The lifelong health and wellbeing trajectories of people who have been in care
16 January 2023
Date: July 2021
A study using secure data found that cared-for children had a deeply unequal chance of enjoying the same social and economic advantages in adulthood as other children. Findings show that there were highly consistent impacts on health, socioeconomic circumstances, family life and living arrangements, the extent of which varied depending on care arrangements. This research provided evidence for the Independent Review of Children’s Social Care, which led to the UK Government pledging an official implementation strategy including further support activities. The project also produced a range of resources to help practitioners and policymakers to understand the disadvantages experienced by adults who had been in care as children.
Nuffield Foundation funded this research to provide robust evidence on the health and social functioning of adults who experienced care in childhood. By using the Longitudinal Study, researchers tracked individuals who were children at the time of the 1971-2001 Censuses, and identified whether they were living in residential, foster, kinship, or parental care. The researchers followed the children up to 1981-2011 enabling a holistic look at their later outcomes.
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The project accessed the Longitudinal Study through the ONS Secure Research Service. The Longitudinal Study contains linked census and life events data for a 1% sample of the population of England and Wales. It currently holds data relating to 1.2 million people, making it the largest longitudinal data resource in England and Wales.
The Longitudinal Study has linked records at each census since the 1971 Census, for people born on one of four selected dates in a calendar year. All information collected on the census is included, for example age, sex, marital status and many other socio-demographic topics. This is then linked to life events data that has happened up to 2017, such as births, deaths and cancer registrations.
DOI (Digital Object Identifier): Office for National Statistics, released 11 June 2019, ONS SRS Metadata Catalogue, dataset, ONS Longitudinal Study - England and Wales. 10.57906/z9xn-ng05
The project identified 353,601 Longitudinal Study members in one or two of the 1971 to 2001 Censuses who also had health and social outcome information recorded in adulthood between 1981 to 2011. This included 5,681 members who had spent time in care.
The research team defined dependent children as aged less than 18 years, of single marital status, not living alone/independently, and not a visitor in the household/residential setting at census day 1971-2001. They then identified four care setting types:
- Living with a parent
- Living with a relative (kinship care)
- Living with an unrelated family (foster care)
- Living in residential care.
The linked census data enabled the researchers to examine outcomes during three adult follow-up periods at ages 20-29, 30-39 and 40-49 years old. Researchers investigated adult outcomes across four areas:
- Health: including limiting long-standing illness; all-cause mortality; cause of death; and self-rated health, which was asked about in the 2001-2011 censuses
- Education and work: including National Vocational Qualifications (NVQs); employment status at the time of the census; social class measured using the 3-category version of the National Statistics Socio-economic Classification; long term non-employment
- Living arrangements: including housing tenure; overcrowding; living alone
- Family formation and relationships: including marital status, number of children (women only); age at first child (women only).
Researchers used random intercept mixed effects models to estimate the association of care setting type with adult outcomes. Potential covariates included gender, country of birth, ethnicity, and head of household’s education, employment status and marital status.
Researchers found that kinship care had the best outcomes, with residential care having the least favourable outcomes, and foster care lying midway between the two extremes. These outcomes might be a consequence of the early life experiences that led to children being in care and/or could be consequential to their experience of the care system.
Researchers looked at educational outcomes as education is a key steppingstone to a secure adult life. The graph below shows that there were inequalities in qualifications across the care groups. Those in parental care had a 32% chance of achieving an NVQ level 3 qualification or higher compared with 14% for those in residential care. However, researchers found that more care-experienced adults were returning to education later in life. When Longitudinal Study members were in their 30s, differences in being in education emerged for children in the 1991 Census, and again in their 40s for Children in 1981 census. This could reflect The Children and Young Persons Act 2008, which recommended that care leavers starting a recognised higher education course be entitled to a minimum one-off bursary of £2,000 from their local authority. Some universities now offer annual bursaries and year-round accommodation to those who have been in care.
Predicted probability of achieving NVQ level 3 qualifications or higher at adult follow-ups by type of care in childhood
Residential care was related to a less than 50% chance of being in employment at the time of subsequent censuses, and a high probability (16%) of being unemployed or out of the labour force for reasons other than education (29%). Being out of the labour force long-term was particularly high for this group, with 11% out of the labour force for 10 years or more. Those who had been in residential care also had a more disadvantaged social class.
Kinship care was associated with the best outcomes amongst the three non-parental care groups. 69% were in work compared with 76% for those who had been in parental care, with unemployment and being out of the labour force being the most likely alternatives. Their rate of being out of the labour force long-term was much lower than for residential care and only slightly higher than for parental care. However, people who had been in kinship care were less likely to be in the most advantaged social classes compared with those in parental care in childhood.
Researchers found that those in non-parental care had poorer health than those in parental care when analysing self-assessed morbidity. The rates of poor health increased across the care types from kinship care through to residential care, and the proportion in poor health increased markedly from the 10-year to 30-year follow up. Those in non-parental care had more limiting illness than those in parental care. However, this does not consider other differences in childhood that might explain higher rates of morbidity among those in non-parental care. This includes the probability that children with complex health conditions or disabilities are more likely to be in care.
Further findings suggest that unlike children in parental care, people with a history of non-parental care were most likely to die prematurely from “unnatural causes.” This category includes causes such as suicide, drug overdoses, alcoholism, car accidents, and assaults. In contrast, people who had been in parental care were most likely to die prematurely from cancer. The risk of premature mortality for the population of children in the 1971-2001 censuses was found to be 43% higher for the non-parental care group than the parental care group with socially disadvantaged backgrounds. This finding showed that even with a disadvantaged comparator population of children there remained an excess risk associated with non-parental care.
Throughout the project, the researchers convened meetings of a small advisory group with representatives from government and the third sector. This included representatives from the Department for Education, Barnardo’s, Become, Working Changes, the Children’s Trust and the Children and Education Policy and Accountability Committee at LB Hammersmith & Fulham. The advisory group and the Nuffield Foundation contributed to the final report.
This project provided informative and timely evidence for the Independent Review of Children’s Social Care which directly cites project publications to argue for “Unlocking the potential of family networks.” In response to the review, the UK Government pledged an official implementation strategy by the end of 2022. The Education Secretary promised more support for family hubs which offer early help and intervention. Funding was also promised for local authorities to help keep vulnerable children in education and for continued delivery of the Social Workers in Schools and designated safeguarding lead supervision programmes.
An equal public benefit has been to increase awareness of the stark social and economic disadvantages of adults who have experienced care in childhood. This has been done through a programme of engagement with charities, GPs, teachers and the wider public. The project has also produced a range of resources for practitioners and policymakers.
Publications and reports
- Findings from the Looked-after Children Grown up Project final report, July 2021: The lifelong health and wellbeing trajectories of people who have been in care
- Science Direct article, January 2022: Out-of-home care in childhood and socio-economic functioning in adulthood: ONS Longitudinal study 1971-2011
- SocArXiv paper, April 2021: Non-parental care in childhood and adult outcomes: double whammy for minority children?
- Nuffield Foundation and UCL policy briefing, October 2021: The lifelong health and well-being of care leavers
- BMC Public Health article, May 2020: Association of childhood out-of-home care status with all-cause mortality up to 42-years later: Office for National Statistics Longitudinal Study
- European Journal of Public Health article, July 2020: Non-parental care in childhood and health up to 30 years later: ONS Longitudinal Study 1971-2011
Blogs, news posts, and videos
- The Guardian news article, May 2020: Childhood in UK care system makes you twice as likely to die earlier, study shows
- iNews news article, July 2020: Children who grow up in care four times more likely to have poor health 30 years later, study finds
- Child of our Time blog, July 2020: We are failing those who spend their childhood in care. Here’s how.
- UCL The Lifecourse Podcast, September 2020: A childhood in care: what consequences for health later on?
- Nuffield Foundation blog, April 2021: Looked after children grown up: using census data to explore later life outcomes of children in care
- UCL Linking our Lives podcast, September 2021: Why data is key to reducing inequalities for the care experienced
- UCL blog, July 2021: Shedding new light on the adult outcomes of people who were in care as children
- UCL blog, May 2022: ONS research plays key role in children’s social care review
- Child of our Time blog, July 2021: Is it time for all policy to consider the needs of care leavers?
Presentations and awards
- Commended for Public Benefit & Impact, ONS Research Excellence Awards 2022
- Nuffield Foundation webinar, July 2021: Evidence for change: understanding the lifelong health and well-being trajectories of people who have been in care
About the ONS Secure Research Service
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