Children and Social Work Bill [HL]

Baroness Tyler of Enfield Excerpts

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

Moved by

[Baroness Tyler of Enfield]

1: After Clause 1, insert the following new Clause—
“Duty to assess and promote physical and mental health and emotional well-being
(1) Section 22 of the Children Act 1989 is amended as follows.(2) After subsection (3)(b) insert —“(c) to assess and promote his physical and mental health and emotional well-being”.(3) After subsection (3C) insert —“(3D) Any assessment conducted under subsection (3)(c) of a child’s mental health and well-being shall be performed as soon as is reasonably possible after the child enters care and conducted by a health professional with sufficient mental health knowledge, skills and competence to conduct these assessments.(3E) Each clinical commissioning group must take steps to assist the local authority in its area in the exercise of its functions under subsection (3)(c).(3F) The clinical commissioning group for each area must appoint at least one registered medical practitioner and one nurse for the purpose of coordinating the discharge of the duty imposed by subsection (3E).””

[Baroness Tyler of Enfield (LD)]

My Lords, as I have said throughout the passage of the Bill, my aim is to secure practical improvements in the care and support that children entering care receive. We have such a responsibility to help improve the life chances of that most vulnerable group of children, given their troubled start in life.

On Report, I was very grateful when the noble Lord, Lord Nash, agreed to meet me to discuss my concerns about why the current approach to identifying and responding to the emotional and mental health needs of children in care is simply not working—a point confirmed in the Care Quality Commission’s report Not Seen, Not Heard earlier this year. I found my meeting with the noble Lord, Lord Nash, and Edward Timpson extremely helpful and constructive, and I was particularly grateful for the opportunity to hear direct from the two co-chairs of the expert advisory group set up by Ministers to develop care pathways for children with mental health problems. I look forward to their report, which is due in October 2017.

It was clear from that meeting that there was much that we agreed on, but there is no time to be lost. The Bill presents an excellent and timely opportunity to make further progress, given that children in care are four times more likely than their peers to have a mental health difficulty and 45% of children entering care have a diagnosable mental health condition—such as anxiety and depression, hyperactivity or an autistic spectrum disorder—a figure that rises to a truly alarming 72% for children entering residential care.

I listened very carefully to what the Ministers said, most particularly to their wish for flexibility and the ability to test approaches to improving mental health support for children in care. I understand why they do not want legislation that is overly prescriptive. I reflected very carefully on this, and my new amendment is cast very much in that light. In short, my amendment today seeks to ensure that local authorities, supported by clinical commissioning groups, assess and promote the mental health and emotional well-being of children entering care. It does not prescribe the time, form or manner of any mental health assessment, and provides for the appointment of a designated health professional, a designated doctor or nurse, to help commissioners to fulfil their responsibilities to improve the health of children in care, including their mental health and emotional well-being.

I want to stress a few points to address some concerns that I know have been raised. First, in this amendment I have sought to avoid prescription in terms of the nature, the timing and the staff who undertake the assessment—the who, when, how and where, if you like. I recognise that the expert advisory group is well placed to advise on such matters. My amendment is very much about the “what” and offers an important opportunity to ensure that the commitments made in Future in Mind—to address fragmentation, to support co-ordination and to intervene early to promote good mental health and prevent escalation to significant mental health conditions later on—are delivered.

Secondly, a physical health assessment is already in place. My amendment would simply result in an extension of its scope so that an initial mental health assessment was undertaken as part of the existing health assessment—that is, its scope would be extended to include both physical and mental health. It would not mean the introduction of a brand-new process, with the inevitable burdens attached.

Thirdly, the integrated approach that I am proposing would also avoid concerns that a separate mental health assessment might be stigmatising. It recognises the close links and interactions between physical and mental health—all part of parity of esteem, of course.

Fourthly, given the nature of the trauma that many children will have experienced before entering care, the initial assessment could be undertaken by a range of health professionals, including nurses, with appropriate training and knowledge of the emotional and mental health needs of this group of children, particularly such issues as attachment style. Of course, any more serious needs identified in the initial assessment could be referred to a more specialist clinician in the normal way.

Fifthly, there is no presumption that every child assessed will need a specific clinical intervention. For some it will be about emotional support, which may come from a teacher responsible for pastoral care, a social worker, some other form of therapeutic support, peer support, group work, school counselling and other ways of supporting emotional well-being and building good relationships. Of course, those assessed with higher levels of clinical needs may well need a clinical intervention and, indeed, should receive it as soon as possible to prevent further escalation.

I remain convinced that this approach would assist greatly with finding appropriate placements for young people, with the right support built in both for them and for foster carers and other support workers, and would therefore lead to greater placement stability, which is so critical to a good-quality experience in care. I am aware from my researches that a range of integrated assessment models are already being used in other settings, such as the CHAT model in the youth justice system, where all young people aged 10 to 18 entering secure accommodation are assessed for their mental health needs, or what is called the DAWBA model, which I will not spell out in detail but which can be used for a younger age group. I certainly would not wish to prescribe the appropriate model myself, but it must be child-centred and age-appropriate. Implementing this amendment would provide an ideal opportunity to test out such approaches.

In conclusion, the amendment, which has strong support from the children’s sector and three royal colleges, would ensure that the emotional and mental health needs of children in care are identified early and that they and those caring for them can receive the support required to meet their needs and prevent the current unacceptably high rate of escalation to mental health conditions, which can affect children long into adulthood.

I look forward to the Minister’s response and know that he shares my wish for further practical progress. I beg to move.

--- Later in debate ---

[Baroness Tyler of Enfield]

My Lords, I thank the noble Lord, Lord Nash, for his response, which I thought was very positive and constructive. I know that he has listened very carefully to the arguments that have been put forward, both inside this Chamber and outside it—there have been, as others have said, a lot of people in the sector campaigning hard for further progress in this area. I was encouraged by quite a few of the things that the noble Lord said. I will not run through them all, but I noted in particular what he said about the further work to be done to guidance and regulations to more fully underline the importance of integrated assessments and of giving really good consideration to mental health and emotional well-being issues.

I am very encouraged by and was grateful to hear the commitment that he made today at the Dispatch Box, announcing that there will be, I think he said, between six and 10 pilots starting in April or May next year, to test out new approaches to mental health assessments for children in care. As he said, this will happen in parallel to the valuable and important work of the expert working group. I consider this to be a really important step forward, so I am very grateful to him and I look forward to making any contribution that I can to the development and implementation of these pilots. I thank him and all noble Lords who have participated in this discussion and I will say again how pleased I am by this progress. I beg leave to withdraw the amendment.

Amendment 1 withdrawn.

--- Later in debate ---

[The Earl of Listowel]

My Lords, I thank the noble Lord, Lord Farmer, for his work and persistence in this area. I recall a 28 year-old woman with experience of the care system who recently married a lovely man, an accountant. She had had the most terrible start in life and never met her father until she was 16. She talked in public about her experience at university and the relationships she had with the women with whom she shared a house while at university, who visited her and comforted her when she often fell into depression and withdrew to her room and isolated herself. I commend the noble Lord for his perseverance on this matter. I am very grateful to the Minister for listening to him and bringing forward this amendment today.

[Baroness Tyler of Enfield]

My Lords, I welcome and support this government amendment. I too thank the noble Lord, Lord Farmer, for pursuing this matter so very vigorously in Committee and on Report. “Relationships” is just one word but in my view it makes such a difference. If this amendment is accepted, as I hope it will be, it will enrich the Bill and make an immense difference to the lives of troubled children entering and leaving care respectively, if the measure is implemented in the way so many of us have argued for. It sends an important message to local authorities, professionals, social workers and others about the importance of relationships in children’s lives and what an important part of their practice it is.

[Lord Watson of Invergowrie]

My Lords, I too welcome the amendment. The local offer for care leavers and the corporate parenting principles are two of the most valuable aspects of the Bill to emerge. Of course, they were originally in the Bill and we have sought to improve them. The inclusion of the term “relationships” is certainly one of those improvements. I will add just one thing to what the noble Lord, Lord Farmer, said. The question of relationships is not just about having someone to whom the child or young person can relate but about having the ability and the knowledge to build relationships in his or her adult life so that, we hope, that can confirm stable relationships for them and their own children. I support Amendment 2 and the somewhat impenetrable Amendment 12, which is consequential, and the other consequential amendments which the Minister has put forward in his name.