News

In a major new study of private fostering published this week, Bob Holman uncovers the diverse circumstances that lead people to foster children and suggests that many positive outcomes arise from unpromising situations. All names of foster carers and fostered children have been changed in this article.

Private fostering has received a bad press. Sir William Utting feared that it could be "a honeypot for abusers".¹ Victoria Climbie was a private foster child. In his recent analysis, Terry Philpot cites examples of private foster children being passed from one carer to another, displaying behavioural problems, and losing touch with relatives^.2 I have met adults who, as private foster children, were horribly physically and sexually abused.

Yet it does no service to private foster carers to depict them all as dangerous menaces who should be banned from contact with children. There are carers who look after children in ways that satisfy both parents and local authorities. Social services departments and social work departments are in touch with only a minority of the 10,000 children who, according to the Department of Health, are estimated to be in private foster relationships. Yet, when most of those departments do investigate, they declare themselves content that the welfare of the children is being satisfactorily safeguarded and promoted.

Nearly 30 years ago, I published an investigation of 100 private fosterings in which I indicated that 45 per cent of the carers were satisfactory. Indeed, some were also acting as foster parents for the local authority.³

Recently, I undertook more qualitative study using lengthy interviews with former private foster children, private foster carers and welfare professionals. The findings confirmed that some private carers offer an important service. I identified three kinds of fostering where social services departments recorded a satisfactory relationship.

First, there were professional carers whose physical standards are beyond reproach, who are affectionate and caring, but who have certain limitations in particular matters or if the placements become long term. They often specialise in West African children aged under-five. I interviewed one couple that had taken children for a social services department but who were unhappy at always taking older children. They turned to private fostering because they could choose the age of the children. Another woman took into care a number of black children over a period of 30 years. She was visited periodically by a social worker who, apparently, expressed herself as satisfied with the arrangements.

However, adequate physical care and affection is not always sufficient. Christine Hanks, like other black children who stayed long-term, spoke warmly of her foster mother yet also complained that she had never tackled issues of racism and culture (see panel, right).

Second, there were those who became private foster carers of a child whom they already knew. Frances Mitcham took in her eight-year-old niece when the child's lone parent was imprisoned. Close relatives are not usually classed as private foster children but, in this instance, the local authority deemed it as such. The girl stayed happily until she was 17 when she went abroad with friends to work. She soon became homesick and her carers, by dint of saving, brought her back to Britain. She has since made a happy marriage and successful career. Mitcham concluded her interview by saying, "We gave her a lot of love but anything we ever did for her we've had back ten-fold. She's a lovely attentive girl. She always talks of this as home. Not a day goes by when she does not phone."

Another private foster mother, Joan Brunt had herself experienced a very deprived childhood before she took in a private foster child, Rena (see panel overleaf).

I spoke with Rena and Joan. Rena explained how she got to know Joan in the street and identified her as the kind of person with whom she could settle. Joan could empathise with Rena and, despite some difficulties, it worked.

People like Frances Mitcham and Joan Brunt were not motivated towards the idea of private fostering in general. But a particular child, whom they knew, came their way and they committed themselves long-term and showed some skill in coping with them.

A third category comprises those who became carers of local teenagers. A typical example is Erica Sutton, a lone parent, with no experience of fostering, who took in the 14-year-old friend of her son when he was kicked out of his own home. The boy's parents rarely visited or made payments. After a few months, Sutton ended the arrangement when the private foster child drew her own sons into trouble. But she did so reluctantly, saying, "I do have feelings for him, I took him into my own home." Annette Ainslow's private fostering experience shows some similarities (see panel bottom).

Sutton, Ainslow and others who take in teenagers tend to be parents who have coped with their own children and so feel they have something to offer others. They appear to have sympathy for demanding teenagers and attempt a thoughtful approach. They also are desperate for help from social workers. They appreciated some of the practical support that was provided but felt that the officials did not know how to deal with teenagers. Sutton commented: "There was little back-up from the social workers." Ainslow complained: "Lorna could not communicate with them (social workers) very well". They considered that, with skilled advice, the fosterings might have survived.

The horror stories of private fosterings sometimes prompt a call for local authorities to accommodate the children. This demand is both difficult to justify and also impossible to implement. As shown here, some private foster carers have much to offer and they provide a form of care that some parents want. Not least, local authorities tend to be short of care facilities and could not cope with the 10,000 or so private foster children. Indeed, private fostering can be viewed as a form of child care which reduces pressure on local authority foster homes.

Of course, local authorities should ensure the safety and well-being of all children in private foster homes. It is not always realised that the authorities already possess considerable powers. The Children Act 1989 and corresponding legislation in Scotland places duties on them to inspect, assess, monitor and visit private fosterings in order to satisfy themselves that "the welfare of private foster children is safeguarded".

In addition, they have certain powers to prohibit placements. The trouble is that many, if not most, private fosterings do not come to the notice of social services departments and social work departments. And, when they do, few departments take their responsibilities seriously. When the Association of Directors of Social Services undertook a survey of work with private fostering, only 41 per cent of social services departments bothered to reply. Local authorities are failing both to safeguard private foster children in dubious placements and also to support private foster parents who are capable of providing reasonable care.

BAAF Adoption & Fostering is lobbying the government to place a legal responsibility upon private carers to be approved or registered before they take children. This is a needed reform but more is required in order to help current private foster carers.

At present, local authorities usually place responsibility for private fosterings with field social workers. Having a host of other pressing duties, they give a low priority to private fostering. I advocate that all departments appoint a specialist private fostering social worker. At present only 17 do so. From my interviews with such specialists, the benefits became clear. At Gloucestershire Council, Brendan McGrath provides an expert service and, as he has concentrated on the issue, has discovered many more private foster children.

Swindon Council family placement officer Angus Geddes helped a group of private foster carers meet with a black tutor about the needs of their West African foster children. He also gained the confidence of natural parents who approached him before placements were made.

Specialist officers should create an awareness of private fostering in their areas, assess potential and actual fosterings, prohibit unsuitable placement, regularly visit private foster children and maintain contact with their parents. Finally, they should provide help, guidance, training and support for private foster carers. A major part of their work would be to enable carers to cope with the needs of children ranging from young West Africans to demanding teenagers. The worst abuses would be minimised while the strengths of the carers would be maximised.

The appointment of specialists would mean - at last - that priority is given to private fostering. But some councils complain that they lack the necessary funds. I suggest that the Department of Health ring-fence grants worth half the salary of a specialist worker and £2,000 a year for every private child identified by the local authority. The cost of about £22m is a mere fraction of the budget of the Department of Health. The outcome would be a proper service for private foster children and their carers.

Legal definition

Private fostering "occurs when a child under 16 (if disabled, under 18) is cared for for more than 28 days by an adult who is not a relative, by private arrangement between parent and carer" (Department of Health, 2001).

'Even today, she is my mum'

Christine Hanks, born in Liberia, was placed with a white foster mother from the age of six months until she was 19. She says, "My foster mother was a really good person. Even today, she is my mum. Had that not happened, I would not be the person I am today. I was in a white area and I was about the only black person in the school and we got called names because we were black. Our foster mum just said, "Well, call them back". It was not that she could not be bothered, she just did not know what to tell us to do.

"When I was growing up, I never thought about my background and culture. Now, having lived in London, I've come across a lot of black people. Sometimes I think that black people act in certain ways and I am not like that which makes me sad. I go to an organisation for people who have been transracially adopted or fostered. There is no support or training for foster carers in dealing with black children. It was never explained to me why I was black."

'I feel very bitter'

Annette Ainslow took in 15-year-old Lorna, a friend of her daughters, who had nowhere to live. She says: "She was a self-harmer and anorexic. I could understand her eating problems because I've got them. We had problems with her at school, she was always skiving. Occasionally she'd come over and I'd look at her and say,'Do you want a cuddle?' And she'd look at me, sob her heart out and cuddle. She was treated like part of the family. The kids adored her and she was great with them. After 13 months, Lorna ran away with a 21-year-old. I really did work hard with her. I feel very bitter."

'She makes me proud'

Joan Brunt says: "My brother went into care. My dad used to abuse me violently. I left home at 13 and lived on the streets. I got into drugs and wrong things. I've had a hard life. I've been there. I know what it is like for children who've got nobody. I knew Rena. She lived up the road from me and I'd come in late at night and she'd still be out on the streets. Rena used to play with my sister's kids and I got to know her. One day the social services knocked and said that Rena had been asking for me and could she live with me. I took her in. She was 10 and she is going on 15 now.

"Rena is a good kid but she has had a lot of problems. Her father is dead and she had nightmares. Lately, she has opened up and can talk about things which have happened in her past. I've done courses in counselling and they've helped me understand her. It is hard. Sometimes she drives me mad with her behaviour. I am only 26 and it is more like having a younger sister yet I've got to be a mother first to her and I do feel she is a part of me. Before she came to me, she never went to school. Since she has been with me she has gone every day and her reports say she is doing well.

"She is a companion to me. If I lived on my own, I don't think I'd be as esteemed as I am now. To see a child who had nothing, to see what she is like now, her education, clubs, certificates - to see what she's done makes me proud. God must have brought us together."

Bob Holman is associated with a locally run project in Easterhouse, Glasgow. His book The Unknown Fostering. A Study of Private Foster Care, is published this week (31 January) by Russell House Publishing.

References

¹ Sir W Utting, People Like Us. Report of the Review of the Safeguards for Children Living Away from Home, Department of Health, 1997

² T Philpot, A Very Private Practice. An Investigation into Private Practice, BAAF Adoption & Fostering, 2001

³ B Holman, Trading in Children, Routledge & Kegan Paul, 1973

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Signs of a sick system

MP Paul Burstow says local authorities may be breaking the law if they charge people with long-term health needs for their care.

With winter upon us, the "care crisis", predicted by many health professionals, is already grim reality. Bed-blocking has increased, while there has been a decrease in the capacity of the care home sector. At the same time, home care services are expected to cover a wider range of needs. The Department of Health has spun this as evidence of "greater independence", and has now issued guidance to local authorities on charging policies which reveals fundamental contradictions at the heart of government policy.

Two years ago, the Court of Appeal ruled in Coughlan v North Devon Health Authority that where nursing care corresponds to health needs under NHS statutory obligations, it cannot be passed on to social services and thereby means-tested. However, post-Coughlan guidance has failed to stop the practice of health authorities seeking to claim that long-term nursing care is the responsibility of social services, even when the NHS is legally obliged to assume responsibility. Social services departments continue to raise charges against the property and assets of those who are legally entitled to free continuing care.

The definition of care is therefore the first issue that needs to be cleared up. The DoH circular on continuing care identifies NHS responsibility where someone's "primary need is for health care".¹ However, this falls short of the Coughlan test in which there is no emphasis on "primary". The distinction is between "continuing care", contrasted with care that is ancillary to accommodation and services, which are very clearly "social care" within the statutory framework of social services. By definition, many who require continuing care due to degenerative conditions such as Alzheimer's, dementia or Parkinson's, fall into the former category, due to the health dimension. This important distinction gets no mention in the home care guidance.²

Solicitors acting for social services would do well to consider whether their actions are lawful when people with degenerative medical conditions are charged. Following instructions from social services departments, without considering care users' rights, could constitute professional negligence. Moreover, particular sensitivity needs to be employed in obtaining consent to liquidation of assets when dealing with elderly and vulnerable care users. Consent obtained without appropriate explanation can breach both common law and the Human Rights Act 1998.

Finally, in issuing new charging guidance to local authorities, the government has missed an opportunity to fully implement even its own meagre reforms of long-term care funding. Care home residents under the "preserved rights" scheme continue to pay disproportionately for their care costs - 8,400 preserved rights residents are paying over £120 per week in top-up fees, £51.9m a year! No wonder the Treasury is leaning hard on the Department of Health to fudge guidance to health authorities and to delay the abolition of preserved rights. At the same time 42,000 self-funders are still paying for their personal care and in practice are still contributing to what any reasonable person would regard as nursing care.

Care is a continuum along which an individual should move depending on his or her needs - whether it is provided by a trained nurse or a care worker is a secondary issue. It is wrong to turn nurses into gatekeepers, rationing access to nursing care - if a nurse delegates care to a health care assistant it suddenly becomes means-tested. Moreover, nurses are placed in a position where in effect they are making a legal adjudication as to which statutory category a care user belongs.

Joint working, multi-disciplinary assessment tools, pooled budgets and partnerships using primary care trusts as the gateway are all welcome, but they do not solve the problem of an unclear funding boundary and unworkable criteria.

In some states in the US, care staff carry hand-held bar code readers and laminated sheets of bar codes for residents' names, each task that is performed and the start and finish times. While some in the US praise this, surely it simply turns care homes into supermarkets and care into a commodity.

You cannot have a privatised "pay as you go" care service without undermining the integrity of the NHS. The elderly population have spent their working lives contributing via national insurance to the NHS and have the right to expect dignity.

Paul Burstow is Liberal Democrat shadow minister for older people.

References

¹ DoH circular, Continuing Care, HSC 2001/015, DoH 2001

² DoH circular, Fairer Charging Policies for Home Care, LAC 2001/32, DoH 2001

Website

Reference 2 circular at www.doh.gov.uk/scg/homecarecharges