Interview with Al Aynsley-Green

Transcript of Al Aynsley-Green’s first in-depth interview since his appointment as children’s commissioner

England’s first children’s commissioner Al Aynsley-Green talks in detail with Community Care’s news editor Lauren Revans about his plans for the role.

Al Alynsley Green: We want to make the work of the commission open and transparent. And I intend to follow exactly the same philosophy as I had for delivering the children’s National Service Framework.

The NSF is probably the most important children’s health policy ever established anywhere in the world. And we did that over a period of three and a half years, starting with nothing in the way of resource or commitment.

Within three and a half years we produced this very, very important policy that is internationally regarded as the benchmark of excellence. And we did that by being absolutely open. We had working groups. We had extensive consultation and participation. So the best accolade we had when the NSF was published was “Al, there’s no surprises”.

I want to engage in an extensive period of time – not too long for obvious reasons – but a period of time for people to access the office, for me to access them to tell me what they think the commissioner should be doing and, in particular, what they think the priorities should be.

You won’t be surprised to know I already have a very comprehensive list of issues. It is almost overwhelming. But I have to be realistic and would ask your readers to see the world through my eyes in terms of what I can reasonably do within the finite budget I have been given and the finite staff etc.

So I am going to have to go through a rigorous process of prioritisation. And that process must include some quick wins to demonstrate that the commissioner is not a poodle, as well as getting some serious sense to advocating for those issues that especially children and young people feel so passionately about.

So openness, transparency, access, participation are the key words for the commission. And I use the word participation rather than consultation. Consultation implies adults ask children and adults make the decisions. Participation means the active engagement with children and young people in making decisions. So I intend to set up a commission in which children are seen to be making decisions with me and my staff.

I get off to a flying start, of course, because the process I went through to be appointed was by far the most rigorous and stressful that I’ve ever seen. There were six stages to the two-month process that everyone went though. The three most challenging components were firstly the written test, with tight invigilation for one hour – it really was like taking an O-level exam again. Then the next challenge was when I offered a power point presentation to a panel of 11- to 19-year-olds with 45 minutes of rigorous discussion after that. Then the third step was a further panel of 11- to 19-year-olds with much more wide-ranging discussion about what they wanted to hear from me in terms of what I could do for them.

And I really enjoyed it. Not least because even the youngest of colleagues there were stunning, in terms of their awareness, in terms of the clarity in what they wanted to ask, their directness in confronting me head on with no polite words.

Lauren Revans: Were there any surprises in terms of what they said they wanted from you?

AAG: No, I don’t think so. I am not someone who has just been a civil servant. The NSF was driven by me working on secondment for three days a week. During that time I was also director of research at Great Ormond Street Hospital and a practising children’s physician, which I’ve been for 32 years. So I am very well experienced in talking with, and sharing issues with, children and young people. In fact, my speciality in training is as a paediatric endocrinologist, which is someone who specialises in hormones. And for many years I have helped countless boys and girls in adolescence who are too short or too tall, those who are late in developing, those who are too soon in developing. These are very sensitive issues. So I think I do have some credibility in trying to understand their sensitivities, their embarrassments and to understand the pressures of what it is like to be an adolescent normally, let alone if you have one of these physical problems.

And I know how to explain to them what my treatment is all about. So my personal practice for many years has been to be absolutely honest and straight with children and young people and to give them all the time they need in my meetings with them and their families so they understand everything there is to it.

So I am someone who actually has a lot of experience of working with, talking to and helping children and young people. In Great Ormond Street, of course, you see many of the most complex and the most difficult diseases. Sadly, many of the children who I have helped there are children with a profound disability. So I am fully aware of the impact of disability on the child or young person themselves and also on their families.

LR: It seems from everything you have said and written around the NSF that disability is an area you really feel very strongly about?

AAG: Absolutely. If there was ever any justification for the NSF, it is actually having listened as seriously as we have done to children and young people with disabilities themselves and their families with the problems they confront in being respected, in being recognised in society, in being given the opportunity to do what other normal children and young people do and all the obstacles put in the way of their families in terms of housing, access to services and so on.

So I got great insight into the special problems of children with a disability. And one of the most thought-provoking sessions we had at the children’s taskforce was when we invited young people with a learning disability or physical disability to come down and meet us from the north-west of England. You could hear a pin drop when these young people described to us the full horror of how they saw their lives, the discrimination against them, the barriers, the obstacles to opportunity, and above all the longing for them to be seen as real people making a real contribution to society.

LR: How do you think children are viewed in society? They are quite often demonised in the media – do you think that is something you will be able to tackle?

AAG: Yes. I’ve got three threads of possible strategy – and there is a health warning going with this as I am obviously going to prepare a business plan for publication in due course – but the way my mind is working at the moment is that I think there are three areas I want to start thinking seriously about. The first is childhood in society: the standing of children, childhood and parenting, where children fit in to society, whether young people fit into society, and how society views them.

The second thing is the real participation of children and young people. How to encourage them to be seen to have important views. How to encourage them and even think of perhaps giving them training to become advocates, to understand how to be advocates then, as they become adults, to become champions for children later on.

And the third thread is to focus on some key issues that may require research or inquiry or whatever. I, through the commission, will advocate to government, to local authorities, whoever it may be – the stakeholders responsible for children’s services. I want to have some key issues to take to them. But I see this to be very much a partnership. I will be the first person to say “well done” to government if I think the government is doing good things for children and young people. I will also be the first person to say to the government “come on guys, what’s going on here. And what can you can do better”. So this has to be a healthy relationship in all directions. And how we build that relationship is going to be key.

LR: You obviously have links with the Department of Health and Department for Education and Skills. Do you think you will find it as easy to get your messages across to the Home Office?

AAG: I’ve got a track record of engagement there because I did work with Lord Norman Warner when he was chair of the Youth Justice Board and we set up a number of very important discussions between the YJB and the DoH looking at the needs of young offenders. As part of that, I actually went to a young offender institution to hear for myself what these young people had to say about their lives. And I came away really quite angry about how society had ignored and disadvantaged them with their access to health services, for example.

“I came away from a young offender institution really quite angry”

Many of these young people have got the most appalling health problems. Not just mental health or emotional health problems, but physical health problems. So we had a very useful dialogue with Lord Warner and one of the products of that was to get a better focus on mental health in relation to young offenders.

So I think I’ve got a little bit of credibility in terms of understanding the issues. That’s part of my badge if you like. I need to understand for myself what is going on. So I expect to spend a lot of time on the road listening and sharing with children and young people.

I have already been to 400 or more events across the whole of England in the last few months as national clinical director for children. I’ve been everywhere. I’ve been to very deprived inner city areas. I’ve seen for myself there the problems of homelessness of young people. I’ve seen for myself the incredible impact of Sure Start. I’ve seen the work of Connexions in the inner city areas.

I’ve also been to see rural poverty in the depths of Lancashire, Cumbria, Cornwall and East Anglia. I think I have a better understanding of what it is like to be a young person in rural circumstances, who are often forgotten about and have real difficulties.

I’ve also been to schools, extended schools, primary schools. I’ve seen stunning examples of how things can be done in localities by head teachers thinking out of the box.

I’m very anxious to make sure that we really do look at the child’s life in all its settings. Not just the education, not just the disease, not just the protection, but what these issues mean for the life of that particular child. And how we start bringing together a holistic construct around this for the child’s journey through life.

One of the very important instruments we developed when we were developing the NSF was to make people think out of the box by the “child’s journey” concept, which is asking people to take a child who has come into their service and ask “why has that child come here?” and then to identify from their knowledge and professional experience what are the likely milestones that child is going to go through as they become a young person and then an adult. And then, with the child and the family and the carers, understanding what are the needs of the child, young person or carer at each of these milestones. And the big challenge is how professional staff can look at the competencies to meet these needs, not thinking immediately of professional bunkers.

The best example I can give is speech and language therapy. Until recently, the shocking fact was that a child of two could expect to wait two and a half years for a speech and language therapy assessment. And that is disastrous.

Now in parts of London the waiting time is zero. That is not because we’ve given them 30 new therapists, because they’re not there. We haven’t given them £2 million, because we haven’t got it. They’ve redesigned their services. They’ve looked at why children were coming requiring their assessments, they’ve categorised them, and they’ve then looked at the needs of individual groups of children and redesigned their services around how those needs should best be met, including working with, for example, schools.

LR: Now that you have been appointed as children’s commissioner, will you be standing down from the DfES Children, Young People and Families board of stakeholders, the Every Child Matters programme board and the interdepartmental Strategic Network?

AAG: At the moment I’m still on them wearing my hat as national director. But I need to develop a new relationship now in my new role with all departments of state.

I have a good relationship with almost all them already, especially the Treasury. I have had several meetings with Treasury officials already. I have met with the Home Office through the Youth Justice Board and others.

I hope the commissioner will continue to have a presence on the stakeholder board for Every Child Matters. But I need get into a dialogue with the department of state on exactly how I am going to relate formally and, much more importantly I think, informally.

Behind the scenes

I see a lot of my work being done quietly behind the scenes, meeting people, talking to people and advocating effectively on the needs and also the rights of children.

LR: You have obviously followed the Children Act right the way through the Parliamentary process. What do you think is the Act’s biggest area of potential?

AAG: Every single sentence, every single word of the Children Act has huge importance.

Of course, I am particularly delighted that it has created the post of commissioner. But I think all the other legislation for joined up working and joined up thinking etc will be very important. As is the issue of responsibility.

This comes back to a key challenge that came from the Kennedy inquiry [into the Royal Bristol Infirmary]. I am very keen to make people realise it isn’t just Laming driving the agenda but Kennedy too. I really want health and social care and education being totally joined up here. Because there were many commonalities between Kennedy and Laming which people need to remember. For example, the fact the children they identified to be always subordinated, the lack of responsibility in children’s services, the lack of leadership in children’s services, the failure to engage in asking children and young people and families what they think about services.

So I think the two key words I pick up from my analysis of Laming and Kennedy are responsibility and leadership. My job as national clinical director emerged directly out of Frank Dobson in the commons saying when Kennedy was debated “who is responsible for children?”. The answer was nobody. And Alan Milburn appointed me to be responsible for leading the creation of the NSF, it led to Margaret Hodge being appointed to be responsible for children, it led there to be the mandate for a director of children’s services in each locality to be responsible for children.

So I see how we build that responsibility as absolutely essential. And I will keep a watching brief on how this emerges.

Both Kennedy and Laming were pretty scathing about the quality of leadership in children’s services. We are going to need to find leaders in the stakeholder groups and to give them time, support and resources to be effective leaders, without which fine words by themselves will do nothing.

“What’s happened has happened”

LR: The Act isn’t perfect. What is its biggest weakness or missed opportunity?

AAG: I’m not going to comment on that. What’s happened has happened. We are where we are now with the proper process of politics. Parliament has debated the Children Bill – now the Children Act – in great detail and it is what they have decided.

Whether the Children Act can be enhanced of course is going to be an important point. And I will be keeping a watching brief on how stakeholder organisations do respond to these new opportunities.

I have been a physician for 32 years and I can say with all honesty, and not speaking as a party politician at all, that what is happening now is the best news for children for 50 years in terms of the extent and the enormity of the policy.

I have got a series of components I want to see by the end of this decade. I want to see every political party giving children, young people and families a high priority, because without successful children we won’t be a successful nation in the future. I want to make sure that there are policies that reflect their needs in society. I want to make sure there is a fair resource allocation for children and young people. I want to see children mainstreamed in what are often adult-centric organisations, particularly the health service. Kennedy reminded people that children’s services were the Cinderella service of the health service and had been that way for 25 years. They had been thought to be an add-on, not mainstreamed. I want to see children, and young people particularly, actively participating in making decisions. I want to see better value given to children and young people and parenting in society. And that I think means engaging with the media.

Until five years ago, I was a very specialist children’s physician working in very rare, complex diseases in a hospital that is one of the top four in the world for complex problems and children’s lives in general. Taking up my job as national director, I suddenly became aware of my deficiency in understanding children in society. (And I think that’s an issue that may need to be taken up with the training of doctors and nurses and so on. We very much focus on the diseases, not the people.) So I suddenly realised to my shame that I was remarkably ignorant about children in society, even though I had been working with them for 30-odd years.

So I have made it my business over the last four years to do personal research into the history of childhood from Greek and Roman days right the way through the Middle Ages and Victorian times to the current era. And it is not good news, by and large.

When we go back to Victorian times, children were exploited for their labour, in the mines, the cotton mills etc. It took the social reformers, led by Charles Dickens, Dr Barnardo’s, Joseph Rowntree to be outraged by what they saw. They were picking up on an issue raised by Thomas Coram in the mid-18th century who was outraged by seeing dead and dying babies that nobody cared about. And so the social reformers – and I take as my role models Coram, Dickens, Barnardo’s, Rowntree – were outraged by what they saw society was doing to children and, in the middle of the turmoil in the 19th century, they created the voluntary organisations that have been very successful and still exist today, and they applied political pressure on politicians. And, against huge opposition from mill owners and the wealthy people of the country, they forced through legislation that took children out of the mines and into education. And that requires courageous politicians like Lord Shaftsbury to recognise the cause of children and childhood. They forced through legislation which gave us the construct of childhood for the last 50 years of children being given a protected time to harness an education that will help them become confident adults.

Now my challenge is we have huge turmoil in our current society for different reasons – it is multicultural, egocentric, consumerist, it has a collapsing birth rate, changing family dynamics in the most extraordinary way in such a short period of our history, an explosion of children not benefiting from society (disadvantaged children, children in poverty, looked-after children, young offenders, drug addiction, prostitution).

So there is huge turmoil going on in our society. And my question is who cares? And who is asking the questions about what actually is shaping the lives of children and young people today?

And there are many pressures. Some, like the Archbishop of Canterbury, are arguing that childhood is fast disappearing – because of relentless commercialisation, relentless early sexualisation of children, and a loss of time for children to be children.

In my youth, as a five or six-year-old, I roamed the streets and fields with my gang. My mother wasn’t concerned about where I was. I learnt to be a social animal, how to be confident and competent in a social grouping. What happens to children today in their lives? So I shall be raising a debate about this.

I’m sure I will create a violent reaction from some people who say of course we care about children, our children are essential to our thinking.

Do we care about the children of others?

But do we care about the children of others, children who do not have the advantages that others do?

As part of this, I want to raise a debate about children and childhood in society. What’s shaping it, including the media, including the influence of advertising and commercialisation. But at the same time, I want to celebrate childhood.

The media portrayal is interesting. On the one hand it is full of sentimentality for children, as evidenced by the reaction to the Soham murders. But, by paradox, where were the cathedral services and bouquets of flowers for Victoria Climbie, who was murdered in equally dreadful circumstances? But she was a black child living in poverty, so who cared about her? So we have an immediate paradox there.
 
“Some people think children are evil”

So we have the sentimentality and the need to rescue the innocence of children. But on the other hand, we have some people who think children are evil. Look at the crowds baying for the blood of James Bulger’s murderers 10 years ago, as they were going through a court process that others have raised questions about in terms of its appropriateness for 10-year-olds.

But much more importantly I think is the media portrayal of young people generally. I have kept very carefully a personal portfolio of newspaper clippings over the last four years. And I can tell you that 70 per cent of those clippings are negative. Negative stereotypes. Lurid headlines about yobs committing crimes. Those are negative stereotypes which reinforce older people’s views that it is only bad news when they see young people on street corners.

LR: But didn’t the government contribute to that climate of fear and these negative stereotypes by introducing antisocial behaviour orders and curfews for children? Do you see antisocial behaviour policies as an area you would like to address?

AAG: Well I want to try to understand the reasons for it to begin with, the debate about it. But I think the starting point has to be intervention in the early years.

I met very recently an inspirational lady from Canada called Mary Gordon. And she has created in Canada a programme called Roots of Empathy. Her argument is that society needs relationships and to understand each other. She has rolled the programme out in eight provinces in Canada, with 18,000 3 to 11-year-olds being enrolled each year, and it is about understanding each others feelings.

It starts with the younger children having a meeting with a mother and a baby. The programme trains up facilitators to work with this mother and baby and the class. And it is the first time four-year-olds have seen a baby, so they try to get them to express what the baby is feeling, how they are observing it, how it feels to be a baby. And then they move on to exploring their own relationships.

This seems to me to be extraordinarily important starting point. If we can get people to understand each others feelings early and, as the science behind this seems to indicate, we can reduce bullying and such kinds of behaviour, then this must be a very important exercise. And then, moving forward, we can take the relationship issue into couple relationships.

I recently heard Dame Butler-Sloss delivering a paper on the impact on partners’ separation on the lives of children and the open warfare that so many children are experiencing in their lives. So, surely as a society we should be thinking about how to prevent breakdown by improving relationship understanding.

LR: If I can take you back to the most vulnerable groups of children you were talking about earlier, do you think there is any danger asylum seeking children have been let down by the Children Act? Is this something you might want to look at?

AAG: Well, I’m not going to declare my hand as to what I am going to do at this moment in time. But, what I will say is that I have been to an asylum seeker reception centre in Hackney (east London) and listened to the stories of some of the mothers and listened to some of the children, and seen how some of these children refuse to let go of their mother’s hand while I am talking to her.

I think there are some issues about how we, as a humane society, should be regarding the most vulnerable who come to ours shores. It is for politicians, for Parliament, to decide on the legislation. But I would certainly want to remind people that we are talking about human beings here.

LR: You say it is up to politicians to decide on policy. But will you be looking for an opportunity to “child proof” all new pieces of legislation before they reach the Statute Book in the future?

AAG: I take as my model what I have seen in Sweden.

In the last few months I have been to Finland, Sweden, Hungary, Spain, Belgium, the Republic of Ireland, Canada and Australia to see for myself children’s services in those countries.

I have met commissioners and ombudsmen and I’ve tried to understand their governments’ focus on children. And there is great variation from one country to another in terms of how children fit into government policies.

And in Sweden I was told of an office whose only function is to look at the impact of the emerging legislation coming out of government from the child’s perspective. And I think that’s a very interesting model to look at.

I believe I’m right in saying the National Children’s Bureau and Children’s Legal Centre in Essex have been commissioned to look at one or two impact analyses of policies and I want to understand that more too.

LR: This sits very well with your whole focus on mainstreaming the child.

AAG: Exactly. And I have got wonderful experience of this in the DoH. Because Kennedy commented that children were the Cinderella of the health service I have been a full corporate member of the top team, every month meeting with senior officials. And I have made it my business to stand up and say, when an important issue is being debated, what does this mean for children and young people who are 25 per cent of the population?

Now I want to see that replicated across the country on boards at all levels – local authorities, health service trusts, education establishments – somebody being charged with actually asking the question “what does this mean for children and young people?”.

The key word is responsibility

LR: And is that a function you see being performed by the new lead member for children?

AAG: Most certainly. And I want to engage with these people. I really want to work with them and understand their lives and how I can be of help to them.

This is the key word: responsibility. Who is actually responsible for asking this question about children? Otherwise they really will continue to be mainstreamed as an add-on, particularly in adult-centric organisations.

LR: Going back a bit now, what made you decide to make the move from specialist paediatrician to national clinical director for children?

AAG: Concern. As the DoH was creating the advisory structures for the NHS Plan in 2000, I was very concerned to note that not one paediatrician had been appointed to any of those boards. So several of us got together to write a pretty powerful letter in the BMJ asking the question “who is speaking for children’s health policy?”.

We wrote a pretty savage commentary, including our wish for an NSF and our wish for a commissioner for the rights of children. And so a few months later I found myself invited to chair the children’s taskforce that was set up. And I then found myself as a naïve newcomer in Whitehall trying to become an advocate from my hands-on knowledge of what it was like on the front-line.

I really enjoyed the challenge of creating the NSF which, as I say, is holistic and not just for health. And I really want people in social care and education to be aware of the content of the NSF because it is just as relevant to them as it is to the NHS.

I think I’ve got a pretty shrewd idea about what it is like to be a child and a young person. And those are the two key sentences I want chiselled in the stone over the entrance to my office: what is it like to be a child or young person and what is in the best interests of children and young people?

LR: What would you say is the single biggest achievement of the NSF – or what will it be once it is fully implemented?

AAG: I hope it will make sure that services are accessible, are evidence-based, they reflect the needs of children and their families, that children, young people and families have an active part to play in making decisions about their care, and above all that we get better consumer satisfaction with the services. Because as I’ve listened to the stories of families of children with a disability they say it is like wading through treacle.

“I can’t pretend to be a with-it 25-year-old-disco dancing freak on roller skates”

LR: I understand you have four grandchildren. How are you going to make yourself the kind of person that children like them will look up to, trust, and open up to?

AAG: First of all, I have to be myself. I can’t pretend to be somebody I’m not. I can’t pretend to be a with-it, 25-year-old disco-dancing freak on roller skates. That’s not me. I am who I am.

I hope people will see me to be someone they can talk to. I will certainly be bouncing off my little grandchildren some of the ideas we are talking about. Already I have very powerful messages from them about bullying at school, for example. I already know the sorts of things they are concerned about and they are very articulate in saying it. So I have on board a ready-made set of stakeholders.

LR: How will you reach children and let them know you exist? Will you go on children’s television to publicise yourself?

AAG: All sorts of ways. Communication has to be one of the most important aspects of the operation of the commission. How are we going to do that? I’ve got some ideas, but I want people’s ideas coming into the commission too. There’s a whole series of levels of communication. There’s the question of the brand of the commission, a logo, an identity. How d