to hear directly from children, young people and their families. We were lucky to meet with children receiving mental health support and children with experience of the family justice system to hear their views on what could be improved. We are grateful for their time and insight, as they shared with us the challenges they face and how they feel let down by the very systems designed to support them. The failure of this Act was clearest to us in the conversations with the very children it was designed to support. As it looks to develop policies affecting children and young people in the future, their welfare should be the Government’s paramount concern and their views should be duly sought and respected.

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