Children’s Social Care

Baroness Tyler of Enfield Excerpts

Tuesday 19th November 2024 Lords Chamber

[Baroness Barran (Con)]

My Lords, I very much welcome the Government’s announcement on their focus on children’s social care and on a number of reforms that have been announced. We recognise that there has been a significant rise not only in the number of children in care in recent years, but in older children and children with more complex needs. My questions to the Minister are really in an effort to make sure that we understand what His Majesty’s Government are aiming to do.

It felt, reading yesterday’s Statement and then the policy paper afterwards, a bit like an early-intervention sandwich. In her Statement, the Secretary of State rightly spoke about the importance of

“breaking the cycle of crisis intervention”

and the need for early intervention. Obviously, that was front and centre in the MacAlister review, which called for targeted early help delivered by multidisciplinary teams. In the list of actions at the end of the Government’s document, it is clear that they have longer-term plans to create teams that look very much like those when the fiscal situation allows. However, in the middle of the sandwich, in the substance of the policy document, it is less clear what the Government’s plans are in relation to early intervention.

Can the noble Baroness give the House some sense of the risk of what has already been announced, in the absence of an early intervention strategy? Can she give the House some sense of the timing? When does she expect targeted early help teams to be introduced and how will the staff be recruited? It would be interesting to have an estimate of costs. There was an estimate in the MacAlister review, but that is now somewhat out of date. Will she comment on the future of family hubs, which also play an important role in relation to early intervention?

More broadly, it would be helpful if the Minister could explain why the Government are removing the payment-by-results aspect of the Supporting Families programme. In my own professional experience prior to being in your Lordships’ House, I saw that some of the most effective multi-agency work undertaken was underpinned by a financial model that really drove a focus on outcomes for the child rather than for any particular agency, so it would be helpful to understand that decision.

I also notice that the Government are proposing to include £400 million of social care funding in the wider local government settlement. Does the noble Baroness agree that there is a risk that, if this funding is no longer ring-fenced, it will end up being used for crisis intervention rather than the early intervention which we all, across this House, recognise is so important?

As the Secretary of State set out yesterday, there are huge pressures both within and on the social care workforce. I note the Government’s plans to reduce dependency on agency staff, which is understandable, but I know that the noble Baroness also understands quite how challenging that is to achieve. Can she say anything more about the Government’s plans to retain the existing workforce and grow it? Do the Government have targets and timings to deliver on those plans?

We also really welcome the work on kinship carers, which obviously builds on the work that we started in government. As has often been said across the House, kinship carers do the most extraordinary job, often in terribly difficult and delicate circumstances. We very much look forward to seeing how the pilot of a kinship carer’s allowance works out.

We also recognise the challenges in the children’s home market, which is why we set up an advisory panel to look at that earlier this year. I wonder to what extent the Government’s announcements in this area reflect the recommendations of that panel, and whether there are plans to publish them.

The noble Baroness is aware that both the Competition and Markets Authority and the MacAlister review did not think that price capping would actually work in practice, for slightly different reasons, but both underlined that the key issue in the market is capacity. I note that the Government have announced £90 million of funding. Can she confirm that this is new funding and how many places it will fund in children’s homes? Do the Government have a plan for where those places will be?

In closing, I would like to recognise the invaluable insights that all of us who have worked in this area have received from those who have been in the care system, but also from those young people who did not get into it and were left at home, living with abuse. I hope very much that the Government will proceed in lockstep with those young people and always listen to their perspectives.

[Baroness Tyler of Enfield (LD)]

My Lords, I also welcome the Government’s Statement on the reform of children’s social care. Such reform is long overdue. For far too long, children’s social care has been the Cinderella of the Cinderella that is social care, so let us hope that this bodes well for a long overdue reform of adult social care.

With almost half of children in care now living out of area, and children still being placed in unregistered accommodation—even caravans and tents sometimes, I am told—coupled with the egregious levels of profiteering by some children’s residential home providers, this clearly demonstrates a system in crisis, if not broken. I am glad the Government are taking steps to address this, particularly requiring placement providers to share their finances transparently with the Government. The whole system needs fundamental overhaul.

First, could the Minister tell me what level of profit the department will deem appropriate? If profit levels do not reduce, how quickly would the Secretary of State introduce a profit cap? For Ofsted to effectively exercise its new powers, the regulator must have the necessary capacity and expertise. Addressing profiteering and ensuring financial transparency requires a sophisticated understanding of the sometimes opaque ownership structures used by the big corporate groups behind care provision. What assurances can the Minister give me that Ofsted will have both the staff numbers, and critically, the expertise to do this work effectively?

On the sufficiency of placements, national data published last week shows that 45% of all children in care in England are now living out of area, and 22% are living far from home. What steps is the department taking to ensure accurate data about the sufficiency of places, at both a national and a local level, and what assessment has it made of the impact of its proposed measures in preventing children in care being moved out of area?

I strongly welcome the renewed focus on early intervention and family care, keeping children out of care in the first place, and I look forward to hearing more about this in the coming period.

As we have already heard from the noble Baroness, Lady Barran, kinship carers are unsung heroes who often step up at a moment’s notice to look after family members. So, can the Minister say whether the Government will now commit to moving beyond the limited pilots that have been proposed to a universal allowance for kinship carers, on a par with those received by foster carers?

No young person should leave care having had support just stripped away when they turn 18, so I welcome the steps announced to end that care cliff edge so that young people are better supported into adulthood. The Government’s plans to legislate for Staying Close to support all care leavers up to 25 is a good first step. However, do the Government plan to extend the Staying Put scheme to the age of 25, as well as Staying Close, to provide more continuity of care for children whose final placement is in foster care?

Care-experienced children and young people have a much harder start in life and experience much worse outcomes. Liberal Democrats have called for care experience to be made a protected characteristic under the Equality Act to strengthen the rights of people who have been or are in care. Can the Minister say whether the Government are considering this proposal?

I welcome the commitment in the paper to a single unique identifier, which I have long advocated for, along with others in this Chamber. I look forward to seeing the details, and I very much hope that the NHS number will be used, as suggested in the policy paper.

Finally, it is crucial that the detail behind these reforms and the funding underpinning them backs up the ambition that has been set out. Can the Minister say when the overall package of funding will be announced, and can she clarify how the £400 million funding for local government referred to in the Statement relates to the £600 million for social care that was announced in the Budget, which was not broken down between adult and social care?

I finish with a couple of wider questions. Can the Minister say when the Government plan to publish the children’s well-being Bill? What is the overall timescale for introducing the measures that have just been announced? Given the scale of recruitment and retention problems in social care, with many jobs vacant, what will the Minister do to tackle the workforce crisis in the sector to reduce the dependency on agency staff?

[The Minister of State, Department for Education (Baroness Smith of Malvern) (Lab)]

My Lords, I thank both noble Baronesses for their positive response to yesterday’s Statement and their positive response to dealing with an area that I think all those who have chosen to attend for this Statement today understand is absolutely crucial for the most vulnerable children and families in our country. I will do my very best to respond to all the questions, and where I fail, I will certainly follow that up in writing.

As the noble Baronesses recognised, this Statement sets out how to rebalance the children’s social care system to improve outcomes for children in care, care leavers and families. It is guided by four key principles: that children should remain with their families and be safely diverted from entering the care system; that where children cannot remain at home and it is in their best interests, we should support most children to live with kinship carers or in fostering families rather than in residential care; that we take action to fix the broken care market and tackle profiteering in the placement market; and that we invest in the key enablers which underpin the children’s social care system, including the workforce, better data and information sharing, and to scale and spread evidence-based and proven approaches.

I will address some of the specific points that the noble Baroness, Lady Barran, raised. On this point about keeping people as close as possible to their families, she asked about family hubs. I can say that family hubs were not specifically mentioned in the Statement because it covered the legislative proposals that the Government are bringing forward. However, we are absolutely clear that they do very good work in helping families to access vital services to improve the health, education and well-being of children, young people and their families. The 75 most deprived local authorities will in fact receive around £300 million from both the DfE and the Department of Health and Social Care up to 2025, to set up family hubs with integrated Start for Life services. Knowing that they improve families’ lives and children’s outcomes, and reduce costly crisis intervention later, we will continue to support that type of initiative. This exactly plays to the point about supporting children and their families at the earliest possible stage before those relationships break down.

On the point about payment by results for the Supporting Families funding, Supporting Families has achieved some very important results for children and their families. However, as is often the case with funding streams such as this, it has also become very bureaucratic. In keeping with the Government’s commitment to resetting its relationship with local government and working in partnership with them to deliver reform for vulnerable children and families, we will be simplifying the funding mechanisms for local authorities as much as possible, reducing the requirement for the payment by results recording and returns. That does not mean, however, that we will not be maintaining the focus on the outcomes for families, as the noble Baroness rightly said. We will continue to expect quarterly returns on the number of successful family outcomes that areas are achieving, so that we can continue to assess the overall impact of the programme. Because we have simplified the processes, we can also say that all local authorities will receive all their remaining available funding for 2024-25 as a one-off payment on 12 December, to enable them to continue making progress.

Both noble Baronesses asked about the £400 million funding. This is £400 million that will go into the overall local government grant, in keeping with the arguments that I made about reducing ring-fencing where possible. The £600 million is additional from this Budget for social care. It will be allocated, and more detail will be provided, at the time of the local government settlement for that.

On the point about agency staff, the noble Baroness is right. We do not believe that it would be possible to have a system with no agency social workers. Lots of agency social workers do very important work. However, when 17.8 % of all local authority child and family social workers are agency workers, that feels like too few permanent staff and too many agency workers. Yes, that does mean that we must work harder to train and retain our children’s social care workforce. That is why we will also be working to ensure that the workforce has the right environment to thrive in, personally and professionally. Legislative measures alone are not the answer, although we will introduce in the Bill a regulation-making power to govern the use of agency workers in local authorities’ child social care. In October, we published a set of online resources, developed by Research in Practice, to support local authorities to improve working conditions, workload, health and well-being and organisational culture. We are also working, through the national workload action group, to identify the unnecessary drivers of workload and to help to provide solutions, so that social workers can spend more time working with children and families rather than carrying out paperwork.

I am glad to hear the welcome of both noble Baronesses for the progress that we are making on kinship care. The £40 million that was announced just in advance of the Budget, and which it was part of, is to enable us to trial the use of the allowance for kinship carers in 10 areas. It would be appropriate to learn from that as quickly as possible, yes, but to learn from that trialling in order to work out how effectively to develop that and other forms of support for kinship care.

On the issue of the placement market, both noble Baronesses argued that a range of methods need to be used to increase the number of placements, in order to get away from the current situation. We do not have sufficient high-quality placements for children, particularly those with the most extreme needs, and we are seeing enormous increases in funding to pay for that. The £90 million we have announced will go alongside encouraging local authorities, charities and ethical investors to enter the market. We will work with the MHCLG on planning and ensure that Ofsted can fast-track the right sort of provision. I am sure I will get to some of the other questions the noble Baronesses asked when I respond to other noble Lords, and if I do not, I will write to them.

Unregistered Children’s Homes: Fees

Baroness Tyler of Enfield Excerpts

Monday 28th October 2024 Lords Chamber

Asked by

[Baroness Tyler of Enfield]

To ask His Majesty’s Government what steps, if any, they are taking to lower fees being charged by unregistered children’s homes.

[The Minister of State, Department for Education (Baroness Smith of Malvern) (Lab)]

My Lords, profiteering from vulnerable children in care is unacceptable. Children must live in safe, high-quality homes, which is why it is a legal requirement for children’s homes to register with Ofsted. This means that they can be inspected and children are safe, and that where there are failings, they are addressed. We will strengthen regulation through the children’s well-being Bill so that children’s social care delivers high-quality outcomes for looked-after children at a sustainable cost to the taxpayer.

[Baroness Tyler of Enfield (LD)]

I thank the Minister for her Answer, but there remains a real concern about the number of children still living in unregistered children’s homes. Is the Minister aware of the recent BBC investigation, which highlighted that some unregistered children’s homes are charging up to a staggering £20,000 a week and still failing to keep very vulnerable children safe, which a senior family court judge has described as breathtaking? What immediate steps are the Government taking to address this issue? Does the Minister also agree that the key aim of addressing excessive costs, which I fully support, should not lead to the eradication of children’s homes, and that we need a mix of high-quality, registered provision to meet all children’s needs?

[Baroness Smith of Malvern (Lab)]

The noble Baroness is right that some extraordinary amounts of money are being charged by placement providers. The Local Government Association found, for example, that in 2022-23, 91% of respondent councils paid at least £10,000 per week or more for one placement, compared to 23% in 2018-19. That is why, as the noble Baroness says, we need to ensure that a range of safe, regulated, high-quality placements are available for children, and to ensure that where there is excessive profit, we take action against that as well.

Independent Review of Children’s Social Care

Baroness Tyler of Enfield Excerpts

Monday 9th September 2024 Lords Chamber

[Baroness Smith of Malvern (Lab)]

Given the noble Lord’s enormously distinguished career in this area and his contribution to ensuring that children are kept safe, I think the whole House will listen to what he has to say. He is right that the objective of the MacAlister review and this Government is to bring timely support to children and families that need help; evidence shows that preventing problems from escalating leads to better outcomes. We will build on the work of the Families First for Children pathfinders, which, unfortunately, are only in 10 places at the moment, to think about how we can develop that early help. The noble Lord also makes the very important point about all our responsibility, as corporate parents, to ensure that children who have to come into the care system get the same very best care from us that we would expect for our own children. That is certainly something that this Government will pursue and think about how we can embed that even more broadly in the public sector and in our communities.

[Baroness Tyler of Enfield (LD)]

My Lords, I will pursue the point made so eloquently by the noble Lord, Lord Laming. Last week, the children’s care coalition of charities highlighted that, for the first time, more is being spent on residential care placements than on early intervention. Can the Minister say how the Government plan to rebalance that spending, given the current tight fiscal climate, including in the upcoming Budget and spending review, to ensure that families, children and young people get the support they need before reaching crisis point?

[Baroness Smith of Malvern (Lab)]

The noble Baroness makes a very important point. The Local Government Association also found that, whereas in 2022-23 91% of councils that responded spent at least £10,000 per week or more for one placement, in 2018-19 that had only been 23%. Not only does the position in the placement market disadvantage children in not being able to find those loving and stable placements that they need, but it is also an enormous burden to local government. That is why, as she said, we have to build on, for example, the £45 million invested in the Families First for Children pathfinders this year to help families get support earlier. Where there is clear profiteering from some providers in the placement market—evidence of this has been discovered—we need to take action and we will do so.

Schools: Mental Health and Poor Attendance

Baroness Tyler of Enfield Excerpts

Wednesday 24th July 2024 Lords Chamber

Asked by

[Baroness Tyler of Enfield]

To ask His Majesty’s Government what assessment they have made of the links between rising levels of mental health issues among school age children and poor school attendance; and what steps they are planning to take to address the situation.

[The Minister of State, Department for Education (Baroness Smith of Malvern) (Lab)]

My Lords, mental ill-health and inadequate access to support are real challenges facing children today and have a detrimental impact on their school attendance. This is despite the excellent work done by education and health staff across the country. Poor mental health and low attendance are mutually reinforcing barriers to opportunity and learning. That is why we are committed to providing access to a specialist mental health professional in every school and developing new young futures hubs.

[Baroness Tyler of Enfield (LD)]

My Lords, I thank the Minister for her Answer. As she has acknowledged, the evidence increasingly shows a clear link between school absences and poor mental health. There is also a growing recognition of the gap in mental health support available to children who need a greater level of support than is currently available in school mental health teams but do not require specialist treatment from CAMHS, and that this gap is best filled, as happens in Scotland and Wales, by school counsellors and suitably qualified practitioners. She talked about providing specialist mental health support for every school, mirroring my recent Private Member’s Bill, and I very much welcome that. Could she confirm when these proposals will be brought forward and whether they will include primary as well as secondary schools?

[Baroness Smith of Malvern (Lab)]

My Lords, I know that the noble Baroness has done much work in this area and, obviously, has had a Private Member’s Bill on it. Access to mental health professionals will be for all schools, secondary and primary. We are working with the Department of Health and Social Care to ensure that we get that model right and that we can, as she emphasises, provide that early support to alleviate the need for more acute mental health provision for young people, I hope.

King’s Speech

Baroness Tyler of Enfield Excerpts

Friday 19th July 2024 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, as this debate draws to an end, I warmly welcome the newly appointed Ministers to their important new roles. I thank the outgoing Ministers, and commend the two excellent maiden speeches that we have heard today. I particularly commend my noble friend Lady Jolly for her excellent valedictory speech and pay tribute to her outstanding contribution as a Government Whip during the coalition and as a party spokesperson, and in particular the work she does for people with learning disabilities. She will be sorely missed on these Benches and beyond.

Like so many others today, I welcome many of the measures in the gracious Speech and look forward to scrutinising legislation when it comes to this House. There are areas where the measures do not go far or fast enough, and there are some key omissions that I will highlight. My noble friends Lord Storey, Lord Sharkey, Lord Addington and Lady Garden have all talked about education with great expertise. I will focus on health.

I welcome the commitment in the gracious Speech to improve the NHS, specifically the urgent need to reduce waiting times, focus on prevention and improve mental health provision. I wholeheartedly agree that there is an urgent need for a more preventive model of care, with investment moved upstream; it is crucial if we are to lower waiting times, improve access and reduce health inequalities.

The answer to overcrowded hospitals is not simply more hospitals: the health and care system must be radically refocused to put primary and community care at its core if it is to be effective and sustainable. In my view, this should include new patient-centric integrated services, such as walk-in clinics, diagnostic centres and polyclinics, to improve speedy access, give patients more control, and take the weight off overburdened GPs and hospitals. We also need to use existing hospitals more efficiently. We know that valuable NHS equipment and operating theatres too often stand idle in the evenings and at weekends. Will the Minister say what plans the Government have to address this and whether they include bringing in independent clinical teams from outside the NHS?

A more radical shift to a preventive model of care was one of the key findings of the integrated care Select Committee, so expertly chaired by the noble Baroness, Lady Pitkeathley, on which I had the privilege to sit. I hope Ministers will take heed of that excellent report and what it recommended. We really do not want to end up reinventing the wheel.

Like my noble friend Lady Walmsley, perhaps my biggest disappointment is the silence on social care. We all know that the current problems in accessing healthcare will never be resolved until social care is fundamentally reformed. There has been talk recently of a royal commission, but no mention of it in the gracious Speech. I wonder whether a royal commission, however well-intentioned, is what we need; I worry that it will simply kick the issue into the long grass. In the last decade, we have seen countless reports, reviews and commissions into social care, but, to the huge frustration of those in the sector and beyond, nothing ever happens. In short, the political will simply evaporates. We know what the problems are and, broadly, we know what needs to happen; we just need to start moving on what will inevitably be a gradual path.

The Government have pledged to establish a fair pay agreement in the adult social care sector and improve working conditions. I welcome that, given that there are over 130,000 vacancies in adult social care. It is certainly to be hoped that measures in the planned employment rights Bill to increase pay and scrap exploitative zero-hours contracts will help to attract and retain more staff, but that will happen only if they are accompanied by commensurate local government funding increases. Will the Government commit to a social care workforce plan to complement the NHS workforce plan?

I turn now to the critical issue of unpaid carers, echoing the words of the noble Baroness, Lady Pitkeathley. Labour’s Plan to Make Work Pay, published in May, included a commitment to review the implementation of the Carer’s Leave Act 2023 and examine all the benefits of introducing paid carer’s leave. However, the background briefing to the employment rights Bill, published on Wednesday, contained no mention of this. There is a real opportunity here for the Government to move quickly to deliver this review and introduce enabling provisions to ensure that a new right to paid carer’s leave is introduced as part of the Bill. What specific plans are in place to deliver that review and to introduce these enabling provisions?

I greatly welcome the commitment to ensure that mental health is given the same attention and focus as physical health and to modernise the Mental Health Act. To say it is grossly overdue is an understatement, and I understand the scepticism of some in the sector who have heard all these promises many times before, only for nothing to happen. For too long the Mental Health Act has failed people who require mental health care. Racial inequalities in the use of detention, high levels of restraint and the removal of patient autonomy are just some of the problems of the current Act. Introducing a new mental health Bill to reform that Act provides a crucial opportunity to enhance patients’ rights, to strengthen safeguards for those admitted to mental health hospitals, particularly for children placed in inappropriate settings and on adult wards, and to rebalance the system to one that prioritises and promotes the patient’s voice and choice in their treatment.

It is welcome to see the tobacco and vapes Bill reintroduced. We should not forget that, of those people suffering from mental health conditions, more than 40% smoke, compared to just over 12% of the general population.

I declare an interest here as a member of the Financial Inclusion Commission, which has not had a mention yet today. Too many people experiencing mental health problems also suffer from financial and digital exclusion. That is why I was so delighted that the Liberal Democrat manifesto included a commitment to introduce a national financial inclusion strategy, including measures such as promoting access to cash, particularly in remote areas, and supporting banking hubs and vulnerable consumers. Could the Minister say what plans the Government have to introduce a comprehensive financial inclusion strategy?

I turn now to children’s mental health. As we have debated so often before, those accepted into child and adolescent mental health services—CAMHS, as we know it—are often left waiting for many months, if not years, for treatment, during which time their mental health often deteriorates. It is estimated that only around a third of children with a probable mental health problem are able to access treatment, showing how far away from the parity of esteem with physical health we really are. I look forward to hearing the Government’s plans in this area.

I welcome the children’s well-being Bill, particularly the pledge to introduce free breakfast clubs in all primary schools, but I would also like to see an equal focus on promoting children’s mental health at primary school age. The gracious Speech contained a pledge to improve mental health provision for young people, which I very much support, and the Labour Party manifesto committed to providing specialist mental health support for every school, mirroring my recent Private Member’s Bill. Could the Minister confirm whether this will include primary schools, as my recent Private Member’s Bill did? Sadly, it narrowly missed its Third Reading, because the election was called. Leaving it until secondary school is simply too late. Could the Minister say when we can expect to see action on introducing open-access mental health hubs for children and young people in every community?

Finally, I turn to child poverty. We have had some powerful interventions here. I was proud that the Liberal Democrat manifesto contained a pledge to abolish the iniquitous two-child benefit cap. I wish there had been more focus on this and on other elements of our ambitious anti-poverty strategy during the campaign. We have heard the figures today of those in child poverty and the fact that it is going up and that many of those families suffering have had at least one parent in work. We welcome the Prime Minister’s very recent announcement of a child poverty task force, but it is quite clear that the two-child benefit cap is the principal policy contributing to this alarming rise. Could the Minister set out the timetable for the task force reporting and say how quickly we can expect to see action taken on the two-child limit?

Children and Young People: Local Authority Care

Baroness Tyler of Enfield Excerpts

Thursday 18th April 2024 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I congratulate the noble Lord, Lord Laming, on securing this critically important debate and introducing it so expertly.

Pressure on children’s social care is at an all-time high. As we have already heard, there are almost 84,000 children in the care system. In my view we are facing a perfect storm, with escalating numbers of young people coming into a system that has become increasingly focused on delivering late intervention services, in particular high-cost residential care placements. Councils are unable to invest in early intervention services that can prevent families reaching crisis point and children having to enter care in the first place.

The figures are stark. On average, the cost of a residential placement is four times that of a foster placement. In the last 10 years, spending on early intervention has almost halved, while spending on late intervention has risen by almost one-half.

We know that more children are entering care with complex or multiple needs. There has been an increase in the number of older teenagers entering care. School age children in care are more likely to have special educational needs and mental health problems. Children in the most deprived 10% of neighbourhoods are over 10 times more likely to be in care or on a protection plan than those in the least deprived 10%.

I think we can all agree that children in care need stability to heal and thrive, yet for too many their experience of care is characterised by instability: being moved from home to home or school to school, being separated from siblings, being moved far away from their support networks, or facing a revolving door of social workers and other professionals.

Over the past decade, as we have heard, there has been a significant change in the way that care placements, particularly residential care placements, are provided. As of last year, private providers operated over 85% of all children’s homes. The Competition and Markets Authority has reported how this changing market has led to what it calls a power imbalance between private sector providers and local authority commissioners, reducing local authorities’ control over the type of provision that is developed, where it is located, and the cost. Little wonder that there are increasing concerns about the role of private equity companies in providing residential care, excessive profit levels among the largest providers and the rising sums that councils are having to spend on residential care.

A recent report by the investigative journalist Justine Smith in The House magazine, already referred to by the noble Lord, Lord Laming, provided truly alarming figures, including a 25% hike in prices in just two years, at the same time as 23% profit margins were taken by the biggest operators. The Competition and Markets Authority report also highlighted that the level of debt carried by some of the largest private providers presents a real risk to local authorities and the wider care system. A real concern is that studies have shown that for-profit children’s homes are too often rated of lower quality than other provision types.

We need to introduce a more effective children’s social care commissioning system as a matter of urgency to help reduce the reliance on private sector firms that are carrying large amounts of debt. I can put it no better than the words of Josh MacAlister, chair of the independent review of children’s social care, who said:

“When sovereign wealth funds are investing in your country’s children’s homes, you know there is something very wrong”.


Like the noble Lords, Lord Laming and Lord Wood, I am concerned about the use of unregulated care homes, which is the subject of another recent Observer investigation. It seems to me that something is going very wrong. I would be grateful if the Minister told me what the Government are doing about this.

Sadly, I do not have enough time to talk, as I would have liked, about the Government’s strategy for reforming children’s social care. As I have said before, it is a very much a step in the right direction but does not go far or fast enough to address the scale of the challenge. I would therefore like to finish by asking the Minister a couple of questions. First, the Government’s Spring Budget provided some welcome additional money for extra children’s home placements. It said that the Government were going to develop proposals to combat profiteering in the sector and look at new ways of unlocking investment in children’s homes. Could the Minister please spell out what these proposals are and how quickly they are likely to come into effect? Finally, could she also give a timetable for when the Government plan to publish a children’s social care Bill, which would provide a vehicle to bring forward many of the reforms of children’s social care that this Government committed to in their Stable Homes, Built on Love strategy?

Schools (Mental Health Professionals) Bill [HL]

Baroness Tyler of Enfield Excerpts

2nd reading
Friday 1st March 2024 Lords Chamber

Moved by

[Baroness Tyler of Enfield]

That the Bill be now read a second time.

[Baroness Tyler of Enfield (LD)]

My Lords, I am delighted to introduce this Bill on a subject that is very close to my heart. I have been calling for counselling to be available in all schools since I first entered the House. I declare an interest as vice-president of the charity Relate. My heartfelt thanks go to the many organisations in the sector that have shared their expertise and briefings with me in preparing for this debate.

Only last Thursday, we had a good debate on the vital role that schools play in promoting good mental health and well-being. Along with other noble Lords, I talked about the need for a whole-school approach to mental health and highlighted evidence pointing out the links between children and young people experiencing mental health difficulties and attendance, exclusion, bullying and academic attainment. My Bill, which provides for all schools—primary and secondary —to have a counsellor or equivalent-level mental health professional, very much fits with that whole-school approach.

Our many previous debates on children’s mental health have revealed a fair degree of consensus that the scale of the problem is growing and requires an ambitious and comprehensive response. It is also clear that the Government take this issue seriously and have taken important steps to improve mental health support in schools, the NHS and the community. I have always welcomed that action. The only real difference is whether that action is sufficient and nationally available. My Bill is about plugging one vital gap in mental health support teams that many who are active in the sector have highlighted, which would improve much-needed mental health support for many young people.

Our debate today is timely. This week’s Resolution Foundation report, on poor mental health preventing people in their 20s working, provoked a predictably wide range of reactions in the press. However, there is simply no getting away from the fact that, unless they are tackled early, mental health problems can easily escalate as a young person enters adulthood and the workplace.

Let me briefly explain why the state of our children’s mental health and the support available to them is so important. I know that it is familiar territory for many noble Lords here, but it is vital to put my Bill into context. According to NHS statistics, almost one in five—18%—of children between the age of seven and 16 years old have a probable mental disorder. For slightly older children, almost half—44%—of those aged between 17 and 18 were classified as experiencing high psychological stress.

According to a report last May by the Children’s Commissioner, the number of young people urgently referred to mental health services had tripled since 2019. Last year, less than half—44%—of the 1.5 million children who needed additional support had received a CAHMS appointment. The average waiting time in England between referral and the start of treatment is the highest it has been in two years.

According to a survey conducted last year by Young Minds, 65% of the young people surveyed who were struggling with their mental health had not asked for any sort of formal help. Critically, 61% of those waiting for some support had stopped attending school, college or work, with one in five children waiting for support missing six months or more of school. According to a YouGov poll commissioned by Barnardo’s, 61% of parents with school-age children experiencing mental health difficulties said that those difficulties were affecting their performance at school. Almost half noted a drop in concentration and focus on their schoolwork.

The cause of this increase is much debated, including in this Chamber. In last week’s debate, although I recognised that many schools are doing a great job, I pointed to the increasing pressure from the academic environment, the growing influence of social media and the online world, and the lasting impact of the pandemic. Indeed, surveys show that most parents are worried about their children’s mental health, with the impact of social media a major cause of concern.

In January 2023, the House of Commons Education Committee stated that it had seen

“overwhelming evidence indicating a radical increase in mental health difficulties amongst school pupils since the Covid-19 pandemic”.

Additionally, the committee argued that the capacity of mental health services was “grossly inadequate”.

I turn to the detail of the Bill. Clause 1 places a duty on governing bodies of state-funded schools in England to provide access to a qualified mental health practitioner or school counsellor. Clause 1(2)(b) states that the qualified mental health professional or school counsellor should be an individual with a graduate-level or postgraduate-level qualification of that name accredited by NHS England. Normally that would be a counsellor or a psychotherapist. Clause 1(2)(c) states that schools with 100 pupils or fewer may collaborate with other schools and share access to this provision, while Clause 2 places a duty on the Secretary of State to give, or make arrangements for, financial assistance to state-aided schools to help them to meet their duty to provide this mental health support.

Before explaining precisely what the Bill would achieve, I reiterate my support for the concept of mental health support teams in schools, which were first piloted in 2019. These teams support a whole-school approach to mental health, working closely with school staff and delivering group and individual interventions offering low-intensity therapy—that is what cognitive behavioural therapy is called in the trade—for children and young people with mild to moderate mental health difficulties.

The teams are mainly staffed by educational mental health practitioners—I am sorry about all the jargon today—who study on a one-year postgraduate course. By last December, nearly 400 mental health support teams were operating in schools and colleges across England covering some 3 million children, which is roughly 35% of pupils. The Government have said that they aim to increase that coverage to 50% by April next year, although that will be considerably lower for primary schools and of course it still leaves millions of children and young people without any support.

An early evaluation of the programme found that many schools reported that they needed most help for children and young people whose mental health exceeded the threshold that the mental health support team practitioners could provide but either did not meet the threshold for CAMHS or needed support while they waited, so a gap in provision is becoming clear. However, I was encouraged by the evaluation showing that, where mental health support teams and counselling services were already working together, the teams were able to pick up and deal effectively with the lower-intensity need, enabling counsellors to work with the more complex issues. Those are two different roles and skill sets but they are a mix that works well together.

I was struck by the research evidence from Barnardo’s, which delivers a number of these teams across England. It found that support teams are effective at supporting children and young people with mild to moderate mental health problems; they improve outcomes for those with access to them and, critically, are cost effective, saving the Government £1.90 for every £1 invested. However, the research also identified a specific gap in the current model in addressing the needs of children with moderate or more complex needs, those with special educational needs or younger children for whom cognitive behavioural therapy is often not appropriate or who do not respond well to its structure. Simply put, some children need to explore their feelings more fully in other ways that are not time limited. The report recommended that the model should include school counsellors to fill this gap, which is what my Bill is all about: ensuring that every school also has access to a qualified school counsellor or psychotherapist.

I shall explain what has been called this missing middle in what I hope are everyday terms. Qualified counsellors and psychotherapists can work safely with young people who are experiencing trauma and abuse, self-harm, suicidal thoughts, violence, anger, issues with food and eating, bereavement, bullying and so on but none the less still do not meet the threshold for CAMHS. Lower-intensity interventions that are currently delivered by existing mental health support team practitioners might include such issues as motivation, exam anxiety, mild to moderate anxiety and depression and behavioural difficulties. Please do not get me wrong: existing practitioners within these teams provide a vital and valuable role, working with children experiencing less intensive symptoms linked to their poor mental health, but many are not trained to work with children who are seen to be at active risk, such as those who may be self-harming or experiencing suicidal thoughts.

There is a clear need for a wider range of therapeutic interventions to be delivered in schools by counsellors and psychotherapists, whose training generally lasts between two and four years, which enables them to hold a greater level of complexity and risk. Without a clear pathway to counselling where required, issues can easily spiral, increasing pressure on already overstretched CAMHS. It is very much a question of both/and, not either/or.

I turn briefly to workforce considerations. When we have had these debates before, Ministers have often raised workforce issues as the reason for the slow pace of rollout or the limited scope of support teams. However, there is good news to be had. The workforce challenge is not simply a question of training more practitioners from scratch. The major counselling and psychotherapy registration bodies—BACP, UKCP and NCPS—collectively represent over 25,000 therapists who currently work with children, most of whom are trained to work with considerably greater levels of complexity than existing support team staff. According to BACP’s most recent member survey, these existing therapists have the capacity to offer over 50,000 counselling sessions for children and young people every week. I strongly urge the Government to look at ways of harnessing the capacity of this workforce in schools, including exploring the integration of counselling within the national mental health support team model. This model has a richer skill mix and the benefit of providing important career progression opportunities and learning opportunities for existing staff, where there have been high levels of turnover.

I cannot end without a quick word on funding. Of course, it is important to acknowledge that the last couple of years have seen welcome increases in funding, but the money is not ring-fenced, nor is it presented in a format that easily enables us to look at total spending across the NHS, schools and elsewhere. There is simply no getting away from the fact that years of underfunding and neglect of children’s mental health services have taken their toll. Recent increases do not in any way match the scale of demand. Back in 2022, the House of Commons Health and Social Care Committee, in those days chaired by the current Chancellor, called on the Government to increase the funding and scale of mental health support teams to cover all schools by 2027-28. Might we expect to hear something to this effect in next week’s Budget?

To conclude, we have the opportunity to transform the landscape if mental health support teams are rolled out to all schools and colleges, as I fervently hope they are, and within that model include a school counsellor in every school, as my Bill proposes. I beg to move.

--- Later in debate ---

[Baroness Tyler of Enfield (LD)]

My Lords, I thank the Minister for her thoughtful response. It is true that we share broadly the same aspirations and, as she said, there is plenty in the spirit of the Bill that we can all agree on. I thank all noble Lords who contributed to this excellent debate. I know we often say, “It’s been an excellent debate”, but this really has been, and I have learned so much from it. It has really added to my understanding.

I particularly thank the noble Baroness, Lady Berridge, for pointing out the position of children detained under the Mental Health Act and in secure units. That was an extremely important point. I thank the noble Lord, Lord Watson, for his support and for emphasising that children need to go into schools ready to learn. At the moment, too many do not. I thank him for his support and for saying that the Bill would ramp up the provision needed.

I am particularly indebted to my noble friend Lord Russell, who, as other noble Lords said, so movingly referred to his personal experience. He highlighted the plight of parents who cannot afford to pay for the provision that they know their children and young people need. It is heart-rending, frankly, to think of that. He vividly described the missing middle that I have been talking about in the Bill. I just wish I had thought of that analogy myself.

I thank the noble Lord, Lord Jackson, for his insightful contribution and for raising the issue, which I had not thought of before, of children with Tourette’s, and how that is another example of children falling through the gaps in provision. The right reverend Prelate the Bishop of Winchester made a powerful and wide-ranging intervention; I was grateful to him for drawing the links with poverty and disadvantage.

It has been my pleasure to work closely with the noble Baroness, Lady Wyld. I am so grateful for her support for the principle of the Bill and for reminding us about the importance of family hubs. As she said, there must be hope, and I hope that the Bill can in some way add to that hope.

I thank my noble friend Lord Storey for his historical perspective on the development of mental health provision in both the NHS and schools. I thank him for his focus on teaching and non-teaching staff, which was a really important point.

I was grateful to the noble Lord, Lord Hunt, for his general support and welcome, and particularly for the way he highlighted the problem of navigating the system, which so many people and parents find so difficult.

Putting that all together, I have been heartened by the cross-party support for the spirit of the Bill. There is a strong understanding that at the moment too many young people are in that missing middle and falling through the gaps in provision. I am firmly of the view that mental health support teams, which do an excellent job, must contain professionals who are properly qualified to help young people who have moderate to more complex needs so that they do not fall through the gaps because they still do not meet the threshold for CAMHS.

I thank everyone for their contributions. It is heartening to have so much support on the principle. There is perhaps slightly less agreement on the precise way of securing it, but the consensus on the importance of this issue has been exemplary. That is why I hope we can carry on these discussions. I would welcome any amendments to the Bill to explore the practicalities that people have pointed out might not be quite right at the moment. I hope we can find a way that will allow us to take this debate forward and find a way forward. We all wait with bated breath for next week’s Budget—let us see what happens there—but I hope to continue engaging with the Minister on this important issue.

Bill read a second time and committed to a Committee of the Whole House.

Pupil Mental Health, Well-being and Development

Baroness Tyler of Enfield Excerpts

Thursday 22nd February 2024 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I add my congratulations to the noble Baroness, Lady Bennett, on securing this debate. We have had a number of debates on children’s mental health in recent times, and the role of school always features, but today’s debate challenges us to think about the wider role of schools in relation to children’s well-being and confronts the perennial question of the purpose of education. Is it simply about academic attainment and preparation for the world of work? Is it also about preparing young people more widely for adulthood, including how they fulfil their potential in all spheres of life, become full citizens in our society and build healthy relationships? Is it also about providing the skills to build their personal resilience and emotional well-being to help deal with the knocks that life inevitably brings?

The answer, of course, is a combination of those things, but not everyone will agree on the precise mix. It might be trite to say that growing up in the modern world feels more complicated, with a whole new range of pitfalls to navigate, but I think it is true. It is clear that young people face increasing pressures from the academic environment, the growing influence of social media and the online world, and the lasting impact of the pandemic. I was struck by some research conducted for the Mental Health Foundation which found that the advent of technology, while offering unprecedented connectivity, also introduces new stressors, as individuals battle with the constant pressure to meet online standards and portray an idealised version of their lives.

It is worth reminding ourselves that The Good Childhood Report 2023, which has already been referred to, focused on children and young people’s experiences of school. Frankly, it did not make for comfortable reading, with more children and young people unhappy with school than with the other nine aspects of life they were asked about. Primary and secondary schools have an important role to play and have great potential to be a protective factor for mental health, but sadly that is not how too many young people feel about school. In a recent survey by Young Minds of more than 14,000 young people, only 3% said educational settings were a positive influence on their mental health, while 59% said that school or college had affected them negatively in some way. What is going on?

As we have heard already today, many schools have become heavily focused on exam results, and pressure to do well in exams can be overwhelming for some young people. Fundamentally, I believe that a whole-school approach is needed which creates a school culture and environment that has well-being at the core, where mental health and well-being are promoted and protected and which includes all pupils, students, teachers and staff members. In my experience, this happens only when the leadership of the school is actively engaged in and championing this work. It means ensuring that every adult who interacts with a child has the knowledge, understanding and wherewithal to support the child. Of course, parents and carers play a key role in teaching children and young people how to understand and manage their feelings as they grow up, and I would like to see more support in this area.

We know that staff in school are often the first point of contact for a young person struggling with their mental health; hence, they need to be provided with knowledge and understanding around behaviour and mental health and how to identify when a child is struggling. An independent study from NatCen on adolescent mental health and educational attainment observed a strong association between mental health difficulties between the ages of 11 and 14 and later academic attainment at age 16. The study found that children experiencing poor mental health are three times less likely than their peers to pass five GSCEs. I am sure that most schools understand this link, but it seems crucial that mental health issues are not viewed as yet another problem issue that they are forced to deal with. It is about creating the very foundations for learning and academic success.

Furthermore, exclusion from school is strongly related to poor mental health in children and young people, so we should be concerned that the rates of exclusion from school have increased in the last five years. I was interested to read in a recent study that, on average, children who had experienced at least one fixed-period exclusion in the year before attending counselling lost significantly fewer school sessions to exclusion in the year when they had counselling. That was from Place2Be, a charity that operates in many schools, providing drop-in sessions, family work and one-to-one counselling for those with more complex issues. Its analysis of pupils receiving counselling indicates that consistently poor mental health over time was associated with higher levels of persistent absence, which we heard about earlier, whereas improving or consistently good mental health was often associated with lower levels of persistent absence. Its findings also suggest that strengthening children’s engagement with and enjoyment of school over time was associated with reduced persistent absence. The same can be said about bullying but I do not have time to go into that now.

Preventing mental health problems arising in the first place is key. When support is available in schools in a non-stigmatising format, young people benefit. Young people themselves have talked about the need for safe spaces at school and safe conversations. By intervening early, building resilience and nurturing a positive understanding of emotions and well-being, we can ensure that young people learn lifelong skills so that their problems do not grow with them. That can be done through whole-class work, lessons and the curriculum. Critically, it needs to start at primary school age, to which we do not give enough attention.

Finally, I turn to mental health support teams. We have heard quite a bit about them and I have always supported them but, alongside many others, I have argued that the rollout should have proceeded at a much faster pace. As we have heard, on the current plans there is funding to achieve only 50% coverage of schools by 2025, leaving over half of schools, particularly primary schools, uncovered, and pupils without the support they need. To be clear, MHSTs are a welcome and important part of the jigsaw of mental health support, but they go only so far.

I will have a lot more to say on the subject next Friday at the Second Reading of my Private Member’s Bill, particularly my concern about children urgently needing mental health support who meet neither the mental health support teams’ “mild to moderate” criteria nor the criteria of specialist CAMHS support, with its very high access thresholds and extremely long waiting lists. Noble Lords should watch this space.

Children’s Care Homes: Private Equity

Baroness Tyler of Enfield Excerpts

Tuesday 30th January 2024 Lords Chamber

[Baroness Barran (Con)]

I am glad that the noble Lord used the word “profiteering”: he beat me to it. As he has heard me say before, the Government are not against profit-making but they are against profiteering. Having much greater financial transparency will go some way to addressing his concerns, but the fundamental thing that has to shift is having fewer children in children’s homes and more children in foster care. That is why the Government place such emphasis on supporting foster carers and, indeed, kinship carers.

[Baroness Tyler of Enfield (LD)]

My Lords, a recent DfE review found that a third of the just-over 6,500 youngsters in residential care homes could have gone to foster homes, which usually offer better outcomes and a better quality of life, and cost about a 10th of the price. The Minister has just referred to this. What precisely is going to happen to ensure that there is proper and meaningful investment in foster and kinship carers to reduce the councils’ dependence on some of these private equity residential care providers and stop this extreme and excessive profiteering?

[Baroness Barran (Con)]

The noble Baroness will be aware that we are investing £36 million in foster care, starting with work with local authorities in the north-east to encourage recruitment of more foster carers. That programme has got off to a very good start. We have also launched the first ever national kinship care strategy, backed by £20 million of investment in the financial year 2024-25.

Children’s Social Care Implementation Strategy (Public Services Committee Report)

Baroness Tyler of Enfield Excerpts

Wednesday 20th September 2023 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I declare an interest as co-chair of the All-Party Parliamentary Group for Children. I congratulate the noble Baroness, Lady Morris of Yardley, on opening the debate so compellingly, and I congratulate her and the whole committee on this excellent report.

It happens that it follows, helpfully, the recent debate on the implementation of the Children and Families Act 2014. We were told then by the Minister, who is on duty again tonight, that many of our recommendations would be considered and taken forward as part of the implementation strategy we are debating tonight. I welcome that commitment and look forward to working with Ministers on it.

In the short time available, I shall make some general points about children’s social care. As the noble Baroness, Lady Morris, has reminded us, the independent review of children’s social care called for an immediate investment of £2.6 billion to address the existing crisis in children’s social care. It talked about a revolution in family help to prevent children entering care where possible. It talked, as we have been told, of a

“once in a generation opportunity”

to better protect children, deliver the right support for families at the right time and create a sustainable system that delivers value for money.

However, more than a year later we seem to be little further forward on the reform that is so urgently needed. The Government have pledged just £200 million over a two-year period to fund 12 family first pathfinders and regional care co-operatives, but the national rollout of new family help services will not happen until 2026 at the earliest, and there is no legislative timetable for introducing further reform. I agree that we need to see a far greater sense of urgency and pace to these reforms.

Recent analysis commissioned by some of the UK’s leading children’s charities reveals that the funding will now need to exceed £2.6 billion due to the impact of inflation and the cost of delaying reforms. That research supports the Public Services Committee’s finding that the level of investment in the stable homes strategy is “inadequate” and will have long-term social and financial costs.

I underline the importance of a shift to a focus on early intervention. As we have heard so many times, not least in reports from the APPG for children in recent years, we need to switch from crisis to preventive work to protect children properly. That means championing the importance of family help and support.

The research that I mentioned by children’s charities has already found that local authorities across England increased their spending on children’s services by £800 million in 2021-22, a substantial 8% surge from the previous year. However, as we have heard, over 80% of that increase was funnelled into crisis intervention: safeguarding, child protection and the ever rising number of children in care. In short, of the additional money spent, £4 in every £5 went on late intervention services. In the light of that research, the Public Services Committee’s recommendations—to roll out early help nationally and to ensure that this is linked to family hubs—are welcome. Unless this pattern of expenditure is shifted significantly, frankly, nothing is ever going to change.

Turning very briefly to child protection, the record number of children who are now looked after by the state, the horrific killings of Arthur Labinjo-Hughes and Star Hobson, and the abuse of disabled children recently uncovered in residential settings in Doncaster are powerful reminders of the urgent need for reform. Meaningful, sustainable change requires long-term investment, yes, but the Government must also introduce an emergency package of measures to stabilise the current child protection system. Can the Minister please provide an update of what is happening in this area?

We also need to see sustained funding for family help services, ranging from children’s centres and youth clubs to targeted support on issues such as drug and alcohol misuse, to stop problems further spiralling. Of course, we cannot ignore the workforce challenges, which we have already heard about from the noble Baroness, Lady Morris.

Finally, on links with wider policy, particularly on health and disability, what assurances can the Minister give that the major conditions strategy will focus on children and young people, in particular mental health, to help alleviate the additional pressure that the crisis in mental health support places on social care? Can the Minister say what support will be made available to adopted children needing help to overcome trauma and what special measures are being put in place for children in care, who are four times as likely to experience mental health issues as their peers?

The Government’s test-and-review approach to reform is unlikely to lead to the level of investment and changes so desperately needed. I conclude once again by urging the Government to reconsider the scope for further investment at their next spending review.