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16 Jan 2008 : Column 314WH—continued
Can Ministers instruct the NHS at local level what it must do about its commissioning decisions? Members of the party of localism talk constantly in this Chamber—usually when people are not here—about not having command and control from Westminster and Whitehall, but instead allowing the people closest to local communities, whether defined regionally, sub-regionally or locally, to make decisions, so I find it
quite extraordinary that they are trying to nationalise the issue; in my view, they are doing so, unfortunately, for political purposes. Much of the case that hon. Members have made is valid, but some of it fails to reflect the reality that we are moving away from command and control from offices in Westminster and Whitehall to a system where we devolve and give more responsibility, and where we trust—in this case—commissioners to make the right decisions.
I accept that the decisions cannot be made, in this case, on a purely local basis; they have to be made on a regional basis, and I shall certainly be reinforcing that message through the NHS.
Tom Brake: I am sorry that the Minister adopts that tone. The debate is not political; it is about what is best in terms of provision. He made a point about value for money. May I again ask him the question that was put to him during our meeting last week? Can he guarantee that, in relation to value for money, issues such as the one raised by the hon. Member for Wimbledon during an intervention about the associated on-costs if people end up in prison instead of hospital will be taken into account?
Mr. Lewis: I agree entirely. When decisions are made by public services about value for money, they must be taken holistically, considering the full impact and implications of changing provision, which may end up costing the state other resources in another part of the public service system. Of course it would be wrong to take such decisions in an entirely narrow way, limited wholly to the mental health system.
Lynne Jones: I understand that the National Institute for Health and Clinical Excellence is working up guidelines on borderline personality disorder and antisocial personality disorder, which it expects to publish at the end of this year. Is not it vital that we keep services such as those at the Henderson and Main house going, so that when we see what the NICE recommendations are we can ensure that those services are still in place and able to evolve? As the Minister said, services will always evolve—we do not have a command and control structure—but we need to ensure that we do not lose services that may be the very services that will be recommended by NICE later on this year.
Mr. Lewis: I agree with the hon. Member for Carshalton and Wallington that this is not a party political issue; of course, it is not. It is about the best interests of people with personality disorders. However, politicians must take responsibility for what they say and they must be consistent in what they say. In this place we are constantly told by Opposition Members that the Government should not seek to command and control public services. The Government are told that they should trust those in the front line and give more power and responsibility to professionals and commissioners. That is the only point that I am making.
I want to respond directly to the comment made by my hon. Friend the Member for Birmingham, Selly Oak. Two areas of discussion are still taking place that
are relevant to the future decision and how the process may work out. One of them is the engagement with relevant local authorities about their overview and scrutiny functions. A local authority could decide that, before a final decision, there ought to be extensive consultation with the local community on overview and scrutiny functions, to inform the overview and scrutiny committee’s ultimate decision. If that happens, the relevant local authority overview and scrutiny committees will still have an opportunity to express a view about whether they want to move to significant and extensive consultation before a decision. The decision made by the trust board is an in-principle one, subject to engagement with the committees to find out whether they think that the decision on Henderson requires extensive consultation.
The discussions taking place between Cassel and Henderson are crucial. As I understand it, the distance between the two units is minimal. If services are being provided to people with personality disorders within a relatively small area, it would be logical for the two units to consider the possibility of offering an integrated service—in fact it would be irresponsible not to do so. There could be a variety of models for that integrated service. However, it is unacceptable that discussions on best meeting the needs of people with personality disorders within the local population have not taken place over the past few years.
Mr. Burstow: My request was not to be a commander, but simply to be the holder of the ring during discussions. The parties to which the Minister referred, the regional specialist commissioners and NSCAG need to be involved. We must stop the PCTs commissioning on a spot basis. They are purchasing individual sites, rather than acting as commissioners. Surely that is not an effective way to provide the service.
Mr. Lewis: That is what ought to happen; we ought to have a regional strategy for those commissioning decisions. However, the hon. Gentleman is not asking me to say that commissioners need to look at those matters objectively, on a regional basis, and to look at patient outcomes and value for money and then make the best decision in the interests of patients. He is asking me to say that in all circumstances, regardless of what the commissioners decide is in the best interests of patients, Henderson will stay open for the foreseeable future. That is not a consistent ask. We have to consider two things: regional commissioning decisions based on a population-needs assessment and giving the local authority overview and scrutiny committees the opportunity to decide what they want to do about the trust board’s in-principle decision.
I know that it is not customary to refer to people observing our proceedings—
John Cummings (in the Chair): I advise the Minister not to do so.
Many people care passionately about the service and the unit, which I completely understand. However, it is important to be honest: Ministers are briefed and receive information from a variety of sources, and I
know that there is a debate about the strength of the evidence for the interventions from the Henderson. There is no professional unanimity about whether its care model delivers outcomes so consistently that it would be superior to alternative interventions and models of care.
I am not a clinical expert or best placed to make that judgment and those choices, and to come to conclusions. I am entirely reliant on the views of professionals, but I have received no advice suggesting that the model is far superior to other clinical interventions for people with personality disorders. I understand the professionalism and passion and the unique ethos that has made a difference to many people’s lives. The services must be commissioned regionally rather than by a single PCT. Services for people with personality disorders have changed and are changing, but there will always be a need for high-quality tier 4 services. The matter lies in the hands of the local authorities that have been asked to decide whether they want to pursue the matter, and in the hands of regional commissioners.
Extended Schools
4.45 pm
Ms Karen Buck (Regent's Park and Kensington, North) (Lab): I am grateful to have the opportunity to raise this subject this afternoon. I am very much a passionate advocate of the extended school programme, which the Government launched in 2003. There has been a huge expansion of investment in that programme, which is designed for many purposes: to offer wrap-around services for children and young people in schools, between 8 am and 6 pm; to offer holiday programmes and enrichment opportunities in sport, drama, music and other activities; to reach out into communities; to offer parenting support; to involve people from local neighbourhoods in their schools; to turn those schools, which generally are highly trusted institutions, into a means of supporting neighbourhoods and contacting parents and others in the community; and to be a springboard for other services, such as access to health care and benefits advice and so forth. I am sure that the Minister will expand on that in her response.
I am hugely in favour of the programme, which did not come about by accident; it was an act of political will to introduce it, with Sure Start, which it complements, and to find the money to develop them. I have one full service extended school in my constituency—Quinton Kynaston—and I know that the pupils there have benefited hugely from the services on offer. It has been run very well. As the Government’s own evaluation of the extended school programme last summer demonstrated, that school has achieved improved results that seem to correlate strongly with the extended school provision itself. I understand that the Department’s research, published last summer, found that the percentage improvement in GCSE results was double the national average. Not only did it produce academic benefits, but it seems to correlate with reduced levels of crime and antisocial behaviour. So there are many benefits.
As the Minister knows—she has been very generous in discussing this matter with me—my critique today is not of the service itself, but of the fact that, for a couple of important reasons, the schools and neighbourhoods that need the extended school offer the most are struggling to deliver it, and will struggle to sustain it, because of the way that resources are used. Some of those issues pertain specifically to the capital, and inner London, including my own local authority, and others pertain to the actions and behaviour of local authorities and their education departments and the ways in which they interact with schools.
This debate is particularly germane, because the extended school offer is also central to the delivery of the next stage of lone parent employment and the welfare reform agenda. For that reason, I am very grateful for the timing of this debate. It is my contention and that of the leading organisations in this field—the Minister knows that I am particularly indebted to the 4Children charity, which has taken an interest in this—that the offer does not match expectations for entry into the labour market for large numbers of lone parents. I shall return to those points later.
The central thesis of my argument, which I have made to the Minister before, is that resources are needed to kick-start and to sustain the extended school
offer. There are two issues: first, central Government support and funding; and secondly, the expectation about, and reliance on, charging policy. I shall deal with them separately.
We have money that we did not have before, so I hope that the Minister understands that I do not intend to sound churlish. We all want more money, I understand that, and we all want more money than we can get into any given service, but the issue is about teasing out what the big numbers of national funding mean for local schools, what the expectation is and what can be delivered. In a letter from the Minister for Schools and Learners to me last June, the investment that was discussed was bundled up with the school standards fund. Indeed, locally, some of it has been bundled up with Sure Start grants. In the letter, the figure for the school standards fund, the personalised learning support and whatever else, added together was £225 per secondary school pupil per year, which is good money and welcome for schools. However, it is not entirely fair to add the school standards fund and the personalised learning grant together and place them in the context of developing extended schools, because they are not the same thing.
I hope that the Minister agrees that we are dealing with schools, such as most secondary schools in my constituency, that have a legacy of desperate underachievement. I do not want to use that word, but the children are all capable of achieving a great deal more. In our education authority, none the less, there is a legacy of serious attainment problems in most secondary schools. We have an academy, which is on the rise, but which achieved only 17 per cent. A to C grades last year, including in English and maths. Surely, we do not expect personalised learning grants to be put into the extended school programme. Those schools desperately need to invest everything that we give them in boosting the curriculum and their in-school provision. If we remove that grant, and consider the Kick Start grant that is dedicated to extended schools, and the Sure Start grant, each school receives £14,000 to £16,000 this year, which equates to about £20 per child per year. As I have said in correspondence with the Minister, we must accept that it is not possible to provide wrap-around services that open at 8 am and close at 6 pm, offer holiday services for the summer, every half term and Easter, and provide enrichment and opportunities for sport, drama, music and all the other activities that we want to provide, for £20 per child per year. It is not possible.
In addition, some of our schools, particularly in inner London, have limited resources. They do not have outside space or playing fields, and in some cases, they are being asked to use their delegated budgets to access the facilities that provide the services that we want to provide. So the situation is made even worse, because the Government offer money to schools, and they have increased core funding to schools dramatically, but in some cases, the local authority takes money with the other hand to levy charges for access to local sports fields.
A representative of one secondary school told me during consultations in the past couple of weeks that it pays £10,000 a year for off-site facilities, including
sports pitches. Almost £5,000 is spent just to access pitches on Paddington recreation ground. That £10,000 is half the money that we provide for extended schools, so does the Minister agree that one thing an education authority can do—particularly in that case, the education authority in my constituency—is say, “Let’s at least support the ethos and practice of the extended school programme by ensuring that access to all local authority facilities, such as sports facilities, is free”? It is no good our giving with one hand and taking away with the other.
I am also concerned that investment in schools in the most deprived communities, and in children from the most deprived households, does not reflect their relative deprivation. That is a central point. I accept that the problem is due in part to the local authority’s distribution formula, but it raises a bigger question for the Government. In my borough, we have an admittedly slightly larger secondary school, where 8 per cent. of children are on free school dinners. It receives from the Kick Start and Sure Start packages a larger grant than a secondary school that has 30 per cent. of children on free school dinners, 45 languages spoken and 35 per cent. of children on school action and school action plus. If we are not only to enrich the lives of children, but to do something to close the opportunities gap for children from the most deprived backgrounds, that situation cannot be allowed to go unchallenged.
I should like money to go to all those schools, and I am not trying to play the class warrior, but I have one ward where 83 per cent. of children live in workless households, many have been homeless, and by definition all live on benefits. They do not have access to the cultural enrichment that middle-class parents can offer their children, and we know that that matters. It is not the only thing that matters—people can overcome those disadvantages, and many do—but structurally that level of disadvantage matters and holds children back. We must reflect on how we can deliver an adequate offer that is biased towards children who experience the greatest disadvantages.
The Government have made it clear that the Kick Start grant is meant to be just that, to set a service up and get it running, and that the expectation is for a charging policy to be introduced to maintain the service. The Minister reinforced that message in a letter to me a couple of weeks ago. I am not opposed in principle to a charging policy, but I am concerned about how it will interact with the needs of the lowest income households in order to make services sustainable. There are two problems. First, there are schools that have a high proportion of children with free school dinner entitlement. They are by definition less able to establish a sustainable charging policy. Parents on income support, incapacity benefit or whatever can neither pay nor draw on tax credit, and if there are enough children in a school from that background, building and sustaining a service will be impossible. I have explained to my right hon. Friend the Minister that we have schools with 30 to 60 per cent. of children with free school dinner entitlement, and the borough is in the top 10 for authorities with the highest proportion of children on free school dinners.
A primary school head teacher wrote to me on Tuesday about the issue. Her school is able to draw on
lottery money—a three-year lottery grant—to help it with sustainability, and she said:
“At the moment we are lucky in that we do not have to charge the parents for any clubs but this is only because they are run by teachers and we have the funding”—
“for external teachers—but this...will not last. It is a cause for concern because we know that there is a huge drop-out when they are charged (as seen at Play centre).”
When Westminster city council increased its charges for play centres in primary schools, the number of children attending them halved, particularly among families on income support.
The second, complementary, problem is that the Department for Children, Schools and Families argues that child care tax credit can help, but as the figures that I have provided to the Minister demonstrate, we are a very long way from making that a reality. The Minister knows from the figures that only 450 households in the entire borough are in receipt of the child care tax credit, which is a tiny proportion. That is equivalent to the number of parents in one primary school only, out of 50 schools in the entire borough. The problem is partly to do with take-up, but overwhelmingly to do with the structural issue of accessing tax credit in high-cost areas, particularly in London. Even in luckier areas, where tax credit receipt is much higher, Rhondda has only 850 recipients, Hartlepool only 660, the whole of Newcastle just over a thousand and even the whole city of Manchester only 3,000. Given that almost all the credit that is paid is used for high-cost under-five child care, I suggest that the number of people using it to pay for holiday and out-of-school provision is in the hundreds across the country. Child care tax credit has its place, but I suggest that that is not it.
We know how many schools are delivering extended schools, which is excellent, and there has been real progress. We also know that in the autumn, under the Government’s plans, 140,000 parents of 11 to 16-year-olds will be migrated on to jobseeker’s allowance from income support. The Government’s stated expectation is that there will be a service from 8 o’clock to 6 o’clock, 48 weeks a year, to back up current services. I appreciate that some of that will happen in 2009-10, but there will none the less be a national programme to meet the needs of those 140,000 people, with 260,000 people with children between five and 11 to be included later. Yet currently, as 4Children and the Make Space review have demonstrated, we have a place for only one in every 200 children. The need is urgent.
I wish to ask the Minister a question to which I have not really had an answer. Who is really monitoring, and can provide hard data on, the availability of provision that constitutes child care, although we would not use those words, that is safe, secure and guaranteed from 8 o’clock until the start of the school day, from the end of the school day until 6 o’clock and in every school holiday—the need is flexible—in each school? It seems that there are different views in the Department for Work and Pensions and the Department for Children, Schools and Families about what extended school provision should do and what the guarantee will be.
We need an urgent review of the capacity to meet the lone parent employment objectives. I should like a
departmental commitment to review delivery in the most deprived areas first and a recognition of the difficulties that we have in delivering in high-cost areas with limited space. I want to see whether London Challenge can make recommendations on how we can deliver in London.
I should like clearer, transparent monitoring of the delivery of full 8 o’clock to 6 o’clock, 48-weeks-a-year wrap-around care, including holidays. I want assurance that we will consider the severe limitations of the child care tax credit for the purpose in question and that there are worked-up proposals for converting the credit into a voucher, which would be simpler, more accessible and help us to deliver the credit. I should like to be assured that the Department is having urgent consultations with regional development agencies. In London, there has been the childcare affordability programme, which has been a huge success in a difficult environment, and a youth offer is improving provision for older teenagers. The gap in the market is provision for five to 15-year-olds, and the RDAs should be prevailed upon to help us fit the missing piece in the jigsaw.
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