Children’s Social Care
Baroness Tyler of Enfield Excerpts(4 days, 1 hour ago)
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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 There was an estimate in the MacAlister review, but that is now somewhat out of date.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?
The Minister of State, Department for Education (Baroness Smith of Malvern) (Lab)
My Lords, I thank both noble Baronesses for their positive response to yesterday’s Statement and their positive response to dealing with an area that I think all those who have chosen to attend for this Statement today understand is absolutely crucial for the most vulnerable children and families in our country. I will do my very best to respond to all the questions, and where I fail, I will certainly follow that up in writing.
As the noble Baronesses recognised, this Statement sets out how to rebalance the children’s social care system to improve outcomes for children in care, care leavers and families. It is guided by four key principles: that children should remain with their families and be safely diverted from entering the care system; that where children cannot remain at home and it is in their best interests, we should support most children to live with kinship carers or in fostering families rather than in residential care; that we take action to fix the broken care market and tackle profiteering in the placement market; and that we invest in the key enablers which underpin the children’s social care system, including the workforce, better data and information sharing, and to scale and spread evidence-based and proven approaches.
I will address some of the specific points that the noble Baroness, Lady Barran, raised. On this point about keeping people as close as possible to their families, she asked about family hubs. I can say that family hubs were not specifically mentioned in the Statement because it covered the legislative proposals that the Government are bringing forward. However, we are absolutely clear that they do very good work in helping families to access vital services to improve the health, education and well-being of children, young people and their families. The 75 most deprived local authorities will in fact receive around £300 million from both the DfE and the Department of Health and Social Care up to 2025, to set up family hubs with integrated Start for Life services. Knowing that they improve families’ lives and children’s outcomes, and reduce costly crisis intervention later, we will continue to support that type of initiative. This exactly plays to the point about supporting children and their families at the earliest possible stage before those relationships break down.
On the point about payment by results for the Supporting Families funding, Supporting Families has achieved some very important results for children and their families. However, as is often the case with funding streams such as this, it has also become very bureaucratic. In keeping with the Government’s commitment to resetting its relationship with local government and working in partnership with them to deliver reform for vulnerable children and families, we will be simplifying the funding mechanisms for local authorities as much as possible, reducing the requirement for the payment by results recording and returns. That does not mean, however, that we will not be maintaining the focus on the outcomes for families, as the noble Baroness rightly said. We will continue to expect quarterly returns on the number of successful family outcomes that areas are achieving, so that we can continue to assess the overall impact of the programme. Because we have simplified the processes, we can also say that all local authorities will receive all their remaining available funding for 2024-25 as a one-off payment on 12 December, to enable them to continue making progress.
Both noble Baronesses asked about the £400 million funding. This is £400 million that will go into the overall local government grant, in keeping with the arguments that I made about reducing ring-fencing where possible. The £600 million is additional from this Budget for social care. It will be allocated, and more detail will be provided, at the time of the local government settlement for that.
On the point about agency staff, the noble Baroness is right. We do not believe that it would be possible to have a system with no agency social workers. Lots of agency social workers do very important work. However, when 17.8 % of all local authority child and family social workers are agency workers, that feels like too few permanent staff and too many agency workers. Yes, that does mean that we must work harder to train and retain our children’s social care workforce. That is why we will also be working to ensure that the workforce has the right environment to thrive in, personally and professionally. Legislative measures alone are not the answer, although we will introduce in the Bill a regulation-making power to govern the use of agency workers in local authorities’ child social care. In October, we published a set of online resources, developed by Research in Practice, to support local authorities to improve working conditions, workload, health and well-being and organisational culture. We are also working, through the national workload action group, to identify the unnecessary drivers of workload and to help to provide solutions, so that social workers can spend more time working with children and families rather than carrying out paperwork.
I am glad to hear the welcome of both noble Baronesses for the progress that we are making on kinship care. The £40 million that was announced just in advance of the Budget, and which it was part of, is to enable us to trial the use of the allowance for kinship carers in 10 areas. It would be appropriate to learn from that as quickly as possible, yes, but to learn from that trialling in order to work out how effectively to develop that and other forms of support for kinship care.
On the issue of the placement market, both noble Baronesses argued that a range of methods need to be used to increase the number of placements, in order to get away from the current situation. We do not have sufficient high-quality placements for children, particularly those with the most extreme needs, and we are seeing enormous increases in funding to pay for that. The £90 million we have announced will go alongside encouraging local authorities, charities and ethical investors to enter the market. We will work with the MHCLG on planning and ensure that Ofsted can fast-track the right sort of provision. I am sure I will get to some of the other questions the noble Baronesses asked when I respond to other noble Lords, and if I do not, I will write to them.
Unregistered Children’s Homes: Fees
Baroness Tyler of Enfield Excerpts(3 weeks, 5 days ago)
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Baroness Tyler of Enfield
To ask His Majesty’s Government what steps, if any, they are taking to lower fees being charged by unregistered children’s homes.
The Minister of State, Department for Education (Baroness Smith of Malvern) (Lab)
My Lords, profiteering from vulnerable children in care is unacceptable. Children must live in safe, high-quality homes, which is why it is a legal requirement for children’s homes to register with Ofsted. This means that they can be inspected and children are safe, and that where there are failings, they are addressed. We will strengthen regulation through the children’s well-being Bill so that children’s social care delivers high-quality outcomes for looked-after children at a sustainable cost to the taxpayer.
Baroness Tyler of Enfield (LD)
I thank the Minister for her Answer, but there remains a real concern about the number of children still living in unregistered children’s homes. Is the Minister aware of the recent BBC investigation, which highlighted that some unregistered children’s homes are charging up to a staggering £20,000 a week and still failing to keep very vulnerable children safe, which a senior family court judge has described as breathtaking? What immediate steps are the Government taking to address this issue? Does the Minister also agree that the key aim of addressing excessive costs, which I fully support, should not lead to the eradication of children’s homes, and that we need a mix of high-quality, registered provision to meet all children’s needs?
Baroness Smith of Malvern (Lab)
The noble Baroness is right that some extraordinary amounts of money are being charged by placement providers. The Local Government Association found, for example, that in 2022-23, 91% of respondent councils paid at least £10,000 per week or more for one placement, compared to 23% in 2018-19. That is why, as the noble Baroness says, we need to ensure that a range of safe, regulated, high-quality placements are available for children, and to ensure that where there is excessive profit, we take action against that as well.
Independent Review of Children’s Social Care
Baroness Tyler of Enfield Excerpts(2 months, 2 weeks ago)
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Baroness Smith of Malvern (Lab)
Given the noble Lord’s enormously distinguished career in this area and his contribution to ensuring that children are kept safe, I think the whole House will listen to what he has to say. He is right that the objective of the MacAlister review and this Government is to bring timely support to children and families that need help; evidence shows that preventing problems from escalating leads to better outcomes. We will build on the work of the Families First for Children pathfinders, which, unfortunately, are only in 10 places at the moment, to think about how we can develop that early help. The noble Lord also makes the very important point about all our responsibility, as corporate parents, to ensure that children who have to come into the care system get the same very best care from us that we would expect for our own children. That is certainly something that this Government will pursue and think about how we can embed that even more broadly in the public sector and in our communities.
Baroness Tyler of Enfield (LD)
My Lords, I will pursue the point made so eloquently by the noble Lord, Lord Laming. Last week, the children’s care coalition of charities highlighted that, for the first time, more is being spent on residential care placements than on early intervention. Can the Minister say how the Government plan to rebalance that spending, given the current tight fiscal climate, including in the upcoming Budget and spending review, to ensure that families, children and young people get the support they need before reaching crisis point?
Baroness Smith of Malvern (Lab)
The noble Baroness makes a very important point. The Local Government Association also found that, whereas in 2022-23 91% of councils that responded spent at least £10,000 per week or more for one placement, in 2018-19 that had only been 23%. Not only does the position in the placement market disadvantage children in not being able to find those loving and stable placements that they need, but it is also an enormous burden to local government. That is why, as she said, we have to build on, for example, the £45 million invested in the Families First for Children pathfinders this year to help families get support earlier. Where there is clear profiteering from some providers in the placement market—evidence of this has been discovered—we need to take action and we will do so.
Schools: Mental Health and Poor Attendance
Baroness Tyler of Enfield Excerpts(4 months ago)
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Baroness Tyler of Enfield
To ask His Majesty’s Government what assessment they have made of the links between rising levels of mental health issues among school age children and poor school attendance; and what steps they are planning to take to address the situation.
The Minister of State, Department for Education (Baroness Smith of Malvern) (Lab)
My Lords, mental ill-health and inadequate access to support are real challenges facing children today and have a detrimental impact on their school attendance. This is despite the excellent work done by education and health staff across the country. Poor mental health and low attendance are mutually reinforcing barriers to opportunity and learning. That is why we are committed to providing access to a specialist mental health professional in every school and developing new young futures hubs.
Baroness Tyler of Enfield (LD)
My Lords, I thank the Minister for her Answer. As she has acknowledged, the evidence increasingly shows a clear link between school absences and poor mental health. There is also a growing recognition of the gap in mental health support available to children who need a greater level of support than is currently available in school mental health teams but do not require specialist treatment from CAMHS, and that this gap is best filled, as happens in Scotland and Wales, by school counsellors and suitably qualified practitioners. She talked about providing specialist mental health support for every school, mirroring my recent Private Member’s Bill, and I very much welcome that. Could she confirm when these proposals will be brought forward and whether they will include primary as well as secondary schools?
Baroness Smith of Malvern (Lab)
My Lords, I know that the noble Baroness has done much work in this area and, obviously, has had a Private Member’s Bill on it. Access to mental health professionals will be for all schools, secondary and primary. We are working with the Department of Health and Social Care to ensure that we get that model right and that we can, as she emphasises, provide that early support to alleviate the need for more acute mental health provision for young people, I hope.
King’s Speech
Baroness Tyler of Enfield Excerpts(4 months, 1 week ago)
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Baroness Tyler of Enfield (LD)
My Lords, as this debate draws to an end, I warmly welcome the newly appointed Ministers to their important new roles. I thank the outgoing Ministers, and commend the two excellent maiden speeches that we have heard today. I particularly commend my noble friend Lady Jolly for her excellent valedictory speech and pay tribute to her outstanding contribution as a Government Whip during the coalition and as a party spokesperson, and in particular the work she does for people with learning disabilities. She will be sorely missed on these Benches and beyond.
Like so many others today, I welcome many of the measures in the gracious Speech and look forward to scrutinising legislation when it comes to this House. There are areas where the measures do not go far or fast enough, and there are some key omissions that I will highlight. My noble friends Lord Storey, Lord Sharkey, Lord Addington and Lady Garden have all talked about education with great expertise. I will focus on health.
I welcome the commitment in the gracious Speech to improve the NHS, specifically the urgent need to reduce waiting times, focus on prevention and improve mental health provision. I wholeheartedly agree that there is an urgent need for a more preventive model of care, with investment moved upstream; it is crucial if we are to lower waiting times, improve access and reduce health inequalities.
The answer to overcrowded hospitals is not simply more hospitals: the health and care system must be radically refocused to put primary and community care at its core if it is to be effective and sustainable. In my view, this should include new patient-centric integrated services, such as walk-in clinics, diagnostic centres and polyclinics, to improve speedy access, give patients more control, and take the weight off overburdened GPs and hospitals. We also need to use existing hospitals more efficiently. We know that valuable NHS equipment and operating theatres too often stand idle in the evenings and at weekends. Will the Minister say what plans the Government have to address this and whether they include bringing in independent clinical teams from outside the NHS?
A more radical shift to a preventive model of care was one of the key findings of the integrated care Select Committee, so expertly chaired by the noble Baroness, Lady Pitkeathley, on which I had the privilege to sit. I hope Ministers will take heed of that excellent report and what it recommended. We really do not want to end up reinventing the wheel.
Like my noble friend Lady Walmsley, perhaps my biggest disappointment is the silence on social care. We all know that the current problems in accessing healthcare will never be resolved until social care is fundamentally reformed. There has been talk recently of a royal commission, but no mention of it in the gracious Speech. I wonder whether a royal commission, however well-intentioned, is what we need; I worry that it will simply kick the issue into the long grass. In the last decade, we have seen countless reports, reviews and commissions into social care, but, to the huge frustration of those in the sector and beyond, nothing ever happens. In short, the political will simply evaporates. We know what the problems are and, broadly, we know what needs to happen; we just need to start moving on what will inevitably be a gradual path.
The Government have pledged to establish a fair pay agreement in the adult social care sector and improve working conditions. I welcome that, given that there are over 130,000 vacancies in adult social care. It is certainly to be hoped that measures in the planned employment rights Bill to increase pay and scrap exploitative zero-hours contracts will help to attract and retain more staff, but that will happen only if they are accompanied by commensurate local government funding increases. Will the Government commit to a social care workforce plan to complement the NHS workforce plan?
I turn now to the critical issue of unpaid carers, echoing the words of the noble Baroness, Lady Pitkeathley. Labour’s Plan to Make Work Pay, published in May, included a commitment to review the implementation of the Carer’s Leave Act 2023 and examine all the benefits of introducing paid carer’s leave. However, the background briefing to the employment rights Bill, published on Wednesday, contained no mention of this. There is a real opportunity here for the Government to move quickly to deliver this review and introduce enabling provisions to ensure that a new right to paid carer’s leave is introduced as part of the Bill. What specific plans are in place to deliver that review and to introduce these enabling provisions?
I greatly welcome the commitment to ensure that mental health is given the same attention and focus as physical health and to modernise the Mental Health Act. To say it is grossly overdue is an understatement, and I understand the scepticism of some in the sector who have heard all these promises many times before, only for nothing to happen. For too long the Mental Health Act has failed people who require mental health care. Racial inequalities in the use of detention, high levels of restraint and the removal of patient autonomy are just some of the problems of the current Act. Introducing a new mental health Bill to reform that Act provides a crucial opportunity to enhance patients’ rights, to strengthen safeguards for those admitted to mental health hospitals, particularly for children placed in inappropriate settings and on adult wards, and to rebalance the system to one that prioritises and promotes the patient’s voice and choice in their treatment.
It is welcome to see the tobacco and vapes Bill reintroduced. We should not forget that, of those people suffering from mental health conditions, more than 40% smoke, compared to just over 12% of the general population.
I declare an interest here as a member of the Financial Inclusion Commission, which has not had a mention yet today. Too many people experiencing mental health problems also suffer from financial and digital exclusion. That is why I was so delighted that the Liberal Democrat manifesto included a commitment to introduce a national financial inclusion strategy, including measures such as promoting access to cash, particularly in remote areas, and supporting banking hubs and vulnerable consumers. Could the Minister say what plans the Government have to introduce a comprehensive financial inclusion strategy?
I turn now to children’s mental health. As we have debated so often before, those accepted into child and adolescent mental health services—CAMHS, as we know it—are often left waiting for many months, if not years, for treatment, during which time their mental health often deteriorates. It is estimated that only around a third of children with a probable mental health problem are able to access treatment, showing how far away from the parity of esteem with physical health we really are. I look forward to hearing the Government’s plans in this area.
I welcome the children’s well-being Bill, particularly the pledge to introduce free breakfast clubs in all primary schools, but I would also like to see an equal focus on promoting children’s mental health at primary school age. The gracious Speech contained a pledge to improve mental health provision for young people, which I very much support, and the Labour Party manifesto committed to providing specialist mental health support for every school, mirroring my recent Private Member’s Bill. Could the Minister confirm whether this will include primary schools, as my recent Private Member’s Bill did? Sadly, it narrowly missed its Third Reading, because the election was called. Leaving it until secondary school is simply too late. Could the Minister say when we can expect to see action on introducing open-access mental health hubs for children and young people in every community?
Finally, I turn to child poverty. We have had some powerful interventions here. I was proud that the Liberal Democrat manifesto contained a pledge to abolish the iniquitous two-child benefit cap. I wish there had been more focus on this and on other elements of our ambitious anti-poverty strategy during the campaign. We have heard the figures today of those in child poverty and the fact that it is going up and that many of those families suffering have had at least one parent in work. We welcome the Prime Minister’s very recent announcement of a child poverty task force, but it is quite clear that the two-child benefit cap is the principal policy contributing to this alarming rise. Could the Minister set out the timetable for the task force reporting and say how quickly we can expect to see action taken on the two-child limit?