Looked-after children and young people
This is an extract from the guidance and may be misleading if read alone. The complete guidance is available at guidance.nice.org.uk/ph28
2 Context
Experiences of looked-after children and young people in England
About 60,900[22] children and young people were looked after by local authorities in England in 2009 (year end 31 March) (Department for Children, Schools and Families 2009a). This was 2% more than in 2008 but the number had changed little since 2005.
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The number of boys who were looked after increased during 2005 to 2009, while the number of girls decreased.
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The number of white children and young people who became looked after decreased during 2005 to 2009, while the number of Asian children and children from other black and minority ethnic groups increased.
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About 40% of the total in 2009 were children younger than 10, but in recent years there has been a decrease in the numbers aged 5–9 and a significant increase in the number of over-16s who are looked after.
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Most looked-after children (about 73% in 2009) were in foster care, about 13% were in residential settings and 10% were placed with parents or were living independently (no separate figures are available for care by family and friends).
Early experiences may have long-term consequences for the health and social development of children and young people. A number have positive experiences in the care system and achieve good emotional and physical health, do well in their education and have good jobs and careers. However, entering care is strongly associated with poverty and deprivation (for example, low income, parental unemployment, relationship breakdown).
About 60% of those looked after in England have been reported to have emotional and mental health problems and a high proportion experience poor health, educational and social outcomes after leaving care (Department for Children, Schools and Families 2009a). However, a small number of research studies and surveys in 2000–2008 have reported improvements in providing settled accommodation and entering employment, further and higher education or training (Stein 2009).
One third of all children and young people in contact with the criminal justice system have been looked after (Department for Children, Schools and Families and DH 2009). However, a substantial majority of young people in care who commit offences had already started to offend before becoming looked after (Darker et al. 2008).
Looked-after children and young people should have clear expectations for their care and wellbeing (Children's Rights Director for England 2007). The report stated that they should expect to take part in decisions that affect their lives, be kept healthy and safe, be treated with respect, and be treated equally to other children and young people. However, local variations in service access and support can mean that these expectations are not always met.
National policy and guidance
There is a wide range of policies and guidance relevant to looked-after children and young people (see the list in section 9).
Statutory guidance on promoting the health and well-being of looked after children
In November 2009 the then Department for Children, Schools and Families (DCSF) published 'Statutory guidance on promoting the health and well-being of looked after children'. This replaced the guidance, 'Promoting the health of looked after children', published by the Department of Health in 2002. The new guidance aimed to remove inconsistencies and promote better-coordinated care. Local authorities, primary care trusts (PCTs) and strategic health authorities in England should implement it in accordance with sections 10 and 11 of the Children Act 2004. Local authorities must also comply under section 7 of the Local Authority Social Services Act 1970 with duties to promote the health of looked-after children and young people[23].
The revised document also includes practice guidance on access to services, care planning and placement quality, physical health and health promotion.
Care planning, placement and case review regulations and statutory guidance for local authorities
In March 2010, the DCSF published 'The Children Act 1989 Guidance and Regulations volume 2: care planning, placement and case review' (2010). This document was issued as part of a set of statutory guidance which, together with the 2010 regulations, defined the core duties primarily of local authorities for ensuring more purposeful care planning, placement and review for looked-after children and young people. Associated documents include the 'IRO handbook' (DCSF 2010a) and the 'Sufficiency guidance' (DCSF 2010b) on securing sufficient accommodation for looked-after children.
The regulations and guidance propose to strengthen the role of the social worker as 'frontline corporate parent' and the role of the independent reviewing officer (IRO) for monitoring the performance of the local authority in properly managing and implementing the care plan. The main aim is to put the child at the heart of the care planning process. The guidance also sets out how to meet the accommodation needs of the child and ensure an effective and timely review of the child's case.
Inspection guidance and standards for looked-after children outcomes and services
Ofsted's 'Framework for inspection and guidance for local authorities and partners' (2009) sets out the process and scope of integrated inspections (with the Care Quality Commission) and identifies inspection topics, including quality of care planning and review, corporate parenting approaches and education outcomes. A limited revision to the framework is expected to be published in Autumn 2010 to reflect feedback from the first year of inspections.
At the time of writing this NICE/SCIE guidance in September 2010, the Department for Education's national minimum standards for adoption, children's homes and fostering were being revised after a consultation (DCSF, 2009b). The standards are for use by Ofsted and may be used by providers for self-assessment of their services. They aim to achieve positive welfare, health and education outcomes for children and young people, and reduce risks to their welfare and safety.
[22] Figures released by the Department for Education in September 2010 put this figure at 64,000 for the year ending 31 March 2010. Of these, 52% are children and young people taken into care because of abuse or neglect, and this figure has increased since 2009.
[23] It includes statutory guidance on: joint working and responsibilities; performance management and inspection; commissioning responsibilities; out of authority placements; notifications of placements; frameworks for healthy care; service management and delivery; health plans; care planning; assessment; child and adolescent mental health services (CAMHS); leaving care; involving children and young people; the roles of the social worker, health and other professionals (including the independent reviewing officer, lead health professional, designated doctor and nurse); and access to positive activities.