Children and Young People with Complex Needs

Charles Walker Excerpts

Friday 10th December 2021 Commons Chamber

[Sir Charles Walker (Broxbourne) (Con)]

Sadly, some children and young people are not able to live safely with their families. The significant majority of these children have experienced trauma at a point during their developmental years, resulting in a range of behaviours, many of which cause distress to them or others. Those behaviours include self-harm and an increased vulnerability to criminal exploitation.

If a young person is unable to live safely at home, he or she may come into the care of the local authority or require hospital care. There is currently an insufficient supply of specialist care to meet the needs of such young people. As a result of the challenges posed by covid-19, health and social care professionals describe an unprecedented level of complexity and acuity of need, making an already difficult situation worse.

When a young person comes into care they will require either a children’s home, with staff skilled and experienced in meeting complex needs, or in some instances a court-directed placement into a secure unit, to keep them safe. Over the past 18 months, Hertfordshire children’s service has made three applications to the national secure bed bank. Despite repeated referrals, a secure placement was achieved for only one child. The most recent referral was made approximately six weeks ago, and on that occasion the local authority was advised that there were 50 referrals for only four available beds. That means that a secure bed was not available for 46 young people who had been assessed as requiring such accommodation to keep them safe. In each of those cases, the relevant authorities, including Hertfordshire, were required to make their own arrangements while the secure referral remained active.

Increasingly, local authorities turn to the courts for a deprivation of liberty order in the absence of more appropriate secure placements. Such orders are sought as a last resort, even though when granted they can place local authorities in the invidious position of having knowingly to place children in environments that are not best suited or equipped to meet their complex needs. Similarly, young people who require psychiatric hospital care find such care unavailable because of a shortage of appropriate hospital beds. In Hertfordshire, a number of young people have been assessed as detainable under the Mental Health Act 1983 and are waiting for appropriate hospital beds. The number waiting for a placement often rests at around 10 children, which means that in each of their cases their needs are not being met.

Despite people’s best efforts, the whole system is creaking because it is unable to cope with the demand. Problems with recruitment and the increasing complexity of some children’s needs mean that Ofsted and the Care Quality Commission too often find themselves in the position of having to close providers down, or reduce their bed capacity. It is important to note that there is a difference between physical beds and usable beds. Many beds are not in service because, in meeting the increasingly complex needs of children in care, there is not the staff capacity safely to service all the available beds in a home.

Not only is the current situation having a detrimental impact on young people, but its impact on the public purse is significant. Delivering bespoke care to a young person, often through a commissioned provider, is very expensive, particularly because these young people, due to the risks they present, will require high staffing levels. Placements are expensive: they can cost from £4,500 a week to upwards of £30,000 a week. Often, a child who has difficulty accessing support further down the needs scale quickly ends up requiring a far most costly set of interventions and specialist care.

It is of course important to intervene early to work with young people in the community to prevent family breakdown and the escalation of needs, but the current placement situation must be addressed, so in this debate I wish to ask regulators to work with the care sector to reopen closed beds through the development of a specialist taskforce that supports providers—be they mental health providers, social care providers or specialist schools—that struggle to deliver good-quality care. Alongside such efforts, we should make a national intervention to reassure providers that their Ofsted rating will not be negatively impacted if they admit children with the most challenging of needs. Too often, specialist care providers will refuse these children because they are concerned that if a child absconds or creates a high level of service demand, that will negatively affect their Ofsted rating.

We also need a national campaign both to challenge the stereotypes about children in care and to recruit residential childcare officers. Such schemes are already in place for fostering and adoption, and we have Teach First and Think Ahead. A similar programme now needs to be introduced to attract people into child social care and, in particular, the care of children with high levels of need.

Backing up this recruitment drive, we need a programme of support to design children’s homes that can accommodate children with the most complex needs but, as I have already said, without extra specialist staff the Government programme to match fund local authorities to develop new children’s homes will face significant challenges. New homes require skilled staff if they are to be viable. Also, in wanting to build new specialist homes, we need to appeal to the better part of people’s human nature, as too many of these specialist homes, when they come up for planning approval, are opposed by local communities.

When it comes to registering specialist residential care homes and facilities, we need to find a way of expediting the Ofsted registration process, which can take upwards of three months. In an emergency, a local authority will sometimes use one of its bedroomed properties as a care setting for a vulnerable child or adolescent, with a rota of specialist social care staff in attendance. Without Ofsted registration, such facilities will be operating outside the regulatory framework.

[Darren Henry (Broxtowe) (Con)]

I hear my hon. Friend’s point about care in the community, which is essential and something we need to focus on. Children and young people with complex needs too often end up in hospital, which is not the right place for them, as they end up being affected by people in hospital with other issues. Care in the community is essential. How can we give local authorities the onus and the investment to make this happen?

[Sir Charles Walker]

I thank my hon. Friend for his intervention, and I will come on to that. We need to have the right setting delivering the right care—the care that the child needs. The child needs to be at the centre of that care.

How does a care emergency arise? That question is often put to me. Beyond the national shortage of beds, a provider can notify a local authority, with only a few hours’ notice, that it will be terminating a young person’s placement in its facility. They can say, “In just a few hours, you will have this child back. This child is now your problem again.” This practice needs to be eliminated, but eliminating it will only alleviate the need for the provision of emergency accommodation and care; it will not end it. That will be done only through the provision of more beds, in both the social care sector and the psychiatric care sector. In the psychiatric care sector, it is not just the overall quantum of beds that counts; it is also the type of bed. These will cover general adolescent units, eating disorders, low-secure units and psychiatric intensive care units.

Almost all the concerns I have highlighted and will highlight this afternoon were identified in Sir Martin Narey’s independent review of residential care and in the Government’s response of 2016. We need to implement the findings of this report and tie them into a review of the Care Standards Act 2000 and the children’s homes regulations.

If anyone watching or listening to this debate wants to learn more about what is happening in this sector, I refer them to an excellent report by the BBC correspondent Sanchia Berg that can be found on the BBC website, dated 12 November, “The court orders depriving vulnerable children of their ‘liberty’”. The report contains harrowing accounts of what is happening, and they are framed throughout by the concerns of the High Court judge Sir Alistair MacDonald, who is deeply concerned about what he is witnessing in the courts and family courts.

Let me return to Sir Martin Narey’s independent review. Beyond its implementation, we need better joined-up care between the NHS and local authorities. The continuing healthcare framework has much to recommend it in relation to children and adolescents, but it is still heavily slanted towards their physical health. A robust commitment to parity of esteem would see the framework cover clinically diagnosed mental illness, as well as the challenges caused by trauma, attachment difficulties and, increasingly, autism. Let me say, as an aside, that all Department of Health legislation should make it perfectly clear that health means mental health and physical health; we cannot have one without the other.

Why is mental health so important? There are still far too many lengthy debates between local authorities and the NHS as to whether a child is suffering from a mental illness or a behavioural difficulty. To many, this seems like dancing on the head of a pin, as the debate does not change the fact that at the heart of the discussion is a child in crisis, as referred to by my hon. Friend the Member for Broxtowe (Darren Henry). A good solution has to be more joint commissioning between health, education and care providers, thereby removing barriers to joint funding. An example of best practice can be found in my own county of Hertfordshire, where we are opening up a three-bed unit that will be jointly staffed by social care professionals and mental health professionals. Perhaps this initiative could pave the way for a national programme of hybrid mental health children’s homes, with a hybrid model of worker.

I must conclude by returning to staffing and recruitment. There really is a need for an enhanced programme of training for residential workers that recognises the unique challenges of the role and the high level of skill required to deliver an effective service. Residential work currently requires a lesser qualification than social work, yet those working in residential settings have significantly more direct contact with the most vulnerable children with the most complex needs. Better training would lead to better pay and an enhanced profile, thereby making the role a career of choice and one which is attractive to graduates.

I have made these recommendations and observations today on behalf of the excellent Hertfordshire County Council, which does a fabulous job across my county, and, of course, on behalf of the children for which it cares. Both Hertfordshire County Council and I want to support the Government’s programme to develop more beds in the secure estate, but we want an estate that is compassionate and able to provide the high levels of care and support that I know, the Minister knows and Madam Deputy Speaker knows, it wants to provide.

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[Maggie Throup]

My hon. Friend makes a very good point, and I will come to that later in my speech.

The lead provider works collaboratively with other providers to ensure the appropriate level of in-patient provision in their area; it is important that we have the right mix of provision, whether it is in-patient or community support. They also ensure that the right community services are available to support children and young people when they are discharged to prevent further crises.

Wherever possible, collaboratives will aim to provide high-quality alternatives to admission. However, where stays are required, they should be short and close to home in a high-quality, safe and therapeutic service. We must of course ensure that the rights of children and young people who are placed under the Mental Health Act 1983 are respected.

We published our White Paper on reforming the Mental Health Act in January 2021, setting out proposals to make the Act work better for people. We are committed to ensuring that the reforms we want to make to the Act also benefit children and young people. We will work to ensure that the rights we plan to introduce for patients are also available to children and young people detained under the Act. Reforms to the Act will limit the scope to detain people with a learning disability or autistic people, helping to reduce unnecessary detentions. To ensure that in-patient settings are therapeutic for autistic people, we are providing £4 million to enable in-patient settings to become more autism friendly.

In children’s social care, we are committed to doing everything we can to support local authorities in ensuring that the most vulnerable children are protected and that there are sufficient places for children in their care. The Government have given more than £6 billion in un-ringfenced funding directly to councils to support them with the impact of covid-19 spending pressures, including in children’s social services.

I take the opportunity to refer briefly to the a point made by the Secretary of State for Health and Social Care in the House a few days ago. He set out that we will be taking further measures to support and protect social care against the threat posed by the omicron variant. We will set out a package of measures at the earliest opportunity. I reassure hon. Members that the timing of the announcement will not have an impact on our ability to implement those protections on the intended date.

The Government are also taking additional steps to support local authorities to fulfil their statutory duties. The spending review 2021 announced £259 million over the spending review period to maintain capacity and expand provision in secure and open residential children’s homes. That will provide high-quality safe homes for some of our most vulnerable children and young people.

We recognise that those in the secure estate are some of the most vulnerable in our society. Children and young people in secure settings are more likely than other young people their age to have additional healthcare needs. The integrated care framework aims to support trauma-informed care, and formulation-driven evidence-based whole-system approaches to creating change for children and young people within the children and young people secure estate.

My hon. Friend the Member for Broxbourne talked about beds. In the NHS long-term plan, we committed to investing at least an additional £2.3 billion in mental health services by 2023-24. That will see 345,000 children and young people a year accessing NHS-funded specialist mental health support if they need it. On 5 March, we announced an additional £79 million of funding that will be used to expand children’s mental health services significantly in this financial year. It will also help to improve access and reduce waiting times for NHS community mental health support.

There is much to be said about how we are supporting and should further support children and young people, not least those who, because of mental illness, learning disabilities, being autistic or complex trauma, are some of the most vulnerable in our society.

[Sir Charles Walker]

On a point of order, Madam Deputy Speaker. The Minister’s Department asked for my speaking notes, which I provided earlier in the week, but barely a question I raised was answered by her. It is not her fault, but I have just had generalities; we got on to social care when I was talking specifically about care for children with a high amount of need. I am confused: what is the point of providing notes to officials in advance of an Adjournment debate if the Minister is not equipped—it is not her fault—with the speech to respond?

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[Sir Charles Walker]

Further to that point of order, Madam Deputy Speaker. I thank the Minister for that kind offer. It was not an attack on her—I think she is as disappointed as I am.

[Madam Deputy Speaker]

I appreciate the points that the hon. Gentleman and the Minister have made.

Question put and agreed to.