Scope and purpose of this guideline
This is a joint guideline produced by the National Institute for Health and Clinical Excellence (NICE) and the Social Care Institute for Excellence (SCIE). It was developed using the NICE public health programme process. It has used a mixture of SCIE and NICE methods – see appendix B for details.
This guideline 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 guideline does not provide detailed information on health promotion, or cover treatments for specific illnesses and conditions. Section 7 has details of NICE and 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 guideline 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 guideline 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 guideline, see the scope.
The guideline 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, local safeguarding children boards, health and wellbeing boards, schools, voluntary and independent agencies, organisations responsible for the training and development of professionals, universities and colleges, regulatory bodies and inspectorates. The guideline may also be of interest to looked-after children and young people, their families, prospective adopters and other members of the public.
The Department of Health (DH) asked NICE and SCIE to produce this joint guideline.
Although not statutory, this guideline 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).
The guideline should be implemented alongside other statutory guidance, relevant policy and regulations (for more details about relevant policies and how they were taken into account when developing the guideline see 'Changes to government policy from May 2010' below and 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 Department of Health)
The Children Act 1989 guidance and regulations volume 2: care planning, placement and case review (Department for Children Schools and Families) and Annex B: The Care Planning, Placement and Case Review and Fostering Services (England) (Miscellaneous Amendments) Regulations 2013 (Department for Education).
Since this guideline was originally written (October 2010), there have been a number of changes to government policy. This guideline does not summarise all relevant policy, regulations or any additional guidance. It is the responsibility of any organisations or individuals to ensure they identify and act on any statutory or legal responsibilities. The guideline should be considered alongside any changes to current policy.
The Children and Families Act 2014 received Royal Assent in March 2014. The Act introduced reforms for tackling delay in the adoption process and for improving the life chances of looked-after children and young people (see Councils told to stop housing vulnerable children miles away from home Department for Education and Children and Families Bill explanatory notes).
The Department for Education has issued statutory guidance for local authorities on implementing the duties in the Children Act 1989 with respect to children and young people who are brought up by members of their extended family, friends or other people who are connected with themsee Family and friends care: statutory guidance for local authorities Department for Education).
From 31 October 2010 the Department for Education withdrew statutory guidance on children's trusts. But the requirement for local authorities and partners to have a children's trust board and to cooperate to improve children's wellbeing, as set out in section 10 of the Children Act 2004, remains in place. Local authorities have the flexibility to ensure that their children's trust board fits with their local health and wellbeing board. The requirement for children's trust boards to produce a children and young people's plan was removed, but they are afforded the flexibility to continue to produce a plan if it makes sense locally.
The Office for Standards in Education, Children's Services and Skills (Ofsted) and the Care Quality Commission (CQC) remain the inspectorates of services for children's social care and health, and there has been an expansion of the economic regulator (currently Monitor) to develop, with CQC, 'licensing' arrangements for the NHS. Ofsted now has a single inspection framework covering child protection, services for looked after children and care leavers, and local authority fostering and adoption services (Framework and evaluation schedule for the inspection of services for children in need of help and protection, children looked after and care leavers [single inspection framework] and reviews of local safeguarding children boards).
There have also been changes to NHS commissioning, including GP commissioning consortia, and clinical commissioning groups. These have gradually taken over responsibility from primary care trusts, which were abolished in April 2013.
Structures and statutory guidance are likely to change as a result of future government policies but the tasks and actions set out in the recommendations in this guideline remain valid. This guideline takes account of policy changes by using generic terms alongside current arrangements to reflect possible structural changes.
The recommendations in this guideline 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 guideline 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 guideline is based, and NICE's processes for developing public health guidelines, are on the NICE website.
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 appendices B and 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.
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.