- Motion made, and Question proposed, That this House do now adjourn.—(Gareth Johnson.)
- 2:39 pm
- Sir Charles Walker (Broxbourne) (Con)Sadly, some children and young people are not able to live safely with their families. The significant majority of these children have experienced trauma at a point during their developmental years, resulting in a range of behaviours, many of which cause distress to them or others. Those behaviours include self-harm and an increased vulnerability to criminal exploitation.If a young person is unable to live safely at home, he or she may come into the care of the local authority or require hospital care. There is currently an insufficient supply of specialist care to meet the needs of such young people. As a result of the challenges posed by covid-19, health and social care professionals describe an unprecedented level of complexity and acuity of need, making an already difficult situation worse.When a young person comes into care they will require either a children’s home, with staff skilled and experienced in meeting complex needs, or in some instances a court-directed placement into a secure unit, to keep them safe. Over the past 18 months, Hertfordshire children’s service has made three applications to the national secure bed bank. Despite repeated referrals, a secure placement was achieved for only one child. The most recent referral was made approximately six weeks ago, and on that occasion the local authority was advised that there were 50 referrals for only four available beds. That means that a secure bed was not available for 46 young people who had been assessed as requiring such accommodation to keep them safe. In each of those cases, the relevant authorities, including Hertfordshire, were required to make their own arrangements while the secure referral remained active.Increasingly, local authorities turn to the courts for a deprivation of liberty order in the absence of more appropriate secure placements. Such orders are sought as a last resort, even though when granted they can place local authorities in the invidious position of having knowingly to place children in environments that are not best suited or equipped to meet their complex needs. Similarly, young people who require psychiatric hospital care find such care unavailable because of a shortage of appropriate hospital beds. In Hertfordshire, a number of young people have been assessed as detainable under the Mental Health Act 1983 and are waiting for appropriate hospital beds. The number waiting for a placement often rests at around 10 children, which means that in each of their cases their needs are not being met.Despite people’s best efforts, the whole system is creaking because it is unable to cope with the demand. Problems with recruitment and the increasing complexity of some children’s needs mean that Ofsted and the Care Quality Commission too often find themselves in the position of having to close providers down, or reduce their bed capacity. It is important to note that there is a difference between physical beds and usable beds. Many beds are not in service because, in meeting the increasingly complex needs of children in care, there is not the staff capacity safely to service all the available beds in a home.Not only is the current situation having a detrimental impact on young people, but its impact on the public purse is significant. Delivering bespoke care to a young person, often through a commissioned provider, is very expensive, particularly because these young people, due to the risks they present, will require high staffing levels. Placements are expensive: they can cost from £4,500 a week to upwards of £30,000 a week. Often, a child who has difficulty accessing support further down the needs scale quickly ends up requiring a far most costly set of interventions and specialist care.It is of course important to intervene early to work with young people in the community to prevent family breakdown and the escalation of needs, but the current placement situation must be addressed, so in this debate I wish to ask regulators to work with the care sector to reopen closed beds through the development of a specialist taskforce that supports providers—be they mental health providers, social care providers or specialist schools—that struggle to deliver good-quality care. Alongside such efforts, we should make a national intervention to reassure providers that their Ofsted rating will not be negatively impacted if they admit children with the most challenging of needs. Too often, specialist care providers will refuse these children because they are concerned that if a child absconds or creates a high level of service demand, that will negatively affect their Ofsted rating.We also need a national campaign both to challenge the stereotypes about children in care and to recruit residential childcare officers. Such schemes are already in place for fostering and adoption, and we have Teach First and Think Ahead. A similar programme now needs to be introduced to attract people into child social care and, in particular, the care of children with high levels of need.Backing up this recruitment drive, we need a programme of support to design children’s homes that can accommodate children with the most complex needs but, as I have already said, without extra specialist staff the Government programme to match fund local authorities to develop new children’s homes will face significant challenges. New homes require skilled staff if they are to be viable. Also, in wanting to build new specialist homes, we need to appeal to the better part of people’s human nature, as too many of these specialist homes, when they come up for planning approval, are opposed by local communities.When it comes to registering specialist residential care homes and facilities, we need to find a way of expediting the Ofsted registration process, which can take upwards of three months. In an emergency, a local authority will sometimes use one of its bedroomed properties as a care setting for a vulnerable child or adolescent, with a rota of specialist social care staff in attendance. Without Ofsted registration, such facilities will be operating outside the regulatory framework.
- I hear my hon. Friend’s point about care in the community, which is essential and something we need to focus on. Children and young people with complex needs too often end up in hospital, which is not the right place for them, as they end up being affected by people in hospital with other issues. Care in the community is essential. How can we give local authorities the onus and the investment to make this happen?
- Sir Charles WalkerI thank my hon. Friend for his intervention, and I will come on to that. We need to have the right setting delivering the right care—the care that the child needs. The child needs to be at the centre of that care.How does a care emergency arise? That question is often put to me. Beyond the national shortage of beds, a provider can notify a local authority, with only a few hours’ notice, that it will be terminating a young person’s placement in its facility. They can say, “In just a few hours, you will have this child back. This child is now your problem again.” This practice needs to be eliminated, but eliminating it will only alleviate the need for the provision of emergency accommodation and care; it will not end it. That will be done only through the provision of more beds, in both the social care sector and the psychiatric care sector. In the psychiatric care sector, it is not just the overall quantum of beds that counts; it is also the type of bed. These will cover general adolescent units, provision for those with eating disorders, low-secure units and psychiatric intensive care units.Almost all the concerns I have highlighted and will highlight this afternoon were identified in Sir Martin Narey’s independent review of residential care and in the Government’s response of 2016. We need to implement the findings of this report and tie them into a review of the Care Standards Act 2000 and the children’s homes regulations.If anyone watching or listening to this debate wants to learn more about what is happening in this sector, I refer them to an excellent report by the BBC correspondent Sanchia Berg that can be found on the BBC website, dated 12 November, “The court orders depriving vulnerable children of their ‘liberty’”. The report contains harrowing accounts of what is happening, and they are framed throughout by the concerns of the High Court judge Sir Alistair MacDonald, who is deeply concerned about what he is witnessing in the courts and family courts.Let me return to Sir Martin Narey’s independent review. Beyond its implementation, we need better joined-up care between the NHS and local authorities. The continuing healthcare framework has much to recommend it in relation to children and adolescents, but it is still heavily slanted towards their physical health. A robust commitment to parity of esteem would see the framework cover clinically diagnosed mental illness, as well as the challenges caused by trauma, attachment difficulties and, increasingly, autism. Let me say, as an aside, that all Department of Health legislation should make it perfectly clear that health means mental health and physical health; we cannot have one without the other.
- 2:53 pm
- I thank my hon. Friend the Member for Broxbourne (Sir Charles Walker) for securing this important debate on care for children and young people with complex needs, and thank him for highlighting good practice in his constituency and across his local authority.The Government are committed to ensuring that all children and young people who need care—be that health or social care—receive the safe and compassionate care that we should all expect. We are taking action to support all children and young people’s mental health, and to support those with complex needs to stay well in the community. This support starts at birth.The Chancellor recently announced £300 million for family and early years support in half of upper-tier local authorities over the next spending review period. This includes: £100 million to roll out bespoke parent-infant mental health support to nurture parent-infant relationships, and improve access to perinatal mental health support; £50 million to fund evidence-based parenting programmes; and £82 million to create a network of family hubs. In addition, the Chancellor confirmed £200 million for the supporting families programme, increasing the number of families supported by the programme from 70,000 in 2021-22 to more than 100,000 in 2024-25.For school-age children, we continue to implement the proposals of the children and young people’s mental health Green Paper. In March, we announced £79 million to boost mental health support for children and young people in England. Part of that will accelerate the roll-out of mental health support teams in schools and colleges to cover around 3 million children and young people by 2023. In May, the Department for Education announced funding worth £9.5 million, which will allow up to 7,800 education settings in England to train a senior mental health lead from their staff in the next academic year.
- My understanding of the point that my hon. Friend the Member for Broxbourne was making is that we should make sure that the investment goes into residential care. The Minister is talking about the money and the investment being put into in-patient care, but that should really be put into residential care. Will she please comment on that? In addition, taking that a step further, should areas with residential care and the staff equipped to deal with children with complex needs not eventually get people into supported living so that we can ultimately get them into independent living?
- My hon. Friend makes a very good point, and I will come to that later in my speech.The lead provider works collaboratively with other providers to ensure the appropriate level of in-patient provision in their area; it is important that we have the right mix of provision, whether it is in-patient or community support. They also ensure that the right community services are available to support children and young people when they are discharged to prevent further crises.Wherever possible, collaboratives will aim to provide high-quality alternatives to admission. However, where stays are required, they should be short and close to home in a high-quality, safe and therapeutic service. We must of course ensure that the rights of children and young people who are placed under the Mental Health Act 1983 are respected.We published our White Paper on reforming the Mental Health Act in January 2021, setting out proposals to make the Act work better for people. We are committed to ensuring that the reforms we want to make to the Act also benefit children and young people. We will work to ensure that the rights we plan to introduce for patients are also available to children and young people detained under the Act. Reforms to the Act will limit the scope to detain people with a learning disability or autistic people, helping to reduce unnecessary detentions. To ensure that in-patient settings are therapeutic for autistic people, we are providing £4 million to enable in-patient settings to become more autism friendly.In children’s social care, we are committed to doing everything we can to support local authorities in ensuring that the most vulnerable children are protected and that there are sufficient places for children in their care. The Government have given more than £6 billion in un-ringfenced funding directly to councils to support them with the impact of covid-19 spending pressures, including in children’s social services.
- Sir Charles WalkerOn a point of order, Madam Deputy Speaker. The Minister’s Department asked for my speaking notes, which I provided earlier in the week, but barely a question I raised was answered by her. It is not her fault, but I have just had generalities; we got on to social care when I was talking specifically about care for children with a high amount of need. I am confused: what is the point of providing notes to officials in advance of an Adjournment debate if the Minister is not equipped—it is not her fault—with the speech to respond?
- I took the hon. Gentleman’s raised eyebrows as an indication that he wished to raise a point of order before I adjourn the House. We could have had more time on the debate, so I gave him the opportunity to make the point. The Minister is at liberty to say whatever she wishes at the Dispatch Box—that is not a matter for me—but she may wish to respond to his point.
- Further to that point of order, Madam Deputy Speaker. I promise to write to my hon. Friend on the specific issues that he raised and I will look into them very seriously.
- Sir Charles WalkerFurther to that point of order, Madam Deputy Speaker. I thank the Minister for that kind offer. It was not an attack on her—I think she is as disappointed as I am.
- I appreciate the points that the hon. Gentleman and the Minister have made.Question put and agreed to.
- 3:04 pm
- House adjourned.