My Lords, I start by responding to the point made by the noble Lord, Lord Ramsbotham, about the preparation for the Bill and consultation. The Bill has been very widely consulted on, and impact assessments have been conducted, including a full assessment in respect of children’s rights. Ministers and officials meet regularly with representatives of local authorities and the voluntary sector to discuss all aspects of the Bill, and their views are always listened to very carefully. In relation to the provisions on looked-after children and care leavers, we have spoken to the ADCS, the LGA and approximately 20 local authorities on the corporate parenting principles and local offer. Our thinking was also informed by eight meetings of care leavers organised by voluntary sector organisations as we developed Keep on Caring. However, I take the noble Lord’s point about, at certain times, the rush of correspondence and the flurry of activity,
for which I apologise. It has not been easy for any of us, and I will take his points back, again, and ensure that they are taken very seriously.
I now turn to the amendment in the name of the noble Baroness, Lady Tyler, which would place a duty on local authorities to promote the mental health of looked-after children and care leavers. I am grateful to the noble Earl, Lord Listowel, to my noble friend Lord O’Shaughnessy, to the noble Lords, Lord Warner, Lord Watson and Lord Judd, to the noble and learned Lord, Lord Mackay of Clashfern, and to the noble Baronesses, Lady Murphy and Lady Benjamin, for their contributions to today’s debate.
All mental health-related amendments have been discussed with the co-chairs of the expert group for mental health for looked-after children. One of the co-chairs, Alison O’Sullivan, attended a meeting with some noble Lords in September to present the work plan and ambition for its care pathway project. Assessment, and how children access the right support, will be at the very heart of its work. The next stage of the group’s work will see the development of options for a care pathway along with models of care and quality indicators for the mental health of looked-after children. A care pathway is an evidence-based journey that outlines possible treatment options, timescales and the professionals involved in a person’s care. It will consider, explicitly, the pros and cons of carrying out a full mental health assessment on entry to care.
The expert group plans to share the evidence base behind the chosen models and the pathway with interested parties, including noble Lords, in the spring. We are committed to acting on the findings of the expert group, and will fully consider all the recommendations it makes, including any recommendations to legislate. Every local authority is already under a duty to safeguard and promote the welfare of the children they look after. That means not just keeping them safe but considering their emotional well-being. Looked-after children already must regularly receive a comprehensive health assessment by a registered medical professional on entry into care.
Where there is concern about possible mental health or special educational needs issues which require further investigation, local authorities must ensure the appropriate professionals undertake necessary next steps. Access to NHS services is based on the clinical needs of each individual. The current approach of undertaking further specialist assessment where there is an established need allows resources to be targeted appropriately.
Transition between children’s and adult mental health services needs to be managed effectively. However, prescribing the age at which a young person leaves CAMHS fails to recognise looked-after children as individuals with varying needs. NHS guidance is clear that the transition must be carefully planned with the young person and should take place at the time which is right for them. Services should, wherever possible, accommodate this flexibility.
Co-operation between local authorities and clinical commissioning groups is vital. That is why CCGs are relevant partners under Section 10 of the Children Act 2004 and must co-operate with local authority arrangements to promote the welfare of children.
That includes those looked after and care leavers in their area. Innovation projects such as No Wrong Door in North Yorkshire show what can be achieved through multiagency team approaches.
There are numerous examples of joint working across local authority and mental health teams: North Tyneside, Kensington and Chelsea, Croydon, Hartlepool, Sheffield and Trafford to name but a few. So what we want to see is already happening, but just not everywhere. Through initiatives like the Innovation Programme, the Government are supporting this work and will be helping the wider sector to learn about what really works in this area. Services are improved through better planning and commissioning. The needs of this vulnerable group should be addressed through local health and well-being boards and the local transformation plans that all CCGs have produced with local authorities, together with other local partners.
I completely agree with the importance to be placed on identifying and responding to the mental health needs of children in care. That is why, as I have said, every looked-after child is subject to regular physical and mental health screenings. Where any potential issues are identified, a more intensive specialist mental health assessment should be pursued. But we must remember that around 50% of looked-after children have a mental health problem; 50% do not require intensive specialist assessment—these assessments should be used where there is cause for further investigation, not indiscriminately. As I say, if the expert group on mental health recommends that we reconsider this position, we will do so, properly considering all its recommendations, including legislation.
The noble Baroness, Lady Tyler, clarified some of her concerns and who she proposes would carry out these assessments, which I personally found extremely helpful. I will commit not only to meeting her to discuss this matter, but also to try to ensure that the co-chairs of the expert group are also at that meeting to listen to and discuss her points.
I turn to the amendment from the noble Lord, Lord Ramsbotham, which focuses on the needs of looked-after children and care leavers with neurodevelopmental disorders or neurodisability needs. The ability to communicate in order to access learning and improve life chances is something to which the noble Lord is deeply committed. The Government share that commitment, both to looked-after children and care leavers and those with special educational needs. However, we need to take a proportionate and targeted approach to assessing and meeting needs.
The amendment includes a long list of issues that a proposed mental health assessment should cover, all of which may require a specialist assessment. We do not think that screening all children for every condition on that list is appropriate, with children only being sent for specialist assessment where the earlier general assessment has indicated this is necessary. An assessment framework for looked-after children and young people is already in place to ensure their needs are addressed.