As of 31 March 2020, there are 80,080 looked-after children and young people in England, with the total number of children being looked after increasing yearly since 2010. Most of the looked-after children are cared for in foster placements (72%), with 14% in connected care, and 13% in residential care, secure units or semi-independent living accommodation. In addition to these, 7% of looked-after children are placed with birth parents.

Although each child or young person will have a unique journey into care, the most common reason for becoming looked after was abuse or neglect (65%). These are considered to be major adverse childhood events (ACEs). These can cause trauma and can lead to long-term damaging effects on children and young people's physical and mental health. Other adverse childhood events experienced by looked-after children and young people include physical abuse (48%), emotional abuse (37%) and sexual abuse (23%). Trauma can also include domestic abuse, serious harm, exposure in the home or community to alcohol, drug misuse or violence. All looked-after children and young people will have experienced trauma in some way.

Every child in care is a unique child with individual strengths and needs. However, the physical, emotional and mental health of some looked-after children and young people will have been compromised by neglect or abuse. The rate of mental health disorders in the general population aged 5 to 15 is 10%. However, for those who are looked after, it is 45%, and 72% for those in residential care. In addition, frequent placement moves can keep looked-after children and young people from receiving the support they need by disrupting treatment plans and access to services. Frequent placement moves are linked to poorer mental health and a lessened sense of belonging. Practitioners and services involved with the child need to work collaboratively to assess and review the child's needs and how these can best be met. Key statutory guidance for promoting the health and wellbeing of looked-after children is available from the Department for Education and the Department of Health and Social Care.

Looked-after children are also at a greater risk of poor educational outcomes. In 2019, 55.9% of looked-after children had a special educational need compared with 14.9% of all children. At key stage 2, 37% of looked-after children and young people reached the expected standard in reading, writing and maths (compared with 65% of those who were not looked after). The higher prevalence of special educational needs, as well as speech, language and communication needs, among looked-after children, in part explains this difference. As of 2018, the rate of permanent exclusions for looked-after children has fallen and is now less than the rate for all children. However, looked-after children and young people continue to be significantly over-represented in the criminal justice system. Around half of the children currently in custody in England and Wales have been in care at some point. Virtual schools oversee the pupil premium grant, which is used by them – or designated to schools – to support looked-after children's education. This and other statutory guidance for the education of looked-after children can be found in the Department for Education's statutory guidance on promoting the education of looked-after and previously looked-after children.

Once a child or young person enters care, a suitable placement will be sought for them. Looked-after children leaving care most commonly return home to their birth parents (29%), but two-thirds of children who return home to birth parents re-enter care within 5 years. However, as of December 2019, although the number of children entering care has been rising year after year, the number of children ceasing to be looked after during the year due to adoption has been falling down to 3,570 from a peak of 5,360 in 2015. This has increased pressures on health and social care providers to continue to provide high-quality care with existing resources. Reductions in adoptions have been partially compensated for with increases in Special Guardianship Orders, which increased from 3,550 to 3,700 in the same period. Statutory support for the transition out of care into adoption, including preparing adopters and arranging contact, is outlined in the Department for Education's statutory guidance on adoption.

From 31 March 2019, the number of young people aged 16 and over leaving care to move into independent living has risen each year from 3,720 in 2015, to 4,560 in 2017, and to 4,680 in 2019. Care leavers as a group also have poorer outcomes on key measures such as housing, health, employment, and continuing in education and training post‑16. For 19- to 21‑year‑olds, 6% were known to be in higher education, 21% were in other education, 25% were in training or employment, and 39% were not in education, employment or training (compared with around 12% of all young people aged 19 to 21 years). Statutory support for care leavers, including providing a personal adviser for all care leavers, can be found in the Department for Education's Children Act 1989 guidance and regulations: transition to adulthood for care leavers (volume 3).

Local authorities have a statutory duty to support looked-after children and young people. Partners cooperate to produce individual care plans covering health, education and placement. In addition, clinical commissioning groups, NHS England and Public Health England have a statutory duty to support local authorities to meet their health needs. The Children Act 1989, Children Act 2004, Care Standards Act 2000, Care Planning, Placement and Case Review Regulations 2010, Children and Social Work Act 2017, Fostering Services Regulations 2011, Children and Adoption Act 2006 and accompanying regulations and statutory guidance provide the legal framework for local authorities, providers of fostering services and children's homes. Other relevant safeguarding legislation and statutory guidance includes the Safeguarding Vulnerable Groups Act 2006, Working Together to Safeguard Children 2018, Children's Act 1989 Guidance and Regulations and Keeping Children Safe in Education 2021.

Despite the gap in health and educational outcomes between looked-after children and young people and the general population outlined above, research suggests that the longer children remain in care, the better they can improve in these areas. And, accounting for their disadvantages, they can do better than children not in care.

The original NICE guideline on looked-after children and young people duplicated existing statutory guidance. This update focuses more on the specific interventions needed to help practitioners improve outcomes for looked-after children and young people, as well as how statutory care is best delivered. It complements existing national statutory guidance, which focuses more on service delivery. It also recognises that looked-after children and young people experience inequality, and these recommendations seek to ensure that their needs are at the centre of any plans being made and are adequately met. This requires special attention and expertise.

The guideline covers support provided to looked-after children and young people and care leavers (from birth to age 25), and their families and carers (including birth parents, connected carers, prospective adoptive parents and special guardians). This includes all who are classed as 'looked-after' under a full or interim local authority care order, whether temporary or long term. For example, it covers looked-after children and young people on remand, those temporarily looked-after under section 20 of the Children Act 1989, and those preparing to leave care. The guideline covers all parts of the care pathway, from entry of looked-after people into the care system, to support provided when moving into permanency and out of care into independent living.

The guideline does not cover children and young people who have moved out of care and are no longer looked after (not including care leavers) – that is, those who have been successfully adopted or reunified with birth parents. It also does not cover those on the edge of care and their families.

Impact of COVID-19

The guideline committee wished to acknowledge that the impact of the COVID‑19 pandemic on looked-after children and young people's mental and emotional health and wellbeing, as well as their educational progress, cannot be underestimated.

Although children and young people have been less affected by the virus than adults in terms of infection and mortality rates, the committee raised concerns about lost learning and greater safeguarding risks to this vulnerable group during lockdown. COVID‑19 has disrupted practitioners' relationships with children and families, and the longer-term impact on the voluntary and charitable sector is unknown.

To address the impact on educational progress, the UK government has announced £1 billion of funding for schools (the 'catch-up premium'), which includes millions of pounds specifically for vulnerable and disadvantaged children (including looked-after children) whose education has been most affected. Services, including health and social care services, have also been increasingly delivered remotely using digital technology.

Implementing new ways of working, reconfiguring services to meet evolving social distancing requirements and offering emergency support has resulted in increased cost pressures on local authorities, the healthcare sector and other organisations and agencies involved in the care of looked-after children and young people. The impact of the pandemic on vulnerable groups outside of the care system, such as those experiencing domestic abuse and neglect, and families suffering financially, has also led to more children being referred to children's services who had not previously been known to local authorities and children's social care, leading to a greater impact on the system.