Schools: Special Needs Pupils

Lord Bishop of Worcester Excerpts
Tuesday 19th March 2024

(8 months, 1 week ago)

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Baroness Barran Portrait Baroness Barran (Con)
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The noble Baroness is right about the success of appeals, but I point out that just over 2.3% of all decisions went to appeal. Although the success rate is very high, the level of appeals is perhaps lower than the House might believe from the media. We are currently trying to test a range of measures that will mean that the quality of decisions—and, crucially, the confidence that parents can take in those decisions—is improved. That includes testing a single national education, health and care plan template and guidance, testing multiagency panels to improve the quality of and parental confidence in decision-making, and resolving disagreements quicker by strengthening mediation.

Lord Bishop of Worcester Portrait The Lord Bishop of Worcester
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My Lords, I declare my interest as a parent who had to fight hard for an EHCP for his child. It is not only in deprived areas that it is very hard to be awarded an EHCP; it is certainly true in Worcestershire, where a large proportion of applications are turned down. As I was fighting through mediation, I was told by a health professional, “Remember, John, only pushy parents get EHCPs”, and that seemed to be the case. Does the Minister agree that this is shameful? Does she also agree with the LSE that the basic problem is that more money needs to be put into the system?

Baroness Barran Portrait Baroness Barran (Con)
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I tried to address some of the points that the right reverend Prelate raised in my answer to the noble Baroness, Lady Hollins. We definitely do not want a world where only pushy parents get an EHCP; we want a world where the children who need an EHCP get one. On funding, this Government have massively increased the high-needs budget; it will be worth over £10.5 billion by 2024-25, a 60% increase on 2019-20. We are also committing significant capital to expand the number of special needs places.

Independent Schools

Lord Bishop of Worcester Excerpts
Monday 18th March 2024

(8 months, 1 week ago)

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Baroness Barran Portrait Baroness Barran (Con)
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I remind the noble Baroness that teacher numbers are at an all-time high. I do not deny that there are recruitment challenges, but it is important to be fair about the context. I also remind her that pupil funding next year will be at an all-time high in per-pupil terms. I refer her to the recent results of our pupils in the international leagues tables for both reading and maths, and the dramatic improvement in their performance over the last 14 years.

Lord Bishop of Worcester Portrait The Lord Bishop of Worcester
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My Lords, I draw attention to my interest as president of the Woodard Corporation, one of the largest Christian education charities in the country. The noble Lord, Lord Black, drew attention to the partnership between Brentwood School and other schools in the area. That is built into the very DNA of the Woodard Corporation, with 12 private schools, six academies, 12 affiliated maintained schools and overseas schools, as schools work well together. Does the Minister agree that this mixed model, which values co-operation between different providers, is a very good one that benefits all children? Does she agree that it would be good to encourage such a model?

Baroness Barran Portrait Baroness Barran (Con)
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I absolutely agree with the right reverend Prelate. I know of a number of independent schools and their local state schools that are considering just the sort of arrangement that he described.

Schools: Data, Digital and Financial Literacy

Lord Bishop of Worcester Excerpts
Tuesday 14th March 2023

(1 year, 8 months ago)

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Baroness Barran Portrait Baroness Barran (Con)
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Our Online Safety Bill goes a long way to addressing the concerns that the noble Lord rightly raises, but I should like to reassure him that some of that is also reinforced by the work that we are doing at every key stage in our schools.

Lord Bishop of Worcester Portrait The Lord Bishop of Worcester
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My Lords, recently I had the privilege of serving on your Lordships’ Communications Committee. What came through consistently in our inquiry into the effects of technology on the creative industries was the need for creative and artistic literacy as well as digital literacy—we need STEAM, not just STEM. I speak as a former scientist deeply committed to science and technology. Does the Minister agree and, if so, what can the Government do to enable that, given their reluctance to review the national curriculum and prioritise arts more?

Baroness Barran Portrait Baroness Barran (Con)
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The right reverend Prelate raises an important point. Certainly, when I was talking to a number of young people recently, they raised exactly the same issues as he does. I do not think that there is any resistance at all from the Government about the importance of a STEAM curriculum; we talk a lot about STEM, but we also talk a lot about our vibrant and incredibly successful creative industries. Our commitment to the teaching workforce has been that, during this period of recovery post Covid, there will be no changes to the national curriculum.

Children in Care

Lord Bishop of Worcester Excerpts
Wednesday 12th October 2022

(2 years, 1 month ago)

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Baroness Barran Portrait Baroness Barran (Con)
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The department is grateful for the work that the Royal National Children’s SpringBoard Foundation does and works closely with it. My noble friend makes a good point. A child in care obviously faces a wide range of challenges starting from their early childhood, as the noble Lord, Lord Laming, pointed out. Therefore, the role of the local authority in supporting children in all those aspects is critical.

Lord Bishop of Worcester Portrait The Lord Bishop of Worcester
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My Lords, the quality of life of children in care is clearly a matter of grave concern, but I wonder whether the Minister is aware of the Children’s Society latest The Good Childhood Report, which suggests deep concern about the continuing decline in the well-being of children generally. As expected, the current cost of living crisis is having a significant effect on families: 85% of parents and carers, the report suggests, are very concerned about the future. The Children’s Society report suggests ways forward. Is the Minister aware of them? Faster rollout of mental health support, a permanent boost to social security lifelines and extended help with school lunches are among them. Will the Minister comment on that?

Baroness Barran Portrait Baroness Barran (Con)
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As a department, we look at all those options, but on the one hand we need to recognise the extraordinary challenges children faced particularly through Covid—particularly teenagers while their schools were closed—but we also need to acknowledge that we are in an economy with more opportunity and more job opportunities than ever before. I think we need to be empathetic to their experience but also optimistic for their futures.

Schools White Paper

Lord Bishop of Worcester Excerpts
Tuesday 29th March 2022

(2 years, 8 months ago)

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Baroness Barran Portrait Baroness Barran (Con)
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I thank the noble Baroness for her remarks. On academisation, she will be aware that the picture is very different in secondary and primary education. About 78% of secondary schools are now academies compared to about 38% of primaries. She questions their performance. Our emphasis has been very clear. We are talking about creating strong trusts and we are building on the experience of the existing strong trusts. If all children did as well as pupils in the top-performing 10% of trusts at key stage 2, our results nationally would be 14 percentage points higher, going from 65% to 79%, and would be 19 percentage points higher for disadvantaged pupils. I know the noble Baroness shares my passion and the passion of my colleagues in the department for supporting particularly those disadvantaged children.

On Oak Academy, far from deskilling teachers, we are going to make the most enormous investment in teachers in terms of teacher training opportunities and continuing professional development at all stages of a teacher’s career. We are aware that, particularly in primary, individual teachers are writing lesson plans from scratch. Oak Academy is by teachers, for teachers and of teachers. It is there as an option for teachers. Again, I know the noble Baroness shares our concerns about teacher workload. One way we can support teachers is by providing them with the best-quality curriculum to draw from.

Lord Bishop of Worcester Portrait The Lord Bishop of Worcester
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My Lords, I echo the noble Lord, Lord Storey, in his thanks for the White Paper. In doing so, I declare my interest as president of the Woodard Corporation. In expressing gratitude, I appreciate in particular how the White Paper recognises the vital role the Churches have played in the educational landscape of this country for more than 200 years and that it sets out how the role needs to continue to be enabled in the future development of the school system. I will focus on two questions regarding the move towards the fully academised educational landscape set out in the White Paper and invite the Minister to agree that it requires two key things.

First, it requires significant investment of resource to make that transition possible. The Church of England is the largest provider of academies, with over 1,500 of our schools having already converted, but that still leaves two-thirds of our schools waiting to become academies. This will require time and resource for the conversion process, as well as strong, new trusts to be formed to enable that transition. Recognition that MATs must grow to a sustainable level of about 7,500 pupils means thinking carefully and strategically about small rural schools and how a funding model can work for them, to enable their vital education to remain at the heart of communities, particularly rural communities, across our land.

Secondly, I hope the noble Baroness can give assurance that legislation will be introduced to ensure that the statutory basis on which the dual system of Church and state as partners in education, which has been in operation since 1944, securely translates into the contractual context in which academies are based, so that the sites on which schools are situated can continue to be used for the charitable purposes for which they were given. So, in expressing thanks, I ask the noble Baroness to assure us that these things will be addressed and secured in order to ensure that Church schools can approach this new future with confidence.

Baroness Barran Portrait Baroness Barran (Con)
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I thank the right reverend Prelate for his questions. I also extend my thanks to Church schools but also to all schools that have been working in the most difficult circumstances, particularly in the second half of this term, with the pressures that Covid has placed, once again, on their staff. I can, I hope, reassure the right reverend Prelate that we will be protecting the faith designation of diocesan schools on a statutory basis as we move forward with our plans. We are providing funding to support academisation and to make sure that schools, particularly schools in the most entrenched areas of educational underperformance, are funded to join strong trusts.

On small rural schools—to go back to the point of the noble Lord, Lord Storey, about feeling local—perhaps there are no schools more local than small rural primaries, which often play a really important part in their community. We will be putting a great deal of thought into this and look forward to working with the right reverend Prelate’s colleagues at the diocesan education board in thinking through how we can deliver this in a way that supports small rural primaries.

Adoption Support Fund

Lord Bishop of Worcester Excerpts
Thursday 13th February 2020

(4 years, 9 months ago)

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Lord Bishop of Worcester Portrait The Lord Bishop of Worcester
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My Lords, I add my congratulations and thanks to the noble Lord, Lord Russell of Liverpool, for securing this debate. I declare an interest: mine is one of the 50,000 or so families who have received support from the adoption support fund. I am immensely grateful for that support. It came at a very difficult time after the death of my wife, my children’s adoptive mother, six years ago, when they were very young. It was invaluable. That is the most important thing I have to say this afternoon. It is a privilege to be able to speak from first-hand experience as an adoptive parent and as someone who has benefited immeasurably from the ASF. I am no longer in receipt of the fund but I offer my heartfelt thanks—to the Government for this excellent initiative, to the all-party parliamentary group for its excellent report and to Home for Good, the wonderful charity involved in compiling that report. I add my voice to those asking for the ASF to be continued after the spending review so that others are able to access the crucial help that it gave us.

Being an adoptive parent has brought me untold joy, but the great demands of being such a parent need to be recognised and appropriate support given. My children are not among the three-quarters of adopted children who, according to the Department for Education, have been removed from their birth families because of abuse and neglect. That heartbreaking statistic brings home how vital it is fully to comprehend the necessity for support of the sort we are discussing. That said, it is also crucial to be aware that all adoptive children will face challenges as a result of what adoption specialists term “the primal wound”—being separated from someone to whom they have been attached, not just psychologically but physiologically in the womb.

It is not surprising, therefore, that adopted children and young people are statistically more likely to be involved in the criminal justice system and to need mental health support; the complications that some adopted children face at school and at home are very great. We should note that—as the noble Lord, Lord Russell, intimated—any such support will enable considerable long-term savings for the Government in the future by reducing the child’s likelihood of exclusion and engagement with the police.

Feedback from parents and children who have accessed the scheme, like me, has been overwhelmingly positive. According to the Adoption Barometer survey, 94% of those who received support from the fund are likely to apply again in the future, with four out of five parents who accessed it saying that it had a significant positive impact on their child and family situation. Such positive feedback makes it clear that for many parents the fund is a vital service. As the noble Baroness, Lady Massey, noted, the charity Investing in Families reported that 79% of parents state that the fund is

“meeting a need which cannot be met elsewhere”.

Mental health and family support should be easily accessible to all children and parents, but in this case the vulnerability of the children in question means that the fund is a vital source of support, not only for the health, happiness and well-being of the child but for the parents, many of whom are unprepared for the realities of the complexity that often surrounds the adoption of a child. Many parents go into adoption full of good will but without the skills or training to support their child, and may have only basic knowledge of their child’s background or psychological history.

The ASF not only equips children with the tools to help to look after their own mental health and process their past but equips parents will the skills and confidence needed to support their child. As a mental health practitioner in East Sussex explained, nearly all the parents they came into contact with

“underestimated just how demanding some of these children’s needs were and found themselves at a complete loss on how to parent such challenging behaviour.”

However, the practitioner went on to say:

“Once the family receive therapeutic services it opens up all kinds of opportunities for them. In addition, family life can slowly return to some ‘normality’ once adoptive parents have the skills, knowledge and support for their child.”


The adoption support fund has been found in multiple surveys to prevent or reduce the risk of adoption breakdown. It hardly needs to be said that such breakdown is devastating for everyone involved, particularly the children.

As one might expect, and as the noble Lord, Lord Russell, observed, there is room for improvement in the operation of the fund. Most significant is the impact of long waiting lists, coupled with a general lack of knowledge of its existence. However, it has been working well. In anticipation of this debate, I was in touch with a very experienced and well-respected clinical psychologist in Worcestershire, Dr Kim Golding, who has been working with and supporting families of looked-after and adopted children for over 30 years. She is an expert in the sort of therapy that we received, dyadic development therapy, an excellent and effective intervention. She states that she has witnessed at first hand

“how this fund has helped these families get the support that they need.”

Dr Golding stresses the importance of understanding the needs of adoptive families, not just the children in question. When many think of adoption, they envision a fairytale ending to a story. The reality is of course very different. As she observes:

“Adopting a child from care means adopting a child who comes with a history of trauma, separation and loss of birth family. The impact of this experience is felt by the child and all family members. This can make the parenting of this child extremely challenging. Ordinary parenting does not come near to meeting the complex needs of a child who is grieving the loss of previous parents (birth and foster parents); who has learnt not to trust in the parenting that they are now receiving and who anticipates that they are going to lose this too, often with a sense of identity formed around them being a bad kid who somehow deserved what has happened to them. This can lead to a range of challenging behaviours”


and vulnerabilities. Dr Golding stresses the need for “wraparound support”, where packages of intervention are focused on, rather than single instances of therapy or counselling. The nuanced history of many children in care and adoption means that there are no easy fixes. She says:

“Interventions are needed in a timely manner and for as long as needed”,


and should involve a range of teams and specialists working in collaboration to create and implement a package of interventions for families. She states:

“The impact of trauma does not resolve quickly, and it can reassert itself at critical developmental stages throughout a child and adult’s life.”


This longer-term intervention should be supported and recognised as vital.

Additionally, as I have intimated, Dr Golding says:

“Such therapy will only be helpful if the support needs of the whole family are also met. Therapy and support is needed for the whole family and not just the child.”


As a judge observed at the time of our first adoption, conception is often a biological accident but adoption is always an act of love. That act of love is undertaken by adoptive parents for the child on behalf of all society. They deserve the support of all society as they live it out.

Education: English Baccalaureate

Lord Bishop of Worcester Excerpts
Monday 21st January 2019

(5 years, 10 months ago)

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Lord Agnew of Oulton Portrait Lord Agnew of Oulton
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I am afraid that I disagree with my noble friend. The EBacc has been transformational, particularly in helping disadvantaged pupils. In 2011, only 8.6% of disadvantaged pupils sat the EBacc, while in 2017 the figure had risen to 25.4%. As I said in my Answer, we know that this is of direct benefit to the number of disadvantaged pupils able to get into good universities. I reassure him that the hours spent teaching music have barely changed over the past seven years. Indeed, in 2010, 3.1% of teachers taught music while last year it was 3%. There were 2.4% of teaching hours given over to teaching music in 2010 and it was 2.3% last year. We have put great emphasis on the arts and do not feel that they are disadvantaged by the EBacc.

Lord Bishop of Worcester Portrait The Lord Bishop of Worcester
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My Lords, one does not need to be an avid follower of the news to realise the huge impact that religion has for good and for ill geopolitically in our world. That is happening at the same time as we see a level of unprecedented and increasing religious illiteracy in our own society. Does the Minister regret the exclusion of RE from the baccalaureate, given the drop in numbers studying the subject at GCSE? Would its inclusion not assist in community cohesion as well as in an understanding of our world?

Lord Agnew of Oulton Portrait Lord Agnew of Oulton
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I do not agree with the right reverend Prelate that we should include religious education in the EBacc. There is tremendous demand from various quarters to include a number of different subjects, but we are adamant that all schools should teach a broad and balanced curriculum. That is further emphasised by the changes to the Ofsted inspection framework that will come into force in September. It will put particular emphasis on academies, which have not had the same level of requirement placed on them previously. However, they will now be judged in inspections on the teaching of a broad and balanced curriculum, which will of course include religious studies.

Schools: Funding

Lord Bishop of Worcester Excerpts
Thursday 29th November 2018

(5 years, 12 months ago)

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Lord Bishop of Worcester Portrait The Lord Bishop of Worcester
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My Lords, I am grateful to the noble Baroness, Lady Morris of Yardley, for securing this important debate on school funding and for her impassioned and powerful introduction to it. I fear that she is right that there is a crisis in school funding. Head teachers in the diocese of Worcester speak of the stress they are experiencing due to funding worries; of not sleeping due to such worries, which impacts negatively on all they are trying to do; of a sense of letting down children with significant needs; and of a feeling that they have nowhere to turn to be truly heard. One head of a school who has been asked to double its numbers has not been provided with sufficient funding to do so, throwing his school into financial insecurity and causing immense stress.

Of course, that stress and anxiety is not unique to the diocese of Worcester, nor to head teachers. According to the 2018 Teacher Well-Being Index, 67% of teachers reported that they were stressed at work, which has led to taking time off work for extended periods. That, of course, not only affects people’s progress and attainment but puts additional pressure on schools, which have to hire cover teachers, often at a much higher level of pay.

Following on from what the noble Lord, Lord Addington, said in his speech, despite the increase in high-needs funding for those with complex educational needs, school leaders still report that funding is insufficient to meet the needs of children with special educational needs and disabilities who attend their schools. One such case in my diocese is a school that has had to cut its speech and language individual intervention support to one afternoon a week, and is unable to support more specialist provision. That has led to a significant number of children not receiving appropriate intervention programmes.

In some cases, the strain on funding for children with special educational needs becomes too much, as has been implied. The Commons Education Select Committee heard evidence from the National Education Union that,

“in the current climate, schools are cutting resources to vulnerable children and permanently excluding instead and saving thousands of pounds”.

It is surely a matter of extreme concern that exclusions should be made on a financial basis and that children with special educational needs are being denied appropriate education because of lack of funding.

Turning to multi-academy trusts, they are witnessing a rearrangement of funding to reflect the needs of individual schools in the trusts, with the surplus of more prosperous schools being used to meet the deficit in the schools that are not thriving. The Minister has spoken about the additional benefits of the economies of scale that can be achieved by joining a multi-academy trust. That is undoubtedly true; it can be of great benefit, but there is a problem when schools are not receiving support and, as a result, fail their pupils and may be forced to close. For small and rural schools, for example, the financial challenges can make them inherently unattractive for academy chains or multi-academy trusts. Thus, they may be unable to provide the access, support and security that being part of a MAT provides.

There are particular difficulties with small and rural schools, and I know that the Minister attended a conference on their needs at Lambeth Palace earlier this week. Such schools are hit much more severely by external factors and are generally less able to adapt. For example, a small school that suddenly has one fewer pupil than expected would lose a larger proportion of its funding and would be less able to adjust to the effect of that reduction. There are also many additional associated costs in running small rural schools that are not reflected in funding structures. For example, because rural locations find it harder to attract young newly qualified teachers, the teachers they do attract are very often paid more, so rural schools have higher associated staffing costs. That is just one of the many instances in which circumstances are stacked against rural schools.

Anyone who has spoken to educators will know that there is a real struggle to make ends meet at present, which could well be described as a crisis. It is of course necessary and right that deficiencies should be pursued, but there is a real danger of perceived efficiency leading to deficiency. We should be looking to those setting the best examples when it comes to making cuts, to learn from best practice. At the same time, it is surely crucial to ensure that funding matches the needs of schools once sensible efficiencies have been made. Efficiency should not compromise the education of any child. I fear that that is now happening.

Schools: Mental Health Support

Lord Bishop of Worcester Excerpts
Tuesday 27th November 2018

(5 years, 12 months ago)

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Lord Agnew of Oulton Portrait Lord Agnew of Oulton
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My Lords, many faith schools are high performing and achieve consistently high exam results. I am happy to join my noble friend in congratulating Yavneh College. Many of the best schools focus on well-being as an intrinsic part of their job, so I welcome the initiatives highlighted by my noble friend. Promoting well-being can help prevent problems arising or escalating, ensuring that both the school and pupils are provided with the tools they need to achieve the best results.

Lord Bishop of Worcester Portrait The Lord Bishop of Worcester
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My Lords, while I am grateful for the increased funding that is now available for mental health services for young people, is the Minister aware of the real difficulties facing young people in a crisis situation? I am thinking of a 14 year-old who asked his father to take him to the GP because he was afraid he might do something silly. The GP sat and listened very sympathetically, but then said, “I’m afraid there’s very little I can do for you. If I give you a referral to CAHMS, you probably won’t get an appointment for a year”. Is that not a crisis situation?

Children: Maternal Care

Lord Bishop of Worcester Excerpts
Thursday 17th March 2016

(8 years, 8 months ago)

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Lord Bishop of Worcester Portrait The Lord Bishop of Worcester
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My Lords, I am also grateful to the noble Earl for securing this debate because I am utterly convinced about the importance of ongoing maternal care for children. I speak as the father of two adopted children. I have learned through experience and study how crucial is the relationship that children have with their mother. It is an essential and defining part of the process of perinatal life that a bond is formed between child and mother, regardless of the latter’s conscious attitude towards her baby.

Research shows that healthy development depends on the quality of attachment from primary carers during the first three years of life when the brain’s structural plasticity is most available to being shaped by interactions with parents. In systemic terms, there is a benign, recursive, interactional loop operating between parent and child such that the baby’s brain responds to parental input—love, care, et cetera—by developing and growing physically and psychologically. This in turn triggers the parent or carer to provide more love and care.

As the noble Earl has said, the Government deserve much credit for their determination to improve the lot of children. I do, however, believe that other measures would help significantly. With this is mind, I applaud the Motion which the noble Earl and others introduced to the Parliamentary Assembly of the Council of Europe in September 2015, advocating, among other things, financial assistance for maternal care in the home for a minimum of three years, ensuring that such a care subsidy is independent of paid work. The organisation CARE, summarising its latest annual review of taxation in this country, said:

“According to our most recent research, a single-earner married couple with two children on the average OECD wage are liable to 35% more tax than the OECD average”.

Of course mothers should be able to go back to work when they wish but CARE boss Nola Leach said, when the report was published:

“Stay-at-home parents are making an important investment in their children and yet at present they end up being discriminated against by our current tax system”.

I should add that I have nothing against single parents or working parents: I am one. However, I would like the tax break for couples, which was announced in April 2014, to be extended, along the lines that the noble Earl suggested, to a 100% transferable allowance, which would carry far more significance and would mean that couples could benefit to the tune of £2,000 a year. The campaigning group Mothers at Home Matter argues that it matters for families to have choices in care, so that all are able to choose what works for them in their unique circumstances. That will surely be for the good of all.

Mothers are also presently concerned about conditionality placed on households on the new universal credit. Will family responsibilities at home be properly factored in? How much pressure will there be on second earners to return to work? Preliminary research seems to indicate that more mothers will be “encouraged” to sign up for interviews when children are 12 months old, even when they have significant care responsibilities at home.

As has been intimated, our concern should not just be about the early years: it is important for someone to be there for children in the middle and teenage years as family circumstances and pressures change. The availability of decent, part-time, paid work, particularly during secondary school, is key to achieving balance for some parents with care responsibilities. We need, in sum, a greater recognition of the loving one-to-one care that babies need and of children’s need for family time at all ages. We need to do all we can to facilitate it.

At the same time, while ongoing maternal care is important, so is parenting in general. The noble Earl, Lord Listowel, pointed to the importance of family and family learning. Churches are also doing much to provide training on parenting, for which there is an appalling lacuna in our society. The Mothers’ Union runs and trains facilitators for its “passionate about parenting” course. A participant said:

“This parents’ group helped me in so many ways. We talked in small groups and helped each other, my children found my parenting handbook (a resource I was given that I could take away and read through at home) so I thought I had been busted. But it was great, after a few weeks my 18-year-old gave me a hug. The first in years and he wasn’t the teenager I was having problems with!”.

Similarly, Care for the Family runs many positive parenting programmes, and Alpha provides parenting children and parenting teenagers courses.

As the father of adopted children, I know that the separation of children from their mothers is immensely traumatic. It is referred to by adoption specialist Nancy Verrier as “the primal wound”. It takes a great deal of love on the part of adoptive parents to begin to heal this wound. That shows the importance of the maternal bond and maternal care. It can be done, as was done by my wife. Tragically, she died when my children were aged nine and 15. That brought home to me, by tragic means, the importance of ongoing maternal care.

It is, of course, not true to say that healthy adults cannot develop if they have experienced a lack of maternal care. There are alternatives to it; attachment from other loving and caring adults, most especially fathers, can be very nurturing and healing. These are important alternatives, but no substitute for ongoing maternal care.