Healthcare Support Services: Conception to Age Two

Alex Norris Excerpts

Tuesday 15th December 2020 Westminster Hall

[Alex Norris (Nottingham North) (Lab/Co-op)]

It is an honour to serve under your chairship, Sir Christopher. I congratulate the right hon. Member for South Northamptonshire (Andrea Leadsom) for securing this debate. She really is one of the leading parliamentarians on this issue, so we were very pleased to see her appointed as the early years healthy development adviser. She has shared with us a lot of insight from her 20 years as well as from the current review. I look forward to hearing those findings and recommendations from that first phase. I hope that we will have a parliamentary opportunity, whether here or the main Chamber, to discuss them further. Hopefully, they will really turbocharge this debate and lead to a renaissance of early intervention at the very forefront of public policy in Britain. I very much hope that will be the case, and I think this is a key moment.

The right hon. Lady’s point about brain development was so interesting; I cannot hear these points enough. Like many colleagues here, I have been involved in early intervention type activities throughout my time in Parliament, but we have been really reminded of the physical impact of emotion in the early stages and how profoundly responsible it is for whether young people—even babies—learn that the world is a good place. The hon. Member for East Worthing and Shoreham (Tim Loughton) said that these things have been well rehearsed, and they have, but I do not think they can be heard enough as they are very important.

The phrase that I underlined twice was “indisputable”; I completely agree there. The evidence for early intervention is indisputable. However, I am struck by the Royal Foundation research with Ipsos MORI that says that only one in four of our constituents understands that. We have a real job to do in taking something about which we are in such profound agreement in this place out to our constituents, so that they understand why it is such a good investment for the individual and for us all as a whole. That is something I am going to return to. The right hon. Member for South Northamptonshire’s points about the lockdown were extremely well made, and I look forward to the Minister’s response to them.

I turn to the contributions of other Members. I was glad that the hon. Member for Glasgow Central (Alison Thewliss) referenced her tireless work on breastfeeding and the importance of support services for that; I will reflect on the public health grant in England shortly. On what the hon. Member for East Worthing and Shoreham said, I make no comments about “old or very old”—I leave that only to the Member in charge. But I recall from his time as a Minister and our time serving together on the Home Affairs Committee his strong commitment to getting all children the best start in life. I thought his contribution was very much in line with that. I loved what he said about health visitors. That is such an important distinction in understanding. Health visitors are the best at getting uniformed services over the threshold for some of the hardest families to reach in our communities. That has to be an important part of our public health response.

The comment he made about all the big spending we do on getting it wrong is at the nub. I will expand on the point shortly, but we have to work it out. We know we are spending the money, but we also know that the old argument we make about what a difference it would make, if only we had a fraction of it invested, does not work with the Treasury. That has not worked with successive Treasuries of whatever political persuasion. We have to try to answer that question of how to do it in a way that is “cashable”, for want of a better word, and deliverable on a timeline that the Treasury will accept.

I will repeat what I said to the hon. Member for Strangford (Jim Shannon) when he and I were here in the late debate last night. In the early debate this morning, his contribution, as always, comes with a burden of empathy behind it. That is at the root of the issue: understanding the impact of empathy on the development of a young person. The reason that matters is because it is important for public finances, of course, but we are all here because we care about people. We do not want anybody to have their potential and outcomes curtailed before they have even had a chance. That is the importance of a source of empathy.

I will take great interest in family hubs and their development, having listened to the hon. Member for Congleton (Fiona Bruce). I recognised a lot of what she said from Sure Start. The loss of Sure Start is a real sadness, but I look forward to reading and hearing more as those other ideas develop.

I will finish by congratulating the hon. Member for Truro and Falmouth (Cherilyn Mackrory) on the anniversary of her first year here. I am sure it has gone in seconds. I know that colleagues and those watching will appreciate her work and her bravery in sharing her personal story of baby loss. That makes such a big difference to people listening and watching. Her points about continuity of care were really important and I hope the Minister will reflect on that.

I will make a few points of my own. Early intervention is the best gift we can give ourselves. It is brilliant for the individual, transforms lives and is great for the collective, not least financially. We saw that with Sure Start under the previous Labour Government, which made a tremendous difference, especially in the most disadvantaged communities such as mine. I see that work and its legacy close up in my community today, as I saw it when I was lead for health and social care on Nottingham City Council, prior to coming to this place.

Nottingham has a proud history in this area. My predecessor, Graham Allen, the previous Member for Nottingham North, was a real leader in the area of early intervention. It is 10 years next month since his first report, “Early Intervention: The Next Steps”, was published, and almost eight years since the founding of the Early Intervention Foundation, following his second report. He has played a formative role in my development on this issue, in politics and in life more generally, so I know he will not mind if I run out his ideas. He texted me on my way to this debate with a quote reminding me that the best early interventions we can make start 100 years prior to a baby’s birth, but I will start at conception, because that is what the right hon. Member for South Northamptonshire chose to do. I am sure he will forgive me for that.

We have good examples of the impact of failing to make these early interventions. I will draw on the Department for Education’s Wave Trust report of 2013 that provided the foundation for the 2014 cross-party manifesto, which was so important and provides a theme I hope we can return to in this decade. Disadvantaged mothers are more likely to have babies of low birth weight and low birth weight is associated with raised blood pressure, coronary heart disease, as well as reduced educational attainment, qualifications and employment. Optimal infant nutrition, especially breastfeeding, increases children’s chances of leading a future healthy life. By age five, according to analysis from the Millennium Cohort Study, breastfed children were already one to six months ahead of those who never were.

Those are little examples of the difference that one thing at birth or in the first two years makes for the rest of a life. We could also have drawn on stress and smoking during pregnancy, trauma, language inequalities and communications. I could go on and on. We know what is at the root of this. Those households in the lowest socio-economic groups have significantly worse health outcomes. If levelling up is the term of the day, this is the crucial piece of levelling up.

This is not a theoretical exercise. As colleagues have said, we are in significant agreement but not just in theory. We have seen excellent early-intervention models working over the past decade. I have talked about Sure Start but there is the Family Nurse Partnership, which has supported young parents and their babies for 13 years and is now in 60 areas across England, including my constituency. My friends at Roots of Empathy have reached over a million children around the world, and their Seeds of Empathy programme is incredible. I have joined in with that, and it helps young children learn by watching a baby’s development. It is a wonderful programme. Those sorts of things make such a big difference, and we can do more to champion them.

The Government have to do their bit. Over the last decade, early intervention grants were reduced by almost two-thirds: £2.8 billion to £1.1 billion. The public health grant has been exceptionally distressed over the last seven years. From my three years stewarding that grant in Nottingham, I know that after demand-led services such as drug, alcohol and sexual health services have been dealt with, there is not an awful lot left. Sometimes, some of those services with longer term impacts—such as early intervention services—are the ones that can get forgotten. It is a prime example of that. Similarly, local authority children’s services departments have been forced to cut back children’s centres—family support services that make such an impact—because of their finances. I do not know what Ministers think they have saved in the last decade by making those cuts, but the cost to the country’s finances in years to come will significantly exceed the savings. It is the falsest of false economies.

Well-implemented preventative services—along with early intervention in the foundation years and in the long run—deliver economic and social benefits, as well as being likely to do more to reduce abuse and neglect than would reactive services. Social return on investment studies have shown a return of between £2 and £9 on every £1 invested when there are well-designed early year interventions. The return could possibly be even greater. But that is easy to say. Similarly, the Royal Foundation says that its figure for late intervention was £17 billion each year. It is easy—certainly in Opposition—to say, “If only the Government were enlightened enough to hive off 10% of that and invest it. They would save all that money.” That is true but that is the argument of fixing an aeroplane in flight, so we must have a real conversation. I would be interested to hear the Minister’s reflections on that. The Treasury does not buy that argument and says that it is for idealists and daydreamers who do not understand the reality of public finances. But as the hon. Member for East Worthing and Shoreham says, we are spending an awful lot to get it wrong.

What do we have to change? How do we have to recalibrate that investment conversation to get the Treasury to move on the issue? Colleagues who are more enlightened on the issue than I am have been trying to do that year after year after year, and it does not happen. What is stopping us here? I have reflected—as have colleagues—on the Royal Foundation, now led by the Duchess of Cambridge, which has now spent nine years on early childhood experiences. That is wonderful political leadership, and has highlighted the fact that only one in four people in this country think that it is a priority. The royals would, hopefully, be good people for leading the conversation and helping to grow that figure, but we must also play our role and talk about the successes. We would be keen to do that in a cross-party manner because it needs helium in the public conversation so that we have greater public space to invest in it. We would all be better off if we did so.

I will not repeat points made by colleagues on the pandemic about the impact of isolation. The impact of covid will be the subject of longitudinal studies for the rest of my life. I want to raise the issue of the impact on local authorities, which is significant. That worries me because my local authority—and, I suspect, the vast majority of the 150 authorities in England—will be doing in-year budgets. They are a bad way to run public finances, because twice as much has to be cut to get the half-year effect. The public health grant, in particular, is likely to be distressed and squeezed by that. We will lose early intervention type activities from that. The Government need to look at that and to back-fill that public health grant loss from the previous seven years, not just from this year. That is the big prize. Dealing with covid and dealing with Brexit are vital. It is right that we spend these weeks and months doing that. As for getting our country where we want it to be—a country in which everybody can reach their potential and flourish—it is about those early interventions we make in the life course. I am glad to see the complete and cross-party agreement we have on the issue. We now need to translate that into more action.