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Dr. Ladyman:
I detect an agenda between the lines of my hon. Friend's question. I do not want to suggest that he does not wholly approve of the reconfiguration going on in his constituency, so I shall not interfere in that. However, any reconfiguration needs to be agreed by all local partners if it is not to come to the Secretary of State. The NSF for children must play an important part in that decision-making process. If a director of children's services is in place in an area, I would expect that director to have a great deal to say about any
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reconfiguration of health services. I hope that my hon. Friend's local authority moves rapidly to appoint such a person, if that will help him in his campaigning.
Mr. Chaytor: I am enormously grateful to my hon. Friend for that clarification of those responsibilities.
Dr. Ladyman: Now I am enormously worried.
The work programme that the Government are taking forward on children's issues demonstrates our real commitment to improving the life chances and opportunities for children and young people. The NSF is a key delivery vehicle for the health and social care aspects of this agenda. It will raise standards in hospitals, in general practitioners' surgeries, in schools and nurseries, in maternity units and in Sure Start children's centres. It will focus the attention of service providers on the needs of all children and young people, including those who have traditionally been hard to reach, such as those who have been abused or live in poverty.
Mrs. Iris Robinson (Strangford) (DUP): In Northern Ireland, we have seen a significant rise in the number of suicides among young people. Has the Minister given any thought to how we can target young people, especially in areas of social deprivation, to show that we value them, to bolster their self-worth and to ensure future prospects for them?
Dr. Ladyman: The hon. Lady is right. I suggest that she look at the totality of the changes that we are trying to implement for children, including the work set out by my right hon. Friend the Minister for Children, Young People and Families in "Every Child Matters"; the change for children programme; the measures in the Children Bill to create co-operation; the White Paper on public health that will be published in a few weeks' time; and the range of changes in the NSF. She will see that we are working as hard and as fast as we can to put in place exactly the mechanisms that can provide the assurance that she seeks. If we make children understand that they are precious and important to us, and give every child the opportunity to fulfil their potential, we will drive down the rate of suicide, not only in Northern Ireland but across the whole country.
We all love our children. But all our nation's children are our children. If one child does not fulfil its potential, we are all diminished. If one child anywhere is in poverty, or is suffering, or is failing to thrive, that is not the fault of someone else, it is my fault and it is our fault, and each and everyone of us has failed in the duty we inherited when we came into adulthood.
No other Government have done more for children and we will not be surpassed in our commitment to making change happen. This NSF is a beacon of that commitment and is a testament to our determination to see change for children, to see every child thrive and to see those special and precious peopleour childrengrow and become the women and men they were meant to be. I commend it to the House and to everyone who works with or for children, and to everyone who has children, will have children or once was a child.
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Mr. Andrew Lansley (South Cambridgeshire) (Con): I am grateful to the Minister for bringing this important subject before the House and giving us the opportunity to debate the national service framework for children relatively soon after publication. I wish first to echo two of the comments that he made.
First, like the Minister, I wish to thank Professor Al Aynsley-Green and many other peopleby no means all of them civil servants, as was suggested earlierfrom children's services across the country who participated in the work leading to the NSF. I know of the volume of work and the thought that went into it, not least because I had occasion to discuss the issue with Professor Aynsley-Green just over two years ago.
Secondly, I echo the Minister's recognition of the enormous contribution that we are already receiving from the people who provide services, including doctors, nurses, other health professionals and social workers in children's services. They are often somewhat under-sung in the health service context, especially social workers. The hon. Member for Lancaster and Wyre (Mr. Dawson) has been a doughty fighter for their cause and I entirely share his view. Just as we celebrate people in the NHS who save lives and people who shape lives in, for example, teaching, so, too, we should celebrate people in the social services who both save and shape lives in their work with children who would otherwise be in despair. There is every reason for us to say, "Thank you very much" to all the services reflected in the national framework.
The Minister inevitably could not elaborate on most of the issues in the vast range on which he touched and I shall not be able to do so either. If I deal with only a few, I hope that the House will understand that that is because otherwise I should consume a high proportion of the available time and I want other Members to have an opportunity to speak about the national service framework.
The Minister made some points about the underlying principles of the framework and I, too, have something to say about them. First, the scope of the national service framework is unprecedented; it covers a wide range of services. It does not, however, extend to all the services that have an impact on children; for example, in many areas, road traffic accidents are a major cause of mortality and morbidity in young children, but that is not addressed in the national service framework. That example illustrates that, through the public functions of the NHS, we need a greater ability to influence the extent to which the private and public sectors address public health needs.
The second good thing about the document is that it understands that children are different. Of course, this is not the first time that children have been considered as more than small adults; people have helpfully illustrated that point in the past, but an underlying principle of the national service framework is that we should never think of children as small adultsthey have their own particular needs.
The documents are interesting because they do not talk about children as an homogenous group, but show an understanding of the distinctions required; everything from child as foetus and neonate to the pre-school child, schoolchild, adolescent and the transition
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to adulthood. Childhood is a range of ages and we need to be able to deal with all of them. The hospital standard accurately understands that sometimes it would be highly inappropriate to admit 16 or 17-year-olds to a children's ward; it is not simply a case of admitting them to separate children's wards. Understanding the nature of adolescence is probably one of the most taxing things; it is certainly extremely difficult in the mental health sphere and in hospital admissions.
Charles Hendry: Does my hon. Friend agree with the representation from the Teenage Cancer Trust that it is wholly inappropriate to put teenagers in wards with older people? A ward with people who may be 30, 40 or even 50 years older does not provide the right surroundings for treating a child who is battling cancer.
Mr. Lansley: My hon. Friend is right. His point illustrates just how carefully hospital services for children must be planned. Last year, I visited cancer patients in the children's wards at Addenbrooke's hospital and saw the astute use of single rooms adjacent to the ward for adolescents; they could live there for the short period of their hospital admission and feel quite distinct from the very young children elsewhere in the ward, thus avoiding the distress they might experience, and which my hon. Friend described, if they were admitted to a ward where a substantial number of the patients were relatively elderly. We need to take on exactly that sort of thing, using the national service framework, to help in the configuration of hospital services.
As I mentioned previously, one of the things that the frameworks do well is to recognise the need to escape from fragmentation and the lack of responsibility for services that has been highlighted in the past. The Minister did not say explicitly that the framework is intended to build on Herbert Laming's report or Sir Ian Kennedy's report, but we know that it is. In particular, Herbert Laming's report certainly showed that fragmented services produce tragic results, as did the lack of responsibility and proper standards in respect of the Bristol royal infirmary. One of the things that I found very useful in reading the national service framework was the theme of treating not only children but their families as being integral to the development of a service that is centred on the needs of children and in which they must be listened to and respected. I welcome all that.
The Minister suggested in introducing the debate that things were going in the right direction and that we just had to push them further along, but it is not quite like that. Many indicators of children's health are not necessarily moving in the right direction. One of the child's journeys reflected in the framework relates to asthma. We now have very high and rising levels of childhood asthma. We have rising levels of childhood diabetes. Children with adult-onset diabetes are starting to present themselves for treatment in their teenage years. We have other public health problems associated particularly with teenagers, which reflect the use of alcohol and drugs and poor sexual health. The Minister referred to some of those issues, but they are serious and things are moving in the wrong direction.
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Although the national service frameworks are very important, I want to make it clear that, within weeks, we will be engaged in another debate about how to achieve a stronger public health strategy. I will not begin that debate now, but it is our contention that the problems of fragmentation are at least as great in relation to public health performance and delivery in recent years. It is important to use the public health mechanisms, such as primary care trusts and others, far more effectively than we have until now, to have an impact on those serious children's health issues. The standards will not be enough in themselves; an interventionist approach to public healthincluding awareness strategies, national campaigns and local actionis needed to deliver them.
The Minister said that this is the first time that there have been such standards. Of course, strictly speaking, that is true only in the sense that these are a complete, co-ordinated set of standards that stretch over a wide canvas. However, one of the reasons why we must be extraordinarily careful about ensuring that the best aspects of the frameworks are delivered is that, frequently in the past, documents have been produced that have not necessarily delivered the intended standards.
In 1991, the Department of Health published "The Welfare of Children and Young People in Hospital", which included guidance on care standards and seven cardinal principles. I shall not go through them now, but they bear examination by comparison with some of the eleven standards to which the Minister referred. In 1993, the Audit Commission produced "Children First: A Study of Hospital Services", which also set out a numbersix, from my recollectionof clear principles. In April 1996, the Department published "The Patients Charter: Services for Children and Young People", which was partly a reflection of the fact that, five years on, some of the previous cardinal principles set out in guidance were not necessarily being delivered. The Kennedy report referred to a much wider list of reports on children's services that contained standards that were intended to be met, but have not been met. When all is said and done, all 2-plus kg of the NSF is made up of guidance on good practice. The Minister tells us that it will be implemented in 2014, but that relatively few milestones will be encountered between now and then.
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