Contribution
My Lords, I rise to speak to Amendments 32 and 35, which relate to children with disabilities, because these children are, sadly, more at risk and so need our protection. Also, before I begin, could I just say that my noble friend Lady Fraser of Craigmaddie is sorry that she cannot be here today—frankly, as am I, as she is exceptionally knowledgeable in this area and so I hope she will approve of the following arguments, particularly in relation to children with cerebral palsy, who I will talk about today?
While there are many different forms of ability and disability in children, if policy, systems and practice can get things right for children with cerebral palsy—the most common cause of physical disability in childhood—then the benefits will be felt by children with other conditions too.
Evidence gathered by the APPG for its report Best Practice in Education, Health and Care Plans (EHCPs), Teaching, and Learning for Children with Cerebral Palsy found that many parents of children with cerebral palsy lack confidence in their local authority’s ability to make suitable arrangements for their child. Some even view their local authorities as being obstructive, inconsistent and unaccountable. Provision inevitably tends to reflect what local authorities are able to provide, rather than what the child concerned requires to have the best chances in life.
Much of this stems from the reality that when it comes to issues relating to children with profound disabilities, local authorities are not always the people who have the relevant condition-specific knowledge, nor the experience of the lifelong trajectory of a condition, to be able to make the right assessments of potential and be suitably ambitious for the child.
Section 17 of the Children Act, as referred to in Amendment 35, outlines the local authority’s duty to assess children who are “in need”, and this definition includes children with disabilities, who may require a paediatric developmental assessment to fully understand their needs.
Amendments 32 and 35, when taken together, would provide an acknowledgement of the necessity for a member of the specialist health team involved in the provision of care for the child—someone who understands the condition and has the sector experience to understand what is possible—to be involved in the multi-disciplinary child protection teams, to ensure that these teams are assessing all the possible options.
The persons referred to in new subsection (3) relating to the provision of health who are to be involved in the multi-disciplinary child protection teams are only defined in new subsection (4)(c) as
“a registered health professional, nominated by an integrated care board for an area any part of which falls within the area of the local authority, with experience in the provision of healthcare in relation to children”.
Therefore, the health professional, nominated by the board, could be the same person who represents the health board for all the MDCPT assessments. The text does not specify that they have to know anything about the child, the health prognosis of the condition, the services and interventions that might be best for the child or whether they are—or are not—available in any one particular local authority area, nor be able to form a qualified view of the potential of the child, based on specialist experience of children with disabilities.
In Scotland, children with profound disabilities have a nominated “lead health professional” who is responsible for co-ordinating relevant, cross-sector, multi-disciplinary services and liaising with parents to take responsibility for ensuring that the needs of the child are met. Sometimes these needs, as the Committee might imagine, can be quite specific and technical; for example, when dealing with specialist resources for communication, assistive technology and mobility needs, particularly for children with complex disabilities. This lead health professional, who has practical knowledge of the individual child’s circumstances and health condition, would therefore always be included in a multi-disciplinary team discussion. It would not be left just to a representative of the health board, or a generic paediatric clinician.
Only recently, in her letter to the Times, Professor Eileen Munro warned against shifting child protection responsibilities to less-qualified staff. I therefore urge the Minister to accept—or at least to think about—these amendments, which outline the importance of including a member of the children’s disability team, someone who knows the condition or conditions, and not just a generic professional who ticks the boxes specified in the current text referring to the persons referred to in new subsection (3)(a).
Guaranteeing the right representation on these teams will go a long way to ensuring that assessments are likely to be safer, that children at risk have swift access to the resources they require and, where local areas lack appropriate provision and/or expertise, that there is a voice of knowledge to ensure there is no fear of commissioning, a voice that can work with other specialist providers in the best interests of the child.