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ACES to Assets 2019 – Creating trauma-informed policy from Health, Education, Care & Justice



[Applause] baby [Applause] I'm delighted absolutely delighted to welcome our panel for of this afternoon each representing the four sectors we've been focusing on today and they are care health education and justice as you know so I'm going to bring our out our guests right now so I would like to hear some rapturous rounds of applause for first of all for Fiona Duncan who's chair of beam dependent care review hello Fiona well here keep that lowest rank for Sir Harry burns professor of global Public Health at Stratford University Mickey Murray head teacher of Burnside primary school in chemistry in Angus and finally I want McCluskey the chief executive of community justice Scotland well welcome you don't get a lot of questions I'm doing um thank you for joining us this afternoon we hopefully will be taking questions from members of the audience so I'd like to think that those microphones are still out and about in the auditorium you've been with us all day and thank you very much indeed for that in terms of care health education and justice what's what's working well in Scotland in each of those sectors Fiona if I could come to you first in terms of care what was working well for is in Scotland okay thank you I think probably what's working well is will be illustrated by by this by today there are people all over Scotland who are absolutely determined to do the very best for children and young people and babies infants who find themselves in the care of the state pick out their bed determined to love and respect and uphold the rights of children and young people and they dedicate their lives to it okay can I just just that's just it's up there are we okay can you hear the answers alright at the moment oh it's just no okay well just check with Harry I'll come back to you in a moment Fiona Harry in terms of health yeah can you hear me okay yeah and so I think health is doing particularly well is got a method for change I think health is a very broad theming health being a state complete physical mental and social well-being not merely the absence of illness or injury so it's not just about illness we need to broaden our view of health and how we can help in this regard but in 2007 we started a major change program which resulted in Scotland know having 36% fewer deaths after surgery since 2007 no other country in the world has done that we've shown that the frontline staff can come together and make change happen we then started to do that with their early years collaborative and we've reduced still birth rate and infant mortality and the ambition is to continue that into improving some of the outcomes that we've been hearing about today so I think better than any other country that I know of Scotland the health system in Scotland is able to make change happen the question is how best do we then begin to use the insights we've gathered today and then subsequent meetings and so on to change the whole landscape around well-being in any language Nikki if we can come to you in terms of Education how is education doing in Scotland you are we punching above our weight or is a wee way to go yet I think there's definitely progress being made within my own sector but as a real focus on the biology behaviour and the number of schools are treating templates for others to fall and Gabor talked about whether or not people were invested in terms of neuroscience within schools but there's a huge number of skills now you're beginning to hold professional learning opportunities that are being gauging staff and adults and schools and the wider community around the bio would you know the biology of behaviour so that's certainly a change within the last few years there is a certain Drive in terms of understanding that there is a willingness to prioritize Leyland also prioritize well-being and that's certainly something that is being different forward most schools at the moment priority prioritizing well-being yeah yeah and also about generating well-being for themselves and others and so as Gabor talked about in terms of agency and lay another agency that's really at the core business of every school at the moment I appreciate these are very big questions for what I'm you know mass gives a very small answer so I appreciate that and Carole in terms of justice I was Scotland doing general I think I might know half the audience to know there's so many things I mean it's really interesting Paul Gray who's the DG used to be the DG of he'll set up a health and justice board Crissy ups so what we saw the connection and so we will connect up all this libel but the thing that I really like most as I know so many social workers and thought sector and the audience who are absolutely seeing the people who we connect wasn't a justice sake what's happened to you and I never saw that that is a fundamental change and it is a great question and for all the people who have supported tying those who are an addiction to change their lives I mean I I see so much great guitar shirts work and what I really like about it was as it's happening for the port month and that's how I think change is happening so you know for 1800 people to turn out and to see the connection between early years and a bit supporting parents and kids and about what happens in the Justice side it's just huge and it's but in it's changing and much more collaboration going on do you go Lutz we're not there yet I mean what's not at the time getting mister point I think our prisons stole them in our watched public health problem that we have where we're hosting a sec you know their level of physical and mental health that's enough presence you know I present no there's another part with the Prison Service they're just they're just passive receivers at the end joint so traumatized and we need to be able to have a philosophical thought experiment with ourselves about how do we change that and to be quite bored going forward so we've talked about we've talked about in each sector what's working well what are the what are the challenges and what could we do better Fiona I think the first thing that we do which we shouldn't do is refer to the care system as a system because Karen's just said there are certain things to do well by joining up but the fact is that any young person child baby or infant traveling through what we refer to as the cure system made by listen to any one of four to four pieces of legislation 19 pieces of secondary legislation or key international conventions and there so we don't have a cure system and we have a lot of custodians of parts of a system that collectively make up what we consider to be caring but earlier when I was listening to Gabor's became about attachment and about all the things are associated around that and really about timeout and what timeout or is it was making me think that at it's very worst Scotland's care system is timing out our children our young people who have already [Applause] they've already faced adverse childhood experiences otherwise there wouldn't be in a situation where they need the care of the state and yet what the state does is remove them for the families possibly for good reasons remove them from their brothers and sisters almost certainly not for good reasons and this is at its very worst they often end up in new skills trying to make new friends in a system that stigmatizes them and discriminates against them and then we wonder why we have intergenerational challenges about care at it's very worst it's built into the system design a whole series of challenges which imbed the conditions against stability and against relationships and against love and against naturally so I'm hesitant to use the word system now but Oh are we getting there so everything that you've encompassed in that's the answer are we getting there is there still a long way to go with that so I was as surprised as anyone else was when I was asked to chair the care of you because I'm really conscious that chairs of reviews don't look like me they look more like me um honey coughs every time he says I see something he doesn't want me to say out loud but chairs of reviews do look like Sir Harry if they don't look like me and we through the process of the care review have made sure that we're not reviewing the system we're recognizing the challenges are within the system but we're looking at what it feels like to be a child or a baby or an infant living and what we need refer to the care system and so far we've spoken to over 3,000 people more than half of them have been people with lived experience of the care system and the other half of being paid at the paid and unpaid members of the workforce and on Saturday I was in Inverness and I was talking to children young people and a boy said something we were all asked the question about what superpower would we have and a wee boy said that his superpower would be to turn into a stuffed animal and I thought you meant like you know one of those beers when you go into the Natural History Museum Ament at a beer or a cuddly animal a stuffed toy and that way he would get cuddles because people forget to hug him the where he is living people are working really hard to make sure that is well fed on the East Indies homework and the East ITD's room but they've forgotten to hug their sweet boy and that's what you want to do superpower to be so to answer your question I think that I hope that the key review process will result in or if you like no other where it's been the experience have been in the system as opposed to the system that's been reviewed but actually that wouldn't matter at all unless every single one of the recommendations that we came up with is implemented and implemented without field so the process is important but the end result and then the implementation is as important so I hope so Thank You Fiona Harry challenges in the health system I'm gonna slag off the system as well and so the late eighties early nineties I think it was it was maybe the end of Sychar zero or Blair's here a beginning of players either that saw the introduction into public service of this idea of new public management which was all about targets and indicators and budgets and whatever you do don't get the organization into trouble and I think that has kind of frozen humanity a bit the most important thing is to follow the protocol you know I talk a lot to frontline staff about how they can change their interaction with citizens and so on and they come back to me with what I've come to describe as the cold dead eyes of the middle manager you know or you can he do that because I'll lose my job if you do that and I try to encourage frontline staff to do what an individual needs to get amount of whatever holder and regardless of whether or not that a while to do it you know I look at the insanity of children being taken in secur carrot a six-figure sum when they're maybe going into secure care because the appearance may be all a thousand pounds worth of rent or something like that well give them the thousand pounds for God's sake but yet our system doesn't allow that to happen and that's true of the health system as well as they any other system so I think what I would want to see happen us as us moving towards a system that is based on genuine care respect and empathy for people who are struggling and part of what I've been trying to do in talking about aces is to make people understand that people are struggling not because they are bad not because they are incompetent but because they have been in this position where they can't make decisions that other more affluent people would find easy to make so we have to understand we have to develop a way of working the empathizes and helps them move through and we'll get a chance to talk a bit more about that later what that really like Nikki same question to you challenges from your point of view in in education in Scotland at the moment yeah I think one of the big biggest challenges is leadership and so Holly talked about decision making and I suppose leading in a trauma-informed we is all about meeting decision making frameworks for the people that you're working alongside and also supporting parents and children the example would be certainly safety choice and Trust and what our may look like is if you need to be both you know a break then you can take a little bit thing or trust us and I'm gonna make them sell available to you at some point during the day and I absolutely make sure that I drop everything and make himself available and choices what do you want your day look like to do and it's as simple as creating that understanding that these concepts are unique and the recognizing individuality of every learner and if you can empower staff with ease decision-making free marks then all the schools in the country can continue the journey and tells you be in trauma informed so decision-making empowering staff with these simple decision-making frameworks like safety choice and trust or rupture relate repair is so powerful but very important so the challenge is leadership I believe and when we've we've conducted interviews with people similar to yourself had teachers for the vodcast series leading up to the conference there have been some real tangible results for schools that have taken on this way of nurturing and looking after their children sure you've seen exactly the same well yes and schools are guided by policy specifically her Majesty's Inspectorate and hope you deserve school documents and last week we were very fortunate to win the national award for health and well-being which in itself is is a real sense of keating a template for other schools to follow and it gives them permission and to balance learning and well-being so yeah I think that the certainly progress being made and recognition that that this is certainly the direction of travel and must be prioritized by every school in the country I think is so important that's cute pouty over and caroling in terms of justice there it's not a system as it's a series of punches it forgets a person Yano and dim it's a really interesting thing I I know I've actually written he'll put my cup just in case I see anything really bad and one of my team stands up says please don't see that I am I spent time and Eden but I Sheriff Court and I just saw just a tragic group people who had just been so abused and traumatized and I'd tweeted after once I've just and it was all mean so I'm not packing on main but I change yeah my ID said I've just seen men with alcohol problems man my drug problems men who are homeless they'd be better be a care package instead of the Geo on somebody had tweeted back that's enough about the sheriff's what about the punters which make me laugh and actually it came from a conversation that Holly and I had had because when you think about her expensive as and what outcome that we want we want people who want to reduce reoffending want to prevent and instill we talked to think about it like that we're just going to process people and Jews gonna become the absolute default so is we need to have a more i supporter a modern day of conversation about what success looks like to us and i would believe and often bold enough to try something different somebody really clever said to me the only reason we're still using the Jews and Scotland is because the Victorians built them so well and there was a very truth in that we seem not to be able to change the system even though we know the system is not working for us and don't get me wrong I am no abolitionist I've dealt with people who are really dangerous and for the protection of lots of people they need to be in jail but I'm always saying you need to jail all those who you're afraid of and not lose who your mother and we see murder an awful lot of people [Applause] I think at the heart of everything we've been talking about today and what we're talking about in the in the panel discussion is we're talking about nurturing safe kind relationships to me being a lay man a broadcaster if you like and rel well the new to aces up to two years ago when I first heard about any was explained to me I was like why doesn't the world why doesn't everybody get this I mean everybody I mean that was from my point of view is it education does media have a part to play or or is there a lack of love is there a genuine lack of love feeling so I facing the some of the hopes that have for the Cure of you and the Fibonacci formula so if every one person leaves here today and tells one other person and convinces one other person that this was a good conversation to be part of and that there's another way of doing things and then that one person tells somebody else then I think that we will build a small army and those Karen says it will be an army of the grassroots I was thinking earlier when Suzanne was talking about telling the soil and I do feel that we have an opportunity in Scotland how do you outline some of the health figures where we have been an exemplar and I personally think it would be negligent overs if we don't grasp this moment I think Darren said that he wanted to take a moment to appreciate the magnitude of this time I think we do have an opportunity because we have got multiple different sectors in this room today and we do have people who recognize that there are things that are broken there's a lot of good that we can build on but there is a lot things are broken we have a national performance framework that's got the word love in it but I think that there will be a part for society to play because if society doesn't buy into this then I think our chances of having politicians buy interest them and ultimately we need the decision makers to be the brave and the bold people who will listen to others and make the changes that have to happen at legislation so that policy can change so that practice can change because otherwise they're called days of them management will always find a reason not to do something so I think it takes all of us and I think if any of us think what's the media or it's politicians or or it's the grassroots and we don't take our own personal responsibility then my view is that we've been negligent in terms of policymaking and contributing to policymaking area over that I come to you for a second have we got the right mix of people contributing to policy so what I mean by that other enough people for instance that that are care experienced that are or should be contributing to the way that the country is going with this and I don't think policy changes very much that would be talk I think the success of the collaborative that have changed patient safety and so on have come about because it was the frontline staff that made the change we actually discouraged our politicians from going to those meetings at the beginning you know I remember having a conversation was one eminent politician and said we'll tell you when we want you to come and you get the frontline staff to design the change and to test that and so on and then you've got a ready-made implementation as someone once said he can't expect frontline staff to be committed to any change they have had no say in shaping and and too often too often policy occurs because experts like me get in a room with ministers and we come up with our a document that gets handed down to civil servant gets sent and and thought look at and see what you know and so we are lucky in Scotland to half of the insightful politicians that we've got come in come in to what we mean but and and they understand this way of working now so I think what we should be aiming for is creating a narrative across all segments of society about importance of support and care and love and compassion for families and difficulty and what implications of that will be in years to come and to me the one the one telling thing that will always get politicians interested is the fact that the Aces study they calculated that one year's worth of child neglect in the United States brought with it a cost to the American economy a lifetime cost of that cohort out on your cohort of one hundred and twenty four billion dollars now if that doesn't get politicians set up the Scottish problem and that's maybe two or three billion pounds actually it saves a hell of a lot of money but it's just unfair and creates wonderful things as these children grow up to be creative and and engaged I'm gonna go to the audience in just a sec clearly you ought to come back at some point and I never thought I'd be sitting on the stage disagreeing with Harry burns but here goes and in terms of the so I I agree mostly with what you said but actually in terms of the care of you I don't want the frontline staff to be the people the designs what good looks like because I think there are many custodians of the system who have a vested interest in maintaining the system as it is so in terms of the care review its children and young people and adults with care experience that are almost finished disagree with you Harry and the other thing that I'm really keen on is I think that we do need so I agree that policy doesn't change things but I think we do need an enabling policy environment because right now there are so many different custodians of the system with a different bureaucracy and their different language and their different timeframes and their different rule books that means that the journey that the childhoods are lost within a system because some of the parts are holding the decisions that the children should be involved and we're losing childhoods and the final thing is I'm really excited about the prospect of doing a proper human and economic cost modeling again words I never thought I'd see out late because I do believe that if we can understand truly the human cost of some of the decisions that we are taking rather than the system cost that we would do things differently just very briefly just coming up on that point in terms of the education sector injustice frontline staff involved in decision-making people who receive our service who need to be involved because if you know asking them what they want then you know I'm always saying that's the best question about what does success look like how can I help you know so they need to be involved more and sometimes you know although some areas have a lab set fantastic at this their voice is too seldom here and I think until we do that more we're not gonna be able to you know we're not gonna be able to meet the progress that we want to I think absolutely accountants point about the importance of establishing gayden coalition's we are you you're taking on board every every voice within the community to try and reform or change but every context is unique and not only is it what success loosely but does it feel like look like insanely it's so important whenever you're driving forward change so I think yeah that's absolutely critical okay very very briefly just to come back to – Fiona's point the question you have to ask before you start any major changes what do you want to change by how much by when and by thought method I think we've got the method we need to agree frontline staff and citizens agreeing what they want and for example in the early years collaborative one of the things that were suggested as enhancing intellectual progress as well as attachment was bedtime stories so that was something that was done between nursery nurses and frontline staff and so of course you have to involve citizens but you don't do it from the top down when you want to make change happen the people who have to make change happen have to be involved with it okay good thank you right at five o'clock can I take a where are microphones by the way microphones there's a lady down here the hand went straight up this lady's bursting to ask a question okay what is it to anybody particular madam yeah it's into Karen it was about so you talked about the tragedy of people caught in the criminal justice system the vast majority are collateral damage of the war on drugs which is a warden people who use drugs are in fact as the Tories are just showing us a war on poor people who take drugs and which you talked about the bold and visionary decisions which you include a complete over over overhaul of our drug policy including it a beyond regulation being part of that I changed a changing drugs policy change in drugs policy to end the war on drugs in Scotland so what you said yeah so changing drugs policy to end the war of drugs in Scotland listen the wooden drugs has filled two years ago never what two mistakes it has me walked here I mean what are ridiculous coin saved do we need to change the policy yes we do and I think we need to include alcohol and that we always seem to talk about drugs and we forget about alcohol and you know I hope you talk about the Wilson and almost everybody Anika I mean I'm I'm not I'm not an expert and often that's I I'm really interested in it because people always talk about would you legalize it and always say well we legalized alcohol and that's not done that we've not been that great with that yellow because we drink to get drunk so there's a bit that we just have to be really thoughtful about it but we also need to look at some of the evidence a quick wake team quit leaked gab or saying that we need evidence based politics which would be really nice at the moment it's a sort of rhetoric that we get and who can be tougher on claim and tougher on drugs and what we see is what I see in the corpse yellow man you know I mean James Daugherty always talks about that you kind of punish people in addiction yellow and you just need to see all these women who have gone to jail and what's a young man who could ended up in jail and died in an overdose ease it snugly and it's it's getting worse instead of better so we need to have a think of what other policy and practices out there and what evidence is out there its own evil laws to get me and I don't know whether that answers your question because I didn't hear all but yeah we are there just a slight bit of difficulty on the stage so bear with us but I hope that answers your question madam there is a lady up the back in a uniform there Danny just up the back and if you could speak quite closely into the into the mic a nice and loud if you can please off you go hi I'm Julie from the Scottish SPCA the animal charity we now take referrals for children who have harmed animals and work with them closely is the panel aware of the link between animal cruelty human violence and the influence of aces and how can we get professionals in Scotland to recognize this link and actually do something about it okay so the question is from the SPCA and it is the link between animal cruelty and violence and aces and are you aware of the connection and what can we do to to highlight the fact okay Fiona oh yeah of course you know I think you know and particularly for loose wooden please sign and so she said you know Social Work etc the link between animal abuse and domestic violence in particular has been well recognized and so much so that we started to train vets many years in fact a long time ago with the medics against violence about how to identify not non-accidental injury and animals and then intervene with the person who was bringing it and who was most often the woman and and awful sometimes victimized and but you're right you probably need to do more that was it was quite small work and should have been you know it should have been I suppose elevated in terms of the AC stuff no I haven't looked at that specifically but I mean I should you know the causal link of shooters is absolutely there okay anybody else want to respond to that I I think we're missing a big trick in terms of identifying where the issues are and delivering help to to people you know this morning it was a conference on from the Scottish Federation of housing associations and asked them the question if one of your housing officers goes into a house maybe twice the month to fix a broken window does that say alarm bell ringing and they cannot look round and then I said okay if in that same house there's a woman who's on antidepressants and if in that house does a school child who's only attending school 50% of the time put all of that together is that beginning to tell you something and and that's the point you know Google knows more about you than the people who can help you Amazon can bring stuff here without you asking but yet we fail to understand that bringing all of this information together allows us to go and say to that family look what matters how can we help you what can we do that allows us to to to save things and then ultimately is one of the children is killed or something like that no hell breaks was totally avoidable so we can be using things and approaches and so on to help people and I really mean that help people ask them what can we do that will turn your life around about looking for more clues well it's about using the information that we've already got in a much more creative and productive way not to do things to people but to support them take control of their own lives and that's that's a critical bit none of us we can't bring that data together at all while we'll still have this public sector that wants to go in and punish people we have to adopt an approach that says how can we help my point builds on Harry's really I think that if we take situations like that in isolation then we run the risk of demonizing children because we're accuse them of being cruel to animals and actually that we don't take time to understand what happened to that child and why is that child doing what it's doing to that animal so I worry about some of the conversations that we have an isolation because I think that we stigmatize and do more harm to children young people than them do good so I worry about things like that in isolation okay and finally on this yeah absolutely in terms of gathering that information which is so important and schools are developing strategies about holding the outside inside or into the center and that's about trying to give people breathing varios training give people what they want what they need starting food banks actually within the actual school premises themselves underpinning that that's only if you're supporting someone in terms of giving them what they need it's really just the start of a conversation and it's down to building relationships and Trust and that that only Congress was really hard work and real determination to actually go and go into people's homes and and and really try and understand their needs and I think that's that's definitely the work and certainly all the services in terms of Children Services have to get better at talking with one another and sharing that information it's all so important okay that's finicky thank you I just remember we had a question that come in via pigeon force I think for the panel please what could be done in Scotland to utilize mindfulness to support our journey from aces to assets interesting question should we start with you Harry yeah so I first learned about the neuroplasticity elements of aces from a chap called Bruce McEwen who's a professor of neuroscience in New York and initially this whole question of ESA's it seemed as if the brain changes were offense lease at by about aged eight to ten or whatever the brain was formed and therefore we couldn't anything about it it's no clear that that's not the case bruce mcewen has published papers that show in thirty five to fifty five year olds using mindfulness and physical activity and creating a positive social environment changes the way your brain is structured and there's a famous writer on mindfulness called jon kabat-zinn who started using mindfulness in elderly cancer patient patients in the 70s and 80s and began to saw changes and behavior and stress levels and so on so the evidence is very clear about mindfulness I've given a couple of talks to organizations that promote mindfulness in Scotland that's a very active very active group of people so it's already out there questioners we have to make it obvious that it's that it is evidence-based it's not some kind of New Age thing or whatever there is strong evidence that it changes things and again it's part of the narrative we have to create we have to make people aware that this is a way in which they can positively influence their futures so just keep talking about Nikki mindfulness to get us on this journey yeah do use mindfulness in your school yes we do we hope we have sessions where families actually participate with the parents and the children and also we have class based sessions also and it's so hard he was talking about it's really just bringing people's attention to and hoping that we start to prioritize what thank for it within the a B and C is something that's really valuable when it's something that at the moment for us it's it's know as research informed in terms of the evidence base that Sahara is talking about but certainly we're seeing benefits and the families enjoy the time and the space to practice impactful mindfulness in the justice system can I do like it to be used by the staff I think people are really stressed and really anxious and how many earth can you empathize and form a relationship with somebody else if that big button is just unsure because you've not dealt with your own anxiety and stress and trauma and so I think getting us all tip like to say and myself included you know I knew you think I need it you know I should think is a first step because I see some really stressed people out there who are dealing me mus of what words were really complicated people who need better support and I think we also need to look after ourselves I don't know whoever said that if you don't practice compassion for yourself how else can you do for someone else and so I think to start off successful great absolutely Fionna Fionna sorry my voice and it's interesting because when you asked what was working and I said at the beginning it's people it's the people that I think are making a difference in children's lives and Nikki's talked about what he does in his school and I've been to visit children in in their homes and they have been surrounded by staff who are stressed minimum contract 0 hours 0 contracts living wage and I do think that part of the structure of how we Commission care and Commission support exacerbates all of that and I think mindfulness is really important I thought Cabras points earlier about empathetic witnesses and people feel validated and worthwhile it was also really important and I guess I agree with Harriet interesting but there's something about there needs to be a narrative we need to find what works for us and mindfulness and they might not work for you but something else might work for you and I think we all have to find what's right rather than going this is the one thing we've got a bit of science we've got a bit first but we're going to apply that universally because it wouldn't it just won't work for everybody so it's about that I suppose it's about that phrase that Nadine Burke how issues in September about self-care I want to take a question from up the top there yes please nice and loud if you could please hello my name is Brian Duncan I work in alcohol and drug services in Aberdeenshire and I'd like just well first to say how pleased I am to be in the same room and the same discussion as gabber and Darren and Suzanne has been brilliant my question is to answer some of the contradictions firstly this huge resource is going into foster care and there's more and more children going into foster care but there's a group of people who care of carers who are terribly under resourced and that's kinship care and I just wonder why that is secondly with in the criminal justice system the drug related deaths are still going up and up and up and so well while we're patting ourselves on the back for doing good positive work something's missing that our drug related deaths are still increasing and lastly in relation to alcohol we have an industry in this country that's that's raised record profits for 18 years in a row and I don't understand how we hold that up as a champion at the same time as we've got such you know dangerous substance that we have kicking around not shucks you sure what the question is but there are some big contradictions going around okay I think there's I think there's three in one there so I'm gonna split it up and if we could be brief because I'm conscious of time we've got about another 10-15 minutes resources money going into foster care and is there is there a gap between the money that's going towards foster care and kinship care okay I'll be super brief and when I was appointed I looked at the six reviews that had taken place between 2009 and today and they'd all looked at parts of the system and one of them are looked at foster care allowances and I think that one of the things that I learned from reading those reviews I'm looking at all the serious case reviews and doing all of the DES piece thoughtful that you would expect me to do is if you left one part out of a really complex system move over here and look at it and compare it to another part take it and drop it back into a complex system the complex system will consume it so what we haven't done is looked at the difference between the allowances for foster care or kinship peers we are looking at that too but there hasn't been a principal focus what we've looked at is what is the best environment for a child or a young person and how unique I'm safe high degree ideal we keep them going to this their school keep them with their brothers and sisters of all of those things worked for them so you're absolutely right there is a difference in terms of the level of resourcing around that but there's a whole bunch of other inherent challenges and differences within the care system like they can't agree looked after at home which is simply akattak lee and not a service and how that's the least spent on it and the worst outcomes but again we're not looking at just those component parts we're looking at it in its entirety so what you say is absolutely true and we will come up with a response to that but it will be based on what works for babies infants children and young people who need to cure Karen drug related deaths in the criminal justice system should we be patting ourselves on the back with your own hands oh it's horrendous I mean you know I I work lovely charlie called this time in community and they're constantly tell me about how many people are dying you know through just expired and on at all you know behind closed doors with anybody all of them then you know they don't care of 11:00 till next year families next week and the fact that we authorized them and we don't talk about them in gap or says why have been overrun a rich is really you know I mean I the kind of terrorism thanks was I didn't tweet that just in case I got some drive-by feedback from the security services but as a national in beach and somebody had said to me love Delia but all I saw and your point is color yellow you know the sailboat you know but younger people are making their decisions but there are citizens as well and we're still not dealing with it well and there is something about someone leave I'm pleasant and mean or have probably have taken drugs and say that lesson and go no and over dozen and that we know that evidence and we know who's most likely and we just feel to intervene and you know I'm you're going to wrestle with us overnights you when the figures come out other figures out yet well this year no I don't think they are I think when the figures come out we're gonna have to have our really you know difficult conversation with each other about what we're doing right more needs to be done okay thank you for that Harry the third part of the question was around the profits alcohol and once again I think was about being self congratulatory in the country well interestingly for most of the past 50 years Scotland had one of the lowest death rates in Europe from alcoholic liver disease and then about the mid 90s it started to go up and then by about 2005 we had the highest mortality from alcoholic liver disease in Western Europe we compared to most 16 most other Western European countries we've come off the top now we're a bit better than we were compared to other other countries and we were never you know in the 50s 60s and 70s France had a huge mortality we were never as high as that so we shouldn't congratulate ourselves there is no question that alcohol consumption I think across Western Europe is higher than it should be but I think it's very difficult to come up with single short solutions you know minimum pricing will make a difference a small difference but it's a complex system that forces people to or allows people to go and consume alcohol and part of that is the fact that they just want to get drunk when I as a surgeon I would see patients coming in maybe the third or fourth time was a life-threatening condition because of the alcohol consumption you teach them you have to stop drinking otherwise you'd die and the response would be I don't care life's crap and booze is the only pleasure of God so we've got to get to that sociological set of drivers if we're really going to see things get back down to where we we're 20 30 years ago so a direct link is there a direct link to to poverty yes yes there always has been but um it's certainly common of the Lord on the social scale you go I think they've just I've got cooked I'm gonna have to wrap up shortly and I think we've talked a lot about poverty today but I think it's important I would imagine for us to all realize that aces does not discriminate whether you're rich or poor thank you the incidence is slightly higher at the lower end of the socio-economic scale but it's still very significant at the upper end you've been here all day sorting as much information as we all have I've got two more questions for you first of all what are you going to professionally and personally take away from today have you had a standout moment from any of our contributors so if we can start with you count you know it just been the opportunity to sit and listen to Gabor you know he's not flashy it just sits and you had another tough and you know just our opportunity to have a think about put aside everything you think you know and they start to think about our problem definitely I mean he talked about addiction that really you know that really came home to me about how else could we look at this you know we you know and it's really important that we do stuff here known but you know just because you put a sling on a cape art it doesn't make it a cake you know we may have to completely you know change the way that we think about this and that's going to be uncomfortable for people who are weighted to certain philosophies or weighted to certain ways of doing things because it would challenge them change is always difficult you know I take away for you today and so I've had an amazing day from the moment I arrived actually in every single thing I've sat down here and listened to his been a privilege and the the when I was terrified about the prospect of coming up here I was trying to think of something clever and profound to see and I struggled but what really occurred to me was was talking about telling the soil in creating the right conditions and I feel that in Scotland we have hope for something different and that feels like the sort of fertilizer for that soil that has been tilled to create the ground and then I was thinking about when gerber was talking about the leaf that needed light and our connection with nature and I think moths are light that we need to continue to shine on everything that we do to try and figure out how we can make life better for the children and people that need us most Nicky come to you next you'll take away from today please yeah well I think I think about 16 pages in notes which he'll digest over and over again however I think the two or the most important part for me was when Gabor talked about two things children needs which are attachment and authenticity and if schools can dedicate themselves to exploring both through educators becoming educated that's something I will be really trying to drive forward that message about attachment and being attached with reformed and also authenticity okay and Harry Wow well I've got a one year old granddaughter and some of his descriptions about the baby turning away in shame if you break eye contact and so it means I will absolutely maintain eye contact with her every time she's there it's very easy cuz she's so beautiful and she just smiles all the time she's so well attached and but I think what I take away is the absolute consistency of what were heard about the importance of this the fundamental importance of supporting young people through those difficult times into an engaged adult life where they they feel they can contribute we feel a high sense of self-esteem and so on and you know there are friends in the audience I know who have been through very difficult times who are absolutely doing that it can be done and what today does for me it just redoubles my determination to make sure that we get to a far better place in Scotland you know we've done remarkable things with health care we should be doing remarkable things with bringing young people to a full and productive life you've you've answered this actually in one way or another as we've we've gone through the our time is nearly up but for all of us in this room the 2,000 of us that have been here today one thing in your professional opinion that we can do immediately as soon as we step out the doors in a sound bite as those can I use my idiot phones with save and you come back to me he come back to me okay I think for me personally it would be about just maintaining that visibility and because being visible was sometimes exhausting but it does provide opportunities for support and acknowledgement which is so important and to young children so for me would be about taking these simple ways of working and some plus it was called the highest form of sophistication and it's true if you can narrow down to something simple even just being there in terms of support and acknowledgement and check and then with children just giving them space and to share so yeah that's something I'll be taking away thank you well what I want to do isn't anything to do with my professional life but when I get out of here a walk down to Central Station and I'll pass to you for people begging in the street who are sleeping rough and so on and every time I give people money I want to stop and have a conversation with them I want to ask them why are you here what what matters to you what could we do that would make a real difference rather than just give them money and I think I'm gonna be going to do that today and finally Fiona and I'm gonna work hard to be as compassionate as I can possibly be and what we can all do as well yeah and I would I would hope everyone else would too and lesson so Tahari's pouring you know listen to somebody give them an opportunity to tell them tell you their story if that's what they want to do and try and understand their perspective and what what you can do to make their life easier or better well thank you ever so much that was a quick 60 minute special do you agree yes oh I think we found it very enlightening and it was very quick I'm sure we could have seen a lot more questions thank you very much indeed – Fiona Duncan sir Harry burns nicky Murray and Karen McCluskey thank you [Applause] [Applause] you

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