Report: Schools Can Make Huge Difference to Children’s Mental Health

On the 16th of November, I asked for the Government’s response to the Values-Based Child and Adolescent Mental Health System Commission ‘What Really Matters in Children and Young People’s Mental Health’.

I called on Government to recognise a key recommendation of the report, that schools if properly funded and supported, have the potential to make a really big difference to improving children’s mental health.

You can find my questions and the debate in full here.

Mental Health Assessments for Children Entering Care

On the 18th of October, I tabled an amendment to the Children and Social Work Bill calling for mental health assessments for children entering care.

This proposal would simply extend the scope of physical health assessments that are already in place to include an initial mental health assessment.

You can find my speech in full here.

My amendment is designed to ensure that we can achieve some practical improvements to the care that children receive. It introduces mechanisms that will ensure that the mental health needs of children entering care are properly assessed and that they have access to specialist support if this is needed. Basically, the amendment has two elements: first, a mental health assessment for children entering care, carried out by a qualified professional; and, secondly, a designated health professional in each local authority who has strategic oversight of the outcomes of the assessments and matches those with the services that are available for children in care to support their needs.

In short, this amendment seeks to establish a mechanism that will identify children’s needs early on, refer the children to the right services and ensure that services exist that children in care are able to access—and access easily. This joined-up approach is supported by the Alliance for Children in Care, a coalition of leading children’s charities, as well as the Royal College of Nursing, the Royal College of Paediatrics and Child Health, and the Royal College of Psychiatrists.

National Disgrace: Premature Deaths of People with Learning Difficulties

On the 17th of October, I made a speech in the Lords about the shocking statistics concerning premature deaths of people with learning difficulties. I called for mandatory participation in learning disability mortality review.

You can find my speech in full here.

We have already heard, from the noble Baroness, Lady Rawlings, the shocking statistics that men with learning disabilities die, on average, 13 years sooner than men in the general public and women with learning disabilities die 20 years sooner. Overall, 22% of those people were under 50 when they died. These are not just dry statistics, they are deeply shocking and nothing short of a national disgrace. Perhaps the most shocking statistic of all is the confidential inquiry’s finding that 37% of deaths were potentially avoidable if good quality healthcare had been provided.

As we have already heard from the confidential inquiry, one of the 18 key recommendations was the establishment of a national learning disability mortality review. A key part of the review programme, commissioned again by NHS England, is to support local areas to review the deaths of people with learning disabilities and take forward the lessons learned to improve services. I am sure we all think that is what should happen. So far, so good. However, as has already been referred to by the noble Baroness, Lady Hollins, participation in the programme is not mandatory, so, unlike the child death review process, and, indeed, many other inquiries, agencies can choose whether or not to contribute to the review of deaths of people with learning disabilities. In the current financial climate, I guess it is understandable that many organisations choose to do only what they have to. In my view, giving this issue mandatory status would undoubtedly raise the profile of the work and show that the lives and deaths of people with learning disabilities are valued. That is the crux of what we are talking about tonight.

Underfunding Prevents Successful Service Transformation

On the 8th of September, I made a speech in the Lords underlining the impact of the 2012 Act on health and social care. I noted that there is simply not enough money to do all the things asked of the health and social care system at a time of rising demand from a growing and ageing population.

You can find my speech and debate in full here.

As we have heard, the 2012 Act introduced major structural changes—I am not going to run through them again—but how has the system responded to these changes in the face of huge financial and operational pressures? To answer that question it is important to highlight some key factors. First, whatever their rights and wrongs, the geography of clinical commissioning groups is not strategic. Simply put, there are considerably more CCGs—some 209—than there are hospitals, of which there are just over 150. That is not helpful. Such fragmentation militates against strategic planning and decision-making.

The simple truth is that there is not enough money in the system to do all the things being asked of the health and social care system at a time of rapidly rising demand from a growing and ageing population—and that is before we come to the newest policy goal of seven-day working. We would all like to see that in an ideal world, but it must be properly resourced and planned if it is ever to become a reality. The current approach of trying to ram it through on resources that are not really adequate for five-day working, let alone seven, is clearly not viable.

Status of EU Nationals in Health and Social Care Post-Brexit

On the 21st of July, I made a speech in the Lords calling on the Government to clarify urgently the status of EU nationals working in health and social care in the UK.  I also underlined how important it is that NHS providers retain the ability to recruit staff from the EU.

You can find my speech in full here.

As we have heard in the debate, the UK’s vote to leave the EU will without doubt have major implications for health and social care, not least because it has ushered in a period of major economic and political uncertainty at a time when the health and care system faces huge operational and financial pressures, as we have debated so many times in this Chamber. The NHS faces an extremely challenging set of circumstances. Demand, particularly from our ageing population, continues to grow faster than funding, putting further pressure on an already strained service. Fundamental change in how we provide care is urgently needed if the NHS is to be successful in meeting the twin challenges of providing high-quality services while balancing the books. To do this it is vital that we have the right numbers of staff with the right skills in the right place, and ensure that they feel valued, welcome and engaged in the work that they do—hence the debate we are having this afternoon.

I end by raising an issue that the noble Lord, Lord Bilimoria, also mentioned. It is about that lie—that most flagrant and disgraceful lie—of the leave campaign. I have to say that there was very stiff competition for that particular accolade, but it is the lie where we were told that £350 million extra per week would be available for the NHS—it was plastered all over the campaign buses. Then of course it was retracted, even before the ink was dry on the results. But the public, quite understandably, now have an expectation that NHS spending will rise after the UK leaves the EU. I have never been very good at maths but I just made a little calculation. It is four weeks now—to the day, I think—since the referendum, so my calculation tells me that, four weeks on, £1.4 billion is now owed to the NHS. Can the Minister tell us whether that money has yet been received and, if not, how quickly he expects that money to be in the Department of Health coffers?

Worrying Retention Rates and Increased Workload of Social Workers

On the 13th of July, I made a speech in the Lords expressing my concerns regarding the setting up of a new regulator. I, along with many others, voiced concerns about the high drop-out rates and increased workloads of social workers.

You can find my speech and the debate in full here.

I was taken with the report that I saw on the BBC this morning about the Commons Education Committee which said that urgent action is needed regarding social workers’ case loads. It drew attention to high drop-out rates leading to increased workloads. It said that these problems must be tackled, particularly the endemic retention problems in the profession. These are the issues that are crying out for urgent attention, and that is my first concern about diverting our attention from them.

Importance of Sibling Contact for Children in Care

On July the 6th, I made a speech in the Lords calling for children in care to have more sibling contact. This is important as children who have regular contact with their siblings tend to do better in terms of outcomes.

You can see my speech and the debate in full here.

It is absolutely the case that relationships with siblings are often the most enduring that those children have. Indeed, as we have just heard from the noble Lord, Lord Warner, they can be as important to children as the relationship with their parents, particularly if they have supported each other through difficult times.

Healthy Relationships at Heart of Care System

On the 4th of July, I made a speech in the Lords calling for the Children and Social Work Bill to include explicit reference to relationships. It is essential that we put healthy relationships at the heart of the care system.

You can see my speech in full and the rest of the debate here.

There is an absolute wealth of research reports, including those from the Centre for Social Justice, concluding that if we do not put strong, healthy relationships at the heart of the care system, we will never see the improvement in life chances that we are all ambitious for. At Second Reading, I talked about the need for ambition—for setting ourselves a higher standard. We simply cannot treat the presence of strong relationships in the lives of children who have been in care and are leaving care as a “nice to have”. That is not just good enough. Strong relationships are of fundamental importance to any young person in their transition to adulthood. Without someone who will provide unconditional love and acceptance, the challenges that the world presents can sometimes seem unsurmountable. Such relationships must be a fundamental element of young people’s care-leaving packages. Those young people need to know how to draw on the resources inherent in good-quality relationships; for example, how to handle misunderstandings and perceived slights, and the constant need for compromise—give and take, if you like.

Corporate Parenting Principles Should Apply to Health Commissioners

On the 29th June, I made a speech in the Lords calling for the new corporate parenting principles to apply to commissioners of physical and mental health services for children in care and care leavers.

You can find my speech in full, as well as the rest of the debate here.

I believe that the corporate parenting principles should be extended to health commissioners, reflecting the vital role that these bodies play in shaping the lives and outcomes of children in care and care leavers. As we know, these children are much more likely than their peers to have poor physical, mental and emotional health. To give one example, children in care in England are four times more likely than the average child to have an emotional or mental health problem. That is an issue we will return to in a subsequent group.

Supporting the Mental Health of Children Entering Care

On the 14th of June, I made a speech in the Lords calling for the Children and Social Work Bill to include a statutory mental health assessment for children entering care. I also underlined the importance of recognising the value of social workers to society.

You can read the full text of my speech here.

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 through a strengths and difficulties questionnaire. Frankly, this is not sufficient or good enough; we need to be aiming higher. Children entering care often exhibit challenging behaviour resulting from their previous experiences—most often, neglect and abuse. Indeed some 45% of children entering care have a diagnosable mental health condition and some 60% are estimated to have emotional or mental health problems of some kind. But the questionnaires I mentioned earlier are completed by foster carers, who may have—it is not their fault—little or no training in mental health. These assessments should be conducted by professionals with specialist knowledge about the therapeutic needs of children in the care system.

Once the needs of a child entering care have been identified, it is also essential that they are offered the appropriate support to enable recovery. A recent survey conducted by the NSPCC highlighted that almost 80% of professionals think that accessing support for children with a diagnosable mental health condition has become harder in the past five years. The NSPCC’s recent analysis of local transformation plans to support the implementation of the Future in Mind report recommendations, in relation specifically to children in care, is not particularly encouraging.

We badly need to develop a holistic approach towards the mental health and well-being of children in care. It is not rocket science; it just needs to be given a far higher priority. A statutory entitlement to a mental assessment would provide the necessary catalyst to action.

The stereotypical and often very negative portrayal of social workers in the press is far from the reality that I encounter in my daily work. I feel that we in this House have a duty to ensure that their value to society is recognised—indeed, the Minister made that point in his opening remarks—and that their professional standing is enhanced. Of course improvements must be made, but this must be done with a clear understanding of the overall context, which other noble Lords have already referred to. It is one of rising demand leading to ever-larger case loads, of falling resources and high turnover, and a workforce who can often feel beleaguered. We ask social workers to do one of the toughest jobs there is; it is incumbent upon us to give them the support and backing they need. The lives of some of the most vulnerable children in our country depend on it.