Children affected by domestic abuse: NHS waiting lists

Domestic Abuse Bill – in a Public Bill Committee am 3:30 pm ar 16 Mehefin 2020.

Danfonwch hysbysiad imi am ddadleuon fel hyn

“The Secretary of State must by regulations ensure that children who move to a different area after witnessing or being otherwise affected by domestic abuse as defined by section 1 of this Act are not disadvantaged in respect of their position on any NHS waiting lists.”—

Brought up, and read the First time.

Photo of Karen Buck Karen Buck Llafur, Westminster North

With this it will be convenient to discuss new clause 23—Children witnessing domestic abuse: school admissions—

“The Secretary of State must by regulations require admissions authorities of all mainstream schools to give the highest priority in their oversubscription criteria to children who have moved as a consequence of witnessing or being otherwise affected by domestic abuse.”

Photo of Jess Phillips Jess Phillips Shadow Minister (Home Office), Shadow Minister (Domestic Violence and Safeguarding)

These new clauses are about child and school admissions and NHS waiting list, and we heard compelling evidence about that from Hestia at the evidence session. They are about the importance of ensuring that children who are forced to relocate because of domestic abuse are prioritised. Last Tuesday, I spoke at length about the need to include children in the definition of domestic abuse—I am sure everybody will be relieved to hear that I will not repeat that now. I very much hope that that has been heard, and I await progress.

Hestia and Pro Bono Economics advised that the average wait for children who move to obtain a new school place is between four and six months in cases of domestic abuse. That is certainly my experience of working in refuges—there were often children out of school. Obviously, we must take account of the fact that we are in this weird time when most children are not at school.

This means they have four to six months away from their peers without the routine and safety of school, while living in an unfamiliar house or refuge. The alternative would be to attend a school that is an impossible distance away, in a location deemed too dangerous for that child to live in.

We see parents and their children day in, day out in my constituency office because those children are not in school, and they are desperate for assistance in finding a school place. Those parents and their children are often living in temporary accommodation—perhaps in a Travelodge, or in a refuge where children of varying ages and needs are sharing one room. Cooking facilities are rare, and they are often reliant on food banks.

Many do not have the required resources or technology to educate their children. Imagine being in a domestic abuse situation and also having to home-school your children—it is worth noting that previously I would have said, “Try to imagine what it’s like to have to home-school your children for that period.” I do not need to ask people to imagine that anymore. I am not in a domestic abuse situation, and I have a loving and kind husband, but I have found it almost impossible to home-school my children. Now layer on top of that a situation in which everyone is living in one hotel room and having to home-educate their children.

I am sure everybody will hear in their constituencies some of the most heartbreaking cases involving a teenage child trying to study in temporary accommodation, living in difficult circumstances and saying, “I just can’t study. I don’t want to tell my friends where I live, so I walk a different way home.” Those are the most heartbreaking stories. I have heard of cases of children with severe PTSD and anxiety being placed in accommodation with men who trigger their symptoms. There are cases of children with sleep disorders and suicidal ideation being placed in a Travelodge where noise is unavoidable and antisocial behaviour is rife.

The impact of covid-19 has demonstrated the importance of schools, not only in education but in the provision of food—a subject that was not quite as topical when I wrote this as it is about to be. It is estimated that 1.3 million children are now dependent on food parcels from their school, and according to my notes there is now a campaign for those food parcels to be available throughout the summer—I should just scrap this part and be grateful that food parcels will now be available over the summer. Children not enrolled in school cannot access the food parcels provided by schools, which forces them further into food poverty. Obviously, we have all had to overcome that during covid-19, but in normal times there is no food provision for children on free school meals living in a refuge who are out of school. It is a complicated situation.

Schools have also remained open for known vulnerable children, including those on a child in need plan, because schools also provide safeguarding and pastoral care. They can act as a referral mechanism for those with mental health problems or special educational needs. Schools can be a safety net and a place of sanctuary for children at risk—I do not just say “can”, because we all have brilliant schools in our constituencies, and it is impossible to imagine what kids’ lives would be like without them.

Schools have also remained open for children with special educational needs and those with an education, health and care plan. Schools are integral in referring those with special educational needs to the local authority so that they can receive an EHC plan—I would like to carry on calling it a “statement”, because that seemed easier. Those plans offer support to children and young people whose special educational needs require more help than would normally be provided. The plans identify educational health and social needs and set out additional support required to meet those needs, most often in the form of support provided by schools. Children who are not enrolled in school do not have access to that safety net and the nature of support that can be provided by a school. They are not afforded these protections and do not have access to support services. They are left at risk and vulnerable in circumstances in which they have experienced extreme trauma and upheaval.

It is also well known that the consequences of domestic abuse are significant and wide-ranging. Brain development can be affected, impacting cognitive and sensory growth. There are associated personality and behavioural problems, and a greater prevalence of suicidal tendencies and depression. Pro Bono Economics has advised that childhood exposure to severe domestic violence can increase the number of children in the UK with conduct disorders by around 25,000 to 75,000, and the number with hyperactivity disorders by around 10,000 to 25,000. Conduct disorders are the most common type of mental and behavioural problem in children and young people. They are characterised by a repeated and persistent pattern of antisocial, aggressive or defiant behaviour, much worse than would normally be expected in a child of that age. I hasten to add that that is quite a gendered view of those disorders. Often when girls present with attention deficit hyperactivity disorder or autism spectrum disorder, it presents in a different way, and those ways are often ignored.

ADHD is often a contributing factor. These children often require psychological therapies, medication and support from health professionals. Children growing up in a situation with domestic abuse are more likely to need help from school, more likely to need food provided by school, and more likely to need the sorts of plans that schools put in place. They are also more likely to be in the referral system regarding a childhood mental health disorder.

For those children to receive support from health professionals, they need a diagnosis. Such diagnoses can take years to receive—a bit like how we all deal with the CMS—and they are often requested by a local authority to produce the aforementioned EHC plan. I see so many constituents who are constantly fighting against local services for a diagnosis that would assist their child. One in particular had been waiting for more than three years for a six-year-old to be diagnosed with ADHD and ASD. That is over half his life, and in that time he was receiving no additional support, either inside or outside school.

When my son was going to secondary school, I got a call to say that he had to go and have an assessment, in his case by the local clinician, who said to me, “I remembered that your son was going to secondary school when I saw you on ‘Have I Got News For You’, and I thought I must give her a call before he goes to secondary school.” We had waited two and a half years for the assessment. That cannot be the referral pathway for the nation: that people have to appear on a comedy panel show in order to get through the system.

The reality at the moment is that people are waiting for years. That is not just the case in Birmingham, Yardley. Berkshire Healthcare NHS Foundation Trust reported a wait of 799 days between referral and the start of an autism assessment, North Staffordshire Combined Healthcare NHS Trust reported a wait of 637 days, and South West Yorkshire Partnership NHS Foundation Trust reported a wait of 535 days. To get a final diagnosis can take up to 1,288 days, as was reported in Northern, Eastern and Western Devon clinical commissioning group. It appears to be another example of a postcode lottery.

The situation for ADHD is no better, with an average wait of 18 months for a child to receive a diagnosis. Although I was unable to find any figures for conduct disorder diagnosis, I can only assume that the situation is similarly bleak. If a child is forced to move to a different NHS trust or CCG due to domestic abuse, they may have to repeat that wait over and over again. That is untenable. These children are vulnerable victims in urgent need of support. Their living situations are often precarious, and their parents may not be in a position, through no fault of their own, to provide the support that they need for an extended period of time.

These children are more susceptible to mental health and behaviour disorders. As such, they should be prioritised on NHS waiting lists for all health conditions, not just those that I have outlined. The estimated cost of the long-term effects of exposure to severe domestic abuse is between £0.5 billion and £1.4 billion per year, including a projected £790 million on education services and £70 million on health services. Providing appropriate resources to children in a timely way can reduce that, and reduce the long-term trauma and difficulties, together with the economic cost. I therefore urge Members to support new clauses 22 and 23.

Photo of Victoria Atkins Victoria Atkins The Parliamentary Under-Secretary of State for the Home Department 3:45, 16 Mehefin 2020

I thank the hon. Lady. I will deal first with the NHS and then move on to schools. I think there is agreement across the Committee that it is important to recognise the impact of domestic abuse on children and the trauma it can cause. The role of the NHS is to give the best care to address the immediate and continuing health needs of such children. It is a key principle that access to the NHS is based on clinical priority, so when patients move home and between hospitals, the NHS should take previous waiting times into account and ensure, wherever possible, that they are not disadvantaged as a result. A child’s need to access and receive health services will be assessed, and services will be provided according to clinical need, which will consider the individual needs of the child. We have to trust clinicians to take decisions about a patient’s treatment.

On schools, I agree with the hon. Member for Birmingham, Yardley that vulnerable children, including those who have been affected by domestic abuse, should be able to access a school place quickly, and that any gaps in their education must be kept to an absolute minimum. As I have said before, wherever possible, we want victims, survivors and their children to stay at home and the perpetrator to leave, but in some cases, sadly, that is not possible for their safety.

Before I explain the Government’s position on that, I will highlight an important distinction between seeking school places in the normal admissions round, such as the start of the school year, and doing so outside that process, which is called in-year admission. As we know, it is important that children who have experienced or witnessed domestic abuse are more likely to seek a school place outside the normal admissions round and to require the in-year process. During the review of children in need and the 2018 consultation on domestic abuse, we heard about the difficulties and delay that such children face in accessing new school places when moving into refuge after fleeing domestic abuse. Improving the in-year admission system is the most effective way to get vulnerable children back to school as quickly as possible.

The in-year application process varies between local authorities and can be particularly difficult to navigate for disadvantaged and vulnerable families, including those who have been victims of domestic abuse, because the school may already be full, and oversubscription criteria are unlikely to be helpful at that point. To ensure that this does not prevent children experiencing domestic abuse from accessing the school places they need, the Government have committed to make changes to the schools admissions code to improve the in-year admissions process. That will ensure that all vulnerable children can access a school place as quickly as possible.

That is not to say that the current system does not support the admission of our most disadvantaged children when they apply for a school place in year. Fair access protocols are in place to ensure that vulnerable children who need a school place outside the normal admissions round can secure one as quickly as possible, but we know from consultation that there is confusion about how fair access protocols should work, which means that sometimes they do not work as effectively as they should do. In some areas, fair access protocols are used as the default way to place every in-year applicant, rather than as a safety net for vulnerable and disadvantaged children.

I am pleased to state that we intend to consult on changes to the school admissions code to better support the in-year admission of vulnerable children, including those in refuge or safe accommodation. In practice, that means making changes to the provisions relating to the in-year admissions process and fair access protocols by introducing a dedicated section in the code that will set out a clear process for managing in-year admissions. We are also proposing to provide greater clarity in the code on fair access protocols, which will improve their effectiveness by making clear their purpose and what they should be used for, and by setting out a clear process by which they should operate.

We will also extend the categories of children who may be admitted via the fair access protocol, specifically to include children on a child in need or child protection plan and children in refuge and safe accommodation. That will ensure that those children are secured a school place quickly, keeping disruption to their education to an absolute minimum.

Photo of Liz Twist Liz Twist Opposition Whip (Commons)

The Minister has talked at some length about the schools provisions, which are important to ensure that children have quick access to a school near them. Will she say some more about the NHS provisions in new clause 22? She has talked about clinical priority but, as most of us know—not just from children, but from other situations—moving from one health area to another means that there is inevitably a setback. The new clause is intended to address that.

Photo of Victoria Atkins Victoria Atkins The Parliamentary Under-Secretary of State for the Home Department

I understand that, but the problem is that we are now rubbing up against the fundamental principle of the NHS, which is that it is based on clinical need and priority. Clearly, if a child is in the most urgent clinical need, we would absolutely expect them to be at the front of the queue to receive help, but there will be different gradations depending on the condition, the length of the condition and the way in which it manifests. We have had to keep to the fundamental principle that that must be clinician-led, because we could not, with the best will in the world, hope to categorise exhaustively in the Bill the many ways, quite apart from domestic abuse, in which children may suffer or be ill

Photo of Liz Twist Liz Twist Opposition Whip (Commons)

I think this is fundamental, really. Simply moving house can put someone back in a queue when clinical priorities are assessed in that new area. What we are all trying to do—as, I am sure, is the Minister—is ensure that the principle is one of clinical priority, rather than where someone is on a waiting list. This change is absolutely vital.

Photo of Victoria Atkins Victoria Atkins The Parliamentary Under-Secretary of State for the Home Department

Very much so; that is the key principle on which the NHS operates. The hon. Lady will appreciate that I am neither a doctor nor a Health Minister. I take her point about waiting times, but once the clinicians have assessed the clinical need, they must surely be the ones to determine what sort of treatment the child receives, as well as when and where.

Photo of Victoria Atkins Victoria Atkins The Parliamentary Under-Secretary of State for the Home Department

I can see that the hon. Lady is perhaps not with me on that, but it explains our position. We stick to the principle of the clinician and the clinical need leading on this matter. Of course, I accept the point about different areas.

Photo of Liz Twist Liz Twist Opposition Whip (Commons)

I am sorry to keep pushing this, but I know that it occurs for other groups of people who are disadvantaged. People receiving alcohol or drug treatments, for example, may move from one area to another and lose all their connections. We are talking about clinical priority within a different group, so although someone might have reached the top of the queue in one place, they might not somewhere else. The amendment seeks to ensure that those children get the best chance that they can.

Photo of Victoria Atkins Victoria Atkins The Parliamentary Under-Secretary of State for the Home Department

Again, that comes back to the principle that, wherever possible, we do not want victims and survivors to have to move and be put in that new place. The hon. Lady articulates very well one of the many ways in which it is incredibly traumatic for the survivor to have to leave the family home to flee to the other side of the country with the children. In some cases, the survivor has to do so because of the danger of the perpetrator, but where we can, let us try to keep her and her children at home, so that they do not have to put up with such concerns about things that are terribly important on a day-to-day basis, but sadly become another consequence of fleeing.

With regard to waiting times, again it comes down to the views of the clinician with that particular condition or range of conditions. CCGs and providers have a duty to provide services within the maximum waiting times set out in the NHS constitution—the rights are set out in that constitution. We very much think that the service should be clinician-led, rather than having a duty set in statute, because although I hope the hon. Lady knows how committed to this I am personally and professionally, as night follows day there will be other categories of very vulnerable people who could turn around and say, “Okay, it is great that you have prioritised children who are suffering the impacts of domestic abuse, but what about children who are suffering child sexual exploitation or modern slavery?” Does she see what I mean? If we come back to the fundamental principle of the NHS, which is that it is led by clinicians, we know we are dealing with conditions as they need to be dealt with.

I will sum up by saying that we think the changes in relation to schools will have the greatest impact in ensuring that all vulnerable children can access a school place as quickly as possible, including those affected by domestic abuse.

Photo of Jess Phillips Jess Phillips Shadow Minister (Home Office), Shadow Minister (Domestic Violence and Safeguarding) 4:00, 16 Mehefin 2020

I thank the Minister for her comments and welcome what she has outlined with regard to school places. She is right that we are talking about in-year school placements in the vast majority of cases. Some people are lucky enough to have to move house just at the right moment for getting kids into school, but the vast majority are not. I therefore welcome what she has said about changes to that process.

With regard to waiting lists for children, she is not wrong to lean on the principle that it should be clinician-led. However, in these instances a clinician will never see the child, because the assessment takes two and a half years. It will not be based on any clinical decision; it will be based entirely on a paper exercise where you just go back into the system. If someone were to move from Berkshire County Council, where they had already waited the 799 days, and then they moved to Staffordshire on day 798, they would just go back into the system. No clinician would lay eyes on them for Staffordshire’s 695 days. The decisions are not being made by clinicians in this instance. As I said, it took two and a half years for me to be sat in front of a clinician with regard to the situation in my own family.

I will not push the new clauses to a vote at this stage, but I think this goes to what we were talking about with regard to public duties. That the local authority has a public duty in this regard is great, but the reality is that if we do not put a public duty on other organisations, such as CCGs and healthcare workers, those are the things that fall through the gaps. For a child who has moved and has already been on a waiting list somewhere—let’s say for 798 days in Berkshire—there should be some way to prioritise their needs. I do not think the Minister would disagree with that as the principle. I will not push it to a vote now, but the Opposition will be seeking answers for that area from the Department of Health and Social Care. I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.