Private gain

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

———————————————————————————

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