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Mr. Stephen Dorrell (Charnwood) (Con): I, too, welcome the publication of the national service framework. I do not claim to have read every word of it, but I have read a fair number. It reads well as a clear aspirational statement of a joined-up serviceto use the modern idiomthat is built around the needs of individual patients. It gives patients and service users in the social care system a clear framework within which the service will be delivered. The NSF is an entirely welcome and overdue statement of our aspirations for the service that we all want delivering, and nothing that I go on to say should be interpreted as resiling from or qualifying that in any way. I genuinely buy into the description of the service set out in the framework.
Having read several documents produced by the Department of Health over the past few years, I wonder what linking or delivery mechanism will connect the clear and attractive description of the service that we want with the actual service on the ground. My hon. Friend the Member for South Cambridgeshire (Mr. Lansley) also made that point. I agree with the Minister that we do not want a snowstorm of micro-targets to define every single output. However, there is a difference between a snowstorm of targets and, to use the Minister's words, a statement of aspiration under which occasional audits will be conducted, but with the eventual target of delivering an up-and-running service in its entirety some 10 years from now.
The hon. Member for South Swindon (Ms Drown) described the kind of maternity service that she wanted, which is one of the subsets of the services defined in the framework. I agreed with virtually everything that she said, but I have heard similar views expressed in the House since the day on which I was first appointed as a Health MinisterI am sorry to admit that that was 14 years ago. It was not the case that our ambitions for the services lacked clarity, but something more urgent always tended to squeeze out important aspirations such as those about which she spoke.
If we really want to depress ourselves for a moment, I can remind the House of the history of mental health service delivery over the past 40 years. During that period, the vision of how our mental health services should develop has been debated, but if hon. Members read Enoch Powell's speeches as Health Minister in the early 1960s, they will find something that is recognisably the same definition of the mental health service that we want to see and which has been redefined and redefined over in official documentsI was responsible for some, as both a junior Health Minister and as Secretary of Statefor 40 years. The difficulty is not defining the aspiration, which the national service framework does admirably, but getting the connection mechanism between the aspiration and the delivery.
My hon. Friend the Member for South Cambridgeshire was right to emphasise the danger of defining something that is important because it is in today's headlines or is a life-and-death matter in the short term. That always puts it ahead of the delivery of long-term objectives, whether it is maternity care,
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mental health services, which are part of the national service framework, or the other longer term aspects of health care delivery.
I say to the Minister in all seriousness that the document is good, but it is not good enough to say that we will look back in 10 years' time to see how we got on. I know that he is not saying that, but the danger of doing that is inherent in what he says. How many documents issued in 1994 has he checked to see whether their aspirations were delivered in the intervening 10 years? That is, perhaps, the test because many of the aspirations have not changed much over the years. It is, of course, an easy escape to say that a Tory Government were in office at the time, but if he reads the definitions of service ambition in terms of service delivery that were issued by the Department under Tory Ministers, and not even those issued by the professionals under Tory Ministers, he will find that they have not changed much, any more than the definition of maternity services has changed. The description of maternity services by the hon. Member for South Swindon was, I am sure she would agree, identical to the one that was issued in my time as a Health Minister when Julia Cumberlege was responsible for changing childbirth. That story repeats itself throughout health care.
The real challenge for Health Ministers is to find a connection mechanism. When my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) was Health Secretary, he used to say that it was a wonderful job with a good office. The officials presented him with an enormous array of impressive levers and he had to decide their positions and which one he wanted to pull, but he always doubted whether the levers he was invited to pull were connected to anything. That test needs to be applied to the national service framework.
Against that background of a degree of scepticism born of disappointmentthat is, I think, the best way to put itI offer a couple of thoughts on how we might improve our chances of delivering this noble ambition, which I think is a shared objective. The first is to consider the concept set out in the NSF of children's trusts. I read the wording of that with interest and there is a kernel of a good idea, but the problem with children's trusts, as with so much else in the document, is that they rely on improving co-operation between agencies.
We can all agree that most of the difficult problems to do with children's services rely on social services, the NHS, the education service and often the probation service and the law-enforcement agencies all working together, which requires them to understand each other's agenda in the case of a particular child or group of children. Many of the reports to which I have referred have relied on the assertion that this Government, with this new set of Ministers and this new political will, will crack inter-agency co-operation. With respect to the Minister, the NSF relies on the same analysis. It does not propose that we change the institutions but aims to ensure that, at last, we achieve genuine co-operation between the agencies. Children's trusts, if they are to add value and not just be barnacles on existing institutions, must do more than send missives that say "Wouldn't it be good if such-and-such happened for this child?". They must be able to break down the statutory
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distinctions between local authority social services and education departments, and they must have the capacity to tie in with the NHS.
Dr. Ladyman: The right hon. Gentleman has made some excellent points. For what it is worth, the Children Bill places a statutory duty on those organisations to co-operate, which is a new factor in the equation. There will be a director of children's services with a wide remit who will make sure that they honour their statutory obligation.
Mr. Dorrell: I welcome the statutory obligation to co-operate, but it is like saying, "This time, we are really going to make it happen." I do not remember a Minister coming to the Dispatch Box to say that they are in favour of agencies not co-operating. Ministers always say that they are in favour of co-operation and if they are to deliver it effectively, the agencies must respond.
I should like to offer the Minister some thoughts on the way in which children's trusts could develop. Local authority children's services and the department in the local education authority that deals with difficult children are, in effect, dealing with exactly the same group of individuals, and have far more in common than the LEA department has with other LEA employees who administer a normal school system for children who do not have special needs. I have always thought that there is a case for looking at the structure of local authorities. Instead of separating social services and education along functional lines, we should draw a line between the delivery of a normal education service to normal childrenI use shorthandand the more intensive specialist services required for individuals who rely both on children's social services and on the low achievers' services of the local education authority. If children's trusts developed in that way, instead of merely aspiring to better inter-agency co-operation, we would establish a machinery for delivering it, and children's trusts would be responsible for procuring services from the NHS, social services departments and LEAs to tackle the needs of particular children. I urge the Minister not to be seduced into believing that he has a wholly exceptional political will that can achieve the inter-agency co-operation that all his predecessors failed to deliver.
I should like to detain the House a little longer on a tiny matter arising from inter-agency co-operation. I declare a personal interest in the inspection regime for independent schools, as I am a trustee of Uppingham school, an independent school that serves the needs of people at the opposite end of the advantage scale. I am wholly in favour of inspection for such schools and I am not arguing that they should not have an inspection regime. However, as we are talking about the importance of joined-up government and inter-agency co-operation, I should point out that schools that parents pay in excess of £20,000 for their children to attend are inspected by the independent schools inspectorate as educational establishments. They are also subject to a wholly separate inspection regime run by the social services inspectorate, which has almost no track record in this field. It seems a rather obvious question to ask the Department of Health why it is not
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possible to have a joined-up inspection regime for independent schools. That is a very particular subject, but I ask the Minister to reflect on it. If he could write to me and let me know his views, I should be grateful.
Nothing that I have said will detract, I hope, from my initial enthusiasm for the service framework. It is a genuinely good document. It reads well, like a new beginninga new opportunity to improve the services available. We must look beyond the aspiration to the delivery. That is the area where the real challenge, as always, lies for Ministers. They have done the easy bit. Now we must hold them to deliver it month by month, year by year, so that when the Minister is sitting on the Opposition Benches and I am sitting on the Government Benches in 10 years' time, he will remind the future Minister of the aspirations set out, and the mechanism that he put in place will have made delivery of the aspirations inescapable.
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