A third of all children’s acute hospital beds in parts of England are being occupied by vulnerable children who do not need acute medical care but have nowhere else to go.
Doctors have expressed that they feel like very expensive “babysitters” for vulnerable children, many of whom are in care but whose placements have broken down because of their violent and self-harming behaviour. Others have severe neurodevelopmental or eating disorders and need specialist treatment not available on ordinary children’s wards, where they get “stuck”, sometimes for months at a time.
Police are increasingly called to help restrain the children, or to bring them back when they run away. Paediatricians told the Guardian they have had to deal with vulnerable children who were not physically ill but displayed such challenging behaviour that they could not be looked after in children’s homes.
“It is estimated that roughly a third of acute hospital beds at the moment are full of these vulnerable young people, many who are subject to child protection plans, or they are already children in care, living in a residential placement that’s falling apart,” said Dr Emilia Wawrzkowicz, a paediatric consultant who is the assistant officer for child protection at the Royal College of Paediatrics and Child Health (RCPCH).
Such children do sometimes need acute medical care – for example, if they have taken an overdose or self-harmed. “But usually, we’re not providing any acute medical care. The way we understand it, as acute paediatricians, we are babysitting, fundamentally. And the children are stuck,” Wawrzkowic said. “It’s a desperate situation.”
Though many of these children are in extreme distress, they often have no diagnosable mental illness and do not qualify for a psychiatric “tier four” bed. Those who do qualify often cannot get one, as the beds are limited. Those who need specialist care placements can’t get them easily either, as they are both rare and expensive, sometimes costing as much as £10,000 a week per child.
“Some children have such extreme emotional and behavioural issues or are at risk of exploitation that they can’t get back to their residential placements or their foster parents. They can’t obviously go back to their homes, and we’ve got to keep them safe. So they sit in the hospital because there’s nowhere else to go. There are children sitting on our wards for months,” said Wawrzkowicz.
“When I first started as a paediatrician, you might have one case like this once a month or maybe even once every three months. Now it’s on a nightly basis.”
Charlotte Ramsden, president of the Association of Director of Children’s Services, warned that a failure to increase the suitable provision for traumatised children would lead to more child suicides and more children ending up in custody after harming others. She said children were being evicted from children’s homes at less than 24 hours’ notice because of their violent behaviour, and some had tried to kill themselves.
In July a judge ordered the release of a 12-year-old boy from Wigan who was detained in hospital. The boy’s behaviour was so difficult that at one point 15 police officers were on the ward to help restrain him, and seriously ill children had to be transferred to other hospitals for their own safety.
A paediatric consultant in the south-west of England, who asked not to be named to maintain patient confidentiality, said a recent vulnerable patient was just eight.
Police have been called to the paediatric ward at her hospital in order to help staff, she said. “Many children displaying distress do not warrant sectioning under the mental health act but cannot return home either because parents cannot cope or the environment is not suitable. It is not just the looked-after children and children on child protection plan cohort. Children with autism are a big group.”
Dr Vicki Walker, a consultant paediatrician who is the looked-after children’s representative on the RCPCH’s safeguarding committee, said the detention of vulnerable children on acute wards was a sign of multiple societal failures. “It is the end point of a very traumatic life. We need to look at what has happened in the run-up to see what support they and their family received,” she said. “This is a whole-societal issue, and it ends up with these very vulnerable children feeling that no one else wants them.”
Dr Peter Green, chair of the National Network of Designated Health Professionals, which brings together doctors and nurses who work in children’s safeguarding and looked-after children, said the hospital setting, coupled with police involvement, made the situation worse.
“If you sit down, shut the door and keep the police officers out of the way and have a caring, relational approach, then suddenly all the anger disappears and the tears start because they are very, very unhappy, and very tragic characters. And they need all the love and care and support we can give them,” Green said.
In the year to March 2020, English councils applied to the high court to deprive 327 children of their liberty, often because a child needed a place in a secure children’s home but none was available. That was a sharp increase from 215 in the year to March 2019 and 103 the year before that, according to figures collected by the Children’s Commissioner.
A government spokesperson said: “The government is providing an extra £2.3bn a year to mental health services by 2024. Our funding will open up NHS services or school and college-based support to an additional 345,000 children and young people every year to 2024.
“At the same time, over £1bn of additional funding for social care has been given to local authorities for 2021-22 to maintain care services – including support for autistic people with care needs.”