Children and Families Bill

Baroness Hollins Excerpts

Monday 4th November 2013 Grand Committee

[Baroness Gardner of Parkes (Con)]

My Lords, I support the noble Lord, Lord Low, on this amendment. I have not taken part in this Bill so far because I do not consider myself to be an expert on education and know little about it, but my concern is that, with the timing of the Care Bill being taken in the main Chamber along with this Bill in here, the whole thing might fall between two stools. In responding to the last amendment, my noble friend Lord Attlee said that there might be some duplication. I should say that I would rather see duplication than a hole. It is terribly important that this is taken into consideration. Even for those most in need of special educational support, there seems to come a time when education comes to an end. However, care needs continue in terms of the social behaviour of the person as much as anything else, and that can be quite a worry if someone falls into bad company. It is important that their social condition as much as their mental and physical condition is watched.

The noble Lord, Lord Low, has made the extremely valuable point that this goes right across these different services. For years, I have been involved in health issues, and there is always an argument about whether health or social care should deal with certain problems. Every time, each sector wants to push them on to the other one. If this provision reached over all of the services, as the noble Lord proposes, it would do away with trying to work out how the other fellow should pay for something rather than you. It would be very valuable if we could simplify this area and I therefore support the amendment.

[Baroness Hollins (CB)]

My Lords, I speak in support of this group of amendments. They aim to achieve equal standing for social care provision in the new education, health and care plans, and they have been ably introduced by my noble friend Lord Low. I pass on the apologies of my noble friend Lord Rix, who had hoped to be able to support these amendments.

Statements of special educational needs specify the special education provision that must be provided by the local authority. The Government have now recognised that health should also be an enforceable part of the new EHC plans, and the Bill has been amended accordingly. But if education, health and care plans are to live up to their name, we need to decide how to put the final piece of this jigsaw in place, which is the duty to provide the social care services that are set out in the plans. This is critical to children and young people with learning disabilities, a significant number of whom need care to help them to achieve their educational and personal aspirations. Let us imagine the position of a parent. They receive an education, health and care plan for their child which sets out all the education, health and social care provision that their child needs. Their child has a legal right to receive the education and health components of the plan, and the parent can hold those agencies to account if the services are not delivered.

However, the social care element seems not to be as enforceable. If the social care services identified in the plan are not delivered, there is nothing that they can do about it. We know that there can be problems with the way in which social care is currently delivered. Ofsted’s thematic inspection of social care for disabled children in 2012 found that social care was not always well co-ordinated and that many social care plans were not detailed enough or focused on outcomes. In a small number of cases, children had no plans or reviews were not held. Surely, those are precisely the types of problems that EHC plans are meant to solve.

We know that similar amendments were tabled in the House of Commons. The Minister in the other place said that he saw the rationale for placing the same duty on the provision of social care as for health and education. Therefore, what is the Government’s objection to these amendments? In many ways, they have already done the hard bit. Placing a specific duty on health to deliver the services set out in EHC plans is a major step forward and should be commended. That is why it is hard to understand a reluctance to consider the duty to deliver the social care part of an EHC plan.

As my noble friend Lord Low has helpfully set out, there are existing duties to deliver social care. This seems to be a matter of aligning existing legislation rather than creating a whole new set of duties. Parents’ expectations have been raised. This Bill will create education, health and care plans, and people will expect the plans to be delivered. At the moment, we are only two-thirds of the way there. I urge the Minister to consider taking the final step to create the truly joined-up plans that everyone is hoping for.

[Baroness Hughes of Stretford (Lab)]

My Lords, I also support this group of amendments and will speak to Amendments 162 and 163 in my name. Although Amendments 143 and 144A, which relate to Clause 37, are about the assessment process, they return to the heart of one of the most important debates that we had earlier in our deliberations; namely, the need to include all the needs of all disabled children. We will turn to the failure of the Bill to be sufficiently comprehensive on Report.

Turning to Amendments 162, 163 and 164, Amendment 164 essentially does the same as Amendment 163. The noble Lord, Lord Low, and the noble Baronesses, Lady Gardner and Lady Hollins, clearly have made the case as to why, in a new system that the Government are proposing in which all three elements of a child’s need—education, health and social care—are being brought together in an integrated system, it is very important that all three elements have the same status in terms of accountability. As the legislation is drafted, ECH plans would offer no more legal entitlement to support from social care services than do statements at the moment. We know that there is a great deal of variability in the extent to which children receive the social care provision that they need, as the noble Lord, Lord Low, has said.

In anticipation of what the Minister might say, he has already said in a letter to Peers that, first, the Government want, if you like, to square off the health provision because the health service is changing dramatically and he wants to make sure that health has a duty alongside the local authority to provide special educational need. That is why the Bill was amended from its first form to include health. I agree with the noble Baroness, Lady Hollins, that that is very welcome. He went to say:

“However for those with social care needs, the section 17 duties”—

in the Children Act—

“are a long-standing means to protect vulnerable children, including those with SEN and disabilities. Social care for vulnerable children under section 17 of the Children Act encompasses a wide range of needs and disabilities to emotional and family problems. It would not be right to prioritise as a matter of course the needs of those children with ECH Plans over all other children in need, for example young carers, asylum seeking children, or children suffering neglect”.

In saying that, the Government are admitting to what we fear, which is that there will not be an entitlement to provision for their social care needs in the way that there will be, under Clause 42, for their healthcare and special educational needs provision.

Are the Government really happy with that? They are proposing an excellent tripartite system. My noble friend Lord Touhig has drawn an analogy in discussions between us on this side of the Committee with a three-legged stool. The problem is that the three-legged stool will have one leg shorter than the other two, so for many families it will topple over because the social care elements—the needs and provisions specified in the plans—will not be enforceable. That is a real problem. It is very important that the three elements are equally visible and accountable and are seen as complementary. The absence of social care from the clause, although possibly technically and legalistically workable, sends entirely the wrong signal to service providers and, in particular, to parents and children. As the noble Lord, Lord Low, said, there needs to be clarity about the parity between those three elements of the service.

Children: Looked-after Children

Baroness Hollins Excerpts

Thursday 25th October 2012 Lords Chamber

[Baroness Hollins]

My Lords, I thank my noble friend Lord Listowel for securing this debate and for his important opening speech. I worked for many years as a child psychiatrist and a psychiatrist with children and adults with learning disabilities, and have had a research and clinical interest in the mental health and behavioural consequences of abuse.

My daughter is also a consultant psychiatrist working with troubled parents and their infants, so I will start my contribution by reflecting on the importance of secure attachments for all children. As my noble friend said so powerfully, children who have been rejected, neglected or abused have to learn to love and learn to trust—possibly for the first time. Early intervention is critical, and we know from American research that family health partnerships are effective in reducing the need for care away from the child’s own family, and have longer-term intergenerational benefits. Do not forget that a large percentage of girls leaving care are pregnant within a year. The provision of peer mentors is a promising initiative that is being evaluated in a study at St George’s, University of London by Gill Mezey and her team in the hope of easing the transition to adulthood for these vulnerable young women.

Some of the most vulnerable parents are those with learning disabilities. This is a group that I have worked with as a psychiatrist. It is almost standard practice for their children to be taken into care. I will say more about this shortly. I will also draw attention to the high number of children with learning disabilities placed in care. Commissioning the right mental health services is very important. Child and adolescent mental health services treat serious diagnosed disorders, but we need more preventive services too and we need more skilled practitioners who recognise the signs of abuse and its emotional and behavioural impact. This means better training of front-line staff, but also more integrated services and better awareness of the mental health needs of disabled looked-after children. In the light of recent child protection failures, the emotional well-being of looked-after children must be first and foremost. It is the key to the prevention of abuse and exploitation, and it is equally important in the healing process after abuse has occurred. What we see time and time again is how crucial early identification and intervention are for those entering the care system. Crucially, since the national child and adolescent mental health services review report in 2008, little seems to have changed according to both young people in care and professionals.

Children under five raised in institutions experience more psychiatric disorders, but those placed in stable foster homes have much better mental well-being and securer attachments. One review of data sources in England estimated that disabled children constitute between 10% and 25% of the looked-after population. Disabled children may be particularly vulnerable to abuse and neglect, which is a common reason for entry into care. The NSPCC reports that children with disabilities are 3.8 times more likely to be neglected, 3.8 times more likely to be physically abused, more than three times more likely to be sexually abused and four times more likely to be emotionally abused than other children. Children with learning disabilities in care are even more likely to run away than other children.

Disabled children in England are a distinct subgroup who are less likely to achieve a permanent placement. Research suggests that disabled children are more likely to display a high level of behaviour that their carers find challenging. This is particularly relevant when we think about stability. Evidence suggests that emotional and behavioural problems have a strong association with placement breakdown. Research shows that the prevalence of mental disorders decreases with the length of time a child has spent in a stable placement. Half of those who have been in their current placement for less than a year have mental health problems compared to a third of children who have been in their current placement for at least five years. That is an improvement.

The findings show that, despite various changes in policies and provision of care, the prevalence of children with recognisable mental health disorders—around three-quarters—has not diminished. For those trying to access services, Sheffield City Council and NHS Sheffield found that in February more than 260 looked-after children had been waiting for child and adolescent mental health services for more than 18 weeks, with some facing waits of up to 44 weeks. This is not acceptable. Services are not flexible enough. Children are expected to go to them instead of the services being flexible and approachable, which these children need.

Difficulties that local authorities have in finding placements for disabled children result in inappropriate placements, including the use of 52-week-a-year boarding schools or, and I myself know of examples of this, disabled children being placed in respite provision, where every week different children will be sharing their corridor, their bathroom and their mealtimes. Permanent placements for disabled children in respite facilities are not acceptable. Disabled children might be placed in adult residential facilities rather than family placements. Local authorities have also documented an increased use of out-of-area placements for disabled children so they are likely to live further away from their families and communities, creating problems in monitoring and problems for their families in maintaining contact. This is especially the case for children with learning disabilities, who may sometimes require psychiatric in-patient admission as well. There are very few specialist units that would accept children with a learning disability who had mental health problems or challenging behaviour. One of the learning points from the Winterbourne View abuses was that abuse is more likely to happen when the person is placed far from home. The victims in that case were adults, of course, but we should have the same concerns for disabled children who are placed away from home.

Then there are the children with a mild or borderline learning disability. They are unlikely to attend youth groups of any sort and often have a background of abuse, making them more vulnerable to sophisticated grooming techniques. This form of exploitation, as we know and have heard today in several speeches, often begins with positive attention from adults, something that these children particularly crave. Flattery and gifts are a new experience for them and they welcome it. They may not have the insight into social behaviours and relationships to determine that while this is how things are beginning, it is most certainly not how they will end.

The education of front-line staff is necessary with regard to spotting the tell-tale signs of possible abuse: a new mobile phone, new clothes or an older man presenting as a boyfriend. Not only is education necessary but the empowerment of front-line staff and carers to communicate their concerns to relevant bodies is essential. Carers may not have the confidence that they have the skill set necessary to make a judgment call over a complex situation. They may feel that they are not expert enough to determine a young person’s capacity to engage in a particular behaviour. These carers need support and training to help them with these difficult situations. Even for a professional it can be difficult to make a capacity assessment on a 17 year-old girl with a mild learning disability, a complex social background and mental health issues who is engaging in sexual behaviours.

Education is also needed before children reach care. Many parents try to use social services to assist them with the emotional and behavioural difficulties that they are experiencing with their children, but they often do not get past the duty desk. Those who do not meet the threshold criteria for a service but who often have a need for mental health services may not be recognised, and may not know where to turn for help. A survey of 440 childcare social workers found that 30% were unaware of local resources available to support the children and families of, for example, those with ADHD. Many inexperienced practitioners did not recognise the importance of psychiatric assessment.

Without appropriate support, training and confidence, how can we expect carers to know that they are the ones probably best placed to carry out such an assessment and, if required, intervention? Empowering those who care is the key to offering these children the protection that they deserve and the chance to enjoy the innocence of childhood.

Marriage

Baroness Hollins Excerpts

Thursday 10th February 2011 Lords Chamber

[Baroness Hollins]

My Lords, I, too, am grateful to the right reverend Prelate for securing this debate. I declare an interest as an honorary member of the British Society of Couple Psychotherapists and Counsellors. I especially enjoyed the maiden speech of the noble Baroness, Lady Tyler, and agree wholeheartedly with her emphasis on the need for good preparation for marriage.

Extensive research has now documented that the breakdown of couple relationships has deleterious effects on the psychological and physical health of the couple, as well as on their children. Children suffer not only from the upheavals of the divorce process but from the impact of turbulent, conflicted marriages. Although divorce has apparently reached a plateau, couples that divorce today do so at an earlier age, with an anticipated 45 per cent of British marriages in 2005—perhaps more now—expected to end in divorce. As fewer couples marry, much relationship breakdown remains unreported.

The right honourable Iain Duncan Smith, in his comments earlier this week as part of National Marriage Week, estimated that the costs of relationship breakdown could be somewhere between £20 billion and £40 billion—rather more than the 1995 estimates of only £5 billion—in health consequences, the impact on children and lost working income. As the noble Baroness, Lady Tyler, alluded to, while the Government have committed support to relationships, they have allocated only £7.5 million per year for marriage support.

I am also very concerned about the lack of financial support for marriage, especially since results from the 2007 adult psychiatric morbidity survey showed that the second most important predictor of mental illness was family debt. A recent international tax comparison by the charity CARE highlighted the fact that among OECD countries Britain is relatively unusual in failing to recognise marriage in the tax system. This has unfortunate effects, including the tax burden on one-earner married couples with two children, who have an average wage a third greater than the OECD average. There is clearly a need for the Government to fulfil their promise to recognise marriage in the tax system. I refer noble Lords to page 30 of the coalition agreement.

Although the consequences of relationship breakdown can be devastating, mental health professionals can now treat relationship breakdown, as well as contribute to its prevention through strengthening couple relationships. When breakdown occurs, mental health professionals can minimise the harm to children, adults and families. Vulnerable periods in the life cycle of a couple can be identified so that targeted interventions can be offered, as was suggested by me and others in the debate about early intervention and parent-infant relationships just last week.

There are also some vulnerable groups of couples in society. Perhaps surprisingly, young marriage and young parenthood are actively discouraged today, with young mothers feeling criticised by first-time mothers old enough to be their grandmothers, despite the biological advantage of young parenthood. They also increasingly have to begin married life without the advantages of support from their extended family.

Another group among whom marriage and parenthood are discouraged are people with learning disabilities—a group that I have worked with for the past 30 years. Research shows that such families do well when there is a reliable and constant supporter, such as a grandmother, social worker or health visitor. These parents may also benefit from relationship support when they have difficulties in sustaining their intimate relationships. However, such relationship support requires rather more specialist skills from the marriage counsellor.

Very little funding has been made available thus far to evaluate the effectiveness of psychotherapeutic interventions, and the lack of an evidence base, relatively speaking, impacts negatively upon the funding situation for organisations that study and treat dysfunctional relationships. What plans do the Government have to provide more research funding to evaluate the effectiveness of support, given the huge cost to society of marriage breakdown? What plans do they have for support in the tax system for married couples?