My Lords, I have Amendments 34 and 87 in this grouping. I shall deal with Amendment 87 first, for reasons that I hope will become obvious. Both amendments are to do with the mental health and emotional well-being of children in care. I support much of what has been said and proposed in this very wide-ranging grouping; there are many very important issues being dealt with here.
At Second Reading I argued that the bedrock of promoting the mental health and emotional well-being of children in care should be the introduction of an improved system of mental health assessments for children entering care, throughout their time in care and indeed when leaving care. I acknowledge the work that is going on. The Minister has already referred to the current pathway that is being developed by the Department for Education’s expert group. It is indeed promising. However, that does not negate the need for a statutory strengthening of current mental health assessments.
Current statutory guidance states that children must receive a physical health assessment when entering care, whereas it is recommended that their emotional well-being should be evaluated by what is called a strengths and difficulties questionnaire. That is widely regarded as inadequate. The latest figures I saw suggested that around only 70% of children in England entering care had these questionnaires completed for them. As we have already heard this afternoon, children entering care often exhibit challenging behaviour resulting from their experiences before entering care, usually to do with abuse and neglect. Moreover, these questionnaires are completed by foster carers, who I am sure are doing their absolute best but who may have little or no training in mental health.
The point of my amendment is that these assessments really should be conducted by professionals with specialist knowledge of the therapeutic needs of children in the care system and how they should be met. The point I most want to emphasise is that the introduction of these mental health assessments for children in care is the first and most basic step towards improving their mental health. However, it is only that. They are a mechanism and not an end in itself. We want to see that these assessments ensure that children in care receive the right support and interventions to deal with their mental health and emotional needs.
This could include a range of things, such as peer support, group working, play or art therapy, counselling or a referral to CAMHS. I was encouraged to hear the Minister say earlier in the debate that access to CAMHS should be based on clinical need. That is absolutely right. However, at the moment, there is precious little evidence that that is happening.
The Minister also quite rightly raised Future in Mind, an excellent report that holds much promise if it is implemented properly. However, recent research by the NSPCC about the local transformation plans, which are the mechanism for implementing Future in Mind, reveals that just 14% of plans contained an adequate needs assessment for children who had been abused or neglected. There is a lot more to do.
As to Amendment 34, much of what I have already said applies. The amendment would introduce a duty to promote children’s physical and mental health and emotional well-being, including a requirement for a designated health professional. Currently, clinical commissioning groups are required to have access to the expertise of a designated doctor and nurse for children in care, whose role is to assist commissioners in fulfilling their responsibility to improve the health of children in care. However, this is not underpinned by primary legislation.
The duty to safeguard and promote the welfare of children in care should also include a particular duty to promote that child’s physical and mental health and their emotional well-being in line with the existing requirement to promote the child’s educational achievement. The two are inextricably linked; a point that was made very clearly by the noble Lord, Lord O’Shaughnessy. All the research tells us that levels of well-being impact on educational attainment and can predict future health, mortality, productivity and income outcomes. There is an awful lot at stake here.
The effect of this amendment would be that all clinical commissioning groups must appoint at least one person who is a registered medical practitioner or registered nurse who will be required to discharge this duty, building on the existing role of the designated doctor. This would put the requirement for the appointment of a designated health professional on the same statutory footing as the requirement for local authorities to appoint a virtual school head and a designated teacher. I see this as another piece of parity of esteem.
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