Thirty-Seventh Report - Support for vulnerable adolescents

There is reluctant leadership of the challenges faced by vulnerable adolescents which undermines ownership of the problem. The Department for Education reluctantly confirmed that it is ultimately responsible for ‘holding the ring’ across Whitehall on vulnerable adolescents. However, it is not clear what this means or how it translates into action when so very many government departments and local agencies play a role in supporting vulnerable adolescents. The Vulnerable Children and Young People Strategy Board has recently been repurposed to provide a co-ordinating picture, bringing together government’s understanding of complex children and young people. This is a start, but it has only met once and it is too early to say what role this Board will play in helping to unify support and identifying and helping to address gaps and overlaps that impact on vulnerable adolescents. The Department for Education tells us that its overarching responsibility should not translate into to a single system but there is a lack of common definitions or language that will help young people navigate the disjoined systems and receive the support they need. Government has specific programmes to support specific vulnerabilities and joins up individual programmes between departments. However, we agree with the current Children’s Commissioner that collaboration is not taking place at the strategic level that is needed to provide the proper support for vulnerable children and young people. Recommendation: The Department for Education should set out within six months its accountabilities for vulnerable adolescents, the terms of its leadership role and how strategic planning and oversight will work. 1 Persistently absent refers to pupils missing 10% or more of sessions where a session is equal to half a day. 6 Support for vulnerable adolescents

Critical local multi-agency safeguarding partnerships are still not working well enough, which risks those vulnerable adolescents that need support and help falling through the gaps. While in some places multi-agency safeguarding partnerships may work well, in other places, sadly, they do not. In May 2022 the Child Safeguarding Practice Review Panel found multi-agency safeguarding arrangements “are not yet fit for purpose everywhere” and are more fractured and fragmented than they should be, with weak links between the leadership and the front line risking vulnerable adolescents that need support and help falling through the gaps. The three statutory partners—police, health and local authorities—have a shared and equal duty to protect children and young people. We are concerned that if no one is solely responsible, the buck will be passed. We note that education is not a statutory partner and that the independent review of children’s social care has already recommended that schools be named as a fourth safeguarding partner. The Department for Education tells us it is continuing to improve multi-agency safeguarding arrangements and it considers that professional curiosity and good quality leadership across the three partners are key. It tells us it works area by area to understand where there are risks and has recently restructured to bring its regional focused teams together. However, the Independent Children’s Social Care Review found the existing mechanisms for independent scrutiny to be ‘relatively weak’ and it is not clear to us how the Department knows where to focus its support. Recommendation: Government should set out within six months how it plans to improve the way multi-agency safeguarding partnerships work.

It is not clear how lessons and learning from changing threats, serious case reviews and child safeguarding review panels are embedded in day-to-day practice. Time and again reviews into child deaths highlight poor coordination between services, including insufficient joined-up leadership and a lack of appropriate and timely information-sharing around cases, as a contributing factor in the death. Adolescents may be exposed to ‘extra-familial’ harms which occur outside the home, such as sexual exploitation, modern-day slavery, serious violence and criminal exploitation. The Department for Education acknowledges the care system was designed to response to harm originating from inside a family. However, we were told there is a growth in older age groups and an increasing occurrence of extra familial harms. As such social work practice and the design of the care system is still adapting to known and changing risks to vulnerable young people. The Department for Education tells us it does evaluate what works but good practice does not reach everywhere, and social work practice is still variable. Despite the learning available it is unclear how lessons are disseminated to those people working directly with vulnerable adolescents to ensure that necessary actions are taken by all those that play a role in safeguarding children. The Department acknowledges that it would be helpful to build lessons into national standards, to reduce the reliance on every individual within the system identifying and acting on lessons learnt. Recommendations • Government should set out within six months how it will ensure that learning from national reviews is built into day-to-day practise, including supporting appropriate and timely data sharing, by those working with vulnerable adolescents. Support for vulnerable adolescents 7 • The Department for Education, in its response to the Care Review should set out how the revised care system will more effectively address the risks to adolescents pos

We are extremely concerned about the waiting time for children to receive support for mental health issues and about the proportion of adolescent girls seeking help. A survey found nearly 1 in 5 of 6- to 16-year-olds in England had a probable mental health disorder in 2021. The same survey also found that almost 40% had experienced a deterioration in mental health since 2017. In addition, 13.5% of 11- to 16-year-olds felt their lives had been made ‘much worse’ by COVID-19 restrictions. But support is not meeting children’s need and some children with mental health issues have had to wait a very long time to start treatment. In 2020–21 the average waiting time for children to start treatment for their mental health issues at different health bodies ranged from 6 days to 81 days, with more than 22,000 (5%) of children and young people waiting more than 12 weeks. The proportion of adolescent girls known to be in contact with secondary mental health services is far greater than for boys. For example, 18% of 16-year-old-girls are in contact with secondary mental health services, compared to 11% for boys. The Department for Education tells us there has been additional funding, some of which is particularly focused around eating disorder services, because it had seen the waiting lists for those rise and a pandemic-related impact, particularly on young girls. There has also been an NHS England consultation, which closed early in 2022, on introducing waiting time standards for access to community and A&E mental health care. However, we are yet to see these standards implemented. Recommendation: Government should report back to the Committee within six months on progress on the implementation of access standards for community and A&E mental health care.

The Ministry of Justice and Home Office seem to lack curiosity about the increase in the proportion of children from ethnic minority background in youth custody and appear to have no current plan to address the situation. While the number of children in youth custody across all ethnicities has reduced by 73% from 2010–11 to 2020–21, the proportion from ethnic minority backgrounds has increased (from 32% to 53%). Furthermore, a recent HMI Probation report found that young black children, aged 10–17, are 2.8 times more likely come to the attention of the youth justice system as would be expected given the proportion of black boys this age in the general population while the numbers of mixed heritage children in the youth justice population has doubled since 2010. These disproportionate outcomes have been highlighted in previous reviews dating back many years, but the Ministry of Justice and Home Office still cannot fully explain the disparity. The Ministry tells us that there are a range of complex “societal factors” at play, but acknowledges that some interventions may be introducing disparity, such as the police’s use of stop and search and decisions about whether to remand someone in custody ahead of their trial. It says it is working to improve the clarity of decisions about whether to remand someone in custody. However, overall neither the Ministry of Justice and Home Office have clear plans for how they will reduce the disparities in the proportion of ethnic minority children entering youth custody. 8 Support for vulnerable adolescents Recommendation: Ministry of Justice and Home Office should report back within six months on what they understand about ‘what works’, and what action they will take to understand why ethnic minority children make up over half of all children in custody. They should also set out how they will use the understanding to address the issues.

Data sharing exercises need to be better used to understand the support vulnerable adolescents need. The poor outcomes experienced by vulnerable adolescents are often overlapping. For example, 72% of children sentenced in 2019–20 were assessed as having mental health concerns. And one in five of 16–24-year-old young people not in education, employment or training had a mental health condition in 2021. The Department for Education told us the overlaps between different vulnerabilities were complicated and that data sharing helped them identify overlapping groups of vulnerable adolescents who need support. But without better data sharing it is very hard to understand how all the different risk factors and vulnerabilities overlap and there is scope for better understanding of all overlapping needs. Departments have plans to improve the join up of different government data sets on vulnerable adolescents, including by linking anonymised health and education data. Whilst this is positive, the government does not have any clear plans for how the exercise will be used to better understand the risks that vulnerable adolescents face so that it can provide more targeted support. Recommendation: The Department for Education should take the lead in coordinating and setting out within six months an agreed approach to how departments will collect and use data to understand the pathways to adverse outcomes for vulnerable adolescents. Support for vulnerable adolescents 9 1 National and local leadership Introduction

On the basis of a report by the Comptroller and Auditor General, in November 2022 we took evidence from the Department for Education, the Department for Levelling Up, Housing and Communities, the Home Office and the Ministry of Justice about how government and local bodies support vulnerable adolescents.2

The NAO report collates for the first time a wide range of information from across government about the adverse outcomes facing the most vulnerable adolescents. The Department for Education told us it would be challenging to report across government on ‘every possible difficulty’ but it would be possible to focus on individual issues or clusters of issues that often co-occur.14 It also said there was value in understanding the complex overlaps between clusters and using that information to identify where a particular approach to a set of overlapping needs makes sense.15 6 C&AG’s Report, paras 3, 1.5 7 Q 23 8 Q 81 9 Q 88 10 Q 94 11 Q 17 12 Children’s Commissioner for England, Teenagers falling through the gaps, July 2020 13 C&AG’s Report, Figure 9, para 1.32 14 Q 92 15 Q 94 Support for vulnerable adolescents 11 Leadership in addressing the challenges faced by vulnerable adolescents.

Activities to support vulnerable adolescents cut across at least seven different government departments.16 The Department for Education confirmed to us that it is ultimately responsible for ‘holding the ring’ on vulnerable adolescents and has an overarching responsibility for children and young people.17 It told us its overarching responsibility should not translate into to a single system nor single definition of vulnerability, but rather it tries to get a sense of the co-ordinated picture of support through the Vulnerable Children and Young People Strategy Board.18 We were told this board, which had evolved from an earlier COVID-19 focused board, had met once in September and would meet again in December. The Department for Education said the board is a cross-government officials’ group chaired by Department for Education focused on bringing together government’s understanding of the most complex children and young people.19 The Department for Education told us Ministers would be brought together on particular topics but there was no equivalent ministerial level board.20 The NAO found that local bodies implementing policies led by different departments are navigating complex requirements which can lead to confusion at a local level. It also found that the multiple programmes from government often impact the same local authority teams who themselves are then in some cases working with the same young people.21

We were told government’s approach is to meet the need of many young people through focusing on individual programmes and focusing their join up on those who have complex and overlapping needs.22 The NAO found that while departments work together on individual programmes and initiatives there is no overall assessment of whether vulnerable adolescents’ needs are being addressed.23 This was also the view of the current Children’s Commissioner for England who said that collaboration seems to happen at a programme level but not at the overall strategic level which it needed to be to provide the proper support for vulnerable children and young people.24 Multi-agency safeguarding partnerships.

Multi-agency safeguarding partnerships started in 2019, aimed at joining up local NHS, policing, and local authority services to safeguard and promote the welfare of all children in their area.25 In May 2022, three years after they started, the Child Safeguarding Practice Review Panel found the new partnerships were “not yet fit for purpose everywhere” and were more fractured and fragmented than they should be, with weak links between the leadership and the front line.26 Previously in 2021, Sir Alan Wood found multi-agency safeguarding arrangements varied in the extent to which non- statutory partners, and particularly schools and other educational bodies, were engaging 16 Q 91; C&AG’s Report, para 5 17 Qq 17, 90 18 Qq 90, 94 19 Qq 20–21, 89 20 Q 22 21 C&AG’s Report para 16 22 Q 89 23 C&AG’s Report para 17 24 SVA0024 25 C&AG’s Report, paras 4, 2.11 26 Q 105 12 Support for vulnerable adolescents in safeguarding arrangements.27 When asked why education was not a statutory partner, the Department for Education told us that schools have a statutory duty to cooperate fully with the statutory partners, that schools take this incredibly seriously and are very active and responsive. The Department for Education told us it is actively considering schools be named as the fourth safeguarding partner following the recommendation from the independent review of children’s social care.28 But the Department for Education told us there is work to do, in response to recent reviews to look at how to strengthen the local safeguarding arrangements.29

The three statutory partners (police, health, and local authorities) of multi-agency safeguarding partnerships’ have a shared and equal duty to protect children and young people. We asked who in the system has responsibility for children who fall through the gaps or for identifying overlaps. The Department for Education told us these three bodies do feel jointly responsible and having one person solely responsible risks the other partners disengaging.30 To reflect what local partners are asked to do the Department for Education told us a new child protection ministerial group had met for the first time in October 2022 to bring together national representatives of the local safeguarding partners.31

We asked the Department for Education what is being done to review multi-agency safeguarding partnerships to ensure they work better and to stop horrific events, such as the cases of Star Hobson and Arthur Labinjo-Hughes from recurring. The Department for Education said there are 135 safeguarding partnerships across the country covering 151 local authority areas. It is looking at recommendations from the children’s social care review on the operation of the multi-agency partnerships, and the expertise of those involved in child protection by looking at the development of early career framework training.32 The Department for Education said it needed to continue working area by area to understand where there are risks and intervene in the places where there is weakness. The Department for Education said it has a “ladder of intervention” but did not expand on how this worked.33 27 C&AG’s Report, paras 15, 2.11 28 Q 97 29 Q 106 30 Q 95 31 Q 96 32 Q 106 33 Qq 106, 107 Support for vulnerable adolescents 13 2 Using data and learning to improve outcomes for vulnerable adolescents Embedding lessons into day-to-day practice

At 31 March 2021, there were 53,790 adolescents in care between the ages of 9 and 17, making up 67% of the total care population. Between 31 March 2014 and 31 March 2021 the number of 9- to 17-year-olds in care increased by 26%, which is higher than the increase in the total number of children in care (18%).34 The Department for Education told us the growth in the number of adolescents in care reflects an increase in the number of adolescents being bought into the care system and an increase in the occurrence of “extra familial harms”.35 These ‘extra-familiar’ harms are those which occur outside the home, such as sexual exploitation, peer-on-peer abuse, modern-day slavery, serious violence, and criminal exploitation.36

The Department for Education explained that the care system was originally set up to address issues that originate from within the home and was not designed to address ‘extra- familial’ harms that take place outside the home.37 It said that to help address this, it has produced guidance on risks from outside the home, and in 2021 it invested £1.5 million in 20 local authorities to help them strengthen their approaches to safeguarding adolescents at risk of extra-familial harms. It claimed that the growth in the number of adolescents in care is a “good sign” as it shows the system is getting better at placing adolescents into the care system where there has been extra-familial harm. However, it acknowledged that its response to these harms and its support to older children through the care system is less mature and still being developed. It also recognised that despite efforts to share good practice, local approaches are still variable.38 It also said it could set clearer expectations and a national framework for safeguarding older children.39

The national Child Safeguarding Practice Review Panel, set up to commission reviews of serious child safeguarding cases, has consistently highlighted cases in which poor coordination between services, including insufficient joined-up leadership and a lack of appropriate and timely information-sharing around cases, were a contributing factor.40 The Department for Education told us that the Panel publish the findings from its review of individual incidents, as well as lesson learnt from the findings of multiple reviews. We asked the Department for Education how these lessons get disseminated and acted on.41 It highlighted that this is a challenge as it only takes one person to miss a lesson learnt for there to be a risk of serious failure. However, it recognised that it currently relies on local authorities building lessons into local practice and that it could do more to incorporate lessons into national care standards to make it easier for people to act on lessons learnt. The Department will reflect on this as it considers its response to the Independent Review of Children’s Social Care.42 34 C&AG’s report, para 1.10 35 Qq 23–25 36 C&AG’s report para 1.7 37 Q 23 38 Qq 24, 25 39 Q 29 40 C&AG’s report, para 2.12 41 Qq 98, 99 42 Q 99 14 Support for vulnerable adolescents Adolescents’ mental health services

In 2021, a NHS survey showed nearly 1 in 5 of 6- to 16-year-olds in England had a probable mental health disorder. The survey also found that almost 40% had experienced a deterioration in mental health since 2017 and 13.5% of 11- to 16-year-olds felt their lives had been made ‘much worse’ by COVID-19 restrictions. Some children with mental health issues are having to wait a very long time to start treatment. In 2020–21 the average waiting time for children to start treatment for their mental health at different health bodies issues ranged from 6 days to 81 days, with more than 22,000 (5%) of children and young people waiting more than 12 weeks.43 The proportion of adolescents known to be in contact with secondary mental health services is far greater for girls than for boys (Figure 1).44 For example, 18% of 16- year-old-girls are in contact with mental health services, compared to 11% for boys. The Department for Education told us that the prevalence of eating disorders had increased since the COVID-19 pandemic, particularly amongst young girls.45 Figure 1 – Proportion of population known to be in contact with secondary mental health services by gender and age group in England, 2020–21 NOTES

We asked the Department for Education what it considers it can do to support young girls with their mental health. It told us that it ensures the work it does with the Department of Health and Social Care is built on an understanding of the data, so that it can spot patterns in the data and “make that part of the conversation”. It told us that the government has invested an extra £2.3 billion a year for mental health services overall by 2023–24, which should enable an extra 345,000 children and young people to access NHS-funded mental health support. It added that some of the funding will be spent on eating disorder services resulting in another 2,000 places in eating disorder services this year. When asked whether departments are doing enough on preventative work on mental health, the Department for Education told us that it could not say it was sufficient given there is “obviously still a problem”.46 Currently there are 750 children and young people waiting for mental health treatment in Gloucestershire with some young people waiting over 18 months. The Department for Education said it would write to us with further details on the waiting times.47

The Department for Education also spoke about an NHS England consultation, which closed early in 2022, on introducing waiting time standards for community and A&E mental health care.48 The new standards would comprise a 24-hour standard for urgent community mental health care, a four-week standard for children and young people who need non-urgent community mental health care, and a standard of one hour for people arriving in A&E and needing a mental health assessment. The Department for Education described the setting of the standards as “important” as they would provide a “yardstick” for measuring performance. It said that people had welcomed the potential setting of the standards but had reported that meeting them would be a challenge.49 Youth justice

Between 2010–11 and 2020–21, the number of children cautioned or sentenced for an offence reduced from 85,300 to 15,751 (an 82% reduction) and the number of first- time entrants to the youth criminal justice system reduced from 46,012 to 8,848 (an 81% reduction).50 We asked the Ministry of Justice about the NAO finding that the government does not fully understand the reasons for this dramatic fall. The Ministry of Justice referred to work it carried out in 2017 which suggested that “potential drivers” of the reduction in first-time entrants to the criminal justice system were an increased focus on early intervention for people on the cusp of criminal activity to prevent them offending, and diversionary activity by youth justice services to reduce the number of children who have offended entering the youth justice system.51 However, when asked whether the impact of that early intervention and diversionary activity was measurable, the Ministry of Justice clarified that it was only measurable in terms of its investment in this area.52 The Department for Levelling up, Housing and Communities said it would write to us with 46 Qq 54–56 47 Q 78 48 Q 57 49 Q 79 50 C&AG’s Report, para 12 51 Qq 30, 31 52 Q 33 16 Support for vulnerable adolescents the reduction in the numbers of adolescents coming into contact with the criminal justice system more than once due to the Supporting Families Programme, albeit that this is a narrower cohort than all adolescents.53

Whilst the number of children in youth custody across all ethnicities has reduced (by 73%) between 2010–11 and 2020–21, the proportion from ethnic minority backgrounds has increased (from 32% to 53%).54 Furthermore, the Ministry of Justice drew our attention to a recent HMI Probation report found that young black boys, aged 10–17, are 2.8 times more likely to enter the youth justice system than would be expected given the proportion of black children this age in the general population.55 The Home Office and Ministry of Justice could not fully explain these disparities. In response to our questions about what is driving the disparity, the Ministry of Justice told us that there are a range of complex “societal factors” at play. However, it acknowledged that some interventions may be contributing to disparities, such as the police’s use of stop and search (for which the Home Office take a policy lead) and decisions about whether to remand someone in custody ahead of their trial (an area of Ministry of Justice policy responsibility). For example, the Ministry of Justice told us that the data shows that a high proportion of Gypsy, Roma and Traveller children are remanded into custody (sent to a secure centre for young people until their trial).56 The NAO report included data on the rates of juvenile first-time entrants to the criminal justice system. The Ministry of Justice were not able to explain the disparities and said it would write to us with any information it has to explain the disparity.57

When asked about its plans, the Home Office acknowledged that nobody should be targeted by the police on the basis of their ethnicity, or any other factor linked to their background. It told us that it works with communities to make sure that communities have a framework for scrutinising the use of police powers where “that would be useful and necessary”.58 The Ministry of Justice told us that it is working to reduce disparities by improving the clarity of decisions about whether to remand someone in custody ahead of their trial, and increasing the legal advice that children are provided when in police custody. It also said that it is pushing to ensure that local partnerships have the data they need to understand local disparities and are acting locally to address these.59 When asked about whether it felt confident it had the resources to address the issue, the Ministry of Justice told us the complexity of the issues causing the disproportionality, and the need for action across many different policy areas, makes it difficult to guarantee success.60 Data sharing

The poor outcomes experienced by vulnerable adolescents are often overlapping. For example, we received written evidence highlighting research which shows people who have been in care are more likely to experience homelessness, long-term physical and 53 Q 39 54 C&AG’s Report, para 1.19 55 Q 44; HMI Probation, A thematic inspection of the experiences of black and mixed heritage boys in the youth justice system, October 2021 56 Qq 44, 45 57 C&AG’s Report, Figure 8 58 Q 50 59 Q 44 60 Q 46 Support for vulnerable adolescents 17 mental issues and be vulnerable to exploitation.61 The NAO’s report shows that 72% of children sentenced in 2019–20 were assessed as having mental health concerns.62 And Bristol City Council told us that its local data showed that 32% of care leavers were not in in education, employment or training in 2021, compared to 3% in Bristol’s 16–17 year-old population.63

The NAO found that Government data sets are not consistently joined-up, which makes it difficult to understand the nature and scale of the adverse impacts faced by adolescents, particularly where these are overlapping adverse outcomes. This makes it harder to understand how risks escalate and how support can be better targeted.64 The Department for Education agreed there are clusters of overlapping needs, but it said these clusters are complicated and it did not consider that there was a single big overlap in adverse outcomes. It told us there is value in interrogating and understanding the particular overlapping sets of need to identify patterns where different approaches would make sense.65

The Department for Education and Ministry of Justice referred to a joint data sharing exercise they carried out in 2020 to understand the educational and children’s social care background of children who have been cautioned or sentenced for an offence. The Ministry of Justice told us this had helped “shine a light” on the overlaps, such as between youth offending and those who have ever been persistently absent from school. The Department for Education added that this provided a good case for a targeted piece of work for those children that were affected by those overlapping needs.66

The government have plans to join up more data sets. For example, the Department for Education told us about work it has planned to link anonymised data on education, hospital admissions, mental health services, community services and maternity services. In response to our questions about how quickly it would develop a strategy in response to the analysis, the Department for Education told us that there wouldn’t be a “single, giant thing” but that it would enable it to “ask and answer better questions over time”.67 61 SVA0007 62 C&AG’s Report, Figure 9 63 SVA0009 64 CA&G’s Report, paras 13, 2.18 65 Q 94 66 Qq 61, 94 67 Qq 64, 67 18 Support for vulnerable adolescents