On a point noted by the Select Committee, I am concerned that the £200 million provided for the Connexions services in the period 2009-10 has disappeared from view, and we no longer see that. Why have the Government been so resistant to including face-to-face guidance by qualified careers advisers? What has happened to the £200 million which, given the transfer of responsibilities, should have been available to help schools take on new careers responsibilities?
6.57 pm
Lord Cormack (Con): My Lords, I am sure that we are all very grateful to the noble Baroness, Lady Sharp of Guildford, for introducing this debate and doing so in such a splendid manner. The whole point and purpose of education is to discover and exploit the talents of each and every child who goes to school and that can be successful if that child, on developing into an adult when he or she leaves school, finds a career that is sufficiently challenging and rewarding in every sense. One problem that has bedevilled education—and I speak as a former schoolmaster, a parent and a grandparent with four grandchildren at school at the moment—has been the lack of comprehensive careers guidance. Many schools implant the idea that, unless the pupil goes to university, somehow or other it is a failure. That is so wrong. What we need to have is a careers guidance system that says to every child that there is a place for you—you can give of your best and achieve of your best and make a real contribution. I quote George Herbert, who said:
“Who sweeps a room, as for thy laws,
Makes that and th’ action fine”.
Whatever is done, if it is done to a high and proper standard, can be intrinsically rewarding. So we have to get rid of the notion that those who do not go to university have somehow failed—and we have to emulate those in Germany, for whom being an engineer is as high a calling as anything else. As the noble Baroness referred to, why are there 87,000 vacancies in this country for engineers? It is because our young people have not been sufficiently motivated.
I am particularly involved with craft apprenticeships, and I chair the William Morris Craft Fellowship Trust. I believe that we ought to get into our schools and tell our young people about this, and demonstrate to them that a career in the crafts can be as richly rewarding as anything else. I live in the shadow of Lincoln Cathedral, one of the most glorious buildings in Europe. How could that cathedral survive from generation to generation without dedicated craftsmen and craftswomen? We need to get into our schools and explain to the children that there are exciting opportunities for them.
How do we do that? One thing which we can and should do is ensure that every school has a panel of careers advisers, drawn from the local community. This should consist of successful business men and women, professionals and those accomplished in the crafts and what would in a previous age be referred to as the manual skills. Our young people would then
have the opportunity not only to hear from those who have succeeded, but also metaphorically to sit at their feet.
Properly constructed work placements should be part of the education of every child, with work experience during the last two or three years of education. I have a granddaughter who just had some work experience in Lincoln itself, in the archives and so on. Her horizons expanded, and she went back to her school in Edinburgh —she lives up in Scotland—feeling much more aware of opportunities than she was previously.
I want a proper panel in every school. Guidance is fine, and the guidance to which the noble Baroness referred is admirable, but we have to give the policy some teeth. I know that the Minister is reluctant to prescribe this and prescribe that, but we are talking about the future of our children and therefore we have to ensure that they all have breadth of opportunity and experience. I beg of my noble friend to toughen up on this guidance. He also knows that I am a great believer in the importance of citizenship studies, and the two go side by side. As he knows, I would like to see every child coming out of school having undergone some form of citizenship ceremony, aware of his or her responsibilities and rights in the context of the wider world. That can come about only if these young people have an opportunity—and, indeed, an obligation —to do not only community service, but also properly constructed work placements.
We have to bring to this a sense of urgency, so that those at school at the moment do not feel that they are failures if they do not get three A* grades. They must not feel that they are failures if they do not go to university, and should feel that they are successful if they are attracted to vocational training, which tends to be denigrated. My six minutes are up so I will finish on that point, but I urge this upon the Minister.
7.03 pm
Baroness Morris of Yardley (Lab): My Lords, I, too, thank the noble Baroness, Lady Sharp, for allowing us to have this debate. I did not realise that we had not had the opportunity to discuss the guidance, which is very important. I thank her for giving us that opportunity. There are problems with careers education guidance at the moment, and I want to say something about that, but let me be clear that there were problems with Connexions as well. We have not got it right for 20 years, so it is not a party-political point. Successive Governments just have not got this right, and I want to address why that might be the case.
One point that has not been said is that we all understand and know about the importance of careers education and guidance for everyone, but for no one more than the youngster trying to break away from the pattern of employment that their family has had for generation after generation. How it plays into that social mobility agenda and opportunity agenda is huge.
When I look at the guidance, I cannot argue with any single aspect of it. Having employer engagement is great; having employers in school is fantastic; work experience is wonderful; raising aspirations and showing people new visions is just what we want. It is right that schools should have a choice in who provides the
services for the children in their care. I also like the encouragement that schools are getting to use destination information. When I look at the component parts that address the careers problem, I cannot argue against them. So why is it not working? That is what I really wanted to look at. In truth, the problem is that it does not hang together. Although all the elements are good and sound, every single one of them risks failing and is likely to fail in a considerable number of schools throughout this country.
If we take businesses, it is great that there is business involvement but, during my very early years of teaching, I used to be a careers teacher, and I can tell your Lordships that some of the most difficult classes I had were when I had an employer in who was not very good at talking to recalcitrant 14 year-old boys. So the notion that the minute you get employers in it is all wonderful is just not true. Our children get good-quality work experience, but if you are in an inner-city comprehensive school, trying to get that quality work experience with no external help for a cohort of 200 students a year is very difficult.
If we look at the structure of schools themselves, none of them do not care about what happens to their children but all the levers are against them doing the careers education and guidance right. It is not just that there is a history of saying that the best thing is to stay until the sixth form and go on to university, as has been said today. Schools carry that weight and history with them, but they are also rewarded for saying that. They are seen to be better schools because sixth forms mean more money and more pupil funding for that age range. All the incentives are for them not to send children into apprenticeships or down to the local college.
Children have to make a decision, but the areas of the curriculum where that used to be encouraged—PSHE and citizenship—are no longer there. The problem is that Ministers will always be able to give us examples of where there is really good practice. However, to be really honest, the chances of all those elements hanging together to provide universal careers provision across the country—of them being brought together by a school that puts it top of its priority list—are next to none. This cannot be a subject where some kids miss out. We have to be able to guarantee that it is available for everyone.
I want to look at something which I think is not often mentioned. I remember that when I was a young careers teacher, I always used to think that there were really three elements to it. You had to give the child information and aspiration—the tools to get some stuff into his or her head. You also had to give them the skill to assess their own strengths and where they were—what was and was not reasonable. But the most difficult thing was getting them to make the decision and, having made it, to stick with it for the rest of their school life. We sometimes underestimate how difficult it is, especially with some children, to equip them with the skills to make the decision and stick with it. I often think of this analogy: anyone who has been house hunting knows of the huge gap between really liking a house and saying, “Yes, I’ll buy it”. It is exactly the same thing as saying, “I really like that job. I wonder if I could do it”. But jumping in and staying with it for years, throughout the rest of your career, is very difficult.
I hope that I do not often say this, but I do not think that we have ever had anything as good as the careers service that we had in the 1980s, when I was teaching. Certainly in my area, which was Coventry, we were an exemplar. As a careers teacher, I taught careers guidance lessons, but we had, devolved from the Coventry careers service, a careers officer who was full time and two assistants. I pay tribute to Bill Grantham, who was our careers officer. So what the children had in our office was not just my skills as a teacher but his skills as a careers officer and those of his team.
It was he who gave the impartial advice; it was he who said, “Is that what you want to do? Well, this is how you need to go about it”. Most crucially, it was he who gave the school leadership and the teachers the confidence to put careers at the centre of what they did. We were not equipped to do it, but with him there, by our side, on our senior management team, we had the cohesion that is so often lacking. I hope that, on this occasion, learning some lessons from the past may stand us in good stead for the future.
7.10 pm
Lord Shipley (LD): My Lords, I thank my noble friend Lady Sharp for initiating this debate. Having spoken a number of times in your Lordships’ House on the issue of apprenticeships and preparation of young people in schools to enter the world of work, I am very glad that we have the statutory and non-statutory guidance which has clarified a number of issues that needed resolution, following Ofsted’s report which concluded that three-quarters of schools were not executing their statutory careers duties satisfactorily. I agree with the noble Baroness, Lady Morris of Yardley, who is right that the new structure needs to hang together. However, following the publication of the guidance, I am now reassured that Ofsted is giving a higher priority in school inspections to careers advice and guidance. I also welcome the clarification in the guidance of the role of governing bodies.
It is important for the Government to be more interventionist. There is a lot of evidence that we have to get more employers into schools, albeit employers who contribute positively to the young person’s experience and motivation, and to get more school students to experience the world of work. Neither is an island. A few months ago, IPPR North produced a report entitled Driving a Generation: Improving the Interaction Between Schools and Businesses. Interestingly, a number of its recommendations have been addressed in the statutory guidance but I will quote one of its conclusions:
“In order to deliver a well-informed careers service with a broad range of job destinations, advisers located in schools need to be aware of the local employment opportunities around them. This means that they need to have some form of contact with local employers. At present, too few have any.”
I emphasise the word “any”, for I find that a very worrying conclusion. It is not simply a question of money; it is as much about culture, knowledge and a clear definition of roles. Students are in schools and the careers guidance they receive needs to be related to the curriculum they are taught. I am unsure whether Ofsted was right to say it was an error to transfer responsibility for careers guidance to schools from local
authorities. Schools are best placed to give guidance to students. They need help in doing that, but the core delivery should be in schools.
I draw attention to what IPPR North said because it specifically recommended the following strategy, based on research it undertook. In year 7, students should know about the different careers available in the subject area and the qualifications and education choices needed to enter those careers. That is information and knowledge-building. In year 8, there should be visits from employers, relevant to subject classes. In year 9, there should be visits by school students to major employers in the local area. As the Browne review of higher education recommended, there should be more individualised career support for students in years 10 and 11.
All this means that secondary schools need to develop much stronger relationships with major employers in their catchment areas. It also means that more employers have to be engaged in the education system. I was somewhat surprised by research published by the Federation of Small Businesses, which showed that 40% of its members have no engagement with local schools. One way of improving things is to use former students to raise aspiration and I am aware of the work of Future First, which builds alumni communities with former students as role models. The guidance says that schools should engage with their former students and get them to raise aspiration. That is wise, because students who lack confidence or knowledge need far more than occasional advice; they need real, sustained motivation.
One of the consequences of the way in which our careers system has worked over so many years reveals itself in the lack of women in engineering. Of the UK workforce, 8.5% are women. When you look at Scandinavia, which has a quarter, or Italy and France, which have a fifth, you realise the extent of the cultural problem we have. As my noble friend Lady Sharp said, the UK needs almost 100,000 new engineering graduates each year to meet current demand; that is twice current levels. Half of our state schools send no girls to university to study maths and sciences, which is a massive loss of talent. Early career support and mentoring to choose the right courses to enter careers in engineering and sciences would help, as would promotion of vocational provision. Again, as has been said, too many schools still focus only on A-level provision.
Overall, I welcome the guidance that has been issued and hope that the implementation will be such that no school will be found to have few contacts with local employers, and few local employers will be found to have no contact with schools.
7.15 pm
Lord Bilimoria (CB): My Lords, the new statutory duty requires governing bodies to ensure that all registered pupils at school are provided with independent careers guidance. There must be,
“a range of activities … including employer talks, career fairs, motivational speakers, college and university visits, coaches and mentors … In-house support for students must be combined with advice and guidance from independent external sources to meet the school’s legal requirements”.
Searching for the word “entrepreneurship”, I found:
“Schools should offer pupils the opportunity to develop entrepreneurial skills for self-employment”.
This is what the Government are asking for. Matthew Hancock, who was the Minister for Skills and Enterprise at the time, said:
“There is now no excuse for schools and colleges not to engage local employers to support students in the transition from education to employment”.
However, as we have heard, Ofsted, in its report Going in the Right Direction? said that the link with employers was the weakest aspect of careers guidance in the 60 schools that it visited. About two-thirds of schools reported that they had cut down on their work experience provision for students in years 10 to 11. Can the Minister explain this? Most of the schools visited, especially those with sixth forms, are generally poor at promoting vocational training and, in particular, apprenticeships. Is the Minister aware of this?
I congratulate the noble Baroness, Lady Sharp, on leading the debate. As she said, the move from state-sponsored careers guidance through the Connexions service to school-mandated careers guidance started in 2011. Only three other countries leave the responsibility of careers guidance to their school systems: New Zealand, the Netherlands and Ireland. In the case of the latter two, this has led to a reduction in the extent and quality of careers guidance provision. Have the Government taken this into account? In England it is estimated that the careers guidance element of the Connexions services received funding of £196 million in 2010-11. However, none of this was passed on to the schools after the transfer. It is therefore estimated that schools have to make an investment of £25,000 each for something that they had previously had for free. Can the Minister confirm this? Is this about means before ends?
The statutory guidance is very weak in that it is spread across two different documents. Ofsted has said:
“We were … told of a head teacher, who, when faced with the option of either buying careers guidance or extra tutorial support for maths and English, commented ‘If I do not hit the floor targets, I get fired. If I do not do careers, I am not sure that I do get fired’”.
The National Careers Service is all very well but there is a lack of face-to-face support for young people. Young people are going to be making the wrong choices about their careers. The recommendation is that the National Careers Service be expanded so that it has capacity-building and can play brokerage role for schools.
There have been so many comments in the press when employers have spoken about youth unemployment hitting 20%-plus, yet the manufacturing industry cannot attract young people to work in the sector. Works Management said that a survey revealed that 42% of people polled thought that careers advice in secondary schools was poor. Furthermore, 42% of people think that the secondary school teachers have a poor understanding of business and industry in general, while 57% of people believe that teachers should undertake two-week work placements. Would the Government encourage teachers to undertake work placements? Are they doing anything about this?
According to HC online, more than half of employers believe that young people receive inadequate careers advice, and almost two-thirds said that the young people they recruited lacked insight into the working world. That is really serious. Another CIPD survey found that more than two-thirds of UK employers have expressed willingness to be involved in the education system; but they need the opportunities to do that.
I am a fellow of the Institute of Chartered Accountants in England and Wales and today I sit on the advisory board of Economia magazine. ICAEW’s manifesto policy on skills and social mobility says that work experience should be mandatory in schools. How are the Government encouraging work experience to be mandatory in schools? They have a programme called BASE—business, accounting and skills education—which is a competition for students aged 16 to 19. It is fantastic; it is working really well. Yet this is being done on a voluntary basis; the responsibility is on schools. If we take the extreme example of a school such as Eton, its entrepreneurship society gets the entrepreneurial stars in this country, week by week, coming in and inspiring its students. How can the other thousands of schools in this country have access to that?
If we look at the destination measures system, what confidence is there that it will actually work? This is a serious situation. According to Ofsted, not all the schools visited had accurate and complete data on the students’ actual destinations. How are the Government going to deal with that challenge? Only one in five schools had well developed provisions for careers guidance.
I conclude with the private sector, which has such a huge advantage in this. For example, ISCO has training courses for the staff. What provision are the Government making for staff to be trained in careers guidance? This country has changed in the last three decades. It was a country with a glass ceiling; it was the sick man of Europe. Today it is an aspirational country. Our careers guidance needs to harness that aspiration, encourage our children and give them a really bright future.
7.21 pm
Baroness Humphreys (LD): My Lords, I add my thanks to the noble Baroness, Lady Sharp, for initiating this debate. I hope your Lordships will indulge me at the beginning of my contribution to the debate and allow me to explain a little about my professional background.
In the 1990s I was the vocational co-ordinator in a comprehensive school in north Wales. Among my duties was responsibility for the school’s careers policy and its implementation. I believe that we delivered high-quality careers education and guidance for our pupils. Careers lessons in the school were delivered through modules in the PHSE curriculum. We had an effective relationship with our careers service, which provided impartial advice that the pupils needed. Careers teachers were helped in their professional development by the education departments of the local authorities—and yes, we did take up work placements in local industries.
In common with many schools at that time, we used the system many noble Lords will remember—the Jiig-Cal programme. Jiig-Cal—or Job Ideas and Information Generator-Computer Aided Learning—did exactly what
it said it would do. It generated ideas and information about jobs after pupils had completed questionnaires and the forms were read by a computer. Jim Closs, the designer of the system, has admitted:
“Sometimes pupils would react quite negatively to jobs of that kind being suggested to them, but one of the principles of careers guidance is to broaden the pupil’s horizons by putting before them ideas that they would never otherwise have considered”.
I agree with that. Although the system has received some criticism, studies have shown that 70% of the pupils who went through the system actually ended up in the jobs suggested for them.
From a teacher’s point of view, the most important factor was the process pupils went through before they completed the forms—being guided, and taking time to reflect on their own interests, skills and abilities, whether they felt they were academic or not, or preferred working indoors or outdoors. All those factors need to be considered when choosing a career. Above all, that led to pupils learning about themselves, valuing aspects of themselves and their choices and valuing and respecting the choices of others—whatever those choices might be.
I argue that almost everything that appears in the new guidance for schools in Section 29 were things we were doing then—except for bringing speakers from the world of work into our schools, and the emphasis on mentoring and coaching. Those aspects of modern careers guidance, inspiring pupils to consider other careers, would have greatly enhanced our provision at that time. However, there is increasing concern among professionals about the diminishing role of the classroom teacher in careers education and guidance. For me, there is a fear that inspiring young people on the one hand, without the reality checks of the processes we went through on the other hand, could lead to what I call the “Britain’s Got Talent” phenomenon—when someone appears on stage and nobody has ever told them that they cannot sing.
Perhaps we should learn from Australia, where, last year, the National Centre for Vocational Education Research reported on its study of more than 2,000 pupils. It found that while many pupils had planned to be lawyers, psychologists, designers and vets at age 15, when interviewed again at 25 the majority had ended up as sales assistants, primary school teachers and retail managers. The centre blames a “patchy” careers advice system which inflated pupils’ expectations, only for them to be dashed 10 years later. Psychologist Professor Helen McGrath said that parents—and, I would argue, teachers—need,
“to focus more on giving their children some realistic feedback about what their strengths are rather than giving that message of ‘you can do anything you want if you set your mind to it’ … You simply can’t do everything, and the end result is that you fall flat on your face when you realise that even if you work hard you’re not getting anywhere”.
Career Development Association of Australia vice-president Dr Peter McIlveen said that parents and educators must encourage kids to aim high but not aim for the impossible. He said:
“It’s vital that our kids dream big but also make those dreams realistic through good guidance”.
Good careers guidance has many aspects, and I welcome the detail we have been given in the documents. Those aspects include: mentoring, inspirational speakers,
work experience and work visits, careers fairs, and interviews with careers officers, yes—but the input of dedicated careers teachers who help the child to understand his or her ambitions, abilities and skills, is also needed. Take away any one of those aspects and one is left with a system that is unbalanced and perhaps ultimately unfair to the child.
7.27 pm
Baroness King of Bow (Lab): I congratulate and thank the noble Baroness, Lady Sharp, on securing this debate.
We have all heard those stories from politicians and everyone else in the public eye; they go along to their school careers adviser at the age of about 14 or 15 to discuss their burning ambition, only to be told that they should shelve the dream and instead stack shelves. My careers adviser gave me slightly better advice. “What do you want to do?” she asked. “Become Prime Minister,” I answered. “Do you like reading?” she asked. “Yes,” I said. “In that case, I suggest you become a librarian”. I do not have anything against librarians, and I am extremely glad that they exist. However, given both my personality and my interests, I honestly had less chance of becoming a successful librarian than Prime Minister. Okay, I blew both my options, but my career advice highlights that unless advice is bespoke, professionalised, and inspirational to young people it is simply a complete waste of time.
In contrast, when I told my mum that I wanted to be Prime Minister, she replied, “And would you like to do that before or after you’re 30?”. I should add that I had to work in the Prime Minister’s office for only 10 minutes to realise that being Prime Minister is a terrible career choice, and not something I would wish on my worst enemy. However, the point is that my mum’s response instilled in me a matter-of-fact belief that I could have whatever career I wanted. That is why I am answering this debate today in the Lords instead of misfiling books in a library. Many people who are deemed to do well in life do so simply because people believe in them from a young age and give them both the tools and the expectation of success. That is precisely the job of an inspirational careers adviser: practical advice combined with great expectations.
What is the situation on the ground? As we have heard, the £200 million a year for the Connexions service has been axed and, as the noble Baroness, Lady Sharp, noted, we do not know where it has gone. Schools now have an unfunded mandate to provide careers advice. An Ofsted report last year found that a staggering 75% of schools offer poor careers advice. This surely is not a moment to withdraw resources from that area. Written evidence from Unison, the main union for careers service staff, is equally damning. Unison states that it is,
“extremely concerned about the future quality and availability of a viable careers service in England and we are particularly concerned that schools are not well prepared to fulfil their new duties as providers of careers guidance”.
Research by the University of Derby, with Unison, found a declining level of local authority involvement in youth and career support—as noble Lords would expect—and a consequent decline in the quality and
quantity of overall support available. In general, therefore, local authorities have followed the direction of government policy and transferred responsibility to schools while focusing their resources on targeted services. In theory, that might not be such a bad thing, but those who were interviewed for the report were clear that the Government’s policy changes are unfortunately impacting negatively on young people. Many who work in the sector said that young people were now making educational and employment decisions without support and in many cases this led to unwise choices.
The Government make high-level inspirational statements. As we have heard, no one could disagree with a word of them—they are fantastic, we all agree with them and sign up to motherhood and apple pie. I do not really mean that sarcastically, but it comes back to the points made in the debate, particularly by my noble friend Lady Morris, that it just does not hang together and, unfortunately, cash-strapped schools are forced to go with the lowest bidder in terms of careers advice.
The CBI conducted a survey of 2,000 14 to 25 year-olds and 93% said that they were not provided with enough information to make an informed career choice. Only 26% received advice on apprenticeships and only 17% on vocational qualifications, another issue raised by my noble friend Lady Morris. This means that young people without parents to help or who are not connected have very little chance of fulfilling their potential. That brings us back to the heart of the matter. Good, targeted careers advice, critically offered early enough to make a difference, is one of the most effective policy tools that we have to increase social mobility and reduce inequality. That is why it is so vital and why it breaks my heart to see standards in this area eroded. As for the guidance itself, whether it is statutory or non-statutory, it cannot on its own rectify problems identified by employers, unions and Ofsted. There comes a point when the Government have to put their money where their mouth is.
The Government’s inspirational vision statement says that:
“The responsibility now lies with schools and colleges, who we have given a powerful new accountability to secure independent and impartial careers guidance”.
Yes, they have been given a powerful new accountability, but not a penny. I might be wrong. I hope that the Minister, magician-like with rabbits to pull out of his hat, can clarify which extra funds schools will have access to, to provide this inspirational careers guidance.
I do not have much time left, so I will mention the importance of enterprise education, which is absolutely critical. It is also timely, because in an interview today in the Daily Telegraph, the Employment Minister said that middle-class children should believe that setting up their own business is every bit as good as going to university or working for a big company. All children should believe that, and A4e is one of the organisations working in that area.
I end by asking the Government if they will provide the well trained staff and structure that are needed, and end their resistance to face-to-face sessions, which are so important. Let us ensure that we provide inspiration for our young people, regardless of whether they want to start their own companies or become librarians or, God forbid, Prime Ministers.
7.34 pm
The Parliamentary Under-Secretary of State for Schools (Lord Nash) (Con): My Lords, I thank my noble friend Lady Sharp for securing this important debate and for her excellent summary of the history and status quo of the Government’s position on careers advice. I also thank other noble Lords for their valuable contributions.
There seems to be an assumption underlying the debate that there was once a golden age of careers advice and that we have to go back to it. I do not recognise that. Even if it was the case, I agree with the noble Baroness, Lady Morris, that the careers system that the Government inherited was clearly a long way short of that. I think that we all recognise that the Connexions model did not work. As Alan Milburn said, hardly one person had anything good to say about it.
I do not believe that we have ever had it right in this country since the days of choice emerged, probably about 60 years ago—before which people basically went into jobs that their parents did or that their parents organised for them. The system of careers advice that I recognise is one that I saw on a bookstall once, when I was in an airport in New York late one night—I cannot remember which; all airports look the same. It was a book written by Jack Welch and his wife. He was the inspirational head of GE. He had written a book about his experience as a manager. Then he and his new wife had gone around the world promoting the book for 18 months. When they came back, they wrote a small pocketbook on the best questions that they had heard. The best chapter was entitled,
“What am I going to do with the rest of my life?”.
He said that basically what you do is: you get a job; you do not like it very much; you get another job; and after about five jobs, if you are lucky, you find something that you enjoy. That was certainly the pattern of careers advice that I recognise in this country for the past 50 years, and certainly that experienced by many of my friends.
Of course we can do a lot better. We in this Government believe that people in jobs they love are best placed to enthuse and inspire a young person. For too long, careers guidance in our schools has been weak, characterised by an expensive, top-down approach and one-off careers interviews that did not prepare young people to take their place in the world of work.
The noble Lord, Lord Bilimoria, referred to Ofsted stating that the links with employers are weak. Frankly, for many schools, the links with business and the professions have been extremely weak for years. In our view, it is clearly getting better. Evidence from the McKinsey report on youth unemployment conducted across Europe was absolutely clear that the best careers advice is active engagement with business, but that face-to-face careers advice experience was extremely patchy. As for the head teacher to whom he referred who could not see the value of careers advice and was focused only on core standards, in my experience, for many successful head teachers in the country, the one way to get their pupils working for those exams is to engage them with work so that they have a clear line of sight and understand why they are working.
I certainly agree with my noble friend Lord Shipley that schools should have responsibility for that advice, because they know their pupils, their aptitudes, interests,
passions, strengths and weaknesses. Through our reforms, this Government are driving closer working between schools and employers. We welcome business input into our schools—probably more so than anywhere else in the world.
We need to equip our pupils with an understanding of how their learning will help them to progress in a rewarding career, and schools and employers can do this by investing in the workforce of tomorrow through careers talks, mentoring, coaching, work tasters and work experience. From September, our guidance will encourage all schools to do what the best schools are doing: securing innovative advice and guidance on a range of ambitious careers. That is why this Government have given responsibility to schools and colleges.
Evidence from the Education and Employers Taskforce highlighted the positive relationship between the number of employer contacts that 14 to 19 year-olds experience in school and their outcomes—including the likelihood of their being NEET and their earnings if salaried. I am delighted to see a growing number of excellent organisations already working with schools to facilitate greater business involvement—organisations such as Business in the Community’s Business Class, which has 300 clusters around the country, as well as the Cutler’s Made in Sheffield programme, the Glass Academy in Sheffield, Make the Grade in Leeds, career academies, U-Explore, Barclays LifeSkills, the Education and Employment Taskforce’s Inspiring the Future, and the Speakers for Schools programme. All those organisations are building those vital links—the plumbing between schools and business.
At Pimlico Academy, my own academy, we have a substantial raising aspirations programme, bringing businesses and professional people to speak at the school. At Westminster Academy they have transformed the schools performance with the help of 200 business partners. At the Bridge Academy in Hackney the sponsor UBS runs a huge mentoring programme for the students and at Stoke Newington School and Sixth Form in Hackney, they have an excellent programme of engagement with businesses including a speed-dating careers fair.
The guidance gives schools a responsibility to act impartially and make sure pupils can find out about the range of options available. The accompanying non-statutory guidance paints a clear picture of what good careers guidance looks like, highlighting case studies and examples of good practice. To further support schools, from October the reshaped National Careers Service will expand its offer to schools and colleges, making it easier for employers and educators to engage. Importantly, schools will now be held to account for the destination of their pupils, be that an apprenticeship, university, job or further study in school or college. The Chief Inspector of Schools has made clear his commitment to give careers guidance a higher priority in school inspections. We are strengthening our focus on that, to answer the point made by my noble friend Lord Cormack.
We have set out a clear vision for careers guidance, clarified responsibilities for schools through new statutory guidance and enhanced the role of the National Careers Service, alongside Ofsted’s tougher scrutiny.
On the point made by my noble friend Lady Sharp about the recommendations from Ofsted and the Select Committee, we have considered these and implemented a number of them. We published our action plan on the same day as Ofsted published its response to all the recommendations. We have strengthened the guidance in relation to a clear framework for schools. We have made it clear to schools that they must build relationships with other education and training providers.
As for the money—on a point raised by the noble Lord, Lord Bilimoria, and the noble Baroness, Lady King—we are in a difficult economic climate, as we all know. We have protected the school budget, which is a fairly remarkable performance given the state of the public finances that we inherited, and we believe that there is money there for this, compared to other sectors.
My noble friend Lord Cormack referred to the culture—that unless one goes to university one is seen as a failure. We are determined to change this ethos, which is why this Government’s reforms have ensured that vocational qualifications are rigorous and can be as highly valued as the alternatives. That is why our new guidance focuses so clearly on apprenticeships. My noble friend referred to his concept of a careers panel, which is an excellent idea. As was noted, we have updated the guidance for school governors this year, which makes it clear that governors can play a key role in helping to connect schools with the local business community, since we know that governors from an employer background can help schools in this way. As for the citizenship ceremony, perhaps the idea could be promoted by forming a new charity or a co-operation with other charities, or through a pilot with a certain number of schools. I know that my noble friend has some interested schools.
The noble Lord, Lord Bilimoria, referred to the fact that not all schools have a complete set of destination data. The DfE is publishing key stage 4 and 5 destination data annually, and Ofsted is using this in school inspections to inform judgments on schools’ career guidance.
The noble Baroness, Lady Morris, referred to work experience. Hundreds of employers are offering work experience, including major national companies, and the offer of work experience has risen over the last couple of years from 63% of employers to 81%.
I think that the real picture is somewhat different from the one that has been painted. We have never had this right and we think that the model of engaging with business is the way forward. We need to get it developed—I have referred to a number of excellent organisations that are doing this. I am sure that noble Lords will agree that giving young people a clear line of sight to the workplace, particularly those from intergenerational unemployment backgrounds, is important in enabling them to fulfil their potential. It is not just economically important but also, as my noble friend Lady Sharp said in opening, a moral imperative. Once again, I am grateful to all noble Lords for their contributions.
Health: Dental Implants
Question for Short Debate
7.47 pm
Asked by Baroness Gardner of Parkes
To ask Her Majesty’s Government what action they are taking to make the public aware of the medical need for periodontal checks following the fitting of dental implants.
Baroness Gardner of Parkes (Con): My Lords, peri-implantitis may seem to be a somewhat obscure matter to debate today, but that is the very reason why I am raising the subject. As a long-retired dentist, I was quite unaware of the condition. I found it most interesting when I heard Professor Nick Donos, head and chair of periodontology and director of research at the UCL Eastman Dental Institute, address an international dental conference on this subject in London last month. I thank him and others who have provided me with valuable material for the discussion tonight.
This is an important and growing health problem and there needs to be an awareness and a degree of understanding of the present position and the growing risks associated with this increasingly popular form of dental treatment. The condition is peri-implantitis. When I attended my first international dental conference in 1955 in Copenhagen, dental implants were a new idea and early cases reported by those dentists present had often failed spectacularly. In some cases, large portions of a jaw were lost in the process, mainly due to the rejection of the foreign body—the dental implant —by the patient’s immune system.
Time moved on and it was found that the metal titanium was accepted by the body. Since then, titanium-rooted dental implants have become widely used in the replacement of missing teeth. Half a million adults have at least one dental implant, according to the latest Adult Dental Health Survey. Studies suggest that one third of these patients will have a milder disease—peri-implant mucositis—which is common and treatable. If undetected or untreated, these red swollen gums can develop into peri-implantitis, which is associated with both inflamed gums and jawbone loss around the implants. As with so many health conditions, smokers have a significantly higher risk of peri-implantitis.
The European Association for Osseointegration emphasises the importance of appropriate patient selection. Most of us would accept that view and, as patients, we would expect to receive sound advice from the appropriately trained dentists performing implant procedures. It is important to indicate for the patient, particularly in complex cases, that implant dentistry should be seen as a multidisciplinary treatment. Within the objectives of the General Dental Council curriculae for dental specialists, it is indicated that periodontology, the treatment of gum conditions, is the specialty in charge for the planning and execution of the surgical component, and prosthodontics is the branch of dentistry that deals with replacement of missing parts with artificial structures and executes the relevant implant superstructures.
Complications of implant therapy, particularly peri-implantitis, are within the objectives of periodontology. Some experts studying the condition of peri-implantitis, a growing problem, believe that there should be formal national registration of implants, national health and private, in the UK. This would probably be the first in Europe, and would enable regulation of the type and quality of the implant-related procedures.
An implant is a titanium screw that is inserted into the jaw under a controlled protocol and, when fused with the bone, forms an artificial tooth root. Their use is growing rapidly in the UK, and although they are costly they are often considered the treatment of choice for replacing missing teeth. They can also be used as a support for a more extensive prosthesis.
When I googled “dental implant”, as a patient often would if they had heard about this treatment, I was disturbed to read the advertisement:
“Get smiling again with our same-day dental implants”.
That is surely what can cause adverse conditions post-treatment and is contrary to all the recommendations from the official dental bodies, which believe the patient must be fully assessed prior to treatment and informed and treated if there is an existing periodontal condition before the implant procedure. It must also be made clear to them that an implant is not a treatment you just have and forget. Regular follow-up visits are required to ensure that a periodontal condition does not develop, first into mucositis, and then progress on to the more serious disease, peri-implantitis, which causes loss of bone supporting the implant and often loss of the implant itself.
Remembering the time when so many women were at serious risk from cheap silicone breast implants and the heavy cost of dealing with unsatisfactory, even dangerous, treatments, including removal or replacement of these, it is particularly important that we are aware that many people seeking dental implants are tempted by cheap offers from abroad. These usually have the great disadvantage that the patient does not have continuing care and may be totally unaware that periodontal follow-up is essential to ensure continuing oral health. These patients certainly need to be clear that care and control of the gums before and following implants are most important.
My noble friend Lord Colwyn sends his regrets that he is unable to be here tonight. He also sends the message, as someone who has done implants himself, that implants should be put only into healthy mouths.
When I tabled this Question for Short Debate, I had seen nothing in the press on the subject. I was pleasantly surprised to see that on 14 July the Daily Telegraph had a very informative article on peri-implantitis titled “The ‘Time Bomb’ in Dental Implants” about a patient, age 52, who had four teeth implanted at a cost of £13,000 in 2002. Three months ago this patient felt a lump on her lower jaw, near one implant. She went to have this checked, and it responded to antibiotics, but the X-ray showed that the bone supporting the implant was receding, and the diagnosis was peri-implantitis.
Ten years ago this disease was almost unknown, but it is now a serious possible consequence of implantation, particularly when the implant patient has not continued to have regular periodontal checks, with treatment if
necessary, following an implant. Some studies suggest that one-third of implant patients will be infected, and because jawbone loss is silent and invisible, people do not realise that they are at risk. Early warning signs are red, swollen gums and bleeding, which is often apparent when tooth-brushing; smoking seems to aggravate the situation, and significantly more smokers develop peri-implantitis.
The Faculty of Dental Surgery at the Royal College of Surgeons points out that long-term assessment and maintenance need to be assured if this threat to stability of the implant is to be prevented. It believes that the General Dental Council should introduce minimum standards of education and training for complex dental treatment, such as implants, to ensure patients are treated by a qualified professional. It supports the view that the General Dental Council should include peri-implant assessment and maintenance in the undergraduate curriculum. Too often the practitioner who inserts the implant does not provide long-term support for the patient, discharging them back to their general dental practitioner.
Periodontal disease has been associated with diabetes, cardiovascular disease and pneumonia. Some people speculate that an increase of bacteria in the body may aggravate these conditions but it is not considered to cause them. Professor Donos says:
“The main challenge is for the patients suffering from periodontal disease who represent a significant proportion of the population. As you know, due to the silent nature of the disease, it does not always provide ‘pain’ as a symptom for the patient”.
“I think it is important for the public to be informed that even though implants are successful and offer great functional and aesthetic solutions in terms of replacing missing teeth, appropriate patient selection is required”—
as my noble friend Lord Colwyn said—
“control of periodontal disease before and after implant placement is essential and all risk factors need to be controlled through regular follow up according to the susceptibility profile of the patient”.
In my experience, pain is the thing that brings many patients into the dental surgery. I cannot end this dental discussion without mentioning the report this week that 26,000 children in England aged between five and nine have been hospitalised to have multiple tooth extractions in 2013-14, which is nearly 500 children a week, at a huge cost to the NHS and a great disturbance and upset for the children and their families. However, that is a debate for another time: I flag it up here for the Minister.
Tonight, I hope that patients who want and should have dental implants will benefit from understanding the importance of dealing with periodontal conditions before and after treatment. I look forward to a positive response from the Minister and to his assurance that his department will create public awareness of this condition.
7.57 pm
Lord Hunt of Kings Heath (Lab): My Lords, the noble Baroness, Lady Gardner of Parkes, is one of our most active Members and I am sure we all owe her a great debt in bringing this matter to our attention tonight. I declare an interest as a member of the
Faculty of Dental Surgery at the Royal College of Surgeons. Last Friday, I attended a celebration of the 50th anniversary of the fluoridation of the water supply in Birmingham. Will the noble Earl join me in congratulating the great city of Birmingham on this achievement? It is interesting that, when one looks at health outcomes, Birmingham is often towards the lower end of the table, but it is way up in the top 10 in oral health. Whatever one’s views on fluoridation—and I also declare my presidency of the British Fluoridation Society—there is no question that it has had a very positive impact in Birmingham and the West Midlands in terms of the number of children who have to go into hospital because of oral issues, which was a point raised by the noble Baroness.
As the noble Baroness said, the use of dental implants has grown rapidly across the UK in the last few years. That has been very welcome to many patients but we know that, on the other hand, alongside this rise, the General Dental Council has seen an increasing number of complaints, particularly regarding the lack of informed consent for treatment, damage to the tissue and bone surrounding the implant, and failures. The noble Baroness was very explicit about some of the health issues that can arise. I have looked very carefully at the briefing provided by the Faculty of Dental Surgery at the Royal College of Surgeons. It makes four points that I will put to the noble Earl, alongside the questions raised by the noble Baroness.
Essentially, the briefing says that it is very important for patients to be given adequate information about the risks and alternative options for treatment. Secondly, patients should be aware that periodontal and peri-implant checks are essential to ensure that problems are detected early. The stability of the implant is threatened by diseases such as the one mentioned by the noble Baroness. I do not dare attempt to repeat its name, although I believe that the noble Earl, Lord Howe, is perhaps braver than me on that. However, this is why checks are essential.
Thirdly, the GDC should consider ensuring that peri-implant assessment and maintenance is part of the normal undergraduate course. Fourthly, I would like to mention the Law Commission draft Bill. We are not to see the Bill, but it contains proposals to give regulators the power to annotate their registrar and indicate specialisms or other qualifications. Given that we are not going to have the Bill—I know that there will be some Section 60 orders—perhaps I could make a plea that this might be considered if a dental order is to be brought forward.
Finally, I refer to a very interesting note I received from the Faculty of General Dental Practice about the standards of training in implant dentistry. This is available from a wide variety of providers in the UK, including universities, royal colleges and hospitals. These standards have been developed to ensure patient safety and protection, and I understand that they also serve as a reference point for the GDC in consideration of patient complaints. The only question I wanted to put to the noble Earl about this is that, although this seems to be absolutely fine, how can we ensure that more dental teams take up these training opportunities?
Clearly, we have a good system where standards are very much developed. The providers have to provide training in line with those standards, and the General Dental Council is there to follow up complaints when there are indications that dentists are not practising according to those standards. I wonder whether the noble Earl thinks that there is an issue of some dental practitioners not doing that, which then has an impact on their provision of clinical services.
8.02 pm
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con): My Lords, before I respond to the particular points raised by my noble friend on the issues to which she drew our attention, I begin by paying tribute to the way she has consistently championed the commitment of members of her profession to improving the oral health of the population and the quality of dental care provided in this country.
The oral health of the nation has been transformed since the creation of the NHS in 1948, and the rate of improvement has picked up pace since the introduction and widespread use of fluoride toothpaste in the late 1960s and early 1970s, and the growing awareness of the need for good oral hygiene.
The coalition made two key commitments in relation to dentistry in 2010: to increase access to NHS dentistry and to improve oral health by reforming the NHS dental contractual system. We are making solid progress on that reform. As noble Lords know, there is currently an engagement exercise aimed at dentists and the wider dental community. As part of this I took part last month in a web chat, and I was encouraged by the positive—though, of course, rightly robust—questioning and debate from those dentists who took part.
However, we are not waiting for this more fundamental reform before starting to tackle access and oral health. We are already making progress on delivering on those commitments. The people of this country appreciate the ability to access dental care when it is needed, and the number of people seeing a dentist under the NHS since May 2010 has increased by 1.5 million. We are also committed to working with our partners, including those in the profession, to improve the oral health of the population—with a particular focus on children. The latest epidemiological data published by Public Health England demonstrates that progress is being made. Like the noble Lord, Lord Hunt, I follow with interest the decisions being taken locally about fluoridation of water.
These decisions are best taken locally and the arrangements we made under the Health and Social Care Act 2012 are intended to increase democratic legitimacy of decisions on fluoridation; I am pleased that the noble Lord attended the 50th anniversary of the city of Birmingham’s fluoridation scheme. Dental caries continues to affect a sizeable proportion of the population and is a common cause of children being admitted to hospital, as my noble friend mentioned, for the removal of decayed teeth. Public Health England recently published a health monitoring report which showed lower rates of tooth decay and hospital admission in fluoridated areas compared to non-fluoridated areas. In March, Public Health England published guidance
for local authorities on improving oral health for children and young people. That guidance advises on the range of measures, including water fluoridation, that local authorities might consider as part of their oral health improvement strategies.
One of the real drivers of this improvement in oral health has been the greater appreciation by the public of the value and importance of both good oral health and acceptable appearance. With this value now placed on oral health has come significant technological development, and again the dental profession must be congratulated on the way it has researched and developed new techniques and procedures to improve oral health and functionality; the use of implants, which my noble friend focused on, is a case in point. We recognise that inequalities still exist and my officials are working with colleagues in Public Health England, NHS England and local authorities to tackle those inequalities; nevertheless, the overall trend is positive.
My noble friend pointed out that smokers are more at risk of peri-implantitis. Public Health England’s Smoke-free and Smiling guidance supports dentists to make brief interventions to help patients who want to stop or cut down to access dedicated stop-smoking services. Dental surgery is a key opportunity to get across brief messages of issues that have implications for oral health—and in this case, of course, the patient’s wider health.
Dental implants can be used in a range of situations. They can play a key role in reconstruction, post-trauma or major surgery. They can sometimes be used, as my noble friend mentioned, as a support for a more extensive prosthesis following surgery for head and neck cancer, and can also be used to retain restorations in the mouth where teeth are missing. I know that the vast majority of cases where implants have been used to replace missing teeth have historically been provided in the independent sector, outside the auspices of the NHS. There are, of course, many other treatment options to be considered, including bridges or dentures, depending on the individual clinical circumstances.
The NHS has a duty to commission services which are both clinically appropriate and cost effective and it is important when discussing the replacement of missing teeth that all those options are discussed. We also need to be aware, as my noble friend mentioned, that some patients choose to travel abroad to have implants fitted because the initial treatment might be available abroad at a lower cost. The General Dental Council has good guidance available on its website for members of the public considering travelling abroad for dental treatment. It is important that people travelling abroad for this sort of treatment understand that, without the ongoing clinical care and support that this type of treatment requires, what looks like a low-cost option initially might ultimately turn out to be high-cost—both financially and from a health outcome perspective.
I am aware that NHS England is providing a series of commissioning guides to give clarity to commissioners and clinicians when discussing treatment options with patients. For dentistry, four such guides are in
development, focused on specific areas of dental care. One of these is a restorative commissioning guide and the appropriate use of implants is, I understand, included as part of that work. As my noble friend quite rightly mentioned, appropriate post-placement care is vital if these restorations are to be successful in the long term.
There has been a significant increase in the placement of intra-oral implants in the last 20 years and, although the immediate result can be instantly impressive, it is vital that patients receive good aftercare, including the periodontal checks my noble friend referred to and instruction on how to maintain a healthy interface between the implants and natural tissue. Indeed, in the third edition of Delivering Better Oral Health: AnEvidence-Based Toolkit for Prevention, published recently by Public Health England, there is a section on peri-implant health which focuses on these very issues. This provides detailed guidance for clinicians on what they should do at each visit for patients who have had implant treatment. We would expect clinicians to carry out procedures only where oral health is good enough to support the treatment being provided—the point made by our noble friend Lord Colwyn, who cannot unfortunately be with us—and to provide aftercare advice to patients, including advice on self-care and the need for regular check-ups.
However, we know that there is more to do. My noble friend will also, I hope, be pleased to hear that my officials and the Chief Dental Officer have already recognised the issue she raises as a potential area for growing concern. A UK-wide working group, which includes representation from the dental faculties, has been established. Chaired by the Chief Dental Officer, it will look at developing clear and consistent cross-system guidance relating to treatment planning prior to the placement of implants, the education and training required by the clinicians—a point raised by the noble Lord, Lord Hunt—and best practice for aftercare, as referred to by my noble friend. It will also look at how appropriate, easily understood information can be made available to members of the public considering this form of treatment. I am pleased that this group has been set up and understand that it met for the first time earlier this month.
I hope that my noble friend is reassured by the fact that we have already recognised this as an area where public awareness needs raising and that we are taking action to address this. At the end of her excellent speech, my noble friend mentioned the recent data regarding the admission of young children for the administration of a general anaesthetic for removal of teeth. This is unacceptable as dental caries is a preventable disease which can be almost eliminated by the combination of good diet and correct tooth-brushing, backed up by regular examination by a dentist. NHS England is working with colleagues within and outside the profession to educate and inform the parents of these young children so that they are not subject to this extremely unpleasant experience at such an early age.
Committee adjourned at 8.12 pm.