Vision statement seven: Care experienced children and young people have access to support ensuring that their health needs are fully met and potential for good health is maximised.
Experience
What children and young people say
This section presents the evidence through an experience lens, focusing on what health and health care feel like for care experienced children and young people since 2020.Click on the take me to navigation pane and jump to different sections here, including sources.
Across the materials reviewed, children and young people describe health experiences shaped by whether they feel listened to, understood and supported, and by how easy it is to access help and continue receiving support when circumstances change. The experiences described are mixed and uneven. Children and young people talk about health care that can feel difficult to navigate, particularly when information is unclear, support falls away or assumptions are made about them. They also described health care as feeling more secure when relationships are consistent and support is planned, and more fragile when children and young people are moving, information is lost or responsibility is unclear.
While this vision statement focuses on experiences of health and health care, the evidence also points to the wider context in which health sits. For care experienced children and young people, health both affects and is affected by other parts of life, including housing, poverty, relationships, early childhood experiences and the support available to parents and carers. These influences are not always visible in health data or in accounts focused primarily on health services, but they shape how health is experienced over time. The materials reviewed suggest that this wider context cannot be separated from health when considering how support is felt in practice, and that incorporating a broader range of sources to explore these connections more fully will be an important area for future work.
To see what changes Scotland is making and still has to make for the promise to be kept, click on the health route map in Plan 24-30. See more about the work of change across Scotland here.
- I do not understand what is happening with my health care.
- No one explains what will happen next.
- My health information does not seem to follow me.
- I’m expected to manage appointments and information on my own.
- Things change and I have to start again.
- Support fades away after a move or big change.
The evidence shows that uncertainty and lack of clear communication can make care experienced children and young people feel anxious, particularly during periods of change. When moves or transitions are poorly planned, health support can become fragmented, leaving children and young people unsure who to turn to or what to expect. Some accounts describe health care relying on the presence of family or trusted adults, leaving care experienced children and young people less supported when those networks are not available.
- people make up their minds about me before really getting to know me
- I am spoken to as if my background explains everything
- I feel labelled instead of helped
- I am treated differently from other children and young people
Care experienced children and young people describe experiences of judgement and stigma within health settings. These experiences affect trust and willingness to seek help, and are described across different stages of childhood and adolescence rather than as isolated incidents.
- I have to wait a long time and no one tells me why.
- Rules or cut-offs mean I cannot get the help I need.
- Support feels too rigid to fit my life.
- My disability or additional needs make things harder, not easier.
- I have little say in everyday things that affect my health, like food or being active.
The accounts describe frustration with health structures that do not adapt well to complexity. Disabled care experienced children and young people are described as being particularly affected where support is inflexible or poorly coordinated, especially when planning does not fully reflect their needs or when responsibility shifts during periods of change. Frustration is also described in relation to everyday aspects of health, such as food, movement and routine, where tight control can leave children and young people feeling they have little influence over their own wellbeing.
- People pay attention to what is actually worrying me about my health.
- The people I talk to believe me when I say something hurts or feels wrong.
- The people helping me know me and remember my health needs.
- I do not have to explain everything again and again.
- Decisions about my health include me and are not rushed.
Across the materials reviewed, care experienced children and young people describe being listened to when adults take time to understand what is worrying them, believe what they say about their bodies and experiences, and remember their health needs over time. Feeling heard is closely linked to being known by the people involved, having some consistency in who they see and feeling included in decisions about their health. The evidence also shows that this experience is fragile. When young people have more than one need, health concerns are sometimes addressed in parts, or they are asked to repeat their story, which can leave them feeling dismissed or unsure whether what they say will be taken seriously.
- My health needs are thought about ahead of time.
- Changes are planned for properly.
- What has been promised actually happens.
- People help me and my family stay well together.
- The people who care for me are included and listened to.
- Support helps us manage things day to day.
- Help is offered before things reach breaking point.
Across the materials reviewed, care experienced children and young people describe feeling less worried when health support is predictable and follows through on what has been agreed, particularly during periods of change. Planning ahead and having some sense of what will happen next reduces anxiety and helps children and young people feel less exposed when circumstances shift or when they move between places or services.
The accounts also show that feeling supported is closely tied to whether health care is experienced as something shared rather than carried alone. Children and young people describe how their wellbeing is affected by whether carers, family members or trusted adults are included, listened to and supported to help manage appointments, information and everyday health needs. Where this shared support is in place, health care feels more reliable and less fragile. Where it is missing, support is more likely to fall away after changes, leaving children and young people feeling more worried about whether their health needs will continue to be met.
What this tells Scotland
This section draws together what the evidence shows about how experiences of health and health care are felt by care experienced children and young people, and how these experiences shape trust, security and wellbeing over time. It is intended to be informative, helping to show why these experiences matter and why they should inform what happens next. The focus is on naming impact and consequence as described in the evidence, drawing attention to patterns that remain unresolved and where continued attention is needed.
Across the evidence, health is not described as a separate or self-contained part of care experienced children and young people’s lives. Instead, it is closely connected to housing stability, poverty, relationships, education, family support and earlier life experiences. Difficulties in one area often intensify health needs in another, while gaps in health support can amplify wider pressures. Where health care feels fragmented or inconsistent, the impact extends beyond physical or mental health alone, affecting confidence, trust and the ability to cope with everyday life.
The evidence shows that when care experienced children and young people understand what is happening with their health, and what is happening next, they feel less anxious. Poorly planned changes, unclear communication and fragmented support during moves or transitions leave children and young people unsure who is responsible for their care. Having confidence in health services and supports is key for young people to feel safe seeking help.
Care experienced children and young people describe experiences of being judged, labelled or treated differently within health settings. When assumptions are made about them based on their background, trust is eroded and willingness to engage with health support is reduced. These experiences are described as occurring across different stages of childhood and adolescence, shaping longer-term relationships with health care.
The evidence highlights frustration when health support does not adapt well to complex or overlapping needs. Rigid pathways, age-related cut-offs and poorly coordinated responses can leave care experienced children and young people without appropriate support. Disabled children and young people are particularly affected when systems fail to adjust to their needs, increasing barriers rather than reducing them.
Feeling listened to is closely linked to continuity and relationships. Care experienced children and young people feel more confident in health care when they are known by the people supporting them, do not have to repeat their story and are believed when they describe pain or concern. Where health issues are addressed in isolation rather than as part of a wider picture, important needs can be missed.
Health care is experienced as more stable and reassuring when families and carers are supported alongside children and young people. When those around a child or young person are included, listened to and supported to manage day-to-day health needs, pressure is reduced and wellbeing is strengthened.
Care experienced children and young people describe feeling less worried when health needs are anticipated and support continues through change. Planned, consistent care reduces reliance on crisis responses and helps young people feel more secure. Where health support is only available once difficulties escalate, anxiety increases and trust can weaken.
Sources Referenced
The purpose of the below citations and summaries is to ensure that sources used are clear and accessible. Web links to the sources are provided, where possible.
Document summaries are provided for any document where analysis produced more than ten ‘coded segments’. ‘Coded segments’ refer to portions of a document that analysts identified and labelled as relevant to the key themes for each Vision Statement.
All documents that have informed the development of the Vision Statement, even if they had fewer than 10 coded segments, are cited in the ‘Additional Sources’ box below.
This review, published by the Care Inspectorate in July 2024, was requested by the Scottish Government; its purpose was to examine the experiences of children and young people placed in residential care in Scotland from other parts of the UK, known as cross-border placements. The review also aimed to understand the impact of these placements on local and national public services in Scotland.
The review found that decisions for cross-border placements were often made due to safety concerns and a lack of suitable care options in the young people's home areas. Young people rarely chose to move to Scotland and often felt unprepared for the move, with some experiencing shock at being so far from home.
Education planning for these young people was often delayed or inconsistent, leading to limited educational experiences for some. While primary healthcare was generally accessible, mental health services were much harder to access. The review highlighted that host authorities and placing authorities did not consistently work together effectively, leading to challenges in providing support and managing emergencies.
Key issues identified included a lack of information sharing before placements, which affected the ability of Scottish services to plan for education, health, and social care. The report concludes with several areas for further discussion, focusing on improving pre-placement planning, strengthening accountability for promised services, clarifying roles and responsibilities, ensuring support for young people wishing to remain in Scotland, improving data collection, and enhancing understanding of relevant legislation.
cross border thematic review: July 2024. Care Inspectorate, 2024. https://www.careinspectorate.com/index.php/news/7674-cross-border-thematic-review
This report, published by the Care Inspectorate in 2024, reviews disabled children and young people's experiences with social work services in Scotland. It aims to understand their views and experiences, assess how well their rights are upheld, and inform policymakers to improve outcomes for them. The review was conducted between May 2023 and May 2024, gathering information from children, young people, parents, carers, and social work staff across 32 local authority areas, with a focus on four specific regions.
The review found that, while respectful relationships are crucial, many disabled children's views are not heard due to high demand and resource pressures, leading to limited staff time and frequent changes in personnel. When support is timely and appropriate, it helps children grow, but increasing complexity of needs often outweighs available support. Children frequently lack meaningful choices about their support, and parents and carers, who provide significant care, need better protection for their wellbeing. The quality of social work assessments and plans varies, often missing parts of a child’s needs, and transitions into adulthood remain uncertain. Social work’s role is frequently misunderstood, while poor data and no shared definition of disability make planning and budgeting harder.
The report concludes that, despite previous findings highlighting inequities, necessary improvements have not been made, leading to many children not receiving timely help. It calls for a shared approach from the Scottish Government, local authorities, and other organisations to define the social work role, strengthen early intervention, maximise opportunities for play and friendships, and ensure adequate resourcing. A national conversation about resource reality and its impact on disabled children's lives is needed to achieve Scotland's ambition of being the best place for children to grow up.
Disabled Children and Young People’s Experiences of Social Work Services: A Thematic Review. Care Inspectorate, 2024. https://www.careinspectorate.com/images/documents/7714/Thematic%20review%20of%20services%20for%20disabled%20CYP.pdf.
This Care Inspectorate report looks at how children and young people are cared for in secure care and what needs to improve to ensure their rights are respected, including whether new rules made by the Scottish Government are helping young people and staff.
Approximately 200 people participated in the study, including young people, family members, professionals and Local Authority representatives. The journeys of 30 young people were also tracked over a one-year period.
The Care Inspectorate found that progress has been made in meeting the aims of the secure care Pathway and Standards, but significant gaps remain across the full journey into, through and out of secure care. The new rules have had the strongest impact for those in secure care, where most young people experienced improved safety, felt listened to, had their rights upheld, and benefited from specialist support and education. Some positive preventative effects were noted—where intensive, relationship-based community support and clear risk-planning processes helped prevent admission.
However, the greatest weaknesses were found after young people leave secure care. Many experienced a sharp drop in support, struggled to access health and wellbeing services, lost educational progress, and faced homelessness or serious safety risks, leading to re-admissions. Ongoing problems included unequal access to community resources, inconsistent understanding of secure care’s therapeutic purpose, lack of stable relationships, and variation in restrictive practices.
Secure Care Pathway Review. Care Inspectorate, 2023. https://www.careinspectorate.com/images/documents/7293/Secure%20care%20pathway%20review%202023.pdf.
This report was published by the Centre for Excellence for Children's Care and Protection (CELCIS), a leading improvement and innovation centre based at the University of Strathclyde.
The Scottish Government asked CELCIS to conduct this research to gather information to help them make decisions about how to best deliver children's services in Scotland. The main goal of the research was to answer: "What is needed to ensure that children, young people and families get the help they need, when they need it?".
This specific report is 'Strand 4' of a larger study and focuses on understanding the opportunities, challenges, and barriers faced by the children's services workforce. It explores their views on local services, how different agencies work together, support for young people moving into adult services, relationships between families and professionals, and the support available to the workforce itself. The report uses surveys, focus groups, and interviews to gather these perspectives.
Dr Alex McTier, Mihaela Manole, Jane Scott, et al. Children’s Services Reform Research: Scotland’s Children’s Services Landscape: The Views and Experiences of the Children’s Services Workforce. CELCIS, 2023. https://www.celcis.org/knowledge-bank/search-bank/childrens-services-reform-research-scotlands-childrens-services-landscape-views-and-experiences-childrens-services-workforce.
This study aims to understand the experiences of mothers with addiction whose children were removed, as previous research often overlooked birth parents' perspectives. The study sought to provide insights for developing better support services.
The research involved interviews with 12 mothers in Scotland who had children removed from their care. Four main themes emerged: feeling safe/unsafe, changing identity, experiencing loss, and a sense of "no way to win" against the ‘system’. These mothers often felt unsafe due to past trauma and found services unsupportive, fearing that honesty would lead to further child removal.
The removal process deeply affected their identity, making them feel like "bad mums" or "bad people," and they often compared their experiences to others. They described the loss of their children as a bereavement, leading to unhelpful coping mechanisms like increased substance use. Many felt the ‘system’ was unfair, citing intergenerational involvement with social services, a lack of appropriate support, and unclear expectations for regaining custody.
The study concludes that services need to build trust through consistent workers, clear communication, and by validating mothers' experiences. This approach is crucial for engaging these mothers and achieving better outcomes, acknowledging their complex trauma and attachment issues.
Russell, Linda, Fiona Turner, Ruchika Gajwani, and Helen Minnis. “‘Everything Is Fear Based’: Mothers with Experience of Addiction, Child Removal and Support Services.” Child and Youth Services Review 170 (2025). https://www.sciencedirect.com/science/article/pii/S0190740925000441?via%3Dihub.
This report looks at the mental health experiences of young people in Glasgow who have been in care. It was written by Social Marketing Gateway for Glasgow City Health and Social Care Partnership, working with PAC (People Achieving Change), a group of care experienced young people. The aim was to listen to young people and understand what helps or prevents them from getting the right mental health support.
Young people said the COVID-19 pandemic had a strong negative effect on their mental health. Many felt anxious, stressed and lonely due to changes in routine, less contact with friends, and reduced support from adults and services. These challenges made existing mental health problems worse.
A key message from the report is that many young people didn’t feel able to speak openly with social workers about their mental health, worrying it might affect decisions about their care. Many said they wanted a trusted person to talk to, either one-to-one or in a group, but separate from social work services.
The report also highlights problems with current mental health services, including long waiting times, short appointments, and staff who do not understand what it means to grow up in care. Moving from children’s services to adult services was described as a particularly difficult time, with many young people feeling unsupported.
The young people recommended having specialist mental health workers for care experienced young people, regular mental health check-ups, quicker and more flexible access to support, better trained staff, stronger help during transitions, and more face-to-face contact.
Social Marketing Gateway (SMG). Glasgow People Achieving Change (PAC) Mental Health Research: Final Report February 2022. Glasgow City Health and Social Care Partnership (GCHSCP), 2022. https://glasgowcity.hscp.scot/publication/glasgow-pac-mental-health-research-2022.
This report was written by a team of researchers from the University of Stirling, Lancaster University, and the Association for Fostering, Kinship and Adoption (AFKA) Scotland. It was funded by the Nuffield Foundation and an anonymous donor.
The report was written to understand how children who needed care in Scotland are doing as they grow up. It looks at what helps them feel safe and settled, and what makes a difference to their lives. The main goal is to share what was learned to help improve rules and practices for children, their families, and the people who look after them. It builds on an earlier study (Phase 1) that looked at these children when they were younger.
The study followed 1,836 children who needed care when they were five years old or younger in 2012-13. It explores where these children are living ten years later, how well they are doing, and what connections they have with important people in their lives. The report uses different kinds of information, including official records, surveys, and interviews with children, their carers and birth parents, to get a full picture of their experiences.
Whincup, Helen, Linda Cusworth, Maggie Grant, et al. Permanently Progressing? Building Secure Futures for Children: Phase 2 Middle Childhood. Key-Findings from Phase 2: final report. University of Stirling, 2024. https://permanentlyprogressing.stir.ac.uk/key-findings-from-phase-2-final-report-and-accessible-summaries/.
Who Cares? Scotland—a national independent membership organisation for care experienced people, dedicated to supporting, empowering and amplifying the voices of Scotland’s care community—provided targeted analysis of their existing evidence for The Promise Story of Progress, sharing material that mapped to the relevant vision statements and contributed insight into how their internal data, participation activity, and qualitative evidence could inform the experiential strand of the Promise Story of Progress.
Their reports reflected advocacy work carried out between 1st January 2020 and 30th June 2025, during which time Who Cares? Scotland advocacy workers supported around 4,800 individuals. Although the report findings do not represent the experience of every care experienced individual in Scotland, they highlight issues that need continued attention as Scotland works to understand what is changing and what still needs to be addressed.
An anonymised and abridged collation of these reports is available at: Who Cares? Scotland. The Promise Story of Progress: Vision Statement advocacy reports by Who Cares? Scotland (abridged). The Promise Scotland, 2025. https://www.plan2430.scot/media/r0jiy2pl/2025-12-17-the-promise-story-of-progress-vision-statement-advocacy-reports-by-who-cares-scotland_abridged.pdf
Aberdeen City Council, Champions Board of West Dunbartonshire Council, The City of Edinburgh Council, Future Pathways, Social Work Scotland, and Who Cares? Scotland. Accessing Records in Scotland: What People with Care Experience Tell Us about the Right of Access. Social Work Scotland, 2024. https://socialworkscotland.org/wp-content/uploads/2024/07/RTA-LONGFORM-REPORT-15-12-23-1.pdf.
Alternative Routes Impact Report 2024-2025. Aberlour, 2025. https://www.aberlour.org.uk/publications/alternative-routes-cashback-impact-report-2024-2025.
Cross Border Thematic Review: July 2024. Care Inspectorate, 2024. https://www.careinspectorate.com/index.php/news/7674-cross-border-thematic-review.
Disabled Children and Young People’s Experiences of Social Work Services: A Thematic Review. Care Inspectorate, 2024. https://www.careinspectorate.com/images/documents/7714/Thematic%20review%20of%20services%20for%20disabled%20CYP.pdf.
Engagement with Care Experienced Young People: Results and Recommendations to Inform Police Scotland’s 2024-27 Corporate Parenting Plan. Scottish Youth Parliament, 2024. https://syp.org.uk/project/engagement-with-care experienced-young-people/.
Guinchard, Sydney. “Experiences of Parents in ‘The Village,’ an Online Support Network for Care- Experienced Parents: A Thematic Analysis.” Scottish Journal of Residential Child Care 23, no. 2 (2024).
Learning Reviews for Children and Adults in Scotland: Summary Report 2025. Care Inspectorate, 2025. https://www.careinspectorate.com/images/documents/8204/Learning_reviews_for_children_and_adults_in_Scotland_Summary_report_2025_Aug_2025.pdf.
Matter of Focus. Impact Report Year 3: Includem’s ADAPT for Cashback Project. Includem, 2024. https://www.matter-of-focus.com/wp-content/uploads/2024/01/Includem-ADAPT-for-CashBack-Evaluation-Report-22-23.pdf.
Mitchell, Mary, Camille Warrington, John Devaney, Peter Yates, and Jennifer Lavoie. North Strathclyde Bairns Hoose Evaluation: Phase One Report. 2023. https://researchonline.gcu.ac.uk/ws/portalfiles/portal/92593848/92438102.pdf.
Reimagining Secure Care - Final Report: A Vision for the Reimagined/Future World. Children and Young People’s Centre for Justice (CYCJ), 2024. https://www.cycj.org.uk/wp-content/uploads/2024/09/Reimagining-Secure-Care-Final-Report.pdf.
Roesch-Marsh, A, K McGhee, and F Gillon. The Digital Divide: The Impact on the Rights of Care Leavers in Scotland. 2021. https://www.celcis.org/application/files/5516/1158/7905/The_digital_divide_The_impact_on_the_rights_of_care_leavers_in_Scotland_Inform.pdf.
Russell, Linda, Fiona Turner, Ruchika Gajwani, and Helen Minnis. “‘Everything Is Fear Based’: Mothers with Experience of Addiction, Child Removal and Support Services.” Child and Youth Services Review 170 (2025). https://www.sciencedirect.com/science/article/pii/S0190740925000441?via%3Dihub.
Scottish Mentoring Leadership Programme-Interim Report-Qualitative Process Impact Assessment. Scottish Government, 2024. https://www.gov.scot/publications/smlp-interim-report-qualitative-process-impact-assessment/.
Secure Care Pathway Review. Care Inspectorate, 2023. https://www.careinspectorate.com/images/documents/7293/Secure%20care%20pathway%20review%202023.pdf.
Social Marketing Gateway (SMG). Glasgow People Achieving Change (PAC) Mental Health Research: Final Report February 2022. Glasgow City Health and Social Care Partnership (GCHSCP), 2022. https://glasgowcity.hscp.scot/publication/glasgow-pac-mental-health-research-2022.
Social Value Lab. Helping to Keep the promise That Scotland Must Strive to Become a Nation That Does Not Restrain Its Children: Evaluation of The Promise Rethinking Restraint Pilot Report for Aberlour Childcare Trust and Kibble. Aberlour; Kibble, 2023. https://web-backend.aberlour.org.uk/wp-content/uploads/2023/05/The-Promise-Report-Final-V3.pdf.
The Challenges Facing Scottish Schools and Children’s Mental Health. Place2Be, 2024. https://www.place2be.org.uk/media/ylhimahc/place2be-education-briefing.pdf.
Transitions for Care Experienced Young People: A Thematic Review. Care Inspectorate, 2024. https://www.careinspectorate.com/index.php/news/7820-transitions-for-care experienced-young-people-a-thematic-review.
Whincup, Helen, Linda Cusworth, Maggie Grant, et al. Permanently Progressing? Building Secure Futures for Children: Phase 2 Middle Childhood. University of Stirling, 2024. https://permanentlyprogressing.stir.ac.uk/key-findings-from-phase-2-final-report-and-accessible-summaries/.
Who Cares? Scotland. “Exclusion Labelled as Support”: Care Experienced Children in Scotland’s Education System. Children and Young People’s Commissioner Scotland, 2025. https://www.celcis.org/news/news-pages/care experienced-children-struggling-access-right-education-scotland.
Whole Family Wellbeing Funding (WFWF) Programme Year 2 Process and Impact Evaluation Full Report. Scottish Government, 2025. https://www.gov.scot/publications/whole-family-wellbeing-funding-wfwf-programme-year-2-process-impact-evaluation-full-report/.
Whole Family Wellbeing Funding Programme East Lothian Collaborative Partnership Summary of Learning. Children and Young People’s Improvement Collaborative (CYPIC), 2025. https://cypic.co.uk/focus/family-support/.
Wilson, Charlotte. “Adjusting the Volume: Reflections on Engagement with Autistic Young People Living in Secure Care.” Scottish Journal of Residential Child Care 23, no. 2 (2024). https://strathprints.strath.ac.uk/91142/.