Report by Children and Young People Now 24.04.13

Posted on April 24th, 2013

Thousands repeatedly run away from care, police figures reveal
By Tristan Donovan, Wednesday 24 April 2013
Nearly 3,000 children repeatedly went missing from care in 2012 according to police figures obtained by the NSPCC.
Police recorded 28,000 incidents of children running away from care in 2012. Image: Alex Deverill/Posed by model
Freedom of Information requests made by the child protection charity revealed that police in England and Wales recorded 28,123 incidents of children running away from residential care homes.
A total of 7,885 children went missing during the year at least once and 2,959 ran away more than once.
In one case a young person went missing from care 67 times.
Tom Rahilly, head of the charity’s looked-after children programme, said the figures were concerning.
“Repeatedly going missing should be a big warning sign as this kind of behaviour can put children at serious risk of harm such as grooming or sexual exploitation,” he said.
“The state needs to be a parent for these children. If any other child went missing their parents would move Heaven and Earth to find them and to understand why they did it. It should be no different for young people in care.”
Most of the young people who went missing were aged 13 to 17 but some were as young as six.
Some were not seen again for more than a week and one police force said that six children were still missing.
The charity warned that the figures would underestimate the extent of the problem since only 29 police forces responded to the charity’s inquiries and many cases were not reported to the police.
The NSPCC said professionals should regard repeat disappearances by children in care as a sign that they are at greater risk of harm and more needed to be done to prevent young people running away from care in the first place.
The charity also said care homes should do more to find out why children ran away rather than punishing them for going missing.
Thousands repeatedly run away from care, police figures revealBy Tristan Donovan, Wednesday 24 April 2013Be the first to commentNearly 3,000 children repeatedly went missing from care in 2012 according to police figures obtained by the NSPCC.
Police recorded 28,000 incidents of children running away from care in 2012. Image: Alex Deverill/Posed by modelFreedom of Information requests made by the child protection charity revealed that police in England and Wales recorded 28,123 incidents of children running away from residential care homes.
A total of 7,885 children went missing during the year at least once and 2,959 ran away more than once.
In one case a young person went missing from care 67 times.
Tom Rahilly, head of the charity’s looked-after children programme, said the figures were concerning.
“Repeatedly going missing should be a big warning sign as this kind of behaviour can put children at serious risk of harm such as grooming or sexual exploitation,” he said.
“The state needs to be a parent for these children. If any other child went missing their parents would move Heaven and Earth to find them and to understand why they did it. It should be no different for young people in care.”
Most of the young people who went missing were aged 13 to 17 but some were as young as six.
Some were not seen again for more than a week and one police force said that six children were still missing.
The charity warned that the figures would underestimate the extent of the problem since only 29 police forces responded to the charity’s inquiries and many cases were not reported to the police.
The NSPCC said professionals should regard repeat disappearances by children in care as a sign that they are at greater risk of harm and more needed to be done to prevent young people running away from care in the first place.
The charity also said care homes should do more to find out why children ran away rather than punishing them for going missing.

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BUTTLE UK REPORT FINDNGS OF THE TRUE COST OF KINSHIP CARE

Posted on April 22nd, 2013

Children and informal kinship carers speak out

‘Successive governments have never ever wanted to acknowledge this underclass of caring that is going on. I can’t tell you how hard it’s been…and the eternal phrase ‘But this is a private arrangement’. (Grandmother bringing up 14 year old)

‘I worry about money every day. There’s not been a week since my mum died that I’ve not worried… about money…We’re just surviving, that’s the only way I can describe it…the fridge is always empty’. (Sibling bringing up 16 year old)

A major study published today (Monday 15 April 2013) by leading children’s grant-giving charity, Buttle UK and the University of Bristol provides the most comprehensive picture to date across the UK of informal kinship care – children cared for informally by relatives and friends because their parents are no longer able to look after them. 

The majority of kinship care arrangements are informal; that is, they are made outside the ambit of child welfare agencies and carers have no automatic entitlement to support. Until now this has been largely a ‘hidden population’ about whom there were few hard facts.  The findings are revealing and demonstrate clearly the true cost of informal kinship care and the huge challenges that this group face.

The Poor Relations: Children and Informal Kinship Carers Speak Out is the largest authoritative report to look at both the child’s perspective of living in an informal kinship care setting and the views of their carers.   It provides insights into how well, both emotionally and academically, these children are doing, how this compares with children in the formal care system and what impact such arrangements have on both children and carers.

It also gives an authoritative account of the financial hardship, sacrifice, isolation and the cost to health of the relatives bringing up children across the UK with little or no statutory support – often at very little notice.  Each child cared for by an informal kinship carer saves the taxpayer between ¹£23,500 and £56,000 a year.

Today’s report is the second of a two-part study commissioned by Buttle UK with the University of Bristol, funded by the Big Lottery.  In June 2011 Buttle UK published the first part of this major study – the first ever attempt to quantify informal kinship care in the UK – showing that under the 2001 Census  173,200 children –  one in 77 children –were  being  brought up by grandparents and other relatives.

Drug and alcohol problems feature heavily in the background of the parents in this new research, causing a child’s move into informal kinship care – which is often sudden and crisis-driven.  Findings show that just over two-thirds (67%) of these children are abandoned by parents who are affected by alcohol or drug misuse, including nearly a quarter (24%) who are misusing both. Exposure to domestic violence and parental mental illness was also common. These parents’ chaotic lives put their children at risk and led to parental indifference (64%) and to active rejection (26%) of their children.  Relatives and friends stepped in to care for them.

Other key findings:

  • While the majority are living with a grandparent, the first part of the study published in 2011 showed that as many as 38 per cent of kinship children in the UK are being brought up by a sister or brother. They are the poorest of all informal kinship carers.
  • The carers said that most of the children (88%) had been abused or neglected while they lived with their parents
  • More than a third (34%) of the children had experienced the death of one or both parents – considerably more than found in recent studies of children in care.
  • Most families are living in severe poverty- as a result of having the children.  Fewer than a third (31%) of the families can provide all the eight basic items considered by most of the population to be necessities, like heating, cooked meals and winter clothes. For example, over a third of the carers (37%) cannot afford warm winter clothes and one in five cannot afford toys and sports equipment for the children. The government’s cuts to welfare benefits will make their lives even more difficult.
  • The fact that most receive no financial allowance from Children’s Services for the children’s upkeep is a lottery.  The willingness of these informal kinship carers to step up to take care of the children is allowing local authorities to view them  as private arrangements, no matter how severe the maltreatment or other difficulties they are experiencing.  The children’s family backgrounds are similar to those of children in the ‘looked after’ system.
  • Many of the informal kinship carers (73%) have long-term health problems or disabilities and a third of their lives are restricted by pain. As many as two-thirds (67%) are clinically depressed.
  • The informal kinship carers experience multiple losses: they have to change their life plans, lose their freedom – and, if young, the chance to train for a job. They lose friends, marriages come under pressure and they can become socially isolated.
  • The informal kinship carers’ commitment to the children provides them with psychological security and stability. As a result the children are doing well; considerably better than children in care.
  • Nonetheless, over a third (34%) of the children have severe behavioural and emotional difficulties as a result of their experiences of abuse and neglect when living with their parents.
  • Even though the children’s backgrounds are similar to those of children in the care system, Children’s Services frequently refuse them help.

Despite the often difficult circumstances of the carers, the research shows that these informal kinship arrangements provide stability for the children. The children are doing well, have strong attachments to their carers and have good levels of academic attainment, particularly when compared to children in the formal care system. Many children have high educational aspirations with half planning to go to college (47%) and almost two fifths aiming for university.

They do, though, carry a great deal of anxiety about the health of their carer and what might happen to them if they are left without a home.  More than a third (36%) have been the butt of spiteful remarks because of their circumstances and a few have been repeatedly bullied.

However, when looking at the carers, taking these responsibilities come at a huge personal cost. While they describe their pleasure at seeing the children thrive, they find parenting children is tiring and physically demanding.  Many (73%) have long-term health problems or disabilities and a third say their lives are restricted by pain.

These informal kinship carers, of whom half (51%) are lone carers, have foregone retirement and given up their jobs and their freedom. The young carers miss out on further education and job training and are the poorest of all. More than half of the carers (60%) had to manage difficult contact with the children’s parents.

Many kinship carers have feelings of hopelessness because of the restrictions on their own lives, their battles to get help and the strain of trying to manage the demands of the children with so few resources.

Buttle UK is pressing for urgent policy action for these ‘Forgotten Families’.  Key recommendations from the report include:

  • A national allowance.  The over-riding message from all four countries of the UK was the lack of financial support.  Giving informal kinship carers adequate financial provision to bring up the children they care for would be an equitable solution and probably enable more relatives to take on this role.
  • A culture change in statutory services. Rather than turning informal kinship carers away –  afraid that they will become liable for these families – statutory agencies should provide support or ensure they refer them on so that they get the assistance they need.
  • Information.   A national information resource pack for each UK country which is widely promoted and easy to access.  It would include information and advice about the services available from statutory and voluntary organisations and the options in relation to legal status and financial allowances.
  • Improved kinship policies and practices. The needs of children and their carers should be better understood, particularly in relation to the extent of bereavement and children’s behavioural difficulties, the high levels of anxiety of the children, the impact of parental rejection and parental addiction, unreliable or harmful contact with parents and the carers’ health needs.  Local authorities must implement the requirement in the statutory guidance to provide accessible information and to provide support according to the child’s needs.

  • Better awareness among universal services such as GPs, teachers and solicitors.  These are the first people to whom informal kinship carers turn.  These professionals need to be attuned to their needs.  For example:
    – Early independent legal advice is crucial but will now be very difficult to get with the new restrictions on legal aid.  A legal aid fixed fee should be introduced to allow free advice and representation to obtain private law orders.
    – GPs need to be alert to carers’ high levels of depression, need for better pain management and for bereavement services.
    – Schools should have a designated teacher to champion the needs of kinship care children.
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The NHS and Social Work

Posted on April 9th, 2013

Article in Community Care this week: What social workers need to know about the new NHS

1 April saw the biggest reform to the NHS in its 65-year history, bringing substantial changes for health professionals in England. But what does it means for their social care counterparts and for integrated working between the two services?

The reforms will affect joint working (Credit: Burger/Phanie/Rex Features)

The reforms will affect joint working (Credit: Burger/Phanie/Rex Features)

Mithran Samuel
Thursday 04 April 2013 10:21

On 1 April, hundreds of NHS organisations were abolished at a stroke, while hundreds of others were created and existing bodies gained responsibilities, transforming the provision, commissioning and regulation of healthcare in the process.

While this is a huge change for the NHS’s 1.35m staff in England, it will also affect significantly social care professionals, who will not only have to learn a whole new set of acronyms, abbreviations and jargon but get to grips with how the reforms will impact on them and their clients.

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Out with the old, in with the new

The Health and Social Care Act 2012 has abolished the 153 primary care trusts, responsible for health commissioning, and the nine strategic health authorities, responsible for performance managing the NHS in their regions. It also signals the abolition of remaining acute, mental health and community NHS trusts; they are all expected to become or be merged with more independent foundation trusts, or be dissolved over coming years.

In comes 211 clinical commissioning groups (CCGs), led by GPs, to take over responsibility for most healthcare commissioning with a combined budget of £65bn. They are overseen and held to account by NHS England, a new super-quango that will commission specialist services and primary care and operate regionally through 27 local area teams. CCGs are supported by 19 commissioning support units, whose functions will include contract management of providers, procurement and service redesign.

It is arguably a more complex NHS for the social care sector to engage with. Most of the 152 councils in England shared the same boundaries with their local PCTs, meaning they only had one commissioning partner in the NHS; but many will now have to engage with more than one CCG and all councils will have to forge strong relationships with commissioning support units and NHS England local area teams. For instance, NHS England is responsible for disbursing £859m of funding for councils to spend on social care services that benefit the NHS in 2013-14, a function previously carried out by PCTs.

Why are the reforms happening?

The reforms are designed to help ensure the long-term sustainability of the NHS at a time of rising drugs costs and demand from an ageing population, by achieving much better value for money and shifting care out of hospital into the community.

CCGs are expected to use their clinical knowledge to purchase more efficient services than more remote PCT managers. In addition, they will be encouraged – some would say obliged – to tender out services to any provider that meets required standards, so that competition can be used to drive up standards.

The legislation is also designed to deliver closer integration between health, social care and other related services, on the grounds that this will deliver better value for money and improved care. PCTs’ public health responsibilities, and almost 3,500 staff, have been transferred to councils, on the assumption that councils’ responsibility over related areas, including housing, leisure and social care, will lead to more effective public health practice and reduce strain on the NHS. As part of this, councils will take responsibility for commissioning substance misuse.

Another plank of the reforms is improving the ability of patients and the public to hold the NHS to account through the creation of new patient representative organisations, Healthwatch England and local Healthwatch groups. Like their predecessors, the local involvement networks (Links), local Healthwatch groups will focus on social care as well as health.

Improving joint working

The Health and Social Care Act 2012 explicitly promotes joint working between health and social care, principally through the creation of health and well-being boards (HWBs) to oversee services in each area. These are committees within every council with social services responsibility, including representation from CCGs, the local Healthwatch and the directors of children’s and adults’ services.

HWBs will prepare joint strategic needs assessments (JSNA) and councils and CCGs will both be under a duty to produce strategies that respond to the JSNA but also to have regard to each other’s strategies. CCGs and HWBs will also be under a duty to promote integration of health and social care.

What this means for joint working at the front line, or social care commissioning, remains to be seen. It is unclear how far it will lead to greater use of formal partnership agreements, under section 75 of the NHS Act 2006, to pool budgets, integrate commissioning or set up joint teams across councils and the NHS. Several of these existed between councils and PCTs, particularly in learning disabilities and mental health, and CCGs will have inherited many of them.

The legislation should also in theory make it easier to set up care trusts – individual organisations responsible for health and social care commissioning or provision – as it removes the requirement for these to be approved by the secretary of state for health. However, so far among CCGs, it appears only the group in North East Lincolnshire, where there was previously a care trust, has taken on responsibility for commissioning adult social care.

One barrier to this happening more widely is that elected councillors are barred from sitting on the boards of CCGs, restricting councils’ ability to exercise direct oversight over adult social care. North East Linolncshire has got round this by setting up a sub-committee with councillor representation to take crucial decisions on adult care.

The risks of competition

One of the chief concerns of critics of the reforms is that their promotion of competition among providers of all hues for NHS business will lead to the fragmentation of care, to the detriment of quality and integration with social care. When the legislation was originally published in 2011, the Royal College of Psychiatrists warned this could happen to mental health, with the potential break-up of community mental health services.The college had wanted the bill amended to ensure that competition should only be employed if it were shown to benefit patients.

However, this did not happen, and regulations under clause 75 of the Health and Social Care Act 2012, published last month, said CCGs could only award a contract  without competition, if it was satisfied that the provider was the only one capable of providing the service – seen as a high threshold by critics. The regulations prevent CCGs from acting in an “anti-competitive manner” unless this is in the interests of patients, including to improve the integration of care. It remains to be seen whether this clause ensures that competition does not lead to fragmentation of care.

Safeguarding adults and children

CCGs have inherited PCTs’ responsibilities for safeguarding children. Like PCTs, they must appoint a designated doctor and nurse with responsibility for safeguarding children and looked-after children, to provide advice and leadership to NHS bodies and professionals in their area; CCGs and NHS England also sit on every local safeguarding children board.

Every CCG must also have a designated adult safeguarding lead, to oversee inter-agency working with councils and the police and ensure systems are in place for responding to abuse or neglect in NHS-funded services. When the Care and Support Bill – currently in draft form – becomes law in 2015 or 2016 – CCGs will become mandatory members of safeguarding adults boards, but they will also now join existing non-statutory boards.

Each NHS England local area team has a director of nursing with overall responsibility for safeguarding adults and children in their NHS region; this will include commissioning any enquiries or reviews of services provided by independent contractors.

NHS England has produced a guide to new safeguarding responsibilities in the health service.

Mental Capacity Act and Mental Health Act: new responsibilities for councils

CCGs must also have a Mental Capacity Act lead, whose responsibilities will include that the care commissioned by the group is compliant with the MCA and the Deprivation of Liberty Safeguards (Dols).

However, councils are now responsible for authorising deprivations of liberty in hospitals, a role previously carried out by PCTs. Councils are also now responsible for commissioning independent mental health advocate (IMHA) services for people detained under the Mental Health Act or subject to community treatment orders.

NHS continuing health and nursing-funded care

Clinical commissioning groups have inherited PCTs’ responsibilities for NHS continuing healthcare and nursing care for people in residential care, and must comply with the national framework for these services, revised last November. This role involves commissioning assessments by a multi-disciplinary team of people most likely to be eligible for continuing care – often following an initial screening assessment – with eligibility determined using a prescribed decision support tool. The CCG is also responsible for commissioning places and care management for those deemed eligible.

CCGs are expected to involve local authorities in this process. There is an expectation that CCGs may delegate some of their continuing healthcare functions to commissioning support units; however their statutory duty to determine eligibility cannot be delegated.

As well as handling current cases, CCGs will have to review cases of people who feel they should have been assessed for NHS continuing care from 2004-12 but were not. Controversially, the Department of Health imposed deadlines for families to apply for a review so that no applications made after 31 March 2013 will be considered for reviews relating to unassessed periods of care from April 2011-March 2012; an earlier deadline of 30 September 2012 was imposed for unassessed care from 2004-11.

The full impact of the NHS reforms on social care will become clear over the coming months. The immediate challenges for social care professionals, managers and providers is understanding how the pieces of the new NHS jigsaw fit together, who they should be doing business with locally and how they can influence the new health landscape in a way that most benefits social care service users.

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