Health Visitors (England)

Tim Loughton Excerpts

Wednesday 23rd October 2019 Westminster Hall

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

I beg to move,

That this House has considered the reduction in the number of health visitors in England.

I am grateful to the hon. Members who have come to speak on this important subject. I declare an interest as the chair of the all-party parliamentary group for conception to age two—the first 1,001 days. I also chair the board of trustees of the Parent-Infant Foundation, which runs attachment facilities and lobbies for better early intervention around the country.

I will start with some slightly alarming statistics. The cost of perinatal mental ill health in this country has been worked out at £8.1 billion per annum, according to the Maternal Mental Health Alliance, with up to 20% of women experiencing some form of mental health problem during pregnancy or the first 12 months after birth. The cost of child neglect in this country has been estimated at some £15 billion, with 50% of all maltreatment-related deaths and serious injuries occurring to infants and babies under the age of one. We currently spend in excess of £23 billion getting it wrong in those early years, particularly for mums and new babies. That is equivalent to something like half the defence budget.

There are 122,000 babies under the age of one living with a parent who has some form of mental health problem. Amazingly—this statistic came out time and again during conversations on the Domestic Abuse Bill—a third of domestic violence begins during pregnancy, and suicide is one of the leading causes of death for women during pregnancy or in the year after giving birth. About 40% of children in the United Kingdom have an insecure attachment to a parent or carer at the age of 12 months, according to Professor Peter Fonagy and others. Alarmingly, there is a 99% correlation between a teenager experiencing some form of mental illness or depression at the age of 15 or 16 and his or her mother having had some form of perinatal mental ill health during pregnancy. It is that close a correlation, making it that much more important that we make sure that the mums bearing those children, and also fathers, are as happy, settled and healthy as possible in those early stages, from conception to age two.

[Luciana Berger (Liverpool, Wavertree) (LD)]

The hon. Gentleman set out the costs incurred in trying to prevent such travesties. Does he agree that the figures he refers to are actually conservative estimates? I believe that he was at the launch, quite a number of years ago, of the Maternal Mental Health Alliance, which arrived at the figure of more than £8 billion. Is it not the case that, although the economic costs are significant, it is the social and moral reasons that have brought Members from both sides of the House here for this important debate?

[Tim Loughton]

If the hon. Lady is patient, I will come on to the social impacts. I think the MMHA report came out in 2014 or 2015, so obviously things will have moved on, although the birth rate has slightly fallen in that time as well. These are substantial financial figures, but as she says, most important are the social impacts and the impact on the child.

On the physical impacts, our childhood obesity rates are among the worst in Europe, while breastfeeding rates in the United Kingdom are among the lowest in the world. We have rising emergency department attendances by children under the age of five, and infant mortality reductions have recently stalled. Just last week, we had the worrying figures about the dwindling vaccination rates in England in particular, with only 86.4% of children having received a full dose of the MMR vaccine. We have effectively lost our immune status, because the World Health Organisation vaccination target to protect a population from a disease is 95%.

The Children’s Commissioner estimates that, in total, 2.3 million children live with risk because of a vulnerable family background, but that, within that group, more than a third are effectively invisible and not known to services and therefore do not get any support. We are talking about an expensive and widespread problem.

[Stephen Lloyd (Eastbourne) (Ind)]

I pay tribute to the remarkable work of health visitors in my constituency. Does the hon. Gentleman agree that cutting the health visitor service by 30% over the last few years has clearly made it even harder for the profession and for the families and mums that they take care of?

[Tim Loughton]

Again, I ask the hon. Gentleman to be patient, because I will come on to all that. I realise that he wants to put on the record his tribute to health visitors in Eastbourne, as do I—as someone who was born in Eastbourne and had wonderful health visitors, I am sure, albeit 57 years ago now.

The one thing that all these problems, and a lot more problems I have not mentioned, have in common is that they come under the remit of the health visitor, to some extent or other. The health visiting service provides an important safety net for infants and young children—as well as mums and dads—who are at particularly high risk of having their needs missed, as they are not visible in the same way as children who are accessing an early years setting or a school, for example.

[John Howell (Henley) (Con)]

Will my hon. Friend give way?

[Tim Loughton]

Another one? Yes, why not?

[John Howell]

My hon. Friend is making a very good speech—

[Tim Loughton]

But hon. Members keep interrupting it!

[John Howell]

I am very pleased to briefly interrupt him my hon. Friend. I pay tribute to the health visitors in my constituency. Is it not an important role of theirs to ensure that health inequalities are drummed out of the system?

[Tim Loughton]

That is a serious point; my hon. Friend is absolutely right. Health inequalities are still a big problem in this country, and those professionals on the ground, not least health visitors, are the first to come face to face with them and have the practical means, in many cases, to do something about them.

[Karen Lee (Lincoln) (Lab)]

Will the hon. Gentleman give way?

--- Later in debate ---

[Tim Loughton]

I am happy to take interventions, but it will mean that hon. Members will have to make shorter speeches, as I am sure Mr Bone will point out.

[Karen Lee]

The Royal College of Nursing’s briefing for the debate says that the number of health visitors with caseloads of more than 500 children rose from 12% to 21% between 2015 and 2017, so it will have risen even more in the two years that have elapsed since. The caseload is really worrying, in terms of people being missed.

[Tim Loughton]

The hon. Lady pre-empts a point I was going to make on page 5 of my notes, so I will take that bit out.

Unlike some other public service professionals, health visitors are non-stigmatising and usually welcomed over the threshold into homes, enabling them to give early advice and support to prevent later problems, encourage healthier choices, detect problems early and, in some cases, act as an early warning safeguarding alarm. Often when social workers are the ones to knock on the door, it may be too late, and that professional has a completely different sort of relationship with the family.

[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

I am grateful to the hon. Gentleman for securing this timely debate. What he just said is so important. The mandatory health visitor contacts in my constituency are not taking place as they should. When constituents complain or I complain, we are essentially told that they are profiled based on risk, which is clearly not how a mandatory set of contacts should work. I worry that we sometimes make assumptions about socioeconomic status or other factors, whereas the kind of problems we are talking about can manifest themselves in any family. If we are serious about having a mandatory system, should it not be that, rather than discretionary? If it is about capacity, let us talk about that.

[Tim Loughton]

Again, the hon. Gentleman makes a good point, which was on page 5 of my notes. This issue affects everybody across society, often better-off, more affluent families who might be better at hiding it or less inclined to come forward to seek help. The charity that I chair has units in Liverpool, Newcastle, London and so on, and we see that middle-class parents who have serious attachment dysfunction problems with their children are less likely to come forward. Those, ironically, may be harder-to-reach people. Health visitors are the early warning system and are able to signpost some of those people to services. They can also point out, “I think you have a problem,” and it will be taken on trust.

I appreciate the good points that have been made, but I will make some progress. The cost of failing to intervene early is enormous—financially and, more importantly, socially. The impact of not intervening early can disadvantage a child through early years, school years, adolescence and often into adulthood. In some cases, it can be life-defining.

One of the great achievements of the coalition Government was to pledge a massive increase in health visitors. In opposition, the then shadow Health Minister, Andrew Lansley, championed the recruitment of no fewer than 4,300 new health visitors, based on the successful model of the Dutch Kraamzorg system—I was involved in research into that—where post-natal care is provided to a new mother and her baby an initial eight to 10 days immediately after birth.

Four years ago, the Government’s health visitor implementation plan and the “Call to action” scheme were the pride of the nation. The policy was built on sound evidence that the health visiting profession had the power to drive health improvements and provide a universal service designed to give every child that best possible start in life, as we all want to see. Impressively, for a Government target, it was achieved—just about—in the lifetime of the 2010 to 2015 Parliament.

Depressingly, since then, the numbers have started to drop dramatically. In June 2015, there were 10,042 full- time equivalent health visitors in England. A year later, that had fallen to 9,491 and the latest figures show a 31% drop from the peak. According to the Institute of Health Visiting,

“one in four health visitors do not have enough time to provide postnatal mental health assessment to families at six to eight weeks, as recommended by the government.”

In response to a survey that the institute put out,

“three quarters of respondents said they are unable to carry out government recommended maternal mental health checks three to four months after birth.”

That is a crucial stage at which to pick up mental health problems with the parents, which may already be impacting or will impact on the infant. It is not only about looking after the baby, but the family unit and particularly the prime carer.

To a large extent, the reason for that has been the transfer of responsibility for health visitors from the health service to local government, as part of its enhanced public health responsibilities. I am not challenging the wisdom of doing that, but it has come at the time of the greatest squeeze on local government spending recently. The architecture of the delivery of health and wellbeing services for babies and young children, I think, has been fragmented in a disorienting manner between local councils, Clinical Commissioning groups and NHS England, with insufficiently qualified scrutiny of how it works. There is an issue around the quality of informed local authority oversight over many of these public health roles.

[Steve Brine (Winchester) (Ind)]

I congratulate my hon. Friend on securing this debate. He has been consistently right in this area. My research ahead of this debate presented a worrying picture from GPs in Winchester, who report a distant relationship with health visitors. That is not their fault; it is because health visitors are so thinly spread. Does he agree that as well as providing more health visitors, it would be smart to address where they sit in the system and, maybe, to co-locate teams around the emerging primary care networks?

[Tim Loughton]

First, I pay tribute to the real acknowledgment of the importance of this area by my hon. Friend when he was public health Minister. He was always prepared to take our sometimes annoying approaches to prioritising the issue. He may be right. I am not too concerned with processes and structures; I am concerned with getting the professional face to face with the parent and baby. We need to be smarter about where we can make that engagement happen and ensure it is not through lack of workforce that we are unable to do it.

[Steve Brine]

rose—

[Tim Loughton]

If my hon. Friend wants to intervene again, he may, but it will eat into his own speech time.

[Steve Brine]

The issue is important because the primary care networks and the GPs who rightly run them are responsible for the outcomes of the patients they manage within those lists. If they had ownership of those health visitors, because they were commissioned within that structure, they would have every incentive to close the distant relationship that I mentioned.

[Tim Loughton]

My hon. Friend may well be right. One of my constituents is a health visitor. According to her, the current status of health is not serving families well, based, as it is, on universally delivered process outcomes, which risk, to use a phrase she quoted to me, “ticking the box but missing the point”. That plays to the point my hon. Friend is making.

To illustrate the most successful ways of dealing with vulnerable families, I will use children’s centres as an example, although I will not get into a whole argument about them. The most successful ones that I have seen are those where hot-desking occurs between a district nurse, a health visitor, a social worker, a school nurse and others, who are all signposting. The health visitor may get over the threshold and say, “I am a bit worried that there is a mental health problem there. When I go back and see the community mental health nurse at the children’s centre, I might suggest she has a word.” That is the way it must happen. These are interlinking problems and it is not just down to one professional to treat them.

On the local authority, public health budgets have seen a significant reduction from 2015. The recent 1% increase for 2021 is welcome, but there is a long distance to go to replace some of the past reductions. Some areas have suffered disproportionately. I want to flag Suffolk, where, I gather, the council has been considering plans to slash the health visiting workforce by 25% to save £1 million. I think that is a false economy and short-sighted.

The decline in the number of health visitors since 2015 has been due to qualified nurses retiring or moving to other roles within the health service and too few trainees entering the profession. Alongside workforce cuts by local authority commissioners, the health visiting profession is also facing recruitment and retention problems, falling staff morale and poor progression opportunities. Health visitors have also raised safeguarding concerns as their caseloads increase to meet increasing need and cover shortages.

In a 2017 survey by the Institute of Health Visiting, health visitors reported that children are put at risk due to cuts in the workforce and growing caseloads, finding that 21% of health visitors are working with caseloads of over 500 children, as the hon. Member for Lincoln (Karen Lee) pointed out.

[Jeremy Lefroy (Stafford) (Con)]

When health visitors visited me in my constituency surgery in Penkridge, their frustration was that, although they love their job and want to do it properly, they cannot do it to the best of their professional satisfaction, because of the caseloads and because there were too few of them. Health visitors want to serve my constituents—the mothers, families and children—but they cannot, for those reasons. I had huge respect for their professional attitude, but it showed their real sorrow that they could not do the job as well as they want to.

[Tim Loughton]

My hon. Friend is absolutely right. I have met many health visitors. They are a fantastic resource and do huge amounts of good work well beyond their remit. They are frustrated by some of the processes and financial considerations that are stopping them from doing their job to the best of their ability with sufficient support.

[Dr David Drew (Stroud) (Lab/Co-op)]

Will the hon. Gentleman give way?

[Tim Loughton]

This is the last intervention I will take, and I will finish shortly.

[Dr Drew]

One of the greatest frustrations is when families do not let the health visitors in, which is a growing trend. They come back time after time and they find there is nobody there or, if the people are there, they will not let them in. Does he agree that that is a very worrying development?

[Tim Loughton]

Earlier, I raised the contrast with social workers where there is a safeguarding issue. It is a completely different dynamic and relationship. There is a reluctance to let the social worker over the threshold. That is less the case with health visitors, because they are seen to be there to help. But there is a reluctance from some people, perhaps due to ignorance as to what the health visitor is there to do from people who think, “I know it all; I don’t need you,” or due to people who may fear that their vulnerability will result in their child being taken into care. That is why that friendly face is so important. The health visitor is on their side to help them in being a new parent, in a way that other professionals cannot be.

According to the state of health visiting survey by the Institute of Health Visiting, one in four health visitors did not have enough time to provide the post-natal mental health assessments to families at six to eight weeks, as recommended by the Government; the hon. Member for Stalybridge and Hyde (Jonathan Reynolds) mentioned that. These PMH checks are a key part of the Government’s maternal mental health pathway. Previous research involving clinical trials with 4,000 mothers found that those who received health visitor support were 40% less likely to develop post-natal depression after six months.

There are five mandated reviews under the healthy child programme that health visitors undertake. While those are spread across the first 1,001 days, they are concentrated in the first 12 months. Health visitors are concerned that the number of reviews is insufficient and leaves too large a gap between contact with families. Not enough scheduled reviews are happening, and we probably need more reviews intensively at those early stages.

There was also a lot of concern about steps being taken to help recruitment. I tabled a question earlier this week, which the Minister kindly answered. I asked

“the Secretary of State for Health and Social Care, what steps he is taking to reverse the fall in the number of health visitors.”

She replied in a written answer, saying that

“Since 2015, local authorities have been responsible for the commissioning of services for zero to five-year-olds and as such, they determine the required numbers of health visitors based upon local needs.”

We understand that. She continued:

“A Specialist Community and Public Health Nurse apprenticeship (Level 7) is currently in development. This will offer an alternative route directly into the health visiting profession.”

I am afraid that that answer raised some alarm among people at the Institute of Health Visiting, and the response to it that I got back was to point out that

“The apprenticeship route is not an alternative route directly into health visiting. Applicants still need to be nurses or midwives and the course presents a number of risks: it is longer, the end point assessment delays qualification unnecessarily…it does not deliver a national strategy for the profession. HVs”—

that is, health visitors—

“who are not employed by the NHS do not have the same opportunities to those covered by the NHS People Plan—this includes NHS funding for CPD”—

that is, continuous professional development—

“leadership development, pay rises, safer staffing and national action to address recruitment/retention difficulties.”

It also pointed out:

“Local Authorities determine the level of HVs dependent on local need, however there is no measure of quality of service or guidance on how far the service can ‘flex’ to meet those needs.”

In addition, the apprenticeship is still not ready to be rolled out; it takes longer than current training; and it is more costly and therefore less attractive to employers and/or recruits.

An urgent workforce plan is needed to tackle dwindling health visitor numbers. I have spoken to representatives of the Local Government Association. They are very concerned about this situation; as representatives of local government, they want to get their public health role right. The LGA said that

“it had offered to work with the Department of Health and Social Care, the NHS and Health Education England to help deliver a plan that would see the ‘right number’ of training places commissioned. It would also develop new policies to ensure health visiting remained an ‘attractive and valued’ profession.”

I hope that the Minister is receptive to that offer; I am sure she is.

What needs to be done? Again, we need to value the role of the health visiting profession. I am sure that all of us in this Chamber and beyond would want to do that, but we have to will not only the inclination but the means as well.

A publication by the Institute of Health Visiting, “Health Visiting in England: A Vision for the Future”, makes 18 sensible and practical recommendations, and they all involve some investment. I will touch very quickly on a few. The institute wants to see

“urgent and ring-fenced public health investment…A review of 0-5 public health funding…to cover the cost of delivery of the Healthy Child Programme in full in all Local Authorities in England.”

All local authorities in England will need that funding. It goes on to say:

“As we await the refreshed Healthy Child Programme, as an interim measure, the proposed metric should be a floor of 12,000”—

that is, 12,000 full-time equivalents—

“to restore the workforce to the target figure calculated for the Health Visiting Implementation Plan, 2011-2015…New National Standards for health visiting are needed to support consistency within the profession. The title ‘health visitor’ and its role should be protected and restored to statute. A review of health visiting training with a risk assessment of the impact of the removal of Health Education England funding of training and replacement by the use of the Apprenticeship Levy.”

Frankly, those are sensible measures. I very much hope that the Minister will look at them positively; I am sure she will. It would be a false economy not to do these things. They need to be part of a bigger shift in Government policy—the policy of any Government; I may be pushing at an open door—towards an earlier, more intensive, preventive intervention approach, from conception to the age of two especially. Health visitors are absolutely at the centre of that.

[Several hon. Members rose—]

Baby Loss Awareness Week

Tim Loughton Excerpts

Tuesday 8th October 2019 Commons Chamber

[Caroline Dinenage]

I am grateful to my hon. Friend for raising that point. He is absolutely right that we need to give that area a lot more attention. Having that ability to spend time together will be an incredibly valuable and important part of the process of grieving and coming to terms with the unbelievably tragic death of a baby.

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

On the question of raising awareness, a job that was so ably started by my hon. Friends, the Minister will be aware of my Civil Partnerships, Marriages and Deaths (Registration etc) Act 2019, which became law in May, two parts of which relate to stillbirth. One gives the Secretary of State the power to have coroners investigate stillbirths and the other sets up a review by the Secretary of State to look into the registration of pre-24-week stillbirths. That review body has not met for over a year, so can the Minister update us on when the legislation will be laid so that, for the first time, coroners will have the power and ability to investigate stillbirths where they see fit to do so?

[Caroline Dinenage]

I am grateful to my hon. Friend for raising that matter, because he brought forward a really important private Member’s Bill. The consultation concluded on 18 June after receiving over 350 responses. Officials are currently analysing all those responses and will report as soon as possible.

Much has been achieved since 2015 to improve the quality of bereavement care for parents, and I put on record the efforts of the all-party parliamentary group on baby loss, ably led by my hon. Friend the Member for Eddisbury with support from Members on both sides of the House. I will speak more about developments in bereavement care in a moment, but first I would like to talk about some of the progress made by the NHS on improving safety and reducing baby loss in maternity and neonatal services.

I cannot continue any further without putting on record my enormous thanks and gratitude to my right hon. Friend the Member for South West Surrey (Mr Hunt), who has done more than anybody to further the cause of patient safety and to investigate the untimely deaths of babies, and across the NHS. I thank him from all of us for his incredible work in that space.

Members will be aware of the Government’s ambition to halve the rates of stillbirths and neonatal deaths by 2025, with an interim ambition to achieve a 20% reduction in those rates by 2020. The ambition includes similar reductions in maternal mortality and serious brain injuries in babies during or soon after birth, and a 25% reduction in the pre-term birth rate from the current 8% to 6% by 2025.

This ambition was set in November 2015, when the Lancet stillbirth series ranked the UK 33rd out of 35 high-income countries for stillbirths. Case reviews of stillbirths and neonatal deaths suggest that many such deaths might have been prevented by better clinical care, and the Morecambe Bay investigation report made 44 recommendations for improving the safety of maternity services.

In 2016-17, the Department of Health launched a range of initiatives that are being delivered by the NHS under the auspices of the maternity transformation programme, and I would like to mention a few of those achievements. Every NHS trust with maternity services now has a board that includes obstetric and midwifery safety champions to lead the development of an organisational safety culture. Every trust has received a share of the £8.1 million maternity safety training fund, and 30,945 training places for multidisciplinary teams were delivered in 2018-19, with courses focusing on training for childbirth emergencies in labour wards and in the community, as well as on leadership, communication and resilience.

Evaluation of the “Saving Babies’ Lives” care bundle found that clinical improvements such as better monitoring of a baby’s growth and movement in pregnancy, as well as better monitoring in labour, mean that maternity staff have helped to save more than 160 babies’ lives across 19 maternity units. An estimated 600 stillbirths could be prevented annually if all maternity units adopted national best practice. A revised version of the care bundle is currently being rolled out across England, and it includes elements to reduce the number of pre-term births and to optimise care where pre-term delivery cannot be prevented.

Women’s Mental Health

Tim Loughton Excerpts

Thursday 3rd October 2019 Commons Chamber

[Wera Hobhouse]

I could not agree more. We need a strategy. More than half of women who experience mental ill health have a history of abuse, meaning that their conditions are rooted in experiences of gender-based violence. In yesterday’s moving debate, we heard many harrowing examples of that. We have a long way to go if we are to change the whole culture around domestic violence and treat its consequences. When it comes to treatment, we must ensure that frontline mental health services for women are trauma-informed. There is a legal framework that we could use; it is called the Istanbul convention. We signed up to it back in 2012, but so far we have failed to bring it into domestic law.

One consequence is that we do not have enough rape crisis centres across the country. Earlier this year, Fern Champion, a survivor of sexual violence, came forward after being turned away by her local rape crisis centre. She launched a petition asking the Government to ratify the Istanbul convention, which has so far received 171,000 signatures. It is hard to suggest that we can do the groundwork to support women and their mental health challenges effectively when there are fewer than 100 rape crisis centres across England and Wales. This is simply not good enough if we are to support women effectively and prevent them from developing serious mental health problems after suffering abuse. Ratifying the Istanbul convention would mean that the UK was upholding international standards on survivors’ rights.

Earlier this year, I tabled a Bill that would guarantee mothers a health check-up six weeks after giving birth. Depression before, during and after birth is a serious condition that is unrecognised and untreated for nearly half of new mothers who suffer from depression. Statistics suggest that mothers are afraid to speak up, and 47% of new mothers get less than three minutes to discuss their mental health with a healthcare professional. Conversations about the reality of motherhood and perinatal depression are still few and far between. This is a huge problem—and not just for the mother; undiagnosed mental health problems in mothers have serious consequences for the newborn child and their development.

I have been campaigning for better treatment of eating disorders. Eating disorders disproportionately affect women, although they do not discriminate. Women in the LGBTQ community are particularly susceptible.

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

I am absolutely in accord with the hon. Lady. Before she gets off the subject of perinatal illness, she will agree, I am sure, that it is a shocking statistic that in the UK, suicide is the leading cause of direct maternal deaths occurring within a year of the end of pregnancy. Perinatal mental illness can actually lead to a loss of life among mothers. We need to do so much better for them in those early mental health checks.

[Wera Hobhouse]

Absolutely. Post-natal depression is hidden, and the NCT’s “Hidden Half” campaign addresses that. Anyone who has been a parent knows that parenthood is not easy. Probably all mothers go through some form of depression, or feel really down after birth. I keep saying that if anybody had asked me how I felt, I would probably have said, “Oh God, I am not feeling particularly well.” The problem is in not addressing that early on, because these things can develop into something much more serious. That is why it is very important that there be a check-up six weeks after birth for women, not just for the newborn child.

--- Later in debate ---

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

I concur with every word of your comments, Madam Deputy Speaker, and the response to this debate, and the one we held yesterday on domestic abuse, has shown this Chamber in a much better light than that of a week or so ago. These are things we can agree on and that are of acute, everyday importance to our constituents.

As I have said previously, I have been in this House for 22 years and we never used to debate subjects such as this, and rarely held debates on children’s issues or many social issues. It is absolutely right that we hold such debates much more regularly these days, and they are enhanced by the personal, often emotional, harrowing and brave testimonies of hon. Members who bring such experience and richness to the debate. They show that we do have some understanding of the complex, complicated and challenging issues that face so many of our constituents every day.

I had not intended to speak in this debate, but I was moved by the contributions from my hon. Friend the Member for Southend West (Sir David Amess) and the hon. Member for Lewisham West and Penge (Ellie Reeves). I have a long-standing interest in this issue, and I declare an interest as chair of the all-party group for conception to age two—first 1001 days. That issue has growing traction and importance, and it should be mainstreamed. I also chair the charity Parent Infant Partnership, PIP UK, and co-chair the all-party group on mindfulness. If any hon. Members present have not attended a mindfulness course, I reiterate that they are available on Tuesday afternoons, usually at 5 o’clock in Committee Room 7. Given the stress of recent weeks, attendance has been noticeably higher and perhaps of more benefit than usual.

I am slightly daunted by speaking in this debate. Yesterday I said that I was daunted by speaking in the fantastic debate on domestic abuse, on the basis, first, that I am a man, and, secondly, that I am not from Wales. Today I am daunted, first because I am not a woman, and secondly because I am not from Essex, which seems to have a dominant geographical impact on the contributions that we have heard and will hear.

Next week we will celebrate Mental Health Awareness Week, and we will also relaunch the charity PIP UK. I have just written a letter to the Minister, and I very much welcome her and the huge amount of experience that she brings to her role from her health background. I am glad that perinatal mental health featured in the remarks of the hon. Members for Bath (Wera Hobhouse) and for Lewisham West and Penge, because that is where I think we can have the biggest impact on the mental health of future generations.

A few years ago, the Maternal Mental Health Alliance produced a valuable piece of work that estimated that perinatal mental health issues affect at least one in six women. Too often that happens in silence, which is why it is so important that the hon. Member for Lewisham West and Penge recounted how it happened to her—why would it not happen to somebody just because they happen to be an MP? The cost to the nation of perinatal mental health issues was estimated at £8.1 billion every year, which is probably an underestimate. We can add to that the cost of child neglect in this country, which is estimated at £15 billion and is often born out of problems with attachment in those early years, even before the child is born, and particularly if a woman is facing huge stresses and challenges, or domestic violence and so on. The statistic that I gave yesterday, which I still find hard to believe, is that a third of domestic violence cases start during pregnancy. The cost of getting this issue wrong is more than £23 billion a year. That is so much more than the more modest investment we could make to get this issue right and prevent those problems and the huge issues they create, financially but also socially—problems that are often lifelong for future generations.

We need better attached children, and attachment dysfunction has gone under the radar for so long. It is therefore essential—I am glad that the hon. Members for Bath and for Lewisham West and Penge mentioned this—that the vital six-week checks on new babies should also include the physical and mental health of new mums, particularly first-time mums. I make no apology for repeating that health visitors have been an important component in helping with those checks, and one great achievement of the coalition Government—I was also part of the shadow health team when we worked on this—was the substantial increase in health visitors. That was based on the Kraamzorg programme in Holland, which we went to see. It showed that if we work intensively with new parents in those early stages, we can prevent many problems from happening later on. Health visitors are such a good investment to ensure happy, healthy, stable new parents who are able to interact in a sensible, robust, proper and healthy way with their children, and that is in the best interests of kids and their parents.

[Wera Hobhouse]

The health visitors in the early weeks when I was first a mother, and subsequently, were wonderful and a real lifeline. We do need to continue with that, but the problem is that it is not systematic enough. Making sure that a mandatory six-week health check is done by a GP and a health professional is the way forward. Currently, the system is too haphazard and we need to have a much more watertight system to get help to every woman who needs it.

[Tim Loughton]

We need both. The health checks are NICE-recommended, but alas not mandatorily funded or instituted across the country. Frankly, all GPs need better training on mental health and mental illness prevention generally, and especially on perinatal mental health.

It was a huge success of the coalition Government that we recruited almost the 4,200 target for health visitors that was set back in 2010. We have lost as many as 30% of those now, since the responsibility for health visitors went from the NHS to local authorities. I am not saying whether that was the right move or not, but, given the cash constraints on local authorities, health visitors have turned out to be a soft target. That is a hugely false economy and certainly needs to be revisited as a priority by the health team.

The lifelong importance of early attachment should not be underestimated. It has been judged that for a 15 or 16-year-old suffering from depression—an all too common problem among teenage children in schools—there is around a 99% likelihood that his or her mother was suffering from depression or some other form of mental illness during or soon after pregnancy. The correlation is as close as that. Not getting it right during the conception to age two period will have an impact on many children for their childhood years and, for too many, continuing into their adult years too. Maternal mental health is very important, not just for the mother herself but for her children and the surrounding family.

Let us not underestimate the impact this has on fathers as well. I will be ruled out of order if I go too much into the subject of male mental health—although I hope we have a debate on male mental health too—but the impact of poor attachment between a mother and baby has significant impacts on fathers. It is important that they are also given every help and support to have that attachment to their children. Too often, children’s centres and other support mechanisms are mum-centric and we overlook the role of the father. The father has an important role to play in the life of the child and an important support role to play in the physical and mental health of his partner, the mother.

The Government have done an awful lot in recent years to raise the profile of the importance of mental health and flag up how we need to do much more. Importantly, they are also investing much more in mental health. We talk about the parity of esteem between mental health and physical health, and we all agree that that is necessary. Much has been done to reduce the stigma that was attached to mental illness just 20 years ago. It is good that so much more money is going into the area. We have a shortage of mental health practitioners and we need to make sure that we prioritise recruiting, training and getting them in service as soon as possible.

The criticism I have is that last year’s Green Paper on mental health included a lot about school-age children, which is important, but virtually nothing on pre-school-age children and perinatal mental health. Shifting the age profile forward and making it more about prevention and early detection—rather than dealing with the symptoms of a child who may already be damaged because their mother was damaged in their early years—is the way we have to go. We have to do much more in schools, but we need to do so much more before children get to school, by working with their mothers and fathers at an early stage.

[Jeff Smith]

The hon. Gentleman made an important point about the reduction in funding for local authorities. When it comes to trying to provide holistic support to the family and mother, does he share my regret at the closure of so many hundreds of Sure Start centres since 2010?

[Tim Loughton]

I do not want to make this a partisan issue. We can have a debate on this subject, and there have been some cuts to support services that have obviously not been helpful and will have some of the long-term impact that I have mentioned. I have visited, and even opened in my time as Minister, several children’s centres, and many of them do a fantastic job. But many were not doing a fantastic job and were failing to do a job of work for the 15% of the most deprived communities for whom they were originally most intended.

The failure to comprehend the importance of children’s centres is to put too much trust in bricks and mortar. Many of the outreach services that went with children centres were more important, and they were not getting out enough. We have children’s centres that have worked really well in my constituency, and we have not closed any in West Sussex, largely because we put them in the right places and turned them into what I call a Piccadilly Circus of services. They have district nurses, health visitors, mental health nurses and social workers hot-desking and sharing information about various families, especially vulnerable children and others, to give a wrap-around, comprehensive support mechanism. The challenge so often for children’s centres is getting the parents—particularly dads—to come across the threshold. Some children’s centres do that really well, but many do not. I know about the importance of children’s centres, but I also know some of their weaknesses. It is the services they offer and the outcomes they achieve that are so much more important than the amount of bricks and mortar that exist to provide them.

[Jeff Smith]

The hon. Gentleman is making an important point, but, with the greatest respect, West Sussex did not have the kind of cuts to its local authority funding that many more impoverished areas such as Manchester and other big northern cities did. He is right that it is not just about bricks and mortar: it is the support services that were also cut that have had the greatest impact on young families in those areas.

[Tim Loughton]

Nice try. West Sussex was the least funded shire county in the whole of England. Do not try and tell me that supposedly affluent areas such as West Sussex have not faced financial challenges. I do not know about the hon. Gentleman’s constituency, but the gap between the per capita funding that children get in my constituency and many of the London and other municipal boroughs is substantial. It is a question of how that funding is used and prioritised.

[Mr Kevan Jones]

Will the hon. Gentleman give way?

[Tim Loughton]

I will give way, now that I have set this hare running.

[Mr Jones]

The hon. Gentleman is making the fundamental mistake that Members on the Government Benches often do—the idea that every area in the country is the same. I am sure that there are many more looked-after children in inner cities such as Liverpool, Manchester and others—and even in Durham—than there are in his area. That comes with a cost, and the areas cannot be treated the same.

[Tim Loughton]

That shows a fundamental misunderstanding. I declare an interest because this was my issue. Where children are placed is not necessarily a reflection of how many children are in the care system in that authority. Children in care placed in other authorities, such as Kent, where accommodation is cheaper than in London, are paid for by the placing authorities, and they can cause challenges to the host authorities. That is a wholly different issue. The original point that the hon. Member for Manchester, Withington (Jeff Smith) made was that children’s centres are part of the solution. We need children’s centres with well-trained people offering well-targeted support services to those who need them, but saying that this is purely a numerical issue, because now we have 3,200 children’s centres as opposed to 3,500, is missing the point. It is about the quality of the care offered to those who most need it.

I will wrap up now—as I see you want me to, Madam Deputy Speaker—by touching on a couple of other points affecting older girls. They include the impact of bullying, social media and bullying online, peer pressure relating to body image, the reports by groups such as the Girl Guides and the surveys showing the number of young teenage girls who do not like their appearance and would, if they could, pay for plastic surgery, which is hugely alarming. We have to give young women in particular the confidence to be able to say, “I am who I am. This is who I am, and if you don’t like it—tough.” That is something that we have a major role in getting across in society, and frankly social media need to be part of those positive messages. We still have problems with the internet and social media companies hosting sites that masquerade as sites giving advice to people with eating disorders, but which are in fact malignly encouraging anorexia and things like that.

[Mark Tami (Alyn and Deeside) (Lab)]

Does the hon. Gentleman agree that social media companies that hide behind the claim that they are just platforms and are not responsible for the content need to take a serious look at themselves?

[Tim Loughton]

The hon. Gentleman is absolutely right, and I am glad that the Government are doing that with proposals, which are currently being consulted on, to fine social media companies that do not take down harmful comment. I am not just talking about hate crime or terrorism; this is about how it can undermine impressionable young people in particular. There are laws in places such as France about such sites, and Germany has introduced heavy fines that can be imposed on social media companies.

This is a big problem. Mental illness is a particular problem for women who might be affected by relationship breakdown, domestic violence, homelessness, housing difficulties, missed education opportunities, unemployment, financial difficulties, debt, ill health, substance misuse and interaction with the criminal justice system. Mental illness takes different guises and different forms, but the earlier we act, and with the most appropriate support, the more likely we will be to do the best job for future generations, and that starts at conception.

Decriminalisation of Abortion

Tim Loughton Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Jackie Doyle-Price]

I know I will disappoint the hon. Lady, and I know she has been a passionate campaigner on these issues for many years, with the welfare of women at her heart. I answer this question with great respect for her desire, but it remains the case that the Government are not minded to repeal the provisions of the 1861 Act in England and Wales, recognising that we have an Abortion Act that provides for access to abortion services.

From the perspective of the safety of women accessing abortion services, the issues raised by the hon. Lady do concern me. It is not good for the welfare of women that pills are being accessed online. I also observe that the Abortion Act is more than 50 years old and was the product of a very different time. Abortions were then entirely surgical, and the medical abortions to which we now have access are clearly far safer.

This is very much a personal view, and I am not speaking for the Government in advancing this view, but I think that making provision for early abortion and for recognising medical abortion in law will get us much further. We need to make sure we have a safe regime that enables women to access abortion services as safely as possible.

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

I supported decriminalisation, I supported the regularising of the abortion law in Northern Ireland last week, and on Friday I shall visit my local BPAS clinic. But changing the law is only part of it. Last year, I was out with an ambulance crew and we were called out to a woman who had been at an abortion clinic and taken the pills. She was bleeding heavily and had been taken very ill, and there was no out-of-hours service—this was on a Friday evening. Does the Minister agree, particularly in respect of the availability of do-it-yourself pills on the internet, that it is absolutely essential that, at a very difficult time for a woman who has taken that decision, the ongoing support is there 24 hours a day, seven days a week?

[Jackie Doyle-Price]

My hon. Friend reminds us that this is not always an easy process for women to go through. As with any medical procedure, full consent must be given, based on full information. As long as pills can be accessed via the internet rather than via medical professionals, it is clearly more likely that women will not be informed of the risks of taking the pills. Any medication can have risks and consequences, and women need to be fully advised so that they can manage what they are going through.

Oral Answers to Questions

Tim Loughton Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Jackie Doyle-Price]

Life expectancy has been increasing year on year, but it is also true that it is an international phenomenon that that rate of increase is coming to a halt. None the less, life expectancy in England is the highest it has ever been: 79.5 years for men and 83.1 years for women. We will continue to invest in our public health programmes and look at the wider issues facing society that can also contribute to good health outcomes, such as housing, work and so on. There is a lot that can be done; it is not just about NHS spending.

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

One of the best ways of getting early public health help across the doorstep is by investing in health visitors to give that much needed early support, especially to new parents to help to ensure that every child gets the best start in life. One of the best achievements of the Cameron Government was the creation of 4,200 additional health visitors. Does the Minister share my concern that since 2015, with the responsibility now having gone to local government, there has been a 26% reduction in the number of health visitors? That is something of a false economy.

[Jackie Doyle-Price]

I do share my hon. Friend’s belief that health visitors are probably the most important army in the war against health inequalities. They provide an intervention that is very family-based and not intimidating. It is based on good relationships and means we can provide intervention at the earliest possible time. He is right to highlight the massive investment we made during the Cameron Government. There has been a decline since, which we really must address if we are to get the earliest possible intervention and the best health outcomes for children.

Children’s Palliative Care

Tim Loughton Excerpts

Monday 1st July 2019 Commons Chamber

[Dr Johnson]

I thank the hon. Gentleman for his intervention. I do indeed share his concern and will come to some of those figures in a moment.

To return to the care that is provided during the palliative care process, finally, the care will indeed be about end of life care and bereavement counselling. Children’s hospices throughout the United Kingdom provide some of this fantastic care. They have specialist medical, nursing and other professional staff and volunteers, and I pay tribute to them, as I know other Members do, for their dedication and the fantastic work they do.

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

My hon. Friend is a great ambassador on this very important subject. I pay tribute to the Chestnut Tree House hospice, which does such a fantastic job in West Sussex. Does she acknowledge that, because of medical technological advances, many of these children will live for much longer than was anticipated many years ago, and for many of them this is about not care in a hospice but outreach care outside the hospice? It is therefore important that we have good support packages for the parents, including respite and care over a longer term, and that we are more imaginative in the way we build houses, so that children with life-limiting conditions can live in houses—perhaps new social house build—that reflect the increasing physical demands that they will have, so they can stay in their homes to be cared for appropriately?

[Dr Johnson]

I thank my hon. Friend for his intervention. He is indeed right. The demand for children’s hospice care is rising because there has been an increase in the number of children with life-limiting conditions and because those children are living longer and therefore require care for a longer period. The cost of providing that care is also increasing at a rate faster than inflation and faster than the money that the sector receives, which means that in some areas the money received has fallen in real terms.

Social Media and Health

Tim Loughton Excerpts

Tuesday 30th April 2019 Commons Chamber

[Matt Hancock]

The regulation of online harms will indeed be statutory. As I said, we are in the middle of a consultation on how, rather than whether, to put that in place. I am sure the hon. Lady will want to feed back, although I know her SNP colleagues in the Scottish Government in Edinburgh have been kept abreast of developments.

The hon. Lady raises complacency and financial resources. I will address both points. She is absolutely right that part of the problem is a complacency about some killer diseases, partly because we have hardly known them in this country for generations. As I said in my statement, measles is a horrible disease and a killer; it is deeply unpleasant. So, too, is rubella. Rubella might be hardly noticed by a pregnant woman. There might be a rash for three or four days which comes and goes, but the impact on the baby is permanent and very, very serious. On measles, rubella and other diseases, we have to be absolutely clear with the public about the consequences not only for their children but, even worse, for vulnerable children and adults who, maybe because they are immunosuppressed or very young, cannot have the vaccination. Their lives are directly threatened by a parent who chooses not to vaccinate. We need to be very clear and stark about that.

The hon. Lady mentions that the social media companies have contributed to Samaritans. That was Samaritans’ ask for this stage of putting together the organisation and experts it needs to provide clarity on the boundary of what is and is not acceptable in this space. I would, of course, be perfectly prepared to go and ask for more if more is needed. What is more, we are bringing forward a digital services tax. Historically, the global tax system has not worked well in taxing such companies fairly, because of the nature of how they make their money. We have worked for years to try to get a global consensus on how to tax them. We are now clear that we will bring forward the tax next year in the UK, regardless of whether we can get global consensus.

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

I applaud the Secretary of State for taking this initiative, and I certainly endorse the comments about the good of vaccination. However, I hope that the warm words of the social media companies that he recounted are matched by actions, because I am afraid that that is not the experience of the Home Affairs Committee, which again saw a woeful performance from the Facebook, Twitter and YouTube representatives who appeared before us last week.

Is the Secretary of State aware that it is not only a question of taking down or not allowing content on which those companies are not doing their job properly, but of the algorithms that they use actively promoting more extreme versions of what people may be searching for, whether that is material on the extreme right wing, terrorism, radicalisation or self-harm? Is he convinced that those companies will actually put their considerable money where he thinks their mouths are and make sure that serious interventions are made to stop this stuff being promoted to some of our most vulnerable citizens?

[Matt Hancock]

My hon. Friend is a man after my own heart on this. Am I convinced? I am convinced that social media companies have committed to it, and it is our job to keep them to those commitments. That is why I have pushed for a long time for a statutory regulator in this space, and I am delighted that the Government are bringing one forward.

For years, we in the House asked social media companies to do something, and there was an argument that, because they are global, we cannot really impact how their algorithms work. That is just rubbish. We are the legislator for this country—we set the rules, and we have a big role in setting the norms and expectations of what happens here. Just because a platform is global does not mean that it can be outside the rule of law of this country, so we will legislate in this space, and there will be a regulator that will be able precisely to keep track of those commitments and make sure that they are followed up. Having said that, the last two meetings have been positive, and we have seen changes as a result. What we have not yet seen is all this content being removed, so there is clearly a long way to go.

Access to Medical Cannabis

Tim Loughton Excerpts

Monday 8th April 2019 Commons Chamber

[Matt Hancock]

I entirely understand the hon. Gentleman’s point, and I feel the same way as he does about the urgency of these cases. The need to get a second opinion can be actioned immediately, and it will be, because the crucial point is that unlicensed medicines cannot be prescribed without a clinician. There are just over 95,000 clinicians on the specialist register, and any of those who have expertise in this area can, if their clinical judgment allows, make these prescriptions. That can happen right now.

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

I was very supportive of the case of Alfie Dingley and the change in the law. The Secretary of State is absolutely right that this must be based on clinical decisions. However, given that there are several hundred children suffering from severe intractable epilepsy, is not the problem that the guidance from NHS medical bodies is just too stringent? Is it true that only two NHS prescriptions have actually been issued to date? Given that Teagan Appleby has had at least a dozen prescribed drugs—I will not list them, to avoid stressing Hansard—as well as a nerve stimulator, what would be the downside of allowing her access to medical cannabis now?

[Matt Hancock]

My hon. Friend makes a good point. More than 80 prescriptions have been made, but that is for both THC and CBD. Of course, THC brings risks—the active elements within cannabis do bring risks. There are also benefits, as I have seen very clearly. It must be for a clinician to decide the balance of those risks. I have enormous sympathy for the families, having heard their personal testimony about the massive benefits for their children, who sometimes, as my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) said, have 300 seizures a day. Having seen that and looked them in the eye, I understand the benefits. However, it has to be a clinician who makes that judgment. I am not medically qualified and cannot overrule a clinician, but there are clinicians available who can provide a second opinion, and that is what I can ensure.

--- Later in debate ---

[Matt Hancock]

Yes, we are looking carefully at how we can use that legislation as effectively as possible. Understanding the medical consequences of any use of a drug is incredibly helpful evidence for where it should be prescribed further, and that is the thrust of the 2016 Act.

[Tim Loughton]

My hon. Friend the Member for Daventry (Chris Heaton-Harris) was a good Minister, too.

[Mr Speaker]

Another ex-Minister to compliment. I am bit surprised by the Secretary of State. He is slipping from his usual standard. I thought that he would be busily cultivating his hon. Friend. [Laughter.]

Health and Social Care Committee

Tim Loughton Excerpts

Thursday 28th February 2019 Westminster Hall

[Dr Williams]

I thank the hon. Lady for those questions. One of the Committee’s early reports of this session was about childhood obesity. We made specific recommendations in that report that we have not necessarily repeated in this one.

We saw many wonderful things in Blackpool. We did not learn about the specific service to which the hon. Lady refers, but we did learn that many services have come under a lot of financial pressure. Even though there was some Big Lottery investment for transformation, services still needed to be cut, which sounds counterintuitive.

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

I declare an interest as the chair of the all-party parliamentary group for conception to age two—first 1,001 days, which is slightly more long-term than the first 1,000 days of life, but not nearly as ambitious as the first 1,000 years of life, to which the right hon. Member for Exeter (Mr Bradshaw) erroneously referred. I am also the chairman of the charity Parent Infant Partnership UK. I am grateful to the hon. Member for Stockton South (Dr Williams) for referring to Sally Hogg, one of our staff members, and Beckie Lang, our chief executive, who gave evidence.

I welcome the report, and particularly the ambitious way that the hon. Gentleman has described it as the “second revolution” in early years services. He is absolutely dedicated to the whole subject, which is so important, and which many of us have been banging on about for some time. I have two questions. First, a slight disappointment is the shortage of space given to the case for investment. The hon. Gentleman knows as well as I do that, as we said in our all-party group report, “Building Great Britons”, the cost of child neglect is £15 billion a year, and the cost of maternal perinatal mental illness is £8.1 billion; that is £23 billion each year that we are spending on getting it wrong. Does he agree that we need to make the case that investment in this area will save substantial amounts financially and, more importantly, socially? The Treasury needs to understand that it is a serious investment case for the future.

Secondly, I approve of what the report says about locally delivered and joined-up services—a point that we put forward in our report, too. Does the hon. Gentleman agree that there is also a case, which we have made in the past, that that should be time-dated? Certainly, it should not take more than five years for every local area to have a united, joined-up, coherent and co-ordinated strategy for delivering this. It also needs to be measured, just as adoption scorecards were used at the Department for Education to measure the quality of the service delivery, so that it is not just a tick-box exercise. If we can get those two things right, the quality of the delivery will be much greater.

[Dr Williams]

I thank the hon. Gentleman for his advice and input at the start of the inquiry, and for the work that he has done as the chair of the all-party group, which is about the first 1,001 days—what is a day between friends? The economic case is exceptionally strong, and I am sure that the Minister has heard him make it eloquently. We all need to work together to make sure that we put the case to the Treasury. Ultimately, those spending decisions will have to be made in the comprehensive spending review; that feels like an opportune time.

The hon. Gentleman suggested that we ensure that there is a timeframe, that the commitment is not open-ended, and that local authorities have plans within a short time. We learned in our inquiry that local authorities are often left to just get on with it. The Committee felt that there was a need for much more central control and measurement, and for more accountability by central Government.

Early Parenthood: Supporting Fathers

Tim Loughton Excerpts

Wednesday 30th January 2019 Westminster Hall

[Tracey Crouch]

I would love to come. Single parents play an incredibly important role, but for various reasons they are often maligned. Meeting single dads who are doing their very best, in whatever circumstances they find themselves bringing up their children, is an incredibly important part of that conversation. I would be delighted to come to the event on 20 March.

I want to address three points: perinatal support, loneliness in new dads, and shared parental leave. The first comes wholly under the Department of Health and Social Care; the second does partially; the third might not, but is important to the debate because it relates to the overall wellbeing of our children.

In December, the Centre for Social Justice published a really interesting report, “Testing Times: Supporting fathers during the perinatal period and early parenthood”. It looked in detail at written evidence submitted to the Select Committee on Health and Social Care inquiry into the first 1,000 days of life by the Fatherhood Institute, which described support for fathers as “toothless” and noted criticisms that within health services,

“well-meaning…father-inclusive policy-making…has been more ‘rhetoric than reality’”.

On the back of those comments, the CSJ did some additional polling. It found that seven in 10 new fathers

“were made to feel like a ‘spare part’”,

six in 10 said that they had

“had no conversations at all with a midwife about their role”,

and nearly half said that they had

“received little or no advice at all…on their role as a dad.”

However, it also found that

“more than 9 in 10 are present ‘at the scans and the birth’”

and that there is

“strong correlation between active father engagement and improved childhood outcomes.”

That is a recurring theme in a really interesting book on equal parenting co-authored by one of our own lobby journalists, James Millar. It includes several quotations from the 2015 UN-backed report, “State of the World’s Fathers”, about how engagement in the first year of a baby’s life is good for the dad as well as the baby. Substantial and high-quality father involvement can encourage a child’s positive social interaction and lead to higher cognitive development scores.

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

I congratulate my hon. Friend on securing a debate on this important issue. It is hardly surprising that so many dads feel left out when the NHS guidance refers to them not as fathers or dads but as “birthing partners”. Perinatal depression in mums is linked to depression in teenagers: there is a 99% likelihood that a 16-year-old suffering from depression had a mother with perinatal mental health problems, including depression. What is overlooked is that 20% of fathers also experience perinatal mental health problems, which has a big influence on their parenting skills and on their engagement with and attachment to their own children. We need to do more about that.

[Tracey Crouch]

I am grateful to my hon. Friend for raising that point. I saw those statistics while researching my speech; perhaps the Minister’s reply will describe her Department’s work on post-natal depression for mums and dads. I do not have time to cover everything, but I agree that language is incredibly important. I appreciate that the term “birthing partners” is used in order not to cause offence, because our society and how we bring up children are very different now, but it is important that we think about the language and make our communication with fathers as inclusive as possible.

--- Later in debate ---

[Tracey Crouch]

One reason why I wanted to hold this debate is that I feel it is hard for male colleagues to raise the subject. As a mother, I know that if my other half had come to me and said, “I am feeling a bit down,” I would have said, “But you didn’t give birth to the child!” For many years, we have forgotten that it is very much about a partnership. There are many issues that mothers still face—there are still huge issues around discrimination in maternity and everything else—but that must not mean that we forget the issues that fathers face, and that is why this is an important debate.

I completely understand why male colleagues might not have felt comfortable in raising this issue, because they may well feel that they would be accused of forgetting all the other issues around maternity discrimination. I feel very honoured to be raising it on behalf of all the dads out there. Perhaps I can talk about it with more ease.

The constituent of the hon. Member for Ogmore (Chris Elmore) is doing a brilliant job in raising the issue of men’s mental health, post-baby. It is important that we do that. If that equates to having more training, that is what must happen, although I am always loth to say that our hard-working health professionals need any more training than they already get. They have a very important job to do, and by and large they are all doing it brilliantly.

One aspect of parenthood that can impact on wellbeing is loneliness. When Jo Cox stood in the Chamber and spoke of her own challenges with loneliness, including the example of becoming a mother, she widened discussion on the subject. I, too, had my own brushes with maternity-leave loneliness. While the rest of the world here was discussing the referendum campaigns, I was on maternity leave. I dealt with that by going to the supermarket every day, just for a chat.

For new fathers, it can be harder. When my other half took his three months shared parenting leave, he felt isolated from baby groups, as many were either branded “mother and baby” or were predominantly made up of mums, making him feel less inclined to go in. There are excellent apps connecting mums, such as Mush, which we profiled in the loneliness strategy, as did the CSJ in its report, but there are hardly any dad apps set up to connect full-time fathers. The Secretary of State for Health and Social Care, with his digital background, may be interested in upscaling that from a health perspective.

The loneliness strategy, which I was privileged to publish on behalf of the Government in October 2018, specifically, on my request, used an infographic of a dad pushing a baby to highlight becoming a parent as a trigger for loneliness while at the same time reflecting that it is not a gender issue. The more we all acknowledge loneliness as an issue, the quicker we will reduce the stigma and instead create connections that help to combat it. I was pleased that the Department of Health and Social Care was a core partner in the delivery of the strategy.

The CSJ noted that children's centres are a key part of delivering opportunities for dads to connect, and that many were not doing so, despite its being a legal requirement. I know that children’s centres are a politically contentious issue because of funding and I would hate the debate to be bogged down by that, but the centres in my constituency, some of which have restructured, could play an enormously important role in creating support networks for dads. It is a shame that because of funding pressures, gaps in services are occurring.

[Tim Loughton]

My hon. Friend makes a very important point. The problem with the children’s centres—a fantastic asset—at the moment is that they are closed most of the time when dads can access them, particularly at weekends. Some of the best children’s centres are those that open at weekends, have football teams that dads and their children can come along to, and have computer-reading facilities latched on to that. It is a way of getting dads into the children’s centres. The centres need to be used much more at weekends and outside of working times when many fathers cannot access them.

[Tracey Crouch]

I agree with my hon. Friend, but it is very important that we do not fall into the trap of talking about dads as weekend parents. The point of the debate is to discuss how society has evolved; there is a lot more equal parenting. I completely understand his point. I shall come on to talk about shared parenting. The take-up of shared parenting is so low that many fathers can play that meaningful role in parenting only at weekends, so we would want those services to be open. Children’s centres have an incredibly important role, which is not just about creating a connection, but also about, for example, trying to break the cycle in domestic abuse. They play a fundamental role. I know that the Stefanou Foundation is doing some excellent work in supporting such initiatives.

I accept that my own experience is based on good fortune, and that it could easily be criticised as coming from a comfortably-off middle-class professional, but we need to do so much more on shared parenting than we do at the moment. We lag very far behind other countries on shared parenting, particularly Scandinavian countries.

What I see from my other half taking shared parenting is a very special bond between him and our son. Sadly, there are still a significant number of men who are ineligible for parental leave, and for those that are eligible there is a financial disincentive to take it. The Fawcett Society found that nearly seven in 10 people believed that men who took time off work to look after a baby should be entitled to the same pay and amount of leave as women. In Germany, fathers on leave are paid two thirds of their salary and in Sweden it is 80% of their income. Here it is £145 per week. We managed because I am paid well, but an average or low-income family would inevitably struggle, so while many might want to, it is unsurprising that take-up of parental leave is so low.

I know that much work is being undertaken to improve the situation. I thought the speeches in our debate on proxy voting on Monday evening encouraging male colleagues to take shared parenting leave were really helpful, and we could set an example in this place. I commented earlier on the wider societal and health benefits of a father’s meaningful engagement in the upbringing of a child. To me, doing more to improve our shared parenting policies is a no-brainer.

There is so much more I could have spoken about this morning, including the emerging organisations that help support fathers, such as workingdads.co.uk, which seeks employment with flexible, child-friendly hours, and the really funny social media accounts, such as Man vs. Baby, which might make light of some of the challenges that fathers face but also highlights that they exist in the first place. Ultimately, if we accept that meaningful fatherly engagement with their children is good for the health and wellbeing not just of the child but of the dad, making sure that we provide the infrastructure to support them, from neonatal to perinatal and beyond, is simply common sense, fair and equal—good economics but also really good politics.

--- Later in debate ---

[Fiona Bruce]

My hon. Friend makes an excellent point and I will indeed refer to it.

My hon. Friend the Member for Chatham and Aylesford (Tracey Crouch), who introduced the debate so well, referred to a CSJ report from this year. Another CSJ report, “Every Family Matters”, which was produced as long ago as July 2009, said very similar things, such as the importance of strengthening families and of having a good, strong input into a child’s life. Yet I have here an interesting statistic: 43% of unmarried parents split up before a child’s fifth birthday, but only 8% of married parents do. That is an interesting factor for us to consider: if we are looking at strengthening family life, we should not forget that supporting marriage is part of that.

Sadly, the UK has one of the highest rates of family breakdown among the 30 OECD countries. Just two thirds of children aged nought to 14 live with both parents. In the OECD countries overall, 84% of children of those ages live with both parents. Very interesting work is being done on the link between those factors and British productivity, which is 18% below the OECD average.

[Tim Loughton]

I admire my hon. Friend’s determination to promote marriage, but I must give a plug for my private Member’s Bill on civil partnerships, which, if it passes through the Lords, will make civil partnerships available for opposite sex couples by the end of this year. They would be an additional incentive for those couples to stay together, as overseas statistics show, particularly for the good of the children.

[Fiona Bruce]

It is so important that we do what we can. In the very short time that I have left, I will touch on some of the practical policies in “A Manifesto to Strengthen Families”, which more than 60 Members of Parliament support, and express a degree of frustration that the Government have not taken them up more practically. I know that individual Cabinet Ministers are very interested, but in order to see some real progress we need a senior Cabinet-level Minister who is responsible for drawing together the manifesto’s several policies.

I will touch on some of the manifesto’s policies on fathers. Policies 8, 9 and 11 talk about promoting the importance of active fatherhood in a child’s life. Policy 8 says:

“Maternity services should maximise opportunities to draw fathers-to-be in early.”

Policy 9 proposes that, where appropriate,

“The Government should…require all fathers to be included on birth certificates.”

Policy 11 proposes that “high quality marriage preparation” should be available at a cost-effective rate for young people thinking of getting married.

Finally, one of our key policies is the promotion of family hubs. As we have heard, children’s centres are not always as effective as they need to be. Families need support bringing up children, not just aged nought to five, but nought to 19. In the teenage years particularly, the input by fathers into their sons’ lives is often critical. We believe that it would be really positive to have family hubs in each local community, to support families at every stage of a child’s development.

I am disappointed that the Government have not taken that up more strongly. We shall continue to persevere and to press them to do so. The good news is that many local authorities have taken up those ideas very strongly and family hubs are springing up across the country. I invite colleagues to a family hubs fair, which will take place on 14 February. It is convened by Westminster City Council, which is setting up its own family hubs. The fair will flagship best practice from local authorities across the country that have set up family hubs, specifically to show how we can best support families with children. I am sure that there will be many examples of how we can best support fathers to engage in their sons’ lives, which is such an important thing on which we need to focus.