Children and Young Persons Bill [HL]

Perhaps I may start in my role as fact-provider-in-chief. The picture before us here is one of much done, but more to do. Between 2003 and 2006, there was a 78 per cent increase in the number of new cases being seen by CAMHS. The size of the CAMHS workforce has risen to its highest level: an increase of 26 per cent between 2003 and 2006. The number of children waiting to access CAMHS is reducing. Approximately 24,000 cases were waiting to be seen by specialist CAMHS at the end of 2006, which was a reduction from 29,000 cases in 2003. The number of looked-after children in social services-targeted CAMHS teams, the initiative to which the noble Baroness, Lady Murphy, referred, rose from 62 in 2004 to 80 in 2006. Although my noble friend was right that not one in five but 17 per cent of looked-after children have not had their annual health assessment, the proportion who have had it rose steadily from 77.1 per cent in 2004 to 83.2 per cent in 2006. All those improvements have been made possible in part by a substantial increase in grant-funding to local authorities for CAMHS, which increased from £10 million in 1999 to £91 million in the current financial year. That grant is ring-fenced. As noble Lords will know, persuading the Treasury to ring-fence is a tough job. Funding to primary care trusts for CAMHS increased from £10 million in 1999 to £50 million in 2005-06. I hope that the Committee will agree that improvements have been made, but there is still more to do. It is precisely for that reason that, in last month’s children’s plan, we announced an independent review of CAMHS, which will look at how we ensure that children’s services support the well-being of children and young people, and provide integrated support across the spectrum of universal and specialist services, including for looked-after children. We are in the process of setting up that independent review, which will report in the summer. I fear that the noble Lord, Lord Elystan-Morgan, anticipated entirely my response on the law. The law currently provides in most but not all respects for what is necessary. There is one important respect in which we propose to make changes and to which I shall refer in a moment. Regulation 7 of the Arrangements for Placement of Children (General) and the Review of Children’s Cases (Amendment) (Wales) Regulations already require that, "““before making a placement, or if that is not reasonably practicable, as soon as reasonably practicable after a placement is made””," a local authority shall, "““make arrangements for a registered medical practitioner to conduct an assessment, which may include a physical examination, of the child's state of health””." The regulations provide also that the health assessment should have regard to the child’s, "““physical, emotional and mental health””." This means that, unless it is not reasonably practicable—for example, it may not be possible to carry out a mental health assessment of a young baby—the assessment must cover each of these elements of a looked-after child’s health. The involvement of health services in these assessments is further underpinned by the duty in Section 10 of the Children Act 2004 for PCTs and strategic health authorities to co-operate to improve the well-being of children. The noble Baroness, Lady Meacher, mentioned the professional status of those who conduct the health assessments. The guidance on promoting the health of looked-after children states that the medical practitioner who carries out a health assessment should, "““have training in the early identification of mental health difficulties””," and that they, "““need a link into CAMHS for advice and consultation and a clear access route to refer children and young people who need more specialist help””." In Amendment No. 47, the noble Baronesses, Lady Walmsley and Lady Sharp, and my noble friend Lord Judd seek to ensure that PCTs have regard to guidance issued by the relevant national authority about the health and well-being of the children and young people who are looked after. The guidance, Promoting the Health of Looked After Children, issued in 2002, is statutory for local authorities, but has no legal status for PCTs and other healthcare bodies. As stated in Care Matters, we intend to make revised guidance statutory for healthcare bodies as well as for local authorities for the first time. That provision is not in this Bill because the statutory authority to do it is given in Sections 10 and 11 of the Children Act 2004. It is on the basis of those sections that we will make the revised statutory guidance applicable to healthcare bodies. That will be a significant change in the direction sought by Members of the Committee. Finally, I shall deal with the issue of Healthy Care partnerships that was raised by my noble friend Lady Massey. My department and the Department of Health have funded the development of the Healthy Care programme for four years using regional and local partnerships to promote the health and well-being of looked-after children. Activities have included improving the understanding of health issues in respect of looked-after children, training for foster carers and the engagement of looked-after children in arts, music and drama programmes. I will write to Members to provide further information about that valuable programme and its future contribution in this area.