Purpose of the paper
This brief paper is designed to promote and support discussion on possible next steps for children and childhood in Cornwall.
Context: You never let a good crisis go to waste! said Rahm Emanuel, former Chief of Staff to President Obama in a quote attributed to Winston Churchill. What does this mean for children in Cornwall today?
Underpinning construct – the Power of the Paradigm and the opportunity for a “Paradigm Shift” based on re-setting services and attitudes based on the fundamental principles of understanding needs, the importance of nurturing children through building local communities with children at their hearts. What does this mean for Cornwall? https://www.routledge.com/The-British-Betrayal-of-Childhood-Challenging-Uncomfortable-Truths-and/Aynsley-Green/p/book/9781138297920
On October 3rd, 2008 at the time that I was England’s first Children’s Commissioner I was privileged to be invited to give its President’s Lecture to the Duchy Health Charity in Truro. In it I shared perspectives on childhood in the UK through the prism of my work nationwide, highlighting its relevance to Cornwall and celebrating the opportunities and aspiration to make the county one of the best in the UK in which to grow up a child.
Over the last 13 years I have been pleased to be invited several times to visit Cornwall again, and to speak with children, young people, parents and inspirational adults from a range of organisations, thereby being in a unique position to comment on how I see childhood there today, informed further by my national and international work with many others.
The recording that was made of the Lecture in 2008 is on a CD and reviewing now what I said then is, I propose, even more relevant today. I wish now to share perspectives on what has happened since then, where we are now, and above all to promote serious open-minded discussion on where we should go next to give our children and young people the political focus and the human, financial and strategic support they deserve.
Children are, after all our single most precious resource, being citizens in their own right now and for those who can, to become the productive workers and parents of the future. But even those who can’t through disability or disadvantage still deserve every support to develop as best they can.
Penetrating question: Is this view supported and promoted in organisations in Cornwall? What is the evidence it is?
Noteworthy developments in Cornwall since 2008
During the last 13 years I have been updated regularly on initiatives and been invited to several events in Cornwall to celebrate developments, many supported by the Duchy Health Charity. I have been able to refer to these developments in my many-fold papers, lectures and events nationwide. These developments include:
* The Integrated Health in Schools programme. This has been conspicuously successful not least by being driven by the ownership of young people themselves https://www.researchgate.net/publication/263231476_Evaluating_three_school-based_integrated_health_centres_established_by_a_partnership_in_Cornwall_to_inform_future_provision_and_practice and needs to be seen to be an exceptionally important exemplar nationwide of innovative thinking https://collegeofmedicine.org.uk/innovations-projects/a-school-based-integrated-health-centre-penair-school/ . I helped to facilitate the publication of an article in the Guardian on it by Fiona Millar https://www.theguardian.com/education/2019/mar/12/condoms-counselling-health-centre-across-playground-cornwall-schools and to facilitate the visit from colleagues in South Ayrshire to assess its relevance to South East Scotland.
This contact followed an invitation to me to attend Dumfries House in Scotland for an event led by HRH Prince Charles to discuss the suicide of young people in South Ayrshire. During this I was able to alert HRH personally of the excellence of the initiatives for children in his Duchy. I also, mischievously argued with his senior staff in the Dumfries House Trust to consider replicating the amazing community support work I saw at Dumfries House to local people in Cornwall.
It is great to see how the integrated health concept is not fossilised and is being modified to accommodate the needs of young people during Covid 19. Innovation continues with the planned roll-out of psychological support in every school. http://www.looe.cornwall.sch.uk/index.php?option=com_content&view=category&id=11&Itemid=306
* The Cornwall Association of Secondary Head Teachers (CASH) https://cornwallsecondaryheads.co.uk https://cornwallsecondaryheads.co.uk is in my view brilliant in the way in which under David Barton’s leadership with its Chair, Tina Yardley it has brigaded secondary heads in friendship and partnership to be a powerful voice supporting the needs of young people. I have been privileged to be invited to several events for CASH practitioners to share perspectives and have been deeply impressed by their willingness to work together.
* The Sowenna programme to develop a specific new in-patient resource for young people with severe emotional health difficulties illustrates and validates the power of a collaborative initiative harnessing the resources and support of local authorities, statutory agencies and the voluntary sector led by the DHC all working together https://sowenna.cornwallft.nhs.uk. Until this facility was provided, young people and their families had to travel out of county often for hundreds of miles to seek the support they needed. This is a brilliant initiative!
At its formal opening event I was especially impressed with the commitment from the head teacher to ensure that all out-of-school young people across Cornwall were registered, followed and given support. This is another exemplar relevant nationally of a mind set and determination derived from understanding the needs of children and young people.
* I much appreciated the thinking behind the ‘One Vision’ document that sets out a vision for childhood across Cornwall https://www.cornwall.gov.uk/health-and-social-care/childrens-services/one-vision/one-vision-partnership-plan/. I know that few other localities in Britain have produced such a comprehensive statement of intent.
* This was celebrated in an outstanding conference in Watergate Bay in February 2019 attended by inspirational young people alongside local influencers. Duncan Selbie, CEO Public Health England gave the keynote address (Fig below). One especially penetrating and highly relevant comment from him stated that nothing in legislation prevented the sharing of budgets across agencies.
*Evidence of commitment to look to new ways of working together is to be found in the
Virtual Ring Binder : Headstart Kernow. Put together during the first lockdown and updated regularly, it’s the result of a host of agencies and the voluntary sector coming together to support young people and families through the current circumstances. Colleagues across the county were anxious that much good work was going on but would then be lost, so a ‘Virtual Ring Binder’ was developed that demonstrated the coming together in the inter-professional way that I am advocating for in this paper. This development deserves to be built on and shown to have impact.
These outstanding examples of worthy initiatives deserve respect and dissemination nationwide and provide a springboard for the future. I have observed however, that relatively few people in key local agencies understand why they are so good, let alone appreciate why they need to be implemented and built on now.
Some key questions to be asked now include:
1)What has happened to the initiatives in the last tumultuous year?
2) Is there an effective comms and media strategy to keep people informed of progress?
3)What has happened with the link with South Ayrshire?
4)Are links with the Dumfries House organisation as good as they could/should be, and is there sufficient contact through HRH for the new community development in Newquay? Are there other localities that might be even more deserving of a community focus supported by the Prince Charles’ organisations?
5) Is there a mind set to get out of Cornwall to explore and share best practice with other organisations across the UK eg the Child Health and Wellbeing network in NE and Cumbria https://nhsjoinourjourney.org.uk/what-we-are-doing/priorities/optimising-health-services/child-health-and-wellbeing-network/ This is a stunning initiative that has brigaded over 150 key people of influence across the universities, statutory and voluntary sector, it has a clear strategy and has evidence of impact. I argue its philosophies are complementary to those in Cornwall, and the greatest of benefit could follow from the collaboration that has already been discussed. Understanding the inspirational £20m development led by YMCA in Newark and Sherwood to promote community support for children and young people is also highly relevant to Cornwall https://ymcanewarksherwood.org
6) Is there any evidence for the Selbie challenge i.e. the sharing of budgets? If not, why not?
7) Whilst recognising that there are 240 or more primary school headteachers in Cornwall in the Cornish Association of Primary Head Teachers (CAPH), are there opportunities for CASH and CAPH to generate discussion on new ways of educating children and young people to meet the needs of employment in the 21st century?
8) Who speaks for the early years sector in Cornwall? See comment below. The Early Years team at the LA (which is very strong and experienced) has now been moved to work within PHE rather than education and they work alongside School Nursing team, Family Health workers and others. This is a new development (eighteen months, approximately) in an attempt to break down silos and encourage all parties to work differently and collaboratively and there is real urgency in addressing the nationwide low standing and status of early years education. This demands more effective advocacy for the importance of early years as expressed in the 1001 Critical Days Manifesto: https://parentinfantfoundation.org.uk/1001-days/
9) Engaging with the Police and justice agencies is especially relevant in view of the extensive data they hold on their communities. I have seen how, for example in Nottingham and Northampton they are taking a leadership role in convening events with important individuals and organisations to improve the lives of local people. Similar leadership is to be found in the police agencies in West Yorkshire: https://www.wyhpartnership.co.uk and in Avon and Somerset https://www.youthandpolicing.co.uk where the use of data has driven local developments successfully.
Are these initiatives relevant nationally?
The following perspectives offer a context through which to explore their significance
The national context for childhood
Headline comment: British children before Covid 19 have been betrayed on a grand scale, having some of the worst outcomes overall for health, education, social care, justice and poverty in the developed world. These outcomes are especially searing in deprived localities.
Despite them being relatively resistant to infection and not being infectious to others, the uncomfortable reality is that the pandemic of Covid 19 has been a further major disaster for them with respect to health, education, social care, justice and poverty.
Key question to people of influence in Cornwall: How many of you really understand the enormity of this? What steps are being taken to educate people on the reality of the ongoing betrayal of children?
What has happened politically for children’s policy since 2000?
The answer to this and the reasons for the betrayal are analysed ‘forensically’ in my best-selling and acclaimed book published two years ago, copy enclosed with this commentary. The book has had international impact in countries from Canada and the USA to Hungary and Australasia. https://www.routledge.com/The-British-Betrayal-of-Childhood-Challenging-Uncomfortable-Truths-and/Aynsley-Green/p/book/9781138297920 In the UK it has been made ‘recommended reading’ for staff and students in 16 universities in their schools of health, education and social sciences and in departments relevant to youth justice and poverty. A second edition is already in preparation for publication by the end of 2021 that assesses specifically the impact of Covid 19 on childhood
Action point: Please read this book that is in three parts: the history of childhood; understanding the betrayal and ways to improve lives – the latter vein especially relevant to this paper.
Four reasons are discussed in detail in Part 2 to explain why our children’s outcomes have been so poor:
1) the indifference and denial of the importance of children in public and political ‘attitudes’ to them
2) political policy being short term, ephemeral, inconsistent and is, as the systematic dismantling of the ‘Every Child Matters’ policy showed, to be untrustworthy
3) the failure of individuals and organisations to advocate effectively for the best interests of children; those attempts that have been made being repeatedly subordinated to the demands of adult services especially for those for the elderly.
4) the existence of ‘bunkers’ and ‘silos’ within and between departments of state and locally in statutory and voluntary organisations.
Further difficulties are evident in the culture of services:
Territorialism – ‘I’m in social care, you’re in education’; I’m in primary care and you’re in acute hospital services!’ ‘It’s impossible to connect with paediatricians in social care matters’
Tribalism – ‘I’m a school nurse, you’re a practice nurse’; ‘I’m a psychologist, you’re a psychiatrist’; I’m in primary school and you’re in secondary school’
Traditionalism – ‘we’ve always done it this way and I’m happy doing it this way’. ‘Why should we change?’
Tunnel vision – ‘Sorry Al! I’m a super specialist with 30 patients waiting in my clinic and I don’t have time to consider this let alone change my way of working’
Timidity – It’s not my job! It’s for others to speak out!’
Terror – ‘what if we get it wrong?’
Treasury – ‘we’ve got no money!’ ‘This is my budget and it’s not for sharing!’ ‘Keep off it!’
Tiredness, exhaustion and cynicism – ‘we’ve been here before and nothing’s going to change’. ‘I’m just serving out my time till I retire in 6 months’ time!’ ‘I’m keeping my head down!’ ‘More re-organisation and moving the deckchairs – that’s all administrators care about and I’ve had enough!’
These are real comments made to me repeatedly in all parts of Britain and illustrate the massive human obstacles to progress. Overcoming them demands clarity in vision and above all effective leadership, a commodity in my view that is so often lacking.
Notwithstanding the strong intent demonstrated in Cornwall’s ‘One Vision’ and the strides made in developing genuine inter professional collaboration across services, I still ask:
* Are these aspects present in services in Cornwall? If so where and why?
* Is there any appetite to have serious open-minded conversations on the reality of obstacles to progress?
* If present, how can bunkers and silos be confronted?
* Who can lead this discussion with credibility?
* What is the evidence for effective, inspirational leadership in key organisations and sectors? Where and what are the examples of it? Where is there poor leadership? How can it be made more effective? What steps are being taken to make it so? How can potential leaders of the future be identified and nurtured?
The impact of Covid 19 on children, young people and families
Children seem more resistant to covid-19 infection, but have suffered disproportionately from 2020’s lockdowns: school closures, isolation, loss of education continuity, denial of play and sport, with soaring rates of family violence, emotional and mental ill health and obesity.
“Children simply haven’t been at the forefront of decisions,” concludes the most recent Children’s Commissioner for England as she steps down. Especially searing are her comments on the plight of children in care.
The pandemic has also had deleterious impacts on children’s health services. Particularly vulnerable children, including those with special educational needs, disabilities, and in the criminal justice system may be faring worst.
Far from being a leveller, the pandemic is exacerbating the widening social inequality exposed by Sir Michael Marmot https://www.instituteofhealthequity.org/resources-reports/fair-society-healthy-lives-the-marmot-review .
The Children’s Society charity wants the government to put children’s interests at the heart of recovery from coronavirus despite children’s needs seemingly forgotten as a government priority, eclipsed by economic concerns of getting parents back to work.
The COVID-19 pandemic and its ‘lockdown’ undoubtedly has been a betrayal of children yet again. The needs and rights of babies, children, young people and their parents have been ignored. Whilst adult life was discussed in-depth, the necessity of play for children, for example, was invisible. Children retreated from being an issue of public policy concern in their own right to one solely for the economic imperative to get parents back to work. Particularly shameful has been ignoring the needs of children with disabilities and their families, especially those with learning disability, with the collapse of vital support services for them.
Who in government is responsible for the overall needs of children? No one. Who has responsibility for developing joined-up policies to support children? Nobody. Is there any sense of a vision for childhood post Covid? None. Where are local organisations mapping across health, education, social justice and poverty the needs of children and families as happens in Canada? There are none.
Our politicians are at best unaware of these facts, at worst, they are in active denial. We adults must understand and disseminate these truths before our communities are truly ready to make the huge changes needed to transform British childhood for the better.
Is there any reason for optimism? There are many willing and able people ready to join a movement to put children at the centre alongside motivated parents and children and young people themselves. Individuals and organisations with passion, skills, innovation, and knowledge are waiting to build on what has gone before. But advocates for a better childhood are stuck because of the siloed working patterns we have become accustomed to. Stuck because the gap between what is needed and what seems possible is daunting. And stuck due to the absence of effective leadership nationally and locally.
We should say: start with the child at the centre. Remember that children are precious and exquisitely vulnerable. Remember that they are the future of the very society which lets them down so badly. Put children at the centre of healthcare services, of schools, of outdoor space, the built environment, care systems, courts and jobcentres. As emphasised in Article 12 of the UN Convention on the Rights of the Children, listening with empathy and a mindset of action to what children and young people tell us is fundamentally important.
A decent post-Covid response puts promotion of child health and wellbeing front and centre. Needs are identified and intervention is early. The country recognises that what happens during people’s childhoods is of lifelong ramification for them, and in turn is what determines the sort of societies we build into the future. Building local communities with resilient children at their hearts should be embedded in policy and practice
We start from a tough place. But we have to start somewhere – by:
1. The need for a core group of people nationally and especially locally with authority charged with re-setting childhood after Covid.
2. Showing leadership by encouraging a ‘paradigm shift’ in how it sees children and childhood and backing this up with the action of creating a new independent Action Group for Child Life, Health and Wellbeing as is being promoted by the College of Medicine https://collegeofmedicine.org.uk/hopeforthefuture/ .
3. Making sure there is a ‘child impact assessment’ for all activities, embedding the UN Convention on the Rights of the Child, especially Article 12, namely that the child has the right to be involved in decisions that affect it.
4. Promoting the science of effective political advocacy not least by translating research into policy and practice and advocating fearlessly for the needs and rights of all children
5. Emphasising by bringing professionals from education, social care, justice, and child poverty together, that the lives and the health and wellbeing of children are not just the preserve of health professionals.
6. Commissioning detailed and near real-time mapping of children’s lives by routinely collected data across sectors (as happens in Canada) thereby providing a springboard for building local communities with children at their hearts.
7. Being proactive in confronting barriers between primary care, hospital and community and mental health services for children alongside their interface with education, social care, justice and poverty
8. Ensuring that no work emerges that is based on outdated siloed ways of thinking.
9. Lobbying local and especially national government to recognise the current lack of responsibility and accountability for children within Government and establish a civil service and political structure for children through a cabinet level Secretary of State responsible for integrating all aspects of policy for children.
The prize if we choose to accept the challenge is nothing less than the opportunity to reset British childhood. Perhaps as we emerge into a new post-COVID-19 world, society can think again about the sort of country we wish to inhabit? Can we stand by to allow children to be betrayed again and yet again?
The fundamental prerequisite is to change incrementally the ‘social norm’ of childhood in Britain. The Frameworks Institute in the USA (and now in the UK) argues that the choice of words matters, with so many worthy initiatives failing because of the negative connotations of children being ‘a problem’. This is why I now use the strap line ‘Celebrating new ways of improving the lives of children and young people – it doesn’t have to be like this! This ‘frame’ has been judged to be outstanding by the Frameworks Institute.
Please click on ‘watch here’ on the u-tube clip below to see and hear Nat Kendall Taylor explain his approach
Practical steps to improve outcomes (see pages 211-235 of my book)
· Appoint effective local directors of children’s services with the authority and resources to integrate all aspects of their lives
· Challenge the re-organisation of services that are not designed to improve the best interests of children and families
· Commission “mapping” of local children’s lives from routinely collected data across sectors using the Vancouver model: https://www.grad.ubc.ca/research-network/human-early-learning-partnership-help . In my view, the understanding of who holds which data and where on childhood by locality is fundamentally important to plan developments. I predict that there is no shortage of data in Cornwall – but who is charged with interrogating it and making it strategically and operationally useful? It would be my delight to signpost you to Dr Pippa Rowcliffe in Vancouver as I have done in Nottingham and the North East to share her >20 years practical experience in using routinely collected data on the lives of children
· Understand, as was performed in Birmingham when I was National Clinical Director for Children. the totality of what is spent for children across all organisations, statutory as well as voluntary, and from this identify joint priorities and the opportunity to share budgets.
· Collaborate with education, social care, justice, and child poverty – child health and wellbeing are not just the preserve of health professionals
· Confront barriers between primary care, hospital, community, and mental health services not least by showing how working together can improve outcomes
· Establish a national cabinet level secretary of state for babies, children, young people, and families responsible for integrating all aspects of policy for children
· Empower doctors and nurses through effective leadership to speak out for the best interests of expecting mothers, babies, infants, children, and young people
· Identify a small number of ‘quick wins’ to give confidence in the direction of travel
· Underpin developments with close partnerships with the academic sectors in providing resources for teaching, training and research.
Reasons for optimism
The pandemic gives some reasons for optimism. Greater family cohesion, home learning, and imaginative online study can mitigate adversity. The Co-space Study has shown remarkable resilience in some young people, and we must acknowledge articulate and motivated young people themselves.
Not all rich countries had similarly dismal outcomes pre-covid-19, and the Netherlands, Norway, and Denmark may have done best for children during covid-19. Canada shows how local organisations can map the needs of children and families across health, education, social justice, and poverty. It is important to learn from successful countries and establishing links between Cornwall with communities overseas, in Canada and Finland for example could be highly relevant.
Article 12 of the UN Convention on the Rights of the Child insists we listen to children. We must put their needs at the centre of healthcare services, schools, outdoor space, the built environment, care systems, and courts. How can we show that outcomes can be improved by using a rights-based framework as promoted by the amazing and impactful UNICEF UK’s Rights Respecting Schools programme? https://www.unicef.org.uk/rights-respecting-schools/
1) The need for an inter-sectorial, collaborative, Covid 19 Children and Young People’s Strategic Focus Group in Cornwall should be considered to define and manage the impact of Covid. This demands the acquisition of hard data on the lives of children by locality, coupled to serious involvement with children, young people and families. Its remit could be to analyse the ‘lived experiences’ impact of Covid on children and on services, identify priorities and vulnerabilities and plan not just to cope with the present but to look to the future. Data are already being collected – funding a focus of expertise to interrogate it and make it operationally useful must be a key action now, this to include the economics of childhood – who is spending what on where for children?
2) Priorities in my view based on a national understanding could/should be
a. Children’s and young people’s emotional and mental health. This has to be the ‘Big One’ in terms of implications for long term wellbeing and deserves targeted focus. Perhaps Sowenna in a leadership role could be the focal point for thinking, coordination and strategic planning. The needs of grieving children should not be overlooked not least because even before Covid 19 struck, children were the ‘hidden mourners’ of today https://academic.oup.com/bmb/article/123/1/5/4080202
b. Child protection is another ‘Big One’ in the light of the tidal wave of domestic violence. New ways of working must be demanded, especially re-defining the role and responsibilities of health visitors. Nationwide there is substantial concern that the traditional responsibilities of health visitors have been subsumed into the dominance of child protection. It could be argued that the need for protection should rightly be in the purview of social services to allow health visitors to regain their fundamental role in supporting families through dedicated locality-based children’s centres. Strategy demands the closest of collaboration between the police and those involved in violence reduction and those involved in safeguarding children.
c. The early years sector is in disarray nationally without political and resource support, and riven by competition, privatisation and absence of effective leadership alongside a failure to recruit a thoroughly professional work force retained by adequate training and status. As mentioned above, perhaps a focussed sub-group should examine critically the provision and outcomes of the early years sector in Cornwall alongside creating a clear strategy for the future.
d. The opportunity to re-set the purpose of education should not be underestimated. The conspicuous success of CASH should be celebrated and their joint work with the Cornwall Association of Primary Headteachers in working closely with early years providers to improve the crucial yet threatening transitions into primary and secondary education. This could in collaboration with faith schools provide an ‘all through’ education philosophy across the county.
3) Of course, there is a plethora of other vital considerations including the prevalence of obesity, the need for exercise and sport alongside a re-consideration of the traditional journeys of children through primary care, secondary care, preventative services and transition to adult services. This is especially relevant to the needs of children with disability, especially those with learning difficulties.
4) One aspect that seems to be ready for development is the link with academic centres and universities in Cornwall. Being provocative from my observations on the implementation of the One Vision concept, one disappointment is the failure to get the attention, support and serious engagement of the universities in the territory and it is not clear why this is so. There is in my view a massive opportunity for research and teaching programmes to be fully integrated into the overall vision as is happening in Nottingham https://www.nottinghamcitycare.nhs.uk/ssbc/ and the North of England https://nhsjoinourjourney.org.uk/what-we-are-doing/priorities/optimising-health-services/child-health-and-wellbeing-network/ and in Newark and Sherwood https://ymcanewarksherwood.org. Nottingham Trent University shows the way in what can be done by its credible support for academic input into community-led initiatives https://www.ntu.ac.uk/about-us/university-reimagined.
The role and responsibilities of the Duchy Health Charity
The organisation has a proud history of unique support for the children of Cornwall, and this should be built upon. Of course, the need for financial resources is key, made even more difficult now in the light of Covid-induced austerity. But many of the changes listed are not resource intensive demanding in the first instance a ‘paradigm shift’ in collaborative working. Perhaps through being independent of government and political affiliations the DHC could have a new incarnation as a highly respected body of ‘influencers’ charged with supporting the overall strategic direction for childhood in Cornwall. It could be a coordinating body and a ‘dating agency’ bringing key people together in think tanks and other activities and encouraging an outward facing view to link with other local organisations nationwide and even internationally. The immediate opportunity is to understand and work with the exciting developments in the N East and Cumbria, and in Newark.
Final penetrating question:
Is there appetite for the Duchy Health Charity to build on its conspicuous successes to date and become a key truly independent enabling agency to make Cornwall the best county in the country to raise a child? This will demand leadership and understanding of the highest order. It also demands a Paradigm Shift in thinking.
It has my unreserved support remembering it really does take a whole village to raise a child, with the nurture of children being everybody’s business!
If you don’t do it who will?
The opinions expressed in this paper are my own and are made in good faith to provoke debate and encourage open discussion. They do not represent the views of any of the organisations I have worked with either previously or currently. If any statements or comments are incorrect then please inform me so that appropriate corrections can be made.
Professor Sir Al Aynsley-Green Kt. May 2021
Copyright: Aynsley-Green Consulting 2021