National Institute for Health and Clinical Excellence (NICE)
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New guidance seeks to give children in care a better life

Children and young people in care need better support if they are to reach their full potential and enjoy the same opportunities in life as their peers, according to new guidance published today by the National Institute for Health and Clinical Excellence (NICE) and Social Care Institute for Excellence (SCIE). It calls for educational, health and social care organisations, professionals and carers (including foster carers) to work together more effectively to deliver high-quality stable placements that promote nurturing relationships and educational achievement for looked-after children and young people. (The term ‘looked-after children and young people' refers to those looked-after by the state where the Children Act 1989 applies, including those who are subject to a care order or temporarily classed as looked-after on a planned basis for short breaks or respite care.)

Over 60,000 children and young people are under the care of local authorities in England at any one time. While many children and young people have positive experiences in care, many do not and are unable to stay in the same place with the same carers, or attend the same school for extended periods of time. Generally they do worse than their peers in terms of their physical and mental health, and also their education. Few leave school with GCSEs and only 1% of looked-after children go to university, compared with 50% of all young people. (Department for Children, Schools and Families 2009. Figures released by the Department for Education on 30 September 2010 now put this figure at 64,000. 52% are children and young people taken into care because of abuse or neglect which represents an increase on previous figures.

The profile of looked-after children in England is also changing. A disproportionate number of children and young people in care are from black and minority ethnic backgrounds and have particular needs. There are also other groups, such as unaccompanied asylum seekers or those who are gay or lesbian, whose needs are not always met by the care system.

Mental health services sensitive to the needs of children and young people, more stable placements, and improved access to further and higher education, are key to helping them maximise their potential.

This new guidance also highlights the importance for high quality, accessible services and support for young people leaving care during this challenging time in their lives. Early preparation and effective support for young people moving on to independent living is associated with better outcomes in later life.

Colin Thompson, Member of the independent committee that developed the guidance, care-experienced adult and Trustee for charity Voice which supports children living away from home or in need, said: “I've been in care and became a trustee of a charity called Voice to help young people in care who've had similar problems to me. For that reason, I became involved with developing this guidance.

“In many ways I fit the typical stereotype of a kid in care; loads of social workers, failed placements and residential care homes. I was moved around the country and had numerous schools. Although in the end I was lucky. I found a family who are still my family 20 years later and have given me the continuity, acceptance and love that I so craved in my early childhood.

“This guidance highlights how important it is that every child is listened to and their needs and feelings taken into account when considering moving them from one placement to another. It is the obligation of the local authority, health services, education and all the people who work in the sector to ensure children in care have the opportunity to not only fulfill their potential but also become happy, healthy and fulfilled adults.

“We can all make a difference and I sincerely believe that these recommendations will go a long way to improving the lives of these children today and in the future.”

Key recommendations in the guidance include:

  • Place children and young people at the heart of all decision-making that affects their lives. For example, ensure decisions on changing placements are based on the needs of the child or young person, or when their care plan indicates it's in their best interests to move
  • Provide a framework for agencies to help them find the information they need to support the particular needs of children and young people, including those from black and ethnic minority backgrounds and asylum seeking children and young people, in a more effective way
  • Provide practical support and encouragement before and during further or higher education so that looked-after young people have the same opportunities to education and employment as their peers
  • Keep accurate and up-to-date health information and stopping this from being lost in the system by recommending protocols are put in place to ensure that health information follows the child or young person
  • Promote and support ‘life story work', such as ‘later in life letters' (usually written by a social worker who knows the child well, setting out his or her early history), photographs, letters and personal information from birth parents where contact has ceased, to help a child develop their self-esteem and sense of identity
  • The need for health, education and social care professionals to collaborate more effectively to collect, monitor and share information and ensure that information follows the child if they move
  • Regulators and inspectors (including the Care Quality Commission and Ofsted) should audit, monitor and inspect local authorities, NHS and key partners who provide services for looked-after children
  • Universal and specialist training for professionals, primary carers, social workers and independent reviewing officers
  • Ensure carers and their families receive the right support to help them care for a looked-after child or young person through early, high-quality and ongoing support, including early access to more flexible mental health services to help support placement stability
  • Ensure there is an effective and responsive leaving-care service for those preparing for independent living. For example, consider ‘a one stop approach' to the provision of services to enable care leavers to access a range of services in a familiar environment
  • The need to develop and deliver services based on accurate early assessment and intervention including referrals to specialist help

Mike Kelly, Director of Public Health, NICE said: “Although many children in care have positive experiences, many do not and can experience a number of changes both at school and at home during their time in care. The challenges looked-after children face are well-established, so this guidance focuses on ways agencies can work together more successfully to improve the lives of these vulnerable children and young people.

“We know some recommendations are good value for money in the short term, and others are good value for money in the long run. For example, children in care who are supported throughout education are much less likely to become unemployed in later life.

”This guidance should enable professionals in universal and specialist services to make a real difference to the lives of looked-after children and young people.”

Amanda Edwards, Deputy Chief Executive, SCIE: “The role of ‘corporate parent' is one that local authorities take seriously. This guidance focuses on how local agencies can work together by, for example, ensuring that looked-after children have good access to mental health services or that good, joint-agency support is provided to foster parents. One way to improve the quality of life that looked-after children and young people experience is to ensure that the relationship with their carers serves to make a big difference in their lives.”

Dennis Simpson, Chair of the independent committee that developed the guidance and previously a director of social services in an inner London borough, said ‘'Above all importance is the quality of the relationship between child and carer and the child's need to be loved, nurtured and cared for. We know high quality care can help build emotional resilience, a stronger sense of identity, and lead to more stable placements in care.

“What's more, the importance of putting the child at the centre should not be underestimated. It's essential to make sure the child is heard and they can shape their own care planning.

“Inevitably, difficult decisions will have to be made about budgets, but looked-after children should be a priority, as one of the most vulnerable and disadvantaged groups in our society. Our high aspirations for this vulnerable group should not be compromised, even in these difficult financial times.''

Christine Blower, General Secretary, National Union of Teachers, said: “We welcome the report's recommendations for teacher training programmes to include a separate module that ensures teachers are given training on how to meet the needs of looked-after children. We also welcome the recommendations that it is important to have designated trained teachers working alongside other support agencies in schools.

“All too often teachers are left feeling they have insufficient knowledge or support to cope with situations occurring in their classrooms which could be managed if all the above were in place”.

Sue Eardley, Senior Policy Lead Children, Maternity and Safeguarding, Care Quality Commission, said: "It's crucial that those who look after young people in care know what is effective and that they are supported to provide quality services. This guidance provides a powerful tool for planners and regulators to ensure that all services meet the essential standards of quality and safety. The guidance will also ensure regulators and planners are working together to focus on the individual needs of children and young people."

John Kemmis, Chief Executive, Voice, said: “Voice welcomes this excellent report from NICE and SCIE focusing on the most important area for children in care and their development. Young people who have been looked-after by local authorities tell us that what has made the greatest difference to them has been the support for their emotional well-being. Practical help and resources matter but what matters most are relationships, which help them cope with what has happened to them and the support with the challenges facing them and particularly as they leave care.”


Notes to Editors

About the guidance

  • This NICE guidance was developed with the Social Care Institute for Excellence (SCIE).
  • NICE provides public health guidance for England; SCIE has a remit that covers England, Wales and Northern Ireland. This joint guidance will be applicable in England and will also be considered for applicability by the Welsh Assembly Government Department of Health and Social Services (DHSS) and the Department of Health, Social Services and Public Safety (DHSSPS) in Northern Ireland.
  • The guidance covers children and young people from birth to age 25, wherever they are looked-after by the State where the Children Act 1989 applies, including those who are subject to a care order or temporarily classed as looked-after on a planned basis for short breaks or respite care.
  • This guidance is for all those who have a direct or indirect role in, and responsibility for, promoting the quality of life for looked-after children and young people. This includes directors' of children's services, commissioners and providers of health (including mental health) and social care services, directors of public health, social workers and social care managers, carers (including foster carers), local authorities, schools, voluntary and independent agencies, organisations responsible for the training and development of professionals, universities and colleges, regulatory bodies and inspectorates. The guidance may also be of interest to looked-after children and young people themselves, their families, prospective adopters and other members of the public.
  • Although the NICE/SCIE final guidance is not statutory, the NHS, local authorities and the wider public, private, voluntary and community sectors are expected to follow it.

About NICE

The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.

NICE produces guidance in three areas of health:

  • public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
  • health technologies - guidance on the use of new and existing medicines, treatments and procedures within the NHS
  • clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

About SCIE

The Social Care Institute for Excellence (SCIE) was launched in October 2001 as part of the Government's drive to improve social care. It is an independent registered charity, governed by a board of trustees. Its role is to promote and advance knowledge about good practice in social care across England, Wales and Northern Ireland.

National Care Leavers' Week

National Care Leavers' Week 2010 'Keep Dreaming' takes place from Sunday 24 October to Saturday 30 October 2010. The aim of National Care Leavers' Week is to ensure that the issues which affect care leavers remain at the forefront of the minds of both national legislators and local commissioners of services.

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