Department of Health

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Speech: PM’s speech at Downing Street reception to celebrate the legacy of Jo Cox: 17 January 2018

19 January 2018, 3:00 pm

Thank you, thank you very much for those excellent words, Seema, and good afternoon, everyone. It’s an honour to have you all here today as we remember the life of a remarkable woman and thank those who are continuing the work that meant so much to her. And I’d like to give a very special welcome to Jo’s immediate family. Her husband, Brendan, who has been an inspiration to so many over the past year and a half. Her wonderful children, Cuillin and Lejla; her proud parents, Jean and Gordon; Brendan’s parents, Sheila and Gordon; and Jo’s beloved little sister, Kim. Kim once said of her older sister that she wasn’t a complainer but a doer. It’s all too easy to stand on the side lines and say that something must be done. Actually getting out there and doing it, as Jo did throughout her life, takes an extra level of effort and commitment. And that determination to make things happen, to bring about change, was something that defined Jo’s work, both before and after she entered Parliament. And in the 19 months since her death, it’s a legacy that has been carried forward both by her family and by the Foundation and Commission that bears her name, and at the heart of that work is the fight against loneliness.

In a country of more than 60 million people, and in an age where we can instantly connect with friends, relatives and even strangers around the world, it may seem counterintuitive that any of us could find ourselves feeling lonely. Yet, more than 9 million of us say that we always, or often, feel lonely. 200,000 older people have not had a conversation with a friend or a relative in more than a month. Up to 85% of young adults with disabilities say they feel lonely most days.

As Jo herself used to say, loneliness doesn’t discriminate. But just as loneliness can affect any of us, so any of us can help to tackle it. And that could mean simply popping round to see an elderly neighbour or picking up the phone to a relative. Or you could follow the example of Phil Burton, a former Royal Artillery Lance Bombardier who is here with us today. After leaving the Army, Phil realised that many of his ex-servicemen were suffering from social isolation; they had lost the close‑knit family that the Armed Forces provided. So, last year, he founded the Veterans Café in Lancashire. Its fortnightly get-togethers create a place where former members of the Armed Forces can come together, talk, share experiences and access support from charities and the NHS, and the projects proved a huge success, attracting hundreds of veterans of all ages. And just talking to Phil earlier on, he was saying that for many veterans they won’t open up to somebody in authority or somebody who’s there to help them, but they will open up to another veteran. And that is so important to them, and so many lives have been changed as a result of what Phil has done. So, I was delighted to meet him and present him with a Points of Light award earlier, which recognises outstanding volunteers in our country for their service to others. And the Veterans Café is exactly the kind of local project Jo supported, celebrated and encouraged.

And over the past year and a half, the Jo Cox Foundation has continued that work, most notably with The Great Get Together, and last summer’s events were the biggest set of neighbourhood celebrations since the Jubilee street parties. I had the pleasure of attending one in my own constituency, and I am very pleased to confirm that The Great Get Together will return this summer, on 22nd June. It will bring together millions of people on what would have been Jo’s 44th birthday. I am certainly looking forward to it.

But Jo’s legacy doesn’t end there. There is also the Jo Cox Commission on Loneliness, created just over a year ago. And in the spirit of having more in common, it is, as you’ve just heard from Seema, jointly shared by two MPs: one Conservative, my good friend, Seema Kennedy, who you’ve just heard from; and one Labour, Rachel Reeves. And both worked closely with Jo during her all too brief time in Parliament. And both have spent the past 12 months looking at what the Government and others can do, to continue her legacy. And the Commission’s report, which was published just before Christmas, highlights a range of areas where action is needed. And in response, we’ve started work on an England-wide strategy to tackle loneliness, which will be published later this year.

Work has also begun on developing the evidence base around the impact of different initiatives, across all ages and within all communities. And the Office of National Statistics is committed to establishing a framework for measuring loneliness, so consistent figures can be used in major research studies. And we will create a new, dedicated fund that will see government working with charities, foundations, and others, to stimulate innovative solutions, provide seed funding for community initiatives, and scale-up existing projects. And all this work will be overseen by a new ministerial lead on loneliness, Tracey Crouch. She will be keeping the challenge of tackling loneliness firmly on the agenda of colleagues across Whitehall. And any of you have met Tracey today at the reception, I think will agree that she is hugely enthusiastic about the role that she has taken on. Because this issue isn’t just an issue for our Health Service, or for local councils, every department has a role to play and Tracey will be responsible for bringing them all together to get things done, and she’ll be continuing to work closely with the Jo Cox Commission. And of course, she’ll also be collaborating with people like you here in this room today. People who, like Jo, believe in causes and ideals, in working together in making a difference. And when I look around the room today, those are the kind of people that I see. You are all contributing in your own way, but in so many different ways. And Tracey and I are looking forward to working with you to make this project a fitting tribute to everything that Jo stood for.

In Brendan’s memoir of life with Jo, he recounts the awful first night after Cuillin and Lejla learnt that their mother had died, and he describes how Cuillin, then aged just five, wrote and sang a song in tribute to her; a song with a simple yet devastating refrain, ‘I love my mummy, I will not leave her behind’. Cuillin, don’t worry, none of us will leave your mummy behind. None of us will forget her life, her ideals, or what she stood for. And all of us will do all that we can to see that, in her memory, we bring an end to the acceptance of loneliness in our society. Thank you.

Speech: Social care commentary: children’s homes

9 January 2018, 9:47 am

Today, I want to talk about the children living in children’s homes. While the majority of children looked after live in foster placements, around one in 12 children live in children’s homes. Too often, children’s homes do not get the recognition they deserve for the significant role they play in some children’s lives. For some children, residential care is a positive option and it should be seen as such. Did you know that our latest statistics show that 82% of children’s homes are good or outstanding? It might not grab the headlines, but it is a real achievement by the sector.

Each child has a unique set of circumstances, so there is no one-size-fits-all approach to caring for them. Some of these children will struggle to communicate easily with others, understand their own feelings or needs, or manage relationships and situations well. For some children, this will be due to a disability or living with autism. Others will have suffered trauma or abuse, often for many years, and may be angry, confused or withdrawn. I realise how challenging this can be for the adults caring for them. I am under no illusion that this is easy work but I equally know how rewarding it can be. All children need a sense of belonging and someone who is ‘in their corner’.

For some children, sadly, the very issues that make them vulnerable and most in need of our help and support can prove to be a barrier to finding a placement. All directors of children’s services will have at times seen, as I have, social workers wringing their hands as they struggle to find a home that will take on a ‘hard-to-place’ child.

I’ve also heard that for some homes, fear of a negative Ofsted judgement can be a factor in their reluctance to take on these children. I’m sure this is a minority, but this misplaced fear should never determine whether or not a placement is offered. Homes can care effectively for children – however complex their needs – and at the same time be rated good or outstanding by Ofsted. Indeed, the proportion of children’s homes we have judged to be good or better is at a 5-year high. These homes do exceptional work with some of the most vulnerable children.

I don’t want to focus on the role of local authorities in securing suitable placements here, although clearly how they approach commissioning placements is an important part of the picture. In this commentary, I want to discuss what the very best children’s homes are doing to help and support these children and share the excellent practice we have found. These are homes that have staff with the knowledge, skills and determination in place to help these children. And their Ofsted judgements reflect that.

I will also identify some of the issues that homes typically find most challenging and how they best deal with them. This includes:

  • supporting children with their behaviour
  • child sexual exploitation
  • children who go missing
  • supporting children with autism and disabilities

Responding to the challenges

Children placed in residential care are sometimes frightened and angry. They could have had several unsuccessful placements previously, or be hurt and upset at being made to live away from family and friends. They may have other problems associated with trauma that they need help and support to address.

We know that even in the best homes, residential staff have to deal with incredibly difficult and challenging situations at times. They could be subject to physical violence, verbal abuse or have to step in to prevent self-harm, assaults, or serious damage to property. Usually, police involvement is a last resort. We rarely see homes inappropriately calling the police. When we do, we take action if we need to. Involving the police is prompted by the most serious behaviour, such as fire setting or use of weapons, and only after staff have been unable to de-escalate a situation themselves.

For staff, finding ways to help children manage their emotions in a constructive way is one of the many challenges of the job. All of our behaviour is a form of communication and children are no different. Their behaviour may be a result of what other adults have done to them or because they have a disability that means they find it hard to communicate their feelings.

For many children, testing adults or boundaries or doing risky things can be as a result of low self-esteem or because the children don’t care what happens to them. The best children’s homes:

  • recognise why children are doing what they are doing
  • respond with empathy
  • support children to regulate their own behaviour, so physical interventions are rare

Having effective matching processes for referrals and planned moves into the home is vital. Homes that do this well make sure that:

  • placements are suited from the get-go and have the best chance of succeeding. This secures the ongoing stability of the home for the other children living there
  • staff use clear and simple risk assessments and regularly review care and behaviour management plans. This means that they know their children really well and understand their particular needs

As I said in my June 2016 commentary, the importance of good leadership in children’s social care can’t be overstated. Children’s homes are no exception. In the very best homes, we see inspirational leaders who set high standards. In turn, their staff are dedicated professionals whose skill, enthusiasm and understanding make them excellent role models for children. These staff:

  • provide consistent care and measured approaches
  • demonstrate tolerance and respect for everyone
  • importantly, stick with children when they try to push them away

As we saw in one home in Yorkshire, children learn from the positive example staff set. Children then make good progress in tempering and managing how they react and respond to life. There is genuine affection between staff and children in this home, which is pleasing to see. I believe that the best staff build meaningful relationships with children and that this is the key to their success.

Homes have the most success when they provide clear and consistent boundaries combined with incentives and rewards for children’s progress and achievements. In these homes:

  • children are helped to understand and regulate their emotions
  • negative incidents are reduced and those that do occur are managed well, respecting the child and their rights
  • children are involved in their own care planning and, as inspectors saw in some homes, allowed to determine the rewards used. This helps children to feel invested in the home. But it also encourages continued positive behaviour as well as promoting confidence and self-esteem

In one of the homes we saw, children described the response of adults to unwanted behaviour as ‘honest and fair’. One child told inspectors, ‘I have a positive box and I can choose treats from it. I am doing really well here. I feel settled.’

It would be too much to expect children to live together in harmony all the time. But when disagreements and arguments inevitably occur, the best homes use a restorative approach to help children understand how they impact on each other. This:

  • teaches them the benefits of treating one another with warmth and respect
  • allows them to explore the reasons behind their behaviour
  • helps repair relationships

Staff in good or better homes are specifically trained in understanding cycles of behaviour. This helps them to act effectively when young people don’t respond well to life in the home. In one East Midlands home, a member of staff commented on this process, stating ‘it is good to be able to reflect’. I don’t think you can underestimate how important it is for the adults working with children to have time to think about their practice. When you combine good quality training with supervision and other support structures, staff are better able to meet the needs of young people. Some homes also use the skills and expertise of other professionals such as clinical psychologists, psychiatrists and speech and language therapists to guide practice and support both children and staff to good effect.

Children at risk of child sexual exploitation

So high profile is the issue of child sexual exploitation that many homes are now well aware of the issues, are alert to the risks and have strong protocols and procedures in place to deal with and prevent it. However, as Ofsted has said before in the thematic report about the sexual exploitation of children, this in itself is not enough to protect children vulnerable from the threat of exploitation.

Homes that really excel in this area take a holistic approach to protecting children. Multi-agency working is pivotal. Leaders and staff work proactively with local police and safeguarding agencies, as well as other homes in the area, so they are fully aware of potential risks to young people in the community. This approach means there is a cohesive and uniform response to local risks.

The best places know how to balance risk with their responsibility to encourage safe growth. One home in the West Midlands exemplifies this. Here:

  • comprehensive, bespoke risk assessments provide safeguards, while allowing children to take some managed risks
  • staff understand children’s specific vulnerabilities and how these impact on their daily lives, while also being responsive to their changing needs

Children tell us they value this kind of individual planning and the sense of stability and clear boundaries it provides. This is enhanced when children are given genuine involvement in their own care: a common factor across all good and outstanding homes.

Effective education is vital. In the best homes, staff explore young people’s understanding about appropriate relationships, sexual health and online safety. Inspectors have been impressed by the inventive and creative approaches used. For example, a home that we saw in the North East used a variety of different media, such as videos, quizzes, computer animations and other visual aids to enhance young people’s understanding of the risks.

Staff in the best places are highly trained both to support young people and to recognise the warning signs. In the East Midlands, one home used support and training from external specialist organisations to enable staff to deliver this work to a high standard.

Children who go missing

Not all children who live in children’s homes go missing. This is another misconception about residential care. But children who frequently do go missing pose one of the biggest challenges to homes. For the child, an episode may stem from the most understandable of circumstances, like wanting desperately to be with friends or family. For adolescents especially, testing boundaries and yearning for greater freedoms and new experiences are natural. And while anyone could empathise with what are normal teenage feelings, children in care are of course more vulnerable and at greater risk of coming to harm. For staff, getting their response right is no easy task.

In the best homes, we see:

  • staff focusing their time and energy on finding the missing child
  • a good understanding of the children and their individual needs, so they are usually able to locate them quickly
  • agreed strategies in place to deal with missing episodes
  • close work and coordination with families, police and other agencies

And then, importantly, staff work proactively with children to support them and ensure that they understand the risks of repeatedly going missing. Effective education, again, is vital. Some homes use innovative ways of engaging with young people to help keep them safe. We saw an excellent example of effective, bespoke education from one home in the North West. They used a documentary on gang affiliation to help children understand dangers that are particularly relevant to them.

A staff member told us: ‘I speak to [the children] as grown-ups and I try to help them through the transition from boys to men. I want to give them a good platform in life.’ This level of passion and compassion ensures that the young people living at the home feel valued and receive the appropriate guidance.

What makes the difference in these places is that that staff are genuinely interested in understanding why children have gone missing and thinking about what they can do to make children want to return to the home. Again, this is why building trusting relationships is so important.

Children with autism or complex disabilities

Many homes specialise in caring for children with autistic spectrum disorder or other complex disabilities, and do so very well. This group of children has unique needs, so specialist training and expertise are essential to ensure that children achieve the very best outcomes.

Those homes doing particularly well first and foremost ensure that placements are stable. Staff in the best homes:

  • have an in-depth understanding of children’s needs
  • are nurturing
  • show emotional warmth towards children

Children come to trust staff and have a strong sense of belonging. These placements are usually long-lasting, which can help children to make good progress across all aspects of their development.

Care plans that are bespoke, detailed and influenced by young people prove most effective. These allow for clear strategies to manage any challenging behaviours. Working closely with occupational therapists and therapeutic services, staff in the best homes are able to identify and plan each child’s unique sensory strategies. This approach helps to lessen the frustration and anxiety that young people experience. In turn, this reduces physical interventions and unwanted incidents.

Excellent multi-agency assessments ensure that children’s complex needs are understood and met. In one North West home, inspectors saw truly comprehensive multi-professional assessments that produce individual strategies to help young people regulate their emotional health. They are closely followed in practice. For example, staff use individual sensory stimuli such as weighted jackets or beanbags to act as a calming measure and to increase children’s feelings of security.

Proactive healthcare arrangements help children to access the right kind of support. Another home we saw gave each child a ‘healthcare passport’, detailing their communicative abilities and likes and dislikes. This means that health professionals can get the right information from children during appointments and offer appropriate treatment or advice in a way they understand.

Good and outstanding homes also understand the value of maintaining relationships with families. They seek to involve them in children’s care at every opportunity. Staff at the best homes facilitate regular contact with families, irrespective of the distance to travel.

Preparing children for independence and the next stage in their lives is key. The best places don’t allow disability to be a barrier to accessing opportunities and broadening experiences. A number of homes forge excellent links with the community, allowing young people to develop their social and life skills. In one home in the South East, staff make good use of local resources to meet young people’s specific needs:

  • a nearby hairdresser allows extra time to cut the hair of children who are anxious
  • the charity shop saves dresses for a child who likes to dress up
  • the supermarket offers support for young people who are learning to shop independently

These may seem simple steps, but they make a huge and positive difference to children’s experiences.

Emergency placements

While a well-planned placement usually has the most chance of succeeding, some emergency placements will always be necessary. I know from my previous experience how we all try to avoid these emergencies, but sometimes things happen. Whether this is due to a sudden breakdown of a previous placement or other unforeseen events such as a parent being taken to hospital, staff in the best homes are well equipped to manage them.

Any child placed in an emergency will be experiencing difficult circumstances. They are likely to feel extremely vulnerable, anxious or distressed. Homes providing this kind of immediate support ensure that they offer a warm and welcoming environment right from the start. Friendly staff are skilled at engaging quickly with young people. This reassures them and helps them feel safe and settled, as well as helping staff gain their trust. Staff can then better understand the child and their particular needs.

One young person we spoke to said, ‘[Name of the member of staff] is really good at what she does. She’s supportive and a really good listener. She actually cares and can get people to listen to her because she doesn’t talk rubbish or lie to you. You get it straight.’

A calm approach from staff enables them to respond to challenges well, reducing the chance of incidents escalating and becoming more serious.

Role of inspection

The very best homes know which children they can work with, and do so. They are equally strong in saying when they are not able to help a child. But as I mentioned above, we sometimes hear of homes using Ofsted and our inspection judgements as a reason for not taking on certain children. I hope that, as with so many things, this is not the case. I suspect that homes that are sufficiently confident in what they do well do not hide behind inspection but learn from it. I do not want inspection to get in the way of children getting the best possible care. And if we are getting in the way, I want to hear about it.

My aim in this commentary is to offer some reassurance that it is possible for homes to support ‘hard-to-place’ children and still achieve a good or better inspection outcome. If inspectors see that proper support is put in place for a child, then homes have nothing to fear from Ofsted. We understand that some children will continue to go missing and be involved in risky situations, despite all best efforts. Change doesn’t happen overnight.

We do however, rightly, expect children to make progress and have positive experiences that contribute to that progress, however slight. But this process is complex, individual to each child and certainly not always linear. This is something inspectors take into account. Of course not all challenges can be overcome, but we do want to see residential homes doing all they can to make a difference and improve children’s lives. There are so many places that are doing this brilliantly. I hope others will learn from their example.

News story: Independent doctors to be rated by the Care Quality Commission

3 January 2018, 11:07 am

New changes mean that, for the first time, all healthcare organisations in England that offer regulated care will be rated by the Care Quality Commission (CQC). Organisations will have to display their inspection ratings so patients can clearly see safety standards.

The CQC’s current ratings programme – which covers hospital care, social care and GPs – will be extended to include more than 800 additional providers. This includes independent doctors that offer primary care online.

The CQC will require providers affected by these changes to publicly display their rating, for instance on their website or business premises. This will allow patients to make an informed choice when deciding which care service they want to use.

The ratings scheme has been ‘future-proofed’ to cover services that may develop in the future. It will ensure that new services are also given a rating.

The changes will bring the services in line with the rest of the NHS. It will reassure patients who use digital GP apps provided by independent doctors about the quality and safety of the service they are choosing.

The CQC will now develop an approach for how it will rate the additional services. The CQC will continue to inspect these services and publish its findings in the meantime.

Health Secretary Jeremy Hunt said:

With our NHS now in its 70th year, we are planning ahead to guarantee safer and better care for patients in the years to come. These changes are a world first for patient safety, modernising our tough Ofsted-style inspection scheme so we keep pace with the changing landscape of healthcare, as well as helping tech-savvy patients to make informed decisions about their care.

Sir David Behan, Chief Executive of the Care Quality Commission, said:

CQC’s ratings of health and care services are helping people to make informed choices about their care as well as supporting providers to improve. Never before has the public had such clear information about the quality and safety of their health and care services.

CQC already inspects and publishes reports for these additional services. The ability to award ratings to them will bring increased transparency for the public about the quality and safety of their healthcare.

We look forward to taking this work forward in the new year.

Speech: Amanda Spielman on the launch of Ofsted’s Annual Report 2016/17

13 December 2017, 10:46 am

Thank you all for coming today.

This is my first Annual Report. I want to start by saying what should be obvious but is all too easily forgotten at events like this.

The quality of education and care in England today is good and it is continually improving. The life chances of the vast majority of young people in 2017 are the best they ever have been. That is the story that our inspection reports are telling:

  • 94% of early years providers are rated good or outstanding
  • almost 80% of secondary schools and 90% of primary schools are good or outstanding
  • almost 80% of further education provision is also good or outstanding
  • more local authorities are on a path to improvement in their provision of children’s social care: in fact, two-thirds of inadequate authorities that have been reinspected have improved their judgement

This sort of positive news rarely makes for good copy. If this speech generates any headlines, I doubt they will be ‘English education is good’. But that makes it all the more important that I acknowledge it up front. These are achievements that we can and should be proud of. They are the result of the hard work and dedication of childminders, teachers, school and college leaders, social workers and many others, often in very challenging circumstances.

Part of our future work, not least as we develop a new education inspection framework for 2019, will be to set high aspirations for the sector and to encourage ever improving standards. We should celebrate how many schools are now good and look at how they can be supported to become even better.

But there is a flip side to this level of good provision. It is that the contrast between the good providers and the less good is becoming even starker.

Our goal is to ensure that every child gets a good education and that every child in need of help, protection or care gets the right support. The destination is a society in which every child can reach adulthood capable, safe and prepared to succeed in modern Britain. If we are to achieve that, we must be ruthlessly focused on the parts of the system that are not doing well enough for children and learners.

Earlier this year, I launched Ofsted’s strategy for the next 5 years. In that strategy, we set out our role as a force for improvement in the sectors we inspect and regulate. We committed to doing that through inspection that is:

  • intelligent – doing all we can to make our work valid and reliable
  • responsible and fair – being engaged and responsive and using our influence with care, not as a sledgehammer
  • and focused – directing our resources and energies into the areas that aren’t yet good enough and exploring what needs to change

It is that focus that will be the subject of my discussion today.

‘Intractables’ and capacity: schools

That includes a group of schools that I would call ‘the intractables’. These are the schools – around 130 of them – that have never been judged good at any point in the last decade. Whole cohorts of children have passed through these schools without ever receiving a good standard of education. And they are joined by another group of schools – of around 500 primary and 200 secondary schools – that have been judged to require improvement in at least 2 recent inspections.

The performance of these schools is not a result of lack of effort on the part of people working in them. In many cases, new leadership teams have arrived, bringing fresh energy and dynamism. Green shoots have emerged but, every time, progress has stalled.

Why is this?

It does not make sense that there are communities that can never have good schools. We have countless examples of schools such as those in the Annual Report – like Dixons Kings Academy in Bradford – in equally challenging environments as many of the intractables, but which have improved. St Peter’s School in Huntingdon, which I visited just last week, or Herbert Morrison Primary School in Vaxuhall are other examples of schools that have finally overcome a history of underperformance.

There is no doubt that the leadership challenge facing some of these schools is great. We recognise the scale of their challenge in our leadership and management judgements. But progress is possible and we should all be wary of using the make-up of a school community as an excuse for underperformance.

And I do find myself frustrated with the culture of ‘disadvantage one-upmanship’ that has emerged in some places. A few years ago, you couldn’t go into a school without being told the number of home languages spoken by pupils. Now, it often seems that school leaders are constantly comparing notes about how high their pupil premium or SEND (special educational needs and/or disability) rates are. Even more depressing, we still hear things like ‘If you met my pupils’ parents, you’d understand why results are as they are’. Indeed, listening to these conversations, I am sometimes reminded of the Monty Python sketch about the 4 Yorkshiremen. But I realise I’m showing my age.

It isn’t that there aren’t many children facing disadvantage and difficulties: they are there in all our schools, and more in some schools than others. But the narrative of disadvantage can become all-absorbing. Fixating on all the things holding schools back can distract us all from working on the things that take them forward. Schools with all ranges of children can and do succeed. Where this is difficult, what is needed is greater support and leadership from within the system. That means making sure the system has the capacity to provide this support.

I am a believer in the school-led self-improving system. Not because of ideology, but because of the clear evidence of what happens when we unleash great leaders and teachers. Multi-academy trusts (MATs), teaching schools, national leaders of education (NLEs) and others have had an immense impact. As a result, much of the improvement of education standards in recent years has come not from central or local government or – dare I say it – Ofsted, but from the school system itself.

With such a large proportion of schools rated good or outstanding, it should be possible for them to provide support to the remaining few. But we can see that this is not happening or, where it is happening, it isn’t making enough difference inside these intractable schools.

And this isn’t about just about incremental ‘interventions’ or ‘challenge’. Good schools teach a strong curriculum effectively and they do it in an orderly and supportive environment: getting this right is the core job of any school.

So we need to ask ourselves: why is support not reaching or working well enough for the schools that need it most? Are the incentives in the system strong enough to encourage our best MATs to grow? How can we encourage outstanding schools to exist not as islands in standalone trusts but as active sharers of their expertise? At the other end, how do we make it plain to struggling schools that asking for help is a sign of strength, not weakness?

There is a real challenge here for both policy-makers and for the school system to do more to break down ivory towers and realise the full potential of a self-improving system.

I am not someone who believes that extra funding for schools is the solution to all of our problems. Indeed, a greater focus on efficiency can sometimes help to sharpen minds about what really matters. Nor do I want to reward failure. But in the case of these intractable schools, extra investment and incentives are needed to make the right things happen. The government’s ‘opportunity areas’ are a welcome move in the right direction, but further work is needed to make sure we build capacity in these schools, rather than relying on propping them up from outside.

Too big to fail: further education and skills

I do not want this to become the annual lecture for criticising the state of further education (FE), but it would be remiss of me not to say that the sector continues to lag behind. Despite some promising recent inspection outcomes, the headline figures show a further 2 percentage point decline in the number of good and outstanding general FE colleges and a rather larger drop of 8 percentage points for sixth form colleges.

The government has recognised the problems in the sector and has begun a series of welcome initiatives investing in skills education. However, I do believe that until base rate funding is increased, the sector will continue to struggle.

It would also be remiss of me not to comment here on our inspection of learndirect. In any sector, becoming reliant on a handful of super-providers is dangerous. Too often across government, we have seen what happens when institutions become too big to fail. learndirect is one such institution. At the time of its recent inspection, learndirect was the largest provider of training in this country, with just short of 100,000 learners. A third of these were apprentices. The inspection found learndirect to be inadequate, with poor outcomes and many of its 30,000 apprentices not acquiring the skills they needed to succeed. Failure on this scale is a travesty for the young people involved. It also points to the need for more assurance across the FE and skills sector, particularly with the introduction of the new apprenticeships levy.

Whenever you inject large amounts of cash into a system, all kinds of unsavoury operators zero in to claim a share. Investment in our skills sector does not have a happy history. My fear is that without adequate scrutiny, we risk sending billions of pounds of levy money the same way as past failures, such as Train to Gain. Already, we are seeing reports of levy money being directed away from the intended purpose. And too many examples of poor provision. That is why at Ofsted we want to bolster the level of assurance that we offer in this area; to play our part in making these reforms a success.

Because whether we are talking about the apprenticeship levy or the broader reforms to technical education, there is a pressing national interest in making them a success. No speech in 2017 is complete without a reference to the need for home-grown skills in an era of Brexit. But the truth is, the need to improve English skills education long pre-dates the referendum. There is a national interest in improving skills education, with our country experiencing a persistent productivity shortfall. And just as important, there is the individual human need as lower-skilled workers risk being left behind in this age of automation and the gig economy.

The right measures: childcare and early years

The childcare sector also relies heavily on the market for provision. Here, it is generally working well. The rollout of 30 hours has largely been a success, though I continue to believe that supply could increase further if the government allowed the additional 15 hours for working parents to be used for childcare rather than for early education. Early education is vitally important, which is why the government makes the first 15 free hours universally available. But the second 15 hours is explicitly designed to support parents to work. Greater flexibility would enable other providers to enter the market, boosting supply and providing more support for parental work patterns, such as shift work.

But, despite the fact that most early years providers are doing well, our recent research into the Reception Year raised some questions about the suitability of the statutory framework under which they operate. The findings from that work do cast doubt on whether the early years foundation stage provides a strong enough curriculum, especially for the children who arrive at school further behind. Reception teachers also told us that the assessment framework, the EYFS profile, imposes unnecessary burdens on providers that detract from education itself. For this reason, I am pleased the government has committed to reviewing them both to ensure that they remain fit for purpose.

It is worth my spending more time on the ‘Bold beginnings’ report, given the reaction to it from some corners of social media. Most feedback on the report has actually been very positive. But I was taken aback by some of the more extreme reactions. I happen to share the view of one education commentator, who said that the report is about as ‘controversial as custard’.

Yes, we reported that the best schools – the ones in which disadvantaged children do best – place a strong emphasis on early reading, on having children sitting properly at a table when learning to write and on developing early number skills. But the report is also very clear that the Reception Year should be filled with opportunities for young children to play and to develop their social and personal skills. The dichotomy here is not about formal learning versus play. It is about understanding the different ways in which children acquire different kinds of knowledge and skills. You don’t learn phonics quickly and efficiently by playing with soggy letters near the paddling pool. The sandpit is not a great place for early number work. But both the paddling pool and the sandpit are important in developing children’s social interactions, their motor skills and their imaginations. That doesn’t sound very controversial to me.

Social care: getting the basics right

A look at the headline judgements for children’s social care might suggest the opposite story to the early years but this is not a failing sector overall. Improvements certainly need to be made. Thirty-four per cent of local authorities being judged good or outstanding is not a cause for great celebration. But more important than that headline measure is the rate of improvement being made. Of the inadequate authorities that have now been re-inspected under the single inspection framework, two-thirds have improved, one directly from inadequate to good.

We should not underestimate the achievement of turning round local authority children’s services in such a short space of time. These are big organisations, much larger than most other providers we inspect. What’s more, they are reliant not just on their own work but on the work of many partners across the breadth of children’s services. It is a testament to the leadership of the local authorities that have taken the lessons from our inspection report and turned themselves around.

How have they achieved that success? First, because it seems that our message about the importance of creating the best conditions for social work has been taken on board. In particular, having emphasised the importance of reasonable caseloads, we have seen a number of local authorities taking action to reduce them, with social work practice improving as a result.

Across the country, we are seeing more local authorities get the basics right. That means having robust processes in place that support social workers in using their professional judgement. Good processes, along with good management and good oversight, allow social workers to have a comprehensive understanding of the factors affecting a child’s life. This in turn means they can plan early and effectively for the child’s next steps.

We want local authorities to build on this work. It is critical that the children who need help get the right services, and speedily. That is why we want to see authorities taking steps to maintain a good ‘front door’ – the first point of contact a child has with social services. Alongside good information-sharing and partnerships, a healthy culture, targeted use of early help and well supported social workers: these are the ingredients for success in social care.

Losing sight of the substance: curriculum

A focus on the basics is not the same as a blind focus on systems and targets to the exclusion of all else. The best local authorities never lose sight of the importance of the child. It is a lesson that some schools would do well to heed.

I made the curriculum the focus of my first year because in recent years I have seen and heard so often that what is taught has been compromised and diluted in the face of all the many pressures on schools.

That should worry us all. The curriculum isn’t an esoteric concern. It goes to the heart of what our schools and colleges are for: it is about the very substance of education. Twelve years of education should give children a lot more than a disposition to learn and some ill-defined skills. Yet the evidence from the first stage of our research this year is that the focus on substance, on the knowledge that we want young people to acquire, is often lost in the dash for grades and stickers. League table positions are trumping learning.

That is absolutely not an attack on accountability. Accountability is a good thing: it is right that schools are held to account for the quality of the education they provide. I believe that the government’s new accountability measures, including Progress 8, are a marked improvement on their predecessors. Just as I believe the level of challenge and content in reformed SATs, GCSEs and A levels is a step in the right direction.

But test performance and league tables should be reflecting what children have learned. Tests should exist in service of the curriculum. But too often, schools are getting this the wrong way around. Curriculum should be designed to give children the best pathway to the future, not to make the school look good.

I will not repeat my recent commentary here. But I will remind you about some of the greatest areas of concern:

  • the primary schools we found that give up teaching most other subjects in Year 6 to focus intensively on SATs prep, rather than meaningful work to improve reading and mathematics or a broader curriculum
  • the widespread shortening of key stage 3 to 2 years, when this means that many pupils lose a whole year of study of the humanities, of languages and of the arts. As my colleague Sean Harford has pointed out, it is ironic that some of the strongest advocates of a condensed key stage 3 are the same people who are most critical of what they claim to be curriculum narrowing caused by the EBacc.
  • and at key stage 4, we saw too many schools pushing lower-attaining pupils away from studying EBacc subjects. These are core academic subjects that should be the norm for all but a small minority of pupils.

No wonder many universities complain that students arrive ill prepared for undergraduate study. If their entire school experience has been designed to push them through mark-scheme hoops, rather than developing a deep body of knowledge, they will struggle in later study. I recently heard from a lecturer at a top university whose students regularly complain about not getting enough training in exam techniques.

And problems with curriculum aren’t confined to schools. Our study of level 2 courses in colleges revealed lots of excellent work. The best colleges are designing courses hand in glove with local employers to meet the need of the local economy. At the same time, they are teaching mathematics and English well and putting extra effort into their students’ personal development.

In other cases, though, the needs of the learner are coming second to the desire to maximise college revenue. This is not a good response to underfunding. It leads to too many colleges majoring on courses that are interesting and engaging – so for example, performing arts and sports subjects, which appeal to many – but which ultimately will leave too many students disappointed when they cannot find a job in those sectors. It is right to have some flexibility in the system and good vocational education prepares students for more than just a single occupation. But when the mismatch between college provision and the labour market gets too great, we are being unfair to students and to the taxpayer, and we are setting up skills shortages.

Student interest is important and it does take extra effort to re-engage many of the level 2 learners who have been disaffected by their education to date. But that ought not to be in tension with courses that have a clear line of sight to jobs or meaningful further study.

A cohesive society: British values and unregistered schools

Preparation for life in modern Britain isn’t just about knowledge and skills. It’s also about understanding the values and culture that bind us as a society. This is an age in which the collective institutions that traditionally brought people together – churches, social clubs, even the 6 o’clock news – are in decline or are splintering into a thousand Twitter feeds. Education is one of the few unifying structures we have in society.

That is why it is right that we use compulsory education to make sure children acquire a deep understanding of and respect for the British values. The values of democracy, the rule of law, tolerance, respect and mutual understanding and the role of these values in shaping the country we are today.

Imparting those values can sometimes be in tension with parental wishes or with community norms. We are seeing this tension playing out in some of our schools. In recent years, Ofsted has found schools that are deliberately resisting both British values and the requirements of equalities law:

  • we have found texts that encourage domestic violence and the subjugation of women
  • we have found schools in which there is a flat refusal to acknowledge the existence of people who are different, so for example lesbian, gay and bisexual people
  • we also find well-meaning school leaders and governors who naively turn to religious institutions of a particularly conservative bent for advice about religious practice, not realising when this advice does not reflect mainstream thinking
  • and of course, there are the so-called schools that operate off the radar entirely, as illegal unregistered schools; often deliberately, to bypass legal requirements

None of this is comfortable territory. We have a proud tradition in this country of respecting religious freedom. The great religions such as Christianity, Judaism, Islam, Sikhism, Buddhism and Hinduism all make important and unique contributions to British society. But there are occasions when multiculturalism can and does comes into tension with the expectation that students should be prepared for life in modern Britain.

This is emphatically not a criticism of faith schools. The vast majority of faith schools we inspect provide a good education. In very many cases, we find exemplary teaching of British values in faith schools. Good faith schools, from all of the major faiths, see no tension with practising their beliefs and setting their pupils up to succeed in both education and in adult society. It is a small core of institutions about which we have real concerns.

As a public body, the easiest thing for us to do would be to ignore the problem, to hope it goes away or to dismiss it as someone else’s concern. I know there are those who would like me to say a little less. But we cannot in good conscience ignore these findings, because we all know what happens when cultural tensions become undiscussable, when we allow concerns to be silenced. We saw that in Rotherham and far too many other places as well.

When I see books in schools entitled ‘Women who deserve to go to hell’, children being educated in dank squalid conditions, children being taught solely religious texts at the expense of learning basic English and mathematics, I cannot let it be ignored.

We will continue to expose the problem in the schools and to provide the Department for Education with the information it needs to take action. At the same time, we maintain our call for new powers under legislation because the current legislative framework is not adequate. We need a better definition of a school so that institutions that should be inspected cannot evade scrutiny and also the powers to collect the kinds of evidence needed to take action.

Out of sight: off-rolling and secure provision

Young people who are being exposed to extreme views are not the only group of vulnerable children about whom we have concerns.

Thanks to the work of Education Datalab and others, a long overdue spotlight has been shed on the problem of off-rolling. Now, I absolutely support the right of schools to exclude pupils, for example when their behaviour is violent, threatening towards teachers or affecting the learning of other pupils. But what is never acceptable is the exclusion of pupils, either formally or through pressure on parents, where the main goal is to boost school performance.

Off-rolling is in some ways an even more extreme and invidious example of where some schools have lost sight of the purpose of education, which should always be to give children the support that they deserve.

The problem of off-rolling affects many children, but our local authority SEND reports show that the pupils most at risk are those who have special educational needs or disabilities. Again, I am not saying it is never right to exclude pupils with SEND. But it is a concern that the exclusion of SEND pupils was high in a third of local areas inspected. Almost half of local authorities had poor attendance of pupils with SEND. In the worst cases, we heard from parents who had been asked to keep their children at home because school leaders said that they could not meet their children’s needs. This is inexcusable and shames our education system. Dealing with students with different needs isn’t always easy but simply passing the job to parents, who rarely have the right professional expertise, is passing the buck. Children with SEND are not a problem to be pushed out of sight and out of mind.

To play our part in tackling this, our inspectors will be looking even more closely for signs of off-rolling. That includes exploring the related problem of reports that troublesome children are being sent home on inspection days.

Finally, I turn my attention to somewhere where I believe the failings are greater than any area I’ve yet touched on. That is secure training centres. There are 3 of these centres in the UK, 2 of which are judged inadequate and one judged requires improvement. Over the past year, our inspectors found increasing levels of violence and poor educational outcomes, most recently at Oakhill Secure Training Centre. A similar picture exists in our young offender institutions. There are 10 young offender institutions in England, of which 4 are less than good. This year, we contributed to the HMI Prisons inspection of Feltham. The prison was found to not be safe for either staff or the boys in it. There was an increase in serious violence, including attacks involving multiple assailants and the use of weapons.

Our number one priority when it comes to juvenile offenders should be to tackle the cycle of reoffending. If we cannot give them a decent education, we are closing down the avenues that lead away from crime. Without proper education and training, we are coming close to passing de facto life sentences on juvenile offenders.


If that sounds bleak, then I want to end by reminding you how I started: to say again that education and care in this country are good. We are lucky to have millions of hard-working professionals who have chosen to work with children and help them make the most of their lives.

We have heard a lot about social mobility recently. It is undoubtedly true that we can do more to raise the attainment of pupils from disadvantaged backgrounds. But what I will also say is this: that the extensive reforms of the past 15 years will take time to bed in. As they do, I believe that social mobility will improve. There is a regular flow of reports from various quarters advocating radical measures. But I would urge policy-makers to build on the work that has been done to date and to help reforms to bed down.

I commend the approach of the Secretary of State in this area and her work to champion social mobility across government. At Ofsted, we look forward to playing our part in supporting the forthcoming social mobility action plan, because I am determined to honour our commitment to be a force for improvement.

In the next year, we will begin our new inspections of local authority children’s services, with a greater focus on catching authorities before they fall. We are also working hard on developing our new education inspection framework. This will build on all that we have learned in recent years, incorporating a new focus on curriculum.

Our collective mission – and by that I mean not just Ofsted, or policy-makers, but everyone involved in education and care – should be to create a society in which every young person, regardless of birth or background, can achieve their full potential. Everything I see in my job, looking at the work of thousands of children’s homes, colleges, apprenticeships providers, schools and nurseries, shows me that isn’t a pipe dream. In fact, the areas I have identified today are some of the last remaining barriers that stand in our way. Tackling them will not be easy. But the prize is great – a country that is both caring and bold, innovative but unified, aspirational and at the same time fair.

Thank you very much.

Press release: National Data Guardian 2017 report published

12 December 2017, 9:45 am

The National Data Guardian (NDG), today publishes the National Data Guardian for Health and Care 2017 report: Impact and Influence for patients and service users

The publication marks 3 years since Dame Fiona Caldicott was appointed as the first NDG, looks back over this first term of office and describes future priorities. It sets out a clear case for the independent advice and challenge the role provides to ensure that confidential data collected by the NHS and social care services is properly safeguarded and used appropriately to improve care. It also anticipates the NDG role being place on a statutory footing during this Parliament.

The report reinforces the fundamental requirement of building public trust for successful advancements in health and care based on data sharing. The 3 principles that have informed the NDG’s work since she was asked by the Secretary of State for Health to take up the role remain crucial:

  1. To encourage sharing of information in the interests of providing care to individuals.
  2. There should be no surprises to citizens and they should have choice about the use of their data.
  3. There must be dialogue with the public, helping to increase their knowledge and choices about how data is used to improve health and care.

Dame Fiona said: “New technologies and ways of sharing data mean that we can now gain huge benefit from the sharing of health and care data, both in terms of individuals’ own care and the broader social good of advancing research and treatment. However, as NDG I have seen time and again that the most praiseworthy attempts at innovation falter if they lose public trust.

“Those entrusted with looking after and using patient data must demonstrate their right to be trusted by adopting the highest standards of data security and giving people a right to a genuine choice over how data is used. The public must be included in understanding and supporting innovation which relies on data generated by their use of health and care services.”

Speech: British High Commissioner’s speaking notes at the Business Cost of Violence Against Women & Girls in Ghana forum

11 December 2017, 12:27 pm

Violence against women and girls remains one of the most systematic, widespread human rights violations worldwide.

Around the world at least one woman in every three has been beaten, coerced into sex, and otherwise abused in her lifetime. Most often the abuser is a member of her own family. In all, women are victims of intimate partner violence at a rate of about 5 times that of males.

Domestic violence is not only a gross violation of human rights; it is a fundamental obstacle towards achieving gender equality and eradicating global poverty.

The UK’s theme for this year’s 16 Days of Activism will be largely focused on Domestic Violence, driven in part by the PM’s personal commitment to tackling the issue in the UK.  

Domestic violence, in the form of physical or sexual violence causes immediate devastating consequences to those affected: physical injuries, mental health problems and poor well-being, to name but a few. But it also has long-term, far-reaching effects, including persistent inequalities between men and women, which limit women and girls’ abilities to fulfil their potential.

Ending gender inequalities such as domestic violence at the heart of the 2030 Agenda for Sustainable Development. The UK is committed to eliminating all forms of gender inequality and uses the full range of our influence to champion women’s and girls’ rights e.g. collaborating with the new FCO Special Envoy for Gender Equality, Joanna Roper. The Special Envoy’s remit covers all Gender Equality issues and focuses on delivering the Foreign Secretary’s vision of ‘a foreign policy that delivers consciously and consistently for women and girls’ under three themes; Equal; Safe; and Empowered.

This three strand framework – Equal, Empowerment and Safe – encompasses our gender equality work by ensuring equality for women and girls by eliminating barriers that limit and hold back women and girls e.g. in accessing education. Helping to harness their full potential by supporting them to achieve greater economic empowerment and ensuring they are safe and secure from all forms of violence.

Our gender equality and foreign policy aims to consciously and consistently deliver for women and girls around the world by tackling violence against women and girls (VAWG). This includes protecting against modern forms of slavery, tackling radicalisation and countering violent extremism and promoting the role of women in preventing violent extremism and promoting peace.

In light of the significant social, economic and public health problems caused by VAWG in Ghana and the increasing rates of reported cases of VAWG in Ghana e.g. domestic violence, rape and defilement, we found it necessary and timely to launch these preliminary findings from the DFID-funded ‘What Works’ programme on the costs of domestic violence on businesses in Ghana.

This significant new study will build on existing data to address the dearth of knowledge on the socio-economic cost of VAWG in Ghana. Thus capturing direct tangible and intangible costs at the household, business, community and national level.

Speech: DFID Ghana Country Director’s speech on the business cost of violence against women & girls

7 December 2017, 9:22 am

Honourable Minister for Gender, Children and Social Protection
Distinguished representatives of Government
British High Commissioner for Ghana, Members of the Diplomatic Corps
Development Partners, academia, representatives of the private sector
Traditional leaders, Members of the press.
Ladies and Gentlemen, Good Afternoon.

It’s great to be here today at the British High Commissioner’s Residence to mark the 16 Days of Activism towards ending gender based violence and to launch preliminary findings from the UK aid-funded study on the “Business Costs of Violence Against Women and Girls in Ghana”.

35% of women across the world have experienced some form of violence in their lives.

As well as a gross violation in itself, Violence Against Women and Girls also limits individuals, communities and societies.

Girls and women who experience violence are less likely to complete their education, 1.5 times more likely to acquire HIV, and are at increased risk of maternal mortality.

For children that see one parent assaulting another, the long-term health and social consequences are similar to those of child abuse and neglect.

For economies, the costs of VAWG are estimated at between 1.2% and 3.7% of GDP. And we will hear more later from Dr Asante and his team on how Violence Against Women impacts on the economy.

In short, violence against women and girls is a global pandemic.

But while the scale of the problem seems daunting, change is possible and is already happening. This year’s 16 Days of Activism is occurring at a time when across the world men and women are standing up to address the issue of violence against women.

The #MeToo movement has gone viral. The hashtag has been used by more than 4.7 million people in 12 million posts. It has trended in at least 85 countries. For too long, violence against women, including sexual harassment and assault, has been unspoken, private, something to be ashamed of. This campaign has succeeded in breaking the silence – providing us with a real sense of the magnitude, and the shocking scale and reach of the phenomenon in both public and private spheres across the world.
And it has opened up a global conversation about men’s behaviour towards women.

Ladies and Gentlemen
The UK is proud to be a global leader in efforts to eradicate violence against women and girls in all its forms. This includes support to women’s rights organisations; tackling the attitudes that make violent behaviour seem normal; getting comprehensive services to those who have experienced violence; and ensuring that national legislation and policies are in place and implemented.

DFID currently works across 12 countries – including Ghana – to tackle Child Early and Forced Marriage – a £39m programme funded by the UK taxpayer. We continue to build on the momentum of the 2014 Girl Summit by supporting new international resolutions on Child Marriage.

The UK also provided financial and technical support to government for the 2016 Domestic Violence in Ghana Survey.

Our new Secretary of State announced last week a £12 million package to help around 750,000 women and girls globally over the next three years.

Studies reveal that in Ghana VAWG is deep-rooted and widespread. We know from a UK aid funded Domestic Violence in Ghana survey that an estimated 71.5% of women and 71.4% of men reported having experienced at least one form of violence (domestic and non-domestic) over their lifetime. A number of other harmful traditional practices still exist in Ghana, including female ritual slavery, FGM, Child Early Forced Marriage, widowhood rites and witch’s camps.

We appreciate that the Government, under the leadership of the Honourable Minister, is actively addressing these challenges – through the work of the Domestic Violence Secretariat, and ongoing reforms are being put in place to tackle violence against women. For example, laws have been passed on inheritance rights, FGM, the Children’s Act (1998), Human Trafficking Act (2005), Domestic Violence Act (2007).

I mentioned earlier the UK’s global lead in efforts to address VAWG.

Ghana could also be a global leader on this issue. In the past week His Excellency the President has passionately espoused the need for African countries to grow “beyond aid”. The President is championing gender equality and ensured that women are represented at the very highest levels in his government with 29 female parliamentarians and 20 female Ministers and Deputy Ministers.

The President is also the AU Gender Champion and Co-chair of Advocates for the SDGs.

Ghana, as it prepares to organise a Girls’ Summit in 2018, could take a leadership role in addressing VAWG across the region, if not the continent. The UK stands ready to support this.

Ladies and Gentlemen, today, the Institute for Statistical, Social and Economic Research (ISSER) – University of Ghana – will present preliminary findings from a survey conducted among 100 businesses in Ghana assessing how domestic violence impacts businesses.

The UK aid-funded research looking at the Economic and Social Costs of Violence against Women and Girls is a three year multi-country project that estimates the costs of violence, both social and economic, to individuals and households, businesses and communities in Ghana, Pakistan and South Sudan. As we stand here this afternoon, people are similarly gathered – but in a much colder London – to launch the findings from South Sudan.

No such analysis has previously been carried out in Ghana, or indeed elsewhere in West Africa.
The impact of the Ghana study, once assessed, is therefore likely to be significant – with the new data helping us better understand the impact of Violence Against Women on community cohesion, economic stability and development and providing further evidence for government to accelerate efforts to address Violence Against Women.

Before I hand over to the Honourable Minister to say a few words, I would like to take this opportunity to thank the Honourable Minister for agreeing to assume the Chairmanship of the National Advisory Board (NAB) – the body which will ensure that the research is used effectively to advocate for increased resources and emphasis on the elimination of violence against women in Ghana.

In conclusion, I’d like us all to remain alert to the fact that VAWG is present in our homes and our work places. With the #MeToo movement in mind, let us create opportunities to break the silence, opened up a conversation about men’s behaviour towards women, and be bold for change in order to end the violence.

I’d now like to introduce the Minister for Gender, Children and Social Protection – Honourable Otiko Afisa Djaba.

Thank You.

Speech: Testing expectations

30 November 2017, 9:30 am

Dr Alan Hassey

I’ve written before about work that the National Data Guardian and its panel members have been doing on how patient data is shared to support individual care, implied consent and the role that people’s expectations play.

Since those pieces were published we’ve been quite busy on this subject, and have more planned.
Today we’re publishing the reports of 2 events we held to examine this topic in conjunction with Sheffield Solutions at the University of Sheffield.

The first, in July this year, looked at what the courts have said about when an individual can be said to have consented to information being shared and how that might be reflected in the way patient data is shared.

Our second event, last month, brought a group of health and care professionals together to see if they saw challenges around the use of implied consent as a legal basis for sharing data, and whether the legal concept of ‘reasonable expectations’ might help.

We are now working with Connected Health Cities and Citizens’ Juries CIC to hold a citizens’ jury in January. This will see a cross-section of 18 members of the public spending 3 days hearing from witnesses, deliberating together and reaching reasoned conclusions about when it is reasonable to expect the sharing of information to support care and when it is reasonable to expect it to be kept private.

Press release: New children’s services inspections announced

29 November 2017, 9:30 am

A new method of inspecting local authority children’s services will begin in January next year, Ofsted confirmed today [29 November 2017].

Inspections of local authority children’s services (ILACS) will look at how well local authorities are supporting and protecting vulnerable children in their area. The new approach is more proportionate, risk-based and flexible than before, allowing Ofsted to prioritise inspection where it is most needed.

ILACS will retain graded inspections, but introduce regular ‘focused visits’ as well as monitoring visits. More frequent contact between inspections will help Ofsted to identify any issues of concern and support local authorities to address them before services deteriorate.

The new arrangements consist of:

  • short inspections – local authorities previously judged to be good or better will receive a 1 week ‘short’ inspection every 3 years
  • standard inspections – those judged ‘requires improvement to be good’ will receive a 2 week ‘standard’ inspection every 3 years
  • monitoring – local authorities judged to be inadequate will receive quarterly monitoring visits, followed by an inspection under the single inspection framework (SIF)
  • focused visits – local authorities that require improvement and those that are good or outstanding will receive at least one focused visit between their short or standard inspection.

Local authorities will also be asked to annually evaluate the quality and impact of their social work practice, as well as having a formal yearly conversation with Ofsted about performance. The inspectorate will use this information to help inform decisions about how and when to inspect each local authority.

Her Majesty’s Chief Inspector, Amanda Spielman said:

This is an intelligent approach to the inspection of children’s services and an important development for the sector as a whole. Ofsted is fully committed to being a force for improvement across all the areas we inspect and I believe this approach will really help us to support improvement in children’s social care.

Ofsted’s National Director for Social Care, Eleanor Schooling said:

This new system of inspection retains our unrelenting focus on the experiences of children and their families. Crucially, it will help us prioritise our work in areas where it is most needed. The quality of social work practice with children that need help and protection, children in care and those leaving care is at the heart of our approach.

More frequent contact is all about identifying what is working well and catching local authorities before they fall. We want to help authorities improve the support they provide for vulnerable children and their families.

We have worked closely with sector leaders in developing this new approach, and I am pleased with the positive feedback we’ve received. This is a step forward for inspection that I hope will make a genuine and positive impact on children’s lives.

Launch events are taking place in the New Year for local authorities wishing to find out more about the new ILACS inspection system.

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News story: Bristol seminar: Transformational change for people with complex needs: Whole systems for whole people

23 November 2017, 11:38 am

Thursday, 11 January, 2018


Gary Wallace

Public Health Specialist I Plymouth City Council

Responses to people with complex needs have traditionally been linear, delivered in silos and experienced by service users as an endless cycle of hand offs and exclusions. Plymouth’s co-productive journey has helped them understand the role commissioning has played in setting these problems, the mismatches and misunderstandings between services and the ways these have conspired to deny people the interventions they need.

In this free seminar Gary discussed their co-production processes and some of their findings and shared lessons learned. He also shared some interesting points, including alliance approaches to contracting and offered examples of how Plymouth are creating a new, inclusive culture together.

Please see the attached slide pack for further information

Transformational change for people with complex needs (seminar slide pack)

PDF, 1.05MB, 25 pages

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Press release: Government to set out proposals to reform care and support

16 November 2017, 2:00 pm

The First Secretary of State and Minister for the Cabinet Office, Damian Green, has announced today that the government will publish a green paper on care and support for older people by summer 2018. The paper will set out plans for how government proposes to improve care and support for older people and tackle the challenge of an ageing population.

As people are living longer and the population ages, the government recognises the need to reach a long-term, sustainable solution to providing the care older people need. As part of this work the government has begun a process of engagement in advance of the green paper to ensure it reflects a wide range of views and requirements. Government will work with independent experts, stakeholders and users to shape the long-term reforms that will be proposed in the green paper.

These proposals will build on the additional £2 billion over the next 3 years that the government has already provided to meet social care needs, reduce pressures on NHS services and stabilise the social care provider market in the short term.

First Secretary of State and Minister for the Cabinet Office, Damian Green, said:

“An ageing population needs a long-term solution for care, but building a sustainable support system will require some big decisions. In developing the green paper, it is right that we take the time needed to debate the many complex issues and listen to the perspectives of experts and care users, to build consensus around reforms which can succeed.”

Secretary of State for Health, Jeremy Hunt said:

“We are committed to reforming social care to ensure we can guarantee everyone dignity and security in old age. It is important we consider a wide variety of views on the future of the social care system – as our ageing population continues to grow it is absolutely vital that we get this right.”

Once the green paper is published in summer 2018, it will be subject to a full public consultation.

Background information

Names of independent experts invited by government to provide advice and support engagement in advance of the green paper:

  • Caroline Abrahams – Charity Director of Age UK
  • Dame Kate Barker – former Chair of the King’s Fund Commission on the Future of Health and Social Care in England
  • Sir David Behan – Chief Executive of Care Quality Commission
  • Dr Eileen Burns – President of the British Geriatrics Society
  • Professor Paul Burstow – Chair of the Social Care Institute for Excellence
  • Jules Constantinou – President-elect of the Institute and Faculty of Actuaries
  • Sir Andrew Dilnot – former Chair of the Commission on the Funding of Care and Support
  • Baroness Martha Lane Fox – Founder and Executive Chair of Doteveryone
  • Mike Parish – Chief Executive of Care UK
  • David Pearson – former President of the Association of Directors of Adult Social Services and Corporate Director for Social Care, Health and Public Protection at Nottinghamshire County Council
  • Imelda Redmond – National Director of Healthwatch England
  • Nigel Wilson – Chief Executive of Legal and General

News story: New sleep-in shift pay compliance scheme launched to support social care sector and identify back pay for workers

1 November 2017, 5:04 pm

The government has launched a new compliance scheme for social care providers that may have incorrectly paid workers below legal minimum wage hourly rates for sleep-in shifts.

Social care employers will be able to opt into the new Social Care Compliance Scheme (SCCS), giving them up to a year to identify what they owe to workers, supported by advice from HM Revenue and Customs (HMRC). Employers who identify arrears at the end of the self-review period will have up to three months to pay workers.

The government is committed to creating an economy that works for everyone, and ensuring workers are paid fairly according to the law. The scheme has been designed to help ensure workers are paid what they are owed, while also maintaining important services for people who access social care.

HMRC will write to social care employers who currently have a complaint against them for allegedly underpaying minimum wage rates for sleep-in shifts to encourage them to sign up to the scheme. Employers that choose not to opt into the scheme will be subject to HMRC’s normal enforcement approach.

The government is exploring options to minimise any impact on the sector. The government has opened discussions with the European Commission to determine whether any support, if deemed necessary, would be subject to EU state aid rules.

Earlier this year the government waived further penalties for sleep-in shifts underpayment arising before 26 July 2017. This was in response to concerns over the combined impact which financial penalties and arrears of wages could have on the stability and long-term viability of social care providers. Enforcement action for sleep-in shifts in the social care sector was temporarily suspended between 26 July and 1 November 2017.

Government reiterated again today its expectation that all employers pay their workers according to the law, including for sleep-in shifts, as set out in guidance entitled Calculating the minimum wage.

Read the updated guidance on sleep-in shifts here: National minimum wage law: enforcement.

Press release: Millions to benefit from groundbreaking mental health support

25 October 2017, 11:15 pm

Updated: Including link to the ‘Thriving at Work’ report

As part of her commitment to tackle the injustice of mental illness the Prime Minister commissioned an independent review of mental health and employers which has found that around 300,000 people a year are leaving their jobs each year due to mental illness – costing employers up to £42 billion annually.

The Prime Minister is today confirming that NHS England and the Civil Service – two of the country’s largest employers – will abide by the recommendations of the report.

As a result NHS and Civil Service employees will now be guaranteed tailored in-house mental health support.
Alongside this, NHS England and the Civil Service will:

  • introduce a set of core and enhanced standards which will ensure employees have the knowledge, tools and confidence to understand and look after their own mental health – and the mental health of their colleagues

  • have support in place to help prevent mental illness being caused or worsened by work and equip those who have a mental illness to thrive

  • be held to account for delivering these standards by their relevant regulators so that employees can have faith they are being introduced effectively

Prime Minister Theresa May said:

I have made it a priority of this government to tackle the injustice of mental illness.

Vital to this is the need to have a comprehensive cross-government plan which transforms how we deal with mental illness not only in our hospitals or crisis centres but in our classrooms, shop floors and communities.

That’s why I commissioned this important review which starkly illustrates the cost of untreated mental illness – around 300,000 people with a long term mental health problem are losing their jobs each year.

And that has a big impact on businesses which are losing up to £42 billion each year as a result.

So we need to take action. That’s why I am immediately asking NHS England and the Civil Service – which together employ more than two million people – to accept the recommendations that apply to them.

With so many of our leading businesses leading the way in this area – and reaping the rewards as a result – I am sure that the private sector will follow suit.

It is only by making this an everyday concern for everyone that we change the way we see mental illness so that striving to improve your mental health – whether at work or at home – is seen as just as positive as improving our physical wellbeing.

The report from Lord Dennis Stevenson, a long-time campaigner for greater understanding and treatment of mental illness, and Paul Farmer CEO of Mind and chair of the NHS Mental Health Taskforce includes 40 recommendations for the public and private sector.

The Prime Minister is today writing to all metro mayors and key business groups including the CBI, IoD and Federation of Small Businesses to draw attention to the review and encourage them to implement the recommendations in their organisations and across their networks.

The government will consider the wider recommendations and respond in due course.

Press release: £20 million improvement programme for children’s social care

12 October 2017, 2:57 pm

  • Sector-led improvement initiative for local authorities, backed by £20 million
  • Launch of new What Works Centre for children’s social care

A multi-million pound government initiative to improve the lives of vulnerable children and families has been announced today by Robert Goodwill, Minister for Children and Families.

In a speech to the National Children and Adults Services (NCAS) conference in Bournemouth, Minister Goodwill announced up to £20 million for a new programme to help all councils improve their services – with a sharp focus on making sure those at risk of failure can make vital improvements.

The programme will give councils the tools they need to build stronger services for our most vulnerable children. This includes:

  • Tailored peer support for local authorities, bringing in more councils to the successful Partners in Practice programme;
  • The testing of ‘Regional Improvement Alliances’, made up of neighbouring local authorities. Alliances will see councils challenging each other on standards, agreeing local improvement priorities, and sharing best practice, in order to deliver more for children and families.

In his speech at the NCAS conference today, Minister Goodwill said:

There is nothing more important than the safety and wellbeing of children. Yet, too many young people, and their families, are being let down by poor quality services – or worse, left at risk of harm. That is why we must take decisive action where performance is not good enough.

Our interventions programme is yielding real results: 36 local authorities have been lifted out of intervention since 2010 and we are seeing a positive impact from the independent children’s social care trusts that we have set up in Doncaster and Slough.

My commitment is that we will build a self-improving system, one that spots where challenges are emerging, and quickly puts the right support in place.

In addition, the Department for Education has announced that Nesta will set up its new What Works Centre for Children’s Social Care, with a focus on improving outcomes for children who are at risk of, or suffering from, abuse or neglect.

The Centre will develop a powerful evidence base that supports best practice on the frontline.

This is a key part of the government’s commitment to ensuring experts and practitioners across the country learn from the latest best practice.

Geoff Mulgan, Chief Executive of Nesta, said:

This new What Works Centre is a great opportunity to support improvement in children’s care – and ultimately to improve the lives of many children who deserve better.

Nesta and our partners Social Care Institute for Excellence (SCIE), the Alliance for Useful Evidence, FutureGov and Traversum will be working very closely with frontline professionals, listening, learning and adapting to feedback and evidence throughout this set-up phase. We’ll also draw on the experiences of other What Works Centres on how to gather evidence, but even more importantly, how to make it useful and used.

Working in partnership with the Association of Directors of Children’s Services (ADCS) and the Local Government Association (LGA), the Department will also test new Regional Improvement Alliances. These will enable local authorities to assess their own performance, and to challenge the performance of regional peers.
Alliances will become the backbone of the new improvement system, with the aim of setting one up in every region by April 2018.

Five councils will now begin taking the National Assessment and Accreditation System forward in its first phase (alpha), with a further 12 -13 in the second phase (beta).

The Department for Education has today invited local authorities with a good or better Ofsted judgement overall and across all sub-judgments to express an interest in joining the Partners in Practice programme, with an assessment and selection process to follow.

Speech: World Alzheimer’s Day: could we create a world without dementia?

21 September 2017, 9:52 am

Could we create a world without dementia in the near future?

This is the question that for years no one has dared to ask. We assumed – wrongly – that dementia was just part of the ageing process instead of the disease of the brain it actually is. But 4 years ago that changed. The UK hosted the first ever G8 dementia summit, which set the explicit ambition to find a cure or disease-modifying therapy for dementia by 2025.

Since then, governments have formally united in the fight against dementia, and adopted the first Global Action Plan on Dementia, during the World Health Assembly in May 2017.

In the UK we have done much to improve diagnosis rates, from one of the lowest to one of the highest in Europe. This matters because an early diagnosis can support patients to make lifestyle changes that slow the progress of the disease – and also help families make adjustments to make their dementia journey easier.

Public attitudes – and specifically the stigma around dementia – are also changing. We now have over 2 million Dementia Friends, and the first dementia-friendly communities – both of them signalling a sea-change in the compassion with which we approach the disease.

And the establishment of the UK Dementia Research Institute earlier this year will provide a new focal point for research across care, prevention and technology as well as biomedical science.

We can’t do this alone. Our partnership with Japan, who pioneered Dementia Friends and like us faces many challenges with an ageing population, shows how valuable cross-border collaboration is when it comes to answering one of the biggest global health challenges of our times. We have been able to ensure a continued focus on dementia throughout Japan’s presidency of the G7, with learning exchanges between both nations, a successful global symposium on Building A Dementia Friendly World, and the establishment of Global Dementia Friends Ambassadors Carey Mulligan and Yuichiro Miura.

Message from Japan’s Dementia Supporters Ambassador, Mr Yuichiro Miura:

Yuichiro Miura.

But partnership needs to be not just between governments but with civil society and voluntary organisations as well. So we strongly support the brilliant work done by the Alzheimer’s Society, Alzheimer’s Research UK and other dementia-focused charities in the UK. And during the 2014 World Health Assembly, I was pleased to launch the Global Alzheimer’s and Dementia Action Alliance, encouraging international NGOs to join global action against this condition.

In the end, though, our approach to dementia is quite simply a litmus test of how compassionate a society we want to be. Living with dementia can be horrific for the individual and their family – but it doesn’t have to be. Social interaction – the love and support of family and friends – is one of the best possible ways to slow progression. We may not yet be able to cure the disease but we can all play a part in tackling the symptoms.

Press release: Prevention and repair essential in domestic abuse cases

19 September 2017, 8:30 am

Domestic abuse is an endemic but not inevitable problem, inspectors said today (Tuesday 19 September).

A report on the response for children living with domestic abuse finds that social workers, the police, health professionals and other agencies such as youth offending teams and probation services are often doing a good job to protect victims. But too little is being done to prevent domestic abuse in the first place, and to repair the damage it causes afterwards.

Inspectors from Ofsted, the Care Quality Commission, HM Inspectorate of Constabulary and Fire and Rescue Services, and HM Inspectorate of Probation carried out joint inspections of 6 areas in England, to evaluate the multi-agency response to cases of domestic abuse. Today’s report highlights that:

  • Professionals have made progress in responding to the large volume of cases of domestic abuse. However, domestic abuse is a widespread public health issue that needs a long-term strategy to reduce its prevalence.

  • While much good work is being done to protect children and victims, far too little is being done to prevent domestic abuse and repair the damage that it causes.

  • Work with families that we saw on inspection was often in reaction to individual crises. Keeping children safe over time takes long-term resolutions.

  • The focus on the immediate crisis leads agencies to consider only those people and children at immediate risk. Agencies are not always looking at the right things and, in particular, not focusing enough on the perpetrator.

  • There is still a lack of clarity about how to navigate the complexities of information sharing.

  • There needs to be greater consistency in the definition of harm, and in the understanding of whose rights to prioritise.

Eleanor Schooling, Ofsted National Director for Social Care, said:

There is a lot of good work being done to protect victims of domestic violence – emergency services are particularly effective. But we’re not so good when it comes to helping victims deal with the aftermath and get on with their lives. The justice system must play a role, but there is work to do to stop it happening in the first place.

That’s why schools have an essential role in educating children about domestic abuse. Teaching children about healthy relationships is already part of the curriculum, but it is often not prioritised by schools.

It is a sad truth that the sheer scale of domestic abuse means that it can be all too easy for police, health professionals and social workers to focus on short term responses to incidents. But the best teams are able to see the bigger picture.

I want to see a new approach to tackling domestic abuse – one which focuses more on prevention and repairing long term damage to child victims. Agencies can address these complex challenges but due to the endemic nature of domestic abuse they cannot do it alone. A widespread public service message is needed to shift behaviour on a wide scale.

Professor Steve Field, Chief Inspector of General Practice at the Care Quality Commission, said:

When children and young people are at risk of, suffering from, or rebuilding their lives after domestic violence, a number of services have the opportunity to intervene or help. Fortunately, we have seen evidence of services understanding the unique position they each have to start important conversations and work together to support individuals and families, such as delicate screening tools for midwives talking to expectant mothers.

This is encouraging but there is still work to be done. We commend the efforts we saw to protect victims after abuse has occurred, but this is an endemic issue that has its roots before individual acts and can spread beyond. Services have to listen to and learn from those who have been at risk. We need to explore every opportunity to safeguard and support those affected, from prevention through to the provision of comprehensive aftercare, including access to child and adolescent mental health (CAMHS) services.

Wendy Williams, HM Inspector of Constabulary, said:

This inspection found that the police – who are often the first respondents to domestic abuse incidents – act quickly and decisively to protect victims, including children, and to remove them from dangerous situations. We also found that senior leaders within the police have a strong commitment to reducing domestic abuse and protecting those children exposed to it and have worked to build effective partnerships to support victims. However, when the police become involved in this way, in one sense it is often too late: an offence has been committed, and a person or family become a victim or victims of domestic abuse, with all the harm this brings.

HMICFRS has constantly underlined the fact that the police cannot address domestic abuse on their own – and this inspection has found many examples of how close working with other agencies is crucial to supporting and protecting victims. However, today we are also calling for recognition that all of society, not just the agencies we inspect, needs to work together if we are truly to reduce the devastating harm caused by domestic abuse. There needs to be a sea change in the approach, with an equal emphasis on placed on preventing it happening in the first place, or from it reoccurring, as there is on protecting victims when it has happened.

Dame Glenys Stacey, HM Chief Inspector of Probation, said:

To reduce the extent of domestic abuse the probation sector needs to deliver effective work with those adults who have been convicted and also those where we have concerns about possible domestic abuse in the households, but no conviction. There are many skilled practitioners who can change perpetrators’ behaviour but services need to be resourced and well organised to reach the right people.

Probation providers also have to look beyond the adults under their supervision to the families and ensure they are vigilant and swift to respond where they see signs of domestic abuse. They can only achieve this by well-trained staff working closely with local services for children.

Domestic abuse has a profound effect on children, completely changing their lives. To move from a broken home to a refuge and a new school can be upsetting.

One adult survivor said:

We are the ones who have to leave our homes, leave our families. We are the ones that have to change our lives completely and everything we do every day. We have to come and live in a house with other people. Your whole life is completely changed.

These inspections highlight the positive impact of the inspectorates working together.

Hounslow Council stated that:

The joint targeted area inspection has enabled a deeper, shared understanding of our joint service offer and practice. It shone a light on the good and some excellent services the partnership is providing and offered insight into areas where joint working can be enhanced to improve outcomes for children, young people and their families.

Partners fed back recently that they found the process of joint inspection and the development of the joint action plan a constructive and positive experience which has enhanced communication channels, professional understanding and collective commitment to a common improvement in services for children and young people and their families.

Domestic abuse is a massive problem, accounting for about one in 10 of all crimes committed in England in 2015 to 2016. It claims the lives of 2 women each week and there are more than 6.5 million victims.

Notes to editors

  1. The report is based on inspections of Bradford, Hampshire, Hounslow, Lincolnshire, Salford and Wiltshire. The report and the individual inspection reports are online.
  2. Ofsted has also published a blog about the findings of the report.

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News story: Reasonable expectations: supporting health and care professionals

11 September 2017, 7:51 am

The National Data Guardian and her panel of advisors have been undertaking work to examine the circumstances under which health and care data may be legitimately shared, and the role that patients’ reasonable expectations play in shaping these circumstances.

Panel members have written about the first stages of this work last year and a seminar held earlier this year to examine proposals for alternative suitable legal justifications for information sharing to support care.

On October 10 the Office of the National Data Guardian will be holding an event to examine these proposals with health and care professionals and we are particularly keen to engage with frontline practitioners.

There are a small number of places available at this event, which takes place from 10.30am to 3pm at a central London location to be confirmed.

If you are interested in attending, please email for more details.

News story: Ofsted websites maintenance work: Friday 1 September

31 August 2017, 4:00 pm

Ofsted will be doing maintenance work on its websites between midnight and 5 am on 1 September 2017.

Please do not log in to the following sites, as they may be unavailable:

  • Ofsted reports website
  • Parent View
  • Learner View
  • Employer View

We apologise for any inconvenience.

News story: Ofsted websites maintenance work: Saturday and Sunday 19 and 20 August

14 August 2017, 9:21 am

Ofsted will be doing maintenance work on its websites on 19 and 20 August 2017.

There will be times when the sites will be unavailable or slow to use.

Over this weekend please do not log in to the sites.

The sites are:

  • Ofsted Online
  • Ofsted reports website
  • Parent View
  • Learner View
  • Employer View
  • inspector portals

We apologise for any inconvenience. We should resume normal service on Monday 21 August.

Press release: National Data Guardian (NDG) statement on government response to the NDG Review

12 July 2017, 1:18 pm

National Data Guardian for Health and Care (NDG), Dame Fiona Caldicott has today welcomed the government’s publication of Your Data: Better Security, Better Choice, Better Care.

Last year Dame Fiona published a Review of Data Security, Consent and Opt-Out, which proposed measures to strengthen the security of health and care information and help people make informed choices about how their data is used.

In the review, the NDG argued that the public should be engaged about how their information is used and safeguarded and the benefits of data sharing, with a wide-ranging consultation on her proposals as a first step. On the day the report was published, the government launched a public consultation on her recommendations, the proposed new data security standards and proposed national opt-out.

The government has now published its response.

Responding to the government’s response Dame Fiona Caldicott, said:

I welcome the government response to the review that I published last year and am very pleased that my recommendations on data security, and on giving people choice about how their health and care data is used, have been accepted.

Past failures to use patient data safely and respectfully have been well-publicised. But I believe that if the right steps are taken now, the great benefits of using such data can become just as familiar to the public in the future.

All of us want to see our health and care services deliver better, more compassionate, efficient treatments and services for ourselves, our families, our friends and neighbours and everyone in society.

We are fortunate to be living at a time when technological advances offer extraordinary opportunities for patient data to be used to improve people’s individual care and to improve health, care and services through research and planning.

We are only able to harness those opportunities if the public trusts that the health and care system is doing all it can to keep the data secure, to meet expectations on confidentiality and to be transparent.

There is still little public awareness of the way information collected by health and care services is currently shared, and that trust has not yet been earned. I believe that the implementation of my recommendations will be an important step in this process.

I do not underestimate the challenges of this implementation. It will involve a great deal of work, including the building of technical solutions, support and training for staff, and not least culture change. Most importantly it will involve an ongoing conversation with the public about how data is used and what choices people can make.

Speech: Exceeding expectations

6 July 2017, 9:30 am

Dr Alan Hassey
Dr Alan Hassey, Member of the National Data Guardian Panel

Last December I wrote an article about some work that we’ve been doing on the National Data Guardian’s (NDG) Panel.

We’ve been looking at how health and care information needs to be shared for people’s individual care and how to ensure there are no surprises for patients and service users about this.

The article discussed implied consent, which is routinely used by health and care professionals as the legal basis to share information about patients and service users to make sure that individuals get the care they need. The article was called ‘reasonable expectations’. This was a reference to the importance of ensuring that when information is shared on the basis of ‘implied consent’, it’s important that this is done in a way that the patient or service user would reasonably expect.

The piece was published to provoke debate about an important issue, to open up discussion and help us decide whether any further work was needed to look at this subject. The response to the piece exceeded my own expectations.

It certainly did stimulate discussion and we are very grateful to all those who took time to reflect and respond. The viewpoints expressed were wide ranging. There were some who felt that the boundaries described to the use of implied consent were not restrictive enough. At the other end of the spectrum, some argued that the limitations described in the article would curb the flow of information in a way that would be against individuals’ best interests.

The range of opinions reflects the continuing variation in understanding of how implied consent can and should be used in health and care. This is understandable. After all, a key question here is whether information is being used and shared in a way that meets people’s reasonable expectations. And those expectations can and will vary and be influenced by a variety of factors. Perhaps most importantly, what efforts have been made to inform people about how information might be used and shared.

The need for more work to reach a consensus on this issue was highlighted in the 2013 Information Governance Review led by Dame Fiona Caldicott prior to her appointment as National Data Guardian. It issued a recommendation for a piece of work to bring together the health and social care professional regulators to achieve this, which was echoed in the report published a year later tracking progress.

In April this year, the General Medical Council’s (GMC) revised confidentiality guidance came into force. This was updated after extensive consultation, during which the GMC heard that doctors wanted more clarity on the circumstances in which they can rely on implied consent to share patient information for direct care.

There are resonances between what the GMC revised guidance says about implied consent and the thinking that the NDG panel has been doing. The guidance will be very helpful to doctors on the ground, but we believe there is still a need for a greater consensus across the whole of the health and social care system about how to ensure that information is shared in a way that aligns with people’s reasonable expectations.

To progress this, the NDG will be testing with members of the public what their expectations are around data sharing, what the boundaries should be and think through how these expectations should be informed and assessed. To do this we will be undertaking a piece of public engagement work with partners – we will provide more details on our web pages later this summer. To help shape the questions and issues that should be put to members of the public, we will be holding a seminar with Sheffield University later this month to bring together clinicians, information experts, commissioners, lawyers and ethicists.

We’re approaching this with an open mind, although I believe that running through this work will still be that vital test – would people reasonably expect how information about them is used and shared?

News story: Reducing delays for people moving from hospital to social care

5 July 2017, 9:00 am

In a written ministerial statement Health Secretary Jeremy Hunt announced (on 3 July 2017) measures to support the NHS and local government in reducing delays for people being discharged from hospital to local social care services.

The measures include:

  • local authorities agreeing with local NHS organisations on the contribution they will make to reducing the number of delayed transfers of care in their local areas
  • a performance dashboard showing how health and social care partners in every local authority area in England are performing against a number of metrics, including: delayed transfers of care, emergency admissions, length of stay in hospital, the number of people still at home 90 days after being discharged from hospital
  • the Integration and Better Care Fund Planning Requirements 2017 to 2019, which set out how the Better Care Fund Planning process will operate

Find out more about the performance dashboard and the Integration and Better Care Fund planning requirements.

The Health Secretary said:

This government is clear that no-one should stay in a hospital bed longer than necessary: it removes people’s dignity; reduces their quality of life; leads to poorer health and care outcomes for people; and is more expensive for the taxpayer.

In this year’s mandate to NHS England, I set a clear expectation that delayed transfers of care (DToCs) should equate to no more than 3.5% of all hospital beds by September.

Alongside this, the spring 2017 Budget announced an additional £2 billion to councils in England over the next three years to spend on adult social care services.

This funding for local adult social care services will help:

  • meet adult social care needs
  • reduce pressures on the NHS, by supporting more people to be discharged from hospital when they are ready
  • support the local social care provider market

The Department of Health has also asked the Care Quality Commission to commission 12 reviews of local areas to consider how well they are working at the health and social care boundary. A further 8 reviews will be commissioned based on the performance dashboard and informed by local authority returns due in July 2017. These reviews will commence immediately with the majority complete by the end of November 2017.

Speech: Communication, expectations, innovation: maintaining public support for new technology

3 July 2017, 11:51 am

Today the Information Commissioner’s Office (ICO) announced the result of its investigation into the way that the Royal Free NHS Foundation Trust shared identifiable data about 1.6 million patients with DeepMind.

This is a matter which I have considered carefully with my advisory panel and on which I provided advice to the ICO at her request. Like the ICO, my panel and I found problems with the way this data had been shared. In particular, the ICO asked my opinion on the question of whether the Royal Free had used an appropriate legal basis for the initial data sharing. After much careful deliberation with my panel, I came to the view that they had not.

Reflecting on this matter, I believe it is important to underline that as National Data Guardian (NDG) I am a strong advocate of work to develop new technology which can improve care and save lives. In this case, the Royal Free and DeepMind developed an app to alert hospital nurses and doctors to inpatients who might have acute kidney injury, a very serious condition, which can be hard to diagnose but can develop rapidly.

The issue that concerned my panel members and me was not that innovation was taking place to help patients affected by this condition. Far from that, it was the legal basis which the Royal Free had used to share data which could identify more than 1.6 million patients to DeepMind.

Innovation within a legal framework

In this instance the Royal Free shared the information on the basis of ‘implied consent for direct care’. This is a legal basis that doctors, nurses and care professionals rely on every day to share information in order to make sure the individuals they are looking after receive the care they need. However, it is my view that this legal basis cannot be used to develop or test new technology, even if the intended end result is to use that technology to provide care.

I’m afraid that a laudable aim – in this case developing and testing life-saving technology – is not enough legally to allow the sharing of data that identifies people without asking them first. We need to reassure the public there are always strong safeguards in place to make sure that confidential information will only ever be used transparently, safely and in line with the law and regulatory framework.

Getting the balance right

The tension between supporting and enabling innovation and acting in line with public expectation is not new. We wrestled with these issues 20 years ago during the Caldicott Committee’s Review of Patient Identifiable Information. This was commissioned when the NHS was just starting to move from paper to computerised records, with the result that information could be sent much more easily from one part of the health service to another.

Our 1997 report highlighted the benefits of what we called an ‘information explosion’ – more effective and efficient care for patients and a better basis for planning and monitoring services. It also acknowledged a tension between the needs of those running and planning services to use patient information on the one hand and, on the other, patients’ expectations about how information about them would be used.

That review said that managing that tension by “adhering to explicit and transparent principles of good practice” will “reassure patients and those treating them that confidentiality is safeguarded” and that “patients expect nothing less.”

If what we were seeing in 1997 was an information explosion, what we are seeing now could be called an information explosion many fold. The technology of today presents extraordinary opportunities to provide even better, safer, more individualised care.

The challenge continues

The technology may be different, it may be developing more quickly than ever, but I believe we face a similar tension which we must address – between the reality that heath and care data is often needed for innovation and public expectations about how such data will be used.

Now, as then, we have to work with where the public is. Confidentiality remains as important as ever. People need to be able to tell their doctor, nurse, or care worker things about themselves and their health and care needs in confidence. If such information is then used in a way that patients and service users do not expect, this precious trust will become undermined. The mantra of “no surprises” sums this up.

A conversation and safeguards to reassure

In the review I published last summer, I highlighted that we had found very low levels of public knowledge and understanding about how health and care data is used. Many were altruistic about data about them being used for research and innovation – but they wanted to know about that and to have a choice. In my report, I argued strongly that it is the responsibility of all health and social care, research and public organisations to make the case for data sharing to the public.

An ongoing conversation with the public is essential. This must be a two-way dialogue, in which people’s expectations are both listened to and informed. We will also need to reassure the public that there are strong safeguards in place to protect personal confidential data.

Just as was the case 20 years ago, I believe we can earn public support for the use of data in innovation, by “adhering to explicit and transparent principles of good practice” to “reassure patients and those treating them that confidentiality is safeguarded”. Now as then, the public rightly expects nothing less.

Press release: PM: mental health training for teachers will "make a real difference to children’s lives"

27 June 2017, 9:25 am

The government’s pledge to transform mental health services for young people has taken an important step forward with teachers and staff across the country starting training to identify and respond to early signs of mental health problems among pupils.

Delivered by the social enterprise organisation Mental Health First Aid (MHFA) England, the training was originally announced by the Prime Minister in January as part of a series of measures to address the “hidden injustice” of poor mental health across society.

Around one in 10 children are believed to have a diagnosable mental health disorder, with half of all mental health conditions begin before the age of 14, making it vital that children with early symptoms receive the support they need.

However, research by the National Association of Schoolmasters Union of Women Teachers (NASUWT) found that 98% of teachers had come into contact with pupils who were experiencing mental health issues, but only 46% reported receiving training on children’s mental health.

The programme, backed in the first year by £200,000 in government funding, and delivered by the social enterprise Mental Health First Aid, will start with 1,000 staff and extend in years 2 and 3 to cover every secondary school in England. They will receive practical advice on how to deal with issues such as depression and anxiety, suicide and psychosis, self-harm, and eating disorders.

Participants in the training programme will be invited to become a Youth Mental Health First Aid Champion, and will help to share their knowledge and understanding of mental health across the school and wider community.

It is hoped that this will mean more young people will get fast and appropriate support for emerging mental health problems, and that all children will receive the highest quality pastoral care through their adolescence.

Prime Minister Theresa May said:

When I stood on the steps of Downing Street on my first day as Prime Minister, I said that the disparity in mental health services was one of the burning injustices our country faces.

Since then we have announced real progress in tackling this unfairness, and this training will make a real difference to children’s lives by ensuring they have access to sensitive and swift support.

Tackling poor mental health is a huge challenge, and we will keep our promises and meet that challenge with the comprehensive cross-society response that is required.

Secretary of State for Health, Jeremy Hunt, said:

Teachers provide outstanding pastoral care and support for their pupils, but many have said that they would appreciate more formal training on how to understand and respond to acute mental distress.

We know that identifying symptoms of mental illness in their early stages can help put young people on the road to recovery. This initiative will mean more children can get the fast and sensitive support they need to stay well, and help build a society with far better understanding of mental ill health.

Education Secretary Justine Greening said:

Growing up in today’s world is not always easy and for some young people the problems can be acute. That’s why we are stepping up our support for children with mental illness to help them become resilient, confident adults who can go as far as their talents will take them.

This new training will give teachers more confidence in tackling mental health issues and build on the fantastic support we know they already give their pupils. It’s great that so many schools are taking part and I’d encourage others to follow their lead.

Caroline Hounsell, MHFA England Director and lead of the Youth MHFA in Schools programme, commented, saying:

Mental ill health in young people is a growing health concern, with half of all lifetime cases of mental health issues starting by the age of 14. It’s therefore vital that we put the right measures in place to ensure that young people get the help they need and at the earliest possible stage.

We are really pleased to be involved in this government-backed programme and supporting our instructors to deliver this important schools-focused training.

John McKee, Headteacher, Patcham High School, Brighton, commented:

We are delighted to be one of the first schools in the country to be involved in the Youth MHFA in Schools programme.

Around one in 10 children have a diagnosable mental health issue – roughly three children in every classroom – so upskilling frontline school staff to be able to support these children is crucially important.

Sarah Brennan, Chief Executive of YoungMinds, said:

Children and young people today are facing a huge range of pressures, from exam stress to online bullying, which inevitably take a toll on their mental health. Many of these pressures become particularly intense during secondary school so it is important and welcome that mental health first aid training will be available for secondary schools.

This training is a move in the right direction and will help give staff the opportunity to gain confidence and understand mental health better. We hope it will encourage more leadership teams to put student wellbeing at the heart of their school which will benefit both students and schools alike.

Young people need to learn about wellbeing and resilience from a young age, so when they leave school they are equipped to deal with problems and have the confidence to seek help. It is vital that this work is part of a whole-school approach to wellbeing, and that mental health is made a priority across the education system.

News story: Secondary school staff get mental health ‘first aid’ training

27 June 2017, 8:42 am

From June 2017, teachers in secondary schools around the country will take part in a new training programme to help them identify and respond to early signs of mental health issues in children.

The programme, backed in the first year by £200,000 in government funding, and delivered by the social enterprise Mental Health First Aid, will start with 1,000 staff and extend in years 2 and 3 to cover every secondary school in England. They will receive practical advice on how to deal with issues such as depression and anxiety, suicide and psychosis, self-harm, and eating disorders.

They will also be invited to become ‘first aid champions’, sharing their knowledge and experiences across schools and communities to raise awareness and break down stigma and discrimination.

Health Secretary Jeremy Hunt said:

Teachers already provide outstanding pastoral care and support for their pupils, but many have said that they would appreciate more training on how to understand and respond to mental health issues.

We know that identifying symptoms of mental illness early can help young people on the road to recovery. This training will mean more children receive the timely and sensitive support they need to stay well.

One in 10 school-aged children will have a mental health condition at any time, with half of all mental health conditions beginning before the age of 14, making early intervention and support vital.

The introduction of Mental Health First Aid training supports the government’s pledge in the Queen’s Speech to improve mental health services and protect those living with mental health problems from unfair treatment and discrimination.

Earlier this year, the prime minister announced that every secondary school in the country would be offered the training, as part of a comprehensive set of messages to transform mental health support for children and young people.

News story: VCSE Health and Wellbeing Alliance members announced

16 June 2017, 8:26 am

Updated: This page has been updated to reflect the fact that the National Council for Palliative Care has since changed its name to End of Life Care Consortium.

On 20 April 2017 the Department of Health, Public Health England and NHS England announced the 21 members of the new voluntary, community and social enterprise (VCSE) Health and Wellbeing Alliance.

They are:

  • Age UK
  • Carers Partnership
  • Citizen’s Advice
  • Clinks, Nacro
  • Complex Needs Consortium
  • End of Life Care Consortium
  • FaithAction
  • Friends, Families and Travellers
  • Homeless Link
  • Maternity Action
  • Men’s Health Forum
  • Mental Health Consortium
  • National Voices
  • National Association for Voluntary and Community Action
  • National Council for Voluntary Organisations
  • Race Equality Foundation
  • The National LGB&T Partnership
  • The Valuing People Alliance
  • UK Health Forum
  • Young People’s Health Partnership
  • Win-Win Alliance

The members were selected from over 180 organisations that applied to join.

The alliance aims to make it easier for the voluntary and statutory sectors to work together to:

  • improve health and care systems
  • address health inequalities
  • help people, families and communities to achieve and maintain wellbeing

It also aims to bring the VCSE sector’s voice and expertise into national policy making.

The alliance succeeds the Health and Care Strategic Partner Programme, which ended on 31 March 2017.

Speech: It’s good to talk. It’s good to listen.

25 April 2017, 8:30 am

New guidance for doctors about maintaining confidentiality comes into force today.

I very much welcome this revised guidance from the General Medical Council, (GMC) and believe it will play an important role in helping doctors to protect the relationship based on trust that is cherished by both clinicians and patients.

As patients we take for granted that we can trust our doctors with the most personal information about ourselves. We understand that they may need this in order to know how best to treat us. We expect that they will treat this information with respect.

Much of the time, the way that doctors should protect and share information to maintain this trust is straight forward. However, sometimes both doctors and patients find that the situation is more complicated.

How about the family of an elderly patient who want to talk about their concerns, and possible treatments, with a doctor, but the patient does not have the capacity to consent to the doctor discussing their case? How about when a doctor is told by a mother that her partner has been violent and she fears for the safety of her children? What is a doctor’s duty when the police want to know something about a patient to help with an investigation? How should a doctor proceed when she thinks that a patient’s health means he shouldn’t be driving anymore? This document provides clear guidance to help doctors navigate such challenges.

Considering this revised guidance reminds me of the phrase “It’s good to talk”. This applies to the process that the GMC has gone through to ensure that the guidance serves the needs of clinicians and patients. I commend the extensive and careful engagement it has undertaken.

The guidance itself rightly lays emphasis on the importance of talking, and listening, to patients so that they know what they can expect to happen to information about them – who will see it, why and what choices they have. And it clarifies that confidentiality is not in itself a reason to refuse to listen to family and friends and doing so can be helpful to the patient’s care, for example providing additional insights into a patient’s condition.

It remains as vital as ever that people can talk in confidence to their doctors. New challenges to that trusted relationship will emerge with time, but we protect when we as patients, doctors, others in the health and care system continue to talk to each other.

Press release: Government helps dementia sufferers as part of next step in fight against nuisance calls

6 April 2017, 2:02 pm

Rogue traders who bombard the elderly and vulnerable with nuisance phone calls are to be stopped in their tracks by a targeted Government scheme designed to protect those with dementia.

Every year, thousands of complaints are made about nuisance phone calls and in February last year, one firm alone was fined £350,000 for making more than 46 million automated calls.

To help tackle the problem, Prime Minister Theresa May, has today announced the launch of a half-a-million-pound project which will see hi-tech call blocking devices installed in the homes of some of the most vulnerable people across the UK who have been identified by doctors, Trading Standards officials and local councils as being at risk from nuisance callers.

The trueCall devices will completely block all recorded messages, silent calls and calls from numbers not already pre-identified by the home owner – offering particular protection to those with dementia.

The Prime Minister said:

We want to create a fairer society by cracking down on unscrupulous practices which target the most vulnerable.

This new, targeted scheme is the latest step in the government’s fight against nuisance calls, protecting those who are most at risk, including those with dementia.

We have seen people tricked out of thousands of pounds by scam callers and this government is determined to clamp down on their activities once and for all.

The project, which is being funded by DCMS, co-ordinated by the National Trading Standards Scams Team and supported by local Trading Standards departments, is the latest of a series of Government crackdowns on nuisance callers

A similar trial scheme run by the National Trading Standards Scams Team last year resulted in 93% of participants feeling safer in their homes. This included one person who had previously paid £150,000 to a scam caller.

The chief executive of Dementia UK, Hilda Hayo, said:

We welcome this project as some people living with dementia are vulnerable to nuisance callers who offer bogus services and financial schemes.

These calls can not only have a negative financial impact but can also lead to psychological affects such as anxiety, depression and a loss of self-esteem. We frequently receive calls to our national helpline from family members who are concerned that their relative with dementia has fallen prey to rogue traders.

This scheme will see the special devices installed in 1,500 homes. They will screen calls and can either ask callers to enter a security code which only genuine callers will know, or direct them to instead call a friend or relative of the home owner.

Lord Toby Harris, the Chair of National Trading Standards, said:

The impact of nuisance calls – both emotional and financial – cannot be underestimated. We know that these call blockers can make a real difference to people’s lives and give those in vulnerable situations, such as those with dementia, and their families a greater sense of protection and security.

Working with the Information Commissioner’s Office (ICO), the Government has already forced companies to display their caller ID when cold calling and given out a series of hefty fines – totalling almost £7 million.

The Government will shortly implement plans to slap company bosses and firms with fines of up to £1 million if they are found to be in breach of Privacy and Electronics Communications Regulations.


Notes to Editors:

  • The funding for this scheme includes £300,000 to supply call blocking machines with the remaining budget spent on the management of the service and raising public awareness of scam and nuisance calls.

  • Plans to make company bosses liable follows previous legislation where only businesses were liable for fines. Many of the businesses tried to escape paying nuisance call penalties by declaring bankruptcy – only to open up again under a different name.

  • The ICO has issued fines totalling almost £7 million since 2012.

  • In 2015, the ICO received almost 170,000 complaints about nuisance calls.

  • To report a nuisance call visit:

  • See what else Government is doing to combat nuisance calls by searching for: #NoNuisance on social media.

Press release: Government helps dementia sufferers in fight against nuisance calls

6 April 2017, 7:30 am

  • elderly and vulnerable – including dementia sufferers – to be given hi-tech devices which block all nuisance calls
  • project is latest government move to tackle the blight of rogue traders
  • Prime Minister: “We want to create a fairer society by cracking down on unscrupulous practices which target the most vulnerable”

Rogue traders who bombard the elderly and vulnerable with nuisance phone calls are to be stopped in their tracks by a targeted government scheme designed to protect those with dementia.

Every year, thousands of complaints are made about nuisance phone calls and in February last year, one firm alone was fined £350,000 for making more than 46 million automated calls.

To help tackle the problem, Prime Minister Theresa May has today announced the launch of a half-a-million-pound project which will see hi-tech call blocking devices installed in the homes of some of the most vulnerable people across the UK who have been identified by doctors, Trading Standards officials and local councils as being at risk from nuisance callers.

The trueCall devices will completely block all recorded messages, silent calls and calls from numbers not already pre-identified by the home owner – offering particular protection to those with dementia.

The Prime Minister said:

We want to create a fairer society by cracking down on unscrupulous practices which target the most vulnerable.

This new, targeted scheme is the latest step in the government’s fight against nuisance calls, protecting those who are most at risk, including those with dementia.

We have seen people tricked out of thousands of pounds by scam callers and this government is determined to clamp down on their activities once and for all.

The project, which is being co-ordinated by the National Trading Standards Scams Team and supported by local Trading Standards departments, is the latest of a series of government crackdowns on nuisance callers

A similar trial scheme run by the National Trading Standards Scams Team last year resulted in 93% of participants feeling safer in their homes. This included one person who had previously paid £150,000 to a scam caller.

The chief executive of Dementia UK, Hilda Hayo, said:

We welcome this project as some people living with dementia are vulnerable to nuisance callers who offer bogus services and financial schemes.

These calls can not only have a negative financial impact but can also lead to psychological affects such as anxiety, depression and a loss of self-esteem. We frequently receive calls to our national helpline from family members who are concerned that their relative with dementia has fallen prey to rogue traders.

The special devices will screen calls and can either ask callers to enter a security code which only genuine callers will know, or direct them to instead call a friend or relative of the home owner.

Lord Toby Harris, the Chair of National Trading Standards, said:

The impact of nuisance calls – both emotional and financial – cannot be underestimated. We know that these call blockers can make a real difference to people’s lives and give those in vulnerable situations, such as those with dementia, and their families a greater sense of protection and security.

Working with the Information Commissioner’s Office (ICO), the government has already forced companies to display their caller ID when cold calling and given out a series of hefty fines – totalling almost £7 million.

The government will shortly implement plans to slap company bosses and firms with fines of up to £1 million if they are found to be in breach of Privacy and Electronic Communications Regulations.

Further information:

  • the funding for this scheme includes £300,000 to supply call blocking machines with the remaining budget spent on the management of the service and raising public awareness of scam and nuisance calls
  • plans to make company bosses liable follows previous legislation where only businesses were liable for fines. Many of the businesses tried to escape paying nuisance call penalties by declaring bankruptcy – only to open up again under a different name
  • the ICO has issued fines totalling almost £7 million since 2012
  • in 2015, the ICO received almost 170,000 complaints about nuisance calls
  • to report a nuisance call visit:
  • see what else government is doing to combat nuisance calls by searching for #NoNuisance on social media

Speech: Op-ed on the visit of Her Royal Highness (HRH) The Princess Royal, Princess Anne to Ghana

4 April 2017, 9:25 am

I am very pleased to announce that Her Royal Highness (HRH) The Princess Royal, Princess Anne, daughter of Her Majesty Queen Elizabeth II, will visit Ghana from this evening as part of a two-country visit to West Africa that also encompasses Sierra Leone.

This visit, The Princess Royal’s third to Ghana, will celebrate the unique friendship between the UK and Ghana as it marks its 60th Anniversary of Independence. Coming on the back of a series of high-profile visits by the Foreign Secretary, Boris Johnson MP, and the Prime Minister’s Trade Envoy to Ghana, Adam Afriyie MP, since Ghana’s seventh successful elections last December, the visit will reinforce the strength and depth of bilateral relations and the UK’s “Global Britain” drive to reinvigorate the Commonwealth.

Ghana is marking its 60th Anniversary with themes of reflection, celebration, challenge and togetherness. Its partnership with the UK embodies just that – built on deep social and cultural ties and a shared future. It is therefore fitting that HRH The Princess Royal’s visit will mix tradition and modernity as she meets His Excellency The President, Nana Akufo-Addo at Flagstaff House, the Asantehene, Otumfuo Nana Osei Tutu II at the Royal Palace in Kumasi and hosts a reception with guests from different walks of Ghanaian society, including His Excellency former President Kufuor.

HRH The Princess Royal will undertake a wide-ranging programme that builds on her previous visits in 1998 and 2011. It focuses on empowering women who act as role models for others, exploring the importance of support for girls, female education and entrepreneurs in delivering Ghana’s future. She will pay a visit to an award winning enterprise, benefiting from a DFID programme called ENGINE, which has so far supported 49 micro and small enterprises across a range of sectors, from indigenous cosmetic products (such as Black Soap and Shea Butter) to environmentally friendly and sustainable bamboo bicycles frames. HRH The Princess Royal will experience first-hand the challenges micro and small enterprises face but also what is possible with the right determination and help.

HRH The Princess Royal will meet inspirational young girls and women from the Girls Education Challenge Fund who are receiving support from the UK – through the Varkey Foundation – to further their education via an innovative distance learning programme that is bringing quality education to thousands of people in remote, rural areas. The Varkey Foundation is a non-profit organisation established to improve the standards of education for underprivileged children throughout the world. Similarly, HRH The Princess Royal will meet young girls and women being supported by Camfed – a UK funded, non-profit organisation that supports marginalised girls to go to school and empower young women to step up as leaders of change.

HRH The Princess Royal will also commemorate links between the UK’s and Ghana’s Armed Forces, partaking in a ceremony at Christanborg War Memorial alongside the Minister of Defence. She will also meet with senior members of the Ghanaian military, veterans, cadets and successful women working in the Ghana armed forces.
The visit will offer an opportunity to celebrate the range of people-to-people links that underpin the bilateral relationship, including volunteers as HRH The Princess Royal visits the local operations of some of the charities and Non-Governmental Organisations of which she is patron, which include VSO International and Opportunity International UK. And she will meet with a number of UK volunteers including the alumni of UK sponsored scholarship programmes, Chevening, Commonwealth and the Queens Young Leaders. All of whom make a significant contribution to the bilateral relationship.

The UK and Ghana already enjoy a special relationship, a unique friendship steeped in history and built upon deep social, cultural and inter-personal links. And both nations are adapting quickly to the shared challenges ahead of them. HRH The Princess Royal’s visit to Ghana comes at an exciting period for the UK/Ghana relationship. As we reflect on the past 60 years, HRH The Princess Royal’s visit is a fantastic opportunity for us to reinforce the strength and depth of bilateral relations and look forward to the next 60 years.

Speech: Social care commentary: creating an effective ‘front-door’

28 March 2017, 8:57 am

Creating an effective front door

In this commentary, I want to focus on what the important ingredients are for an effective front-door service – one that responds quickly and appropriately to children and child protection concerns. I want to dispel the myth that there is a certain ‘model’ that will solve the problems that this part of the children’s social care service faces.

Throughout the country, local authorities are struggling to get the front-door service right. While it is a hugely complex task, there are some basics that always need to be done well. Some authorities that are struggling to get the whole of the front-door service working well have shown good practice in certain areas, which is something I want to recognise in this commentary. We must praise and share good practice where we see it, even where authorities are less than good.

We need to move away from the idea that local authorities need to use a particular front-door model. What works in one place will not work everywhere. There are various names for different models in different places, such as multi-agency safeguarding hub (MASH) or contact and referral service, and they are not always used to describe the same thing. Some of these multi-agency arrangements work well, but providing a good service is about more than adopting a specific model or a name.

Every area will have different challenges around multi-agency working and ensuring that children and their families get the right help at the right time. The best authorities will continue to develop ways of working that best meet these local challenges as they change over time.

There are a variety of ingredients to an effective front-door service that, when applied flexibly, will deliver what children and their families need. We know that each part of the children’s social care system is reliant on the work carried out in other parts of the system. So getting it right at the front door makes a huge difference to children both in the short and long term.

What is the front door?

The ‘front door’ in a social care context is the arrangement that local authorities have in place to respond to an initial contact from a professional or member of the public who is concerned about a child. At the front door, local authorities provide advice and make decisions about how they will act on information about the health, well-being and safety of children.

The front door, therefore, is where professionals gather information and make decisions about which pathways to follow for different contacts and referrals. This may lead to an assessment by children’s social care, early help or a response from universal services.

There are many different ways of organising work at the front door. Some local authorities have models run by the corporate call centre, while others have multi-agency hubs. Each can work well. And some have multiple front doors, for example in different locations or to allow for specialist teams.

It is not uncommon for a child to be referred to children’s social care during their early childhood. It is estimated that 1 in 5 children will be referred before they start school. This gives a sense of the volume of work that local authorities and professionals at the front door have to manage.

All partners, including schools, health services, the police and others are responsible for providing their own high-quality initial response services. Other agencies need to know what information to share, when and with whom. Everyone involved in children’s lives has a responsibility to identify and share concerns.

What are the important ingredients of an effective front-door service?


Partner agencies such as health services, schools and the police often have a lot of in-depth knowledge about children and families. Advice on making referrals helps them to distil the information needed and to keep thresholds consistent across agencies. Good-quality advice at the front door should also be available to individual members of the public and service users.

In Croydon for example, members of the public, including young people, can access and speak to a duty social worker at any time through the reception at council offices and the emergency duty team after hours. This service is particularly well used by young people who have accommodation issues. Croydon also has an information and advice line for professionals. It allows anyone considering non-urgent referrals to discuss their concerns. This is improving the quality of referrals.

Gathering and analysing information

Leaders must ensure that the information systems that professionals use support them to do their work well. All relevant information about children, families and incidents has to be captured and analysed so that risks are properly understood and the right decisions can be made. Every effort should be made to ensure that collating this evidence is as efficient, quick and as easy as possible to allow staff to focus on their work rather than duplicating paperwork or ‘feeding’ unhelpful information systems. Leaders must ensure that this work is quality assured to maintain high standards over time.

Sharing information well

There has to be clarity about what information can and should be shared. Each agency and all professionals should have a clear understanding of their roles and responsibilities, both separately and to each other. A significant challenge for local authorities is organising all agencies to share information. Only the most determined leaders can make sure that everyone involved understands how this works, that everyone is confident in sharing the right information and that there is a consistent approach.

Contextualising family strengths and risk

Historical factors about children and families have to be taken into account and fully analysed to understand families’ strengths and risks. Inspectors commonly identify this as a weakness in their evaluation of cases. Where possible, staff should take a proactive approach rather than a reactive approach.

They should seek to understand the context in which children are living and the strengths of the family and their protective factors, as well as the risks children might be facing. In one family, an incident may indicate a more significant risk, but in another, evidence of strengths within the family may mean there is less concern.

Any incidents or events must be considered within that context if we are to build resilience in families wherever it is appropriate.

Using early help appropriately

Time and again, we hear that early help is critical. Helping families early prevents smaller risks from escalating, which keeps parents and children together. Families must receive the right help at the right time. The focus should be on an early, co-ordinated response.

But early help has to be purposeful and families must understand what they need to change. This means helping them to build resilience and resources, rather than becoming reliant on services. Good front-door services know what help is available locally and in communities. They can signpost families to where they can get the help and support they need when the threshold for social care involvement has not been met.

It’s worth bearing in mind though, that the best front doors are about getting families the right help and support quickly, rather than functioning as a ‘gatekeeper’ of services.

A culture that places the welfare of the child at the centre

Professionals should try and see through the eyes of a child. They should ask the questions: ‘What is the experience of this child? What is daily life like for this child? What is the response that will most meet this child’s needs?’

Valuing professional disciplines and expertise

Different agencies and professionals have a variety of expertise. Valuing that range of expertise and difference in perspective and focus, is important and bringing it together leads to better decision-making. This can happen virtually or through co-location.

However, simply sitting in the same room as one another is not enough. Inspectors have found instances of agencies located together, but still missing opportunities to share information and make joint decisions. All agencies, including probation, adult services, health, education and schools must understand their own and each other’s roles. The best authorities work hard to ensure that they have a good relationship with their schools.

Making use of specialist knowledge in critical areas of child protection, such as domestic abuse and child sexual exploitation, can help to improve services. Care needs to be taken to root this knowledge in teams so that it is sustainable and helps inform thinking in the longer term rather than being a quick fix for difficult cases.

A responsive out-of-hours service

A good out-of-hours service is run by people who know the work well and are able to respond to a whole range of challenging circumstances. Crucially, this service is responsive and does not just act as a ‘waiting area’ for the next day.

In Wakefield, for example, out-of-hours social workers provide a wide-ranging service to both new and open cases. This includes welfare visits, follow-up on cases that have come through the duty team and timely completion of child protection enquiries, including strategy discussions.

Despite the service requiring improvement overall, Wakefield’s co-location and good communication with the police supports multi-agency information-sharing and decision-making. Staff are timely in their response to children and families’ needs out of hours.

Close working with health partners

This needs to be embedded and routine. In Central Bedfordshire, for example, the children’s social care service works jointly with the safeguarding nurses at the hospitals, health visitors and school nurses. All GP practices have a linked social worker, and this is assisting communication, decision-making and understanding of each other’s roles.

Multi-agency strategy discussions

Despite prioritising, and increasing their investment in, multi-agency working and information sharing, too many local authorities have weaknesses in the way they run strategy discussions. Not all partners are always present and this severely affects the quality of the discussion, the information that is shared and the decisions that are made. Risks around children and their families can be missed more easily if agencies that work closely with them are not at the discussions.

Managing the work

I can’t emphasise enough how important good leadership is in ensuring that children and families get what they need. I discussed this in a commentary on practice leadership last year.

Robust management oversight of how children move through the system is vital. A blockage in one area can produce significant delays in efforts to help and protect them. At the front door, this oversight is absolutely critical.

Management of workflow is similarly important. Applying thresholds consistently is still a challenge. Children need the right help no matter what time the referral comes in, the quality of the referral, which staff are on duty, or the management arrangements.

Good leadership also includes:

  • well-supported, confident and knowledgeable managers, who have an overview of the work through monitoring
  • good systems for recording and sharing information
  • a clear information-sharing policy that is understood by all staff
  • performance monitoring, performance management and quality assurance arrangements that support managers in monitoring the work and taking action

Maintaining high-quality work

Quantitative measures are not effective by themselves in measuring the quality of the front door. The story of the front door needs to be told through qualitative measures as well. We know that some quantitative measures, such as low re-referral rates, can give false reassurance. Qualitative data is fundamental to understanding the quantitative information.

Regular ‘dip sampling’ of cases helps managers to understand the effectiveness of information sharing, information gathering, assessment and joint decision-making. Dip sampling is a valuable learning opportunity for front-door staff. It must account for different factors, such as different staff teams and managers, as well as decision-making on different days.

Local authorities need to make sure that they have enough regularly scrutinised quantitative and qualitative information. This can include themed audits, multi-agency audits and information from dip sampling. Learning identified should be disseminated and where necessary, action should be taken and monitored for impact.

Local authorities must have systems to identify if a particular agency does not understand thresholds or is not providing timely, good-quality referrals and information. Not only can this have an impact on the quality of decision-making, but poor-quality referrals can seriously hinder processes at the front door. A social worker can potentially deal with a higher number of referrals when they don’t have to spend time chasing further information that could have been there from the start.

Taking care of frontline social workers

Although this is last in my list, taking care of our social workers at the front door is so important. As I discussed in my commentary in November 2016, ‘the environment in which we work can help or hinder us to do the best job we can do’.

In Cornwall, inspectors found that leaders have created a culture of continual learning, support and challenge for social workers. Historically, these areas had been a real problem for Cornwall. But in recent years, these improvements have enabled social work, and social workers, to flourish. Leaders have ensured that their social workers at the front door have manageable caseloads and are part of a stable, knowledgeable workforce.

Indeed, a challenge for local authorities is workforce planning. How do you balance that mix of experience and a fresh view? If a professional works at the front door continually for a long period of time, they can potentially be desensitised to the seriousness of risks. This can happen due to the volume of cases, speed of decision-making, as a coping mechanism in dealing with distressing information, the responsibility of working at speed and getting it ‘right’. This is a challenge that needs to be addressed by all agencies.

One way that this can be addressed is by rotating staff working in the front-door services. There are of course those who thrive well on the nature of the work at the front door. They should, naturally, be supported to remain there to provide stability and continuity of knowledge and understanding of the service.

Keeping hold of your good social workers and building the knowledge, skills and confidence of new social workers is critical. Supporting front-door staff well is integral to a good front-door service. Too often, caseloads are high, which impacts on the quality and timeliness of the work. Looking after your staff and helping them to be skilled and confident in their decision-making is an important part of getting it right for children.

News story: NHS-funded nursing care rate for 2017 to 2018

15 March 2017, 3:59 pm

The reduction follows a review of agency costs by Mazars LLP in 2017

Registered nursing care for eligible nursing home residents is funded by the NHS, with the standard weekly rate per patient currently set at £156.25. This was a 40% increase on the 2015 to 2016 rate following an earlier review of the overall rate by Mazars in 2016.

In announcing the 40% increase last year, the government committed to further review the contribution of agency staff costs to the rate. In line with Mazars’ latest evidence on agency costs, the government will now reduce the agency cost component of the rate by £3.29 to allow for lower agency costs. This reduction is partially offset by an uplift in the remainder of the rate by 1.7% to reflect overall nursing wage pressures.

These rates are based on the best evidence currently available to the Department of Health on the costs of providing nursing care in the sector.

The Department of Health plans to consult on the introduction of a regional rate of NHS-funded nursing care ahead of future rate change announcements.


The headline agency cost reduction calculated by Mazars (on page 4 of their report) has been uprated based on a 1% uplift. The Department of Health has decided that for the non-agency component of the rate, a 1.7% uplift for overall changes in staffing costs should be applied for a full year (this approach is based on recommendations from the Mazars 2016 review).

The Department of Health has therefore taken the agency rate on page 15 of the most recent Mazars report and applied a consistent 1.7% methodology for 6 months of the year. This is because the agency data runs to September 2016 (see page 35 of report). This ensures the uprate methodology for both the agency and non-agency component of the rate is on a consistent basis, and uprated to April 2017 for overall estimated changes in staffing costs.

The higher rate of NHS-funded nursing care will be reduced to £213.32 per week, the same percentage decrease as applied to the standard weekly rate (this is only relevant for those people who were already on the higher rate in 2007 when the single band was introduced).

Press release: Time to Talk Day 2017: Prime Minister’s message

2 February 2017, 9:00 am

Prime Minister’s Time to Talk message

Prime Minister Theresa May said:

Time to Talk is an important day in our national calendar – a day when we put the issue of mental health at the forefront of our minds.

These problems affect millions of people – an estimated 1 in 4 of us has a common mental disorder at any one time.

Last month I set out the first steps in our plan to transform the way we deal with mental health problems at every stage of a person’s life.

I said that the inadequate treatment of these problems was a burning injustice – and that we needed to deal with them not just in our hospitals, but in our classrooms, at work and in our communities.

From crisis cafés to online therapy, there is much we can do to remove the stigma that stops so many people seeking help.

Getting people talking to one another is central to that. Because, as the theme of this year’s Time to Talk Day puts it, ‘conversations change lives’.

It is this personal contact – a chat over a cup of tea; a heart-to-heart over the phone; a text message to check someone’s OK – that can help free people from the prison of their own thoughts and help them to see a brighter future.

So many people – especially charities and campaigns, like Time to Change and Heads Together – are helping to get people talking and get these issues out in the open. But we can all do more.

Together, by giving our time and reaching out, we can end the suffering that blights so many lives.

Speech: Social care commentary: preventing child sexual exploitation

26 January 2017, 11:00 am

First, as we enter 2017, I would like to wish you all a happy new year.

I want to use this year and these commentaries to share and promote the good practice that we see during our inspections. While we all know that protecting and caring for vulnerable children is challenging to get right, it is important to recognise and share the good work that is happening across the country. Some of it is innovative, and it is all based on good social work practice.

There is by no means a one-size-fits-all model. Different areas face different problems and challenges. Local authorities must understand the needs of children and families in their local areas. They must design their services to meet those needs, with genuine input from local children and families. However, models of practice that work well in one area may well work for others, perhaps with some local adjustments.

And so, I encourage you all to share with each other what you know works well for children. Through my commentaries, I will also share some of the practice we have seen that is making a difference.

This month, I am focusing on some of the good work we have seen in relation to tackling child sexual exploitation. In September 2016, we published a themed report on the findings of the 5 joint targeted area inspections (JTAIs) last year that focused on child sexual exploitation. The report identified many areas of effective practice across agencies, including:

  • the importance of mapping child sexual exploitation in each local area
  • raising awareness of it
  • the various elements of direct work with children to reduce risk and respond to child sexual exploitation
  • the indisputable value of the commitment of local leaders to tackling the issues in their local areas

As I hope these commentaries are making clear, across all areas of social work, that leaders must understand frontline practice, know what good practice looks like and provide both challenge and support to staff to really make a difference to children’s lives.

Knowing children well and understanding their needs and professionals building sound relationships with them as individuals are all crucial in bringing about positive change. These themes are evident in the following examples. In particular, I would like to highlight the pivotal role that schools play in identifying, monitoring and educating children about child sexual exploitation.

Raising awareness of child sexual exploitation with children, parents and those in the local community is an important element in preventing the exploitation of children. Practitioners can learn a great deal from children about what they need to do to both protect themselves and be protected by adults in their lives. What better way to understand the life of a child than to ask children what their lives are like?

The local safeguarding children board in Thurrock, for example, used anonymous questionnaires in 2014 and 2015 to gather crucial information from children to identify the most serious and common dangers they had faced.

The responses showed that the risks to children online were far greater than had previously been recognised by local professionals, including risks to children as young as 8.

As a result, Thurrock’s local safeguarding children board began holding ‘Walk On Line’ roadshows in 2014. Over 10,000 children have attended these workshops so far. These interactive safeguarding workshops consider the broadest range of risks to children, including:

  • child sexual exploitation
  • grooming
  • sexting
  • going missing
  • cyber-bullying
  • female genital mutilation
  • radicalisation

Children decide how the events are organised and have been involved in developing a specially commissioned play and a DVD on e-safety. Impact is evident, with follow-up surveys providing examples of changed behaviour. For example, children have changed their online privacy settings since attending the roadshow.

Beyond raising awareness, local authorities and partners need to understand the local profile of offenders and patterns of exploitation in order to prevent, disrupt and put an end to child sexual exploitation. This means that agencies need to have a nuanced understanding of what child sexual exploitation is, who the perpetrators and victims are and where it happens.

Frontline practitioners across the country are increasingly aware of the prevalence of peer-on-peer abuse, which can start at a very young age. In Hackney, for example, when analysing the historical behaviour of some of the children who are involved in exploiting others, staff found a pattern of allegations of previous sexual assault and inappropriate sexualised behaviour. In some instances, this sexualised behaviour stemmed back to primary school.

The partnership has carried out research and scoping work to better understand the extent of the issue in Hackney and developed a programme of work across agencies. In working with children who show sexually harmful behaviours as soon as those behaviours emerge, agencies can prevent risk of harm to others. Importantly, they can address the safeguarding needs of the children who may be harming others. Responsibility for inappropriate behaviour is still addressed, but there is an understanding that with peer-on-peer abuse, the young person responsible for the abuse is also likely to have experienced sexual abuse or witnessed the abuse of others. A coordinated, skilled and empathic response is needed from professionals to work sensitively with these children, if they are to be helped.

A range of work is now in place in Hackney to address harmful sexual behaviour. Involving schools and colleges is crucial in Hackney’s work to tackle child sexual exploitation, particularly in strengthening children’s understanding of consent and challenging gender stereotypes. While it is too early to know the full extent of the impact of this work, increasing numbers of children displaying harmful sexual behaviour are now being referred for support. It is important that any learning from such projects is shared in order to promote understanding of what works well in preventing the abuse of children.
Recognising the signs of children who are vulnerable and at risk is also a critical role for schools. Too often, we find that providers either don’t recognise the links between going missing from school and other ways that children are vulnerable, such as where they’re at risk of child sexual exploitation or don’t share that information quickly enough.

In Calderdale, however, a system has been developed for recording and analysing a range of known risks to children. They have done this by means of a central record of all of the most vulnerable children in the area. This has been established to ensure that a range of risks are identified, in particular risks about non-attendance at school. This helps schools to share information promptly in a way that we don’t see everywhere in the country. Children included on the central record are those missing from education, those not receiving their full-time educational entitlement, those who are known to go missing from home or care and those at risk of sexual exploitation. The record incorporates information on other known risk factors, such as special educational needs, whether children are known to the youth offending team and whether there is any risk of radicalisation. The record is updated on a daily basis and can be accessed by the police, children’s social care and the head of learning. All the children on the central record have a key worker.
This process supports the agencies involved in working together and sharing information to develop strategic and individual responses to protect children. Timely gathering of a range of information informs ongoing assessment of the level of risk to a young person. This means that, as risk changes, it can be addressed quickly and children can be supported appropriately. Patterns and trends around episodes of missing can be easily identified from the central record, as can patterns around school attendance.

Working effectively with children is at the heart of any service tackling child sexual exploitation. All frontline staff, be they teachers, health professionals, police officers or social workers, need the time to develop and maintain meaningful relationships with children that are built on trust, as we discussed in our thematic report. To build these relationships takes time, especially with children who may not recognise that they are being abused.

Once established, it is important that these relationships are sustained. This means that professionals must meet with children when they say they will. Children must feel safe enough to be able to disclose information and know that it will be handled sensitively and appropriately. Once these individual relationships have been established, professionals can come together to share detailed information that will help them expose, prevent and disrupt child sexual exploitation.

One example where we found good engagement with children and their families and effective multi-agency working was in the Rochdale ‘Sunrise team’. The team is well established and pivotal to how the local authority, police and health services work together to respond to sexual exploitation.

The team’s multi-agency meetings ensure that comprehensive information about the risk of exploitation is shared on a daily basis so that children at risk are identified early. These daily briefings mean that information about offenders and potential offenders is shared and individual children at risk or known to be subject to child sexual exploitation are discussed. This results in swift and robust action planning to reduce risk and support successful disruption techniques. For example, even small pieces of information are taken seriously and sometimes result in early intervention from the police and other agencies to address early signs of a young person being groomed. This team can only function well because they know their children well. Without consistent and meaningful engagement with children and families, this project would not work.

The team has an open-ended commitment to working with children and their families, because staff understand that it can take time before children are ready to speak about what has happened to them. Maintaining relationships is crucially important. Support work with families is seen as central to this work, to help parents and carers understand the complexity of child sexual exploitation and to enable them to support their child to stay safe. An experienced family worker provides intensive support to families, sometimes visiting one family three or four times a week or offering short-term intervention when required.

Measuring the impact of work to address child sexual exploitation is not straightforward. But, in visiting the team and reviewing the work with children, it was clear that the skilled and gentle persistence of staff to get to know children well and continue working with them was reducing risks for many of them.

In our joint thematic report, we identified how rigorous management oversight and supervision are essential in ensuring that children get the support and help they need. The report highlighted that:

Leaders’ and managers’ oversight and supervision of frontline practice are critical.

This is particularly the case when children are at such high risk, may not recognise the risks themselves and may be reluctant to work with professionals. Staff need the right training and effective supervision to recognise the range of risks children may face and to be able to monitor changing risks. Managers need to review whether interventions are making a positive difference for children and reducing risks.

In Bury, the local authority and partners understand the challenges of tackling child sexual exploitation and work together well to identify and assess the level of risk faced by vulnerable children. One important element of their approach is that each child at risk of child sexual exploitation is allocated an independent reviewing officer (IRO) who has been employed as the dedicated child sexual exploitation lead. The IRO chairs the child sexual exploitation strategy meetings and the subsequent reviews. This provides an additional level of scrutiny to the work with children and a level of independence from direct frontline practice. The IRO ensures that all partners agree when work can come to an end and this decision is made through a review of the plan and a further risk assessment. While many local authorities review risks, this additional challenge and oversight in Bury strengthens practice.

There are many other examples of effective work that we have seen across the country. Today, I am just sharing some. I hope this will prompt reflection and create interest in how other areas are tackling some of the challenges.

We all, including Ofsted, local authorities and the government, need to recognise that there are particular groups of children who may be more vulnerable to child sexual exploitation and less able to speak up. I am concerned that we do not know as much about children who are not in mainstream education or who are disabled, girls in pupil referral units and boys in the criminal justice system, just to give some examples. We need to make sure that in delivering services, we are giving a voice to all children and including to those who are heard the least.

Speech: Ambition interrupted: Young Carers Awareness Day

25 January 2017, 1:41 pm

I can’t imagine there’s a single person on this planet who, at some point in their lives, has not had a dream or ambition they wanted to achieve. Mine was to be a professional pilot.

Whether we want to succeed in education, business, politics or another sphere, our aspirations and desires are acutely personal – never more so than when we are young. So, when life circumstances change, resulting in children and young people caring for parents or siblings whilst still in school, higher education or work – it’s not difficult to understand how hopes and dreams can be derailed.

That’s why ‘When I Grow Up’ is this year’s theme for Young Carers Awareness Day. Organised by Carers Trust, it’s about remembering what we aspired to in our youth, connecting those aspirations to better ways to support young carers now and helping them fulfil life goals alongside caring.

An estimated 700,000 young carers in the UK provide care in, or outside, family homes for someone who is physically or mentally ill, disabled or misusing drugs or alcohol. The median age of a young carer is 13. On average, 2 young carers in every UK secondary school miss or cut short around 10 weeks of school each year because of their caring role. Many report problems coping with school work and nearly 60% say they struggle to meet deadlines.

Most young carers are happy and proud to care for loved ones, but too often this important role goes unnoticed. Young people not only have to cope with the complexities of growing and learning, but also that of their parents or siblings’ health conditions, preventing them from enjoying childhood in the way other children do. It’s a challenge no one, regardless of age, should face alone – especially if they have their own health concerns.

However, when you consider the difficulty of identifying young carers (some choose to keep their caring role private or may not see themselves in that way), it is likely that nationally – as with older carers – we are underestimating numbers and levels of need. Whatever the scale of the problem, our children’s futures should not be compromised by a collective lack of awareness which exposes them to excessive or inappropriate caring responsibilities.

Young carers need to be identified early and directed to help and support already available in many schools and colleges, such as the young carers in schools programme. Identification, though, should not be an end in itself. We must support young carers to achieve their potential at school, in further education, training and work.

It’s why the new national carers strategy, launching this year, has such an important role to play in facilitating opportunity, health and wellbeing for all carers. It will recognise that truly effective support can only happen when we reach beyond health and care services into schools, workplaces and community centres. The more we all know, the more we can do to help.

The strategy will build on progress made in recent years. We’ve already changed the law to improve how young carers and families are identified and supported. And our work with care sector partners, including Carers Trust, Children’s Society and the Learning and Work Institute – means that together we are helping local authorities to plan, commission and deliver services providing better outcomes.

I personally feel very fortunate about the opportunities I’ve enjoyed in my life – opportunities that have culminated in the enormous privilege to be health minister with responsibilities for carers and the cared for. If I had been obliged to take time out to look after loved ones in my teens or twenties, my life may have turned out quite differently.

I’d therefore like to echo the Carers Trust’s challenge to get involved and take action to raise awareness and support for young carers. In your communities, schools and work places display posters, post messages on social media, and even record short films about what you wanted to be when you were younger. You’ll find plenty of resources to support you on the Carers Trust’s website.

In short, let’s realise our collective ambition to do more for young carers – they deserve it.

Speech: Supporting local government

24 January 2017, 11:38 am

Thank you Gary for that kind introduction, and for inviting me along to speak to you all today.

It’s great to be here at the Local Government Association’s (LGA) temporary home.

I know some people have complained that I’m not as close to Gary as Greg Clark was.

But it’s not for lack of trying!

Look at it from my point of view.

In July I arrived at DCLG’s HQ, just around the corner from Smith Square.

Literally a 2-minute walk away.

By October, the LGA had moved to the other side of London!

It’s hard not to take that personally…

That’s not the only grumble I’ve heard.

Unlike my predecessors all the way back to Hazel Blears, I’ve never served in local government.

That drew some criticism when I was appointed.

People were saying: “This guy Javid, he doesn’t understand us. He was never a councillor. He’s just a banker”.

Well, I think they said “banker”…

But look, I don’t have to have been a councillor to appreciate what a phenomenal job you all do.

You really are the front line of democracy, our local heroes.

Last month, Ipsos Mori released their annual “Trust in the professions” survey.

And, once again, local government was by far the most trusted tier of politics.

That’s no surprise.

For one thing, you’re directly responsible for many of the services that people use and rely on every day of the week.

You provide homes, take care of the vulnerable, protect consumers.

You educate our children.

You keep the roads open.

And you do so much more besides – including, of course, managing the service that troubles my mailbag more than any other.

You empty the bins!

Across this huge range of responsibilities, you do a great job.

These are tough times for all parts of the public sector, central and local government alike.

But your record in efficiency and delivery is second to none.

We asked you to do more with less and that’s exactly what you did.

Satisfaction with most council services has remained high.

Some services, such as road maintenance, even saw rises in satisfaction last year.

As I told MPs last month, there’s a lot that Whitehall can learn from councillors when it comes to delivering value for money.

So whatever tier of government you serve in, whatever party you’re from, let me say thank you.

Thank you for being willing to stand up, to put in the time and effort to represent your community.

And thank for you getting on with the job and showing just how effective and efficient local government can be.

I know it’s not been easy.

I know it’s not all plain sailing.

I know that what some of you want me to do today is stand here and promise additional funding for local government.

Well, there’s an old politician’s adage that goes:

“Everything you want to hear I can’t say, and everything I can say you don’t want to hear.”

But hopefully things won’t be quite that challenging today!

Because I get where you’re coming from.

No, I’ve never been a councillor.

But since I became Secretary of State last summer I have worked tirelessly to get under the skin of local government.

I’ve travelled the country, talking to councils of all types and political persuasions.

A week doesn’t go by that I don’t have councillors in my office, talking through the challenges they face and the support they need.

I recognise your innovation, your management and your local leadership.

And I understand your concerns.

One of the biggest, of course, is adult social care.

There’s no doubt about it, adult social care is a huge challenge for the public sector right now.

People are living longer, and that inevitably means greater demand for care services.

Every year you spend more than £14 billion on adult social care.

It’s one of the biggest cost pressures facing councils.

The last Spending Review put in place up to £3.5 billion of additional funding for adult social care by 2019 to 2020.

But I recognise that more needs to be done.

You, in local government, have a statutory duty to take care of vulnerable people.

But I believe that all of us have a moral duty to do so.

It’s what a civilised society does.

That’s why I was proud to fight for and secure more than £900 million of additional funding for social care.

Longer-term solutions are needed, but this additional cash will make a huge difference here and now.

I’m afraid we’ll have to agree to disagree on whether it’s so-called “new money”.

I’m very clear that there is more cash available for adult social care than there used to be.

Nearly a billion pounds of it.

I know many of you, for various reasons, view things differently.

But let’s all be very clear on one point – whether it’s old money or new money, it’s all taxpayers’ money.

I’ve heard some people object to the precept on Council Tax on the grounds that central government should pay for social care.

They’re missing the point.

Regardless of whether funding is raised or allocated by central government or local government, it is all raised by taxing the people of this country.

It’s not your money.

It’s not my money.

It’s their money.

And the social care precept means that their money gets spent in their areas supporting vulnerable members of their communities.

Of course, some local authorities will be able to raise less than others.

That’s why the Improved Better Care Fund, worth £1.5 billion by 2019 to 2020, will take into account councils’ ability to raise funding through the precept.

And we have listened to calls from across the board saying funding is needed sooner in order to meet short-term pressures.

That’s why we’ve made available a £240 million Adult Social Care Support Grant for one year, distributed fairly according to need.

I can also give you all some reassurance today.

Like I said, I’ve been talking to a lot of council leaders over the past 6 months.

And one concern that comes up again and again is the possibility that Attendance Allowance funding could be resourced from retained business rates.

Well, I’m listening.

Today I can confirm that the localisation of Attendance Allowance is no longer being considered as part of the business rates reforms.

I’ll be announcing further details on business rates reforms shortly.

But I can tell you now that Attendance Allowance will not be included.

Let’s not pretend that increased funding is the only solution to the care challenge.

You can pour as much petrol as you like into your car; if the engine’s not working it still won’t go.

And there is variation in performance across the country that simply cannot be explained by different levels of spending.

Look at one of the biggest challenges in social care, Delayed Transfers of Care from hospital.

In some areas it’s a chronic problem, while others have virtually no delayed transfers at all.

In fact there’s a 20-fold difference between the best-performing 10% and the worst-performing 10%.

That can’t be explained away by differences in funding or demographics.

I know that most of the delays are down to the health service.

But a gap that size also has to involve some councils simply doing things better than others.

Look at Southampton.

It has reduced delayed transfers of care and unnecessary hospital admissions by integrating 7 health and social care teams into a single service under a pooled budget.

If you’re tempted to shake your head and say “that’s great, but things are different in the south”, look at Northumberland.

£5 million saved thanks to the council working with the local health trust.

Demand for residential care cut by 12%.

And those statistics aren’t just numbers on a balance sheet.

They mean more people managing their own health.

More people able to live independently in their own homes.

More people recovering with their families in familiar surroundings rather than being marooned on a hospital bed.

More efficient working is good for councils, good for taxpayers, and good for the people who matter most – those on the receiving end of services.

Health and social care should be fully integrated so that they feel like one service.

The Better Care Fund is already supporting this with £5.3 billion of funding pooled between councils and Clinical Commissioning Groups last year.

But we also want to make sure that all local authorities learn from the best performers and the best providers.

So we will soon publish an Integration and Better Care Fund Policy Framework to support this.

And in the long term, we will need to develop reforms that will provide a sustainable way of working that benefits everyone who needs care.

Of course, social care isn’t the only big challenge on all our plates right now.

There’s also that most basic of human needs: housing.

For decades now, this country has not been building enough houses.

That’s not the fault of any one government or any one council.

But it’s a problem that we will all have to work together to fix.

The LGA has just made a great contribution to that with the report from its Housing Commission.

So thank you to everyone who worked on that.

My plan for getting homes built, the housing white paper, is going to be published shortly.

As you know, it’s not an easy challenge to overcome.

We want to make sure we get it right, that we make the biggest impact on the housing shortage that we can.

It wouldn’t be right for me to reveal everything that’s in the white paper before it’s published.

But I will say this much.

I’m not going to be tinkering around the edges.

The white paper will set out serious, lasting, long-term reforms that will boost housing supply immediately and for many years to come.

I know you’ve heard that before.

But this white paper isn’t just about changing guidelines or passing legislation or cutting red tape.

It’s about a whole new mind set.

A whole new attitude to house building at all levels – in central government, in the building industry and, yes, in local government too.

Make no mistake, you will have a huge role to play in the future of house building.

You are the enablers.

You are the planners.

You are the local leaders.

Leadership, as you know, sometimes means taking tough decisions.

Unpopular decisions, even.

It’s not easy.

But we have to ask ourselves what kind of country we want to live in.

Do we want a divided nation, with an unbridgeable and ever-widening gap between the property haves and have-nots?

Where only those with wealthy parents can get a foot on the property ladder?

Where elderly people are forced to work well past retirement age in order to keep paying off their mortgage?

Where unfettered, unplanned and unhelpful development overwhelms communities who have no say in the matter?

Or do we want a country where anyone who wants to work hard and get on can ultimately afford a place of their own?

Where social mobility is boosted, the environment is protected, and quality of life is improved?

I know which one I want to see.

And the white paper will help bring it about.

Housing is a complex business.

Different people and different places have different needs.

There is no simple, off-the-shelf, one-size-fits-all solution.

The same is true of devolution.

The Sheffield City Region and Cornwall, for example, are very different places with very different strengths and some very different problems.

And that’s why the devolution deal that’s right for one area might not be right for another.

The West Midlands will benefit from having a mayor, but not all areas will.

Just because Wiltshire has made a huge success of unitary status, it doesn’t mean all district councils should shut up shop.

Areas that opt for a directly elected mayor will always be in line for the greatest degree of devolution.

As I’ve said before, I don’t want to devolve power without accountability.

But the whole of point of our approach to devolution and reorganisation is that it’s locally led to meet local needs.

It’s about bottom-up consensus, not top-down reorganisation.

The last thing I want to do is repeat the failed experiment of identikit regional assemblies imposed along arbitrary geographical lines and imposed from Westminster.

But let me be very clear – we are not going cold on devolution.

We have not lost interest, it has not slipped down our list of priorities.

Myself, my department and my Prime Minister remain absolutely committed to making existing deals a success.

And my door is always open to local authorities who want to put forward their own plans.

I want to see strong, effective, efficient local government in whatever form best suits your area.

If you can deliver that, I’ll give you as much as I can.

After all, last June, the people of Britain voted to take back control.

We’re not about to reclaim power from Brussels only to hoard it in Westminster.

On the subject of Brexit…

Earlier this week, as you’ll have seen, the Prime Minister set out the core principles of our departure from the European Union.

And on everything from consumer protection to economic growth, local government is central to getting Brexit right.

Yes, we want to see a global Britain.

But that has to be built on firm local foundations.

I know my predecessor promised local government a “seat at the table”.

I also know the current joke is that he didn’t say which seat, at which table or even which building it’s in!

But, earlier this week, my colleague David Davis announced that he’d be sitting down with elected leaders.

And you can rest assured that I’m going to make sure your voice is heard.

Because whichever party you represent, I represent you.

I am your Secretary of State, your champion in Westminster, your voice in Cabinet.

I am proud to speak for you, I am proud to fight for you.

We won’t always agree on everything.

But this is a big, big year for local government.

Elections in counties and combined authorities, devolution deals being delivered, the Brexit process beginning, the housing white paper…

And if we’re going to make a success of it we are all going to have to work together.

I’ve talked about 4 of the big issues today.

I know there’s a lot more on your mind.

If I haven’t touched on something it doesn’t mean I don’t care about it, I just don’t want to spend the whole of this session talking at you.

For all the time I spend meeting with council leaders, the realities of my life and yours mean I don’t get enough opportunities to hear from other councillors.

And I really want to hear from you.

I can’t promise to give you the answer you want.

There may some questions where I have to hold up my hands and say “I don’t know, let me get back to you on that”.

But I can promise that I will listen.

That I will go on listening.

And that I will continue doing everything I can to support the single most important part of the public sector – our local councils.

Thank you.

News story: New Director for Corporate Strategy, Ofsted

19 January 2017, 11:05 am

I am delighted to announce that we have appointed Luke Tryl into the new Director, Corporate Strategy role. Luke is joining us from Public Policy Projects, an independent think tank, and has previously worked as Head of Education at Stonewall as well as Reform, Tetra Strategy and a spell as a Special Adviser at the Department for Education.

Amanda Spielman

Statement to Parliament: Mental health and NHS performance

9 January 2017, 5:52 pm

With permission Mr. Speaker, I would like to make a statement on mental health and NHS performance.

This government is committed to a shared society in which public services work to the highest standards for everyone. This includes plans announced this morning by the Prime Minister on mental health.

I am proud that, under this government, 1,400 more people are accessing mental health services every day compared to 2010 and we are investing more in mental health than ever before, with plans for 1 million more people with mental health conditions to access services by 2020. But we recognise that there is more to do so as will proceed with plans to further improve mental health provision including:

  • formally accepting the recommendations of the Independent Taskforce on Mental Health which will see mental health spend increase by £1 billion a year by the end of the parliament
  • a green paper on children and young people’s mental health to be published before the end of the year
  • enabling every secondary school to train someone in mental health first aid
  • a new partnership with employers to support mental health in the workplace
  • up to £15 million extra invested in places of safety for those in crisis following the highly successful start to this programme in the last parliament
  • an ambitious expansion of digital mental health provision
  • an updated and more comprehensive suicide prevention strategy

Further details of these plans are contained in the written ministerial statement laid in the House this morning.

However turning to winter, as our most precious public service, the NHS has been under sustained pressure for a number of years. In just 6 years the number of people over 80 has risen by 340,000 and life expectancy has risen by 12 months. As a result, demand is unprecedented: the Tuesday after Christmas was the busiest day in the history of the NHS and some hospitals are reporting that A&E attendances are up to 30% higher compared to last year. I therefore want to set out how we intend to protect the service through an extremely challenging period and sustain it for the future.

First Mr. Speaker, I would like to pay tribute to staff on the frontline. 1.3 million NHS staff, alongside another 1.4 million in the social care system, do an incredible job which is frankly humbling for all of us in this House. An estimated 150,000 medical staff, and many more non-medical staff, worked on Christmas Day and New Year’s Day. They have never worked harder to keep patients safe and the whole country is in their debt.

With respect to this winter, the NHS has made more extensive preparations than ever before. We started the run up to the winter period with over 1,600 more doctors and 3,000 more nurses than just a year ago, bringing the total increase since 2010 to 11,400 more doctors and 11,200 more hospital nurses. The NHS allocated £400m to local health systems for winter preparedness; it nationally assured the winter plans of every trust; it launched the largest ever flu vaccination programme, with over 13 million people already vaccinated; and it also bolstered support outside A&Es with 12,000 additional GP sessions offered over the festive period.

The result has been that this winter has already seen days where A&Es have treated a record number of people within 4 hours, and there have been fewer serious incidents declared than many expected. As Chris Hopson, head of NHS Providers said, although there have been serious problems at some trusts, the system as a whole is doing slightly better than last year.

However there are indeed a number of trusts when the situation has been extremely fragile. All of last week’s A&E diverts happened at 19 trusts, of which 4 are in special measures. The most recent statistics showed that nearly three-quarters of trolley waits occurred in just 2 trusts. In Worcestershire in particular there have been a number of unacceptably long trolley waits and 2 deaths whilst patients were in A&E. We are also aware of ongoing problems in North Midlands with extremely high numbers of 12 hour trolley waits.

Nationally the NHS has taken urgent action to support these trusts, including working intensively with leadership and brokering conversations with social care partners to generate a joined up approach across systems of concern.

As of this weekend, there are some signs that pressure is easing both in the most distressed trusts and across the system. However, with further cold weather on the way this weekend, a spike in respiratory infections and a rise in flu there will be further challenges ahead.

So NHS England and NHS Improvement will also consider a series of further measures which may be taken in particularly distressed systems on a temporary basis at the discretion of the local clinical leaders. These may include:

  • temporarily releasing time for GPs to support urgent care work
  • clinically triaging non-urgent calls to the ambulance service for residents of nursing and residential home before they are taken to hospital
  • continuing to suspend elective care, including, where appropriate, suspension of non-urgent outpatient appointments
  • working with the CQC on rapid re-inspection where this has the potential to re-open community health and social care bed capacity
  • working with community trusts and community nursing teams to speed up discharge

Taken together these actions will give the NHS the flexibility to take further measures as and when appropriate at a local level.

However, looking to the future, it is clear we need to have an honest discussion with the public about the purpose of A&E departments. There is nowhere outside the UK that commits to all patients that we will sort out any urgent health need within 4 hours. Only 4 other countries, New Zealand, Sweden, Australia and Canada, have similar national standards which are generally less stringent than ours.

This government is committed to maintaining and delivering that vital 4 hour commitment to patients. But since it was announced in 2000, nearly 9 million more people are using our A&Es, up to 30% of whom NHS England estimate do not need to be there, and the tide is continuing to rise.

So if we are going to protect the 4 hour standard, we need to be clear it is a promise to sort out all urgent health problems within 4 hours, but not all health problems however minor. As Professor Keith Willett, NHS England’s Medical Director for Acute Care, has said, no country in the world has a standard for all health problems, however small, and – if we are to protect services for the most vulnerable – nor can we. So NHS England and NHS Improvement will continue to explore ways to ensure that at least some of the patients who do not need to be in A&Es can be given good alternative options, building on progress underway with the streaming policy in the NHS England A&E plan. This way we will be able to improve the patient experience for those with more minor conditions who are currently not seen within 4 hours as well as protect the 4 hour promise for those who actually need it.
In the meantime, when it comes to NHS provision more broadly, we will not let up on our commitment to a shared society in which public services work to the highest standards for everyone. This includes plans announced by the Prime Minister this morning on mental health.

Mr Speaker, taken together what I have announced today are plans to support the NHS in a difficult period, but also plans for a government that is ambitious for our NHS, quite simply, to offer the safest, highest quality care available anywhere for both mental and physical health. But they will take time to come to fruition, and in the meantime all of our thoughts are with NHS and social care staff who are working extremely hard over the winter, and throughout the year, both inside and outside our hospitals and I commend this statement to the House.

Speech: The shared society: Prime Minister’s speech at the Charity Commission annual meeting

9 January 2017, 2:05 pm

The shared society: Prime Minister’s speech

Thank you for inviting me to be here this morning to deliver the prestigious Charity Commission annual lecture.

I am delighted to have this opportunity to express my appreciation for all those who work in our charity sector and for those who freely give their time, money and expertise in the service of others. We are a country built on the bonds of family, community and citizenship and there is no greater example of the strength of those bonds than our great movement of charities and social enterprises.

But the strength of that civil society – which I believe we should treasure deeply – does not just depend on the ingenuity, generosity and commitment of countless volunteers, social entrepreneurs and philanthropists. As with other parts of our economy, it also depends on the practices that our charities and social enterprises adopt; and above all on the public trust they command.

That is why the work that William, Paula and their team at the Charity Commission are doing is so important. Because the reforms they are leading are strengthening the sector – and together with the new Fundraising Regulator – ensuring public confidence in our charities and the contribution they make in helping to meet some of the greatest social challenges of our time.

The challenge of our time

And let’s be clear that some of those challenges are significant and long-standing.

We live in a country where if you’re born poor, you will die on average 9 years earlier than others. If you’re black, you’re treated more harshly by the criminal justice system than if you’re white. If you’re a white, working-class boy, you’re less likely than anybody else in Britain to go to university. If you’re at a state school, you’re less likely to reach the top professions than if you’re educated privately. If you’re a woman, you’re likely to be paid less than a man. If you suffer from mental health problems, there’s not enough help to hand. If you’re young, you’ll find it harder than ever before to own your own home.

There are not easy answers to these problems, but it is vital that we come together to address them. For they are all burning injustices that undermine the solidarity of our society and stunt our capacity to build the stronger, fairer country that we want Britain to be.

But the challenges don’t end there. Governments have traditionally been good at identifying – if not always addressing – such problems. However, the mission I have laid out for the government – to make Britain a country that works for everyone and not just the privileged few – goes further. It means more than fighting these obvious injustices. It means acknowledging and addressing the everyday injustices that too many people feel too.

Because while the obvious injustices receive a lot of attention – with the language of social justice and social mobility a staple of most politicians today – the everyday injustices are too often overlooked.

But if you’re from an ordinary working class family, life is much harder than many people in Westminster realise. The injustice you feel may be less obvious, but it burns inside you just the same.

For you have a job but you don’t always have job security. You have your own home, but you worry about paying the mortgage. You can just about manage but you worry about the cost of living and getting your kids into a good school.

You are putting in long hours with little time for yourself – working to live, and living to work. You give work your all, but there is still little left over at the end of the month to spend on the things that really matter to you. Your wages have stagnated for several years in a row, and you feel you are getting by, not necessarily getting on.

And at the same time, over recent years these people have felt locked out of the political and social discourse in Britain. If they voiced their concerns, their views were shut down. Decisions made in faraway places didn’t always seem to be the right decisions for them. They saw their community changing, but didn’t remember being consulted – or agreeing to – that change. They looked at the changing world – the onset of globalisation and the advances in technology – and worried about what the future held for their children and grandchildren.

It is clear to me – and I believe that last year’s vote to leave the European Union partially revealed this to be true – that there are growing numbers of people in every part of our country – in our cities, suburbs, towns, countryside and coastal areas – for whom this is the reality of life.

And the consequence is this: when you see others prospering while you are not; when you try to raise your concerns but they fall on deaf ears; when you feel your very identity – all that you hold dear – is under threat, resentments grow, and the divisions that we see around us – between a more prosperous older generation and a struggling younger generation; between the wealth of London and the rest of the country; between the rich, the successful and the powerful, and their fellow citizens – become entrenched.

That’s why I believe that – when we consider both the obvious and the everyday injustices in unison – we see that the central challenge of our times is to overcome division and bring our country together by ensuring everyone has the chance to share in the wealth and opportunity on offer in Britain today. And that starts by building something that I call the shared society.

The shared society

The shared society is one that doesn’t just value our individual rights but focuses rather more on the responsibilities we have to one another.

It’s a society that respects the bonds that we share as a union of people and nations. The bonds of family, community, citizenship and strong institutions.

And it’s a society that recognises the obligations we have as citizens – obligations that make our society work.

A few months ago at the Conservative Party Conference in Birmingham, I upset some by saying that “if you think you’re a citizen of the world, you’re a citizen of nowhere”.

But my point was simple. It was that the very word ‘citizen’ implies that we have responsibilities to the people around us. The people in our community, on our streets, in our places of work. And too often today, those responsibilities have been forgotten as the cult of individualism has taken hold, and globalisation and the democratisation of communications has encouraged people to look beyond their own communities and immediate networks in the name of joining a broader global community.

I want to be absolutely clear about what I am saying here. I am not arguing against globalisation – nor the benefits it brings – from modern travel and modern media to new products in our shops and new opportunities for British companies to export their goods to millions of consumers all around the world. Indeed, I have argued that Britain has an historic global opportunity to lead the world in shaping the forces of globalisation so that everyone shares in the benefits of economic growth.

But just as we need to act to address the economic inequalities that have emerged in recent years, so we also need to recognise the way that a more global and individualistic world can sometimes loosen the ties that bind our society together, leaving some people feeling locked out and left behind.

And the central tenet of my belief – the thing that shapes my approach – is that there is more to life than individualism and self-interest.

We form families, communities, towns, cities, counties and nations. And we embrace the responsibilities those institutions imply. And government has a clear role to play to support this conception of society.

It is to act to encourage and nurture those relationships, networks and institutions where it can. And it is to step up to correct injustices and tackle unfairness at every turn – because injustice and unfairness are the things that drive us apart.

This means a government rooted not in the laissez-faire liberalism that leaves people to get by on their own, but rather in a new philosophy that means government stepping up – not just in the traditional way of providing a welfare state to support the most vulnerable, as vital as that will always be. But actually in going further to help those who have been ignored by government for too long because they don’t fall into the income bracket that makes them qualify for welfare support.

It means making a significant shift in the way that government works in Britain. Because government and politicians have for years talked the language of social justice – where we help the very poorest – and social mobility – where we help the brightest among the poor. But to deliver the change we need and build that shared society, we must move beyond this agenda and deliver real social reform across every layer of society so that those who feel that the system is stacked against them – those just above the threshold that attracts the government’s focus today yet who are by no means rich or well off – are also given the help they need.

So we will recalibrate how we approach policy development to ensure that everything we do as government helps to give those who are just getting by a fair chance – while still helping those who are most disadvantaged. Because people who are just managing, just getting by, don’t need a government that will get out of the way, they need a government that will make the system work for them. An active government that will help them share in the growing prosperity of post-Brexit Britain.

That’s why we will shortly launch a new housing white paper to boost supply, tackle the increasing lack of affordability, and so help ordinary working people with the high costs of this most basic of necessities.

It’s why we will shortly publish a green paper to put forward our approach for a modern industrial strategy, setting out our plans to encourage growth, innovation and investment and ensure that as we aim to increase our overall prosperity – that prosperity is shared by people in every corner of our country.

It’s why as part of building a great meritocracy I have already outlined plans to increase the number of good school places so that every child – not just those who are fortunate to have parents who can afford to move to a good catchment area or pay to go private – can enjoy a school place that caters to their individual interests, abilities and needs.

So with all these steps we will deliver this new agenda of social reform. And government will step up to support and – where necessary – enforce the responsibilities we have to each other as citizens, so that we respect the bonds and obligations that make our society work.

This means government supporting free markets as the basis for our prosperity, but stepping in to repair them when they aren’t working as they should.

It means standing up for business as a great driver of prosperity and progress, but taking action when a minority of businesses and business figures tear away at the social contract between business and society by working to a different set of rules from everyone else.

It means creating an environment in which our charities and social enterprises can thrive – but responding when a small minority pursue inappropriate and unacceptable fundraising practices.

And it means not being ambivalent about the efforts of all those who give their time, money and expertise in the service of others; but recognising, supporting and championing those who lead the way in shaping a civil society that can bring the talents of so many in our voluntary sector to bear on some of the great social challenges that we face together.

That is why I have continued the important work that David Cameron began through the Points of Light programme, using the office of Prime Minister every day to recognise an outstanding volunteer in Britain whose service can be an inspiration to us all. It is why we are making National Citizen Service a rite of passage for every young person in Britain and supporting all those brilliant organisations in the Prince of Wales’ #iwill campaign who are encouraging our young people to give their time in the service of others.

And it is why we will continue to lead the way internationally in the development of social finance to harness the full potential of our charities and social enterprises in working with business and government to tackle some of the biggest social challenges in our country.

Our opportunity and responsibility

This is the new approach – the new philosophy – that we need in Britain today. An approach with fairness and solidarity at its heart.

And as we reflect on – and implement – the result of the referendum, we must recognise that we have a unique opportunity and responsibility to deliver the change that people need.

An opportunity because Britain is going through a period of great national change, and as we do so we have a once-in-a-generation chance to step back and ask ourselves what kind of country we want to be.

A responsibility because a failure to take this opportunity to show the ability of mainstream, centre-ground politics to respond to public concern would further entrench the very divisions we seek to overcome.

For we know what happens when mainstream, centre-ground politics fails. People embrace the fringe – the politics of division and despair. They turn to those who offer easy answers – who claim to understand people’s problems and always know what – and who – to blame.

We see those fringe voices gaining prominence in some countries across Europe today – voices from the hard-left and the far-right stepping forward and sensing that this is their time.

But they stand on the shoulders of mainstream politicians who have allowed unfairness and division to grow by ignoring the legitimate concerns of ordinary people for too long.

Politicians who embraced the twin pillars of liberalism and globalisation as the great forces for good that they are, but failed to understand that for too many people – particularly those on modest to low incomes living in rich countries like our own – those forces are something to be concerned, not thrilled, about.

Politicians who supported and promoted an economic system that works well for a privileged few, but failed to ensure that the prosperity generated by free markets and free trade is shared by everyone, in every corner and community of their land.

Politicians who made the deals and signed the agreements that changed the nature of their country, but failed to listen to the public’s concerns – dismissing them as somehow parochial or illegitimate instead.

The result of this consensus – this way of conducting politics – has been to bring us to a place where all the old certainties are called into question.

People are questioning whether the system of globalisation, free markets and free trade – one that has underpinned so much of our prosperity – is actually working for them.

When they lose their jobs, or their wages stagnate, or their dreams such as owning a home seem out of reach, they feel it is even working against them – serving not their interests or ambitions, but those of a privileged few.

And they are questioning the legitimacy of all the old institutions and systems we have relied on for decades. They have seen a small minority in the banking and business sectors appearing to game the system and play by their own rules. They have watched Parliament dragged into a row about political expenses, the media mired in questions about phone-hacking, a system that allows lawyers to get rich by hounding our brave troops.
And they come to a simple conclusion: that there is one rule for the rich and powerful and another for everyone else.

This is dangerous for it sows division and despair as the gap between those who are prospering and those who are not gets ever larger, and resentments grow.

And it emboldens the voices of protectionism and isolation who would tear down all we have achieved and take us back to the past.

So our responsibility is great. It is to show that mainstream, centre-ground politics can deliver the change people need. That mainstream, centre-ground politics can respond to public concern. And that a mainstream, centre-ground government understands what needs to change and has a plan to set things right.

Our plan for a stronger, fairer Britain

And that’s why this government has a plan, not simply to manage our withdrawal from the European Union, but to take this opportunity to fundamentally change Britain for the better.

A comprehensive, wide-ranging plan for the kind of country we want to be. A plan to build a country where wealth and opportunity are shared; where all of us, no matter what our background, play by the same rules; and where future generations enjoy the same opportunities from which their parents have benefited throughout their lives.

I will say more about this plan in the coming weeks. I will talk more about our plans for economic reform, our plans to build a global Britain and our ambitions to build a more united country.

But at the heart of the plan is a commitment to building a fairer society and tackling the burning injustices that have been allowed to stand for too long.

The burning injustice of mental illness

And I want to turn to one of those burning injustices in particular – the burning injustice of mental health and inadequate treatment that demands a new approach from government and society as a whole.

Let me be clear: mental health problems affect people of all ages and all backgrounds. An estimated 1 in 4 of us has a common mental disorder at any one time. The economic and social cost of mental illness is £105 billion – roughly the same as we spend on the NHS in its entirety.

And for children – 1 in 10 of whom has a diagnosable condition – the long term effects can be crippling: children with behavioural disorders are 4 times more likely to be drug dependent, 6 times more likely to die before the age of 30, and 20 times more likely to end up in prison.

We all know someone – a family member, friend or colleague – who is directly affected by mental health problems. But while people talk about ‘parity of esteem’ – and it was a Conservative-led government that legislated for it – there is no escaping the fact that people with mental health problems are still not treated the same as if they have a physical ailment – or the fact that all of us – government, employers, schools, charities – need to do more to support all of our mental wellbeing.

As Home Secretary I was determined to take on the grave injustices concerning mental illness that were within my remit – and I made improving the police response to people with mental health needs a top priority.

And I am delighted that we have taken great strides forward in reducing the number of people suffering a mental health crisis who end up in a police cell, for want of somewhere else to go.

Since 2011 to 2012, there has been an almost 80% reduction of such incidences across England – so more people detained under section 136 of the Mental Health Act are rightly being taken to a health-based place of safety, rather than being held in a cell.

And for children and young people the reduction is comparable, and through the Policing and Crime Bill I personally introduced, this practice will be abolished entirely for under 18s from this spring.

This proves that innovative reforms that challenge the established way of doing things can improve the response to mental illness.

Now as Prime Minister I want us to go further. I want us to employ the power of government as a force for good to transform the way we deal with mental health problems right across society, and at every stage of life.

For years the only people who have stood up for those with mental ill health have been civil society groups and charities. Now I want us to build upon your success and the fantastic work that many including those here today are doing.

Organisations such as Mind who have led the way in helping those experiencing mental health problems. The Heads Together campaign – and the fantastic leadership shown by their Royal Highnesses the Duke and Duchess of Cambridge and Prince Harry – that aims to break the stigma surrounding mental health problems.

And the tremendous campaigning work by Black Mental Health UK – with whom I worked at the Home Office – to expose injustices in the way black people with mental ill health in particular are treated, and ensure politicians take action to put things right.

So you are leading the way – but today I want us to forge a new approach recognising our responsibility to each other, and make mental illness an everyday concern for all of us and in every one of our institutions.

What I am announcing are the first steps in our plan to transform the way we deal with mental health problems at every stage of a person’s life: not in our hospitals, but in our classrooms, at work and in our communities.

This starts with ensuring that children and teenagers get the help and support they need and deserve – because we know that mental illness too often starts in childhood and that when left untreated, it can blight lives, and become entrenched.

There is, for example, evidence to suggest an increase in self-harm among young people, with the number of 16- to 24-year-old women reporting self-harm increasing threefold – to 1 in 5 – between 2000 and 2014.

And we know that the use of social media brings additional concerns and challenges. In 2014, just over 1 in 10 young people said that they had experienced cyberbullying by phone or over the internet.

So first, we will introduce a package of measures to transform the way we respond to mental illness in young people starting in our schools.

We will pilot new approaches such as offering mental health first aid training for teachers and staff to help them identify and assist children experiencing mental health problems. And we will trial approaches to ensure schools and colleges work closer together with local NHS services to provide dedicated children and young people’s mental health services.

These steps will accompany a major thematic review – led by the Care Quality Commission with input from Ofsted – looking at services for children and teenagers across the country to find out what is working, and what is not.

Following this, CQC and Ofsted will consider how their future joint programme of inspections can ensure child and adolescent mental health services are properly held to account for performance.

And alongside these reviews, later this year we will bring forward a new green paper on children and young people’s mental health to transform services in education and for families.

These measures will build on the work we are already doing to put a stop to the untold misery of hundreds of children being sent halfway across the country to access mental health services.

By 2021, no child will be sent away from their local area to be treated for a general mental health condition.

But treatment is only part of the answer. We must look at what more can be done to prevent mental health problems, and work with you to capitalise on the crucial role civil society has to play in helping young people – and indeed people of all ages – build resilience.

Second, I want us to do more to support mental wellbeing in the workplace. So I have asked Lord Stevenson, who has campaigned on these issues for many years, and Paul Farmer, CEO of Mind and Chair of the NHS Mental Health Taskforce, to work with leading employers and mental health groups to create a new partnership with industry, and make prevention and breaking the stigma top priorities for employers. Because mental wellbeing doesn’t just improve the health of employees, it improves their motivation, reduces their absence and drives better productivity too.

We will also review employment discrimination laws for employees with mental health problems to ensure they are properly supported.

And we will do everything we can to get the right support to those with mental health problems who are out of work. For example, through our global leadership on social impact bonds – which drive investment in social outcomes – we are already providing up to £50 million to support those with mental health issues back into work and to help local areas tackle the link between drug and alcohol dependency and co-existing mental health problems.

Third, I want to ensure more people get the support they need, when they need it, in their communities. So we will make up to £15 million of extra funding available for community clinics, crisis cafes, and alternative places of safety to support a wider range of preventative services in the community, and ensure that charities, churches and community organisations can access funding to run them too.

And we are already investing over £10 million to support the fast track Think Ahead programme – which aims to increase the number of high-calibre mental health social workers – by at least 300.

Fourth, we will rapidly expand the treatment available by investing £67.7 million in digital mental health services. Online therapy has the potential to transform the way mental health services are delivered by allowing people to check their symptoms, be triaged online and receive clinically-assisted therapy over the internet much more quickly and easily, assuming it is clinically appropriate. These treatments have been tested in other countries and they work. In the right cases, they can offer access to treatment far quicker than traditional services.

Fifth, we will right the everyday injustices that those with mental illness encounter – starting by examining GP forms relating to mental health and debt. Because sometimes those whose illness has resulted in debt, or means they are struggling to pay their debt, have to prove their mental ill-health to debt collectors and pay their GP to fill in a form to do so. Such a process can worsen both mental illness and financial difficulties, so we will work with the Money and Mental Health Policy Institute to consult on these forms, with a view to ending the practice.

And finally, today we are publishing a strengthened cross-government suicide prevention strategy, which sets out a comprehensive plan to reduce the suicide rate in this Parliament, and targets those most at risk such as young and middle-aged men, those in contact with the criminal justice system and those in the care of mental health services. Because, on average, 13 people kill themselves every day in England, and if we want to improve the life chances of current and future generations, we need to address this shocking reality.

And in addition to all this we will ensure that the NHS itself takes the steps it needs to ensure that parity means just that: parity. We will hold the NHS leadership to account for the extra £1 billion we invested in mental health last year. We will make sure that mental illness gets the attention it deserves, in funding, research and technology investment. And we will be clear that when NHS leaders are redesigning services and developing new local solutions, mental health should get its full weighting.

As I have said these are just the first steps in our plan to transform our approach to mental health in this country. Meeting this challenge will take years and require more than government action alone – it will need a sustained effort on the part of everyone in this room and everyone across society.

But this is a historic opportunity to right a wrong, and give people deserving of compassion and support the attention and treatment they deserve. And for all of us to change the way we view mental illness so that striving to improve mental wellbeing is seen as just as natural, positive and good as striving to improve our physical wellbeing.

For too long, mental illness has been something of a hidden injustice in our country, shrouded in a completely unacceptable stigma and dangerously disregarded as a secondary issue to physical health. Yet left unaddressed, it destroys lives, separates people from each other and deepens the divisions within our society. Changing this goes right to the heart of our humanity; to the heart of the kind of country we are, the attitudes we hold and the values we share.

I remember the reaction when, back in 2012, Charles Walker and Kevan Jones spoke in Parliament about their own personal challenges with mental illness. The courage of these 2 MPs – Conservative and Labour – to speak out in this way, encouraged us all to put aside party differences and come together in solidarity.

That sense of solidarity will be essential in helping us to transform the support we offer those with mental health conditions and to defeat the stigma that makes addressing this issue so much harder than it should be. But I also believe that in a wider sense, that commitment to strengthening the bonds we share as a union of people, can be a defining part of how we meet the great challenge of our time and bring our whole country together.

It is by tackling the injustice and unfairness that drives us apart and by nurturing the responsibilities of citizenship that we can build that shared society – and make it the bedrock of a stronger and fairer Britain that truly does work for everyone.

Speech: Mental health problems are everyone’s problem: article by Theresa May

9 January 2017, 11:20 am

It is a tragic fact that 1 in 10 children in this country has a diagnosable mental health condition.

The long-term effects can be crippling: children with behavioural disorders are 4 times more likely to be dependent on drugs, 6 times more likely to die before the age of 30, and 20 times more likely to end up in prison.

While this government legislated for ‘parity of esteem’ in healthcare – so that whatever your illness, physical or mental, you are treated the same – very often the treatment for those with mental illnesses is inadequate.

For years it has fallen to civil society, charities, and the media to take on the problem – and I applaud all the work that the Huffington Post has done to raise awareness through its Young Minds Matter series.

But it is time for government to do more – to join HuffPost and other campaigners in the fight against something that blights so many young lives.

The need is urgent: the number of girls saying they’ve self-harmed has more than trebled in recent years, as just 1 example.

That’s why I raised mental health during my speech when I arrived at Downing Street for the first time as Prime Minister.

And it’s why today I’m announcing a step-change in the way that we deal with these issues.

I want to see mental health addressed not just in our hospitals, but in our classrooms and communities.

I want to see the stigma stripped away so that no-one in this country feels unable to talk about what they’re going through or seek help.

I want to see a focus on prevention as well as treatment, especially since so many adult mental health problems – which 1 in 4 of us will suffer from at any one time – begin in childhood.

This is part of a wider approach to tackle the burning injustices we face in society, and to build a stronger, fairer Britain that works for everyone.

For no parent should feel helpless when watching their child suffer. No teacher should feel ill-equipped to deal with a troubled pupil. No teenager should have to leave their local area to seek treatment. No child should ever be left to feel like their life is not worth living.

Mental health problems are everyone’s problem. As a society we must face up to that fact. And the announcements I am making today will ensure we do just that.