Handicapped Children (Hansard, 25 November 1985)

§ Mr. Peter Thurnham (Bolton, North-East)

I apologise to my hon. Friend the Under-Secretary of State for keeping him up at this late hour. If he were to join those families who have chosen to adopt a handicapped child, he might get used to it. Before then, he would have to get through the hurdle of being approved by the local authority. One is asked whether one has secure employment. I hope that my hon. Friend feels, as I do that there is no reason to suppose that our employment is anything but secure.

I am pleased to have the opportunity to bring this subject up for five reasons. First, this is the month that the British Agencies for Adoption and Fostering has launched its appeal for £200,000 towards its excellent work in placing children with special needs. This month we are celebrating the 2,000th placing in 17 years.

Secondly, 1985 is the year in which the Exodus campaign has reminded us that many hundreds of children are still in long-term care in mental hospitals, despite repeated claims by Ministers over many years that they are not the right environment in which to bring up children.

Thirdly, this is the year in which BAAF has produced an excellent publication—"Against the odds: adopting mentally handicapped children" by Catherine Macaskill. I have a spare copy if my hon. Friend the Under-Secretary of State would like to glance at it. The author describes the timing of this study as crucial to the changes that have occurred earlier in the United States and the revolution that is occurring in this country.

Fourthly, this year has seen a great crusade for the sanctity of human life. More than 2 million signatures were on a petition presented to the House. This has occurred at the same time as BAAF's director, Mr. Tony Hall, has appealed about the desperate shortage of families willing to take the children who are in long-term care.

Fifthly, there is my personal interest, arising out of having fostered a handicapped child for two years. I hope that adoption can soon take place.

My purpose in requesting this debate is, I regret to say, to make the usual call for more funding. I hope that my hon. Friend will listen particularly to the special reasons for my plea, because he is probably aware that I have not often called for more Government expenditure. I should like to link that with a request for more centralised co-ordination of services for handicapped children who need placement families.

I think that I share a common purpose with the Government. In a recent letter, Baroness Trumpington wrote to the leader of the Exodus campaign, Mrs. Peggy Jay, stating: We do have a common purpose, to achieve better alternative provision for mentally handicapped children at present in hospital. The only difference between us is in how this can best be achieved. Much of the present spending is wasted. We do not have the exact figures, but it must be costing more than £10 million a year to keep 1,000 children in long-term residential care in NHS hospitals in England, Wales, Scotland and Northern Ireland and a similar sum to keep children in long-term care in local authority homes. This 722 money will be wasted if it fulfils an objective that runs counter to the Government's policy that children should not be there in the first place.

I link my appeal with humanitarian grounds. In 1946, nearly 40 years ago, the Curtis committee said that these children are the most deprived of all, yet we are still debating the subject. Government Ministers have said repeatedly that the Government's aim is to get these children out of long-term hospitals. Cmnd. 9674 which was published last week states that the Government's aim is to get all long-stay children out of hospitals for the mentally handicapped. They have asked all health authorities to ensure that these children are identified and that their needs are reviewed jointly.

We have a common purpose, but I question whether the Government's policies are working satisfactorily. My experience is that with these children it is more like the game "Pass the parcel." The policy of leaving this job to local authorities is not working. The evidence is contained in the Government's survey of local authority social services for handicapped children. If my hon. Friend the Parliamentary Under-Secretary of State has not yet had an opportunity to refer to this document I can show him a copy. It refers to the work being done by local authorities.

May I also refer my hon. Friend to Catherine Macaskill's book and to my personal experience. Catherine Macaskill's book contains 20 case studies. Nine of the families first approached voluntary agencies while 11 of them first approached local authorities. The 11 families who approached local authorities saying that they were interested in taking a handicapped child were rejected. It was only when those 11 families approached voluntary agencies that they were given any sort of encouragement. The local authorities told them nothing at all or fobbed them off with unhelpful remarks.

The attitude of social workers can be too negative. May I refer my hon. Friend to page 94 of Catherine Macaskill's study. She describes what it is like for a family that says that it would like to adopt a second handicapped child. Such families are regarded as being not only singularly odd but doubly odd. She said: Applicants for a second handicapped child were not generally viewed favourably. Some adoption workers expressed the view that the stress associated with integrating one handicapped child was more than enough for any family. One project leader had no hesitation in expressing her verdict: 'Im dubious about it. I think we need to think about how the family look in the community. If a family adopt one handicapped child, they are considered odd — if they adopt two, they're considered even odder.' Of the few adoptions of children who have been difficult to place that my local authority has arranged in Bolton, half of them went to one family. This shows the division between what families are able to offer and what some local authorities are prepared to understand.

My experience was that after telling the local authority that we were interested in fostering or adopting a handicapped child nothing happened for two years. We discovered later that 30 miles away the same local authority had at the same time been advertising a child for 18 months. We found out about the child who is now with us only when we were on holiday in Majorca. We read an advertisement in The Guardian. The same local authority was dealing with us and with that child, but two different offices were involved. There was a complete lack of liaison.

723 I called upon the excellent officer in charge of social services in Bolton, North-East, Miss Barbara Swayles, and asked her whether she knew of any handicapped children who needed to be adopted or fostered. She made inquiries and said that there was none. The following week I visited the Elizabeth Ashmore home for handicapped children in Bolton. It is run by an excellent lady by the name of Mrs. Jean Farnworth. I asked her if she had any handicapped children who were in need of fostering or adoption. She said that she had three and that she had been looking for parents for them for up to five years, and yet a divisional officer of a different division only two miles away, although still within Bolton local authority, did not know about them.

The social worker responsible for those children told me that the local authority had for years been making vigorous efforts to place those children. How vigorous can those efforts have been when they were so completely unsuccessful? We must regard such children as the truly forgotten children.

The Government's study shows a number of weaknesses. To start with, it does not contain one number. It is one of the most extraordinary documents that I have ever read. That is brushed off with the explanation that there was great difficulty in collecting reliable information.

I refer my hon. Friend to paragraph 7.222. It states: The chances of a handicapped child being placed in a substitute family varied widely from place to place. We can see why from what I have just said.

Paragraph 7.228 states: Adoption of handicapped children is achieved very rarely. That is hardly surprising.

Paragraph 7.410 says, "Pressure of work"—one wonders what work it was— prevented one authority from taking into care any children in hospital who had lost touch with their parents. What work could that local authority have been doing that was more important?

Page 89 of the Government's report recommends: Every local authority department should consider fostering and adopting. That is a weak recommendation. Page 90 deals with, "Children with profound handicap." That chapter does not mention fostering or adopting. It confirms the view held by many social workers that the more difficult the child's need the more unlikely it is that the child can be placed. That is contrary to what Catherine Macaskill found. She found that the challenge that the more profoundly handicapped children present to would-be adoptive parents makes them in many cases keener to take the children who have the greatest needs, and yet local authority workers tend to view them as the ones least likely to be placed.

Is my hon. Friend satisfied with the points that have emerged from the survey? Does he not consider that it shows that there is a failure by local authorities to collect the parcel that the Government are offering them? Does he think that it displays a failure by the staff in his Department fully to understand the potential of placing children with difficult needs? The social workers are failing to understand the revolution that is occurring. It started in America and it is now here. It is most important that people recognise that fact. The Government's survey 724 also pointed to the need for legislation to tidy up uncertainties. I would be grateful if my hon. Friend would comment on that point.

I would like the Government to review their policy on this matter and to estimate the cost of setting up a standard national minimum adoption allowance. BAAF called strongly for that. It is felt that the present system is crazy. In the United States, the adoption of children with special needs by low income families has been made much more possible by the standard adoption allowances that prevail there. Only 65 of our local authorities out of 128 have approved adoption schemes. That is 10 years after the Children Act 1975 was passed. That does not take account of special needs because the Disablement Income Group has estimated that it costs £130,000 to bring up a severely handicapped child compared with £70,000 for a normal child.

The present scheme is described as experimental and it is due to lapse in 1989. Does my hon. Friend think that it is now time for the Government to grasp the nettle and introduce a standard national minimum allowance for adoptive parents? If we set the figure at £50 a week and enabled another 1,000 families to take children it would cost £2.5 million a year. The numbers are difficult to get at. The Government have access to a lot more information, and I challenge them to produce a costing.

Attempts have been made to get the figures, and local authorities have told the National Foster Care Association that they would be willing and able to submit figures of payments to foster parents of handicapped children in their returns to the DHSS. I was shattered to learn from a written answer by my right hon. Friend the Minister for Health on 20 November that the Government did not feel that the information was necessary. As the local authorities say that they are willing and able to provide the details, it is offhand for the Government to say that they do not want them.

We have some information about the numbers. It is estimated that between 2,000 and 3,000 severely mentally handicapped children are born each year in the United Kingdom; there are also about 2,000 abortions of what would have been severely handicapped infants. The vast majority of severely handicapped children live with their natural parents and the support services are much welcomed, but the work done by Madeline Simms at the Institute for Social Studies in Medicine shows the strains on many of these families. In a recent survey reported in The Lancet on 2 November, she showed that two thirds of mothers of mentally handicapped young adults said that they wished they had had an abortion. That shows the acute need for post-adoptive services to encourage would-be adopters.

We know that it costs up to £20,000 per annum to keep a child in institutional care in London, and the latest figures that I have for Bolton show that it costs £19,000 per annum to keep a severely mentally retarded child in institutional care there. I hope that the Government do not underestimate the cost of transferring children from the NHS. I note that the White Paper issued last week showed that the money available had been increased from £9 million to £10.5 million, to be made available over an unspecified period, but that is a paltry subsidy for children who must be costing the NHS at least £10 million a year. Professor Lawrence of Cardiff recently estimated the lifetime cost of caring for a Down's syndrome child at £250,000. Against those costs, £2,000 to place a child in 725 the BAAF "Be my Parent" book seems paltry, yet many local authorities claim that they cannot afford even the modest proportion of that fee which BAAF charges them.

I recommend the Government to review policy in this area and introduce a national minimum adoption allowance, on the United States model, without delay. That would allow BAAF to get on with promoting its schemes nationally. The Government should also recognise the inability of local authorities to make placements of children with special needs. Each child is different, and each family is different. It is not easy to link the two. The policy of leaving that task to local authorities is clearly not working.

I urge the Government to increase the grant to BAAF and the other voluntary services, such as Parent to Parent and Parents for Children, which do such excellent work. I am sure that a double grant would be cost effective. I also ask the Government to produce additional funds for post-adoptive services, especially for adolescents. Workers in this area say that there is a vacuum when children reach 18 or 19. Many parents adopting handicapped children must wonder what will happen when the children reach that age.

I do not believe that local authorities can co-ordinate joint services properly. Surveys show how they are struggling, and the recommendations of the 1976 Harvie committee have still not been implemented.

One of the most important aspects of post-adoptive services is respite care, which could help to avoid a number of the breakdowns that might occur if more children were placed. The Parents for Children survey showed that 14 of 89 placements over eight years broke down for this and other reasons. I recommend that there should he at least one place for each 12 who are mentally handicapped, so that the necessary care can be provided. I look forward to seeing the Government's resources guide, which I understand is to be published shortly.

I wonder whether my hon. Friend could persuade other newspapers to follow the lead of The Guardian, which carries a monthly advertisement of a child in need? Does he agree that the Daily Telegraph would be a much better newspaper if it showed the same enlightened attitude? If standard adoption allowances were introduced, does my hon. Friend accept that that would be an excellent basis on which to advertise in The Sun as well? We could have a page 3 Sun child of the week.

The Exodus campaign should be recognised now by publicising the list of local authorities, and not merely a list of health authorities, with children in long-term care. That would enable pressure to be brought on the local authorities with any new legislation that may be necessary to help us transfer children who are in National Health Service hospitals.

I am grateful to have had the opportunity of inititating this Adjournment debate at such a critical time. I look forward to my hon. Friend's reply. I hope that the clock has not been running too fast in the limited time that is available to us.

§ The Parliamentary Under-Secretary of State for Health and Social Security (Mr. Ray Whitney)

I am happy to respond to the debate, which was initiated by my hon. Friend the Member for Bolton, North-East (Mr. Thurnham). He made entirely unnecessary apologies for the lateness of the hour. As he said, those of us who have 726 had children are well experienced in being awake at this hour. I am aware of his experience with the child whom he fostered and the great contribution that he has made broadly to the subject that he has brought to the attention of the House tonight. That contribution is well recognised and it is of much value to the House and to the several causes which he has espoused. I shall try to cover the major issues which my hon. Friend has raised, but the rules of the House will, I am sure, prevent me from covering all the ground. In any event, some of the issues which he has raised are of considerable importance and I should like the opportunity to study them carefully before reacting.

I reinforce the remarks of my hon. Friend about BAAF, the British Agencies for Adoption and Fostering. We both had the privilege of taking part in recent celebrations and a most impressive press launch. I record my great pleasure at being able to participate and to see some of the children, who demonstrated how they had benefited—the same can be said of the families—from the fostering that has been the result of BAAF's initiatives. I hope that our commitment is clear to the objectives of BAAF and to the principle of placing children who need it in a family environment, especially the work that it has done to foster the adoption of children with special needs. It has made great strides in that area of its work over recent years and it had celebrated its 2000th placing.

The Government have a record of which they should be proud. We would all like to do more, and my hon. Friend will recognise the financial constraints within which Governments must necessarily operate, but we have given substantial support both to BAAF and to other agencies. In money terms, that support will amount to a sum slightly less than £300,000 in this financial year. We support the specialist agency that is called Parents for Children and our grant last year was £54,000. As my hon. Friend says, he is not one who is in the habit of calling constantly for more money, and I know that to be true. He will recognise the inevitable constraints that all Governments must concern themselves with, and especially this Government, who rightly pay the closest attention to keeping public spending under control. However, since taking office in 1979, our spending on the personal social services has increased in real terms by no less than 20 per cent., which is a formidable record. Our contributions to voluntary agencies has increased from just over £7 million when we took office to over £30 million now, which is a significant increase in real terms.

It is also true that we are not talking entirely about what the Government should or can do. That is an area where there must be the maximum co-operation among central Government, local authorities and the voluntary sector. BAAF and its resource exchange are excellent examples of such co-operation.

My hon. Friend spoke about the need to get children out of mentally handicapped hospitals and into the community and the efforts of the campaign called Exodus. I should like to pay tribute to Exodus. As my hon. Friend recognised, it is the objective of this Government, and of previous Governments, to get as many children as possible out into the community. I believe that we are making significant progress in that direction.

I offer the House two figures that demonstrate that claim. In 1982 the number of children in National Health Service mentally handicapped hospitals was 2,421 and two years later, at the end of 1984, it had fallen to 1,074. That 727 is a dramatic fall, which we should all acknowledge and pay tribute to. The funds used to achieve that included £1 million made available from 1981 from central finance on a £1 for £1 basis to voluntary bodies. From 1983–84 we devoted £10.5 million to health authorities to help to get children out of hospitals.

We must proceed at a measured pace and ensure that all placements are suitable. I am sure that my hon. Friend would be the first to agree that to get such a placement wrong would be more damaging than not to seek to remove a child from the hospital in the first place. A great deal of collaboration is necessary as well as a great deal of training of professional and other staff. That was the subject of the Court report and the Jay report.

My hon. Friend referred several times to one of the reports by the social services inspectorate of the Department. It is true that there is a patchy performance among local authorities. Some are undoubtedly better than others; many are a good deal better than others. The function of the social services inspectorate is to bring out the best factors so that they are adopted and followed throughout the country. That was one of the major objectives of the report to which my hon. Friend referred. I am sure that we have a long way to go, but we recognise the fundamental structure of local government and its statutory responsibilities. I hope that my hon. Friend will 728 agree that there are strict limits as to how far we could or should go from the centre. We can provide training, funds, advice and example, but at the end of the day we have to continue to strive for a balance between the agencies involved—central Government, the local authorities and the voluntary agencies.

I should like to believe that we are moving in the right direction, but I recognise that there are areas where improvements will always be necessary.

As time is closing in, I should like to write to my hon. Friend about the points that he has made on the adoption allowance scheme. As he knows, after the introduction of the adoption allowance scheme, which was a controversial measure, the recommendation was that there should be research. That is now being carried out by the National Children's Bureau. The Secretary of State will report to the House by February 1989. I believe that that is the right way to go because it is an important area. It takes time to identify the benefits and any problems that arise. I welcome the fact, as does my hon. Friend, that the take-up by local authorities has been much wider than envisaged—