Children and Social Work Bill [ Lords ] (Seventh sitting)

Tulip Siddiq Excerpts

Committee Debate: 7th sitting: House of Commons
Thursday 12th January 2017 Public Bill Committees

[Mrs Lewell-Buck]

I beg to ask leave to withdraw the clause.

Clause, by leave, withdrawn.

New Clause 18

Assessment of physical and mental health and emotional wellbeing needs

‘(1) In section 22C of the Children Act 1989, after subsection 11 insert—

“(11A) Regulations made under subsection (11) must make arrangements for—

(a) the assessment of a looked after child’s mental and physical health and emotional wellbeing needs, and

(b) the assessment of the mental and physical health and emotional wellbeing needs of relevant and former relevant children.

(11B) Subsection (11A) shall come into force at the end of the financial year ending with 31 March 2019.”’—(Tulip Siddiq.)

This new clause requires the Secretary of State to make regulations for mental health assessments for looked after children. A time delay in commencement is included to allow time for the pilots to be completed before details of the regulations are decided.

Brought up, and read the First time.

[Tulip Siddiq (Hampstead and Kilburn) (Lab)]

I beg to move, That the clause be read a Second time.

[The Chair]

With this it will be convenient to discuss new clause 19—Duty to promote physical and mental health and emotional well-being—

‘(1) In section 22 of the Children Act 1989, in subsection (3)(a) at end insert—

“(3D) The duty of a local authority under subsection (3)(a) to safeguard and promote the welfare of a child looked after by them includes a particular a duty to promote the child’s physical and mental health and emotional wellbeing.

(3E) For the purpose of supporting a local authority in discharging its duty under subsection (3D), each clinical commissioning group must appoint—

(a) at least one registered medical practitioner, and

(b) at least one registered nurse,

for each local authority with which any part of the clinical commissioning group overlaps.”’

This new clause would improve the outcomes for looked after children through a clarification of duties of cross agency working between local authorities and health partners, by elevating the roles of designated doctors and nurses into primary legislation.

[Tulip Siddiq]

It is a pleasure to serve under your chairmanship, Mrs Main, and to speak to new clauses 18 and 19. Following the Prime Minister’s announcement that she wants to employ the power of Government to deal with mental health problems across society, I hope that these new clauses will not prove contentious to the Minister and Government Members.

According to the Care Quality Commission’s report last year, “Not seen, not heard”, almost half of children in care have a mental health disorder. Worryingly, the Department for Education’s report on young people leaving care shows that they have five times the risk of a suicide attempt of their peers. We tabled new clause 18 because we believe that mental health assessments are important tools for identifying mental health conditions early. Barnardo’s has made the point over and over that mental health needs must be met early to avoid crisis points.

Last year, the Government argued that automatic mental health assessments for children in care and care leavers would be stigmatising, and that it would not be appropriate for them to have mental health assessments at a given time. We have taken that on board. Bearing in mind what the Government have said about stigma, our new clause does not propose automatic mental health assessment for all children in care and care leavers at a specific time. Instead, we simply seek to ensure that the changes to mental health provision are supported by primary legislation.

By agreeing to the new clause, the Minister could ensure that the Government give mental health priority at every level, and that the Bill covers children in care and care leavers. New clause 18 would allow the Government to incorporate the outcomes of the recently announced mental health assessment pilots into regulations, and I hope that he will support it.

The same goes for new clause 19, which would improve outcomes for looked-after children by clarifying the duties for cross-agency working between local authorities and health partners and elevating the roles of designated professionals into primary legislation. Children in care and care leavers need someone who can ensure that health and social care services meet their particular mental health and wellbeing needs. Children in care currently have a designated doctor and nurse tasked with assisting local commissioners in addressing the health needs of looked-after children in their area, but the problem is that their exact responsibilities are unclear. Many local areas struggle to fill posts, and where posts are filled, professionals report that they are unable to influence planning decisions.

The Alliance for Children in Care supports stronger requirements for the role of designated doctors and nurses for looked-after children, as they believe that would begin to address current shortcomings and enshrine the role of designated professionals in legislation. I hope that the Minister will listen to the experts and the views that I have outlined and support the new clause.

[Edward Timpson]

I thank the hon. Lady for raising the important issue of the mental health and emotional wellbeing of looked-after children and care leavers. Improving mental health services and support for all children and young people is a priority for the Government. As she reminded the Committee, on Monday 9 January, the Prime Minister announced that the Department for Education and the Department of Health would work together to produce a Green Paper on the mental health of children and young people. That Green Paper will consider specifically how to build on what has already been done since “Future in Mind” to bring together a practical strategy for improving specialist mental health services, as well as how to improve preventive activity to help and support children and young people from nought to 25 years.

The paper will cover all relevant parts of the system—not just health but the care system, schools, universities and families. I agree that looked-after children and care leavers should receive the best possible assessment of their needs and then the necessary mental health support, but unfortunately, we know that not all such young people experience the best possible response. I have seen at first hand, both in my constituency and in my previous practice, how transformative timely and high-quality mental health support can be. Sadly, I have also seen the consequences where that is not provided.

However, improvements to mental health assessments are unlikely to be delivered by additional legislation; it is better practice on the ground that will deliver a better response to children’s needs. There are already legal requirements for health assessments, covering both physical and mental health, for looked-after children on their entry into care. Under the Care Planning, Placement and Case Review (England) Regulations 2010, all local authorities must set out a care plan for looked-after children, which must include a health plan setting out what arrangements the authority will make to meet the child’s health needs. A child’s health is expressly defined as including emotional and mental health.

To help inform the health plan, local authorities are required to carry out a statutory health assessment for all looked-after children on entry into care. It must be carried out by a registered medical practitioner and must address physical, mental and emotional health. Guidance from the medical royal colleges sets out the knowledge, skills and competences needed to undertake the assessments. Department for Education and Department of Health statutory guidance on care planning and promoting the health of looked-after children emphasises the importance of mental health, developmental milestones and social and relationship skills, which form part of a statutory health assessment.

Although the law and statutory guidance are clear, I share the concerns of the hon. Member for Hampstead and Kilburn about the quality of the initial health assessments for looked-after children and about whether in practice enough importance is placed on mental health needs. We listened to the issues raised by the Select Committee on Education, organisations such as the National Society for the Prevention of Cruelty to Children, and Baroness Tyler and other peers. As a consequence, we have announced that we will establish pilots to test new approaches to mental health assessments for looked-after children.

I am happy to reiterate that commitment today. Initial meetings have already taken place among DFE, Department of Health and NHS England colleagues, who will take forward that work with a view to beginning pilots in April or May. The pilots will give us an opportunity to test and explore a range of approaches, building on the findings of the Education Committee and other research in this area. We may, for example, look at the skills and training of those carrying out healthcare assessments, and particularly at assessment methods and identification tools, and models of multi-agency working. I am also keen that children and young people themselves help to shape the pilots and inform best practice in this area.

Alongside the pilots, the expert working group on the mental health of looked-after children provides a huge opportunity to improve the mental health support that children in care receive. How looked-after children’s mental health is assessed is a focus for the group, crucially alongside the services that are put in place to support those children. The expert group is looking not only at entry into care but at suitable assessment support as a continuum across the child’s life. That includes the support that they receive on leaving care, including through routes such as special guardianship or adoption.

It is important that we do not pre-empt the group’s findings. Legislating before the expert group’s report and the pilots would risk tying the Government to a legislative option that may not make the tangible improvements to services that young people need. At worst, it would stymie the ability to use the findings from the expert group and the pilots in the best way possible for children and young people. We are committed to acting on those findings. Should they recommend that further legislation is needed, the Government will of course consider introducing it at that point. I appreciate that the hon. Lady’s new clause would come into force after the pilots have finished, but it simply duplicates what is already set out in law. In our judgment, what is needed is a change in practice on the ground, not in legal requirements.

Turning to the needs of former relevant children, looked-after children should have a review of their care plan, including their health plan, prior to leaving care. Consideration of their health needs, including mental and emotional health, should already be part of the review. We know from young people themselves that one of our priorities needs to be to get the transition between child and adolescent mental health services and adult services right. To improve practice regarding that transition, in December 2014 and January 2015, NHS England published new service specifications for commissioners, giving guidance and best practice on the transition from children and adolescent mental health services to adult services or elsewhere. Those specifications intentionally do not stipulate an age threshold for transition. They state that transition should be built around the needs of the individual, rather than their age.

I turn briefly to the proposed duty on local authorities to promote looked-after children’s physical and mental health and emotional wellbeing. There is an existing statutory duty under the Children Act 1989 to safeguard and promote the welfare of looked-after children. Promoting a child’s health is an integral part of promoting their welfare, and the regulations and statutory guidance on care planning are explicit that health includes mental and emotional health.

In addition to what I have already set out, we have further strengthened the legal position by making explicit reference to physical and mental health in the corporate parenting principles in clause 1. A Government amendment in the other place on the subject has been widely welcomed. It means that all local authorities in England will be required to have regard to the need to promote the physical and mental health and wellbeing of all looked-after children and care leavers. I hope that reassures the hon. Lady enough that she will be able to withdraw her new clause.

[Tulip Siddiq]

I thank the Minister for his response. The trials and pilots are a welcome step forward. With some reluctance I will withdraw the new clause, although it would clarify the exact positions of the designated professionals and put a little more practice into looking after a vulnerable group. Opposition Members will keep a close eye on this matter, because the Government’s record on mental health in all areas so far has been appalling. However, I will withdraw the new clause, because I appreciate the points about defining what the trials cover and the outcome of the pilots that he proposes and the Green Paper. I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 21

Designated support for family and friends carers

“(1) In the Children Act 1989, after section 17ZI insert—

“17ZJ Designated support for family and friends carers

Each local authority must appoint at least one person as a designated lead for family and friends care, to co-ordinate the provision within their area of family and friends care support services.”” .—(Mrs Lewell-Buck.)

This new clause would provide kinship carers, council staff and other agencies with clarity as to who is the named senior manager with responsibility for family and friends care in the authority and who has responsibility for ensuring that the local authority complies with family and friends care guidance.

Brought up, and read the First time.