Good morning and welcome to the second meeting in 2014 of the Finance Committee of the Scottish Parliament. First of all, I remind everyone to turn off their mobile phones or any other electronic devices that they have. Michael McMahon is not here, but we have not received any apologies from him so he might simply be running late.
The first item on our agenda is to take evidence on the early years change fund from the Minister for Children and Young People, the chief medical officer and two Scottish Government officials. I welcome to the meeting Aileen Campbell, Sir Harry Burns, Shirley Laing and Philip Raines. I understand that the minister would like to make a brief opening statement.
On behalf of the early years task force, I thank you for inviting us to discuss the progress of the early years change fund. As the task force’s co-chairs, Sir Harry Burns and I will represent its views. Unfortunately, our local government co-chair, Councillor Chapman, is unable to attend today and sends his apologies.
The early years framework signified an important milestone in encouraging partnership working to deliver a shared commitment to giving children the best start in life and improving the life chances of children, young people and families at risk. The early years task force shares that commitment.
Established in November 2011, the task force has the role of developing the strategic direction for the early years change programme and of co-ordinating policy across Government and the wider public sector to ensure that early years spending is prioritised by the whole public sector. In setting out its vision and priorities in March 2012, the task force made it clear that the establishment of the early years change fund signified a significant shift to preventative spend over the current parliamentary session.
That is because the early years change fund is the first time we have collectively discussed a financial mechanism for delivering on the aspirations of the early years framework. Each year, the public sector spends £2.7 billion on children in their early years, and the change fund presents a huge opportunity and a good starting point for the Scottish Government, local government and NHS Scotland to fulfil their joint intention to shift resource to where it makes the most difference by supporting prevention and early intervention.
The clear expectation set out by the task force is that, through the early years change fund, partners can consider how they can better support universal services to deliver better for children in their early years and their families; raise public awareness of the significance of the early years to children’s healthy development; and bring the totality of their resources to discussions on how best to deliver the aspirations of the early years framework.
We know that from the outset the early years change fund has had an impact. For example, in its year 1 change fund return, Angus has told us of its plans to integrate education, early years services and social work family support services to provide locally based early intervention and prevention teams. That is but one example. Returns from all community planning partnerships have been overwhelmingly positive, providing us with strong evidence of a move towards prevention and early intervention.
The early years task force always viewed the change fund as a good first step to achieving the longer term goals of prevention and transformational change in service delivery. Given its very nature as a change fund, its lifespan was designed to be limited. The funding commitments from health and local government will end in 2014-15, and the Scottish Government has committed £8.5 million to the early years change fund for 2015-16 to support the transition away from the change fund model.
However, the fund’s impact and legacy will continue. Together with the task force’s wider work, it has enabled the development and establishment of the early years collaborative, which is the world’s first multi-agency quality improvement programme. The collaborative provides us with the method of continuing to ensure that the Scottish Government, health and local government embed prevention and improvement at a local level. Delivered at a national scale, this locally based work is helping us collectively bridge the gap between what we know works and what we do through improvement science to improve outcomes for our children and families.
The ambition of the early years collaborative is nothing short of making Scotland the best place in the world to grow up. All 32 CPPs in Scotland have embraced the approach and are actively looking to build on the good things they already do and to learn from others to improve the outcomes for Scotland’s children with regard to stillbirth, infant mortality and the reaching of developmental milestones. Although it is still early days for this groundbreaking work, we are already starting to see that small changes are having an impact.
In March 2012, the early years task force made it clear that its aim is to put Scotland squarely on course to shift the balance of public services towards early intervention and prevention by 2016 and to sustain that change to 2018 and beyond. The early years change fund has got us off to a good start, and the early years collaborative, as a vehicle for embedding this prevention and improvement, provides us with the way forward.
Thank you, convener, for allowing me to make those opening remarks. We stand ready to answer any questions you have.
Thank you, minister. You are probably aware of how this committee works—I will ask a few initial questions and then open up the session to colleagues around the table.
I found your introductory remarks very interesting. In fact, you have partly answered one of the questions that I was going to ask, which was whether further money would be allocated to the early years change fund from the health and local government budget, by saying that that will not happen. In 2014-15, the Scottish Government, health and local government will put £99.25 million into the fund but, the year after, the funding will fall dramatically to only £8.5 million from the Scottish Government. What impact is that likely to have on delivery?
As I have said, the change fund was intended to be the mechanism by which we would establish the culture of change and encourage people in the 32 CPPs to bring to the table the totality of their resources to help improve the lives of children in their earliest years.
The £8.5 million that you have mentioned is for the transition from the change fund itself to embedding the changed behaviour further. Of course, the method by which we are delivering this change is the early years collaborative, which will take forward many of the early intervention measures and measures to prevent problems before they arise that we want if we are to improve children’s lives.
As the lasting legacy of the change fund and the task force, the early years collaborative will move forward with embedding changed behaviour and ensuring that improvement science is used to analyse any changes that have been effected by improved service delivery. The £8.5 million is for the transition away from the change fund model, which, as I have said, was designed to be limited in its lifespan.
I fully appreciate that, but is there any evidence that it has delivered fully enough to allow us to downsize the available funds to such an extent over a one-year period?
As I have said, the change fund was designed to be limited in its lifespan. It has already led to some very good examples of prevention in action, and the collaborative will take forward a lot of that work. The £50 million from the Scottish Government was new money and the £8.5 million is for the transition away from the change fund model to embedding some of the changes that we expected to see through the work of the task force and the change fund itself.
You have already mentioned the early years collaborative. How does the early years change fund impact on that, and what do you expect the collaborative to deliver in this specific area?
I will ask Sir Harry Burns to talk in general about the collaborative, but I can say that the model for delivery, which will change from a deficit model to a model in which we build on assets to improve children’s lives and to prevent problems before they develop into crises, has been subject to improvement science and has come through the collaborative. It has already reaped real rewards; for example, it is improving the way we work with children and families in their earliest years. The task force has overseen that work and the change fund, and it has paved the way in setting up in Scotland what is a world-leading collaborative.
As I have said, Sir Harry Burns will be able to give you more specific details about the collaborative.
Would it be helpful for me to describe what a collaborative is and how it works?
It certainly would.
A lot of international evidence going back 40-odd years shows that early intervention transforms life chances by improving not only health but educational attainment and employability and reducing offending behaviour. In fact, much of that evidence comes from the United States, where President Johnson’s huge social reforming agenda in the 1960s delivered a lot of early years interventions.
A few years ago, we got a fellowship for a public health doctor to spend a year at Harvard reviewing that evidence. They came back with a convincing set of interventions that had been evaluated by Nobel prize-winning economists, which showed that the longer you left them running, the bigger the return on investment.
The real returns began to appear when the children who experienced those early years interventions hit their mid-teens. By then they were succeeding at school, had not had serious illness—which often arises as a result of violence in American inner-city communities—and were not getting involved in offending behaviour.
That work has gone on and now, after about 30 or 40 years, we are looking at return on investment of about $50 or $60 for every $1 spent on intervention. At the same time, a range of new scientific studies showed the importance of supportive, nurturing environments in creating attachment behaviour, which explained why the early interventions were so successful in a social sense.
What we lacked was a method for implementing those changes. Historically, all Governments have typically made changes by coming up with three-year projects. They have said, “Let’s have a project; let’s fund it for three years and see what happens.” Usually, when the money runs out, the project dies. To be honest, we are all fed up with that: good ideas have flourished and then faded away.
We decided that we needed a method that would last, be done at scale—it would be a whole-Scotland set of interventions—and engage the front line. Typically, the great and the good get together and write a report that gets published and then ministers say, “Yes—we’ll all go and do this,” but if the front line is not involved in shaping the interventions, the sense of ownership will not be as good as it should be and take-up will be patchy.
The collaborative methodology brings together the front line; front-line staff, working with parents, voluntary agencies and so on, help to shape the interventions and how they will be delivered. We say to them, “We need to help parents who do not know how to be parents attach to and nurture their children, and do the kinds of things for their children that we know will prepare them for school.” Across Scotland, all CPPs come together every four or five months and say what they have done to do that.
For example, reading bedtime stories to children helps improve their vocabulary, speech and learning. We can tell you how many children get a bedtime story most nights of the week and we can tell you the CPPs where that is above 90 per cent, because CPPs are testing it. They go out and do things: they give parents aide-memoires and books, and they measure. The next day they ask the kids, “How many of you guys had a bedtime story last night?” The CPPs measure it constantly and then come together and share their experience, so that their learning is spread.
We do not get the change in scale overnight, but over a period of maybe two or three years we begin to see the successes—the things that work—being shared across the whole of Scotland and they become embedded in what we do. This is a behaviour change programme, which will embed good practice across the whole of Scotland as quickly as possible. We have learned from the patient safety programme, which uses the same methodology and which has been staggeringly successful—I would not have believed how successful the patient safety programme has been in transforming the quality and safety of healthcare in Scotland. After five or six years, we have very hard data on how things have improved. It will take five or six years to see the same for this programme.
One of the aims of the early years collaborative is to reduce infant mortality by 15 per cent by 2015. If we reduce it by 15 per cent, we will be down at the same level as the Scandinavian countries. We already have the lowest infant mortality of the four United Kingdom countries, and we will get down to levels similar to those of places such as Sweden if we achieve our aims. There is maybe just a wee sense that that is beginning to happen. I would not want to promise anything yet, but we are beginning to see things in small pockets, and they will be scaled up.
The collaborative is reorienting the way in which the public sector, working with voluntary agencies and Government, does things. It is a process that is in train and one that has really been active for only a year—it is early days yet.
09:45
As you say, it is early days, and these things do not happen overnight. You say that you want to involve the front line. In the evidence that the committee took on the draft budget, we heard concerns that the delivery is fairly patchy across Scotland, despite what you have said about the CPPs. As you are probably aware, that issue is covered in our report on the draft budget. What does the Government intend to do to try to remove and address the barriers that still exist to cultural and structural changes?
The patchiness is absolutely what we would expect. The whole point is that we do not dictate to people what local circumstances require them to do. People will develop things, and those in different parts of Scotland will develop different aspects of the change at different rates, but they will come together. We will get successes. For example, Lothian will do some things successfully and other things less successfully, as will Perth and Kinross. The areas will then come together, and people will ask, “How did you do that?” and decide that they will do it, too.
The patchiness will disappear as the collaborative matures, but it will take two or three years for that to happen. There is nothing unexpected about the current situation at this stage. The collaborative is designed to avoid the attitudinal and cultural barriers in public sector organisations to which you refer—such as people thinking, “Who are they to tell us what to do?”—because the local staff are out there testing and measuring what works. The approach is not about a smart Alec such as a chief medical officer telling people what to do; it is about staff saying, “Hey, we’ve tried this and it works.”
The collaborative seeks to provide a culture change, but that does not happen overnight.
The—
However, it is the best way to deliver what we want. Sorry, minister.
Let the minister have a word. [Laughter.]
The collaborative exists and the momentum behind it is incredible. Even though there is a national approach, it is respectful of the local approaches that will take forward the improvement that we expect.
Aside from the collaborative, the change fund and the early years task force, we have the legislative programme that accompanies the Government’s wider public sector reform, which includes the Children and Young People (Scotland) Bill. That bill will embed a degree of consistency in the approach to children’s services by putting elements of the getting it right for every child programme on a statutory footing. That should help with consistency, but it is still respectful of the different approaches that each local authority will want to take and how they can best tackle issues to do with children’s services and dealing with children and young people and their families.
Aside from the collaborative, therefore, there is the work that we are doing through legislation to try to ensure that every young person across Scotland gets access to much more co-ordinated and joined-up services, such as those in the pathfinder programme in the Highlands. The aim is to ensure that many more children across the country receive such services.
As well as the legislative tools, we have a leadership strand within the early years collaborative, because we need leaders to take forward the message, too. Of course, the approach is also being informed by the fantastic work of front-line practitioners.
I will ask one more question and then allow colleagues to come in, as they will want to explore some of the issues in greater depth.
In our report on the draft budget, the committee asked what progress has been made on developing a monitoring and evaluation framework for the early years change fund—the Government stated in January 2012 that it would produce such a framework—and when an evaluation report will be published.
We have asked each local authority to provide returns on their activities. That was taken forward by a sub-group of the early years task force headed up by David Martin, who is the chief executive of Renfrewshire Council and a member of the task force. In those returns, we have examples that clearly demonstrate the work that CPPs are doing to live up to the aspirations of all of us in the early years task force.
That has been a first stab, and it has in itself been a learning process. As we proceed, we will be able to be more sophisticated in the way in which we get back the information that we require to see how effective the approach has been. As a first attempt, it certainly has shown that each local authority and CPP is committed to the agenda, along with their other partners, including the third sector. That information is available publicly if the committee wants to see it.
Monitoring and evaluation are important. If we are going to eliminate some of the patchiness, we need to know that there is a degree of commonality in the way in which progress is being evaluated across the country.
I now open up the session to members. The first question will be from Jamie Hepburn, to be followed by Jean Urquhart.
The submission that the Government has provided says:
“The Change Fund is the first time that we have collectively discussed a financial mechanism for delivering on the aspirations of the Early Years Framework”.
The minister emphasised that in her opening remarks. It might be helpful to know what the position was previously and what happened before the new approach was taken.
The task force and the change fund are about bringing people together and people bringing the totality of resources to the table. The early years change fund is a first step towards transforming how we use that money and towards getting the maximum benefit so that children and families have the best possible outcomes.
The point of the initiative was always about changing the culture and stopping the silo mentality. The CPPs brought people together but, at the higher level, the task force has meant that we can talk about how to shift resource and make a first attempt at ensuring that the money that we use in the early years brings maximum benefit. Because the early years change fund is now funding the collaborative, as we heard from Harry Burns, that is significantly changing the approaches that local authorities are taking. They are sharing information in a safe way so that they can learn from one another. Even if some things do not work out, that still provides learning. So we have made the first step towards changing our approach to our finances in the early years. The collaborative has been funded and it will bring further transformation.
Before the change fund and the new approach, was there little evidence of that type of collective working, or was it patchy across the country?
It probably would not have been so consistent. There have always been pockets of good practice around the country, but we need to make it the rule rather than the exception. The task force is bringing together the key players from local government, health and the third sector, and parents as well. A range of different people are getting round the table to monitor how some of the resources are spent. The change fund has now funded the early years collaborative, which will further embed collaborative working.
The public does not see public money as health money or local authority money—they just want to have good services. The initiative is about making sure that those services can be provided in the best possible way. Resources are tight, so we need to make the best use of what we have. A considerable amount of money—about £2.7 billion—is being used for early years. That is about 10 times the amount that we have in the change fund, so it is about how we use that to make maximum impact and get maximum benefit. The key is to make sure that prevention is our hallmark, as Harry Burns outlined. The best use of money is to get good outcomes later in life. If we spend early, we can prevent some of the persistent social problems.
You referred to the figure of £2.7 billion, which is also mentioned in the submission. We are focusing on the change fund, which is a lot smaller but, in relation to the work of the collaborative and the task force, are you looking at the whole pot of money rather than just the change fund?
Yes. It is important to recognise that the key players that we are talking about had not sat round a table together before the task force was set up. Of course, one of your committee members sits on the task force, so it also has cross-party political representation. It is about making the best use of the money that we have. The task force and the change fund have given us the mechanism by which we can do that.
On the question whether the current way is better than the old way, I worked in health boards for a decade or so and I found the old way intensely frustrating. The typical way of trying out things was to have a call for bids, and five or six health boards or whatever would be successful and go off and do things with three months’ funding, but the thing would stop when the funding ran out and it would not be embedded in practice. The extent of the learning across the country from such projects was limited according to the extent to which people shouted about them. We suffer a bit from the not-invented-here syndrome so that, if Edinburgh does something, the question is whether Glasgow will pick it up—maybe, but maybe not. However, with a collaborative approach, there is continual quality improvement and sharing of successes, which just becomes the way in which we do things.
There has been a big transformation, which is attracting quite a lot of international attention. As far as I can tell, we are the first people to have applied the collaborative methodology to something other than healthcare. As I said, that is attracting quite a lot of attention.
The paper that the Government provided refers to the
“objective of our joint early years change programme and our ... work on the Early Years Collaborative”.
There are three bullet points on the outcomes from that objective. They are:
“Deliver tangible improvement in outcomes and reduce inequalities for Scotland’s vulnerable children.
Put Scotland squarely on course to shifting the balance of public services towards early intervention and prevention by 2016.
Sustain this change to 2018 and beyond.”
I accept the chief medical officer’s point that it will be many years hence before we can see some of the changes. He said that he had a wee sense of there being some changes, although he asked us not to hold him to that, so I will not. However, can you set out what progress there has been in achieving the three outcomes, in so far as it is possible to assess that?
There has been a culture change, not least that by which the task force has allowed us to get together to ensure that we are working holistically to improve children’s services. There are already indications in the returns from community planning partnerships that local authorities are changing the way in which they do business. For example, I previously gave the example of Angus, which is integrating education with social work for the early years. West Lothian has a preventative interventions board, and Highland Council has allocated an additional recurring £2 million for early years services, with £1 million each for 2013-14 and 2014-15. Work is taking place to identify further preventative spend across partners.
The returns—which are available online should the committee wish to look at them—show clear examples from each local authority that has given us returns that they are doing things differently. Again, that lives up to the aspirations that we set of ensuring that the approach is put on a sustainable footing by 2016 and is sustained beyond 2018.
The high-level outcomes that Scotland has agreed on are: reduce infant mortality by 15 per cent; reduce the number of children with developmental delay at the 30-month assessment; and reduce the number of children with developmental delay when they reach school. Underneath those high-level outcomes, there is a set of processes on which we have evidence that, if we do them at scale, we will deliver those outcomes.
At present, we have evidence of process change in relation to things such as nurturing behaviour through the family nurse partnership, which is spreading round Scotland; reading to children; and healthy-start vitamins and other nutritional things. We can see processes changing, but achieving the high-level outcomes is a bit like winning an Olympic medal. As Chris Hoy said, the British cycling team won all its Olympic medals through the accumulation of small gains across lots of different areas. The small gains added up to big change. Similarly, we are seeing small changes across hundreds of different processes in the early years, which will ultimately produce the big changes that we are aiming for.
So we can see a change in culture and process, but it is too early to see a change in outcomes.
Yes.
With regard to the minister’s answer a minute ago about local examples, one of the things that the committee asked for was evidence of additional resources that the change fund had leveraged in to local authorities. Presumably, the examples that you gave, which you said are publicly available, are evidence that that is happening.
Yes, absolutely. Of course, the family fund within the change fund has also levered in Big Lottery funding to make the total pot larger. Again, that is leveraging in money from not just local authorities or health but the third sector. In the returns, local authorities have pointed to funding from the third sector to help to deliver local projects that they have worked on. Beyond the funding in local authorities and health boards, we can point to additional funding because of the changed approach and culture and everyone’s recognition that the best way to spend the money is on prevention.
10:00
Typically, we will see backfill. When health visitors get involved with the family nurse partnership, their jobs as health visitors working with general practitioners and so on will be backfilled. That is where a lot of the stuff is coming from. People are picking up new roles and tasks, and to give them time to do them, other funding is being made available to backfill the space that they have left in their traditional roles. It is about reorientating how we deliver services.
There was an announcement last week about free school meals for primary 1s to primary 3s. How does that fit in with the issue that we are discussing? Could that also be viewed as part of early intervention and the preventative spend agenda, in which the committee has taken a real interest? Will that be measurable? Will we be able to see a change in outcomes for those youngsters?
The early years go beyond the pre-school years; they go up to the age of eight. To reflect that, there is a new workstream through which we will look at how we can improve the life chances of children in that cohort. I absolutely think that, once we can examine the free school meals initiative, we will see that it has had an impact on children of those ages. We know that the approach will help their health, wellbeing and attainment, as they can learn much more ably if they do not feel hungry and are not worried about that in their life. I imagine that that will have a positive impact in the collaborative work that we are taking forward. However, that is a new workstream with which we are moving forward.
I want to ask about the end of the change fund. The minister said that, by then, the front-line services that are delivering will, we hope, be working in a new culture, and that will be that but, in a sense, that is not reflected in the reports that we have had of local authorities being nervous about the end of the fund and perhaps their understanding of what the change means. One reading of that is that the funding is a kind of add-on and that, instead of its making a change, the service will stop when the funding is withdrawn.
Will the task force continue when the funding ends? What monitoring or evaluation will there be? As Sir Harry Burns said, our infant mortality rates are moving towards Swedish rates, which is fantastic. How will the measurement look to you in practical terms? How will we have confidence that the change has been made?
On the early years change fund, I said that the approximately £50 million of new money is Government money, and that will come to an end. The £8.5 million will be for the transition away from the change fund. The fund was only ever designed to be limited in its lifespan to bring about the change in culture that we expect. The funding from local authorities and the national health service brought their resources to the table, too, and that remains in place going forward. We expect that the cultural changes that will have happened through the change fund will remain, and the £8.5 million will be helpful in the transition. I hope that that answers some of your questions.
The early years task force has been reviewed. We refreshed it quite recently, not least to reflect the fact that there is the new workstream that goes up to the age of eight. Bill Maxwell from Education Scotland is taking forward the work that will be happening in schools because of that new age group. We will look to review that thereafter, following the changes in the change funds. We have just reviewed the work, and we will review it again.
A whole load of monitoring goes on all the time anyway, of things such as hospital admission rates. One of the unanticipated consequences of the smoking ban was a significant fall in the number of children who are admitted to hospital with acute asthmatic attacks. That implies that people have not only given up smoking in public places but stopped smoking at home when children are present. We monitor such things all the time, so we get a picture of people’s health, and in addition a number of things are monitored in education.
There is a lot of routinely collected data. The challenge is to put it together in ways that give us a global picture of the way in which performance across a range of dimensions of child wellbeing is improving in Scotland, and work to do that will continue. The money is already out there. It is being used to produce routine statistics and so on, and that will continue.
There are also opportunities in the Children and Young People (Scotland) Bill, because it requires local authorities and health boards to prepare reports about how they jointly plan their services to deal with children and families. There are opportunities through the guidance that will accompany the legislation to make sure that it dovetails with the work of the collaborative and other work that is going on across Government, whether that is through the getting it right for every child programme board or the work that we do for looked-after children. There are opportunities to ensure that the work that Sir Harry spoke about goes into the returns that we get through the plans that local authorities and health boards will jointly have to prepare when the provisions in the bill come into effect.
The plans sound exciting and they are hugely appealing. I know about some of the difficulties in the early days involving NHS Highland and Highland Council, but the appeal of the plans lies in the fact that they will bring CPPs together. I therefore assume that they could be seen as grass-roots, bottom-up solutions, with people at the front line sharing their experiences.
Absolutely. The Christie commission spoke about things being top down and people not working with communities and with families’ assets. The collaborative is about changing that and turning it on its head, as it is reflecting local environments, working with people to demonstrate to them what they can do and helping them to improve their lives, and the CPPs have absolutely bought into that.
At the learning sessions that accompany the collaborative—I think that the fourth one will be held in a couple of weeks—we have had 700-plus people in one room at the Scottish exhibition and conference centre, talking about how they can collectively change the way in which they do business to ensure that the early years are prioritised, that prevention is the hallmark of what they do and that they embed good local practice and share that knowledge. The enthusiasm has never stinted or wavered at all through those learning sessions. I cannot be dead certain, but it is probably the first time that we have had that number of people in one room talking about these things collectively. There is a session coming up soon, and if members want to see it for themselves and get a feel for the change that the collaborative is inspiring right across Scotland, we are absolutely happy to extend an invitation to you.
Harry Burns may want to add to that.
I tend not to be fazed by public speaking, but the energy in the room at those sessions is astonishing. The first time I walked in, I thought, “Wow.” There were 800 people sitting there, with people from every single CPP in Scotland plus people from voluntary agencies and so on, and boy do they want to pick this up and run with it. Ultimately, they are the ones who are delivering the change, and it will be embedded in their practice. The sessions really are worth a visit. You will not have seen anything like it.
It is probably also worth while for members to try to get a feel for and a grasp of the tests of change that are happening in your local areas. There will be ones in each of your local authorities that you can go and see. One good tangible example that I have seen is delayed cord clamping, which is happening in the midwife-led maternity unit in Montrose. The point at which the cord between mother and child is cut is delayed, which allows some of the blood to flow back. I am no medical expert—I am just paraphrasing—but that allows the nutrients to go back into the baby, which allows the baby to thrive a bit more quickly.
The unit is testing that small change, and if it can demonstrate that it works and can gather the data, it can start to consider how it might scale up such changes. Members can not only look at what is going on in their areas, but ask for the data to demonstrate the impact that the changes are having on children’s lives.
One of the actions that Finland took on diet was educating people along with switching from farming dairy to farming berries as a basic. Scotland is in a similar situation. Is diet part of the programme too, given that it is recognised more and more as a huge part of health?
I see that Harry Burns is itching to come in, but I wanted to add that Perthshire, where I am from, is the soft fruit capital, and that the Clyde valley, the area that I represent, is also famous for its soft fruit. Given the abundance of local produce in Scotland, we should perhaps look towards the Finnish example. As Jean Urquhart pointed out, Finland recognised that it had a problem and used its resources to tackle it.
In addition, some of the agencies that we are talking about bringing together to deliver change are part of organisations that do not necessarily promote healthy eating. There is still criticism of hospital food, for example.
I think that Harry Burns wants to come in now.
Finland is a sore point with me.
Oh—sorry.
The percentage fall in heart disease mortality from the 1960s to the 1990s in Finland, which it attributed to the change in taxation and subsidies for farmers, is exactly the same as the percentage fall in heart disease that occurred in Scotland over the same time. We attribute the fall in Finnish heart disease to a significant fall in male smoking rates and an increase in the use of new therapies such as statins. It is hard to attribute the fall in heart disease in Finland to a change in diet.
In addition, the evidence base for five-a-day actually came from the fruit growers of America. There are a lot of myths out there but, having said that, I think that it is clearly very important to avoid obesity. The high-fat, high-sugar diet that a lot of us eat is certainly the driver behind much of that problem, and there is no question but that eating more healthily will improve health and wellbeing. For example, the impact of the childsmile programme has been as great as the impact of fluoridation would have been. It has been astonishing, and it has centred on a dietary intervention—namely, breakfast clubs.
There is a lot that we can do, but we must be mindful of what our expected outcomes are. I am certainly with the minister in taking the view that we need to tackle obesity in a significant way.
Going back to Jamie Hepburn’s point about the importance of the free school meals policy and the opportunity that it presents, I think that there has been a huge improvement in school meals, and there is a further opportunity to build on that.
I am already feeling slightly less guilty that I do not eat five portions of fruit a day—
Oh, you should. You must.
And vegetables—there are potatoes in chips.
And there is marmalade, too.
As I understand it, the change fund, which has been the main focus of our discussions, provides a bit of extra money in the short term to try to change attitudes. We have talked about the way in which we do things; I am interested in disinvestment and whether we are really shifting—and whether we can shift—resources from one group to another.
Minister, you are responsible for children and young people, and if we shifted resources from older people to younger people, that would probably boost your budget. However, in your area of responsibility, we are wanting to spend less money on 16-year-olds and more money on three-year-olds—that type of thing. I refer to a report that we published in which we mentioned that a couple of times. We said,
“The Committee is concerned that there appears to be a real lack of evidence of the necessary disinvestment taking place to support the shift towards a preventative agenda”,
and we asked the Government to provide examples of resources being unlocked for preventative measures. Can we move resources from an older age group to a younger age group?
10:15
We have established the early years collaborative because we know that spending on the early years pays dividends in later life, but I would hesitate to say that that means that we should not spend money on 16-year-olds. We should always remember that we can intervene effectively in a young person’s life at many different points to change their life course. For instance, last week we announced that we want to allow looked-after children to stay in foster, residential or kinship care up to the age of 21 if they want to, because we know that that can help them to lead more positive lives and avoid graduating to Polmont, where a disproportionately large number of young people who were looked-after children end up. We are doing such things to prevent negative consequences later in life. That is an example of why we do not always want to concentrate on the early years and how we can intervene effectively at many different points in a young person’s life to prevent problems from arising.
The question of disinvestment is a good one and is probably much more tricky to answer because we have not had any specific examples, from the change fund returns, of that happening. Nevertheless, people are working together to achieve their shared priorities at a CPP or task force level and are pooling their resources to allow that to happen. We need to try to be a bit more sophisticated in teasing out potential examples of disinvestment through further monitoring of how the change fund has worked and what change has happened.
If we enhance attachment and nurturing behaviour in early life, we will have fewer looked-after children and fewer young men in prison. If we think about the demographic issues that are affecting the whole of western society—the small base of young productive people and the big base of dependent elderly people—we see that the situation is worse than we thought because the small base of young productive people is made even smaller by the fact that 10 or 20 per cent of them are not contributing; indeed, they are costing society a lot to be looked after. The aim of the early years collaborative is to broaden the base, as those young people who are not contributing will become the dependent elderly. You will hear more later about work that is being done to reduce the burden of dependency in the older population.
There are big macroeconomic consequences of this that should not necessarily mean active disinvestment but might mean that we just do not spend money on looking after children who have not experienced adverse events through drug-misusing or violent parents or whatever but have just lost their way. That is what the American economic evaluation showed led to far more stable families with children growing up to be actively involved in the labour market and not sustaining serious illness.
So we might not see what some of us thought we would see—major changes in the way that we use resources within, say, the health service or whatever. The change will be more in the way that we use the resources for particular age groups.
It will happen naturally. If we reduce the number of looked-after children by 50 per cent, there will be a natural realignment of spend. I do not think that anyone is saying that we are actively going to take money away from areas that we anticipate will not need it in the future.
You have cited figures such as that for every $1 that was spent in the States in the 1960s, there has been a saving of $50 or $60. I am an accountant and I want to see where that $50 or $60 is.
It is a return on investment of $50 or $60, which will be in things such as increased tax income because people are in employment who would not have been in employment. A return on investment is different from a saving.
Okay. So some of that is a saving and some of it is extra income or whatever.
Yes.
We were told about a case somewhere in the States in which a decision was made not to build another prison but to put the resources into children or whatever, which sounded like a great idea. That was a real saving—mind you, I do not know what was done with the extra prisoners in the meantime.
I would not be the least bit surprised if, 20 years from now, we shut a prison, because young people do not end up there.
When I was asked for an opinion for the review of community planning, I said that the early years collaborative would get things started off well but that we should have a reducing offending and reoffending collaborative, because the turbulent young parents who end up in prison go back home and create a turbulent early environment for their children. We should get them on the right track while they are in prison. We should also consider having a collaborative to reduce dependency in older people and to keep them fit, active and engaged. Added up, all that will transform people’s quality of life.
The registrar general’s report talks about the fact that, at the moment, there are about 750 people in Scotland who are over the age of 100. He anticipates that, by 2035, there will be 8,000 people over the age of 100. We must get those 8,000 people out there running half marathons and things like that. We need to be ambitious about transforming people’s quality of life, their productivity and their connectedness within society.
Yes. I suppose that I am still a bit puzzled, because the change fund is a short-term, temporary measure to kick-start something new. If I have understood the minister correctly, the resources that have been put into the change fund from health and local government will still be there to do the work in the future but, going forward, do we not need to spend more money on one to three-year-olds, or is it all about collaborating and doing things differently? If we need to spend more money on the young kids, that money has to come from older people or teenagers—surely it must come from somewhere.
As I have said, the change fund is about kick-starting the change to allow us to ensure that we can bend the spend on the early years more effectively. Local authorities and health spend £2.7 billion per annum on the early years. How can we use that to maximise the potential that we can achieve if we do things in a better way, as outlined by the collaborative and Harry, in what he has said today? We want to bring about that change, and the change fund has allowed that to happen and has enabled us to move forward to the work that the collaborative is doing.
You do not think that we need to bring in more resources from somewhere so that we can put more into the early years. It is more a case of how we use the resources and rearranging things.
In the first instance, that is what we are doing—we are trying to change the way in which we spend but, of course, other things are happening, not least welfare reform, which local authorities have cited as a particular challenge that they have to deal with. We are in a climate in which other things are happening that need to be coped with.
However, the collaborative is demonstrating results. Brain science tells us that we should be doing more in the early years. If we know that we can provide nurturing, loving homes for children and can care for them in the nine months before they are born, that can set them on a firm footing for a positive life later on, in which they can contribute fully to society and to the economy, and can have their own children who will be born into a nurturing environment. We are talking about a perpetual cycle that can have long-lasting implications for Scotland as a whole, not just socially but economically. We are taking the first steps on that journey with the change fund and the collaborative. As we have said, we are in the early stages of bringing about the transformational change that we want to see.
A number of local authorities have said to us that they are using the change fund—as we anticipated—as bridging finance. While they reorientate from one pattern of spend to another, there is a bit of double running. In the context of two and a bit billion pounds, the change fund is pretty marginal. It is designed to provide such bridging. I think that it is being used for what we anticipated that it would be used for but, as the minister says, all sorts of unanticipated things will have to be dealt with in the future. There will be new science and all sorts of social changes that may cause bigger problems. It is hard to predict but, at the moment, it is behaving as we expected it to, and is allowing a reorientation of activity.
You talk about a reorientation of activity, but difficult decisions regarding disinvestment will have to be made to ensure that preventative spending becomes integral to service delivery. In its guidance on the early years change fund, the early years task force states:
“The decision to disinvest will be difficult, but if we are to make the shift we need, those decisions are crucial.”
That suggests that disinvestment is essential if we are to access the resources that we need to put into the areas that will provide the benefits that we all seek, given the challenging economic times.
But we would hope that that disinvestment would come because CPPs and areas in general discovered better ways of doing things.
An academic from the south of England recently produced a report that calculated that, over the course of several years, a looked-after child costs society £2 million, on average. How many looked-after children do we have to avoid having in order to be able to fund the change? The number is relatively small. The aim would be to have every family being a nurturing place so that we are in a position in which very few children end up in that unfortunate position.
You mentioned the issue of running in parallel. Do we have the resources to enable us to do that? We have got these folk in care just now, whether we like it or not, and we have to fund them. Obviously, we want to ensure that there are fewer of them in future but, while we are creating the environment that enables us to have fewer people in care in future, we still have to fund those who are already in care. That is surely where the difficulty lies.
We have to see what emerges. The point about the collaborative and letting those on the front line design the change is that they will come up with things that we cannot anticipate. That is emergent thinking. They will find things that, with the best will in the world, we could never have predicted. We have to let things run and see how quickly they produce the change. The American experience would suggest that it will be at least a decade before we begin to see the full benefits of reduced spend in dealing with adversity.
It is also worth pointing out that, at a CPP level, jointly agreed priorities will be set out in each of the single outcome agreements as well. People will have to get into quite rigorous and robust discussions about where the priorities will be and where they will direct their spending. I cited the example of Angus Council integrating early years services and social work family support. That integration will allow the council to move forward in a positive way, and it is the result of discussions within the council to try to achieve the priorities that it has set itself, working in tandem with what is going on in the collaborative and what we expect of the council with regard to its responsibility in relation to early years.
You have mentioned the Angus Council example twice now—
It was just a for instance. There are probably good examples—
Is that being rolled out across the country? Do you have an example of something that is being rolled out elsewhere in the country as a result of a collaborative?
I am sorry—an example of what?
One of these initiatives. Earlier, Mr Burns was talking about eliminating patchiness and sharing best practice. Do you have an example of how that is working in relation to the collaborative? Is the example of what Angus Council has done being rolled out, or is it just going to help the people of Carnoustie and Arbroath?
The collaborative provides a method whereby, at each learning session, every local authority will discuss its good practice and the things that it has done to help it to achieve the collaborative’s stretch aims. However, one example of a national roll-out that has come about through the change fund would be the family nurse partnership. That is being rolled out across the country. It will be working in partnership with good parenting programmes in each local authority and, at a local level, some other work that will be done with the third sector.
10:30The other thing that we have rolled out is roots of empathy. That decision was taken by members of the task force for the change fund. Scotland is the only country in the world that will have rolled out roots of empathy countrywide. That will not be for every school, but it will be for every school that requires that additional assistance. Those are things that we are doing in the earliest years of a child’s life to enable us to realise social and economic benefits later on. They will enable those children to form relationships and attachments in adult life, allowing them to be good parents and keeping the perpetual positive cycle moving forward.
Those are two examples of national roll-out of good practice that will be working with local authorities to allow that to happen. It will be happening in schools in members’ local authorities. That is the local dimension to the national roll-out.
I have already visited a school in my constituency that has roots of empathy.
It is very good, is it not?
When the change funds—not just for the early years but all the various change funds—were being set up, a number of stakeholders who gave evidence to the committee said that they were worried that not all the money would end up going on preventative spend. A year and a half or so into it, in your view has all or most of that money gone on preventative spend? Is that something that you track and can tell the committee about?
The £50 million that was new money has gone on a number of projects, not least roots of empathy and play, talk, read—all of those things that we know work to enable parents to be as good as they can be.
The early years change fund returns are available online and you can look for more examples of what local authorities have told us they are doing in their CPPs to try to bring about the preventative approach that we seek. Although a lot of what is happening will be very much the nitty-gritty, some of the headline findings are in the change fund returns.
It certainly seems as if the money has facilitated preventative spend. As we have said, some of it might be used to backfill staff who are involved in prevention development work. Technically speaking, therefore, the money is being used in a slightly different way, but it is still facilitating preventative spend, and I guess that it would be logged against that.
You have given some good examples of where the money has gone on preventative spend. I just wonder whether, if we were to invite the same stakeholders back to give evidence two years down the line, they would raise the same fears with us or whether they would say that they were worried about it initially but that, in practice, the money had pretty much gone on preventative spend. Do you track that specifically?
We have had the first run at getting feedback on what local authorities are doing individually at the CPP level—the changes that they have made and how they have approached the change fund in their area. We have got some of that information back, but it has been a learning exercise in itself. We will probably need to reflect on what we have been told and what stakeholders have told the committee, and find out what we can do to monitor the change fund and improve on the information that we get back as we go forward.
Nevertheless, it has been a catalyst for change, which has enabled collaborative and other forms of work and ensured that there is more joint working and more of a joined-up approach. There has also been more embracing of the third sector and what it can do to allow us to achieve the aims that we have set out, whether that is in the early years framework, the early years task force or the early years change fund. The Children and Young People (Scotland) Bill is another important tool in bringing about a much greater level of working together in local authorities and health boards throughout the country.
One of the issues that cropped up was the high-level outcomes, which you outlined. You suggested that there are a number of processes underneath each of those outcomes; I think you said that most of the work and the analysis so far has looked at the change to processes. I accept entirely that it is early days, but has any work been done on the high-level outcomes? You have anecdotal stuff, obviously, but has there been any formal measurement?
There is constant observation, which is part of our routine monitoring. That is why we chose the high-level outcomes: we were measuring them anyway, so we would see the change.
The experts on collaboratives, who have seen them in many different settings—mainly in the delivery of healthcare—say that for the first two or three times that learning sets come together, there is intense frustration because people want to see change but it has not yet happened. We are beginning to build it up. We are about to have learning set 4, in which some significant changes will begin to be reported.
It is far too early to see the high-level outcomes. The first learning set was in January 2013, so it has been going for a year. We would report such things as infant mortality a year behind, so we have not seen that yet. I do not want to pre-empt anything, although I am itching to see those results.
Sure. I will not pressure you on the point.
There are probably good examples in your own patch of Lothian and in Edinburgh. One such example is that by the end of 2013, 90 per cent of parents at Tynecastle nursery sang or said number rhymes and songs for their child at least three times a week. That aim has been achieved with the morning group and because that seems to have worked, it has been scaled up to include the afternoon group.
There are high-level aims but, beneath that, tests of small changes are showing that once we are confident that we know what works, we can scale it up to benefit far more children. I offer that as an example in your area.
Thank you.
You touched on disinvestment and answered a number of questions on it from the convener and the deputy convener. Paragraph 2 of your paper says:
“The Health and Local Government monies”—
which is the lion’s share of the money—
“are a blend of currently allocated and redeployed resources.”
I still feel that we have not got to the bottom of the issue of redeployed resources. Some great interventions are happening—you have highlighted a number of them—but if those resources have been redeployed, they must have come from somewhere else. It is not all new money; only the Scottish Government slices new money. Where has that money been deployed from and are there interventions that are being scaled back or ceased either because they do not work at all or because they are not as effective as the collaborative approach? Something must have been scaled back if moneys have been redeployed.
It would be for local authorities to talk about where they have taken a local decision about how they have brought their share of the pot of money to their partners at CPP level. Local government money has been a blend of new and currently deployed money. Beneath that, it would need to be a question for the 32 local authorities about what they have done locally—how they have come to bring that particular part of their pot to the table and what they have done to redeploy it. In the returns, that is the message that we have had: it has been redeployed and it has been maybe additional money as well.
Our money is the new money and health has brought to the table money that is currently deployed. The childsmile programme used one parcel of the money that health brought to the table, and it has now been expanded to enable a lot more children to benefit from it. There is a blend of old and new money. Scottish Government money is new money, but that is only a small percentage of the larger pot that is spent on children, which is £2.7 billion. The pot of money for early years is 10 times what we have in the change fund.
Forgive me for dwelling on that point, but at this stage you are not sure where the money is being deployed from; you would have to check with local authorities. Will you ask them that question?
Each local authority has done it in its own way and taken that decision locally. We know that the money may have been new, additional or realigned. The returns from the CPPs show some examples of what they have done, which is additional.
I mentioned the Highlands model, which is an additional recurring £2 million for early years services. That has been allocated by Highland Council for 2013-14 and 2014-15, and work is taking place to identify further preventative spend across partners. Highland Council is therefore working collaboratively to find out where it can leverage in more money at local level, but that will not be the same for all the 31 other councils. We will have to drill down further and ask them what they have done to create the pot that they have brought to the table.
My question is also about disinvestment. Sir Harry Burns mentioned that a lot of the ideas that we are dealing with here are not new; they have been around for a long time. We have also had change funds in different forms. We used to call it pump priming, and we have heard it being referred to as bridge funding. The ideas are not new.
The Finance Committee said in 2011:
“difficult decisions regarding disinvestment will need to be made”.
We have taken evidence previously from the directors of social work, who said that such decisions were being made and had always been made but that difficulties arose when leadership was required about budget decisions or political decisions; that is part of the problem.
In order to avoid déjà vu happening all over again, how do we get to a position in which, when the decisions that have to be made to shift budgets to redesign services and to make viable change happen—decisions that all the practitioners such as the clinicians and the front-line staff can buy into—they are not made because of short-termism?
Harry Burns has talked about this. We are looking at the long term and talking about avoiding what happened in the past when people suffered from projectitis and new things were springing up continually. We are ensuring that a longer-term approach is taken to tackling some of the persistent issues that we face in Scotland.
You mentioned the leadership role. There is an expectation within the joint work that CPPs do and clear expectations that local authorities and NHS and other public bodies will sit around the table, share budgets and resources, and have discussions about that at that level, as well as deploying those resources in a way that meets the priorities and needs that have been set out, whether those are local priorities or the priorities that are set in the single outcome agreements. Those are some of the ways in which we expect leadership to be shown, so that resource is shared and we get the maximum benefit from the money.
One would hope that disinvestment decisions would be made on the basis of taking money away from things that do not work and putting it into things that work. The whole point about the early years collaborative—the whole point about any collaborative methodology—is the test of change. You have heard the term “test of change”. That test is about finding out what works. We do it to three people today and, if it works, we do it to five people tomorrow; if it still works, we tell everyone about it. That is it.
We are doing something here. We are doing something with mothers and pregnant women who smoke, and what we are doing works because it stops them smoking. Let us therefore put money into that and then find the things that are not working and which do not contribute to the aim of making Scotland the best place in the world for kids to grow up. That is the principle underlying the initiative.
Although I understand perfectly that Michael McMahon wants to follow the money, it is the time that is money. We are talking about shifting the time that people spend doing things that do not work. Social workers tell me about all the bureaucracy and the form filling that they have to do, so maybe they will do less of that in order to do more of the things that work. Those are the kinds of decisions that will have to be made.
Again, making the system a bit more slick is one of the reasons for having the Children and Young People (Scotland) Bill. We want to allow people to do what they want to do, which is support families and children. Once the bill has been enacted, we will ensure that the guidance is robust enough to allow people to reduce some of the bureaucracy, to free them up to share the information that they need, and to allow them to help the most vulnerable in society. A lot of work is going on that complements the actions of the collaborative, and the bill is part of that.
10:45
I am not so much asking about chasing the money, or even about projectitis—I liked that phrase, minister. It is not about saying that a certain amount of money has been set aside for three years and we will now measure whether it worked. That is not what concerns me. I am concerned about the fact that history is littered with reports, analyses and programmes that have been devised with the buy-in of clinicians and service providers, but which have been prevented from progressing by the decisions of budget holders and, unfortunately, even politicians. I am not pointing the finger at anyone, because every political party is guilty of making short-term decisions to avoid bad headlines or to try to create headlines for political benefit. We are talking about a cultural change but, from my experience, we do not need a cultural change within the services, because the clinicians will lead the changes and will be enthusiastic about reform and development of services. The problem comes when the leadership from those who have the budgets does not allow that transformation to take place.
Sir Harry is nodding, so perhaps he wants to respond.
That makes a lot of sense to me, because I have lived through that time. I am confident that, in the next year or two, we will see movement on some of the high-level aims. Who would want to reverse that? We have to go on the basis of the evidence. As I mentioned, last week, I had 40 international people here in Edinburgh, all of whom are involved in a programme that started off as a programme to transform healthcare. However, after we had spoken to them, it became a programme to transform health and, after that, it became about transforming the notion of assets in delivering health. Those academics, who were predominantly from all over Europe and North America, although some were from Africa, have seen in our approach the most striking evidence, and they now have confidence that it will succeed. They want to know more about it, and to come back in six months.
We have struck a chord internationally, so I would be intensely disappointed, not to say furious, if middle managers in the system dismantled something that has a real chance of transforming thousands of lives. If I get any scent of that happening, I will come back and name names. We have something very important here, and we need to stick with it.
To back that up, I point out that the reason why we have the leadership strand in the early years collaborative is to ensure that we get buy-in at the top levels. I think that that will go some way to enabling the process to continue at the current pace and to continue the momentum. If members want to come to the collaborative’s next learning session, just to get a feel for the amount of good will and commitment to the agenda, an invitation is open to you. The next one will be on 28 and 29 January, if you would like to come along.
I will certainly consider that.
I thank colleagues for their questions. Obviously, Malcolm Chisholm, because of his involvement in the task force, had a self-denying ordinance in terms of asking questions.
I see that the witnesses have decided to pack up, but Ah’m no finished yet, so haud yer horses.
Sorry.
Obviously, I am concerned about Sir Harry’s comment that there are still projects out there that do not work and which we are still spending public money on. Michael McMahon talked about leadership. A couple of years ago, when we took evidence from Birmingham City Council, we were told that, although the leadership is in place there, sometimes there is real inertia on the ground. The council told its social work department that some of the practices in the department had, over 20 years, failed to produce any positive outcomes whatsoever. The difficulty was that the people who had been delivering the service had an emotional attachment to it and thought that it was positive and effective, but it did not turn out to be so when the outcomes were analysed. Inertia can creep into a system and prevent change at every level.
Another thing that has come out in evidence to the committee is that the change funds are being used to prop up existing service provision at a time of financial challenges to mitigate funding pressures. I am keen on hearing how we can tackle that. However, I return to one of my initial questions because I want to finish on this issue. NHS Greater Glasgow and Clyde stated that it needs
“breathing space to provide some of the bridging finance that enables us to address ... issues simultaneously”,
which means changing while maintaining existing services. NHS Fife said that there is a need to extend the change funds for another couple of years beyond 2015
“to fully deliver the future model of delivery that we all envisage.”
That view was shared by Glasgow City Council, which said that
“people are changing, and we must allow enough time for those changes to be delivered.”
The issue is whether it is appropriate to end, in effect, the involvement of health and local government funding from 2015-16 when so many health boards and local authorities say that they need a bit more space if they are going to deliver what the Scottish Government seeks.
The funding remains. The new funding of £8.5 million from the Scottish Government will tail off in the last part of the £50 million funding, but the local government and health money is money that those sectors have brought to the table. So, that money is there for them to be able to continue some of the changes that they may have made as a result of the change fund being in place. The money is still there for them to be able to move forward on the change agenda.
The figures in your submission show that the money from health and local government is £92 million for 2014-15, but that will go to zero the following year. The point that I am trying to make is that it is clearly not being specifically allocated for the purpose of change.
Yes, but they still have their resources to deploy in light of the evidence from the collaborative approach and the decisions and recommendations from the task force. That money remains with health and local authorities to enable them to continue to have the local discussions at the CPP level that we would expect them to have on sharing resource and budget. The money will enable them to continue down that path.
But given the concerns that have been expressed, which I have outlined, is there not a concern that there will be a loss of momentum in terms of delivery?
The collaborative approach remains; it is not stopping with the change fund and the task force. As I have said, we will review the task force in 12 to 18 months’ time to think about the work going forward. However, the collaborative approach, as Harry Burns and others have said, is not a short-term project; it is a long-term approach that will demonstrate long-term benefits. I imagine that the collaborative approach’s momentum will continue because it is changing lives and will change lives in the future. That momentum will continue beyond the lifespan of the change fund.
Thank you very much. Do you wish to make any further points to the committee before we wind up the session?
I do not think so. Thank you for your questions and your interest.
Thank you very much for answering our questions. I thank committee members, too.
We will have a short suspension until 11 o’clock to enable members to have a natural break and for a change of witnesses.
10:53 Meeting suspended.Previous
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