Children and Social Work Bill [HL]

Debate between Baroness Tyler of Enfield and Lord Mackay of Clashfern

Wednesday 29th June 2016 Grand Committee

[Lord Mackay of Clashfern]

Amendment 33 in this group is mine. In the natural parent system there are normally one or two people who are linked to the child, and that link continues. When children go into care, the difficulty is that the staff looking after the children are apt to be different from day to day and week to week, and certainly from month to month. My proposal is that when a child comes into care, a member of the local authority care staff should be appointed with a responsibility for the well-being of that child. When I use the phrase “well-being”, I am thinking of course of the Care Act and the wonderfully large coverage that that phrase embraces. It is extremely important that this should happen.

Inevitably, there will be a need for change from time to time. I have therefore proposed that where it has to be changed, a new appointment is made so that there is always some individual responsible for the well-being of that child. An example of where this can happen and be important is in relation to the provision for the child. If a child is being provided for in a certain situation and it appears that a more inexpensive arrangement can be made for that child’s care, the idea might be to move that child from the more expensive arrangement to the less expensive. It is important that someone with responsibility for the well-being of that child should have an opportunity to be involved in that kind of decision. That seems to be well worth while.

The noble Lord, Lord Harris of Haringey, in his report on deaths in custody, suggested that where a vulnerable person came into the custody system it was important that a single person should have responsibility for looking after the well-being of that vulnerable person. I do not think the Government have actually refused to accept that particular proposal but they have not accepted it as yet. What lies behind that proposal is very much the same as what lies behind mine and I hope the Government will accept both.

[Baroness Tyler of Enfield]

My Lords, I have Amendments 34 and 87 in this grouping. I shall deal with Amendment 87 first, for reasons that I hope will become obvious. Both amendments are to do with the mental health and emotional well-being of children in care. I support much of what has been said and proposed in this very wide-ranging grouping; there are many very important issues being dealt with here.

At Second Reading I argued that the bedrock of promoting the mental health and emotional well-being of children in care should be the introduction of an improved system of mental health assessments for children entering care, throughout their time in care and indeed when leaving care. I acknowledge the work that is going on. The Minister has already referred to the current pathway that is being developed by the Department for Education’s expert group. It is indeed promising. However, that does not negate the need for a statutory strengthening of current mental health assessments.

Current statutory guidance states that children must receive a physical health assessment when entering care, whereas it is recommended that their emotional well-being should be evaluated by what is called a strengths and difficulties questionnaire. That is widely regarded as inadequate. The latest figures I saw suggested that around only 70% of children in England entering care had these questionnaires completed for them. As we have already heard this afternoon, children entering care often exhibit challenging behaviour resulting from their experiences before entering care, usually to do with abuse and neglect. Moreover, these questionnaires are completed by foster carers, who I am sure are doing their absolute best but who may have little or no training in mental health.

The point of my amendment is that these assessments really should be conducted by professionals with specialist knowledge of the therapeutic needs of children in the care system and how they should be met. The point I most want to emphasise is that the introduction of these mental health assessments for children in care is the first and most basic step towards improving their mental health. However, it is only that. They are a mechanism and not an end in itself. We want to see that these assessments ensure that children in care receive the right support and interventions to deal with their mental health and emotional needs.

This could include a range of things, such as peer support, group working, play or art therapy, counselling or a referral to CAMHS. I was encouraged to hear the Minister say earlier in the debate that access to CAMHS should be based on clinical need. That is absolutely right. However, at the moment, there is precious little evidence that that is happening.

The Minister also quite rightly raised Future in Mind, an excellent report that holds much promise if it is implemented properly. However, recent research by the NSPCC about the local transformation plans, which are the mechanism for implementing Future in Mind, reveals that just 14% of plans contained an adequate needs assessment for children who had been abused or neglected. There is a lot more to do.

As to Amendment 34, much of what I have already said applies. The amendment would introduce a duty to promote children’s physical and mental health and emotional well-being, including a requirement for a designated health professional. Currently, clinical commissioning groups are required to have access to the expertise of a designated doctor and nurse for children in care, whose role is to assist commissioners in fulfilling their responsibility to improve the health of children in care. However, this is not underpinned by primary legislation.

The duty to safeguard and promote the welfare of children in care should also include a particular duty to promote that child’s physical and mental health and their emotional well-being in line with the existing requirement to promote the child’s educational achievement. The two are inextricably linked; a point that was made very clearly by the noble Lord, Lord O’Shaughnessy. All the research tells us that levels of well-being impact on educational attainment and can predict future health, mortality, productivity and income outcomes. There is an awful lot at stake here.

The effect of this amendment would be that all clinical commissioning groups must appoint at least one person who is a registered medical practitioner or registered nurse who will be required to discharge this duty, building on the existing role of the designated doctor. This would put the requirement for the appointment of a designated health professional on the same statutory footing as the requirement for local authorities to appoint a virtual school head and a designated teacher. I see this as another piece of parity of esteem.

Care Bill [HL]

Debate between Baroness Tyler of Enfield and Lord Mackay of Clashfern

Wednesday 9th October 2013 Lords Chamber

[Lord Mackay of Clashfern (Con)]

I warmly support that. I am happy with the parliamentary counsel’s draft, which is what the Government are going to move, and we have to understand that some lawyers are better than others at making drafts.

So far as the amendment of the noble Baroness, Lady Barker, is concerned, I hope that the Government will pay considerable attention to what has been said about it.

[Baroness Tyler of Enfield (LD)]

My Lords, I rise briefly to speak to government Amendment 2 on dignity and respect. I know that it was implicit in the well-being clause in the earlier versions of the Bill that we looked at, but I am very pleased that the need to ensure that all people are treated with dignity and respect has been brought out so explicitly. These are words that the man and woman in the street really understand; they get to the heart of some of the concerns about the type of social care that has sometimes been provided, which has fallen well below those standards, and caused some of the scare stories that we have heard so much about recently.

The noble Lord, Lord Bichard, and I raised this issue in Committee, but as he is unavoidably unable to be in his place today, I thank the noble Earl, Lord Howe, on behalf of both of us, for listening and for bringing this amendment forward.