Grand Committee
Co-operative and Community Benefit Societies and Credit Unions Act 2010 (Consequential Amendments) Regulations 2014
(9 years, 10 months ago)
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Lord Newby
That the Grand Committee do consider the Co-operative and Community Benefit Societies and Credit Unions Act 2010 (Consequential Amendments) Regulations 2014.
Relevant document: 1st Report from the Joint Committee on Statutory Instruments
Lord Newby (LD)
My Lords, the regulations represent the latest step in the Government’s drive to deliver improved legislation for registered societies in Great Britain, by which I mean co-operatives and community benefit societies, hitherto known as industrial and provident societies, as well as credit unions. The regulations relate to how we refer to this group of businesses, and make the necessary changes in secondary legislation to enable new industrial and provident societies in Great Britain to register as either a co-operative society or a community benefit society.
Around 6,000 co-operatives and community benefit societies are registered across Great Britain. They come in all shapes and sizes and cover a diverse range of activities and industries. Their continued popularity is evidenced by growing numbers of members. Some of these mutually run businesses already refer to themselves as co-operatives or community benefit societies, and many industry stakeholders now regard the expression “industrial and provident society” as old fashioned.
The sector requested a formal change of description in legislation to modernise the language used to describe these businesses, which will enable them to become more relevant to members and the general public. I imagine that most people would have a sense of the terms “co-operative” and “community benefit society”, but many might struggle to describe quite what an “industrial and provident society” might be.
These regulations will make amendments to secondary legislation consequential upon the commencement of Section 1 of the Co-operative and Community Benefit Societies and Credit Unions Act 2010 as re-enacted in the Co-operative and Community Benefit Societies Act 2014, which lays down new registration requirements for societies in Great Britain, other than credit unions.
As well as requiring a new society to be registered as a co-operative society or a community benefit society, the 2014 Act refers to all societies registered under the 2014 Act or before 1 August 2014 under existing legislation—including credit unions—as “registered societies”. The consequential amendments reflect those changes for Great Britain, but will preserve references to industrial and provident societies in Northern Ireland legislation.
Any new societies registering under one of the new terms from 1 August will not face any additional costs. For existing societies, only those that choose to amend their description may incur minimal costs; for example, to replace stationery or to amend website information. In any case, the sector has indicated that any costs as a result of registering under a new description will be more than offset by the benefit of using language that is more transparent to the public and their members.
These regulations form a small part of the Government’s wider commitment to support mutuality. Beyond this, a number of changes to mutuals legislation have been progressed during this Parliament. Those included a package of measures that came into force in April, which included: increasing the amount of withdrawable share capital an individual can invest in a society from £20,000 to £100,000, making it easier and cheaper for societies to raise capital; giving the FCA additional powers to investigate a society if suspected of unlawful or improper behaviour; making insolvency rescue procedures available to societies that previously would have had no alternative but to be wound up; and simplifying electronic registration for new societies.
Linked to the regulations we are discussing today, the Government also brought forward the Co-operative and Community Benefit Societies Act 2014, which was announced by the Prime Minister in January 2012. The Act has now gained Royal Assent and is due to come into force in August this year. It is a consolidation Act, which brings together and modernises the existing legislation for co-operatives, and was requested by the sector.
Today’s regulations are a necessary step in the work under way to strengthen the legislation for the co-operatives and community benefit societies. They form part of the wider package of measures implemented during this Parliament to strengthen and support the mutuals sector. The changes included in these regulations have received wide support from the sector.
Lord Graham of Edmonton (Lab)
My Lords, it gives me great pleasure to welcome this stage of the legislation and the changes. In looking at my research, I am reminded of the efforts of John Roper—the noble Lord, Lord Roper—who played a large part in getting credit unions on to the agenda. Since then, Ed Balls in his ministerial capacity welcomed the issue and moved it forward. Of course, the present Minister, who I am delighted to see in his place, and his colleague the noble Lord, Lord Freud, have played a major part in keeping the issue alive.
I go back not to 1844 but to 1852 and the first industrial and provident societies Act. One of my studies has been co-operative law, and from 1852—certainly to 1863 and then into the 1890s and beyond—there have been genuine attempts to improve the raison d’être of co-operation as an economic form. There has been no objection. I am a Newcastle upon Tyne co-op society man, and one of my jobs for a period was to pay out the dividend accrued. That was the way in which many members of what I am still proud to call the working class saw an opportunity to save for the rainy day; it was marvellous. They would keep and take out of the dividend what they wanted, but they knew it was safe, secure, guaranteed and that it was their own.
We come to governance and changes, and of course this is not the place to go wider than the topic that we have here. That is why I was delighted to notice in a document from ABCUL, the association of British credit unions, that the ministry has already earmarked £38 million to be available for leadership training. It has been a great sadness to see something go catastrophically wrong for an organisation of this kind—there are thousands of credit unions and more than a million individual members—but one discovers that it was not the principle that was wrong, but the manner in which it was led or monitored. As a consequence, there have been blemishes in the credit union movement; I will not say more or less. However, I am delighted that one aspect of the legislation is to continue the good work that has already been done to ensure that those who have the temerity and courage to start a credit union will have the backing in due time of an organisation and of leadership. There must be nothing more catastrophic or devastating for a group of people, be it small or large, who have put their faith in a savings bank or whatever one likes to call it only to find that they have been let down by a lack of oversight and tightness. Having followed the development of legislation, I am certain that, in time, credit will be given to all three main parties in the House and many people will be rewarded by organisations which are sustainable and guaranteed.
I have nothing specific to talk about, because, being associated with the Co-operative movement even now, I am certain that if there were matters to be raised I would have been asked to raise them, and I have not been. I am not looking for trouble these days, so I do not write to somebody asking whether there are any points they want to make. If a point wanted to be made, they would have made it to me and other Members who have a close association with the Co-operative movement. I simply say to the Minister who has carried this legislation through that he will get no trouble from me, because I understand that a great deal of consultation has been done with the Co-operative Credit Union, Co-operatives UK and ABCUL, which plays a vital part in providing leadership. I believe that this is as big a step forward as was taken in 1844, when the Rochdale Pioneers took a leap forward. They were not the first co-operative in the country, but they are looked on as the founders of the modern Co-operative movement. After 180 years, who is to blame anybody for accepting that something that was relevant in 1844 and 1852 requires an overhaul, which is what it has had with this legislation? There has been no malice or agitation. I think that it is generally accepted in the country that small businesspeople are just as competent to run the affairs of a body such as a credit union as anybody else, provided that they have sound principles, that there is oversight and that, from time to time when required, the members will be faced with the fact that they will have do something drastic. To the Minister and anyone who is listening I say, on behalf of myself and others in the Co-operative movement, “Well done”.
The best guarantee of an audience at the City Hall in Newcastle was when there was a fear that the dividend was in danger or that a general manager was going to be sacked. I was there on two occasions when those things were prospective. We have to avoid that situation. I speak as an ex-student of the Co-operative movement. There are a number of other noble Lords, including the noble Lord, Lord Tomlinson, who have a strong connection with it. I wish this legislation well and congratulate all three main parties on having done a very good job on behalf of millions of people.
Some reference was made to numbers. I have some figures, too. There is great co-operative movement in Ireland. It is strong on credit unions. The same goes for the West Indies. A number of people have come from there and established their lives here. Across the world, the principle of co-operation as an economic and social force is well founded and I am proud to stand here and say on behalf of all those people, “Thank you very much”.
Lord Tunnicliffe (Lab)
My Lords, it is the duty of Her Majesty’s loyal Opposition to oppose, so I have worked on these regulations to see what I could oppose. The answer, frankly, is nothing. It is good of the Minister to review the general primary legislation connected with this statutory instrument. I thought that in general this was the privilege of the Opposition, but never mind. I congratulate him, and the noble Lord, Lord Graham, for his complimentary speech. Together, their speeches are a gratifying review of this movement and the work that all parties have done to improve it. However, as I read these regulations, they do no more than change the name of “industrial or provident societies” to “co-operative or community benefit societies”. I hope that the Minister will reassure me that it does no more or less than that, because otherwise I have misread the paperwork.
The Explanatory Memorandum goes on to say that the change has been requested by the sector. Will the Minister outline how, because in the paragraph about consultation in the memorandum, it says it was carried out in 2007? I know this has been going on for a long time, but is the sector’s request to change the name more recent, and through what mechanism has that request been made? Finally, I think it is clear, but will the Minister confirm this? As I understand it, it is a matter of choice for societies that are already registered or who register before 1 August whether they change status. I am curious how they will exercise that choice. Will the FCA communicate with all industrial and provident societies to see if they want to change their former registration? With those really trivial questions, I indicate our support for this instrument.
Lord Newby
My Lords, I thank the noble Lord, Lord Graham of Edmonton, for his generous welcome to this statutory instrument. He spoke eloquently about the role of the divvy. The divvy had a particular place in the Newby household because my mother in 1931 went to work in what was then called the check department of the Leeds co-op. Her role was to work out the divvy for the members of the co-op. She—and as a result I—have fond memories of the divvy and the part it played in working-class communities at the time. The noble Lord is absolutely right to say how important it was to people. That explains why the Co-operative movement was so strong at the time.
The noble Lord also drew attention to the funding that the Government are giving to the credit union movement. As he said, the DWP has earmarked £38 million for its credit union expansion project. The aim is to get credit unions to have a million more members by 2019. This is an ambitious target, but it will be achieved only if the leadership of the sector is well qualified. As the noble Lord said, skilled practitioners are needed to make it work and there are a lot of downside risks if they do not, so we hope that this funding will substantially help in doing this. I can also tell the noble Lord that only yesterday the Treasury launched a 12-week call for evidence and opinions on what more we can do to help credit unions to grow sustainably in future. We hope that we are not resting on our laurels, but are continuing to push this agenda forward.
The noble Lord, Lord Tunnicliffe, asked a number of specific questions. He was right that this statutory instrument just changes the nomenclature. It has no other substantive components to it. He asked about consultation. The original consultation that is referred to in the documentation was undertaken in 2007, and this was taken into account when the 2010 legislation was drafted. These regulations flow from that 2010 primary legislation and simply implement that. The Treasury did not undertake a formal review, but talked to Co-operatives UK and other stakeholders in the sector informally, just to confirm that their view had not changed. I can confirm that their view had, indeed, not changed. They very much welcome this, simply as part of bringing the nomenclature and thereby the sector more up to date.
I can confirm that the regulations are a permissive piece of legislation. An industrial or provident society currently in existence can do nothing if it opts to do so. The noble Lord asked what is being done to explain what the options are if one opts to change. The FCA is preparing guidance notes to bring the legislation to the attention of the sector, and to set out what its members need to do if they are changing status. However, as I said in my introduction, the cost involved in doing that will be minimal. We hope that many current industrial and provident societies will simply do it as they change their stationery and upgrade their websites.
Having dealt with noble Lords’ points, I hope, I commend the regulations to the Committee.
Legislative Reform (Clinical Commissioning Groups) Order 2014
(9 years, 10 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, this draft legislative reform order would amend the National Health Service Act 2006 in two ways. First, it would allow clinical commissioning groups—CCGs—to form a joint committee when exercising their commissioning functions jointly. The NHS Act already allows two or more CCGs to exercise their commissioning functions jointly, but does not make any provision for them to do so via a joint committee. Secondly, it would allow CCGs to exercise their commissioning functions jointly with NHS England, and to form a joint committee when doing so. The Act already allows NHS England and CCGs jointly to exercise an NHS England function, and to do so by way of a joint committee, but it makes no provision for them jointly to exercise a CCG function.
This draft order has already been scrutinised by the Delegated Powers and Regulatory Reform Committee and I was pleased with its recommendation that it should continue under the affirmative resolution procedure. I hope it will assist the Committee if I set out the need for these proposals.
I emphasise from the outset that the proposed arrangements are voluntary. One party cannot impose the arrangements upon another. This allows CCGs to retain their autonomy and to continue to make decisions that are in the best interests of their local populations. At the moment, the lack of provision for CCGs to form joint committees is placing a burden on CCGs and preventing them from working in the most effective and efficient way. Without the power to form joint committees, CCGs have had to find other means of reaching joint decisions which are binding. As an interim measure, some CCGs are forming “committees in common”, whereby a number of CCGs may each appoint a representative to a committee in common; those representatives then meet, and any decisions that are reached are taken back to their respective CCG for ratification. This leads to costs in people’s time to sit on multiple committees and administrative resource, as well as extra financial costs.
For example, I am aware of the limitations that the current commissioning arrangements are having on the East of England Ambulance Service. NHS Ipswich and East Suffolk CCG is lead commissioner for ambulance services across the east of England, and the remaining 20 CCGs in the region are associates to that commissioning arrangement. The CCGs established a commissioning consortium, which brings together all 21 CCGs to discuss both delivery against the ambulance contract and future strategy for ambulance services. However, due to the restrictions of current legislation, the consortium itself is not delegated any decision-making authority. While most CCGs party to the consortium have delegated a level decision-making authority to the individual officers who attend the consortium, the contract with the ambulance service is large, and decisions may exceed delegated limits. In those instances, decisions must be referred to CCG governing bodies, introducing a delay to the decision-making process.
Clearly arrangements such as these are burdensome, particularly when compared to the simplicity of a joint committee. Primary care trusts, the predecessors of CCGs, were able to form joint committees at which, subject to the terms of reference, all participating PCTs were bound by the decisions reached. We therefore want to allow CCGs a route in which, when they are collaborating with other CCGs, they can take decisions in a properly constituted forum. Furthermore, CCGs when agreeing to form a joint committee will have the freedom to agree terms of reference, including voting arrangements. This will not dilute the emphasis of local decision-making.
Similarly, the lack of any power for CCGs to exercise their functions jointly with NHS England is also causing inflexibility. NHS England and CCGs may wish to act jointly to commission better out-of-hospital services, for example. Making sure that services are integrated around the needs of the patient is the best way of ensuring that care is provided in a safe and compassionate way that most benefits the person. This amendment would allow CCGs and NHS England, as co-commissioners, to develop and agree strategic plans and delivery processes that take into account the effects of services across a whole pathway, facilitating design and continuity of services across primary, secondary and community care.
For example, CCGs and NHS England may wish to review service delivery across specialised services, commissioned by NHS England, and any impact redesign may have on non-specialised acute services, commissioned by CCGs, in order for services to be designed and delivered to achieve the best possible outcome for the population served. The inability of NHS England and CCGs to jointly exercise a CCG function and to form a joint committee when doing so makes it more difficult to make timely decisions, which can delay the ability to improve patient safety. Furthermore, the amendments would encourage the formation of new commissioning partnerships, allowing the most effective approach to be used.
The amendments would build upon them by giving CCGs greater flexibility and control in the way that they work. As CCGs become more established organisations, they need to have more flexibility to work together, and with NHS England. In any commissioning structure you have in place, there are always going to be some decisions that may need to be taken locally and some that span a wider population.
CCGs are still accountable as individual organisations. Joint arrangements mean that each CCG is still liable for the exercise of its commissioning functions, even where they are being exercised jointly with another CCG or NHS England. These proposed arrangements will not lead to reconfiguration by the back door. The purpose of these changes is to support more effective joint working and to allow discussions about service redesign to take place across the health economy. The proposed changes will not affect the existing processes and tests that any significant service redesign needs to follow. I beg to move.
Baroness Brinton (LD)
My Lords, the NHS Act 2006 started us down the route of commissioning; obviously, with the updating and creating of clinical commissioning groups under the Health and Social Care Act 2012, we are still moving into fairly new territory. Inevitably, CCGs are feeling their way in the new structures, including joint working. I am pleased that the order will now legislate more formally for CCGs to work closely with each other and with NHS England, and to jointly commission where appropriate.
One of the many reports that come back to your Lordships’ House from CCGs and NHS trusts is the desire to gold-plate any system with legal advice. For example, we know that the Health and Social Care Act enabled tenders to be taken for quality and efficacy, not just on cost, as under the 2006 Act, yet we hear time and again that lawyers tell commissioners that cost is the most important point. I also welcome the issues around CCGs and National Health Service England overlapping. The Minister referred to some of those; it is also important where there is a pathway in rare diseases, where there may also be some linkages with CCGs perhaps implementing at a lower level. That will smooth the way for that to work well.
To this non-lawyer at least it seems extraordinary that CCGs could not form joint committees to commission over boundaries. This draft order now makes it crystal clear that joint commissioning and the arrangements for ratification by the separate CCGs are not just acceptable but welcome. It is encouraging to see in the accompanying notes that the consultees to this order also see it as a cost-efficient measure; I add to that smoother working systems and, most importantly, joined-up services for users of the NHS.
Lord Hunt of Kings Heath (Lab)
My Lords, on the face of it the order is unexceptional, although I agree with the noble Baroness that CCGs have got themselves into a ludicrous state of getting legal advice on almost everything. It is patently obvious that there are ways in which they can come together to make decisions. We also see that as regards tendering, where, despite the commitments the noble Earl made, we see CCGs absolutely panic-stricken about making a decision not to tender out services. If ever one wanted evidence of the foolishness of the arrangements we now have, it would be the kind of reaction we are seeing from CCGs.
I will ask two or three questions on the order. I noted in paragraph 4.6 of the consultation paper that the department points out that there was opposition to the proposal to enable CCGs and NHS England to form joint committees. I understand that while it is mainly about CCGs forming joint committees, they can also form a joint committee with NHS England. The necessary protection is laid out in paragraph 3.6 of the paper we received, which says that:
“The Minister considers that the proposals maintain the necessary protections. CCGs enjoy a degree of autonomy”.
I thought that they were going to be autonomous, but there we go; it has been qualified in that document. The paragraph goes on:
“To this end, NHS England is under a duty … to promote the autonomy of persons exercising functions in relation to the health service. The wording of the proposed amendment to section 14Z9 is designed to ensure that a CCG function can only be jointly exercised with NHS England where both parties are in agreement, thus preserving a CCG’s autonomy”.
I put the point to the noble Earl that if you talk to CCGs, they do not feel autonomous, because they are used to being beaten up by NHS England—receiving incessant phone calls from the local offices of NHS England—and they and the accountable officer find themselves under huge pressure when there are problems with the system. Therefore the idea that there is an equal partnership between NHS England and the CCG as regards a joint committee is simply not believable. Clearly, local area teams will use that mechanism to force CCGs into joint committees and then force decisions through. I would have thought that that is patently obvious from what is happening in the field in the National Health Service. I would be grateful to hear the noble Earl’s comment on that.
Of course, I have no problem about CCGs working together so that we can get rid of some of the current fragmentation. If we take my own patch of Birmingham, where three and a half CCGs cover the city, there is no chance, it seems, of actually having a strategy for the city which can embrace all the trusts and commissioners unless it is done jointly. I would like to hear from the noble Earl how in fact this mechanism is going to be used to encourage CCGs, which are patently too small in many areas, to come together so that we get some decent strategic planning instead of the fragmented and inadequate contracting process that so many CCGs are undertaking at the moment.
I would also like to ask the noble Earl about consultation when decisions are made by a joint committee. I assume that the consultation rights and responsibilities would apply to a joint committee as much as they do to an individual CCG but, as there is scant evidence of CCGs undertaking proper consultations, I suppose that that is not much comfort. It would be good to hear a little more about how CCGs are going to work this. I must say that after two years of this wonderful new system, I am still waiting for a letter from my CCG saying that it actually feels some form of accountability to me as an individual, but alas that letter has yet to come. From the legal cases which have been brought against some CCGs, it is clear that they do not have any sense of accountability to their local population. That is not surprising because they are membership organisations. They are owned by GP practices, which are the members of the organisation.
This morning I listened to Simon Stevens, appearing before the Public Administration Select Committee, talk about the proposal to hand over some of the contractual responsibilities of NHS England to CCGs. So, in effect, not only are the CCGs membership organisations, they are now going to be given co-power with NHS England to contract with the individual members of the organisations in relation to primary care services. I can well understand why the local area teams do not have the capability to manage the primary care contract. It was patently obvious that they were not going to do so. But what it comes back to is that the governance of CCGs is hopelessly compromised. They ought to be public bodies with much greater lay representation. If they were, we would have much more confidence in the arrangements, but they are not. They are dominated by contractors who have a vested interest in the decisions made by those clinical commissioning groups.
Finally, I turn to page 3 of the impact assessment that provides the evidence base for the supporting paper. It is implied that decisions to deal with specific funding requests might be dealt with by a joint committee. That, of course, is a euphemism for rationing services. Again, we know that some CCGs are making highly dubious decisions about restricting patient services to which NHS patients are entitled. I would like some reassurance that if the joint committee is going to do this, it will be done in public, not behind closed doors, and after full consultation. Recently I have been particularly concerned about evidence which shows that NICE technology appraisals are not being fully implemented in the National Health Service. I remind the noble Earl that it is a legal requirement for a NICE technology appraisal to be fully implemented by the NHS. Again, I would like to hear what the Government are going to do to ensure that CCGs actually play fair by the public and do not unnecessarily restrict treatments.
The order itself is unexceptional and it is supported, but I have to say that the performance of some CCGs leaves a lot to be desired. It is because of the potential of the joint committees to make major decisions that I raise some concerns today.
Earl Howe
My Lords, I am grateful to my noble friend and the noble Lord, Lord Hunt, for their comments and questions. My noble friend was quite right to cite the example of rare diseases and specialised services as one which will be assisted by the order before us, because while we have a mechanism for NHS England and CCGs to get together to discuss these things, we lack the ability for decisions to be taken about the whole patient pathway. This, of course, is vital when we look at the aspiration to join up services for the benefit of patients—not just the specialised care they receive in a centre of excellence, but also the follow-on care that they receive in the community. I therefore share my noble friend’s welcome for this aspect of the order.
I turn to the questions put by the noble Lord, Lord Hunt. A key plank of the Government’s reforms was to increase clinical commissioning. We do not want to depart from that, or from the principle of giving clinical autonomy to those who run clinical commissioning groups. We want to encourage them to enter into arrangements that have the buy-in not just of the local GPs, but of health professionals in their local area and the local authority. We have been clear on the need for a different splitting out of the commissioning functions—for example, to avoid CCGs commissioning individual GP practices and the conflicts of interest that may arise. The arrangements for safeguarding against conflicts of interest are still in place, but what we hear is that as organisations become more established they need a bit more flexibility to work together. In any commissioning structure, there is going to be that need and this order is about allowing those CCGs to work more efficiently. I emphasise that point about allowing them and not requiring them to do so. There is no compulsion about this. The noble Lord indicated that he felt that CCGs do not feel autonomous. I am surprised to hear that, because the arrangements that we have put in place are designed to ensure that local area teams of NHS England are there to support CCGs, not to oppress or breathe down their necks. That is my experience as I go about the health service. This is about joint working and taking decisions together in the best interests of patients.
The noble Lord asked me about transparency. CCGs are under certain duties with respect to patient involvement and transparency when they exercise their functions. Those duties would continue to apply when they exercise their functions jointly with other CCGs. The duty to consult still applies. CCGs will be under the statutory obligations as to patient and public engagements. However, it will be up to committees to agree precisely how they will work in accordance to their obligations. Some consultation responses that we received refer to committees in common that meet in public. Joint working does not have to entail working behind closed doors.
The noble Lord asked about NICE technology appraisals. He is right that some CCGs are slower than they should be under the legal provisions that pertain to adopting and commissioning approved technologies flowing from NICE. To shine a light on that, as he may know, under the Innovation Health and Wealth provisions, we have the NICE implementation collaborative, which is the mechanism designed to measure the extent to which local commissioners adopt approved technologies. The innovation scorecard is also designed to show how innovation in various forms is being rolled out and diffused across the NHS. I believe that mechanisms such as these will be enormously helpful in exposing the laggards in the system.
I hope that I have answered the noble Lord’s questions. I shall write to him if I have failed to cover any substantive point.
Defibrillators
(9 years, 10 months ago)
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Lord Storey
To ask Her Majesty’s Government what action they will take to ensure that all schools, sports clubs and public service buildings have defibrillators as part of their first-aid kit provision.
Lord Storey (LD)
My Lords, today we debate a topic that is close to many of our hearts. I note that defibrillation has been raised in your Lordships’ House 57 times in some form or another since 1995, but today I hope that we will see some movement on this issue. Much like the conditions that trigger the need for a defibrillator, this issue will refuse to go away until we fully grasp it. Of course, I am talking about defibrillator provision and what the Government plan to do to ensure that all schools, all sports clubs and all public service buildings include AEDs as part of their first-aid kit provision.
My concern and my involvement in this area stem from the tragic death of a young Liverpudlian boy, Oliver King, in March 2011. He suffered a cardiac arrest during a swimming race at his school, King David High School, in Childwall. Sadly, he passed away as a result of SADS, or sudden arrhythmic death syndrome. His father, who has campaigned tirelessly for the past three years, is here today. I pay tribute to him and the foundation that he and his friends set up in Oliver’s memory, campaigning to get SADS provision in every Merseyside school and for their life-saving work in Merseyside and across the nation. They do tremendous, largely unsung work. I thank them and encourage the Government to pay heed to their suggestions.
In advance of today’s debate, I have received several briefings, notably from the London Ambulance Service, which sent me its Shockingly Easy campaign booklet. That title sums up this issue perfectly. St John Ambulance, the British Red Cross and the British Heart Foundation also sent me notes, as of course did Mr King. I thank them for their assistance and their efforts.
All present will know that a defibrillator is a machine that delivers an electric shock to the heart when someone is having a cardiac arrest. Used in conjunction with cardiopulmonary resuscitation, defibrillation massively increases one’s chances of survival during heart failure. Every second counts, as they say, and I echo calls for defibrillators to be made available within easy reach of anyone who needs such life-saving treatment.
Much like the provision of fire extinguishers and first-aid kits, defibrillators save lives. However, unlike the case with the regulations that mandate fire-extinguisher facilities and first-aid kits, currently no legal safeguards require provision of defibrillators. This is a disgrace, especially when we think that there are 60,000 out-of-hospital cardiac arrests every year in the UK. Survival rates, which have barely improved over the years, range from 2% to 12%. In London, one’s chances of survival shoot from 28% to 80% in cases where a trained person uses an AED.
I shall not labour the facts any further, but they beg the question why, if we think it important to place first-aid kits and fire extinguishers in our schools, old people’s homes and sports clubs, we are holding back defibrillators. More to the point, why is it that we have 16, soon to be 17, defibrillators on the Parliamentary Estate? If it is good enough for your Lordships’ House, surely it is good enough for everybody.
I shall return to the wider question and the topic of this debate. I suggest that the first step towards making our communities more resilient to the devastating effects of cardiac arrest must be to place AEDs in areas that see the highest number of cardiac arrests. To me this sounds like a no-brainer, and it is. I welcome the move by David Laws and the Department for Education to encourage schools to install machines, although I regret that, in this Parliament, we are not yet any further forward in making them mandatory.
As well as the installation of defibrillators in places of high footfall such as schools and public buildings, we should not forget the other side of the coin, which is education. People, young and old, must be educated in how to use a defibrillator, whether in a school, a young offender institution or at work. Fortunately, here in Parliament we are offered training. For the record, the next training session will be at 10 o’clock on 16 November in 7 Millbank, although perhaps that is a long time to wait. In order to make any investment in defibrillators worth while, young people must have access to and be able to engage in first-aid and life-saving education. Only 7% of the population have the skills and confidence to carry out basic first aid in an emergency, which is an appallingly low figure that must increase. What plans do the Government have to ensure a more comprehensive approach to first-aid education?
I know that it is not the done thing to use visual aids, and my noble friend will be pleased to learn that I do not intend to do so, but a defibrillator is very easy to use. You do not actually need any training. Although Mr King has brought one with him, I do not suggest that he should show it to us, but even I could use it without ever having had any training. You just follow the simple instructions. However, it is still important that first-aid training for all should be linked to that.
I think that we agree on the need for and importance of defibrillators, but it is worth stating that they must be installed in areas where there are high numbers of cardiac arrests. According to St John Ambulance, 74% of people think that it should be compulsory to have AEDs in care homes, and I agree. Indeed, I suggest that we should examine the case for having them in all care-home settings, both public and private, because this is a topic that should cut through the distinction between public and private provision. Quite simply, it is too important not to mandate the use of AEDs across the board, whether that be in football clubs, cinemas, schools, train stations or churches. Indeed, I know of some churches that have defibrillators because they save lives.
I am determined that we should do more. My noble friend Lord Nash, who supports efforts in this area, informed me on 3 February that,
“it is a matter for individual schools to decide whether to have defibrillators and to arrange individual training”.—[Official Report, 3/2/14; col. 7.]
Even though the governing bodies of maintained schools must now make arrangements to support pupils with medical conditions—we should remember from the Children and Families Act the importance of the duty of care in terms of medical conditions—perhaps we should extend that duty of care to those pupils who might suffer cardiac arrest.
I want to raise one other issue, on which I have already written to my noble friend the Minister. It concerns a universal logo. If you want to find a fire extinguisher quickly, you know the logo. Similarly, you know the logo for a first-aid kit. However, there is as yet no universal logo for defibrillators, although the Minister did mention that NHS England is considering all avenues to increase the uptake of bystander resuscitation, including the location and use of AEDs. I suggest that a universal logo, combined with their inclusion in first-aid kits and a comprehensive approach to training and education, might be the way forward. Would the Minister consider taking a lead on this issue, particularly with the NHS, by suggesting that we should look at adopting some form of universal logo?
Finally, a word from Mr King, who says that use of defibrillators is often,
“the difference between life and death”.
This fact has been recognised by the national clinical director for heart disease, Professor Huon Gray, who I met with Mr King, as well as the Secretary of State, last year. Let the message go out from this short debate that lives can and will be saved by immediate access to defibrillators.
Baroness Grey-Thompson (CB)
I congratulate the noble Lord, Lord Storey, on tabling the debate this afternoon. I felt compelled to speak after a chance encounter with a young girl and her family who I met at the Paralympics in 2012. Ruby is a wheelchair user because she had a heart attack in school at the age of five. She is now 10. Luckily, and amazingly for Ruby, her teacher had been on a course—I think just a week before—and knew what she had to do to save Ruby's live. She was starved of oxygen for 40 minutes and left with many severe impairments and a heart condition. Apart from one or two isolated cases that I had heard in the news, this was the first time that I had met a child who had had a heart attack, and it had a big impact on me. Her parents are amazing and they give her an incredible and fulfilling life, but it led me to wonder whether, if there had been a defibrillator in the school, her life might now be very different.
In researching for this debate I was contacted by a number of people. One or two raised some legitimate questions about the potential cost of having this equipment in every school and sports club versus the number of heart attacks that occur. In the end, all members of the public who got in touch were in support of equipment in every school. I have seen figures suggesting that up to 12 young people a week are affected by this and perhaps the Minister would clarify the scale of the problem. Obviously the cost per unit versus the cost of medical treatment constitutes a significant saving, but this is not about money. It is about saving young people’s lives—and other people’s lives. I was contacted by a teacher who said that they had a defibrillator in their school; a teacher had had a heart attack and survived.
I was also contacted by a lady from a local community group who said that a person had had a heart attack at their centre and died. However, there was a lot of reluctance to have equipment in the centre because people were not sure about how to use it or about the safety. Most of the time when we think about defibrillators, we think about something from a movie or TV when everybody stands back and it is all very dramatic, rather than the modern technology which, I have been assured, is fool-proof. Someone puts the pads on and the machine takes the decisions. No one has to make the decision about whether it is a heart attack or not, the machine does that.
We also tend to think of this occurring when somebody takes exercise. There was a report in the Hampshire Chronicle on 29 March 2014 about a Mountbatten School pupil in Winchester, Sam Mangoro. He nearly died when he had a heart attack in a PE lesson. He was just 16. Again, he was really lucky. His life was saved by trained members of staff who had access to a defibrillator. As a result of this, the parent-teacher association of another school in the area, the Westgate School, purchased one. However, these are really hard decisions for head teachers to take. Put “defibrillator” and “schools” into a search engine and there is a list of companies willing to sell this equipment. How does a head teacher, a parent or somebody raising money know what is the right equipment to buy?
I was therefore delighted with the Department for Education announcement that the Government are working to identify suppliers. They will look at competitive price, because that is important, but also at the statutory guidelines and advice for schools on supporting pupils with medical conditions. It is important that the Department for Education and the Department of Health take a lead on this, to guide PTAs and schools and make sure that they buy the appropriate equipment.
This should also be on the school curriculum. My husband, who is a triathlon coach, recently went on a first-aid course and learnt how to do heart massage. It reminded me that the last time I did anything like this was when I was a Brownie a very long time ago. Until my husband mentioned it, I thought that I knew what I was doing. I remembered that the numbers five and two were involved, but I could not remember whether it was how many times I was meant to breathe or how many times I was meant to press somebody hard. It made me realise that if I saw somebody have a heart attack, I would be extremely reluctant to get involved, because I would be more worried about causing any more damage than doing something that could help. My daughter helpfully joined the conversation. She is 12 and in school she was taught what to do, using the song “Nellie the Elephant”, which is a brilliant way of doing it, and she would be able to step in and help.
Since I saw this debate tabled, I have noticed signs in many more shopping centres and elsewhere showing where defibrillators are. It made me realise that I am not sure where they are in the Palace of Westminster. I suppose that we are lucky to have a number of eminent doctors or professors here, so we are in a pretty good place if anything should happen to us.
Most sports clubs are very small. They are run by volunteers and do not have a lot of money, so the cost of installing such equipment would be prohibitive even though I think that a lot of them would want it. If there were to be a scheme for schools, it would be an excellent idea to extend it to local sports voluntary clubs so that they would be able to access the right equipment. It is also important that we carry on pushing training courses. I know that they are provided in many sports, but for a lot of voluntary sports clubs it raises issues around training, insurance and the worry about what would happen.
I did not realise until I saw this debate tabled that you can get a free app for your phone which enables you to find the location of your nearest defibrillator. It also has an emergency 999 button already on the screen so that you do not have to press all the buttons. I have not tried it yet, and hope that I will not have to, but things like that should be publicised. It is in that moment of panic, when you see something happening, that you need all the help and guidance that you can get.
We should take this matter very seriously. I want to see defibrillators installed in schools and sports clubs and generally more awareness about what can be done to help people if they suffer a heart attack.
The Lord Bishop of St Albans
My Lords, I am grateful to the noble Lord, Lord Storey, for raising this important issue and for keeping it to the forefront. When I was training to be ordained, I became used to some people going off for a little doze while I was preaching. What I did not know was that, during my very first sermon, somebody—a very nice lady—would have a heart attack. Fortunately, she did not die and I got to know her and her family very well during her convalescence. I saw something of the impact of such events on families; indeed, my sympathy goes out to those who know something of this in their own family.
Each year in the UK, some 60,000 people suffer a sudden cardiac arrest. Ambulance services are able to attend on average only 25,000 of those and the corresponding survival rate is depressingly low. Sudden cardiac arrest is therefore a key issue for us.
Time is of the essence in such instances. Survival is often dependent on quick access being gained to medical assistance in the form of CPR, defibrillation and then excellent follow-up care. I am told that, for every minute that elapses following a cardiac arrest, the victim’s chances of survival decrease by 23%. If CPR alone is available, the survival rate remains alarmingly low—at around 5%—but if defibrillation is conducted within five minutes of the arrest, the survival rate soars to some 50%. Given the stretched resources of our ambulance services and the large and often complex geographical areas that they serve, it is not always easy for professional medical assistance to be with the victim in that very short timeframe. Even the current eight-minute general response target is reached in only two-thirds of incidents. It is obvious, therefore, that for assistance to reach the victim before time runs out, we need some more help to be available locally.
The technology of defibrillation, as many of your Lordships will know far better than me—I am not a medic—has advanced in spectacular ways in recent years. The development of automated external defibrillators—AEDs—represents a huge step in the right direction. AEDs allow ordinary people like me to administer defibrillation to victims of SCAs. They are fully automated and include audio and sometimes visual instructions so that defibrillation can be carried out safely and effectively.
In recent years, thanks to the hard work of charities such as the British Heart Foundation and the Community HeartBeat Trust, many AED schemes have been initiated, which have served communities to good effect. For example, the villages of Wooburn Green and Bourne End in Buckinghamshire recently set up their own AEDs to provide the communities with the ability to treat those who suffer from SCAs in the area. In my own diocese, Buntingford Cougars Youth Football Club, which provides football training in East Hertfordshire for over 200 people, recently acquired a defibrillator for its ground thanks to money given to it by the local council. Thanks to the British Heart Foundation and the Football Association, 11 Hertfordshire football clubs recently acquired their own AED units. These things are happening; it is just a question of whether we can encourage them to happen even more often. These examples show just how much awareness has increased and how the chance of survival for those who suffer SCAs has likewise increased. The tragic case of Oliver King and the almost miraculous incident involving the former Premier League footballer Fabrice Muamba just go to show how increased awareness of cardiac arrests and the need to administer defibrillation is making a difference.
That awareness, as has been pointed out, has extended far beyond sports clubs and into schools, which are providing both defibrillators and the training that has been referred to. I will give two other examples from my diocese that I know of: Bishop’s Stortford College and the Robert Bloomfield Academy in Shefford both have AED units and are able to administer defibrillation if required. Those local examples show that things are moving. Why are we not thinking about what we can do in our churches and church halls? I want to think more about that; indeed, this debate has made me think more about it. On a typical Sunday in my diocese, we have about 30,000 people in our churches and, over a week, it is probably double that number. With the church halls, many of which have lots of events, we are certainly talking in excess of 100,000 people. These sorts of debates make a number of us ask hard questions about what we can do ourselves rather than just looking to government to do things. Sometimes we just need local communities to get on with it.
I commend the work of community first responders—volunteers trained to administer basic medical assistance, including defibrillation. They carry AEDs with them and are often able to treat the victim before the emergency services have arrived. In the east of England alone there are over 2,000 community first responders, who are able to reach those who have suffered SCAs. They are, however, only able to reach about 20% of them, which is where the work of groups such as the Community HeartBeat Trust comes in. They help to fund the installation of community AED units and provide education and training so that people are able to spot the signs of an SCA and are able to use the AED units effectively. For example, the Community HeartBeat Trust has worked with the authorities in Central Bedfordshire—part of my area of responsibility—to develop plans to install units in a number of towns and villages.
For all of this work to have maximum effect, it is essential that there are good levels of communication between the emergency services, the community first responders and AED volunteers. In many cases, the emergency services alert the community first responders in the event of an SCA, who are able to respond and treat the victim if possible. That is a great example of bringing help to patients promptly, which maximises their chances of survival, rather than simply relying on bringing them to hospital. The Community HeartBeat Trust also works in collaboration with ambulance services to ensure that all parties are aware of where AEDs are located and that those AEDs are properly maintained and ready for use.
I am convinced that the growing use of AEDs should be seen as a great and positive development in tackling the relatively poor survival rate of SCAs. However, AEDs certainly should not be a replacement for the emergency services, nor are they an alternative to improving access for all to emergency medicine. They are not suitable for all types of SCA, so it is critical that calling 999 is still the first action taken upon witnessing an SCA or coming across a victim who has recently suffered one. None the less, as part of our integrated emergency care system, in the hands of trained volunteers, community-based AEDs have the potential to save many thousands of lives each year and their deployment in schools and sports clubs as well as in public places—and, yes, I hope in churches and church halls as well—ought to be encouraged and supported. I hope that we can move that forward.
Lord Aberdare (CB)
My Lords, I warmly congratulate the noble Lord, Lord Storey, on tabling this debate. It is a subject that is not only close to my heart, if your Lordships will forgive a feeble pun, but quite literally a matter of life and death for a significant number of our fellow citizens in the UK. Having listened to the three excellent speeches so far, I could probably cut my own contribution to little more than the words, “Hear, hear!”, but I hope that I will be allowed to reinforce some of the arguments and will be forgiven for inevitably covering a considerable amount of the same ground. No doubt that is due in part to my having received the same helpful briefings from the bodies mentioned by the noble Lord, Lord Storey, and indeed from the House of Lords Library. I have to say that my heart sank as one after another of my points was made by the previous speakers. I do not think that my heart has actually stopped yet but, if it does, there is a defibrillator in the Peers’ Lobby.
As we have heard, some 60,000 out-of-hospital cardiac arrests occur each year in the UK. Somewhere between 20% and 40% of them are estimated to occur in public places, with nearly half of them being witnessed by bystanders. The remainder take place at home. Any assistance that is provided at the scene by those bystanders before the emergency services arrive can help to save life. In such cases, every minute that passes without intervention reduces the chances of survival by around 10%. So what are the chances of survival from shockable cardiac arrest? In Oregon, they are as high as 56%, while in Norway they are 52%. In the UK, the average comparable survival rate is only 20%. What accounts for the difference is, quite simply, the number of people who have been trained in first aid. In Germany and the Scandinavian countries, where first aid training in schools is mandatory, the proportion of people with first aid skills is estimated to be as high as 80%. It seems to me a matter of national embarrassment, to put it mildly, that only one in 13 people in the UK feels confident that they could carry out emergency first aid.
Automatic external defibrillators can and do save lives. They are a key part of the so-called chain of survival as defined by the British Heart Foundation and the Resuscitation Council (UK). That includes four elements: early recognition of a cardiac arrest, cardiopulmonary resuscitation, early defibrillation and post-resuscitation care. In order to improve survival rates, that whole chain needs to be in place. AEDs themselves will be effective only, first, if there are enough of them; secondly, if they are in appropriate and visible places; thirdly, if they are accessible and not locked away with the key nowhere to be found, about which I have heard stories from time to time; and, finally, if people know how to use them and are willing to do so. I therefore welcome the policy of encouraging the wider installation of AEDs. Research by St John Ambulance indicates that the majority of people, some 79%, think that it should be compulsory to have AEDs in places such as NHS buildings, 74% that they should be in care homes, as the noble Lord told us, 73% that they should be in large event venues such as concert halls, 67% that they should be in sports centres and gyms, 55% that they should be in workplaces, 53% that they should be in hotels and 50% that they should be in supermarkets.
As important as having defibrillators in place is, of course, knowing where that place is. I was going to suggest that this would be a perfect opportunity for an app, only to hear from the noble Baroness that the app already exists. That is another good point gone. Moreover, as the noble Lord, Lord Storey, mentioned, there are 16 defibrillators on the Parliamentary Estate and a significant number of trained first-aiders who know where they are and how to use them, including, I believe, most or all of the House of Lords attendants. Some noble Lords may not be aware that the best number to call on the Parliamentary Estate in the event of my having an emergency during my speech is not 999 but extension 3333. That is the first point that I alone have made.
All the AEDs that have been or are about to be installed, however numerous, well located and easily accessible, will be effective only if people know how to use them and are willing to do so. Current research shows that only one person in 10 knows what an AED is and, of those who do, just half know how to use it. Again, training is needed. The only way to increase, over time, the proportion of the population who have basic emergency life-saving and first aid skills is to teach those skills in schools, not just to teachers but to students as well. In that way, we can ultimately create a nation of lifesavers, to quote a phrase whose source I have mislaid.
Many voluntary organisations, such as St John Ambulance, the British Red Cross, the British Heart Foundation, the Resuscitation Council (UK) and SADS—Sudden Arrhythmic Death Syndrome—UK, do a good job of providing both information and training. I declare an interest as a trustee of St John Cymru Wales. I have now been trained in first aid three times: by St John Cymru Wales, by St John Ambulance under the auspices of the All-Party Parliamentary Group on First Aid, of which I am a vice-chair, and by the parliamentary Safety, Health and Wellbeing Service, which also covered the use of defibrillators. At least 14 parliamentarians have completed the training offered via the first aid all-party group.
The Government have committed to enabling schools to acquire defibrillators at discounted prices, which I welcome. However, they also believe that schools should decide for themselves whether to include first aid training in their curriculum. That is just not working. The combined efforts of all the groups that I have mentioned reach only a relatively small proportion of students in schools—I believe about one in seven, or 14%. This is nowhere near enough to address what should surely be a significant national priority. Leaders of all five of these bodies signed a letter to the Times last month, expressing their disappointment that, at the same time as encouraging schools to buy defibrillators,
“the government did not go further and insist on first aid education for all pupils and staff”.
I apologise if I am overrunning. I am very much encouraged by the fact that I seem to have spoken for no time at all, but that is presumably not the case.
At the very least, government should surely look at providing much more in the way of incentives and encouragement to schools. Subsidised AEDs, at least for schools in England, are a welcome start, but what about subsidised training in how to use them? What about awards and recognition for schools that achieve the best results in numbers of students trained or in levels of proficiency attained? Incidentally, I welcome the Social Action, Responsibility and Heroism Bill, which should help to overcome any concerns that people may have about the possibility of being sued after trying to resuscitate someone.
Children aged 10 and above can learn the full range of emergency life support skills, including CPR. From the age of 14 they can be, and are, trained in using defibrillators. A significant number have had to use the skills that they have learnt to save the life of a family member or fellow student. Of the children on a British Heart Foundation Heartstart programme in Northern Ireland, 98% enjoyed the training and 67% shared what they learnt with family and friends. Separate BHF research found that 86% of teachers thought that emergency life support should be part of the national curriculum, 78% of children wanted to be taught how to save someone’s life in an emergency and 70% of parents thought that children should be taught emergency life support at school.
First aid and defibrillator training is straightforward; it is quick, requiring as little as two to three hours; it is cheap; it promotes self-esteem and citizenship; it is fun; and it can save lives. Without it, the Government’s laudable initiative to enable more schools to acquire defibrillators may not—will not—be as effective as it could be. So why on earth should such training not be made mandatory in all schools? I look forward to the Minister’s response to that question.
Lord Hunt of Kings Heath (Lab)
My Lords, I thank the noble Lord, Lord Storey, for starting this debate; I very much agree with his central points. I also pay tribute to the Oliver King Foundation and Oliver’s father, whom I have had the pleasure of meeting on a number of occasions. Indeed, I think that the noble Earl would agree with me that the Liverpool primary schools’ defibrillator programme is a remarkable effort on the part of the foundation, which embraces all primary schools in the city. As part of the project, 12 staff in each school were able to receive training. It is a model for what ought to happen in the rest of the country.
Noble Lords have given us a lot of information about what is happening and raised some of the concerns. I will refer to the research undertaken in Hampshire which was published earlier in the year, the authors of which included the South Central Ambulance Service NHS Foundation Trust and the University of Southampton. They reviewed all calls to the ambulance service between September 2011 and August 2012 following a heart attack. For all emergency calls made from locations other than a person’s home, the call handler specifically asked whether the caller could access a defibrillator. If so, instructions were given on how to use it. During the course of this study over a number of months, the service received just over 1,000 calls about confirmed cardiac arrests away from hospital, which was the equivalent of one for every 600 members of the public each year. For 44 of those incidents in 34 different locations, the caller was able to access an external defibrillator—that is 4.25%—and it was successfully retrieved and used in less than half the cases, 18 cases, before the arrival of the ambulance.
This gave an overall use rate of just 1.74% of all cardiac arrests recorded, which the authors understandably felt was disappointingly low and was apparently similar to previous figures from the London Ambulance Service. Looking at the Hampshire picture, 673 defibrillators that could be accessed by the public were located in 278 places, including 146 devices in large shopping centres. The research also showed that only just over one in 10 nursing homes, around one in 20 railway stations and a similar number of community centres and village halls had defibrillators. The suspicion is that figures in Hampshire are probably similar to many other parts of the country. This shows the scale of the challenge before us, for which we hope for a government response.
Noble Lords mentioned St John Ambulance, to which I am grateful for the briefing I received. The survey work which it undertook shows that a majority of the public think defibrillators should be compulsory in NHS buildings, care homes, concert halls, sports centres and gyms, workplaces, hotels and supermarkets. This seems persuasive evidence that the public would welcome a more decisive response by the Government.
In relation to schools, where I would have thought there was an overwhelming argument for having a defibrillator and trained staff—and indeed trained students—we are relying on the response which the Government have given. This is simply to say that it is up to each school, then relying on changes to the Children and Families Act in relation to the duties of governing bodies and the common-law duty on staff to act in loco parentis while children are at school. We could expect a little more action now from the Government. Particularly in relation to schools, I want to hear that the Department for Education will reconsider its disappointing response so far.
The noble Baroness, Lady Grey-Thompson, made a good point about the need to help people to use defibrillators and for education programmes. I also take her point about the need to help sports clubs. Does the noble Earl not think it would be good for health and well-being boards to take this on? Because of the potential collaboration between local government, the health service, third-sector and many other organisations within a locality, might they not spearhead an approach to getting many more defibrillators fitted and people trained to use them?
Finally, Public Health England is a wholly owned subsidiary of the Department of Health. Could the noble Earl be tempted to give an instruction to Public Health England to treat this as a priority for the future? The Department of Health has a really positive role to play if, through Public Health England and health and well-being boards, this was seen to be important and I am sure we could make much further progress.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, I thank my noble friend Lord Storey for giving us the opportunity to debate what is undoubtedly an important issue. I know that many people feel that better provision of defibrillators could help save more lives of people who have a cardiac arrest outside a hospital setting—known as out-of-hospital cardiac arrest. I acknowledge in particular the work of the Oliver King Foundation in this area.
First, I emphasise that responsibility for the provision of defibrillators rests with ambulance trusts, which are undoubtedly best placed to know what is needed in their local area. Notwithstanding that, last year’s Cardiovascular Disease Outcomes Strategy set out some recommendations around defibrillators. NHS England is implementing the strategy’s recommendations, which includes working with stakeholders to promote the site-mapping and registration of defibrillators and to look at ways of increasing the numbers trained in using defibrillators. The strategy also acknowledged that, although defibrillators are important, more lives could be saved if more people had life-saving skills. As I shall indicate shortly, NHS England is also working with stakeholders to help achieve just that.
Schools are of course at the centre of their communities and are often used for other purposes outside school hours. They are also frequently the location for sports events and other types of physical activity. There have been tragic incidents in which young children have had a sudden cardiac arrest and were not subsequently able to be resuscitated. The number of such incidents is thankfully very low, but of course every child who dies in this way is one child too many. The use of a defibrillator may have made a difference in these cases, which is why we are encouraging schools to acquire defibrillators in a broader package of measures designed to ensure that the medical needs of children in our schools are supported. It might be helpful if I explain a little more about these measures, particularly in answer to my noble friend’s questions.
We have introduced a new duty on school governing bodies which requires them to make arrangements to support pupils with medical conditions and to have regard to new guidance on Supporting Pupils at School with Medical Conditions, which will come into force from this September. We will also inform schools via the “need to know” e-mail and the “myths and facts” documents, which are sent out to schools each term. I absolutely agree with the noble Baroness, Lady Grey-Thompson, and the noble Lord, Lord Aberdare, that emergency life-saving skills are very important. Those skills can be taught as part of personal, social, health and economic—PSHE—education. However, it is also right that teachers should be free to exercise their professional judgment in designing curricula that meet the needs of their pupils. Giving teachers greater flexibility and freedom than ever before will help to raise standards and expectations for all pupils. However, one must put that in the context of the role of governors of schools, who undoubtedly have an influence. The Government do not believe that the teaching of emergency life-saving skills should be a statutory requirement, but we encourage schools to teach PSHE, which may well include emergency life-saving skills, and have outlined that expectation in the introduction to the new national curriculum.
On defibrillators, we believe that head teachers are best-placed to make decisions about installing them in schools. They may, for example, wish to have multiple AEDs, or to share a machine between two schools located on the same site. By strengthening guidance and working to secure the devices at a reduced price, we are encouraging schools to install defibrillators.
The noble Baroness, Lady Grey-Thompson, asked me to give some statistics in so far as I have them about the scale of the issue in schools. The Office for National Statistics says that the total number of cardiac deaths of patients of school age—that is aged five to 19—is 88, although we do not know how many of those deaths occur in schools. However, I have some very interesting statistics from the London Ambulance Service. In London, between 1 April 2012 and 31 March 2013, there were 3,848 patients with a presumed cardiac origin to their arrest and in whom resuscitation was attempted. The breakdown of location for these shows that 79.2% were in the home or in a care home. Of the 800 cases which happened in public, 1.1% were in a sports centre and 0.3% were in a school. I shall make a further comment about that in a moment.
The Department for Education intends to produce a protocol on the use and purchase of AEDs in schools. The guidance to which I referred asks schools to consider purchasing a defibrillator as part of their first-aid equipment and, if they do so, encourages them to promote knowledge of cardiopulmonary techniques more widely in the school, among both teachers and pupils alike; I have already referred to that point. To help schools, we will be working with the Department for Education to identify a supplier that will provide suitable defibrillators to schools at a competitive price. We will provide schools with additional advice on the installation and use of these potentially life-saving devices so that staff will feel confident in using them should the need arise.
Safety in all sports is a matter for the national governing bodies—NGBs—as the designated authorities with responsibility to regulate their sport. The Football Association is working alongside the British Heart Foundation to oversee a £1.2 million investment towards state-of-the-art automated external defibrillators at football clubs in England. This initiative, which started in 2013, will see almost 1,300 defibrillators distributed to those clubs in which they will have the greatest potential use. Through bulk purchase, the FA has secured the defibrillators at a reduced cost and eligible clubs may apply for a defibrillator at a further reduced cost. The FA’s partnership with the BHF has ensured that this investment in defibrillators has the greatest possible impact. In addition, all FA-licensed coaches are required to undertake a first aid course and should be able to administer CPR while awaiting the arrival of emergency medical services.
In answer to the noble Baroness, Lady Grey-Thompson, on who is responsible for the safety of people participating in sports in local venues, the national governing body for the particular sport is responsible for the safety of athletes and/or their training. In practical terms, the responsibility would fall to the coaches and/or any other support staff at the facility. We would expect the owner or manager of the building to be subject to any other relevant health and safety regulation or legislation, such as that on fire safety.
There is frequent discussion about screening for the causes of sudden cardiac death. Screening may have the potential to save lives but it is not a fool-proof process. For example, I understand that the footballer mentioned by the right reverend Prelate, Fabrice Muamba, who suffered a cardiac arrest during a match, had received several screening tests. However, it is important that we keep the issue of screening under review. That is why the UK National Screening Committee, which advises Ministers about all aspects of screening, is reviewing the evidence for screening for causes of sudden cardiac death in people between the ages of 12 and 39. The review is looking at the most up-to-date international evidence, including evidence from Italy, where all competitive athletes are offered screening. There will be a public consultation on the review this autumn.
Noble Lords raised with me separately the need to make sure that, when a person dies of sudden cardiac death, potentially affected family members are identified and are offered counselling and testing to see whether they are also at risk. We know that this does not always happen. That is why in last year’s CVD strategy we said that work would begin to improve the necessary processes. I can tell the Committee today that, since the strategy was published, NHS England has met the chief coroner to discuss what can be done. At the beginning of the year, the chief coroner wrote to local coroners asking them to make the families of those who had died of the condition aware that it may be inherited and encouraging them to contact either the British Heart Foundation, Cardiac Risk in the Young, or their GP.
On the general question asked by my noble friend Lord Storey about why the Government should not be providing more funding for defibrillators, I am sure he will agree that we must direct NHS resources responsibly, particularly now. As I indicated earlier, the statistics show that most out-of-hospital cardiac arrests occur in the home, which means that in our view more lives could be saved if more people had life-saving skills. NHS England is continuing to work with the British Heart Foundation, the Resuscitation Council (UK) and other organisations on how best to increase the number of people trained in basic life-saving techniques. The BHF and the Resuscitation Council (UK) have both produced a variety of free publications to help members of the public understand the importance of basic life-saving techniques, as well as offering training through the Heartstart scheme in various mediums that enable more individuals to learn the basics of helping to save someone’s life in the event of an emergency.
But I come back to the point I made earlier: since February 2007, ambulance trusts have been responsible for sustaining the legacy of the National Defibrillator Programme. To address a question asked by the noble Lord, Lord Hunt, we undoubtedly expect the commissioners of urgent and emergency care who take part in discussions at health and well-being boards to engage with ambulance trusts in an appropriate way and, if necessary, to feed in their views to the priority-setting process that the boards engage in.
The noble Lord, Lord Aberdare, asked whether I have numbers for the people who are trained in life-saving skills. I understand that 3.5 million people have received emergency life support training through the Heartstart scheme. The right reverend Prelate the Bishop of St Albans correctly referred to the important role played by community first responders. I have with me an extensive note which unfortunately I do not have time to read out, but suffice it to say that CFRs carry automated external defibrillators and are trained and equipped to provide oxygen therapy. Finally, my noble friend Lord Storey asked me about a universal logo. I am very happy to take that point away and ask Huon Gray in NHS England to consider the matter. I will then feed back to my noble friend as appropriate.
In closing, I would like briefly to take this opportunity to pay tribute to charities such as the British Heart Foundation and the Oliver King Foundation for their tireless work in placing defibrillators locally and raising awareness of sudden cardiac death. I would also like to take a moment to acknowledge and thank the wide range of stakeholders we have collaborated with to develop the new statutory guidance for schools that I mentioned earlier. I know that they include my noble friend, with the Health Conditions in Schools Alliance, along with a range of other cardiac organisations such as the Oliver King Foundation and the British Heart Foundation. Their advice played an instrumental part in shaping the arrangements that we are now introducing.
Education Institutions: Autonomy and Accountability
(9 years, 10 months ago)
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Baroness Perry of Southwark
To ask Her Majesty’s Government what assessment they have made of the appropriate balance between the autonomy and the accountability of educational institutions.
Baroness Perry of Southwark (Con)
My Lords, it was the French Prime Minister, François Mitterrand, who, on introducing reforms of education in France in the 1980s, declared that accountability had to be “le contrepart même”—the exact balance—to the autonomy of institutions in the education system. We need no persuasion today that the issue of accountability of schools and teachers, as well as the degree of autonomy that they should be allowed, is central to the future shape of our education system.
Rather than starting with the accountability side of the equation, I begin by asking how much freedom schools and teachers need if they are to accomplish all that they and we hope for our children’s education. There is plenty of evidence to show that granting freedom to professionals to do the job they are trained and motivated to do is the surest way to achieve high quality.
In his excellent book, Education, Education, Education, the noble Lord, Lord Adonis, says rightly that,
“governors—and the headteachers and management teams they appoint and sustain—need to be unambiguously in control of their schools without managerial interference from local and national bureaucracies”.
This, he says, is the magic ingredient of the success of academies. I agree. It is the quality of leadership in a school which determines its success, which means good governors, a good head and a good management team.
Of course, as we have seen all too recently, there can be governors who are not capable of good governance, and heads and teachers who get it wrong, but this does not mean that the model is faulty. As Samuel Johnson said—in what is my favourite quote—it is,
“happier to be sometimes cheated than not to trust”.
Through the huge expansion of academies and free schools, this Government have had the courage to trust schools and teachers. I rejoice in that.
We have at present possibly the best generation of teachers that we have ever enjoyed. They are well qualified and well educated, with strong support available from heads and senior staff for those who enter the profession for the first time. I pay tribute to the previous Government for the Teach First initiative, which has brought some outstanding young graduates into our schools. This Government have made teacher quality rightly central to their policies, and new entrants to the profession are of the highest quality, as are many of their older colleagues. It therefore makes absolute sense to trust their professionalism to the maximum extent.
Teachers, like doctors with their patients or other client-centred professionals, are more motivated to do the best for the pupils in their charge than to seek the approval of those above them in the hierarchy. We want them to feel that way, for that way quality of provision lies. However, as Mitterrand said, this freedom needs to be exactly balanced by accountability. The public who pay their taxes for public services, as well as the parents and students who benefit from the public service of education, have a right to know whether the provision offered is of good quality and appropriate for the needs of its recipients.
In achieving the delicate balance of accountability and autonomy, it is important that teachers and heads are not distracted from their prime self-motivation towards their pupils by the imposition of too much bureaucratic regulation. We need them to be looking into the classroom and the children in it, not looking out to the inspectors and regulators. Good schools and good teachers are not driven by their external regulators; they take them in their stride, recognising that if they behave with professional dedication to the task at hand, the results will be what the regulators seek. For this reason, I welcome and applaud the much needed changes which this Government have made in the two key tools of accountability: inspection and examinations.
Ofsted was set up for the best of reasons: to inspect every school often and thoroughly. Such a remit demanded a huge taskforce. By the time the excellent Sir Michael Wilshaw came into office as chief inspector, more than 2,000 people were involved in inspection, employed by private contractors, mainly part-time and often with scant educational know-how or even none at all. Quality control of their activity had therefore to resort to giving them a list of predetermined items in boxes to be ticked, rather than trusting informed, senior professional judgment. As a tool of accountability, Ofsted in this form far too often simply alienated teachers. More seriously, it could, especially for the less secure and inexperienced teachers, reduce their creativity to meeting the tick-box requirements, which might bear little relation to a broad education.
It is therefore with huge pleasure that I welcome the decision to trust future inspection mainly to the 400-plus HMI who are experienced, senior professionals whose judgment can be trusted, and to dispense with the contractors. HMI can judge the key index of a school and the experience of the pupils. This may or may not match the items in the box-ticking exercise, but it will go to the heart of whether the school is providing the pupils in its care with an education fit for the values of our society, and which allows every child and young person to achieve across the widest possible range of elements in and beyond the curriculum.
In my view, it is not possible to overestimate the value of this change. By applying the broad professional judgments that teachers accept and share, Ofsted can become a tool to reward good schools and good teachers for their creative ways of achieving the best possible outcomes for their pupils. It can also become a more developmental and less regulatory tool that will spread good practice and encourage those schools which are struggling to succeed in providing the high-quality education that other comparable schools have achieved.
Examination results are the second measure of accountability by which schools are rightly judged. This has not always been a reliable measure to use. When schools and their pupils were allowed a wide choice of subjects at GCSE, the results were hard to compare. Those schools, and there were many, which avoided basic English and maths, for example, might achieve good GCSE results overall, but when their performance including English and maths was measured, it was not so impressive. In one school, 100% of the students achieved five good GCSE grades, but only 45% included English and maths. The EBacc was therefore a much needed incentive for all schools to include these basic tools, and now the new standard allowing more choice at key stage 4 is an innovation that will raise true performance standards for all young people. The inclusion of high-quality technical and vocational qualifications that was announced last week will at last bring real quality to areas that are attractive to the many young people whose motivation is more practical than academic.
Finally, the long-debated issue of value added has been recognised in a simple and fair way by the planned introduction of progress 8 as a measure for secondary schools. This charts the progress from entry standards to GCSE performance and will be the measure of whether a school is achieving appropriately. At last, a school’s performance will be measured in relation to its own intake rather than against schools with very different pupil populations.
I am proud of our Government and the developments in both autonomy and accountability which are being introduced. Above all, I hope that through these changes the many excellent teachers who serve us so well in schools and colleges every day will find that their dedicated and creative work will flourish, and that they will welcome them.
The Lord Bishop of Birmingham
My Lords, I welcome the opportunity to address the topic of autonomy and accountability in our educational institutions, particularly in our schools. As noble Lords can imagine, coming from Birmingham, this is a very pertinent topic. We are experiencing a perfect storm of anonymous allegations. Birmingham City Council is conducting various investigations, of which I am a part, into those allegations.
There is confusion among ordinary people between politics and process, about which the noble Baroness has been telling us and which the Government are promoting to achieve high standards. There is also confusion between faith and fear. These are softer, organic areas that need to be introduced and understood when we are trying to raise standards, achieve excellent exam results, and put in place a proper inspection regime. Of course, we all want our children to have an excellent education. We want high academic standards and high vocational standards for pupils for whom those are appropriate. We especially want good governance, and that is something we are all attending to at the moment.
In terms of our accountability and sense of autonomy, we also want a real and in-depth understanding of what it means to have an ethos in our schools—whether they be church or community schools, academies or free schools—of both diversity and unity. These are areas that local people care about deeply in trying to achieve the very best for their children.
You might want me to mention a wonderful biblical pattern of accountability and autonomy, where human beings in many faith traditions are expected to grow up to be responsible, engaged and fulfilled. In the Christian scriptures, if you turned to Matthew chapter 18, you would see the appropriate introduction about receiving the kingdom of heaven like a child, and the parable of the lost sheep, where so many people can go wrong and stray from a pattern that is set out for them. Then there is the command to forgive; not just once or twice but an infinite number, of 70 times seven. There is a culture of empathy and sympathy, but also a culture of real responsibility, and in the middle of that, there is a little teaching about accountability and how it might work in an ordinary community.
If your neighbour offends you, go and see them personally. If that does not work, take two or three trusted people with you and allow them to examine the controversy or problem. If that does not work, then bring the whole community together and examine the issue. If it is unresolvable, then there are harsh things to do. There are examination or inspection judgments. However, there is a pattern there which ordinary, local people can instinctively understand and which would allow us not only to have autonomy locally, but also to have responsibility where it truly lies, in those local communities: responsibility for education and unity, but also for rejoicing in diversity.
In our own Church of England in Birmingham, I should mention the expansion we have had in the academies programme which the Government have been promoting. This is something we have embraced and found to be very effective. However, to achieve the ambitions of the Government and the excellence we want for our children in a great variety of communities, we have formed a diocesan board of education trust, which publishes, for example, an academies accountability framework. Such a framework enables both support and challenge in our local schools. In other words, it expects responsibility and people to be accountable, but at the same time, where there is difficulty, they should have the appropriate support at the appropriate level.
This lays out clear requirements and expectations. It is a local framework of support and there is proper challenge within it. There is complete clarity about the improvement of tasks before the school, the resources that are available to tackle the tasks, clear lines of accountability to monitor and evaluate the pace and scale of the improvements required, and an appropriate balance between support, challenge, self-evaluation and external evaluation. In a church school, we would go further, to give a guarantee to parents, communities, pupils and staff about what are the various granular expectations that they would find in various areas to do with religious education, prayer and worship, spirituality, valuing of pupils, opportunities that there are at any good school, and what the school should undertake to achieve those values to do with ethos.
I am arguing today for accountability and autonomy, but in our experience, the way to make this succeed in all our schools is to make sure that there are proper, local and trusted arrangements: trusted by pupils, staff and parents, by the whole community and, of course, by the Secretary of State.
Baroness Shephard of Northwold (Con)
My Lords, I congratulate my noble friend Lady Perry on securing this debate and on the expert and typically penetrating way in which she introduced it. It is also a privilege to follow the right reverent Prelate, who comes fresh from Birmingham to tell us how it feels there right now, and with some gloriously practical suggestions. Even better, some of them are based on parables. There can be no argument about the fact that the more autonomy an institution has—whether it is a school, company, university or public body—the more likely it is to be successful.
That belief underpinned the introduction of local financial management and GM schools in the 1980s, from both of which far-reaching reforms the academies movement developed. Equally, it is beyond argument that all truly successful institutions, especially publicly funded ones, regard the establishment of clear, accessible lines of accountability between them and those they serve as a sine qua non. If you do not have those lines, you are not a success. There should, therefore, in theory, be no conflict between on the one hand the autonomy of educational institutions, and on the other the absolute clarity of the systems put into place to ensure their full accountability.
When local financial management was introduced in Norfolk schools in the late 1980s, school heads, until then accustomed to asking, and blaming, county hall for everything, realised that the buck would now stop with them. After some initial nervousness and after, together with their governors, appropriate and thorough training, the vast majority relished the extra responsibility and flexibility it gave them, especially as it was made crystal clear to the wider community that that local accountability was underpinned by the more general accountability of an elected local authority.
That was a halfway house between full LEA control and a step towards autonomy, and it was always intended to be transitional because the movement towards full schools autonomy was unstoppable. No one today is making the case to restore the role of LEAs. The 22,000 schools in England now include 2,500 academies and 174 free schools, with many more to come. The overwhelming majority of those academies and free schools are hugely successful, transforming their pupils’ life chances. The problems with the system, as we have seen in Birmingham and elsewhere, often boil down to a lack of appropriate oversight and an incomplete preparation of heads and governors for what autonomy and accountability actually mean in practice. We are once more in a transitional period.
I have a very simple definition of accountability, which I do not find an abstract concept; it is about knowing who to speak to if things go wrong, as I rather think the right reverend Prelate said. The government website on complaints guidance—which I assume applies to all schools, including academies and free schools—encourages parents first to raise matters of concern with the head. But what if he or she is the problem? Well, then you go to the members of the governing body. However, will you know or can you find out who they are without going through the head, and will they tell the head? Alternatively, you can contact the DfE direct, although that might be daunting for some. However, does the department now have the resources to deal with the volume of cases it receives in the Schools Complaints Unit, and how, practically speaking, are they dealt with? I hope that my noble friend will be able to tell us the answers to both of these questions.
I think that LEAs’ roles are now limited to child protection cases, and Ofsted—which is in a way a long stop—can deal only with whole-school issues. I think I am right in saying that it cannot seek to resolve or establish cause for any individual complaint. There are now regionally based Ofsted offices; perhaps my noble friend can tell us what the role of those offices is and whether staff in them have systematic contact with local schools and a systematic report back.
I will give two examples of the accountability problem. A town council in Norfolk with no educational role at all has just called a public meeting in order to oblige the local academy trust to explain its policies and plans to parents and the public following the resignation of more than half the teaching staff and, I think, the head. There is undoubtedly an inside story here, and I do not know what it is, but there is no doubt that the children’s education is currently suffering from the uncertainty. In that case, although it is an isolated one, the situation does little to demonstrate an understanding of accountability within that particular academy system. These will be isolated examples. At another local academy, no fewer than 16 key members of staff have left, feeling unable to complain to the head or to the chair of governors because she, the chair, has been put in place by their employers, the academy chain. Now, that is not good. The students, parents and staff in the school do not know who to speak to. This is bad, but it is isolated and not at all like the pattern of overwhelmingly successful academies. In Birmingham, accusations of extremism in schools are serious enough. However, as serious, if not more so, are the allegations that complaints were made but the lack of a clear accountability system apparently made it impossible for them to be dealt with. I know that four or perhaps five investigations are now under way, so I will say no more about that because we shall all know more when those investigations have reported.
We are again in a transitional period. I spoke earlier of the training and oversight arrangements put into place to ensure the success of the 1980s schools reforms. Those simple principles are still relevant. Academies and free schools will transform our education system. The best academy chains already prepare staff and governors to be accountable. That work is being done and the experience is there. We do not need a nation-wide, one-size-fits-all solution, just to use all the clichés. What we need is reassurance that it is understood, no matter how humdrum it may be, that the preparation of heads, teachers and governors for ensuring the accountability of all our schools is as important as their academic performance.
Baroness Farrington of Ribbleton (Lab)
My Lords, I begin by saying how much I agree with the noble Baroness, Lady Shephard, in her analysis that local authority control no longer exists. I get so angry when people refer to schools needing local authority control. Control disappeared years ago. Local accountability, as the noble Baroness said, is important.
I refer to personal experience in education in Lancashire over a 20-year period as a councillor. It is often forgotten that all the great innovations subsequently claimed by all political parties—such as nursery education, a full year in reception class and education maintenance allowances—began as local authority initiatives, working accountably with the local community. I cite one example in Preston, which occurred because the tax arrangements meant that Skelmersdale suddenly lost Courtaulds to Spain. That was one of the initiatives that led to encouraging young people to stay on in full-time education and training as an alternative to going on to what many now agree were youth training schemes with no future. That is important.
I praise the many leaders of our Catholic and Anglican schools and Jewish leaders in Lancashire, and my noble friend Lord Patel of Blackburn, for developing in the early 1980s an education document about education for a multifaith, multicultural society that was totally agreed across the community. In the early days in Blackburn, we saw the BNP rising. The response was to bring people together rather than to let people divide us.
The noble Baroness referred to teacher innovation. I pay tribute to the late Lord Joseph, who said of the curriculum that there was no place for a politician to make a comment about which books teachers should use; I shall say no more on that.
He was also superb on political education. In a statement circulated to all Lancashire schools, he said that, when questioned by secondary school pupils, a teacher could say that they were a member of CND but should also say that other teachers or their parents or councillors might hold totally different views. Sir Keith took the view that education was an important process, and our best teachers recognised that.
In looking at accountability and the role of local authorities in the future, it is important that we recognise the importance of responding to the needs of the whole community and of the school. In particular, children facing problems should be able to draw on the range of local authority services, with a co-ordinated approach taken towards social and housing problems, which afflict the lives of our children.
My conversations with the noble Baroness, Lady Perry, go back over decades. I am sure that she will remember the local authority higher education funding body and the former Preston Polytechnic, now the University of Central Lancashire—I blow the trumpet for it at this stage—which developed the most diverse student intake of its time. It accepted people from all sections of society. It co-operated successfully with Lancaster University and the Open University, with students being able to switch between them for different modules or different years of their course. Perhaps an answer to the funding crisis now being faced by people going into higher education would be to look back at that sort of experience.
I have worries about accountability and judging schools. Like the noble Baroness, Lady Perry, I believe that HMI has a deep fund of experience which is invaluable in looking at how to help schools. London First gave us a very good example of heads from one school going into another school, of linking and pairing. In the early 1980s, which were not easy financially, we in Lancashire developed curriculum co-ordinators. A good individual teacher in a specific subject or year would be given supply cover to go and work with another teacher. That is the variation on the scheme that London First operates, but it costs money, because one has to have people able to leave their own class and go into another.
I worry about the local community becoming more fragmented. I worry that we may not have the balance of experience. I remember a Conservative county councillor—she was the aunt of the noble Lord, Lord Horam—being appalled when we were interviewing for a head teacher in a school in a very deprived area. Quite obviously, county councillor Mrs Horam was uneasy about the candidate who had been the most forthcoming. She had answered all the questions beautifully and, in despair, Marjorie turned to me and said, “Is there any other question you could ask?”. I grasped at the fact that that candidate had been on a course to identify gifted children. I asked, “Was it a good course? Was it useful—was it great?”. She answered, “It was a superb course and I learnt a lot from it, but it wouldn’t be useful in a school serving an area like this”. At that point Marjorie Horam put her pen down and we nailed her.
It is important that there is a thread of responsibility in making appointments and judgments about teachers, which must involve those with experience—like Marjorie, who knew that something was wrong—and be able to draw on that. Those children come from communities which have both very diverse problems and some very similar problems. In the middle of dealing with the problem of surplus places, which was a fraught experience, I had to talk to people about meeting the needs of all the children. I worry that we are in danger of continuing to provide schools where they are not needed, and not providing them where they are.
Baroness Sharp of Guildford (LD)
My Lords, I am grateful for receiving permission to speak in the gap. I was interested in speaking in this debate because at the moment, as the governor of a fairly newly converted primary academy, I am in negotiations with our academy chain over the scheme of delegation between the local governing board and the academy chain. That has thrown up an interesting conundrum about the role of the local governing board in relation to the academy chain.
That is first illustrated by who appoints the head. If the academy chain appoints them, and delegates responsibility for management and organisation of the school to the head, the local governing body has very limited responsibilities; it becomes a very largely advisory body. Yet when Ofsted comes along, it will look to and examine the local governing body, which will be held responsible. Therefore the relationship between the local governing body and the academy chain is an extremely important one.
If one takes the traditional local authority model, the local governing body appointed the head and was responsible. It set the scheme of delegation and had broad strategic responsibility. However, if the head did not perform, the local governing board had to make sure that it was accountable. When Ofsted came along it would examine the local governing board for doing that. If, however, the academy chain is to appoint the head, and sets the scheme of delegation and organisation, there is a very considerable fuzziness there, and it is not clear whom Ofsted should examine and hold responsible. You also lose the link between them, as the local governing body represents the local community. That is an interesting issue, and not one that we have fully resolved, although we are discussing it. However, I thought it was worth raising in this debate.
Baroness Jones of Whitchurch (Lab)
My Lords, I am very grateful to the noble Baroness, Lady Perry, for tabling this debate today and for giving us a chance to have what has been a well thought-through and—despite the shortage of numbers—very detailed and interesting debate. The debate was also very topical, sadly, for the wrong reasons. As we know, a number of examples have hit the headlines which are an illustration of the fact that the Government have not found the right balance between autonomy and accountability, and that a number of challenges remain. That is particularly sad because when that balance fails, it is the children’s education which suffers, and many of these young people will never get a second chance to recover those lost years from an education that has been damaged. Therefore we all have a responsibility to get this issue right.
We know, for example, the issues that have been in the headlines recently: the collapse of Discovery Free School, concerns over the mismanagement at E-ACT academies, the poor educational standards at the al-Madinha Free School and the financial concerns at Kings Science Academy. All those remind us of what can go wrong if we do not get these policies right and rush them through. As the National Audit Office said,
“the primary factor in decision-making has been opening schools at pace, rather than maximizing value for money”.
There is a concern about the pace at which these changes have occurred.
Now we have the turmoil at the Birmingham schools and the Trojan horse allegations. This was an issue that the Minister’s predecessor was worried about back in 2010, but was then unwilling or unable to intervene. We know now that the Permanent Secretary has been asked to investigate that issue. We await the outcome, but I would be grateful if the Minister would confirm that the Permanent Secretary’s report will be made public when it is concluded, so we can all share the lessons. I should tell the noble Baroness, Lady Shephard, that one of the rumours coming out from Birmingham was that people felt they did not have anywhere to go. The complaints existed and they were desperate to have their voice heard, but people felt that, for whatever reason, it was not being heard at a local level. We therefore all have something to learn from that.
Now, four years on, we have a situation where schools which were given a clean bill of health by Ofsted suddenly find themselves being downgraded on re-inspection, leading to questions about Ofsted’s role, independence and judgments. We cannot be sure that these concerns and problems are contained only in one city. Already, new allegations are coming to light elsewhere, each one again highlighting that there is a problem about the local oversight of what is happening in our schools.
Whatever the outcome of the inquiries now taking place, particularly in Birmingham, I hope that the Minister recognises that the impact on community relations has been particularly damaging. I could not have put better myself the issues raised by the right reverend Prelate about the challenges to the local community that have occurred in the way the allegations have come to light and been handled by all sides, particularly by the media. That is a particular challenge for us. We also perhaps expect too much from Ofsted, because it is now the only intermediary between individual academy and free schools and the Secretary of State. In a sense, it is put in an impossible position, because it is expected to oversee, in quite some detail, a growing band of autonomous schools, facing it with particular challenges.
I agree with the noble Baroness, Lady Perry, that because of Ofsted’s style and the way it behaves when it goes into schools, there have been a number of occasions when it has lost the confidence of the teachers in the schools and the governors. That is a real concern to us when it is the only port of call for many people. Like the noble Baroness, I welcome the fact that the inspectors have been brought back in-house and that quality is being driven up, because it was long overdue.
Of course, not all the schools caught up in the turmoil in Birmingham were academies. While I am sure that Birmingham City Council has its own governance issues that it needs to address, the fact is that, of the 21 schools recently inspected, five out of the six found to be inadequate were academies. I hope that the Government are coming to realise what we told them all along: that 5,000 schools and rising cannot effectively be monitored from behind a desk in Whitehall. The Minister will know that this point was made to him in a private briefing by civil servants recently. They advised that, as ever more bad publicity came from failing schools, there would be a growing public realisation that the department did not really have the tools to enable it to intervene effectively.
I hope that the Government are now reflecting on what has gone wrong with this policy. Perhaps the Minister will share with us details of the steps that they are taking, rather belatedly, to put in place an intermediary tier of accountability.
On these Benches, we already have proposals that we believe will address this accountability deficit. David Blunkett’s recent report sets out an effective blueprint to devolve power down to local areas and ensure that all schools are supported and challenged to improve. This echoes the argument made by the right reverend Prelate and, indeed, by the noble Baroness, Lady Shephard, that we need more local oversight and involvement in the performance of schools. Under our proposals, a new director of school standards would be appointed in every area. The director would have powers to intervene in underperforming schools, to broker collaboration and to commission new schools.
The issue of collaboration between schools marks a clear distinction between our approach and that of the Government. My noble friend Lady Farrington commented on the London Challenge, which was introduced by the last Government. It was highly successful in transforming poorly performing schools in London and went on to achieve some of the fastest improving schools in the country. The key difference in that approach was that it was done through a policy of sharing best practice and collaboration between schools. It happened in London, and my noble friend went on to point out where it happened elsewhere in the country, such as in Lancashire. We need to learn more about what schools can do in terms of collaboration rather than have them acting as isolated, autonomous institutions.
A recent OECD report has confirmed the importance of this approach. It states that:
“Knowledge about strong educational practices tends to stick where it is and rarely spreads without effective strategies and powerful incentives for knowledge mobilisation and knowledge management”.
The report goes on to identify a number of high-performing PISA countries and regions, including some of Michael Gove’s favourites such as Finland, Japan and Shanghai, and shows that they have strong histories of co-operation networks and shared resources. Those are what have made them successful. But that does not happen by osmosis. The plan has to be laid down and determined, with a clear expectation that this is the way schools will behave, and rewards have to be linked to it.
The report goes on to address another clear dividing line between ourselves and the Government, which is on the importance of high-quality teachers. Again, this point was made eloquently by the noble Baroness, Lady Perry. It emphasises the need for continuous professional development. We on these Benches believe that all teachers should be qualified and expected to be involved in continuous professional development, and should indeed be periodically revalidated. The OECD data support this approach. Further, this research has been backed up by the Sutton Trust and shows that teacher quality can make as much as a year’s difference to the learning progress of disadvantaged children, so it is a very important tool when addressing the issue of social mobility.
To sum up, while we share some of the Government’s desire to give teachers autonomy over the curriculum and how subjects are taught, we believe that it has to go hand in hand with the professionalisation of teaching and evidence of continuous school improvement. The problem with the Government’s approach is that schools sink or swim, and sometimes they sink. When they do, they take with them a cohort of children and their aspirations and dreams. We do not think that that is the right approach. We believe that driving up teacher quality, allowing for early intervention in all schools, a new element of local oversight and, most important, building in an element of continuous improvement through learning and collaboration, are the right way forward. I hope that the Minister will be able to agree, and I look forward to hearing what he has to say.
The Parliamentary Under-Secretary of State for Schools (Lord Nash) (Con)
My Lords, I thank my noble friend Lady Perry for securing this important debate and for her insightful speech. I also thank all noble Lords for their valuable contributions. Autonomy and accountability are the two key pillars of our school system, and the OECD PISA results show clearly that greater autonomy coupled with strong accountability can lead to a better-performing school system. Strong evidence of this can be seen in countries such as New Zealand and Poland.
By contrast, we have seen in Sweden the perils of an autonomous system which is not strongly coupled with accountability, and we can see in Wales the shambles created when you have neither. It is therefore critical to strike the appropriate balance and we have done exactly this in creating a self-improving, school-led system, which has the resounding success of the academies and free schools programmes behind it. As my noble friend Lady Perry mentioned in quoting the noble Lord, Lord Adonis, the academy programme gives schools the magic ingredient of the freedom to run their schools in the best interests of their pupils.
We are continuing to work to bring decisions much closer to schools through the introduction of our eight regional school commissioners, through which we are trusting school leaders to run their own system and provide the department with much better local intelligence to enable it to insist on matters to which my noble friend Lady Shephard referred. Unlike the Labour Party, we believe that breaking the country into eight regions run by leading heads and supported by other leading heads on their teacher boards is the way to run the system. The noble Baroness, Lady Jones, referred to the Blunkett report, which talks about breaking the country into 50 bureaucracies, each with their own layers of management. We feel that that would basically be a retrograde step.
As the PISA findings show, the more freedom given to schools, the better the performance of the whole system. In sponsored academies open for three years, for example, the proportion of pupils who achieved five good GCSEs, including English and maths, has increased at twice the rate of local authority-maintained schools. Converter academies are more likely, against the new tougher Ofsted inspection framework, to retain their “outstanding” ratings, or to improve from “good” to “outstanding” than LA schools.
Combined with this is the outstanding success of the free schools programme. I should also mention that academy chains, with their clear lines of sight mentioned by my noble friend Lady Shephard, are working particularly well, as recently outlined in an excellent study by the University of Southampton. Of course, these chains and other local groups are very much focused on schools working together locally to create a less, rather than more, fragmented school system.
On the right reverend Prelate the Bishop of Birmingham’s point about local arrangements, I assure him that—certainly since I came into office—we have concentrated the academy programme on local regional clusters of schools working together, such as in his own diocese. It has worked well in the London Challenge, to which the noble Baroness, Lady Farrington, referred.
The free schools programme has been an unqualified and outstanding success; I use the word “outstanding” advisedly. Free schools are inspected by Ofsted after only four or five terms from opening and, so far, of those free schools which have been inspected, 24% have been rated “outstanding”. This is a truly remarkable experience and the facts speak for themselves. I am sorry that the noble Baroness, Lady Jones, is still in denial about this, but those facts are pretty powerful. The fact that we have closed one and a half free schools with 200 pupils in them—although that is significant for those 200 pupils and their parents—compares not only to the 24% “outstanding” figure but to the 175,000 new places we have created under the free schools programme.
By comparison, 73 local authority maintained schools have gone into special measures this year alone, and 38 council-run schools have been in special measures for 18 months or more. In 2013, Ofsted found that one in three local authority action plans in relation to underperforming schools were not up to standard. As my noble friend Lady Shephard said, no one is making the case for reinstating the local authority model. Indeed, Ed Miliband said exactly that himself in other place only a few days ago; although, as I have said, the 50 bureaucracies planned by the Labour Party are, in fact, a return to the local authority system.
We are committed to increasing autonomy for all schools, not just academies and free schools. Through reforms linking pay and performance, bringing teacher training closer to schools and reducing bureaucracy and box-ticking, and dramatically reducing regulation, we have made it easier for schools to focus on what is important: ensuring that children succeed. With Ofsted reporting that schools improved faster last year than at any time in Ofsted’s history, we are clearly getting it right. Autonomy must be strongly coupled with accountability and, under this Government, academies and free schools are held more rigorously to account than council-run schools.
All schools should have strong financial controls in place. However, academies and free schools have stronger and tougher financial frameworks and are held up for greater scrutiny than council-run schools. That enables swift resolution if there are any financial issues. In local authority maintained schools, it is the local authority that has responsibility for financial oversight. The frequency and depth of audit is variable and maintained schools are often not subject to the same rigour as academies and free schools, which must publish annual audited accounts submitted to the EFA. We monitor those carefully and will investigate immediately and diagnose any problems. That accountability mechanism works extremely well.
We also have the ability to issue a pre-warning notice if we have any concerns. Since 2011, we have issued 44. Over half, 26, were for the relatively few academies approved under the previous Government; 18 were for those approved under this Government. In the eight academies issued with pre-warning notices in 2011, there was an average improvement of 16 percentage points in the proportion of pupils achieving five good GCSEs in 2012. For those issued with a pre-warning notice in 2012-13, the average improvement rate so far has been 8 percentage points.
We have also recently strengthened the guidance for local authorities by putting in an expectation that they act quickly and do not wait for Ofsted to go in before intervening. We expect warning notices to be issued in instances where, for example, standards are below the floor, disadvantaged pupils are achieving low standards, or there is a sudden drop in performance.
In giving schools greater autonomy, good governance becomes increasingly important, as the right reverend Prelate mentioned. Our reforms are designed to encourage that and we are focusing governors on three core functions: the vision and ethos of the school, as the right reverend Prelate again mentioned; holding the head to account for the progression and attainment of pupils and the performance management of his or her staff; and money. Since 2012, the quality of school governance has been central to the overall inspection judgment on the overall leadership and management of a school.
We are committed to ensuring that children at primary school have the best possible start in life and have increased primary accountability in a number of ways: with the new curriculum; an increased emphasis on the importance of grammar, punctuation and spelling; abolishing the requirement for schools to use national curriculum levels; reintroducing level 6 stretch papers for key stage 2; and the introduction of phonics at every stage of teaching. That helps help children to develop faster; evidence shows that children taught to read using phonics could be “two years ahead” by the age of seven.
As my noble friend Lady Perry mentioned, in secondary school we have introduced new accountability measures to provide clear information and give a fair and balanced picture of each school’s performance. She was quite right about the failure and falseness of the exam accountability system previously. As a result of the scandal of false equivalence that operated previously, under the previous Government the number of pupils doing a core suite of academic subjects fell from 50% to 22%. All the evidence from all successful education jurisdictions around the world is that it is necessary for pupils to do that core suite of subjects, particularly those from a disadvantaged background. I am delighted to say that, under this Government, the number of pupils doing that core suite as a result of our EBacc is now back to 36%, and we expect it to rise further this summer.
As the noble Baroness mentioned, our new accountability measures include: progress 8, which will track the progress of all pupils of whatever ability throughout their school careers, and should focus schools on the attainment of all pupils rather than on what Tristram Hunt has described as the great crime of the C/D borderline; attainment 8, the percentage of pupils achieving a C grade or better in English and maths; and the EBacc. Alongside that, our destination measures will be important. The Government have also set tougher minimum standards for schools. We have raised the floor standards at primary to 65% from 60%, and at secondary to 40% from 35%.
High-quality inspection is an important aspect of the school accountability system. Building on the changes that the coalition Government put in place in 2011 to focus inspection more strongly on teaching and learning, Sir Michael Wilshaw has set his own priorities, which are helping to drive improvement. The inspection framework was amended in September 2012 and a higher benchmark has been set. When inspecting schools, Ofsted now holds them to account for the attainment and progress of their disadvantaged pupils, and the gap between them and their peers. The abolition of the “satisfactory” label was clearly an important move.
The number of Ofsted categories has also been substantially reduced to avoid confusion, and as my noble friend Lady Perry said, in future Ofsted itself will take control of far more inspections. Moreover, the regional operation to which my noble friend Lady Shephard referred is working extremely well. She also mentioned a number of cases, and I am reasonably sure that I recognise one of them. I can assure her that the department is monitoring the situation closely, and I would encourage any teacher or parent who has concerns about any matter that they do not feel is being dealt with effectively at the local level to contact the Education Funding Agency. The noble Baroness, Lady Jones, referred to the Permanent Secretary’s report. I do not know whether it will be published, but I am sure that the Secretary of State will be very happy to answer any questions about it; of course, it is looking into any warnings that the department may have received in 2010 and previously.
I turn now to the excellent points made by the right reverend Prelate the Bishop of Birmingham. Perhaps I may take this opportunity to thank him for all the work that is done by the diocese of Birmingham Educational Trust, and ask him if he would kindly pass on the department’s thanks to Reverend Jackie Hughes for her excellent work over the years and its best wishes for every success in her retirement. I also pay tribute to the trust’s academies accountability framework, a copy of which I have with me, which is particularly clear on matters like challenge and lines of accountability.
My noble friend Lady Sharp talked about the relationship between the local governing body and the centre, which is very important. The academy chain may appoint the head, but it is important that the local governing body is made aware of all the KPIs and targets so that it can advise the centre of its performance. Only today I had an interesting conversation with the noble Baroness, Lady Sherlock, about this in relationship to a playgroup, and I suggest that it would be very helpful to her if she talked to my noble friend about it.
I come back to the old story about non-qualified teachers, which we had again earlier today in the House. I think that noble Lords know our arguments on this. We do not think it is right to deny people the opportunity of having the best teachers, and there is no clear evidence at all that QTS is an effective arbiter in itself of the quality of teaching.
I am extremely grateful to all noble Lords for this debate, and to my noble friend Lady Perry for her comments and support. In conclusion, by creating a system that is autonomous by giving schools the freedom to innovate and upholds them to a higher level of accountability, we are giving more children and young people a firm educational foundation on which they can build the rest of their lives.