As the Children Bill continues through Parliament, Terry Philpot looks at the problem of private fostering and speaks to two champions of child wellbeing
There are no family photographs discreetly turned away from visitors on Al Aynsley-Green's desk at the Department of Health: several very large photographs of his four grandchildren adorn his office wall.
Across from them is a large poster of Picasso's Child with a Dove , and on a windowsill sits a small reproduction of Murillo's The Holy Family . He doesn't say so, but for someone who used to wear a teddy bear on his stethoscope, the personal is political.
Aynsley-Green, England's national director for children's healthcare services, speaks rapidly and with enthusiasm - with evangelism, even - about his job, throwing out a thought, citing statistics, making international comparisons. His is an all-encompassing view of children and their needs: he offers references not only to current research and government policy; as author of a short history of childhood, he can draw on poetry, history, academic studies and Greek and Roman philosophy to set in context today's reforms.
This makes it all the more curious that he should confess, after several decades as a paediatrician and academic, "it was only since taking up this post have I been confronted by the question: what is childhood?" He says there is no such thing as a child: "There are several stages of childhood - the foetus, neonate, infant, preschool child, school child, adolescent and transition to adulthood - each of them having different needs." To this end, he castigates the National Health Service for seeing children as "smaller adults who need smaller beds".
Aynsley-Green was appointed ("plucked from obscurity") to his post in 2001, at a time when the imperatives of Sir Ian Kennedy's inquiry into the scandal of babies' deaths at the Bristol Royal Infirmary were very much at the forefront of public concern. Within a month, the new "tsar", who heads a team of six administrative staff, had called for a children's commissioner (now contained in the Children Bill, which is passing through Parliament) and set up an expert group, co-chaired with David Hall, professor of paediatrics at Sheffield University, to create the National Service Framework for Children to design care around children and modernise children's services from birth through to adulthood.
Most recently, he was professor of child health at the Institute of Child Health, University College London and Great Ormond Street Hospital. It was only last September that he stepped down as director of clinical research and development, but he still works at the ICH one day a week. Before that, he had a decade as professor of child health and head of clinical medical sciences at Newcastle upon Tyne University. Aynsley-Green is an endocrinologist by training, and he has published more than 300 papers on infant and childhood diseases and several books. The stage on which he now performs may be much bigger, but the leap isn't so great - he continues to bridge the gap between policy and practice.
Since his appointment, the pace and aim of policy has changed radically: Margaret Hodge has become the first Minister for Children; the Laming report into the Victoria Climbie case delivered a damning judgement on established ways of protecting children; last September the Government's Green Paper Every Child Matters appeared; and the Children Bill is raising all sorts of issues, from parents' right to smack their children to private fostering.
In this and much more, Aynsley-Green's job is one of the most critical in realising the wide-ranging ambitions of the Government's strategy for children. The Green Paper set the tone - it was not just about child protection or even children in need, but all children. For too long, as he says, children's services have been "bunkered and siloed".
He says that he and the other six service tsars are "grounded very much in the reality of the front line", something underpinned by his continuing association with the ICH. Ministers, he suggests, "may not always have that reality check", but he sees his job as being to communicate to them as much as to children, parents and professionals.
Aynsley-Green chairs the children's task force and is responsible for the implementation of the National Service Framework for Children, which takes the Green Paper philosophy forwards. Yet he remains within the DOH when almost all other services for children and young people have shifted to the Department for Education and Skills. It is justifiable, he believes, because children's healthcare is so complex. He does not, however, see himself aligned solely with the DOH - he works across Whitehall, not to mention town hall and the voluntary sector, while dipping in and out of other non-health services such as education.
"There is something a bit funny about us in England," he claims, "where, unlike southern Europe and Scandinavian countries, we don't value children, childhood or parenting. This accounts for the low profile children have had in policy for the past 50 years.
"There are many paradoxes about how we individually view children and the way, until recently, the Government has dealt with them. There's an ambivalence. We treat them sentimentally - like with the memorial service and all the flowers after the Soham murders - and demonise them, especially adolescents. There's the paradox of their potency for fundraising, yet they are invisible in policy-making. There's the paradox that most children are doing better than ever in terms of health, education and physical wellbeing, but there are 2.7 million living in poverty; teenage pregnancies are among the highest in Europe; and there's the rapid rise in childhood obesity. There's no standing room in the Commons for a debate on fox-hunting, but half a dozen MPs turn up for a debate on truancy."
Academic life, Aynsley-Green believes, equipped him with three attributes useful for his present task: the ability to condense complicated issues; the ability to ask "what?", "how?" and "what is to be done?"; and leadership skills, although he is critical of how these are often neglected in academic life. He sees leadership as critical not only in his present role but also for those responsible for education, health, social care and other services for children if the new strategy is to work.
He has referred approvingly to the concerns Rowan Williams, the Archbishop of Canterbury, has voiced about the loss of childhood through the sexualisation and commercialisation of children. But mostly he looks in vain for intellectual debate about childhood and, especially, responsible participation from the media. He is pleased, however, that, for the first time, children and young people are being asked their opinions and being involved in policy-making. But Aynsley-Green also feels that it is vital to seek the engagement of local communities in shaping conceptions of childhood and future services.