Health assessments and care
‘After section 90 of the 1989 Act insert—
“Health assessments and care
90A Health assessments and care
(1) Where a child is looked after by a local authority, the Primary Care Trust (“PCT”) or, where there is no relevant PCT, the Health Authority or Health Board, must co-operate with the local authority in the provision of physical, emotional and mental health assessments and care.
(2) The Secretary of State shall make regulations providing for physical, emotional and mental health assessments of a child looked after by the local authority.
(3) Regulations made under this section shall make provision about—
(a) the qualifications and experience of an individual undertaking a health assessment;
(b) the length of time after a child starts to be looked after by a local authority by which a health assessment must take place; and
(c) the inclusion of details in the care plan of the arrangements made jointly by the local authority and PCT, or if there is no PCT, the Health Authority or Health Board, for the area in which the child is living for the physical, emotional and mental health care of the child.”’.—[Annette Brooke.]
I beg to move, That the clause be read a Second time.
This amendment has also been supported by a number of organisations. I should like to make that clear from the outset. I suspect that I will be given assurances that it is all dealt with already, but the NSPCC, BAAF, Who Cares?, ChildLine and the NCB support this, so I am not alone in thinking that rather more could be done. Ever since the Sexual Offences Bill, I have had a particular interest in seeing that when a child has been sexually abused an assessment is made and therapeutic treatment is available. I have raised this on many occasions. A child who has been abused sometimes goes on to become a perpetrator. We have more and more unhappiness and misery by not addressing the situation at the time when it needs addressing. The availability of therapeutic treatment across this country is very patchy. We could prevent many tragedies if we could ensure that that treatment was available.
The amendment concerns assessment, treatment and support. My particular interest in therapeutic counselling and treatment for sexually abused children will, sadly, form part of that. About 60 per cent. of children are brought into care is because they have been abused in some way, be that physical violence, sexual abuse or other forms. That tells us quite a lot. Children who come into care have at least a 60 per cent. chance of needing some form of treatment. They often need mental health treatment.
Despite the fact that the Government have invested greatly, and I will not underestimate the extra investment, there is still a long way to go until we provide enough services. There can be a long time lag between assessment and treatment. That is critical for this group of vulnerable young people. They have already had a bad start in life. We need to be able to act to do the best that we can to remedy and make good as soon as possible
I therefore call in the new clause for an explicit duty to be placed on PCTs to co-operate with local authorities in the provision of health assessments and care to looked-after children, for assessment to be undertaken by suitably qualified and experienced practitioners and for regulations to set out in detail how joint arrangements for the individual child will be made, recorded and reviewed. I should add that 45 per cent. of looked-after children and young people aged five to 17 are assessed as having an emotional or mental health disorder, compared with 10 per cent. of the general child and young person population. Those are Government figures. Looked-after children and young people exhibit high rates of self-harm and high risk behaviour. Two thirds of looked-after children are reported to have had at least one physical health complaint. Some of those complaints are speech and language problems, and in other arenas we talk a great deal about how much such problems inhibit a child’s development.
The problem is that provision is patchy, as is working together, despite provisions that state that there should be a multidisciplinary approach and that primary care trusts should work closely with local authorities. I shall give an example from my own constituency, where local authority boundaries are not coterminous with primary care trust boundaries. That problem has been overcome with help from the Government for the council concerned. Nevertheless, I have a letter from a health service worker saying:
Those east Dorset children have been sent to a specialist school in west Dorset. That problem has now been dealt with, but it has taken a long time and an MP’s intervention. I do not buy the assurances that “it is all happening”. We have a long way to go, and that is why the duty is important.
I have the feeling that everybody is trying to hurry me up. I am doing my best, but these are meaty new clauses. I am sure that Hansard will show that I have not had more than my fair share of time. The new clauses that I am leading on are really important to me and to all our looked-after children, and I do not want to rush through them at the cost of not making a point. I am looking for a number of assurances on how the arrangements will work. Given the intensity of the problems regarding the health of looked-after children, a duty in the Bill is called for.
I will not list for the hon. Lady the various current regulations, because I want to focus on the steps we are taking, which I think will achieve what she wants to achieve in a different but equally effective way. She will be aware of the duty to co-operate in sections 10 and 11 of the Children Act 2004, which applies to a range of health bodies and other agencies. The guidance that flowed from that and the power to issue statutory guidance were not implemented in relation to primary care trusts and health bodies. Guidance was issued to health bodies but it was not statutory—that power was not switched on.
I give the hon. Lady an assurance that we intend to issue new statutory guidance in relation to the powers in sections 10 and 11. The revised guidance will be statutory for primary care trusts, strategic health authorities, NHS foundation trusts and local authorities. It will cover assessments of the physical, emotional and mental health of looked-after children, health plans, the involvement of qualified medical practitioners in assessments and reviews, the time scales for completion of assessments and reviews, health promotion, the provision of child and adolescent mental health services for looked-after children—which the hon. Lady rightly says is important—and the roles and responsibilities of health bodies and local authorities in improving the health of looked-after children. For the first time, the guidance will have the statutory bite that has applied to other agencies under sections 10 and 11 of the 2004 Act.
In addition, we are using some of the architecture of the national health service to build in a focus on looked-after children. The statutory guidance will be complemented by the new joint strategic needs assessment, the new NHS operating framework for 2008-09, and the national indicator set for local government. For the first time, the NHS operating framework includes keeping children well, improving overall health and reducing health inequalities as one of the top five priorities for the NHS. That marks the beginning of a new chapter in the journey of the NHS to a focus on more preventive services for children and young people.
Let me explain how we will monitor that. In addition to our existing data collection, there is a new indicator on the emotional health of looked-after children. That will be particularly important in driving up the supply of CAMH services. Under the children’s plan, we asked Jo Davidson, the director of children’s services for Gloucester, to undertake a review of CAMH services. The call for evidence closes tomorrow, I think, and Jo Davidson will report in the autumn on what more needs to be done in that regard.
Can the Minister give a time scale for publication and implementation of the revised guidance? I am talking about the statutory position. When will that happen?
It is part of our process of either revising existing guidance or, in this case, introducing revised guidance with a new status. I do not have information on the specific time with me, but I might be able to get that if I keep talking long enough-albeit without wishing to delay the Committee. Otherwise, I can write to the hon. Lady. I am not clear on where it is in our list of work to be done on guidance, but I can tell her that it will be published before the end of this year—in 2008. With that, I hope that the hon. Lady feels that the points she made have been covered and she will withdraw the motion.
Again, the test will be in the monitoring to see what difference statutory guidance makes and whether we will need to return to the matter at a later date. I would just like to leave the Minister with a thought about the availability of therapeutic treatment across the country. There has been a long-term campaign on that by the NSPCC—I am an ambassador for the NSPCC, so I ought to declare that interest. I know that not having therapeutic treatment escalates problems and leads to further incidents in society. I thank the Minister for the fact that we have the statutory guidance. I hope that that will result in change, but I feel that we have a long way to go and we may well have to revisit this issue. I beg to ask leave to withdraw the motion.