5.1 pm
Eric Ollerenshaw (Lancaster and Fleetwood) (Con): It is nice to speak at this point in the debate, when everybody has said everything.
May I begin my adding my plaudits to those already heaped on my hon. Friends the Members for Brigg and Goole (Andrew Percy) and for North Swindon (Justin Tomlinson)? I was a mere foot soldier in their regiment as they steamrollered this through and I must say what an efficient manner—[ Interruption. ] I was sometimes cannon fodder, yes.
If I were a little younger, I could have had when I was at university the e-book that my hon. Friend the Member for High Peak (Andrew Bingham) had and it might have saved me from being part of that generation that got one credit card to pay off another before I realised that I was not gaining very much by it.
I cannot remember ever being taught financial education at any time in my history at school. People from the Post Office came in once in the 1950s and I think I still have a Post Office account with 10 shillings in. If anyone finds the book, I would be grateful for that. I spent 27 years as a teacher in secondary education and I never saw financial education taught; indeed, one of the surveys in the report shows that 45% of teachers have never seen it taught in school. The only time I touched on it—it is a pity the shadow Minister is not here—was when I taught American history in the 1920s and 1930s, with the Wall street crash, the depression, and banking and shares. I was going to say to the shadow Minister that it takes a good history teacher to teach decent economics.
In my constituency, I came across a scheme run by two guys from Fleetwood, Paul Freeman and Martin Hull. They are community support officers and they noticed that in the areas where there were problems, kids did not understand the idea of saving. This goes back to what my hon. Friend the Member for Congleton (Fiona Bruce) said: they wanted instant money. A scheme was developed in conjunction with a primary school and pupils were rewarded with school pounds, but the school had to take part in various business exercises to earn the prizes that the kids had to save up for. The scheme has been developed through other schools and it is now working with a primary school outside my constituency, with the involvement of a secondary school in my constituency, Rossall school—I mention it for a reason—whose lower sixth has already set up its own businesses and it is running them as a practical demonstration. Rossall school is a public school and the primary school that it is helping is a state school. The example is double edged: the private sector is helping the state sector and we have the involvement of
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one of those schools about which the shadow Minister kept talking. They do not use the national curriculum but, because they are good schools, they are already way down the line in financial education.
One thing that we in the all-party group have been trying to do is help state schools to catch up. Having said that, none of us underestimates the problem and I am grateful for the Minister’s generosity in taking our proposals on board. Perhaps this debate is timely, given that a review of the national curriculum is coming forward, but none of us who has been a teacher underestimates what we are asking teachers to do. The hon. Member for Makerfield (Yvonne Fovargue) and others have said that we need confident teachers with really good back-up to do this.
Fiona Bruce: Does my hon. Friend agree that we ought to consider including this subject as an element of teacher training in colleges?
Eric Ollerenshaw: I think we need to deal with this in all kinds of ways.
On the remarks we have heard about maths teachers and the lack of maths, if we want this kind of revolution to begin, teachers need to be utterly behind it—not just theoretically but practically, and with that confidence. As my hon. Friend the Member for Brigg and Goole has said, we had a debate in the all-party group about personal, social and health education and maths. I still warm to the applied maths idea, partly because I would have been like my hon. Friend the Member for Worcester (Mr Walker). I scraped through maths because I had to, but then forgot most of it, as was obvious in my subsequent financial career. So I veer more towards the latter approach. My hon. Friend the Member for Brigg and Goole commented on how PSHE is regarded in some schools.
There is also the issue of back-up and time. The Personal Finance Education Group has given us a lot of support. Given the financial support that it has had from some banks, perhaps it would be apposite for the Minister to challenge the banking and financial institutions of this country, which have suffered somewhat in the public’s estimation, to provide the back-up that is needed to deliver financial education in a substantial way. I take on board what my hon. Friend the Member for Congleton said about training and suggest that financial support could involve the provision of money to release teachers to train or to provide materials for schools. We are asking for a huge turnaround in schools if such education is to be provided properly and is not just to be drip-fed, with some good schools doing it but more schools just paying lip service and trying to get by. Is this subject as fundamental as hon. Members from all parties have said it is? I am not underestimating its importance.
Time is running out and all my best lines have been taken my hon. Friends who have expressed the points far better than I could have. I think the hon. Member for Darlington (Mrs Chapman) ended on a quote and I should like to end on a quote from an article in The Independent today by Andreas Whittam Smith, who said that
“the real explanation of the fall of RBS was the incompetence of the British ruling and managerial classes…without having the foggiest idea of how business worked.”
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I am not suggesting that if we carry out these recommendations, we will end boom and bust tomorrow, but it might be a start.
5.7 pm
Damian Hinds (East Hampshire) (Con): As my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw) has just said, it is difficult to think of anything original to say at this stage of the proceedings, so I shall be mercifully brief. I must start with the obligatory fawning to my hon. Friends the Members for Brigg and Goole (Andrew Percy) and for North Swindon (Justin Tomlinson) for the genuinely outstanding work they have done on the all-party group. The way that group has grown is not just impressive but phenomenal. In double-quick time it has brought to the British Parliament an issue that matters so much and about which so many people are genuinely bothered. The report and the depth of the analysis and work the group has done are already helping to stimulate debate here and more widely—and will do so further.
Today’s debate is not about approving every line in the report. I would have loved to remind the shadow Minister, if he were here, that the motion does not say that there should be compulsory financial education in free schools and academies or that it should be part of the national curriculum in primary schools. The key phrase in the motion is:
“That this House…believes that the country has a duty to equip its young people properly through education to make informed financial decisions”.
I shall not go into examples of the problems that we have all seen when people have come into our surgeries or when we have met people. My hon. Friend the Member for Worcester (Mr Walker) has mentioned that some people, astonishingly, think that a high APR must be better than a low APR because it is a bigger number. These things would be funny if they were not so tragic. When we hear about them, our natural reaction is to say, “If we get them young and educate them, we will sort out all these problems.” There is, of course, as it says in the motion, a great advantage to equipping people with the capability to make smart financial decisions. There can also be a more immediate benefit, to which the hon. Member for Makerfield (Yvonne Fovargue) alluded. If teachers get kids to bring in material—junk mail—that they have received at home, and they discuss it, messages can then get back to home, so there will be a beneficial impact even in the shorter term.
Even better than telling, of course, is doing, through schemes such as junior savers clubs. I was a member of the Abbey National junior savers. It used to have gold, silver and bronze; I only ever made bronze, but there you are. We have savings clubs in schools, and I pay tribute to credit unions in particular, although others do this as well, which run schemes in schools, often with parent volunteers and schoolchildren helping to manage them. That is another great way to pick up experience.
I have an issue with PSHE, however. It sometimes feels as though the answer to any social problem in this country is another module in PSHE. That is true whether the problem is that people are too fat or that people are too thin, or whether it is teenage pregnancy. Whatever it
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might be, we do it in PSHE. There are limitations to PSHE. When one mentions it to teachers, their response is not one that can be written down because it is just a groan. As a general rule, teachers do not like doing PSHE lessons. Although the report of the all-party group says “only 45%” of teachers in the survey had taught personal financial education, I have to say that that struck me as an extraordinarily large number. Almost half the teaching population has taken on the teaching of that subject. I think it unlikely that they are all experts in that area.
In PSHE in general, and this applies also to financial education, there is naturally a reliance on off-the-shelf—or more likely, these days, off-the-net—lesson plans and on input from third parties. Although I accept that the banks and building societies who take part do so with responsibility and do not use it as a way to ram home their brands, there is an element of indirect marketing. It certainly gets the message out there that there is a massive range of financial products, including ones that can get people into debt.
Andrew Percy: My hon. Friend’s points are exactly those that we identified during the inquiry and support the argument for putting financial education into PSHE to support maths and raise the profile of PSHE. He is quite right: a lot of the stuff that is used is photocopied hand-outs. That is not teaching a subject properly. If we link PSHE with maths, we can raise its profile and the standards of the teaching and lesson plans.
Damian Hinds: I recognise the point, and the report stimulates such debates, but I do not agree.
People mean different things when they talk about financial education. There is a whole continuum. If we talk about pure financial education, as opposed to a mathematical way of approaching it, there are two key dangers. The first I call the redundancy danger, and the second is the ubiquity danger. None of us did financial education at school, and although some people have great financial problems, not everybody does, and it is perfectly possible for somebody to get through life without the benefit of that education. Had we done financial education, we would have learned about cheques, clearing houses and endowment mortgages, and, spreading it out to the wider economy, the public sector borrowing requirement and sterling M3. None of that would be of particular relevance today. We would not have learned about debit cards and payday loans because, to all intents and purposes, they did not exist at that time. There is a real danger that although we think we are equipping people with skills, by focusing too much on financial services, as opposed to the underpinning principles, that education may become redundant.
Andrew Percy: It is true that the world does not stand still, but does my hon. Friend agree that if we give young people the ability to understand what is available now, we give them the skills to be able to understand products as they develop and move on into the future?
Damian Hinds: I cannot do geometry in a written speech without slides. I would be more tempted to go for the underlying principles, which could enable people to understand the things that used to be there and the things that will be there tomorrow.
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The second danger is ubiquity. Already, on the television and the internet, when kids are at home or out, everywhere there are messages about debt. There is a danger that introducing discussion of specific financial services too early in schools might contribute to that feeling by normalising and legitimising the idea that everyone uses such products.
As I said to my hon. Friend the Member for Brigg and Goole, the key things are the tools, and I think that we agree on that but perhaps differ on how best to use them. To my mind, the key tools and principles that help inform financial decisions are mathematics, but not mathematics on its own. There is also a big element of personal responsibility, common sense and some of the maxims to which my hon. Friend the Member for High Peak (Andrew Bingham) referred. Make no mistake: young people do not learn common sense, wisdom and personal responsibility simply by turning up to PSHE. It is a much wider issue. I would welcome more emphasis on practical mathematics at GCSE, especially at foundation level, although it applies to both levels.
I am pleased to say that I have an original point to make. We also now have an opportunity post-16, because raising the participation age to 18 means that more young people who have perhaps not passed GCSE maths could, if we are to follow the guidance in the Wolf report, be encouraged to keep up maths and English. We need new, innovative, creative and engaging ways of taking on maths, and this would certainly be one of those. I thought that the sample questions that my hon. Friends who constructed the report included in it illustrated very well the practical ways we could use the maths curriculum.
The introduction of these concepts into mathematics is no panacea. The hon. Member for Makerfield and I agree on many things related to debt and personal finance, but I completely disagreed with her today when she implied that there was no element of personal irresponsibility in being over-indebted. There are of course times when it is purely a matter of a change in circumstances and completely unpredictable, but there is also a major issue of responsibility. She was right to say that there are broader concerns about regulation and too-easy access to credit that we must also address. The reason we need to address those concerns, even if we did financial education perfectly, is that in that market, alarmingly, the basic laws of economics, such as the way competition works and the assumption that consumers will be rational, frequently do not apply.
I congratulate the members of the all-party group again on the report that stimulated the debate. My view is that I would say no to adding more to PSHE and specifying exactly how these things should be done at a younger and younger age, but I would say yes on the need to refocus GCSE maths and to find new and creative ways to teach practical maths at 16-plus. I would also say yes to not being afraid to say that people must take responsibility, which is also a good thing to teach in school.
5.18 pm
Justin Tomlinson:
I will give a brief conclusion to what has been an extremely positive debate. I thank all Members who contributed from both sides of the House for taking the time to set out their support for our
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ongoing campaign. I hope that the 100,000 people who took the time to sign Martin Lewis’s e-petition will feel that Parliament has served them well today. We have shown one of the better sides of Parliament, as we have taken a tangible issue that the public are interested in and tried to set out a way of dealing with it. I thank all the members of the all-party parliamentary group and the supporters, particularly the individuals and organisations—over 1,000 of them—who contributed to our comprehensive report. We deliberately took our time and were patient so that we could deliver something that was thorough and that set out constructively and comprehensively our case as part of the national curriculum review. I am grateful that the Minister and shadow Minister acknowledged that our delivery of the campaign is an example that others should follow. Interestingly, this is not just a pie-in-the-sky request. We look at our international neighbours and find that many states in America, and Australia, New Zealand and Canada, are leading the way in financial education.
As part of the national curriculum review, I hope that today we have taken a very good opportunity to set out our positive case, so that we might deliver on our duty to equip the next generation of consumers with the ability to make informed decisions.
That this House notes that young people today grow up in an increasingly complex financial world requiring them to make difficult decisions for the future, often without the necessary level of financial literacy; believes that financial education will help address the national problem of irresponsible borrowing and personal insolvency and that teaching people about budgeting and personal finance will help equip the workforce with the necessary skills to succeed in business and drive forward economic growth; further believes that the country has a duty to equip its young people properly through education to make informed financial decisions; and calls on the Government to consider the provision of financial education as part of the current curriculum review.
Petition
Protection of War Memorials
5.19 pm
Mr Gordon Marsden (Blackpool South) (Lab): I have the pleasure and honour of presenting to the House the petition of Ian Coleman and ex-service personnel in Blackpool on the subject of war memorials. It incorporates more than 3,000 signatures, which Mr Coleman and his colleagues in Blackpool have collected.
The Petition of Ian Coleman and ex-service personnel in Blackpool,
Declares that the nation’s war memorials and their surroundings should be treated as special places and respected in a manner which befits those whose lives they commemorate.
The Petitioners therefore request that the House of Commons urges the Government to ensure the protection of war memorials via a more rigid enforcement of existing laws or by bringing forward new legislation to ensure that war memorials are adequately protected.
And the Petitioners remain, etc.
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Health Services (Disabled Children)
Motion made, and Question proposed, That this House do now adjourn.—(Mr Vara.)
5.21 pm
Annette Brooke (Mid Dorset and North Poole) (LD): I am extremely pleased to have the opportunity today to raise directly with the Minister, who I recall from previous debates has a significant interest in the area, a number of concerns about services for children with disabilities.
Earlier this afternoon, I hosted a function for the Council for Disabled Children, at which its young ambassadors presented a film that they had made. Their message was, “Young, disabled and in control”. They wanted to be seen as individuals, to be listened to and to have their views and needs taken on board. The function made me reflect on what I had written in my speech, because we should remember that I am talking about lots of precious individuals. It sounds generic, but, when one has the great honour and privilege of meeting amazing young people who are achieving so much, one realises that there is so much more that we as individuals can do for them. Indeed, one of them referred to the use of personal budgets, and as we bring health and social care together that will all become part of the same discussion.
Throughout my long political career locally and nationally, I have been very much aware that families with disabled children face constant battles to secure support, help and access to services. Not so long ago, I was supporting a family to make sure that they were supplied with sufficient and adequate incontinence pads for their growing child, and I asked myself, “Hasn’t anything changed over the years?” There have always been issues when services such as education and health have been brought together, with cross-service battles over who picks up the bill, rather than people putting the needs of the child first.
Given the coalition’s proposed policy changes, there are some potentially amazing opportunities—specifically within the Health and Social Care Bill, and in the delivery of the single assessment process, the education, health and care plan and the local offer, which are proposed in the “Support and aspiration” Green Paper. But we need to grasp those opportunities and address the issues that are seen as threats, and in that respect I hope that the Minister will be able to provide some reassurances today.
Disabled children and those with complex health needs are disproportionate users of health services, but they face long-standing barriers to accessing both universal and specialist health services. The evidence from professionals, the voluntary sector and families with disabled children is clear: if local areas are not required to have a clear focus on child health, disabled children are not given the requisite priority by local decision makers. As a mother of a child with complex health needs put it:
“What’s so sad is that years have been lost because there doesn’t seem to be any clinical leadership for services for disabled children or even children in this area. And there haven’t been any targets that they need to reach so they are not interested. They’re only interested in targets and services for adults.”
Sir Ian Kennedy’s recent report “Getting it right for children and young people” stated:
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“Those caring for children ‘are not the biggest players in the clinical system’ and are not well placed within professional hierarchies. They often lose out to other, more powerful, professional and patients’ groups in the contest for resources and the attention of senior management.”
The Health and Social Care Bill represents an ideal opportunity to address these issues. However, it does not include measures to ensure that the Secretary of State, the NHS Commissioning Board, clinical networks and senates, health and wellbeing boards, clinical commissioning groups, HealthWatch or monitoring bodies will prioritise child health. There is a concern that that will perpetuate a system that is designed for adult health and social care but does not work for children’s services.
Campaigners feel that the Health and Social Care Bill has not indicated how health services for disabled children will be configured within the new system and wish to make sure that there is no confusion on the ground as primary care trusts close and health and wellbeing boards and clinical commissioning groups are set up.
I am aware that some issues should be resolved as part of the Department for Education’s “Support and aspiration” Green Paper pathfinder programme. But there are concerns that that is a long-term agenda that will not produce results for at least 18 months. In the meantime, there is already widespread confusion about how health service reform will affect disabled children. There has also been no demonstrable evidence that health and wellbeing board early implementers and clinical commissioning group pathfinders have been asked to link their work with the “Support and aspiration” Green Paper pathfinders.
There are particular concerns that the overarching proposals set out in the “Support and aspiration” Green Paper will not be deliverable unless the structures set up by the Health and Social Care Bill provide clarity on commissioning structures and accountability for child health. For example, the Green Paper proposes an education, health and care plan for disabled children and an overarching “local offer”, but the Health and Social Care Bill does not require health and wellbeing boards to include that in their local strategies.
I know that there are many concerns about the fact that although there is currently a statutory duty to provide education services identified in a statement, there is not the same statutory duty for the provision of health services. It is always difficult when professionals from two different cultures and backgrounds are asked to work together, but a number of issues could be resolved earlier. The Bill also does not provide a platform for education providers to take part in local decision making at health and wellbeing board level, which will make integrated commissioning more difficult. I would be really grateful for the Minister’s views on that.
The current scrutiny on the health service created by the Health and Social Care Bill represents a unique opportunity to address long-standing problems with the services used by disabled children. Families with disabled children describe these barriers in the latest report from Every Disabled Child Matters and The Children’s Trust, Tadworth entitled “Disabled Children and Health Reform”. They include delays in getting equipment—wheelchairs, for example.
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This afternoon I met Becky, who is at university. She drives her own car and has a specially adapted wheelchair that comes apart. She puts all the wheelchair’s parts into her Mini. It is amazing how she has been able to use her skills and aptitude and access a university education, but the NHS could not provide that specialist wheelchair for her. That makes us think that we need to do more for so many children.
I have already mentioned the restrictions on vital support; it is just dreadful when a family contacts you to say that they cannot get large enough, or enough, nappies for children with continence issues. There are disputes over who funds the service, poorly co-ordinated appointments, poor communication across the system and a cliff edge in support at transition to adult services.
Some parents are quoted in the “Disabled Children and Health Reform” report. On the complexity of the health service, one said:
“I’ve had really good experience of Health and individual Paediatricians…The problems arise from the complexity of the system and the different services your child needs”.
There is always so much praise for the individuals who are doing the work, but it is about pulling it all together and the structures. On the delays to getting vital equipment, another parent said:
“My daughter has a helmet and boots supplied by the Child Development Centre. She’s outgrown the helmet now and it took them two months just to make an appointment to measure her head. In the meantime, she’s confined to her wheelchair. They said they had the money to do it, but didn’t have the means to order it.”
We know about the disputes over who funds the service. A parent said:
“Sometimes the local authority says, ‘Well, that’s a Health issue and so the PCT should pay.’ Then the PCT turns round and says, ‘No, actually that’s an Education issue.’ It feels like we’re having to fight and it wastes valuable time because we have to wait for the local authority and the PCT to meet somewhere in the middle about something which could be helping and making a difference now.”
“What’s so sad is the years that have been lost because there doesn’t seem to be any clinical leadership for services for disabled children or even children”.
There is a lack of targets and a focus on adults.
Then there are the problems with transition between child and adult health services, on which one parent said:
“My daughter’s been seen by 2 consultants at least twice a year for the last 17 years so it shouldn’t be a surprise to anyone that she’s going to need continued monitoring and support from Health as she moves into adult services. But the divide between health services for children and adults is significant. Many of the professionals we have come to rely on shake their heads about it…but there’s nothing they can actually do beyond offering to attend a meeting with us where they can hand over to someone who works for adult services.”
In the past few years, we have spoken a great deal in the House about the transitional period. We are aware of the issue but we must keep working at it.
The Health and Social Care Bill does not provide any clarity on how the reformed system will affect the child health system. Child health services operate on a separate system to that of adults, with separate structures and relevant partners—for example, education providers.
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Consequently, child health requires specific attention within the reform process, which the current legislation does not appear to provide.
The Every Disabled Child Matters campaign is very concerned that, unless specific attention is given to the health processes and professionals who work within child health, the modernisation of the NHS will perpetuate a system that fails children, particularly disabled children and those with complex and/or palliative care needs. The campaign believes that there is a clear choice: act now and use the opportunity of reform to create a system that works for disabled children, or proceed with reform concentrating solely on adult services and leave families with disabled children still struggling to fill the gaps.
The EDCM campaign asks for national leadership. It would like the Secretary of State to be required to set priorities for child health as part of his mandate to the NHS Commissioning Board. As a matter of urgency, it would like the Department of Health to set out a clear vision for the way in which the reformed system will meet the needs of disabled children and children with complex health needs. On commissioning, it would like an overarching clinical network for disabled children's health to be created in order to address long-standing issues, including barriers to commissioning specialist health care services. It would like health and wellbeing board early implementers to be asked to test and report on integrated working for the delivery of services for disabled children which includes all relevant partners. It would also like careful consideration to be given to the impact of current reforms on the commissioning of specialist health services for children and young people with high-cost, low-incidence conditions. The campaign would like information and support to be provided to disabled children and young people and their families to ensure that they understand the way in which the changing health system will affect them.
The report poses 10 key questions, which I would like to pose to the Minister. What role will the NHS Commissioning Board play in improving the national delivery of health services for disabled children? Where will the responsibility lie for designing care pathways and shaping local services for disabled children within the modernised system? How will clinical networks and senates support clinical commissioning groups to deliver high quality universal and specialist health care for disabled children? What practical steps are being taken to ensure that the experiences and interests of disabled people and families with disabled children are represented as an integral part of patient involvement at every level of the reformed NHS? How will the success of the modernised NHS in meeting the needs of disabled children be monitored in local areas and how should that information be published? How will health and wellbeing boards work with local HealthWatch and clinical commissioning groups to achieve integrated care for families with disabled children who use health, social care and education services? How should awareness of the particular needs of disabled children be built into the work force development programme being developed by health education England? How will the modernisation of the NHS work with pathfinders of the “Support and aspiration” Green Paper, particularly in the development of a single education, health and care plan and a local offer? What plans are being made to improve the collection
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of information about disabled children? Finally, how will families seek redress if the package of care for their disabled child is not delivered or integrated with other care, or if the quality of the health care they receive is poor? There are so many questions. We should try to provide answers and to improve the legislation that is going through Parliament, or at least the guidance that will go alongside it.
In the rest of my time, I would like to touch on two areas. Of course, one could talk about every possible condition and make lots of points, but I will touch on two areas that have been on my agenda over the past five years or so. The House has debated the provision of mental health services for children, with particular reference to autism. There has been improved provision of child and adolescent mental health services over recent years, but I believe that the gap between needs and provision remains. I would be grateful for the Minister’s comments on the future provision of these vital services. So often, as we know, mental health services have been a Cinderella service. If we can intervene early with children, we can save a great deal of money, pain and anguish later on.
Specifically on autism, what steps will the Government take to ensure that child and adolescent mental health services staff are trained in autism and that specialist support is available? On a previous occasion, the House has discussed the problem that even when parents have accessed CAMHS, they have not had satisfactory outcomes because of the lack of training.
I would also like to touch on speech, language and communication needs. To return to my starting point, the lack of joint working between education and health has, over the years, been apparent in speech and language therapy and in the battles over who pays. Will the Minister comment on the importance of integrated commissioning for speech, language and communication services, not just within the health sector, but between health and education commissioners? What role will health and wellbeing boards play in ensuring that there is effective and co-ordinated commissioning of children’s services? Will the Minister confirm whether health and wellbeing boards will be encouraged to consider the use of pooled budgets and joint commissioning arrangements for speech therapy services for children?
As an aside, I would like to mention some adult speech therapy that I have seen. I was privileged to visit Poole hospital following the lobbying by the Royal College of Speech and Language Therapists in Parliament. A display had been set up for me and patients had been invited in to cover all the aspects of speech therapy for adults in the health sector. I would like to tell the Minister and place on the record how impressive that was.
Returning to the subject of children’s services, there is so much that could be said, but I have one overriding question for the Minister. Will she and the Secretary of State do everything they can to improve the provision of services for children with disabilities and special needs, and to ensure that the new structures deliver what is needed so greatly?
5.39 pm
The Parliamentary Under-Secretary of State for Health (Anne Milton):
I begin by congratulating the hon. Member for Mid Dorset and North Poole (Annette Brooke) on
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securing a debate on this extremely important issue. I know that, like many Members, she has shown a very strong personal interest in it. I share that interest, and I thank her for acknowledging that. I hope that what I say today will reassure her that we are doing what we can to improve the availability and quality of health care for all children and young people, including those with disabilities.
I cannot answer all the questions that the hon. Lady asked. Interestingly, from listening to her questions we could hear the complexity of the current system. I share her sadness about the years that have been lost to many children, and I am sure we also share sadness about the terrible struggle and battle that a lot of parents of disabled children have faced. The debate provides an opportunity for us to put on record our tribute to those parents, who struggle in unbelievable circumstances and feel unsupported. I cannot quantify the traumatic nature of what they have to face, not only in dealing with a child with disabilities but in getting everything they can for them.
I do not think I will be saying anything very controversial by acknowledging that the NHS, as it currently works, does not get everything right for children and young people. The hon. Lady referred to Sir Ian Kennedy’s report “Getting it right for children and young people”, which made it clear that the quality of health care for children was very variable and that the outcomes for too many children were poor compared with those in other countries.
We have 12 million children and young people in England, which is a fifth of the total population, and the number of them with disabilities is high. For example, some 108,000 have been diagnosed as having an autistic spectrum disorder, and some 70,000 would benefit from mobility support, including wheelchairs. Their well-being, as with all children and young people, must always be at the top of our list. We must pay particular attention to services that help the most vulnerable children or those with the greatest needs. They are our future, and the NHS needs to do better for them.
I am particularly pleased that the hon. Lady mentioned children who are on the autistic spectrum. There is no doubt that those children and young people in particular, like adults with autism, often fall through the net. Child and adolescent mental health services do not necessarily fill the gap.
The Department of Health has simple but ambitious goals. It may be stating the obvious to say that they include the right start to life in the foundation years, improved support for mental health and well-being, more co-operative and joined-up services for children with disabilities, and improved health in adolescence. Those ambitions lie behind the health reforms that the coalition Government are proposing. We are moving towards a service in which the use of evidence-based treatment is adopted consistently and to the best effect; in which promoting good health is of equal importance to caring for the sick; and in which children, young people and their families are always involved in decisions about their care. “No decision about me without me” applies as much to children as to anybody else, and I think we often underestimate the ability of young people and even quite young children to be involved in decisions
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about their care. We also a want a service in which commissioning is underpinned by informed and expert knowledge. I believe that it is in commissioning services that we have often got things wrong.
As the hon. Lady will know, those ambitions are supported by measures such as the increase in health visitors by 4,200 and the expansion by 50% of the family nurse partnership programme. Health visitors and family nurses play a vital role in identifying, intervening in and sorting out babies’ and children’s problems early. We frequently hear about the need for early diagnosis so that we can have early intervention and support, which prevents problems later on. That includes children with disability and other special care needs.
I would also like children’s health to be built in throughout the new system, so that everything we do is geared towards supporting children. We have made our intention clear to put in place a system that achieves better outcomes for everyone, and one that delivers services for individuals, not organisations. We often end up believing that we need to get the processes right and the arguments on that continue without our seeing the outcome that we are trying to achieve.
Of course, not just the NHS has a role to play in the health of children with disabilities. Schools, children’s centres and wider children’s services all have a part to play. That is why we are putting in place a system of health and wellbeing boards in each local area, the job of which will be to achieve a truly jointly owned assessment of local need, which leads to a joint health and well-being strategy and commissioning decisions that span the NHS and local government. Joint leadership and joint responsibility is for the whole population, including disabled children. Local authorities have a key role to play.
I should take this opportunity to commend the work of Disability Challengers in my area, which is well supported by people locally and offers an invaluable service to parents. It is those sort of initiatives and third sector organisations that we can bring together to make joint leadership and joint responsibility actually work. We always talk about integration—we have been talking about it for years—but now we need to make it happen. We need to stop that fragmentation of services. We need to stop arguing about who will pay for what and ensure that people get what they need.
The hon. Lady and others have concerns about the priorities that general practitioners will give to children and young people when commissioning services, but in fact it is estimated that about 40% of the average GP’s work load is to do with children and young people. Nobody is in a better position to understand children’s needs. On top of that, the clinical commissioning groups will have access to advice from people with a broad range of professional expertise, including those who work particularly closely with children, such as paediatricians, nurses, other clinical professionals, and health and wellbeing boards, the membership of which will include, for example, directors of children’s services in the local authority.
The hon. Lady mentioned speech and language therapy, which is much talked about. Its critical role in meeting many children’s needs is much underestimated. The allied health professionals, which we often miss off our
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list after we have mentioned nurses and doctors, are critical in ensuring that those children get what they need.
To ensure that that happens, the NHS Commissioning Board will be accountable to Ministers for improving health care provision for children and young people. They will be judged on their delivery of improved outcomes. The NHS outcomes framework and the public health outcomes framework include measurable outcomes to demonstrate improvement in critical areas relating to children and young people. As the data get better and more meaningful—it is important to say that the data must be meaningful—we will refine the outcomes that the NHS needs to deliver, along with our understanding of the outcomes that are important to disabled children, young people and their families. That will be an evolving work in progress, but the focus on outcomes is important.
One important matter—the hon. Lady will be interested in this—is how the integrated care pathway can be used to provide children with disabilities, long-term conditions or complex needs with the best opportunities to make progress and live life more independently. A number of activities are under way at the moment to ensure that that happens. The learning network for health and wellbeing board early implementer programme includes a learning set on effective joint working to improve those outcomes for children and young people. That work is just getting under way—it was launched only about three weeks ago—but there is incredible energy and enthusiasm to develop and share innovative ways in which to change things for the better. One of the priorities for the network is tackling health inequalities and increasing access for those groups that traditionally have had difficulty in securing the provision that they need. I refer here to the group of children that we are talking about.
Similarly, there is a small group of early implementing clinical commissioning groups that are focusing on children and young people’s issues. With my colleagues in the Department for Education, we have set up
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20 pathfinder groups, including 31 local authorities and primary care trust clusters, to test the ambition of the Government’s Green Paper to support children with special educational needs. They will test improvements to the current system, including the new single assessment process with a single education, health and care plan, along with the option of a personal budget. Things happen incredibly slowly in Government and it is very frustrating for the people who are in receipt of services. It is important that we use this opportunity to capture the enthusiasm and energy and to use the reforms that we are making to get this right once and for all. The lessons that we learn from those early implementers will be crucial. They will help inform more effective commissioning and service provision. Where these effective integrated care packages and personal budgets are available, the impacts are very dramatic.
I hope that the hon. Lady is reassured by the fact that we are committed to children with disabilities. I have a personal interest in the matter, and we want to ensure that the NHS plays its full part. It sounds a cliché to say that the NHS works in partnership with local authorities and schools to improve the lives of children and young people, but I mean it from the bottom of my heart. We have to ensure that partnership becomes a reality.
I pay tribute to organisations such as Every Disabled Child Matters. My noble Friend Earl Howe has answered a letter to that organisation quite recently. We are talking about special children with very special needs and some very special parents. We must ensure that those needs are met and that the terrible battle that the parents and young people face is halted and they get what they need to live those independent lives. There can be no better words to end this debate on than these: young, disabled and in control.