by Fran Abrams

Three pieces of research using the ONS Longitudinal Study were cited in the recent report of the Independent Review of Children’s Social Care. The findings from the Looked After Children Grown Up project played a key part in providing evidence to the review – and were reflected in its report and the Government’s response.

The government’s 2019 Manifesto included a commitment to a review of the care system, and in March 2021 the independent review of children’s social care, led by Josh MacAlister, was given a year to produce a report.

The Looked After Children Grown Up project, which was funded by the Nuffield Foundation and led by Professor Amanda Sacker with colleagues at the UCL Institute of Epidemiology and Health Care and Kings College London, had already begun in February 2018 and was able to provide important evidence to the review.

The adverse consequences of being looked after as a child were already well recognised, but this research project was set up to address a lack of evidence on what happened to looked-after children later in life. Studies tended to follow them into early adulthood and no further, but using census data from the ONS Longitudinal Study the researchers were able to explore outcomes for those who experienced care from the 1970s onwards, up to the age of 50.

The study allowed researchers to track those who were children at the time of each census, and to identify whether they were living in residential care,  as an unrelated member of an individual household, as a biological or adopted child in a parental household or as a child in a relative’s household.

By tracking care-experienced children into mid-life, the project was able to look at their later outcomes from a variety of different angles: it was able, for instance, to look at their likelihood of long-term illness, their employment, their education, their housing tenure, the type of family relationships they had and even whether they were at greater risk of dying early.

A fuller picture

The research, which was shared with Josh MacAlister at an event last July, was also able to drill deeper into the later experiences of children who experienced different types of care: it compared the outcomes of those who experienced residential and foster care with those who remained living with relatives, both parental and other.

Findings from the project were shared in an earlier Linking our Lives blog, and were welcomed by Josh MacAlister at the event last Summer.

In his report he focused on many aspects of the research, both citing it explicitly and reflecting its findings in his narrative.

The review

In particular, he focused on a 2021 report from the study which showed lower rates of long term illness and higher rates of employment for adults with a history of kinship care compared to those that grew up in foster or residential care.

He also highlighted  a second report from the team which showed that care leavers who were in residential care had the highest prevalence of limiting long term illnesses (around 32 per cent on average), followed by adults who lived in foster care (around 16 per cent on average) and adults who lived in kinship care (12 per cent on average). This was significantly higher than the average prevalence of limiting long term illnesses amongst individuals who had not been in care (7 per cent) , he said.

The review report also focused on mortality rates among care leavers from different types of care, and cited a 2020 report which used the ONS Longitudinal Study to link childhood out-of-home care status with all-cause mortality up to 42-years later.

It highlighted findings which showed adults who spent time in care between 1971-2001 were 70 per cent more likely to die prematurely than those who did not, and were also more likely to experience an unnatural death through self-harm, accident, mental or behavioural causes.

The review report made a number of recommendations which chimed with the research findings, including:

• Support for families to cut down referrals and help to keep children in their family homes or with relatives – £2 billion over five years.
• Unlocking wider family support networks including payments for relatives to act as foster carers.
• Support for a ‘new deal’ with foster carers to help larger numbers of children to be cared for in families rather than in residential care – 9000 new carers over three years.

The response

In his response for the Government, the Education Secretary Nadim Zahawi promised more support for family hubs which offer early help and intervention. This would add seven new areas to an existing network of centres in 75 areas that receive a £302 million pot of funding for family hubs. A further 5 areas would receive part of a £12 million investment to deliver on a manifesto commitment to a network of family hubs around the country, he said.

Addressing concerns about the educational outcomes of children who had been in care – the research found those in parental care had a 28 per cent chance of achieving an NVQ level 3 qualification compared with just 11 per cent for those in residential care – Mr Zahawi promised funding for local authorities to help them keep vulnerable children in education.

Funding would be provided to local authorities for continued delivery of the Social Workers in Schools and designated safeguarding lead supervision programmes, which launched in September 2020, he added.

An evidence-based approach

In both the review report and in the Government’s response, there was a strong focus on the need for reforms to be underpinned by evidence.

The review suggested the Office for National Statistics should collect and report data on the mortality rate of care leavers and care leaver health outcomes, and that the Government should also launch a new cohort study which tracks the health outcomes of care experienced people and helps to gather other missing data on housing, education and employment outcomes.

In his response, Mr Zahawi promised support to help the most at-risk families to stay safely together, and a focus on early help, preventing them from reaching crisis point.

As part of this, he said, the government would set up a new National Implementation Board of sector experts and people with experience of leading transformational change and the care system. This would boost efforts to recruit more foster carers, increase support for social workers including on leadership, recruitment and retention, improve data sharing, and implement a new evidence-based framework for all the professionals working in children’s social care.

“Everything we do to raise the outcomes for children and families must be backed by evidence,” he said. “This report will be central in taking forward our ambition to ensure every child has a loving and stable home and we will continue working with experts and people who have experienced care to deliver change on the ground.”

The Looked After Children project involved Professor Amanda Sacker, Dr Emily Murray, Professor Barbara Maughan and Dr Rebeccca Lacey. 

by Fran Abrams

Census data from the ONS-LS has helped shed new light on outcomes for children who have been in care in a major research project led by the UCL Institute of Epidemiology and Healthcare. The study uses Census data to push forward the boundaries of knowledge by looking at what happens in mid-life to those who have been in care as children. It finds disturbing disparities – with some groups faring much worse than others. 

Care-leavers have long been known to suffer worse outcomes than their peers. Now a programme of research funded by the Nuffield Foundation has highlighted the ways in which these issues continue throughout the lives of those affected. At an event to share the project’s findings with those interested in improving the lives of children who cannot live with their parents, Josh MacAlister, who is leading an independent review of children’s social care, said the research had already had a major impact on its work. 

It is actually breaking new ground in our understanding of where care-experienced people end up in later life,” MacAlister told an audience of more than 200 practitioners, policymakers and academics.

“One of the questions we pose is: ‘How many parents don’t know where their own child is at 30, 40 or 50?’ It’s a common refrain that the state is the corporate parent, and actually not knowing really basic things about destination and outcomes for care-experienced people later on into life has been a huge blind spot. So this study is very significant in that respect,” he said.

Raising the bar

The Government review led by MacAlister was launched earlier this year with the aim of ‘raising the bar for vulnerable young people across England.

The UK’s National Statistician, Sir Ian Diamond, who chaired the event, told the audience the care research was an exemplary use of data from the ONS-LS dataset.

Sir Ian highlighted a key issue for those studying children’s social care: the evidence shows those who have been in care suffer worse outcomes than their peers – for example higher than average levels of unemployment, lower levels of educational qualification and early pregnancy. But that research tends to focus on recent care-leavers while this project follows them into mid-life.

The project, led by a team of researchers at University College London, used Census data from the ONS-LS to explore outcomes for those who experienced care from the 1970s onwards, up to the age of 50.

Census data

The ONS-LS has gathered information on approximately a million people, and from this the researchers were able to look at a sample of just under 500,000 children. Of those, around 3,500 were looked after by family members other than their parents, 2200 were in formal foster care and 900 in residential care. Over time, residential care had become less common and family or kinship care more so.

There were four main aims of the research:

• To determine whether children who had experienced care had worse health and social experiences from 10 to 40 years later, compared to others.
• To explore whether children in residential care did better or worse than children in foster or kinship care.
• To look at care differences related to gender, ethnicity or migration status.
• To investigate trends and look at whether longer-term outcomes had improved over time.

Amanda Sacker, Professor of Lifecourse Studies, Epidemiology and Public Health at UCL, who led the study, told the launch one of its strongest findings was that inequalities within the cared-for population were as great as inequalities between that group and those in parental care.

Impacts of a childhood in care

The research found the impact of being in care on health, socio-economic circumstances, family life and living arrangements varied according to the type of care experienced – those who were cared for by relatives had the best outcomes and those who had been in residential care the worst, with foster care sitting between the two. 

This did not necessarily mean the type of care had led to better or worse outcomes, Professor Sacker explained at the event – those who were most vulnerable or damaged by early experiences might be more likely to go into residential care rather than family care or a foster home.

In relation to employment there was some evidence these inequalities between care groups reduced with age, though adults in their 20s were twice as likely to be employed if they had been in their parental home rather than in residential care.

Social inequalities between care groups also extended to the age of death: while those brought up by parents had become less likely to die prematurely in the past 30 years, this was not true for those in non-parental care. Those in care in 1971 were 30 per cent more likely than average to die but by 2001, this ratio had grown to more than 300 per cent, most commonly from preventable causes such as car accidents, alcoholism and assault.

When the researchers looked at education, they found a similar picture: those in parental care had a 28 per cent chance of achieving an NVQ level 3 qualification compared with just 11 per cent for those in residential care. There was some good news, though – the care groups were more likely to be in education later in life, and this helped them to catch up with their peers.

The project’s findings on ethnicity were more mixed. White and south Asian groups were found to have worse outcomes if they had been in care, but for black children the study found having been in care did not seem to be associated with any additional detrimental effect over and above the inequalities seen for all black children. The researchers said more investigation was needed into this complex picture.

Caregivers’ children

The final key findings of the study were on the children of those who give care. They too, it found, were affected by their experiences – there had been reports that the children of foster parents or of kinship carers had felt disadvantaged.

The research looked at five ‘transition milestones into adulthood: leaving education, leaving home, starting work, forming a relationship and becoming a parent. It found children of care-givers were less likely to have higher qualifications, more likely to be unemployed, more likely to be married early and less likely to own their own home than others. If they were female, they were likely to be younger when they had their first child.

“Our work in the field of life course social epidemiology has highlighted that inequalities in health cannot be reduced without tackling social inequalities too,” Professor Sacker said.  “By shining a light on the life courses of children who have had to be placed in care, our aim is to get it right for care leavers.”

Further work

Sir Ian Diamond said the Office for National Statistics was keen to make more use of longitudinal data such as the ONS-LS to help inform policy on issues such as this one.

“Among the most disadvantaged in society are clearly those young people and children who have experienced care, and care  leavers, we know empirically, have not had great outcomes.  It’s always seemed to me that we needed better longitudinal data to understand the pathways that would help us to inform policy, which could improve the outcomes for people who are under-achieving because they have been let down early in their lives for all kinds of reasons.  So it seems to me there’s an enormous need for this work,” he said.

Tim Gardam, Chief Executive of the Nuffield Foundation, said the research fitted very well with its aim of viewing social wellbeing primarily through the lens of the experiences of the most disadvantaged and vulnerable.

“What we find here is the ONS-LS using Census data from five decades, painting a vivid and complex picture of vulnerable people’s lives and their health and social outcomes that in places brings the reader, quite frankly, up short in shock. 

“We have known for a long time that being in care as a child is associated with poorer outcomes in adulthood. But most research has previously ended with young adulthood and been based on small population samples. This research documents people’s lives in their 40s and enables us to understand the longer-term effects,” he said.

The lifelong health and wellbeing trajectories of people who have been in care: Findings from the Looked-after Children Grown up Project, is by Amanda Sacker with Emily Murray, Rebecca Lacey and Barbara Maughan. It is published by the Nuffield Foundation.