Mental Health: Children in Local Authority Care

Earl of Listowel Excerpts

Monday 23rd May 2011 Lords Chamber

Asked By

[The Earl of Listowel]

To ask Her Majesty’s Government how they are meeting the mental health needs of children in the care of local authorities.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, supporting and promoting the mental health needs and well-being of looked-after children is of the utmost importance. It is not the job of any one person or organisation. Strong and effective multi-agency working across local authority and health partners is essential. No Health without Mental Health provides a co-ordinated, cross-government focus to improving mental health outcomes for people of all ages, including those in vulnerable groups such as children in the care of local authorities.

[The Earl of Listowel]

My Lords, I thank the noble Earl for his reply. Will he urgently consider working with local authorities to ensure that, in the early assessment of children when they are taken into care, a clinical psychologist with appropriate training or a child psychiatrist is involved so that mental health needs are recognised and can be acted on? Furthermore, will he say what the state of specialist looked-after children’s mental health services is? These are multidisciplinary teams developed in some local authorities and are particularly vulnerable to closure at this time of funding shortage.

[Earl Howe]

My Lords, with his experience in this area, the noble Earl hits upon some extremely important points. As he will be aware, support for the mental health needs of looked-after children is at its most effective when child and adolescent mental health services, CAMHS, provide dedicated resources to work with looked-after children and their carers with trained and experienced staff. It is up to local authorities to decide the level at which staff should be appropriately deployed. Targeted CAMHS for looked-after children should work closely alongside the child’s social worker, carers and other professionals such as nurses and paediatricians. It is reassuring that data collected over past years for the CAMHS mapping survey by Durham University show an increase from 2003 to 2009 in the number of social services teams and teams with a focus on looked-after children, although those data carry a slight health warning in that participation in the survey, I understand, was voluntary.

NHS Reform

Earl of Listowel Excerpts

Monday 4th April 2011 Lords Chamber

[Baroness Tonge]

My Lords—

[The Earl of Listowel]

My Lords—

[Baroness Farrington of Ribbleton]

Will the Minister give the House two assurances? One is that the Government have done nothing that is not legal in anticipation of the Health and Social Care Bill being passed. Secondly, although he may not have the figures with him, what are the relative administrative costs of private healthcare providers and the NHS?

Health: Visitor Service

Earl of Listowel Excerpts

Monday 14th March 2011 Lords Chamber

[Earl Howe]

My Lords, we hope to recruit nurses and midwives for upskilling from a variety of sources. Some will come out of retirement, we hope, while others will, we trust, come from the acute sector. As my noble friend knows, the trend for a long time has been to try to get care increasingly out of acute settings and into the community. I think that we will see that transfer of skills taking place from a variety of sources.

[The Earl of Listowel]

My Lords, given the important and welcome drive to recruit health visitors, will the Minister consider hosting a meeting for health visitors and Members of the House of Lords so that we can understand this issue better and support this work as far as we can?

[Earl Howe]

My Lords, I draw the noble Earl’s attention to the document which my department published last month, Health Visitor Implementation Plan 2011-15: A Call to Action, which sets out how we are going to work with partners to deliver our ambition, including, very significantly, the Sure Start children’s centres which play an important role in our agenda. However, I will take the noble Earl’s idea back with me and be in touch with him about it.

Health: Mental Health Strategy

Earl of Listowel Excerpts

Monday 14th February 2011 Lords Chamber

[The Earl of Listowel]

My Lords, it is a privilege to follow the noble Lord, Lord Alderdice, given his career as a practitioner in mental health services. I second his desire to encourage the Minister and his colleagues the honourable Paul Burstow and the right honourable Andrew Lansley to take every opportunity to go out and visit services, schools, young offender institutions and the wider services catering for young people with mental health problems. There is tremendous anxiety out there about the impact of the cuts. It might be difficult to experience that but people need to see Ministers and Members of Parliament on the front line and know that there is interest in the issue and support for it.

I welcome this very timely and important debate initiated by my noble friend Lady Murphy. I am grateful that the noble Earl, Lord Howe, will reply to the debate, given his long experience in this area. We are grateful for that, given the challenges that lie ahead of us. I welcome the Government’s No Health without Mental Health strategy. I was particularly struck by the evidence that many smokers have a mental health disorder. I also welcome the fact that early intervention is emphasised. The work that the Government have commissioned from Frank Field MP, Graham Allen MP, Dame Clare Tickell and Professor Eileen Munro to look at how we can intervene early to improve outcomes for children is all very welcome and I am sure will be an important part of the strategy. Tim Loughton MP is a great example of someone who has got out there and found out what is happening on the front line. Practitioners have immense respect for him as he has done that. At a recent meeting on children’s centres, he spoke about the need to share best practice in Sure Start centres. I hope that there may soon be a means to do so. I understand that the Government are considering making a grant to organisations to hold a conference on that, which I welcome.

Unfortunately, I have a number of concerns. On a quick reading of the document, I saw no reference to the mental health of looked-after children and specialist looked-after children mental health teams. The statistics for the mental health of children, especially in children’s homes, point to a high degree of unfairness in this area. It needs constant thought and attention. CAMHS concerns me very much. A huge amount of CAMHS funding comes from local authorities. In the London Borough of Barnet, five-sixths of the funding for CAMHS comes from the local authority. That funding has been hit by the current cuts. Lots of thought needs to be given to how to support CAMHS at this time.

The report refers to targeted mental health services in schools—TAMHS. Very successful pilots have been run in schools but I understand that if there is no will or funding to sustain them, this early intervention, which is so effective, may be lost. The Minister is kindly giving careful thought to the future of the Cassel Hospital and the possibility of providing national funding. I know that he has been concerned about the vacancy rates in the family assessment unit. I understand that they have been rising for a number of years following a 2005 ruling in the High Court which forbade judges insisting that local authorities fund assessments at the Cassel Hospital. In short, the Cassel Hospital has not been funded adequately. It provides specialist services for families with very complex needs. I am grateful to the Minister for the attention that he is giving it. I should be interested to hear what other options he may be considering for these families. That interesting information would inform our further discussions on this matter.

There is concern that the Sure Start centres in the most impoverished areas are the ones most at risk of closing. I hope that the Government will listen to their adviser, Frank Field MP, and will consider ring-fenced funding if it seems to be necessary, or other means to incentivise local authorities to fund these fundamental early intervention services.

I have here a note about the number of commissioners who have already been lost, with all their experience in local authorities and the health service. There is a shortage of psychiatrists, as I have said. Clinical psychologists are more in abundance, but future generations may be put off by the fact that it is difficult for the current generation to find work. This profession is crucial. For example, Hackney’s social services have in the past three years experienced a reduction from 500 to 270 in the number of children taken into care, and it is astounding that a quarter of young people leaving care in Hackney have gone on to university—the highest proportion across the country. Hackney’s teams have included clinical psychologists with additional training to become systemic psychotherapists. Support from that sort of professional can make a huge difference, and I know that the noble Earl is considering a review of NHS professions. I hope that that consideration will be given priority.

To conclude, I welcome this strategy and hope that the Minister will take every opportunity to visit the services I have described.

NHS: Reorganisation

Earl of Listowel Excerpts

Thursday 16th December 2010 Lords Chamber

[The Earl of Listowel]

My Lords, I, too, thank the noble Lord, Lord Touhig, for calling for this timely debate. As a citizen I share with him his concern at the emphasis on competition in this paper. Reflecting over the past 20 years, a lack of emphasis on collaboration and co-operation, and a lack of respect for the professionalism of all our providers working on the front line, has tended to undermine morale. That has led to situations, to which the noble Baroness, Lady Williams, referred, such as doctors feeling that they want to go for the best deal for themselves because they are not respected for their work and the care they give the public daily.

In the time available I shall ask the Minister about the impact of reform on specialist mental health services for children. I shall also ask him for reassurance on the future of the family assessment unit at the Cassel Hospital in London. I apologise for not giving notice of that.

I applaud the Minister and his colleagues for deciding to pass decision-making, as far as possible, back to the social workers, teachers, probation officers and doctors nearest the front line. I welcome the fact that it was recently decided that an offender will no longer be automatically incarcerated if he breaches an order twice but that the probation officer will decide what needs to be done. It seems that the Government are operating on a principle across policy in this area, which I welcome. Of course it has to be balanced and not move from one extreme to another, and it has to recognise the problems of professional capacity near the front line.

I am particularly grateful for the comments of my noble friend Lord Kakkar on leadership in the NHS. His reference to clinical leadership led me to reflect on the work of the National College for Leadership of Schools and Children’s Services and the parallels to be found there. I also welcome the injection of more health visitors, an issue about which we will speak on other occasions.

I am concerned about the future of specialist looked-after children’s mental health services, of child and adolescent mental health services and of targeted mental health services for schools. Can the Minister reassure the House that the lessons learnt from the move to commissioning by primary care trusts some years ago have been fully digested by him, particularly in regard to the difficulty in the strategic commissioning of specialist health services?

Specialist looked-after children’s mental health services have been an important success story in an area that urgently needed improvement. In 2004, the Office for National Statistics found that more than 69 per cent of children in children’s homes had a mental disorder and about 40 per cent had a conduct disorder. The latter can be extremely challenging for staff to deal with. The needs of English children in residential care are generally far more intense than those of children in Denmark and Germany. About half the children in local authority care in those countries are in children’s homes. The figure here is only 10 per cent, and they tend to be the ones with the highest needs because of the high cost of residential as opposed to foster care.

In Denmark, 90 per cent of staff have a degree-level qualification and in Germany 50 per cent have such a qualification, while here only 20 per cent of staff are qualified to such a level. Clearly in these circumstances it is imperative that staff have access to the best professional mental health support both to enable them to reflect on their work with their children and for the referral of children.

A psychiatrist managing one such specialist service for a local authority has pointed out that the needs of the children in children’s homes often differ very little from those in adolescent psychiatric units, and yet the latter are managed by clinicians and staffed by nurses while the former may be managed by someone without a degree, and some staff may have no relevant vocational qualification. Certainly when social workers from Germany and Denmark visit this country the thing that shocks them most is the low status of staff in children’s homes. They would say that the most vulnerable and challenging children demand care by the best professionals.

A 16 year-old woman recently spoke at a meeting in the Committee Corridor. Also attending were several mothers who had had their children removed from them by their local authority. The young woman explained that, for her, being taken into care had been a positive experience. In particular, she felt that she had benefited greatly from the therapy she had received from her mental health services. Another woman, in her early 20s, speaking at a meeting of the Associate Parliamentary Group for Looked After Children and Care Leavers, expressed her view that the child she had recently had removed from her would not have been removed if she had had access to mental health services when she had been in local authority care. There is a great deal at stake here.

Specialist looked-after children mental health services have begun to address these issues, but they are not available everywhere. They are expensive to maintain and so are vulnerable to cuts. I ask the Minister for his reassurance that reform will not endanger these services.

Turning briefly to general child and adolescent mental health services, can the Minister say how they may be impacted by reform? In particular, there is concern that senior posts in CAMHS are already being lost under the pressure of spending cuts. How might the reforms play into this? Will they distract from the urgent need to encourage more medical students to choose child and adolescent psychiatry as a specialism? We urgently need more child and adolescent psychotherapists, together with clinical psychologists. Would the money that is being spent on reform be better spent on recruiting more of these professionals? How may the reforms impact on the transition from CAMHS to adult mental health services, which are currently so poor in many areas?

Let me take this opportunity to briefly express my concern about the fate of the Cassel Hospital family assessment service. The hospital is designated as a beacon of best practice; it is an exemplar of what can be achieved. It trains up many excellent professionals and provides hope in an otherwise somewhat barren landscape. It enables mothers who have experienced abuse and failures in the care system to bond with their child and break the generational cycle of failure. We have learnt that its local health trusts will not fund the service in future. Will the Minister please communicate my concern to the Secretary of State about the future of this beacon service and my request that national funding is found to sustain it if possible? I refer your Lordships to the coverage of the Cassel Hospital in, I think, the Times last weekend if they are interested in finding out more.

I look forward to the Minister’s reply. I recognise that I have not advised him of those questions, and if he would prefer to write to me, that would be very welcome.

Health: Chronic Obstructive Pulmonary Disease

Earl of Listowel Excerpts

Wednesday 17th November 2010 Lords Chamber

[Earl Howe]

My Lords, I am concerned to hear the noble Baroness’s comments because I know that an enormous amount of good work is going on around the country. There are programmes to encourage clinical leadership, improvement projects designed to integrate services, a commissioning toolkit, benchmarking data on outcomes and tools to aid local campaigns. If the services designed to help COPD patients are being diluted in any way, I should be very concerned about that and interested to hear the details.

[The Earl of Listowel]

My Lords, does the Minister recall the recent paper from the Royal College of Psychiatrists that highlights that mental disorder is behind a large number of people taking up smoking and drinking? Will he consider whether this is not an argument for further investment in child and adolescent mental health services, so that children and young people suffering from anxiety and depression receive the help that they need at an early stage and do not reach for alcohol, tobacco and other substances that can have these awful outcomes in later life?

[Earl Howe]

My Lords, I congratulate the noble Earl on linking mental health with COPD in that neat way. He is absolutely right that smoking is an activity that puts one at high risk of COPD and that smoking is closely associated with poor mental health. Fifty per cent of the tobacco smoked in this country is smoked by those with mental health problems. We are determined to continue efforts to discourage smoking in the general population. We are also keen to raise awareness of good lung health generally, which brings us back to the Question on the Order Paper. To a large extent, such efforts will fall to the new public health service in future.

Health: Spending Cuts

Earl of Listowel Excerpts

Wednesday 30th June 2010 Lords Chamber

[Earl Howe]

My Lords, the Government are conscious that the health and well-being of the population are affected by a number of factors outside the strict confines of the healthcare system. At the same time, we should not underplay the role of the NHS in tackling health inequalities, and not least the role of primary care. In that context, my department is privileged in being able to look forward to a budget that is not going to be cut over the course of this Parliament.

[The Earl of Listowel]

My Lords, we know very well the health inequalities among looked-after children in public care. Will the Minister look very carefully at the specialist mental health services provided by local areas to children in public care and ensure that they are sustained as far as possible? He may recall that, in 2004, 68 per cent of children in residential care were found to have a mental disorder. Will he look especially carefully at children’s homes and ensure that, wherever there are partnerships with the mental health services, those partnerships are sustained?

[Earl Howe]

My Lords, I acknowledge the noble Earl’s continuing interest in this area, about which I know he is extremely well informed. The Government are committed to improving the health and well-being of children and young people in whatever setting, especially the most vulnerable and disadvantaged. We are conducting a thorough review of the programmes that my department funds. There is nothing sinister in that; we want to ensure that, as part of the spending review, our programmes and policies have the strongest evidence base and represent the best value for money.

Queen's Speech

Earl of Listowel Excerpts

Thursday 3rd June 2010 Lords Chamber

[The Earl of Listowel]

My Lords, I join others in congratulating the noble Earl, Lord Howe, on his new post as Parliamentary Under-Secretary of State. I also thank the noble Lord, Lord Hill of Oareford, for his maiden speech. I shall speak about young people in care and care leavers, but I should like to raise a few points before I do so.

The principles behind the Queen’s Speech were freedom, fairness and responsibility. The noble Lord opened the debate by talking about the need to free up professionals at the front line to do the job that they understand and know how to deliver. That is crucial. A general theme in this debate has been that professionals and users on the front line can make the most difference. We can deliver freedom, fairness and responsibility through teachers, social workers, foster carers and all those other workers.

Listening to the noble Baroness, Lady Morris of Yardley, I recalled that two months ago the former Secretary of State, Ed Balls, said in Church House that if he regretted one thing from his term in office it was that he did not do more for social workers early on. No matter how often we say that we need to support and develop teachers and social workers on the front line, somehow they manage to slip off the agenda. I pay tribute to the Government’s excellent work in raising the status of teaching, but there is still a long way to go. The noble Lord will recall that, over several years, Finland has been the highest performer on the PISA tables. It is so demanding about who should teach its young people that it rejects 90 per cent of those who apply to become teachers.

The noble Baroness, Lady Howarth, talked about social work training and the social work college. I look forward to hearing information about the future of this important new institution. The National Centre for Excellence in Residential Child Care has over several years provided excellent support to a sector that has very little capacity in working with children with the most complex needs. Paul Ennals, the director of the National Children’s Bureau, started out as a residential childcare worker. Jonathan Stanley, the director of the National Centre for Excellence in Residential Child Care, which is based at the National Children’s Bureau, was director of the well respected Caldecott Foundation, a therapeutic community for children, of which my noble friend Lord Northbourne was once a trustee. The institution has a great deal of experience in residential childcare, so the Government’s decision to switch funding to another organisation caused some consternation. That may be quite the right thing to do, but I am glad that there is a second opportunity to look at the contract and I hope that the Minister can provide further information on why the decision was made.

I do not believe that we have spoken this afternoon about early years. I remind the Minister that research by Professor Melhuish at the University of London highlights the fact that, working in particular with disadvantaged communities, if one provides good-quality pre-school education, pupils will still be doing well at the age of 11 whether they have gone to a bad primary school or a good primary school. I hope that the Minister will take thorough note of that. I am sure he is aware of the importance of early intervention. There has been much progress with the early years workforce, although there is still a high turnover of staff and the work is still regarded as low-status and is poorly paid. Much more attention needs to be given to it.

The noble Lord referred to unruly children. I hope that soon he will consider meeting exemplary charities, such as The Place2Be, which provides much-needed mental health support to children in primary schools, to the parents of those children and to the teachers in those schools. It has a very good track record in this area and I hope that the Minister will decide to meet its staff soon to discuss their work. Volunteer Reading Help is a charity that provides support to more than 1,000 primary schools, helping children to read. Volunteers trained by the charity work, over a year, with children who are identified by their teachers as having a particular need for support. Over that period, the children benefit not only from improving their literacy but from developing a relationship with an adult. I have visited the organisation’s training sessions and have noted that many of the volunteers are men, so boys who are experiencing life without a father have an opportunity to develop a relationship over the period of a year.

I declare my interests as vice-chair of the All-Party Parliamentary Group on Children and Young People in Care, and as a trustee of TACT, the largest voluntary adoption and fostering agency operating in England, Wales and Scotland. I am also a trustee of the Michael Sieff Foundation.

I see that I am running out of time, for which I apologise, but perhaps I may take this opportunity to thank Her Majesty’s Opposition for their huge commitment over many years to young people in care. I recall the Quality Protects initiative, which ring-fenced funding for children in care. I also recall the legislation, including the Children (Leaving Care) Act, which introduced new duties on local authorities to support young people, sometimes up to the age of 25, providing them with a personal assistant. There was also the Children and Adoption Act, which introduced a right for children to have an advocate when making a complaint—something that was very much welcomed in the sector. In addition, there was the Children and Young Persons Act, which introduced a duty on local authorities to secure an appropriate range of placements for these children. I am very grateful to the noble Baroness, Lady Morgan, and her predecessors for the commitment that they showed in that role.

I ask the Minister how the Government will build on those achievements. I know that there has been some concern that, despite all the investment, the outcomes for these children have not improved as we would have wished. Professor Jackson was the academic who first alerted us to the way in which we had, over many years, failed these children in terms of their education. Two weeks ago, she told me that the admission rate to university for these young people has moved from 1 per cent to 9 per cent—an increase of 900 per cent. Although that is far below what we would want and what is acceptable, clearly progress has been made. Indeed, although these children’s GCSE results are still not where they should be, they are at last beginning to follow the rate of improvement experienced among the general population. Therefore, the work invested in the past is beginning to pay off, but how will the Government build on that?

The previous Government introduced two pilots to enable young people to stay with their foster carers past the age of 18. Will the Minister consider how that might now be progressed and how such an arrangement might be made available to all young people in care? There is a shortage of 10,000 foster carers in England and Wales. Perhaps the Minister would care to write to me about how that will be addressed.

Many Peers among the Opposition have been strong champions of looked-after young people over the years. I shall briefly speak of the work of Timothy Loughton MP who, fortunately, has been shadow Minister for children and families for several years. He has built relationships with NGOs working in this area; he is well respected; he has visited Denmark and seen children's homes there and the excellent model of social pedagogy operated in that country; and he has several children's homes in his constituency of Brighton and Hove. It is reassuring that he now has an office within the children and families section of the Department for Education. We cannot expect too much given the budgetary constraints, but it is encouraging, especially as he chaired the committee on the excellent report on social work, No More Blame Game, to which my noble friend Lady Howarth of Breckland referred. I am encouraged that the Government are talking about freeing those at the front line to do their job. Of course, they need to be equipped to do that job. Through teachers, social workers, foster carers and early-years' workers, fairness, responsibility and freedom for our citizens will be delivered. I am grateful to the Government for taking these matters so seriously.