Stillbirths and Infant Mortality

Tim Loughton Excerpts

Wednesday 26th March 2014 Westminster Hall

[Tim Loughton (East Worthing and Shoreham) (Con)]

It is a pleasure to serve under your chairmanship, Mr Davies. I congratulate my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) on an excellent speech and on raising the profile of this much neglected but hugely important subject for many of our constituents who have been through the pain of stillbirth, infant mortality or perinatal mortality.

I am, slightly shamelessly, going to use this debate as a further opportunity to plug the ten-minute rule Bill that I put before the House on 14 January, with the support of my hon. Friend and other hon. Members. I am pleased to see the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison) here, as she sat in on that ten-minute rule Bill. I am glad that her colleague at the Department of Health has now, I hope, agreed on a meeting to take that forward; some of us can take constituents affected by stillbirth to that meeting and see whether we can bring about the change in the law that I will come back to in a minute.

I echo the accolades that my hon. Friend the Member for Chatham and Aylesford bestowed on all the organisations that have an interest in this matter and have for many years, quietly but assiduously, been campaigning for better care for people bereaved by stillbirths or who lose their children at an early age, giving support and advice, and campaigning for improvements and changes in the law.

This is quite a complicated area. Although the debate is entitled “Stillbirths and Infant Mortality”, we talk about neonatal deaths, perinatal deaths and post-neonatal deaths—those deaths between 28 days and a year after birth—as well as infant and stillbirth mortality rates. However, across all those fields the record of the United Kingdom is not good. My hon. Friend contrasted the UK’s record with the great progress made on sudden infant deaths, particularly on cot deaths, during the “Back to Sleep” campaign. A concerted, focused and well promoted campaign led to a decrease of more than two thirds in the horrific spate of cot deaths that afflicted so many families. It is perplexing and worrying that, although there has been some progress in reducing mortality rates across the board, pre and post-birth, they still remain alarmingly and unacceptably high, certainly compared with European partners.

Total perinatal mortality rates now stand at some 7.4 per 1,000 live births in this country. In comparison, the figure for Finland, which has the best record on this front, is 3.2 per 1,000 live births, and even Portugal, which has challenging questions to face about infant health, has a rate of 3.8 per 1,000 live births. We are still way behind. An awful lot of those perinatal mortalities, particularly the stillbirths among them, remain completely unexplained.

We also have to add miscarriages to the figures, which apply only to the official recognition of stillbirths as embryos born dead after 24 weeks. Those figures, of course, do not include miscarriages, yet more than one in five pregnancies in this country ends in miscarriage, which means that more than a quarter of a million of our constituents are affected by miscarriages each year. The problem is huge.

Most miscarriages happen in the first three months of pregnancy. Some women may hardly know that they have had a miscarriage, and some may have miscarriages without knowing they were pregnant in the first place, but many women, including some constituents who have come to me since I presented my ten-minute rule Bill, have miscarriages well into their pregnancy, when the grief, trauma and distress of losing a hoped-for child is that much greater.

The way in which we support women who have been through such experiences is also worrying. Research by the Miscarriage Association found that 45% of women who have experienced a miscarriage did not feel well informed about what was happening to them. Only 29% feel that they were cared for emotionally, and nearly four out of five, 79%, received no aftercare. We know that at least one in six women—a very large number—experience some form of perinatal mental health problems. That has a great cost, socially and emotionally to those women and financially to our national health service. It is a false economy not to ensure that we support those women, whether they have suffered a miscarriage early or late, or whether they have suffered a perinatal mortality either before or after birth.

[Dr Lee]

On the subject of false economies in the national health service, historically we have spent significant sums on antenatal care without a lot of evidence to support that expenditure. Does my hon. Friend agree that we need to concentrate resources in the appropriate hands? We need appropriately staffed maternity units—there are worrying statistics about midwifery-led versus obstetric-led maternity services—and by doing that we can address our infant mortality rates, which compare poorly with those of our European neighbours. As politicians, we must also accept that doing that would involve reconfiguring services. There would be fewer maternity units and perhaps more obstetricians.

[Tim Loughton]

My hon. Friend has great hands-on experience, and he knows a lot more about this subject than I do. He opens a far greater debate on the accessibility of maternity services. I am sure I am not alone in having marched and campaigned for the retention of midwifery-led maternity services at a local hospital. Interestingly, the biggest growth in mothers giving birth at that hospital has been among those who live outside the Worthing catchment area. Those mothers choose to go to the hospital.

[Dr Lee]

I want my hon. Friend to know that I campaigned to close my local midwifery-led unit because it was not delivering many babies—it was delivering less than one baby a day. I have real concerns about the potential for increased infant mortality in such midwifery-led units.

[Tim Loughton]

It is horses for courses. I am glad to say that my maternity unit delivers well in excess of 3,000 babies a year. It is a centre of excellence, and the customer votes with her feet by choosing to go there from outside the area. My hon. Friend is absolutely right that the assessment of units must be primarily based on the quality and safety of care for mothers, but I fear we are straying slightly beyond stillbirths and infant mortality rates into the availability of maternity services and hospitals. You would not want us to go there, Mr Davies.

My hon. Friend also raises an interesting point about delivering services in the most appropriate way. There are certain constituencies of women and certain parts of the country where the problem is that much greater. To take one of the classifications, the infant mortality rate in the UK overall is 4.4 deaths per 1,000 live births, but the variations for mothers born outside the United Kingdom are worrying. For babies of mothers born in the Caribbean, the figure more than doubles to 9.6 deaths per 1,000 live births. For babies of mothers born in Pakistan, the rate is 7.6 deaths per 1,000 live births, and so on.

There are also regional variations, particularly for perinatal mortality overall. In the south-west, the figure is 4.7 deaths per 1,000 live births, but in the north-east it is 5.8 deaths per 1,000 live births—a 23% difference. Why are there those differences? We simply do not have enough research; we have not commissioned and are not doing enough research to find out why certain types of women and certain geographical locations are faring worse. Such research would enable us to focus, say, additional scans or support services, or whatever is required, to ensure that we make the best use of our NHS resources. My first call is for there to be rather better research across perinatal mortality.

[Mr Gregory Campbell (East Londonderry) (DUP)]

On geographical differences, we heard earlier about the improvement recently reported in Scotland. Does the hon. Gentleman agree that when Ministers from across the United Kingdom and beyond meet either at a joint ministerial council or at other levels, best practice, where it has been established, should be carefully researched and, where possible, implemented immediately?

[Tim Loughton]

I agree. My hon. Friend the Member for Bracknell (Dr Lee) gave the example of Scotland, where people have clearly examined the matter a bit further; they appear to be achieving more than people in other parts of the United Kingdom. We should be sharing that best practice, rather than being parochial and not sharing it beyond the United Kingdom, with or without Scotland after 18 September. That goes beyond sharing ministerial best practice on health issues; I would guess that not just health considerations but deprivation, housing and other local environmental factors are involved, too. More than just the Health Ministers of the respective parts of the United Kingdom need to be involved. If we compare deprivation with infant mortality rates, some signs certainly start to emerge.

Last year there were 3,558 stillbirths; in 2011 there were 3,811 and in 2003 there were 3,612. The stillbirth level has remained persistently high for a long time. One in 200 pregnancies ends in stillbirth, but stillbirths are currently defined in law as being after 24 weeks of gestation, which still means that there are 15 times more stillbirths than cot deaths—the progress on cot deaths was alluded to earlier. The problem with the definition is that it masks the higher number of stillbirths that happen before the 24-week gestation qualification currently in legislation. If a woman gives birth to a stillborn child at 23 weeks and six days or earlier, the child counts not as a stillbirth but as another “miscarriage.”

That was the case for my constituent Hayley, who came to see me and was present when I presented my ten-minute rule Bill in January. She had been through the dual tragic experience of giving birth to a stillborn son at about 19-and-a-half weeks. She had to have her pregnancy induced, and she went through labour. She experienced all the pains and anguish of labour in a hospital for more than 24 hours before giving birth to her son. She and her partner, Frazer, held their son and took handprints and photographs. To all intents and purposes, their son had been born, but sadly born dead. In the eyes of the law, their son did not exist, because he had been born after less than 24 weeks. That child had no recognition in the eyes of the law. Some months afterwards, Hayley tragically went on to have a miscarriage after five or six weeks. Those two experiences were different—that is in no way to belittle the pain, anger and trauma of going through a miscarriage—but in the eyes of the law, they were identical: neither of those children was recognised as having been born.

That is what my Bill is all about. Since introducing it, I have been swamped by the experiences of women and families up and down the country. To take one example, a woman gave birth at about 21 weeks to twins. It might have been slightly more than 20 weeks—I forget now—but it was less than 24 weeks. One of the children was born just alive and lasted for a few hours. The other twin was born dead. As the first was born alive, albeit at less than 24 weeks, that child was recognised. The other twin, born dead, did not exist. How traumatic and cruel is that on the part of the state? Someone gave birth and had two dead children, but only one existed in the eyes of the law. That is why the law needs to change.

I will persist with the Bill well beyond the confines of this Session, when it will expire because of the constraints of this place, until I persuade the Government to take the issue on. It is about fairness and recognition for people who have had to go through trauma, anguish and pain unimaginable to those of us lucky enough to have had healthy, albeit slightly annoying, children. It is not acceptable for those who have lost a child before that child was ever able to breathe then to have the second blow of the state not recognising that child.

My Bill would amend the Births and Deaths Registration Act 1953, but not in a way that says that we should redefine the 24-week limit. I do not want to make it 23 weeks or 22 weeks; this has absolutely nothing to do with abortion thresholds and things like that. I want to make a differentiation between what are clearly miscarriages and instances of when women, to all intents and purposes, go through all the pains and experiences of giving birth to a child. The definition in my Bill of a “stillborn child” does not mean a child born dead from 24 weeks’ gestation onwards, but

“a child which has issued forth from its mother and which did not at any time breathe or show any other signs of life, following the recognised processes of labour including regular, painful uterine contractions resulting in progressive cervical effacement and dilation; and the expression ‘still-birth’ shall be construed accordingly.”

It is a bit technical and a bit physical, but it is a way of giving some comfort to mothers: if they gave birth to a stillborn child, it would be a birth. The Bill would say that they had had a child, that there had not been a miscarriage and that the state should recognise that.

We have not introduced the Bill to meddle with the abortion laws—it has nothing to do with that—and it is not intended to meddle with bereavement leave entitlements or benefit entitlements. The more enlightened employers of someone who has been through such an experience would give the employee some allowance on the time they need to get over the death. For them to receive some sort of closure and to give them the support and relief that they desperately need to be able to move on, the state needs to recognise what they have been through in giving birth to a stillborn child.

At the moment, a hospital or clinical practitioner can issue a certificate of birth. It has no status in law. It is of some comfort to some people, but it is certainly not sufficient comfort for many of our constituents. That is why I am putting forward the changes to the law. They are simple and do not involve a lot of cost, but they would offer huge support, relief and comfort for mothers and their partners who have been through these sorts of experience.

As well as wanting to change the law and calling for better research into why we appear to be so vulnerable to perinatal mortality and stillbirths, we need greater research and better guidance. I do, however, pay tribute to the existing guidance, particularly that issued by the Royal College of Obstetricians and Gynaecologists on recurrent first and second trimester miscarriage, and some of the best practice.

I echo the points that my hon. Friend the Member for Chatham and Aylesford made about foetal alcohol syndrome, which strays slightly beyond the confines of the debate. When I was a shadow Health Minister, I considered the issue. I visited children’s homes in Copenhagen that specialised in children born with foetal alcohol syndrome. In many cases, the child was born to parents from Greenland’s Inuit community, which has high alcoholism rates. A lot of research has been done on that in Denmark.

It is undeniable that a lot of our children are being damaged due to excessive drinking through pregnancy and that an awful lot of that is not being properly diagnosed. In my simple layman’s view, a lot of the symptoms have parallels with autism and the autism spectrum, and there may be links between autism and foetal alcohol syndrome.

The issue is very little researched in this country, but it potentially affects an awful lot of our children, and we need to do much more to identify it. More importantly, we need to give clear, stark, but accessible warnings to women about the practical perils of drinking irresponsibly at all stages during pregnancy. That is not to say that pregnant women must not drink at all, but we need to set out clearly what is and is not tolerable, just as we should for women who smoke during pregnancy.

To make a side point—a point I made during a debate on the Children and Families Bill—I cannot understand why the Government have set criminalising smoking in cars with children in them as a priority, yet have done nothing to criminalise, if that is the principle they want to follow, smoking for pregnant women whose foetuses are in rather more confined spaces than the back of a car. Smoking and drinking are highly damaging to children before and after they are born. People are irresponsible if they do that, and we need a much clearer and more pungent health message to mothers. We need to disseminate best practice better than we do now, whether that is from Scotland or other parts of the country that appear to have achieved some success in reducing some of these mortality rates.

This is a bigger public health crisis than we have given it credit for. I have met constituents and heard some tragic stories from around the country of families who have been through stillbirths and other perinatal mortalities. We need to take this issue much more seriously.

[Jim Shannon (Strangford) (DUP)]

I apologise for not being here on time; I had a Committee to go to. This issue is important to all of us here, as well as to those outside the Chamber. In Northern Ireland, there are four infant fatalities a week. The UK mainland has 17 to 19 infant fatalities a day. Obviously, the populations are different, but that figure tells its own story. Does the hon. Gentleman feel—perhaps it will be in the Minister’s response—that those in the health service should consider why the infant mortality rate is so low in Northern Ireland?

[Tim Loughton]

I agree with my hon. Friend, who is a co-sponsor of my Bill. The hon. Member for East Londonderry (Mr Campbell) made references to Northern Ireland, and earlier in my speech—I think before my hon. Friend entered the room—I did flag up the regional differences between parts of the United Kingdom. Far more research must be done to discover why certain parts of the United Kingdom are affected more or less than others and why women of certain ethnic backgrounds are affected more. We simply do not have the level of research to discover why such things are happening so we cannot better target our resources, as my hon. Friend the Member for Chatham and Aylesford mentioned earlier.

Finally, we need more work on mental health support for women before and after giving birth. There have been too many tragic stories of women self-harming or, in extreme cases, taking their own life and those of their children. We need better targeting of resources and better diagnosis of mental health problems. We need health visitors—I hope we will get the phalanx of new health visitors that the Government have rightly committed to provide—who can work with new parents and get into homes, where there is a much better chance of spotting problems. They can refer on to mental health services or parenting skills classes through children’s centres. That will form an important part of dealing with the epidemic of perinatal mental illness, in particular for first-time mothers.

This is an important subject for constituents across the country. The Minister is sympathetic to the problem and the Government would like to do more. Working with the royal colleges and some of the excellent charities, which have worked tirelessly over many years, we can get a better solution for better support for families who suffer from the pain of infant or perinatal mortality and hopefully do more to prevent the problem from occurring in the first place.

Adult Autism Strategy

Tim Loughton Excerpts

Wednesday 5th March 2014 Westminster Hall

[Mrs Gillan]

I congratulate my hon. Friend’s local charity on setting up that apprenticeship scheme. That is important. When I started looking at autism all those years ago, one of the interesting things I realised was how valuable people on the spectrum can be. They can make a fantastic contribution to businesses right across the board. Apprenticeship schemes should be looked at quite carefully by the Government. If there is an example in my hon. Friend’s constituency, I am sure that the Minister will take it on board and perhaps even arrange a visit to see how it operates.

Adults with autism were still being overlooked by local services back in 2009. They were falling through the gap between learning disability and mental health services, because no one had responsibility for taking a lead locally to ensure that appropriate services and support were being developed for adults with autism.

The diagnosis can become more complex as a person gets older and often needs a referral to a specialist centre, for which out-of-area contracts are often needed. Some local authorities are doing that, but some, I am afraid, are not. That is why the Autism Act was so important. As a piece of disability-specific legislation, it set a legislative framework for that gap to be closed and for the responsibility to improve support for adults with autism to cover every local area.

[Tim Loughton (East Worthing and Shoreham) (Con)]

I congratulate my right hon. Friend. I remember well the Autism Act and the many hoops that she needed to go through to get it passed. I am sure that she is aware of the findings from the National Autistic Society, which said that just one in three people said that, in their experience, social workers had a good understanding of autism. There is a big cliff edge between children and adults, with services completely changing or becoming non-existent when someone reaches 18. Does she agree that, given the big emphasis now being placed on the better training of social workers, particularly regarding vulnerable children, we need to do a lot better with training social workers to deal with adults as well, in terms of the sensitivities and requirements of people with autism?

[Mrs Gillan]

I agree entirely with my hon. Friend. When I come to talk about the actions I want the Minister to take, I will ask him to ensure that local community care assessors have autism training.

--- Later in debate ---

[Mrs Gillan]

Yes. I rely a great deal on statistics from the NAS, which does detailed work in this area. It is still a crying shame that we have wasted capacity and wasted lives in this area, and we should not stand idly by and let that happen.

Having said that, I am gratified by what has been achieved so far in improving the support at the front line. Just for starters, almost all areas now have someone who is responsible for improving services for adults with autism. It might not seem much, but that development alone has been a mighty step forward. I will also highlight some progress in my own constituency of Chesham and Amersham where there are two clinical commissioning groups and they have agreed that one of them will take the lead on autism issues for the whole county, identifying within the two CCGs a GP who will take work on autism forward. That is the sort of activity that I want to see being replicated across the country.

Elsewhere, I know that some excellent and innovative practice has emerged on issues such as training and diagnosis. Sadly, however, as I am sure other colleagues will testify, progress is still patchy and many areas have not made progress as rapidly as we had all hoped for when the Act was passed.

Research by the NAS shows that, four years on from the passage of the Act, many adults with autism are still waiting—unjustly, in my view—for the support they need. Seventy per cent of adults with autism who responded to the recent NAS survey said they are not receiving the help they need from social services, and more than a third of respondents said that they needed help with simply washing and dressing. In addition, two thirds of respondents said they needed help to prepare a meal and 83% said that they needed support to pay a bill or to deal with letters. Those are things that we all do every day of the week, but in the majority of cases adults with autism are unable to get help from their local council to deal with them.

There is also a lack of clarification between low-level and high-level support. Low-level support services are often right for individuals, as they can prevent them from developing more complex problems and therefore can be almost disproportionately cost-effective. My grandmother used to have a saying about such situations: “A stitch in time saves nine.” That is exactly the principle that we should apply in this area.

The impact of such a lack of support is quite clear. The NAS research indicates that a third of adults with autism have developed a severe mental health problem because they lack support. Of course, the statistics vary slightly, but one statistic I will cite is that just 15% of adults with autism are currently in full-time work. We must urge our local authorities to press on, and the necessary support and impetus must come from Government.

The good news is that we are to have a refreshed strategy—it is the Heineken moment for the Minister. I will turn now to the priorities for that refreshed strategy.

[Tim Loughton]

Before my right hon. Friend downs the Heineken, may I take her back to the alarming statistic she just cited about the number of people with autism in full-time employment? Does she agree that there is an onus on businesses to do more, as many of the smarter businesses have done in the past? Those businesses particularly took on board the sensitivities and requirements of people with autism, and considered how they might be encouraged to apply for a job in the first place; many people with autism never even get to that hurdle. Not surprisingly, many of those businesses turned out to be rather good employers, and we need some rather more enlightened employment practices from some more of our businesses.

--- Later in debate ---

[Mr Robert Buckland (South Swindon) (Con)]

It is a pleasure to serve under your chairmanship, Ms Clark. Indeed, it is a pleasure to follow the hon. Member for Strangford (Jim Shannon), who made some powerful points on cross-departmental working. I am glad to see the Minister is here with the lead civil servant on autism from the Department of Health, with whom I have had many conversations about cross-departmental working.

I have a quick example of cross-departmental working in relation to the transition period. We have all had casework in recent years involving 17 or 18-year-olds who are moving away from secondary education into further education and who find that their transition period is, frankly, stymied by lack of clarity on the funding of their FE places. I have had a number of such cases. Last year was particularly problematic in certain instances. That was through no-one’s ill will, but it was a result of the lack of genuine communication and cross-working between those responsible for the funding of further education and the other services that work with young people with autism. They are young adults coming into the adult world, and their first experience is negative. That is not a good sign of what is to come, not only for those young people but for their families and carers. There is a fear that I call the 4 o’clock in the morning syndrome, which is when a parent wakes up and thinks, “My child is young now, but what will happen when they grow up?” We keep having to ask ourselves that question. It is the exam question that I set for the Minister in today’s debate and at every opportunity we have to discuss the strategy for adults with autism.

I pay tribute to my right hon. Friend the Member for Chesham and Amersham (Mrs Gillan) for her sterling work to help to bring the Autism Act to the statute book, which was before I came to this place. The Act means that the autism strategy, which is now being revised, is the core document for local authorities and all providers and commissioners of services across England in working with and providing a proper strategy and service for adults with autism.

I have the pleasure and honour of chairing the all-party group on autism, and I enjoy working with Members from both sides of the House. The all-party group has had significant success in the years since it was founded in 2000 not only in campaigning but in achieving real change for children and adults with autism and their families. As my right hon. Friend said, the Act has, in certain areas of the country, delivered that real change. I am delighted that in my constituency in Swindon we now have not only an autism partnership board, the meetings of which I have attended, but an efficient adult diagnostic service. Our social enterprise, SEQOL, was commissioned to provide that diagnostic service, which is one of the best in the country. We are now able to identify adults in their 50s, who are getting a diagnosis for the first time. That is important for them and is an acknowledgement not only of the questions and issues that they have been raising over the years but that, for far too long, far too many people have lived without any support or diagnosis. Diagnosis, of course, is only the first stage. What comes next is as much a challenge, and it is a question that we need to answer.

[Tim Loughton]

My hon. Friend is a much greater expert than I am on autism. I was one of the founding officers of the all-party group on autism back in 2000, and it has done important work in this area, among the most important of which was our work with schools and local authorities to encourage early diagnosis, joined-up work and greater consistency in how we detect autism in the first place. If we can do that and tailor the school experience to the special needs of people with autism, we will not end up with people not being detected until as late as their 40s or 50s, which means that they miss out on a whole lifetime of support.

[Mr Buckland]

I entirely agree with my hon. Friend. I am grateful to him not only for his work on the all-party group but for his work as shadow children’s Minister and as children’s Minister in this Government. He played his part in ensuring that early diagnosis is a step closer to reality. The Children and Families Bill, which is shortly to be enacted, now incorporates education, health and care into one plan for young people who previously received statements of special educational needs. I am talking about children, but what my hon. Friend says is relevant. If we fail to take those early steps, the problems that manifest in later life become not only more difficult for the adults and their families but more expensive for the state. One example is that adults with Asperger’s are seven times more likely to come into contact with the criminal justice system than those without the condition. Why? Because Asperger’s is still a relatively unknown condition. It is not understood by many agencies that deal with it, and misunderstanding leads to sad results.

--- Later in debate ---

[Mr Buckland]

In a word, yes. GPs would welcome it and it would, at a stroke, deal with a whole range of unidentified problems. With greater awareness among general practitioners, referrals can take place. Where there are existing diagnostic services, as there are in Swindon, they can be used and, as I have mentioned, SEQOL and other organisations in other areas can get to work, using the pathways and identifying the condition.

What is next? What else is needed? I am a great believer in advocacy services, and I can see their power in some excellent local examples. The Swindon Advocacy Movement has recently had more funding to extend its remit to help people with autism and Asperger’s. It is a wonderful organisation, with a one-stop shop in the centre of Swindon that gives support to adults with learning disabilities. Its motto is that it is not there permanently to do things for people, but to empower people to help themselves. With that little bit of help, support and advocacy, lives can be changed for the better, and I see that happening through its wonderful work.

We also have Discovering Autism Spectrum Happiness, a voluntary organisation set up by a group of like-minded individuals some years ago in Swindon. It is now working from the Pinetrees community centre, offering the Swindon autism information and advice service, which is an invaluable resource. It only started last year, and it has already reached out to more than 150 individuals with autism and their families. By its estimate, there might be a couple of thousand of people in the community who have not yet been identified. Through its support work and its network, it is giving advice and empowering people with autism. I had the pleasure of visiting it only two weeks ago to talk about some of the cases that it is finding and some of the cases that are coming across my desk. There is a lot going on in local communities, but there is much more that we can do on an overall strategy to identify best practice, to knit that together in a co-ordinated and coherent way and to give other commissioning bodies and other authorities a gold standard from which they can work.

The Minister knows that I am not into lowest common denominators or prescriptive measures when it comes to this sort of thing, because I believe in localism. There has to be, however, some standard to which all commissioning bodies should work. Like adults who are neurotypical, adults with autism should not be frightened or worried to move about. If they can move to another part of the country to secure employment, they should reasonably expect that autism services in their new town or city will be of a similar standard to where they have come from. When they have a family support network, the tendency is for people with autism to stay close to home, and in many cases that is not a bad thing at all. Bearing in mind the Winterbourne View example, bringing people with a disability closer to home and to their network is a good thing, but there will be many high-functioning people with autism who want to travel, want to move about and want to take that job at the other end of the country. Why can they not do that? At the moment, there is a fear that the support network that they might enjoy in Swindon would not exist in another part of the country. That is the function that the strategy could fulfil; it is an empowerment strategy, not some prescriptive “We know what is best for you, so we will tell you what to do” strategy.

On community autism awareness, I have talked somewhat about advocacy services and information, but I want to talk about the sense of isolation that many with autism and their families feel. In a survey conducted by the National Autistic Society, 82% of adults with autism said that they have days and 42% said that they have weeks when they do not talk to anybody outside their household. Just think about that for a moment. Some 72% said that they have been bullied or discriminated against. A survey by Ambitious about Autism found that 87% of parents and carers of people with autism felt unsupported by the community. Those are stark statistics, but some of the solutions are simple. Small adjustments are all that is needed to change things. In the supermarket, staff are often not trained to know how best to deal with individuals who have autism. In the hairdressers, a few sensory adjustments would allow someone with hypersensitivity to access those facilities. The cinema at Greenbridge in Swindon regularly hosts autism-friendly screenings for children and young people, which make all the difference in the world. Parents at those screenings do not need have to have eyes in the back of their heads or worry about whether their child will be seen as naughty or misbehaving. They can relax, secure in the knowledge that everybody around them is accompanying someone with autism. Such adjustments make a huge difference in the lives of not only the individuals who have autism but their carers and families.

[Tim Loughton]

My hon. Friend is making an important point. The large DIY chain B&Q made a virtue of employing older people and disabled people, who are sensitive to the needs of their older and physically disabled customers. As a result, more disabled or older people tend to shop there than at other DIY chains, because the staff understand them. There is a commercial advantage in training and employing staff who have greater sensitivity to, and experience of, autism and other learning disabilities.

[Mr Buckland]

That is a powerful point. Employing older people and disabled people is good not only for business but for employment. Doing so is not simply about being a kind employer; it is about being savvy. We have already heard about the huge potential that those with autism, Asperger’s and related conditions offer. They have qualities and gifts that we do not have, and they have incredible resources. If we only empower them, they can show us what they are capable of.

Children and Families Bill

Tim Loughton Excerpts

Monday 10th February 2014 Commons Chamber

[Jane Ellison]

My understanding is that if a nicotine-containing product is licensed for medicinal use—licensed as a quit-smoking tool—it can already be prescribed by doctors. Some e-cigarette manufacturers have already indicated that in order to make a medicinal claim about their product’s ability to help people quit, they will seek to use the medicines regulations. If such a product becomes licensed as a medicine, it will be able to be prescribed as a smoking cessation aid in the same way that other nicotine-containing products can be. I hope that answer is helpful.

On proxy purchasing, we believe we must take action to address both the supply of and demand for tobacco products among young people if we are to reduce the uptake of smoking. Many retailers over the years have felt a little left alone to bear the burden of enforcement in this area, so I welcome both the work of responsible retailers to ensure that tobacco is not sold to people under the age of 18, and the support provided to them by retailer bodies such as the Association of Convenience Stores. There is support in both Houses for creating a proxy purchase offence for tobacco, and the Government have carefully reflected on the arguments that have been made. Retailers feel it is unfair that it is an offence for retailers to sell cigarettes to children and young people, yet there is no offence of proxy purchasing on behalf of children and young people. Retailers also feel it is inconsistent to have a proxy purchase offence for alcohol but not for tobacco. The Government want to continue to tackle the access that young people have to tobacco, which is why we have proposed this amendment.

The provisions would make it an offence for an adult to buy, or attempt to buy, tobacco for someone under the age of 18. That will be enforced by local authority trading standards officers, who will be able to issue a fixed penalty notice if they believe an offence has been committed, rather than taking prosecution action in the first instance. Local authorities will not be required to carry out regular programmes of enforcement in the way they have to on age of sale of tobacco, so we do not believe that this offence will bring into place any significant new regulatory burdens. Local authorities know their communities better than anyone and will know how best to address their public health priorities. We have devolved wide public health responsibilities and ring-fenced budgets to local authorities, and this amendment allows them to take targeted enforcement action on proxy purchasing where they consider it is needed.

The arguments relating to effective enforcement have been well rehearsed in previous debates. Experience in Scotland suggests that we should not to expect a vast number of convictions, and we should not measure the success of this new offence by the number of prosecutions or fixed penalties issued. I expect, however, that the new offence will generate worthwhile deterrent effects. As I said, in a new public health landscape where more powers are devolved to directors of public health there may be opportunities to explore work where there is a particular local problem.

Finally, I will address the issue of smoking in private vehicles carrying children. In another place an amendment was agreed to enable the Government to make regulations to make it

“an offence for any person who drives a private vehicle to fail to prevent smoking in the vehicle when a child or children are present”.

The amendment we are debating today was drawn up by the Government, with the support of the peers who tabled the initial amendment, to deliver the intention of the amendment in a legally workable way. We have a responsibility to be sure that any amendment that could make its way on to the statute book should work in practice. The technical amendment was agreed on Third Reading in another place.

[Tim Loughton (East Worthing and Shoreham) (Con)]

My hon. Friend says that she wants this to be workable. If a 17-year-old was driving a car and smoking at the same time, but nobody else was in the car, would they be guilty of an offence?

[Jane Ellison]

We have been discussing the issue earlier today, but we will look in more detail at that sort of detail when the House has voted on the principle of this and we have the view of both Houses. Today, the House is examining the principle, not detailed regulations, which would need to be brought forward and which would be subject to the affirmative resolution.

--- Later in debate ---

[Luciana Berger]

I shall come on to talk about measures on vehicles that were introduced in the 2006 Act. Lords amendment 125 refers specifically to private vehicles.

I also welcome Lords amendments 122 and 123, which deal with nicotine-containing products. I agree with the Minister that it is sensible to prohibit the sale of e-cigarettes to under-18s. E-cigarettes can help smokers who are trying to quit, but they should not be available to children, especially when there are so many question marks about the long-term health effects of nicotine and when concern has been expressed that e-cigs might act as gateway products that could lead some young people to take up tobacco smoking.

I am especially pleased to support Lords amendment 121, on proxy purchasing, which will prevent adults from buying cigarettes on behalf of children. Labour proposed that policy by tabling amendments in the other place last year. It is already illegal to buy alcohol on behalf of under-age children, so it does not make sense that the same offence does not apply to tobacco products given that, if they are used as directed, they kill half of all lifetime smokers. I am glad that the Government now agree with us, but I hope that the Minister will be able to share with hon. Members the Government’s rationale for introducing a maximum fine of £2,500, given that the equivalent penalty for the alcohol offence is £5,000.

Let me turn to Lords amendment 125 and the question of protecting children from adults smoking in cars. I pay tribute to everyone who has campaigned for such a measure, especially the British Lung Foundation and my hon. Friend the Member for Stockton North (Alex Cunningham). I also applaud my noble Friend Lord Hunt of Kings Heath, who tabled the original amendment. Since that amendment was successfully passed, the Government have laid out how that Labour proposal could be written into law. In the final analysis, the decision before the House comes down to a simple question: if we know beyond doubt that passive smoking in an enclosed space can do serious harm to a person’s health and that hundreds of thousands of children are being subjected to passive smoking in a car every single week, and if we know from our experience of similar laws passed in this country and others that legislation can have a major impact by changing behaviour and improving public health, should we act and do something, or stand by and do nothing? We say that we cannot afford not to act.

[Tim Loughton]

By that same token, does the hon. Lady concede that we should criminalise pregnant women who smoke, on the basis that their child is in an even more confined space than a car?

[Luciana Berger]

We are considering a specific provision, but if the hon. Gentleman wants to bring forward further measures, I am sure that the House would wish to debate them. We are talking about children who do not have a choice when travelling in a car.

We all know the dangers of passive smoking, but the reality is that its worst consequences are inflicted predominantly on the very youngest in our society. Children are especially vulnerable to the dangers because they have smaller lungs and faster breathing rates than adults.

--- Later in debate ---

[Mr Steve Reed (Croydon North) (Lab)]

I met the school council at Broadmead primary school in Croydon last Friday and I took part in a school assembly at Norbury Manor primary school this morning. I asked the children what they thought of the proposal to ban smoking in cars that are carrying children like them. Every single child supported the ban. When I asked how many of them had been inside a car when an adult was smoking, nearly half the children put their hands up. I asked one little girl what she did when she was in a car and an adult was smoking. She held her nose and told me that she tried not to breathe.

Although those children hated the experience of being forced to breathe in cigarette smoke, they did not understand the damage that it does to their health. The Royal College of Paediatrics and Child Health and other professionals estimate that up to 160,000 children a year develop lung diseases, including asthma and bronchitis, as a result of breathing in second-hand cigarette smoke. Developing lungs are far more susceptible to smoke-related disease than those of adults. That raises the question of why we protect adults in the workplace, on public transport and in pubs from the dangers of second-hand smoke, but subject children to it in cars.

I have listened carefully to the arguments against this proposal, but I find very little merit in them. The idea that this measure is an example of the illiberal nanny state is misguided. Law making is often about striking a balance between competing rights. On what balance of rights does the right of a smoker to smoke outweigh the right of a child to grow up healthy? I do not accept that an adult should have the right to harm a child who is powerless to protect him or herself. An adult who is in a car with a smoker can get out if they want to. Often, a child cannot.

To those who say that the measure is unenforceable, I say that we heard exactly the same about the seat belt law. Education in this case has clearly not worked well enough. We need to change behaviour. That requires a strong education campaign but, crucially, that needs to be backed up by law to show how seriously the country takes the issue and to create a sufficiently powerful deterrent.

We have taken many steps to protect people from passive smoking. Without this further measure, too many children will be left struggling to avoid breathing in smoke in the back of cars and, far worse, could find themselves struggling with lung disease in later life. It is our duty today to act to protect them.

[Tim Loughton]

I am a veteran of many children’s Bills. Yet again, such a Bill has been hijacked at the 11th hour by a subject that was not part of the original Bill. Usually, the subject is smacking; today, it is smoking.

I hate, loathe and detest smoking. I do not want any of my children or anybody else’s children to smoke. However, I also hate, loathe and detest the nanny state and its increasingly frenetic and insidious tentacles, which are creeping into individuals’ private lives and spaces.

I support many other measures that will suppress smoking and reduce the prevalence of smoking. I am for in-your-face, horrific graphics that show people the ghastly things that smoking does to their insides. I am in favour of higher tax. I am in favour of pariah status for people who smoke. I have no problem with the Lords amendments on packaging and on discouraging people from buying tobacco for under-age people.

However, I am against a measure that yet again undermines the parenting role of parents in favour of the state. The state makes for a poor parent. This measure will criminalise good parents, as my hon. Friend the Member for Broxbourne (Mr Walker) said. People should not smoke in front of their children, whether they are in a car, outside a car, in a house or wherever else, not because the state threatens them with a fine or a criminal record, but because it is a stupid thing to do. I will not quite use the language of the hon. Member for North Antrim (Ian Paisley), but it is stupid on so many levels. We should have much more empathy towards the health and welfare of our children, but we should support parents, not seek to supplant them, as the state has an increasing tendency to do and is trying to do yet again with this amendment.

If we are serious about this measure, we should have the courage of our convictions and ban smoking altogether. There is only one way that this legislation can go, and the natural conclusion is that there will be a ban on smoking in private homes. As I said earlier—not entirely facetiously—we must face the logic that pregnant women who can do untold damage to their unborn children through smoking and through foetal alcohol syndrome, which affects one in 100 children with very serious consequences, should be criminalised for doing the same thing in principle that this amendment tries to criminalise. Then there are the implications of not feeding our children healthy food. The amendment is unenforceable. It is bad law and is about supplanting, not supporting, the parent, and I cannot support it.

[Mr Winnick]

There is the notion that this amendment on the safety of children in cars is an attack on freedom, but as my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) rightly said, a model society will always need to put various restrictions on what individuals can and cannot do.

Reference has been made to seat belts, and it so happens that I was in the Chamber during the debates on that. I imagine that if the hon. Member for Shipley (Philip Davies) had been present at the time, he would have argued strongly against compulsory seat belts in cars—of course he would have because when I was listening to him today, I heard the authentic voice of primitive Toryism.

Early Childhood Development

Tim Loughton Excerpts

Thursday 30th January 2014 Westminster Hall

[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.

--- Later in debate ---

[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.

[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.

--- Later in debate ---

[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.

Oral Answers to Questions

Tim Loughton Excerpts

Tuesday 22nd October 2013 Commons Chamber

[Dr Poulter]

The right hon. Lady makes a good point. We want improvements to the procurement process not just to save money, so that hospitals have more money to spend on the front line, but to support small and medium-sized businesses appropriately, such as by simplifying the qualifying questionnaire process, which is often too complex for small businesses to become involved in and therefore rules them out of the market. There are a lot of good things and I am happy to meet her to discuss the matter further if she would like.

[Tim Loughton (East Worthing and Shoreham) (Con)]

The Secretary of State knows Worthing hospital well; he has rolled his sleeves up there. When I went there a few weeks ago, I was told that the average age of patients in the hospital, stripping out maternity, is 85, yet we have qualified for no winter pressures money and we have a diminishing number of community hospital beds. Will he look into this anomaly, as he well knows the specific pressures we have on the south coast?

[Mr Hunt]

I understand my hon. Friend’s concerns and I know that there is a large elderly population in Worthing. I thought it was an excellent hospital with a fantastic atmosphere when I went and did part of a shift there. The winter pressures money went to the third of A and E departments that are struggling the most, so it is probably a compliment to his hospital that it did not receive it. We felt that with limited funds we had to concentrate resources where they were going to have the most impact. I hope that he understands why we had to make that difficult decision.

Oral Answers to Questions

Tim Loughton Excerpts

Tuesday 23rd October 2012 Commons Chamber

[Anna Soubry]

My information is that any 40% reduction is a result of cuts in administration—and that, if I may say so, seems the right way to go about things. This Government are determined to make sure that when we make cuts of that nature, they are not actually cuts—[Interruption.] It is about moving money around so that it goes to front-line services. This Government are determined to reduce bureaucracy in the NHS and to make sure that patients get the benefit of our spending—unlike under the last Administration, who had it round the other way.

[Tim Loughton (East Worthing and Shoreham) (Con)]

11. What steps he is taking to deliver better access to mental health services for school-age children.

[The Minister of State, Department of Health (Norman Lamb)]

The children and young people’s improving access to psychological therapies project, which we introduced in 2011, is about transforming mental health services for children and young people with mental health conditions. The Government’s mental health strategy implementation framework, published in July, suggests actions that schools, colleges and children’s services can take to provide better support.

[Tim Loughton]

The Government should be congratulated on tackling the stigma of mental health by their “No health without mental health” policy, but the growing problem of mental illness among school-age children is a concern and with the demise of the early intervention grant, which included the targeted mental health in schools funding, there is a worry that too many schoolchildren will be neglected. Will the Minister liaise with the Department for Education and with school nurses to make sure that appropriate and timely access to talking therapies and others are available for school age children rather than having to rely on the belated chemical cosh of powerful drugs?

[Norman Lamb]

May I first pay tribute to my hon. Friend’s work in this area? He has been really impressive and dedicated in his work. I absolutely agree with him about the importance of ensuring access to mental health services for children and adolescents. In fact, the Government are investing over £50 million over a four-year period through the children and young people’s improving access to psychological therapies programme and, critically, involving schools and colleges in that work. I would be very happy to work with my hon. Friend to improve access for children and young people.