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We know that the discretion available to social services departments sometimes results in grossly unfair treatment of grandparents or members of the child’s extended kin who provide exactly the same amount of care as foster parents. The law allows this unfair treatment, or even discrimination, against grandparents simply because they are relatives. One example is that from time to time—I think this is the practice; it has happened too many times for it to be just a one off—late on a Sunday night, or late at night, a grandchild is brought round to the grandparents and they are asked “Will you take this child?” That is the last the grandparents see of social services; they do not come back. It is safe for them to say that social services are stretched, they have very little money, “but we have managed that case and so we do not have to worry any more”. This is not acceptable and something needs to be done. The law needs to be changed so that people doing the same job are treated in the same way, otherwise we cannot talk about equality of treatment.
Baroness Howarth of Breckland: My name is on the amendment and I am the rather unlikely original sponsor of the All-Party Parliamentary Group on
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There is an issue with our amendment which seems to imply that every grandparent who takes over the care of their grandchildren wants a payment. I know from working with the Grandparents’ Association that that is not necessarily so. Many grandparents wish to take on that care; they know what has happened to their own children and want to provide surrogate parenting because that is what is needed in the family. But they need all kinds of other things and many of them need financial support. What irks them—and this is rather scandalous—is when children are taken into foster care in an emergency and then, with good kinship care programmes, placed with the grandparents, and finance is given to the original foster parents but no finance is given to the grandparents, who then have a terrible struggle. Not only that, there is very little help and advice about how to access the other financial supports which are available in the system.
I have spoken to a number of grandparents who have taken on difficult adolescents—I have lots of surrogate grandchildren and the joy about grandchildren is that you can give them back—who need support as they get older and have to struggle with the adolescent’s emotional needs. It is very interesting that grandparents, like many other members of the community, are not anti-social services. They are not frightened that social services are going to come and take the children away—indeed, they know they will not take them away—but they want local authorities to give them advice and support and sometimes a break. Occasionally a bit of respite care is needed to keep the situation going.
I recognise that this comes into kinship care but these grandparents, as a group, underpin our society. I hope the Government will look at their special needs and at how to help them to do the task they are undertaking.
Lord Williamson of Horton: When I was young there was a group called the “Hell’s Grannies”. Under the amendment—which I support—we are talking about “Heaven’s Grannies”. It is important to recognise that what is proposed here is not in relation to any old informal arrangement but in relation to cases where a child is placed with a sole carer. This can be clearly defined from the point of view of finance and support and we know what we are talking about.
I support the principle that finance should follow the logic. If the logic is that this is the best way to do it, I cannot understand why we do not follow it up with the kind of finance and support that we make available to foster carers. I support the amendments and I am sure the logic of what we are saying will influence the Minister, who will jump to his feet and give us a friendly reply before dinner.
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Baroness Howe of Idlicote: I have already spoken about grandparents and I support everything that has been said. The issue is crucial. However, this is not only about the financial side but about all the additional support that should be available. For example, where a grandparent is ageing a bit, if you could arrange for the child to be taken to school and back, that would open up opportunities for many more grandparents to play this role. I warmly support the amendment, just as I did the kinship care amendment—but this is even more important.
Baroness Morris of Bolton: This falls in line with what I said on kinship care. As the noble Baroness, Lady Greengross, said, more than 200,000 grandparents and extended family members are already raising their grandchildren because their children cannot do so. We need to harness the dedication and love that extended family members have for the younger generation in their families. At the moment local authorities are too often missing a trick by not tapping into it more readily, but it is the children who are missing out most of all. We support the amendment’s attempt to utilise and appreciate this valuable resource.
Lord Adonis: I fully endorse all that my noble friend Lady Massey and other noble Lords have said about the important role played by family members, including grandparents, who take care of children who cannot be brought up by their parents.
The Bill addresses concerns that some local authorities have considered placement of a child within their extended family to mean that the child is no longer looked after. Clause 7 of the Bill will ensure that if a grandparent or other relative agrees to care for a child at the local authority’s request, this will be a placement under Section 23(2) of the Children Act 1989 and the local authority will continue to be responsible for the accommodation and the maintenance of the child as a looked-after child.
All individuals who care for looked-after children must be approved as a local authority foster parent within six weeks of the child being placed with them by the local authority, unless they are a parent of, or someone who has parental responsibility for, the child, or, if the child is the subject of a care order—unless they had a residence order for the child immediately before the care order was made.
The requirement to be approved as a foster carer applies equally to related carers and stranger carers. All foster carers should be paid at least the national minimum allowance for foster carers at the rate set by the Government and be eligible to receive any additional fees or allowances paid by the local authority concerned in accordance with the authority’s policies, which should not discriminate against carers who are related to the looked-after child. No foster carer, including those who are grandparents, should be out of pocket because of their foster-caring responsibilities.
I am aware that concerns have been expressed about some local authorities that pay foster carers who are grandparents at a lower rate than other foster
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Baroness Massey of Darwen: I thank the Minister for that response and much appreciate his words. His reply was very positive. However, we need to look at the matter again to make sure that we cover all the points that have been raised by previous speakers, whom I thank for reinforcing my sense of the anomaly in payments to kinship carers, particularly grandparents. I might tell my small grandson about Hell’s Grannies; it sounds like a pop group.
We need an amendment or statutory guidance on kinship care which makes the matter clear. I think that the Minister has just done that, but I need to read the debate to make sure. We all need to read it to make sure that we have covered what we wanted to cover. There is a lot of experience and expertise in the Room, including in the Minister and his team. Surely we can come up with something which reassures all of us about payments to kinship carers, especially grandparents. I am sure that we shall have much discussion before Report and perhaps come up with something that is fitting. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Baroness Meacher moved Amendment No. 24:
“Assessment and mental health careIt is the duty of each Primary Care Trust to ensure that a holistic assessment of a looked after child’s health, development and mental health needs is undertaken as soon as a care order has been made, and to ensure that services meet those needs.”
The noble Baroness said: I shall speak also to Amendment No. 25. The Amendment would ensure that the mental health needs of children who are placed outside their own local borough are met. At present, local authorities are reluctant to see placements for looked-after children from other boroughs developed in their own borough, because they know that the provision of services could be
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The British Association for Adoption & Fostering argues the case well for these provisions. We know that 45 per cent of looked-after children aged between five and 17 are assessed as having a mental health problem. In the five to 10 year-old group, 42 per cent of looked-after children have mental health disorders compared with only 8 per cent of children in private households. The case is very strong. The mental health needs of looked-after children have been overlooked to an extraordinary degree when we consider not only the long-term consequences of neglect for the children themselves but also the consequences for the community at large, and, indeed, for the taxpayer.
In theory, we have a universal health service. We have the Department of Heath practice guidance on the health of looked-after children and the national service framework for children, young people and maternity services. However, in the 2004 report Children’s health, our future, which reports on the progress of implementing the national service framework, there is not one mention of looked-after children. Care Matters sets out an objective to publish statutory guidance on the health of looked-after children.
The British Association for Adoption & Fostering is rightly very sceptical. It takes the view that the barriers to implementation are so significant and the problems so longstanding that only with primary legislation, including our Amendment No. 24, will sufficient priority be given to addressing this considerable problem. Introducing such a duty in the Bill would put health on an equal footing with education, where a clause gives a statutory basis, as we all know, to the designated teacher role in every school. If a looked-after child needs a school place, they get to the top of the list automatically. This is not the case for mental health services. Yet, without mental health care, these children will not be able to take advantage of the education. Similarly, if a looked-after child is physically ill, they will become inpatients or go for emergency treatment and get to the top of the list for whatever their needs are.
When I raised this issue at Second Reading, the Minister responded by saying that looked-after children have a mental health assessment under present arrangements. I checked that out. My understanding is that all looked-after children have a general medical assessment undertaken by and large by a nurse, but probably not a mental health nurse.
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Research from the Social Services Inspectorate suggests that 23 per cent of adult prisoners had been in care at some time. About 46 per cent of young people in custody have had some experience of the care system. That shows that the Minister is not the only person providing facts to the Committee. The evidence in support of these amendments is overwhelming, I hope therefore that he will support them. I beg to move.
Lord Judd: I happen to agree with the noble Baroness, Lady Meacher, that the arguments are overwhelming. I always find her arguments when she is speaking in favour of a proposition, clear, concise and extraordinarily well assembled. I really think it would be difficult to add anything to the very convincing arguments she has put forward. I only emphasise that the reason I put my name to this amendment is that it comes into the whole area of prevention rather than cure. The long-term implications for the youngsters concerned, if this sort of thing is not done effectively, are severe. The cost to society can be extraordinary because, as all of us know—and I am sure that the noble Lord, Lord Ramsbotham, may have something to say about this—it is true that our prisons are full of people who should never be in prison because they are basically there as a result of mental health problems. Here we are, if we do not make effective provision, aiding and abetting that extraordinarily negative process.
I warmly welcome the amendment. I am glad at the same time to express a word of support for Amendment No. 47, spelling out the responsibilities of primary care trusts, and Amendment No. 92, setting out exactly how assessment should be made. I hope that the Minister will feel able to take these points seriously. As I have said before, I do not see the point of the Moses Room process unless it is turned into a prelegislative process in which the Minister has a chance to take on board the arguments and go away and think about them before we get to what we have turned the Report stage into—a de facto Committee stage, when we actually take votes. So I hope that my noble friend will listen.
7.30 pm
Baroness Massey of Darwen: In Amendment No. 92, I seek assurance from the Government that they will fulfil their commitment set out in Care Matters to make the guidance on the health of looked-after
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The NSPCC passed me some Ofsted statistics today that showed that for the 12-month period up to September 2006 one in five children in care received no health assessment, which means that 8,888 children did not receive any assessment at all. What the figures do not show is that in a significant number of cases the assessment will be only a basic health check and will not consider the child’s emotional and mental health needs. Clearly, that system needs changing.
Looked-after children and young people are often disproportionately affected by physical and mental health problems, such as many different physical complaints, mental health disorders, high rates of self-harm or other high-risk behaviour, substance misuse and high rates of teenage conception and motherhood. This can obviously result only in them not achieving, or not achieving so well, across the five Every Child Matters outcomes of being healthy, staying safe, enjoying, achieving and making a positive contribution. I also know that some children—for example, children from black and minority ethnic groups and with disabilities—have health problems that may be more severe than those for children who do not have those disabilities.
The Comprehensive Spending Review talks about the health and well-being of children and young people overall, in PSA target 12, and improving emotional health and well-being, particularly the emotional health of children in care, which is priority 4 of the same PSA target. There is the Healthy Care programme—perhaps the Minister could say something more about this—which seeks to develop Healthy Care partnerships across England, funded by the Department for Children, Schools and Families and developed by the NCB. The programme is rolling out across 90 local authorities via local multi-agency partnerships. That provides an excellent model for partnership working between local authorities, healthcare bodies and other partners. However, the responsibilities must be set out in legislation to ensure that looked-after children and young people experience improvements in their physical, mental and emotional health outcomes. Perhaps the Minister could give some detail on how these partnerships might work and how the Department of Health guidance, Promoting the Health of Looked After Children, can be developed on a statutory footing and revised to clarify the role of PCT chief executives in prioritising the health of looked-after children at the PCT board level. I realise that that is not his specific responsibility but I think that it overlaps with this amendment.
Baroness Sharp of Guildford: I wish to speak in support of Amendments Nos. 47 and 24, both of which have my name and that of my noble friend Lady Walmsley attached to them, and of Amendments
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We on these Benches are particularly concerned about the lack of assessment and treatment for mental health problems, which, as has been explained, we feel are particularly prevalent among looked-after children. Regulations are in place which state that the health assessment should have regard to mental and emotional health, but there is no requirement for assessments in these areas to take place; nor is there a requirement for assessments of emotional well-being or mental health to be conducted by individuals with training and/or expertise in the fields that they are assessing. Furthermore, there are examples where assessments have not occurred as soon as reasonably possible and where therapeutic care has not been provided due to a breakdown in communication between local authorities and the health agencies concerned. One example has been quoted in the briefings that we received of a foster parent who said in interview:
“[The child] destroys everything in his sight. He self-harms, doesn’t sleep, doesn’t get on with other members of the family, isolates himself, needs 24 hours of supervision, he pulls his hair out, pulls his finger nails off ... [the child and adolescent mental health services] won’t work with him as he is not in a permanent placement. They see him to monitor his medication but do no one-to-one work”,
Some 90,000 children will pass through the care system in any one year, and there are 60,000 children in care at any one time. Approximately 37,000 of these children are in care explicitly for reasons of abuse and neglect. They will have experienced emotional trauma, often over a sustained period, and it is reasonable to assume that a high number will have had experiences which may impact on their emotional well-being. It is essential that PCTs and CAMHS pull their weight alongside other partners in children’s trusts. Evidence to date suggests that that is not happening, which is why in these various amendments we wish to give some statutory backing to the duties placed on them.
Specifically in relation to Amendment No. 47, we note that the forthcoming public service agreements for 2008-11 are consistent in setting out the health and well-being of children and young people as a government and public service priority. In particular, PSA 12, whose aim is to improve the health and well-being of children and young people, is a key area for all children’s trust partners to work towards. PSA 12 is supported by other, equally important PSAs. The aim of PSA 10 is to raise the educational achievement of children and young people; PSA 11 aims to narrow the gap in educational achievement between children from lower-income and disadvantaged backgrounds and their peers; and PSA 18 seeks to promote better health and well-being for all.
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