Our State of Child Health 2020 report showed an increase in the number of children in care across the country and highlighted these poorer health outcomes. The report also showed what good looks like. Data in this scenario can be difficult to interpret, though. We don’t know if increased numbers of children in care are because of a higher incidence of, say, neglect, or because the services that exist are getting better at identifying and dealing with need. Depending on which lens you’re looking through, more children in care can be positive or negative.
What we know for sure is that children and young people in care often have increased health needs, and that these health needs are often unmet as they move through child protection services. And the disruption to their day-to-day lives builds on the reason why they are in care in the first place.
Children in care are disproportionately exposed to adverse childhood experiences (ACEs), which have a direct impact on health that can last a lifetime. ACEs are used to describe a range of events that can occur in childhood, which have the potential to cause significant stress and trauma responses. This includes exposure to things like abuse, substance use, and mental health problems. The greater the number of ACEs experienced in childhood, the greater the relative risks of disease, dysfunction and life difficulty including short and long-term health harm, and using health risk behaviours or coping strategies such as binge drinking or smoking. Not all children who experience abuse and trauma will go on to develop issues—but we shouldn’t underestimate the need for early intervention and support across all domains of life.
So, what are we doing about it?
Last month, the Children’s Commissioner published a report about children in residential care homes, and the title alone is enough to cause concern. “The children who no-one knows what to do with” discusses variable standards of care across the country and a lack of suitable places for vulnerable children. It also puts forward actions that must be taken by local and national Government, including provision for quality accommodation and foster care close to where those in need currently live.
The future is, however, uncertain, particularly with the dismantling of Public Health England. The new National Institute for Health Protection will handle pandemic preparation and response, meanwhile other important functions are being rehomed. We still don’t know what this will look like, so it’s hard to know exactly how public health bodies will be able to best support children in care.
In any case, Royal Colleges must do their part. The RCPCH has a representative for children in care on its longest standing committee—safeguarding, setting standards and leading training with the Royal College of Nursing. The visibility of children in care has, in some ways, risen in the pandemic, but there have always been research projects, reports, documents, NICE guidance and conferences. We should also not forget the importance of foster carers.
Lockdown was tough for many people, and vulnerable children and families suffered. In the children in care environment, the Government allowed certain relaxing of rules for social care. I don’t know of any services that took advantage of that. If anything, they upped their game and did even more. This month, I attended a joint professionals planning meeting and the agenda included a discussion on how we would distribute donated Christmas presents to young people on their own, in semi-independent placements, and how to ensure that care leavers have enough money to buy festive food. It could break your heart, but it made me glad that we have talented, passionate people working in this space.
Children in care want permanency—a home, to reach their potential, to be loved. They want to be healthy and happy. As corporate parents, we should want that too. So we should deliver it and, where necessary, demand decision-makers do their part to deliver it too.