Early Years Intervention

Baroness Finlay of Llandaff Excerpts

Thursday 8th January 2015 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, like others, I congratulate the noble Baroness, Lady Massey of Darwen, on having secured this debate and on attracting a large number of speakers.

I want to focus on the development of the brain. Without our brains, we cannot learn, we cannot learn language and we cannot interact. If in the next generation we do not ensure that brains are developed property, we will not break the cycle of maltreatment and failure within the social environment and every other environment in society.

It is worth noting that 90% of brain size has been acquired by the age of three, so the focus on the first 1,001 days—that is, from conception to the age of two—which has already been alluded to by other speakers, is critical. The Wave Trust has done a lot to raise awareness and to pull together the evidence in this area. The long-lasting effects of maltreatment are in the physical, socioemotional, cognitive and behavioural domains.

The consequences and costs of such maltreatment are phenomenal. As has already been said, managing it costs about £15 billion a year. As well as the physical and mental suffering of the individual and the damage to educational prospects, there are also high levels of aggression, which damages others in society. It is of note that 68% of those in the prison population have been abused or neglected in childhood. The Christie commission in Scotland estimated that 40% of public spending is necessary only because of our failure to intervene early enough. We are accumulating huge future expenditure by not looking at this very important area.

It is also worth noting that about one in five children is maltreated, the peak time being in the first year of life. Sixty-two per cent of those entering care in 2013 had been subject to abuse and neglect. In March of that year, more than 68,000 children were in care, so it is a very big problem. Five per cent of children have a diagnosable mental health condition, and 15% to 20% of behavioural problems are severe enough to cause concern. This is costing about a quarter of a million pounds per child. Interventions on parenting programmes that cover the period from birth onwards cost less than £2,000 per case. The difference in cost is phenomenal, and it seems almost madness that we have not addressed this issue on economic terms alone.

About 1 million children in the UK are suffering the long-term effects of maltreatment, with all kinds of behavioural disorders, but it is worth noting that the greatest predictor of prenatal depression is that the mother was herself abused. She has a tenfold likelihood of becoming an abuser. A third of abuse occurs when under the influence of alcohol. I urge the Government to get to grips with alcohol policy, particularly pricing and so on, because it may have a huge effect. In families with a history of domestic violence, there is a 23 times greater likelihood of abuse being perpetrated against children under the age of five. I stress the importance of domestic violence as a contributory factor.

It is worth considering briefly why this happens. As the brain develops, areas that are stimulated develop more. Those that do not receive stimulation, as the noble Lord, Lord Winston, has already pointed out, do not develop to the same extent. Therefore, even in the womb the child subject to stress develops a stress reaction, and the brain develops the ability to respond to stress. Children who have not experienced a calm environment do not develop the ability to have empathy and they cannot be expected to feel remorse for later hurting or killing somebody, because that part of their brain is not properly developed. Nor can they develop communication skills. Therefore, the child subject to hyperarousal all through those very early days and weeks will develop a state of permanent hyperarousal and response within the brain. That plasticity of the brain carries on throughout the child’s development until the age of 16, so the other educational interventions referred to by noble Lords all help in developing the areas of the brain that have not developed well.

In my last seconds I would just stress that cutting back on mental health services in the perinatal period may be the most serious adverse disinvestment that the NHS is currently undertaking.

Children and Families Bill

Baroness Finlay of Llandaff Excerpts

Wednesday 5th February 2014 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, it has been an enormous privilege to be part of the movement across all Benches in this House to do something about controlling the use of tobacco, particularly in relation to child protection. Tobacco control has for many years been something that medicine, the discipline from which I come, has been arguing and pushing for. It is with a great sense of relief that I see these amendments before us today.

I thank everyone who has contributed to these and previous debates, but I especially thank the noble Earl for the way in which he has remained in contact, listened to discussions, been very open to suggestions and has really taken on board a rapidly changing landscape in the atmosphere of this House, which has supported these moves. I would have added my name to the other amendments had I not been so busy checking the one to which I did add my name before the time ran out.

The issue of e-cigarettes is really important; they have crept up on us rapidly. They give a bigger nicotine hit, so users say, than cigarettes and they have flavourings that are likely to attract young people. So, moves towards controlling them as well are really important. I know that the Chief Medical Officer has looked at this carefully and is concerned. I share those concerns, as do many others in my discipline of medicine. I hope that in the years ahead we will see a drop in cigarette and tobacco-related diseases presenting in our A&E departments, GP surgeries and hospitals.

[Lord Ribeiro (Con)]

My Lords, I add my appreciation to my noble friend the Minister for getting us to the point where we are today. Little did I wonder when I introduced my Private Member’s Bill way back in July 2012 that we would actually be at this position. As the noble Baronesses, Lady Finlay and Lady Tyler, rightly said, this has been a cross-party initiative right across the House. I am grateful for the conversations that I have had with my noble friend and for the way in which the Government have shifted their position both publicly and privately. That is very rewarding.

Thanks to the Tube strike today, I came in by taxi. The best way to find out what the average member of the British public thinks about anything is to ask your taxi driver. I noted that he had a no-smoking sign in his cab. I asked, “What do you think about this Bill on smoking in cars that we might be able to resolve today?”. He held up a packet of cigarettes, to my surprise, and said, “I’m a smoker. I don’t smoke in the cab, I go outside to smoke. Why would anybody want to smoke in a car with children present? Why would they?”. That was his reaction. When we know that 85% of smokers think that it is bonkers to smoke in a car when children are present, we realise that we have finally made the point that this is more about child protection—protecting young children with young lungs, who are likely to end up with long-term respiratory problems—than it is about removing personal liberties.

I hope that the Government will continue to re-energise this educational programme because it is that 15% of the public who do not recognise the importance of not smoking in cars that we need to get at. I have every confidence that the Government will do so. Legislation can always be used as a blunt instrument but it is interesting that, since the seat-belt legislation was brought in, the current compliance rate is more than 90%. Some 95% of people who clunk-click would never even think of driving off without putting their seat belts on. In years to come, I hope that people will wonder why they ever smoked in cars with children present.

Schools: Emergency Life Support Skills

Baroness Finlay of Llandaff Excerpts

Monday 3rd February 2014 Lords Chamber

Asked by

[Baroness Finlay of Llandaff]

To ask Her Majesty’s Government how many secondary schools teach emergency life support skills as part of their compulsory school curriculum.

[The Parliamentary Under-Secretary of State for Schools (Lord Nash) (Con)]

My Lords, the ability to save a life is one of the most important skills that a young person can learn, and many young people take part in activities on emergency life support skills in schools. For example, in 2012, St John Ambulance provided support resources for the direct teaching of first aid to more than 500,000 young people in schools. It is for schools to decide whether, how and when pupils should learn emergency life support skills. The Government do not collect data on school provision in this area.

[Baroness Finlay of Llandaff (CB)]

Given that 60,000 people a year have an out-of-hospital cardiac arrest and yet three-quarters of our population are not trained to give basic cardiopulmonary resuscitation, does the Minister recognise that this is a problem? It is devastating for anyone, particularly a child, to see someone have a cardiac arrest in front of them and not know what to do. We know that immediate cardiopulmonary resuscitation will triple the chance of survival. Life-saving skills really should be mandatory in schools, as they are in other European schools. I ask the Minister to reconsider. Has the current consultation over key stage 4 curriculum content in English, maths and science considered including heart function, cardiac arrest and CPR as part of science teaching?

[Lord Nash]

The noble Baroness is quite right to draw attention to this very important point. Emergency life-saving skills are extremely important. In addition to the St John Ambulance provision, the Red Cross and the British Heart Foundation run excellent schemes. The BHF’s Heartstart scheme has to date trained more than 3.5 million people.

The answer to her curriculum question is that I do not believe we are intending to put this in, but I will investigate that and write to her about it. With regard to particular incidents in schools, we are looking at that in the context of defibrillators to see if there is anything more that we can do.

Education: Personal, Social and Health Education

Baroness Finlay of Llandaff Excerpts

Wednesday 24th April 2013 Grand Committee

[Baroness Finlay of Llandaff]

My Lords, I add my sincere thanks to the noble Baroness, Lady Massey, for having secured this debate, which is extremely important.

Our schools are now labouring against a much bigger problem than in the past. In the days when we went to school, figures relating to society were far better. Just to quote a few, the UK now has the highest rate of family breakdown in the western world and only just over half—55%—of 15 year-olds live with both their birth parents. That is a huge social change. Children are considerably more likely to have a television in the bedroom than a father living at home. We also know from good, sound research that 80% of variability in pupil achievement is attributable to so-called pupil factors, particularly family influence, so schools are struggling against a huge backdrop of problems that children may be bringing in with them, which are not the children’s fault.

I will touch briefly on emergency first aid, which has already been covered by the noble Lord, Lord Aberdare, and the noble Baroness, Lady Masham. I cannot but join wholeheartedly with their comments. If there was one thing that every child should learn, it would be the two hours of CPR. The children are very likely to be on the scene when the person concerned drops dead. Even though there is only a 15% chance of success, if unsuccessful, they can in their grief be consoled that they did everything they could.

I know of a woman, now in her 60s, who in her late teens found her father dead in the chair, and she has never recovered from the fact that she did not know what to do. She did not even know how to try. She just dived for a telephone and waited, and of course her father was dead. If only she had known to give him one thump on the chest, she might have felt better about the whole of her life. But it is not just about CPR. It is about coping with bleeding, choking, fractures—the real basics. Young people are the ones at risk of those; they are the ones at risk off falling of a horse, falling down a cliff face and so on.

As regards the life skills with which we are trying to equip children, they are about relationships. We are not dealing with only the nuts and bolts, if you like, of sex; we are dealing with the whole business of relating and coping with all the emotions that go on. Sadly, we have seen a rise in the number of girls reporting non-consensual sex from 28% in 2002 to 38% in 2008. Something is wrong and we cannot ignore it.

We also have to help children to cope with all those difficult emotions. EU Kids Online looked at children’s concerns on the internet and found that 22% are concerned about pornography and 18% about violent content. We know that between 1995-96 and 2005-06 there was a 66% increase in the hospitalisation of 12 to 14 year-olds from for self-harm. We have the data from the report on child well-being in rich countries and we do not do well. The United Kingdom does appallingly on teenage fertility rates. We rank badly for alcohol being drunk twice a week and children having used cannabis in the last 10 months. But we also do badly on children being involved in a physical fight and in being bullied at school at least once in the past couple of months. All of those are negative influence on children’s emotional development.

Unless we grasp the nettle, tackle this, make it part of our statutory provision and value the need to teach children all the aspects of thinking and relationships, we will continue to fail, as we seem to be doing now. I ask the Minister: where is the Government’s teenage strategy? What is happening to that group who appear to be invisible in policy?

Education Bill

Baroness Finlay of Llandaff Excerpts

Wednesday 13th July 2011 Grand Committee

We have a chance through this amendment to ensure that all young people learn about the importance of relationships now and in the future.

[Baroness Finlay of Llandaff]

My Lords, I shall speak to my amendment in this group.

First, though, I shall address a small point just raised about relationships. In new Section 85B(1)(b), perhaps we should also insert, “bereavement reactions in grief and loss”. There are some fantastic programmes that help children prepare for the inevitability of experiencing bereavement, grief and loss, which are tailored for different ages. We know that by the time children leave school, 10 per cent of them are going to be seriously bereaved, but we are just ignoring that when we talk about other aspects of development. Those children do very badly if they do not understand their emotions.

My amendment is focused on community resuscitation. In the UK we have over 30,000 out-of-hospital cardiac arrests a year, and currently fewer than 10 per cent of victims survive to leave hospital. That means that we have 27,000 sudden deaths in the community. To put that in perspective, about 12,000 women a year die of breast cancer, 3,000 people die on the roads and 270 people die from knife crime. The number of sudden cardiac arrest deaths out there is huge. It takes around five to 10 minutes for an emergency ambulance to reach someone and for every minute that passes in cardiac arrest the chance of successful defibrillation decreases by 10 per cent, so time is of the essence. Immediately administrated cardiopulmonary resuscitation, which I am now going to call CPR because it is much shorter, will prolong the time that the patient remains shockable and therefore can be put back into a normal rhythm. It increases the chance of survival by a factor of around three. If there is a defibrillator nearby, survival rates of up to 50 per cent from a baseline of under 10 per cent have been reported.

Other parts of the world have already addressed this. It is part of the curriculum in Norway, Denmark and France. The American Heart Association has advised that no pupil should graduate from secondary school without being proficient in CPR, not just learning it. In Seattle, schools have taught CPR in PE lessons for over 30 years, so now half of the population of Seattle and the surrounding area are trained. In 2009 the survival rate for witnessed cardiac arrests was 46 per cent, while ours is under 10 per cent. The difference is dramatic.

Here in the UK, the British Heart Foundation has put Heartstart into over 2,700 schools, 700 of which are secondary schools or colleges. It trains thousands of children every year. British Red Cross and St John Ambulance also run training schemes, but the trouble is that the provision is patchy. There are 3.6 million children in secondary education in England, but only around 14 per cent have any training in CPR provided by one of these organisations. It is estimated that around 3 million secondary school pupils are not trained, even though the voluntary organisations are very ready to offer this training. By contrast, a poll taken by the British Heart Foundation at the beginning of this year found that 86 per cent of teachers, 70 per cent of parents and 78 per cent of children want to be trained. There is no resistance anywhere; it is a question of making the link. The campaign has wide medical, nursing and teaching support, as well as from the charities that deal with bereavement following cardiac death.

Training and support for teachers would enable them to deliver emergency life support. Currently, the British Heart Foundation spends around £800,000 a year on teaching resources, including mannequins, school packs, teacher supply cover and so on. It is estimated that it will be necessary to increase the provision of community resuscitation development officers, who are linked with the 12 ambulance trusts in England, by around five people to ensure that every child in every school is taught. With additional resources, the models could be successfully applied across all schools. There are over 3,000 local authority maintained secondary schools in England. The amendment aims to amend Section 84 of the Education Act 2002 so that this training becomes a community requirement at the first, second and third key stages.

I know that the Government can be much more prescriptive with the curriculum for maintained schools and I hope that they might consider adopting this training because that will influence the academies to take it up. However, I am well aware that the Government cannot be prescriptive for academies. Sadly, this is not part of PSHE at the moment. First aid training in the curriculum covers some parts of emergency life support but not emergency CPR, which is what can save lives. We could go from 27,000 sudden deaths in the community to approximately half that number if we spent a few hours on training all children in CPR. It has been estimated that the training takes only around four hours. It would mean that when they come across someone who has collapsed and is effectively dead on the street, they will know what to do.

[Lord Elton]

My Lords, I know that there are quite a number of people who, like me, should declare an interest in this, having been identified as a potential victim. I shall just tell my noble friend that he will have to argue very strongly against this amendment to stop me supporting it at a later stage.

Education Bill

Baroness Finlay of Llandaff Excerpts

Thursday 30th June 2011 Grand Committee

[Baroness Jolly]

I also support the noble Lord, Lord Storey, on Amendment 43, to which the noble Baroness, Lady Howe, has added her name. Almost by their nature, children who are excluded can be stroppy and awkward, but what is hidden—and what they probably fight very hard to hide—is that they are really very scared and apprehensive of the whole process. There is no provision in this Bill to show that children also figure. There is no provision to ensure that they are aware of the process, to allow them to make representation themselves to the panel or to appeal against their exclusion.

This amendment calls upon those who are involved in the process to ensure that the pupil is clear about these issues—about the reasons and the evidence. The language that is used should be in the appropriate tongue or at the appropriate level to allow the pupil to be completely clear about what is happening. They should know who is going into the process. There should be no doubt for the child what is there before them.

One thing that I would like the Minister to consider, should he be minded to do so, although it is not written as part of the amendment, is that the child could have an advocate with whom they could work as they go through the process. That could be useful.

The amendment would align England with the devolved nations. It would also put England in line with Article 12 of the UN Convention on the Rights of the Child and would meet the recommendations of the Committee on the Rights of the Child. There is an element of natural justice to it and, whatever the reasons for the exclusion, the child deserves that.

[Baroness Finlay of Llandaff]

My Lords, I hope that the Committee will forgive me for intervening briefly but the last point is very important. What has triggered the behavioural deterioration that has resulted in exclusion? These children may already have special educational needs. The behaviour may be down to bullying but sometimes it is due to abuse. Sexual abuse is particularly difficult to uncover in these children. It may also be a grief reaction to loss or bereavement, which can sometimes be delayed. One problem is that in the majority of our schools staff do not have adequate training to deal with children who are bereaved and have bereavement and loss reactions. The reactions to grief and loss in this group of children can appear to be disruptive and bad behaviour, and it can exacerbate other behaviours in the children around them. Therefore, the triggers that have set this cascade towards exclusion going are absolutely critical, and if we do not focus on them we will continue to fail children over time.

[Lord Willis of Knaresborough]

My Lords, I rise briefly to address some of the issues raised by the noble Lord, Lord Ramsbotham, in Amendment 39A. His comments, which I strongly support, take us back to 1979 and the Warnock report. They take us back to why that report and the 1981 Act moved away from the categorisation of special needs and conditions associated with special needs and towards two things. The first was to look at the severest cases and to make sure that they were properly assessed with a statement of special needs, which then had to be statutorily supported in our schools. I very much supported that at the time.

The Warnock report also recognised that in 1979—not in 2011—some 20 per cent of our children had some form of special needs which should, if recognised, be supported within the school community. From that time through to when I entered Parliament, I spent most of my professional career working first in the north-east, opening the first school to look at the inclusion of children with physical impairments; and then latterly in Leeds, working to ensure that children with severe learning difficulties—mostly Down’s syndrome, hearing impairment and sight impairment—became part of the mainstream setting.

In all those cases, both in the north-east, where we did some pioneering work with NFER and then HMI, and in Leeds, the crucial factor—I am sorry that the noble Lord, Lord Sutherland, is not here at the moment—was training your staff. You can identify until you are blue in the face but, following that identification, you have to ensure that you translate the needs of the child into an appropriate action point, as the noble Lord, Lord Storey, said, with the appropriate resources. This is not a massive resource issue but it is a training issue. It is a question of ensuring that people have the skills to support these children. I am sorry that the noble Baroness whose name I should remember—

Schools: Curriculum and PSHE Reviews

Baroness Finlay of Llandaff Excerpts

Wednesday 27th April 2011 Lords Chamber

[Lord Hill of Oareford]

My Lords, generally we are keen to ensure that the national curriculum is as little overloaded as possible because we believe that one should make space in the school day for important subjects such as financial literacy. PSHE would be another good example. That is why we are trying to simplify and reduce the burden of the national curriculum, to leave schools more discretion and time to decide on the subjects they want to teach and the best and most appropriate way to do so, knowing their children.

[Baroness Finlay of Llandaff]

How much consideration has been given to helping teachers and, therefore, children understand their emotional responses in bereavement, given that we know that 10 per cent of school children are bereaved of either a parent, sibling or close friend and that those who do not have support become victims of bullying and have a higher instance of depression, suicide, alcoholism, teenage pregnancy, and so on?

[Lord Hill of Oareford]

Again, my Lords, I agree with those points. Part of what one would want to look at in the review is what support children need and therefore what support teachers need to make sure those children have the appropriate knowledge and skills.