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More recently, we have had headlines stating that one in 10 children is sexually abused every year. That is what the Lancet allowed to go out in a press announcement. In the papers behind the announcement, the figure is 0.5 per cent. You might argue that it is actually a lot higher than that and that some studies somewhere have perhaps shown that the figures are underestimates. We have to have the courage of our understanding of the world, our morality and our convictions, stand up for them and not be cowed by the drama of what is happening in the press.

In the schools Bill, we must look at how we can help schools to support teachers, who are in an exceptionally difficult position. If a teacher is accused of doing something that might be interpreted sexually, we have deprived the school of jurisdiction. The school must immediately refer that teacher to outside agencies, and the teacher is likely to be suspended for six months or more. We learnt this week that the Department for Children, Schools and Families will keep that accusation on record even if it is disproved. We are putting enormous pressure on teachers in schools not to hug that crying child. We should have the courage of our understanding that that is not how we want things to be, and we should use this Bill, and, I suspect, the Bills that follow, to try to work back a bit. It is very difficult, but we should try to get there.

I wanted to concentrate on the process of change and innovation in schools. We seem to proceed in education from catharsis to catharsis. Something is proposed and worked up by the department, which is largely cut off from real education. How many senior or even half-senior civil servants in the Department for Children, Schools and Families have actually been part of a senior management team in a school? I do not know that the figure is not zero. It is certainly very small. There is no system at all for interchange between the department and schools, so the department is entirely in the dark about the likely effects of its actions in the real world in schools. Although the department comes up with something that it feels is absolutely the right thing, it will always be a cathartic process to put it into effect in schools.

The QCA should be doing something to moderate this process, but it appears to be interested only in its own dogma. Moreover, the political pressures mean that these changes are dumped on schools all at once before the schools are ready. There is no sufficient system of support for schools when these changes are made. When the schools have recovered from them and are getting used to them, we put through another set of changes. That is what these annual education Bills are about. We are absolutely committed to keeping

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schools in a state of constant chaos. The results, when we analyse them, are not that good. We have not been making the progress that we should have been making. In fact, the only crumb of comfort that I have been able to draw out of the statistics over the past year or two is that the Scots appear to be doing worse than us, for once, which is a strange way of being cheerful.

There is another way of dealing with these things, which, if the noble Lord, Lord Darzi, were here, he would recognise. If he were to step out of the Department of Health and into the Department for Children, Schools and Families, he would be stepping back to the evidence base and innovation of 25 years ago. He said in his speech that he wants front-line staff to be free to innovate. I got a report the other day from the Printed Paper Office on keeping track of innovation in schools as a result of the Bill that we passed two or three years ago. It was ridiculous. It was so thin you could have rolled it around a cigarette. Most of it was about schools faced with some kind of physical reorganisation asking permission to change their hours or the times of the terms a bit. We have suppressed innovation in schools, rather than encouraged it. If only we could learn from what this Government have done successfully in health. I am cheered by much of what the noble Lord, Lord Darzi, says about that, but if only we could transplant that into evidence-based education, that would be great. We do not have systems for spreading good practice in schools. A good teacher from here or there or one who has gone on a good course is a matter of chance. It is terribly random.

However, there are examples, even in education, of innovation proceeding in the right way. When the international baccalaureate was introduced into this country, at no stage did it cause any pain to the schools into which it was introduced because they took it on as and when they wished. It has caused no disruption to the system and has happened quietly. There is a case for co-ordinated change to outward- looking parts of the system, such as the admissions system or admissions regulations, which clearly ought to be changed centrally and should be uniform. However, inward-looking changes, which look at how schools work and the provision of education, work much better if they are continuous self-evaluated improvement rather than just cathartic and episodic.

I should like to see change, first, as a demonstration when it is initiated by schools, pressure groups or examination boards. Innovation should appear from everywhere in the system, rather than just centrally. The Government could carry out a pilot study which, having been carefully monitored, could be rolled out slowly, again being monitored. Once the process gets to a point of critical mass—perhaps when 30 per cent or 40 per cent of schools are doing it—Ofsted could start to push and encourage, and, 10 years down the road, it could become universal. In that way, schools would take on changes as and when they are ready for them. Through the whole process of developing a new system, there would be continual evaluation and improvement. There would be a continuous flow of people who are used to the new system and who could help to support it in schools. There would be an ongoing foundation of good practice. That would be much easier and more constructive.

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The recent interim report on the primary curriculum from Professor Rose promises, in several ways, a complete upset of the way things are taught in primary schools. If we do that in the way we are used to doing, we risk going back to the chaos of the 1960s when a whole generation was just not taught. It may work. I am a great supporter of many of Rose’s suggestions, but bits of them may not work. We should try them out to see their effects. In education, they have to be done at a level where you can afford to carry out evaluation and to provide support to make sure that things are going right. Unless you do that, you have to wait several years, by which time a whole clutch of children will have been failed. If you are engaged in intense and close evaluation and support, things going wrong can be picked up probably within a few months and certainly within a year or so. That would give a chance to adjust things or to get back on to the original track.

Such a system also would be better for Ministers. It would not be the all-at-once grand creation or the big change that Ministers like, but, because changes would be starting small, they would be able to do more of them. They would get more of the headlines they want because more projects would get under way. They would not have the headaches that go with the big changes, with everyone saying, “It’s going wrong. It hurts. It’s not happening for us”.

If one looks at educational history and asks what has succeeded, a pretty good example is my noble friend’s CTCs, which started small. There were a dozen or so of them. It took some time before they got off the ground, but by then we knew how the system worked and how to make them work. Now my noble friend is at it again. He proposes to start at a sensible level with 10 to 12 of these new university technical colleges to show how they work, to have enough of a critical mass and to have a collection of people who will be able to develop them. If they work—I hope that they will because we need them—things will spread from there. That is the way to build a lasting legacy and a good education system. It is the example that we should all follow.

3.40 pm

Lord Harrison: My Lords, I welcome the opportunity to speak in this debate on the gracious Speech, as there are three Bills concerned with children, learning, schools and health. I was interested to hear the noble Lord, Lord Lucas, say that big strides have been made in health provision in this country over recent years. For instance, the Healthcare Commission has applauded NHS improvements, citing the enormous benefits derived from increases in funding, the improving health of the nation, a sustained improvement in achieving government targets and a reduction in waiting times. However, had noble Lords been listening to the BBC this morning and heard its interpretation of the commission’s findings, they would have a completely different idea and would think that the NHS improvements were being criticised. There is a question to be answered here: why is public opinion to a large degree sceptical about the advances made in the NHS? Noble Lords who have received healthcare recently should ask themselves whether they were happy with the outcome. For myself, I have done very well from many wonderful people in the

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health service. However, when people are asked about their perception of the NHS as a whole, they seem to have a dimmer view of it. Touching again on a point made by the noble Lord, Lord Lucas, this is more to do with perceptions bred in the press, and no less in the BBC, where a certain negativity and lack of balance in the presentation of reports sometimes snares us.

I want to point out to my noble friend the findings of the Economic and Social Research Council, which has also examined public perceptions of the NHS. In an important article published recently, the council points out that NHS reforms are often presented as bureaucratic and budgetary in nature where perhaps greater emphasis should be placed on the Government providing resources for doctors, nurses and all the other staff working in the NHS to provide care to patients and those who wish to maintain good health. Perhaps we have to make progress in this regard because we are not going to get much help from the media.

I want to concentrate on the treatment of diabetes, the condition known as the “silent killer”. I welcome the appointment of Dr Rowan Hillson as National Clinical Director for Diabetes. This week she addressed the Parliamentary All-Party Group on Diabetes. While recording many advances, she declared that there is still much to do. I take just one point from her address, when she asked why the life expectancy for men with diabetes is 17 years shorter than for those without the condition, and for women it is an astonishing 20 years. For all the advances made, why is that the case? We need to recognise that when diabetes is properly treated, people can lead long and fulfilling lives.

I have a series of specific questions for my noble friend, although he may wish to pass them on to my noble friend Lord Darzi. We have seen the establishment of a successful retinopathy screening initiative recently, in which I have taken part, as well as vascular risk assessments, which are so important to diabetes sufferers. However, we need more investment in raising awareness of diabetes. Diabetes UK believes that there are still some 1 million undiagnosed diabetics who, if their symptoms were recognised early enough, could benefit from the success of earlier intervention. The incidence of diabetes may be high in Britain, but it is certainly also very high elsewhere in the world.

Why is the take-up of insulin pumps dramatically lower in the United Kingdom than in other countries of comparable economic standing? This is an important point because pumps provide a better way of controlling the condition. Will he also note that diabetic in-patients are still having considerable problems if they have to stay in hospital? A recent survey demonstrated that only one in four patients in that situation is visited by a diabetic specialist, which is deplorable. Will he also consider training for paramedics and ambulance staff to enable them to better recognise when someone is having problems with diabetes after a hypoglycaemic reaction?

Have the Government considered whether there should be a separate approach towards the treatment of diabetes 1 and diabetes 2? They are both diabetes but in many ways they separate and diverge and perhaps

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we need greater sophistication of treatment. The transition from paediatric to adult services for young diabetics needs to be planned around the needs of young people and, again, we need more sophistication there.

On the issue of children with diabetes, there was a parliamentary day here on 18 November to which I went along, as did some Ministers. This was in the wake of an excellent paper from DCSF about making all children matter, which has some useful things to say about young diabetics in school. It was an inspirational day, not only for the children involved but also for their parents. I know that the noble Baroness, Lady Pitkeathley, who is on the Woolsack at the moment, has a very strong interest in carers, and those of us who have had the experience within families of seeing a mother—and it often is the mother rather than the father—having to care for a young diabetic and trying to get them to inject themselves with insulin will know that it is a terrible imposition. These people are real heroes and heroines, if I am still allowed to use that phrase within our society.

There are too many bad practices in schools. As someone who is married to a teacher, I realise that teachers have to absorb an enormous amount of knowledge, but I received a letter from a woman with a young diabetic child who had come to see us on that parliamentary day on 18 November. She describes how bad it was in the first school that her five-year old attended. The teacher there stated that she was not aware that the child needed insulin injections, even after she had read the literature. She said that once the child had had a hypoglycaemic reaction it should be treated by an injection of insulin—but it is deadly to get that wrong. There was also a desire to keep from the rest of the children the fact that the child from time to time had to leave the classroom to administer whatever was required for her therapy.

The mother then moved the child to an adjacent school some two miles away and she describes—this is the heartening bit—how astonished she was at how seriously this school took the treatment of the child within the educational set-up. The head took the view that the other children should be involved and know that the child had diabetes and, in time, help to ensure that she was able to have a successful day in school. The mother said that she was absolutely stunned when the teaching assistant thanked her for entrusting the child to her. She also tells me that the head and the other teachers had planned the transition to year two at least one month in advance and had called her in to discuss it. We have contrasting good and bad practices and we should encourage the good practices as much as we can.

I also wish to mention Parkinson’s disease. The Parkinson’s Disease Society, of which I am a vice-president, welcomes the opportunities provided by the welfare reform Bill for helping Parkinson’s sufferers to remain in or to return to work. However, we need more support, resources and understanding of Parkinson’s, which is an unusual disease in that it is complex and fluctuating in nature.

I end with the example of the single equality Bill. Some 17 per cent of Parkinson’s sufferers have had to give up work because of the difficulty in accessing key

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public transport services, so we support what the Government are doing, but resources must be supplied on the other side to ensure that those who are suffering—from Parkinson’s, in this case—have the ability to remain in work or return to it.

3.50 pm

Lord Dearing: My Lords, it is a great pleasure to listen to colleagues speaking on subjects on which they have expert knowledge to share. I shall respond to a number of points made, beginning with those of the noble Baroness, Lady Walmsley.

I took the noble Baroness’s remarks as a statement that her objective in these deliberations is to help the Government come forward with first-class legislation that will stand the test of time, that will not be met with the groan factor—“Oh, here we go again. How long will this last?”—but which will work, and to which we will be committed. She referred in particular to the new diplomas and described them, perhaps in response to what the noble Lord, Lord Baker, has been saying, as “pre-vocational diplomas”. I understand that, and there is a valid place for it, but the initiative that the noble Lord and I have taken has been to try to complement that approach with an alternative: the opportunity to engage not only the brain but the hand, the eye and the equipment by doing things in a much more hands-on way, because that will appeal to a wider range of people. The involvement of the universities will mean the highest quality and will engender great respect as well as commitment. It will also provide the kind of commitment that the noble Baroness, Lady Warwick, is looking for, from both the apprenticeships and the diplomas into higher and further education. That is what we want to see. There is a narrow focus, too, on how the motivation to be top in maths, English and science, which will be part of the curriculum and will be taught in the context of the subjects those kids have chosen, excites them.

The right reverend Prelate, the noble Baroness, Lady Howe, and perhaps also the noble Lord, Lord Baker, mentioned FE colleges. I am very much in favour of the local authorities’ role being crystallised; indeed, there was a hole in the Education and Skills Act that we have waited for the forthcoming Bill to fill, defining and expressing the role and powers of local authorities so that they could discharge their duties. In the FE colleges, however, there is a real fear that in the change in leadership to the local authority, funds will be at risk. These colleges have emerged as a powerhouse for industry and education, particularly for second chances. They are very important to that 70 per cent who will already be at work in 2020 whom we have to up-skill. We know that powerful FE colleges, standing strong and first rate, can deliver.

I want local authorities to be involved and to have a clear role, but when it comes to prisons, as the noble Baroness, Lady Howe, said, the motivations are different. It is one thing for someone out there to have responsibility to deliver, but how do we ensure that, especially when the juvenile or young person is in a prison well away from the local authority area? There must be motivation in the prisons to deliver, and the local authority must have the power to ensure that there is delivery.

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I turn to the remarks of the noble Lord, Lord Lucas. He referred to the report by Sir Jim Rose. I fear knee-jerk reactions to that report. We do not want that; we want careful consideration. When I read that there are six areas of defined study, I could just imagine, as could all of us who remember the experience of the past, a knee-jerk reaction to it. We must proceed reverently, soberly and calmly, through thought and evidence, to gradual change. We have seen too much enlightenment without scrutinised evidence. I am not criticising the report in any way; I am just talking about the approach that appeals to me. We have these children’s future in our hands. We cannot turn the clock back if we get it wrong. Above all, in thinking of Sir Jim’s words, I want teachers to go into a classroom looking forward to the day’s teaching, with kids keen to learn, and us having confidence in the learning outcomes towards which they will be working.

Rather than respond only to the stimulation of others, may I make some points of my own? I want to thank the noble Lord, Lord Young, for a letter to me offering to follow up some points that the noble Baroness, Lady Howe, and I were making on the last Bill, in particular how the Government intend to use some of the powers they are taking to help people, particularly those who did least well at school, to get back into learning and good employment and be assets to their families. This would enable us to deal with poverty among children rather than people being dependent on the state. We must get these things right. I hope the discussions with the noble Lord, Lord Young, will enable us to move forward constructively.

I welcome legislation on apprenticeships as a mark of the respect and importance we attach to an area where we have fallen behind. There are two issues. First, Government are rightly concerned about the numbers taking up apprenticeships. In the scrutiny work in the other place, a great emphasis is placed on the quality of what we do. We could soon damage what must be a very strong brand, something that parents have confidence in. We can reconcile the need for numbers with the need for quality by a pre-apprenticeship programme, that is, to enable people who are not well equipped yet to get into it by going through preparatory stages. Then we can seek to marry the two, but we must have both. I agree with the scrutiny report: this must be written into the legislation.

The next point is that it is not difficult to legislate; it is much more difficult to be sure we are legislating for something that will work in practice. We are creating new bodies, and that gives assurance to the world of teaching that they are there to stay and they can have confidence. But we must avoid any risk that, in establishing themselves, they are equally concerned to make the whole system work as one, articulated to agreed, shared objectives. We need to have in our mind all the time how it is going to work—we cannot legislate for it—in framing the legislation. We have got to get it right.

I am particularly concerned about this issue of reconciling the objectives of people. I was chairman for some time of a body that was created to bring together an organisation responsible for tests and exams and one responsible for the curriculum. There

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were good reasons for doing so—a gentleman here knows a bit about it. There were problems when they were separate. Now it is proposed to de-merge them: we are going to have one body responsible for regulation and one responsible for the curriculum. One is going to report to Parliament and one is going to report to the Secretary of State. Okay, it can work. There can be advantages, particularly in the involvement of Parliament, but when you get a body such as the Royal Society of Chemists writing a memorandum that the curriculum for chemistry is all wrong, we have to look through it again. There is a mismatch between what has been taught and what is needed. How are we going to reconcile that within the new system? We must be sure that that kind of thing is built into the arrangements rather than the attitude, “Well, we’ll solve that next week” to see if they advance. These curriculum issues are very testy. I came into the job that I have been referring to many years ago, thinking “What a nice, safe subject history is,”. But God! Run for your life! when historians get hold of you saying things like that. There is such great passion. These differences are profoundly argued and felt. What is my share of the bacon of the curriculum? We need to be mindful of these kinds of problems, but I believe it can work.

What really matters is that teachers go into a classroom wanting to teach, knowing that we have confidence in them and will give them the kit to do it. We need to be satisfied that the objectives of learning and the achievement of those objectives are clear. Alongside that is the wisdom to move carefully, to test the ground and to be sure that it will work before we dare to say, “That’s the right way to do it”. We need to be a bit humble, too, and have in our mind all the time that boy, that girl and that teacher.

4 pm

Baroness Pitkeathley: My Lords, it is a great pleasure to follow the noble Lord, Lord Dearing. I thank my noble friend Lord Darzi not only for his excellent introduction to this debate but for all his work on NHS reform, which will shape the nature of the service for years to come.

It is on this that I wish mainly to concentrate in my brief remarks. I shall concentrate especially on the NHS constitution, which will have far reaching effects for patients and public involvement, which is one of my main interests in the NHS. I make at the outset two declarations of interest. First, I have been appointed as chair of the new Council for Healthcare Regulatory Excellence, an independent body accountable to Parliament whose main aim is to promote the health, safety and well-being of patients and members of the public. We scrutinise and oversee the nine health service regulators and work with them to promote good practice in regulation. Secondly, I chair the Specialised Healthcare Alliance, a coalition of 42 patient organisations which campaigns on behalf of people requiring specialist medical care.

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