Children and Young Persons Bill [HL]

My Lords, we are all agreed that it is vital that we improve the health of looked-after children. We also agree that doing this requires us to improve both the proportion of looked-after children who receive health assessments—both initial and ongoing assessments—covering their physical, emotional and mental heath and the quality and timeliness of these assessments. To reinforce the existing legislative framework, we will put revised guidance on promoting the health of looked-after children on a statutory footing for health bodies as well as local authorities, using the powers in Sections 10 and 11 of the Children Act 2004. The revised guidance will be statutory for primary care trusts, strategic health authorities, NHS trusts, NHS foundation trusts and local authorities. Responding specifically to the questions posed by the noble Baroness, Lady Meacher, as to what this revised guidance will cover, it will cover health assessments for looked-after children, including their physical, mental and emotional health; health plans, including the implementation of these plans through the provision of appropriate health care; the involvement of qualified medical practitioners in health assessments and health reviews; the timescales in which the initial health assessment and reviews must be completed, a particular point that the noble Baroness raised; health promotion; the provision of targeted child and adolescent mental health services for looked-after children, which we know are important for improving their mental health; and the roles and responsibilities of health bodies and local authorities, including, to respond to the point of the noble Baroness, Lady Sharp, how they should work together to improve the health of looked-after children. I hope that that addresses the noble Baroness’s concerns relating to the timeliness of health assessments and reviews, the qualifications of those carrying out the reviews and the involvement of health services. The noble Baroness also raised the issue of whether health bodies will have only to ““have regard”” to this guidance. I can assure her that this does not mean it is in any way optional. Health bodies, when exercising any discretion, and particularly when making decisions about delivery of services, will have to take proper account of the guidance and follow it unless they have good reasons not to do so. Failure to have proper regard to statutory guidance would be a ground for impugning a health body’s decision and challenging it thereafter. In the Court of Appeal case of the London Borough of Newham versus Khatun and others, Lord Justice Laws said that, "““an authority is not entitled to depart from guidance given in a circular issued by central government, to which it is obliged by statute to have regard, merely because it disagrees with it””." This underlines, "““what is conventional law, namely that respondents to such a circular must (a) take it into account and (b) if they decide to depart from it, give clear reasons for doing so””." There are strong duties on health bodies in respect of the guidance that I have set out. The revised 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 five priorities for the NHS. The JSNA forms the basis of local authority and PCT commissioning. Statutory guidance on the joint strategic needs assessment states explicitly that it should take particular account of the needs of vulnerable groups such as looked-after children. In addition, from April, the NIS forms will form the basis of all local area agreements and the new local government comprehensive area assessment. They will include indicators on the emotional health of looked-after children, placement stability and the timeliness of care reviews as well as indicators on the education of looked-after children, the proportion of care leavers in education, employment or training at 19 and adoption. Improvements to the health of looked-after children will be monitored through our existing data collection systems, the new indicator on the emotional health of looked-after children and the Ofsted-led programme of inspection of services and outcomes for looked-after children. My officials are currently discussing this programme of inspection with Ofsted. I hope that that meets the concern of the noble Baroness in respect of monitoring. Finally, on Amendment No. 33, the noble Baroness is right to raise the issue of ensuring that we use the most effective interventions in our work with the most vulnerable children and families. The Care Matters White Paper makes several references to the use of the term ““evidence-based interventions”” both for families where children are on the edge of care and for carers for looked-after children. The broad definition of such an intervention is that it has been the subject of reliable evaluation, preferably using a randomised control trial. As part of our wider parenting strategy, we are piloting nurse-family partnerships, which are aimed at vulnerable new mothers, and family intervention projects, which are comparing the use of Webster-Stratton and triple P programmes. I particularly draw attention to the plans set out in Chapter 2—on page 37—for multisystemic therapy. MST has a strong evidence base in the US and my department is funding 10 pilot sites jointly with the Department of Health. In addition, the Department for Children, Schools and Families intends to support a single pilot of a new MST programme, which has a focus on child abuse and neglect rather than anti-social behaviour, as part of a wider international pilot. We take the noble Baroness’s points about evidence-based interventions very seriously in our work with vulnerable children and young people.