Quality standard

Introduction and overview

Introduction and overview


At the end of March 2012, there were 67,050 looked-after children and young people in England. Almost 75% of these were in a foster placement and approximately 12% were cared for in residential accommodation (including secure units, children's homes, hostels, residential schools and other residential settings).

The health and wellbeing of looked-after children and young people – that is, their physical health, and social, educational and emotional wellbeing – is influenced by nearly all aspects of their lives and the care they receive. Experiences early in life may have long-term consequences for health and social development. Some looked-after children and young people have positive experiences in the care system and achieve good emotional and physical health, do well in their education and go on to have good jobs and careers. However, looked-after children are more likely to have experienced deprivation and poverty as a result of low family income or parental unemployment. About 60% of children and young people who are looked after in England are reported to have emotional and mental health problems and a high proportion experience poor health, educational and social outcomes after leaving care. The main reason for children and young people entering care in the year up to April 2012 was abuse or neglect (reported in 62% of cases).

Looked-after children and young people should expect to have the same opportunities as other children and young people, including being healthy and safe. They should be provided with the opportunities needed to help them move successfully to adulthood.

The needs of looked-after children and young people vary, but are often complex, and can be met only by a range of services operating collaboratively across different settings.

The Children Act 1989, the Care Standards Act 2000 and accompanying regulations and statutory guidance provide the legal framework within which local authorities, providers of fostering services and children's homes must work. Relevant documents that practitioners and managers need to consider alongside the quality standard are set out in development sources. For each NICE quality statement the section 'Context for this quality statement' signposts practitioners to regulations, statutory guidance and national minimum standards for looked-after children and young people that are of particular relevance to the NICE quality statement and its associated measures.

This quality standard covers the health and wellbeing of looked-after children and young people from birth to 18 years and care leavers (including young people planning to leave care or under leaving care provisions). It applies to all settings and services working with and caring for looked-after children and young people, and care leavers, including where they live. For more information see the scope. The term 'looked-after children and young people' is used throughout the quality standard to refer to this population. The aspiration is that the quality statements will apply to all looked-after children and young people, and care leavers in all settings where applicable.

There are a range of people who may be carers of looked-after children and young people. This includes foster carers (including family and friends carers), residential carers and supported lodging providers.

NICE quality standards describe high-priority areas for quality improvement in a defined care or service area. Each standard consists of a prioritised set of specific, concise and measurable statements. NICE quality standards draw on existing guidance, which provide an underpinning, comprehensive set of recommendations, and are designed to support the measurement of improvement.

The quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following frameworks:

The table below shows the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving:

NHS outcomes framework 2013–14

Domain 4: Ensuring that people have a positive experience of care

Improvement area

Improving children and young people's experience of healthcare (4.8 indicator in development).

Public health outcomes framework 2013–16

Domain 1: Improving the wider determinants of health.


Improvements against wider factors that affect health and wellbeing and health inequalities.

1.2 School readiness (placeholder)

1.3 Pupil absence

1.3 First-time entrants to the youth justice system

1.5 16–18 year olds not in education, employment or training

Domain 2: Health improvement


People are helped to live healthy lifestyles, make healthy choices and reduce health inequalities.

2.23 Self-reported wellbeing

2.5 Child development at 2–2.5 years (placeholder)

2.8 Emotional wellbeing of looked-after children (placeholder)

The independent Children and Young People's Forum was established to inform the development of a Children and Young People's Health Outcomes Strategy published in January 2012. Following the report of the forum, work is in progress against a number of proposals for developing the strategy for improving and measuring health outcomes for children and young people. This includes recommendations for new national outcome measures and the strengthening of existing indicators for children and young people; it will consider information to be made available for looked-after children where appropriate (alongside the general population).


The Health and Social Care Act (2012) sets out a new responsibility for NICE to develop quality standards and other guidance for social care in England. The Act outlines a vision for establishing quality as the defining factor for health and social care, through the use of quality standards. The use of quality standards for health and social care can allow people to hold their local commissioners to account, can help guide the commissioning of efficient and effective services and can assist service providers and users to assess the quality of the services they are involved in.

Quality standards support the role of HealthWatch as a consumer champion. Social care providers will need to work with the NHS to ensure that they provide a comprehensive service for all.

From April 2013, NICE will develop a library of quality standards and guidance to improve the quality of social care, as part of an integrated approach with healthcare quality standards.

A child- and young person-centred and integrated approach to providing care and services is fundamental to delivering high-quality care to looked-after children and young people.

The quality standard should be read in the context of national and local guidelines on training and competencies. All professionals involved in caring for and supporting looked-after children and young people should be sufficiently and appropriately trained and competent to deliver the actions and interventions described in the quality standard.

It is envisaged that quality statements will apply to all looked-after children and young people in all settings wherever possible, including care leavers. Services should consider this when implementing quality statements.