Keeping the Promise - health and wellbeing of care experienced children and young people: longitudinal quantitative evidence review

Executive summary

This evidence review was commissioned to explore how longitudinal quantitative data can support monitoring the health and wellbeing of Scotland’s care experienced children and young people, in line with The Promise 2030. The Promise is Scotland’s commitment to reform the care system so that care experienced children and young people grow up loved, safe, and respected, with their voices and needs central to all decisions. The Promise sets out a vision for sustained improvement in health, wellbeing, and life outcomes, requiring robust evidence to monitor progress over time. This evidence review considered data sources capable of tracking health and wellbeing outcomes over time, either through repeated observations or linkage across datasets, where these included quantitative measures.

The findings showed that care experienced children and young people face persistent health inequalities compared to the general population. This included markedly higher risks of mortality, developmental concerns, substance use, and hospitalisation. Mental health challenges were particularly pronounced, including elevated rates of psychiatric admissions, self-harm, and suicide. Physical health concerns such as epilepsy and poor dental health were also more prevalent. Some evidence showed that outcomes varied by placement type. Placement types refer to the different settings in which children are cared for when they are under the care of their local authority (see Annex 2). Future analyses should consider the variation in outcomes across different placement types, with children experiencing different trajectories and needs. The period of transition out of care also requires focus, as it was associated with heightened health vulnerabilities.

Scotland benefits from the Children Looked After Statistics (CLAS) – a high-quality, population-wide administrative dataset. CLAS allows for precise identification of care status and enables linkage to rich outcomes data. CLAS supports robust longitudinal analyses capable of generating generalisable findings. However, important gaps remain. Most available analyses using CLAS, including those from the Children’s Health in Care in Scotland (CHiCS) project, predate the implementation of The Promise. Existing evidence focuses heavily on service use and clinical outcomes, while missing important aspects of health and wellbeing such as preventive healthcare and sexual and reproductive health. There is little intersectional analysis to explore how outcomes vary by sex, disability, ethnicity, or socioeconomic status. Another key evidence gap relates to early childhood. Existing linkage approaches exclude children who experienced care before school entry. This is because Scottish Candidate Numbers (SCN), which are currently used for linkage purposes, are not assigned until school age. This limits our understanding of health and wellbeing outcomes for some of the most vulnerable children. Lastly, there is a lack of up-to-date longitudinal follow-up data following the introduction of The Promise. Other data sources, such as the Census and household surveys (e.g., Growing Up in Scotland and Understanding Society), either lack direct measures of care experience and/or contain too few participants from Scotland to provide reliable insights. Addressing these gaps will require expansion of data linkage across health and social care, and improvements in the recording of care status in the Census.

The review concludes that supporting Public Health Scotland’s (PHS) Children’s Health and Monitoring The Promise ongoing data linkage and analysis programme offers the most sustainable and proportionate approach to strengthening the evidence base on children’s health data in Scotland. Building on this work would allow more meaningful evaluation of outcomes in more recent years. These efforts will be essential to provide the timely, robust, and independent evidence needed to monitor Scotland’s progress towards keeping The Promise by 2030 and beyond.

However, while PHS’s initiative represents a promising foundation for future monitoring, its current scope is limited, including a current lack of focus on children under five. Further investment to ensure comprehensive coverage and sustainability will be necessary. To complement these efforts, the review recommends exploring the potential of Scotland’s Census to better understand the circumstances of care experienced children and young people. This could involve assessing how Census data might provide insights into their health and wellbeing. It may also involve investigating whether future censuses could include an indicator for care experience. Doing so would allow for clearer identification of historic care experience across both household and communal settings.

The review also acknowledges the developing landscape around care experienced children and young people’s data and outcomes more widely than just health, including across housing, education, and justice. The review recommends continued investment in CLAS, as well as working with data partners across Scotland to enable access to linked data, and conduct analyses to build a stronger evidence base.