Children and Young Persons Bill [HL]

moved Amendment No. 24: 24: After Clause 7, insert the following new Clause— ““Assessment and mental health care Assessment It is the duty of each Primary Care Trust to ensure that a holistic assessment of a looked after child’s health, development and mental health needs is undertaken as soon as a care order has been made, and to ensure that services meet those needs.”” The noble Baroness said: In moving the amendment, I shall speak also to Amendment No. 25, which would ensure that the mental health needs of children who are placed outside their own local borough are met. At present, local authorities are reluctant to see placements for looked-after children from other boroughs developed in their own borough, because they know that the provision of services could be considerable. Kent, for example, provides large numbers of placements for looked-after children from east London. Why should Kent foot the Bill for CAMHS for those children? We have already discussed an amendment designed to ensure sufficient local authority placements in each local area. The Minister assures us that such provision will be made even under the Bill as it stands, but, however it is done, it is likely to involve negotiation between neighbouring local authorities to provide placements for their looked-after children. Such negotiations must be based on a clear understanding of the responsibility for funding the services for those children. The British Association for Adoption & Fostering argues the case well for these provisions. We know that 45 per cent of looked-after children aged between five and 17 are assessed as having a mental health problem. In the five to 10 year-old group, 42 per cent of looked-after children have mental health disorders compared with only 8 per cent of children in private households. The case is very strong. The mental health needs of looked-after children have been overlooked to an extraordinary degree when we consider not only the long-term consequences of neglect for the children themselves but also the consequences for the community at large, and, indeed, for the taxpayer. In theory, we have a universal health service. We have the Department of Heath practice guidance on the health of looked-after children and the national service framework for children, young people and maternity services. However, in the 2004 report Children’s health, our future, which reports on the progress of implementing the national service framework, there is not one mention of looked-after children. Care Matters sets out an objective to publish statutory guidance on the health of looked-after children. The British Association for Adoption & Fostering is rightly very sceptical. It takes the view that the barriers to implementation are so significant and the problems so longstanding that only with primary legislation, including our Amendment No. 24, will sufficient priority be given to addressing this considerable problem. Introducing such a duty in the Bill would put health on an equal footing with education, where a clause gives a statutory basis, as we all know, to the designated teacher role in every school. If a looked-after child needs a school place, they get to the top of the list automatically. This is not the case for mental health services. Yet, without mental health care, these children will not be able to take advantage of the education. Similarly, if a looked-after child is physically ill, they will become inpatients or go for emergency treatment and get to the top of the list for whatever their needs are. When I raised this issue at Second Reading, the Minister responded by saying that looked-after children have a mental health assessment under present arrangements. I checked that out. My understanding is that all looked-after children have a general medical assessment undertaken by and large by a nurse, but probably not a mental health nurse. The amendment would ensure that the mental health needs of these children are identified early. I hope the Minister will accept that present arrangements are not working. The cost is of our continuing failure to identify and treat the mental health problems of these looked-after children is considerable. Up to 90 per cent of young people in custody have some kind of mental health problem, including 10 per cent who manifest signs of schizophrenia. Children and young people in care are around three times more likely than other children to be cautioned or convicted of an offence while in care, and, I guess, quite a lot of that has to do with the child’s mental instability of one sort or another. Research from the Social Services Inspectorate suggests that 23 per cent of adult prisoners had been in care at some time. About 46 per cent of young people in custody have had some experience of the care system. That shows that the Minister is not the only person providing facts to the Committee. The evidence in support of these amendments is overwhelming, I hope therefore that he will support them. I beg to move.