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Children and Social Work Bill [Lords] – in a Public Bill Committee at 2:45 pm on 13 December 2016.

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Photo of Emma Lewell-Buck Emma Lewell-Buck Shadow Minister (Education) (Children and Families) 2:45, 13 December 2016

I beg to move amendment 28, in clause 3, page 4, line 10, after “the” insert—

“physical and mental health, emotional well-being and”.

With this it will be convenient to discuss the following:

Amendment 30, in clause 3, page 4, line 11, after “child” insert—

“, including their needs as a young parent where applicable,”.

Amendment 29, in clause 3, page 4, line 16, at end insert—

“(5A) The assessment of the former relevant child’s mental health and emotional well-being under subsection (5) must be carried out by a qualified mental health professional.”

Amendment 31, in clause 3, page 4, line 26, at end insert—

“(9) In this section “young parent” means—

(a) an expectant parent,

(b) a parent who has their child or children in care, or

(c) a parent who had a child removed to kinship care, local authority care, or adoption.”


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Photo of Emma Lewell-Buck Emma Lewell-Buck Shadow Minister (Education) (Children and Families)

It is a pleasure to serve under your chairmanship again, Mr Wilson.

Amendment 28 would extend the duty on local authorities set out in clause 3 to include access to a mental health assessment for care leavers. When a care leaver requests support from their local authority and the local authority conducts an assessment of their needs, it must include an assessment of mental health and emotional wellbeing that is carried out by a qualified mental health professional. The corporate parenting principles set out in clause 1 make it clear that local authorities should promote the mental health and wellbeing of care leavers. Currently, there is huge amount of unmet need in the area due to squeezed budgets, high thresholds and the lack of relevant specialism in adult mental health services.

Photo of Tulip Siddiq Tulip Siddiq Shadow Minister (Education) (Early Years)

Is my hon. Friend aware that there are now 5,000 fewer mental health nurses than there were in 2010, and 1,500 fewer mental health beds? The amendment is more important than ever to ensure that mental health does not slip even further down the agenda.

Photo of Emma Lewell-Buck Emma Lewell-Buck Shadow Minister (Education) (Children and Families)

I was not aware of those statistics. I knew the situation was dire, but I did not realise how bad it had actually become.

Young people leaving care are much more likely to have mental health problems than other young people: they are five times more likely to attempt suicide; many have suffered abuse or neglect before coming into care; and they may have moved around several placements, making it hard to form stable relationships with carers, professionals or even friends.

The Government have committed to piloting mental health assessments for children in care, but there was no mention of young people over 18 who have left care. We all know that turning 18 does not mean that people stop being vulnerable and stop needing support. In fact, mental health problems often manifest at the challenging time of transition into adulthood. At 18, young people can no longer access child and adolescent mental health services; they have to rely on adult services—but only if they are lucky enough not to slip through the net in transition. The reality is that if young people with mental health needs are not getting help, it is unlikely that they will be able to make the most of other opportunities such as education, training or employment, because mental health problems can have a debilitating effect on all other areas of their life.

On Second Reading in the House of Lords, Lord Nash acknowledged that:

“All the evidence shows that care leavers are among the most vulnerable young people in our society. Many are still struggling to overcome the impact of the trauma they faced in childhood and, in most cases, they are expected to make the transition into adulthood without the unconditional love and support of a family or close circle of friends. As a consequence, they are far more likely to end up NEET, more likely to experience homelessness or mental health issues, and more likely to end up in the criminal justice system. However, with good, stable care and a more personalised and supported transition into adulthood, those stark facts need not be the culmination of their time in and leaving care.”—[Official Report, House of Lords, 14 June 2016; Vol. 773, c. 112.]

Clearly the Government know what the problem is, yet they have still failed to provide a full solution.

If the mental health and emotional wellbeing of every child leaving care is not professionally assessed, how will we know whether they are ready to cope in the adult environment? We cannot just expect them to leave care and cope in a vacuum, without some appraisal of their wellbeing. We would not allow that for a physical problem so we should not allow it for a mental health one. We must put in place measures to prevent care leavers from falling off the cliff edge of care. Assessments would provide a basis for care leavers to address their future needs, albeit under a different system.

Given the vulnerability of the young people in question and the likelihood that they will face challenges relating to mental health or emotional wellbeing coupled with the difficulty of accessing those services, it would be good if the Minister took the opportunity to extend the duty in clause 3 to include mental health. Amendment 29 would extend the duty on local authorities to include access to a mental health assessment for care leavers; and it would ensure that if amendment 28 is agreed, the assessment will be carried out by a qualified mental health professional.

The Conservative-led Select Committee on Education rightly recommended that a dedicated mental health assessment by a qualified mental health professional be completed for all looked-after children, so healthcare professionals and local authorities have a solid and consistent foundation on which to plan the best care for a child. The recommendation was based on an extensive body of evidence from experts that clearly showed why more action and less talk are needed.

The Government’s response to the Select Committee report on mental health acknowledged the vulnerability of looked-after children and the need for timely and effective mental health diagnosis and treatment. The Chair of the Committee said of the Government’s response:

“We are pleased that the Government have set up an expert working group for looked-after children’s mental health and wellbeing; however, having conducted a lengthy and detailed inquiry on the issue, we are disappointed ?that so many of our recommendations have simply been referred to that group.”—[Official Report, 20 October 2016; Vol. 615, c. 496WH.]

I was similarly dismayed to observe that the Government’s response to the report deflected many answers to the new expert working group on the mental health of looked-after and care-leaving children. Although I make no criticism of the experts appointed to the group, both chairs of the expert panel had already submitted evidence to the Committee, so further consultation seems a somewhat unnecessary duplication. The consultation will serve only to cause further delays, meaning that more children will suffer unnecessarily.

Services are inconsistent across the country, and initial mental health assessments are highly variable. Many local authorities are not meeting their statutory requirements to ensure that all children are properly assessed even when they enter care, so it is important that we get the basics right. We can do so only with professional assessment as children enter and leave care.

It is astonishing that currently children entering care are asked to fill in strengths and difficulties questionnaires, from which it is decided by people who are most likely not medically trained whether the child qualifies for mental health intervention. Administration of the forms from local authority to local authority is patchy, with great variations in timeliness of completing the form. It is not uncommon for the questionnaire not to be completed at all. Only a trained mental health practitioner should be able to assess a patient’s needs; such needs cannot be determined simply from ticked boxes on a form.

It is not enough just to say that help is out there. There are difficulties with the availability of mental health provision for all children, including difficulties accessing and navigating the system. Accessing mental health care, asking for help and overcoming stigma are hard enough for any young person, even those with strong, supportive families; we must acknowledge that. A mental health assessment is one step in ensuring that children get the care and support they need for healing to take place and for them to be integrated into society and feel part of it. That is why they must be assessed on leaving care as well. The whole point is to ensure that care leavers are robust enough to leave care as independent adults who can go out and find work, start families and participate in society fully, like everyone else.

Amendments 30 and 31 strengthen support for care leavers who are also parents. Despite their extreme vulnerability, the particular needs and circumstances of young parents who are looked-after children or care leavers and whose own children are subject to child protection inquiries are not sufficiently identified, recognised or addressed in care planning regulations and guidance. These amendments seek to establish a duty on local authorities to ensure that advice, assistance and support are offered to all looked-after children and care leavers who are young parents. It will help ensure that important information is not overlooked when plans for such young people are made by expressly identifying critical sources of information which should be drawn upon in formulating plans to keep the young parent’s child safely in their care.

Photo of Kate Green Kate Green Labour, Stretford and Urmston 3:00, 13 December 2016

Some people leaving care do become young parents very quickly, but that is not always a recipe for problems for themselves or for their children—indeed, those young parents can be very enthusiastic and committed parents, determined to do the best for their child. However, many lack family support. Does my hon. Friend agree that they need help to be good parents, but also encouragement and family assistance of the kind that other parents perhaps draw from their own family members?

Photo of Emma Lewell-Buck Emma Lewell-Buck Shadow Minister (Education) (Children and Families)

Many children who have left care go on to be fantastic parents, but those who need an extra bit of support should be recognised in the legislation. This amendment seeks to achieve that.

While the Government have suggested that existing statutory guidance makes some reference to young people who are young parents, we need to recognise and respond more robustly to the additional vulnerabilities of this group of care leavers in a way which is not presently provided for in primary or secondary legislation. Evidence from the Centre for Social Justice in 2015 based on data provided by 93 local authorities revealed that 22% of female care leavers became teenage mothers. That is three times the national average. The same report identified that one in 10 care leavers aged 16 to 21 have had their own children taken into care. Care leavers are particularly vulnerable to early pregnancy, early parenthood and losing their child to the care system.

A recent research project carried out by Professor Broadhurst based on national records from the Children and Family Court Advisory and Support Service between 2007 and 2014 examined cases relating to 43,541 birth mothers involved in care proceedings. The study estimated that around a quarter of these mothers who had a child subject to care proceedings will have sequential care proceedings about another of their children. The study found that young women aged 16 to 19 years were most at risk of experiencing repeat proceedings, with almost one in every three women in this age group estimated to reappear. Provisional results from the study’s further in-depth analysis of court files indicate that more than six out of 10 others who had children sequentially removed were teenagers when they had their first child. Of those mothers, 40% were in care or had been looked after in the care system for some of their own childhood.

Like most parents who are subject to the child protection system, young parents often feel lost, angry and scared. However, many of these young parents, particularly care leavers, also have multiple challenges. Some of them are alienated by prior negative experiences of state services in their childhood, making it difficult for them to engage with professionals. At times, this lack of parental co-operation can be a trigger for the issuing of care proceedings. Young parents often feel judged by their youth and background rather than by their parenting abilities. That is particularly the case for care leavers, who often feel that being in care itself counts as a negative against them. Previous childhood experiences including suffering abuse, mental health problems and exclusion from school may adversely impact on their resilience, their resources, their support networks and their ability to deal with both the challenges of transitioning to adulthood and being a parent. Young parents who are care leavers also identify that even where support has been provided to them in their capacity as young people leaving care, the support often ignores their role as parents or fails to assist them in safely raising and keeping their child.

As referred to in new clause 16, a national offer for care leavers would go some way to mitigate the financial challenges that care leavers face, which are only exacerbated when they become parents themselves. Our amendments would ensure that their needs as parents were fully taken into account.

Photo of Edward Timpson Edward Timpson Minister of State (Education)

I thank the hon. Lady for tabling amendments 28 to 31, which would provide that when a local authority assesses care leavers’ needs, they must take account of that young person’s requirements in relation to their physical and mental health, their emotional wellbeing and their needs as a young parent if that applies. Amendment 29 would require that any mental health assessment should be conducted by a qualified professional. I recognise that these issues are important, and that they could impact significantly on the lives of care leavers, whose health and wellbeing outcomes tend to be worse than for young people who have never been in care. The likelihood of care leavers becoming teenage parents is also much greater than for their peers, for the reasons set out by the hon. Lady in her speech.

There are, however, many other wider issues, such as health and development, education, training and employment, and financial and accommodation needs, which are also vital to care leavers’ transition to independent life and adulthood. All these issues— it would not be practical to list them all—are arguably of equal importance and will be different for every child, so I do not agree with giving some more weight than others. It is also unnecessary because these and other issues are already comprehensively covered in volume 3 of “The Children Act 1989 guidance and regulations”. The statutory guidance is clear that local authorities must produce for each care leaver a comprehensive pathway plan, which must be based on an up-to-date and thorough needs assessment taking into account how to support their health and development and their physical, emotional and mental health needs. I shall read a small extract from that guidance, which states that pathway plans must address the

“young person’s health and development building on the information included in the young person’s health plan established within their care plan when they were looked after” and that personal advisers, who, under the clause, will cover all care leavers up to the age of 25,

“should work closely with doctors and nurses involved in health assessments and would benefit from training in how to promote both physical and mental health.”

I reiterate that the Government have established the expert group on the mental health of looked-after children and care leavers, and we have asked them to recommend the most appropriate way to deliver the care. The group have already met twice, and I have met them, and they are free to make recommendations during the period of their work. Their remit is substantial and wider than that which they had in relation to the Education Committee, albeit that that also had worth.

On the initial assessment when a child comes into care, it is not just a strengths and difficulties questionnaire, as regulations already require the responsible authority to ensure that all looked-after children have an initial health assessment by a registered medical practitioner, who should cover their emotional and mental health as well as their physical health needs. The reason we wanted the expert group to consider the matter is that there will be circumstances where it is not appropriate for a child coming into care to have a mental health assessment at that specific moment, either because they have suffered trauma at the moment of coming into care, or because they are a newborn baby, or because other elements in their circumstances might require it to be done in a more individually appropriate way. That will ensure that the right decisions are made about how to get to the bottom of what may be underlying issues due to pre-care experiences. We do not want to set a single process that restricts those who are charged with responsibilities to ensure that they take the appropriate action for that child.

Photo of Steve McCabe Steve McCabe Labour, Birmingham, Selly Oak

I understand the Minister’s point about a relatively young child or a baby not necessarily having a mental health assessment, but who would make the decision whether it was appropriate for a child to have a mental health assessment? Would it be a qualified mental health practitioner who would have the ability to make that judgment, or would it be a member of the local authority, or a member of the residential home, or the social worker? There is clearly a temptation for people to say, “Well, it is not appropriate at the moment.” Given what we now know about the longer-term effect on the mental health of many of these children, who is the most appropriate person to make that judgment, and at what stage?

Photo of Edward Timpson Edward Timpson Minister of State (Education)

As I set out a few moments ago, the regulations make it clear that the health assessment is carried out by a registered medical practitioner.

Photo of Edward Timpson Edward Timpson Minister of State (Education)

The hon. Gentleman asked who makes the decision, and the regulations are clear about who carries out the assessment. He knows as well as I do that local authorities have a responsibility to triage cases according to the law and the regulations that apply. If he is suggesting that it should or should not be a certain person, I would be interested to hear his views.

Photo of Steve McCabe Steve McCabe Labour, Birmingham, Selly Oak

That is not quite what I asked. It is all very well to say that, at the moment, a child coming into care has a regular health assessment, but the Minister then told us why it would not be appropriate at certain stages or certain ages for children to have a mental health assessment. He is making that judgment at the moment. I am asking who is entitled to make a judgment about a child’s mental health, given what we now know about the long-term consequences for many of these children.

Photo of Edward Timpson Edward Timpson Minister of State (Education)

I have already explained to the hon. Gentleman that the process is clearly set out in law. I am not making that judgment; I am reflecting on the evidence provided by others about the experience of children who are brought into the care system. The whole point of the expert group is to try to ensure that the care pathway that is created for each child coming into care will ensure that they get the right support based on the right diagnosis at the right time. We want to avoid ending up with a process at the inception of a child’s time in care that does not enable that pathway to be created in a way that meets their individual needs.

The hon. Member for South Shields spoke about the most vulnerable mothers who have had multiple children taken into care. As we know, that group includes a disproportionate number of care leavers. I draw the Committee’s attention to the Pause programme, which seeks to break the intergenerational cycle of care, which the hon. Member for Stretford and Urmston mentioned. Pause has been operating in Hackney for some time and has now been extended to six other local authority areas, with funding from my Department’s innovation programme.

Last month, the Secretary of State announced funding to roll out the Pause programme in a further nine areas, bringing Government funding support to more than £6.4 million in the next four years. The programme works intensively with young women to prevent repeat pregnancies and the subsequent removal of their children into care. The initial findings are extremely encouraging and, by extending the programme, we want to reach out to more parts of the country so that more mothers who find themselves in that situation get the support they need so that they can make good life choices and have a future that is not just about turning up at court once every few years to fight for custody of their own child.

Photo of Emma Lewell-Buck Emma Lewell-Buck Shadow Minister (Education) (Children and Families)

Notwithstanding the good work being done through the Pause programme, does the Minister accept that the work is rather piecemeal? It is not happening in every local authority. As I said earlier, we should be offering such services to everyone across the board, not just to some people who live in certain local authority areas. What happens when this innovation money runs out? Do we just go back to where we were?

Photo of Edward Timpson Edward Timpson Minister of State (Education) 3:15, 13 December 2016

I will answer that question in two parts. First, interested parties always ask for evidence when we try something new. Before we roll out a programme nationally, we want to be able to demonstrate that it will be effective in tackling the issue that it was set up to try to resolve. Before we roll out a programme nationally, we want to be able to demonstrate that it will be effective in tackling the issue that it was set up to try to resolve.

Secondly, of course we want to ensure that we get uniformity right throughout the country, but the only way we can establish whether the care leaving services work well is by having a strong legal framework backed up by strong accountability. When services work well—we now have four or five councils with an outstanding care leaving service—we need to get better at spreading that good practice. The new What Works centre is going to be a good way of achieving that. We must ensure that we find out where local authorities are falling short. That may be in the transitional work they are doing on the care pathway that is put in place to plan for the young person’s future, including the need to secure their emotional and mental health needs.

I do not disagree with the hon. Member for South Shields about the concerns she has expressed, which is why we are trying to tackle the problem through the innovation programme and the extension of the role of the personal adviser, who has an important part to play in providing mentoring support and engaging young people in the services they need, pushing their elbows out on their behalf so that by the time they reach 25 they are in a much stronger emotional, mental, physical and financial state than would otherwise have been the case. I do not think the approach the hon. Lady is suggesting would help in the way that she would hope. For the reasons I have set out, the Government are taking this approach because we want to try to tackle the problem that we both acknowledge remains long-standing. We are determined to do more than ever to put it right.

Photo of Emma Lewell-Buck Emma Lewell-Buck Shadow Minister (Education) (Children and Families)

The other part of my previous question was what happens in the areas we are discussing when the innovation money runs out? I am assuming that each programme is time-limited.

Photo of Edward Timpson Edward Timpson Minister of State (Education)

Every innovation programme, of which we have more than 50 throughout the country and in every region, is provided with funding for the duration of the programme only if can show how it will be sustainable in the long term. That is done through an independent panel that makes decisions about which programmes should be supported and which should not. The panel will feed directly into the What Works centre so that other parts of the country can learn from projects that have already demonstrated a discernible impact in the area that they hoped to help through their initial proposal.

Take the example of North Yorkshire, where the No Wrong Door project to support care leavers has been hugely successful in improving support for care leavers. That model is now being shared and replicated—albeit crafted to meet individual need—based on the fact that it is showing benefits not only in North Yorkshire but in other parts of the country. The model is one of creating the evidence base, having the ability to spread best practice, and then ensuring that the sustainability proposed in the original programme is there. On that basis, I urge the hon. Lady to withdraw the amendment.

Photo of Emma Lewell-Buck Emma Lewell-Buck Shadow Minister (Education) (Children and Families)

If I withdrew the amendments, would the Minister consider updating some of the guidance on mental health assessments? In the pathway plans I have seen in the past they are not given the prominence they should have.

Photo of Tulip Siddiq Tulip Siddiq Shadow Minister (Education) (Early Years)

I echo the shadow Minister’s comments on pathways. In the past three years, the number of female teenagers who have been admitted to hospital with eating disorders has more than doubled. That is particularly relevant for female care leavers who suffer eating disorders such as bulimia, anorexia and binge eating. A lot of these disorders were not reflected in the past and were not at the forefront of the minds of the people assessing not only care leavers but teenagers in general, especially female teenagers. The Mental Health Foundation clearly labels eating disorders as mental health problems. Will the shadow Minister comment on the fact that when we make legislation and take into account society’s problems, we need to be aware that things are changing? Things that did not previously have the prominence they have now must be acknowledged by authorities, especially with the rise of social media—

Order. That was only supposed to have been an intervention.

Photo of Emma Lewell-Buck Emma Lewell-Buck Shadow Minister (Education) (Children and Families)

I beg to ask leave to withdraw the amendment, but perhaps will return to the matter at a later date. However, I wish to press to a vote the amendments on recognising care-leaving parents, who have particular vulnerabilities. The Minister has not satisfied me that they are being provided for in a holistic way, as it seems to depend on which local authority area people live in.

Amendment proposed: 30, in clause 3, page 4, line 11, after “child” insert “, including their needs as a young parent where applicable,”—(Mrs Lewell-Buck.)

Question put, That the amendment be made.

The Committee divided:

Ayes 6, Noes 10.

Division number 4 Christmas Tree Industry — Advice and support

Aye: 6 MPs

No: 10 MPs

Aye: A-Z by last name

No: A-Z by last name

Question accordingly negatived.

Amendment 31 is consequential upon amendment 30, which has just been defeated. It follows that it will not be called for a separate Division.

Clause 3 ordered to stand part of the Bill.

Clause 4