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15 Oct 2009 : Column 162WH—continued
Dawn Primarolo: I am grateful to the hon. Lady for giving way. I do not know whether she has to hand the Conservative party policy document "Helping new families", but on page 3, where it talks about how to pay for the policy, it says that the cost of the policy is £200 million per year and that that will be funded from the children's centres budget, instead of funding outreach to isolated communities. That is £200 million, cut. We do not need to read the hon. Lady's Sure Start document, because it is in another document, which she may not necessarily be familiar with, but perhaps she could comment on that document, or has it now been withdrawn? If it has, could she explain that to hon. Members?
Mrs. Miller: I am not sure that that directly links to the point that I was making, but as the Minister will know, from having perhaps read the document more than she let on earlier, the prime objective behind having health visitors working integrally at the heart-[Interruption]-of Sure Start-[Interruption]-is that they will have a professional outreach role, which as she will know from other-[Interruption.]-documents that she has read is one of the most effective ways that outreach is put in place.
Dawn Primarolo: That is a yes.
Mrs. Miller: The Minister is clearly over-excited. If she holds on to that excitement, she will hear a little later about how important it is that we get outreach right. She will of course have listened to the hon. Member for Mid-Dorset and North Poole, who brought a note of realism into the debate: outreach has not been as effective as it needs to be. If the Minister is complacent about the way in which outreach is working, she needs to do her homework more thoroughly on some of these issues-[Interruption]-because with the bricks and mortar that have been established and a-
Dawn Primarolo: On a point of order, Mrs. Dean. I know that the hon. Lady might have slightly different views from me, but she cannot put words into my mouth. For the record, the Government are investing very heavily in outreach work because they value it for the reasons that both hon. Ladies have given in their remarks.
Mrs. Janet Dean (in the Chair): That is a debating point rather than a point of order.
Mrs. Miller: I could not agree with you more, Mrs. Dean. Perhaps the Minister needs to calm down a little.
Dawn Primarolo: Don't be so patronising. Come on!
Mrs. Miller: May I first complete the point that I am making? It is important that we get outreach right. If we do not get that important service properly through Sure Start, not only will the Government be ignoring a lot of evidence but they will be letting down the most vulnerable groups in our communities. I am sure that that is not the intention, but if the Minister were to listen to the points that are being made today, she would understand why we believe that our approach is measured and well thought through, and that it will provide the sort of support required.
Judy Mallaber: Would the hon. Lady be more precise about the extra amount that will apparently be going toward the cost of further health visitors? Exactly which of the current Sure Start services will have to go in order to fund that? I am not clear about what could go without damaging the current services. It would help to have a bit more precision on that point.
Mrs. Miller: I am not sure that such an intervention should have been made, as I have not yet raised the subject. I am not sure that a Government debate on the progress of Sure Start should allow the House to scrutinise the financial details of Conservative party policy. The hon. Lady may not have seen our document, but I can tell her that the funding for such a policy is to be found in the Government's paper on outreach; they identify a significant shortcoming in Sure Start, saying that the money will be used more effectively to put trained outreach workers in place. That approach is absolutely right; we need to sharpen the way in which Sure Start is to deliver outreach. However, the delivery of funding for outreach workers is not the only debating point today. I shall now return to the other points that I wish to make.
Before considering whether progress is being made, we need to clarify exactly what we are trying to progress towards. Sure Start has faced that problem from the beginning. It is all about child development. It is child centred, and firmly draws on
"evidence that outcomes for children from disadvantaged backgrounds were to a large extent influenced by early-childhood experiences".
Those are not my words but the words of the late Norman Glass, the architect of the programme. It focuses on child development and ensuring, above all, that children from the most disadvantaged backgrounds have the sort of support that everyone knows they deserve.
Mr. Jamie Reed: Will the hon. Lady give way?
Mrs. Miller: I shall give way, but this is getting tedious.
Mr. Reed: The hon. Lady identified the benefits of early years intervention and of Sure Start itself. With that in mind, does she regret not supporting the budget allocated to fund Sure Start?
Mrs. Miller: I am not sure how that point ties in with the objectives of Sure Start. The hon. Gentleman needs to focus a little more on my speech rather than on making interventions that may have been given him by his Whip.
Mr. Reed: If only I had been given intervention points by my Whip.
How on earth can social objectives be met without funding?
Mrs. Miller: The hon. Gentleman may not have been focusing on what I was saying earlier. Ultimately, we support Sure Start and its objectives. That is the important point. However, I wish to continue my speech rather than have an in-depth discussion of Sure Start's budget.
I do not know whether the Minister has a reason for pressing the matter further, but we are here today to discuss the progress of Sure Start. We have not spoken about it in detail, although the hon. Member for Mid-Dorset and North Poole valiantly tried to put on the table some of the facts and research that were so lacking in the Minister's speech. Rather than pursuing a financial analysis, we should be reviewing the subject of the debate-the progress of Sure Start in reaching its objectives. That is why we are here today.
Mrs. Miller: I shall resist giving way to the hon. Gentleman again. He could have made a speech himself rather than making a series of lengthy interventions that were almost speeches in themselves.
When discussing whether Sure Start has been making progress, we need to consider the evidence. It is not a small programme. It is important not only for the impact that it has on our communities, which has been mentioned extensively, but for its effect on the Department's purse-£2 billion plus every year. Every five years, the programme deals with another generation of children. We should not forget that the programme was launched in 1998. In some areas, it has had 11 years to develop and come to fruition, although, as I said earlier, it is not the same in all areas. For instance, in my constituency Sure Start is a relatively new phenomenon; however, it has been in place in some areas for more than a decade.
I am pleased that the Minister seems keen to consider the results, because a great number of studies have been made over the last decade, including some over the past few months that we have not had the chance to consider fully, given the length of the summer recess. I am sure that the Minister would not want to appear complacent to parents, or to the staff of Sure Start centres, by overlooking the important results of that research. The dedication of Sure Start staff is overwhelming. Day by day, they do whatever they can to strengthen our communities. However, as one centre manager told me, all too often it can feel as if they are working with one hand tied behind their backs. I realise how important it is to unpick why people feel like that, and how important it is to scrutinise Sure Start in order to make it even more effective.
The Minister spoke about Jobcentre Plus. How many Sure Start centres have working within them an effective Jobcentre Plus? How many have had problems securing the sort of relationship that she mentioned in her anecdote? First and foremost, however, we need to consider the problems faced by Sure Start in our communities. Those issues need to be addressed. Although we fully support Sure Start, we should start to address those problems that are clearly starting to raise their heads.
It will come as no surprise that one of the key factors alluded to by many Members is the role of health within Sure Start centres. It is always useful to put facts on the table. Less than one in five children's centres have formal agreements with primary care trusts about what services should be provided through Sure Start. Although I could give some case studies of those Sure Start centres I have visited that offer excellent health care services, all too often it is a postcode lottery. It can depend on local people and local relationships; it is not embedded into the culture of Sure Start as was intended.
Interestingly, when Sure Start was launched, I would not have been standing opposite just one Minister, but a Minister from the then schools Department, and a Health Minister. At that time, both Ministers were working hand in glove, much as I work with my hon. Friend the Member for Guildford (Anne Milton), the shadow Health Minister. That critical link with health must be embedded into Sure Start if we are to see some of the developments and improvements needed in the outcomes for children. I am not the only one to say that. The Minister may be aware that the Select Committee on Health recently reported on health inequality, a subject that she mentioned herself. The report states that Sure Start
"has yet to demonstrate significant improvements in health outcomes for either children or parents"
and it calls for more rigorous monitoring. The report was issued earlier this year, so it is quite contemporary in its analysis. It favours significant developments in the programme with a more structured role for health.
Annette Brooke: As the hon. Lady is reflecting on health, I wonder whether I could mention childhood obesity, which I omitted in my contribution? We clearly have not done enough on that matter. The Pre-school Learning Alliance has made the staggering prediction that a high percentage of two-year-olds will be obese in the very near future.
Mrs. Miller: The hon. Lady makes an excellent point. If individual Sure Start centres have an embedded health structure, they can start to pick up on specific local issues. The Sure Start centre in Chatham, which I visited, has a strong relationship with its primary care trust, and has addressed the very issue that the hon. Lady raises. It has identified obesity as one of the main issues in its local area, and has used the flexibility within the Sure Start system in a very constructive way. It has put in place a healthy eating café, to which parents and children can come when they are attending breastfeeding classes or other activities. There is a desire to help parents understand how to improve the diets not just of their children but of themselves as well. However, that embedded health role is not the norm. The National Audit Office's own figures graphically show that that direct link with health is not the norm. Will the Minister tell us what she is doing to ensure that there is a change in the future? She will be as aware as I am of the data that show that having health at the heart of Sure Start will improve its delivery.
The Minister gave another anecdote about a health visitor who advised one mother to attend her local Sure Start centre. That mother was very fortunate because the average case load of health visitors means that many do not get that one-on-one treatment or that level of advice. In my own constituency, the case loads of health visitors are near enough double what is recommended for a national standard. Throughout the UK, the average case load of a health visitor is some 362 families. Therefore, although, anecdotally, we can say that health visitors are able to offer personal advice, we know that the reality is that the numbers are not there and that people have not been recruited. That is why our Sure Start health visitor programme will address the very issue that the Minister raised-the personal advice and support that mothers and parents need at what is a very pressured time in their lives.
If we are to analyse the progress of Sure Start and not just pretend that all is rosy, we must consider a second challenge, which is the fundamental understanding among parents of the role of Sure Start within their community. The Minister referred to a piece of research that was commissioned by her own Department-I am not sure whether she was there at the time-that stated that 90 per cent. of those who use Sure Start services are pleased with them. However, she did not point out that the same piece of research, which was published by the Department for Children, Schools and Families in February, stated that only 50 per cent. of parents were aware that Sure Start offered services other than just child care. They did not know, for example, that it offered health and family and parenting services. When we dig down further into the detail, we find that just 13 per cent. of the target population have used the other services. Having a Sure Start centre in the community to bring together the services that will support families to thrive is the right objective, but, at this point in time, all too many parents are simply not aware that that is what their Sure Start centre is doing. A vast majority of those people-not just anybody off the street, but the target market of Sure Start centres-are not making use of what are fundamental and vital services. In contrast, 70 per cent. of the target population are aware that Sure Start offers child care.
As a working mother, I know in my heart how critically important child care is, but Sure Start offers more than that. Every hon. Member here today will agree with me on that. Will the Minister tell us what she is doing to help Sure Start centres' hard-working staff raise the profile of the other services that are on offer? I urge her to consider how important Sure Start health visitors would be in helping parents not just to understand but to take delivery of the broader range of services. Parents should be signposted to support services right from the start when those important early routines are established.
The third area that the Minister did not cover in her notes is the importance of reaching out to the most disadvantaged families, which is an issue that the hon. Member for Mid-Dorset and North Poole raised. Perhaps other hon. Members who spoke in the debate-although there is only one of them left here-are not aware of that either because they did not cover it in their contributions.
Judy Mallaber: The provision started in areas of deprivation precisely for that reason. It reaches out very much to people in difficult situations, as do some of the services that function from Sure Start centres.
Mrs. Miller:
I understand the hon. Lady's point. What I was saying was that there is an awful lot of evidence, which is not simply from the Department's own national evaluation of Sure Start but from other organisations, that points out that more can be done. Obviously, the centres in the hon. Lady's constituency are working incredibly hard to reach out to disadvantaged families, and I am sure that they are going above and beyond the call of duty in what they are doing. None the less, the evidence is that outreach to the most disadvantaged families is not consistent in its execution
or efficacy. Therefore, it is incumbent on hon. Members to ensure that we scrutinise what is happening with Government money, that we make the service more effective, that we listen to the logical evidence that is presented to us, and that we look at ways in which we can evolve policy so that it can be more effective in the future.
I refer to a report that Ofsted brought out two or three days before the summer recess-I am sure that some hon. Members will have seen it-that said that half of all centres are not reaching out to the most vulnerable families. I am sure that the Minister will tell us why she feels that Ofsted has got to this position and what her Department is doing to address it. Ofsted is not the first organisation to point out such a fact. Let us hope that the measures that the Minister puts in place will ensure that it is the last.
The Minister will know that the core objective behind our Sure Start health visitor programme is to address that very issue, because the research shows clearly that the most accepted form of advice is from health visitors. Health visitors are the people who can get their foot in the door. They can help families who find it difficult, for whatever reason, to seek out the support of services themselves. It could be a single mum who finds it quite tough to go down to a Sure Start centre with her baby-she could be young and feeling like she is being judged. Alternatively, it could be a mum with children who have special educational needs, or a mum who has had a multiple birth. There are many different reasons why individual families find it difficult to seek out support and help for themselves. What the research shows extremely clearly is that a health visitor can go into the home in a way that almost nobody else can, to help to direct and deliver services that this most vulnerable group of people needs.
I want to ask the Minister to comment on another part of the Ofsted report, given that we have not had a chance to discuss that report before now, although it was issued in July. It showed that three out of 10 Sure Start centres find it hard to gain the trust of black and minority ethnic families. Again, we know from the NESS evaluation that that is a group of people who have not been positively impacted by Sure Start. That is yet further evidence that there is more work to do to reach out to BME communities in a positive way, to ensure that the full benefits that right hon. and hon. Members have said are received by many families in their communities are received by all those families who are in need.
The fourth area that needs to be addressed is evaluation. The hon. Member for Mid-Dorset and North Poole picked up on that, too, and I hope that the Minister will comment on it. As the hon. Lady said, we are talking about long-term goals in relation to Sure Start, but we need to have short-term and medium-term evaluations in place, so that we can see how we are doing in our attempt to achieve some very important outcomes for children.
There are now three, or perhaps even four, pieces of research that point out very clearly that the way in which Sure Start is being evaluated makes it very difficult to assess whether some work is effective. We are talking about some of the most important problems that a Government can try to deal with, such as how to remove entrenched poverty; how to help children to
escape a cycle of poverty; and how to use Sure Start as a positive force for good, to strengthen families. However, in the past few months alone, we have had four separate reports that clearly indicate that we do not have a sufficiently rigorous appraisal process in place to be able to say, hand on heart, exactly what is working within Sure Start and what is not working within it. We can all give anecdotal evidence about what is working, but when one looks at the facts and figures, there are some gaps. Perhaps the Minister, with her Treasury background, can help her Department to start to fill those gaps.
I do not need to remind the right hon. Lady, but there are four different reports on Sure Start. Most recently, Ofsted looked at outreach and clearly stated that some centres are simply not collecting data on how to evaluate the impact of their work. That is a very simple problem; methods of collecting such data are not in place and data collection is not ingrained into the culture.
Capacity, the third sector organisation, has also examined the question of evaluation. It has said:
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