SCIE/NICE recommendations on looked after children: Promoting the quality of life of looked-after children and young people

About this guide

What is this guidance about?

This guidance aims to improve quality of life (that is, the physical health, and social, educational and emotional wellbeing) of looked-after children and young people. The focus is on ensuring that organisations, professionals and carers work together to deliver high quality care, stable placements and nurturing relationships for looked-after children and young people. The recommendations set out how agencies and services in a complex, multi-agency environment can improve the quality of life for looked-after children and young people through more effective collaboration that places them at the heart of all decision making. The recommendations cover local strategy and commissioning, multi-agency working, care planning and placements, and timely access to appropriate health and mental health services.

This guidance does not provide detailed information on health promotion, or cover treatments for specific illnesses and conditions. Section 7 has details of National Institute for Health and Clinical Excellence (NICE) and Social Care Institute for Excellence (SCIE) guidance that is particularly relevant to looked-after children and young people and their families or carers.

The term ‘looked-after children and young people’ is used in this guidance to mean 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. This guidance covers children and young people from birth to age 25, wherever they are looked after – in residential care, foster care, young offender or other secure institutions or boarding school, or with birth parents, other family or carers, and including placements out of the area. When the term ‘carers’ is used in this document, unless explicitly stated otherwise, it means all those involved in the direct day-to-day care of children and young people including foster residential and carers who are family or friends.

For further details of what is included and excluded from this guidance, see the scope at www.nice.org.uk/guidance/PH28

Who is this guidance for?

The guidance is for all those who have a direct or indirect role in, and responsibility for, promoting the quality of life of 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 work 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, their families, prospective adopters and other members of the public.

What are the implications for changes to government policy?

Changes to government policy have major implications for this guidance, which are as follows.

At the time of writing (September 2010), the duty on schools to cooperate with children’s trusts is likely to be removed, as is the requirement for local authorities to set up children’s trust boards, and for those boards to produce a children and young people’s plan. Government policy is to support effective local partnerships, but to allow local innovation and solutions to emerge. Importantly for this guidance, the ‘duty to cooperate’ will remain but the list of statutory partners will be reviewed.

Announcements have been made that affect the current regulation arrangements. The Audit Commission is to be abolished and the Comprehensive Area Assessment audit of local authorities will cease. The Office for Standards in Education, Children’s Services and Skills (Ofsted) and the Care Quality Commission (CQC) seem likely to remain the inspectorates of services for children’s social care and health, and there will be an expansion of the economic regulator (currently Monitor) to develop with CQC ‘licensing’ arrangements for the NHS.

Changes to NHS commissioning have been announced. GP commissioning consortia are likely to be fully operational in 2013/14, gradually taking over NICE public health guidance 28 Page 7 of 168 responsibility from primary care trusts (PCTs). PCTs are likely to be abolished from April 2013.

Structures and statutory guidance are likely to change as a result of proposed government policies but the tasks and actions set out in the recommendations in this guidance remain valid. This guidance takes account of proposed policy changes by using generic terms alongside current arrangements to reflect possible structural changes. For example, the term ‘commissioners of health services’ has been used in place of ‘PCT commissioners’.

What is the status of this guidance?

The Department of Health (DH) asked the National Institute for Health and Clinical Excellence (NICE) and the Social Care Institute for Excellence (SCIE) to produce this joint guidance.

Although not statutory, this guidance can help children’s services in social care and health meet their obligations to improve the health and wellbeing of looked-after children and young people (for further details, see section 4, ‘Implementation’).

The guidance should be implemented alongside other guidance and regulations (for more details see sections 2 and 9), including:

• ‘Statutory guidance on promoting the health and well-being of looked after children’ (Department for Children, Schools and Families and DH 2009)
• ‘The Children Act 1989 guidance and regulations volume 2: care planning, placement and case review’ (HM Government 2010).

How was this guidance developed?

The recommendations in this guidance are based on the best available evidence. They were developed by a Programme Development Group (PDG), which included people working in social care, health and education as well as young people with experience of being looked after. Members of the PDG are listed in appendix A.

The guidance was developed using the NICE public health programme process. It has used a mixture of SCIE and NICE methods – see appendix B for details. Supporting documents used to prepare this document are listed in appendix E. More details of the evidence on which this guidance is based, and NICE’s processes for developing public health guidance, are on the NICE website (www.nice.org.uk).

What evidence was the guidance based on?

The evidence that the PDG considered included research reviews, a practice survey, a consultation with young people who are or have been in care, fieldwork with practitioners and the testimony of expert witnesses. This evidence demonstrated that the health and wellbeing of looked-after children and young people is affected by nearly all aspects of their lives and care. The PDG therefore examined the wider looked-after children’s system and adopted a broad definition of health and wellbeing. Further detail on the evidence is given in section 3 (3.36–3.48) and appendix B and appendix C.

The PDG recognised that some groups – for example, disabled children and young people – have specific needs, but it has not made recommendations about all of these. In some cases the evidence was insufficient and the PDG has made some recommendations for future research.

Taking account of the views of children and young people

During the consultation, children (where appropriate) and young people in care were asked what they thought about the recommendations that would directly affect them. For example, some said that they felt adults responsible for their care could be more honest with them, especially about decisions they can have some control over and those that are out of their hands. Their opinions were reported back to the PDG, some of which resulted in changes to the recommendations.

When will the guidance be updated?

This guidance will be reviewed 3 years after publication to determine whether all or part of it should be updated. Information on the progress of any update will be posted at www.nice.org.uk/guidance/PH28