Children and Young Persons Bill [HL]

moved Amendment No. 32: 32: After Clause 29, insert the following new Clause— ““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 the local authority the Primary Care Trust (““PCT””) or, where there is no relevant PCT, the Health Authority, 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, for the area in which the child is living for the physical, emotional and mental health care of the child.”””” The noble Baroness said: My Lords, I propose the insertion of two new clauses after Clause 29. I had it in mind to cut my speech down because it is very late, but a lot of people are relying on me to put some points here, so I hope that the House will bear with me. The amendments provide for health assessments and care for looked-after children and young people, and evidence-based therapeutic interventions. I shall focus first on health assessments in Amendment No. 32. The purpose of the amendment is to strengthen arrangements between primary care trusts and local authorities to assess and meet the physical, emotional and mental health needs of children in care. The aims are to ensure the provision of those services, and that the practitioner conducting the health assessments has the required qualifications and experience. That is simply not the case at present, I am told. The amendment also aims to ensure that the health assessments take place within a reasonable period after the child enters care. I understand from the Bill team that we have no idea how many of the children have the assessments within a reasonable period. Finally, the amendment provides a clear expectation that appropriate support for children, young people and carers, including therapeutic support or mental health services, will be provided for children who have experienced abuse and neglect and have been assessed as needing that care. The amendment is strongly supported by the NSPCC, the Who Cares? Trust, the LGA, the National Children's Bureau and others. They wanted me to emphasise that it reinforces the Care Matters White Paper and other significant government policies, as the Minister will be well aware. The Minister assured the Grand Committee that the Government would fulfil their commitment to place the relevant guidance on health assessments on a statutory footing. He also referred to the statutory authority for such assessments being in Sections 10 and 11 of the Children Act 2004. The Bill team explained to me that a raft of guidance would be produced on these issues. The reason for bringing the amendment to the House is that I—along with the NSPCC, the Who Cares? Trust, the LGA, the NCB and others—believe that the current legislation, even with all those assurances, does not ensure that children and young people will receive timely health assessments, including mental health assessments. The amendment would fill the gaps in the legislative framework. The disproportionately poor health outcomes of looked-after children were well rehearsed in Committee and I want to make only one of the points now, which is that 45 per cent of looked-after children and young people aged 5 to 17—27,000 in all—have an emotional or mental health disorder. However, only about a third of those—9,500—receive any support from the child and adolescent mental health services. Ofsted found that only one local authority had a 100 per cent achievement of initial assessments. The poorest performing authority achieves only 48 per cent, but only if those assessments are undertaken can we know the demand for services. Only then will services be provided at a satisfactory level for those children. The amendment is the building block on which there may be some hope at some point of having the services available. In relation to the amendment, I hope that the Minister will be willing to give a number of assurances to the House. First, the Staying Safe: Action Plan states that the Government will work, "““with the Healthcare Commission on measures to hold PCTs to account in providing services for children and young people””." Will that include measures relating to the health of looked-after children, and could the Minister provide some details of that? Secondly, will issues around the physical, emotional and mental health and well-being of children in care be included in the Government's forthcoming children and young people's health strategy, referred to in the children's plan, and, again, could he provide details? Incidentally, I provided all this information to the Bill team, so I hope that the Minister may have some information available. Thirdly, current regulations state only that the medical practitioner carrying out a health assessment must ““have regard”” to their mental and emotional health. Will the revised regulations under the 1989 Act specifically address the emotional and mental health needs of looked-after children who have been abused? Fourthly, and finally, what plans does the Minister have to monitor the implementation of the revised statutory guidance and to assess its impact on the health of looked-after children? I acknowledge that the Government are committed to placing guidance on the health of looked-after children, as I have made clear, and I very much welcome the Minister’s initiatives on all these issues. The fact remains, however, that the provisions will still be only guidance to which PCTs must have regard. That is my understanding. If that is the case, we know what will happen or, rather, we know what will not happen, from my experience. We believe, therefore, that this amendment would make a substantial difference in reducing the number of looked-after children with ongoing unresolved serious emotional and mental health problems, and would ultimately vastly cut the criminal justice bill. I turn briefly to Amendment No. 33, which proposes that where a family court has recommended the provision of evidence-based therapeutic intervention, it should be the duty of the local authority to make such provision. The aim here is to try to ensure that, wherever possible, the appropriate intensive therapeutic work is undertaken at an early stage with the whole family of a child at risk of being taken into care, in order to try to avoid the need for that child to be taken into care. Since our earlier debate on this issue, I have had a very helpful meeting with the Bill team—as happened regarding my other amendments—who pointed out that the Government are piloting a number of different therapeutic interventions including, for example, functional family therapy, multisystemic family therapy, multidimensional treatment in foster care—which was developed in Oregon, with very promising results—and several other approaches. In the light of that discussion, I have revised my Committee stage amendment to take full account of the likelihood that, over time, the evidence will clarify those interventions that are most effective in different situations or in relation to different family circumstances. The important point, which I hope will persuade the Minister to take this amendment seriously, is that there is now good international evidence in support of therapeutic family interventions. I understand that there is good evidence within the UK of the success of such interventions with young people in the youth justice system. I trust that the Minister will not argue against this amendment on the grounds that we do not yet have the final results of all the evaluations of pilots, particularly bearing in mind, perhaps, the social work practices situation within this legislation. This amendment is carefully worded to take account of the need for flexibility and research findings. I do not wish to repeat any of the arguments that I put during our earlier deliberations. I would remind the House only that I have personal experience of the remarkable results for children’s health, emotional and mental, of intensive family therapeutic interventions. But far more important than my experience is the international and national evidence of the cost-effectiveness of those interventions. I hope that the Minister will respond favourably to both of my amendments. I beg to move.