Early Intervention

Andrea Leadsom Excerpts

Tuesday 31st January 2012 Commons Chamber

[Andrea Leadsom (South Northamptonshire) (Con)]

Last year’s riots were unprecedented in their violence and in the damage done to our society. We saw headlines such as “Mob Rule” and “Flaming Morons”. I hope never to see such things again. We owe a debt of gratitude to the police, who had to clear up under such difficult circumstances.

No one made those young people loot and steal and cause so much damage and fear, and there can be no excuse. The punishments meted out were right and I fully support them, but since those days the headlines have changed. We are not talking about the riots and the problems caused by those people, but asking why they did it. What caused that disorder? Is it moral decline, that the young have no respect, the benefit society or something more fundamental?

I want to prevent that type of appalling activity from becoming the norm in Britain or any other society, as I am sure all hon. Members do. To do that, we need to look seriously at prevention. I want to put the case that prevention is not just kinder than cure but incredibly cheaper.

[Ian Paisley (North Antrim) (DUP)]

I congratulate the hon. Lady on securing this debate. Does she welcome the “searching for answers” conference, which will commence tomorrow under the auspices of His Royal Highness the Prince of Wales, and which will be about the riotous situation that occurred in this land? Is that a welcome opportunity to try to get some of the important answers to the problems that she is describing in the House tonight?

[Andrea Leadsom]

The hon. Gentleman makes a good point. Anything that helps to prevent a repeat is to be welcomed.

I want to focus on a topic that we do not often discuss in the Chamber: the importance of love. Love in a prevention context begins with conception. It needs to go on throughout the baby’s life, but the critical period is conception to the age of two years. There is a very important reason for that: a loved baby who has his needs met will generally learn that the world is a good place and that people are generally kind. That baby will grow up expecting to be able to form secure bonds, make friends and hold down a job, and will generally have more capacity to lead a normal life.

On the other hand, the baby who is neglected or abused, or inconsistently treated, suffers two profound impacts. First, the baby who is left to scream is unable to control or regulate his or her feelings. When a baby knows something is wrong, he does not know whether it is because he is too hot, too cold, bored, tried or hungry—he just knows something is wrong, and he looks to an adult carer to sooth his feelings, relax him and get him back off to sleep.

When a baby is left to scream all the time, the stress hormone in the baby’s body—cortisol—rises to a level where it harms his immune system, and that harm can be permanent. What is more, if the baby constantly experiences raised stress levels, he becomes tolerant of his own stress level. You or I, Madam Deputy Speaker, might be excited by a scary episode of “Doctor Who”, but somebody with a high tolerance of their own stress level might need to go out to stab somebody to get the same level of excitement. Being permanently left to scream therefore has a profound impact on a baby.

The second impact is even more amazing. When a baby is born, his brain is barely developed; he simply has the amygdala, with the fight or flight instinct. Between six and 18 months old, the frontal cortex—the social part of the brain—starts to develop and puts on its peak growth spurt. That growth is literally stimulated by a loving relationship between baby and carer. Playing games such as peek-a-boo or gazing into baby’s eyes and saying, “I love you” and “Aren’t you beautiful?” literally stimulates the development of the baby’s brain. Conversely, as we saw from the appalling situation in Romanian orphanages, the orphans, who had no human contact at all, literally suffered brain damage; they were unable to communicate in any way, because they had had so little human contact.

[Anna Soubry (Broxtowe) (Con)]

I congratulate my hon. Friend on the debate and on all the sensible things she is saying with great passion and clear knowledge. Does she agree that it is imperative if children born into the most terrible circumstances are to be adopted, we make sure they are adopted as quickly as possible, given the excellent evidence she has placed before us this evening?

[Andrea Leadsom]

I thank my hon. Friend for that point, and I will come to it later.

If someone does not love their baby, and they do not bond properly with him in those first two crucial years, they are literally impairing their capacity to lead a normal life. The sad truth is that research shows that 40% of children in Britain are not securely attached by the age of five. That does not mean that they all go on to become criminals, psychopaths, sociopaths, paedophiles or drug addicts, but it does mean that their capacity to deal with the things life throws at them and the problems they will encounter is much lessened. They are less likely to be able to cope with holding down a job, making friends, and forming and keeping a relationship. At the extreme end, a baby will have been severely neglected or abused, and that is where we will find sociopaths. Sociopaths are not born, but made by their earliest experiences in the first two years of life.

Before we all go out and throw up our hands in despair, I want to make the case that there is a huge amount that can be done. Things do not have to be like this. If we as a society committed to making the very earliest intervention to provide the support needed for families, we could do so much in the first two years of life, when the baby’s brain has the ability to reach its full potential. We could turn things around and do great things.

The Oxford Parent Infant Project—a charity that I chaired for nine years, and of which I have been a trustee for 12 years—does precisely that work in Oxfordshire. In the past few months, I have launched a sister charity, the Northamptonshire Parent Infant Project, to do the same work. We work together with families—normally the mum, but it can be the dad or the grandparents—and the baby to help the carers understand, first, their own feelings about caring and parenting, and, secondly, the baby’s needs. We literally enable the adult to love the baby; we reintroduce them to each other, with astonishing results.

When Oxpip and Norpip get their referrals, the parents are desperate—they are about to commit suicide, infanticide or both. We have referrals from health workers, midwives and social services, which, in Oxfordshire, certainly often use Oxpip as their emergency service. If they have tried everything else, they will come to us to see what we can do. As I said, the results have been astonishing. An enormous amount can be done, therefore, to reverse this cycle of deprivation. The problem is that so often a failure to attach in those early years is the result of the parents’ own terribly unhappy lives.

[Jim Shannon (Strangford) (DUP)]

In Northern Ireland, an organisation called Home Start—it probably covers the whole of the United Kingdom—provides that level of support when it is needed most. I know of many ladies in my constituency and across the whole of Northern Ireland who benefited greatly from Home Start. Is that an example of what we need to do everywhere in the United Kingdom?

[Andrea Leadsom]

I completely agree that Home Start does some excellent work—in my constituency, it is actually based directly below Norpip—and we work together with it. But I am talking about psycho-therapeutic support for the most difficult early relationships. Often it is parents’ own unhappy lives that give them problems bonding with their babies.

[Andrew Selous (South West Bedfordshire) (Con)]

I hugely congratulate my hon. Friend on the mature way in which she is discussing issues that politicians often find hard to discuss. Does she agree that it is often easier to give children this incredibly important love if both parents are loving and committed to each other? That can be hugely helpful.

[Andrea Leadsom]

My hon. Friend makes a good point. Of course, as I said, it is often parents’ own unhappy lives that cause them to struggle to bond with their baby. For example, a mother who did not form a bond with her own mum as a baby will struggle to bond with her own baby. Her capacity to love her baby will be impaired. Often, relationship or marital breakdown, extreme poverty, drug abuse, perhaps domestic violence and other such issues make it incredibly difficult for the mum and the family to find the love that the baby desperately needs. Often, the baby becomes the last person whom anybody thinks about.

In truth, of course, early intervention and early attachment is no respecter of class or wealth. One can be extremely poor and extremely securely attached to one’s baby, but equally one can be extremely wealthy, with all the privileges it brings, and bring up the least happy child in our society. It simply does not go with the turf.

I urge the Government, in the light of our correct decision to turn to localism in the early intervention agenda, to allow local communities, in as many ways as possible, to make decisions for themselves. We must educate people much more on the importance of early attachment and the need for that early bond. Oxpip, for example, trains social workers, health visitors and midwives, and on the evaluation forms almost everyone says, “If only I had known this sooner.”

In the case of baby Peter, I remember thinking, “How could any mother allow someone to stub out a cigarette on her baby? How poorly attached was she to that baby!”, but then my next thought was, “What if he had survived?” All the talk was about how physically damaged he was, but what about how mentally damaged he was? This is the problem. We have to educate people, particularly in the perinatal, infant health care and mental health care professions on the crucial importance of early attachment.

That requires, first, proper training for social workers, health visitors and midwives on understanding early attachment itself. We need proper training of the sort that Oxpip provides. Secondly, sadly we often find that schools say to a young girl, “Well, if you’re not going to make it as a hairdresser, have you thought of child care?” Too many nurses, therefore, are very young people—often girls—who themselves have not had a happy childhood and who are looking for love with somebody else’s baby, but of course it does not work that way. To be a proper nursery worker, somebody needs to have the empathy skills, not simply the right national vocational qualification or GCSEs. That is incredibly important.

Thirdly, on another call to action for the Government, we desperately need to ensure that children themselves understand this point. The right hon. Member for Birkenhead (Mr Field) has talked of children entering school who do not recognise their own name unless it is yelled at them with real hatred—and probably with some stinking epithet attached at the end. The point is not that the child is not school-ready but that massive damage has already been done. If we do not intervene until school age, therefore, we are just dealing with the consequences—but that is not prevention; it is firefighting. What I would like to see, therefore, is all children in their science GSCE being taught about early brain development—being taught that the brain is not fully developed at birth and that the earliest relationship will have profound consequences for the healthiness of the brain as people grow up.

Finally—this is the other call to action—the protocols in nursery care often mean that someone will do the nappies for the morning run, while someone else will do the noon run and someone else the after-lunch run. That has to stop. Nurseries need to understand that for attachment to take place, there must be a bond between the nursery worker and the baby, so that that person can make a genuine contribution to the baby’s attachment ability, rather than detracting from it. Nursery protocols can therefore be either extraordinarily helpful or extraordinarily harmful in improving the quality of attachment.

There is an awful lot of understanding about the issue now. Most people would accept that early intervention is crucial, but when I go and talk at conferences, or even when I talk to colleagues in the House, people understand “early intervention” to mean different things. I have had councillors saying, “We do early intervention to prevent people from having house fires. We go round and advise them on smoke detectors, and so on.” Other people say, “Of course, early intervention is stopping teenage girls getting pregnant.” Others think that early intervention is about sports clubs to stop boys joining gangs. The terminology has become so confused that people do not really understand what early intervention is. All those other interventions have their place. They are all critical in repairing the damage that has been done. However, if we are serious about creating a better society for our children and our children’s children, “early years prevention” must mean just that: from conception to the age of two. We can do no better than that for our children.

[The Minister of State, Department for Education (Sarah Teather)]

I congratulate the hon. Member for South Northamptonshire (Andrea Leadsom) on giving an absolutely fascinating speech. I always respect what she says, and I am always grateful for her contributions on these issues. It is good to hear someone who has so much interest, expertise and passion speak on this subject. I share her passion for this subject, which is incredibly important.

Early intervention is a hugely important issue, and the term refers to many of the things that she described. However, I should say that I am the Minister with responsibility for early years, so I have a particular bias towards ensuring that early intervention really focuses on early years issues. The point about attachment is gathering pace in debate, as well as in the knowledge among professionals on the ground. The work that Oxpip has done, along with the hon. Lady’s work in continuously raising this issue, is important in ensuring that professionals understand the importance of attachment and that the Government consider it when we develop our early years policies.

I absolutely agree with the hon. Lady’s points about the importance of warm parenting and bonding. Those issues go to the heart of many of the things that we have been trying to do over the last 18 months. She will be aware that I and the Under-Secretary of State for Health, the hon. Member for Guildford (Anne Milton), who has responsibility for public health, jointly published a document in the summer called “Families in the Foundation Years”, which covers many of the things that she picked up. There is a lot more work to do in this area—some of it is just beginning—but some of the themes that the hon. Member for South Northamptonshire picked up are being addressed by what is very much work in progress, across both the Department for Education and the Department of Health. In a sense, the things that she has talked about go right to the heart of the intersection between those two Departments. Indeed, it was a toss-up as to whether it would be me or my colleague the Minister with responsibility for public health responding this evening. We both take such issues incredibly seriously, which is why we are collaborating on much of the work on the nought-to-five age group.

The hon. Member for South Northamptonshire outlined the impact that insecure attachment can have on neurodevelopment and, in particular, the ways in which it affects levels of cortisol and the long-lasting impact that this can have on brain development. That is worth emphasising. Not all the research is concrete enough for us to be able to tell in retrospect whether somebody’s difficulties are a result of attachment issues, but there is good evidence that stress in early years results in attachment issues later. It is not always possible to bring that back retrospectively, when somebody’s behaviour is difficult, but there is certainly good correlative evidence that the lack of a warm bond from the beginning can result in serious behavioural problems later.

The issues that the hon. Lady has raised go to the heart of a number of matters that are a priority for the Government in the areas of family policy, health policy and child development. We have many of the systems in place that will begin to pick up on those issues. This is about universal and targeted services. She made the powerful point that issues of attachment are no respecter of class or income, which is precisely why we need children’s centres that are universal, but that can focus on those who are in the most need. They must have a universal front door through which anyone can walk, and they must not stigmatise those people who walk in and ask for the services. They must then focus their resources on the most difficult and challenging problems, including those that the hon. Lady mentioned. That is exactly what we have been trying to achieve.

Regarding the statement that we published in the summer, a number of things will be key if we are going to get this right. First, it is about identifying need early and putting in place the support to help the families that need it. Frankly, the first problem that we need to get over is that of data sharing. As I have said, this problem goes to the heart of issues covered by the Department for Education and the Department of Health, and data sharing is one of the big nubs that the previous Government tried to get to grips with. My colleague the Under-Secretary of State for Health and I are determined to pick up on this issue, because until the information about which families are most in need can be passed between the different professionals, it will be difficult to put in place the help that we know is available.

Over the past six months, I have seen some really good examples of where the services are working really well, and it is worth taking a minute to talk about them. The most exciting of the examples was in Manchester. I visited the Clayton Sure Start children’s centre just after the riots to find out about the work that it had been doing in this area. As part of a drive to improve the integration of services with GPs in the area with the most deprived wards, the GPs themselves had arranged for junior doctors who were training to become GPs to spend time at children’s centres to see the services that were being delivered. Among the messages that they were trying to get across was that, when a woman presents with post-natal depression, it is not just the woman whom they need to treat. They need to look beyond the patient and to understand that a newborn child is also involved and that, unless they get the services right, there could be a risk of attachment disorder later. That is not to say that every woman who presents with post-natal depression will have a child who ends up with attachment disorder, but GPs need to be aware of these issues.

The hon. Lady made a point about training for professionals. Health visitors are trained to understand these things, as are early years workers, although I think that there is much that we can do to improve on that. I will come back to that in a moment. Many GPs have very little knowledge of child development and attachment issues. That was a really exciting project on social prescribing, and I will be fascinated to see the results. I hope that many other areas will follow Manchester’s example, and learn just what can be done.

Similarly, some really good work has been done in Hull, involving an agreement to share information between local health services and children’s centres. The project has been led by one inspirational woman who is absolutely determined to ensure that the information was shared. The result of the agreement was that health visitors and family outreach workers were not duplicating each other’s work. They were sharing information and getting to the families in need quickly. They were also able to put in place the kind of support that the children’s centres offer, to help parents to understand the need to speak to their children in a particular way, and to understand about the warm parenting styles and firm parenting styles that are important right from the beginning.

The hon. Lady will be aware that the Government have committed to significantly increasing the number of health visitors. We plan to increase the health visitor work force by 4,200 by 2015 to ensure that the healthy child programme is fully and consistently implemented. At the moment, because of the patchy availability of health visitors, not everyone gets the support that they need. Ensuring that that service is well linked to the work that we are doing with children’s centres is at the heart of what we are trying to do.

Similarly, the Government have doubled the amount of funding available for the family nurse partnership—a programme that works intensively with particularly vulnerable young mothers and young parents to make sure that they get support right from conception, as the hon. Lady said, so that we do not pick up problems several months down the line when some of the problems have already begun to cement. It is an important programme, which we know makes an enormous difference to families at what is often a particularly difficult time. The nurses are very experienced and receive additional training in motivational interviewing, neurological development, attachment, mental health and strength-based working in a therapeutic relationship. Those are important skills, which help to ensure that the nurses are able to support mothers at that time.

[Andrea Leadsom]

I agree that the family nurse partnership is excellent, but does the Minister agree with me that it is entirely possible to come up with other strategies that would be less expensive and less prescriptive, including different therapies that might be more appropriate for certain types of parents rather than a prescribed particular programme that costs the taxpayer a lot of money to implement?

[Sarah Teather]

As the hon. Lady says, the family nurse partnership is one of our more expensive programmes. It is focused on very young mothers, and the doubling of the programme has been aimed primarily at expanding the help available to young, mostly teenage mothers who we are know are vulnerable. That is not to say, however, that other forms of help cannot also be extremely effective. The hon. Lady speaks with great passion about the work of the charity with which she is involved. Children’s centres have other models for helping to support women, particularly in areas where data sharing is working well and someone might be brought into a children’s centre before they give birth. It does not necessarily mean that the support they get is through the FNP system. There may be other ways of supporting those women. It is important for children’s centres to build on the best evidence available, but they must also be left free to innovate and develop their own work—based on what is known works.

Let me provide an example—outreach work. We are trying to improve the quality of the work done on outreach and family support. At the moment, there is a great variety of types of work on outreach. We have been working with the National College for School Leadership to develop some leaders in this area so we can draw together the evidence of best practice and disseminate it to encourage all areas to adopt the elements that we know work. That is not to say that every programme has to be badged or that everybody has to call their family support worker—sometimes called something slightly different. We know that certain key components of this work make a difference, so the key components of best practice will make a difference to families in difficulty.

I have only a few minutes left, so I would like to pick up some other points raised in the debate. The hon. Member for South West Bedfordshire (Andrew Selous) raised a point about relationship support. I think that is critical for both the reasons the hon. Gentleman suggested, but also because when parents are in conflict, it is incredibly damaging for children as they grow up. That is the main reason why the Government are providing support for relationships—formal face-to-face relationship support, but we have also provided money for telephone counselling. This is an important feature of parenting programmes that work well. If we are to support parenting, we know that it is key to support the parents’ relationship and get them to talk to one another. They must have some support to ensure that the relationship is solid; parents should have the skills to negotiate with one another, not just with the child. Working with only one parent in such circumstances tends to be less effective. It may not have no good results, but the results will be much better if a component of relationship support is included.

Last September the Government announced a trial of a new offer of universal parenting support, which will take place in three areas for parents with a child under five. That was a response to evidence that parents’ relationships with their children was critical to the home learning environment—the hon. Member for South Northamptonshire mentioned children aged between nought and two, but in fact the relationship is critical throughout, and is one of the most important factors that determine how well a child does—but also a response to what parents tell us, which is that they want more support in this regard.

We will begin the trial, and we will see what happens. We will see whether parents take up the offer, whether it is popular, and whether it has an impact on parenting style. It is one of the things that we will need to evaluate at a later stage. We will want to know whether it deals with some of the points that have been raised this evening about harsh parenting styles that have an impact on children’s development and on discipline, but we also want to test the theory that if we provide this—