Examination of Witnesses (Questions 20-39)
PROFESSOR SIR
AL AYNSLEY-GREEN
25 JUNE 2007
Q20 Helen Jones: How do you decide
what issues you wish to investigate or concentrate on, and how
do you determine what is relevant to young people? I am struck
by hearing the evidence you give, which we hear a lot, about what
goes wrong in young people's lives and where the problems are;
but many of us round this table think most of the young people
we know are very decent, hard-working, well-adjusted young people.
Bearing that in mind, how do you ensure you are taking on board
the concerns of young people who are representatives of those?
I am not suggesting that the investigations you carried out are
not worthwhile, but there is a balance to be struck, is there
not?
Professor Sir Al Aynsley-Green:
There is indeed, and we must not forget the needs of those who
seem to be doing very well. One of my arguments is actually celebrating
their achievements and contributions. Ten times more young people
volunteer in communities than cause trouble. I am sure that in
Warrington you will have the spectrum of young people too, those
who are doing very well and those who are not. In terms of what
we do, can I show you this, which is from my strategic plan? It
is a pyramid in three sections. Let me say in preface that when
we started this organisation two years ago there was an enormous
temptation to do everything. We were being bombarded with requests
for this, that and the other. We were bombarded with media invitations
and all sorts of issues. We rapidly discovered we could not do
everything, and so we resorted to focus, and we would like to
be judged on the quality of what we do rather than the quantity
of what we do. We need to have flexibility to be able to react
quickly to unforeseen events. We need to identify which areas
we can have the greatest impact on. Over the development of this
five-year plan, which I do commend to you—and you might
like to call it up our website—we have come up with this
construct of a pyramid in three sections: our proactive work at
the top, our responsive work in the centre, and our listening
function at the bottom. Of these three sections the most important
for children is being listened to. We hear this repeatedly across
the country: "Nobody listens to us; nobody asks us for our
opinions." So we are investing in technology to track every
input from every child that comes away from fieldwork and our
website. We are investing in a new website, which will be interactive,
to get their views as well. The big issue here is how you get
to the most marginalised children. One way of doing this is to
deliberately go out to target them. We are just starting a series
of regional road shows where I will go for three days at a time
to a locality. We will be well briefed before we go. During those
three days I will make it my business to meet as many different
children and young people as I can, working with local organisations
to find out where they are. For example, I went up to Durham to
listen to traveller children, who are some of the most disadvantaged
children, so the listening side is very important. Each year we
are taking one issue to be our proactive theme, where we invest
seriously in what children want us to do. This is a year-long
process of development, where we will engage with stakeholder
groups across the country and learn what they want us to focus
on. We will have an annual residential event for one hundred children
this year. Again, we will decide what they want us to do for this
annual theme. We will also give them spending power and make 50%
of our budget for projects available to them for what they think
they should be spending the money on, and working with them on
that. This year, 2007-2008, we have chosen, with their input and
their advice, the theme of Happy and Healthy, which resonates
immediately with the UNICEF report. We are going to work with
children of three ages at transitions in their lives: children
who are starting school; children who are moving into secondary
school; and those who are leaving school. We have locations across
the country where we are working with them. We are going to deliberately
target in those locations the children who are most disadvantaged
and ask them, "What is it that makes you feel happy? What
is stopping you feeling happy? What are the services doing in
the locality that prevents you from being happy? What are your
views about being healthy, and how can services improve in relation
to your health?" We will feed this input into a report at
the end of the year. Some of the work will, of course, be ongoing.
That is our proactive theme. In August, we will be having our
first major residential event to see what the children and young
people want us to focus on for next year. Then, in the middle,
we have the responsive mode, where we have chosen six spotlight
areas. These areas have been chosen very much with the input of
children, through conferences and participations across the country.
The six spotlight areas will each be run by a manager in my office,
with a big participation framework. The first is youth justice.
Children tell us that this is one of their most important issues;
the fact they feel increasing criminalisation. They are very angry
and concerned about ASBOs, about dispersal orders, about the Mosquito
device, and about the attitude of the police towards them. I remind
you that last month I took part in a Radio 4 programme around
a 13-year-old who had stolen 49 pence worth of sweets from a local
shop with his mates. It was the first time he had done that. He
was arrested by the policeman and taken to the police station.
He was fingerprinted and DNA'd and was charged. He now has a citable
offence on his record for the rest of his life. Is that proportionate?
Children are very angry about these things. We want to explore
the whole issue of youth justice and what we are going to do there.
Q21 Helen Jones: That does raise
an issue. It is interesting that you gave the example of children
being very angry about the criminal justice system and ASBOs.
Is that rather not a self-selecting group because if you have
not come into contact with it, you are not going to be very—I
certainly do not pick up from a lot of the young people I deal
with a sense of anger about the criminal justice system. I sometimes
pick up the opposite. We had a dispersal order made near where
I live, and a lot of young people felt a lot safer because of
it, because they were the ones who were being harassed sometimes.
How do you get the balance between young people who may be complaining
about a particular issue—it may be a perfectly relevant
issue—but also deciding how that fits in to the concerns
of the majority of young people who may have entirely different
concerns, or may not? Deciding these things is really rather difficult,
is it not?
Professor Sir Al Aynsley-Green:
It is extremely difficult. I have to say that we are still relatively
naive in the methodology to prioritise, and this business plan
is our first attempt to do just that. I accept your point unreservedly
that there will be a huge spectrum of opinion. Many young people
are extremely reactionary to youth justice and actually want more
children locked away. I have also met young people, who have had
ASBOs applied to them, and they say it has turned them around;
they have seen the benefit of being pulled up short. There is
a big range of issues and opinions, but overall there are concerns
about youth justice and anti-social behaviour. In terms of what
those doing well want, let me rehearse some of the points they
have made to us. As I said, we now have a large database of the
concerns of children and young people across the piece, leaving
aside those at various ends of the spectrum. What are children
and young people concerned about? They are concerned about safety
and security and family break-up. That comes unanimously from
all parts of the country. They are concerned about safety on the
street, their safety on the street, and security in schools against
bullying; security at home—domestic violence. Many children,
with the statistics of family break-up, are terrified of their
families breaking up. Even those who appear to be in stable relationships
with their parents are concerned at what they see happening to
their peers in society. Safety, security and family break-up come
top of the list of what all children, by and large, are telling
us. That is coupled immediately by bullying, which still remains
one of the most important issues that children confront every
day of their lives, inside and outside of school. Commendable
progress has been made, but we still have a long way to go. Underneath
the top headlines, there is a series of other issues. Enjoying
school more—"Please help to wave a magic wand so we
can enjoy school more." They are concerned about the incessant
pressures they are exposed to with testing. There is an interesting
debate taking place about SATS and whether very young children
should be exposed to relentless testing. Young people feel quite
strongly about this. A young girl said to me last year in Newcastle:
"I have just come back from Christmas. I had a miserable
Christmas. I did not enjoy my Christmas because as soon as I got
back to school I knew there were the mock exams for my GCSEs."
That is reflected in statistics about emotional and mental ill
health in young people, which are increasing and quite shocking.
So people feel under enormous stress in the school environment.
They are also concerned about issues about lessons about sex and
sexuality, about accessing reliable information that they can
use to make their judgments on their behaviour. They are concerned
about racism. I find this remarkably encouraging actually because
there is so much feeling amongst young people and even young children
about stamping out racism. They do not like it and, by and large,
they want to have it stamped out. Then, of course, there is the
issue for young people about places to go and things to do. The
adults say: "We did not have these things when we were young",
but the world has moved on since then. The reality for many young
people's lives is that they gather on street corners because that
is where they feel safe with their mates, and they have nowhere
to go and nothing to do. We can give you the lists of issues that
apparently happy and healthy children are experiencing.
Q22 Chairman: Can I share with you
a management problem I have? We are enjoying your full answers
but I will have a rebellion if all my troops do not get the chance
to ask you questions. Could you be a little bit shorter?
Professor Sir Al Aynsley-Green:
I will do my best.
Q23 Helen Jones: You also said that
society is not very child-friendly, and in many ways I would agree
with that. I think it has improved since my son was small when
you could not even get a high chair in a restaurant.
Professor Sir Al Aynsley-Green:
It is improving slowly.
Q24 Helen Jones: We come across quite
frequently a lot of intolerance of young people. I get complaints
about children playing football in the street, not because they
are causing damage, which would be a legitimate complaint, but
simply because they are playing in the streets. How do you try
and change that culture, and do you see yourself as having a role
in changing the perception to one where children and young people
are not always a problem?
Professor Sir Al Aynsley-Green:
Exactly right. I can speak with great personal authority on the
very issue you raise because it has happened where I live. Children
were playing in the street and congregating around a bus shelter.
The starting point is to listen to the children about why they
are doing it, which is what I did. I asked these kids: "Why
are you doing this?" "We have nowhere to go. The adults
do not like us doing it." We then did work with the young
people and the youth workers—and I have already expressed
my serious support for youth workers—we arranged inter-generational
dialogue. We put young people and old people around the same table
to start exploring their perspectives of each other—asking
young people, "What do you think it is like to be an old
person" and asking the old people, "What do you think
it is like to be a young person?" Having broken the ice and
got the dialogue going, there was a remarkable discourse between
the two segments of society, leading to pressure being put on
the council to provide facilities for these young people. I think
there is a lack of understanding between the young and the old
which you should try to break down.
Q25 Mr Marsden: Professor, I would
like to focus quite sharply on some of your spotlight areas for
the year ahead. You have identified six key spotlight areas: youth
justice, antisocial behaviour, asylum and trafficking, a fair
life, mental health, enjoying education and leisure and staying
safe. I want to focus on a fair life to start with. We had a report
from the CSN briefing on your one-year and five-year plans. In
the area dealing with fair life it talks about the way in which
you had identified that disabled children are let down by poor
services and lack of coordination between service providers. That,
as you know, has been of particular interest to this Committee
with the Special Educational Needs Inquiry. Having identified
that problem, what have you managed to achieve or what do you
hope to achieve over the next year?
Professor Sir Al Aynsley-Green:
You raised the issue of disability, and that is something that
has been of great concern to us. We have put in a number of submissions
to the parliamentary hearings on disability and the Comprehensive
Spending Review. I am pleased to say that our comments have been
reported and referred to in the documents. I have a special insight,
having been a children's doctor, and having seen the quagmires
that families walk through with disability. I welcome the parliamentary
process. I welcome the Treasury review that was published recently
about disabled children accessing services. The real challenge
is not the fine words of policy but transforming the cultures
in which services are delivered to make sure that the needs of
children are being met. Only four or five weeks ago a group of
parents came to see me under the auspices of BLISS, the charity
especially concerned about in intensive care for sick new-born
babies. It had a resonance because for 10 years of my life I was
a neonatologist looking after the sickest and most vulnerable
small babies. They described to me that whilst they were in intensive
care, they received superlative treatment, by and large. As soon
as they left that intensive care they disappeared into a black
hole—"wading through treacle" is what one mother
said to me—a disconnection of services and so on. I have
had discussions with Ed Balls and the Treasury about this: I welcome
the review, but how are we going to make it happen?
Q26 Mr Marsden: The reality is that
much of what you are talking about, the aspirations of the Government
and what you are saying about joined-up services, has to be delivered
locally.
Professor Sir Al Aynsley-Green:
Correct.
Q27 Mr Marsden: And yet you said
earlier on—and I understand why you said it—that you
would have to pull back from a localised conception of what you
are doing. Other than going and having a chat with Ed now and
again and saying, "You are doing a great job, and how can
we take this forward", how are you going to be able to help
the process of translating that on to the ground, so that you
get social services and education services working together to
look after children across the autism spectrum after school as
well as during it?
Professor Sir Al Aynsley-Green:
Exactly right. When I said "local" versus "national",
I was talking about taking individual children's cases locally.
The issue of locality is common across the country; it is this
challenge of integrated services and getting co-ordination. We
have several important allies in this area, and I select one,
Sir Ian Kennedy at the Healthcare Commission. You are aware of
his statutory responsibility to have special regard for the health
needs of children and young people. Recently, the Healthcare Commission
published a report on the implementation of the National Service
Framework. It demonstrated some serious deficiencies and the speed
with which the NSF was being implemented, not least for safeguarding
children and in the context of their safety. Ian and I were very
concerned about this and so we made it our business to go to talk
to Patricia Hewitt ourselves about our concern about the engagement
of the NHS generally in the health of children, and particularly
the health of disabled children. We reflected the importance of
getting action at the local level. I know what happens at the
local level. In my previous job, as National Clinical Director
in the DH, I made 400 visits all over the country to see for myself
how local services were operating. I found three things: remarkable
ignorance in the minds of people who matter about why children's
services are different to those of adults; secondly, a failure
of anybody locally to be responsible for those children's services;
and thirdly, a failure for them to be mainstreamed in the everyday
business of essential organisations. We represented to Patricia
Hewitt and others the importance in the Health Service of having
responsible people to work with the new structures directed at
children's services to be responsible for those services. We are
delighted to see that the Directors General and the DfES and DH
have recently written to all PCTs to remind them of the importance
of children; so there is a cascade. We are targeting the top level
to get action, but at the end of the day we can only get people
motivated locally to change things, which is where our personal
interaction at the local level is so important. Directors of children's
services—150 of them—are crucially important people.
I respect many of them. I have been to their patches. I have a
dialogue with them, and I intend to contact every one of them
in the next few weeks to reflect these sorts of issues. Can I
also make a point about my travelling road shows? We will be going
to hospitals to see for ourselves what is going on and to promote
discussion.
Q28 Mr Marsden: You have rightly
made great play today about involving young people in determining
your goals and policy-focused areas. In the last week we have
had Carers' Week, which has been a great focus. I went to my own
constituency to visit carers' organisations in Blackpool. I am
told that in Blackpool we have between 800 and 900 young carers
who are not necessarily, for a variety of reasons, getting all
the support that they should. I am sure that Blackpool is not
an isolated case. What have you been able to do and what are you
planning to do to include the issue of young carers and their
education and social support in the kinds of dialogue that you
have been talking about?
Professor Sir Al Aynsley-Green:
I am glad you raised that point because the plight of young carers
is of concern to us; they have been an invisible group for far
too long. As part of our intelligence gathering and listening
to children and young people, I have many stories from young carers
about how they have been discriminated against, often starting
with the fact that the school and the school teachers did not
know that they were a young carer. We have that information and
we are certainly feeding it through to people who matter in government,
and officials and so on. It will not be an issue, because of our
resource constraints, that we can make a major focus for action
in this particular year. We are certainly making the views of
those children well known.
Q29 Mr Wilson: You said you thought
that a Cabinet Minister should be responsible for children. Have
you had a word with the new Prime Minister about this? Have you
lobbied him in any way?
Professor Sir Al Aynsley-Green:
No, I have not yet; I have not had a chance to talk to the new
Prime Minister. The reason for this is not to deny the excellence
of much of what has been going on, but the interests of children
fall across so many Departments of State and there are certainly
differences of attitude and culture towards them—the relevance
of Every Child Matters to the Home Office, for example,
or the Justice Ministry, the relevance of Every Child Matters
to the NHS or the Department of Health. These are important points.
We feel there should be some central co-ordination function. You
could say it is for the Secretary of State for Education, but
that actually is a broader remit than just education. We would
like somebody at Cabinet level, if Gordon Brown is going to be
serious about the importance of children in society, and have
that flagged at Cabinet level. It is the integration of all this
work that is so important. I have seen many examples myself of
how Departments of State are talking to each other; but there
is so much more that still could be done, and I think that deserves
to come from the very top.
Q30 Mr Wilson: On the face of it,
the UNICEF report was reported very negatively. Do you think it
was as negative a report as everybody said it was?
Professor Sir Al Aynsley-Green:
This was bounced on us, and there were all sorts of reactions
to it. I think that government legitimately felt a little bit
aggrieved about this; that the data in some areas were not particularly
recent. They did not reflect the needs or views of very young
children, and there had not been time for the data to feed through
from the impact of Every Child Matters and so on. As I
said before to previous questions, I think that others have certainly
commented on this not being good news for the UK. What was pleasing
in the UK, however, was the enormity of the media coverage that
followed from this. I was in Canada a few weeks later. Canada
did better than us but not particularly better—it was not
in the top 10 of the best countries—and there was almost
no coverage at all in Canada about the plight of Canadian children,
from the UNICEF report. It touched a nerve in the commentators,
which reinforces my point about the tipping point. We have had
a progressive series of issues raised, and there is now much more
sensitivity and alertness to what is going on. I am disheartened,
but not surprised, by the findings. As I said previously to Helen,
there is a spectrum where children tell us about their relationships
et cetera, but I think we need to look beyond the statistics
and ask ourselves the hard question: are we failing our children?
If so, why, and what do we do about it? If that only generates
that debate, it will have been worthwhile. I am interested to
hear, by the way, that UNICEF is planning to do a well-being survey
of British children in the near future, using much more contemporary
data. That is an important point for the future. I just hope that
the Government will invest in serious research to plot what happens
over the next 10 or 20 years.
Q31 Mr Wilson: The problems that
develop for children later in life are sown in the earlier part
of their lives.
Professor Sir Al Aynsley-Green:
That is right.
Q32 Mr Wilson: Do you think that
marriage matters in the life of a child?
Professor Sir Al Aynsley-Green:
What matters to children, as they tell us, is their parents.
Q33 Mr Wilson: So a mother and a
father in the life of a child are very important.
Professor Sir Al Aynsley-Green:
Children want parents. What do they want from parents? They want
love. When do we ever talk about love as being essential for the
nurture of children? They want safety and security. They want
a warm, loving home. They want boundaries. Most children want
to grow up in a structured life where they know what the boundaries
are. They want to be encouraged. They want to confront risk, and
they want to be supported in making their life choices for the
future. The real challenge is to decide who is best to deliver
that. There is a great deal of political interest in families,
and we have to accept the reality that family structures are changing.
There is a plethora of different styles of family. What matters
to the children are the aspects of nurture. I have met people
who argue that same-sex couples can give those qualities of nurture
just as much as a heterosexual relationship. It would be very
interesting to find out the views of children in those relationships,
and I cannot comment on that because—
Q34 Mr Wilson: What is your view?
Professor Sir Al Aynsley-Green:
My responsibility is to speak on what is for children, and I do
not want my personal views to colour the debate.
Q35 Mr Wilson: So you do not have
a view, for example, as to whether one parent should stay at home
in the first couple of years to form an attachment with a child?
Professor Sir Al Aynsley-Green:
Let us look at the evidence for that. There is robust evidence,
going back to John Bolby, some 20 years ago, who emphasised the
importance of attachment theory. As a neuroscientist, in my medical
career I have observed that magical moment that you may have seen
yourselves when your own babies have been born, and how the human
baby is programmed to gaze with rapture at the face of an adult.
Eyeball to eyeball contact triggers a whole change of neurological
development to the baby's brain and also the mother's brain in
the circumstance, so the attachment of the baby is something unique
to animals across the spectrum; and we are animals too, so how
we get attachment is important. Bolby is right; the attachment
to the child's mother is crucially important. I am nervous when
people talk about single-parent families because I was brought
up in a single-parent family through bereavement. I did not have
a father during my growing years, and I very much regret that.
It is possible for single parents in difficult circumstances to
give love, commitment, security, expectation and a sense of purpose
and boundaries just as much as a couple. In the ideal world, I
do not think many would dissent from the view that a traditional
family of a mother and father, with a father in work and a mother
who can spend time with the child, and growing up in safety, security
and stability, would be the ideal for the outcome. Sadly, that
is not the case for so many children. How policies from political
parties can support the family is for you guys to thrash out.
Q36 Mr Wilson: I was asking whether
one parent should stay at home for the first two years, so in
a single-parent family the single parent would obviously stay
at home.
Professor Sir Al Aynsley-Green:
Can I answer that point specifically? There must be a range of
answers to that, and it is not for me to proscribe one model.
There are many mothers, or fathers who would like to stay at home
with their child, but for economic reasons they cannot do that.
If we are serious about childcare, then one component must be,
I would argue, to give a parent or parents the incentives, the
financial support, to stay at home with their children. Conversely,
there are many parents who, because of career pressures and also
finance, do not want to spend time with them. It would be wrong
of the state to interfere and say, "You must stay at home".
If these children are going to be looked after, then it behoves
the state to provide the resources to make sure the care is of
high standard, high quality, delivered by people trained in the
profession, who have a low number of babies to look after. There
is no point putting a baby into a nursery with 25 others and one
carer; that baby needs one-to-one attention and support. I am
trying to say that there is a range of opinions and a range of
needs, and government and political parties should be supporting
them.
Q37 Mr Wilson: That is a fair point.
You are an advocate of choice, effectively. Do you think parents
are serving the interests of their child best when, for example,
they put a three or six-month-old baby in a nursery environment,
for 8, 10 or possibly 12 hours a day?
Professor Sir Al Aynsley-Green:
It depends, again, on what that family is wanting for its children.
Let us look at the evidence. The evidence, as I understand it,
is not particularly robust in regard to the impact of those babies
being in the nursery. I am aware of some evidence looking at proxies
for baby distress by measuring stress hormone concentrations on
these babies when they are in nurseries. Certainly, going to a
nursery is a stressful experience for baby. I have seen it with
my own grand-daughter recently, who started nursery for the first
time. She was really quite distressed at being separated from
her mother. Does that do any long-term harm? That is a very important
question. I would come back to the point that if the baby is going
to be looked after in a nursery, it must be done by properly trained
staff who understand the issues of attachment and bonding, and
can give that child the security and love it needs.
Q38 Mr Wilson: Effectively you are
saying that there is not enough evidence to form a conclusion
on that point.
Professor Sir Al Aynsley-Green:
I am not aware of all the evidence because it has not been one
of my spotlight areas. I am reflecting my experience as a children's
doctor and what I have been told. I would argue that if you are
going to make important political decisions we must have the best
evidence as we can, so investing in that must be good news.
Q39 Mr Wilson: But if there were
enough evidence, would you be prepared to come to a conclusion
where you thought that three to six-month-old babies should not
be put into a nursery, and it did not serve the best interests
of the child?
Professor Sir Al Aynsley-Green:
Yes, I would be robust in my comment on that.
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