Preventative Spending and Early Intervention
Good morning and welcome to the fifth meeting of the Finance Committee in session four. Agenda item 1 is to take evidence from Graham Allen MP. As members will be aware, Graham has been responsible for, or involved with, three key reports on early intervention and preventative spending. He has also been involved in delivering early intervention in Nottingham, where he chaired the local strategic partnership, One Nottingham. I welcome Graham Allen MP and invite him to make an opening statement.
Thank you, convener. It is a great privilege and honour to be here and a new experience to be on this side of the table. Thank you for inviting me.
My best way into this is to tell you a little bit about my personal journey. I represent Nottingham North, which I characterise as a white, working-class area of former council estates across the north of the city of Nottingham. It is where the people lived who worked in the mines or the textile mills, or made Raleigh bicycles, which members may know were made in Nottingham. None of those jobs exists now. Along with much of our manufacturing, they have gone down the river. That does not help to address the social deprivation that we have.
Two statistics will give members a sense of my constituency. Until a couple of years ago, we had the highest teenage pregnancy rate in western Europe and we sent the fewest number of kids to university of any constituency in the United Kingdom. Members may have an impression of Nottingham as a prosperous place with universities, football teams, a cricket ground, a castle and all the rest of it. I am the other half of that city.
I have been a member of Parliament for 24 years and have set out my stall to try to do something about the situation in Nottingham. One of the things that I have noticed in my constituency, as I am sure that members will have noticed in theirs, is the intergenerational nature of a lot of the problems of dysfunction. We can define dysfunction in many ways, but its symptoms, whether drink and drug abuse, lack of educational aspiration, or not aspiring to work and spending a lifetime on benefits, are very evident, certainly in my constituency.
In attempting to tackle that I had, in a sense, a lucky break in that I was one of the people who organised the biggest rebellion in a governing party in British political history. It was against the Iraq war and it rather deflected my meteoric ministerial career towards the prime ministership into—
Surely not a local strategic partnership.
—the back benches. At that moment, fortunately, the people in Nottingham asked me to chair the LSP. I did not even know what that was, but it is the local strategic partnership. I believe that it is comparable to the community planning partnerships in Scotland. It pulls together all the public sector bodies with the private sector and third sector. Having some executive power as a member of Parliament is quite unusual and I set the mission for what became known as One Nottingham—for Nottingham to be the first early intervention city in the UK—and we set about doing that.
To cut a very long story short, we have about 16 policies in the generational cycle from zero to 18. Anyone who sees me describing a circle in the air with my finger as I have just done will know it is like my signature tune. We look at the baby as the potential parent of tomorrow and consider what we can do to end the dysfunction that runs round in families. In essence, we came to the conclusion that early intervention could be defined as giving every baby, child and young person the social and emotional bedrock that they need to make the best of themselves.
You all know what that means because you got it from your parents and you passed it on to your children, but there are all too many families where that intergenerational transmission of skills does not take place. We can either step back and deal with the consequences of that or get stuck in and try to help people, when they need it, to develop such skills not only for themselves but for their babies, children and young people above all. That is what the cycle of policy seeks to do in Nottingham.
I will quickly run through some of the key policies. The family nurse partnership, which I think now has a couple of experimental pilots in Scotland, has taken place in 60-odd different places in England and Wales. Its purpose is to give direct, one-to-one health visitor assistance to teen mums. That is really what health visiting should have been about for a long time, but we have tended to turn our health visitors into clerks with enormous case loads.
Our health visitors help the mums from minus nine months, if possible, to when the babies are two. We obviously then have our sure start and children’s centres; then at primary school we have the social and emotional aspects of learning—SEAL—programme, which teaches children how to interact, relate, resolve arguments without violence, be empathetic with their peers at school and how to learn. Again, you may take that, as I do, as almost second nature, but there are families that just do not have that at home. We either help such children when they need it or we pay for the consequences later.
We continue the cycle round into the teen years of secondary school. We have developed a programme called life skills. Members may have heard acronyms such as PHSE, SRE and this, that and the other. Basically, we have called all that what an ordinary person can understand: life skills. The programme gives teenagers in our city the ability to understand what it is like to have a family, raise a child and make and sustain relationships. Again, that is stuff that they will not get at home in all too many cases. So, that is the Nottingham snapshot, if you like.
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As I was doing that, I came across Iain Duncan Smith, who had had his own catharsis having been the leader of his party. I think that he spent some time in Glasgow, which opened his eyes a little bit as he had come from a leafy outer London suburb. He got a sense of some of the very serious social problems that exist there, and all credit to him for doing that.
Our paths coincided and we were both talking the language of early intervention. One of the things that struck me as being really important was that if we are going to make intergenerational change, all parties must be signed up. We cannot stop and start. There must be a steady programme of development and steady and sustainable investment—of less than enormous amounts of money, it should be said—over a long period of time: a generation. Everyone must come to the party and I am delighted that the leaders of the Liberal Democrats, Conservative Party and Labour Party all did nice blurbs to say that both my reports were going in the appropriate direction.
I did a little book with Iain Duncan Smith and I would be pleased to send that to people. It is a bit more manageable than the two enormous reports that have been sent your way. It is a couple of hours’ read and gives a sense of early intervention, why it is important and what the evidence is to support it.
Iain Duncan Smith came to power with the Conservative Government and he and the Prime Minister asked me if I would do two reports on early intervention, which I have now done. In January, I published a report that outlined what early intervention is and how it can be progressed, and the second report was a little more about finance and how we might pay for early intervention. I would be very pleased to talk about those reports and answer questions.
They contain lots of recommendations, which are thankfully all compressed into the first couple of pages if you need a quick scan of the field. If I had to pick one recommendation, it would be that the work should continue. Lots of people do reviews and they are then put on the shelf and nothing happens. I was always determined that there would be a continuation of the work into reality; I am a politician and I want some outcome from all the effort I have put in during the past year or so.
The key thing for me is the creation of an independent early intervention foundation that is separate from government and that can continue the work. In essence, the foundation would pull together all the really great practice that is out there, much of it in Scotland. Indeed, there is a preponderance of creativity and initiatives in all the places where there is a more devolved settlement than there is currently in England—but don’t get me started on that. One day, with your help.
There is also great practice in parts of the north-west of America. Washington state and Colorado are doing tremendously innovative work. I would love to be able to pull all those things together as a package within the foundation and then have local authorities, third sector bodies and charities draw that information down in a comprehensible way to enact in their own areas, as they see fit, the sort of programme that they need. Different places will need different things from a big menu. I want to pull together best practice and the evidence-based work.
We hear a lot about the evidence and we have to chant the mantra “evidence based” to get in front of certain people, but there is another reason why it is important. It is not just that the evidence proves, as much as anyone can, that something works. If we want to go to the second step and get non-government investment in early intervention, we must prove to a potential investor that such programmes work. That is not to disparage or dismiss the thousands of really good programmes out there. I am just saying that if I go to someone for money, they will want to know that, for example, Professor David Olds has been working on family nurse partnerships for 30 years, and that they can see the evidence, take it away and deal with it.
Flipping back to Nottingham briefly, and separate from the work that I have been doing for HMG, I have been pulling together a consortium of people to try to finish the last third of the teen mums programme. We have dealt with two thirds of it through the family nurse partnership, but my ambition is to deal with every teen mother in Nottingham. To deal with the final third, I am talking to the Department of Health in Whitehall about a payment-by-results scheme because the evidence base on family nurse partnerships is so strong. I would be pleased to talk about that further.
There is a whole field of issues relating to how things are financed and how we will develop the market in social finance, which is very immature at the moment. Nonetheless, it needs to be helped and moved along. In my second report, there is a lot of work on incentives, tax possibilities, individual savings accounts, personal equity plans and other things that we may reinvent to make that market work.
Finally, I am sorry that I did not get to the committee earlier a letter from the Prime Minister, which I will précis. Perhaps this is almost an advert. I spoke to the Prime Minister at some length and raised the possibility of an early intervention foundation. He gets it. I should not quote him directly, but he said in effect that, if I could raise £10 million from non-Government sources, he would match fund what I raised in order to create an endowment. We would live off the interest, as it were, to create an early intervention foundation. I am trying to find that money at the moment, so a hat will go round at the end of my evidence session.
I thank the committee for inviting me to the meeting and for listening to me. It is a real honour to be here. I am happy to answer members’ questions.
We are delighted to have you here, and I thank you very much for your opening statement. I will ask one or two questions before other members ask questions, as is normal practice.
In your report entitled “Early Intervention: Smart Investment, Massive Savings” you raise the issue of overcoming barriers. We in the Scottish Parliament are keen on implementing preventative spending and early intervention. The arguments have been won, there is cross-party support and the Scottish Government is determined to pursue the ideas, but the Finance Committee wants to consider barriers. You say on page xxiv—I am pleased that Roman numerals are used—of your report that the barriers to early intervention investment going further
“include: a lack of funding certainty, which particularly affects local area confidence”.
How can barriers to implementation be overcome?
When I was running the local strategic partnership, the money that we received from the Government went up and down every year, and the criteria that the Government gave us—the guidance and its indication about where the money should be spent—changed every year. If there was a way of destroying continuity, the Government found it. I would almost be prepared to take half of the money if I could be certain that that would be the budget for the next five or 10 years and that I could get on and do the job without the criteria constantly changing.
The same point arises about sustainability. If we want to change dysfunction over a generation, we need a steady and certain financial disposition and government is not very good at providing that. It chops and changes and moves things around. That is why I am using the endowment model for the early intervention foundation. It will mean that, once the first payment is made and I have raised the matching funding, we will be independent and secure, so we will live or die by our own efforts. I suspect that most devolved Governments and most local authorities would prefer that criterion to rather dislocated spending that goes up and down.
In your detailed report you talk about a number of sources of funding, one of which I was quite curious about. You mention
“lessons learnt from tax credits within the Dutch Green Funds Scheme”.
It is good to learn from one another within the United Kingdom and to consider successful projects elsewhere. You talked about Colorado in the USA, for example. Will you tell us a wee bit more about the Dutch green funds scheme and how it works?
I do not know a great deal about the detail of those funds, but we were referred to them. There is a section on them in the report. In essence, we need to be open and willing to learn from best practice everywhere else. That must apply to financial matters as well.
Oddly, I expected a lot more help from people in the US, because I expected that private sector involvement would be much more developed there than it is. Strangely enough, we are sending expertise in the other direction.
For example, Social Finance Ltd, which is probably the leading organisation in the social finance market at the moment, has set up an office in Boston. I believe that President Obama, rather like Scotland, has sought to put a certain amount of money aside to promote early intervention and preventative policies, and I think that Social Finance is trying to tie into that, although I cannot speak on its behalf. Similarly, Professor David Olds, who invented the family nurse partnership programme—one of the best evidence-based policies—is interested in what we are trying to do with payment by results, because that is not being practised in the US.
I was a bit taken aback by that. I thought that we could borrow a lot more on the financial side, just as we borrowed a lot on the policy side, from the creativity that exists in a genuinely devolved system of state capability versus federal capability. We are not proud; we will take lessons from anybody.
Absolutely. “Early Intervention: Smart Investment, Massive Savings” talks a lot about private sector funding and the return on investment. What do you mean by that?
There is a spectrum of involvement, from philanthropic giving—in which somebody gives an organisation £1 million because they know that it will do good work and, although they ask for a report, it is essentially the organisation’s money to use—right through to the other extreme, which is hard money from the city of London that wants to make a return and a profit.
If we can get the foundation running and, in its second phase of development, consider some of the financial instruments, we can do something that will appeal to hard-faced city types, who have no interest in the children in your constituencies or mine but can see that there will be a return on their money. That is where we need to get to ultimately, but the social market is somewhere in the middle. It is people who want to invest and want their money back but will not demand the top rate of return. That is where the social market needs to develop.
A lot of work and a lot of thinking is going on, such as the flowering of ethical funds, the experiments that Social Finance is doing in Peterborough on recidivism among prisoners, and another four payment-by-results examples—they are in all England—that are coming out of the Cabinet Office. However, that work is not all pulled together and, as you probably picked up from the second report, coordination within the Whitehall Government is not as good as it could be.
Even towards the end of my review, I kept finding little experiments tucked away in corners, perhaps because people were anxious about their budgets. Good stuff was going on, but it was not being shared and the Cabinet Office was not pulling it all together. It should pull it together, but an independent body could also do that. The information should then be available to everyone at low cost or, if at all possible, no cost. That would include Scotland, Wales and Northern Ireland, which are nominally not included in that experience at the moment.
I want to ask for clarification. I understand perfectly how such investment can produce a return under the broad heading of spend to save, but you talked about producing a cash return for hard-headed investors. Will you explain how that might be achieved?
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It can be achieved if certain benchmarks for achievement and outcome can be met. Let us stick with the example of family nurse partnerships, in which a health visitor goes in and helps a teen mum and her baby. The clearest way to demonstrate the effect is to have one cohort of people who are involved with a family nurse partnership and one who are not. The programme finishes when the children are two. If we can extrapolate from all the other factors that are involved in families and demonstrate that those in cohort 1 achieve better at school, are school ready at four or five and have the appropriate maths and reading capability at 11 to go on to the next school, we can put a price on the approach or monetise it. If we can put a money price on it, we can normally get Government to pay to achieve the outcomes of the first cohort rather than the other ones.
First, we need someone to take the initial risk and to carry the burden of the programme from birth to age two. An example of how that is working now is the work programme that the Government has introduced on a payment-by-results basis. Big service providing companies—they need to be big to carry the initial burden of expenditure—such as A4e, Ingeus or Serco will take on the risk on the basis that, when they demonstrate to the Government that benchmarks have been met, the Government will pay. The Government will save immense amounts of money that would otherwise go on remedial teaching, dealing with low educational attainment or lifetimes spent on benefits.
That is the basic model, but we are early in the process. There is a role for pioneers to take the work forward. Many different models might be possible.
In the local partnership in Nottingham, how did you get all the public sector partners to work together? It cannot just have been through the sheer force of your personality.
The likely answer is that it was through blood, sweat and tears. The key was probably having one clear mission and ensuring that people knew that we were serious about it. With that focus and leadership, the process was easier than just trying to keep everybody round the table happy. Everyone who came to the party knew that we were trying, for example, to get education to work more closely with health, the police and so on. In Nottingham, we reached the point at which the greatest advocates of having more health visitors were the police. Enlightened and capable—not soft touch, but tough—cops said that we needed to remove the tsunami of dysfunction so that they could concentrate on the job that they were paid to do.
Intervening early frees up immense public sector resource because it puts in place a series of filters that allows kids to start to achieve. They become self-starters, they love school, they want to do well and get a job and they want to have a family. That is wonderful, because they do not come on to the radar, which means that the cops can deal with the bad guys and that teachers are not crowd controllers but inspirational figures. It means that local elected representatives can focus on policy issues a little more than they do when they are trying—as I and, no doubt, committee members do—to deal with loads of people with difficulties that should have been resolved much earlier in the life-cycle.
I cannot do the accent, but I often quote John Carnochan, who I believe was head of homicide in Strathclyde and who is quoted in my report as saying that, if he had the choice between 100 extra police officers and 100 extra health visitors, he would go for the health visitors every time. Anyone who knows John, as I do, knows that he is not weak and willing and that he is a tough cop. He arrested the granddad and dad and now he is arresting the 15-year-old lad with a knife. He knows that the way to deal with the issue is to strip out the dysfunction before it becomes a public expense and he has to divert resources.
Quantifying that and monetising it is not easy, otherwise we would have done it before. However, particularly in the current economic circumstances, looking to do that will become more and more of a duty upon policy makers, wherever we are.
I am still intrigued. I agree with you entirely that, if we get the culture, objective, mission and leadership right, it makes the process much easier, but what about the mechanics? In your example, did the police pay for any of the extra work? How did you manage the financial arrangements and the non-financial contribution to the things that made a difference?
Where there is a will, there is a way. There was not a given structure. Beg, steal and borrow is a phrase that is sometimes used. I did match funding deals. For example, we entered into a match funding arrangement with the respect unit, as it then was, to get the family intervention project, which was pioneered in Dundee by Gill Strachan.
We got the probation service and the police to fund our programme that deals with the children of prolific and persistent offenders, who are those most doomed to repeat the intergenerational cycle. I threatened to pay for a family nurse partnership. It was all bluff, but the prospect that I might be in control of the partnership frightened the local health service so much that it decided to put the money up.
There are various ways to do it, but I am afraid that we do not have an effective central settlement to deal with such interventions in the localities. We therefore end up mixing and matching. Ultimately, the thing that guarantees such an approach is people’s commitment to the concept that early intervention is better than late intervention.
I constantly give the example that the cost of the project for the first tranche of teen mums in my city—there were 115 teen mums with their babies so, because some had had second babies, it was about 300 individuals—was the same as putting three lads in a secure unit for a year at 16 years of age. You can deal with 300 or three. The difference is that two of the three would reoffend. If I put it to people like that, it becomes a no-brainer. If there is such interaction in a partnership and everyone realises that everyone is in this one—the chief executive of the local council said that early intervention is now in our DNA—it becomes part of what we do.
It is a brilliant idea and I am totally sold on it, but do you have figures and details of how successful early intervention up to 18 years of age has been when compared against the investment that you have put in? Those figures could be used to show other organisations that it really worked and that, for example, you reduced the pregnancy rate in those age groups by X, Y or Z. If we are trying to get such an approach up and running, we could use such statistics to put it forward.
Yes, there is a lot of information out there. That is what I mean by evidence basing. Part of the spending on each programme is for proper assessment as you go. That produces the figures that you are thinking about. The most difficult figure to get is often what the cost would have been if we had not done it. That is what I mean when I talk about monetising outcomes. We can track the cohorts and say what the differences are between the ones with the intervention and the ones without it, but putting financial figures on that is a very detailed process, although it is not impossible.
For example, if we in Nottingham complete the arrangement on which we are at a very early stage with the Department of Health, it will set us benchmarks that we must meet. Those benchmarks must be sustainable. The officers in Nottingham need to deal with the officials in the department to agree almost contractually what the benchmarks are and what the saving is. We need to provide proof to the Government. At the moment, I can tell the Government that the saving will be massive but, obviously, that is not good enough—the Government wants the absolute money figure, and quite right too.
That is why we are at the sharp end. We are pioneering such stuff. As the family nurse partnership comes to Scotland, I hope that you are doing such work. Scotland is innovating on the roots of empathy programme, whereby a young couple take their baby into a school, with immense impacts on kids’ social and emotional development, even when they have siblings at home. That programme is just starting in Scotland. It would be easy to track the progress of kids involved and to benchmark them and their personal development against kids at a school next door that did not have such a programme. An attempt would then have to be made to convert that into real money.
I have seen cuts in preventative care in the national health service in Lanarkshire, because of financial cuts in the current economic climate. Does Nottingham have the same problem?
Very much so. The same problem applies nationally and is eating the seedcorn. We are talking about small amounts of investment for massive social and economic pay-offs.
The coalition Government at Westminster has set up an early intervention grant, which is to be welcomed, as it pulls together all the spending in one place. The only downside is that it is not the sum of the parts—it is quite a percentage down on what the previous bits added up to. That appears to be the climate in which we must live, which is why we must be creative and innovative about drawing in other money.
I served for five years as the LSP’s chair in Nottingham. When I left the One Nottingham structure, six people ran it. One person now runs it. We have managed to mainstream the spending back to the partners. The partnership was so effective that the partners have picked up all the spending. The initiative is now run by children’s services rather than by One Nottingham. I am sure that the chief executive will not feel that I disrespect him by saying that he is the chief executive and the bottle washer, too—he is everything.
I know quite a lot about the new deal programme and the training for work programme, which have been filtered into the work programme. If you are looking at financial incentives for early intervention, perhaps you can bear in mind my concerns about the work programme. When big organisations obtain a contract, they tend to cream money off the top. The rest filters through to other training providers, which must do the work and achieve the targets, although their financial input is considerably reduced. I am afraid that that dilutes the quality of programmes that are delivered to unemployed people. Will you bear that in mind when you consider joint partnership working?
What you say is spot on. We must learn lessons, particularly from the private finance initiative. Whether we are in devolved Government or—perhaps even more pertinently—in local government, we must all relearn skills in contract making. There are lots of local examples of people pulling the wool over the eyes of officers and officials in what was not their field. Some contracts were peculiar and extremely costly and did not deliver what was wanted.
The drive for that was that we wanted more schools and hospitals, which is a really good political drive. Similarly, the current drive is for early intervention, but we need to ensure that it delivers sound financial returns for the people who are pushing it forward. From our point of view—I am digressing, although I think that this is relevant—one of the big problems with the work programme in my city is that I have been the person to get the big private providers to meet local people and local councils. That is working quite well now, but it was not part of the deal and it happened only because I got involved—particularly over the summer recess—and all but convened meetings to get those people face to face.
There is immense expertise available. For example, we ran the future jobs programme in Nottingham, which was abolished. The great expertise that exists should be meshed in with the work programme to get the best value for everybody. Part of what I am doing with the early intervention foundation to prevent that from recurring is ensuring that the foundation is locally driven. I currently have a sort of advisory board of 27 different local authorities—soon to be joined, I hope, by some of the local government associations—which are trying to ensure that we keep the foundation on the straight and narrow so that it does not go the way that you describe.
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John Mason has a question.
Hello, John. How are you?
Very well, thank you. It is good to see you again.
I am interested in how quickly we can save money. The National Endowment for Science, Technology and the Arts has said that it is looking at disinvestment as well as investment. We have had one or two witnesses at previous meetings who have been very enthusiastic about how quickly savings could be made, but I am a little sceptical. Is that part of the equation as well? You have talked about raising money, which is fine although that will be difficult. The question is how quickly we can disinvest from other services.
That is an important point. We will still need to firefight and tackle the symptoms. I sometimes address gatherings of police officers and say that my ambition is to put them all out of work, although they should not draw their pensions just yet. We will need services that attack the symptoms for a very long time. We are in the smoke alarm business. If we can get these policies out there early, people will focus on the jobs that we pay them to do and we will be able to disinvest at some point.
It is very difficult to do that. Some of the barriers that the convener has talked about are to do with the retention of budget and personnel. What people have, they hold and will not change—they say that they will still need all those people. There are serious structural management issues to do with freeing up that money and those personnel once we get to that stage. We are a long way from that stage at the moment, so, like you, I am a little sceptical when people say that they will be able to show us something for the money this time next year. It is a long-term investment strategy, and it can be quite destructive if we insist on having stuff that produces an apparent gain in the short term.
I would even be so bold as to say that I am sceptical when people say that we have 120,000 disadvantaged or dysfunctional families and that we need to attack that problem and deal with it swiftly. In Nottingham, I set a target of dealing with the 50 most difficult families—I did not mince words about it; they were highly destructive families—and it has taken four years for us to deal with those 50 families. Therefore, I caution against destroying the longer-term credibility of the strategy by saying that we are going to make a lot of money on it early on. It is a strategy, not a quick fix or a tactic, and it will slowly start to layer money back over a considerable time.
I presume that, to be crude, there will be a quicker return in some areas than in others. You gave the example that the cost of helping 300 young mothers was the same as the cost of keeping three teenagers in a secure unit for a year. We are talking about a timescale of maybe 18 years, while their babies are growing up; whereas, if we do stuff with zero-to-twos, there might be a difference as soon as they start school, which might be only three years ahead.
Even earlier than that. At the same time as my review, there was another by Dame Clare Tickell, who runs Action for Children, which I think runs several hundred children’s centres and sure starts around the country. A number of us who were working on reviews used to meet and talk about these issues. Dame Clare was keen—and I supported this point in my report—for children to be assessed regularly. I am not clear about the situation in Scotland but, in my city, health visits stop when the child is around two, and the education provision does not start until the child is three or three and a half. Between those stages, the interaction and the exchange of information are not the best—let me put it at that level. However, if, as we proposed, there were regular sets of assessment, it would be possible to see very early if a child was not thriving educationally, for example, or whether greater help with social and emotional capabilities, or with interactivity and learning, was needed.
If problems are spotted very early, something can be done about them—and that is measurable. Teachers or nursery nurses can administer tests that will show that one child is back on track whereas another one is not. It is not rocket science to quantify the savings that are made by helping that little one get back to being a self-starter. The alternative might be £5,000 of remedial teaching, or additional help from a teaching assistant, for example. Such effects can be seen even before the age of five. If we can put half as much effort into early assessment and tracking as we put into throwing money at well-entrenched and deeply rooted problems—money that will not be especially effective—we will have a lot of young people growing up to fulfil their potential. Rather than being a drain on resources, they will be taxpayers.
There is a fantastic example of early and preventative intervention in southern Ireland. When babies are born, they are given hearing tests. The tests are simple and cheap, and they mean that any hearing problems will not go undetected until primary school, when more costly hospital treatment might otherwise be needed—with grommets, for example.
I wanted to ask about the SEAL programme. You mentioned basic core skills such as communication skills, working with others, and basic literacy and numeracy. Should more emphasis not be put on those basic core skills in primary school, so that, when kids come out of secondary school, they have those basic qualifications? Funds could then be released to be diverted into other areas of preventative care.
That is exactly where we need to be. In most families, experience at school is reinforced when the children go home. At home, mum and dad might be interested and ask questions, and the little ones will engage with their parents. The next day at school, the virtuous circle will be completed.
If at home there is no dad but just mum, she may have two or three little ones and, although she loves her children just as much as you and I love ours, she may not be able to give the same amount of help. If that mum can listen to an authority figure whom she respects—for example, a woman who has achieved a qualification as a full-time nurse or has become a health visitor—and who is also her friend, who gives the mum her mobile phone number and who, when three kids are screaming all at once, is there to offer advice, that will be better than the mum having someone who will just weigh the baby and ask whether the baby is receiving the right nutrition. That type of interaction and relationship with mum continues while the baby is growing up, and relates to all the skilling issues that we discuss in the reports.
The picture of the two brains that appears on the front covers of the reports is very dramatic. I would not ever claim that it shows two kids from Nottingham; it does not. One brain image is from a loved and nurtured child who is given every possible stimulation, while the other one—the smaller cranium and brain—is from one of those unfortunate children in the Romanian orphanages. They had no stimulation, not just for a day but for months and months, other than having something to eat dropped into their cot. That picture shows the wild extremes; just about everyone else is in the middle and needs the help and stimulation that we normally give to children.
There are a lot of really good programmes, such as the SEAL programme, a number of which we assessed in the first report. The PATHS—promoting alternative thinking strategies—programme is quite similar, and some people argue that it has an even better evidence base. We want to offer people that information so that they can make a choice about what is appropriate for their circumstances to back up what should be going on anyway in a good teaching environment.
It is about giving everybody a common denominator of social and emotional capability. This is a big claim, but it is pretty damned hard for a child who has social and emotional competences to go off the rails, although it can happen. If the child does not have those competences, their life chances in so many areas are massively reduced.
On Margaret McCulloch’s point, one thing that I steal without shame from Scotland is the sense that this is a public health issue, not a criminal justice issue or a welfare and benefits issue. I use the example of cholera and smallpox. We were told 150 or 200 years ago that it was divine will that we were all going to suffer from those diseases, and there was nothing that we could do about it. People, particularly in local government, seized on that issue and dealt with sanitation, hygiene and the quality of the water supply, and no one would now even think of saying the things that the early Victorians said.
It is the same with social and emotional capability. People will look back at the present day and say, “My goodness—why didn’t they just help those kids when they needed a hand? Why didn’t they help that mother who wanted the best for her child? Why did we let that problem fester?”
The most extreme result might be the riots; I do not know. Some people are not attaining or even holding down a job, and they do not feel that they want to get off benefits because that is the way their families have run for a couple of generations. We need to give them the choice, and that is what social and emotional capability does for them. It allows them, probably for the first time, to make a choice about certain key points in their life.
I see that Margaret McCulloch wants to ask another question, but that last one was a supplementary—Paul Wheelhouse can go next.
Sorry—I gave a long answer.
I welcome Mr Allen. I have read the reports, which were fascinating, and I totally buy into what you are saying. I feel almost ashamed to reduce the issue to a practical level but, in the executive summary of your January 2011 report, you state:
“What parents do is more important than who they are. Especially in a child’s earliest years, the right kind of parenting is a bigger influence on their future than wealth, class, education or any other common social factor.”
You go on to raise the issue of
“providing the data and measurement tools that we need to help identify those in need and to track progress”.
There is a clear steer that we should target preventative measures not just at those who might be at risk but at those who are very likely to be at risk. Which agencies will have the data that we will need to be able to identify the scale of the problem at a local level and—as you rightly mention—to track that?
11:30
We at the political level often have to confront those whom we pay to work for us on the question of data sharing and data protection. Too many people say, “Computer says no,” but, when we dig down and ask what is stopping them, it often turns out that they just do not want to do it. I have taken that issue up with ministers and the report recommends that a ministerial working group be convened to clear the thicket of stuff out of the way that allows someone in the health service to say, “I can’t give this information because of patient confidentiality.” A police officer telling the local health visitor service that the daughter of a well-known family is pregnant is carrying out a tremendous public service. That is just good intelligence and swapping of information. It should not be caught—and I do not believe that it is caught—by anything that could be regarded as either criminal record confidentiality or patient record confidentiality. Often, the onus is on us to call people’s bluff. Making sure that we get the right help to people when they need it is far better than waiting until they have entered the official record through an antisocial behaviour order or exclusion from school. That is way too late. Without abusing anyone’s human rights, we are talking about giving people their human rights by getting them help when they need it.
On a related point, there are also strong messages about workforce development and the importance of changing the culture within the various public sector agencies that we rely on to help to deliver preventative spending. You have just made a point about the need for a cultural shift so that that kind of intelligence can be passed between partners; will that be a key element of that workforce development?
It has to be. We have the common assessment framework in England; I do not know whether there is anything comparable here where a record is run on a particular person to help them through their development.
The workforce argument goes much deeper. One of the things that we have managed to do in Nottingham is make front-line staff aware of the early intervention strategy and of their role in it. That is really important. They understand that everyone else is in the game as well and that it is not just a matter of looking after their own little patch.
An even more interesting area in workforce development is evidence basing. Sometimes people will portray the use of an evidence-based policy as removing people’s discretion to use their professional judgment. That is not the case. Eileen Munro, who is another reviewer in this field, has made the case strongly in the past year or so that, if someone is trained, they must use their professional judgment but do so within a good framework of proven policies that work, rather than using it to muddle through somehow. We must keep that framework of things that work because the expectation and hope that we are going to be able to attract private, non-government, philanthropic or ethical finance will dissolve if we just say, “I think that I should deal with this particular issue in this particular way,” rather than saying that we should deal with an issue collectively through proven programmes in which professional judgment is even more likely to get traction with individuals. That is rather a convoluted way of putting it but, essentially, we need the best people to use their judgment and professional training alongside the best and most proven programmes to help people through some of the obstacles that the convener mentioned in his first remarks.
Do you agree that sometimes there will be targeted approaches and that, on other occasions, there will be whole-population approaches? I am very mindful of, for example, the promoting positive parenting—or triple-P—programme, which starts with a whole-population focus and then drills down.
I think that, with the zero-to-18 model, there need to be some cornerstones. We need zero-to-two stuff, for example, but finances are such at the moment that we can start only with teen mums, who probably need the help most. Nevertheless, a good health visiting service should be providing help for those early years. Then there are heavy-hitting programmes such as the SEAL and life skills programmes and, finally, specific and targeted initiatives, such as the early intervention mentoring scheme for eight-year-olds that we introduced in Nottingham. Instead of bringing in a mentor to help a single mum who might be trying to get her 6ft 3in 16-year-old with raging hormones to do his homework, we thought that it would be better to get help—in some cases, a male role model—into the child’s life when they were eight years old. There are specific things that can be done but, if general initiatives are not in place alongside them, we will simply be doing the remedial stuff again. Taken in isolation, each of the programmes is just remedial; taken collectively, they are genuinely early intervening, developing and, where necessary, topping up social and emotional capability.
In your July report, you say:
“Inside government, decisive leadership at the political level and effective planning and co-ordination at official level are required to secure a steady and ongoing shift in spending from ineffective later intervention to cost-effective Early Intervention.”
However, on page xv of your January report, you say:
“Central government should champion, not control, the expansion of Early Intervention.”
The Scottish Government is rolling out preventative spending and early intervention across all its departments, while the approach south of the border has been, I would suggest, a bit more tentative. I am sure that you are quite keen for something similar to what we are doing to happen in the UK, but where should we strike the balance? Where should politicians intervene? What sort of lead should the UK Government be showing to local government, the NHS and others without prescribing their activities?
Central Government should facilitate wherever possible and then keep out of the way wherever practicable. After all, the people who know the best way of handling the specific problems and difficulties in my city of Nottingham are the people of Nottingham themselves. Five years ago, I would have killed to have had an early intervention foundation giving me certain options. Let me make no bones about it—I made mistakes in what I did in Nottingham. You are desperate to do the right thing. Every summer, you see another bunch of 16-year-old kids being flushed down the system. Anyone in politics knows that such a situation is intolerable; you have got to get in there and try to do stuff. I readily admit that I did some things too quickly and we had to unpick them and put them right.
That said, having such drive and energy in the political classes is really important, because that is what motivates change. However, what you need at national level is a menu that you can draw down, for example, to be able to see what is happening in Scotland, go to Nottingham or Croydon or send someone off to Washington state. It is very important to pull together best practice.
As for what Westminster and Whitehall could learn, I make it clear in the second report that the next comprehensive spending review should be themed around early intervention. I am not saying that there should be big switches of money, but I think that, in all the analysis that goes on for 18 months before a CSR is produced, people should have in the back of the minds some idea about how this or that move might influence preventative and early intervention policies.
Secondly, I suggest that a very small percentage of budgets—1 per cent a year—be moved from late intervention or reactive policies to early intervention policies. Of course, given the total UK budget, that 1 per cent would be quite a sizeable amount of money per department, but the measure would indicate that people were taking the matter seriously and were moving resources. They would see that a gentle shift was an intelligent way of handling some of these policy questions.
As for where the balance lies, I do not wish to flatter the committee, but Scotland has achieved a much better balance than England. That has partly to do with the fact that you can do a little bit more in your own backyard than we can in Nottingham. There is a bit of jealousy in that comment, but perhaps it is also a plea for good communications and connections.
As a final advertisement, I would certainly want Scotland to be represented very intimately in our work in the early intervention foundation, whether or not England is responsible for it. Anything else would not be good enough. The answers lie in no one place; they lie everywhere good practice is happening—and there is some great practice happening up here.
I fully agree with that. It is important that we maintain a very close dialogue and continue to learn from each other. Your comments about the UK-wide spending review have already been taken on board up here and I hope that they will inform future reviews south of the border.
I thank colleagues for their questions but, more important, I thank Graham Allen for his responses and, indeed, for travelling up here today. We will certainly study the Official Report of this session as we think about how we take things forward.
It has been a pleasure. Thank you for the inspiration.
We have been here for two hours now, so I suspend the meeting for five minutes to give members a natural break.
11:42
Meeting suspended.
11:48
On resuming—