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UNCORRECTED TRANSCRIPT OF ORAL EVIDENCE
To be published as HC 852 i
House of COMMONS
TAKEN BEFORE the
Foundation Years: Sure Start children’s centres
Tuesday 22 January 2013
Naomi Eisenstadt CB and Dame Clare Tickell
Evidence heard in Public Questions 1 116
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Taken before the Education Committee
on Tuesday 22 January 2013
Mr Graham Stuart (Chair)
Mr David Ward
Examination of Witnesses
Witnesses: Naomi Eisenstadt CB, Senior Research Fellow, Department of Education, Oxford University, and Dame Clare Tickell, Chief Executive, Action for Children, gave evidence.
Q1 Chair: Good morning. Welcome to this session of the Education Committee looking at Sure Start children’s centres. Thank you both for coming and attending. What is a Sure Start children’s centre, who is it for and what is it supposed to do?
Dame Clare Tickell: You do the first version and then I will do the now version.
Naomi Eisenstadt: Right. I think that is the most important question, because it is meant to do lots of things and the question is: can it do all of them? The original design of Sure Start was about multipurpose education on health and parenting outcomes, but also parental employment outcomes and also a very strong model on community development, so a onestop shop for families and children. In the beginning, of course, it was largely mothers, and I would say it is still probably largely mothers, but children would get developmental activities, and parents would get help with parenting in informal and formal ways-parenting classes-and also on employability skills. That is a very, very wide brief.
Dame Clare Tickell: I think the current version is also that. What we do not have so much now as when we had phase one or as we had with Sure Start centres at the beginning is the oversight from the centre, which defines very clearly what can and cannot be done. In some respects that is a good thing, because in fact they reflect locality very well now, but it makes them vulnerable to decisions that are taken that are not necessarily consistent with what we know works for Sure Start or children’s centres. I do think at some point I would like to land the point, but there is something about what we call them, because some people think Sure Start and that evokes a response, which takes me back to the first phase one Sure Starts, and other people think about different things. One of the great things that you guys could do is to decide what they are called in this review, because I think that sometimes creates a dissonance for people making decisions or having views that are about preconceptions that they had as opposed to what it is that they do now.
Q2 Chair: We have done various inquiries into assessment, and I think there was one academic who came up with 23 different purposes for assessment, so however brilliantly your exam is designed, it can only handle a few of these purposes. Naomi, you gave a list of headings, but they so easily subdivide. How many purposes do these Sure Start children’s centres have? You have community development, whatever the meaning of that is. You obviously have preparedness for employment for the parents. You have straightforward education. You have parenting help per se. You have child development and you then have this school readiness, which I suppose relates. Has there been a change in the emphasis given to these policy priorities at different times, and what has fallen back, what has come to the front and where do you think we should be going?
Naomi Eisenstadt: There has been a huge change in terms of community development, and that was based on evidence from the evaluation. In the beginning, we were very, very interested in coproduction and codesign and parentled and all that stuff, and just because the parents like it, it does not mean it is going to help the kids or, indeed, help them. If they do not like it, they will not come. So there is a problem about to what extent you are responding to what mothers and fathers want and to what extent you are delivering things that you know will help their children or, indeed, help them. So that is a tension in itself.
Q3 Chair: Is there a tension in that those who are best able to articulate what it is they want are not necessarily the people for whom you are primarily trying to design the service in the first place?
Naomi Eisenstadt: I think that is exaggerated myself. I think that most people can articulate what they want, but they want different things. The joke was always the great aromatherapy debate: that parents say they want aromatherapy, but this does nothing for their employability skills nor does it do anything for their children, their children’s school readiness or, indeed, their children’s social and emotional development. But if it gets them through the door and then you use that to assess wider needs and have those discussions, then it is a useful thing to do, provided you realise it is your technique for getting them through the door and not something in itself-that it is going to promote community cohesion or whatever. That is the big issue.
I really could not care less what you call them. Call them "banana". The question is what does Government think the offer is for children and families and how is that offer made and what are the key priorities? To go back to your question, Graham, there is a range of outcomes we want for children and a range of outcomes we want for adults. A few can do it, but it is very difficult for single centres to do all those, and at some level, either at the centre itself or, indeed, at local authority level or at central Government level, someone has to decide which are the preeminent of those and concentrate on them, because it is unfair to judge them by, as you say, too many different measurements of success, because it all flattens out.
Q4 Chair: Naomi, you have been instrumental in the whole programme; as you say, it is for policymakers to prioritise, give clarity and be realistic about what most centres can do. There is always a danger you meet the superhero head, the superhero children’s centre leader and you say, "Well, if they can do it, everyone can do it," and that is a false idea that ministers are often gripped by. So what do you think the priorities should be, or should they not be decided? Of course, this is supposed to be a Government of localism. We believe in devolution and allowing people to tailor their service to meet local need. Is this a decision that should not be made at this level of Government but should be made locally?
Naomi Eisenstadt: I am quite happy either way. I tended, when I was running things, to be terribly authoritarian and wanted to decide everything at the centre, so I just own that, but I think it is okay as long as, if you are deciding locally, the measurements are local. So, I have my own view about what should be the key concentration. One of the big changes, and, indeed, one of the big successes since Sure Start was invented, is universal, 15 hours a week free for all three- and fouryearolds. There has been a fantastic uptake and that is massively important. So, I would like children’s centres to concentrate on underthrees, so I think underthrees are really important. If I was going to have it childcentred, I would be concentrating on social and emotional development and language development, because I think language development is enormously important in terms of school readiness. But I also believe, if your main aim is antipoverty, you should be concentrating on parenting and employability skills. Again, it is that dichotomy, because basically if you do not want to be poor, you have to have a job, and if women are home with their children, improving their literacy skills is a double hit: if you cannot read, you cannot read to the baby; if you cannot read, it is unlikely you are going to get a decent job. We should just think through specific things like that, but certainly I think the concentration should be on underthrees.
Q5 Chair: You are clear on that. One of the initial big impetuses was around employability skills for the parents so they get into work, and we know the children of parents who work have much better outcomes. Has the focus on that been diluted over time and do we need to return more to it?
Naomi Eisenstadt: It has been diluted in taking away the childcare requirement, because if the parents do not see the childcare, if they do not see it as reality, they are much more reluctant to go into work, and the childcare in children’s centres tends to be higher quality.
Dame Clare Tickell: I agree with pretty much everything that Naomi has said, and I am happy if it is called a banana too. We need something that does not have multiple definitions, I think, for me. That is the bit that is not hugely helpful.
To go back to your question on the statement of intent, I absolutely take your point that there are lots and lots of things that now get chucked into the Sure Start or the children’s centre basket. One of the things that certainly we are experiencing in the children’s centres that we provide, and in some ways I welcome it, is there is an expectation that they provide a onestop community shop in lots and lots of different ways for parents with young children. Increasingly-and this is where I think Naomi’s point about underthrees is important-also they are a way that maybe you can absorb older children. That is a good thing and a legitimate thing, because of course lots of mothers and fathers-indeed, lots of parents-do not just have underthrees; they also have siblings who need to be looked after. But there is a risk that if you do not remember what the core purpose is, you dilute what the children’s centre is doing and turn it into really just a community resource or maybe a family centre. So there is something about remembering that these are primarily a resource for young children and we need to see them in that way.
Interestingly, what the coproduced statement of intent does not express, which is something that was kind of in the first principles and is really, really important for us, is that we are providing a multidisciplinary centre and health is really, really important in that, and that is not specifically and explicitly in the statement of intent. For us, when I think about our best children’s centres and how closely they work with health professionals-where we have paediatricians, health visitors and midwives working in those children’s centres, working very closely not only with children but with parents-I think that is missing, specifically as a way of recognising the importance of pulling together all of those professionals.
Q6 Chair: Effectively, you think that we have to keep this wide range of priorities, but then that comes down, I would imagine, to the quality of leadership at the centre if you are going to have genuine integration rather than just a whole bunch of services provided from the same building.
Dame Clare Tickell: Leadership, for me, is absolutely critical. The point about lots of different services takes us into the locality point, which is where I think locality is really helpful, because different localities are of course different, and our children’s centres reflect what is happening at a local level. So I do not think it would work to be totally prescriptive and say, "You have to have one of all of these in a children’s centre for it to be good." What you need to recognise is the importance of ensuring that the children’s centre reflects the locality and can demonstrate strength of relationships and partnerships.
On leadership, I think it is really, really important that we have good leaders in children’s centres. Just as I think it is important that we have qualified healthcare workers and qualified teachers-we may come on to that question-I think it is really important that we recognise the importance of leadership and a high quality of professional person who is running children’s centres in order to have the kinds of conversations that we need to have. Remembering always that it is really important that they are, for me, a universal service, we do lots and lots of work on early intervention in our children’s centres. Safeguarding is a real issue, and we need to have the kinds of conversations that can recognise the fact that children may be at risk, parents may be struggling, they may be neglected, and the children’s centre has a really key role to play in both doing something about that and working with agencies to ensure that there is not harm to a child.
Naomi Eisenstadt: Graham, can I just make a point about leadership, because it was something that struck me when I was writing my book about Sure Start? One of the reasons that leadership is so important is, when Clare describes interagency and interdisciplinary work, if you do not have status within the community and you ring the health agency, they are not going to ring you back. This happened to me. When I ran a children’s centre many, many years ago in Milton Keynes in the late 1970s, early 1980s and I rang the community paediatrician because I was worried about a health issue affecting the children in my centre, she thought I was out of my mind. I was a nursery worker. What was I doing ringing a doctor? So unless there is some status in being a children’s centre leader, you will not get the interagency cooperation that you need to make it work properly, because I do not want the children’s centre to manage the health visitors; I want the children’s centre leader to be able to work collaboratively with the health service managers so that the colocation means something.
Dame Clare Tickell: Just as an addendum to that, one of the issues that is around very much-I asked the question, in Action for Children, before the Select Committee-is this knotty issue about communication and data sharing between health, having said how important health is. One of the things that a number of my staff got back and said is that there is a real issue, because very often it is difficult to share information because health professionals are, quite rightly, concerned about confidentiality around vulnerable adults who are parents. So you get an interesting social work conversation about what takes primacy. Is it the wellbeing of the child and safeguarding issues with the child or is it protecting a vulnerable adult? You do need someone who can fight that and have professional credibility in order to have that conversation.
Q7 Neil Carmichael: We have been round that course with Professor Helen Mundel’s1 report in terms of the need to have more judgment in these matters, and that is what you are essentially saying, is it not?
Dame Clare Tickell: I have not read her report, so forgive me.
Q8 Neil Carmichael: She was talking about social services and the move away from the tick box, bureaucratic approach towards harm and judgment and so on of social work, so you would endorse that, presumably.
Dame Clare Tickell: Absolutely and I would say these social work discussions are infinite, particularly when you are talking about vulnerable adults who are parents and also their children. They are all about infinite shades of grey and it would be lovely if there were very straightforward answers. There never are straightforward answers. You need to have a deep conversation that thinks about risk and how it is that you mitigate risk.
Q9 Neil Carmichael: Building on that point, what you need is not so much little boxes of solutions but a whole pool of professionals able to relate to each other on relatively equal terms and able to make judgments upon the circumstances that they find.
Dame Clare Tickell: Indeed, and very often the characteristics of serious case reviews are that in fact that rich conversation has not managed to take place, because the connections between the different agencies, for whatever reasons, have fallen down.
Q10 Chair: In any area, health always seems to be the elephant in the room. But flows of information, first of all, from local authorities to children’s centres, are they adequate?
Dame Clare Tickell: From our perspective, that does not feel to me to be a problem. The children’s centres we run are commissioned by local authorities. I do think that the idea that there should be known social workers where there are none is a very good one. It is not hugely helpful if you have to work with duty social workers, but that does not feature as a big issue of concern for us in the 200 or so that we run.
Q11 Bill Esterson: I want to ask you about the new core purpose. Have the Government got this right when they say that the purpose should be to improve outcomes for young children and their families, with a particular focus on the most disadvantaged families in order to reduce inequalities in child development and school readiness, supported by approved parenting aspirations, selfesteem and parenting skills and child and family health and life chances? On the concentration on the most deprived, some of the children’s centres I have been to have a good social mix and that seems to have a very beneficial effect. Discuss.
Naomi Eisenstadt: This is a real problem and it comes up all the time, and the other issue is whether addressing the tail is shifting the curve. I think the social mix in children’s centres is really important, provided the staff are skilled enough to notice and identify the most disadvantaged and provided they have the data from their area to do the outreach work and find out who is not coming and why.
Dame Clare Tickell: And go and find them.
Naomi Eisenstadt: Yes, and go out there and find them. It is interesting in terms of my saying that community development is not part of it anymore, but one of the community development bits of it is making sure that the current crop of users are not offputting to the most disadvantaged, because that is what happens. They do not want the drugabusing woman there; they do not want their children mixing with that family. So it is a very skilled task to get that mix right. I think you can do it, but I think that you have to be very explicit about it. I kind of have a quadrant box about wants and needs, and the difficulty is that there is the wants yes, needs yes, which makes everybody feel good because they are grateful for the services and they tell the Minister, "It changed my life; he really could not do this before he came," and all that. Then there is the wants no, needs yes, and the wants no, needs yes group of families are the ones that the other mothers do not want around either. So it is the outreach work and understanding the community and having those links with social services and having links with adult mental health and having them with the drug services, because when an adult goes to use a drugs service, they do not know if they are a parent or not. They do not know if they have a twoyearold or not, and that is how you find out. You sit in the housing office. The most disadvantaged families will still need a place to live and it is those links that will link you to the most disadvantaged, but unless you keep your other group in, you will not get the benefits of social capital building, which it talks about later on, and also you wind up with a highly stigmatised service.
Q12 Alex Cunningham: When you talk about not understanding the cohort of people that make use of it, you mentioned that, more or less, some mothers or families are driving other families out. Is that what has happened across the country with Sure Start centres?
Naomi Eisenstadt: No, but it is a skill that you need to make sure that you have. It is not that they drive them out; the initial evidence from Sure Start-the big shocker evidence-was on teen mothers. Teen mothers were not benefiting from Sure Start. A whole bunch of other women were.
Q13 Alex Cunningham: Were they driving the more needy out? I thought that was what you were suggesting.
Naomi Eisenstadt: I do not think they are driving them out. I think it is about whether it is a comfortable place for everybody and how you make it a comfortable place for everybody. Driving out is a bit hard. I do not think anyone says, "No, you cannot come." I think it is how you feel when you walk into the place and what kind of welcome there is and how much you introduce the other people, and that is really, really important. My view is if you go too hard on the community development line and parentrun, the danger of parentrun is that the confident parents will drive out, and I have seen that happen. So you cannot have a wholly parentrun centre, nor can you have a centre that is wholly for the most disadvantaged, and you need to use your data to keep checking that.
Dame Clare Tickell: One of the things I would add to that is I can think of a number of such instances in our children’s centres work, which speaks to Naomi’s point about how skilled a job it is to integrate people who otherwise, in some instances, have felt hugely stigmatised within their communities. Very often in those communities everyone knows who everyone is and there will be a handful of families that people have a whole set of preconceptions about, and it takes great skill to gently get those people engaged with a children’s centre and the people within it. When that flies, what you get is people who have had all of those preconceptions realising that there is something they can really do, as members of the community, to integrate that family, and that is really exciting, but that needs to be managed very carefully.
Q14 Mr Ward: Particularly with a lot of the young mothers, the last experience of a similar setting was when they were at school, and that was a pretty unpleasant experience for many. There is no easy way to say this, but how do you reach the hard to reach and particularly mothers in certain ethnic minority communities where there is a reluctance to let the female out of the house, particularly into a setting where there may be-well, hopefully-young fathers in the setting as well? How can we reach out to them?
Naomi Eisenstadt: If you want the Bangladeshi women, you need Bangladeshi staff.
Dame Clare Tickell: And you need sometimes to think about providing services off site, very specifically, so you would take services to people, as Naomi says, in ways that are more recognised on those cultural issues. It is really, really important to do that.
Naomi Eisenstadt: It is an important both/and. It is a terrible cliché, but you start where people are but you do not leave them there. I had so many really interesting experiences. When I first took Norman Glass to Birmingham to visit something I was running when I was in the voluntary sector, he was going around the country deciding what he was going to do. It was the first place he had ever been to that was absolutely packed with men. It was East Birmingham; it was all Pakistani and Bangladeshi community and it was benefits advice day and the men handled the money, so it was a way that men got in. You just need to figure it out within different communities, but I think it is really, really important that you do not set up separate provision that stays separate. That is what is really important, because then we are encouraging isolation and also we are enormously disadvantaging their children in terms of the social mix that they will benefit from at school. The problem works the other way in Cumbria: will the children growing up in Cumbria feel comfortable working in Birmingham or in Tower Hamlets? So those social mixes are really important.
Q15 Chris Skidmore: You have mentioned the word "community" several times so far in the discussion, but how do you go about defining community, because obviously it is such a loose term that it means nothing to me as a politician. We use the word "community" all the time and it sounds like a nice warm word that we can put in our leaflets.
Chair: Hardworking families in the community.
Chris Skidmore: Yes. When it comes to looking at the numbers and the location of the service, even within wards, how do you go about constructing what is a definable community? Obviously the location of the children’s centre itself is often vital-whether it is in a middle class area, which stops people from the council estate crossing a road. Have you got any thoughts on how you would define a community or should it just be left loosely for the local services to decide themselves once they are leaders in the community themselves?
Dame Clare Tickell: That is such a good question. They are all good questions, sorry.
Chair: Some are better than others.
Dame Clare Tickell: I could not possibly comment. In a way, it is both. I think there are communities, and to ignore the way a community or a set of communities traditionally has defined itself would be a silly thing to do, because you would not get traction beyond a selfdefined community of people. I can think of a children’s centre that we run on Merseyside that I went to, which was just absolutely fantastic and the resources that have gone into it are-sorry, not Merseyside, the North East-quite staggering. As a consequence, I met people who-exactly your point-were crossing a road and going into a community that traditionally they just did not. There was a station on one side of the road and a station on the other side and never the twain shall meet. But because the schools, the children’s centre and everybody had made it a priority to get people from both of those communities into that children’s centre and there was no sectarian element to it at all, it was working. I think you can redefine communities or you can do work that will redefine them that will encourage people to challenge some of the ideas that they may have had for generations about people from those different communities by what it is that you are providing in those children’s centres very deliberately and explicitly. Also, very often they are offering stuff that otherwise they are not going to get. The question is making sure that people know that those services are there and that it is not going to be a problem for them coming into them. Does that make sense?
Q16 Chris Skidmore: Yes. Essentially, you are saying also that the key to the door with children’s centres is that there is a limited range of addon services as well.
Dame Clare Tickell: You have to create something that, within the context of your locality, is something that people want or absolutely offers something that makes some sense and that they will hear about from other people, not just because you put things through their door or because their social worker or their teacher tells them that it is a good thing to do. It becomes something that they want to be a part of.
Q17 Chris Skidmore: In terms of trying to create that and trying to get that outreach and attraction to the service, does there come a point where there is an issue of funding and resources in that you need to create a larger service that is going to span across several communities, rather than having several cottage Sure Start centres that are going to be too small to effectively have the resources.
Naomi Eisenstadt: It is extremely difficult. It is the same thing we are facing in health with specialist hospitals, six in the whole country-and I would rather go to the specialist hospital and travel. But as to the types of services we are talking about, when we first did Sure Start we said prampushing distance. Of course, now that we have obesity problems, we should lengthen that so you have to walk further to get to your centre, and then that will solve two problems.
Dame Clare Tickell: As long as they do not have a heart attack on the way.
Naomi Eisenstadt: Yes. I think neighbourhood locality is really important and I think that you can have some specialist services that move around. I had a really nice example. I visited the most wonderful children’s centre, and I was really very uncomfortable about visiting it, but when I went I was completely knocked out by it. It was Lubavitch Orthodox Jewish Centre in Stamford Hill. I do not like separate provision-just historically I do not; I am very uncomfortable about it. But first of all, the woman who ran it said she was very proud of how diverse it was because there were so many different sects of Orthodox Jews in Stamford Hill and they let people in who were not Lubavitch, so this was really impressive. What I really liked in particular was that this was Haringey, Hackney authorities and there was a Muslim centre, an Orthodox Jewish centre and a general centre, and the three centre leaders met once a month to decide where the midwife would be and where the health visitors would be. So they were moving the specialist services around the centres and around those communities. When I challenged her on whether this is the way to bring up British children, she said, "Nobody would come if we do not do it this way, and these children need support like anybody else’s children." I would recommend any of you visit it; it is a remarkable place. Adult education is on the top floor; it has the largest Yiddish library in London, in a children’s centre. It is wonderful. But I think that notion about what makes up community and then how you take scarce resources and move them around communities, rather than trying to have big centres with everything that are further apart, will not work for early years services.
Q18 Chris Skidmore: That will not be as effective almost because it reflects a critical dividing line in services. That is, I guess, you can target educational services, but under NHS constitution rules you have to have-
Dame Clare Tickell: Yes. I know you want to move on, but to your resources point, one of the things that a number of local authorities are doing that we are working with is commissioning clusters of children’s centres over a geography, and we are doing quite a lot of that. So there may have been six children’s centres where, traditionally, we would have had the full panoply of services and specialisms and expertise in each of those children’s centres: they are now clustered. As long as you have the leadership in each of those children’s centres, you can say, "This one will specialise in this and this one will specialise in this," which allows you to make better use of resource, but there are caveats to that in terms of leadership. That is not a reason not to have good leadership in each of the children’s centres.
Chair: Thank you. This is a fascinating discussion and terribly informative. One thing I should just remind you of is of course the business end of what we do. We conduct these inquiries, we then write our report, we make our recommendations, and the Government has to respond. Just make sure, by the end of the session, if there are any recommendations coming out of these insights about any changes that could be made at governmental level, not to leave those unsaid and untested.
Q19 Bill Esterson: Speaking of which, if we talk about money for a bit, how do we get the best value for money and the most effective use of resources when those resources have been reduced? You mentioned parenting, employability and making Sure Start a resource for young children. Is that the answer to that question and is that what the Government’s new core purpose is going to achieve?
Naomi Eisenstadt: I am going to say something deeply unpopular, but I do believe that we do not need 3,500 children’s centres. I would rather see fewer better, and I think there is a really interesting irony in all of this: because they are so popular, there is incredible toxicity in closing them. So instead of closing, you reduce staff and you reduce staff and you reduce staff, and they cannot do anything. I am advising Oxford on the evaluation of children’s centres. I am really worried we are not going to find much impact, because if they are so thin, they cannot be effective. I would rather have the model of a full service, all singing, all dancing, in the poorest communities and have significantly fewer. Because we have universal preschool education now, I think that makes sense. I also think we should not sweat the asset of our universal services in health and education, so if you really do not have children’s centres in nonpoor areas, what is the health visitor doing, what is the school doing, what is the preschool doing? Almost everybody comes in touch with a public service.
Q20 Bill Esterson: So, use health and education to target the undertwos and their families where there are no children’s centres.
Naomi Eisenstadt: Yes. We have brilliant universal services in this country. We do not sweat the asset.
Q21 Chris Skidmore: Just quickly on that point, if you had to give a number as to the 3,500-
Dame Clare Tickell: I think you walked into that one, Naomi.
Chris Skidmore: There must be some figures out there that you would say are realistic.
Naomi Eisenstadt: I cannot.
Q22 Chris Skidmore: You have made a statement saying you should do it, so you must be able to give some suggestion about, in percentage terms, what would be a reduction.
Naomi Eisenstadt: The fear in the reduction is that the money is not reinvested in those poorer areas. So if I felt safe that the money was going to be invested in those poorer areas, I would feel much more comfortable. If it just goes off into the ether-
Q23 Chris Skidmore: If there was a ringfence, then what would you be looking at?
Naomi Eisenstadt: 1,500.
Q24 Craig Whittaker: What the Minister said when she came before us, Liz Truss, was that only 25 would physically close with the rest being more like mergers. Do you see that model as more effective going forward?
Naomi Eisenstadt: No, I think it is really depressing that only 25 were physically closed. A lot of those centres will be half a person and a bunch of leaflets. What we have seen is where each centre used to have their own centre manager, they take that centre manager out and that manager manages five centres, and that manager may be the only graduatelevel qualified person in the centre.
Dame Clare Tickell: This is my point about quality. If you cluster, you cluster your back office, but what you do not do is to think that you can have one person-like in the Catholic Church, where they now have priests managing a number of parishes. That is not going to work. This goes right back to the very beginning, which was the point about the importance of having highly professional staff leading children’s centres who are able to engage with the other professionals to ensure that you get that integrated response.
Q25 Bill Esterson: Most of the centres in my constituency are in schools or colocated in schools, so the logic of what you have just said, Naomi, is to get the school to use that physical space if you are going to reduce the numbers. How common is that as an experience-that they locate either with health or with education, and therefore there is a space there, so the kind of model that you have just identified-
Naomi Eisenstadt: I did not mean the physical space. I think colocation with schools is a good thing provided the school is sympathetic and understands the wider interagency work. Of course, what it does do is it brings that interagency work into the school in more general terms, which is a very good thing. So I think that is a good thing. I am talking about where I started earlier on: what is the offer for children and families? In the poorest areas there should be a centre you can go to that is a multiagency centre and all that, so what about the poor kids who live in nonpoor areas, because there are a lot of them, and what about the nonpoor kids where families have complex problems anyway? It is about the way the public services work in terms of what we used to say when I did social exclusion-no wrong door. No matter which bit of the public service you come in contact with, what is the awareness of safeguarding issues? What is the awareness of maternal mental health on child outcomes? Would a school know that the mother of a child in the school has a serious mental health problem? It is how the system works together where we have a system already in place.
Q26 Bill Esterson: It leads into things like the Common Assessment Framework.
Naomi Eisenstadt: Yes, exactly.
Dame Clare Tickell: Yes, absolutely.
Q27 Bill Esterson: But is it important to have a physical place for people to go to?
Dame Clare Tickell: Yes, I think it is.
Q28 Bill Esterson: Sorry, while you are thinking about the answer, I think this is one of the reasons that closures have been avoided and I think what you have said is what I have seen as well-you get this skeleton function. But if you close them, people have to travel very large distances and then they are not accessing, or does that just come back to your point about the alternative with other services?
Dame Clare Tickell: I went into one the other day that we have taken over in Hampshire that is part of a bigger community centre. It was very challenging intellectually, because you walked into this huge community centre, which has a library attached to it and there is a tiny little corner and a room that is called "the children’s centre". It was very challenging in lots of ways, but in fact what it does very well is to signpost into a much large children’s centre that is down the road, and your point was that if you did not have the signposting and people could not go into that one first, they probably would not end up accessing the other range of services.
Q29 Bill Esterson: So the satellite model is effective.
Dame Clare Tickell: In that particular instance, but then behind that in Hampshire there are a lot of children’s centres, so it is quite difficult to take a particular piece out and say, "If you have that, that works for everything," because you are back to the locality point. But the infrastructure in different local authority areas is universally different and, in a sense, that is the challenge.
On your education point, I have seen and we run some fantastic children’s centres that are next door to schools. When that works well and you get something that can work from birth through into reception and beyond and picks up on all of the fantastic recommendations that I met on the Early Years Foundation Stage, it works brilliantly well. There is a risk, though, that at the moment when there is so little money around we distort into an overemphasis on health or an overemphasis on education. One of the great strengths-and this is not just me saying this because I work in the voluntary sector-around the independence of Sure Start is that it levels out all of those disciplines, so that you will genuinely get people who become focussed on doing something with all of their colleagues that is in the interests of the child. That is a secondary thing that informs the fact that they are there with the child at the centre of what it is that they are doing. The risk, when you start dropping it into different public sector agencies, is that becomes the thing that determines the approach that is taken, if that makes sense.
Q30 Bill Esterson: Yes, it does. I suppose the answer I am looking for in what you are saying is about how you make sure that there is a consistency of approach across the whole of-let us go for utopia-public services, the voluntary sector and everybody who has anything to do with families and children.
Dame Clare Tickell: I do not think you can ensure it, because you just cannot, but I think that there are some ingredients that will help it to happen, as with everything. You know how fragile these things are sometimes because a key member of staff leaves one of the agencies and it is something that was completely taken for granted, so they fall through everybody’s fingers, and they realise quite how important that person was and the skills that they had in holding the piece together. What you can say, though, is that if you have professionally qualified, articulate, confident professionals working across that system, you have a better chance of having the right conversations, which we were talking about earlier on, than you have if you have people who are underqualified in any part of that system, because they will not be able to get their particular perspective across when it is really important.
Q31 Chair: The message that could be taken out is cut the numbers, so we are going from 3,500 down to 1,500, because you would rather have fewer, much better, richer, better qualified and supported and better paid leaders in place. But there is always the fear, and it is the reason one sits defending the indefensible, that if you reduce the number they will just reduce the budget and you will end up with fewer underfunded, poorly led, poorly rewarded leaders, and so you get into basically fighting very hard to defend the indefensible because they fear what would happen if they do not. How do we negotiate our way through so that we do not lose the insight, the impetus and the belated recognition by Government of the need to support early years as part of a rational approach to preparing young people for the world?
Dame Clare Tickell: In terms of the problem with the counting thing and the 3,500, I am not sure I would have said what Naomi said
Chair: It was very brave, yes.
Dame Clare Tickell: I am quite sure, because that 3,500 is made up of phase ones, phase twos and phase threes, so in point of fact you have apples, pears and bananas sitting in that 3,500.
Naomi Eisenstadt: That is exactly right.
Dame Clare Tickell: So I would start from something else, which is about the definition of a good children’s centre, and I think some of the things in the core purpose are there and right. We need to be thinking about what it is that children’s centres do, recognising that sometimes you are proving a negative, because in point of fact it is what does not happen as a consequence of having children’s centres in communities, and it is the fact that by intervening early and providing that range of different services you are reducing the number of children who will go into tier three and tier four, up at the safeguarding end. Lest we forget, lots of children’s centres are delivering the Early Years Foundation Stage. What we know in our organisation is that the profile on Early Years Foundation Stage outcomes is improving year on year in our children’s centres, and that is good for schools. So there are secondary benefits that you need to be sighted on in order to understand their value and that, I think, is a better way of thinking about why it is we need to protect them.
Q32 Mr Ward: There was a rationale for centres or areas being within phase one, two and three, so that could be a starting point in terms of looking at how we get to fewer.
Naomi Eisenstadt: I think the difficulty is that it is not a helpful argument. I know that at some point you have to do it, but in terms of numbers or how many I think the key question is: what is any family with an underfive in this country entitled to, what do we think they need, and what is going to deliver the best outcomes for their children? Now, we know what that is in schools. Nobody argues that we should not have schools and no one has done a randomised, controlled trial about whether school works or not. No one has taken half the eightyearolds out of school for a year, randomly, to see what happens. Everybody knows where the school is. Everybody knows where the GP is. Everybody knows where the hospital is. We now have that in place for three- and fouryearolds in terms of childcare, early education, and that is an enormous plus.
The puzzle that is missing is this integrated, complex, family support when children and families are most vulnerable. Families tend to be poorer when their children are young. Being poor when you are young has the longest impact on your life, and when I say young, I mean minus nine months to three; I am including pregnancy and very, very early in. If there is one thing that we fail on, I think we fail babies. I do not think we do enough support through the baby period. So it is not about how many; it is about how you distribute the resource you have in a way that is going to have the biggest impact. Where I really agree with Clare, and I say it in a slightly different way, is that these places shift the families on the cusp just back from the brink of where they may fall into deep disadvantage, real problems. We will never know how many, but the savings on that are enormous, and I am very, very worried that if unemployment increases, if child poverty increases, those families on the cusp are going to fall the wrong way. So the need for these sorts of services will be increasing over the next couple of years, not decreasing. The funding to provide them is going to be decreasing.
Q33 Neil Carmichael: It is a really fascinating discussion. I just want to go back to a point you made before about making public services sweat a bit more. By that I suppose you are talking about the vulnerable groups being directed or at least advocated on behalf of through professional structures so that they get to the right place at the right time, so that whatever public services are available-and there are much more than you sometimes think-they are using them in a more robust way. Is that a summary of your argument?
Naomi Eisenstadt: It is the whole business about hard to reach. It is almost impossible to find a family that is not in touch with something, because the very poorest families will probably be in touch with housing and benefits. So it is about we join up housing and benefits in terms of not just referral-"here is a leaflet"-but the phone call. It is sort of reverse outreach work, if you know what I mean.
Q34 Neil Carmichael: There is another issue, which stems from Chris’ question before about what a community is. If you have a community that is, effectively, too introverted in its outlook and location and so forth, it is going to be really hard to break into that community. So another area of focus, if you like, is effectively, I suppose, social opportunity, social awareness and more information flowing around to areas that have basically been starved of information in the past. So how do you construct the sort of community that is sufficiently local but also sufficiently well connected to the professionals and to the other structures that can support it?
Dame Clare Tickell: When we talk about sweating assets with children’s centres, we talk very much about how it is that we make sure that our children’s centres are integrated properly within the wider system, which I think is your point. I think that is a really interesting point, so, for instance, the twoyearold offering or the conversations and difficulties that there are around the delivery of the twoyearold offering seem to have happened in parallel to, but not talking to, children’s centres. So there has not been a conversation. I am not necessarily saying that the twoyearold offering should be universally delivered in children’s centres, but there is sometimes a disconnect between the two, which means that we waste an awful lot of time, effort and resource not thinking about, "Well, how do those two complement each other? If that is happening there, what does not happen there or vice versa?" So, for me, asset sweating is about how it is that your local system connects up to make sure that you are not duplicating or even triplicating effort, because if you do that, somewhere else something else is not going to be happening.
Q35 Chair: Is there any recommendation coming out of that-any blockage to that? What kind of impetus could be given to the system to make that more likely to happen?
Dame Clare Tickell: For me, there is definitely something about thinking, if you are planning or if you are looking at some of the troubled-family stuff or some of the twoyearold offer stuff at the moment, about where children’s centres sit in that. What impact might it have and how might we think positively about where children’s centres sit in that, rather than them being something that happens over there?
Naomi Eisenstadt: How do you make the twoyearold offer not 15 hours of childcare and 15 hours of parent support-a much more inclusive offer?
Dame Clare Tickell: Yes.
Q36 Chair: That is my question and I get only questions back. You are the experts to give us the answers, so we can put them in our report and take the credit for them. That is what we are looking for.
Naomi Eisenstadt: It is great, because I am not employed by anybody anymore, so I can say what I want. I think the twoyearold offer is nuts, myself. I do not think we are in a position financially to offer a free good to 40%, and I would much rather have the twoyearold offer be a conditional offer on a kind of support within a children’s centre or, indeed, reducing the cost of going to work by childcare. If it is an offer that says, "I am a mother at home, I am not working, I am in the bottom 40% and I can just go somewhere and leave my child in childcare for 15 hours and that childcare is not particularly high quality," I do not think it is a good use of public money. I do not think that we have the quality in place to offer those that will make a difference. What we know from the evidence of the evaluation of the twoyearold pilot was, unless it was high quality, it did not make a difference.
Q37 Chair: It also, as it happens, goes completely against a Government that is supposed to believe in two things: an outcome rather than an inputbased approach and localism. Instead, we tell them precisely how many hours, precisely who gets it, because we know best.
Naomi Eisenstadt: Yes.
Dame Clare Tickell: There is a better question, which is: which twoyearolds most need that support and how do you find them? In a sense, that will give you your percentage as opposed to the 40%.
Q38 Chair: Maybe those who need it most need 35 hours or it may be that they only need it for four months intensively, who knows, but we cannot find out because we have to fulfil the national-
Dame Clare Tickell: Yes, and that would be a qualitative response rather than a quantitative.
Chair: I am going to move to Ian and then I am going to, finally, move to our second scheduled question.
Ian Mearns: Chair, you are very kind, but the moment has passed.
Chair: Ah, excellent.
Q39 Alex Cunningham: The moment did not pass when I was having a drink. Our witnesses seem to have an uncanny ability to answer the next group of questions before we ask them, but I want to take Naomi back to when she was running the Sure Start unit. That was a time when the number of centres grew to, I think, three times more than what you are suggesting is perhaps the core number that should be serving our communities. You said they got to about 4,500-
Naomi Eisenstadt: 3,500 is what we are up to.
Q40 Alex Cunningham: Now you are suggesting maybe 1,500. My constituency has four or five centres within a twomile radius embedded in communities of great need. They do not necessarily work perfectly, but how do you get to the point where you can reduce the numbers and retain the quality but ensure that the access is taken?
Naomi Eisenstadt: The example I can give you is the area I know, Milton Keynes, where I live and where I have just done a child poverty review. Milton Keynes is very interesting because it has average child poverty levels but real concentrations in particular areas. There are a couple of wards that have three children’s centres that are all within walking distance of each other. One of the children’s centres wanted to offer GCSE English and some of the mothers wanted to take it, but they did not have enough takers for it. I think those three children’s centres should have got together and offered GCSE English and walked the mothers there-just made a real assertive effort-because the adult education could not afford to put on a course for the numbers who were willing from the one centre. If you did that, if you worked exactly as Clare is describing-more collaboratively in these poor areas-then three centres makes sense, but they work together in a different kind of way. I just think the number is irrelevant; it is what is on offer, can people access it, who needs what and how do we make sure that happens?
Q41 Alex Cunningham: How can you make a recommendation that you feel 1,500 is the right number?
Naomi Eisenstadt: I was strongly advised to pick a number. I do not want that number. I do not think the number matters. I think we need better fewer. It is what you define as a children’s centre. So, if you take that area and you say we have some satellites, we have some dropins, but that is one centre with one manager, that manager needs to know who is coming and needs to know the nature of the community. Once you go up to five or six or seven, then they do not know enough about what is happening in detail on the ground, and that is what worries me.
Q42 Alex Cunningham: You have talked quite a bit about quality, which of course is absolutely essential. The charity 4Children found that there has been a reduction in the number of fulltime childcare places but also the number of teachers in the centres. Does this not trouble you?
Naomi Eisenstadt: It troubles me enormously.
Q43 Alex Cunningham: What are we going to do about it? What do we need to do about it in terms of recommendations?
Dame Clare Tickell: We talked of the requirement that there should be a qualified teacher in children’s centres. Interestingly, everywhere I go I hear support for there being qualified teachers in children’s centres. It seems to have a momentum of its own, which is great. So, as a recommendation, I think it would be very helpful to say there should be qualified teachers in children’s centres.
Q44 Alex Cunningham: So what then is the relationship between Sure Start children’s centres and the early education thing, particularly when they are next door working very closely with their local schools?
Dame Clare Tickell: For me, there should be a relatively seamless transition and I would take Naomi’s point: minus nine months through to Key Stage 1 should happen in a way such that a child is unaware of the fact that they are moving through a system from something that starts with antenatal care and is very much driven by health, through to something that is about early years and all of the things that Naomi has talked about-so we are concentrating on personal, social, emotional development, communication and language and physical development-into something that takes you into preparing your child so that they can go happily into reception. Where that is delivered and how that is delivered will vary in different places and it is not hugely helpful to be prescriptive about it. That, in a sense, is the journey that the child should go through without realising that they have suddenly been handed from health into early years, and there comes a point where they are handed from early years into Key Stage 1 and it all feels very different.
Q45 Alex Cunningham: Again, you are managing to answer my next question before I ask it, but just to quote UNISON, they said that it would be a retrograde step to remove the requirement to have a qualified teacher linked to children’s centres. Do you both agree with that?
Naomi Eisenstadt: The requirement was for the children’s centres in the 30% poorest areas that were phase one or two. It was not all children’s centres. I think the other serious requirement that was taken away and relates to the qualified teacher argument is the childcare, because where the qualified teacher adds the most is in good childcare. The qualified teacher does not add that much in terms of parent support or in terms of evidencebased parenting programmes. I used to say, again, when we had this real separation between early education and care, the threeyearold does not know that they are in a group setting because their mother thinks they need early education or because their mother is working. The threeyearold still needs a high quality early education and the twoyearold needs a high quality early education, and the removal of the need for childcare loses that opportunity, but also, I think, is a disincentive in terms of getting mothers into work.
Q46 Alex Cunningham: Going back to your expression that what the Government was proposing is "nuts" in relation to twoyearolds, how do we make sure that we get to the right twoyearolds? If we cannot do everybody and there is insufficient capacity, how do we get to the right twoyearolds, particularly in light of the fact that a lot of Sure Start centres have not succeeded in achieving the outreach that we would all have required in the early years of Sure Start?
Dame Clare Tickell: One of the recommendations that was in my Early Years Review was that we get a proper integrated check at between two and two and a half for children, so that the existing health visitor check is expanded so that early years professionals have some input into that. The explicit thinking behind that recommendation was that we identify those children who may need extra support either because their parents need support or because they themselves have some kind of language delay or an indicator that they need some help. That would go some long way to cracking this one. There are still discussions taking place between the Department of Health and DfE on this, so a strong recommendation from me would be that the Committee finds a way of saying that it would be really helpful if that could be expedited. That is a way specifically to identify those children who need support or those families that need support, because sometimes it is the families rather than the children who will show that they need support.
Q47 Alex Cunningham: You both talked about sweating the assets and getting value out of the money that is available. Is there sufficient resource there that could be realigned with the sorts of things that you have just been saying, Clare?
Dame Clare Tickell: On the twoyearold check, that should not be hugely expensive. The twoyearold check is specifically about aligning two systems up and getting people who work in early years and people who work in health to have a conversation about what it is that they are seeing, putting it all together and saying, "Does this signal something that we otherwise would not spot?" So the twoyearold check is simply a question of getting agencies to work more closely together.
Q48 Chair: But then there is simply the matter of getting together the agencies to do this, one of whom is health.
Dame Clare Tickell: I know.
Q49 Chair: That is the most absurd thing I have heard, Clare.
Dame Clare Tickell: I am answering the question on resource.
Q50 Chair: How do we change the incentives, because obviously the incentives and the framework are not sufficient at the moment to encourage that behaviour? How do we change it?
Dame Clare Tickell: There is a clear recommendation that I made in my review in March two thousand and whenever it was-two years ago-that is still being discussed. It is turning into a monster: I have seen some stuff that is the output and it is huge. It was supposed to be a small, intelligent way of getting people to have that conversation. It is not that people are not having intelligent conversations, but they are very big.
Naomi Eisenstadt: The other big change that is happening that will help on this, I believe, is that as we get health and wellbeing boards under way, moving public health into local authorities, we get much stronger linkage between health and universal health services, particularly health visitors. What I am worried about-this Committee can ask this of the DH-is it still is not clear to me where midwives are going to be managed or commissioned, and midwifery, in terms of identifying those families, is enormously important. Again, it is a brilliant universal service. Are we using it to help identify those families?
Dame Clare Tickell: On the broader resources question, which I think we were partly talking about there, it goes back to this centre localism point and I suspect is behind the 40%. At the moment, because there are diminishing resources, there is a bit of central determination taking place, so we have the Troubled Families stuff, we have the twoyearold-
Q51 Alex Cunningham: What starts that diminishing of resources, Clare?
Dame Clare Tickell: The local authority settlements being less than they are. There are two things, are there not? There are local authority settlements being less than they are and contracting services, and there is also the fact that the need being experienced by people who are now coming into our children’s centres is greater and will become more so, I think, when the welfare benefit reforms kick in. So you have two things taking place at the same time.
One of the things that is happening centrally as a way of trying to protect resource is we will get the Troubled Families initiative, for instance, and we will get the twoyearold offer, which is trying to determine how that money gets spent. That then makes the conversations that take place across the system more difficult, so we, sitting in modern children’s centres, have potentially targets set by different people trying to hit different policy initiatives, which is just clunky. Whereas if you sit and think across the system at a local level about what our resources are and how we can deploy those best and to what extent we need to make sure there are not perverse incentives pulling us in different directions, we could make better use of the diminishing resources that we have.
Q52 Alex Cunningham: Sticking with quality and the need for professional staff and everything else, in your book Providing a Sure Start, Naomi, you noted that the Government is keen to encourage the voluntary sector and the local community organisations to become more involved in running children’s centres. What is the risk associated with that shift into the community organisations, particularly for your quality, professional staff and things of that nature?
Naomi Eisenstadt: Well, if Clare is running them, it is fine. I think it is about standards and the way you commission and how you write those contracts for commissioning. I am not against voluntary organisations running children’s centres or, indeed, running all sorts of services. It is about intelligent commissioning and how you measure success.
Q53 Alex Cunningham: I do not disagree with you. I agree that voluntary organisations should be involved. I just wonder how low a common denominator you could get in providing services in the future, particularly with shrinking resources.
Naomi Eisenstadt: I think the problem is-and this is always a tension within the voluntary sector-that the big voluntary organisations have infrastructure that provides staff training and staff support. They have infrastructure that manages their finances. They have infrastructure. When it comes to very small organisations running these things, I remember saying to David Blunkett, "Do you want 500 Sure Start programmes? Then you will have 1,000 personnel officers." I do not want each children’s centre to have to have its own personnel officer. It is those sorts of things. I do not think it matters whether it is private, voluntary or public; what matters is the infrastructure support that is behind the provider to deliver the quality.
Dame Clare Tickell: And that is about who does the commissioning. That is about the commissioning rather than who is doing the providing.
Q54 Alex Cunningham: And the commissioner knowing what they need to commission.
Dame Clare Tickell: Absolutely, and that is about quality.
Q55 Craig Whittaker: Can I just challenge you on your point about intelligent commissioning? One of the problems we are having locally, our voluntary organisations are telling me, is that what we are seeing is a reshuffling of the deck chairs because of TUPE, which is a huge inhibitor of the voluntary sector getting involved. Is that just particular to my area?
Dame Clare Tickell: No, it is not. It is not TUPE particularly. TUPE is a bit of a nightmare, but if you stand back from "why the TUPE?" I think there is a point that I would make really passionately, which is that we are now in a situation where all of our children’s services are being recommissioned on a triennial basis. We know that one of the things the most vulnerable children need the most is continuity, and we are now in this extraordinary place where we bid for work, we bid for children’s centres, and we will win children’s centres initially on a 12month basis and then, if everything has gone alright, it will be extended for two years. As part of that, we need to inherit lots of staff through the TUPE arrangements. For a year we are worrying whether we are going to keep the contract, for the second year we can just about calm down and then everything is okay, and then in the third year we are beginning to think about the fact that it is going to be tendered out again. The amount of effort and energy that goes into that, as opposed to the core purpose of delivering services, is huge. Whilst I think it is absolutely right that public money should be used in a way such that we are accountable and it is costeffective and so on, there is a risk that we are losing something by an overemphasis on the commissioning for price as opposed to thinking about continuity.
Q56 Craig Whittaker: What you get rid of TUPE?
Dame Clare Tickell: I would not get rid of TUPE within the context of what I have described. What is wrong there is the fact that we are now operating in a quasi-market environment.
Q57 Craig Whittaker: So, TUPE is not an inhibitor for you, as a voluntary organisation, to take over services.
Dame Clare Tickell: No, it does not inhibit us. It is a big bureaucracy, but the bigger issue for me is the fact that we are taking services in and out all of the time. As I say, I would absolutely not want to say that is a bad thing, but when we are thinking about that commissioning environment within which we now work, we put insufficient premium on the importance of continuity of very vulnerable children.
Q58 Alex Cunningham: So a certainty of funding over a longer period of time, facilitating longer term contracts with competent organisations-
Dame Clare Tickell: Yes, absolutely. It used to be, and in some instances it still is, the case where we had very accountable-very uncomfortable, sometimes-conversations with commissioners on the basis of performance and on the basis of things that had not gone as well on either side. But what we were able to do was develop a relationship over time that recognised the importance of having those very open conversations. It is quite difficult to be quite as open and quite as honest when you know that the contract is coming up again next year.
Q59 Alex Cunningham: So the recommendation to Government would be, particularly at this time because of the considerable changes, we need more certainty about funding for children’s services and the longer-
Dame Clare Tickell: And we need to commission in a way that puts more emphasis on the stability of children, and we have lost a bit of that focus.
Q60 Neil Carmichael: We have been talking quite a lot about the effectiveness of Sure Start in a surprising number of ways, and Naomi has, quite rightly, drawn our attention to variants, as far as I can see. We touched upon some work, funnily enough, from Durham University, because both of you have talked about being more targeted. Certainly you have, Naomi, and that was an observation made by the Centre for Evaluation and Monitoring at Durham University, where they noted that, "If we really want to improve life for more vulnerable and poorer sections of society, we need to target assistance much more effectively." Now, my question-because I have been listening carefully to what you have been saying-is how do you think that targeting can work, given what we have already been talking about: the definition of communities, relevant professionals, our Chairman’s astute observation about Government being more prescriptive sometimes when it is intending to be less so and so on? What targeting do you think we can apply here?
Naomi Eisenstadt: My argument was for area targeting, so within the poorest areas you have a combination of universal and targeted services. I think that you lose a tremendous amount of value that children’s centres offer if you only offer targeted services by families and children-if there were not some open access services. It is through the open access services that you get those families on the cusp and you prevent them falling over into the neediest. So I think a mix of open access and targeted, but your resources in poor areas. That would be my argument.
Dame Clare Tickell: And making sure that the staff that you are employing in your children’s centres have the skills-because this is early intervention-to identify those children where there are potentially concerns around neglect and a range of different issues.
Q61 Neil Carmichael: You both emphasise professionalism and so forth. I drew attention to Professor Mundel’s2 report earlier quite deliberately, because I think it helps professionals to work with each other if they are trusted at the level in which they are operating. I also think that would help to produce a more holistic approach to services. Presumably, you both agree on that.
Dame Clare Tickell: Yes, completely agree with that.
Naomi Eisenstadt: Yes.
Q62 Neil Carmichael: Sure Start has been shown to improve parents’ wellbeing and family functioning. Why has it not led to a positive impact on child development in all cases? That is something else that comes through the evidence.
Naomi Eisenstadt: We decided I would answer these questions. One of the interesting things about those results-this is going to sound like a positive spin-is that we think one of reasons that you do not get the differences in children is that all the children are now getting the 15 hours a week, three and fouryearolds, and the children in the most recent study were seven. They all would have had early education, and a great leveller in terms of levelling up is early education. I cannot say enough how important it is, and how the Government is to be congratulated for not touching the three and four universal offer.
Q63 Chair: And yet they are nuts to do it at two for 40%?
Naomi Eisenstadt: Well, of course, it is not 100% at two, and it is too much money to do it 100% at two.
Dame Clare Tickell: Set the target.
Naomi Eisenstadt: Yes-once you target it and once you target it without parent support, etc. The added value on Sure Start is, sensibly, parenting. Now, the question is at what point do those values on parenting begin to show through? The American evidence is that it shows through when children do not do better at school but they stay on at school longer, they are more likely to be employed, they are less likely to be pregnant as teenagers and less likely to do crime. The trouble is those are very, very long-term outcomes. So, obviously it is disappointing, but it is not surprising to me that the key evidence on benefits continues to be on adults, not on children.
Dame Clare Tickell: Do not forget, we run most of the evidencebased programmes and they concentrate on the parent. You can run an evidencebased programme and you do not see the child, because it is an evidencebased programme that is about parenting and parents will come back and report, as opposed to doing the stuff with children. Alongside that, you can look at foundationstage profiles. There are a number of other things that you can look at and measure, which are things that are showing some very encouraging results.
Q64 Neil Carmichael: What are the key things we have learned about helping children, do you think, from Sure Start since its beginning?
Naomi Eisenstadt: Never underestimate the skills you need to run a Sure Start centre. That was the biggest light bulb for me when I was writing the book. We really underestimated the skills required and how complex it is, and a lot of work has been done on that since.
I think the other thing that we learned is what I said about community development. It is funny; in the core purpose it talks about selfesteem. Selfesteem is completely irrelevant to child outcomes. People like it and all that, but we found that, although parents liking a service does not help their children necessarily, if they do not like it they are not going to come. It is that lesson about "just because they like it". We thought all that community stuff was going to make kids better; it did not. That was a really important lesson about what we got wrong. What we got wrong was underestimating the skill level need. What we got wrong was too much emphasis on community development. What else did we get wrong? We got lots of other things wrong.
Q65 Chair: Too much emphasis on community development. That means giving too much power to the parents to dictate what happens.
Naomi Eisenstadt: Yes.
Q66 Chair: Both because it can occasionally be exclusive and create an exclusive atmosphere, but also because what they want and what they need may not necessarily be the same thing. It needs that professional mediation.
Naomi Eisenstadt: Yes, but the other thing we learned, which I think is a really important lesson, is that parents love these places, and that is good news.
Dame Clare Tickell: And parents need to feel part of it and have some ownership as well.
Naomi Eisenstadt: Yes. They love them, and if we make it too prescriptive and too narrow, they will not enjoy it and then they will not come. So, again, we need a both/and on that, not an either/or.
Q67 Chair: They will not like it when you close them.
Naomi Eisenstadt: No, they will not. That is what is so moving-that they get so upset when you close them.
Dame Clare Tickell: Can I just add two things that I do not think were there at the beginning? One is, notwithstanding all the things we have said, the importance of health within that system and the importance of active participation of health in children’s centres. The second is, for me, they were overprescriptive from the off in terms of what it is that they needed to look like, and the importance of locality and the importance of them reflecting what a locality is and has I think is one of the things that-
Naomi Eisenstadt: Can I just-
Dame Clare Tickell: Disagree?
Naomi Eisenstadt: Yes. The first Minister I reported to was a Health Minister, and the best outcomes in the early phases of Sure Start came from Healthrun programmes. The reason that the Healthrun programmes were better was because they had better data and they had qualified staff.
Dame Clare Tickell: I am not disagreeing with that at all.
Naomi Eisenstadt: They were very strongly Healthoriented. We lost Health when we moved to employment and got joined up with DWP instead of Health.
Q68 Mr Ward: There are some flashing lights in my mind, because there are some community cohesion issues about closing certain centres in more affluent areas and in an area like Bradford that would be an issue, I would say. Can I come back to the point you were making about child development to see if I understand it? You seemed to be saying that we cannot really assess the development of child development until later on in terms of teenage pregnancies and so on, but the best predictor of attainment is preattainment, so it must be identifiable earlier on, I would have thought.
Naomi Eisenstadt: It is, but I think the key contributor to attainment is good early education. The key indicators of those wider social skills in terms of long-term development into a productive adult come from parenting. Now, obviously, parenting counts on early education as well. A home learning environment is enormously important, but even in Sure Start where we have evidence of an improved home learning environment we are not getting differences in the educational attainment. Again, that is really disappointing, but I have to be clear with you about what the evidence tells us from a very good evaluation.
Dame Clare Tickell: In a way, there is an unintended consequence, I think, of the emphasis on evidencebased programmes on parenting programmes. There has been a lot of discussion about the importance of people not just charging in and doing stuff and not being able to demonstrate that it works. People are asking the evidencebased programmes on parenting to answer a question that they are not designed to answer, because they are about parents rather than children. That is why I am saying if you look at foundationstage profiles you begin to get some really interesting data about how children are improving in the Early Years Foundation Stage, and that is tracking through into Key Stage 1 and beyond. But people ask us to prove that they are working using evidencebased programmes in terms of children, and they are not designed to do that.
Chair: Is the Early Intervention Foundation helpful in that respect?
Q69 Neil Carmichael: I have three more questions. Following on from that discussion particularly about education, in a world where we have limited resources-we always do but they are even more scarce than usual-in terms of education outcomes do you think investment in early years education is more important than Sure Start for children in the vulnerable groups that we are talking about?
Dame Clare Tickell: I would not necessarily make the distinction. In most of our children’s centres we deliver the Early Years Foundation Stage. That was my point about understanding-that in fact they talk across at each other. Where that is not the case, where there are nurseries or where there are child minders delivering the Early Years Foundation Stage, I think it is really important that we find ways of connecting them into children’s centres, if children’s centres are there offering all the resources that we have been talking about-so, child minder networks. We do that in lots of our children’s centres and it is not only ours. Lots of children’s centres do that. They facilitate ways for child minders to access what is being delivered in children’s centres. It allows them to talk to each other. It allows them to connect in with other professionals in a way that does not mean, "We are going off to talk to a social worker." They can have a conversation about some concerns that they might have, either with their peers or with others. That is about integrating those assets rather than it being an either/or.
Q70 Chair: We are faced by either/ors and limited evidence of child development and school readiness improvement-the critical role of early education. If we want to deliver universal, we can deliver it at two-it won’t be nuts any more-but what we would have to do is shut down all the Sure Start centres. We would take the money from that and stick it in and have superb, universal, early education, moving the entitlement, which we all accept from the age of four or five, down to the early years. The question is would that be a better use of scarce public resource for the betterment of children than the way it is currently deployed in Sure Start centres?
Naomi Eisenstadt: It would shift the curve, but it would fatten the tail. It would not help your most disadvantaged families. It would not help in terms of antipoverty, because you would not be getting the support on parental employment. I am sure that it would have an impact on attainment, but attainment is not the only thing that we want, so you will get a split that is very uncomfortable.
Dame Clare Tickell: Your social mobility-
Naomi Eisenstadt: Yes.
Q71 Neil Carmichael: You are really talking about the targeting problem there, are you not?
Naomi Eisenstadt: Yes. That is why I say there should be extra support in the poorest areas where we know there are the most difficulties, even for things like language development. The social class gradient on language development is absolutely stark and extremely depressing, and language development is zero to two.
Q72 Neil Carmichael: I was going to ask about that in a moment, but, before I do, Ofsted are slightly concerned about the lack of achievement of children going through Sure Start. They have said so in several reports and it is implicit in a number of other observations. So the question arises-and having listened to what you have said-what can be done to address that particular problem?
Naomi Eisenstadt: I think Ofsted are looking at the wrong thing. There is a very nice report from Sandra Mathers about Ofsted, where she compares Ofsted ratings with the ITERS and the ECERS, ITERS being the Infant Toddler Environment Rating Scale, and there is no correlation. Ofsted do not know how to look at underthree provision. They are fundamentally about education. They do very good ratings on education. There is not perfect correlation but better correlation for the older children, the older underfives, in terms of the Ofsted ratings and the academic ratings, but on the underthrees the correlation was very poor. Ofsted rated some things as very good that ITERS thought was terrible and vice versa.
Q73 Neil Carmichael: They would probably say, if they were looking at children who have, say, been through the Sure Start as compared with those who have not, there is still a gap that needs to be closed.
Dame Clare Tickell: I do not think they say that.
Naomi Eisenstadt: It is about comparing like with like. If you are looking at the 30%, the Sure Start areas are very, very poor areas and there is a social class gradient on those kids and the schools in those areas you just carry through. If you want the boost, then you need to do, I think, much more intensive work much earlier on, and my recommendations are about underthrees and adult skills and poorest areas.
Q74 Neil Carmichael: You have mentioned that language development is an important issue and there are concerns about it. Again, the question I have is what can be done to address that?
Dame Clare Tickell: The twoyearold check would do it. The twoyearold check that I talked about in my review very specifically is about picking up on language delay and getting early years people talking to health people to think about what this might mean and doing something about it. The intention was to use that as a way of signposting services that children might need, so that may be speech and language therapies or support for a family that is struggling, so in fact they are not talking very much to their child.
Q75 Chair: What would we do before the check, though, because nought to two is the most important time? The check may give information to make us change our practice, but how do we change our practice?
Naomi Eisenstadt: I am advising on a Big Lottery project called Better Beginnings. The Lottery is going to spend a specific amount of money in very few areas, very intensively working on underthrees’ language development, social and emotional attachment and diet and nutrition. We are now looking to other particular programmes on language development zero to two. The difficulty is the number of words heard, the complexity of grammar heard and there is also the ratio of positive to negative, so how often the child is praised, how often the child is criticised. All those three things in terms of language development undertwo are critically important, but do I have a programme in my box of tricks that says, "This is what you do"? I do not, but as part of this Lottery programme that is what we are looking for.
Q76 Neil Carmichael: Is there a case for upgrading or developing the "red book" or the baby book that all parents have to start going into the territory you are talking about in more detail?
Naomi Eisenstadt: Maybe.
Dame Clare Tickell: Yes, and again I absolutely take Graham’s point, but the red book is the vehicle for the delivery of the integrated check. Rather than having an early years record and a health visitor record, very explicitly we should expand what it is that the health visitor puts into the red book to include other agencies and other people’s views.
Q77 Neil Carmichael: Yes, because there is an obvious opportunity there, is there not, to start gathering more information, recognising the value of that information and then hooking up to the appropriate professionals?
Dame Clare Tickell: Absolutely.
Chair: Thank you. After a discursive not to mention louche chairmanship up to this point, I am going to urge my colleagues and, indeed, witnesses to do short, sharp questioning and answering to get through the rest of our material and get ourselves finished in a prompt manner. So, with a change of tone, which naturally and properly follows immediately from Neil’s questioning, we come to Craig.
Q78 Craig Whittaker: Thank you, Chair. I just want to briefly ask you about the NESS, the National Evaluation of Sure Start-the economic study. Does the value demonstrated in that report justify the cost?
Naomi Eisenstadt: No. The point is, when you start something new you make a lot of mistakes, and as you go along you get better. So I think the money spent on the evaluation was absolutely right, and I absolutely defend the evaluation. A lot of ministers hate it because it told us stuff we did not want to hear, but the whole point of an evaluation is to find out what is not working as well as what is. So everything I have said to you this morning comes from what we learnt as we went along, and we have learnt some really important lessons. We have learnt some lessons about what not to spend money on and lessons about what to spend more money on, so I would defend NESS. Was money wasted on Sure Start? Yes, it was, but, overall, have we learned a huge amount to make things better now for underfives? Yes. The other thing that people do not give Sure Start enough credit for in terms of money spent is the capital expenditure. In poor communities we now have some absolutely stunning centres. They are fabulous and people feel proud of them and get very angry when anybody wants to close them, and I think that is a good thing.
Q79 Craig Whittaker: Is there any link between the amount of money spent on a particular programme and how effective it is?
Naomi Eisenstadt: There is a minimum. It is very, very hard to go below a minimum, but no. Part of the difficulty is that rural programmes cost more per child. In very concentrated urban areas not only is it easier for transport, but you have a lot of other services to choose from that are already funded and in the system, so there will be differences like that, but I could not say, "Yes, this programme is more cost effective." Some programmes were definitely more effective than others.
Craig Whittaker: Providing they spent the minimum.
Naomi Eisenstadt: Yes.
Q80 Craig Whittaker: We have spoken a lot about status in children’s centres. I think it was you, Naomi, who said that we should not underestimate the skill set required. Is the Government doing enough to make sure that we have that skill set in the leadership within the school sectors?
Naomi Eisenstadt: No, and there are no entry requirements. Can you imagine being a head teacher in a primary school and not having to have a degree? There are no formal entry requirements for running a children’s centre.
Q81 Craig Whittaker: Is there any strong evidence to suggest that that link between those strong qualifications, rather than leadership skills-we spoke earlier on about having a qualified teacher, for example-means it is going to be better?
Naomi Eisenstadt: There is strong evidence on qualified teachers in terms of childcare. There is less strong evidence, because we have not looked at it carefully enough, in terms of children’s centre leadership. The strong evidence is on the childcare side, but we will be developing the evidence base on the children’s centre side through the evaluation of children’s centres in the ECI project. It is one of the questions we are looking at.
Dame Clare Tickell: Cathy Nutbrown is definitely a start and the emphasis that she has put on quality, but it needs to be developed further for the reasons that Naomi has said, in terms of there not being entrylevel qualifications and what that means for all the things that we have talked about.
Q82 Chair: Are there any children’s centres that are damaging and it would be better if they were not there? Is it possible that poorly led, poorly qualified staff can do more harm than good in certain circumstances in early years?
Naomi Eisenstadt: I would say unlikely, but I do not know.
Dame Clare Tickell: Certainly none of ours.
Q83 Chris Skidmore: We have already spoken about children’s services and whether they should be in more deprived areas, but on the intake itself would you have any recommendations to make about what the mix of intake should be in order to achieve the best outcomes for children in any centre, or is it hugely variable?
Dame Clare Tickell: I think it is hugely variable. I think the question always to ask, though, is: are you reaching the most disadvantaged families? There is an old adage that there is no such thing as a hard-to-reach family; there is such a thing as a hard-to-reach service. When I came into NCH, as it was, I was quite struck. There were two or three children’s centres that we ran where we were being asked to provide services that did not reflect the ethnicity of those particular areas. So there is something about your local community and your population, and understanding that and being able to demonstrate that you are speaking to the ethnicity and the demography of where it is that you are working. Even if you are full, that might not mean that you are reaching the right people.
Q84 Chris Skidmore: You have obviously spoken about having that element of universality there to bring people through the doors. Ofsted, for example, have already shown in their annual report that having a properly integrated service is crucial for that. What does a really good integrated service look like, firstly, and can you recommend somewhere and say, "This is the best model; in an ideal world this is what an integrated service would look like and it exists here already"? Do you think there are services that should be in an integrated service that are not? You mentioned housing, for instance, which was very interesting. Do you think there are ways in which we can improve integrated services? It is just really defining the best integrated service that we should have.
Dame Clare Tickell: For me, there is an element of locality to it, but I would expect, in the best children’s centres, definitely to see health playing a huge part, and I cannot say it enough. There should be demonstrable buyin from local children’s services. The best children’s centres will certainly have links with the employment service-with people, say, from Jobcentre Plus who come to the children’s centre and run session. I would expect to see volunteers from the local community and I would also want an educational input. Also, the police as well, not within the context of going around arresting people but the community support that is provided by the police. I would want an integrated set of services. Then, around that, there may be other organisations-housing-depending on particular pressures in a particular locality. But without that core group I think that you will struggle when there are particular issues that need to be addressed.
Naomi Eisenstadt: I would not disagree with that. The housing point was about outreach. It was about that is where you will find the families, not that the housing offer should move to the children’s centre-just the opposite. That is where you hang out.
Dame Clare Tickell: We are now picking up a lot of people, particularly in places like London, where there are real struggles because of the housing benefit cap, which is identifying a whole smorgasbord of different need that is triggered by housing need. Funnily enough, we have some fairly acute issues coming up through the housing route that did not before, simply because that is becoming apparent as a consequence of the housing benefit cap.
Q85 Chris Skidmore: With the question of limited resources, is there a danger that, by putting all the eggs into one basket and creating a very good integrated service, the outreach withers?
Dame Clare Tickell: I do not think there is a risk that you would lose the outreach. That is my point about hard-to-reach services as opposed to hard-to-reach people. I think there is a risk, which we are sighted of at the moment, that, if you big up your children’s centre too much, other services that should also be there get decommissioned. We are seeing some HomeStart going and we are told that is fine because there is a children’s centre here, and we need to be very careful about the unintended consequences of thinking that a children’s centre can do absolutely everything without thinking about the other bits that need to be there as well.
Q86 Chris Skidmore: How far are we down the road? We have done a lot with the children’s centres. Has it got the ability at the moment to have that integrated service? How far would you say we are?
Dame Clare Tickell: I think it really depends on where you are. There is some absolutely excellent stuff and there is some stuff that is not yet off the blocks.
Q87 Chris Skidmore: Can you give an example of excellent?
Dame Clare Tickell: I think that Hampshire has taken a very creative approach, quite a brave approach, to redesigning their children’s centre offer right across the county. It is still bedding in; it is relatively new, but it is an interesting, very holistic approach, which links in well with the other professions.
Q88 Chair: What does it look like? We heard mere colocation delivers little, integration is key, and where there is integration Ofsted and everyone else says it is brilliant, but what does it look like? What does integration mean and how do we see it when it is there?
Naomi Eisenstadt: I think we get caught up in the words. Basically, do the teams work together? Do they share information?
Dame Clare Tickell: Is the whole greater than the sum of the parts?
Naomi Eisenstadt: Yes, is the whole greater than the sum of the parts? Do they sit down and say, "I am really worried about this family. Who is going to be the lead person and how do we each contribute what we know we can offer?" That, for me, is what good service integration looks like. There is a mixed view about whether, for example, the health service should be managed within the centre. What I really like is to have the midwife or the health visitor have some time in the centre and some time back and the ranch, because then they bring some of that knowledge and experience on service integration and how other services work back to the health service. I think that bleeding across is very, very good for the area in general.
Dame Clare Tickell: I agree with that.
Naomi Eisenstadt: But as to defining it specifically, it really depends on the relationships locally. If people get on well and respect each other’s differences and respect each other’s expertise, it works well. If they think, "The only solution to this is me and the only solution would be 10 more of me," then we do not have a good system.
Chair: No. That is a very good explanation.
Q89 Chris Skidmore: I guess also integration is at its most vital when it is to do with the problem families and where you target it. Several submissions that we have already had, written submissions, have really stressed the importance of universal service and worrying about overtargeting. How do you get that balance? Is it simply to just state that we need an approach of proportionate universalism and use the idea of a gradient? With money scarce, how would you prioritise between targeting families as opposed to having the universal service there? Is there any logical solution?
Dame Clare Tickell: I think you are looking for something that we cannot find, in a sense. We sound boring because we keep talking about locality, but to some extent it is going to be determined by what is in your system. Naomi said it earlier on, but we need to start from a premise that it is something that has open access, for all the reasons that we have talked about and more, which is about the extent to which very disadvantaged children will thrive in universal settings far more than they will if you put them into targeted settings. Then you go back to what it is that you are seeking to achieve in your children’s centre and ask those questions, rather than saying what is the balance, because the balance will vary depending on what is in the wider system in a particular geography and how commissioning takes place in a particular geography. Unfortunately, there are however many-180something-local authorities and they all do it slightly differently.
Q90 Chris Skidmore: But at the same time, I guess, talking about location in terms of more deprived areas or your point, Naomi, about looking at midwives, those are then making judgments on priorities and those priorities are around targeted services.
Naomi Eisenstadt: Well, you do not target birth support. Every woman will get a midwife when she is having a baby. They do not decide on risk factors and say, "You can do it alone or maybe with a volunteer." They do not do that. We do not do that with schools either. We think it is a good idea to have teachers in schools. We do not say, "Volunteers could do it and we have this guy who is a physicist; he could volunteer. We do not need a teacher there." We would like to do the mix of the guy who is a physicist as well as the teacher.
Q91 Chris Skidmore: In schools, though, we do have the pupil premium focussed on free school meals.
Naomi Eisenstadt: Exactly, but that is the whole point about a universal and a targeted service sitting together and how you identify who your targeted people are based on universal access. There are the people who come through your door through universal access and then there is just understanding how many people live in this area and who is not coming through your door. That is the most important thing in terms of targeting: knowing who is not turning up and trying to figure out why and knocking on doors. One of the things that happens is you get enormously busy, you are very popular and it takes up all your time and they love you, so you do not bother to find out who is not coming. It is the finding out who is not coming that is the key to the targeted work.
Q92 Chris Skidmore: I guess there is a tension there with the universal service that you only have so many hours in the day or in the week, and you have to say, "Sorry, I am going to have to put you down the queue."
Naomi Eisenstadt: No, it is the way that people use it. My hairdresser goes to the stay and play twice a week, and she really enjoys it. There are staff on hand there to answer questions if she is worried about something, but if she had a serious problem at least she already goes to the stay and play. It does not run seven days a week, 24 hours a day. I think it runs three mornings and she goes two mornings.
Dame Clare Tickell: You need to remember that for those families where there are real concerns you will access the wider system at that point. It is not all being absorbed by the children’s centre.
Naomi Eisenstadt: Sorry, I have one really nice example that came up during Sure Start. When I was running Sure Start, the Deaf Children’s Society argued that every single Sure Start programme should have a deaf specialist. We worked out that, given the size of the programmes, you were likely to get a deaf baby every other year. So this was not a good use of resource in terms of targeting, but what you wanted to do was make sure that the people in the centre would know how to support a family if there was a deaf baby and know whom to call. So you do not need a specialist on everything everywhere, but you need to make sure that people are aware enough to know whom to call.
Q93 Ian Mearns: You strayed into the territory of evidence earlier on in answer to David’s question. Do most children’s centres use evidencebased interventions or do we still have some distance to go to achieve desirable improvements in practice? If so, what do you think the resource implications would be of the required change?
Dame Clare Tickell: I do not know the answer on that. Most, if not all, of the ones we provide provide an evidencebased programme. They do not run the same ones, because local authorities want different ones to be run, but I do not know the answer. I suspect not everybody uses them. What I look for in a children’s centre is a children’s centre that is reflecting and thinking about the difference that it is making. We need to get people prepared to engage with a lot of evidencebased programmes. They are not able to engage with them when they first come in because they do not have the skills, so we have to do some work before they access that evidencebased programme. So the fact that a children’s centre does not run an evidencebased programme does not necessarily mean that it is not doing good stuff.
Naomi Eisenstadt: Most of them do now, because the Government is really pushing.
Dame Clare Tickell: Most of them do, yes.
Q94 Ian Mearns: Would you say that examples of best practice, especially those with strong evidence of effectiveness, have been disseminated and adopted across the country, or do you think it is horses for courses?
Dame Clare Tickell: As Naomi said, I think it is quite difficult now not to be using some form of evidencebased programme. Local authorities increasingly commission wanting sometimes a specific one to be used, so that can integrate with the other bits that they may be doing in that local authority, or they will expect evidence that an EBP is in place.
Q95 Ian Mearns: How involved do you think the Government should be in specifying which evidencebased programmes to be used and how should local authorities and children’s centre leaders choose which programmes to use?
Dame Clare Tickell: My personal view is that I do not think it is helpful for Government to determine what evidencebased programmes should be used. They are very different. Some of them lend themselves better to inner-city environments than others and it seems to me unhelpful. Local government may want to satisfy itself that people are thinking reflectively about what it is they do and whether it works. That is pretty much as far as I would go.
Q96 Ian Mearns: Do you think there is any danger of stifling innovation by rolling out programmes on a regional, local or national basis?
Dame Clare Tickell: I do not think that the use of an evidencebased programme should be seen as a proxy that guarantees that everything is absolutely fine. We do need to be thinking creatively. One of the problems about bringing the evidencebased programmes, which are universally not British, over into this country has been we have had to think about how it is that we adapt them-how it is that we allow them to reflect the particular ethnic mix that we may have in a locality, and so on and so forth. So there is something for me about asking the right questions, but not slavishly producing robots who can work within the context of an evidencebased programme but do not think.
Naomi Eisenstadt: And as soon as you adapt them, it is not the evidencebased programme anymore.
Dame Clare Tickell: And we get into these conversations about fidelity and so on.
Naomi Eisenstadt: Just in terms of the ethnic mix, the most famous one that delivered the highest resources was HighScope, which of course was all black children-very, very poor children in the most deprived bit of Detroit-and it was about 100 kids.
Q97 Ian Mearns: Naomi, you spurred me into thought earlier on, because you were talking about the Jewish provision at Stamford Hill, was it?
Naomi Eisenstadt: Yes.
Q98 Ian Mearns: In my community in Gateshead I have a very Orthodox Jewish community of about 4,000, which rises to about 7,000 when all the students are in town.
Naomi Eisenstadt: They have lots of children.
Q99 Ian Mearns: They have lots of children, indeed. The whole community live within about a square mile, because you have to be able to walk to the synagogue on the Sabbath, etc. I would welcome the opportunity to visit the provision that you were talking about.
Naomi Eisenstadt: Sure, sure.
Q100 Ian Mearns: Would you say that, in developing this whole programme over the term of the last Government, too much emphasis was possibly placed on the development of buildings as opposed to developing the range of services that were required within the building or around the building in order to make things work well?
Naomi Eisenstadt: I think the capital investment was fantastic. Some very, very beautiful buildings went up in very poor areas that people felt very proud of. Ironically, one of the reasons that we had such disappointing results in the first evaluation was that nobody was running any services; everybody was trying to design a building. Again, the kind of person you recruit to run a Sure Start is not the kind of person who knows how to commission a building. I certainly do not know how to commission a building. So it took much, much longer to get going because of the time it took to do that capital investment, but I think as a legacy it is something to be proud of.
Dame Clare Tickell: And they are iconic and they are magnets for people who will come in and use them, and it becomes easy for people to access them. We get people coming into our children’s centres who want to talk about really quite difficult stuff, who may have safeguarding concerns, and they feel able to go into those children’s centres because they are there. I am not so sure it would be quite as easy to do without that fairly iconic statement in a local community.
Q101 Ian Mearns: Was enough thought put into the planning so that these centres would become sustainable and useful to the communities that they were meant to serve? I am sure there are many examples of buildings that are currently a bit thin on the ground in terms of the people using them, just because the resources available are no longer as plentiful as they were, say, five years ago.
Dame Clare Tickell: We had some phase ones that happened slightly too quickly, so they did not have outdoor space and stuff because of the need to spend that early capital, and some thinking would need to be done around that. I do think that, at a local level, what we are seeing is people being incredibly inventive about how they use those spaces. They are not ossified into what was a phase one children’s centre or a Sure Start. They are shifting in lots and lots of different ways, because they reflect a living and breathing community, so I would not have concerns about that.
Naomi Eisenstadt: The revenue assumptions were not thought out enough and, ironically, in part that is because the design came from the Treasury, not from the spending department.
Dame Clare Tickell: Absolutely.
Naomi Eisenstadt: It was designed by people who did not run services.
Q102 Chair: The difficult and the important thing is to get your people right, and it is much easier to just spend money on buildings.
Naomi Eisenstadt: Exactly.
Dame Clare Tickell: Absolutely.
Q103 Chair: Because with school investment in capital everyone has exactly the same reaction: iconic, positive. You meet a child on the first day: "We never thought our area would have a school like this." The evidence of effectiveness in transforming their lives, which is the whole point, is rather weak.
Dame Clare Tickell: That is absolutely right. Lots of our children’s centres, though, were old buildings that were demolished and new buildings put on those sites, so they tend to be bang slap in the middle of a community, in a really good and accessible place, but you are absolutely right.
Q104 Ian Mearns: I am wondering about this and I do not know, but one of the reasons for the number of youngsters who are really benefiting from these systems could be that the numbers of youngsters in particular localities who are coming forward with a range of complex needs are greater than they were. Is that the case?
Dame Clare Tickell: Absolutely.
Naomi Eisenstadt: Well, you are identifying more. As soon as you put a service in, you are identifying more need.
Q105 Chris Skidmore: When it comes to outcomes, you have talked about the questions that need to be asked and, Naomi, in your book you have said that we need to measure as we go along, but finding the right set of measures that can deliver the kind of data that will inform practice without being overbureaucratic is a significant challenge. If you were both able to explore that challenge-you mentioned language, for instance-what should be the outcomes that we really should be focussing on?
Naomi Eisenstadt: I think Clare is really right on the integrated twoyearold check, and I would really like to see that in place for a whole set of reasons, not least because we could do that and then see comparisons with EYFS results, the Foundation Stage profile. So that between two and five, I think, would be really, really useful.
One of the positive outcomes from Sure Start was that more parents got jobs, and that is measurable. That is a good measurable outcome within a reasonable amount of time. The difficulty is that a lot of the outcomes from all the American studies and the evidencebased programmes and all that are outcomes at 16, 17, 18, and they are not going to help us design now.
Q106 Chris Skidmore: But it is possible, you think, to link progress from Sure Start centres, the outcomes from Sure Start centres, with the EYFS.
Naomi Eisenstadt: I think the main gain in EYFS will be from early education, the 15 hours free, and we need to keep an eye on that; I think that is really important. I think that the measurable change in Sure State children’s centres is largely parents.
Q107 Chair: Seeing that the core purpose is child development and school readiness, there is a bit of a mismatch between what is happening and what is wanted, is there not?
Dame Clare Tickell: While the EYFS is being delivered in a children’s centre, no, which it is in lots, because you just take it through.
Q108 Ian Mearns: Chairman, I think how we manage the benefits of some of these programmes is also important, because, under the last Government, Single Regeneration Budget programmes, for instance, measured outputs in particular geographical areas. Quite often, things like getting people into economic activities was one of the measures, but the trouble was the people who got into economic activity moved out of that area and then were replaced with somebody with equally as many problems. So at the end of the programme the SRB judgment was that area had not uplifted at all, but lots of people had benefited from it.
Naomi Eisenstadt: Yes.
Dame Clare Tickell: On your point, Graham, about school readiness, the other point is not to see school readiness in that very limited way, which is simply about a child who is able to sit down and hold a pen, but understand the way that journey works within the context of PSED, communication and language, sociability, and children who are able to concentrate, and play and so on and so forth. That is the foundation that then will make a child’s ability to engage in the totality of what they encounter at school there.
Q109 Mr Ward: Is it more about parent readiness then?
Dame Clare Tickell: Well, when I did the review, I talked about school unreadiness as opposed to readiness, and that was one of the things I talked about, which was standing back and thinking about what it is that will enable a child to take full advantage of everything that they will encounter when they go into school, both playground and classroom. That absolutely will include what it is that they get from their parents, which goes back to the twoyearold check.
Q110 Alex Cunningham: The school readiness thing is very central to all of this, but can I just ask about health and some of the output as far as health is concerned, maybe in terms of an increased uptake in inoculations or maybe a more successful smoking cessation programme for mothers and expectant mothers.
Dame Clare Tickell: Dentistry.
Alex Cunningham: Is there clear evidence of all that sort of stuff and where do we find it?
Dame Clare Tickell: On uptake in children’s centres?
Alex Cunningham: Yes. As a result of children’s centres and the programmes that they run, have we got better uptake on inoculations and better uptake on other healthy programmes?
Dame Clare Tickell: Certainly at a local level. We could certainly provide you with evidence of where, in local children’s centres, we have been asked to do that and have delivered that: breastfeeding programmes and uptake in dentistry, obesity and so on and so forth-diet. Nationally, it is not asked for.
Q111 Alex Cunningham: Sometimes that is just lost.
Dame Clare Tickell: Yes.
Naomi Eisenstadt: The truth is it is lost. We had some Sure Start results on better uptake on inoculations, but the trouble was that we were not sure about the timing of that. It was comparing it with the Millennium Cohort study, so it might have been a timing issue in that, when they asked the question, some kids had not been inoculated yet, but that was definitely a Sure Start finding. But you are absolutely right we do not have the clear data on that, and it is part of the problem about what they are meant to do and whether they are meant to do everything. If a centre could say, "This is what we are really going to concentrate on," then we would want to measure those outcomes for that centre. Once you gross it up, if 20% of the centres are doing smoking cessation, you are not going to get an effect on all centres, so that is the difficulty, but I think breastfeeding, smoking cessation and certainly diet and nutrition are really important, again, particularly if we concentrate on the first three years.
Dame Clare Tickell: In our experience, people commission on the basis of local public health data, so where we have been asked specifically on, for instance, dentistry it is because that has been a big issue-because tooth decay has been a huge issue in a particular area.
Q112 Chair: Public health is moving to local authorities, and earlier you were talking about different local authorities having different evidencebased interventions. I wanted to ask: is that because they have different outcomes they are after or they have different interpretations of how to get there, and will this change when they have this public health thing? Is there going to be a big change and they are going to be talking about health outcomes far more than they are about school readiness and education?
Dame Clare Tickell: It provides an opportunity.
Naomi Eisenstadt: It is my impression, and this may be completely unfair, that at most levels the decision on which programme to do is about what magazine article you happened to read and, "Gee, that sounds really interesting and I think we will do that." I do not think there is enough that is really good databased decisionmaking on what to provide, and that is about intelligent commissioning, and it happens at the central level too.
Q113 Chair: If you wanted to pick an educational one, you look at children who do not leave primary school with the expected level. I think only 6% of children who fail to get Level 4 at the end of primary school-this is data from a couple of years ago-get five good GCSEs including English and maths. We know that if you do not get that, your likelihood of a whole range of negative outcomes in life massively increases. Would it be a crude and harmful oversimplification to say that Sure Start children’s centres should be part of a package that contributes to minimising the number of children who fail to get the required level at age 11? We are simple creatures, politicians, and talking about ossifying, we will turn ossifying to a purpose and we want to see it delivered, if we are going to maintain the focus and the money.
Dame Clare Tickell: You couched that. I think the caveats are good.
Chair: You accept only my caveats, good.
Dame Clare Tickell: No, what I am saying is I am pleased that you are caveating it. I think that for children's centres not to be part of that story would be silly. It would be a complete waste of resource. Children’s centres should be part of that story, and lots of the things that we have talked about today, including the stuff that Naomi said about minus nine months through to when a child moves from a children’s centre into reception or Key Stage 1, need to be included in that. There is a real contribution that children’s centres have to make to the Early Years Foundation Stage, not specifically delivering it but supporting those people who are delivering it, which then becomes absolutely part of that story.
Naomi Eisenstadt: I think that the major contribution to what you are saying in terms of GCSE results or age 11 results is preschool education. I do not think it is children’s centres. I think the major contribution children’s centres should be making for those children who go through that system is reducing teen pregnancy, better staying-on rates, employability skills as opposed to clear academic skills, persistence to task, being able to pay attention, being able to take instructions. If we cracked the language development one, that might help, because I think that is a key factor, certainly in cognitive development and school readiness, but I do not think we have cracked it yet. So I am being overly cautious and I do not want to make promises that I think we could not keep, but I think the key things that children’s centres offer tend to be much more on the health and social side than on the academic side. I know that this is the Education Select Committee-
Chair: Despite the name, we are broad in our remit.
Naomi Eisenstadt: I was going to say I grieve that this no longer the Children, Schools and Families Committee, because I much preferred that name.
Q114 Chris Skidmore: I wanted to ask you both your opinions on the Government’s payment by results trials. It is still early days but, in principle, do you agree with the idea of trialling this?
Dame Clare Tickell: We had a conversation about this outside, because I started with, "Well, it is here with us, so we need to make the best of it," and Naomi said, "Does that mean that you would want payment by results to be there?" and I think that was quite a good call. We are involved in a number of payment by results pilots. I think, given that they are there, they are a bit mucky at the moment; there is some work to do in eliminating perverse incentives. It is not sometimes clear whether or not they are concentrating on inputs and outputs or outcomes, and the point I made earlier on about there being different incentives coming from central Government, whether it was troubled families or whatever, makes it quite complicated sometimes when delivering on payment by results stuff. My personal view is that payment by results works when there is a very discrete, measurable and fairly straightforward output that can be measured and attributed to the payment by results. I think there is a risk with payment by results that we overpromise. We have children in children’s centres, some of them come in for stay and play or whatever, who do not stay for very long, so they may be with us for 1/24th of their day. For us to pretend that we can influence the wider system and overpromise I think is potentially problematic, but I do recognise the importance of accountability, and I think, against specific results, it has a place.
Q115 Craig Whittaker: I just want to challenge you on that, because you also said there is a huge amount of waste in the system, so surely there has to be some element of both.
Dame Clare Tickell: As I say, I am not saying that there is no place for payment by results, but I think one of the things that we need to guard against is overstating the influence that we can have, running a children’s centre, on the wider system. The other end of that is to claim that we are responsible for success when in point of fact we are just a small part of that. That is my point.
Naomi Eisenstadt: I think it is great for the prison system and I would do prison governors’ bonuses based on reoffending rates. So I think there is a place for it, but I think it is where it is easy to count. You know who goes back into jail and you know a period of time: two years-do they go back into jail or not? It is easy to count. What worries me about it for children's centres is having a simple enough system that does not add layers of bureaucracy and does not have perverse incentives. I have not seen any of it yet that calms my worries.
Q116 Chair: Is it at the wrong level? Let us take my outcome: let us have no 11-yearolds, or practically none of them, failing to get to the required level. When you have a vast complexity of services needing to contribute towards an outcome you want, is it the local authority or some higher level thing that should have payment by results for delivering that? They then commission sometimes, if it is nice and easy and measurable, by payment by results, but most of the time they commission youth services because they think it will contribute to that goal.
Dame Clare Tickell: I think there is some truth in that, but we need to be careful the responsibility for delivering results is not passed too far down the system. I would not have a problem, and do not have a problem, with somebody paying me to get enough children engaged in a dental programme, so they do six weeks and so on. That seems to me to be straightforward, because it is measurable, as Naomi says. To ask me to take responsibility for ensuring that the number of tier four referrals in a particular local area reduces by 50% is completely outside my gift, and I should not be doing it.
Naomi Eisenstadt: But you can still cherry-pick those children for the dental programme.
Dame Clare Tickell: Yes, you absolutely can.
Naomi Eisenstadt: As soon as you do it, you get perverse incentives, so you will pick the children who are most likely to attend the programme. The costbenefit analysis is complicated in this area, but I am not against it in principle. I think there are some areas where it is very easy to count.
Chair: If you have any further thoughts on that, as to where the appropriate level should be in order not to lead to the kinds of things you say, let us know. A system that has been brought in in order to recognise the power of incentives to drive behaviour in itself then being poorly constructed so that it drives the wrong behaviour is an irony of which of course Government policy is all too often prey. Never mind. Thank you both very much indeed for giving evidence to us this morning. If you have any further thoughts or specific recommendations, as I say, that is the clunky business end. You guys will be the experts and we will still be laypeople at the end of this, but if there is a way you can provide us with ideas and recommendations that we can put to Government, whether or not they are already in reports you have written and have not been implemented, that would be very helpful. Nothing is too simple to be made very clear to a bunch of politicians. Thank you very much indeed.
 Member meant to say Professor Eileen Monroe
 Member meant to say Professor Eileen Monroe