Examination of Witnesses (Questions 40-59)
MS NAOMI
EISENSTADT, MS
SUE HACKMAN
AND DR
SHEILA SHRIBMAN
19 APRIL 2006
Q40 Helen Jones: The reason I did
not mention the rest of the health care team is that we have not
really encountered problems there. There are problems about how
far GPs are engaged in the process and there are problems about
record sharing, for instance, that need to be addressed and I
wondered what you had found about how that is working on the ground.
Dr Shribman: I think we will come
on separately to information sharing because we have just published
new guidance on that, as you know. I should perhaps declare an
interest and tell you that I am married to a GP so I spend a lot
of time talking to GPs.
Q41 Chairman: Is he earning £270,000?
Dr Shribman: I can tell you he
is not earning that but I am sure he would prefer me not to tell
you how much. I am sure you will be aware that the average GP
earnings quoted yesterday were around £90,000.
Q42 Chairman: You do not mind me
teasing you on that?
Dr Shribman: Not at all. I guess
it is only to be expected. I feel that GPs are an incredibly important
part of the children's agenda. Quite self-evidently they are dealing
with children on an every day basis in relation to minor health
problems as well as major problems and they are important, so
in putting them in the context of the primary health care team
I am not trying to say that they are anything other than important
but they have a very large workload to address and a diversity
of issues and I guess the concerns have been can we ensure that
they are engaged on the children' agenda specifically. Going back
to topical issues, the Quality and Outcomes Framework (QOF), on
which they are remunerated in practice these days does have, for
example, a requirement that individual health care professionals,
including GPs, have information on local safeguarding procedures,
so there are being built into the system more levers around ensuring
that that engagement is there. Concerns were expressed by people
that with practice-based commissioning, our new way of commissioning
health services and engaging GPs and clinical front-line staff
more effectively, that the children's agenda would not be taken
forward. On the contrary, I think this is a great opportunity
to engage GPs and other members of the team more effectively in
the children's agenda. We are going to have some pilot areas for
practice-based commissioning specifically looking at the children
and young people's agenda so we can learn what could be best to
take forward as GPC rolls out, and of course GPs as commissioners
when they put forward their plans will have to have those plans
overseen by the PCT who will look at the plans, taking into context
the Every Child Matters agenda. I think the concern that
people will be disengaged and be somehow able to go off in an
opposite direction is untrue. I feel that the current framework
enables more collaborative working and more engagement. I think
in terms of working with GPs it is very important to be mindful
of their variety of duties and to ensure that we as a system enable
them on the ground to participate, for example, in child protection
conferences. It is just a practical point but they have to be
organised at a reasonable time of day to enable them to come.
It really is not good enough to arrange it for first thing on
a Monday morning when all of the patients are concerned from the
weekend and so on. There are some practical ways of ensuring that
GP engagement can work. In my own experience, as a designated
doctor I have done a lot of lot training and education with named
professionals and with individual GPs and I have always found
them extremely keen to learn more. I have also done training on
child health promotion and on children with disability and a certain
amount in relation to child mental health issues, and again it
is about meeting in the training opportunities the particular
agenda that the learners have, so understanding what the GPs really
need to know to do their job effectively and delivering the training
in that way is key, in my view, to taking things forward. I understand
the concerns but I feel that the opportunities are good with the
positive framework that we now have to increase engagement rather
than decrease it.
Q43 Helen Jones: We kept noticing
when we looked at this topic before the need for training. You
referred earlier to training across the piste and professionals
working together. In your view, how well is that proceeding? I
am thinking both right at the top of the children's trust but
also right the way through because an issue we came up against
in our special needs inquiry, for instance, was whereas you want
to train teachers in recognising special needs you require the
schools to release them for that training and that is down to
the individual head teacher. What are you picking up about what
is happening on the ground?
Ms Hackman: I think if head teachers
were here they would say to you, "I understand what is happening
with the local authority up there. I understand that this is integrated.
I understand the intention of the policy. I understand what is
coming," and I think they would have a very good grip on
how it would work on the ground. If you look at extended schools
most head teachers would have got as far as thinking "Who?
How? How will I manage it? What about the time? What about the
money?" They have got that. I think they might be more anxious
about what it would mean for particular teachers in schools. For
example, right now I would say your average year four teacher
or your average head of maths in a secondary school has been briefed
about the policy but the word "training" would not quite
apply. They have been briefed and there is a difference between
being briefed and understanding exactly what your role is. You
may disagree with me but I would think at this stage that is probably
where we would expect them to be. They know the idea, they know
that something is coming, but I would say speaking for ordinary
teachers outside the senior management team right now they would
probably say, "I know and I agree with the policy but I am
not quite sure right now how I will fit into it." That is
an honest answer. That is what head teachers say.
Q44 Helen Jones: Is the real problem
at that level not time? It is very difficult to release teachers
for extra training.
Ms Hackman: It is difficult. You
have probably got children in school. I have got children in school.
I do not want their teachers out of the class all the time. I
will be honest with you. I want them in the class teaching. For
example, there are ideal opportunities when schools have closure
days if they could put in those dates with colleagues in other
services to have joint planning time and joint sessions. I think
that would be ideal. That is better than taking teachers out of
the classroom. If you have a policy you have to create time. Right
now—this is my own view—I can see that there is money
and I can see there is a well-understood policy but I think time
might be the biggest issue. I think we have got to help them to
see where the time might be created without forever taking teachers
out of classrooms.
Ms Eisenstadt: I think there is
a further issue of who needs to know what. I am not sure how much
the secondary maths teacher needs to know. I would want the secondary
maths teacher to know a lot about working with parents and information
for parents and those sorts of things. I am not sure they would
need to know the detailed workings.
Ms Hackman: I can tell we are
about to disagree.
Q45 Helen Jones: They do need to
know how to recognise a problem a child has and how to call in
the appropriate support.
Ms Eisenstadt: That they do need.
Q46 Helen Jones: Our evidence is
that that does not always happen.
Ms Hackman: That is it. If they
are in your class they are your problem. If they are in your class
the child with autism is your responsibility. Is that not the
point of the policy that if it is in your class it is your problem?
Ms Eisenstadt: That is absolutely
right but what I was thinking about was the structural changes
in all that. What the teacher has to know is something about the
children in the class and something about parents. I think we
have to be careful that we do not overplay that everyone needs
to know everything because everyone does not need to know everything
because then you are duplicating and wasting. I think we do agree.
Ms Hackman: Let us just revise
it to say that what we want every teacher to do and health care
professional to do is to say, "I may not myself be the person,
I may not myself know the answer but it is absolutely my responsibility
if there is an issue at home, if there is an issue with health,
and I am not a health professional, to make sure that it is attended
to by someone somewhere.
Ms Eisenstadt: And to know of
whom I need to ask the question. I think in the past that has
not happened and in the past teachers have been quite nervous
about asking the question because if they did not feel confident
about getting the help, why do it.
Helen Jones: Thank you.
Chairman: We are now moving on to the
involvement of schools. Jeff Ennis?
Q47 Jeff Ennis: Following on primarily
from the line of questioning Helen has been pursuing latterly,
the last report from the evaluation of children's trusts found
that just one% of schools were involved in the management of trusts
and only eight% were working with their trust. Do these findings
concern you?
Ms Hackman: Yes, it is a concern.
I am astonished, I did not know that, I am very sorry. It astonishes
me and depresses me.
Ms Eisenstadt: I think the issue
is about what exactly does the report mean and this is the 38
pathfinder trusts where for many of them the nature of what they
were doing is very different to what we expect of trusts now.
The way in which we have designed trusts now and the way in which
within the current Education Bill the school has a duty to have
regard to the children and young people's plan is the way that
we are addressing that issue. It is exactly as we were saying
before. We want schools to have regard to young people's and children's
plans, we want the local authority and the children's trust key
partners to engage schools in developing the plan. When that evidence
was collected it was long before we had these wider strategies
about the role of the local authority to organise strategically
the whole range of children's services. I am less worried about
it given the timing of the report than I would have been, say,
six months ago and the issues that we have steps to remedy that
situation because I think we have taken a lot of steps to remedy
it.
Q48 Jeff Ennis: So we are rectifying
that current situation?
Ms Eisenstadt: Yes.
Q49 Jeff Ennis: Do you think more
needs to be done to secure a commitment from individual schools
to the Every Child Matters agenda?
Ms Eisenstadt: Our evidence on
the extended schools agenda in terms of their participation is
very good and the other evidence we have is the Guardian
Headspace Survey. 70% of head teachers are very, very supportive
of the Every Child Matters agenda. You could say that means
30% are not but 70% as far as I am concerned creates a critical
mass in terms of peer relationships because I think it is much
more likely that head teachers are going to be able to convince
each other than they are going to listen to what I have to say
and they are certainly going to listen more to what Sue has to
say than what I have to say. The way in which we deal with that
30% is the issue. I was very pleased about that Headspace result.
I thought 70% was very, very good. Sue, I do not know if you want
to say more on that.
Ms Hackman: As I said earlier,
I think the policy is popular. I do not come across people who
disagree with it. If they have got anything to say that is negative
at all it is about the practicalities of it, about finding time,
about when the staff are going to find out about it. I think the
policy is well supported.
Q50 Jeff Ennis: Do we need to consider
taking sanctions against schools who do not participate in the
ECM agenda?
Ms Eisenstadt: It depends what
you mean by "participate" and "engage" because
it is quite important to say that schools' responsibility is to
their children and the parents and what those parents want. Given
the relationship with schools, my view is that we should not take
sanctions because they are clearly doing something that local
parents want and if they were not they would lose kids and the
school would be in trouble anyway. If it is a popular school and
it has good results and it is doing what parents what then I think
there are issues about convincing and cajoling. I do not think
there are issues about sanctions. I think that goes against what
we are trying to do with the rest of the system on users leading
the system. You cannot have it both ways. You cannot say that
parents have the role to play in leading the system so long as
the school does exactly what we tell them to do.
Q51 Jeff Ennis: Moving on to extended
schools, the logic of the extended schools programme is that such
schools should draw their intake from the local community, shall
we say. How can we reconcile this against the strategy based on
academies and trust schools and the diversity that is being proposed
in the Education Bill?
Ms Eisenstadt: It depends what
you mean by "local community" because the community
is the community of the school and I think that is a both/and
not an either/or, in the sense that if you have got good IT facilities
and good sports facilities of course they should be open to the
local community, they should be open for adult education to local
service users, but on the other hand schools will draw from a
much wider catchment than their local area because that is what
school choice is all about.
Ms Hackman: On the more general
issue, I was going to say that trust schools, in common with all
other schools, have to give due regard to the children and young
people's plan and work within it. We are not without levers. For
example, Ofsted inspections will take account of how schools perform
against the final outcomes in Every Child Matters so it
is not that schools will be completely free-floating and able
to do their own thing. I think there are levers in the system.
I do not know if you count this as a lever but there is always
a very considerable field force to support the local authorities
and schools to implement the policies, and I think probably giving
constructive advice is more effective than applying sanctions.
So I do think it looks like there is enough in the system but
time will tell.
Q52 Jeff Ennis: Jointly sited facilities—such
as children's centres in school buildings and extended full service
schools—should mean that teachers and other school staff
will be working more closely with those from early years and other
sectors. What are the implications of this in terms of staff development
needs and remodelling professional identities? I know we have
touched on this briefly in the past.
Ms Eisenstadt: I think there is
an interesting debate on the role of the head and to what extent
the head is the head of a combination of services. I have seen
children's centres literately in the school playing field and
they are separately managed and they work really elegantly together
and there is no problem at all. I have seen ones where the head
runs the whole show. My best advice is to go to Millfields in
Hackney and see Anna Hassan in action. When you see these schools
that really do the lot they are awe-inspiring, they are amazing
places. At the end of the day it does have implications for school
staff, but it is not that unusual to have a two year old and a
six year old and the idea that you can take them both to the same
place for parents is fantastic and the idea that the teachers
in the reception class can walk across to talk to the nursery
staff and say "What was he like? I am a little worried",
it allows for those sorts of relationships to develop. There are
challenges to it, there is no question, but I think the benefits
far outweigh the challenges.
Ms Hackman: There is a certain
amount of training you can give to people to prepare them for
the new world, but I think we have got, a radical and interesting
plan for how we are going to spread good practice. We did do 35
pathfinders for that specific purpose so that we would have examples
of how to make it work on the ground and people who could give
testimony to how they found it, and we are going to try to spread
that good practice very vigorously. Beyond that our plan is less
to have top-down cascade training and a bit more to give people
mentors who have, for example, already implemented the policy
in another school or to pair schools together, one which has got
experience and one which does not or for example to have open
days at schools which have developed the policy very well so that
other people can come and participate and watch and observe it
in action for half a day and have training in the second half
of the day. So we are imagining a much more vigorous field operation
of sharing practice rather than an inert cascade model because
there is a difference between being told and being shown, and
we think probably the latter is going to be more effective in
this case.
Q53 Jeff Ennis: On the issue of children's
centres, it seems to me that you are favouring a children's centre
being sited on a joint campus rather than in a separate location
from schools. Can I draw that conclusion?
Ms Hackman: You cannot from me.
I can think of examples either way that are good. I just suppose
it is geographical logistics. Schools are places where children
are and they gravitate towards. I can see why there is an inclination
to locate there.
Ms Eisenstadt: It depends on the
nature of the children's centre. There will be a lot that are
developed from local Surestart programmes where there has already
been significant capital investment and it would be mad not to
continue to use that significant capital investment. That investment
does allow for the join up with health and it does allow for a
much more integrated service for young children. I think where
schools are particularly beneficial is on the lighter touch model
of children's centres and where if it is an extended school the
inter-agency support can be across the whole age range. I am saying
that it would be really wasteful not to do that. As Sue says,
it is horses for courses and areas are so different.
Q54 Jeff Ennis: Do we have a statistical
breakdown of the number of children's centres that are on joint
campuses as opposed to not?
Ms Eisenstadt: I am sure we do
but I do not have it on me.
Q55 Chairman: How many children's
centres are there?
Ms Eisenstadt: Right now there
are over 800.
Q56 Chairman: How many do we expect
to have?
Ms Eisenstadt: 3,500 by 2010.
Q57 Jeff Ennis: Can you provide that
information to us?
Dr Shribman: That is straightforward,
yes.
Q58 Chairman: In the idea of the
extended school what kind of activity goes on?
Ms Eisenstadt: Out-of-school childcare,
breakfast clubs, opportunities for stretch, homework clubs, maths
clubs. It is a mix of child care with the kind of activities that
always happened in schools and after school anyway but on a basis
where it is more regular and more dependable. So sports activities,
arts activities, academic stretch activities.
Q59 Helen Jones: Do you include relaxation?
Ms Eisenstadt: We talked about
that, too. I have said that. I think a place to sit and watch
TV would be very good, but for other people sports is often relaxation.
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