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Andrea Leadsom (South Northamptonshire) (Con)
I am delighted to have secured this debate, and I am grateful to the Backbench Business Committee for selecting it. Mr Weir, did you know that 36% of all case reviews into deaths or serious abuse involve a baby under the age of one, and that a quarter of all babies in the UK have a parent affected by domestic violence, mental health or drug or alcohol problems? Furthermore, if one asked most local authorities how much they spend on specialist parent and infant mental health services, the answer would be, “Nothing.”
I am proud of the fact that with three cross-party colleagues, I have launched the manifesto “The 1001 Critical Days” to propose specific ways that the Government can better support the needs of new families. The 1,001 critical days is the period of time from conception to the age of two. In our cross-party manifesto, the right hon. Members for Birkenhead (Mr Field) and for Sutton and Cheam (Paul Burstow), the hon. Member for Brighton, Pavilion (Caroline Lucas) and I seek to recognise the overwhelming evidence now available that a secure early relationship between baby and key carer is vital to the infant’s lifelong emotional and physical well-being.
We are grateful for the strong interest that the manifesto has received from Ministers and shadow Ministers, particularly the Under-Secretary of State for Health, my hon. Friend the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), and the hon. Members for Manchester Central (Lucy Powell) and for Washington and Sunderland West (Mrs Hodgson). We have also been delighted by the amazing number and range of endorsements for our manifesto, from the chief medical officer for England and Wales to UNICEF UK, the National Society for the Prevention of Cruelty to Children, the Centre for Social Justice, Barnardo’s, the Royal College of Midwives, the Royal College of General Practitioners and the Institute of Health Visiting. The list goes on and on.
Mr Weir, you might be wondering what on earth is left to debate if the topic is such a love-in, but the truth is that there is an enormous amount to be done if we are to seize the opportunity to change our society radically for the better. An NSPCC study shows that only 64% of NHS trusts have a perinatal mental health strategy. Other recent research shows that 42% of GPs feel that they have very little knowledge about the specialist services available for severe mental illness. Nearly a quarter—23%—of all maternity professionals say that they have received no education on maternal mental health, and the Royal College of Paediatrics and Child Health estimates that the annual short-term costs alone of emotional, conduct and hyperkinetic disorders among children aged five to 15 in the UK are £1.58 billion, and the annual long-term costs are £2.53 billion.
The Institute of Health Visiting is delighted by the Government’s commitment to significantly increasing the number of health visitors, and progress in training new health visitors is on target. However, in a recent survey by the institute, 87% of midwives said that their work loads had increased and that they were seeing the following worrying trends: 65% were seeing increased child behaviour problems, 61% reported seeing an increase in the prevalence of speech delay, 73% were seeing an increase in poverty that was having a bad influence on families, 82.5% were seeing an increase in domestic violence and abuse and 70% reported an increase in the incidence of perinatal depression. Perinatal depression includes antenatal depression—that is, before a woman has her baby—as well as the depression that can arise during birth as a result of a traumatic birth experience and, of course, post-natal depression, which is the main subject that people talk about when they talk about depression in the perinatal period, if they ever talk about it.
Everyone would agree that prevention is better than cure. Everyone, or pretty much everyone, would agree that many of our society’s greatest problems stem from alcohol and substance abuse and mental illness. But too few people realise that in a vast number of cases, those in our society who cause the most damage and cost the most money have been permanently set up for disaster from their own infancy. The absence of a secure bond between baby and carer in the 1,001 critical days has profound lifelong consequences for the baby. I am convinced that once the strong link between experiences in the earliest years and whole-life outcomes becomes more widely accepted, we will start to make huge progress in tackling society’s most intractable problems.
The efforts of 20th-century politics achieved great strides in tackling the physical health of our nation. The challenge for our 21st-century generation must surely be to secure sound mental health that will lead to a stronger and happier society. Imagine how wonderful it would be if we were to shut down prisons, not because of overcrowding or poor conditions but because we did not have enough criminals to fill them. Imagine if we could close psychiatric hospitals due to a lack of need for them.
Steve Brine (Winchester) (Con)
I congratulate my hon. Friend on this debate. I know that she is achieving quite a reputation in this area. The Select Committee on Justice, of which I am a member, held an inquiry recently into youth justice and the drivers of youth justice. As she will probably know, just 10% of children and young people in the general population have a speech and language difficulty, but in the prison population the figure is somewhere between 60% and 65%. Does she agree that delayed language development leads to issues at school, exclusion from school and many of the problems that cost our society so heavily?
Andrea Leadsom
My hon. Friend is absolutely right that delayed speech is a key contributor to later problems for the infant who does not reach the right level of speech capability in the first critical years.
Think of walking through any big city in the UK without seeing teenagers living rough in the streets. Finally, imagine a society where the number of babies and children being taken into care and removed from their families was falling, instead of rising as it is at the moment.
Tim Loughton (East Worthing and Shoreham) (Con)
I congratulate my hon. Friend on bringing this important subject before the House again. I should disclose an interest as the chairman of the Mindful Policy Group, which is all about promoting attachment. The figures that she gives are stark, but does she also acknowledge that this has become a generational issue in too many of the statistics that she mentioned? Half of young people in young offenders institutes who come from care will then go on to have children subject to similar problems. In many cases, the common cause is domestic violence and lack of attachment built at an early age. It is not rocket science; these are common themes. It is a false investment not to do something early, as her excellent manifesto so clearly proposes.
Andrea Leadsom
I completely agree, and I will discuss that in a moment. It is called the cycle of deprivation, and my hon. Friend is absolutely right to raise it.
I honestly believe that it is possible to change our society for the better, but it needs a concentrated focus on the mental health of our nation. I want us to build a third pillar to our great universal services. Alongside the achievements of free and universally available health care and education, I want a free and universal service focusing on the mental health of our people. It must start at the very beginning—the period of 1,001 critical days between conception and age two—and it must ensure that every child can build the emotional capacity and resilience to cope with life’s ups and downs.
I make the case that what we do with a baby from conception to age two is all about building the human and emotional capacity of that infant. Supportive interventions with a child after the age of two are often too much about trying to undo damage that has already been done. I would never advocate giving up on anyone, but it is an incontrovertible fact that if we want to change our society for the better, we must focus on the crucial period between conception and age two.
Human babies are unique in the animal kingdom in the extent of their underdevelopment at birth. What other animal cannot walk until it is nearly a year old and cannot fend for itself in any way at all until it is at least two years old? However, the physical underdevelopment is only a tiny part of it. The human brain is only partially formed when a baby is born. The billions of neurones in the brain are largely undifferentiated at birth, and parts of the brain are simply not there. Humans are born with only the fight-or-flight instinct and the earliest experiences of the human baby literally hardwire his or her brain and have a lifelong impact on the baby’s mental and emotional health.
What are a baby’s earliest experiences? It is quite simple. When a baby cries, he does not know that he is wet, tired, hungry, bored or too hot; he just knows that something is wrong, so he relies on a loving, adult carer to soothe his feelings. Most parents will remember, as I certainly do, long nights spent walking up and down, hugging a baby, saying, “Go to sleep, go to sleep,” desperate for sleep ourselves and determined to try one thing after another to sort the situation out. The baby whose basic needs are met learns that the world is a good place, and he or she will retain that sense as an instinct for life. That baby will be more emotionally more robust than the baby who does not have his needs met.
For the baby who is neglected or abused, there are two critical impacts on development. First, a baby cannot regulate his or her own feelings at all. If the basic needs are not met, he or she will simply scream louder and louder, and eventually take refuge in sleep. The first impact is that a baby who is left to continually scream night after night will experience raised levels of the stress hormone, cortisol. Excessive amounts of that damage the baby’s immune system permanently, and evidence suggests that a baby left to scream for hours at a time, day in and day out, will develop a higher tolerance to their own stress level, meaning that in later life, they will have more of a predisposition to high risk-taking behaviour than a baby who has only a normal level of cortisol. A lot of evidence shows that violent criminals have a high tolerance to their own stress levels. However, it is not only that—for a mother who is very stressed during the time that her baby is in the womb, the outcome is that the baby can physically be very desperately damaged. For example, maternal stress during pregnancy can lead to a thinning of the baby’s arteries, which has profound consequences later in terms of congenital heart disease, diabetes and obesity.
There is also a very real physical impact on the brain. The pre-frontal cortex—the social part of the brain—only starts to develop at about six months, and the peak period for that part of the brain to develop is between six and 18 months old. Growth is stimulated by the relationship between the baby and carer, and peek-a-boo games, gazing into each other’s eyes, singing songs, saying, “I love you, you gorgeous little thing!” and lots of cuddling all play a really strong role. Love literally shapes the baby’s brain. The brain develops millions of neural connections during that period and the pre-frontal cortex physically grows in size.
Steve Brine
Although I appreciate that saying, “You beautiful, delightful thing” is clearly the thing to do, at 3 in the morning, especially as a brand-new MP with a vote at 10 pm the next night, saying, “The Prime Minister really needs to be on my game” does not cut much ice with a newborn baby—I say that from bitter experience. My point is that parents have to learn how to be parents and how to give that love and care. Will my hon. Friend take a moment to recognise the amazing work of organisations such as Home-Start? They do brilliant work in teaching parents how to be parents.
Andrea Leadsom
Yes, Home-Start does a fantastic job, as do other volunteer organisations, peer-support groups and so on; there are many around the country. It is true to say that becoming a parent is the most difficult thing that someone ever does. There is no on-off button for a baby and no rule book, guidebook or handbook, so we all struggle on in our own way, with better or worser results—[Interruption.] Probably not “worser”—worse, thank you. The Secretary of State for Education is not responding to the debate, so we are all right, but the point is about being a good enough parent, and if a baby knows that he or she is loved, a parent does not have to say it at 3 o’clock in the morning when they are at their wits’ end. However, a baby does have to learn that their parent loves them.
When a baby does not receive attention from a loving adult carer, the pre-frontal cortex does not grow and may never grow. Many will remember the tragic story of the Romanian orphanages, where the minimal physical and emotional contact with babies left them profoundly and permanently brain-damaged. Some of them died literally from a lack of love.
It ought to be natural and automatic for families to form a loving and secure bond with their babies, but post-natal depression, problems with conception, trauma during childbirth, domestic violence and issues of poverty and deprivation all get in the way. Insecure attachment is no respecter of social class or wealth. One of the biggest obstacles to forming that crucial secure bond is when mum did not have a secure relationship with her own mother. As my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) pointed out, it truly is a cycle of deprivation that is all too often passed down through generations.
Fiona Bruce (Congleton) (Con)
I thank my hon. Friend for securing the debate and for the passion that she has for the issue. Does she agree that a strong relationship between the child’s parents is critical? On the tragic costs of family breakdown within the country, she cited some statistics, but another is that £46 billion is the cost of social breakdown. Does she agree that, given that three different Departments have already been mentioned in the debate—the Ministry of Justice, the Department of Health and the Department for Education, and I could add the Department for Communities and Local Government, because we have health and well-being boards—we need to look at having a team responsible in a Government Department, with a lead Minister who will give the issue priority on a daily basis?
Andrea Leadsom
My hon. Friend is a passionate advocate for support for relationships, and she is absolutely right that the best results for babies and young children come when they have two parents who love each other. There is no question about that. All the statistics back that up, so she is absolutely right; we ought to prioritise the essential importance of helping families to stay together.
The brain development of babies has deep implications for society. A human being without a properly developed social brain finds it very difficult to properly empathise with other human beings. That can pose risks along a spectrum, from a general lack of emotional resilience, leading to depression or general unhappiness, to antisocial behaviour, drug-taking, criminality and, at the most extreme end, psychotic behaviour.
The charity Railway Children estimates that there are up to 100,000 children at risk on the streets in the UK every year. Research shows that more than 80% of long-term prison inmates have attachment problems that stem from babyhood. Evidence now suggests that two thirds of future chronic criminals can be predicted by the behaviour seen in two-year-olds. A New Zealand study showed that a child with substantial antisocial behaviour aged seven would have a 22-fold increased chance of criminality by the age of 26. Statistics issued by the Office for National Statistics show that almost 80,000 children and young people suffer from severe depression, and that 95% of imprisoned young offenders have a mental health disorder.
There is also a very real financial cost to society: each looked-after child costs the taxpayer about £347 a day, each adult prison inmate costs the taxpayer about £112 a day and each person in acute psychiatric in-patient care costs the taxpayer £225 a day. Analysis of spending in local authorities shows that that cannot go on for much longer. The wonderfully named “Barnet graph of doom” shows that on current trends, spending on children’s services and adult statutory services alone will outstrip the income of the local authority of Barnet by 2025. That means the council will have nothing to spend on other important services such as refuse collections, potholes, or parks and leisure facilities.
A pretty shocking statistic is that research suggests that in Britain, 40% of children are not securely attached by the age of five. Of course, that does not mean that they will all go on to have behavioural or relationship problems, because other life events will play a part, but it does mean that they will be less robust in their emotional make-up to meet the challenges and disappointments of life. It also means that later in life, as parents, they may struggle to form strong attachments to their own babies, thus perpetuating the cycle of misery through the generations.
Having set the scene and described the challenge, I shall move on to the proposals that we have set out in our “The 1001 Critical Days” manifesto. The key overarching call is for an holistic approach to the perinatal period whereby the needs of the family are met in a seamless way.
First, we need specialist mental health midwives and health visitors in every local authority area. We must enable women with a history of mental illness to receive tailored antenatal and post-natal care, and thereby reduce the risk of later post-natal depression. Secondly, those families experiencing difficulties should be able to access evidence-based services that promote parent-infant bonding, such as video interaction guidance and parent-infant psychotherapy. Thirdly, all parents should have access to antenatal classes that deal with both the physical and emotional implications of childbirth, as well as the baby’s own mental health needs.
Fourthly, the registration of the birth of a baby should be made possible in children’s centres in every area. Benchill children’s centre in Manchester Central, where the hon. Member for Manchester Central plays such a key role in promoting early years intervention, is a fantastic example of how registration in children’s centres can help new families. It has been offering birth registration for more than a decade, and its reach to new families has grown from less than 50% in a very deprived ward to 87.5%. In addition, its re-engagement rate with families is astonishing: for young parents, it is 100%. All parents have access to the services that they may desperately need, to help them to get the best start in life with their babies. In—
Tim Loughton
I did not mean to interrupt my hon. Friend mid-sentence. She makes some very fine points, especially about accessing antenatal classes and children’s centres. Does she agree that we need to make both types of facility more dad-friendly as well as mum-friendly because too often they are dominated by mums, and that, where partners are available, the support that they can be encouraged to give if seen as an equal partner in the family could help to prevent some of the perinatal mental health problems that befall one in six women around the time they give birth?
Andrea Leadsom
Yes. I am grateful to my hon. Friend for making that point. Benchill has that amazing ability to reach new families by offering birth registration. As hon. Members will know, if a man is not married to the mother of the child, the only way to have his name on the certificate is to be present physically at the registration as the father. Therefore, the advantage of offering registration in children’s centres to families is that it offers the opportunity for the children’s centre to look at the parents together. Benchill certainly encourages its staff to chat to dad. It encourages them not to focus just on mum or baby, but to talk to dad and the other children if they are there—to engage with them, try to give them support and let them see what services are offered to dads and babies and not just mums and babies. That is a perfect example of how to support the entire family. In one fell swoop, Benchill deals with the problem of stigma—everyone goes to the children’s centre, so clearly there is no stigma—and those families who are deemed hard to reach and who so often need services but do not get them are automatically engaged.
The fifth proposal in our manifesto is that there needs to be a presumption of data sharing among perinatal health professionals. The incorrect perception remains that sharing concerns about a mum, a family or children is against the law. In fact, professionals talking to one another and sharing their concerns and the information that they have on different families could very often save lives by allowing earlier interventions to be made.
Sarah Champion (Rotherham) (Lab)
The hon. Lady is making a very interesting point. I am doing an inquiry into child sexual abuse, and one of the key blocks to getting prosecutions is the lack of information sharing among health bodies, education bodies, local authorities and the police, so I fully support the recommendation on that, because it seems to me the only way in which we can prevent abuse and other forms of neglect.
Andrea Leadsom
The hon. Lady is absolutely right. Sadly, in serious case reviews there is very often an element of failure on the part of health professionals—a failure to talk to one another. Very often, that is a contributing factor to the disastrous outcomes that we sometimes see for families and children.
Tim Loughton
My hon. Friend makes a very good point about data sharing, but it does not happen in practice and is too often used as an excuse by professionals who are too lazy in some cases or have various other professional reasons for not wanting to speak to other professionals. Through the proliferation of MASHs—multi-agency safeguarding hubs—and through local safeguarding children boards and other bodies, professionals now come together regularly to share strategy, and they should be able to change that information as well. The regulations do not deter them from doing that, so it is an excuse and in practice that excuse should not be tolerated.
Andrea Leadsom
Yes. Even my hon. Friend’s harder line is absolutely right: there should be a presumption in favour of data sharing. It should not be a case of people saying, “Oh, I didn’t know,” or, “I didn’t think it was allowed.” It should be a case of people being told, “If you didn’t share information, you should have done.” At the moment, that is not understood strongly enough.
Of course, data sharing is relevant not only in child neglect or child abuse cases. Let us say that a midwife meets a mother antenatally and is aware that that mother is terrified at the prospect of giving birth because of the physical implications, because she is afraid that her partner might leave her or because she is afraid that she will lose her job as a new mum. Often, when such issues are picked up antenatally, there is, first, a lack of places to refer that mum on to and, secondly, a lack of a communication path to enable the midwife to think about whom they should be talking to.
There is, therefore, a very strong argument for creating formal links between midwives, health visitors and children’s centres to ensure not only that they can talk to someone else, but that they must talk to someone else. The relevance of that to the mum’s experience is that if a midwife is concerned about a mum, they can perhaps refer her on to a mental health specialist midwife and a mental health-focused health visitor. That could all take place under the auspices of a sensitively attuned children’s centre, so that the mum’s needs can be met throughout the perinatal period, giving her the best chance of forming the vital secure bond with her baby. Data sharing is relevant not only to cases involving severe child protection issues; it is also about supporting mums who are just struggling. As we know, the statistics suggest that as many as 100,000 mums a year may be just generally struggling. It is not that there are severe physical or neglect threats to their babies; it is just that those mums need a bit of support, and at the moment we are not giving them that.
That takes me on to our sixth proposal. There is a huge need to provide proper training for front-line health and social care professionals in the importance of attachment and early brain development. I have been involved for about 15 years with parent-infant partnership charities that provide psychotherapeutic support to families. We also provide training to front-line professionals. It is astonishing how many post-training evaluation forms we get from midwives, health visitors, GPs and social workers that say, “Wow! I wish I had known before how important the earliest relationship is.” That is not as much about the physical health as about the emotional health and the attachment.
Our seventh proposal is that local commissioning groups and health and wellbeing boards should specifically consider the social and emotional needs of babies in their local strategies.
The eighth proposal is that childminders and nurseries should consider how they can better meet the attachment needs of babies in their care, and that Ofsted inspections should specifically provide guidance and assess their performance. As a member of the Committee considering the Children and Families Bill, which passed through the House of Commons recently, I was pretty shocked, when we had Ofsted in to give pre-Committee evidence, to be told that Ofsted inspectors do not routinely assess those looking after the very youngest—potentially babies from the age of three months to two years old—on how well the care setting is meeting their attachment needs. There is this sense of schoolifying in the inspection regime. It forgets about how well the key worker is playing with the baby, responding to the baby, smiling at and cuddling the baby and being the key person who changes the nappy, does the feeds and so on. All those things are absolutely crucial for secondary attachment if mum or dad is out at work.
Sarah Champion
I know that the debate is about early years, but I was also surprised to find that in schools, there is no requirement for Ofsted to measure safeguarding; they deal only with educational attainment. We must look more holistically at a child from birth onwards.
Andrea Leadsom
As the hon. Lady said, the debate is about the earliest years. If we can get those right, there will be many fewer problems later in a child’s development. We can close down the pipeline of later problems by intervening and supporting families far earlier.
The final proposal in our manifesto “The 1001 Critical Days” is that although children’s centres should continue to provide a universal service, they should prioritise specialist services for families with the highest level of need regardless of their social and economic circumstances. Service provision must be needs-based and universal, but focused on specialist services for those who really need them.
As I have said, since 2001 I have been closely involved with parent-infant charities that provide psychotherapeutic support to families who are struggling to form a secure early bond with their baby. I am delighted to say that a year ago I set up a charity called Parent Infant Partnership UK, which has set out with philanthropic donations to establish specialist parent-infant psychotherapy services based in children’s centres around England and Wales. The first brand-new Parent Infant Partnership, LIVPIP, will launch this month in the constituency of the shadow Minister, the hon. Member for Liverpool, Wavertree (Luciana Berger). It will provide psychotherapeutic services for families who need them in the Liverpool area. I am absolutely delighted about that, and I hope that other local authorities will want to establish similar specialist services themselves.
Sarah Champion
I am very supportive of the scheme that the hon. Lady is describing, and I hope that it can be rolled out more widely. In Rotherham, we have some fantastic Sure Start centres that offer great parenting classes. Does the hon. Lady share my concern that because our early intervention grant has been reduced, we are having to look at cutting the number of Sure Starts from 22 to nine? I am concerned that the vital parenting support given by the Sure Starts will be lost.
Andrea Leadsom
The hon. Lady will know that there is a presumption against closure, and several local authorities have considered closing Sure Starts but have chosen not to. I once took my hat off in the Chamber to the Labour party for creating Sure Start—I was subsequently told that props were not allowed in the Chamber—but the problem is that they are not universally understood. If we ask the proverbial man on the Clapham omnibus what a school is for, we will get the same answer from every man on that omnibus. If we ask what a children’s centre is for, however, we will get all sorts of different answers. The fundamental problem with the Sure Start children’s centre system is that there is no common understanding of what they are for and the extent to which they should be provided.
My opinion—this is not part of our manifesto—is that children’s centres should have a statutory footing like schools do. If a school year 4 is failing, we do not say, “Well, shut it then, and those children can just go without learning to read and write.” The profound implications of children’s centre services on a child’s development may be far greater than whether they learn to read and write at the age of four, and far more fundamental for their life chances, but we are willing to shut children’s centres. I appreciate what the hon. Lady has said about cuts, but we need to improve understanding of children’s centres and spread the good practice that undeniably exists in some. We must persuade local authorities that children’s centres are not for cutting; they are profoundly important—at least as important as schools and hospitals. That is my opinion, but I hope that answers the hon. Lady’s good point.
Psychotherapeutic interventions from parent-infant partnerships have changed lives for the better for thousands of families. For those families whose babies now have the best start in life, rather than a disastrous one, politicians can count the savings to the public purse. Early years intervention has the potential to save billions of pounds from the cost of dealing with poor mental health, antisocial behaviour, crime and violence. My hope is that all political parties will adopt the achievable and sensible recommendations of our manifesto “The 1001 Critical Days”, and that we will together strive for the real prize, which is, surely, to change our society for the better.
Fiona O'Donnell (East Lothian) (Lab)
I apologise for my late arrival. I congratulate the hon. Member for South Northamptonshire (Andrea Leadsom) on securing, with her friends and colleagues, such an important debate. It is excellent to have the opportunity to debate these important matters at length under your chairmanship, Mr Weir.
Hon. Members might be surprised to see a Scottish MP contributing to the debate, because Scotland and England have such separate and distinct approaches to child care, maternal care and paternal care, but there are lessons that we can learn from each other, and that is why I was keen to make a contribution today. In addition, I have been working closely with two third-sector organisations, the National Childbirth Trust and Bliss, on problems that arise when babies are born prematurely, and I want to focus on the needs of children, parents and the wider family when babies are born prematurely.
I have personal experience of the strain that that causes, having given birth to twin boys eight weeks prematurely when I also had a two-year-old and a four-year-old. When anyone asks me how I do the difficult job of Member of Parliament, I assure them that it is a piece of cake compared with being a mother of four children under four. My first-born—my daughter—has cerebral palsy, and when my twins were born I was living in rural Oxfordshire and not driving, so I faced multiple barriers to making that important bond with my premature babies. It is an awful experience for a mother to arrive home when it is more or less obvious that she has given birth—it is especially evident when twins have left the uterus—but because the babies are not with her, no one comes up to ask what happened. The mother is deprived of the opportunity to celebrate the birth of her children.
There is constant worry and strain over whether those children will grow up healthy and well, or even make it through that dangerous period in their lives, and parents have to take each day at a time. I pay tribute to the staff in the special care baby unit in Banbury who brought my babies—who are now 6 feet 2 inches and feet 3 inches and making a useful contribution to society—through that time. The right hon. Member for Banbury (Sir Tony Baldry) had newly been elected, and while my twins were still in the womb, I marched in protest to keep the special care baby unit open, not realising that they would soon be using the unit’s services.
There are particular strains for working parents. I was not a working parent at the time, so I did not have to make choices about maternity pay. People frequently do not understand that a baby who is born significantly prematurely often does not catch up, in terms of age and stage development, until they are at least two years old—I believe that it can take longer than that, and it certainly did in the case of my boys—and maternity pay does not allow for that. A mother is faced with the difficult choice of whether to take paid maternity leave while her baby is in hospital and possibly critically ill, or wait until the baby returns home. I would like the Government to look at that, because it puts such a strain on parents.
The hon. Member for Congleton (Fiona Bruce) spoke about the need for other Departments to be involved. Given its responsibility for maternity and paternity leave, the Department for Business, Innovation and Skills should be part of a joined-up approach. The Department for Work and Pensions must also be part of that, because although poverty and deprivation are certainly not the only factors that contribute to a lack of secure attachment or the health and well-being of parents and children, they can make a huge difference. In my case, we suffered from the combination of four children under five and huge financial pressure on our family, and we were at risk of losing our home. I started childminding the children of wealthy parents, so that they could have piano lessons and beauty spa treatments, to try to make ends meet. That puts a huge strain on a family, and for a mother or father at home, the child is often the only outlet for that frustration.
My hon. Friend the Member for Rotherham (Sarah Champion) rightly raised the issue of Sure Start centres. We do not have them in Scotland, but like many Members, I have watched at least two episodes of “Benefits Street.” When a Sure Start worker worked alongside some parents, it was incredibly inspiring to see how empowered the mother was. She was talking about the need to create a calm atmosphere and be consistent. It was the most inspiring and optimistic thing to see a parent given such skills. The way to do that is not by punishing them or withdrawing benefits, but by getting alongside people, showing them that we are on their side and understand, and giving them the necessary skills. I very much hope that the children from that family will grow up happier, healthier and able to contribute to society, and that they will not need that kind of support when they are parents. Investment in the early days is so important and can make such a difference to children’s outcomes.
Sarah Champion
I was surprised, and quite shocked, that 26% of babies in the UK—that is 198,000—are estimated to live in a traumatic family environment, and the effect on their well-being is considerable.
Fiona O'Donnell
I thank my hon. Friend for her intervention. It is so distressing—no child chooses where it is born. No child is born bad; bad things happen to children. It is really depressing to face the idea that a child’s outcomes should be determined by the streets they were born between. At NCH, which is now called Action for Children, I worked with children who were at risk of being removed from their family. I always felt that that was an ironic term, because the best thing for some children was to be removed from their family, as it was for the parents, too. For those children, there was really no opportunity. Many had suffered emotional and, at times, physical and sexual abuse.
I urge the Minister to look at the excellent children’s panel hearing system that we have in Scotland, because it works well. It is great, because the child is absolutely at the centre of the process. This is not about what happens in the first 1,001 days, but seeing a child finally disclosing the abuse they have suffered, with us all having to leave the room until they felt able to tell their story, was the most remarkable thing, as was knowing that, hopefully, it was the beginning of a process of survival and recovery from that abuse. It was desperately sad to hear a 10-year-old boy say to me, “I know I can never be a parent, Fiona, because I couldn’t be trusted.” It is unthinkable that children should have to face such choices. As the hon. Member for South Northamptonshire said, we must educate health workers, teachers, nursery workers—everyone involved in a child’s care—to spot the early signs of abuse and not be frightened to raise concerns.
I look forward to hearing the Minister’s response, as well as that of my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger), particularly on the issue of parents of premature babies. We know that breastfeeding brings huge benefits to babies. I am a mother of premature twins.
Andrea Leadsom
I am grateful to the hon. Lady for giving way, because I wanted to make one little point that I did not cover in my speech. I am so glad that she received such excellent care for her pre-term babies. However, does she agree that it is rather shocking that if someone has a baby pre-term, we move heaven and earth—we helicopter babies all over the place—to find a neonatal intensive care unit, whereas if a child is born full-term and the mother has a psychotic incident, which happens in up to 1% of births every year, affecting up to 7,000 families in the UK, it is a postcode lottery as to whether an in-patient unit can be found? That could be a death sentence for the baby. It is completely unfair.
Fiona O'Donnell
I absolutely agree, and I am grateful to the hon. Lady for making that point. It is unacceptable that there should be a postcode lottery when there could not be a more vital time to intervene.
I return to my point about the importance of breastfeeding and supporting mothers in providing nourishment for their child. That is especially true in the case of premature babies, because the recommended start date for a mother to breastfeed is three weeks post-term. Maternity leave rights and—particularly when parents cannot afford to take unpaid leave—maternity pay are therefore vital. This was 27 years ago, so some time ago, but when I had premature twins, the support and encouragement for mothers of premature babies to breastfeed was not what it should have been. I hope that that has improved, because it is a vital part of the bonding process. Although the mother cannot put the baby to her breast, at least being involved in putting the milk into the baby’s gut—knowing that they are giving that nutrition—is a vital part of feeling a success as a mother.
I congratulate the hon. Member for South Northamptonshire again on securing this debate. I hope that the Minister will look at the recommendations in the manifesto and work with organisations such as the NCT and Bliss, so that across the UK, we are all working to give all our children the best possible start and opportunity in life.
Damian Hinds (East Hampshire) (Con)
I rise to support my hon. Friend the Member for South Northamptonshire (Andrea Leadsom) and her cross-party colleagues in the important work that they are doing in highlighting the issues we are discussing. The manifesto is accessible, understandable and persuasive. Speaking as a relatively new dad, so much of it is also very intuitive. It makes one think, “Yeah, of course; that is pretty straightforward and obvious,” although we need to see a lot more of it happening.
I want to take a slightly different angle and talk a little about social mobility and the effect of the first days and years of life on children’s eventual chances. When considering child development, it is always helpful to have in mind a sort of pyramid—in fact, there is such a pyramid in the manifesto. It creates a hierarchy of need. The sharp end of the pyramid is the very sharp end of the scale—the acute cases where, frankly, social mobility is not the top priority. The top priority is child protection, basic safety and health; social mobility is a worry for another day. At the base of the pyramid is the massive part—the world at large; most people. In the middle is the section of children I want to talk about today: those born into poverty and disadvantage who are not quite in the acute bracket.
We know that social mobility in this country is low by international standards—we are usually bracketed with Italy and the United States—and it has not been improving. On average, those of us here in our forties—including, as of a couple of days ago, my hon. Friend the Member for Winchester (Steve Brine)—have been less mobile in our lives than those of us here in their fifties. That is a poor state for any advanced democracy to find itself in. Why is that the case? When I was on the Education Committee, we used to find that everyone blamed the stage before. If we spoke to universities, they said that they were not getting the kids coming through from sixth forms; the sixth forms blamed the teachers doing the GCSEs; the secondary schools blamed the primary schools; the primary schools blamed the nurseries; and the nurseries said, “We are just not getting the kids through the door anymore.”
There is an element of truth in what they all said. The more one studies social mobility and children’s life chances, the more one realises that it increasingly does come down to the very earliest age. The all-party group on social mobility published a report called “Seven key truths about social mobility”. Truth No. 1 was that the point of greatest leverage for children’s life chances is what happens between the ages of zero and three—that is what we said, although it could equally be what happens between the ages of zero and two. The problem is that, of course, this is the public sector—we are trying to influence the Government and so on—and most of what happens between the ages of zero and two or three does not happen in a state-controlled or influenced setting; it happens at home. That makes things much more difficult.
Why is this a social mobility issue? How children are brought up is not particularly, or does not have to be, dependent on parents’ income, but there is quite a strong correlation. Figures from “An Anatomy of Economic Inequality in the UK”, a report made by the previous Government at the end of their term, show that on school readiness, for example, children from the poorest fifth of households reach about a third of the way up the percentile scale at age 3, versus more than 60% of children born into the wealthiest third. There is a bunch of statistics like that.
It is frightening that even toddlers’ cognitive ability test scores vary more dramatically according to their parents’ income than according to innate differences in ability. In the millennium cohort study, which tracks children through time, that gap does not narrow between the ages of three and five; in fact, it seems to widen as children go through school. Why? I am careful not to infer any direct causality. All sorts of factors may be involved, but there are significant differences in some things that people associate with home learning environments, and so on, according to socio-economic groups. In the lowest socio-economic group—the poorest fifth of households—only about 40% of children are read to every day at age 3, as opposed to more than 80% in the top 20%. Again, those figures are from “An Anatomy of Economic Inequality in the UK”. Those things can be tracked with a series of measures, including bed time, and so on.
Fiona O'Donnell
The hon. Gentleman may not be aware of work undertaken by the chief medical officer of Scotland, Harry Burns, on brain development in children from families with generations of economic deprivation. It showed that their brains were developing differently: the fight-or-flight part of the brain was overdeveloped. That shows that there is a real link between children’s life opportunities and deprivation.
Damian Hinds
Clearly, there is a link—a range of studies suggest different ways in which that link manifests itself—and I do not think that any commentator argues about its existence, but there is nothing inevitable about that; it ought to be possible to equalise children’s life chances. Of course, there are examples of both brilliant and awful parenting in every income bracket. Children’s development is no respecter of the home they happen to have been born into. As the right hon. Member for Birkenhead (Mr Field) says,
“it is primarily parents who shape their children’s outcomes—a healthy pregnancy, good mental health, the way that they parent and whether the home environment is educational”.
As he and many others say, what parents do is much more important than who they are.
Home life is difficult territory for the state. I suggest that we need to think harder about how to communicate what is known about successful, positive ways to parent—a quite substantial body of evidence—in a way that does not come across as, and in fact is not, telling people how to bring up their children.
Geography, as well as income group, reveals other interesting differences in early child development. There is a particular difference in London. When people are told this, they assume that child development is worse in London than elsewhere, because of all the issues in a big city like this. However, that is not so. There was another report last week about the different school results of children growing up in London, versus those growing up elsewhere. That is often attributed to the London Challenge, which started in 2003. There are a number of reasons to believe that the London Challenge was not the sole or primary cause of those improvements. One reason to disbelieve that is that the difference in attainment scores for disadvantaged children is apparent way before they get to secondary school; in fact, it is apparent even in pre-school assessments: on average, disadvantaged children in London seem to do about 20% better on the “good level of development” scale than disadvantaged children in the rest of the country. A bunch of things are different about London children and families.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
Excuse my missing the beginning of the hon. Gentleman’s speech, Mr Weir. As someone who was involved in the London Challenge, I should like to know what the relationship is. I am not clear about that. If it was not the London Challenge, what made the difference?
Damian Hinds
The hon. Gentleman asks a big question. I do not want to test your patience, Mr Weir, by debating the London Challenge, rather than early child development. I will talk in a minute about societal differences that may or may not be driving factors. The honest answer is that we do not know, but there are reasons to disbelieve that the simple explanation for London’s improvement is the London Challenge. First, the differences are apparent long before children reach secondary school, and the hon. Gentleman will recall that it only started in 2003. Secondly, when translated from London to the black country and Manchester, there were not the same results. Thirdly, so many other things that are different about London are worth looking into.
Andrea Leadsom
My hon. Friend speaks so authoritatively on social mobility. It is always interesting to listen to him. However, I put it to him that one reason for London’s exceptionalism could, of course, be that its large immigrant population comes from a different cultural place. My opinion, as opposed to a research view, is that immigrant populations have not suffered the same degree of family breakdown. We found, through my work with the parent-infant projects, that often in immigrant populations there is much more of a family network. Therefore, the bond is often quite secure, even in areas of great deprivation, because of the support for the earliest period of the baby’s life.
Damian Hinds
My hon. Friend anticipates where I am going. We are into the realm of speculation. We do not know. It is true that many things are different about family structure, and so on, in London, compared with the rest of the country. We do not know what is the causality, if any, of any of those things or of the outcomes.
Let me start by mentioning some of the things that are the same. There is no significant difference in gender mix, age and birth weight of babies born in London; mothers tend to be older—we know that that is a factor in child development—and better educated; families are bigger in London, and children are more likely to have brothers and sisters; and the mix is massively more diverse than in the rest of the country, both in terms of ethnic diversity, recent immigrants and families with English as an additional language.
In London, there is a slightly lower percentage of children with either a single mother or both parents working; in other words, there are more families where at least one parent is at home. This surprises people. There is also lower participation in pre-school provision and use of formal child care, which, again, surprises people, because ordinarily we expect that participation in early years settings and use of formal child care is associated with positive improvements in child development.
Finally, as my hon. Friend the Member for South Northamptonshire mentioned, although it is, bizarrely, difficult to get reliable statistics, it appears that London is above the national average for the proportion of families with children in which parents are married. That flies in the face of what most people would assume about this city. However, that raises an important question. A massive debate has been going on in America in the past couple of weeks about a Harvard report by Chetty et al. called “Where is the Land of Opportunity?” which presented a number of challenging results in the US context, in terms of social mobility. Its No. 1 conclusion is that family structure is the single most important determinant of social mobility in America and that, interestingly, it affects not only the immediate family, but has a broader effect. In other words, in a neighbourhood where most children are born to two-parent families—specifically, families where the two parents are married—even if people are not in one of those families, by being in such a neighbourhood, they have more chance of getting on.
Tim Loughton
My hon. Friend is making a fascinating point. I entirely agree with the personal views of my hon. Friend the Member for South Northamptonshire (Andrea Leadsom) on the different complexion of London, but one only has to look at Mediterranean countries to see the far lesser influence of family breakdown, which is related to inter-generational support. We have spoken about support for parents, the preference for having two parents and how marriage makes for greater stability. Places such as Barcelona have been rebuilt with a view to having different generations living on top of each other, whereas in this country, grandfather and grandma increasingly do not live round the corner, or within easy distance, to help look after the children, which adds extra pressure on the family. There is a bit of a clue, if we look further south, about the influences that may result in different outcomes in London.
Damian Hinds
I have a similar instinct. I want to be careful not to imply a causality that we do not know to exist, but one factor in some ethnic communities is that there is greater multi-generational support and more extended families. Intuitively, it makes sense that such support can be an advantage.
Where does all that leave early child development from the perspective of social mobility? First, the Government have to address, head-on, the thorny question of how to help parents to parent, while keeping in mind the pyramid of need, with acute cases at the top, children born into poverty and disadvantage in the next layer down and everyone else below that. I suggest that that should start pre-natally, which is a big part of the manifesto “The 1,001 Critical Days”. Speaking as a recent dad, it is amazing how little we were told or read about what was going to happen after birth, because we were so fixated on pain and the other things that people worry about at the moment of maternity. Sure Start and Sure Start outreach can play an important part in that. I echo what my hon. Friend the Member for Winchester said on the variety of views on what Sure Start is. On the Select Committee, I always used to ask people to define Sure Start, and even when talking to professionals in the field, I would get different responses.
There is also a question about the role of television and new media in supporting mums and families to bring up children. Bookstart is fantastic, but it could be more targeted. I was surprised when we received free books through our door. If people in the income bracket of all of us in this Chamber are failing to buy books, or to get them out of the library, to read to our children, it is not a problem that will be solved by being given two or three books when the child is born. Like my hon. Friend, I pay massive tribute to the work done by Home-Start UK and others on direct one-to-one support.
Fiona O'Donnell
Will the hon. Gentleman also pay tribute to Mumsnet? Mumsnet is a safe, non-judgmental and anonymous place where mothers can chat and seek advice and information.
Damian Hinds
The hon. Lady makes a good point. Mumsnet is the sort of thing to which I was alluding when I talked about new media. When we talk about Mumsnet, we are obliged to say that Netmums is also available. There is a range of sources of non-judgmental peer-to-peer support, which is vital.
Secondly, the importance of evaluation also comes out of the manifesto “The 1,001 Critical Days”. Intuitively, we all know that there are lots of things that we can do in the earliest years of life that will make a massive difference to a child’s development and later opportunities, but it is difficult to persuade other people of what those things are. Evaluation therefore trades at a huge premium. I pay tribute to the work of the hon. Member for Nottingham North (Mr Allen) on early intervention, which I hope will change our mindset as a polity on how we intervene.
Thirdly, I am not suggesting for a moment that I think I have the answers, but we should not be afraid of talking more about the wider social context and what some of the impacts might be. While respecting people’s life choices and celebrating the diversity of society—families now come in all shapes and sizes—we should not, for the sake of children, be agnostic about what those choices are. We should also see what we can learn from the differences between communities in different parts of the country.
Steve Brine (Winchester) (Con)
It is a pleasure to follow my neighbour, my hon. Friend the Member for East Hampshire (Damian Hinds), whom I thank for the age check. I congratulate my hon. Friend the Member for South Northamptonshire (Andrea Leadsom) on securing this debate and on the manifesto. She knows of my interest in this area, and she sent me a copy hot off the press. I read the manifesto avidly, and I am totally impressed with her work. She spoke eloquently about the cycle of deprivation, and she set out the case as to why, in many ways, society is broken. I will not go on about that, but I think the family unit is the answer that holds so much of this together. Some of my comments will probably tie together the interventions that we have had over the past 15 minutes.
Many Members will be familiar with the work of the Centre for Social Justice, which was set up by the Secretary of State for Work and Pensions when we were in opposition. The CSJ produced a report last year called “Fractured Families: Why stability matters,” which built on the seminal 2006 work “Breakdown Britain” and the 2007 work “Breakthrough Britain.” Basically, “Fractured Families” re-examines how family breakdown continues to plague our society, and it is blunt in saying that, despite the scale of the problem continuing to increase, Government action has been extremely weak. The report shows that the outcomes for children and adults who suffer from family breakdown are often terrible, and that there are huge costs to society. Someone mentioned a huge figure earlier, which I will repeat because it is so staggering. Family breakdown is currently estimated to cost the country some £46 billion a year, which is set to rise to just under £50 billion a year by the end of this Parliament. That is more than the Government spend on the defence budget—talk about ideas for deficit reduction.
The report also says that
“governments have chosen to ignore this problem, they have done so despite the public’s views.”
Those views are striking:
“89 per cent of people agree (52 per cent strongly agree) that ‘If we want to have any hope of mending our broken society, family and parenting is where we’ve got to start’…81 per cent of people think that it is important for children to grow up living with both parents.”
I think that it is time, and the report clearly agrees, that politicians on both sides of the House acknowledge that family breakdown is an issue that matters to the vast majority of people in this country and take whatever action they can to reverse it. The report makes a series of recommendations to all political parties in advance of the next general election, which people can read in their own time.
I want to restate something that my hon. Friend the Member for South Northamptonshire said. Earlier, I mentioned the statistics on speech and language difficulties among inmates. Some 80% of long-term prison inmates have attachment problems that stem from babyhood, which is staggering evidence. The good thing that must come out of that is to find a way to help families form the loving and secure bond that she talked so much about. That bond should come naturally when there is a new baby in the house but, as we know, post-natal depression, problems with conception or birth experience, domestic violence and the issues of poverty and deprivation set out by my hon. Friend the Member for East Hampshire can, and so often do, get in the way.
That is where Home-Start UK, which I mentioned earlier, has to be part of the toolbox. Its formula of parents helping parents has been incredibly successful over the course of my lifetime—40 years, as we have been reminded. In August 2013 I spoke at the annual general meeting of Home-Start Winchester and Districts, which has been going for a long time and does so much to help families through the really tough times.
When my wife and I had children, people said that children throw a hand grenade into marriages. I think that is nonsense; it is more like an atomic weapon. We had marriage preparation classes before we got married. The vicar who married us said that his one piece of advice was to share the teaspoon moments—the things that get on each other’s nerves. Ten years on—we celebrated 10 years last year—we still regularly share the teaspoon moments, more of them coming my way than going out. There is nothing like children, supercharged after a night of poor sleep or on a whiney day, to create teaspoon moments and to exaggerate them into whopping great soup ladles.
Fiona O'Donnell
I join the hon. Gentleman in praising Home-Start. I have experience of using its services in Banbury and it was the only group that came and said to me, “What do you need? What can we do for you?” Every other service said, “This is what we do. Is it of any use?”
Steve Brine
Absolutely. There are so many similar examples throughout the country. I urge all hon. Members who do not know their Home-Start people to get to know them. They work with families, and can share the teaspoon moments when they are there, or sometimes just shine a light of perspective. When new parents are exhausted, perspective is hard to come by. My experience of seeing Home-Start at work is that it helps parents to learn to live together after children. Learning to live together is hard enough, but doing so after children is a whole new skill.
Home-Start has been demonstrated to work. Its volunteer support and positive impact on parents and families have been shown to work. A three-year research project by a team at the universities of Amsterdam and Utrecht a couple of years ago revealed that children are still benefiting up to three years after their Home-Start volunteer stopped visiting. The good thing about what Home-Start is able to do here is that it is being copied: the Incredible Years programme and the family nurse partnership are both maternal and early-years public health programmes providing ongoing, intensive support to mums and dads and their babies.
The family nurse partnership is of particular interest to me. It is welcome that the Government have recently agreed to increase the number of family nurse partnership places to 16,000 at any one time by the end of this Parliament. I saw its inspiration at work last summer in Houston, Texas, where it is called the nurse family partnership. I was there with the Justice Committee and saw the partnership at work in Harris county. We were there as part of our major inquiry into crime reduction policies and the data we were shown were very impressive. The programme is expensive but the outcomes are good, with 60% fewer arrests and 72% fewer convictions among children of mothers participating in the programme than among those of mothers in a similar demographic and income bracket who did not. The number of days babies were hospitalised was reduced by around one third among programme participants. The figures are impressive.
It goes without saying that any remarks about early intervention in the first 1,000 days would not be complete without mentioning the troubled families programme. I am a big fan, and despite some mixed messages in the June 2013 spending review, the Government gave a commitment to extend the programme through the next five-year parliamentary period and confirmed £200 million from several Departments for a wider focus in 2015-16. That is sensible. I am regularly updated by Hampshire county council and Hampshire troubled families mapping, which have confirmed that 70% of client families are located in the top 30% of wards for health deprivation in the county. That laser-like focusing at a time of shrinking resources must be right. I know that it is bearing a dividend in Hampshire, as it is throughout the country.
The early years are about the state, but they are also about the big society, the third sector—the voluntary sector—and, ultimately, about creating more stable learned environments where those early years count, so that babies have a chance of normal development. The prize for us is absolutely huge, as all hon. Members who have spoken today have said, not just in money value, but in the value of human life. Ultimately, that is what we, as Members of Parliament, are about.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
I commend and congratulate the hon. Member for South Northamptonshire (Andrea Leadsom) on securing this debate. I also congratulate the hon. Member for Brighton, Pavilion (Caroline Lucas), my right hon. Friend the Member for Birkenhead (Mr Field) and the right hon. Member for Sutton and Cheam (Paul Burstow) on their work in developing this manifesto and promoting the ideas within it. This debate has been constructive and well-informed. Many excellent points have been made that will resonate strongly with those on both sides of this Chamber.
When the first national health service hospital opened its doors in 1948, it was conceived as part of an all-encompassing system of social security, supporting everyone in our society from cradle to grave. Only in recent years, more than 60 years on, have we have come to understand just how much that short time in the cradle—those very first few months—can ultimately decide how long, healthy and happy a life a newborn baby will enjoy.
We must do everything we can to give all babies born in Britain today the best possible start in life. That was underlined earlier this week in an open letter to The Times from 23 of the UK’s leading child health experts. They warned that, for the first time since the Victorian age, it is predicted that living standards for children will be lower than for their parents and that child mortality is still stubbornly higher in Britain than in other western European countries. They called for a greater focus on younger generations. We have heard some powerful and encouraging contributions to that debate today; I want to build on what other hon. Members have said and focus on some of the challenges that we must address. I want to focus on early intervention, maternal support and care, and general help for all mums and dads. That is by no means a comprehensive list of what I would like to cover, but it is most fitting for the debate.
All hon. Members who spoke referred to the importance of early intervention. The maxim that prevention is better than cure is one of the most enduring in public health. As the “The 1001 Critical Days” manifesto details, more than a quarter of all babies in the UK are estimated to be living in complex family situations that present heightened risks to their well-being. The sad reality is that babies are far more likely to suffer from abuse and neglect, and up to seven times more likely to die in distressing circumstances, than older children.
We have a duty to reach out to families in difficult circumstances and to maximise opportunities for them to access support. Not only is it the right thing to do, but it is the best thing for the public purse. According to the Royal College of Paediatrics and Child Health, there is increasing evidence to show that spending on early-years intervention can yield a return on investment as high as 6% to 10%. If it is done in the right way, early intervention can save money, save lives and improve the well-being of parents and children.
An example is the pioneering work by Manchester city council and its partners. They have created a scheme in which midwives, outreach workers and health visitors work together to identify at the earliest opportunity the families most in need. It is an inspiring project, with which my hon. Friend the Member for Manchester Central (Lucy Powell), the shadow Minister with responsibility for children and child care, has been closely associated. We heard from the hon. Member for South Northamptonshire about how the programme is making a difference when it comes to registering a child’s birth.
Under the scheme, every new mother is visited eight times from about 12 weeks before the birth of their child until just before the child’s fifth birthday. Crucially, all the professionals who are supporting those mothers hold joint fortnightly meetings and can let each other know if a parent needs additional help. Their work is integrated and intelligence is shared between organisations —a very strong theme in the “The 1001 Critical Days” manifesto. It is a world away from some of the haphazard experiences of the past. Hon. Members may have heard the anecdote about how health visitors in the past would wait by the nappy aisle in supermarkets to identify expectant mothers; we must do more to encourage close working and data-sharing, so that that is no longer necessary.
Mr Sheerman
I totally support the work of the 1,001 group. All the work done—certainly during my chairmanship of the Select Committee on Children, Schools and Families—indicates that early intervention is vital. It is also vital that such intervention is regular, persistent and delivered by highly skilled, well-trained people. The problem is that that is expensive.
Luciana Berger
My hon. Friend makes knowledgeable points that, given his experience on the Children, Schools and Families Committee, he is well placed to make. The example that I shared with the House—this is separate from the 1,001 days manifesto—shows that there are many activities going on around the country to address some of the issues, but the challenge is that the activity is not happening everywhere. We need to lead from best-case examples, which is why data sharing is so vital to make a difference. Will the Minister comment on what steps the Government are taking to encourage these activities to happen throughout the country?
I am also keen for the Minister to address the point made by my hon. Friend the Member for Rotherham (Sarah Champion), who is no longer in her place. She mentioned the early intervention grant, which has funded many of the programmes that we are discussing. When the fund was first introduced, it totalled nearly £3 billion, but by 2015 it will have almost halved to around £1.5 billion. We have had contributions this afternoon about Sure Start centres, many of which have relied on the funding of the early intervention grant, and it is a blow that 576 such centres have had to close their doors since the last election. The hon. Member for East Hampshire (Damian Hinds) commented that he did not know what Sure Start was for—
Damian Hinds
To be clear, I was talking about what happened when I was on the Education Committee, the successor Committee to the one chaired by the hon. Member for Huddersfield (Mr Sheerman). When we asked people what the purpose of Sure Start was, we got different answers, even from practitioners in the field.
Luciana Berger
I thank the hon. Gentleman for his clarification. I apologise if I misrepresented his words.
Mr Sheerman
I, too, found that fascinating. When we first started looking at Sure Start children’s centres, they were concentrated in the 500 wards with the greatest poverty. We soon realised that more families in poverty were outside those 500, so we had to change the policy totally.
Luciana Berger
The point that I wanted to make about Sure Start, as a result of what has been said by both Government and Opposition Members, is that it is widely acknowledged that the centres have made a real difference to families. I have Sure Start centres in my constituency; Liverpool city council has gone out of its way to do everything possible to keep all centres throughout the city open—it has had to remodel and look at a hub-and-spokes model, given that we will have experienced cuts of 54% by 2016-17—all because of the centres’ importance to communities.
In one of the most deprived wards in my constituency, the Sure Start centre is giving vital support to parents in the most deprived households. It is providing meal packets for £1—fresh food with recipes—to encourage parents to cook for their children. That is making a real difference to those children’s nutrition, in particular in their early years. In another, more affluent, part of my constituency, the children’s centre is tailoring its services to the need in that area, because this ward has a high incidence of multiple births. That Sure Start centre is providing a vital support service for mothers who have twins and triplets—for parents contending with the challenges presented by a multiple birth.
Those centres are making a real difference in my constituency. Their staff—including Liz Parsons, a manager in the Picton Sure Start centre, to name just one person—provide vital hands-on support to parents, often first-time parents or parents with lots of children. The centres provide support, including parenting support, to many families in my constituency.
Damian Hinds
Like the hon. Lady, I pay tribute to the staff in the Sure Start centres in my constituency; they do a fantastic job. We all know that there are fantastic Sure Start children’s centres out there, but it is also worth dwelling on the fact that at the macro level we may not quite have cracked the formula. If we compare the millennium cohort study with the previous one, for the children who have been alive throughout the Sure Start period, the gap between the rich and the poor has not been narrowed at age five.
Luciana Berger
Towards the end of my contribution, I shall reflect on the hon. Gentleman’s points about social mobility. He commented that the gap between rich and poor might not have changed. Nevertheless, Sure Start centres have provided vital services to parents and families who might not have contended with that specific issue, but have dealt with a lot of other ones that we have discussed.
In the debate, we have not touched on health visitors, who are integral to this issue. It is welcome that the Government are committed to increasing the number of health visitors. The latest figures from the Health and Social Care Information Centre, however, show that there are 1,234 more health visitors than in April 2010, but that is less than a third of the way towards the Prime Minister’s target of 4,200 new health visitors by April 2015. With the deadline looming, will the Minister please offer some words of assurance about meeting the target?
Andrea Leadsom
I have talked to a lot of health visitors, and there is a concern that by letting speed be the only target, we might pile a lot of new health visitors into the system but diminish our ratio of experienced health visitors to inexperienced ones, and those trying to support new health visitors will struggle. Generally speaking, my feedback from health visitors is that they are happy that the rate of new arrivals is not as rapid as the hon. Lady might like.
Luciana Berger
I listened to the hon. Lady’s point about the speed of introduction, but reflecting on the experience in my area of Liverpool, the work load on our health visitors is such that they cannot provide the best service possible, because they are so swamped by the amount of visits that they have to do. I contend that there is a challenge in the work load on health visitors. Will the Minister share with us what steps her Department is taking to meet the target?
On maternal support, in particular during the months of pregnancy, with births in the UK at a 40-year high, prioritising maternity services has never been more urgent. Around 10 stillbirths happen in Britain every day, and we have one of the highest stillbirth rates: according to The Lancet, Britain is ranked 33rd out of 35 countries with similar income levels. The charity Sands has linked that to maternity care, issues to do with inappropriate risk assessments for potential mothers and low uptake of perinatal services. Given that neonatal mortality and stillbirth have been indicated as areas for improvement in the NHS mandate to 2015, will the Minister please share with us what activities her Department will undertake to lower the stillbirth rate in England?
The findings of a National Audit Office review late last year are also of concern. It found that more than half of birthing units are not meeting staffing guidelines; that more than one in 10 had to close for a fortnight or more last year; and that 28%, or nearly a third, were forced to turn away mums-to-be at the door between last April and September because of a lack of space or a shortage of midwives. We can all understand how stressful that must be for women towards the end of their pregnancy.
[Mr David Amess in the Chair]
I thank my hon. Friend the Member for East Lothian (Fiona O'Donnell) for raising the important issue of premature babies and for sharing her personal experience of having premature twins and of the importance of the neonatal care received by her sons. A parent in a similar position who had to work might struggle to balance that with visiting the hospital and developing a bond with the babies.
We all have friends or family, or know people who have been expectant mums—some people in the room have been expectant mums—so we know that a skilled midwife can make all the difference between a smooth pregnancy and a stressful one. It is deeply concerning, therefore, that the NAO has highlighted that there is a shortfall of 2,300 midwives. The hon. Member for South Northamptonshire highlighted the increase in midwives’ work loads. The Royal College of Midwives has also calculated that the gap between the number of midwives we have and the number that the NHS in England needs will not be closed until 2026.
Before the previous election, the Prime Minister promised that there would be 3,000 new midwives during this Parliament. Again, regretfully, that target is some way short of being delivered. I am aware that there are many midwives in training, but the high drop-out rate and impending retirements could mean that we face significant shortages for some time to come. We would appreciate any reassurance that the Minister can provide on that matter.
Will the Minister also comment on the training that midwives receive? We have heard from a number of Members about the importance of maternal mental health. Mental ill health is one the biggest risks to a pregnancy, with one in 10 mothers suffering a mental illness before or after birth. Last November, I asked the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), what proportion of midwives were trained to provide expectant mothers with mental health support. Unfortunately, he was not able to provide a figure, but I am sure that both he and the Minister agree that we need more midwives who are confident in providing that kind of support.
We also need more specialist mother and baby mental health units. It has been estimated that as much as 50% of the UK lacks any kind of specialist perinatal mental health service. There are only 17 mother and baby mental health units across England, and they are geographically disparate. There are just two in Scotland and one in Wales, and none in Northern Ireland. As both the hon. Member for South Northamptonshire and my hon. Friend the Member for East Lothian said, it is a postcode lottery.
The hon. Member for South Northamptonshire talked about the 1% of mothers who might experience a psychotic episode. That could lead to mothers being hospitalised two or three hours’ drive away from their loved ones. It could also mean that they are separated from their babies. That is good for neither the mother’s well-being nor her newborn child’s development.
I thank all those Members who have raised the importance of support for parenting. A number of Members thanked Home-Start for the work that it has done and the way in which it so helpfully supports parents. We have also heard about specific challenges on early intervention, maternal support and maternity care. However, we know that the challenge of improving early years development reaches far beyond those specific issues. The hon. Member for East Hampshire raised the issue of social mobility, for example; many social determinants extend well beyond the reach of the Department of Health. The hon. Member for South Northamptonshire suggested that the issue could be looked into more widely, perhaps at Cabinet level, and I take that point on board.
Both my hon. Friend the Member for East Lothian and the hon. Member for East Hampshire raised the issue of the importance of digital networks and social networks. They are indeed important, and I welcome the work done by Mumsnet and Netmums, but I would like to put on record the challenges there are for many mums who do not have access to the internet, or perhaps do not know how to use computers. Although digital networks are important and can help to support parents—both mums and dads—one issue that we need to look at further, which is far beyond the reach of the Department of Health, is access to the internet and to broadband, particularly for people living in rural areas. There is also the issue of being able to afford that internet access: people might not want to have to go to a public library to connect and reach out about specific personal issues. We should be thinking about those matters.
There are other issues that we should address, which again reach far wider than the remit of the Department of Health. For example, there is the problem of parents who are struggling with the cost of living, and those who are working all hours and do not have the time to be with their children because they are working all day. We must establish genuine parity of esteem between mental and physical health, across the board. We have to protect babies and children from specific dangers—just yesterday in the House of Lords, for example, there was a debate about protecting children and babies from smoke in cars. There is no better investment that we can make as a society than in our children.
Dame Tessa Jowell (Dulwich and West Norwood) (Lab)
I pay tribute to the hon. Member for South Northamptonshire (Andrea Leadsom), with whom I have had the pleasure of collaborating on the all-party group on conception to age two—the first 1,001 days. Does my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) agree that there is an increasing amount of scientific evidence on early childhood that shows the value of intervention in the first 1,000 days? Will she join me in commending the campaign to see early childhood represented in the new millennium development goals in 2015, which will benefit tiny children and their mothers, not only in this country but around the world?
Luciana Berger
I thank my right hon. Friend for her important contribution to this debate. She has summed up many of the earlier speeches on the importance of this issue and how vital early intervention is. Right at the start of the debate, we heard about the science relating to the difference in brain development of children who get that care, love and affection in early life, and those who do not. As we heard, that care is vital to the development of a child over their entire lifetime. I echo her remarks on the millennium development goals. This issue is important not only for us in the UK but further afield, right across the world. I support her call for early intervention to be included in the 2015 goals.
Andrea Leadsom
I pay tribute to the right hon. Member for Dulwich and West Norwood (Dame Tessa Jowell) for all her work on promoting early years development in the post-millennium development goals. I did not touch on that today, but she has played an enormous role. I can report that UNICEF has asked us to speak at the UN on the importance of the earliest years and how early intervention can support children, not just in this country but around the world. It is fantastic that she has been able to pop into the debate, and I commend her for all that she is doing.
Luciana Berger
I thank the hon. Lady for her intervention. I will now seek to conclude.
Mr Sheerman
My hon. Friend briefly alluded to smoking and children’s exposure to smoking in cars. There was good news this morning from the Government: there will be a free vote on the issue. Back in the mists of time, my very first private Member’s Bill was on banning children from being carried unrestrained in cars. There was a tremendous backlash against that Bill in certain parts of the House; people said that it breached human and individual rights. We won that battle, and I hope that we can win the next one. It is wrong that a child, who has no choice, has to go in a smoky environment and breathe in dreadful fumes that can affect their health for the rest of their life.
Luciana Berger
My hon. Friend’s intervention has given me the opportunity to expand on this serious political issue, with which we are engaging in the House at the moment. He rightly points out the opposition there was to rules on wearing seat belts. The discussions on that issue are relevant to our discussions about banning smoking in cars when children are present. When we had no rules on wearing seat belts, only 25% of the population wore one; since the introduction of the rules, more than 90% of the population wear a seat belt, and that has made a massive contribution to safe car travel.
It is worth noting that there is overwhelming public support for banning smoking in cars when children are present. Around 80% of the public think that we should deal with the issue, and it will be interesting to see what happens in the vote. It is also worth putting on record that when there was a vote on a private Member’s Bill on the issue in 2011, 22 MPs from the coalition supported it, including a current Health Minister. I welcome the free vote, and I hope that we are successful when the proposal comes before the House on, I believe, 10 February.
To conclude, a broad, holistic approach will ultimately make the difference for children, and for future generations.
The Parliamentary Under-Secretary of State for Health (Jane Ellison)
It is good to serve under your chairmanship, Mr Amess, and to respond to such an interesting debate.
I shall focus my remarks fairly narrowly on the subject of the debate, because I have a feeling that I will get the chance to talk about smoking in cars quite a bit in coming weeks. I have had the chance to discuss today’s subject many times with my hon. Friend the Member for South Northamptonshire (Andrea Leadsom), and her passion and knowledge have shifted parliamentary opinion in that important area. I remember sitting through a late-night debate which, unusually, attracted double-figure attendance; she has moved the dial for political discourse about the importance of early years. She has a positive and constructive relationship with several Departments’ officials, who enjoy working with her on that agenda; I think that will continue.
The debate has been fairly consensual. I accept that there is some challenge with respect to numbers to do with Sure Start, and funding issues; but, to be honest, whoever was in power would have faced the same issues over the past few years. I shall therefore focus on what we are doing in response to the manifesto “The 1001 Critical Days”. I shall try to pick up on points that have been made. I am standing in for the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who is the lead Minister and is at present in a Bill Committee. He is sorry not to respond to the debate in person, but my hon. Friend the Member for South Northamptonshire will know that the issue is close to his heart and is the focus of much of his work. However, it is an honour for me to sit in on such an amazing debate, with so many excellent contributions.
Like the shadow spokesman, I pay tribute to the other hon. Members who contributed to the manifesto, and to the hon. Member for Nottingham North (Mr Allen) for his tireless campaigning on early intervention. I have had several stimulating and fulfilling conversations with him on the subject. He is passionate about the issue. What he has done to formalise matters through the Early Intervention Foundation—and the information, knowledge and evidence base that has been established because of that—will be extremely important. Evidence is important in this context because, to pick up the point about pressure on resources, the more evidence that can be presented to show that interventions work, the easier it will be to persuade people that such interventions are a good investment of public money, when that is in relatively short supply.
A clear case has been made, and the manifesto has support from across the political spectrum. The message is clear and simple: prevention and early intervention can improve outcomes and transform the life chances of children. Several hon. Members ably explained where the costs pop up in the system when people suffer damage and how much better, safer and kinder it is to make interventions early in people’s lives, to prevent such problems. That message sits well with the Government’s pledge to improve the health outcomes of children and young people so that they become some of the best in the world. That is a challenging goal, but the Government are determined to rise to it.
I want to touch on the risks associated with pregnancy. A healthy pregnancy provides the best foundations for a healthy life. Poor diet, smoking, using illicit drugs and consuming alcohol at that time can all have an impact on the child’s later cognitive functioning and on their health and well-being. As my hon. Friend the Member for South Northamptonshire said, a fetus exposed to extreme stress in the womb will have higher levels of the stress hormone cortisol, which can create higher levels of stress later in life. There is a highly relevant example of that in another part of my portfolio. Domestic violence can peak during pregnancy and, as a very significant stress factor, it can cause the very conditions in the womb that have long-term consequences for children.
Hon. Members have articulated the early years risks very well during the debate. There is a growing consensus about the agenda and the fact that early years intervention offers the greatest opportunity to create secure, happy and healthy adults. Moving forward in accordance with that shared agenda is the key. I will mention one or two of the risk factors. Smoking in pregnancy is highly relevant to much of my work in public health. It can lead to low birth weight, which is linked with heart disease later in life. The key messages on smoking in pregnancy are getting through to many people, although not to everyone. We still have some way to go, but in 2012-13, 12.7% of mothers were smoking at delivery. That is lower than the 2009-10 figure of 14%. However, the regional variation is extraordinary. Figures that recently came across my desk showed enormous regional variation, and responding to that is a challenge that I have put to public health directors in the regions. It is a good example of the way that a regionalised public health system can focus intensely on problem areas.
Experts are still unsure exactly how much alcohol it is safe to drink during pregnancy, so the safest approach is not to drink any at that time. Drinking heavily in pregnancy can lead to low birth weight and damage brain development in the womb. Fetal alcohol spectrum disorders are a range of cognitive and functional disabilities that can be caused by exposure to alcohol in the womb. In short, smoking and drinking alcohol while pregnant can cause irreparable damage to a child and make them more susceptible to illness throughout life. The manifesto highlights the numbers of babies affected by those issues, and I reassure the House that those are on our radar.
Perhaps less obvious is the impact of events in early childhood on later health and well-being. A drive towards wider understanding of that, among parliamentarians and in local government and the voluntary sector, is very important. I think that initially it is difficult to take on board the detail of the issue, and that is why it is so important that my hon. Friend the Member for South Northamptonshire has persisted in making the case to colleagues, and explaining it in detail, with the evidence to back it up. Many of us now have a wider understanding of what may not be as intuitively grasped as messages about not smoking or drinking during pregnancy. Traumatic emotional experience in childhood can translate into a greater risk of disease and mental health problems. Many hon. Members focused on that during the debate. We have, I think, learned that the old adage that time heals all wounds is not true. Adverse events in early childhood can resonate down the years.
According to the emerging research, growing up with exposure to multiple adverse childhood events can have a lasting impact. For instance, growing up in a household where the mother is treated violently, where a parent is chronically depressed, mentally ill or suicidal, or where someone uses drugs can increase a child’s risk of a range of conditions. Those who experience multiple adverse childhood events achieve less educationally, earn less and are less healthy. All those consequences were articulated in the debate. The hon. Member for East Lothian (Fiona O'Donnell) spoke of some sad examples, and about sitting with very young children and talking about their personal experience.
One of the saddest papers that I have read as a Minister was one that I submitted to the Chair of the Select Committee on Home Affairs, about gang violence. It was about the early lives of children who, at a young age—under 10—were on the fringes of being drawn into gang violence. I set myself a challenge, before reading the attached case history, of guessing what was happening in the child’s life. Every guess I made about the factors that were present was right, and I am sure that other hon. Members would have made the same ones. The case history showed that a child much younger than 10 was already showing signs of post-traumatic stress disorder. There is a lot of emerging evidence to show that such children are far more likely to be drawn into gangs. Good work is being done, particularly in London, on understanding how to diagnose that. It all goes to support the case being made through the debate for intervening very early; otherwise, children grow used to high levels of stress and aggression.
High-quality care during pregnancy is crucial and we want women to receive excellent maternity services that focus on providing the best outcomes for them and their babies. There has been significant investment in maternity services. Since 2010 the midwifery work force has grown by 6.9 %—that is 1,380 additional midwives. I of course understand the challenge, in that there is always a call for more midwives; that is an important area. There has been £35 million of capital investment in the environment where maternity care is provided and where women give birth to their baby. We are working with NHS England to ensure that women receive better care during pregnancy, with every woman having a named midwife responsible for providing personalised antenatal and post-natal care. Women can now make more informed choices about their care. Again with the support of Health Education England, we have increased the number of midwives and are working to ensure that specialist mental health support is available in every birthing unit by 2017.
The NHS does an excellent job in nearly every case of delivering babies safely, but it is crucial, as has been highlighted, to ensure that we do more to look after mothers’ mental health. More than 10% of women will have a mental health problem or mental illness during pregnancy, and we must ensure that we provide all-round support for women to detect and treat such conditions. Again, Health Education England is taking forward work with a range of partners to ensure that training is available for health care professionals in perinatal mental health. It is working with the Nursing and Midwifery Council and the Royal College of Midwives to ensure that midwives’ undergraduate training includes a core module focusing on perinatal mental health and with the medical royal colleges to provide postgraduate training on maternal mental health by 2015.
For a relatively small number of women, specialist perinatal mental health services are required. Through maternity and children’s strategic clinical networks, NHS England is supporting the development of maternity and perinatal mental health networks, as recommended by guidelines from the National Institute for Health and Clinical Excellence on antenatal and post-natal mental health. The networks will develop action plans and collaborative working to drive improvements in access to and quality of care.
Andrea Leadsom
As I understand it, NICE guidelines still only approve video interaction guidance, which is an effective but quite short-term intervention, and cognitive behavioural therapy as talking therapies for the perinatal period. There is a wealth of evidence that parent-infant psychotherapy, a psychodynamic form of therapy, is far more effective in parent-infant situations. As randomised controlled trials are the only acceptable evidence base to NICE, and as psychodynamic therapy does not lend itself to that, there is a bit of a chicken-and-egg situation. How do we improve the availability of specialist parent-infant mental health services if NICE will not approve them because they do not undergo randomised controlled trials?
Jane Ellison
If my hon. Friend does not mind, I will write to her after the debate to respond in the level of detail that she asks for, as that is not in my brief. However, I can reassure her that I think there are trials, supported by Government research funds, to consider some of the areas that she is interested in. I think that there is room to give her encouragement in that regard.
To return to the networks that I was describing, for women at risk of poor mental health during pregnancy and following childbirth, services do exist. Ministerial colleagues have visited excellent services in Blackpool, for example, that support women who have or are at risk of developing mental health or substance misuse problems in pregnancy or post-natally.
The key messages on smoking in pregnancy are also getting through. We have some way to go, but as I have said, the figure is beginning to drop. Teenage pregnancy can, of course, lead to poor outcomes for both teenage parents and their children. Teenage mothers have three times the rate of post-natal depression and a higher risk of poor mental health for three years after the birth. They are three times more likely to smoke during pregnancy and 50% less likely to breastfeed, with consequences for their children. It is imperative that we reduce the numbers of young women and girls getting pregnant and mitigate the impact of having a child when young.
The good news is that our rate of teenage pregnancy now stands at a historic 40-year low. In 2011, the last year for which we have figures, our conception rate for young women under 18 was 30.7 per 1,000, down from 35.4 per 1,000 in 2010. That is due to a lot of hard work, dedication and passion from our health care professionals, many of whose efforts have been described by Members in this debate. I pay tribute to their efforts and the important results that they are yielding.
Reducing conception by under-18s is one of a basket of indicators in the public health outcomes framework and our sexual health improvement framework, which was published in March 2013, to drive continual improvement. Despite our best efforts, though, some young women and girls will become pregnant, and we must do our best to mitigate the risks to those young mums-to-be and their babies. Several hon. Members, including my hon. Friend the Member for Winchester (Steve Brine), have paid tribute to the family nurse partnership, a preventive programme for vulnerable first-time mothers under the age of 20. It offers intensive and structured home visiting delivered by specially trained nurses from early pregnancy until a child is two. There are now more than 80 teams covering 91 areas across England, and the Government are committed to increasing the number of places on the programme to 16,000.
The family nurse partnership successfully engages with disadvantaged young parents, including fathers, to pick up a point mentioned by my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton), who is no longer in his place. Of those who are offered the family nurse partnership, 87% enrol and a high proportion continue to engage until their child reaches their second birthday. My colleague the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich, witnessed—other Members have referred to this during the debate—the transformational power of the programme, and he met family nurses and their clients in London in 2013.
Thankfully, we have 30 years of evidence from the USA and elsewhere that shows that the family nurse partnership programme improves outcomes for mothers and children in the short, medium and long term. That includes health and behaviour during pregnancy, reduced child abuse and neglect, improved school-readiness for the child and improved economic prospects for the mother. That list is the mirror image of all the different threats to health and wealth that have been articulated during the debate. It shows that the impact of some of these powerful early interventions can ripple down the generations, as other hon. Members have said.
To pick up a point made at the start of the debate, such interventions have also made great savings to the public purse in health, social care and the criminal justice system. I am glad that my hon. Friend the Member for Winchester mentioned the US research. We are undertaking a large-scale independent randomised control trial that will rigorously evaluate the programme’s effectiveness in the English context, and the initial findings will be reported later this year. I am sure that hon. Members present will be interested to see that, because it will be useful to see those data expressed in an English context.
The Healthy Child programme is a universal evidence-based preventive programme to improve the health and well-being of all children and to identify and treat problems early. Effective implementation of the programme should improve many of the outcomes highlighted in the “The 1001 Critical Days” manifesto, including the strong parent-child attachment, positive parenting, better social and emotional well-being among children and care that helps to keep children healthy.
Fiona O'Donnell
The Minister speaks about bonding between mother, father and baby in the early days. May I draw her out on the issue of maternity and paternity pay being included in the cap on benefit spending announced by the Chancellor in his autumn statement? Will she give an undertaking that that will not lead to a freeze or a reduction in maternity and paternity pay?
Jane Ellison
The hon. Lady will understand that that is not in my portfolio, but I am happy to draw her concerns to the attention of colleagues in whose portfolio it rests. I undertake to do so after the debate.
The Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich, has asked Public Health England to commission a rapid review of the evidence base for the Healthy Child programme, with a focus on primary prevention. The Department of Health is also working with the WAVE Trust, which was instrumental in developing the evidence base for the manifesto, with the Early Intervention Foundation and with others to explore how valuable work in prevention can be built upon. We will be interested in the outcomes of that evaluation.
Mark Durkan (Foyle) (SDLP)
The Minister has referred to looking at the issues by drawing on data and evidence that are available in the English context. As well as sharing that, importantly in this context, will she ensure that questions in the “The 1001 Critical Days” manifesto are addressed at the level of the British-Irish Council? That would enable all eight Administrations throughout these islands who face such challenges in common to share their experience, good practice and piloting. The work could be elevated to that level rather than all the different Administrations trying to do the same things back to back.
Jane Ellison
The hon. Gentleman makes a good point, and I have regular dialogue on matters in my portfolio with Members of the devolved Administrations. I am happy to look into that point after the debate, because some of the lessons to be learned are universal across different countries in the UK.
There has been a lot of interest in health visitors. They and their teams lead the delivery of the Healthy Child programme, and of course they are the bedrock of our children’s public health services. They are often the first professionals to recognise that a mother is depressed or that parents are struggling with the negative effects of many sleepless nights; we have had a few descriptions of those from colleagues in this debate. Through their work, health visitors can have an impact on the well-being of the whole family. Because of their vital preventive role, the Government are committed to growing the health visitor work force by 4,200 by the year 2015 and to transforming health visiting services to improve outcomes and reduce inequalities in the nought-to-five age group.
Taking up the point about whether recruitment is on track, and weaving in the point made by my hon. Friend the Member for South Northamptonshire, we believe that we are on track. There have been a couple of challenges in one region, to which we are now responding, but the rate of increase in health visitors will increase. It is determined by training intakes, which determine the rate of qualification and entry into the profession. We are happy that that is on track. I give that assurance to the shadow Minister. The latest health visiting work force data that we have, which are from October 2013 and were published this month, show that the total number of health visitors nationally is 9,770 full-time equivalents. Overall, there are 1,678 more health visitors than the May 2010 baseline of 8,092. That is a growth of 21%, but we intend to grow that number more, as we have said, because we think it is so important and crucial to the aims of the manifesto.
On troubled families, we know that some families have multiple problems and cause problems in the community around them. I will not go into a lot of detail, but there is clearly relevance and read-across from some of the early years issues that we have been discussing in this debate. In particular, I have seen the Troubled Families programme in my area encouraging critical working together and getting everyone around the same table to consider people and families as a whole.
That programme will have done a great deal of good to embed that idea and approach as good practice for many local authorities. There is a strong read-across to the other things that we are discussing about earlier years, and in some cases, of course, they will be the same families, depending on the nature of the family. I have certainly seen in my area, and in lots of the other pilot areas, how services have embraced the opportunity to stop working in silos and consider a whole family’s needs instead. I hope that that will become orthodoxy in how we move forward with Government policy in numerous areas and in the local government approach to things.
The Government are increasing local authority budgets by £448 million over three years on a payment-by-results basis to support troubled families across England. Again, my ministerial colleague is meeting those involved in the Troubled Families programme to discuss the health contribution to this valuable programme, and he can then address some of the points to which I will draw his attention as a result of this debate.
I do not have time to go into much detail, as I am aware that I have already made a long speech, although I am drawing to the end of it. I have many points to respond to, but I wanted to touch on the points about social mobility made by my hon. Friend the Member for East Hampshire (Damian Hinds), which I have heard him articulate before. He discussed how to support parents. I think that my hon. Friend the Member for South Northamptonshire was present when Alan Milburn, presenting his most recent social mobility report, urged Government and politicians generally to break what he called one of the “last taboos” of public policy, which is telling people how to be good parents and supporting them to be good parents. That is an interesting challenge for us all to consider and respond to, because it is undoubtedly difficult terrain for both Governments and individual politicians.
Andrea Leadsom
I would just like to make the point that although politicians attempt to say, “Family and the first couple of years are really private, and you mustn’t interfere,” often, in my experience of 15 years’ work with charities, people are actually desperate for help, and they do not know where to go. It is completely the opposite. It is not as though we were trying to ram support down people’s throats and tell them how to live; it is that they are desperate for it. I have lots of meetings with people who have set up charities to support mums who are desperately depressed or tearful or who cannot cope. They do that because they themselves went through it and there was nobody there to help them. I think it is the exact opposite. We kid ourselves if we think that we are interfering. We are not; we are simply providing support that people desperately want.
Jane Ellison
I think that is right. My experience mirrors my hon. Friend’s. I suppose the sensitivity is always about people being tempted to stray into saying how everybody should live their lives, but I agree with her. My experience is just the same as hers. Most people are crying out for support. I guess that the key thing is how that is delivered and how people are asked whether they would like to receive it. There are ways of doing that, and I think we are close to breaking that taboo. It is all about how the support is offered. Rather than telling people, it is about saying, “We are here to support you and we think that we can nurse you through this difficult time,” so I think she is right. Common sense dictates that that is nearly always the case, but it is not an area that Governments have previously dealt with. It is an area that people have been nervous to go into.
I am glad that my hon. Friend mentioned charities. I want to touch on some work done in the area, because giving people the best possible start in life is not only a job for parents, the NHS and Government. Charities such as the WAVE Trust—Worldwide Alternatives to ViolencE—and the Early Intervention Foundation, which is funded by the Government, are contributing to, even leading, the debate in crucial areas about early child development. The Big Lottery Fund is working with both those charities and many others on the “A Better Start” initiative, where it will invest £165 million over the next 10 years to stimulate new and innovative preventive approaches in pregnancy and the first three years of life, again to improve life chances. I congratulate it on that work, and Ministers and parliamentarians will want to keep in touch with that significant programme of work and look at the outcomes it achieves.
Before I move off charities, I pay my own tribute to Home-Start and many other charities like it. I am privileged to be the patron of Home-Start Wandsworth, so I have seen at first hand the great work that it does, which I know is mirrored up and down the country. I have spoken to many mums who said that Home-Start were the people who stood by their side when they felt they had no one else to help them. They talked about the difference that it made to them at a difficult time in their lives.
On the points about integration, we can definitely do more to look at ensuring that all those initiatives are joined up. My ministerial colleague the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich, is hosting a round table on the subject of integration, with a specific focus on the early years. That will look at what more we can do to ensure that children and families get that integrated support. A number of Members have mentioned that.
That is only one part of the system, however. The challenge of data sharing was brought up in earlier contributions. The sharing of information between NHS services and across the health, education and care system underpins good integrated working. It is not really possible to do it without that, and it is important for promoting good outcomes. In recent years, there have been a number of attempts at a national level to improve information sharing, including through specific work in foundation years services.
As my hon. Friend the Member for South Northamptonshire and other Members will know, the Government commissioned Jean Gross, a former communication champion for children, to explore ongoing barriers to information sharing in early years and to identify examples of good practice. I reassure my hon. Friend that Ministers from the Department for Education and the Department of Health welcome that report and its excellent analysis of the issues on information sharing. Much local good practice is outlined in it, and we are working with places such as Wigan, Warwickshire and Hackney to move that agenda forward through the programme to introduce integrated assessment of children aged two to two and a half. We know that there is variation across local areas, but we are working to try and understand how to reduce that.
The Department for Education’s statutory guidance for children’s centres is clear that health services and local authorities should share information, such as live birth data, with children’s centres on a regular basis. The Department of Health is taking forward work with NHS England and others, including the Health and Social Care Information Centre, to explore how regular updates of bulk data on live births can be provided to local authorities, including the benefits of local sharing versus sharing nationally held data. My hon. Friend the Member for East Worthing and Shoreham said in an intervention that sometimes there is a culture of using it as an excuse. As highlighted in the Caldicott reviews and reports, we know that culture and relationships need to change, and we need to make sure that there is an understanding of the existing framework in law that supports much greater information sharing than perhaps is always undertaken.
Jean Gross’s report also made recommendations about training on information sharing. We are working with the Royal College of Paediatrics and Child Health and with the DFE’s strategic partner, 4Children, to explore how an e-learning package on information sharing can be developed that is accessible to and appropriate for both health and early years professionals. We are hoping to see progress there.
To summarise, system-wide change is required to achieve all of this. Each part of the system, at each level, has a vital contribution to make. As the response to the debate has illustrated, work is going on across different Departments, and how we integrate them is critical to it. All of us see the manifesto “The 1001 Critical Days” as a rallying point for all those who have an interest in ensuring that, as the Government state in their pledge, we improve the health outcomes of children and young people so that they become among the best in the world.
The manifesto comes at an exciting time, because the evidence on the importance of a healthy pregnancy and on the early years is growing. As I have said, the evidence is becoming clearer, which makes it easier to make the case. It makes it easier for those who make decisions about how to structure services to do that with the confidence that they are doing something that will make a real difference, and that the consequences of a poor start for long-term physical and mental health will be addressed. Government, the NHS, charities and others are working well together to take the agenda forward, and I know that my hon. Friend the Member for South Northamptonshire will continue to champion it in Parliament and continue to improve the understanding that we all have of this important agenda.
I pay tribute to everyone who has taken part in such a good debate. I will follow up a number of points, and I will of course report back to the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich, on the debate that we have had. I look forward, as do officials in the Department of Health, to ongoing, dynamic and constructive relationship working to take the objectives of this important manifesto forward into the future.
Andrea Leadsom
It is a pleasure to speak under your chairmanship, Mr Amess. I, too, thank all right hon. and hon. Members for their contributions here today. This has been a very interesting debate. Some particularly different aspects of the subject have been raised. My hon. Friend the Member for East Hampshire (Damian Hinds) raised the very important question of social mobility. My hon. Friend the Member for Winchester (Steve Brine) raised the very important contribution made by Home-Start to the help for families in the vital early years.
As I said earlier, I am delighted that the right hon. Member for Dulwich and West Norwood (Dame Tessa Jowell) has come to the debate to make her own contribution on the importance of the early years, not just here in the UK but, potentially, in the post-millennium development goals. That would mean that we were looking at early years intervention right across the world. Other hon. Members have also made very valuable contributions to the debate.
I shall finish by calling on the Government and all parties to try to focus on making the perinatal period a period of holistic support for new families. There are some examples of superb practice but—rather like the situation with Sure Start children’s centres—there is no agreed customer perspective, shall we say. Mums who are pregnant come in all shapes and sizes—literally—and from all demographics: all sorts of age groups, ethnic backgrounds, social backgrounds and economic backgrounds. There are working people and non-working people. They all have varying needs, but unfortunately the provision for the crucial perinatal period tends to be one size fits all.
A woman is allocated a midwife and then she is stuck with her. If she does not like her, bad luck. She is lucky if she sees a health visitor before the baby is born, so there is no chance of bonding with someone. Someone turns up in the woman’s home. This happened to me. I was in tears at the time. Someone turned up and decided to take my baby away and give the baby a heel prick without my permission. To me, it was a case of “You’re torturing my baby!” I had to be restrained by my husband. Women who have just had a baby or are pregnant are extraordinarily vulnerable, even those of us who like to think that we have got life sorted. Also with my first-born, I remember that one day we were snowed in. He was due on 15 December, but he decided to hang around until the 29th, so having cancelled Christmas, I had to reinstate it on Christmas eve. I remember going to midnight mass and our lovely old vicar saying, “Can you imagine? There’s the Virgin Mary, sitting on a donkey, heavily pregnant.” I was thinking, “Yes, let’s not talk about this any more!”
For pregnant women, there are those extraordinary sensitivities. We need to imagine things from their viewpoint and ensure that we do not provide services at our convenience. My all-party group had an extraordinary meeting with registrars recently. The registrar in question said that it was much more convenient for the registrars if people went to the civic centre to register their babies—that it is much more convenient for registrars and therefore that is what families should continue to do. That is not good enough. We have to go to them; we should not expect them to come to us, but at the moment that is the case in almost every area of the perinatal service, even children’s centres. Far too many of them expect the families to find them: “If you don’t come to us, you’re hard to reach, so that’s your fault.” We must go to them.
I urge the Government, in everything that we do and in every policy that we put forward, to think about it from the customer’s perspective. I think that if we look at things from the viewpoint of the mum and, crucially, the dad, the baby and the siblings and think about how we can make the experience of childbirth better for them, we will have cracked it.
Question put and agreed to.