Children and Social Work Bill [HL]

Baroness Benjamin Excerpts

Report: 1st sitting: House of Lords
Tuesday 18th October 2016 Lords Chamber

[Baroness Benjamin (LD)]

My Lords, I support this group of amendments because we all know that while each year, here in England, thousands of children enter the care system, too many who enter it cannot rely on the loving support offered by family and support networks. Many have already experienced terrible traumas in their young lives and we know that without the right support, these traumas can have long-lasting consequences. The challenges that looked-after children face after they leave care are well known, so we have to cater for their needs and find ways to encourage them to aim high by fulfilling their ambitions, inspiring aspirations and laying foundations to help them find ways to achieve happiness and personal fulfilment. That is why I am delighted to support especially the amendment tabled by my noble friend Lady Tyler to ensure that mental health assessments will be provided for all children entering care.

It is essential to ensure that the assessment of need will be translated into practical support because we in the state—the corporate parents—have a moral duty to do so. Too many children are crying out for support, like the child who told the NSPCC:

“I live in a residential unit. Other people in the unit keep bullying me. One of them attacked and injured me. I feel really lonely because I have to stay in my room to avoid them”.

They said that it had already upset them so much,

“that the staff won’t arrange a transfer for me. I don’t know who to turn to for help”.

Another young person told ChildLine:

“I don’t understand why everyone hates me. I feel like nobody wants me anymore and I just want to go to a normal family that loves me”.

At the core of the amendment proposed today is the desire to ensure that the emotional and mental health needs of children in care are assessed at the point of entering care, so that their needs will be properly supported through their care placement while at school and through a clinical intervention, if that is what the child needs.

Without a better system of support in place to help the 31,710 children who entered care last year, we know that many of them will struggle to overcome the legacy of those early experiences. As recent statistics released by the Department for Education showed, 40% of children who left care last year were not in education, employment or training. We must therefore take this opportunity before us today to improve the assessment of the mental health needs of children in care. We will otherwise continue to see children in care struggling to stay afloat with the weight of their past experiences. The Prime Minister has highlighted the need to tackle mental health issues; the earlier that we do so, the better.

[Baroness Howe of Idlicote (CB)]

My Lords, I too begin by thanking the noble Lord, Lord Nash, for his amendment on mental health and the corporate parenting principle. I tabled an amendment on this issue in Committee and I am pleased to see that our concerns are being addressed. Ensuring that the mental and physical health of children in care reaches a point of parity is a welcome amendment. It represents an important statement of principle and I am pleased to see steps being taken towards achieving the ambitions set out in the Government’s Future in Mind strategy.

Principles are important, but so too are actions. I should like to use the remainder of my time to speak in support of the amendment tabled by the noble Baroness, Lady Tyler. There are currently more than 70,000 children in care in England—70,000 children who no longer live in their family home and who are reliant on the support of the state for all their needs. We have a duty to care for their physical safety, but we have a fundamental responsibility to care for their emotional well-being as well. It is not enough to remove a child from their family home and hope that this will be enough to change their lives. We must aim higher than this. We must aim to provide them with homes that are far better than the family homes they have just left.

It is vital that we find proactive ways of supporting children in care. The first step in this process is to identify the types of support from which a child in care would benefit most. To do this, we need to introduce mental health assessments for children entering care and throughout their time in the care system. The point at which they enter care is crucial, as other noble Lords have said. If a child’s first experiences of life in care are positive—if it becomes a space through which their mental health and emotional needs are attended to—then they will be so much more likely to thrive and have the confidence to take advantage of the opportunities afforded to them. If problems are left unidentified, this can have particularly grave consequences for looked-after children.

The research report, Achieving Emotional Wellbeing for Looked After Children, published by the NSPCC last year, highlighted how children are particularly vulnerable when they experience poor emotional well-being while in care. This report illustrated the way in which poor mental health can lead to placement instability which, in turn, leads to a further decline in emotional well-being.

A teenage girl called Emily told the NSPCC about the impact that placement instability was having on her emotional well-being. She said:

“I can’t cope any more. I have been in care my whole life and have been pushed around between foster families and adopted families. I feel so let down, broken hearted and like I don’t belong anywhere. No one wants me to be here so maybe I should do them a favour”.

What a horrible thought to come from anybody, let alone a child of that age.

Sadly, many children who enter care come from chaotic circumstances. Often they have never known what it was like to live in a safe, stable and secure family home. Entering care should be about giving them this stability but, sadly, this is not the experience of many looked-after children. Having the right support in place to help children make sense of their experiences from before they entered care is crucial. If we can find ways to help them manage their emotions in a safe way, many of the challenging behaviours that often lead to placement breakdown could be avoided. We can, and surely must, do better by these children. This strikes me as an eminently sensible place from which to start.

Children and Social Work Bill [HL]

Baroness Benjamin Excerpts

3rd reading (Hansard): House of Lords
Wednesday 23rd November 2016 Lords Chamber

[Lord Watson of Invergowrie (Lab)]

My Lords, times without number during the Bill’s various stages, noble Lords from all quarters have highlighted the fact that children in care are four to five times more likely to have a mental health problem than children in the general population. We have advanced convincing arguments at each stage that there is a pressing need for all children entering care to be given the parity of esteem to which the noble Lord, Lord Warner, referred between physical and mental health assessments by appropriately qualified professionals.

We thought that the Minister was going down that track on Report when he tabled an amendment to Clause 1 to make it clear that all local authorities must promote both the physical and the mental health of children in care. That was certainly an important and welcome step, because the current system simply is not working. However, he was not willing to go what we regarded as the logical step beyond that.

It is fair to say that the Minister set out his reasons why he and his colleague, the Minister for Vulnerable Children, Mr Timpson, are not in favour of that. It has been argued that such a move would be too prescriptive in terms of when and how the assessment should be carried out and who might be qualified to do so. It has been argued that the assessment would be seen as potentially stigmatising, and it has also been said that it would cut across the work currently being undertaken by the Department for Education’s expert working group.

I do not think that any of those three holds water. I will not spend any time on the first two but in terms of the expert working group, it should be said that the Alliance for Children in Care and Care Leavers, which has assiduously provided noble Lords with briefings on various aspects of the Bill throughout its progress, is concerned at the Government’s failure to fully support this amendment. That organisation has 24 members, 21 of which are charities actively involved in the sector, but it also includes the Children’s Commissioner for England, the British Association of Social Workers and the National Association of Independent Reviewing Officers.

All those involved in the alliance deal on a day-to-day basis with the mental health and emotional well-being of children in care. The alliance is a body of some substance, and it speaks with some authority. The Department for Education appears to acknowledge that, because the alliance is represented on its expert working group. While that group has the respect of most within the sector—noble Lords were certainly impressed when we met its co-chair, Alison O’Sullivan in September—it will not report until this time next year. As I said on Report, it means that many children will continue to have their mental health issues undiagnosed in the intervening period. Of course, it is not just the end of next year; it is the fact that when the recommendations come out and the Minister decides which to accept and implement, a suitable piece of legislation has to be found. That may not become available until after the next general election—and by that I mean the one scheduled for 2020.

We feel that that is much too far off into the distance. I remain at a loss as to why Ministers are not able to overcome their doubts and simply get on with filling what is palpably a serious gap in the services offered to children entering care. I know that the Minister has been considering representations made to him by the noble Baroness, Lady Tyler. I am not alone in sharing her hope that he will have something positive to say in this area when he answers the debate, so that this matter, which has been discussed for too long, can at least move forward.

[Baroness Benjamin (LD)]

My Lords, I rise briefly to support my noble friend’s amendment and congratulate her on all the hard work she has done to ensure that the Minister listens to what she has said. I have visited many schools recently, and I am really surprised at the number of children, especially those in care, who are suffering from depression and anxiety. If we can do anything to make sure that no child slips through the net, it would be perfect, because childhood lasts a lifetime and we must give children the best start in the world—especially children in care, who need us to consider them.

[The Parliamentary Under-Secretary of State, Department for Education (Lord Nash) (Con)]

My Lords, I am delighted that we have come so far in our scrutiny of this Bill and are now debating the final amendments. I am sure that noble Lords will agree that the collected efforts of this House in bringing together different views and meeting a shared position have paid dividends that we can see in the Bill now before us.

I thank noble Lords for their time, attention and scrutiny, not only during the debates but in the many meetings and exchanges of correspondence between us. I am convinced that the House will be sending a Bill to the other place that will help ensure that all children, whatever their background, get the best start in life. I am grateful for this further opportunity to consider how collectively we can do more to promote the mental health and emotional well-being of looked-after children. As the noble Baroness, Lady Tyler, said, we had a positive discussion when the Minister for Vulnerable Children and I met her on 7 November along with the co-chairs of the expert working group. I am pleased that the co-chairs, Alison O’Sullivan and Professor Peter Fonagy, were able to give a full account of their work.

We have listened very carefully to the arguments put forward by the noble Baroness and other noble Lords, and have reflected on the informative debates in Committee and on Report. The way in which the mental health of looked-after children is assessed, and the timing and scope of those assessments, is one of the key areas within the expert group’s remit. The group is currently collecting evidence about approaches to assessment so that the assessment happens at the right time and with the right people involved. The group intends to consider the pros and cons of specialist assessment and the optimum method of assessment. Its work will specifically reference the Development and Wellbeing Assessment, the Comprehensive Health Assessment Tool, and the use of the Strengths and Difficulties Questionnaire.

Our considered view, as I indicated on Report, is that we should not pre-empt the findings of the expert group. We need to let it develop its recommendations to be confident that we are making changes that will have the effect that I believe that we all, including the Department for Education, the Department of Health and NHS England, as well as noble Lords, want to see, and to which we are all committed. Of course, I completely understand the noble Baroness’s motivation: to ensure that opportunities to make progress are not lost ahead of October 2017, when the expert group is due to report, and I pay tribute to her for that. I am sure that the expert working group will want to engage with her and other noble Lords as it starts to consult expert witnesses.

I reassure the noble Baroness that we are not sitting idly waiting for the expert group to report. We are engaging with the Department of Health on its work with NHS England and Health Education England to identify how new training models for talking therapies might be expanded beyond healthcare services settings to, for example, school counsellors or those working in colleges. We are working with NHS England to roll out a new model of integrated mental health care in secure children’s homes to address needs holistically, co-ordinating the services of several providers. We have been testing the concept of a single point of contact in schools and CAMHS to improve collaborative working across schools and mental health services.

I also reiterate a commitment made on Report, which the Minister for Vulnerable Children has made to the Education Select Committee. The expert group plans to share the evidence base behind the chosen models and the pathway with interested parties, including noble Lords, in the spring. We are committed to acting on the findings of the expert group and will fully consider all the recommendations that it makes, including any recommendations that require legislation.

The amendment seeks to bolster what is already in Section 22 of the Children Act 1989, which places a general duty on local authorities to safeguard and promote the welfare of looked-after children. It is implicit that this means promoting their mental health and emotional well-being. Care planning regulations spell out what that means in more detail: undertaking health assessments that explicitly address mental and emotional health as well as physical health. I am very happy to revisit the relevant guidance and regulations to consider whether the terminology might benefit from being more explicit on the importance of mental health.

We had a helpful and constructive debate in Committee about strengthening the first corporate parenting principle in Clause 1 so that it included an explicit reference to mental and physical health. We have amended the Bill accordingly. In the accompanying statutory guidance we shall emphasise this further. Together with the principle that local authorities must have regard to the need to help looked-after children make the best use of services, it is a powerful lever to bring health to the table.

Alongside the work of the expert group, however, and given the importance of getting this right, I am very pleased to be able to tell the House that we will test new approaches to mental health assessments for looked-after children. We are in the early stages of working out what this should look like and we will want providers themselves, and children and young people, to help us develop and shape the model. We have not settled on the number of pilots, but our initial thinking is that between six and 10 would be sensible. Of course, we would want to ensure that they were representative in terms of factors such as urban and rural, and the characteristics of the looked-after population. What I can tell noble Lords today is that we plan to begin the pilots in April or May next year, and that they will run in parallel to the considerations of the expert working group. We intend to pilot mental health assessments as part of the existing health assessments that children receive when they start to be looked after.

We believe that running pilots in a number of local authority areas, potentially on a regional basis, to look at how mental health can be better assessed as part of the wider health assessment, will be complementary to the work of the expert group. It will also help to inform the implementation of any of its recommendations. These pilots will also guard against treating mental health in isolation from physical health and ensure that we address the needs of the whole child in a holistic manner. While I am not in a position to give chapter and verse on the details of the pilots this afternoon, I want to put on record our intention to develop and pilot a model of a holistic health assessment.

The point made by the noble Lord, Lord Ramsbotham, about a postcode lottery and how we would quality-assure the delivery of these pilots is something that we will consider. It is an important point and we will ask the expert group to look at it. We will ensure that the pilots look at quality-assurance models to see how any assessment should be assured. The independent reviewing officers will also have a role in ensuring that plans deliver what children need.

I will say a personal thank you to the noble Baroness, Lady Tyler, for her continued passion and commitment on this issue. I hope that the commitments that I have made today will provide sufficient reassurance for her to be able to withdraw her amendment.