‘In section 47 of the Children Act 1989 (local authority’s duty to investigate) after subsection (8) insert—
“(8A) Where, as a result of complying with this section, a local authority conclude that a child may need to become looked after in order to safeguard and promote their welfare, the local authority must, unless emergency action is required—
(a) identify and consider the willingness and suitability of any relative, friend or other person connected with the child, to care for them as an alternative to them becoming looked after by unrelated carers; and
(b) offer the child’s parents or other person with parental responsibility a family group conference to develop a plan which will safeguard and promote the child’s welfare.”’—
This new clause would ensure effective work is undertaken with the family so that all safe family options are explored at an early stage of intervention.
I beg to move, That the clause be read a Second time.
The new clause would ensure that effective work is undertaken with families so all safe family options are explored at an early stage of intervention. I know that some social workers already do that—I was one of them—but the introduction of a 26-week timetable for care proceedings and strict case management guidance for courts means that once care proceedings are under way, it can sometimes be too late for potentially suitable kinship carers to be considered and assessed.
I recall receiving a case where multiple family members had not been approached to care for a child who had been in foster care for two years and in multiple placements. The plan for that child, which the court had indicated it approved of and all parties in the proceedings bar the parents agreed upon, was adoption. I appeared before the court and pleaded with the judge for the proceedings to be halted to allow for proper family exploration. It turned out that there were suitable family members, and after intensive and complex work, that child was able to go and live with extended family and maintain contact with their wider family.
The new clause would make that kind of work standard, saving unnecessary heartache and pain and the disruption that can be caused by fostering and care proceedings, not to mention the staggering cost to the public purse. The absolute worst case scenario of a child being adopted when there are family members who are willing to love and care for them might also be avoided.
In answer to a recently parliamentary question, the Minister revealed that 73% of children in a kinship care foster placement had previously experienced a looked-after placement. Although we do not and cannot know the circumstances of every child in that cohort, that means that 73% of children in kinship care may have gone through being removed from their parents—their primary carers—and placed with strangers when there were family members out there who were willing to care for them.
If more extensive work had been done by children’s services, such as offering family group conferences or investigating wider families, such traumatic events for children could and would have been avoided. Leeds City Council is leading the way in demonstrating the benefits of family group conferences, but the Family Rights Group has found that 25% of local authorities neither run nor commission such conferences, and among the 75% that do, Leeds is unusual in routinely offering them.
“facing a crisis and, truth be told, we have no very clear strategy for meeting the crisis.”
Child protection inquiries are increasing, and the number of new care proceedings, which is at a record level, continues to rise. New care applications increased by 21% between April to November 2015 and the same period in 2016. As of March last year, there were more than 70,000 looked-after children in England—the most since 1985. Those numbers suggest that we are missing opportunities to safely avert the need for some children to come into care. Placing a child in care, even when it is for their own protection and completely the right thing to do, can have a profound impact on their mental and emotional wellbeing, not to mention their overall development. It always should be a last resort. If we agreed to the new clause, the premise that it is a last resort would only be strengthened.
I rise to add briefly to my hon. Friend’s remarks. The Minister will be aware of the rise in the number of care proceedings initiated—my hon. Friend alluded to that—and the disparity in outcomes for different ethnic groups. There are much higher instances of children from certain ethnic backgrounds being in care compared with the population as a whole.
I particularly draw the Minister’s attention to the appalling outcomes for Gypsy, Traveller and Roma children. I have been looking at the figures for March 2011 to March 2015. They show that the number of looked-after children from Irish Traveller backgrounds rose from 50 to 90. The number is small, but the increase is large. For Gypsy and Roma children, the number rose from 90 to 250 children over that period. That is an increase of 177% in the number of Gypsy and Roma children in care, which is shocking when compared with the overall rise in the number of children in care.
Gypsy and Traveller family networks are exceptionally strong. Family is very important to those communities, so it particularly concerns me that we are seeing such high numbers of those children being taken into care when it seems likely that family members could in many cases provide suitable care for those children. That would enable them to maintain links with their communities, heritage and families.
While I appreciate that we are talking about a small number of children in the grand scheme of things, it is a vulnerable group of children who suffer particularly poor outcomes. I hope that the Minister will acknowledge the opportunities that exist for family care for those children and undertake to look with colleagues at what can be done to improve their chances of remaining in family care.
The new clause would insert a new subsection into section 47 of the Children Act 1989. My understanding from what the hon. Member for South Shields said is that the first part of the new clause would require local authorities to
“identify and consider the willingness and suitability of any relative, friend or other person connected with the child” who may need to become looked after before starting formal care proceedings. I agree that children and young people should be supported to maintain relationships with relatives and friends where that is possible and in their best interests. Such relationships are often crucial in providing continuity and preserving the child’s sense of belonging to a wider family network.
The statutory guidance already requires local authorities to consider relatives and friends as carers at every stage of the decision-making process. Section 22C of the 1989 Act provides that where a child is looked after and not able to live with a parent or other person with parental responsibility, local authorities must give preference to a placement with an individual who is a relative, friend or other connected person. The individual must be a local authority foster carer in order to ensure that they can provide the high-quality care and support that the child needs.
The court orders and pre-proceedings statutory guidance and the care planning, placement and case review statutory guidance, which accompany the 1989 Act, reinforce that position. Local authorities must demonstrate that they have considered and, where appropriate, prioritised family members at each stage of the decision-making process and at the earliest opportunity. In addition, existing secondary legislation allows local authorities to place a looked-after child with a relative, friend or other person connected with the child for up to 16 weeks, even if that person is not a local authority foster parent. That allows the child to be placed with that relative, friend or other connected person until they become a local authority foster parent or other more permanent arrangements can be made. In such circumstances, the local authority must have assessed the suitability of the relative, friend or connected person and be sure that the arrangements will safeguard and promote the child’s welfare and meet the child’s needs as set out in the care plan.
The second part of the new clause would require local authorities to offer a family group conference to those with parental responsibility for the child before starting formal proceedings. The court orders and pre-proceedings statutory guidance is clear that local authorities should consider referring the family to a family group conference service if they believe there is a possibility that the child may not be able to return to their parents. Promoting the use of interventions at the pre-proceedings stage is important, and we are committed to doing so. For instance, we have previously funded the Family Rights Group to develop family group conference services, working with local authorities across the country, including North Yorkshire, Essex and Lancashire. We have also provided £4.85 million of funding to Leeds City Council, as the hon. Member for South Shields referred to, through the children’s social care innovation programme, to embed restorative practice across its children’s services, including by introducing an entitlement to family group conferences.
The evaluation of the project will include looking at the extent to which the family group conference model has been established and whether the outcomes achieved may be spread more widely across the system. We believe, however, that local authorities are best placed to decide the circumstances in which a family group conference should be offered.
We are able to know whether local authorities are making progress on this important matter, because all Ofsted inspection reports look at it and challenge poor practice where they find it. For example, in one local authority Ofsted found:
“The creative potential of family group conferences to explore and develop family-based solutions is not being fully realised.”
It has also found examples of good practice. For example, it found that Cheshire West and Chester
“assisted families to make informal appropriate arrangements within the wider family to avoid the need for the child to become looked after by the local authority”.
We need to improve that local practice everywhere. Ofsted inspectors are challenging poor practice where they find it, an important legal framework is already in place and local authorities are improving their practice. We need to meet the challenge of ensuring that, when a case eventually comes to court, every effort has been made to ensure that families have had an opportunity to demonstrate that they can care for a child, as is set out in the Bill. That care might be from an individual or a group of family members, as I have seen when I have taken cases through the family courts.
I will look at the issue raised by the hon. Member for Stretford and Urmston in relation to Gypsies and Travellers. I am aware of the point she made and I am happy to discuss it with her further. Clearly, any case that comes to court is the result of a decision made by the tribunal as to whether the threshold has been met and whether an order is necessary. That is irrespective of the background of the child and the community they might have come from. We are talking here about what happens before then, and some of the decisions made by local authorities in that context. It is a serious area that we need to look at, and I am happy to do so. If the hon. Lady has any further information that she would like to share with me, I would be happy to receive it.
I hope that, on that basis, the hon. Member for South Shields will feel able to withdraw the new clause.
I thank the Minister for that response. I hope that when we next meet to discuss all the matters he has committed to discuss with myself and others on the Bill, he is open to exploring how often this situation occurs, because the example I gave is not isolated. If the Minister is prepared to explore further incidences such as I have raised, I would be happy to withdraw the new clause.
Clause, by leave, withdrawn.
New Clause 18
‘(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.”’—
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.
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.
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.
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
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.
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.