Early Intervention
The next item of business is a debate on motion S3M-7923, in the name of Murdo Fraser, on early intervention in health and education.
09:04
We are starting rather earlier than had been expected, but I am sure that the chamber will fill up and that other front-bench members will appear in due course. In any case, it is my pleasure to open this Conservative party debate on early intervention in health and education.
It might seem obvious to say that the early years of children’s development provide the basis for all areas of the rest of their lives, but the point is often overlooked in the provision of health and education. Too often, instead of making a concerted effort to provide the best service and care in the initial stages of life, services begin to address problems and issues only when they have developed fully. The importance of early childhood development and the impact of early intervention in determining future health, social wellbeing and educational achievement have been widely recognised, and a large and growing body of empirical evidence has highlighted the importance of child and parental interaction in the early years of life with regard to the child’s physical and mental wellbeing and future development path.
The early years have a huge impact on outcomes for the rest of a child’s life. Dr Philip Wilson of the University of Glasgow, who provided evidence to the Health and Sport Committee in 2009 and to the Finance Committee’s inquiry on preventative spending in October 2010, has highlighted the key role that early intervention plays in the trajectories of young lives. He said:
“there has been an enormous blossoming in the evidence base on ways of identifying early in life the children who are going to follow a problematic and painful trajectory.”—[Official Report, Health and Sport Committee, 25 March 2009; c 1728.]
Investing early in young people’s health and education has been shown to produce a better return on the time and resources spent both in terms of financial capital in skills-based outcomes and having emotionally able young people. Dr Wilson has also said:
“There is robust evidence that expenditure in the preschool years gives the highest rate of return on investment in human capital ... Public expenditure on the under-3s is minimal when compared with expenditure on any other age group ... There is no doubt that early intervention with vulnerable families by nurses is highly effective, and cost-effective.”
The later it is left, the less the investment provides. Given the ability to act early to identify issues and potential problems before they impact on the child’s development, it remains a great mystery why more emphasis has not been put on resourcing all those who work in intervention to safeguard the future of Scotland’s upcoming generations by affording them a solid start in life.
The quality of the child’s first years of life is strongly associated with his or her educational achievements later in life, and investing time and resources in the initial months and years of a child’s learning reaps many subsequent benefits. Moreover, it is clear that conditions in early life have long-term effects on health and wellbeing. Childhood is the key stage for developing resources to underpin adults’ physical and emotional health, social identities and behaviour. For instance, David Olds’s seminal work in the United States on home intervention by health professionals shows that around 30 hours of input between mid-pregnancy and the age of 2 can halve the incidence of criminal behaviour, substance abuse, smoking, absconding and high-risk sexual behaviour by the age of 15, all of which are issues that the Parliament subsequently has to try to address through legislation and intervention.
The Scottish Conservatives are committed to providing early intervention to a universally high standard. For too long, the provision of the best supportive care for young children has been a postcode lottery, and indeed has been available only to those whose health boards have chosen to provide regular contact with health professionals as a matter of course or those who are in the additional or intensive support brackets. As such, the Scottish Conservatives have pledged an additional £20 million a year to recruit, train and maintain Scotland’s health visitors, who we believe are one of our most valuable assets for effective support and intervention.
Members of other parties will rightly ask how we might be able to afford such a measure in the current climate. We in our party have been clear that we oppose the abolition of prescription charges for people such as MSPs who can well afford to pay, as the move will simply take precious resources out of the national health service budget. Restoring a £5 prescription charge would save £37 million, £20 million of which would be allocated to the vital task of expanding employment of health visitors.
We are also committed to investing in improving parenting skills and support for parents and creating more flexible and accessible nursery education provision. My colleague Liz Smith will expand on those points in a few minutes.
I will take a few moments to explain why sustained investment in health visitors is so important. Far from being able to provide a universal and comprehensive service to all parents and young children at present, health visitors are having to focus on a narrowing number of cases. The restructuring of services under “Health for all Children 4”—Hall 4—brought a change in emphasis to health visiting, meaning that the only formal assessment that is available to all children is at six weeks and that only children who are in the additional and intensive care bracket are offered an assessment at two years. Follow-up after two, three or fourth months of age is no longer expected, and families are left without regular contact, advice and support—a potentially dangerous development in the provision of early years care. Changing the focus to place it primarily on children in the additional and intensive care bracket has left thousands of parents every year without the expertise and care from which they could benefit under a truly universal system, forcing them to identify early signs themselves and to approach proactively their general practitioners or other health professionals.
The Royal College of Speech and Language Therapists has highlighted the effects of the demise of universal care. Professor Law told the Health and Sport Committee that, for many years, a large proportion of pre-school referrals to speech and language therapists—between 40 and 50 per cent—was from health visitors. A review after the implementation of Hall 4 saw the number drop to only 15 per cent. Fewer problems are being picked up in the crucial early stages, as health visitors’ time and resources are being channelled solely into supporting those who are in a particular bracket of care.
I apologise for arriving late for the debate. The point that the member makes about speech and language is even more crucial because of delays in referral. The average age of referral is 15 months older than it was prior to the changes to which he refers.
I welcome Dr Richard Simpson to the debate and thank him for his constructive intervention, with which I agree.
Parents’ response to the situation is clear. When asked in a recent survey by Ipsos MORI whether they thought that health visitors should visit only those parents who were having problems with their child, 91 per cent of parents disagreed. Nine out of 10 parents agreed that they found the advice of health visitors reassuring. A significant 76 per cent felt that they would have missed the help that was provided by the health visitor if they had not had it. Far from supporting those parents, all too often we make the advice and assistance that they need available to them for only a brief number of weeks, which rarely allows the all-too-crucial relational links between parents and health professionals to be made.
Is the member aware of my colleague Shona Robison’s recent announcement of the revision of Hall 4 guidance, which—among other things—addresses the issues that he raises by providing for regular reviews of children on a universal basis, including the introduction of a 24-month review of the child’s development and the nature of relationships? That is an important improvement.
I am aware of the announcement that has been made. My concern is that we need to ensure that it is backed up by resources and the availability of health visitors. If the minister bears with me for a moment, I will expand on that point.
The links between parents and health visitors and between health visitors and GPs are invaluable. Continuous contact must be fostered between GPs and health visitors in working relationships, to provide a universal and non-stigmatising service for communities that links with social work and education to provide a powerful service. Removing health visitors from that equation cannot but limit the reach and scope of the care that is provided.
My concern is highlighted in the statistics, if we look at the number of vital health visitor posts across Scotland. Despite a small increase during 2009-10 in some health boards—notably in NHS Greater Glasgow and Clyde, where there has been an expansion—the overall number of health visitors has fallen across Scotland since 1998.
It is important that we establish the facts. Mr Fraser is right to say that there has been a reduction in seven health boards, but he is not right to say that there has been a reduction across Scotland. Actually, there has been a 6.4 per cent increase in the number of health visitors. It is also important to say that there has been an 82 per cent increase in the number of public health nurses. We need to be accurate.
I am grateful that the minister is attempting to be accurate, because I am referring to a parliamentary written answer that I obtained from her, which gives the figures. The figure that I quoted is very important: I said that there had been a fall since 1998. Between 1998 and 2005, the number of health visitors in Scotland was more or less steady at around 1,500. There was then a substantial drop in 2007 to just over 1,100. The figure has since come back up, but only to 1,200. Therefore, we are better off today than we were three years ago, but much worse off than we were in the period between 1998 and 2005. The minister should not rest on her laurels, but should accept that there is a serious problem. Even within the period to which she refers, within the past year there has been a fall in the number of health visitors in seven health boards in Scotland.
Each of our 14 NHS boards has a separate strategy on the use of health visitors, which leads to inevitable variation in service delivery across the country. Indeed, some boards—for instance, NHS Highland—are abandoning the training of health visitors altogether, under the belief that the profession may soon become obsolete.
I have been told that the average age of health visitors in Scotland today is 55, and the concern is that, as they retire, they are not being replaced, as health boards try to make savings by not filling vacant posts.
I referred to Dr Wilson earlier. In his evidence to the Health and Sport Committee, he told of the devastating effect that recent policy developments have had on the morale of the remaining health visitors. In its helpful briefing for this debate, the Royal College of Nursing Scotland reports that 61 per cent of health visitors feel underpaid and that 70 per cent say that they are under too much pressure at work.
My colleagues in the chamber will not have failed to notice the emphasis that the United Kingdom Government has placed on the provision of health visitors in health boards across England and Wales. The UK Government has committed to creating 4,200 new positions for health visitors, to revitalising training and recruitment, and to creating a new identity for the profession. That investment south of the border in early years services will result in a doubling of the number of health visitors who are supporting families in England and Wales and will help to secure many healthy and active generations of families and children. This is an area in which Scotland cannot afford to lose out or start to lag behind. Making the effort to invest in these key services now will reduce the need to try to resolve problems that will go undetected if we continue to reduce health visitors’ capacity to help families across the country.
The £20 million investment that the Scottish Conservatives propose would go a long way towards redressing the imbalance in the provision of early years care in Scotland. Through the creation of a truly universal service of health visiting, working with all families throughout the early years of a child’s life, we would be able to offer the support and advice that parents need, and to work towards combating problems before they take root. That widened provision would not mean a move away from increased care for the most vulnerable. The greater number and provision of fully trained health visitors, working in partnership with GPs and health professionals across the community, would serve to provide a greater level of care for all and would allow the most vulnerable to receive the care that they deserve, as well as opening up that care for everyone, regardless of postcode or region.
The benefits of resourcing now for the future are clear. Scotland cannot afford to sit back and watch while children in other parts of the United Kingdom are offered a better start in life while we have the ability, the opportunity and the duty to provide them and their parents with the most comprehensive universal service of early years care that we can offer.
I move,
That the Parliament recognises the importance of early childhood development and the impact of early intervention in determining future health, social wellbeing and educational achievement of individuals; notes the large and growing body of evidence that highlights the importance of child and parental interaction in the early years of life; recognises the vital role performed by health visitors in supporting families in the early years; notes with concern that, in seven NHS board areas, there was a fall in health visitor numbers between 2009 and 2010; supports a national health visiting strategy that ensures that all families, regardless of income, area or need have access to a health visitor service that will provide a guaranteed level of support to families until their child reaches the age of five; further believes that there needs to be greater flexibility in how parents use their child care entitlement; supports a more flexible mix of state, partnership and private provision of nursery school places, and believes that more information relating to good parenting should be made available to all parents through maternity units, early years settings, GP practices and on NHS websites.
09:19
We welcome the opportunity to have this debate. However, the motion that we are debating rather implies that we in Scotland have not got the message about the importance of the early years and early intervention—nothing could be further from the truth. The reality is that this Government has already heeded the national and international research on the early years. We have had a well-supported policy in place since 2008. We know that the early years are the most significant period when it comes to making a difference in a child’s life. Some of the most powerful evidence focuses on the significance of early years interactions for brain development and the extent to which that can influence future life chances for children. In this context, early years means from conception onwards.
Our aim is to ensure that the health, social and parenting needs of families with young children are identified early and met by adopting the getting it right for every child methodology. Murdo Fraser’s motion points out that there has been a fall in health visitor numbers in seven health board areas between 2009 and 2010. However, as my colleague intimated, I wish to make Parliament aware that, since this Government took office in 2007, the number of health visitors across the whole of Scotland has increased by 6.4 per cent, the number of public health nurses has increased substantially by more than 82 per cent and the number of children’s nurses has increased by 238 per cent.
Before we leave the statistics, does the minister share my concern that, since 2007, we have seen a fall of 25 per cent in the number of health visitors who are employed by NHS Lothian? Perhaps more important, we know about the budget pressures that health boards are under. What has the Scottish Government to say to health boards about the future employment of health visitors?
NHS Lothian is the test site for our family-nurse partnerships. The member should look at the figures and the situation in the round. In terms of health board commitments, I will allow my colleague to return to the issue in her summing up.
Public health nurses and health visitors are very valued members of the community care team. We remain committed to maintaining their vital contribution to the health of vulnerable groups, particularly children and families. Indeed, the revised Hall 4 guidance to which I referred, which was issued last month, recommends that the public health nurse/health visitor should be the named person in GIRFEC terms for all children until entry to primary school. As members will be aware, the named person’s role is to take initial action if a child needs extra help, which is critical for early intervention.
Of course, maintaining the health and wellbeing of children and families requires multiprofessional and multi-agency working. We are therefore asking all NHS boards in Scotland to adopt a multi-agency approach to community care, utilising a wider mix of skills to ensure that those children and families who are identified as requiring additional support receive the care that they need when they need it. Working with NHS boards, we are looking at ways to increase the capacity of community nursing teams to meet Scotland’s present and future health care needs. For example, we are developing new roles such as advanced and specialist practitioners. As I indicated earlier, we are also testing a family-nurse partnership approach to support young first-time mothers in NHS Lothian, as we are in NHS Tayside.
We are looking at how health care workers can assist school nurses and health visitors by undertaking more routine work to allow those highly trained professionals to focus on where they make the most difference to families and children. We are also working with NHS boards through the modernising nursing in the community board, which aims to provide leadership and vision to support NHS boards in developing and delivering high quality, sustainable and person-centred community nursing services. The board has identified the health care needs of children, young people and families as a priority area.
In its 2009 report on child and adolescent mental health services, the Health and Sport Committee twice asked for urgent action to introduce regular health and development checks. The Government has brought in one additional health check at 24 months. Despite all the teamwork, still nothing is in place for development checks in the three years pre-school.
I take issue with Mary Scanlon’s analysis of the situation. CAMHS have been underfunded for decades and we are now looking at increasing their capacity rapidly.
We are piloting a programme to increase health care capacity in schools, particularly in communities with the most vulnerable children and young people. The programme’s focus is on early intervention at key transitional stages of the child’s life, such as nursery to primary school and primary school to secondary school. I look forward to seeing a report on the programme’s outcomes later this year.
The motion highlights the importance of supporting parents, which I am happy to endorse. The vast majority of our children will develop and flourish with support from their parents and from universal health and education services, but some parents and families struggle and need support. Most of our local authorities have local parenting strategies in place, and there are excellent examples of joint working.
We provide direct financial support to the key national parenting organisations in the third sector and to organisations that provide relationship support, counselling and family mediation to families who face difficulties. Through the play, talk, read campaign, we encourage closer bonding and engagement between parents and their children.
I am delighted to inform Parliament today that—unlike our counterparts south of the border—we have agreed to continue our support for the excellent and much-valued children’s book-gifting programmes that the Scottish Book Trust runs in Scotland. We will provide funding that amounts to £1.05 million, which is a substantial investment in the current financial environment. That is tangible evidence of the importance that we place on children’s literacy and on parents taking the time to read to their children. The Scottish Book Trust has warmly welcomed that investment. Its chief executive, Marc Lambert, said:
“The renewal of Scottish Government support for this universal programme is seriously brilliant news for all children, families and carers right across the length and breadth of Scotland ... It demonstrates how, in contrast to England, the Scottish Government is genuinely committed to ensuring that all children have the best possible start in life.”
It is just over two years since the Scottish Government and the Convention of Scottish Local Authorities published the early years framework, which sets out a long-term vision for transformational change in Scotland. We have recently published a comprehensive report on progress on implementing the framework and there are many examples of progress.
The golden thread that knits together all the Scottish Government’s policy objectives for children and young people is the transformational change programme called getting it right for every child. If the early years framework sets the agenda, the GIRFEC approach is the methodology for delivering it. GIRFEC has been endorsed by the Parliament and has received support from all parties.
GIRFEC establishes a common language and a shared way of identifying concerns and the needs of children and young people. It operates across all agencies and provides the framework into which specialist and targeted services can be integrated. That is why GIRFEC is a central part of the Scottish Government’s commitment to improving outcomes for all children. It articulates clearly the need for transformational change across systems, practice and culture to drive improvements.
The economic case for getting it right in the early years is sound. We have published research—based on data from the Scottish context—that shows the potential cost to the public sector of not intervening early in the lives of disadvantaged children. The research shows that, in the short term, savings from investing in early years services and support, from pre-birth to the age of five, could reach up to £37,400 a year per child in the most severe cases, and approximately £5,100 a year for a child with moderate health and social care needs. In the medium term, the savings—if interventions from pre-birth to age eight are 100 per cent effective—could be up to £131 million a year across Scotland. In the long term, failure to intervene effectively to address the complex needs of children in early life could result in a ninefold increase in costs to the public purse.
I do not underestimate the impact that worsening budget pressures will have on the pace and scale of implementation, at both national and local levels, across the early years agenda. However, for this Government, the case for driving forward this agenda with our partners is indisputable, and it deserves full support from all parties in the Parliament.
I move amendment S3M-7923.3, to leave out from “with concern” to end and insert:
“the establishment of the Modernising Nursing in the Community Board, which is working with NHS boards to ensure that community nursing services in Scotland are fit for the 21st century, and further notes the increase in public health nurses/health visitors during the current parliamentary session; supports the current flexible use and mix of state, partnership and private provision of nursery school places in line with local needs and circumstances; welcomes the fact that the vast majority of Scottish local authorities and their partners have local parenting strategies in place, and endorses the current financial support to the leading third sector organisations that provide information and support to parents, including family mediation organisations that provide assistance to families in difficulty.”
09:31
I begin by thanking the Conservatives for choosing the topic for debate. It is an extremely important issue, and the debate allows the different parties to put forward their thinking in advance of the election in May. I assure the Parliament that during the election—and thereafter, whether we are in opposition or in government—early intervention in education and health will be a major issue for Labour. We wish to work with other parties and with health organisations, local authorities and the voluntary sector to implement the strategies and policies that we seem to have in such abundance on this issue.
Although I have lodged a lengthy amendment to the Conservative motion, we are not in fundamental disagreement with the Conservatives—or with the other parties that are represented in the chamber—about what we want to achieve. I can also easily endorse the Liberal Democrat amendment. We all support the early years framework and the other strategic documents to which it is linked: the three documents work together.
We all share concerns about the physiological, psychological and social problems that are associated with the impaired development of children before the age of three, which were drawn to our attention so forcefully by Dr Harry Burns, the chief medical officer. The costs of not intervening early were highlighted by Alan Sinclair and other witnesses in their evidence to the recent Finance Committee inquiry, as referred to in the Liberal Democrat amendment.
If there are differences among us, they are more to do with judgments about the relative effectiveness of different types of intervention and the priority that they should be given. There is another level of possible disagreement that people are probably more reluctant to talk about, regarding the volume of resources that should be made available for early intervention, as opposed to other requirements in the budget. To be frank, I do not think that any of us have been entirely honest about it. People are looking for a step change—a significant shift of resources that will make a difference. We all have to agree: first, that we will do that and, secondly, on how it should be done and on what the priorities within that change should be.
It was noticeable that during yesterday’s budget debate there was almost no mention of early intervention as an area that requires additional resource but, in theory, all the parties are signed up to the Finance Committee report, which advocates investment in preventive rather than reactive measures, and proposes a long-term shift in resources towards early intervention.
We have all the policies and strategies. What we lack is the will to proceed. In my party’s view, that has to change. The report by the Convention of Scottish Local Authorities on progress on the early years framework essentially says that all the ideas are there, but that we are yet to start on the joint working that is needed, and that we still need to get to first base on implementation. Given the scale of the problems that have been identified and the need to take on the issue, that has to change.
We are entering—in fact, we are already in—a period of severely constrained budgets, but it is clear that the social problems that are associated with crime, addiction, worklessness and intergenerational poverty are not going away, but are getting worse. There is a lot of evidence around Scotland to suggest that some of the problems in the worst-affected communities, and for children who are brought up in poor circumstances, are definitely not improving.
We need to do something, and we need to try to stem the tide of young people who are growing up in stressful, chaotic or disadvantaged circumstances. If, as my amendment suggests, we can identify those young people who have serious communication and language difficulties long before they arrive at school, we can take steps to prepare them for education, rather than leaving them to be frustrated, as soon as they get to school, by their inability to learn.
My colleague Richard Simpson highlighted in his intervention that since the changes, children with serious language and communication difficulties are being identified around 15 months later. That is a step backwards at a time when we need to step forward.
Like the Conservatives, Labour believes that we need to provide a much better service to all mums and that health visitors and GPs are crucial. The changes made to the health visitor service mean that, for many families, visiting stops when the child is eight weeks old. Those changes happened under Labour—let us be honest about that. We need to revisit that service and move it forward.
I will make the same point that I made to Murdo Fraser. The Hall 4 guidance has been reviewed, and the new guidance was launched last January. It supplements the existing guidance, and—to address the nub of the issue—allows that there must be discretion, which is what health visitors were seeking. They did not want to be constrained by guidance that would not allow them to use their professional judgment. I hope that Des McNulty welcomes that.
I welcome that, but I believe that we need to go further. The review makes some serious criticisms of what has happened to the health visitor service. As Shona Robison said, the guidance has been reissued, but we need to go a bit further.
Health support and advice need to be available for longer, although perhaps not at a universal level until age five, as the Conservatives argue: until age three might be more realistic. One of the issues is that we cannot focus all the responsibility purely on the health visitor service. We would argue strongly that greater co-ordination and integration of services is needed: it is crucial that education and health work together.
In the Health and Sport Committee’s report on its inquiry into child and adolescent mental health and wellbeing, we made the point that there is a big role for nursery nurses and nursery schools in integrating with health visitors. As most children now have a nursery place between the ages of three and four, will Des McNulty agree that that is a way forward?
It is a way forward, but if we look at the distribution of budgets, we can see that there has been a decline in the numbers in nursery education and a reduction in the budget for care staff. We need to pay attention to that. It is about priorities, and young children should be more of a priority than they are at present.
We need integrated resources, particularly for those who require intensive support—or who need more than the norm, if I can put it like that. Murdo Fraser came a bit close to saying that we need a universal service rather than a targeted service, but I think that we need both. We need improvements in the universal service, but we need integrated and targeted resources that are directed particularly at teenage mothers and harder-to-reach parents who may be living with health difficulties, social issues or learning problems of their own.
Senior social workers have told me that the children who are most at risk of growing up with multiple problems can often be identified at a very young age, but under current arrangements there is too much time before intervention takes place. All too often, intervention is sporadic, with not enough partnership working at the right time between the different agencies.
As well as health and education agencies—
Will the member give way?
I will just make this point.
It is important that we talk about the voluntary sector too, because it has a major role to play and it could play a much greater part than it does at present.
Does Des McNulty agree that although integration and intervention are critical, identification of the child’s need is most critical? He emphasised nursery staff. Does he agree that they need more support, help and training to identify that need?
I agree with both of those points. Teachers—particularly nursery teachers—make the same point. Intervention is too fragmented and too late. The parents, rather than the children who are brought up in chaotic circumstances, are often seen as the clients of the agency, and the child’s interest is not given the consideration that we—certainly, that I—would want it to be given.
I do not pretend that there are any easy answers, but we need better integration between agencies—particularly health and education—a stronger role for the voluntary sector, and more structured provision of parenting support, which should be designed with the active participation of recent parents to ensure that it is relevant to the people to whom it is directed. If we rethink what has gone wrong in service delivery and identify clearly what we want to put right, we can move in the right direction.
We have the policies and strategies—many reams of paper are available on the issue—but we need action, co-ordination, a clear sense of direction and prioritisation. That approach must improve universal services for parents and children, but it must also target resources at the families and children who most need it. As a Parliament, we must give children the highest possible priority and be prepared to act decisively and quickly when we feel that the child’s interest merits it.
I move amendment S3M-7923.2, to leave out from first “supports” to end and insert:
“believes that NHS boards and local authorities working with third sector organisations and volunteers must give children’s community services more integrated resources; recognises the valuable role being played by Sure Start and Family Centres and expresses concern regarding the impact of funding reductions on low-income families; further believes that health visitors linked with a GP practice and social workers have a key role to play in assessing, advising and supporting the parents of babies and very young children, especially young mums; welcomes the nurse family partnership pilots but proposes that Health for All Children 4 guidance should now be reviewed; considers that families should be partners in determining how services, including parenting support, should be provided; believes that early education and care is vital in providing a positive start for every child as well as in identifying and overcoming barriers to learning such as poor language and communication skills; believes that, where a child is at risk of neglect or abuse, a strict timeline for intervention is required, and welcomes the pilot being undertaken by Glasgow City Council, ensuring that giving every child the best chance in life as well as the protection of the child are the overriding considerations.”
09:42
I welcome the Conservative motion and the opportunity that it gives us to discuss early intervention. Although the motion and amendments have differences of emphasis, they show a great deal of consensus on the broad approach that we seek to adopt.
Coming from the West of Scotland and an area of traditional deprivation, I am conscious that many of the problems that we seek to address are certainly not new. Indeed, rather tragically for this generation of politicians—that includes me—we have failed to address those problems and, therefore, face problems that do not emerge from a single generation but manifest themselves through two, three or, in some cases, even four generations.
The urgent need for us to stop talking and get on with it, as Des McNulty hinted, seems to be clear. However, if it was that simple, we would have done it before. We must recognise that there have been real changes in thinking and outlook. I will make it clear why Liberal Democrats believe that the issue is important and why the thinking has altered.
I was struck by a passage in the Barnardo’s Scotland briefing for the debate. It reminded me of speeches and policy papers that I had heard and seen earlier from my party, but perhaps the message is more authoritative if I draw on Barnardo’s. The passage concerns the simple, elementary fact of
“the importance of the child’s early development for long-term outcomes”.
More particularly, the briefing states:
“Supporting parents and working with the whole family to improve the quality of parent-child relationships in the early years and beyond, is effective in improving outcomes and tackling problems ... Parenting and family support programmes are effective early intervention because they raise the self-confidence and self-esteem of socially excluded parents”
and the young individuals who are affected.
That idea was missing from much of the investment and political time and effort in the 1960s and 1970s. Members should be in no doubt that political parties of all hues have invested huge amounts of time in trying to solve the problems, but they have done so in a structural way. Their approach has had much to do with the physical environment, and they have rather overlooked the essential need to improve the capacity of the individual to regain the self-confidence and self-esteem that are vital if they are to help themselves by being helped to help themselves out of the problem. That is why Liberal Democrats share with other members a real sense of urgency about having to get things right.
I totally accept what the ministers have said about great improvements having been made, but the fact remains that we still have great problems. Those who deal with and are integrally involved with the problems, and even our Finance Committee’s recent report on preventive spending, have not given all of us a clean bill of health. They have been quite clear that there are still issues to be addressed. There is an interesting point in the Finance Committee’s report about the early years framework. Although the committee subscribes to that framework, it asked whether it should be more targeted at the zero-to-three age group as opposed to the zero-to-eight age group. We are all increasingly asking that question. That assumes that there are mechanisms through which those who require that level of support are identified. Mary Scanlon mentioned that in her interventions.
I think that there is general agreement about where we should go, but it is clear that if we agree that we are going to shift our emphasis on to genuine early intervention, it falls to all the political parties to skew their financial and other commitments to match that political ambition. I share Des McNulty’s view on that. That will require us to think carefully about where we are with some of the structures.
The Conservative motion rightly places great emphasis on the importance of health visitors. Richard Simpson can give members a short lecture on RONIC—the review of nursing in the community—as he is one of the world’s experts on it. If time permits, we may get that from him.
There will be a personal seminar later.
My serious point is that what was started with the early changes to the health visitor service was done with good intentions. We should not forget that some of the real difficulties that emerged from making those changes, to which the minister and Murdo Fraser have alluded, have caused us real problems.
The service is still under review. The minister has issued revised guidance on Hall 4, and I think that the modernising community nursing board is still due to complete its work, but we know that people throughout Scotland apply things in different ways. We know that NHS Greater Glasgow and Clyde, which does not have a bad record in respect of its employment, does not believe that there is necessarily any relationship between health visitors, GP practices and, much more crucially, the client group—the individual, the young person and the family—for which it might provide that support.
There is disengagement by our respected bodies. As Murdo Fraser said, that calls for a much clearer focus and strategy. The Liberal Democrats support that approach. We have all signed up to GIRFEC, but it is remarkable that, although we want multi-agency support, and for it to sit within the early years framework, people throughout the country still believe that we can simply split up communities and have a disconnect between the GP and the health visitor, but things will still work. I find that remarkable, as do other Liberal Democrats; nobody who has studied the papers could come to that conclusion.
The purpose of our amendment is quite simple. I share the view that it is imperative to have a health visitor framework that is slightly more targeted and seeks to provide holistic support. However, we must widen the debate and recognise that the social, education and health frameworks must be integrated in an holistic approach and that the preventive approach, which was endorsed by the recent Finance Committee report, is how to take that forward. Our amendment is not intended to diminish the importance of the health visitor, but rather to suggest that we take a slightly broader and more holistic approach, and emphasise the critical importance of preventive spending.
We have had to make difficult choices in the current financial climate. If we are to justify to everybody why we should make a bigger investment in the early years, they must see that not only will there be a return for the young people, parents and families, but that we can improve how we spend our money and get a better return.
Liberal Democrats are clear that early intervention is a crucial area of policy. Problems in this area have bedevilled parts of Scotland for many years, which is a tragedy. The people who suffer are not the politicians who make the decisions, but the young people who, generation after generation, are born in circumstances by which they are permanently disadvantaged. That is a blight on our society that Liberal Democrats feel passionately about because there is certainly no liberty in poverty and no liberty in ignorance. The two matters of health and education are important to me and my party, so we support the general thrust of the motion. However, I hope that we will get support for the amendment in my name.
I move amendment S3M-7923.1, to leave out from first “supports” to end and insert:
“agrees with the conclusions of the Finance Committee’s recent inquiry into preventative spending that the current balance of government spending is skewed too much in favour of reactive, rather than preventative, spending; recognises that early intervention has proven benefits not only in health and education but also in other areas such as crime reduction measures, support for carers and services for older people, and supports a long-term shift to sustained investment in a high-quality, preventative approach to the growing social and economic challenges faced by public services.”
We now move to the open debate.
09:52
In this hectic season of budgets, election preparation and the endless requests to attend hustings and briefing meetings, there is also the very important business for parliamentarians in interpreting the key messages that come from the main groups that are interested in our respective portfolios. There is a wealth of information in which each group sets out its own manifesto. Reading through those that relate to education, including—interestingly—those that relate to the tertiary sector from where there is perhaps the greatest demand at the moment for additional resources, there is universal acceptance that the early years are paramount, not just because of the health and social aspects that were described by Murdo Fraser in his introduction, but because it is a delicate task to get the balance right between those factors and the child’s education.
It is a given that children invariably fare better when they grow up in a loving, caring and well-balanced environment in which family life is the centrepiece and in which they can flourish, both socially and academically, in the company of their teachers and school friends. It is important to recognise that there is no ready mix of those factors and that success can never be prescribed merely by the actions of Government. That point has been made in each of the thoughtful preceding speeches.
Of course, what Government can do is put in place a raft of policies that help to create a more conducive environment in which parents and their children can thrive and where the education experience, from its earliest stages, is of the highest quality. Apart from ensuring that there is greater support for parents to recognise and adopt their full responsibilities in fulfilling their challenging role in society, we need to find ways of providing a structure of education that can combine excellence with flexibility, greater parental choice and greater diversity, so that the child’s needs and the expectations of the parents drive the system, rather than its being driven by any doctrinaire vision that believes that the state knows better than anyone else.
So, what needs to be done on the education front to complement the health policies that were outlined by Murdo Fraser? First, we need to ensure that we do much better in providing parents with greater choice and flexibility in nursery school placing. I suggest that there is a consensus among all the parties that nursery support is invaluable, not only to the wellbeing and development of the 107,000 children in Scotland who attended pre-school education in 2010 but in providing support to parents who live away from their own parents or relatives or who are raising a child on their own and cannot rely on their partner for support.
That is why we think that there is room for improvement in the current system. Many parents want greater flexibility when it comes to using their entitlements. As a result, some—not all—parents want a wider range of providers. A Daycare Trust report that came out yesterday, shows that the average annual cost of 25 hours of nursery care a week for a child under two is highest in Scotland, at £5,220, compared with just more than £5,000 in England and a little more than £4,700 in Wales. Conservatives argue not only that if there is more choice, parents will have more options in choosing which provision best suits them and their child, but that more robust competition between providers will inevitably lead to an overall reduction in costs, in some cases.
Does the member accept that the changes to the child care element of working tax credit that her party’s Government in Westminster is introducing will mean that 1,280 families will lose an average of £454 in help with childcare costs in the next financial year? How is that going to help?
The member has made a reasonable point. There is work to be done in that regard and it is important that child care be included in the package. That is something that we definitely need to think about.
Secondly, when it comes to providing greater choice, partnerships need to work properly. Partnership nurseries that involve local authorities and private providers should be true partnerships. Currently, some local authorities are dictating the allocation of places and ignoring official guidelines. Indeed, partnership status has been withdrawn from some private nurseries in Scotland, which means that parents have had to find another partner nursery or risk losing a part-time funded place. In some cases, that is worth up to £1,550 per year for each child. That is a wholly unsatisfactory situation.
Thirdly, we want to work with teachers, support staff and teacher training colleges to ensure that there is greater emphasis on effective training for all teachers and support staff in recognising special needs at the earliest stage. As Mary Scanlon has said, detection is vital. The Scottish Government has done pioneering work in that respect and we give Adam Ingram and his colleagues credit for the Education (Additional Support for Learning) (Scotland) Act 2009, but we need to do more to help teachers and parents to identify problems at the earliest stage, so that there is proper co-ordination of the individual programmes that can help children who have special needs. We need to be aware of the demands from teachers about the important need to address the issue.
Fourthly, we need to address literacy and numeracy at the earliest age. There are many international studies on the theme, the vast majority of which show that an early grasp of literacy and numeracy can heighten a child’s confidence and success, and that children are more likely to flourish when teaching methods are consistent. We look forward to further developments in the area.
Children need and want stability. Without doubt, what happens in a child’s earliest years has the biggest influence on their future. There is a very fine balancing act for Government to achieve, between standing aside to allow society to place its full trust and faith in parents and the family and legislating, where it must, to provide better welfare. Like many other social debates of the modern era, the debate is highly emotive and complex, but it is one from which we must not shy away. If we do not get parenting and early education right, we will not get our future right.
For members’ guidance, I advise that any excess time that we have in the debate amounts to less than half a minute per member.
09:59
The tone of the debate suggests that we are heading towards a broad consensus on the issue and a recognition that all members might have lost opportunities to address it. A saying that I have held dear—particularly in recent times—is that someone who never made a mistake never made anything. If we are able to look forward, that is an excellent way in which to go, and I thank Murdo Fraser and his colleagues for giving us the opportunity to debate this important subject.
It is clearly a long-run issue in the sense that we have been engaged in it for decades without having identified everything that we need to do. More fundamentally, it is a long-run issue for our youngsters. Neglect in the early years will result in issues that remain all the way to the end of one’s life. Ross Finnie, in particular, captured that when he said:
“there is no liberty in poverty and no liberty in ignorance.”
When I was a minister, I had the great pleasure of attending a GIRFEC event on behalf of Adam Ingram on 12 March 2010 in Aberdeen. The room was full of several hundred very enthusiastic people who were very switched on. If they are representative of the professionals in the field, our confidence level ought to be seriously high. The presentation that preceded mine was an interesting one about the role of music and how kids interact with music. We were shown videos of children who, in their first day of life, were beating along with a musical beat, showing a degree of interaction. I have no insight into that; I only report what I saw. However, that illustrates that it is never too early to engage a newly born infant with the world and that learning starts, if not in the womb—although who knows?—certainly from the moment that we leave the womb. We must create an environment in which that learning enables people to develop into well-rounded and capable adults.
The multi-agency approach is important. My father was a general practitioner from the 1940s onward, and even at that time he had to work with other practitioners. That not only made a difference to his ability to support his patients; more fundamentally, he was able to bring professionals to the table, although we must accept that the world was much simpler then than the one in which we live today.
The sort of things from which children benefit are diverse. I was lucky enough to be brought up in a house that was chock-a-block with books. Ironically, my ill health in the first decade of my life—I am an asthmatic—helped me because I spent most of my time at home picking up books and reading them. These days, too many children live in houses with no books. The minister’s comments about the provision of books highlighted an important part of what we must do.
Liz Smith talked about literacy and numeracy. We often talk ourselves into thinking that we are innumerate. Many people say that they do not understand numbers; yet, in any bookie’s, we find mathematics that I, a mathematics graduate, am incapable of doing. The guys with the wee pencils behind their ears, working out complex odds on five-way accumulators, can tell one instantly whether to pay the tax in front or behind and how much it will be. People do not realise how numerate they are. I also have a small personal obsession with our failure to utilise the Trachtenberg speed system of basic mathematics, which is a wonderful system for engaging children in mathematics.
We must always support the next generation. I am now almost certainly in the last quarter of my life, and I am conscious—as others should be—of the fact that it is the younger people in our society who will choose the care home in which I will live. If I do not look after them now, there will not be a very good outcome for me. The question that has always engaged us all is that of nature versus nurture. In parts of Scotland, there are generations of people who have not been brought up in a nurturing environment, and there is a clear need to address that.
We have seen that the early years of children’s lives are crucial and that successive Governments have sought to engage on the issue. I very much welcome the contributions that have been made to the debate. There has been unexpected humility, so far, and welcome consensus.
In closing, I make the observation to the Labour Party that I am not entirely sure that four-day weeks in school and the mooted proposal that I heard last week to delay entry to school until the age of six will necessarily help, but I am interested to hear what proposals will be made, by Labour and others, in the coming election.
I am happy to support the amendment in Shona Robison’s name.
10:05
I welcome the opportunity to speak in today’s debate on the importance of early intervention. The Conservatives are right to bring this issue to the chamber. There has been consensus among all those who have spoken that this is a crucial issue for the future of Scotland’s citizens.
I thank all the organisations that provided briefings for today’s debate, and particularly thank Barnardo’s for the information that it provided to me.
We all recognise the importance of early intervention. In the drive to squeeze ever more value from public spending, early intervention’s time may have come. Intervention models, along with shared services, will increasingly become the standard approach to public service delivery.
Properly targeted resources, applied at the right time, can lead to substantial economic and social benefits over the long term. In his opening speech, Adam Ingram pointed out that there are cost-saving benefits to be gained if effective early intervention models can reduce the number of interventions that might be required in the life of an individual by the social work, drug and alcohol addiction services or the criminal justice service, but the issue is not just about saving money. Early intervention is a good thing in itself, not only for the individuals involved but for society. The approach can be relatively costly in the early years of introduction, which is why we need to build a strong case for the view that early intervention delivers cost savings and social improvements over the long term.
Ross Finnie was right to point out that, if the solution to the problem was simple, we would have solved it already. I sometimes think that all politicians are driven by quick fixes, but there is no quick fix for early intervention and no quick return. Politicians of all parties need to recognise that, by refocusing our resources and our efforts into those formative early years, we will get a return, but that return will come not in the next four or five years, but in the next 15 to 20 years. The prize that we will get by directing our efforts towards that end is far greater than most of us can imagine.
I will speak about how the early intervention approach has been used in New Orleans in the area of child protection and child development. I will also briefly mention the pilot project that Glasgow City Council has been developing, which uses the New Orleans approach
The New Orleans intervention model is a foster-care intervention that was developed by Professor Charles Zeanah. The programme is designed to address the developmental and health needs of children under the age of five who have been maltreated, abused or neglected and, as a result, placed in foster care. Sadly, many of our children in Scotland will find themselves in that situation as well. In this model, every child that the courts have found to have been maltreated receives a detailed assessment of each of their attachment relationships and interventions are provided to address the needs that are identified. That includes work on the relationship between the child and its biological parents as well as the relationship with its foster parents. There is a time limit of 15 months, by which time the courts have to make a decision regarding a permanent placement for the child. The decision is formed by the assessments of the attachments between the child and the parents and the outcomes of any interventions that have taken place.
An evaluation has shown that since the introduction of the programme, there has been an increase in freeing for adoption, but that for the children who go back to their birth families—the number is not insubstantial—there are significant reductions in maltreatment both for them and for subsequent siblings.
A seven-year follow-up of 80 children who received the New Orleans intervention has shown that on virtually all mental health measures, graduates of the intervention, whether adopted or rehabilitated, are similar to the general population.
The intervention has shown considerable promise in an overseas setting, but further evaluation is required to determine whether that approach could fit our circumstances here in Scotland. That is why I am pleased that Glasgow City Council is attempting to try out the approach. It is putting together a funding application to introduce the model. We should examine carefully the results of the project to see whether it benefits children in Glasgow and whether it could benefit the rest of Scotland, too.
I believe that much earlier intervention in relation to child protection is not only the most effective approach but is morally correct. Yes, we must ensure and protect the rights of parents, but those must be carefully balanced against the rights of the child to live free from abuse and neglect. Surely that is the hallmark of a modern, progressive society. Sometimes that might mean intervening at an early stage, which could be controversial, but I believe that we should not shy away from those difficult policy decisions. We need to learn from the best examples of child welfare from across the globe and we need to have the courage to be radical in our approach, because Scotland’s children quite simply deserve no less.
10:12
I commend Des McNulty for his contribution. Not just the content but the tone of his speech was positive and constructive. It is helpful for us to have joint health and education debates. Too often, we talk about those subjects individually; they are not always as integrated as they should be.
There is no doubt that early intervention, care, advice and support for parents and children can benefit people so much in later years in terms of good health, positive mental wellbeing, self-esteem and life opportunities. We know that—the evidence base supports it—and yet what we have in Scotland is a muddle of approaches: RONIC pilots combined the role of health visitor, district nurse and school nurse in the new role of community health nurse; the family nurse partnership programme is being piloted in Tayside and Lothian, whereby specially trained family nurses provide intensive support for first-time mothers and their babies in deprived neighbourhoods; some health visitors are still linked with general practitioner surgeries; and some health visitors are now being embedded in social work departments.
I called the Royal College of Nursing yesterday, because I was getting a little confused by all those titles. It made it quite clear that health visitors now come under the umbrella of public health nurses, along with occupational health nurses and school nurses. So, when the minister says that we have more public health nurses, that does not necessarily mean that we have more health visitors.
The uncertainty over the future of health visiting over the past decade has undoubtedly resulted in low morale, as revealed in the RCN briefing, with most health visitors feeling underpaid, undervalued and under too much pressure at work. We do not have a clear strategy for or approach to a clearly defined role for health visitors. The Government’s modernising community nursing board is due to finish its work by the end of this year—10 years after the generalist model of family health nursing was started.
As part of the Health and Sport Committee’s child and adolescent mental health services inquiry, we heard about the link between nurseries and health visitors. From my knowledge, in the Highlands, the link is the health visitor’s phone number on the wall, which can be called only if the nursery staff think that a child or parent is in need of a health visitor’s advice or support. There have been occasions when parents have considered that the nursery is interfering by going behind their backs and calling in a health visitor. The current system of leaving it to parents to call a health visitor if they need to see or talk to one simply does not work. If parents do not realise that the child has a problem, the health visitor will not be alerted and they will be unable to offer help and support.
The fact is that the parents who are most in need of help and support are, in many cases, the least likely to ask for it. It is not good enough for children not to be seen by a health visitor between their MMR vaccination at 15 months and the pre-school check at five years—that is three years and nine months with no check. I welcome the health check at 24 months, but I would like to know what is involved in it and who will do it.
How different this could all be if a universal health visiting service was established with standard health and development checks on every child at crucial stages in the early years. That is precisely what the Health and Sport Committee recommended two years ago, but the minister’s response to the committee’s report was disappointing, and I think that the response today is still disappointing. We understand and acknowledge that some parents need much more health visitor input and support, but that should not detract from a basic, universal health service.
In the same report two years ago, the Health and Sport Committee called for urgent action to address
“the problems provoked by changes to the health visiting profession in response to the fourth edition of Health for All Children”.
I am not aware that the Government has attached any sense of urgency to the issue. The Government publication “Towards a Mentally Flourishing Scotland: Policy and Action Plan 2009-2011” does not even mention nursery staff. That said, I am aware that in Moray Council, at least, nursery staff are attending courses on the identification of development and mental health issues. I would like to think that that is happening throughout Scotland ahead of all staff in pre-school education registering with the Scottish Social Services Council in 2014. However, given that the Scottish Social Services Council was set up in 2002-03, it will have taken 10 years for nursery staff to be required to be registered, trained and qualified. I understand that they will be the last profession in the social services workforce in Scotland to be registered. That says something about the emphasis that we place on pre-school provision. Furthermore, I understand that the registration will be subject to staff holding certain qualifications or gaining them within three years of registering, which will take us to 2017.
Even with a universal health visiting service and interventions, there will still be a need for better trained staff in pre-school education to help to identify general and mental health as well as development issues in all children. I listened carefully to what Adam Ingram said about GIRFEC and all the rest. I looked at the publication “Early Years Framework: Progress So Far”, and the section on the workforce states:
“By early 2011 this Group”—
that is, the common skills working group—
“will have agreed a draft common core skill-set for the workforce and will enter a period of consultation.”
I do not see any urgency there. The evidence from Dr—
You must close, please.
Right. Finally, I will say that health visiting is a non-stigmatising service. It is a positive input and approach to the family unit, unlike social work, which can be perceived as a threat or an accusation. If we all work together, we can do more.
I believe that the Deputy Presiding Officer intimated that members could have about an extra half a minute each. I would be grateful if they could stick to that.
10:19
Those statements always seem to be made before I get up to speak. Members will be watching the clock now.
I congratulate Ross Finnie and other members on their thoughtful contributions. However, despite Mr Finnie’s extremely interesting point about generational problems, I think that our society has a number of special problems. There are more single parents, more family break-ups, more people with several partners and more siblings who are half related to each other. Parents and, indeed, children have different expectations of relationships. We also have to take into account the pressure on relationships from being part of a materialistic society that puts people into debt and, if we put alcohol and drug addiction into what is already a pretty heady mix, it is clear that we are dealing with a situation that is perhaps worse than it was in previous generations. In that light, I commend to the Parliament the Health and Sport Committee’s very thoughtful report on mental health and wellbeing, which was published on 23 June 2009, and will highlight from it two or three issues by way of background. Of course, many of these points have already been addressed by other members.
First, Dr Wilson from the Scottish needs assessment programme—or SNAP—core working group on child and adolescent mental health told us that neglect before the age of two was the strongest predictor of later childhood mental health and also made it clear that
“Early neglect ... can take many forms ...”
and was not limited to
“neglect by parents whose drug and alcohol problems mean that they are so preoccupied that they cannot connect with the child.”—[Official Report, Health and Sport Committee, 25 March 2009; c 1737.]
Of course, as we heard in evidence, 100,000 children in Scotland live with a parent with a drug or alcohol addiction. In what is a very complicated situation, we have to tackle parents as well as intervening early with children.
No one has mentioned this yet, but in some cases the child will have to be taken from a parent at a very early age. That happens under the auspices of the children’s panel system, in which the child’s best interests are always considered.
Christine Grahame is right to raise the point, but does she recognise people’s frustration in this matter? The difficulty is that children tend to go back and forth before any decision is taken and children’s panels can be reluctant to take the final decision for the child to be permanently adopted out. Chances are given time and again, whereas the New Orleans model prevents that and ensures that the decision taken is the best one for the child.
I am not familiar with the New Orleans model, but I am familiar with the children’s panel system. I know that children can be taken away from parents at a very early age after a discussion with all parties, because the panel always considers the child’s best interests.
I have a great deal of sympathy with what has been said about the important and specialist role played by health visitors, but we must be practical. As we have heard, many of them are in their late 50s. That is not the fault of the Parliament, let alone the Government; it is simply a fact of life that this professional group is reaching the age of retirement. Moreover, the demographics are changing. The Scottish Borders, for example, has a very large elderly population, which means that more district nurses and fewer health visitors are needed. Nevertheless, we still need health visitors. I realise that both specialisms require different skills and know that it is terribly difficult for people to build in flexibility, but the fact is that flexibility will have to be built in here.
Does the member share my understanding that nurses coming into the profession want that kind of flexibility to allow them to make career choices as they go through their professional life?
That might well be the case, but I am talking about existing district nurses and health visitors. They have met the Cabinet Secretary for Health and Wellbeing, who was very sympathetic to the fact that, despite the many years of expertise in their own areas, they would be facing difficulties, but I do not think that we can stay in the same position. That said, we should move from health visitors coming in only when they see difficulties towards a more universal approach, because under the current approach they are being stigmatised. I never thought that I would see the day when a health visitor who knocked on someone’s door would be treated like a social worker and rejected. I am not saying that social workers are to blame for that situation, but the family in question would say to the health visitor, “Why are you at my door? What’s wrong?” Previously, it would have been normal for the health visitor to show up. Such an approach was more subtle and less in the face of parents.
In the very brief time that I have left, I will talk about the abolition of prescription charges. I say to Murdo Fraser that, first, most prescriptions are for chronic illness. As we have discussed previously in the chamber, it is impossible to compile a comprehensive list of conditions, so some people would pay for a large number of prescriptions.
Secondly, the Murdo Fraser always cites MSPs’ salaries and says that MSPs should not have access to free prescriptions. However, it is necessary to draw a line somewhere and to say that people who are over it will pay. If I recall correctly, in a previous debate in which I participated, Derek Brownlee came up with the figure of £21,000. That is not a lot of money. People who are ill may have additional liabilities, as they must heat their houses more and must travel to clinics. It is not good enough just to cite MSPs’ salaries—members should cite the salaries of people who would be just over the barrier.
Thirdly, medication is free if people are in hospital. Why should they be charged for it if they take it at home? What principle is in operation there? Prescription charges are an easy hit, but when we examine them, we find that they are not good.
My final point is directed to Ross Finnie and concerns preventive spending, which the Liberal Democrat amendment advocates. However, as we saw clearly yesterday in the chamber, with a limited budget—I will restrict my comments to health—it is extremely difficult to strike a balance between preventive spending and firefighting. We cannot do that with our limited budget. I think that that is my only controversial point for some people; perhaps there were more. The Parliament must have more financial powers, to give us the flexibility to make real social change in Scotland. All of us would love to target women who are pregnant and need assistance, because troubles often start in pregnancy, but we will not be able to do that within the existing financial constraints.
10:26
Stewart Stevenson said that the tone of the debate is leading to consensus—yes, on fine words by the Tories, but no, if we take a reality check. Early intervention has always been a priority for Labour, both in Scotland and at Westminster. If I were in the minister’s shoes, I would not take any lectures from the Tories today, based on what they have said down south.
I find it really concerning that in today’s debate the Conservatives cannot or will not protect children’s budgets, although they say that early intervention is a good thing. Murdo Fraser talked about the Conservative Government south of the border. I believe that people should and will want to invest in early intervention, because it is a proven public finance saving. However, the Tories just cannot see that, despite their fine words. I shall expand on that point in a moment.
The Conservatives should take heed of the 2005 Nobel prize winner, James Heckman, who has shown that the economic payback of pre-school intervention is three to six times higher than that of any intervention post-school. The same logic applies to health issues. I have always believed that there is no bigger, simpler or more beautiful idea than that of early intervention. As the Jesuits said:
“Give me the child until he is seven and I will give you the man.”
The idea of early intervention is to refocus the attention of public spending on the earliest years of life, to give all our children the health, emotional and social skills that they require to make the right choices later. Research in the US into the effects of nurse-family partnerships demonstrated that children who receive that kind of intervention have 81 per cent fewer arrests than their peers and that as 15-year-olds they have 63 per cent fewer sexual partners. In its briefing for the debate, the Royal College of Nursing describes the impact of work that is being done in pilots of that nature in parts of Scotland. I welcome that.
However, according to headlines in our national newspapers, under the Con-Dem coalition Government,
“Cuts will force 250 Sure Start centres to close, say charities”.
Murdo Fraser’s colleagues at Westminster are responsible for those horrendous cuts. According to a report that was published earlier this week, to which other members have referred, hundreds of sure start centres face closure, and thousands of others are cutting services and have warned of job losses. Maureen Watt was absolutely right to intervene on working family tax credits. The cuts that I have described are a result of the uncaring Tory approach to policy and cutting budgets. I am afraid that fine words from David Cameron and Nick Clegg in the south have led to weasel actions. Their track record is exactly what Scotland would get from the Tories.
Does the member accept any responsibility on behalf of the Labour Party for the huge mega-billion-pound debts that that party has left the Conservatives to deal with?
Mary Scanlon knows only too well that the world global financial crisis started with sub-prime mortgages in the States. She is being disingenuous if she says that she does not remember that. Anyone who is in denial about that needs to take a reality check, which is the biggest problem that the Tories have in Scotland today.
The cuts to sure start will affect 60,000 families, including families in Scotland. A joint study by the charity about children and families, 4Children, and the Daycare Trust suggests that 2,000 centres will provide a reduced service and 3,100 will have a smaller budget. Staff at 1,000 centres have been warned about the threat of redundancy, according to the survey, which involved almost 1,000 centre managers in England. Those sure start centres are all about early intervention, so we should not mock them.
Frank Field, the Labour MP who is now a Government adviser on poverty and life chances for the Con-Dem coalition, said:
“It is inconceivable that we can make the foundation years effective if Sure Start ... Centres all over the place are ... slaughtered.”
It is claimed that the closures and reduced services as a result of Government cuts could mean that 60,000 families lose their local centre. Frank Field continued:
“Local authorities must seek to employ innovative methods to ensure families—especially the poorest families—do not lose the vital support they need.”
I have a particular concern for disabled children and children with special needs. Parents of disabled children tell us that the major challenge for them is not their child’s impairment, but the fight to secure the services that they need to support them to lead ordinary lives. I urge the Conservative party to make a clear public statement on its policies for improving services for disabled children in the run-up to the election.
Early intervention applies to children of school age or younger who are discovered to have or to be at risk of developing a handicapping condition or other special need that might affect their development. Early intervention consists of the provision of services for such children and their families to lessen the effects of the condition. Early intervention can be remedial or preventive in nature—it can remediate existing developmental problems or prevent their occurrence.
We have heard about the frustrations of the Royal College of Nursing. I agree with Mary Scanlon’s points on that. As a consequence of the evidence to the Health and Sport Committee inquiry into child and adolescent mental health services, the Scottish Government was influenced to change tack on the health visitors policy. As Des McNulty rightly said, we have reams of paper setting out policy direction. However, the Health and Sport Committee found when it took evidence that, although successive Governments have set a clear policy direction, it is evident to all that health boards have not cascaded the policy to practitioner level. The committee has often found that boards elect not to make child interventions.
10:33
I am not sure how to follow that consensual contribution from Mrs Eadie.
It is the truth.
Rather than commenting from a sedentary position now, Mrs Eadie should have made her comments during her speech.
Previous speakers have rightly made observations on what constitutes early intervention and have spoken in chronological terms about age, years and so on. I would like to take a slightly different tack. For most young people, their status can be influenced at various stages in their lives. Children who may be in a loving, warm and stable family unit of whatever composition for the first four years of their lives can have that changed in the blink of an eye. Therefore, to be too prescriptive in saying what constitutes early intervention and when it should occur on a timeline has the potential to work against the child.
There are a number of early intervention projects in Lanarkshire that deal with young people whose lives have changed, getting in at the first manifestation of an issue. At times, the manifestation is a behavioural change in school. Yesterday, with Dr Simpson, I had the pleasure of being at Niddrie Mill primary school for a presentation by a voluntary sector organisation called Place2Be, which provides a place where children can relax in a confident and safe environment and explore the issues that have manifested themselves in behaviour such as verbal aggression, withdrawal and failure to attend. The children are given an opportunity to speak for themselves. In our contributions to the debate so far, we have not addressed this subject. At any given point—subject to age as far as verbal communication is concerned—children have a right to speak up for themselves. There is no question but that giving them the opportunity to do that has to be a constituent part of what we do in getting it right for every child.
My next observation is perhaps a little more controversial. There has to be a much stronger development of the understanding among the members of the multidisciplinary team of the skills that the other professions bring to the table, including the valuable contribution that the voluntary sector makes. That is a serious concern. We hear—anecdotally at least—that social work and education colleagues collide almost as frequently as party politicians do, because their objectives are different. Perhaps more progress on joint training for social workers and teachers will be helpful. In dealing with early intervention, all parties have to recognise the skills that are brought to the table.
The fly in the ointment of early intervention is that, as Ross Finnie highlighted eloquently, were it simple, we would have done it. One challenge is who holds the purse strings. Regrettably, whether we are in times of financial constraint or plenty, the attitude is, “If it’s no ma budget, it’s no ma responsibility.” As Karen Whitefield rightly pointed out, the short-term approach will not work in this regard. This is an area that I am exploring with my colleague Jeremy Purvis. Our concept of a pupil premium could—with sufficient flexibility—bring together disparate bits of budget and focus them on the child, so that they follow the child at the early stages of intervention and the money is used for the benefit of the child. That would perhaps overcome the problem of people saying, “That’s a health service budget,” and so on.
I am delighted to hear that. When I raised the issue of local authority and health board money following the child—I called it backpacking—in the previous session of the Parliament, the coalition Government rejected it.
That is an interesting observation. I am not aware of that, as I was not part of the previous Administration. However, we are living in different times.
Yes.
I would not cast away so readily the suggestion at this stage.
My observation in all this is simple: we need to be very careful that early intervention is seen not only on a timeline—early intervention is not purely chronological. Early intervention should be delivered at the appropriate age and stage, depending on the circumstances of the individual child.
10:39
Research has shown that the interaction between a child and its parents early in life is key to that child’s physical and mental development, educational attainment, emotional development and social responsibility as it progresses through childhood. I am in no doubt that investment in child support from birth—indeed, from pre-birth—to school age pays off handsomely in later life.
Those of us who are parents have experienced the joy of early interaction with our children and of seeing their excitement as they discover their surroundings and their responses to the people and things that are around them. We probably did not realise at the time—I certainly did not—how crucial that was for our children’s future welfare and success in life.
I still recall the fun that we had at bedtime sharing with my son the Richard Scarry books that were popular when my son was young—that might date me. My son squealed with delight night after night as he found the little gold bug character that was hidden in the books’ illustrations. I recall, too, the stories that my mother made up for the children when she looked after them—I was lucky enough to have my mother to look after the children on the days when I worked. Her scary introduction to witches and ghosts caused trembling excitement but left the children unscathed, because they were safe in the knowledge that they were secure and would not really be harmed by those wicked creatures. Surely that is how imagination develops and how children learn to come to terms with the world that is around them. To achieve that, they need security and stability.
My children were privileged to have two resident parents and three grandparents who had the time and interest to interact with them. I can only imagine how hard it must be for single parents who live far from their parents and want to do the best for their children but do not have the knowledge, resource or support to give them what they need.
Ross Finnie is right: we face second and third generations of parents who have not received adequate parenting. It is sad that many children live in chaotic households with parents who are addicted to drugs or alcohol and who cannot parent them adequately. That results in many grandparents taking over the care of their grandchildren.
Many such kinship carers do not receive the support that they need emotionally or financially. That applies particularly to informal carers who have rescued their grandchildren from an emergency and who are left literally holding the baby. I know that the Minister for Children and Early Years has engaged with that group of kinship carers, but there is still some way to go to help them. Those people sacrifice much to support their grandchildren and save significant public resources by doing so.
Parenting is not easy. We have not reached the stage at which we can be satisfied that the support for all who cannot give their children the best start in life is adequate.
We have heard from Murdo Fraser about the importance that we attach to a comprehensive health visitor service as part of the primary care team, which can give invaluable support to the parents of babies and young children up to the age of five and can pick up problems quickly when they arise. As a GP, my husband had a high regard for the input of his health visitors, who could identify families who needed extra help or who had problems such as communication difficulties that needed quick investigation. I will not elaborate further on that, other than to say that health visitors are an ideal source of the advice and information that parents need if they are to be the good parents most of them aspire to be.
We also want other sources of helpful, clear and concise information to be made available and readily accessible in all maternity units, early years settings and GP surgeries. We are committed to providing information about good parenting websites via trained staff and information through leaflets and other explicit publicity material.
All three and four-year-old children are legally entitled to 12.5 hours per week of pre-school education, but Liz Smith has explained why more flexible provision and a wider range of providers are needed. Parents should be able to choose the nursery provision that best suits their needs and those of their children.
When children are under three, mother and toddler groups and playgroups are invaluable organisations for bringing parents together and allowing them to share their problems and for allowing children to learn to socialise and play together before they enter the more structured world of pre-school nursery. Many parents enrol their children in those groups. Such groups would benefit from enlisting the help of older people, who could share with younger parents their experiences of parenting and of life and could help them with storytelling, teaching nursery rhymes and playing with the youngsters. They would bridge the generation gap and act almost as surrogate grandparents. That might not be feasible in the current climate of child protection and disclosure, although I have seen excellent intergenerational contact with an older group of children in a community cafe in Aberdeenshire, where the youngsters help the oldies with the internet and in return learn about the history of their village from the first-hand experience of the older generation.
On a different note, and in line with what Karen Whitefield covered in her speech, Barnardo’s Scotland has highlighted for us some of its continuing work to support dysfunctional families, and it has called for more decisive action in responding to people in cases where the support that is available does not appear to be improving outcomes for children. That includes proper consideration of removing the child from the family at an early stage. Barnardo’s has also highlighted the problems that arise from failed attempts to reunite families and the need for timely decisions about a child’s permanent future, such as adoption, which can be a very positive outcome for a child who is permanently removed from its birth family. We would do well to heed the advice of an organisation such as Barnardo’s, which has very practical experience of the problems that are faced by all too many young people.
There is general agreement that early intervention has a positive impact on a child’s ability to achieve its potential, but its provision needs to be more strategically planned and delivered, and in a more integrated way. Scottish Conservatives regard early intervention as a positive and productive investment in our country’s future, which we will treat as a priority, and we will work with other parties to ensure its effective delivery.
10:46
I was delighted to read Murdo Fraser’s motion. It is good to see that he has joined the SNP and others in recognising the importance of early intervention. I was almost persuaded that he was praising the SNP Government for the work that it has done so far in early years provision—and that he was looking forward, as we all are, to a second term of the SNP in government.
I take it that Mr Fraser has read the early years framework as interestedly as I have, and that he is entirely in favour of the fine ideas and concepts that are embodied in it. I know that he reads everything that is produced by this Government, and that he is always persuaded by the fine arguments and eloquent debating style of SNP members, so I know that he will agree with everything that I say today.
It is no exaggeration to say that what happens to children in their earliest years says much about our society and is key to outcomes in adult life. As Helen Eadie has already said, the Jesuits had it in the phrase, “Give me a boy until he is seven, and I will give you the man.” Over the past few decades, research has tended to suggest that there is enormous truth in that. Evidence from education, health, justice and economic experts has leaned towards the earliest years of life as being the most critical for development—much of it suggesting that the Jesuits were in fact taking too long over things.
The Scottish early years framework is about giving children the best start in life. It lays out the journey that the Scottish Government, its partners in local government and practitioners in early years services need to take for the benefit of Scotland’s new and small citizens to ensure that they get the very best and that they grow into the best adults they can be. Just as important is that they can enjoy their time as children. That is something that we seem to forget. Some of us took part in a debate not that long ago on children’s play and the importance of developing that.
In fact, the framework starts even before those wee citizens put in their first personal appearance. It starts in the pre-birth period, which is a recognition of the importance of pregnancy in influencing later outcomes and of the mother and child having a healthy relationship right at the start, so that birth and the beginning of independent life becomes a critical stage of development.
Stewart Stevenson spoke about the impact of music on babies when they are born. Any of us here who has had the privilege of carrying a baby will realise that the baby will usually recognise music and voices before they are born, too.
The framework takes the child to eight years old, covering the transition into primary school—through the infant classes into mainstream schooling. There is a good argument that much of the framework is just as relevant to older children, extending into the transition into secondary school and perhaps even beyond that.
Sometimes, the first intervention that is recognised for a child comes through the children’s hearings system, and it is generally on welfare grounds. Sometimes, issues are picked up not through health or education but through the children’s hearings system. The reforms to that system will allow that to be recognised earlier and some of the reforms in the Education (Additional Support for Learning) (Scotland) Act 2009 also help with the early identification of problems.
As Murdo Fraser will have seen during his lengthy examination of the framework, it is about the very things that he mentions in his motion: the provision of good professionals and their excellent professionalism, the broad interpretation of needs and the provision for those needs in a wide range of settings.
The framework recognises the right of young children to high-quality relationships, environments and services that offer an holistic approach to meeting their needs. That runs across the whole spectrum from play, through learning and social relationships, to emotional and physical wellbeing.
It is recognised in the framework and the underlying approach that, although such an approach is important for all children, it particularly benefits those children and families who require higher levels of support. Providing support at the intensity required and ensuring that children and their parents are neither left in limbo without help nor smothered by the state is a job that must be done on a case-by-case basis. It cannot be decided here in Parliament, nor can it be prescribed in a textbook or seminar. That is where the professionals are at their most valuable, helpful and effective.
The Scottish Government realises that, although we can have as many frameworks, strategies and working groups as we like, it is always the people who are right on the scene who make the difference, as I have found from my experience. We are in a position to create the right frameworks, and the Scottish Government has done that, but that is about the extent of what we can do. We must create the framework, provide the resources and leave those who know what they are doing to get on with it.
I agree with Des McNulty—he may not hear that again in the chamber—that a true holistic approach is the most effective way forward. The strategy, the other frameworks and the legislation that we have created on a cross-party basis in Parliament will enable that approach to work and allow the support to be put in place.
One of the most important things about the framework—and the one area in which the motion may stray from the path of righteousness—is that a big part of the strategy aims to ensure that professionals enable parents, families and communities to develop their own solutions using the public services as required. Remedies are not imposed, nor does anyone take the decisions for those whom they help. Independence is as important here as it is anywhere else, and I am sure that Murdo Fraser has a deep appreciation of exactly how important independence is.
The framework is about ambition—about wanting more for our children, our communities and our nation, and about wanting them all to be better and to be better served. It is about making children’s lives better today so that we all have better lives tomorrow. The changes that had to—and still have to—come in the delivery of our public services reflect that.
I congratulate all those who have been involved in developing all the frameworks, the additional support for learning legislation, the reforms to the children’s hearings system and every piece of legislation that we have put in place to support children, and in bringing all those things to this point. I look forward to seeing continuous improvements in our early years provision.
10:52
I welcome this debate on early intervention in health and education, which is crucially important to future generations. Every child deserves a good start in life regardless of where and to whom they were born.
When we took evidence in the Health and Sport Committee on spending priorities a couple of years ago, I remember that the evidence was stark. We were told that the health budget should be targeted towards the early years, as those years will impact on a child’s mental and physical health throughout their lives. The children who face the biggest disadvantage are those whose parents are drug or alcohol dependent. Without support, their future mental health suffers because they do not learn resilience. As a society, we have a big job to do to protect those young people.
There is always a dilemma about what form intervention should take. There are those who would remove children from their home where their parents are drug or alcohol dependent, and I have some sympathy with that view. However, history has shown us that looked-after children can be more vulnerable than those who are left at home. A child may be reluctant to seek help and confide in adults if they are afraid that speaking out will lead to them being taken into care and removed from their parents. Parental love is probably the most important thing for a child when they are growing up, but wider family support is also crucial.
Children of addicted parents are likely to suffer from poverty, poor housing and poor nutrition, and they are less likely to participate fully in education. Those are dangerous conditions for a child’s development and welfare, and we often see several generations of the same family suffering from the same problems. Children need the state to intervene to help them to break the cycle, and it will never be a cheap option. The best way of doing that is working with the family. That work must be intensive and continuous, because a lifestyle that has been learned over generations cannot be put right by a couple of short parenting classes. Resources are tight, and finding funding for such intensive intervention is not easy. However, if we do not fund it, the costs to us will be even higher, because it is also clear that the later the intervention, the greater the cost.
I remember the discussion in the Health and Sport Committee in which it was suggested that we should concentrate all our efforts on children and forgo any intervention with the parents, but I find that approach difficult because parents are the most important influence on a child’s life. Helping the parent will ultimately help the child. However, the later in a person’s life that intervention happens, the higher the cost to the person and to wider society. If the intervention comes only when the child grows up and becomes a parent, the problem has doubled.
Therefore, it is imperative that at-risk groups are identified quickly. Other issues besides living in poverty and having parents with addiction problems indicate which children are most at risk. They include living in disadvantaged areas, being brought up in households in which there are poor parenting skills or in which there is conflict and domestic abuse, and living in a home where they are not provided with adequate support, perhaps because of illness or disability.
Health visitors have their part to play, as their intervention with the family during the early years will pick up those issues and they are able to guide parents towards solutions. However, we cannot leave it to one group of professionals alone. If we do that, we will fail. For example, midwives interact with women in pregnancy. Early intervention should start at that stage. Drug and alcohol consumption, as well as a poor diet, in pregnancy can affect the unborn child.
Greater reporting to social work and child protection agencies should be encouraged through continuous professional development within the health and education sectors.
The Benefits Agency also has a role to play but seldom gets involved. Anyone on benefits will be pretty close to poverty. Surely staff in the benefits offices have a role in identifying those who are at risk and pointing them to support services.
A study this week showed that children who had poor diets and ate more processed food at the age of three had lower intelligence quotients in future years. How do we tackle that? We all know that processed food is cheaper. Some families really cannot afford to provide a balanced, healthy diet.
The Labour Party has long promoted policies to help young people in that position. We introduced free nursery care, breakfast clubs and the child trust fund, increased child benefit and introduced tax credits that were designed to lift children out of poverty. The Conservative party in the Parliament has used its debating time to highlight the importance of early intervention. I am grateful for that, but I say to the Conservative members—this is meant to be constructive—that they should try to extend their influence to their Conservative colleagues in Westminster, impress on them the importance of the issue and urge them to stop dismantling the much-needed support that vulnerable families receive. They should ask their Westminster colleagues not to freeze child benefit and to remove the restrictions on family tax credits.
Yesterday, I listened to news reports that child care is more expensive in Scotland. That prevents low-income parents from working and damns their children to poverty. The abolition of the child trust fund also takes money from the most needy in our society. I was also horrified to hear that the Child Support Agency will top-slice absent parents’ contributions to their children’s upbringing. That literally takes the food out of the mouths of children.
The Conservative party would do us all a great service if it used its influence with its Westminster colleagues to stop those policies, but we cannot forget about the cuts that are being imposed on local authorities by yesterday’s SNP Government budget, which the Conservatives and Liberal Democrats in the Parliament supported. The budget will lead to the closure of breakfast clubs, as well as to cuts in the numbers of teachers and support staff—the very professionals who are trained to assess children’s needs.
We owe it to future generations to get it right. By getting it right for every child, we benefit not only financially but as a society.
10:59
As the session comes full circle, the Scottish Conservatives make no apology for bringing back to the Parliament a debate on the areas that consume the greatest resources: health and education. During the session, we have celebrated the 60th anniversary of the national health service and the people who work in it, but at times we have not always been as honest as we should have been about the fact that outcomes from our health service still fall short of those in many other countries in Europe. We understand that the context is often cultural and historic and that the problem is endemic and deep-seated. That is the context for the debate that we want to have on the importance of early intervention in trying to tackle long-term problems.
I thank Ross Finnie for raising the issue of the Finance Committee’s report, which says that we spend too much time on the reactive rather than the preventive. That was why we opposed the final tranche of the abolition of prescription charges proposed by the Government. That was not for ideological reasons. Too much investment was going into reacting rather than preventing.
No member who has participated in the debate could have been other than fascinated by the glorious tirade that was Helen Eadie’s contribution on what the UK Government is doing. I wonder whether she is opposed to the £10.7 billion extra that will be spent each year on health between now and 2014-15, which Labour voted against and which will produce consequentials for the Scottish Parliament to spend on health, or whether she is opposed to the fall of 3,000 managers and the additional recruitment of 2,000 new doctors in the past nine months, or to the £200 million for a cancer drugs fund. In relation to this debate, I wonder whether she is opposed to the 4,200 new health visitors who are being recruited down south. I say to Ms Eadie that the proper response of the people of Scotland to her tirade should be, “Away and bile yer heid.”
Will the member take an intervention?
How can I refuse?
Perhaps the member might have more regard to banking and the fact that his colleagues in Westminster are putting more money in the banks’ coffers—the bankers bankrolled his party’s election campaign—than they are giving to people in any part of the United Kingdom.
Ms Eadie is not reading or listening. Some 4,200 extra health visitors are being recruited down south. We should be putting our resources into doing that.
That is why Scottish Conservatives believe that we need a national strategy. Fourteen health boards are adopting a variable approach. If we are going to concentrate on nutrition, which Rhoda Grant mentioned, tackle obesity, ensure that the herd immunisation rates increase, improve the sex education of teenage women in order to avoid pregnancies, or improve the welfare of children, we need a national strategy that concentrates on the development of children up to the age of five.
I enjoyed Des McNulty’s speech, which contrasts with the rather Abba-esque policy of the Labour Party in recent times. I was delighted to see Agnetha, Frida, Benny and Björn on the Labour front benches this morning in addition to Helen Eadie, although I see that Björn has rather divorced himself from the group for some time. I suppose that that is in keeping. Jackie Baillie is not with us this morning. I am willing to be persuaded that there is a non-partisan bone in her body, but I have simply never seen evidence of that. Yesterday, we saw Labour’s unseemly arrogance in thinking that it is entitled to power, but that arrogance was absent from Des McNulty’s speech, in which he was humble enough to say that, whether Labour is in government or opposition, he will work with the other parties in the Parliament to address and improve matters and ensure that we have an effective early intervention strategy.
We have said that we want a national strategy, and we are prepared to see an annual investment of £20 million in that. We want to make that investment because we want a fundamental change in culture.
In previous debates, when I have talked about the need for us to ensure that there is a greater sense of self-responsibility in our approach to health, Shona Robison has characterised that as a threat. It has been seen as an implied threat that would mean that we would withdraw health care from those who do not show that self-responsibility, but I did not mean that at all. Indeed, I commend to Shona Robison the working partnership on tackling carbon emissions that we have evolved with her colleague Roseanna Cunningham. We have resisted the suggestion that others have made that we should put in place a regulatory framework with penalties, because we need to change the culture of people and the approach to carbon emissions. Exactly the same approach needs to be taken to health. We need a national effort so that people become more responsible in their health care, and an early preventive strategy is fundamental to that.
A very good example of that is the emphasis that is being put on self-management, which is about people being helped to manage their own condition. That is extremely effective.
I merely wanted to reassure Ms Robison about what I meant when I talked about the need for a greater sense of self-responsibility.
There are two reasons for that. If, through early preventive strategies, we can improve the health of the next generation, the cost to the health service of that generation will reduce. That is fundamental, because we have a demographic time bomb. The NHS will have to bear all the costs associated with a much older population, so, if we are to succeed in the task of improving the health of the next generation, we need to have a strategy that is effective at early intervention.
A culture shift is required. We need a national strategy for early intervention. We have had the courage to say what we would do and how we would fund it. I believe that it is necessary to produce a generational shift in the dynamics for the future health of Scotland.
11:05
I welcome the fact that we are debating early intervention in Scotland, which has such a lasting impact on the course of people’s lives. Study after study has demonstrated that the first few years of a child’s life are critical to their development and the opportunities that they are likely to have.
The presentation that ministers were given by Harry Burns when we were developing the equally well strategy, in which he talked about the holes that can develop in children’s brains as a result of neglect, such as not being fed, changed or put to bed at the right time, will stay with me forever. Although a direct cause-and-effect relationship cannot always be proven, a positive nurturing environment is likely to help a child to develop, whereas all too often a negative environment can make it difficult for a child to succeed in education and can lead to health problems or to crime and antisocial behaviour.
As much as we might wish there to be, there is no single silver bullet that we can use to ensure that every child in Scotland grows up in the kind of environment that we would want. Problems do occur, particularly when families are trapped in poverty, and when there is a risk of that happening, it is critical that any interventions to improve a child’s situation are as effective as possible and are taken as early on as possible. Communities and people who work in them know where those families are. At the same seminar, John Carnochan from the violence reduction unit said that it was possible to identify where in a particular postcode area the problem families were likely to be and where there were likely to be continuing problems.
In my view, early intervention begins at the antenatal stage. Every woman who finds herself pregnant will pitch up at the doctor’s, go for a scan and be offered antenatal classes. Those classes should be not just about the process of childbirth and how to bring up a child in the very early months; they should be an opportunity for social workers and health workers to engage with the mother—at that stage, every mother wants the best for their child—to help them to break the cycle of poverty or drug or alcohol addiction so that they can begin to provide a better life for their child.
Whether it is to address a child’s health, their educational attainment or their behaviour, the earlier that intervention is made to change a child’s circumstances, the more effective it is likely to be in the long term. Although speed is certainly no substitute for quality in such cases, the earlier a positive change can be made when a child’s opportunities are at risk, the better.
As others have said, the alternative is crisis management. Waiting for problems to develop before trying to patch them up is more costly and more damaging to children and the people around them. I know that the Scottish Government has been determined to move away from that approach through measures such as its early years framework and the equally well strategy. Prevention and effective early intervention—addressing issues before things reach crisis point and irreparable harm is done to a child’s potential—are the only sensible approach to improving children’s start in life.
Two years on from publication of the early years framework, demonstrable progress is being made in achieving the shift in attitude and philosophy that is necessary if we are to put prevention and early intervention at the heart of Scotland’s early years strategy. That was highlighted in a recently published report, which also identified further progress that can be made.
It is estimated that if early interventions for children from pre-birth to eight years old were 100 per cent effective, up to £131 million of Scottish taxpayers’ money could be saved in the medium term. Not only is early intervention effective but it represents a more cost-effective option. As is the case for so many issues, it is far more expensive to deal with a crisis than it is to take preventive action.
Against the background of the cuts to Scotland’s budget, which we debated yesterday, such efficiency is more important than ever. The undoubted challenges of recession, unemployment and reduced money for services make the successful refocusing of our strategy on prevention and early intervention even more essential. I welcome the progress that has been made so far. I firmly believe that the approach will stand us in good stead in the coming years.
If professionals co-operate, rather than work in silos, no child should fall through the net, as Ross Finnie said. If all professions work together and enmesh their services, perhaps the mesh in the net will become tighter and fewer children will be likely to fall through it.
Mary Scanlon and Jackson Carlaw should not get hung up on titles. The Royal College of Nursing Scotland said in its briefing for the debate:
“Health visiting services are critically important to the present and future health of families, however, they must not be seen in isolation from the rest of the community nursing team. Healthcare and other professionals must be able to work together to support the development of children.”
It is about all agencies working together. Identification of the most vulnerable families is crucial, and the policies that the Government has identified and is pursuing will bear fruit, if they are allowed to continue during a second term of office. I support the amendment in Shona Robison’s name.
11:12
The debate has been consensual, by and large, with a single exception. I always enjoy Helen Eadie’s staunch and resolute defence of a perfect Labour Party, which sees no evil, does no evil and has done no evil. I gently make the point to Helen Eadie that for bankers, the biggest benefit that they are currently getting is from the interest on the monumental debt that the Labour Government managed to amass, which is the equivalent of a new primary school a day. That is obscene. Governments are right to rein in the debt and to ensure that hard-earned taxpayers’ money does not go to bankers at the rate of a new primary school a day but is used to rebuild the social fabric of the nation.
Will Ross Finnie take an intervention?
I will be delighted to do so, if it is very brief.
Two words. Lord Oakeshott.
Lord Oakeshott. Splendid gentleman. I know Matthew well; he is an excellent fellow.
Christine Grahame made an interesting point about there being different relationships and characters, but I do not think that what I said about generational problems and what she said about relationships are mutually exclusive positions, because relationship issues can be traced through three generations of a family. It might be that in the third or fourth generation different relationships and more chaotic lifestyles have developed, but the problems can still be traced back to a failure in our society, which is regrettable.
Another interesting point that Christine Grahame made was on preventative spending. Of course, in tight financial circumstances we will face some difficulties; however, we must use financial methods that are a dashed sight more sophisticated than the information that has been presented to us, as some Government ministers would admit. In its inquiry into preventative spending, the Finance Committee came across a number of examples. A Children 1st report talked about £1 spent on early intervention producing savings of £7 in later years. Another report talked about the estimate of the cost of family intervention projects being around £10,000 to £20,000 per family per year compared with the cost of looking after a child in foster care, which is £25,000 a year, and the cost of looking after a child in secure accommodation, which is £134,000 a year. I agree that there will be pressures, but we need to look more intelligently at the options that are available to us if we are seriously to tackle the problem.
I quite agree that we must have long-term investment. The problem is that the Parliament has budgets only for four years and that we will be unable to plan according to that kind of trajectory unless we are in charge of our own finances.
I am not entirely sure about the correlation between the two. I know that the SNP thinks that every problem would be solved by our being independent, but let us not spoil the morning by getting into the fiscal autonomy debate.
Why not?
Well, we could ruin a good day.
There is now much greater consensus about the importance of early intervention. I do not criticise the current Government, which has travelled in that direction. We all understand that some of the early attempts to deal with the problems simply focused on the wrong area. If we are genuine about recognising the importance of early intervention and the benefits that it can bring, we must take note of the range of issues have been raised in the debate.
It is also important that we take international experience into account. Karen Whitefield was right to draw our attention to the New Orleans example, and there are other examples. We do not need to reinvent the wheel every time that we come upon a good idea. There are many good international examples—including in mainland Europe—that the Parliament should be taking the time to look at so that we can consider implementing them in a constructive way.
Liz Smith talked about the flexibility that is required in nursery places and the partnerships that are needed between the nursery scene and other elements of society. All of that must be woven into a solution, if it can be.
Mary Scanlon described the way in which nursing care has developed as a bit of a muddle. Now that we have been promised a report at the end of the year, the prospect of our getting out of that muddle is better. Nevertheless, as I said in my opening remarks, the three-and-three-quarter-year gap to which she has referred on a number of occasions needs to be addressed.
This has been a helpful and constructive debate. However, now that we have all the reports and a general level of agreement, there must be a clearer direction and greater purpose. There must also be a sense of a shared programme not just within the Parliament, but among the various agencies, local authorities and health boards. We cannot have them all continuing to operate in a disparate way. The Liberal Democrats are very keen on, and much persuaded by the arguments for, local people making local choices. I do not mind their doing that but, for goodness’ sake, we must all move in the same direction and with the same end purpose in mind.
11:19
I welcome this debate and the generally consensual approach that has been taken. None of us could forget the picture that Harry Burns published in his report two years ago of the difference between the brain of a normal child and that of a child who has suffered severe neglect. That is our starting point.
There are 100,000 children living in families with alcohol and drug problems in Scotland, and many more that face other serious challenges. There are 210,000 children living in relative poverty, and that number will increase—children with single parents constitute the largest group within that number.
If we do not achieve the early identification, which members from every party want to happen, before a child is three years old, the consequences for that individual, society, the taxpayer and the budget are appalling: between 3 and 8 per cent of those children will have behavioural problems; exclusions will be higher; there will be more smoking, drug use, alcohol use, antisocial behaviour, underachievement, poor educational achievement and unemployment; and more of them will go to prison, become pregnant as teenagers and be obese. We do not need any more evidence to tell us that.
The Dunedin study, which started in 1972, showed that the overwhelming majority of children who will be in the groups that I have mentioned can be identified before they reach the age of three. Hugh O’Donnell is right to say that we need to get on with the identification process, and I will return to that point in a minute. Dr Wilson, from the SNAP group, also indicated that that is perfectly possible, as Christine Grahame said. If we agree on that point, we must focus the resources on that area.
Ross Finnie invited me to give a lecture on RONIC. I will not, but I will say that it was a well-intentioned blind alley that has delayed progress for this Government and has meant that its achievement has been less than it would have liked.
I agree with Ross Finnie that the system is highly dysfunctional. We need only consider the fact that we have yet to align budgets. We have not got an integrated paediatric health and social care service. That failure is disastrous for individual families. We do not have workforces that are aligned and focused—Mary Scanlon and Christine Grahame talked about some of the workforce issues that need to be addressed.
I want to pay tribute to the Government—as I have done in almost all my speeches—for its attempts to move things forward, including its review of “Health for All Children”, the progress on the early years framework and its work on GIRFEC. However, all of that has yet to lead to any significant achievements. We are only at the stage of refreshing the maternity care framework. Why are we simply refreshing the framework when there are many mothers with drug and alcohol abuse problems and we have only a couple of specialist teams dealing with that? As Rhoda Grant and Maureen Watt pointed out, we should start at the point of pre-delivery, not the point after the child is born, yet we do not focus on that to any great extent. We are losing maternity posts today, even though we have a higher number of births than we had before.
There is much activity—a new maternity care framework, NHS Quality Improvement Scotland’s forthcoming pathway of care for vulnerable families, a forthcoming national syllabus for parents and the new guidance on Hall 4—that is about to take effect. However, if we go back further, our teenage pregnancy rates are huge. The healthy respect programme has been in place for many years but it has achieved nothing in terms of outcomes for teenage pregnancy. However, in Oldham, through a focused approach, there has been a 29 per cent reduction in the number of teenage pregnancies, and that is not the only area in England where a similar approach has been hugely beneficial.
The family-nurse partnership pilot arose from one of Tony Blair’s papers back in 2004. Here we are, seven years later, with two pilots costing £1.6 million and supporting 145 families. That is great, and in time we might see that the cost is low relative to the costs that would have developed later on, but it is still £10,000 a family. We will see whether the approach works.
Reference has been made to the New Orleans programme. As a practitioner in adoption and fostering for 18 years, I was repeatedly appalled by the fact that children went in and out of care again and again, and their attachment was never assessed. Without attachment, individuals will not develop properly, so the New Orleans programme might be helpful to us in that regard.
I have had a lucky week, as my new grandson has been born. He is very small—less than 5lb. The breastfeeding nurse in Wishaw general hospital has been hugely helpful in supporting my daughter-in-law, but the nurse told me that the 22 breastfeeding nurses in North Lanarkshire will be made redundant at the end of March—another successful pilot down the tubes. We are pilot-ridden in this Parliament. We have all been trying our best, but the pilots are not good enough. We have to roll things out.
The sure start issue is important. If we do what England is doing under the Tory coalition and have a third of our sure start centres close, that will be bad. That was the point that Helen Eadie was trying to make.
Hugh O’Donnell talked about Place2Be—I am wearing the badge today—which runs a hugely successful but inexpensive programme that helps schoolchildren.
Christina McKelvie, Maureen Watt and others made the point about integration. We have a dysfunctional system that is not integrated. There are separate records on the same child for GPs, health visitors, social work and nursery schools. We must get to grips with that.
I welcome this debate and I support our amendment.
11:26
I certainly welcome the contributions to this morning’s important debate. It was very consensual in the main, with one notable exception—as always.
I want to take a moment to dwell on a bit of an uncomfortable truth. I say this not in a partisan way—even though it is me saying it—because it applies to us all. There is a bit of an irony in the fact that we are having this debate the day after the motion on the budget was passed, because throughout the negotiations with every party in the budget process, the early years and early intervention agenda was never raised. I want to dwell on that for a moment. Perhaps what Karen Whitefield said has some truth to it: we all want short-term outcomes and gains for the things on which we choose to spend money, but this is an area in which that clearly does not happen. Perhaps when we were all talking about our priorities during the negotiations, that was somewhere in our mind, but we must challenge ourselves on that. It is worth us all reflecting on it.
If we are truly to translate what we all say and believe—and there is clearly a consensus around this—into action, we will require collectively to make some difficult decisions about where not to invest. Murdo Fraser suggested that we should not invest in abolishing prescription charges, but why prescription charges? It could have been any of the things that were put forward as alternatives to the budget. I hope that Murdo Fraser takes that point in the spirit in which it was intended.
We all have something to reflect on. I agree with the point that a number of members made about successive Governments having had the best of intentions. Richard Simpson is right to some degree: a lot is happening, but perhaps too much is happening and what is happening is too disparate. Perhaps we need to reach conclusions about what we think will work and do that well everywhere. That is difficult, given some of the governance arrangements in our key agencies, but perhaps we need to begin to think about some of those issues. I will go on to say a little bit about why I think that the family-nurse partnership is a good candidate for that.
In January, I launched a number of key documents that underpin our commitment, some of which have been referred to already: “A Refreshed Framework for Maternity Care in Scotland”; “Reducing Antenatal Health Inequalities”; “Improving Maternal and Infant Nutrition: A Framework for Action”; and “A New Look at Hall 4—The Early Years—Good Health for Every Child”. All that is good and we are going in the right direction. I suppose that the challenge is to make it happen and to overcome some of the workforce issues, where integrated working is not happening as we would like.
Richard Simpson ended on the lack of joined-upness. Interestingly, if we look at Highland, where a lot of interesting things are going on, we see that there the GIRFEC model is fully implemented. That model very much overcomes the problems that Richard Simpson mentioned with different records and a lack of communication, which are so significant for child protection. The challenge is to ensure that GIRFEC is happening everywhere, and that is not without its challenges. We know what works, but we need partners throughout the country to make GIRFEC the priority that it should be.
Richard Simpson also talked about the alignment of professionals—such as paediatricians and paediatric nurses coming together with social care staff—and how we can make that happen. Again, interesting work is being done on that in Highland under the lead agency model. There has been a lot of focus on the adult social care element of that, but there has been less attention on the fact that children’s services are also coming under one roof. There might be something in that. We talk about people working together, but perhaps they actually need to be together to make things work. Perhaps we need to rethink how we structure the workforce.
I will make a further comment on the subject of the workforce before it goes out of my mind. A few comments have been made this morning about who the workforce is in this important area. Christine Grahame, I think, made the point that the workforce is not just a health visiting workforce but must be seen in its broader context. There is a reasonable story to tell on that. The number of district nurses has gone up by 544 since 2007. There are another 150 public health nurses, another 123 health visitors and, indeed, 71 more school nurses. Those of you who are quick at maths will realise that that means that we have nearly 900 additional staff whose focus is very much on this area.
The question is whether they are being deployed in the most effective way, because it is what we do with the workforce that counts, and I think that there are some issues. We await with anticipation the modernising community nursing board’s report, which will be published at the end of the year, because we have to take a hard look at how we deploy those resources, the training that staff receive, the skill set that they have, and what we expect them to deliver and prioritise. We need to be clear about that.
I will touch briefly—because I am running out of time—on family-nurse partnerships. I take on board Richard Simpson’s point that the programme is expensive, but the best programmes are not always the cheapest ones. The evidence that we should acknowledge is not necessarily Tony Blair’s report on family-nurse partnerships but the huge amount of American evidence that shows that, over the lifetime of the child, the investment undoubtedly produces benefits. Under the programme, the vulnerable family has a close relationship with the nurse, who is often the only stable influence on the family, because they might not have the granny who can give advice and there might not be anybody else around. The nurse can be a solid rock and open doors not just on health matters but on many other issues that the family will face. There is solid evidence that we reap the benefits when the child reaches their teenage years, so I am a fan of the family-nurse partnership approach.
You should be finishing now, minister.
I think the approach works. We look forward to doing more with it, and I think the evidence will speak for itself.
11:34
I thank everyone who has spoken in what has been a largely consensual debate. I will try not to single out Helen Eadie—although I might say something later if I have the time.
What was important was to achieve a proper consensus on the importance of early intervention. As various members have pointed out, an election is coming up in less than three months and, no matter what party or combination of parties might be in government, everyone needs to understand that this issue is vital.
Opening for the Government, Adam Ingram referred to the early years framework and the review of Hall 4. After listening with great interest to Christina McKelvie’s request that I agree with the Government, I will agree that I agree with a lot of the early years framework, but I still believe that we need to do more in specific areas. For example, as Mary Scanlon pointed out in her powerful speech, a 24-month health check is simply not enough. We need pre-school development checks. Indeed, we should not rely on a reactive approach but should take an interventionist approach. It might be unusual for a Conservative to say such things, but I think that intervening more in this area will pay dividends. As Mary Scanlon also made clear, there are too many different approaches in Scotland. We need a universal service—indeed that is, for us, the key issue. Although I see merit in the Labour, Liberal Democrat and Government amendments, I cannot accept any of them because they delete from our motion the reference to a national health visiting strategy, which, for us, is the single most important point in this debate.
In a very good speech, Des McNulty raised a number of fair points and I certainly agree with his statement that there are large areas of agreement in this policy area. The key message that I took from his speech is that we know what we should do, but we must now make it happen. Perhaps we have had enough strategies; now we need delivery. He very fairly accepted that the changes to Hall 4 introduced by the previous Administration had not been beneficial and that it was time to think again. As for the debate about a universal versus a targeted service, I want to reassure Mr McNulty that we are not saying that we should not target resources. Instead, we want both; we want to ensure that a service is available to all, with an additional resource for the most vulnerable. I also agree with Des McNulty and, indeed, Hugh O’Donnell on the importance of the voluntary sector, which will play a huge role in delivering this agenda.
Des McNulty, Ross Finnie and a number of other members mentioned the importance of preventative spending and referred to the Finance Committee’s report on the subject. In this respect, Shona Robison was right to point out that the issue did not feature in the budget discussions, which I believe illustrates one of the challenges that we have to face. We are all under pressure from constituents to deliver on certain policy areas and funding for bursaries, housing or whatever, but the fact is that this important agenda gets overlooked because we will not see any of the benefits of spending this money until many years down the road. If we are to introduce preventative spending, we have to ask ourselves what we will stop spending money on today to fund something that will produce benefits tomorrow. That challenge, which faces all parties in the chamber, will not be solved as a result of this debate or, I suspect, any time soon.
In its briefing, the RCN draws attention to the various changes in approach that have been made. It points out, for example, that the RONIC pilots were not progressed; that the modernising community nursing board, which was introduced by the Scottish Government, is due to finish its work at the end of the current year, after which a clear way forward for community nursing should be set out; and that this is creating uncertainty in the nursing profession and among health visitors. All that those people are looking for is certainty and a clear way forward.
Liz Smith and Nanette Milne pointed to the importance of education in early years. As we know, nursery education is vital; however, the current set-up does not suit all parents, which is why we are calling for greater flexibility. Moreover, as a number of members made clear, by the time a child reaches the age of three, it is already too late to intervene effectively and deal with many of the problems that we need to address. As a result, although nursery is important, waiting until children get to nursery before intervention takes place is not the answer.
Parenting skills are vital. There is nothing automatic about having good parenting skills. In most cases, such skills are passed down from generation to generation, but we know that many families do not have that benefit—it simply does not happen. That is why support for parenting initiatives is essential. There are tremendous examples of good work that is being done by voluntary sector groups—Barnardo’s and Care for the Family are two that come to mind—and which provides support for families that need extra help with parenting. We should encourage that. We do not need massive new quangos to be set up, or even massive new state funding—we need support for the voluntary sector projects that are providing those vital skills.
I have a moment to deal with the points that Helen Eadie and Rhoda Grant made about the coalition Government. I gently remind Helen Eadie that we are making cuts today because the previous Labour Government left us with the worst set of public finances in the industrialised world. When we talk about cuts, let us not forget that the Labour Party, if it had remained in Government, would have cut two thirds of every pound that the coalition Government is cutting.
Rhoda Grant rose—
The member does not have time for interventions.
When we talk about early intervention, let us never forget Labour’s legacy to every child in this country. Every baby who is born in Britain today is saddled with a debt of £22,300, thanks to the debt legacy that the Labour Party left.
To quote Des McNulty again, we have policies and strategies, but what we now need is action. Today we have proposed solutions on health visitors, nursery education and parenting. Others have different ideas, which is fair enough. One of our major concerns is that we do not fall behind what is happening south of the border. The UK Government is creating 4,200 new positions for health visitors—a doubling of the number of health visitors who are supporting families in England and Wales. In health and education, people in England and Wales benefit from having the Conservatives in government, at least in coalition. How much we look forward to May, when people here in Scotland will have the same opportunity.