Improving health and education September 2004

Introduction

September 2004 National Policy Forum

Our challenge is clear: world class public services, fair to all and personalised to each. A future where education and good health are at the heart of every community, where young people feel they can achieve and everyone takes charge of their health.

Labour believes in a society where, whatever their background, parents and children are valued and inspired at school, where patients feel that their health is safeguarded and improved by the NHS. Existing inequalities in educational opportunity and health are not acceptable. Labour will introduce and implement measures to remove inequalities in education and health and promote equal access to services. We believe too that the state alone cannot tackle the challenges of learning and health. We must all develop our responsibilities, with parents more involved in their child’s learning, attendance and behaviour, with every individual taking steps to guard their own wellbeing.

Labour will continue to tackle unfairness and inequity by providing specific support for those who are particularly disadvantaged. In the most deprived areas, we will continue to transform the opportunities of those who have the least and inspire ambition where once there was none. Inequalities will only be successfully reduced if people who have been previously disadvantaged are able to take charge of their own learning and their own health. We do this not only because it is fair but because it underpins a prosperous and modern economy that benefits us all.

For too long, the Conservatives encouraged hard working families to demand nothing and expect less from a government that cared little about health and education. They encouraged people to despair of public services. In the end we all paid the bills of their economic failure. Since then Britain has changed. The Tories have not. They are committed to an immediate £18 billion cut to public services and the privatisation of health and education.

This document is shaped by the positive vision of Labour Party members. It describes the challenges that members want to overcome and their ideas and responses as part of Labour’s policy making process. It builds on two of the work streams in the Partnership in Power policy making process, ‘The best education for all’ and ‘Improving health and social care’, and brings together the feedback from the public and the party through the Big Conversation, Labour’s major national policy consultation with the British people. It points to a compassionate and ambitious way forward for each of us to realise our true potential and for all of us a community in which power, wealth and opportunity are in the hands of the many not the few.

Transforming public services

We believe that access to excellent healthcare and first-class education should be the right of everyone. We also believe that choice should not be the privilege of those who can afford to pay for a private service. We believe in collective provision responding to individual need and preference. Our goal is for every child, every adult to realise their potential and enjoy an education that suits their individual needs and talents. For every child, every adult to develop their health and well being to the fullest, supported by a health service that recognises their individual concerns. We will put patients and carers, pupils and parents at the heart of our policies.

Record investment and reform

Labour are the party of investment. We are investing more money in public services than ever before, outstripping many of our international competitors and the investment is delivering record numbers of nurses and doctors, teachers and support staff.

Record investment has gone hand-in-hand with major reform. We have changed the role of those who work in health and education by allowing them to take on more challenging and interesting roles that they were prevented from doing in the past. We have renegotiated, in partnership with the unions, major contracts to back up that change.

In health, we are putting patient power and control at the heart of the NHS by establishing patient forums in every Trust and giving local hospitals greater opportunity to respond through NHS Foundation Trusts. We have developed the organisation of the NHS, with new Treatment Centres cutting waiting lists by doing back-to-back operations; NHS Direct, run by nurses, providing 24-hour health advice; and NHS Walk-in Centres where people can get treatment straight away. We will continue to encourage mutual solutions in health and social care by rolling out new community interest company models in the NHS as a way of involving people in their own care, for instance in mental health, learning disabilities and in the management of chronic diseases.

In education, we are building a more flexible and fair system around parents and pupils, and shaping services to meet the needs of working families. Sure Start schemes, which Labour set up in the most disadvantaged areas, to make sure every child gets the best possible start in life, have trail-blazed new ways for providing joined-up services, tailored to suit each parent and child. Sure Start is discussed in greater detail later in the document. Our schools are changing too, opening up to adults, not just pupils, to learn the basics during the evenings and holidays. We are giving young people more choice in their education, with new incentives for pupils to stay on in schools, a stronger emphasis on vocation and a massive expansion of apprenticeships.

Making a difference

The real change these reforms have made can be most clearly seen in the results which flow from them.

In health, the NHS is now providing much faster treatment with maximum waits for operations halved (and still falling). 97 per cent of patients can see their GP within two working days and nearly 99 per cent of people with suspected cancer now see a specialist within two weeks of an urgent GP referral. The Tories, who want to keep speedy access and choice as a preserve of the rich, don’t think quicker access for all matters. But quicker treatment means more people alive today who would not have survived in the past. The fall in death rates of 23 per cent for coronary heart disease and ten per cent for cancer in the last five years is astounding but true. The falls in these mortality rates are the fastest in Europe and are a tribute to the hard work and care of NHS staff.

In education, the hard work of pupils and teachers has delivered the best ever results at age 11, 14, 16 and 18. As a nation Britain is doing better than ever before. In an independent international survey of 30 countries, carried out by the Organisation for Economic Co-operation and Development, Britain ranks second in the world for the proportion of four-year-olds in education, third for literacy in primary schools, fifth for completion rates on academic courses and second when it comes to our research output and impact.

Our reforms and investment have made a massive difference but there is more we must do if we are to achieve Labour’s vision of truly world class public services.

Fair to all

We need services that are fair to all. That means high quality services wherever you live, whoever you are. That’s why in health we set up NICE (the National Institute of Clinical Excellence) to ensure that everyone – not just the lucky few in the right places – have the best access to the right drugs for their treatment. In education, OFSTED is committed to high standards, providing information, incentive and support to drive up ambition and achievement in every area. We have established high national standards in both health and education, together with inspection services to check that the right quality is being delivered. Labour is determined to make sure no community is left behind and to be fair to all, providing extra support where necessary to those who are most disadvantaged. Labour will provide additional resources to identify and address inequality in health due to poverty, ethnicity and social status. Funding will be targeted to systematically reduce inequality in health.

We will extend to everyone the options that have historically been the preserve of the few who paid privately. Our goal is for every child, every adult to realise their potential and enjoy an education that suits their individual needs and talents. For every child, every adult to develop their health and well being to the fullest, supported by a health service that recognises their individual concerns.

Personalised to each

To achieve the goal of world class public services for the many not the few we must build public services that are highly responsive to the demands of each individual, providing them with the opportunity to take decisions, and the information and support to choose the path that best suits them within a publicly funded, publicly accountable National Health Service based on equal access for all, free at the point of need and the vast bulk of NHS services will remain directly provided, in the context of an improving, expanding NHS.

But the need to personalise services does not mean that all forms of choice are beneficial. Proposals for the extension of choice in the public services should be judged according to whether they empower the lives of individuals and communities, and whether they support the Labour values of social cohesion, equality and the provision of high quality, local public services for all. The failed reforms of the Tory years, far from increasing choice, unleashed destructive forces of competition and internal markets into our public services that reduced choice for the many, fragmented services and increased inequality. In meeting the challenge of providing more personalised and responsive public services, Labour will, therefore, develop an approach that builds on collaboration, not competition.

In health, increased capacity and personal empowerment are the keys to world class health services. For most people, the ideal health service has always been the one which provides the best quality care with the fastest possible treatment, with the fairest and most equal access, in the most convenient – usually local – setting. This means investing in capacity increases for everyone throughout the country. However, today’s working families expect a standard and quality of healthcare far greater than in the past and expect also, more information, control, power and say in their own healthcare than ever before. It is our ambition and our task to provide both that capacity and that enforcement.

In the context of improving national standards, capacity is the partner of choice, not its enemy. Additional capacity gives patients the chance of greater quality, information, power and choice. In turn, choice enables people to get the best out of increased capacity.

For example, in the past, the mother who had a sick child at night had to wait to call her GP for an appointment in the morning and then may have had to wait days or weeks for an appointment. Alternatively, a visit to an A&E department would have entailed very long waits. This was because the previous shortage of investment and capacity meant that she was denied any choice in how she obtained the treatment her child needed.

Now, because of increased investment and capacity, she has several options to deal with her problems – much faster access to A&E treatment; or to a local practice nurse within 24 hours; or a GP within 48 hours; or to visit a walk-in centre; or call NHS Direct 24 hours day or night. This extra capacity creates choice in action. All of this provided with equal access for all, free at the point of delivery. Contrast this with the Conservatives who will use NHS money to help those relatively rich who can pay to jump the queue outside the NHS. Their choice is for the few.

Of course, choice can neither be infinite nor absolute since finance, national standards and resources are constrained. However, we can give people a greater degree of control over their treatment in a manner previously confined only to the better off. This helps us build our health service around the convenience of the patient.

All of these choices provide patients with more control and power over their own health, thereby carrying out Labour’s historic role of empowering ordinary people.

The NHS relies on respect and trust – sharing moments of deep vulnerability calls for exceptional levels of understanding and empathy. Given this, at different times of our lives, we each need different things from the NHS and it is clear that one size does not fit all. Many people, especially older people and those with chronic conditions, place a high value on the traditional model of general practice, on continuity of care and the personal relationship between patient and GP or nurse. Others attach more importance to being able to get help quickly at a time and a place to suit their busy lives, from a variety of producers. We need to provide a service suited to the individual. We need to provide services suited to individuals and their families that are equally accessible to all. To ensure services do meet need we must retain our commitment first and foremost to ensure all services reach the highest standards of effective and safe care.

Despite historic levels of investment and reform, health inequalities stubbornly remain. A child born in Dorset has a life expectancy eight years longer than a child born in Manchester. This is unacceptable. We will help people make healthier choices through our policies on public health but we must also make sure that services are delivered to respond to the needs and lifestyles of everyone, particularly in areas of lower health outcomes.

We are making the education system more flexible, enabling parents to learn in schools and pupils to learn at work and college. Specialist schools are delivering the kind of personalised education that for too long has been the preserve of private schools. We are providing more choice for learners to choose their path, with tailored teaching and learning and increased curriculum choice (especially post 14) and we have made it possible for all schools to go for specialist schools status. Pupils can expect schools to work with them to develop their best talents and provide tailored support specific to them. If you are a parent, our schools will work with you to provide your child with a personalised service at every stage of your child’s education and consult with you about your child’s needs and share with you, on a regular basis, detailed information on progress. School leaders will encourage teachers to share their own individual skills for the benefit of other schools as well as for their own classes. We will ensure sufficient diversity in the system so that the days of one size fits all are over.

Individual responsibilities

We can only succeed if individuals recognise their own responsibilities for the health and education of themselves and their families. We need to increase the involvement of people, local employers, sponsors, and volunteers in health and education and support local government to help lead their involvement and to develop democratic mutual ownership and management structures that give these stakeholders a real say in decision making. Our vision is of a society where our duty, collectively, is to provide for all and our duty, individually, is to show responsibility to all.

When it comes to the health service, patients will be able to expect greater rights – increased choice, faster service, higher standards of care – but they must also recognise the duty they owe in return. Each of us needs to take steps to safeguard our health.

The NHS must not just tackle sickness but promote health. We need to discourage smoking and encourage healthy eating. We must make the right information available and provide support to break unhealthy habits. There is already plentiful evidence that enhancing a patient’s wider role in self-management of chronic diseases can produce real benefits. The Expert Patients Programme has developed self-management training programmes for patients with chronic diseases, giving patients advice, tools and techniques to look after themselves better and take control over their lives.

There was support among submissions for a stronger, more formalised method of reminding patients of the nature of their relationship to the NHS. People recognised that the NHS has finite resources and were prepared to countenance additional measures to help get the most out of the health service budget. There was support for ideas including the drawing up of a ‘partnership in care’ agreement between patient and doctor, putting down in writing the rights and responsibilities each could expect from the other.

In education, there are responsibilities too. The co-operation of parents and families with teachers is the most decisive factor if a child is to reach their full potential, particularly for children with special educational needs. Recent research shows that parental support can significantly enhance a child’s achievement.

Submissions sent to the policy commission highlighted the challenge of involving parents and developing family learning as a priority. They agreed that parents should share with their children the duty to ensure that pupils attend school regularly but parents should also feel welcome in schools too. Similar views were put forward in a Big Conversation with the Education Secretary in Tilbury and participants discussed whether pupils should be made to stay on campus at lunch – an idea that received general support, although it was agreed that heads are best placed to decide what suits their school. Submissions also called for a particular effort to involve parents in their children’s education at the point of transition between primary and secondary school.

Developing the workforce

As we develop the public services, it is vital that we encourage public service staff to develop too. There needs to be continuous workforce development, with clear career pathways for all. We need to build on the work of trade unions in raising the skill levels of employees. Across both health and education, we are creating a UK-wide Sector Skills Council for Social Care, Children and Young People to bring employers together to lead reforms and raise skill levels.

We need to ensure that all support staff in our public services are able to climb the ladder of qualifications, working with unions to support and guide them. Labour will consider extending regulation to those categories of staff currently unregulated who need to have high standards of clinical practice to ensure public safety and whose work has a direct impact on patient care. Nurses will have the opportunity to become nurse practitioners, carrying out some of the basic jobs that doctors currently do (for example, they might prescribe asthma inhalers). We also want to pilot a new role for pharmacists, empowering them to be able to provide some basic services, so as to free up the time of doctors and consultants to treating patients.

Staff employed by private companies in the public sector, for instance hospital cleaners in PFI projects, also need to be able to benefit from career paths and training, and we will ensure PFI contracts offer every opportunity for them to contribute and progress. The people who work in the NHS deserve great credit for the improvements we have seen in recent years. Putting patients at the heart of the NHS will allow staff to work in new ways to make further improvements, but will also place demands on all parts of the service. That’s why the next Labour Government will help the NHS reduce barriers to partnership and teamwork, for instance by encouraging more new NHS models of service provision bridging health and social care, and giving Trusts the power to take back into public control ancillary services such as catering and cleaning where they are hampering improvements or underperforming.

For the many teaching assistants who excel we want to introduce higher level teaching assistant posts, with higher pay and better training. We will provide more opportunities for assistants to climb the ladder, improve their skills and pay and become teachers. We recognise that the National Agreement ‘Remodelling the School Workforce’ will need to be fully and properly funded by LEAs and the government and welcome the recent announcement on schools funding. Labour supports a more coherent approach to the provision of supply teaching by local authorities, the Teacher Unions and DfES with any financial surpluses being redirected back into the education system rather than creamed off by external suppliers.

Agenda For Change, negotiated between the unions and the Labour Government, provides a good base for developing staff over the next Parliament. The unions and the Government must continue to build on this to reward staff playing their role in improving public services.

Labour is committed to developing the diversity of public service staff, with more employees from disadvantaged backgrounds and a significant increase in the number of employees in well-qualified posts from ethnic minority backgrounds. The Teacher Training Agency has set targets to increase the proportion of entrants to training from ethnic minority groups to 9% by 2005/06. We also recognise the importance of doing more to encourage members of ethnic minority communities to become school governors and to increase the number of black and Asian people holding senior posts in local education authorities.

Improving education

Labour’s first task has been to raise achievement and aspirations in every community. Our reforms and record investment are driving up standards and building new schools in every part of the country. Parents now expect a world-class education for their child, regardless of where they live or what they earn. And all our children have a right to the acquisition of knowledge, enlightenment and personal fulfilment that a first-class education system can provide.

Labour believes that our population should be educated and skilled to levels that set the standard for the rest of the world. Labour’s challenge is to drive Britain into the top three of the thirty countries that belong to the OECD (the Organisation for Economic Co-operation and Development) at each stage of education – a feat that seemed impossible only a decade ago.

Education will remain at the heart of the Labour government, driving forward a strong education service that supports better health, less crime and good citizenship. We are committed to a future where every child – and every adult – has access to the best education available and where no one is left behind.

Increased investment, powerful literacy and numeracy strategies, workforce reform and leadership reform have together built a platform for the education service to move on to a new stage of reform. We support the idea of three year budgets for schools alongside three year budgets for councils. Labour opposes the Tories’ plan for selection, vouchers or the removal from councils of the responsibility of admissions. Local councils will retain an important role in promoting accountability of publicly funded schools through a wider overarching scrutiny role.

We have delivered higher standards, improved buildings and more teachers. Our approach has concentrated on the basic building blocks of an education system but the time has now come for us to reshape our schools to meet the needs and ambitions of every learner. As the Prime Minister has said, we must make the system fit the people, not fit the people to the system. Our best schools are leading the way on this and are now leading our education system.

An important role for local authorities

We expect local authorities to champion the interests of parents and pupils in their localities particularly where change is needed to ensure that every parent has a choice of a good school and no pupil is failed by a poor education.

Central and local government have agreed through the Central Local Partnership chaired by the Deputy Prime Minister that ring fencing should be reduced.

However, the government’s decision to ring fence education spending reflects the particular circumstances at this time affecting schools and the priority we give to enabling governors and head teachers to focus their time and energies, and on raising standards.

The Lyons enquiry will address the wider issue of local government funding moving towards a shared partnership. The government’s general aim remains to provide greater funding flexibility at a local level through, for example, local area agreement, and it will not extend ring fencing to children’s or other whole services.

As part of the implementation of three year budgets for schools the government will also consider and discuss with local authorities, governing bodies and head teachers how funds within the overall schools budget that are currently ring fenced for particular purposes might be de-ring fenced to allow greater flexibility.

The introduction of three year budgets for schools will bring financial security and freedom to head teachers and school sin their forward planning. It will guarantee a dedicated schools budget which will be delivered to schools through local government.

Making sure this change happens in a smooth and effective way in 2006 will require a joint effort between national government, local government and the Audit Commission and will involve representatives of head teachers, governing bodies and Directors of Education and Children’s services. There will be consultation in Autumn 2004 about the new arrangements for the new School’s budget. No authority will receive less funding for education than its current local government.

Although the national per pupil minimum funding guarantee will continue, local government will continue to play a key role in allocating money to schools through the local needs and circumstances. Any changes in the way these formulae are to work will be developed in partnership with local authorities and schools. Local authorities will also continue to be responsible for decisions on spending on Special Education Needs, schools transport and a wide range of other issues.

Local authorities will also play an important role in ensuring that education funding is effectively used, as set out in the recent Audit Commission report. They will work to help schools develop their capacity for good financial management, work with schools that have financial problems and make sure that with the advent of three year budgets school’s general balances are progressively reduced.

The government is also committed to looking at how best to bring together fragmented and overlapping streams for children’s and youth services so that they give greater flexibility to local authorities in tackling difficult cross-cutting problems. This new flexibility will enable local authorities to commission child care and extended schools services from schools and a range of other providers.

Labour believes the highest possible priority should be given to safeguarding and promoting the well-being of children and young people in care. How well government treats these children is a good measure of how seriously they take child welfare and parenting issues generally. A great deal of progress has been made but more needs to be done to deliver placement choice, stable placements and improve their educational achievement.

Education is about encouraging and enabling every child to fulfil his or her potential in terms of learning, citizenship, the acquisition of vocational skills, creativity, and personal fulfilment. The education system must reflect these requirements and whilst providing choice for parents and children should do so in ways which ensure that the choice exercised by the minority does not restrict choices available to the majority. The education system should be seen as a network of providers affording different options on a complementary basis.

Labour’s positive vision of the future is in stark contrast to the Tories. Their negative rhetoric is that every step up a child takes in their achievement is actually a dumbing-down. Tim Yeo, the then Tory education chief, said: ‘I would be quite proud if for the first time in 25 years I announced a deterioration in results’. They want to abolish Sure Start and are committed to cuts across the board, including cuts to training and higher education. They see every extra penny invested in education as a penny wasted and their policies are for the advantage of the few at the expense of the many.

The early years: universal flexible pre-school learning and targeted support:

Our priority is to give every child the best start in life and over the last seven years there has been a revolution in early years care and education. Every three and four year old has the guarantee of a free part-time nursery place and already over 1.6 million children have benefited.

There were hundreds of responses on the challenge of expanding child care and children’s services. In an online survey on the Big Conversation website, four out of five respondents wanted quality centres and well-qualified staff, even if that meant slower expansion. This view is one shared by submissions from party members: that the focus should be on expanding high quality children’s centres, such as Sure Start, but that there should be some expansion of nursery places to help working parents who find that there is still a lack of affordable childcare at the times when working parents need It.

The cost of early years education and care (or ‘educare’) is now a key issue, both in terms of under 5s and in terms of out of school hours. In January 2003 the Daycare Trust reported that Britain’s childcare costs were still among the highest in Europe. Many of those who took part in policy consultation would like to see significant steps towards addressing the childcare needs of working families and Labour will take action to increase the amount of affordable childcare provided by public sources.

Labour can now make a world-class offer to parents. We will provide universal childcare for all parents that is responsive to their work and life needs. At the heart of this offer will be 1700 children’s centres, offering a range of childcare, health and family facilities, in the most deprived areas. We are also piloting nursery places for 2 year olds and embedding Sure Start principles in developing children’s centres. We will provide a children’s centre in every community by 2010.

Labour is already committed to additional funding of £669 million for early years education and childcare by 2007-08, moving towards the goal of a children’s centre for every community.

The challenge that we face is how to provide universal nursery provision flexible enough to suit the different needs of every family. We need to work with parents to build on their existing rights of part-time provision for three and four year olds, and create a system which is more flexible and responsive to their everyday needs and which recognises the high proportion of parents who need to work.

5 – 11 years: Broadening reform in the primary years

Labour will continue the drive for excellence and enjoyment in the primary years backed up by sports, language, music and trips to provide exciting early years schooling for every child. To overcome the barriers that poverty puts up we must encourage and support parents to take an active role in their children’s education and look at new ways of involving parents and families in schools and their children’s learning.

We recognise that there are real and practical barriers to a child’s enjoyment of the outdoor environment, both in their leaning and play, such as the fear of accidents, constraints on time and poverty. We will support children, parents and schools by making outdoor education a key part of our strategy to educate all citizens about the environment in its widest possible sense, and its future challenges such as Climate Change.

Standards are continuing to rise throughout our primary schools. In 1997, around half of children left primary school unable to read and write at a basic standard. In 2004, the figure is down to around one in four. That is still too high and our priority now is to build on those early improvements.

Since 1997, schools in the most deprived areas have seen the greatest improvement. The percentage of schools achieving below 65 per cent in English and maths tests at age 11 has been roughly halved. We want to see faster progress for those 11 year olds not currently reaching the expected standard. We must target the 25 per cent of primary school pupils who miss out on reaching Level 4.

Testing of pupils should be seen as a diagnostic tool gauging whether a particular school is adding value and which children need additional support. The most useful form of testing is where it is individual and child centred, used to inform the child’s teachers, parents and those involved in educating the child. A fresh approach to Key Stage 1 assessment (at age 7) is currently being trialled, where testing underpins teacher assessment instead of being reported separately. The party welcomes the introduction of a ‘value-added measure’ in the reporting of Standard Assessment Tests and is strongly supportive of a more rounded image of primary school performances, which takes into account both the indoor and outdoor nature of the school’s educational provision, ensuring that children are able to learn in a ‘real-world’ context wherever possible. We need to enrich the curriculum through sport, modern foreign languages, music and regular opportunities to learn about the real world through trips away from the classroom.

We need to enrich the curriculum through sport, modern foreign languages, music and school visits. By 2010, all primary school pupils will have the opportunity to study a foreign language. A pilot programme to bring more music into primary schools has been running since September 2002 in 13 local councils. These new local councils. Music Services have worked with schools and the wider musical community to increase access to music for primary pupils. Playing sport in school can also have a positive impact on attendance, behaviour and attainment, not just in primary schools but for pupils of all ages – our target is for at least two hours a week of PE and sport. The ‘Playing for Success Scheme’, to which 89 football and other sports clubs have signed up, is also making a marked difference to achievement and aspirations.

Primary school teachers are playing a decisive role in raising standards. There is still a need to ensure every primary school has strong leadership. We have introduced a new leadership programme, where 1000 of the best headteachers work with their colleagues to improve leadership in every school. Good school leadership requires good people management skills. It is now a requirement of all head teachers that they successfully complete appropriate personnel management training. The government has established the National College of School Leadership which provides an opportunity for such training to be available to all school heads and we encourage all schools to take it up.

There is no substitute for a good teacher but we want to develop further the role of teaching assistants and expand their number. Assistants provide excellent team support for teachers, relieving them of administrative tasks and freeing them for planning and preparation time. We must build on the successful reduction of bureaucracy and unnecessary paperwork.

Government recognises the need to address the issue of term time work among school staff. While term time may suit employees with school age children, not all staff working in education support services want to work this pattern. Trade unions and local government employers should act in the recommendation of the local government pay commission and seek to resolve this issue urgently. The Government believes that change in this area is necessary because the changing pattern of services on schools, much of it funded by government, including the development of all-year-round childcare and the expansion of extended schools. The example of Northern Ireland provides one possibility for making progress on this issue. The Government will therefore monitor progress in resolving this issue and consider what action to take as a result.

Labour aims to provide the best education for all with learning and access difficulties. All children have the right to a good education and the opportunity to fulfil their potential. All teachers should expect to teach children with special educational needs (SEN) and all schools and children’s services should play their part in educating children from their local community, whatever their background or ability. We must reflect this in the way we train our teachers, in the way we fund our schools, and in the way we judge their achievements.

In recent years we have made good progress in improving provision for children with SEN. However there is much further to go. Causes of SEN are misunderstood. Some children are socially disruptive, others have serious learning limitations. More resources will be provided to research into SEN. Too many children wait far too long to have their needs met. Children who should be able to be taught in mainstream settings are sometimes turned away and too many staff feel ill-equipped.

We will continue to promote and support the development of inclusive education for disabled pupils and students. Inclusive education has been shown to be the most effective way to develop disabled people’s potential as full citizens.

Despite overhauling the statutory framework and extending the Disability Discrimination Act to cover education, a recent Ofsted report (September 2004) shows that the percentage of disabled pupils segregated in special schools has remained the same for the last five years.

The postcode lottery further affects the life chances of disabled young people, there being a twenty-four-fold difference in whether a disabled child is educated in a special or mainstream school, depending on where they live in England.

Labour will, in line with Barriers to Achievement, develop inclusive practice in all areas. We will build on what is already in place by:

· setting time limits and providing funding to remove physical barriers;

· ensuring that staff get disability equality and inclusion training;

· building the capacity of mainstream schools to include a wider diversity of students by appointing advisory teachers in LEAs;

· exchanging good practice through Teachernet and regular exchange visits;

· seeking to ensure that that adequate resources are available to support the inclusion process.

The above will ensure that at the earliest opportunity and by 2020 at the latest, every disabled young person should have the choice to be educated in a mainstream school. Schools should be more closely involved in the wider provision of children’s services as outlined in Every Child Matters.

Early intervention is crucial to ensure that children who have difficulties learning receive the help they need as soon as possible and that parents of children with special educational needs and disabilities have access to suitable childcare. We want children with SEN to have their needs met as soon as they become apparent, without the need for a period of failure, and to feel valued members of their school community.

To this end we support a new role for special schools. Though an increasing proportion of children will attend mainstream schools, the special school will be developed as a hub for coordination of health, social and educational services for children with profound and severe disabilities, as well as a centre of expertise providing training, support and advice for neighbouring schools, managing classes in mainstream settings and offering secondments to and from its partners in the local school network.

It is essential that all schools fully participate in the local childrens and young peoples agenda led by local government. They are key stakeholders and we must make clear our expectations and support their involvement.

Getting the right start to the secondary years: 11-14

Labour is committed to continuing our record investment in schools and broadening the curriculum. In secondary education, as in primary education, standards are going up across the board and rising fastest in our toughest areas. We must build on the progress we have made and set new goals: high quality teaching with learning tailored to each pupil’s needs; a stronger vocational offer; more choice for pupils over what to study and the pace they progress; and out of school hours activity and learning available to all children and young people.

Our reforms for 11 to 19 year olds are ambitious. Every school in every community must meet high standards. We need to lift the performance of all students, but especially to increase vocational options, and tackle the drop-out rate at 16. For years, the Labour Party have called for a stronger recognition of vocational qualifications, and we have made good progress, with a broader offer of vocational GCSEs and the resurgence of apprenticeships. We need to keep improving results for 14 year olds by making sure the most able are stretched and by targeting the 25 per cent who are not improving on their performance at 11.

There also needs to be more support to ease the transition between primary and secondary schools. The transition to a larger and more impersonal school can lead to a dip in performance for some children. We must address why children who are ranked third best in the world at reading when they are ten years old, fall back to eighth by the time they are 15. Parents responding to the Big Conversation were keen for schools to develop a small learning community or house system to manage the transition from primary to secondary.

School clubs and out of school hours activities, especially in the arts and sport, have repeatedly proved their value in extending horizons, addressing poverty of aspiration, and reducing anti-social behaviour. Yet current provision is uneven and often unsustainable, with many children having no access to school clubs. Looking to the future we need to recognise the huge potential of out of school hours activities for creating a more holistic, aspirational and rounded school years experience.

Specialist schools are having a real and positive effect on the achievements and aspirations of pupils. They get extra resources to excel in one of eight areas: arts, language, sports, business and enterprise, engineering, mathematics and computing, science, and technology. They have to work with other local schools to share their facilities and expertise so that all pupils with a particular interest are able to develop their talents. And they are getting better results too (as Table 5 shows).

In future we will apply this principle of sharing expertise and resources by encouraging partnerships across all parts of education including all schools in a locality, private schools, universities, colleges and workplaces.

Those who made submissions to the policy commission and who took part in the Big Conversation were generally supportive of specialist schools. A significant concern was that pupils might get trapped into a subject that did not suit them. Because pupils can get trapped into a subject that does not suit them, specialist schools will be encouraged to offer more than one specialism and to collaborate. Children should be allowed to change or add to their chosen specialism with another subject. Labour will also consider the expansion of specialism to include many more schools, particularly those who currently find it difficult to raise the required funds from the community. Submissions were also keen for every child to have access to the opportunities provided by specialist schools.

Labour recognises that choice of school is more restricted in rural areas. If children do not attend their local school, alternatives may involve travelling many miles, lengthening the school day and taking the child out of their community. Even in cities, choosing distant schools adds to the ‘school run’ congestion which our other policies seek to reduce. In rural areas where the distance between schools is greater, we will encourage schools to develop in ways that include all the children in that community.

We want specialist schools to work with the local authority and other schools to tackle underperformance and provide tailored learning for every pupil. Our priority is to build on the success of specialist schools and get all schools to develop their strengths, backed by three year budgets and streamlined funding that will give them greater stability in their long-term planning. We are changing the inspection regimes to cause less disruption and become more effective.

Labour is committed to ensuring that all schools have the resources they need to excel, and that additional investment and support are made available to help improve those schools that are under-performing. Local councils and government must work together to ensure that no new hierarchy of schools is created, which would cause increased problems for those perceived to be at the bottom of the pecking order.

City Academies are helping to bring new sources of money and educational expertise into the poorest areas, and as the numbers of them expand, the government should consult with teachers, pupils, parents and the party on this programme. In selecting academy sponsors it is important that there are clear procedures including reassurances about sponsors’ commitment to fair admission and equal opportunities policies and respect for the professionalism of headteachers and their staff in curriculum matters. It is essential that all schools including academies work together to deliver coherent admissions and transitions.

Local councils have a fundamental role to play in delivering the best education for all and it is essential that government and local authority bodies work together. Local councils are in a unique position to help schools raise standards and should play a central role in Children’s Trusts, providing educational leadership and innovation in their local areas, championing the interests of parents and pupils and promoting local partnership between all those involved in children’s education. We value the ongoing role of local councils in distributing funds to schools and the new responsibilities they will be taking on, ensuring they remain at the heart of the challenge to raise standards for all. We believe that three year budgeting for schools will provide a greater ability for schools to plan for their future.

Headteachers have called for greater autonomy for secondary schools. There are clear benefits to delegating more decision-making to heads and giving them a greater say in the management of their budgets but there must be a framework of collaboration in order to avoid a return to the worst excesses of the grant maintained era, when Conservative policy deliberately set school against school in a false market-based belief that greater competition automatically produced system-wide improvement.

We have made other reforms, making it possible for schools to collaborate, share staff, and support each other in raising standards. Federated schools – where the governing bodies of local schools join up together – are encouraging an environment of co-operation, not competition and are helping to spread the benefit and excellence of schools and staff in one particular area.

We also want schools to involve pupils through school councils and other forums to ensure all young people can be engaged in decision making as much as is practical.

Admissions

The Prime Minister has defined our approach by saying: ‘We will not extend selection by ability, either at five or eleven – We want parents to choose schools, not schools choose parents’ and ‘more good schools, more help for schools that are failing, more types of school for parents to choose from – that is our policy.’ Labour will deliver choice and opportunity for every pupil, not just a privileged few.

Our vision for education promotes quality choice for parents and pupils. We reject the damaging Tory assumption that general ability is fixed or predetermined and their damaging proposals for every primary and secondary school to select and choose their pupils, and to do so on their own criteria.

We will avoid the dangers of social exclusion, continue to tackle inequalities between schools and to end the growth of selection. We have also removed the ability of schools to use interviews as a covert form of selection.

We are pursuing a non-selective system in secondary education. So we will continue to ensure that all schools abide by the strict requirements of the admissions code of practice which does not allow any extension by ability.

The Government will study carefully the report on secondary schools admissions by the Select Committee on education and skills. We recognise that as we move to a system of all schools becoming specialist there us a case for examining carefully the role of selection by aptitude. Few specialist schools exercise their power to select by aptitude but it can provide opportunities for children talented in areas such as sport and music develop their natural skill. Given the new circumstances the Government will review the current list of prescribed aptitudes to see if they all continue to be appropriate.

As schools become specialist so collaboration, federations and partnerships between them ARE growing. This development is to be welcomed particularly in the context of the emerging 14-19 curriculum reforms, which will break down the academic vocational divide particularly in selective areas, and should therefore be accelerated to drive up opportunities and standards for every pupil in every school.

Submissions reflected a wide range of concerns about school admissions, including issues such as the importance of a smooth transition from primary to secondary school, the operation of selection in certain local councils and the need to make it easier for parents to understand how the systems of admissions work.

Councils will continue to have an important role on securing a school place for every pupil, co-ordinating secondary school admissions, supporting and promoting local protocols for dealing with disruptive and excluded pupils and, where appropriate, objecting to the Schools Adjudicator regarding potential breaches of the Admissions Code of Practice.

Councils will also continue to be responsible for admissions for community schools. The Government will ensure that academies admissions procedures are in line with the Admissions Code of Practice and will encourage all academies to liaise with appropriate authorities over their proposed arrangements. We will give consideration to the Select Committee Report on Admissions.

In addition we will, as set out in the Child Poverty Review recently announced by the Chancellor, review in partnership with local authorities and head teachers the way that funding is distributed within local authorities to schools. As part of that review we will consider whether all authorities should follow the example of those local authorities that use their local funding formulae to provide extra support to schools that admit disproportionately high numbers of underperforming pupils.

In every area, we must ensure that all schools are supported, that every child is receiving quality education and that no group of children is failed. The party is opposed to a two-tier education system. There must be a strict requirement that all schools continue to abide by the admissions code of practice which prevents selection by ability.

Private schools with charitable status should have to demonstrate the public benefit they offer by for example creative partnerships with neighbouring state schools and local communities. Their charitable status will be dependent upon the wider manifestation of this public benefit to the Charity Commission.

In response to the challenge in ‘The best education for all’ of improving and supporting management and governance, many submissions, including those from heads and governors themselves, called for more flexibility and support. In particular, many heads called for a streamlining of educational funding so that they can plan their budget more soundly and reduce the administration and bureaucracy that funding applications require. In this regard, the party welcomes the guaranteed three-year budget and the continuing role of LEAs in distributing funding between their local schools.

We will ensure that all providers of education in schools, colleges and universities implement the Race Relations Act and carry out regular impact assessments and report to managers and governors of progress of the implementation of the RRA as amended in 2000. OFSTED has a critical role to play here and we shall ensure that inspectors are fully trained to fulfil their responsibilities under the RRA 2000

Reforming provision for 14-19 year olds

We need to find a balance between academic and vocational study and equip pupils for the world of work. Mike Tomlinson is chairing a Working Group for 14-19 Reform to transform the learning experience for young people, whether in school, college or the workplace. Built into the new 14-19 curriculum should be the ability to change direction so a child is not tied for life to a decision made at 14. There are key challenges these reforms must address: they must stretch the most able young people, reduce the burden of assessment , stop the scandal of our high drop-out rate and tackle the historic failure to provide high-quality vocational opportunities. We must build on the success of the best local authorities in doing this.

We will provide school, college and work-based training to provide every pupil with the opportunity to become a young apprentice. Apprenticeship schemes are giving new choices and opportunities to teenagers. Since the inception of Partnership in Power, policy forums up and down the country have argued for an extension of apprenticeships, providing high quality training for those who wish to work and learn at the same time. In 1997 75,800 students studied Modern Apprenticeships; today there are 255,500 – the highest ever level. We want to build on the success of the apprenticeships so far and create on the job learning at school. Motivated and able 14 and 15 year old pupils could be given the chance to become “Young Apprentices”, and combine traditional school studies with up to 2 days per week learning on the job alongside skilled workers. Opportunities should be available to everyone, no matter what their age. That is why we will pilot the first ever ‘Adult Apprenticeship’ by scrapping the arbitrary 25 year old age limit on Modern Apprenticeships to enable more people to skill up and get on in their careers. The 14-19 Pathfinders programme is also testing innovative models of collaborative working between business and schools to offer a wider range of general and specialist qualifications, including, amongst other things, work-related learning and enterprise education.

Although school attendance in 2002/03 was at its highest ever recorded level, we need to do more to tackle truancy. Truancy rates are slightly better than they were in 1997. There are solutions, but they are not just about school discipline. The truth is that a lot of children misbehave and truant because they find too many lessons boring: changes to the 14-19 curriculum will address this problem but parental responsibility remains key to tackling behaviour and discipline issues.

Behaviour was an important issue for parents and teachers responding to the Big Conversation. It has been a repeated message from teachers that a small minority of disruptive pupils in the classroom can affect the achievement of the many. We will ensure that no school is obliged to take an unmanageable amount of disruptive pupils and these pupils should be allocated between schools via local agreement between schools. Many thought that pupil’s achievement and behaviour would improve if they are kept on school premises throughout the day but some argued that children should be allowed to leave school if they are responsible enough.

Under Labour, the number of permanent school exclusions has fallen by 25 per cent since 1997, following the implementation of our Behaviour and Attendance Strategy in schools. It is important we support teachers and school governors when they believe pupils’ behaviour warrants exclusion, although we should also ensure that children throughout the UK have their right to participate in schools’ exclusions upheld and that they are supported in making their voices heard. It is equally important we ensure that children who are excluded from school do not drop out of education altogether. Local councils are now obliged to provide every child who is excluded for more than three weeks with full-time and appropriate education. Labour will build on the best examples of good practice in Pupil Referral Units and community-led initiatives with an aim to reintegrating pupils into mainstream education as soon as practicable. Labour will continue to give particular emphasis to reducing the disproportionate number of school exclusions amongst African-Caribbean children and will support community projects which provide an innovative and effective approach to tackling this problem. Labour will also work to substantially narrow the gap between the educational attainment and participation of children in care and their peers.

In the majority of schools, standards have risen since Labour came to power in 1997. However, a small number of schools fail their pupils and are taken into special measures. We have taken decisive action to help these schools recover but we realise there is no ‘one size fits all’ solution, as many of the problems are specific to the individual school and have built up over time. We will look at innovative ways of helping these schools overcome their difficulties and recognise the key role of teaching and support staff in achieving this. In particular, we will seek to find ways of refreshing and expanding classroom teachers’ experience, for example by short sabbaticals.

In response to the challenge of increasing staying on rates, many submissions called for expansion of the new Educational Maintenance Allowance (EMA) to tackle drop-out rates head on. The allowance is paid direct to a student, as long as they attend classes and show real progress, with bonuses for achievements and learning. The allowance is available to all 16-19 year olds from families with an annual income of less than £30,000 a year. In the last round of Partnership in Power, many called for such targeted support to encourage those who were in danger of dropping out of school to remain in education. So far, the pilot schemes have shown a gain of around six per cent in staying on rates.

By personalising public services we can better meet the needs of children from ethnic minority backgrounds, who form around 13 per cent of the pupil population. Efforts to raise the achievement of ethnic minority pupils are beginning to bear fruit. Improved performance of Black, Indian and other Asian (including Chinese) heritage pupils is particularly encouraging. However there is more we must do to tailor teaching to suit every child.

In response to the challenge in ‘The best education for all’ of improving and supporting management and governance, many submissions, including those from heads and governors themselves, called for more flexibility and support.

Skills

Skills are at the heart of our ambition for a fair and prosperous Britain. They are vital in supporting individuals to achieve their potential, improving business and public sector performance, enabling people and communities to respond to the challenges of globalisation and ensuring Britain can close the productivity and competitiveness gap.

It is a scandal that approximately 5 million adults in Britain lack basic literacy skills and 14 million do not meet the numeracy standards of the average 11 year old. The vast majority were failed a decade or more ago, when successive Conservative governments failed to invest in schools and allowed poor educational attainment and lows aspirations to disfigure our disadvantaged communities.

In the long term Labour’s early years’ programmes, school standards agenda and reform of the 14-19 phase of education will transform people’s life chances and reduce skills gaps. However, in the short and medium term we must match these reforms with a strategy that addresses the needs of employers and adult citizens both in and on the edge of the labour market.

Our future success in this area will depend on a number of key factors.

Social partnership

For the first time Labour in government has brought together the TUC, CBI and Small Business Council and key central government departments in a Skills Alliance to oversee the development of our skills policies. Only by these partners working together and fulfilling their responsibilities will we achieve sustained improvements.

Funding

This government has and will continue to invest record levels of sustained funding in basic skills, workforce development, adults and community learning and support for trade unions to engage individuals and businesses in the skills agenda.

In future, this government will focus its resources on supporting adults to gain basic and first Level 2 qualifications (the equivalent of 5 GCSEs). This may be extended to Level 3 qualifications (equivalent of A Levels) in regions or sectors where there is market failure. Learning for leisure will continue to be valued and have a protected budget allocation.

In addition, we will ensure that public spending is directed towards training in sectors where social partners come together to identify clearly their training priorities and demonstrate significant employer financial commitment.

Our skill needs will not be met by state funding alone. We will create a new demand-led system where employers and individuals will also contribute to the attainment of higher level skills.

We will continue to work with business to increase the provision of training and need to convince employers of the real business benefits of working in partnership with trade unions to promote the development of learning and skills for everyone in the workplace.

Training providers

Further Education colleges and private/voluntary sector training providers have benefited from our ‘Success for All’ reform and investment strategy. Record levels of capital and revenue funding have been provided in return for improved performance.

Colleges and training providers will increasingly need to make sure that their courses are high quality and respond to the needs of employers, individuals and local communities. Not only will they need to be effective themselves but they will also need to form strong partnerships with schools and universities in order to provide a wide range of integrated training opportunities. Colleges offering flexible curriculum for 14-16 year olds in partnership with schools will be supported to meet the distinct needs of these young people.

Local Learning and Skills Councils will drive and support this approach. They will no longer fund training found to be of poor quality.

Sector Skills Councils

19 Sector Skills Councils (SSCs) are now established and by the end of 2005 we expect that number to grow to 25 covering well over 90 per cent of the UK workforce. SSCs are employer-led but are required to have trade union representation on their Boards and to ensure that trade unions are fully engaged in the development of Sector Skills Agreements. In sectors where employers and unions agree, the government will use its powers under the Industrial Training Board legislation to introduce training levies to pool the costs of training across employers.

We will also consider what action and interventions are necessary in sectors where, after a reasonable period of time and despite there being a serious skills shortage or problem, there is a failure to develop a Sector Skills Agreement. We will consult widely in such circumstances on the appropriate way to drive forward the skills agenda in those sectors. This may include the introduction of a training levy.

Employer Training Pilots

Employer Training Pilots (ETPs) are a new way of incentivising and supporting more employers to provide training and support. They help to match employers with the type of training they need, address basic skills problems in the workplace and support employers to meet the costs of giving staff paid time off for training. The pilots are currently covering one third of the country. The initial evaluation of the pilots shows that ETPs are helping to bring training to parts of the labour market that have traditionally been hard to reach – for example, employers in small and medium sized businesses.

We will draw on the principles of these pilots – customised training support, free or heavily subsidised training to help employees gain skills or qualifications up to Level 2 and financial support for employers to provide paid time off for training – and the further evaluation as we consider the form of programme across the country to support employer training.

Level 2 Entitlements

From September 2006 we intend to extend the offer of free tuition for adults without basic literacy, numeracy and ICT skills to those who lack a first level 2 qualification. Pilot schemes are beginning in September 2004 in the north east and south east regions. They will help determine the most effective way of delivering this new historic entitlement.

A new Adult Learning Grant that provides weekly maintenance payments for 19-30 year olds who are studying for a first Level 2 or 3 qualification is also being piloted. Alongside Education Maintenance Allowances and the new Higher Education Grant this will over the next few years represent a strong and coherent package of maintenance support across the age ranges for learners from low income families.

Trade Unions

Trade unions have a vital role to play in the skills agenda. They have the capacity to reach some of the hardest to reach learners and influence employers to see and realise the ‘bottom line’ benefits of training and skills.

Since 1998 the government has invested around £35 million in the Trade Union Learning Fund and recognised the valuable role of Trade Union Learning Representatives (TULRs) by putting them on a statutory footing. As a result trade unions have been able to support many of their members to experience self improvement for the first time in their lives. In addition they have encouraged many employers to view the training agenda as an integral part of their organisational development. Whether it be promoting the Level 2 entitlement, supporting the Sector Skills Agreements or being partners in the Employer Training Programme, the Labour Government sees trade union engagement as crucial to the success of its skills agenda.

The government will, therefore:

• Guarantee real terms increases in the Trade Union Learning Fund each year until at least 2008;
• Aim to treble the number of TULRs from the current number of 7,000 to 22,000 by 2010;
• Review any barriers which prevent TULRs from carrying out their duties effectively, including the potential benefits of Learning Committees;
• Ensure that the Trade Union Learning and Modernisation Funds can be sued flexibly to strengthen the trade union capacity to engage with union members and employers in delivering skills in the workplace;
• Work with the TUC to develop the concept of a trade union academy.

For their part we will look to the unions to bring lifelong learning to the centre of their offer to members and potential members.

New Deal for Skills

We will as described in Chapter Three bring together Welfare to Work and Skills policies so that those on the edge of the labour market can secure sustainable employment.

Regional Skills Partnerships

The Government will also support the development of the skills agenda at a regional level. Regional Development Agencies, local Learning and Skills Councils, Job Centre Plus, Local Authorities trade unions and other partners will work together through Regional Skills Partnerships (RSPs).

RSPs will be expected to create a skill strategy which meets the economic needs of their region. This will require co-operation with SSCs and a ‘joined-up’ approach which maximises the capacity of SSCs to stimulate demand for training amongst employers and individuals.

Where elected Regional Assemblies are established they will have nominated representatives on local LSCs. They will also be expected to support RSPs and work closely with the Executive Directors of Regional LSCs.

Furthermore we welcome the development of the Regional Skills Partnerships and the Concordat signed between the Government, the Regional Development Agencies and the Learning and Skills Council on carrying forward the skills agenda at regional level. The measures set out in the draft Regional Assemblies Bill also supports this agenda.

Lifelong learning

Lifelong learning is not just about developing skills for work – it is about building the confidence of those who have not benefited from learning in the past. As a result of this it is far more likely that employees will be happier, healthier, better paid and participate actively in public life.

Labour will continue to champion policies for lifelong learning in the European Union, and will seek to apply European Social Funds and other EU assistance where they are most needed.

Building a successful higher education sector

Traditionally, most money has been spent on university students and least on under 3s. Many of those who responded to Partnership in Power or the Big Conversation felt that this was not the fairest way of providing the best education for all. Labour is now beginning to shift this imbalance.

At the heart of Labour’s education policies is the belief that people with aspiration and talent, irrespective of background, must have the opportunity to get on in life. We should not put a cap on ambition. Opportunity must be open to all. That is why we believe we need to expand, not restrict the numbers that go to university. Our target is for 50 per cent of 19 to 30 year olds to go to higher education, giving many in their mid or late twenties the second chance of graduate training.

At the same time we recognise that that the academic path is not suited to all young people. Those who choose to pursue their ambitions through entry into employment or self employment at 16 or 18 should not be made to feel that this is a lesser option, they will be supported with easily accessible appropriate and excellent careers advice and guidance such as the Connexions scheme.

Labour recognises that the funding system has had to change in order to achieve this, but we must now build on the reform in higher education and communicate the changes so that everyone understands how the new system works.

Neither parents nor students will have to pay upfront fees before or during their university education. For the least well off there is the guarantee of a minimum package of £3,000 to cover all fees for the poorest 30 per cent of students. Student loans will rise to meet the average basic living costs and we will increase the amount of student loan available to ensure that all students have enough money to meet their average basic living costs while at university. Repayments will be linked to their wages after they have left university, starting only when they earn £15,000 or more, and paid through the tax system. We will establish the new Office for Fair Access whose role it will be to break down the historic social barriers that have traditionally limited the number of students from disadvantaged backgrounds. The party also welcomes the announcement of an Independent Commission to review the reforms and examine the impact of variable fees based on the first three years of operation.

Our reforms for higher education will ensure that no student has to pay while studying and that we continue to increase participation, particularly among those from lower socio-economic backgrounds and other disadvantaged groups. In addition we will improve advice and information about higher education to ensure that potential students can make a genuine choice based on educational need. We are committed to a policy which will improve funding for all universities, including those that already have an excellent track record in expanding opportunites and cater for the majority of students from lower socio-economic groups.. Already we are increasing the number of students that go to university and we are committed to increasing the diversity of provision and a guarantee of support for disadvantaged students. We want a financially secure and diverse higher education system to help raise the achievement and aspirations of students and to increase the contribution to UK productivity. We recognise that the staff working in Higher Education are a great asset and we are tackling low pay and unequal pay in the sector with our support for single status for the workforce.

We must widen student participation (particularly to the best universities) from the most disadvantaged families. We need to support universities to develop more of their own income streams through endowments and business links, and we must also develop Foundation Degrees to provide more choice.

Labour will continue to support the ‘Bologna Process’ to help British students benefit from educational opportunities in other EU countries, and to remove bureaucratic hurdles against the mutual recognition of qualifications across Europe.

Through all of these reforms, we remain committed to the principle of world class education, fair to all, regardless of wealth, personalised to each and with no one left behind.

Improving health

Labour is the party of equality and social justice. Our starting point for all that Labour wants to achieve is our belief in a publicly funded National Health Service, free at the point of need with equal access for all, irrespective of their wealth: the fairest system of healthcare in the world. In the 21st century, to achieve fairness to all it must be patient-centred and increasingly personal to each of us.

Where, in each generation, working people’s ambitions increase it is Labour’s belief that they should be met; where these new needs and ambitions clash with old systems of delivery, it is Labour’s belief that these needs should take precedence. People today expect a service that fits more easily around their lives and we as a Labour government, through the values of the NHS and improving delivery, will help them achieve it. Labour will protect the values of the National Health Service, making them relevant to today by ensuring that people’s access to treatment is fair to everyone and that the care they receive is increasingly personal to each. Above all, we will deliver this for the whole of the nation, not just the few.

Throughout the EU, the UK is the only state where health care is free for all citizens at the point of access. The Labour Party believes that this is an achievement we can be proud of. At the same time, Labour’s policy of co-operating with other EU states allows us to share information and best practices which benefit us all.

It is not enough for us to focus on improving the state of our health service, vital though that is. Our goal must be to work with people to improve their health. Though health inequalities remain, we are determined to use a third term in office to reduce them further. The task in hand is one of prevention as much as it is of cure.

Tackling inequality in health will need a renewed focus on promoting healthier living, preventing as well as treating ill health or disease. Local authorities make a major contribution to improving the nation’s health, linking policies in related areas such as residential care, housing, pollution, the environment and public protection. Councils should also take a strong lead at a local level to promote take up of benefits and tax credits.

For over 50 years, although health generally has improved, the health gap between the better off and the least well off has widened not narrowed. Labour exists to create a society based on fairness and on justice, in which each citizen gets the opportunity to fulfil the potential of their talents. It is simply unacceptable to us that the opportunity for a long and healthy life today is still linked to social circumstances, childhood poverty, where you live, how much your parents earned, how much you earn yourself, your race and your gender.

And if we are successful at reducing health inequalities within and between our communities, improving the lot of the most vulnerable in Britain, it also means we can achieve more from our finite resources. Improving the nation’s health needs a joined up approach across government. It needs a commitment from the whole government. A commitment to provide opportunity for all, to end child poverty, to work towards full employment and to provide decent homes for all.

Today it is more and more difficult for our opponents to deny the very real improvements that are taking place in the health service but we recognise that there is still further to go. If we are to achieve our vision of an NHS which is fair to all and personal to each of us we must offer everyone equal access to, and greater power to choose from, the widest possible range of services of the highest quality, free at the point of need.

By the end of the next Parliament in 2010 the NHS will be helping to create a healthier population where more people make the right health choices. By working with others we will diminish the nation’s health inequalities to create a fitter, fairer society.

We will create easier and faster access to a wider range of services than ever before, backed up by investment in medical staff, hospitals and new drugs that will increase to reach £90 billion in 2008. Patients will have more choice, for example concerning how and where they access NHS services, and the timing of hospital appointments. But we do not wish to see the introduction of destructive competition and markets into the health service: as the Tories’ Internal Market demonstrated, setting hospital against hospital is not the way to improve the NHS. Labour has reviewed the NHS financial system to ensure that the expansion of choice does not lead to the unleashing of competitive market forces in the NHS..

NHS staff will have the information they need at their fingertips. A new information culture supported by the use of modern information technology will provide patients and staff with more and faster information and connections to the advice they need. Patients themselves will help drive improvements through their preferences and backed up by more power to local hospitals, clinics and health care providers.

Given the medical differences between us all, the modern NHS recognises that one size does not – and never can – fit all. To help the NHS work differently for each of us, the new NHS must be a system where patients are better informed about, and in better control of both their health service and their health. Patients will have the right to choose the treatment option most convenient to them. Increased NHS capacity will make that possible for all, not just the few.

The role of the private sector in the NHS needs to be determined. It is right to use spare capacity in the private sector to tackle waiting lists but if a two-tier service is to be avoided we need to establish what the ultimate intended share of the private sector is in provision, and what areas of provision will utilise the private sector. It will be important to ensure that the private sector does not poach staff from the NHS and that the pricing of the contracts with the private sector should allow for a return to the NHS or the investment made in training staff previously employed by the NHS. The NHS must be seen to be a provider as well as a commissioner of services and not merely as a social insurance fund.

Our vision is entirely different to that of the Tories since it will protect equal access free at the point of need – the Tories’ patients’ passport will abandon this principle, creating both queues and queue-jumping. The Labour Party is committed to increasing investment, including in medical science and research – the Tories would cut it. And Labour’s increased investment will increase quality and choice – their subsidy to the patient’s passport outside the NHS will offer choice only to the rich few to jump the queue on taxpayer’s money.

The use of public money to help the better off jump the queue takes no account of clinical, need, pain or suffering and is abhorrent to the British people.

Better, faster healthcare

As a direct result of long-term Tory neglect, over the next few years a core challenge for the NHS will remain one of capacity. That’s why Labour will continue to build capacity, especially in primary care, and why since 1997 the Labour government has so far given the go-ahead for 68 major new hospitals (24 of which are now fully operational), the UK’s biggest-ever hospital building programme. By building new hospitals and modernising primary care facilities, the NHS will be in a better position to improve treatment and reduce waiting times further.

The extra investment will allow the NHS to plan for an increase in treatment capacity equivalent to more than 10,000 beds. Existing NHS general and acute bed capacity currently stands at around 135,000 beds. The target to increase the number of adult critical care beds in England by 30 per cent by 2003 has been achieved and capacity is at an all-time high.

There is a growing range of ways in which people can access care including 42 new NHS Walk-in Centres serving 11 million people, with four million attendances so far, as well as the NHS Direct telephone service used by more than 6.3 million people last year, NHS Direct Online and NHS Direct Digital TV.

We are making the biggest reforms to the system of dentistry since the inception of the NHS. We are devolving power and resources to primary care trusts so that they can commission dentistry at the local level. We are introducing a new contract for dentists to replace the one brought in by the Tory government which led to dentists walking away from the NHS. We will increase the dental workforce and through new ways of working we will maximise the skills and potential of all in the dental team.

Annual patient services are showing increasingly positive results. Bedside TVs and telephones are being installed in every major hospital and to maximise customer choice, Labour will ensure that the TV can be switched off if the patient wishes. Single-sex sleeping accommodation is now provided by 98 per cent of hospital trusts. Also, a ward housekeeping service now exists at 47 per cent of larger hospitals, supported by an investment of £14 million.

NHS targets have worked and are continuing to work. They mean that people in pain wait for shorter times. For some they are a matter of life or death. They are driving forward the recruitment of more doctors, nurses and other NHS staff. They are ensuring that we have the biggest hospital building programme in the history of the NHS and above all, targets have delivered speedier access to healthcare. However, the government also recognises how important it is not to tie the hands of healthcare professionals working in the NHS everyday, through overly bureaucratic management of targets. Within four years most of the targets set in the NHS Plan will have been reached and increasingly the means by which we achieve the high standards we all seek will then lie in the hands of front line staff themselves. Average treatment times are falling and we will guarantee still faster treatment times by the end of the next parliament.

Improving public health

We now need to take bolder steps to improve the health of the population and reduce demands on the health service. Action to reduce health inequalities goes way beyond health care. It covers the widest spectrum of life experiences that can be influenced by government. It requires joined-up thought and action by a whole range of government departments responsible, for example, for the economy, housing, education, the arts, the environment, leisure and transport. Each major government department could therefore have its own health champion, and each department’s contribution to public health should be reported annually. National, regional and local government should undertake health and health inequalities impact assessments of any major new policy that is proposed. This programme should be co-ordinated by a minister of cabinet rank.

As well as the NHS and the government, the public recognises that they too bear the responsibility for improving their health. Throughout our Partnership in Power consultation, people have called on the Labour Government to ensure public health issues are given proper priority. Recently there has been a huge upsurge of interest in improving people’s health and wellbeing. Issues ranging from tackling alcohol abuse, to improving our sexual health, to turning around Britain’s growing obesity problem are now headline news every day. Labour’s previous, second-year health consultation document identified itself with this growing public mood, focusing on the specific challenge of how to tackle the problems associated with tobacco use and how to reduce smoking, the leading cause of preventable death in the UK.

Reducing smoking is essential to improving the health of the nation. Smoking hits poorer people harder and widens health inequalities – this is an affront to Labour values. It is why the Labour government has implemented tough anti-smoking measures and is considering even more radical action. There are a number of ways we can help people cut down or stop smoking. But in drawing up our response to the problem we must strike a balance between the two extremes of an over-prescriptive state on the one hand and on the other an irresponsibly laissez faire government.

Labour in Europe has introduced a ban on tobacco advertising, clearer, starker health warnings on tobacco products and has established world-leading smoking cessation services. We know that seven out of ten smokers want to give up. It is our duty both to help them to quit and to protect others by reducing second-hand smoke. Since Labour’s white paper on smoking was published in 1998, around 800,000 people have kicked the habit. Over the next parliament the government should work with the public, media and industry to reduce smoking amongst all groups in society by at least 20 per cent.

Throughout the consultation period there was recognition of the gravity of the issue. Many saw the need to protect young people and children as of paramount importance. Sustained and above-inflation tax increases levied on tobacco products were viewed as the minimum the government should be doing to restrict their consumption. There was a sense that the balance between rights and responsibilities now needed to move decisively towards asking people to take more responsibility and not expose others to smoke. There was overwhelming support for further restrictions on where people should and should not be permitted to smoke. In view of the clear medical evidence of the dangers of passive smoking and widespread public support for measures to reduce exposure to second-hand smoke, Labour will give serious consideration to a range of clear and enforceable measures in smoking in the workplace to protect employees and the public, including legislation for a ban. More widely, there has been a great deal of engagement. Individuals, organisations and communities are all looking at how to make things better and we must harness this drive for improvement coming from people themselves. One of the government’s responsibilities in this regard is to provide clear information, helping more people to make informed, healthy choices.

Healthier lifestyle choices must become easier choices. At present many factors – mostly commercially driven – conspire to make unhealthy choices easier. There should be an emphasis on the importance of wellbeing, and positive healthy values must be brought into play in relation to recreation, leisure and sport. We will begin a programme of measures to control the epidemic of obesity which poses such a threat to the health of the country by much more effective measures to encourage walking and cycling and other exercise for people of all ages. At the same time we will ensure that information about the content of food, whether bought to cook or ready to eat is easier to understand so that people can make informed decisions about their diet.

Indeed many strands of action have begun; both local initiatives in neighbourhoods, communities, councils and healthy living centres, and national initiatives like smoking cessation clinics.

Labour is also committed to ensuring that the labelling of food takes great strides forward. Present labelling is at best adequate and at worst misleading.

The increasing diagnosis of illnesses such as diabetes, celiac disease as well as growing numbers of allergies to lactose and peanuts are examples of the necessity for such action. Others who have chosen lifestyles and diets where labelling improvements would be helpful are also presently disadvantaged. By ensuring accurate, precise and concise labelling we will be returning choice to millions and reducing the burden on the NHS which is called upon to treat incidents that arise due to consumption of presently inadequately labelled products.

We shall also ensure that food stuffs labelled as healthy or as having health benefits are not high in substances such as salt, fat and sugar which in turn lead to dietary and health dangers. This action will provide a major opportunity for all consumers to make informed decisions which will lead to a general improvement in the nation’s health with all the obvious benefits.

The development by the Co-op over the last few years, especially in relation to their Gluten-free labelling should be applauded and used as a model for other food retailers to aspire to.

Shifting the emphasis from secondary to primary care

We are approaching the half-way point of the ten year NHS Plan, part of the focus of which was shifting much of the emphasis from national to local initiatives to make the system more responsive and patient-centred. Making clear improvements to primary care services will help us to work with people to not only treat ill health but also to prevent it. The NHS plan depends, at its heart, on a modern effective and well resourced primary care sector. Greater decision making powers and resources are being devolved as close to the front line as possible. And GPs and other primary care professionals are leading the work of Primary Care Trusts in commissioning and planning the delivery of local health services. The full capabilities of primary care staff are being deployed in new and expanded roles and responsibilities benefiting patients and staff alike and investment is being targeted to make the most difference.

The amount of activity which takes place in primary and community settings is also being increased, with more outpatient appointments taking place in the community rather than in hospital. Already 2,000 GP surgeries have been improved and 269 one-stop primary care centres have been established from a total investment in premises of up to £1 billion to 2005. We will work with NHS staff and trade unions to reshape the healthcare workforce to support the shift from secondary to primary care.

We need to ensure that the increase in resources goes to the primary and community sectors and not just to the acute sector. Primary care trusts need to work closely with local government including through the use of local PSAs and local strategic partnerships to agree joint programmes that will help improve the provision of health care. Labour will ensure that PCTs have a strong local authority presence and give adequate support for non-executive members. In order to assist joint working, PCTs should continue to ensure that, where it is possible and practicable, they are coterminous with local authority boundaries, either singly or jointly with other PCTs.

We are making the biggest reforms to the system of dentistry since the inception of the NHS. We recognise there are areas of the country where there are problems of access to NHS dentistry and we will ensure that patients get easier access to NHS dentists wherever they live. We will:

• train more dentists -170 extra places in dental schools from October 2005 with £80 million capital and £29 million revenue;
• provide more resources for NHS dentistry – £250 million extra from 2005-06, a 19.3 per cent increase over 2003-04;
• devolve the commissioning of NHS dentistry to primary care trusts to address local access issues and so they can plan properly to meet local need;
• introduce from October 2005 a new contract for NHS dentists to remove the treadmill effect of the current contract and to reduce bureaucracy for dentists;
• continue our programme of international recruitment and encouraging returners to NHS dentistry.

A £150 million modernisation programme has allowed 180 accident and emergency departments to be upgraded and refurbished, and £10,000 has been allocated to every A&E department where a modern matron is in post to help improve the ‘patient experience’ by raising standards of cleanliness, hygiene and care. Good lighting, comfortable seats and a high standard of cleanliness can help people feel more relaxed and positive about the care they receive. In view of the unprecedented public concern over hospital acquired infections in general and MRSA in particular, we need to ensure that adequate provision and financing is made for cleaning services and that, specifically, contracting-out of services does not and has not become a vehicle for substituting cheapness for cleanliness. This should be an important consideration in any review on the expiry of existing contracts.

More help for people in the management of their chronic diseases has been raised at nearly every health related Big Conversation event and throughout the Partnership in Power consultation. This is not surprising given that there are 17.5 million people affected by long-term conditions; they use both primary and secondary health services a great deal; and some people have said that at the start, Labour overemphasised the importance of hospital services as against primary care services.

We will introduce more than 3,000 “community matrons” offering NHS patients tailor-made services suited to individual needs – another shift away from hospitals and out into community and primary care settings. Currently there are just 100 such community matrons, and expanding their number will help support patients on their journeys through the NHS. This would be of greatest benefit to people who have long-term medical conditions, such as asthma, arthritis, diabetes, heart failure and depression.

Labour’s approach is to give extra help and support to those living with chronic conditions. In contrast, the Tory approach is to allow those who can afford it to pay to jump the waiting list queues. Those who cannot afford to pay are denied choice under the Tories’ policy, especially with long-term conditions where patients are not facing one-off operations for things like knees or hips. If a patient is receiving renal kidney dialysis treatment, for instance, the top-up costs would average £65,000 per patient. Labour will offer choice within the NHS, the Tories offer choice for those who can pay.

Social care

Social services are one of the major public services. At any one time there are up to 1.5 million of the most vulnerable people in England relying on their help. Social services that interface smoothly with the NHS and other services, in reducing the problem of delayed discharges (so-called ‘blocked beds’) from hospital for example, create an altogether better patient experience. Putting the patient first is as relevant to our agenda for modernising social services as it is to our programme for personalising the National Health Service.

If patients are to receive the best care, then the old divisions between health and social care need to be overcome. Despite the best efforts of dedicated and professional staff, the NHS and social services have not always worked effectively together as partners in care, so denying patients access to seamless services that are tailored to their particular needs.

All patients, but particularly older people, need health and social services to work together. They rely on good integration between the two to deliver the care they need, when they need it. The government has begun to address the problems that currently exist in the system. Budget 2002 delivered a six per cent a year increase in social services investment providing over £3.2 billion extra by 2005/06. This significant new investment will help build a bridge between hospital and home for over 4,000 (mainly older) people currently occupying hospital beds even though they are ready to be discharged. To promote independence, and ensure patients receive the right care in the most appropriate setting at the right time, Labour’s Community Care (Delayed Discharges) Act is helping to significantly reducing this number. Since January 2004, if a patient is delayed solely because supporting community care arrangements are lacking, the relevant local authority will have to financially reimburse the relevant NHS acute trust.

We believe services should be person-centred, seamless and pro-active. Person-centred services will give the individual real options and we expect everyone to have a spectrum of choice available, choices that help maintain independence, not create dependence. For example, we reject the Tory notion that ending up in a care home is the inevitable result of old age. We recognise that elderly people want to stay in their own home and outside institutions for as long as possible and as part of our choice agenda Labour will be pursuing this even more strongly. Labour will develop a strategy for long-term care that aims to promote independent living for elderly people wherever possible. The next Labour government will fund and provide such care on an equitable basis but always with the aim of promoting independent living wherever possible.

For some older people, medication prompts will ensure that they avoid unnecessary hospital admission. PCTs and local authorities will work together with new community matrons to ensure that medication prompts are considered as part of each care plan. Investment in this sort of support to people is more important than just investment in buildings.

Services must also be seamless. Service users don’t care who delivers health or social care to them, so long as it is there when they need it. And proactive, so services are planned ahead of demand and help people to keep out of hospital.

And we must not forget the many people – daughters, sons, parents, relatives and neighbours – who act as carers, giving help and support in many ways to those they care for. The national strategy for carers, the first ever by a government in Britain, is one example of Labour’s commitment to the needs of carers as well as the cared for and means carers will have better information, they will be better supported and have better access to the health service. What carers do should be properly recognised, and properly supported. Labour takes pride in what carers do and in government is helping make sure that carers can take pride in themselves. We will also extend respite care and support to enable carers to take a well-earned break when it is required.

Mental health services

Mental health is a top clinical priority for Labour. But for years, mental health services were the Cinderella of the NHS, despite the fact that millions of people – perhaps as many as one in four of the population – face a problem at some point in their lives. This situation has been exacerbated by a system too focused on acute cases. Each year, 600,000 adults with serious mental health problems are cared for by specialist mental health services. Thousands more young people and tens of thousands of elderly people also receive care.

To get the range of mental health services and provision right we are reforming services through new national standards. The mental health national service framework that the government published three years ago has been widely welcomed, not just by clinicians and managers, but even more importantly, by carers and users of the services. This has been underpinned by new money, including the provision of special funding for mental health services for the first time. But there is more to do – community and primary mental health services remain underdeveloped in many places more resources are needed on the frontline. Labour will ensure full implementation of the mental health national service framework by 2008-09 so that every person that needs it will have access to high quality and comprehensive community, hospital and primary mental health services, including round the clock crisis resolution and assertive outreach services.

Many mental health problems, such as dementia and Alzheimer’s, present particular dilemmas in relation to maximising informed choice of care whilst minimising the risks of harm to self and others. The next Labour government will examine how best to maximise informed choice for people using care services including where people have diminished capacity to make their own choices.

We know that people from black and minority ethnic communities experience inequalities in accessing mental health services. Through its Delivering Race Equality strategy the government will work to eradicate these inequalities.

We have introduced a new strategy for people with learning disability. We will ensure that the ‘Valuing People’ national strategy continues to be driven by ‘person-centred’ approaches and not by the operational or organisational requirements of service providers.

Ethical international recruitment

The consultation reminded us to ensure our efforts to recruit more doctors and nurses are fair and ethical and that they do not imperil the health systems of other less developed countries. The NHS is now getting the substantial investment it needs to expand and modernise its services; it is now the fastest growing health service of any major European country. We want it to be the best.

That requires us to increase the number of doctors, nurses and other key professionals as fast as possible. More staff are being trained and recruited within Britain than ever before. This is Labour’s investment in the future, but that takes time. So we are now working with other nations to welcome other well-qualified health professionals from overseas to work in the NHS.

This can be a mutually beneficial arrangement: work experience, travel and continuing education benefiting the individual, whilst the NHS can fill its vacancies and increase productivity. While some countries are happy to export staff on a short-term basis to the NHS, others see the ‘brain-drain’ of qualified nurses and doctors from their own health services as a significant problem.

Those responding to the previous consultation document were almost invariably supportive of Labour’s efforts to increase the number of nurses and doctors, from overseas and from the UK, working in the National Health Service, but most were also keen to underline the importance of doing so in an ethical manner. This is an ongoing policy and close and regular monitoring is needed but Labour is acutely aware of the ethical issues involved and in government has issued guidance to NHS employers. The guidance intends to ensure that international recruitment fulfils its proper place in the NHS; that good practice and value for money are encouraged; and that it is done on an ethical basis.

International recruitment should never be carried out against the interests of host countries and must not adversely affect health care systems in developing countries who can ill afford to lose domestic medical expertise. Furthermore, the guidelines are clear about how NHS organisations should decide from where they should and should not recruit.

Harnessing the genetics revolution

The consultation document warned that when we look to the future, eager to harness the great potential benefits of technology and the genetics revolution, we must do so by taking an informed and consenting public with us. It is the government’s job to help prepare Britain to reap the benefits of genetic advances. But that can only be achieved if scientific breakthroughs are matched by public support and understanding. It can only happen if we are open and honest about the potential and the pitfalls which the genetics revolution presents.

Breakthrough developments may be some way off, but Labour’s increased investment in science is already helping patients through, for example, our new disease collaboratives for conditions such as Alzheimer’s, stroke, mental health and for children that together with our investment in things like the UK stem cell bank will aid research and bring new scientific discoveries right to patients’ bedside tables.

Genetics is changing the world in which we live, offering the potential for new treatments and a means of predicting and preventing ill health. Gene therapy works by introducing healthy genes into the body. In time, genetic science will be able to predict the risk of developing diseases such as cancer, heart disease, genetic disorders and diabetes.

It is Labour’s conviction, because of our central belief in fairness for all, that the NHS is best placed to harness these advances. The values on which the NHS is based – providing care on the basis of need rather than ability to pay – are a protection against the inequalities of an insurance-based health system. If you have to rely on private insurance, those with genes that could predict bad health will either get no health insurance or it will be very expensive. But with the NHS, people will be able to take genetic tests free from fear that, should they test positive, they face an enormous bill for insurance or treatment, or become priced out of care or cover. In the United States, where 40 million people have no medical cover, advances in genetics are raising precisely these fears. It highlights one of the most fundamental failings of the Conservative’s health policy where, to get to the head of the queue, people will be forced to pay for their own treatment. Labour announced, in last year’s Genetics White Paper, a £50 million strategy to harness the potential of advances in genetics to benefit NHS patients.

Cross-cutting issues

Joined up services – building on the success of Sure Start

We are determined to raise standards in schools and hospitals and build world-class public services. To achieve these goals we need to ensure that we meet the needs of every individual and that is why we must put consumers at the heart of the services they use. Throughout the consultation on health and education, party members and others who have contributed to Partnership in Power or the Big Conversation have asked for more joined-up working across public services.

We have already begun to shape new public services around the needs of families. Sure Start centres are a good example of the kind of joined-up community support we want to encourage. Labour has introduced 500 Sure Start centres, supporting 400,000 families. They offer early years care and education, together with a range of support services, in the poorest fifth of wards. Submissions were overwhelmingly supportive of the Sure Start model of joined-up services and so Labour will build on the Sure Start model, extending children’s centres to more areas across the country in recognition that deprived children also exist in our most advantaged areas.

Evidence shows that these joined-up services have a significant positive impact not just on improving basic literacy levels for young children, but on a whole range of issues relating to the health and welfare of families: in an East Sussex Sure Start area, the number of 0-3 year olds admitted to Accident and Emergency fell by 47 per cent; in Somerset, there was a 10 per cent increase in active library membership for local families; in Cumbria, a Sure Start programme persuaded one quarter of mothers to quit smoking during pregnancy ; in Rotherham, the Sure Start Speech and Language service boosted children’s speech and language development by more than 5 per cent; in in the East Riding of Yorkshire, almost all the participants in a Sure Start Post Natal Depression group have gone on to get training or work.

The Policy Commission also visited a children’s centre in Birmingham which offered local families a great diversity of support, from support for vulnerable young mothers to graduate study for adults. Strong leadership, funding and flexibility were key to making the centre responsive to the individual.

‘Extended schools’ provide another good example of new ways in which traditional public services are adapting to meet consumer needs. These are ‘schools that never close’, open during the evenings, weekends, and holidays to provide childcare, adult learning, health advice and parental support. They ensure that the local community gets the most out of its public resources, such as the local school computer suite or health centre. Increasing the provision of out-of-school services (from after-school clubs for children to basic skills training for adults) can also help parents who lack basic skills to overcome their negative experience of education. Submissions were in firm support of changes to the most basic idea of schools: no longer just places to teach children during the school day, but offering breakfast and after-school childcare, as well other facilities to support parents. Labour wants to see more extended schools, with sports and music facilities opened up during the holidays to help keep kids off the streets and with school computer rooms opening up to the local community in the evening to provide tuition to parents who lack basic IT skills. By encouraging the involvement of parents in schools, and by lengthening their opening hours, we can also tackle some of the causes of anti-social behaviour.

By providing a wide range of services in one place we can provide more effective centres for local communities, making the most of shared resources and encouraging greater joined-up working between services. We are developing Children’s Trusts to work closely with Primary Care Trusts and bring together family support services, education, health, children’s social services and childcare. This will provide the safety net and clear accountability that many submissions asked for. Joining up services in this way will help to improve care and life chances for children in care, ensuring that no child is left behind.

Putting people at the heart of their services

We want to put more power in the hands of individuals and local communities. Already we are devolving power away from Whitehall and closer to the patient and the pupil.

In health, it is important that local people feel ownership of the health service they pay for, so the real power and resources must move to the NHS front line. Locally-run Primary Care Trusts will be responsible for spending 75 per cent of the NHS budget. Local communities already control three-quarters of NHS spending through their Primary Care Trusts (PCTs) and high performing hospitals are earning freedom, able to become NHS foundation trusts looking to their local communities for direction not Whitehall. To ensure PCTs are able to act as effective planners and funders of care, they need to devolve budgets and power to their GP practices, and they should consider forming networks across the country to share sophisticated information and analytical support. Patients will continue to choose NHS hospitals for much acute care so for the foreseeable future NHS providers are likely to continue to deliver most health services. But there also needs to be greater plurality of provision – to expand capacity fast, to stimulate improvement.

In education, local school governors have been given greater freedom and power to collaborate with other local schools, forming federated governing bodies. They have called for changes at central and local level, with more support and more flexibility for leaders, and more devolvement to local institutions. Children’s Trusts are already helping to join up children’s services, encouraging them to collaborate, and offering the kind of local accountability that means that no child can slip through the net when it comes to their care, education, health and protection.

It is important that the workforce reform agreement is implemented in a fair and consistent way in every school and the government, local authorities and trade unions should work to achieve this and monitor progress through the Workforce Agreement Monitoring Group. The government will also provide the funding to support adequately the agreement.

Front line staff and organisations will have new powers to make decisions. We will champion transparency throughout the services and challenge those in the system who are unconcerned with good governance or write off children or patients. Our goal is to give schools and hospitals the freedom to respond to the different needs and preferences of their communities.

Improving technology and communication

Throughout schools and hospitals, technology is transforming the way our public services are run and improving the communication and engagement with individuals.

The NHS can now hold and process more information than ever before, enabling a consultant to be aware of the specific needs and medical history of an individual at the touch of a button. A common complaint from patients has been that they have to provide the same information to many different health care professionals. The new electronic NHS Care Record will give them the information they need without the patient continually having to repeat it. HealthSpace, linked to the electronic Care Record, will allow patients to keep information online about themselves, their health and the way they want to be treated by the NHS. The NHS needs to be much more proactive in using information to help us improve our health.

In our schools, the internet is helping children to learn vital IT skills and give teachers access to a wealth of new learning resources. Every child has access to a school computer and over 98 per cent of secondary schools are already on broadband (fast speed internet connection). We are gradually phasing out old blackboards and in their place, we want to put an interactive whiteboard in every classroom to enable teachers to present interactive lessons. We are also piloting new ideas, such as a unique ID reference number for every child can help ensure that no child is allowed to slip through the net of support. We are developing new software, such as the Pupil Achievement Tracker (PAT), to help teachers and heads ask questions about the achievement of different groups within the school and review the success of different initiatives.

Health and education for prisoners

We owe a duty of care towards everyone in Britain and that includes the health and education of those living in Britain’s prisons – both for an acceptable standard of life whilst in prison and for improved life and health chances upon release.

For too long prison health care has been separated from the NHS. Prisoners should receive access to good, wide-ranging health care services but the isolation of health professionals and poor communications have, to date, been common, resulting in enormous variations in the standard of care across Britain’s prisons. That is why we are putting in place changes, and increasing the involvement of the NHS via primary care trusts. We are starting to see the benefit of this partnership. Where the partnership is strong and the NHS is actively engaged, the isolation is starting to decrease and the standards of care for prisoners is starting to improve. As there has been inadequate provision for prisoners with mental health problems in particular, we have worked hard with colleagues across government to ensure that each health and local authority has a clear gateway to specialist mental health services, counselling and other services. Contributors to the Big Conversation stressed the importance of access to good quality, confidential sexual health services for prisoners, including counseling and other services.

Education can make a difference too, helping to cut re-offending. Both prisoners and prison staff have reported some benefits for prisoners participating in cognitive skills training, such as improved prisoner behaviour; increased self-confidence; enhanced literacy skills and better interpersonal skills. They also said that cognitive skills training helped to prepare prisoners for other offending behaviour programmes.

Healthy schools and lives

The health benefits of nutritious meals in school are clear as are the educational gains, particularly for pupils from disadvantaged backgrounds. The success of the free fruit in schools initiative and the increasing use of healthy menus has shown that long term benefits in terms of behaviour management and exclusion can be expected.

As a first stage in providing a healthy school meals service available to all pupils we will:

• Review and improve the nutritional content of meals for all schools
• Support training for catering staff
• Provide new guidance in procurement for schools, including promoting more local sourcing of ingredients
• Promote nutritional breakfast clubs

We will also:

• Build upon the safer routes to school programme, which will see all schools develop transport plan, by encouraging walking, cycling to school
• Use PSHE, physical education, science, dance and food technology lessons to teach and develop healthy lifestyles and learning
• Tackle the topics of drug, alcohol and tobacco abuse
• Provide information and advice to parents and others to take responsibility for promoting a healthy lifestyle for the children
• Encourage early intervention with mental health problems in schools with teachers being given more awareness to identify early signs of mental health issues
• Encourage discounted access for children to leisure facilities to help promote healthy living and reduce anti-social behaviour

We will consider the results of the free school meals pilot in Hull and the free schools breakfasts in Wales and consider the implications for healthy eating in schools across the country.

We want schools to work with parents to play a more active part in shaping attitudes to food, exercise, sexual and mental health, through the curriculum. They can encourage children to make healthy choices about what they eat and drink, provide a wide range of opportunities for sport and other forms of exercise, and provide access to a wide range of support services. We also want to see more school nurses, providing a range of support and advice for children and young adults.

The duty of care owed to children by schools must be extended to their diet. Cookery lessons as well as regular sports, dance and other exercise will be re-introduced to the school timetable to tackle the increasing problem of childhood obesity, complemented by a full arts curriculum that enhances self-esteem and mental well-being. Parents should be actively discouraged from taking their children to school in cars, and each school should have a target to increase the number of children who walk or cycle, where it can be done safely, to school.

Learning to live healthy lives should have a place in the National Curriculum, where young people discuss their own and their community’s health. Sensitive issues must be tackled head on. The topics of drug, alcohol and tobacco abuse are avoided in many schools because they are controversial, yet children respond well to factual information on such matters. Education in sexual health and teenage pregnancy issues must also be available in all schools.

Research shows that children are not getting the healthy diet that could protect them against serious illness later in life. Over the last 30 years levels of obesity have risen among children while physical activity in school has fallen by 70 per cent. We need to improve children’s diets and encourage them to take exercise.

School lunches are a key area for improvement as they reinforce healthy eating messages from the classroom. They provide a significant proportion of children’s food and nutrient intake – over 30 per cent on average, and can encourage pupils to eat more fruit and vegetables, and develop a taste for foods low in fat, salt and sugar. Some submissions suggested a reward system for pupils to encourage them to make healthy food choices.

We are encouraging schools to offer healthy breakfasts and lunch. A breakfast service offering healthy food, perhaps with other activities, together with strict policies on food consumed at breaktime can cut the levels of fat, sugar and salt that children consume and boost their intake of fruit and vegetables. We have also introduced a School Fruit and Vegetable Scheme in many areas and now we want to expand it nationally to enable every four, five and six year to receive a free piece of fruit each school day. In addition we are piloting ways of replacing fizzy drinks in school vending machines with water and fruit juice.

We want children’s experiences in school to lay the foundation for an active adult lifestyle. All children must be taught PE from age 5-16. We want children to have access to at least 2 hours of high quality PE and school sport every week. We are investing over £1 billion in PE and school sport, making it much easier for young people to get involved in sports clubs. We are also piloting ways of encouraging different groups – not just school pupils – to take more exercise, for example, by offering free swimming lessons.

We recognise that this issue is not just a matter for government – it involves individuals and the choices they make, as well as the food and leisure industries – but action is needed right across departments to encourage and enable people to eat more nutritious food and take more exercise. Furthermore, obesity is one of the key issues to be addressed in Labour’s public health white paper later this year. We are also looking at whether there should be restrictions on advertising food to children – and if so, whether they should be voluntary or mandatory. There should be a more responsible attitude to the promotion of foods to children. It is vital, therefore, that there is tighter regulation of advertising to children through television. Labour will also investigate the impact of fast food outlets on childhood diet.

Schools are also getting help to promote safe, healthy and sustainable travel to school and to tackle the growing proportion of children who are overweight. We will encourage schools to provide secure cycle parking and set up ‘walking buses’, which allow children to walk together in a group under adult supervision. New investment is being made available to make school routes safer and schools will be encouraged to consider fresh ideas. Staggered start and finish times are another option. For example, some schools help to beat the morning rush by starting at 8:30 a.m.