Children’s Social Care

Debate between Baroness Tyler of Enfield and Baroness Barran

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 There was an estimate in the MacAlister review, but that is now somewhat out of date.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?

Children’s Care Homes: Private Equity

Debate between Baroness Tyler of Enfield and Baroness Barran

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.

Secondary Schools: Autistic Pupils

Debate between Baroness Tyler of Enfield and Baroness Barran

Thursday 26th January 2023 Lords Chamber

[Baroness Barran (Con)]

I think I have already said that the implementation plan will be published early this year.

[Baroness Tyler of Enfield (LD)]

Does the Minister agree that some children diagnosed with autism are also experiencing mental health difficulties, and that that is a complex interaction? What training is being given to mental health professionals working in mental health support teams in schools to understand and support autistic children who also have mental health problems?

[Baroness Barran (Con)]

I may need to write to the noble Baroness on the specifics of the training, but she is correct that we are supporting those professionals to respond and help identify mental health issues early among children in schools.

Social Care: Children

Debate between Baroness Tyler of Enfield and Baroness Barran

Wednesday 22nd June 2022 Lords Chamber

[Baroness Barran (Con)]

My noble friend raises an important issue. Indeed, one of the young women to whom I was speaking just before this Question talked about exactly the point that he raises. I would be delighted to meet the organisation that he mentioned.

[Baroness Tyler of Enfield (LD)]

My Lords, I too had the privilege of meeting some of those young people a little earlier, which included hearing a rather harrowing story of two brothers who had been brought up in foster care. The review recommends more support, both practical and financial, for kinship carers, which include grandparents, aunts, uncles and others who care for family members. Is the Minister able to say what is going to happen to that recommendation and whether the Government are planning to take it forward?

[Baroness Barran (Con)]

The Government recognise the incredible role that kinship carers play in the system. It would be premature for me to judge what the Government will decide, but obviously it is being considered carefully along with the other recommendations.

Mental Capacity (Amendment) Bill [HL]

Debate between Baroness Tyler of Enfield and Baroness Barran

Committee: 3rd sitting - (Hansard): House of Lords
Monday 22nd October 2018 Lords Chamber

[Baroness Tyler of Enfield]

My Lords, I have two amendments in this group and my name is attached to four others. It is a little unfortunate that we are coming to this important group of amendments, which affect the Bill as a whole—there are some very important implementation issues—quite so late in the day when the appetite for debate is understandably somewhat limited.

My Amendment 88 seeks to do two things. It seeks, first, to enhance scrutiny of regulations in Parliament and, secondly, to ensure proper consultation if the Government seek to amend regulations later on down the line. According to the Explanatory Notes, as drafted the regulations are subject to the negative procedure, except where the Secretary of State wishes to change primary legislation, in which case the affirmative procedure applies. My amendment proposes a different approach, whereby the positive procedure applies in both cases. That would mean that, should the Government wish to amend regulations, such a change would automatically trigger scrutiny in both Houses. Why do I think this is important? Fundamentally, depriving someone of their liberty is a very major and fundamental action which warrants strong safeguards and scrutiny. I think it is absolutely vital that we closely monitor the implementation of this legislation and debate any proposed changes that the Government may wish to introduce.

The second part of my amendment—which I think is equally important—means that, before laying a regulation, the Government must consult with stakeholders on its potential impact. Again, given that this legislation concerns extremely vulnerable people, it is absolutely vital that we get it right—that is both primary legislation and the detail of any regulations. One of the threads throughout our debate in Committee, both today and in our two previous sessions, has been that, while the Law Commission consulted widely on its draft Bill, the Government’s Bill, which we are now discussing—and which is very different in a number of important aspects—was introduced with very little consultation with those who work in the sector. It is absolutely vital that we hear from mental health practitioners, legal professionals, charities and those representing vulnerable people.

Amendment 87F is a probing amendment and it is to highlight the current unsatisfactory situation, which I gather is causing real concern to clinicians in relation to when they are obliged to complete court reports requested by the Court of Protection. This issue was drawn to my attention by the Royal College of Psychiatrists and I draw the House’s attention to my interests in the register. Currently, Section 49 of the Mental Capacity Act 2005 authorises courts to,

“require a local authority, or an NHS body”,

to prepare a report on such matters,

“as the court may direct”—

generally, the relevant person’s mental health or mental capacity.

I understand that drafting such a report requires a senior clinician to review previous reports, examine the patient, talk to family members or carers and carry out necessary tests. Notably, it often relates to a patient who has never been under the care of that clinician or even the hospital trust employing them. I have been told that the average time required to complete such a report—although it varies—would be around 10 hours, which does not include the extra time required if the clinician is required to attend court in person to give evidence.

The nub with the concern here, which has been raised by many clinicians, is that an unknown quantity of clinician time is being taken away from front-line patient care. As there is no national data, as I understand, on this, it is unclear how much. Again, as I understand it, CCGs and NHS trusts are not being paid for or equipped for their staff to be required to spend their time in such a way, and the very short timeframe often set by the court can lead to very considerable disruption of clinical priorities and patient appointments being changed at the very last minute.

I emphasise that I have no problems with the Court of Protection needing reports and expert advice—it is just that the system for getting it does not seem right to me, with the NHS being required to provide these reports in such a way. Frankly, there is cost shunting on to the NHS, but it is also having no regard for the impact on wider patient care. The Minister has said that he will be talking to the MoJ about a number of things. It would be very helpful to hear how the MoJ thinks this system could be better managed so it does not have such a deleterious effect on wider patient care. The purpose of this amendment is to get the Minister to explain and outline the Government’s thinking in this area.

Finally, Amendments 86 and 93 require two very crucial documents to be laid before Parliament before the provisions of the Act can come into force: the code of practice and the Government response to the Independent Review of the Mental Health Act. It is really where we started off this evening—certainly where I started off was looking at the interaction of those two pieces of legislation.

The one point I will make is that whatever recommendations the Mental Health Act review ends up making, it is clear that as long as we have separate legislation to govern mental illness and mental capacity, we absolutely must consider the interaction between those two frameworks. In terms of implementation, the early introduction of the Bill prevents the review from making suggestions that touch on the scope of the LPSs we are discussing. Therefore, it is crucial that the Government respond to the review’s recommendations before the LPSs that we are talking about at the moment can come into force.

[Baroness Barran]

I am sorry to take noble Lords back a step to Amendment 87D, which is in my name and is really a probing amendment. I thank the noble Baroness, Lady Finlay, for her very warm support—she has unfortunately had to run for a train, but I am grateful to her.

It seemed to me, in thinking about this amendment, that there are a couple of points in the process of authorising liberty protection safeguards where there needs to be real rigour to check that the best interests of the cared-for person lacking capacity are upheld and that the least restrictive option is found in terms of depriving them of their liberty. We spent a lot of valuable time looking at the role of the care home manager in relation to this. The noble Baroness, Lady Hollins, was also alluding in part, in her Amendment 66, to the second actor in this, namely the responsible body. My amendment explores the role of the responsible body.

The first part of the amendment seeks to address the role of the responsible body, which, as I understand it, is effectively a safety net in the process. The aim is to encourage the responsible body to identify cases where it is more likely that those two key considerations have not been upheld. The second part of the amendment sets out a course to follow if that is the case. What I have been trying to imagine is what it is like to be sitting in the responsible body, the local authority or the hospital, with a pile of LPS forms to authorise. How can we keep the person doing that alert and using their discretion appropriately?

In the first part of the amendment, what I am getting at is a way to set clear criteria for the responsible body to follow, such that if the criteria were met it would trigger a review of the applications in more detail. I do not have a definitive list of what those criteria might be but, for example, one might imagine that if the care home in which the cared-for person was going to reside had been rated as inadequate by the CQC, it might be a prompt for a further review, if that care home manager had arranged the assessment.

Other possible criteria might involve what the noble Baroness, Lady Barker, referred to as “unbefriended” people. I am much sure whether this is technically unbefriended, so forgive me, but if someone has no friends or family and a carer has some kind of indirect financial interest in the outcome of the decision, that might be another case of where these criteria might trigger further review. The assumption would be that this amendment would apply whatever the source of funding for the cared-for person. There may be other criteria that would be more helpful, and I am sure that noble Lords who are more experienced in this area than I am will think of what these might be.

In the second part of the amendment, I have simply suggested that, if there is cause to examine an application more closely, it should follow the pathway set out in paragraph 18 of new Schedule AAl. Obviously, if this route is taken, consideration needs to be given to resources, since we do not want to create a conflict of interest for the responsible body—the mirror image of some of the conflicts we have talked about for the care home manager. We certainly want to avoid a situation where there is a financial disincentive to review those cases which genuinely warrant a review.

Mental Capacity (Amendment) Bill [HL]

Debate between Baroness Tyler of Enfield and Baroness Barran

Committee: 1st sitting (Hansard - continued): House of Lords
Wednesday 5th September 2018 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I was not going to intervene on this group of amendments but I have listened carefully to all the points that have been put and they have all been absolutely excellent. There is a tension here, as the noble Baroness, Lady Finlay, just said. My main reaction, particularly when I read the letter from ADASS—I shall not read it out again; I have it in front of me—was of real concern. As the noble Lord, Lord Hunt, said, they are not the sort of people who say these things lightly. They do not scaremonger. They do not exaggerate. They make very carefully calculated judgments, as you would expect of people at that level. I read the letter with great concern.

I was equally concerned when I read the briefing, as mentioned earlier, from the Relatives & Residents Association. One phrase really resonated with me, about the association’s great concern that too often we were asking care managers to be judge and jury about decisions in which they were involved. That is how it was expressed. The noble Baroness, Lady Finlay, made some excellent points. We have to find a way through. It would be genuinely helpful if, as in her proposition, there was time to think about those who will be most involved, as they must be, in care planning for these very vulnerable people, and a sufficiently independent element in arrangements so that people feel that care home managers are no longer judge and jury. I do not think we are there yet. I cannot articulate it at the moment but we must work together to secure a slightly different way forward.

[Baroness Barran (Con)]

I echo the appreciation of the noble Baroness, Lady Tyler, of the explanation of the noble Baroness, Lady Finlay, of the choices we face between the care home manager, who in the best cases will know “P” well, and the local authority assessor, who, as was said, might be parachuted in. It underlines the need for the now-familiar new paragraph 17(2) to be well thought-through and implemented. It is clear that the Bill’s intention is for this to be one of the critical safeguards of how this all works in practice, along with the scrutiny role of the responsible authority, which we will no doubt cover in detail.

Amendment 11 in the name of the noble Baroness, Lady Hollins, raises an important point about supported housing and care homes. It raised in my mind a slightly different question, which may have occurred to other noble Lords: do we need more clarity in the Bill on how it applies in domestic settings? For example, when someone who is normally cared for at home is in a care home for a short stay, perhaps because their carer is in hospital, what is the position in the home once the protection of liberty safeguards have been authorised? I wonder whether my noble friend could consider whether there is a need to clarify exactly the role of the safeguards in domestic settings and how they interface with the Care Act and other bits of legislation that would apply in such cases.