Examination of Witnesses (Questions 380
- 399)
WEDNESDAY 2 FEBRUARY 2005
MR TOM
JEFFERY, MS
ANNE JACKSON,
MS SHEILA
SCALES, MS
ALTHEA EFUNSHILE,
DR JEANNETTE
PUGH AND
MR MARK
DAVIES
Q380 Chairman: So is Professor Aynsley-Green
happier now about joined-up Children's Services or is he still
unhappy?
Mr Jeffery: I have never known
Al be other than challenging as to how we should work closely
together. Al and I see a lot of each other. He is a great champion
for children's issues across government; he is a strong member
of the cross-government Change for Children Programme Board which
I chair. The Department of Health, working with the Department
for Education since Every Child Matters, has come out with
the national service framework for children (which is a very significant
statement about children's health and services working together)
and with the Public Health White Paper (which will decidedly involve
the partnership of all the agencies concerned with Every Child
Matters), all those things need to be taken forward together
in a single cohesive programme of change rather than be delivered
from government separately to different agencies. That is very
much what we are trying to do.
Mr Davies: I think it is important
that you have been to British Columbia; Al Aynsley-Green has been
there too. He has been there at their invitation because of their
interest in the national service framework and what he has reported
back to us are the same findings that you came up with, that it
is very focussed on safeguarding and child protection and on the
early years programme. However, they are very envious of our national
service framework and I think we should not underestimate the
importance of the national service framework; it is the biggest
national service framework we have in the health service and it
is the most important set of standards ever produced anywhere
in the world for children's services and it covers everything
from pre-birth through to teenage years and transition to adulthood.
It is a very important document and it is a joint document between
education and health, and sets out some very clear standards and
a very clear framework for the NHS. Obviously just describing
a framework is not enough to deliver change at the local level
and I think there is no question we have a challenge there. We
have 150 local authorities, we have 303 primary care trusts, we
have a number of hundreds of NHS provider trusts providing services
for children and getting that integration with education and the
criminal justice sector is very important and very challenging
for us, but we have the framework there and we have the good will
of professionals as well who welcome the national service framework
and are committed to implementing it over time.
Q381 Chairman: As we listened to
the evidence we had—informally mostly in British Columbia—they
told us about the inspiration that the inquiry had given them
and that the legislation had provided, but found that people still
did work in their silos; the joined-upness did not happen for
them and still has not happened in many cases. They still saw
themselves as having discrete roles and communication had not
improved in the way they had anticipated. Are we sure that this
joined-upness is possible in our system? It looks very complicated
on the ground, giving enormous new roles for people who are already
very busy anyway.
Mr Jeffery: Perhaps we should
start with examples of joined-upness that we have already. I think
it is an important consideration that Every Child Matters
and the change programme we are now setting up are not starting
from anything like a blank sheet of paper. There have been some
very significant integrated programmes over the last few years—there
is SureStart, there is the work of the Children's Fund, there
is Connexions, there is Quality Protects—all of which began
to bring agencies and people together at managerial and strategic
level and in the front line. The issue really has been their success
which has kept them separate, one from the other, as they have
each had their own funding streams and accountabilities. We need
to learn from what they have succeeded in doing in bringing the
whole system together at a local level. There are many additional
incentives now towards that integrated working. There is the appointment
of a Director of Children's Services, the one person in charge;
there is the example of what the inspectorates have done in themselves
working together to create the new inspection framework and to
set up the joint area reviews so that they will work together
to look at outcomes for children locally. I guess it is that emphasis
on outcomes which has perhaps done more than anything else to
move the debate forward. People have been very ready to look beyond
their professional backgrounds or their organisational arrangements
to consider how they can work together to improve a broad range
of outcomes for children. Thus we have built those outcomes into
the Children Act and we have built them into the change programme
and they absolutely run through the inspection framework. While
we all maintain a focus on those ultimate ends which are about
children's lives, the incentive for organisations, professionals
and the voluntary sector and all concerned to work together is
very clear.
Q382 Chairman: We do not doubt the
intention but when it gets back to this Committee that 70 out
of 150 directors of Children's Services have now been appointed
and 63 out of the 70 have been former directors of education,
in a sense it does give a signal that this is all going to be
rather biased towards the education world and the other partners
are going to be minor partners.
Mr Jeffery: What is important
about the appointment of a Director of Children's Services is
that they have the leadership qualities, the vision and the ability
to bring all those organisations together. They can come—some
of them will come—from many different backgrounds. They
will need to work right across the piece.
Q383 Chairman: They are not going
to be from many different backgrounds, are they, if 63 out of
70 appointed were all from education?
Mr Jeffery: The figures differ
as to exactly how many are in post or about to take up posts.
Q384 Chairman: You do not think that
is an accurate figure?
Mr Jeffery: The figure is there
or thereabouts; it is a little less than that from our understanding
at the moment, but it does represent quite significant progress
towards the appointment of that important role and, indeed, faster
progress than was originally expected.
Q385 Chairman: You are not going
to do very well if all the other partners are sulking in their
tents because none of the top jobs have gone to their role.
Mr Jeffery: We do not have any
evidence of other partners sulking in their tents. We do have
evidence of many different partners talking to us about this.
There is some concern—I would not deny it for a moment—on
the part of ADSS about appointments. There are some quite significant
appointments of people with social care backgrounds. There are
very important jobs in social care as directors of adult services
where one might expect some of those people to be looking as well.
It would be good to have a broad range of people as directors
of Children's Services.
Q386 Jonathan Shaw: You would be
given a fairly hard rebuke if you started advising local authorities
on who should they appoint, would you not?
Mr Jeffery: Beyond general comments
on the generic skills which will be required—and colleagues
may wish to add something on the draft guidance we have out at
the moment on the role of the Director of Children's Services—we
would not get directly involved in appointments, no.
Q387 Jonathan Shaw: Do you have any
intention of doing so?
Mr Jeffery: We are not involved
in those appointments.
Q388 Paul Holmes: You have talked
in broad terms about the national service framework, however there
are concerns that it is a great idea as a framework but is it
any more than an aspiration? There is no funding to make it happen
and there are very few specific targets or timetables to make
it happen.
Mr Davies: There are a few points
I want to make about the national service framework and we have
heard these comments. The first comment about funding is that
we are in a position now where we do not allocate money for particular
purposes in the NHS, we give the money to the people in the front
line—75% of the NHS money goes to the primary care trusts—and
we ask them to deliver services and deliver improved outcomes
within a framework set nationally. We are setting fewer and fewer
targets and have made a commitment to set fewer targets to people
locally. We have set fewer targets in the document which we issued
earlier this year called National Standards Local Action
which sets out the targets for people locally. Within that there
are a few key elements which are germane to the national service
framework. First of all, we have set targets which are reflecting
the national service framework; we have PSA targets around child
and adolescent mental health services and there is a whole standard
around that which requires the delivery of a comprehensive child
and adolescent mental health service everywhere. There are some
very fierce targets around that for people locally. We have targets
on teenage pregnancy and obesity which are joint targets with
other government departments. We have PSA targets which we share
with DfES which again are required to be delivered by the NHS
locally. We also have a health inequalities target around infant
mortality. So there are plenty of targets around the area of delivering
improved services for children all of which are reflected either
in the national service framework or we judge that if you deliver
the standards in the national service framework it will help deliver
the PSA targets. When we launched the national service framework
the Minister said that although we were not requiring people to
deliver it immediately, it is mandatory over a 10 year period.
We have what we call for the NHS developmental standards which
will become over time core standards so there will be things that
all services and all NHS bodies will have to deliver. I feel that
the money is out there.
Q389 Chairman: Where is it?
Mr Davies: It is with primary
care trusts.
Q390 Chairman: If you are in West
Yorkshire as I am, my primary health care trust ran out of money
long ago; they cannot purchase any more operations from the acute
trust let alone spend money on new responsibilities.
Mr Davies: I do not feel qualified
to comment on the overall funding situation.
Q391 Chairman: If there is no ring
fenced funding for this new responsibility how on earth is it
going to be delivered now or in 10 years' time?
Mr Davies: There are four or five
public service agreement targets which people will be required
to deliver and that will, in a sense, require them to implement
the national service framework. As you know—I think you
took evidence from Anna Walker, the Chief Executive of the Health
Care Commission—they will be looking at inspecting again
the standards set out in the national service framework and that
will be one of the biggest drivers of performance within primary
care trusts. I feel that we have the leverage in place to support
delivery of the national service framework. I would not deny that
it is going to be challenging; that is why we are saying that
it is a ten year programme because people are starting from very
different points. What we have asked them to do is to determine
locally what their priorities are for their local communities
and populations in order to deliver it.
Q392 Paul Holmes: Is it the same
situation with, say, head teachers who are involved in all this,
but their main priority is their school and their league table
positions and all the other government targets? Are they going
to give full attention to this programme? Going back to the PCTs,
they have 75% of NHS money but it is all committed already to
different programmes?
Mr Davies: The performance of
PCTs will be judged against their delivery of some of the key
targets that they have been set, which include targets for children:
child and adolescent mental health service, teenage pregnancy,
obesity, infant mortality, inequalities. These are all important
targets which they will be required to deliver and their performance
will be judged against delivery of those targets amongst others.
There are other targets for the NHS and I think we recognise that.
On the question of funding we know that there have been record
levels of growth in the funding for the NHS but, as I say, I do
not feel qualified to comment on general funding issues of the
NHS or specific issues in Yorkshire. There have been record levels
of growth and the money has been given to primary care trusts.
It is better that primary care trusts have the money than I have
it to distribute through some bidding process I feel.
Mr Jeffery: The implementation
of the national service framework goes well beyond the health
service and it is crucially a matter of co-operation between Children's
Services generally—including local authority Children's
Services—and it is very important that its standards are
increasingly reflected in the inspection framework which the inspectorates
are now drawing up. Then we can look at the area as a whole and
see the progress which is being made against those standards on
the part of all the agencies involved.
Q393 Paul Holmes: From the DfES point
of view—as the Chairman said at the start—Every
Child Matters brings to this Committee an area that we
have never looked at before. Similarly for the DfES in general
it brings in an area they were never involved in before; it is
quite an expansion of responsibility. At the same time as taking
that on the DfES has said it is going to cut staff by 31% in three
years. How can you reconcile the two things?
Mr Jeffery: Every Child Matters
and the appointment of a Minister for children does indeed bring
a range of issues to DfES which we have not dealt with before,
although it also brings together a number of key interests which
we had in the Department including around SureStart and Connexions.
Just as the Department is seeking a more strategic approach to
its business, so we are in the Directorate. When we came together
we had about 1100 people and we will be looking to reduce that
in size over time. The drivers for that really are this whole
system change which we are seeking to put in place and the development
of a key role for local authorities leading children's trust arrangements
locally. We need to support that change by moving out of the micromanagement
of some services—after all we have been very hands-on in
the development of early SureStart programmes—and by rationalising
a lot of what we do. When all these functions came together we
brought together a huge array, for example, of grant schemes.
We need to think about how we use information much more effectively
to support change locally. We need to think about how we do business;
do we do it through the proliferation of guidance or do we do
it through seeking to work much more in concert with our partners
who are leading change on the ground? We will be reducing in size
but we will be seeking to do so in a way which is about supporting
change for children.
Q394 Paul Holmes: So the cut of 31%
in staff will not undermine the service the DfES delivers and
are you saying that none of it will be offset by just moving those
staff over to other bodies, to quangos or to consultancies?
Mr Jeffery: By and large we will
come down in size alongside and perhaps a little bit more than
the departmental average. We are saying that we think we ought
to be able to work in a way which is more supportive of our local
partners. One of the things that we have at the moment is a substantial
array of field forces and that has followed almost inevitably
from having an array of different policies sometimes driven out
of different departments. It is not a criticism of the way people
have put policies together to say that in the past inevitably
they have said, "Right, we must have a field force to work
out there with our partners" but whether that is the most
helpful set of arrangements for partners is very debatable. They
may find they have too many well-intentioned people coming to
them to help them deliver change. We need to rationalise those
arrangements; we need a more effective way of working through
government offices and we need authoritative respected interlocutors
with key people leading change in local areas. We have a lot of
work to do around that as well.
Q395 Paul Holmes: There is no hint
there that reducing the staff would partly be done by simply moving
their functions to other departments.
Mr Jeffery: In a sense this is
about moving responsibility for strategic change to children's
trust arrangements and local authorities, if you take the SureStart
example; it is not about moving it to a plethora of non-departmental
public bodies. We do not have a plethora of non-departmental public
bodies in this territory.
Q396 Helen Jones: I want to follow
up what you said, Mr Davies, about the national service framework
for children because we are hearing a lot of talk both from you
and your colleague about delivery on the ground but in my experience
departments are very good at drawing up strategies and not so
very good at seeing them implemented on the ground. Without ring
fenced funding for the national service framework for children,
is this not all a bit of moonshine? You are expecting it to be
delivered by PCT boards who are untrained by and large in this
area and who face a number of competing demands. Are you convinced
they are going to put this NSF at the top of their agenda? Yes,
they will be inspected but the chickens may come home to roost
several years down the line and some of them could be gone by
then.
Mr Davies: It is a very good point
you make. I think our experience in the Department of Health—where
we have been through a change which Tom has just described the
DfES is just beginning, one where we have reduced our number of
staff by 38% within a year so we are a very much leaner and fitter
organisation than we were a year ago—is that we do not drive
things from the centre. We support people locally delivering services
and it has been a big shift for us in our mindset as to how we
work with people locally. I know health is not your key area of
interest but one of the key government targets for the NHS was
to reduce the amount of time that people wait in A&E departments.
I was responsible for that target until a year ago and by and
large there has been huge progress made on that without any ring
fenced money at all; there was no money allocated specifically
to that target although it is a different type of target, I admit.
I think the point is that money is not the answer to these questions.
What people are looking for is support and advice and help to
deliver services locally, to deliver change locally. We have good
experience of putting in place systems of support for people through
things like the Modernisation Agency in the National Health Service,
through the National Institute for Mental Health (in another area
for which I am responsible, mental health services), where people
work alongside local services to support their delivery of change
and to advise, to help and to share good practice. That is a model
that we support and we promote and is actually effective. If we
just gave them the money I still do not think it would be delivered
because this is about a change in the way of working.
Q397 Helen Jones: Are you then telling
me that you are convinced that in delivering this through PCTs
you have in place chief executives of PCTs and PCT boards who
fully understand the necessity of this? I am not convinced from
my experience that they do. They may be very willing but I have
experience of a no-star PCT. They do not the training or the expertise
to do this, have they?
Mr Davies: I understand that and
I would like to make the point that it is not just through PCTs,
it is through the whole of the NHS and through their partners
as well. The national service framework is not just about the
NHS, it is about the NHS working with its partners and that is
part of why we are using the Change for Children programme as
the framework within which it is delivered. I think that is one
aspect of this, that it is not simply an NHS issue. I know what
PCTs are concerned about, they are concerned about their financial
bottom line and they are concerned about delivering access targets
and delivering improvements in particular service areas. However,
they have a responsibility to all the citizens they serve; they
have welcomed the national service framework by and large and
they see this as an important set of standards. It is a ten-year
strategy and if people at the moment do not understand the importance
or the consequence of the national service framework then that
is the challenge for us over the next 10 years. It was published
in September last year and we set it out as a 10 year strategy
and we are only at the start of what I think is a very long journey.
Some places are further down the road than others and clearly
your primary care trust has a lot of work to do but that is precisely
why we want people out there to work alongside them. I think for
people working across education, health and social services we
have regional training advisors who are jointly appointed by Education
and Skills and Health to support them. I take your point that
it is a long journey we are on and it is a challenge; it is the
largest most comprehensive set of standards for Children's Services
anywhere in the world and if in 10 years we can look back and
say that we have delivered it then we will probably have the best
Children's Services anywhere in the world.
Mr Jeffery: Sheila Scales does
a lot of work on supporting change, including issues of leadership
locally and at some point—now or in due course—Sheila
may want to say something about that.
Q398 Chairman: Sheila Scales, we
would be delighted to hear from you.
Ms Scales: Mark mentioned that
we have put in place 10 regional change advisors to help support
this agenda and they are jointly owned by the two departments.
That has meant adding to the number of strategic advisors who
are out there helping and supporting across the piece. We have
education advisors—as you probably know—working with
local authorities as well and the Social Care Inspectorate also
has advisors. What we are trying to do is to bring those together
into a single force by April of next year so that we have a joined-up
set of regional advisors who can talk with authority to local
authorities, to PCTs and hospitals and make sure that where there
are issues locally that need to be pursued we can put our collective
effort towards getting those sorted. That would be one of their
roles. The others—and this is about the issue of sharing
good practice as a key driver for change in this new model which
we are very conscious of—is that we have done quite a lot
of sucking good practice up to the centre and trying to bottle
it and use it as the basis for a lot of the advice and guidance
that has gone out. We prepare that in consultation with a lot
of our partners. What we really think would be powerful is developing
much more lateral arrangements for transmitting good practice
and developing networks. We have a network already of the new
directors of Children's Services whom we bring together to share
their own good practice and help with that leadership challenge
which they all have across the piece locally. We are also starting
to run some regional events starting next week up in the north
east which will bring together all the key partners locally—education,
social care, health, the police, the whole package of partners—and
start to use those as the basis for regional networks for sharing
good practice and making sure that those who are leading edge
in this (as Tom says, a lot of people are way ahead of us in terms
of developing this policy on the ground) can actually help those
who are finding it more of a struggle and use that as an effective
way of driving change without us having to do it all from the
centre with our smaller forces.
Q399 Jonathan Shaw: Are there regional
advisors for particular areas within Children's Services? If I
am running a local authority do I get one regional advisor providing
advice across the piece or are there separate ones for education,
for child protection, et cetera?
Ms Scales: As I was trying to
explain, currently we do have a set of advisors.
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