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Mr. Andrew Lansley (South Cambridgeshire) (Con): Before we move on from the hon. Lady's point, we must recognise that Herbert Laming's report on the tragic death of Victoria Climbié also made it clear that the
 
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fundamental issues of poor practice in a range of services relating to the case were not primarily about resources. They were about the fragmentation of services, the failure of the services to deliver the standards of service that were expected and the fact that no one took responsibility for that. It must be part of the national service framework's remit to solve that problem of fragmentation and to require that responsibility as an integral part of the framework.

Dr. Ladyman: I entirely agree with the hon. Gentleman. That is why the national service framework is not just a recipe for change or a list of things that must be gone through with boxes to tick, but is about changing the culture of all the services that we provide for children, generating a step change in the quality of those services and, as he says, making sure that people are properly inspected and accountable for failures.

The services that we create will address the needs of the whole child, not just the specific problem or illness with which they present. That will allow services to pick up problems early. The national service framework covers the full range of issues across health and social services, as well as the links with education. Consequently, it is intended for everyone involved in delivering services to children, young people and pregnant women. It is made up of 11 standards. Each standard conveys the central aims of the NSF that all agencies should work actively together to promote high-quality services that are centred around the needs of children, young people and pregnant women; respond to children and young people according to their age, recognising that children are different from adults both physiologically and psychologically; involve children, young people and families in decisions about their care and how services are designed; and are easy for children and young people to access and use.

Mr. Hilton Dawson (Lancaster and Wyre) (Lab): The challenge that my hon. Friend sets to integrate the various professions working with children to achieve that transformation is one of the most difficult that any Minister could face. Has he given any thought to how the Government could celebrate the good work that takes place, and in particular, celebrate work across the boundaries by people working within integrated children's systems in the future? For instance, we publicly celebrate nurses. Why should we not celebrate integrated child care professionals?

Dr. Ladyman: My hon. Friend is right that we need to celebrate successes. Increasingly, we have opportunities to recognise very good people at award ceremonies. At one recent ceremony, which was intended for those who are innovating in training in social care, I reminded people about "The One-Minute Manager". When I was working in the private sector, my director insisted that all his managers read it. The key message in the "The One-Minute Manager" is to catch people doing something right, which will be fundamental to achieving this culture change. That is why the inspection mechanisms that we are putting in place will be largely
 
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about identifying best practice, celebrating it, then making sure that it is disseminated so that everybody can work together on the agenda that he has identified.

Mr. David Chaytor (Bury, North) (Lab): My hon. Friend has strongly emphasised the need for greater integration in planning and decision making, which is to be welcomed. Can he spell out exactly how the different agencies will be expected to integrate and who will have the key responsibility for planning services? What is the division of responsibility between the new children's trust, the primary care trust, the acute trust and the strategic health authority, for example?

Dr. Ladyman: If my hon. Friend will forgive me, I will deal with those matters in some detail later in my speech because they are fundamental.

The first five standards deal with key issues that relate to all children: preventing illness and promoting health; supporting parents and carers; creating children, young person and family-centred services; growing up into adulthood; and keeping children safe. The rest of the standards address more specific issues: children who are ill; children in hospital; disabled children and children with complex health needs; children with mental health problems; and medicines for children. The final standard sets out our commitment to a high-quality, woman-centred maternity service.

Jeff Ennis (Barnsley, East and Mexborough) (Lab): As I am sure the Minister knows, I have been concerned for some time about the low level of NHS funding for children's hospices. It is about 5 per cent., compared with between 30 and 35 per cent. for adults' hospices. What will the framework do to increase Government agency funding for children's hospices?

Dr. Ladyman: I hope that my hon. Friend will forgive me for saying that he is starting at the wrong end. We should be starting with outcomes rather than funding. The framework describes the range of services needed for children with long-term conditions. The palliative care that we should provide includes care at home and in hospices. It will be for each primary care trust to think strategically about how it can give the population that it serves a sufficiency of each of those options. If it needs to commission services case by case, it can; or, if it wishes, it can put significant extra funds into the development of a local children's hospice.

Charles Hendry (Wealden) (Con): That answer could be considered complacent by children's hospices that struggle daily to make ends meet and face a real struggle to survive at all. Does the Minister agree that there could be no more deserving cause in our society than dying children?

Dr. Ladyman: Of course the hon. Gentleman is right: there is nothing more serious to deal with than children with long-term conditions. Such conditions, however, tend to be different from long-term conditions affecting adults, especially when it comes to hospices and palliative care. Palliative care for children tends to involve helping them to cope with what are often life-limiting illnesses that can last for a long time, whereas palliative care for adults is often related to an end-of-life choice.
 
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Most palliative care for children is delivered not in hospices but at home. What I want, and what the national service framework calls for, is a range of provision in every area that is suitable for all children with long-term conditions who are receiving care. Some, including the hon. Gentleman's party, have argued that a foundation level of NHS funding should go directly to children's hospices. In many areas, that funding would come from services needed to keep children at home. I think it more appropriate to allow each primary care trust responsibility for ensuring that there is a full range of provision. If that makes it necessary for a PCT to support a local hospice directly, it should do so, but it should be a local decision rather than one made by me in my office in Richmond house.

Mrs. Annette L. Brooke (Mid-Dorset and North Poole) (LD): Will the Minister give way?

Dr. Ladyman: I will gladly give way in a while, but I need to make progress because many hon. Members want to speak.

Today, I can do no more than scratch the surface of the content of the national service framework, as any Member who has read the document will appreciate. It weighs in at more than 2 kg and consists of several hundred pages—and that excludes the huge body of evidence on which it is based. It even comes with a DVD explaining how to spot a sick child. There is a family version, a version that is accessible to people with learning disabilities and a children's version. I can, however, highlight some of the key components.

The framework sets out a new child health promotion programme to replace the current system of developmental reviews. The programme is a comprehensive system of care including assessment, health promotion involving key public health issues such as obesity, childhood screening, and early intervention to deal with identified needs. It provides a structure to ensure the promotion of health and well-being for individual children and young people.

The framework describes how we should give support to the parents of pre-school children to help such children to develop their full potential. It places particular emphasis on the importance of identifying parents who need extra support, and on our need to ensure that they know how to gain access to the full range of services. It includes a common assessment framework for use throughout agencies to reduce the amount of time spent on repeated assessments of the same child by different practitioners. That will encourage agencies to work and plan together and to share appropriate information.

The framework refers to how we must educate and support young people to help them to make informed choices about their health and well-being. It focuses on five key health issues: nutrition, sexual and reproductive health, mental health, injury and substance misuse. All the standards on child protection issues that apply to the relevant agencies have been compiled into one document, which ensures that safeguarding children is recognised as being everybody's business. The document emphasises the recognition that a higher level of co-operation and information sharing among staff, both within and between agencies, is required for children in special circumstances.
 
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The framework describes the provision of comprehensive and integrated local services through managed local children's networks. They will be responsible for making sure that children and young people who are ill can get the services that they need at the right time. The framework calls for discharge from hospital to be planned in good time and with other agencies. Stays in hospital are to be kept to a minimum through improved co-ordination of community-based care.

The framework requires the extension of the Government's early support programme to all local authorities, which means that families of young disabled children aged between birth and three will receive high-quality early intervention and family support. It highlights the need for full equitable access to child and adolescent mental health services for learning disabled children, young people and 16 and 17-year-olds, who are often excluded from these services.

The framework also explains how we should provide better support for children and young people who take medication at home, in care and in education settings, with health professionals providing information and training for staff working in schools and other institutions to help them manage the use of medicines. It further shows how we should be tackling inequalities in outcomes for mothers, fathers and babies through the flexible planning and delivery of maternity services, and that we should allow women a say in how those services are designed. That will mean that all women, including the vulnerable and the hard to reach, can feel confident about using services throughout their pregnancy and after.

If all that is not enough, we have also used exemplars to show the life journey of children with special needs and indicate where they can look in the national service framework for guidance on what they should be able to expect. The first two exemplars are for autism and asthma, and on a personal note, I am very proud of the fact that as a Back Bencher, I was involved in lobbying for the autism exemplar, and that as a Minister I have had the privilege of delivering it.

The national service framework is broad in scope and far-reaching. We know that some services across the country already meet aspects of the standards, but it will take time to bring about the required cultural change and embed new working practices across the board. That is why the NSF has been developed as a 10-year strategy. Of course, although local services will be required to meet the standards by 2014, implementation during this period will be left to their discretion. They will have the freedom to prioritise those parts of the standards that are most important to their local areas. But let no one be in any doubt: the NSF is mandatory for the national health service by the end of that 10-year period.

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