Coronavirus Update

Andrea Leadsom Excerpts

Tuesday 14th July 2020 Commons Chamber

[Matt Hancock]

The hon. Gentleman is absolutely right. He and I are passionately of one voice on this—as, I think, is the whole House. The Government will recommend a vaccine only when it is known to be safe and effective. We will then need to administer that vaccine, and for people to have confidence in it. People who propagate untrue myths about vaccines are putting lives at risk—that is true of the measles jab and other jabs, and it is true in this case too.

The social media companies have an important responsibility. They have taken some action already, and I pay tribute to them for that; in fact, I have a meeting later this week with a Mr Nick Clegg, who is in a position of responsibility at Facebook, but it is not only Facebook and Instagram that have taken action. We will be discussing what more action can be taken to make sure that people who are propagating lies about vaccines do not manage to spread those lies.

[Andrea Leadsom (South Northamptonshire) (Con)]

Nobody has worked harder than my right hon. Friend to try to save lives and protect people throughout this pandemic, but I know that he, like me, would like a safe and fast economic recovery, so can he please clarify something for my constituents? I have wedding events organisers and business meeting organisers who are genuinely asking what the difference is between a restaurant, which can safely socially distance with perhaps 60 covers, and a wedding, which is allowed only 30 people, who are also socially distancing with all the motivation to do so. Is there some health reason for that, or is it simply a straightforward matter of trying to reduce the return to economic activity?

[Matt Hancock]

No. This is essentially a judgment about ensuring that people have the appropriate social distancing, with, of course, the maximum possible return to economic and social life. There is a judgment to be made about where such restrictions are put; they are the sort of restrictions that nobody would ever want to put in place, but the problem is that the virus thrives on exactly the sort of social contact that people want to undertake when they are celebrating something like a wedding.

We cannot negotiate with the virus; all we can do is try to have the right balance of measures to keep the spread of the virus down while allowing the restoration of economic and social life. Ultimately, the rules we put in place are judgments, and they are the best judgments we can make with the information available. We keep them under constant review—as I hope my right hon. Friend has seen, for instance, with the reopening of nail bars and beauty salons this week—just as we keep the data on the spread of the virus under review.

Early Childhood Development

Andrea Leadsom Excerpts

Thursday 30th January 2014 Westminster Hall

[Andrea Leadsom (South Northamptonshire) (Con)]

I am delighted to have secured this debate, and I am grateful to the Backbench Business Committee for selecting it. Mr Weir, did you know that 36% of all case reviews into deaths or serious abuse involve a baby under the age of one, and that a quarter of all babies in the UK have a parent affected by domestic violence, mental health or drug or alcohol problems? Furthermore, if one asked most local authorities how much they spend on specialist parent and infant mental health services, the answer would be, “Nothing.”

I am proud of the fact that with three cross-party colleagues, I have launched the manifesto “The 1001 Critical Days” to propose specific ways that the Government can better support the needs of new families. The 1,001 critical days is the period of time from conception to the age of two. In our cross-party manifesto, the right hon. Members for Birkenhead (Mr Field) and for Sutton and Cheam (Paul Burstow), the hon. Member for Brighton, Pavilion (Caroline Lucas) and I seek to recognise the overwhelming evidence now available that a secure early relationship between baby and key carer is vital to the infant’s lifelong emotional and physical well-being.

We are grateful for the strong interest that the manifesto has received from Ministers and shadow Ministers, particularly the Under-Secretary of State for Health, my hon. Friend the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), and the hon. Members for Manchester Central (Lucy Powell) and for Washington and Sunderland West (Mrs Hodgson). We have also been delighted by the amazing number and range of endorsements for our manifesto, from the chief medical officer for England and Wales to UNICEF UK, the National Society for the Prevention of Cruelty to Children, the Centre for Social Justice, Barnardo’s, the Royal College of Midwives, the Royal College of General Practitioners and the Institute of Health Visiting. The list goes on and on.

Mr Weir, you might be wondering what on earth is left to debate if the topic is such a love-in, but the truth is that there is an enormous amount to be done if we are to seize the opportunity to change our society radically for the better. An NSPCC study shows that only 64% of NHS trusts have a perinatal mental health strategy. Other recent research shows that 42% of GPs feel that they have very little knowledge about the specialist services available for severe mental illness. Nearly a quarter—23%—of all maternity professionals say that they have received no education on maternal mental health, and the Royal College of Paediatrics and Child Health estimates that the annual short-term costs alone of emotional, conduct and hyperkinetic disorders among children aged five to 15 in the UK are £1.58 billion, and the annual long-term costs are £2.53 billion.

The Institute of Health Visiting is delighted by the Government’s commitment to significantly increasing the number of health visitors, and progress in training new health visitors is on target. However, in a recent survey by the institute, 87% of midwives said that their work loads had increased and that they were seeing the following worrying trends: 65% were seeing increased child behaviour problems, 61% reported seeing an increase in the prevalence of speech delay, 73% were seeing an increase in poverty that was having a bad influence on families, 82.5% were seeing an increase in domestic violence and abuse and 70% reported an increase in the incidence of perinatal depression. Perinatal depression includes antenatal depression—that is, before a woman has her baby—as well as the depression that can arise during birth as a result of a traumatic birth experience and, of course, post-natal depression, which is the main subject that people talk about when they talk about depression in the perinatal period, if they ever talk about it.

Everyone would agree that prevention is better than cure. Everyone, or pretty much everyone, would agree that many of our society’s greatest problems stem from alcohol and substance abuse and mental illness. But too few people realise that in a vast number of cases, those in our society who cause the most damage and cost the most money have been permanently set up for disaster from their own infancy. The absence of a secure bond between baby and carer in the 1,001 critical days has profound lifelong consequences for the baby. I am convinced that once the strong link between experiences in the earliest years and whole-life outcomes becomes more widely accepted, we will start to make huge progress in tackling society’s most intractable problems.

The efforts of 20th-century politics achieved great strides in tackling the physical health of our nation. The challenge for our 21st-century generation must surely be to secure sound mental health that will lead to a stronger and happier society. Imagine how wonderful it would be if we were to shut down prisons, not because of overcrowding or poor conditions but because we did not have enough criminals to fill them. Imagine if we could close psychiatric hospitals due to a lack of need for them.

[Steve Brine (Winchester) (Con)]

I congratulate my hon. Friend on this debate. I know that she is achieving quite a reputation in this area. The Select Committee on Justice, of which I am a member, held an inquiry recently into youth justice and the drivers of youth justice. As she will probably know, just 10% of children and young people in the general population have a speech and language difficulty, but in the prison population the figure is somewhere between 60% and 65%. Does she agree that delayed language development leads to issues at school, exclusion from school and many of the problems that cost our society so heavily?

[Andrea Leadsom]

My hon. Friend is absolutely right that delayed speech is a key contributor to later problems for the infant who does not reach the right level of speech capability in the first critical years.

Think of walking through any big city in the UK without seeing teenagers living rough in the streets. Finally, imagine a society where the number of babies and children being taken into care and removed from their families was falling, instead of rising as it is at the moment.

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

I congratulate my hon. Friend on bringing this important subject before the House again. I should disclose an interest as the chairman of the Mindful Policy Group, which is all about promoting attachment. The figures that she gives are stark, but does she also acknowledge that this has become a generational issue in too many of the statistics that she mentioned? Half of young people in young offenders institutes who come from care will then go on to have children subject to similar problems. In many cases, the common cause is domestic violence and lack of attachment built at an early age. It is not rocket science; these are common themes. It is a false investment not to do something early, as her excellent manifesto so clearly proposes.

[Andrea Leadsom]

I completely agree, and I will discuss that in a moment. It is called the cycle of deprivation, and my hon. Friend is absolutely right to raise it.

I honestly believe that it is possible to change our society for the better, but it needs a concentrated focus on the mental health of our nation. I want us to build a third pillar to our great universal services. Alongside the achievements of free and universally available health care and education, I want a free and universal service focusing on the mental health of our people. It must start at the very beginning—the period of 1,001 critical days between conception and age two—and it must ensure that every child can build the emotional capacity and resilience to cope with life’s ups and downs.

I make the case that what we do with a baby from conception to age two is all about building the human and emotional capacity of that infant. Supportive interventions with a child after the age of two are often too much about trying to undo damage that has already been done. I would never advocate giving up on anyone, but it is an incontrovertible fact that if we want to change our society for the better, we must focus on the crucial period between conception and age two.

Human babies are unique in the animal kingdom in the extent of their underdevelopment at birth. What other animal cannot walk until it is nearly a year old and cannot fend for itself in any way at all until it is at least two years old? However, the physical underdevelopment is only a tiny part of it. The human brain is only partially formed when a baby is born. The billions of neurones in the brain are largely undifferentiated at birth, and parts of the brain are simply not there. Humans are born with only the fight-or-flight instinct and the earliest experiences of the human baby literally hardwire his or her brain and have a lifelong impact on the baby’s mental and emotional health.

What are a baby’s earliest experiences? It is quite simple. When a baby cries, he does not know that he is wet, tired, hungry, bored or too hot; he just knows that something is wrong, so he relies on a loving, adult carer to soothe his feelings. Most parents will remember, as I certainly do, long nights spent walking up and down, hugging a baby, saying, “Go to sleep, go to sleep,” desperate for sleep ourselves and determined to try one thing after another to sort the situation out. The baby whose basic needs are met learns that the world is a good place, and he or she will retain that sense as an instinct for life. That baby will be more emotionally more robust than the baby who does not have his needs met.

For the baby who is neglected or abused, there are two critical impacts on development. First, a baby cannot regulate his or her own feelings at all. If the basic needs are not met, he or she will simply scream louder and louder, and eventually take refuge in sleep. The first impact is that a baby who is left to continually scream night after night will experience raised levels of the stress hormone, cortisol. Excessive amounts of that damage the baby’s immune system permanently, and evidence suggests that a baby left to scream for hours at a time, day in and day out, will develop a higher tolerance to their own stress level, meaning that in later life, they will have more of a predisposition to high risk-taking behaviour than a baby who has only a normal level of cortisol. A lot of evidence shows that violent criminals have a high tolerance to their own stress levels. However, it is not only that—for a mother who is very stressed during the time that her baby is in the womb, the outcome is that the baby can physically be very desperately damaged. For example, maternal stress during pregnancy can lead to a thinning of the baby’s arteries, which has profound consequences later in terms of congenital heart disease, diabetes and obesity.

There is also a very real physical impact on the brain. The pre-frontal cortex—the social part of the brain—only starts to develop at about six months, and the peak period for that part of the brain to develop is between six and 18 months old. Growth is stimulated by the relationship between the baby and carer, and peek-a-boo games, gazing into each other’s eyes, singing songs, saying, “I love you, you gorgeous little thing!” and lots of cuddling all play a really strong role. Love literally shapes the baby’s brain. The brain develops millions of neural connections during that period and the pre-frontal cortex physically grows in size.

[Steve Brine]

Although I appreciate that saying, “You beautiful, delightful thing” is clearly the thing to do, at 3 in the morning, especially as a brand-new MP with a vote at 10 pm the next night, saying, “The Prime Minister really needs to be on my game” does not cut much ice with a newborn baby—I say that from bitter experience. My point is that parents have to learn how to be parents and how to give that love and care. Will my hon. Friend take a moment to recognise the amazing work of organisations such as Home-Start? They do brilliant work in teaching parents how to be parents.

[Andrea Leadsom]

Yes, Home-Start does a fantastic job, as do other volunteer organisations, peer-support groups and so on; there are many around the country. It is true to say that becoming a parent is the most difficult thing that someone ever does. There is no on-off button for a baby and no rule book, guidebook or handbook, so we all struggle on in our own way, with better or worser results—[Interruption.] Probably not “worser”—worse, thank you. The Secretary of State for Education is not responding to the debate, so we are all right, but the point is about being a good enough parent, and if a baby knows that he or she is loved, a parent does not have to say it at 3 o’clock in the morning when they are at their wits’ end. However, a baby does have to learn that their parent loves them.

When a baby does not receive attention from a loving adult carer, the pre-frontal cortex does not grow and may never grow. Many will remember the tragic story of the Romanian orphanages, where the minimal physical and emotional contact with babies left them profoundly and permanently brain-damaged. Some of them died literally from a lack of love.

It ought to be natural and automatic for families to form a loving and secure bond with their babies, but post-natal depression, problems with conception, trauma during childbirth, domestic violence and issues of poverty and deprivation all get in the way. Insecure attachment is no respecter of social class or wealth. One of the biggest obstacles to forming that crucial secure bond is when mum did not have a secure relationship with her own mother. As my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) pointed out, it truly is a cycle of deprivation that is all too often passed down through generations.

[Fiona Bruce (Congleton) (Con)]

I thank my hon. Friend for securing the debate and for the passion that she has for the issue. Does she agree that a strong relationship between the child’s parents is critical? On the tragic costs of family breakdown within the country, she cited some statistics, but another is that £46 billion is the cost of social breakdown. Does she agree that, given that three different Departments have already been mentioned in the debate—the Ministry of Justice, the Department of Health and the Department for Education, and I could add the Department for Communities and Local Government, because we have health and well-being boards—we need to look at having a team responsible in a Government Department, with a lead Minister who will give the issue priority on a daily basis?

[Andrea Leadsom]

My hon. Friend is a passionate advocate for support for relationships, and she is absolutely right that the best results for babies and young children come when they have two parents who love each other. There is no question about that. All the statistics back that up, so she is absolutely right; we ought to prioritise the essential importance of helping families to stay together.

The brain development of babies has deep implications for society. A human being without a properly developed social brain finds it very difficult to properly empathise with other human beings. That can pose risks along a spectrum, from a general lack of emotional resilience, leading to depression or general unhappiness, to antisocial behaviour, drug-taking, criminality and, at the most extreme end, psychotic behaviour.

The charity Railway Children estimates that there are up to 100,000 children at risk on the streets in the UK every year. Research shows that more than 80% of long-term prison inmates have attachment problems that stem from babyhood. Evidence now suggests that two thirds of future chronic criminals can be predicted by the behaviour seen in two-year-olds. A New Zealand study showed that a child with substantial antisocial behaviour aged seven would have a 22-fold increased chance of criminality by the age of 26. Statistics issued by the Office for National Statistics show that almost 80,000 children and young people suffer from severe depression, and that 95% of imprisoned young offenders have a mental health disorder.

There is also a very real financial cost to society: each looked-after child costs the taxpayer about £347 a day, each adult prison inmate costs the taxpayer about £112 a day and each person in acute psychiatric in-patient care costs the taxpayer £225 a day. Analysis of spending in local authorities shows that that cannot go on for much longer. The wonderfully named “Barnet graph of doom” shows that on current trends, spending on children’s services and adult statutory services alone will outstrip the income of the local authority of Barnet by 2025. That means the council will have nothing to spend on other important services such as refuse collections, potholes, or parks and leisure facilities.

A pretty shocking statistic is that research suggests that in Britain, 40% of children are not securely attached by the age of five. Of course, that does not mean that they will all go on to have behavioural or relationship problems, because other life events will play a part, but it does mean that they will be less robust in their emotional make-up to meet the challenges and disappointments of life. It also means that later in life, as parents, they may struggle to form strong attachments to their own babies, thus perpetuating the cycle of misery through the generations.

Having set the scene and described the challenge, I shall move on to the proposals that we have set out in our “The 1001 Critical Days” manifesto. The key overarching call is for an holistic approach to the perinatal period whereby the needs of the family are met in a seamless way.

First, we need specialist mental health midwives and health visitors in every local authority area. We must enable women with a history of mental illness to receive tailored antenatal and post-natal care, and thereby reduce the risk of later post-natal depression. Secondly, those families experiencing difficulties should be able to access evidence-based services that promote parent-infant bonding, such as video interaction guidance and parent-infant psychotherapy. Thirdly, all parents should have access to antenatal classes that deal with both the physical and emotional implications of childbirth, as well as the baby’s own mental health needs.

Fourthly, the registration of the birth of a baby should be made possible in children’s centres in every area. Benchill children’s centre in Manchester Central, where the hon. Member for Manchester Central plays such a key role in promoting early years intervention, is a fantastic example of how registration in children’s centres can help new families. It has been offering birth registration for more than a decade, and its reach to new families has grown from less than 50% in a very deprived ward to 87.5%. In addition, its re-engagement rate with families is astonishing: for young parents, it is 100%. All parents have access to the services that they may desperately need, to help them to get the best start in life with their babies. In—

[Tim Loughton]

I did not mean to interrupt my hon. Friend mid-sentence. She makes some very fine points, especially about accessing antenatal classes and children’s centres. Does she agree that we need to make both types of facility more dad-friendly as well as mum-friendly because too often they are dominated by mums, and that, where partners are available, the support that they can be encouraged to give if seen as an equal partner in the family could help to prevent some of the perinatal mental health problems that befall one in six women around the time they give birth?

[Andrea Leadsom]

Yes. I am grateful to my hon. Friend for making that point. Benchill has that amazing ability to reach new families by offering birth registration. As hon. Members will know, if a man is not married to the mother of the child, the only way to have his name on the certificate is to be present physically at the registration as the father. Therefore, the advantage of offering registration in children’s centres to families is that it offers the opportunity for the children’s centre to look at the parents together. Benchill certainly encourages its staff to chat to dad. It encourages them not to focus just on mum or baby, but to talk to dad and the other children if they are there—to engage with them, try to give them support and let them see what services are offered to dads and babies and not just mums and babies. That is a perfect example of how to support the entire family. In one fell swoop, Benchill deals with the problem of stigma—everyone goes to the children’s centre, so clearly there is no stigma—and those families who are deemed hard to reach and who so often need services but do not get them are automatically engaged.

The fifth proposal in our manifesto is that there needs to be a presumption of data sharing among perinatal health professionals. The incorrect perception remains that sharing concerns about a mum, a family or children is against the law. In fact, professionals talking to one another and sharing their concerns and the information that they have on different families could very often save lives by allowing earlier interventions to be made.

[Sarah Champion (Rotherham) (Lab)]

The hon. Lady is making a very interesting point. I am doing an inquiry into child sexual abuse, and one of the key blocks to getting prosecutions is the lack of information sharing among health bodies, education bodies, local authorities and the police, so I fully support the recommendation on that, because it seems to me the only way in which we can prevent abuse and other forms of neglect.

[Andrea Leadsom]

The hon. Lady is absolutely right. Sadly, in serious case reviews there is very often an element of failure on the part of health professionals—a failure to talk to one another. Very often, that is a contributing factor to the disastrous outcomes that we sometimes see for families and children.

[Tim Loughton]

My hon. Friend makes a very good point about data sharing, but it does not happen in practice and is too often used as an excuse by professionals who are too lazy in some cases or have various other professional reasons for not wanting to speak to other professionals. Through the proliferation of MASHs—multi-agency safeguarding hubs—and through local safeguarding children boards and other bodies, professionals now come together regularly to share strategy, and they should be able to change that information as well. The regulations do not deter them from doing that, so it is an excuse and in practice that excuse should not be tolerated.

[Andrea Leadsom]

Yes. Even my hon. Friend’s harder line is absolutely right: there should be a presumption in favour of data sharing. It should not be a case of people saying, “Oh, I didn’t know,” or, “I didn’t think it was allowed.” It should be a case of people being told, “If you didn’t share information, you should have done.” At the moment, that is not understood strongly enough.

Of course, data sharing is relevant not only in child neglect or child abuse cases. Let us say that a midwife meets a mother antenatally and is aware that that mother is terrified at the prospect of giving birth because of the physical implications, because she is afraid that her partner might leave her or because she is afraid that she will lose her job as a new mum. Often, when such issues are picked up antenatally, there is, first, a lack of places to refer that mum on to and, secondly, a lack of a communication path to enable the midwife to think about whom they should be talking to.

There is, therefore, a very strong argument for creating formal links between midwives, health visitors and children’s centres to ensure not only that they can talk to someone else, but that they must talk to someone else. The relevance of that to the mum’s experience is that if a midwife is concerned about a mum, they can perhaps refer her on to a mental health specialist midwife and a mental health-focused health visitor. That could all take place under the auspices of a sensitively attuned children’s centre, so that the mum’s needs can be met throughout the perinatal period, giving her the best chance of forming the vital secure bond with her baby. Data sharing is relevant not only to cases involving severe child protection issues; it is also about supporting mums who are just struggling. As we know, the statistics suggest that as many as 100,000 mums a year may be just generally struggling. It is not that there are severe physical or neglect threats to their babies; it is just that those mums need a bit of support, and at the moment we are not giving them that.

That takes me on to our sixth proposal. There is a huge need to provide proper training for front-line health and social care professionals in the importance of attachment and early brain development. I have been involved for about 15 years with parent-infant partnership charities that provide psychotherapeutic support to families. We also provide training to front-line professionals. It is astonishing how many post-training evaluation forms we get from midwives, health visitors, GPs and social workers that say, “Wow! I wish I had known before how important the earliest relationship is.” That is not as much about the physical health as about the emotional health and the attachment.

Our seventh proposal is that local commissioning groups and health and wellbeing boards should specifically consider the social and emotional needs of babies in their local strategies.

The eighth proposal is that childminders and nurseries should consider how they can better meet the attachment needs of babies in their care, and that Ofsted inspections should specifically provide guidance and assess their performance. As a member of the Committee considering the Children and Families Bill, which passed through the House of Commons recently, I was pretty shocked, when we had Ofsted in to give pre-Committee evidence, to be told that Ofsted inspectors do not routinely assess those looking after the very youngest—potentially babies from the age of three months to two years old—on how well the care setting is meeting their attachment needs. There is this sense of schoolifying in the inspection regime. It forgets about how well the key worker is playing with the baby, responding to the baby, smiling at and cuddling the baby and being the key person who changes the nappy, does the feeds and so on. All those things are absolutely crucial for secondary attachment if mum or dad is out at work.

[Sarah Champion]

I know that the debate is about early years, but I was also surprised to find that in schools, there is no requirement for Ofsted to measure safeguarding; they deal only with educational attainment. We must look more holistically at a child from birth onwards.

[Andrea Leadsom]

As the hon. Lady said, the debate is about the earliest years. If we can get those right, there will be many fewer problems later in a child’s development. We can close down the pipeline of later problems by intervening and supporting families far earlier.

The final proposal in our manifesto “The 1001 Critical Days” is that although children’s centres should continue to provide a universal service, they should prioritise specialist services for families with the highest level of need regardless of their social and economic circumstances. Service provision must be needs-based and universal, but focused on specialist services for those who really need them.

As I have said, since 2001 I have been closely involved with parent-infant charities that provide psychotherapeutic support to families who are struggling to form a secure early bond with their baby. I am delighted to say that a year ago I set up a charity called Parent Infant Partnership UK, which has set out with philanthropic donations to establish specialist parent-infant psychotherapy services based in children’s centres around England and Wales. The first brand-new Parent Infant Partnership, LIVPIP, will launch this month in the constituency of the shadow Minister, the hon. Member for Liverpool, Wavertree (Luciana Berger). It will provide psychotherapeutic services for families who need them in the Liverpool area. I am absolutely delighted about that, and I hope that other local authorities will want to establish similar specialist services themselves.

[Sarah Champion]

I am very supportive of the scheme that the hon. Lady is describing, and I hope that it can be rolled out more widely. In Rotherham, we have some fantastic Sure Start centres that offer great parenting classes. Does the hon. Lady share my concern that because our early intervention grant has been reduced, we are having to look at cutting the number of Sure Starts from 22 to nine? I am concerned that the vital parenting support given by the Sure Starts will be lost.

[Andrea Leadsom]

The hon. Lady will know that there is a presumption against closure, and several local authorities have considered closing Sure Starts but have chosen not to. I once took my hat off in the Chamber to the Labour party for creating Sure Start—I was subsequently told that props were not allowed in the Chamber—but the problem is that they are not universally understood. If we ask the proverbial man on the Clapham omnibus what a school is for, we will get the same answer from every man on that omnibus. If we ask what a children’s centre is for, however, we will get all sorts of different answers. The fundamental problem with the Sure Start children’s centre system is that there is no common understanding of what they are for and the extent to which they should be provided.

My opinion—this is not part of our manifesto—is that children’s centres should have a statutory footing like schools do. If a school year 4 is failing, we do not say, “Well, shut it then, and those children can just go without learning to read and write.” The profound implications of children’s centre services on a child’s development may be far greater than whether they learn to read and write at the age of four, and far more fundamental for their life chances, but we are willing to shut children’s centres. I appreciate what the hon. Lady has said about cuts, but we need to improve understanding of children’s centres and spread the good practice that undeniably exists in some. We must persuade local authorities that children’s centres are not for cutting; they are profoundly important—at least as important as schools and hospitals. That is my opinion, but I hope that answers the hon. Lady’s good point.

Psychotherapeutic interventions from parent-infant partnerships have changed lives for the better for thousands of families. For those families whose babies now have the best start in life, rather than a disastrous one, politicians can count the savings to the public purse. Early years intervention has the potential to save billions of pounds from the cost of dealing with poor mental health, antisocial behaviour, crime and violence. My hope is that all political parties will adopt the achievable and sensible recommendations of our manifesto “The 1001 Critical Days”, and that we will together strive for the real prize, which is, surely, to change our society for the better.

--- Later in debate ---

[Fiona O'Donnell]

I thank my hon. Friend for her intervention. It is so distressing—no child chooses where it is born. No child is born bad; bad things happen to children. It is really depressing to face the idea that a child’s outcomes should be determined by the streets they were born between. At NCH, which is now called Action for Children, I worked with children who were at risk of being removed from their family. I always felt that that was an ironic term, because the best thing for some children was to be removed from their family, as it was for the parents, too. For those children, there was really no opportunity. Many had suffered emotional and, at times, physical and sexual abuse.

I urge the Minister to look at the excellent children’s panel hearing system that we have in Scotland, because it works well. It is great, because the child is absolutely at the centre of the process. This is not about what happens in the first 1,001 days, but seeing a child finally disclosing the abuse they have suffered, with us all having to leave the room until they felt able to tell their story, was the most remarkable thing, as was knowing that, hopefully, it was the beginning of a process of survival and recovery from that abuse. It was desperately sad to hear a 10-year-old boy say to me, “I know I can never be a parent, Fiona, because I couldn’t be trusted.” It is unthinkable that children should have to face such choices. As the hon. Member for South Northamptonshire said, we must educate health workers, teachers, nursery workers—everyone involved in a child’s care—to spot the early signs of abuse and not be frightened to raise concerns.

I look forward to hearing the Minister’s response, as well as that of my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger), particularly on the issue of parents of premature babies. We know that breastfeeding brings huge benefits to babies. I am a mother of premature twins.

[Andrea Leadsom]

I am grateful to the hon. Lady for giving way, because I wanted to make one little point that I did not cover in my speech. I am so glad that she received such excellent care for her pre-term babies. However, does she agree that it is rather shocking that if someone has a baby pre-term, we move heaven and earth—we helicopter babies all over the place—to find a neonatal intensive care unit, whereas if a child is born full-term and the mother has a psychotic incident, which happens in up to 1% of births every year, affecting up to 7,000 families in the UK, it is a postcode lottery as to whether an in-patient unit can be found? That could be a death sentence for the baby. It is completely unfair.

--- Later in debate ---

[Damian Hinds]

The hon. Gentleman asks a big question. I do not want to test your patience, Mr Weir, by debating the London Challenge, rather than early child development. I will talk in a minute about societal differences that may or may not be driving factors. The honest answer is that we do not know, but there are reasons to disbelieve that the simple explanation for London’s improvement is the London Challenge. First, the differences are apparent long before children reach secondary school, and the hon. Gentleman will recall that it only started in 2003. Secondly, when translated from London to the black country and Manchester, there were not the same results. Thirdly, so many other things that are different about London are worth looking into.

[Andrea Leadsom]

My hon. Friend speaks so authoritatively on social mobility. It is always interesting to listen to him. However, I put it to him that one reason for London’s exceptionalism could, of course, be that its large immigrant population comes from a different cultural place. My opinion, as opposed to a research view, is that immigrant populations have not suffered the same degree of family breakdown. We found, through my work with the parent-infant projects, that often in immigrant populations there is much more of a family network. Therefore, the bond is often quite secure, even in areas of great deprivation, because of the support for the earliest period of the baby’s life.

[Damian Hinds]

My hon. Friend anticipates where I am going. We are into the realm of speculation. We do not know. It is true that many things are different about family structure, and so on, in London, compared with the rest of the country. We do not know what is the causality, if any, of any of those things or of the outcomes.

Let me start by mentioning some of the things that are the same. There is no significant difference in gender mix, age and birth weight of babies born in London; mothers tend to be older—we know that that is a factor in child development—and better educated; families are bigger in London, and children are more likely to have brothers and sisters; and the mix is massively more diverse than in the rest of the country, both in terms of ethnic diversity, recent immigrants and families with English as an additional language.

In London, there is a slightly lower percentage of children with either a single mother or both parents working; in other words, there are more families where at least one parent is at home. This surprises people. There is also lower participation in pre-school provision and use of formal child care, which, again, surprises people, because ordinarily we expect that participation in early years settings and use of formal child care is associated with positive improvements in child development.

Finally, as my hon. Friend the Member for South Northamptonshire mentioned, although it is, bizarrely, difficult to get reliable statistics, it appears that London is above the national average for the proportion of families with children in which parents are married. That flies in the face of what most people would assume about this city. However, that raises an important question. A massive debate has been going on in America in the past couple of weeks about a Harvard report by Chetty et al. called “Where is the Land of Opportunity?” which presented a number of challenging results in the US context, in terms of social mobility. Its No. 1 conclusion is that family structure is the single most important determinant of social mobility in America and that, interestingly, it affects not only the immediate family, but has a broader effect. In other words, in a neighbourhood where most children are born to two-parent families—specifically, families where the two parents are married—even if people are not in one of those families, by being in such a neighbourhood, they have more chance of getting on.

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[Luciana Berger]

Towards the end of my contribution, I shall reflect on the hon. Gentleman’s points about social mobility. He commented that the gap between rich and poor might not have changed. Nevertheless, Sure Start centres have provided vital services to parents and families who might not have contended with that specific issue, but have dealt with a lot of other ones that we have discussed.

In the debate, we have not touched on health visitors, who are integral to this issue. It is welcome that the Government are committed to increasing the number of health visitors. The latest figures from the Health and Social Care Information Centre, however, show that there are 1,234 more health visitors than in April 2010, but that is less than a third of the way towards the Prime Minister’s target of 4,200 new health visitors by April 2015. With the deadline looming, will the Minister please offer some words of assurance about meeting the target?

[Andrea Leadsom]

I have talked to a lot of health visitors, and there is a concern that by letting speed be the only target, we might pile a lot of new health visitors into the system but diminish our ratio of experienced health visitors to inexperienced ones, and those trying to support new health visitors will struggle. Generally speaking, my feedback from health visitors is that they are happy that the rate of new arrivals is not as rapid as the hon. Lady might like.

[Luciana Berger]

I listened to the hon. Lady’s point about the speed of introduction, but reflecting on the experience in my area of Liverpool, the work load on our health visitors is such that they cannot provide the best service possible, because they are so swamped by the amount of visits that they have to do. I contend that there is a challenge in the work load on health visitors. Will the Minister share with us what steps her Department is taking to meet the target?

On maternal support, in particular during the months of pregnancy, with births in the UK at a 40-year high, prioritising maternity services has never been more urgent. Around 10 stillbirths happen in Britain every day, and we have one of the highest stillbirth rates: according to The Lancet, Britain is ranked 33rd out of 35 countries with similar income levels. The charity Sands has linked that to maternity care, issues to do with inappropriate risk assessments for potential mothers and low uptake of perinatal services. Given that neonatal mortality and stillbirth have been indicated as areas for improvement in the NHS mandate to 2015, will the Minister please share with us what activities her Department will undertake to lower the stillbirth rate in England?

The findings of a National Audit Office review late last year are also of concern. It found that more than half of birthing units are not meeting staffing guidelines; that more than one in 10 had to close for a fortnight or more last year; and that 28%, or nearly a third, were forced to turn away mums-to-be at the door between last April and September because of a lack of space or a shortage of midwives. We can all understand how stressful that must be for women towards the end of their pregnancy.

[Mr David Amess in the Chair]

I thank my hon. Friend the Member for East Lothian (Fiona O'Donnell) for raising the important issue of premature babies and for sharing her personal experience of having premature twins and of the importance of the neonatal care received by her sons. A parent in a similar position who had to work might struggle to balance that with visiting the hospital and developing a bond with the babies.

We all have friends or family, or know people who have been expectant mums—some people in the room have been expectant mums—so we know that a skilled midwife can make all the difference between a smooth pregnancy and a stressful one. It is deeply concerning, therefore, that the NAO has highlighted that there is a shortfall of 2,300 midwives. The hon. Member for South Northamptonshire highlighted the increase in midwives’ work loads. The Royal College of Midwives has also calculated that the gap between the number of midwives we have and the number that the NHS in England needs will not be closed until 2026.

Before the previous election, the Prime Minister promised that there would be 3,000 new midwives during this Parliament. Again, regretfully, that target is some way short of being delivered. I am aware that there are many midwives in training, but the high drop-out rate and impending retirements could mean that we face significant shortages for some time to come. We would appreciate any reassurance that the Minister can provide on that matter.

Will the Minister also comment on the training that midwives receive? We have heard from a number of Members about the importance of maternal mental health. Mental ill health is one the biggest risks to a pregnancy, with one in 10 mothers suffering a mental illness before or after birth. Last November, I asked the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), what proportion of midwives were trained to provide expectant mothers with mental health support. Unfortunately, he was not able to provide a figure, but I am sure that both he and the Minister agree that we need more midwives who are confident in providing that kind of support.

We also need more specialist mother and baby mental health units. It has been estimated that as much as 50% of the UK lacks any kind of specialist perinatal mental health service. There are only 17 mother and baby mental health units across England, and they are geographically disparate. There are just two in Scotland and one in Wales, and none in Northern Ireland. As both the hon. Member for South Northamptonshire and my hon. Friend the Member for East Lothian said, it is a postcode lottery.

The hon. Member for South Northamptonshire talked about the 1% of mothers who might experience a psychotic episode. That could lead to mothers being hospitalised two or three hours’ drive away from their loved ones. It could also mean that they are separated from their babies. That is good for neither the mother’s well-being nor her newborn child’s development.

I thank all those Members who have raised the importance of support for parenting. A number of Members thanked Home-Start for the work that it has done and the way in which it so helpfully supports parents. We have also heard about specific challenges on early intervention, maternal support and maternity care. However, we know that the challenge of improving early years development reaches far beyond those specific issues. The hon. Member for East Hampshire raised the issue of social mobility, for example; many social determinants extend well beyond the reach of the Department of Health. The hon. Member for South Northamptonshire suggested that the issue could be looked into more widely, perhaps at Cabinet level, and I take that point on board.

Both my hon. Friend the Member for East Lothian and the hon. Member for East Hampshire raised the issue of the importance of digital networks and social networks. They are indeed important, and I welcome the work done by Mumsnet and Netmums, but I would like to put on record the challenges there are for many mums who do not have access to the internet, or perhaps do not know how to use computers. Although digital networks are important and can help to support parents—both mums and dads—one issue that we need to look at further, which is far beyond the reach of the Department of Health, is access to the internet and to broadband, particularly for people living in rural areas. There is also the issue of being able to afford that internet access: people might not want to have to go to a public library to connect and reach out about specific personal issues. We should be thinking about those matters.

There are other issues that we should address, which again reach far wider than the remit of the Department of Health. For example, there is the problem of parents who are struggling with the cost of living, and those who are working all hours and do not have the time to be with their children because they are working all day. We must establish genuine parity of esteem between mental and physical health, across the board. We have to protect babies and children from specific dangers—just yesterday in the House of Lords, for example, there was a debate about protecting children and babies from smoke in cars. There is no better investment that we can make as a society than in our children.

[Luciana Berger]

I thank my right hon. Friend for her important contribution to this debate. She has summed up many of the earlier speeches on the importance of this issue and how vital early intervention is. Right at the start of the debate, we heard about the science relating to the difference in brain development of children who get that care, love and affection in early life, and those who do not. As we heard, that care is vital to the development of a child over their entire lifetime. I echo her remarks on the millennium development goals. This issue is important not only for us in the UK but further afield, right across the world. I support her call for early intervention to be included in the 2015 goals.

[Andrea Leadsom]

I pay tribute to the right hon. Member for Dulwich and West Norwood (Dame Tessa Jowell) for all her work on promoting early years development in the post-millennium development goals. I did not touch on that today, but she has played an enormous role. I can report that UNICEF has asked us to speak at the UN on the importance of the earliest years and how early intervention can support children, not just in this country but around the world. It is fantastic that she has been able to pop into the debate, and I commend her for all that she is doing.

[Luciana Berger]

I thank the hon. Lady for her intervention. I will now seek to conclude.

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[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

It is good to serve under your chairmanship, Mr Amess, and to respond to such an interesting debate.

I shall focus my remarks fairly narrowly on the subject of the debate, because I have a feeling that I will get the chance to talk about smoking in cars quite a bit in coming weeks. I have had the chance to discuss today’s subject many times with my hon. Friend the Member for South Northamptonshire (Andrea Leadsom), and her passion and knowledge have shifted parliamentary opinion in that important area. I remember sitting through a late-night debate which, unusually, attracted double-figure attendance; she has moved the dial for political discourse about the importance of early years. She has a positive and constructive relationship with several Departments’ officials, who enjoy working with her on that agenda; I think that will continue.

The debate has been fairly consensual. I accept that there is some challenge with respect to numbers to do with Sure Start, and funding issues; but, to be honest, whoever was in power would have faced the same issues over the past few years. I shall therefore focus on what we are doing in response to the manifesto “The 1001 Critical Days”. I shall try to pick up on points that have been made. I am standing in for the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who is the lead Minister and is at present in a Bill Committee. He is sorry not to respond to the debate in person, but my hon. Friend the Member for South Northamptonshire will know that the issue is close to his heart and is the focus of much of his work. However, it is an honour for me to sit in on such an amazing debate, with so many excellent contributions.

Like the shadow spokesman, I pay tribute to the other hon. Members who contributed to the manifesto, and to the hon. Member for Nottingham North (Mr Allen) for his tireless campaigning on early intervention. I have had several stimulating and fulfilling conversations with him on the subject. He is passionate about the issue. What he has done to formalise matters through the Early Intervention Foundation—and the information, knowledge and evidence base that has been established because of that—will be extremely important. Evidence is important in this context because, to pick up the point about pressure on resources, the more evidence that can be presented to show that interventions work, the easier it will be to persuade people that such interventions are a good investment of public money, when that is in relatively short supply.

A clear case has been made, and the manifesto has support from across the political spectrum. The message is clear and simple: prevention and early intervention can improve outcomes and transform the life chances of children. Several hon. Members ably explained where the costs pop up in the system when people suffer damage and how much better, safer and kinder it is to make interventions early in people’s lives, to prevent such problems. That message sits well with the Government’s pledge to improve the health outcomes of children and young people so that they become some of the best in the world. That is a challenging goal, but the Government are determined to rise to it.

I want to touch on the risks associated with pregnancy. A healthy pregnancy provides the best foundations for a healthy life. Poor diet, smoking, using illicit drugs and consuming alcohol at that time can all have an impact on the child’s later cognitive functioning and on their health and well-being. As my hon. Friend the Member for South Northamptonshire said, a fetus exposed to extreme stress in the womb will have higher levels of the stress hormone cortisol, which can create higher levels of stress later in life. There is a highly relevant example of that in another part of my portfolio. Domestic violence can peak during pregnancy and, as a very significant stress factor, it can cause the very conditions in the womb that have long-term consequences for children.

Hon. Members have articulated the early years risks very well during the debate. There is a growing consensus about the agenda and the fact that early years intervention offers the greatest opportunity to create secure, happy and healthy adults. Moving forward in accordance with that shared agenda is the key. I will mention one or two of the risk factors. Smoking in pregnancy is highly relevant to much of my work in public health. It can lead to low birth weight, which is linked with heart disease later in life. The key messages on smoking in pregnancy are getting through to many people, although not to everyone. We still have some way to go, but in 2012-13, 12.7% of mothers were smoking at delivery. That is lower than the 2009-10 figure of 14%. However, the regional variation is extraordinary. Figures that recently came across my desk showed enormous regional variation, and responding to that is a challenge that I have put to public health directors in the regions. It is a good example of the way that a regionalised public health system can focus intensely on problem areas.

Experts are still unsure exactly how much alcohol it is safe to drink during pregnancy, so the safest approach is not to drink any at that time. Drinking heavily in pregnancy can lead to low birth weight and damage brain development in the womb. Fetal alcohol spectrum disorders are a range of cognitive and functional disabilities that can be caused by exposure to alcohol in the womb. In short, smoking and drinking alcohol while pregnant can cause irreparable damage to a child and make them more susceptible to illness throughout life. The manifesto highlights the numbers of babies affected by those issues, and I reassure the House that those are on our radar.

Perhaps less obvious is the impact of events in early childhood on later health and well-being. A drive towards wider understanding of that, among parliamentarians and in local government and the voluntary sector, is very important. I think that initially it is difficult to take on board the detail of the issue, and that is why it is so important that my hon. Friend the Member for South Northamptonshire has persisted in making the case to colleagues, and explaining it in detail, with the evidence to back it up. Many of us now have a wider understanding of what may not be as intuitively grasped as messages about not smoking or drinking during pregnancy. Traumatic emotional experience in childhood can translate into a greater risk of disease and mental health problems. Many hon. Members focused on that during the debate. We have, I think, learned that the old adage that time heals all wounds is not true. Adverse events in early childhood can resonate down the years.

According to the emerging research, growing up with exposure to multiple adverse childhood events can have a lasting impact. For instance, growing up in a household where the mother is treated violently, where a parent is chronically depressed, mentally ill or suicidal, or where someone uses drugs can increase a child’s risk of a range of conditions. Those who experience multiple adverse childhood events achieve less educationally, earn less and are less healthy. All those consequences were articulated in the debate. The hon. Member for East Lothian (Fiona O'Donnell) spoke of some sad examples, and about sitting with very young children and talking about their personal experience.

One of the saddest papers that I have read as a Minister was one that I submitted to the Chair of the Select Committee on Home Affairs, about gang violence. It was about the early lives of children who, at a young age—under 10—were on the fringes of being drawn into gang violence. I set myself a challenge, before reading the attached case history, of guessing what was happening in the child’s life. Every guess I made about the factors that were present was right, and I am sure that other hon. Members would have made the same ones. The case history showed that a child much younger than 10 was already showing signs of post-traumatic stress disorder. There is a lot of emerging evidence to show that such children are far more likely to be drawn into gangs. Good work is being done, particularly in London, on understanding how to diagnose that. It all goes to support the case being made through the debate for intervening very early; otherwise, children grow used to high levels of stress and aggression.

High-quality care during pregnancy is crucial and we want women to receive excellent maternity services that focus on providing the best outcomes for them and their babies. There has been significant investment in maternity services. Since 2010 the midwifery work force has grown by 6.9 %—that is 1,380 additional midwives. I of course understand the challenge, in that there is always a call for more midwives; that is an important area. There has been £35 million of capital investment in the environment where maternity care is provided and where women give birth to their baby. We are working with NHS England to ensure that women receive better care during pregnancy, with every woman having a named midwife responsible for providing personalised antenatal and post-natal care. Women can now make more informed choices about their care. Again with the support of Health Education England, we have increased the number of midwives and are working to ensure that specialist mental health support is available in every birthing unit by 2017.

The NHS does an excellent job in nearly every case of delivering babies safely, but it is crucial, as has been highlighted, to ensure that we do more to look after mothers’ mental health. More than 10% of women will have a mental health problem or mental illness during pregnancy, and we must ensure that we provide all-round support for women to detect and treat such conditions. Again, Health Education England is taking forward work with a range of partners to ensure that training is available for health care professionals in perinatal mental health. It is working with the Nursing and Midwifery Council and the Royal College of Midwives to ensure that midwives’ undergraduate training includes a core module focusing on perinatal mental health and with the medical royal colleges to provide postgraduate training on maternal mental health by 2015.

For a relatively small number of women, specialist perinatal mental health services are required. Through maternity and children’s strategic clinical networks, NHS England is supporting the development of maternity and perinatal mental health networks, as recommended by guidelines from the National Institute for Health and Clinical Excellence on antenatal and post-natal mental health. The networks will develop action plans and collaborative working to drive improvements in access to and quality of care.

[Andrea Leadsom]

As I understand it, NICE guidelines still only approve video interaction guidance, which is an effective but quite short-term intervention, and cognitive behavioural therapy as talking therapies for the perinatal period. There is a wealth of evidence that parent-infant psychotherapy, a psychodynamic form of therapy, is far more effective in parent-infant situations. As randomised controlled trials are the only acceptable evidence base to NICE, and as psychodynamic therapy does not lend itself to that, there is a bit of a chicken-and-egg situation. How do we improve the availability of specialist parent-infant mental health services if NICE will not approve them because they do not undergo randomised controlled trials?

[Jane Ellison]

If my hon. Friend does not mind, I will write to her after the debate to respond in the level of detail that she asks for, as that is not in my brief. However, I can reassure her that I think there are trials, supported by Government research funds, to consider some of the areas that she is interested in. I think that there is room to give her encouragement in that regard.

To return to the networks that I was describing, for women at risk of poor mental health during pregnancy and following childbirth, services do exist. Ministerial colleagues have visited excellent services in Blackpool, for example, that support women who have or are at risk of developing mental health or substance misuse problems in pregnancy or post-natally.

The key messages on smoking in pregnancy are also getting through. We have some way to go, but as I have said, the figure is beginning to drop. Teenage pregnancy can, of course, lead to poor outcomes for both teenage parents and their children. Teenage mothers have three times the rate of post-natal depression and a higher risk of poor mental health for three years after the birth. They are three times more likely to smoke during pregnancy and 50% less likely to breastfeed, with consequences for their children. It is imperative that we reduce the numbers of young women and girls getting pregnant and mitigate the impact of having a child when young.

The good news is that our rate of teenage pregnancy now stands at a historic 40-year low. In 2011, the last year for which we have figures, our conception rate for young women under 18 was 30.7 per 1,000, down from 35.4 per 1,000 in 2010. That is due to a lot of hard work, dedication and passion from our health care professionals, many of whose efforts have been described by Members in this debate. I pay tribute to their efforts and the important results that they are yielding.

Reducing conception by under-18s is one of a basket of indicators in the public health outcomes framework and our sexual health improvement framework, which was published in March 2013, to drive continual improvement. Despite our best efforts, though, some young women and girls will become pregnant, and we must do our best to mitigate the risks to those young mums-to-be and their babies. Several hon. Members, including my hon. Friend the Member for Winchester (Steve Brine), have paid tribute to the family nurse partnership, a preventive programme for vulnerable first-time mothers under the age of 20. It offers intensive and structured home visiting delivered by specially trained nurses from early pregnancy until a child is two. There are now more than 80 teams covering 91 areas across England, and the Government are committed to increasing the number of places on the programme to 16,000.

The family nurse partnership successfully engages with disadvantaged young parents, including fathers, to pick up a point mentioned by my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton), who is no longer in his place. Of those who are offered the family nurse partnership, 87% enrol and a high proportion continue to engage until their child reaches their second birthday. My colleague the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich, witnessed—other Members have referred to this during the debate—the transformational power of the programme, and he met family nurses and their clients in London in 2013.

Thankfully, we have 30 years of evidence from the USA and elsewhere that shows that the family nurse partnership programme improves outcomes for mothers and children in the short, medium and long term. That includes health and behaviour during pregnancy, reduced child abuse and neglect, improved school-readiness for the child and improved economic prospects for the mother. That list is the mirror image of all the different threats to health and wealth that have been articulated during the debate. It shows that the impact of some of these powerful early interventions can ripple down the generations, as other hon. Members have said.

To pick up a point made at the start of the debate, such interventions have also made great savings to the public purse in health, social care and the criminal justice system. I am glad that my hon. Friend the Member for Winchester mentioned the US research. We are undertaking a large-scale independent randomised control trial that will rigorously evaluate the programme’s effectiveness in the English context, and the initial findings will be reported later this year. I am sure that hon. Members present will be interested to see that, because it will be useful to see those data expressed in an English context.

The Healthy Child programme is a universal evidence-based preventive programme to improve the health and well-being of all children and to identify and treat problems early. Effective implementation of the programme should improve many of the outcomes highlighted in the “The 1001 Critical Days” manifesto, including the strong parent-child attachment, positive parenting, better social and emotional well-being among children and care that helps to keep children healthy.

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[Jane Ellison]

The hon. Gentleman makes a good point, and I have regular dialogue on matters in my portfolio with Members of the devolved Administrations. I am happy to look into that point after the debate, because some of the lessons to be learned are universal across different countries in the UK.

There has been a lot of interest in health visitors. They and their teams lead the delivery of the Healthy Child programme, and of course they are the bedrock of our children’s public health services. They are often the first professionals to recognise that a mother is depressed or that parents are struggling with the negative effects of many sleepless nights; we have had a few descriptions of those from colleagues in this debate. Through their work, health visitors can have an impact on the well-being of the whole family. Because of their vital preventive role, the Government are committed to growing the health visitor work force by 4,200 by the year 2015 and to transforming health visiting services to improve outcomes and reduce inequalities in the nought-to-five age group.

Taking up the point about whether recruitment is on track, and weaving in the point made by my hon. Friend the Member for South Northamptonshire, we believe that we are on track. There have been a couple of challenges in one region, to which we are now responding, but the rate of increase in health visitors will increase. It is determined by training intakes, which determine the rate of qualification and entry into the profession. We are happy that that is on track. I give that assurance to the shadow Minister. The latest health visiting work force data that we have, which are from October 2013 and were published this month, show that the total number of health visitors nationally is 9,770 full-time equivalents. Overall, there are 1,678 more health visitors than the May 2010 baseline of 8,092. That is a growth of 21%, but we intend to grow that number more, as we have said, because we think it is so important and crucial to the aims of the manifesto.

On troubled families, we know that some families have multiple problems and cause problems in the community around them. I will not go into a lot of detail, but there is clearly relevance and read-across from some of the early years issues that we have been discussing in this debate. In particular, I have seen the Troubled Families programme in my area encouraging critical working together and getting everyone around the same table to consider people and families as a whole.

That programme will have done a great deal of good to embed that idea and approach as good practice for many local authorities. There is a strong read-across to the other things that we are discussing about earlier years, and in some cases, of course, they will be the same families, depending on the nature of the family. I have certainly seen in my area, and in lots of the other pilot areas, how services have embraced the opportunity to stop working in silos and consider a whole family’s needs instead. I hope that that will become orthodoxy in how we move forward with Government policy in numerous areas and in the local government approach to things.

The Government are increasing local authority budgets by £448 million over three years on a payment-by-results basis to support troubled families across England. Again, my ministerial colleague is meeting those involved in the Troubled Families programme to discuss the health contribution to this valuable programme, and he can then address some of the points to which I will draw his attention as a result of this debate.

I do not have time to go into much detail, as I am aware that I have already made a long speech, although I am drawing to the end of it. I have many points to respond to, but I wanted to touch on the points about social mobility made by my hon. Friend the Member for East Hampshire (Damian Hinds), which I have heard him articulate before. He discussed how to support parents. I think that my hon. Friend the Member for South Northamptonshire was present when Alan Milburn, presenting his most recent social mobility report, urged Government and politicians generally to break what he called one of the “last taboos” of public policy, which is telling people how to be good parents and supporting them to be good parents. That is an interesting challenge for us all to consider and respond to, because it is undoubtedly difficult terrain for both Governments and individual politicians.

[Andrea Leadsom]

I would just like to make the point that although politicians attempt to say, “Family and the first couple of years are really private, and you mustn’t interfere,” often, in my experience of 15 years’ work with charities, people are actually desperate for help, and they do not know where to go. It is completely the opposite. It is not as though we were trying to ram support down people’s throats and tell them how to live; it is that they are desperate for it. I have lots of meetings with people who have set up charities to support mums who are desperately depressed or tearful or who cannot cope. They do that because they themselves went through it and there was nobody there to help them. I think it is the exact opposite. We kid ourselves if we think that we are interfering. We are not; we are simply providing support that people desperately want.

[Jane Ellison]

I think that is right. My experience mirrors my hon. Friend’s. I suppose the sensitivity is always about people being tempted to stray into saying how everybody should live their lives, but I agree with her. My experience is just the same as hers. Most people are crying out for support. I guess that the key thing is how that is delivered and how people are asked whether they would like to receive it. There are ways of doing that, and I think we are close to breaking that taboo. It is all about how the support is offered. Rather than telling people, it is about saying, “We are here to support you and we think that we can nurse you through this difficult time,” so I think she is right. Common sense dictates that that is nearly always the case, but it is not an area that Governments have previously dealt with. It is an area that people have been nervous to go into.

I am glad that my hon. Friend mentioned charities. I want to touch on some work done in the area, because giving people the best possible start in life is not only a job for parents, the NHS and Government. Charities such as the WAVE Trust—Worldwide Alternatives to ViolencE—and the Early Intervention Foundation, which is funded by the Government, are contributing to, even leading, the debate in crucial areas about early child development. The Big Lottery Fund is working with both those charities and many others on the “A Better Start” initiative, where it will invest £165 million over the next 10 years to stimulate new and innovative preventive approaches in pregnancy and the first three years of life, again to improve life chances. I congratulate it on that work, and Ministers and parliamentarians will want to keep in touch with that significant programme of work and look at the outcomes it achieves.

Before I move off charities, I pay my own tribute to Home-Start and many other charities like it. I am privileged to be the patron of Home-Start Wandsworth, so I have seen at first hand the great work that it does, which I know is mirrored up and down the country. I have spoken to many mums who said that Home-Start were the people who stood by their side when they felt they had no one else to help them. They talked about the difference that it made to them at a difficult time in their lives.

On the points about integration, we can definitely do more to look at ensuring that all those initiatives are joined up. My ministerial colleague the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich, is hosting a round table on the subject of integration, with a specific focus on the early years. That will look at what more we can do to ensure that children and families get that integrated support. A number of Members have mentioned that.

That is only one part of the system, however. The challenge of data sharing was brought up in earlier contributions. The sharing of information between NHS services and across the health, education and care system underpins good integrated working. It is not really possible to do it without that, and it is important for promoting good outcomes. In recent years, there have been a number of attempts at a national level to improve information sharing, including through specific work in foundation years services.

As my hon. Friend the Member for South Northamptonshire and other Members will know, the Government commissioned Jean Gross, a former communication champion for children, to explore ongoing barriers to information sharing in early years and to identify examples of good practice. I reassure my hon. Friend that Ministers from the Department for Education and the Department of Health welcome that report and its excellent analysis of the issues on information sharing. Much local good practice is outlined in it, and we are working with places such as Wigan, Warwickshire and Hackney to move that agenda forward through the programme to introduce integrated assessment of children aged two to two and a half. We know that there is variation across local areas, but we are working to try and understand how to reduce that.

The Department for Education’s statutory guidance for children’s centres is clear that health services and local authorities should share information, such as live birth data, with children’s centres on a regular basis. The Department of Health is taking forward work with NHS England and others, including the Health and Social Care Information Centre, to explore how regular updates of bulk data on live births can be provided to local authorities, including the benefits of local sharing versus sharing nationally held data. My hon. Friend the Member for East Worthing and Shoreham said in an intervention that sometimes there is a culture of using it as an excuse. As highlighted in the Caldicott reviews and reports, we know that culture and relationships need to change, and we need to make sure that there is an understanding of the existing framework in law that supports much greater information sharing than perhaps is always undertaken.

Jean Gross’s report also made recommendations about training on information sharing. We are working with the Royal College of Paediatrics and Child Health and with the DFE’s strategic partner, 4Children, to explore how an e-learning package on information sharing can be developed that is accessible to and appropriate for both health and early years professionals. We are hoping to see progress there.

To summarise, system-wide change is required to achieve all of this. Each part of the system, at each level, has a vital contribution to make. As the response to the debate has illustrated, work is going on across different Departments, and how we integrate them is critical to it. All of us see the manifesto “The 1001 Critical Days” as a rallying point for all those who have an interest in ensuring that, as the Government state in their pledge, we improve the health outcomes of children and young people so that they become among the best in the world.

The manifesto comes at an exciting time, because the evidence on the importance of a healthy pregnancy and on the early years is growing. As I have said, the evidence is becoming clearer, which makes it easier to make the case. It makes it easier for those who make decisions about how to structure services to do that with the confidence that they are doing something that will make a real difference, and that the consequences of a poor start for long-term physical and mental health will be addressed. Government, the NHS, charities and others are working well together to take the agenda forward, and I know that my hon. Friend the Member for South Northamptonshire will continue to champion it in Parliament and continue to improve the understanding that we all have of this important agenda.

I pay tribute to everyone who has taken part in such a good debate. I will follow up a number of points, and I will of course report back to the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich, on the debate that we have had. I look forward, as do officials in the Department of Health, to ongoing, dynamic and constructive relationship working to take the objectives of this important manifesto forward into the future.

[Andrea Leadsom]

It is a pleasure to speak under your chairmanship, Mr Amess. I, too, thank all right hon. and hon. Members for their contributions here today. This has been a very interesting debate. Some particularly different aspects of the subject have been raised. My hon. Friend the Member for East Hampshire (Damian Hinds) raised the very important question of social mobility. My hon. Friend the Member for Winchester (Steve Brine) raised the very important contribution made by Home-Start to the help for families in the vital early years.

As I said earlier, I am delighted that the right hon. Member for Dulwich and West Norwood (Dame Tessa Jowell) has come to the debate to make her own contribution on the importance of the early years, not just here in the UK but, potentially, in the post-millennium development goals. That would mean that we were looking at early years intervention right across the world. Other hon. Members have also made very valuable contributions to the debate.

I shall finish by calling on the Government and all parties to try to focus on making the perinatal period a period of holistic support for new families. There are some examples of superb practice but—rather like the situation with Sure Start children’s centres—there is no agreed customer perspective, shall we say. Mums who are pregnant come in all shapes and sizes—literally—and from all demographics: all sorts of age groups, ethnic backgrounds, social backgrounds and economic backgrounds. There are working people and non-working people. They all have varying needs, but unfortunately the provision for the crucial perinatal period tends to be one size fits all.

A woman is allocated a midwife and then she is stuck with her. If she does not like her, bad luck. She is lucky if she sees a health visitor before the baby is born, so there is no chance of bonding with someone. Someone turns up in the woman’s home. This happened to me. I was in tears at the time. Someone turned up and decided to take my baby away and give the baby a heel prick without my permission. To me, it was a case of “You’re torturing my baby!” I had to be restrained by my husband. Women who have just had a baby or are pregnant are extraordinarily vulnerable, even those of us who like to think that we have got life sorted. Also with my first-born, I remember that one day we were snowed in. He was due on 15 December, but he decided to hang around until the 29th, so having cancelled Christmas, I had to reinstate it on Christmas eve. I remember going to midnight mass and our lovely old vicar saying, “Can you imagine? There’s the Virgin Mary, sitting on a donkey, heavily pregnant.” I was thinking, “Yes, let’s not talk about this any more!”

For pregnant women, there are those extraordinary sensitivities. We need to imagine things from their viewpoint and ensure that we do not provide services at our convenience. My all-party group had an extraordinary meeting with registrars recently. The registrar in question said that it was much more convenient for the registrars if people went to the civic centre to register their babies—that it is much more convenient for registrars and therefore that is what families should continue to do. That is not good enough. We have to go to them; we should not expect them to come to us, but at the moment that is the case in almost every area of the perinatal service, even children’s centres. Far too many of them expect the families to find them: “If you don’t come to us, you’re hard to reach, so that’s your fault.” We must go to them.

I urge the Government, in everything that we do and in every policy that we put forward, to think about it from the customer’s perspective. I think that if we look at things from the viewpoint of the mum and, crucially, the dad, the baby and the siblings and think about how we can make the experience of childbirth better for them, we will have cracked it.

Question put and agreed to.

Oral Answers to Questions

Andrea Leadsom Excerpts

Tuesday 14th January 2014 Commons Chamber

[Mr Speaker]

We come now to topical questions. It would be good to get through the list and beyond, so may I just remind Back Benchers and Front Benchers alike that topical questions and answers are supposed to be brief?

[Andrea Leadsom (South Northamptonshire) (Con)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health (Mr Jeremy Hunt)]

I know that the whole House will wish to join me in remembering Paul Goggins at our first Health questions since his tragic death. He campaigned with great distinction on a number of health issues, including contaminated blood, mesothelioma and services at Wythenshawe hospital. I had the privilege of visiting a GP surgery in his constituency with him, and I know how much this utterly decent and selfless man cared about the health of his constituents. He has so sadly passed away, and the whole House will want to honour his memory and pass on our condolences to his family.

[Andrea Leadsom]

I certainly associate myself with the Secretary of State’s remarks. Will he undertake to look carefully at The 1001 Critical Days manifesto, which was recently launched by the right hon. Member for Birkenhead (Mr Field), the right hon. Member for Sutton and Cheam (Paul Burstow), who is in his place, the hon. Member for Brighton, Pavilion and me? Will he look at what more can be done to provide a comprehensive care pathway for the perinatal period?

[Mr Jeremy Hunt]

Yes, we are looking at that closely, with the Minister responsible for paediatric services doing so particularly closely. In principle, we support what my hon. Friend is trying to achieve with that document and we welcome its contribution to the debate.

Oral Answers to Questions

Andrea Leadsom Excerpts

Tuesday 22nd October 2013 Commons Chamber

[Dr Poulter]

The hon. Gentleman is right to highlight the fact that local commissioners have a duty to ensure adequate community health care provision. I hope that that is an issue that he will take up with them. If he would like help in that fight, I am happy for him to come and meet me, and to bring in the local commissioners to talk this through, as it is important that we have enough community nurses to provide good care in communities and local commissioners need to listen to that.

[Andrea Leadsom (South Northamptonshire) (Con)]

T6. Can my hon. Friend update the House on what he is doing to support the earliest relationships of new families through early years intervention? Specifically, will he support the cross-party “1,001 Critical Days” manifesto?

[Dr Poulter]

I pay tribute to the work that my hon. Friend has done on the early years, and there are many good things in that manifesto. That is why we are investing in an additional 4,200 health visitors by 2015 and why we are supporting the most vulnerable families by increasing to 16,000 the number of families that will be supported by family nurses by 2015. A lot of investment is going into early years, which pays back to the Exchequer and gives much better care to families, too.

Progressive Supranuclear Palsy

Andrea Leadsom Excerpts

Wednesday 23rd January 2013 Westminster Hall

[Andrea Leadsom (South Northamptonshire) (Con)]

It is a pleasure to serve under your chairmanship, Mr Bayley. I am delighted to have secured this debate, in which I will draw to the Chamber’s attention the needs of a specific group of people who need us to take action on their behalf.

In Towcester, in my constituency of South Northamptonshire, there is a national charity called the PSP Association, which is the only charity in the UK working solely for people with the neurological conditions progressive supranuclear palsy and the related disease corticobasal degeneration and those who care for them. PSP and CBD are diseases closely related to motor neurone disease and Parkinson’s disease.

[Amber Rudd (Hastings and Rye) (Con)]

Will my hon. Friend clarify how many people suffer from PSP compared with motor neurone disease?

[Andrea Leadsom]

I will address that later, but my hon. Friend is right to make that point, because it is believed that more people suffer from PSP than from MND, despite the fact that the latter disease is much more commonly known in general society.

PSP and CBD are similar diseases, and PSP is often used as shorthand for both conditions. In progressive supranuclear palsy, progressive means that it gets steadily worse over time; supranuclear means that it damages parts of the brain above the pea-sized nuclei that control eye movement; and palsy means that it causes weakness. Members may never have come across PSP before, but, sadly, it takes many lives.

PSP is caused by the progressive death of nerve cells in the brain, leading to difficulty with balance, movement, vision, speech and swallowing. Over time, PSP can rob people of the ability to walk, talk, feed themselves and communicate effectively. The average life expectancy is seven years from the point of diagnosis. Those who are diagnosed with PSP suffer severe and unpredictable impairments that have an enormous impact on the individual and their family. PSP is a dreadful disease.

I am pleased that since 2010, having written several times to the Department of Health, there is now better recording of PSP on death certificates, giving a clearer indication of the number of sufferers. Our attention, however, must now turn to diagnosis. Statistics show that some 4,000 people are living with PSP in the UK, but because diagnosis is still so uncertain, neurologists believe the figure could be as high as 10,000. Astonishingly, as my hon. Friend mentioned, there may be more PSP sufferers than sufferers of MND in the UK today.

[Andrew Percy (Brigg and Goole) (Con)]

I congratulate my hon. Friend on securing this debate. She has mentioned the relatively small number of people living with PSP, but is not part of the problem that many health care and social care professionals do not fully understand the condition?

--- Later in debate ---

[Andrea Leadsom]

Yes, my hon. Friend is right. That is one of the points that I want to put to the Minister today.

The PSP Association offers advice, support and information to people living with the disease. The association also funds research to find potential treatments for the condition. The charity’s aim is to ensure that people affected by PSP do not feel that they have to face the future alone.

Although the PSP Association operates with few resources and no statutory funding, it supports people living with the disease and their carers through a variety of means. The association has a telephone helpline and information advisory service, for example, and it offers support groups across the country and a small team of specialist care advisers. It produces a wide range of publications and communications.

The PSP Association is active in scientific research, and it has given projects £2.5 million in funding over the past 15 years to find causes, treatments and an eventual cure for PSP. I sincerely congratulate the association on its wonderful work, and I am delighted that many PSP supporters are here today.

I will share the story of one recent fundraising event. As patron of the PSP Association, I was delighted to be invited to the Dorchester—Sebastian Coe was the guest of honour—as the guest of Brigadier Michael Koe, the association’s founder and former chairman, and Christopher Kemball, the current chairman.

The tragic irony of PSP is that Brigadier Michael Koe, who is a constituent of mine, lost his wife to PSP. His four sons, who were determined to do something to raise awareness of the disease, decided to run in the London marathon. The brigadier blagged his way in to Lord Coe’s offices when he was still a Member of Parliament, using the fact that they shared the same surname although not the same spelling, to ask for help in promoting awareness of PSP.

Lord Coe offered his help. He went out and had photos taken of himself training with Brigadier Koe’s sons. For the next few years, he supported them in that way only to find that on the fourth anniversary of his involvement, his own mother was diagnosed with PSP, so he ended up with his own bitter experience of how PSP can affect families. He has kindly sent a short quotation for today’s debate, which I would like to share with hon. Members. He says:

“I am always pleased when an opportunity to raise awareness of PSP and the challenges faced by those affected arises. My mother lived with PSP for a number of years so I know only too well how important it is to receive the appropriate and timely support from health and social care, and the difference it can make to the individual affected and their family.”

Although many sad stories were told at the Dorchester that evening, the event was a huge success. Lord Coe had invited many sporting legends such as Daley Thompson and Steve Cram, as well as some of the current Olympians. It was quite an amazing evening and they raised more than £200,000 for the worthwhile cause.

The work of Brigadier Michael Koe and his family and their determination to honour the memory of his wife is truly touching. I pay tribute to the fantastic work that he has done in promoting the importance of the awareness of PSP.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on bringing this very important matter to Westminster Hall. Does she agree—I suspect that she does—that physio and aids should be made available at an early stage of diagnosis, so that those in the last few years of this debilitating disease have a quality of life and a relationship with their families at a time when they need it most?

[Andrea Leadsom]

The hon. Gentleman makes an extremely good point. He raises issues that I want to come on to in terms of calls to action for the Minister. Sadly, the speed of degeneration of PSP sufferers often means that the need for extra resources quite rapidly increases, so it is important that the right care pathway is put in place.

The association is developing a UK-wide research network to allow researchers to share their knowledge, experience and data from their studies into the condition and to increase the number of people with PSP that individual researchers can have contact with.

In 2011, the association commissioned a UK-wide needs mapping exercise for people with PSP and their carers. The results highlighted that the nature and rapidity of PSP means that the needs of those living with the condition are very specific. For example, the palliative care that would be deemed to be required in the late stages of many conditions or at the end of life may very well be required for someone with PSP for almost half of the time that they live with the condition. The rapid progression of the disease and often early onset of communication and cognitive problems have a huge impact. Advance decision making on end-of-life issues needs to take place much earlier with PSP than with many other conditions.

The ongoing needs of a sufferer are ever-changing, and so is their need to see a range of health and social care professionals who can provide the right care, support and equipment at the right time. It is not easy for the carers of people with PSP who face equally difficult challenges trying to navigate their way through the labyrinth of health and social care services and to keep up with the pace of the disease and the ever-changing needs of those for whom they are caring.

As a charity, the PSP Association is indebted to other organisations such as the Neurological Alliance and Carers UK for championing the needs of carers at every level. Although the work of such organisations is critical, it should not replace the needs of carers also being addressed by the statutory services.

In April this year, we will see the introduction of clinical commissioning groups, which will hold the purse strings for our local health services and will be responsible for commissioning the health and social care services for their local population. We are awaiting the imminent appointment of the national clinical director responsible for championing patient involvement and improvement to neurological services in England. Those reforms of our health and social care services are very much welcomed by the PSP Association, but with a caveat, which is that it is essential that people with PSP, their carers and other people living with similar neurological conditions have a voice locally.

The PSP Association has developed a care pathway guide for PSP that outlines the standards of care and support that sufferers will need from diagnosis onwards. It is intended to inform and educate health commissioners and social care professionals to ensure that people with PSP are made as comfortable as possible. Care must also be co-ordinated, as it is essential that it involves a multidisciplinary approach and a regular assessment of the patient’s ongoing needs. That is not only about commissioning services locally, but about saving the NHS funds used in unnecessary emergency admissions to hospitals.

A recent report by the National Audit Office found that the number of emergency neurological admissions to hospital had doubled since 2005. Between 2004-05 and 2009-10, the number of neurological emergency admissions increased by 32% compared with a 17% increase in general emergency admissions over the same period. As well as putting a significant strain on the NHS, that has a severe impact on the well-being of patients and their families. The PSP Association is proactive in helping to predict the care needs of patients in the future. That is vital in reducing emergency hospital admissions with increased awareness of PSP.

As MPs representing our constituents, we need to support neurological charities such as the PSP Association and ensure that people suffering from neurological conditions are fully understood and considered in the proposals for health and social care reform and in the commissioning of services locally and nationally. Access to timely, co-ordinated care and improved integration across health and social care services should be seen as a priority, to enable quality of life for people with PSP and those who care for them.

I should be grateful to my hon. Friend the Minister if he responded on four key points. First, how are people with PSP and other rare neurological conditions being considered in the proposals for health and social care reforms? Secondly, what support is available not only to the individual, but to the carer, especially as the needs of PSP sufferers are quite specific in terms of palliative care? Thirdly, what education and training is given to health and social care professionals, so that they are aware of the specific condition and can respond to the needs of sufferers and their carers? Finally, what can be done to ensure that more research into PSP is carried out, so that the diagnosis is quicker and more accurate?

I am grateful to the Minister for being here today. I look forward to his response and, I hope, the answers to some of those questions.

Mental Health

Andrea Leadsom Excerpts

Thursday 14th June 2012 Commons Chamber

[Andy Burnham]

I am proud of the improvements we made in the last Parliament, but I did not come here today to say that everything the previous Government did was right and wonderful. I will talk a little about those improvements, but given my failure to sing about Labour achievements, I am grateful to the hon. Gentleman for doing so.

We are reticent to talk about mental health as much as we should. There is a complacency in the public debate—that is not to make a political point, because it involves hon. Members on both sides of the House. The complacency goes throughout the civil service and the Government. To reflect on my time in government—not just in the Department of Health, but in the Treasury and the Home Office—it is remarkable how few submissions or meetings I had relating to mental health, given that it underlies the spending of hundreds of millions of pounds of public money. Indeed, £105 billion is the estimated cost of the full burden of mental health to this country.

That complacency is not shared by everybody and I congratulate the hon. Lady on introducing this debate. We have heard two unbelievably powerful speeches, from my hon. Friend the Member for North Durham (Mr Jones) and the hon. Member for Broxbourne (Mr Walker), to which I will turn at the end of my remarks. My hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott), who leads on these matters for the shadow health team, has rightly pointed out how mental health lies under the whole public health challenge. We will soon introduce Labour’s public health review.

We are beginning to wake up from our complacency. I am leading the debate for the Opposition to show that that comes from the top. We see the mental health challenge as central to health policy. Indeed, I made a point of making my first speech on returning as shadow Health Secretary on the subject of rethinking mental health in the 21st century at the Centre for Social Justice.

I must be honest: I shared the complacency about the mental health debate, or perhaps did not give it enough attention, but two things changed that when I was a Health Minister. First, I spent a day work-shadowing an assertive outreach team in Easington. I will never forget what one of the team told me about the early ’90s, when the mines closed and GP referrals for support were piling up on clinic desks, but there simply was no support to offer people. She said that that lay behind the social collapse in those mining communities. People facing difficult times were given no help.

A second thing made me think differently. When I became Health Secretary in June 2009, I inherited Lord Bradley’s report into mental health problems and learning disabilities in the criminal justice system. I will never forget sitting in my office at Richmond house reading that about 70% of young people in the criminal justice system have an undiagnosed or untreated mental health problem. If that is not truly shocking to every Member and does not make us do something, frankly nothing will. That was the moment that changed how I thought, and I have tried to follow it through ever since.

I mentioned that we had a public service designed for the 20th century, rather than the 21st century, and I want to illustrate that point with reference to my own constituency. The world that gave birth to the NHS was a very different place. When the NHS was set up, Leigh, like Easington, was a physically dangerous place to live and work in. Working underground exposed people to coal dust, explosions and accidents, and people had no choice but to lock arms, look out for each other and face the dangers together—that is how it was—and that spirit of solidarity was carried over into the streets above.

Like many places in this country, then, Leigh in the ’50s was a physically dangerous place but emotionally secure, because people pulled together. In the 21st century, however, that has completely reversed. We now live in a physically safe society—our work does not generally expose us to dangers—but it is emotionally far less secure than it was for most of the last century. The 21st century has changed the modern condition. We are all living longer, more stressful and isolated lives, and have to learn to cope with huge and constant change. Twentieth-century living demands levels of emotional and mental resilience that our parents and grandparents never needed, yet the NHS does not reflect that new reality; essentially, it remains a post-war production-line model focused on episodic physical care—the stroke, the hip replacement, the cataract—rather than the whole person. That is the issue to confront.

The demands of this society and the ageing society require a change in how we provide health and social care. We need a whole-person approach that combines not only the physical but the mental and social, if we are to give people the quality of life that we desire for our own families. That one in four people will experience a serious mental health problem makes this an issue for all families and people in the country. It also means that mental health must move from the margins to the centre of the NHS.

I shall say a couple of things about that necessary culture change. How can it be that an issue that causes so much suffering and costs our society so much still accounts for only a fraction of the NHS budget? It cannot be right. We also have to consider the separateness of mental health within the NHS. This has deep social roots—the asylum, the separate place where people with mental health problems were treated, the accompanying stigma and suspicion about what went on behind those four walls. Essentially, we still have the same system in the NHS, with separate organisations—mental health trusts—providing services on separate premises. That maintains the sense of a divide between the two systems and raises a huge health inequalities issue.

The wonderful briefing that Mind, Rethink and others have prepared for this debate contains this startling statistic: on average, people with severe mental health problems die 20 years earlier than those without. What an unbelievable statistic! Why is that? It is partly—not completely—explained by the separateness within our system. If someone is labelled a mental health patient, they are treated in the mental health system, and consequently their physical health needs are neglected.

[Andrea Leadsom (South Northamptonshire) (Con)]

Is the right hon. Gentleman aware that, right from the very start, the way in which a baby’s brain develops—whether development is healthy, through a loving bond, or not—can have profound implications for future physical health, and therefore life expectancy? It starts as early as that.

[Andy Burnham]

I completely agree, and obviously that was one of the major conclusions of the Field report, which the hon. Lady’s Government commissioned. The problem is not just the separateness of the system, although that is one of the factors; rather, it starts much earlier. We need to take that broad view.

More co-location of acute care and mental health care within the same hospital would be a good thing to encourage. We heard on the radio this morning about the RAID—rapid assessment interface and discharge—service in Birmingham, which is an excellent example of that and something we need to follow. That is part of the culture change we need in the NHS. The other part of that change is that practitioners dealing with mental health, particularly GPs, at the primary care level, should not just reach first for medical interventions, rather than social or psychological interventions. However, I am afraid that that is what we do. Let us look at these, more startling statistics. In 2009, the NHS issued 39.1 million prescriptions for antidepressants—there was a big jump during the financial crisis, towards the end of the last decade. That figure represented a 95% increase on the decade, from the 20.2 million prescriptions issued in 1998. Were all of those 40 million prescriptions necessary? Of course they were not.

Prompted by my north-west colleague, the hon. Member for Southport (John Pugh), let me pick up the point about Labour’s successes. We did address some of these issues. The improving access to psychological therapies programme is something I am very proud of taking forward as Secretary of State, because it began to give GPs an alternative to antidepressants and medication to refer people towards. That was an important development, and—credit where it is due—it was Lord Richard Layard who made such an incredible change, by pushing so determinedly for that programme.

--- Later in debate ---

[Andrea Leadsom (South Northamptonshire) (Con)]

I congratulate my hon. Friends the Members for Loughborough (Nicky Morgan) and for Broxbourne (Mr Walker) on what has turned out to be a fantastically refreshing debate, which has been part debate and part group therapy.

I want to add my own personal contribution. Like my hon. Friend the Member for Totnes (Dr Wollaston), I suffered from post-natal depression. It is unbelievable how awful you feel when you are sitting with your tiny baby in your arms and your baby cries and so do you. You cannot even make yourself a cup of tea. You just feel so utterly useless. Looking back on that time, I genuinely agree with my hon. Friend that going through that experience makes you a better person. It also makes you determined to do something for other people in that situation.

Post-natal depression is a key issue for women as individuals. Like many others, I got over it with the help of a good family and husband, and by going back to work. Many people do not get over it. Although the consequences are profound for those women, the consequences for their babies are often even more profound.

I want to talk briefly about the experience of a baby. When babies are born, they are about two years premature. Their brains have barely developed. They have all of the neurones but none of the neural pathways are laid down. That happens only during the first two years of life. The peak period for the growth and development of a baby’s brain is between six and 18 months, and that growth is literally stimulated by a loving relationship with an adult carer—usually their mum, of course. If a baby’s mum has a lovely, smiling face and always picks them up, cheers them up, hugs them, feeds them and changes them whenever they cry, their brain becomes hard-wired to understand that the world is a good place. They will go on to be a person who can deal with life’s ups and downs, and who retains the idea that the world will be good to them.

It is like Harry Potter. He had loving parents until he was two, but then along came Lord Voldemort and murdered them, and he had an unspeakable experience until he was into his teens and escaped to Hogwarts. What kept him on the straight and narrow, and understanding right from wrong, was his secure foundation. I put it to the Minister that that is how to secure good emotional health for our society.

If babies do not have a secure bond—usually with mum, but it can be with another parent or with adoptive parents—their brain develops in such a way that they expect to have to fight or withdraw. Those babies are the people who go on to fail to cope with what life throws at them. They struggle to make friendships, and they are the people who are bullied or become victims, or indeed become bullies themselves at school. Babies at the acute end, where there is real neglect and abuse, are the ones who go on to become drug addicts or violent criminals. In fact, research shows that 80% of long-term criminals have attachment problems stemming from babyhood.

A sad truth about our society is that research shows that 40% of children aged five are not securely attached. Of course, that does not mean that they all go on to become psychopaths or murderers, but it does mean that we are raising generations of babies and young children who do not have the emotional capacity to meet the ups and downs that life throws at them. They will have a much greater tendency than other people to mental illness. They will struggle to have all the things that we perhaps take for granted, such as a secure family and a decent job, and they will be less robust in their emotional make-up.

There is much that we could do to support people. We heard yesterday in the debate on early intervention about how much more could be done to support social workers and destigmatise going to children’s centres and seeking help. One very good example came from the right hon. Member for Birkenhead (Mr Field), who has talked about it for a long time. Why do we not ensure that people go to a children’s centre to register their baby’s birth, and then to get their child benefit? That would instantly mean that most people would use children’s centres, so it would destigmatise them.

Children’s centres should not just be places where people go for antenatal and post-natal check-ups; people should be able to go there for psychotherapeutic support such as that offered by the Oxford Parent Infant Project, the charity of which I was chairman for nine years. It provides psychotherapeutic support for families who are struggling to bond with their babies. Social workers, health visitors and midwives love it because it is somewhere to which they can on-refer people. We hear a lot of talk about training for health visitors, but no talk about what they should do when they spot attachment problems and what help they should provide to families to turn the situation around. OXPIP has shown how incredibly easy it is to do so, because both mother and baby are extraordinarily receptive to being supported in such a way as to develop the attunement and empathy that they need for a good relationship with each other.

Mums who adore their babies do not allow partners to stub cigarettes out on them. They do not shake them to death or neglect and ignore them when they are crying. It is all about building an early relationship. It is greatly in the interests of our society for sound relationships to have been built by the age of two so that we do not constantly have to deal with the consequences of failed attachment later in life.

EU Working Time Directive (NHS)

Andrea Leadsom Excerpts

Thursday 26th April 2012 Westminster Hall

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

It is a great pleasure to speak under your chairmanship, Mr Brady. I pay tribute to my hon. Friend the Member for Bristol North West (Charlotte Leslie) for securing this debate on an important issue in medicine and in improving front-line patient care that affects every MP’s constituents, whatever the constituency. I also pay tribute to the hon. Member for North Antrim (Ian Paisley) for a real tour de force in his speech just now. In my contribution to the debate, I will touch briefly on some of the points that he made, but I will try to expand on some of the points made by my hon. Friend.

My hon. Friend made a couple of very good points. Early in her speech, she pointed out the effect of the European working time directive, saying that it has effectively taken 4,000 doctors out of circulation. Effectively, therefore, hospitals throughout the country have to recruit an extra 4,000 doctors as a direct consequence of the EWTD. That is a huge financial burden, but it is something that hospitals have effectively had to do in many cases and in many specialities in a very quick fashion—indeed, almost overnight. That has been very difficult to do.

Many hospital services in many parts of the country, particularly the more remote rural areas, are reliant on locum doctors, who are often not necessarily trained in Britain—not that that is a bad thing, because a huge contribution is made to the NHS by overseas workers. However, as has been very publicly highlighted by the Dr Daniel Ubani case, some overseas doctors are not necessarily familiar with the British medical system.

The failings of the EWTD and its implementation go further than just increasing the strain on doctors and the loss of continuity of care for patients. They relate to the way that hospitals have been forced to deal with the shortfall in their rotas and the problem of how they will look after their patients and to the fact that the system that is used to employ locum doctors is not fit for purpose. The General Medical Council and the British Medical Association are looking into those matters. Nevertheless, the failings of the EWTD have exposed a very important issue, and patients are suffering.

My hon. Friend also said that medicine is a profession and a vocation; I know that, too, and I obviously speak from personal experience. Medicine is not about clocking on and clocking off. It is about looking after patients effectively, whenever that may be. The result of introducing the EWTD has been to encourage hospitals, through fear of litigation, to encourage doctors to have a clocking-on and clocking-off culture. That is wrong; it is against the duties of the doctor, as laid down by the GMC; it is against what medical professionals want to do, because they care about their patients; and it is actually bad for patient care, for all the reasons that were outlined earlier by my hon. Friend.

My hon. Friend said that we do not want to go back to the bad old days of 100-hour weeks. I worked those 100-hour weeks, and I am sure that the other medical doctors who are in Westminster Hall today did so, too. It was certainly not ideal to work 100-hour weeks; it was not good for patient care. However, the point that was made earlier is that there is actually a happy compromise between doctors working a rota pattern—one that allows for training, continuity of care and proper treatment of patients—and ensuring that doctors have proper rest and are in a fit state to look after their patients. That happy compromise can be achieved. As has been highlighted already in speeches and interventions, it has been achieved in many countries within the European Union, and we should be able to achieve it effectively in this country, too.

The point that has been highlighted is that the previous Government dressed up the introduction of these reforms in the idea that they would be better for doctors with families and better for doctors’ training. In fact, neither of those things have actually come to pass. Doctors’ training has suffered as a result of the introduction of the EWTD in this country. Doctors do not get enough on-the-hour time with patients, and because many hospitals are forced into looking at service provision—in other words, having enough doctors on the ground as a direct consequence of the EWTD—the time allocated for junior doctors to receive proper training has been reduced massively. Given the rigid nature of the rotas introduced under the EWTD, they are often less family-friendly than rotas were in the past when doctors were asked to work more hours than now.

My hon. Friend highlighted the increased rates of sickness, particularly among physicians but also in other specialities where—quite rightly—an increasingly high proportion of women are entering the medical profession. In many cases, the reason why those women are finding things difficult and taking time off work is that they are unable to meet the demands of looking after their family properly. The fixed rotas are damaging to family life. My hon. Friend has made some excellent points.

I will now talk about a few other issues that are important to highlight in this debate. The Minister is working hard on our behalf to address the EWTD issue, by raising it in Europe for the Government and ensuring that we can put right what the previous Government got wrong. The issue of locum doctors goes to the heart of out-of-hours care. Many hon. Members, particularly those of us with more rural constituencies, have experienced the previous Government’s reforms of out-of-hours care by GPs. Thanks to those reforms, we now have a system that is not fit for purpose. We have locum companies running local out-of-hours care on the basis of care models that are, in many respects, not fit for purpose. Many locum companies often employ out-of-area doctors who do not understand local patients to run those services.

[Andrea Leadsom (South Northamptonshire) (Con)]

I am grateful to my hon. Friend for giving me the opportunity to make my point. Does he agree that there is also a great concern about the fact that other European legislation means that the GMC cannot systematically check locum doctors’ ability to speak English and communicate with their patients and that that is also putting patients’ health at risk?

[Dr Poulter]

My hon. Friend makes a very good point and the issue that I was just raising—that of locums and out-of-hours care—ties in very well with it, because those checks and balances very much occur in the sector of locum work. To fill staff vacancies in GP rotas in primary care and in hospital rotas, doctors are often rushed in at short notice from locum firms, even though we have not necessarily got the proper checks that would be in place when doctors are working in hospitals.

As I have said, doctors from overseas make a huge and valuable contribution to the NHS, but they do so when they have been familiarised with the British medical system and they are embedded in our hospitals up and down the country. However, there is a real danger: when we have an over-reliance on locums, which is a direct consequence of the EWTD, the problems that my hon. Friend has highlighted occur, and that has damaging effects for patients.

The key issue for me in this debate is the continuity of care. The point has already been made in interventions that bad things happen to patients at weekends and out of hours, because there are fewer doctors, nurses and members of staff working in the hospital. If we have a system in place whereby doctors are clocking on and clocking off and they are encouraged to do so because hospitals are worried about the dangers of litigation and that encourages the handover of information to another professional because people think, “I’ve finished now; it’s not my job anymore,” that will encourage bad things to happen out of hours.

--- Later in debate ---

[Andrea Leadsom (South Northamptonshire) (Con)]

I am delighted to follow my hon. Friend the Member for Totnes (Dr Wollaston). What a fascinating speech, and what a fantastic insight. I congratulate my hon. Friend the Member for Bristol North West (Charlotte Leslie) because, so often, discussions about EU legislation revolve around the EU itself, but she brought to life the practical implications of EU legislation that is having a real impact on our society and patient care in the UK.

Article 168 of the EU treaty states:

“Union action shall respect the responsibilities of the Member States for the definition of their health policy and for the organisation and delivery of health services and medical care. The responsibilities of the Member States shall include the management of health services and medical care and the allocation of the resources assigned to them.”

It is fundamental in the treaty that health is simply not an EU area of competence. All that we are hearing about today is the unintended consequences of something that was introduced for an entirely different purpose. I want to go into the background of that.

Hon. Members will know that I have been involved with an all-party group on EU reform, and with the Conservative end of that—the Fresh Start project. It is trying to look at precisely how Britain could renegotiate a better relationship with the EU that would work in Britain’s better interest. The very first area we looked at was the working time directive. We looked at the headline figure that the cost to the UK economy is about £2.6 billion per annum, which is a real issue for us at this time. In its research, Open Europe suggested that halving regulation could deliver a £4.5 billion boost to GDP in the UK. What was slightly less expected from the research was the fundamental effect on the NHS, precisely because health is not an EU competence.

Why should that be the case? The all-party group recently visited the EU to talk to our MEP group and to commissioners about the working time directive and the impact on the health service. Our MEPs told us that the directive is the least popular piece of legislation ever introduced by the EU, and that 16 of the 27 member states have negotiated opt-out arrangements. Interestingly, under the Lisbon treaty, if a majority of member states get together and propose a reform, the European Commission and the European Council have to look closely at it and consider repeal of the legislation. I find it astonishing that we have not taken the lead so far in doing just that. It would certainly be worth considering.

[Mr Nuttall]

Is this country one of the 16?

[Andrea Leadsom]

Yes, Britain does have an opt-out.

[Mr Nuttall]

But not obviously for the NHS.

[Mr George Howarth (in the Chair)]

Order. If the hon. Gentleman wishes to make an intervention, he should stand up and do so in the approved manner and not mumble from a sedentary position.

[Andrea Leadsom]

Thank you, Mr Howarth. Occasionally it is difficult to remember that we are not having a conversation.

The point about the opt-out is that, under the working time directive, individuals can opt out of the maximum 48 hours per week if they choose to do so—they cannot be compelled to do so.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

Is the hon. Lady suggesting that we opt out of, for example, co-ordination on public health strategy or communicable diseases? Co-ordinating at an international level on bird flu and other pandemics is hugely important.

[Andrea Leadsom]

All I am saying is that, under the Lisbon treaty, member states that do not like certain legislation have the opportunity to club together and to propose that the European Commission look at it for possible deletion or significant amendment. That happened with the working time directive at two points in the past, in 2004 and 2010, but the attempts to amend it came to naught. The great tragedy is that with 27 member states there is simply a Chinese whispers effect. Someone says, “This is ridiculous, it is harming our national health service”; everyone agrees, “Yes, it’s ridiculous”, and therefore an amendment is proposed; but by the time it has gone around 27 member states, it is completely lost and gets nowhere. That is the fundamental problem with negotiating amendments.

My original point was about the importance of the time line of the working time directive. In 1990, the European Commission tabled the proposal for the working time directive as a health and safety measure. In November 1993 the UK was outvoted 11 to one at the European Council negotiations. The European Commission stated that the working time directive was

“a practical contribution towards creating the social dimension of the internal market”—

it was all about health and safety for employees, and employees in the real economy overworking; it was not intended to have the profound impact it has had on the national health service. David Hunt, who was Employment Secretary under the then Conservative Government, said that he would fight the legislation and not accept it. He tried hard, by going to the European Court of Justice to challenge the legal basis of the directive as health and safety legislation, but the UK was outvoted.

In 1996 the ECJ ruled against the UK, and Labour implemented the working time directive in 1998. The directive requires a maximum working week of 48 hours, a rest period of 11 consecutive hours a day, a rest break when the day is longer than six hours and a minimum of one rest day per week, as well as the statutory right to four weeks’ holiday. Such a list of requirements highlights the directive’s complete inflexibility; it clearly cannot be applied to absolutely every type of worker in our economy. In the end, the European Union had to admit that there were certain exceptions, which is why in some countries trainee doctors are treated as autonomous—in other words, self-employed. That is used as a means to get round the rules, because it is never going to be possible to enforce that kind of rigidity on people who are self-employed. There are all sorts of unintended consequences from a prescriptive and damaging set of rules.

In his response, will the Minister confirm whether the NHS has caused some of those problems—not necessarily deliberately—by offering contracts to doctors and junior doctors that are subject to a maximum of 48 hours? We should remember that the NHS is not allowed to invite new employees to opt out of the 48-hour working week at the same time as they sign their contract, because of fears of coercion. Does the Minister have a view about whether the NHS has created part of the problem by telling junior doctors and other health workers in their contracts that they will be paid for a 48-hour week, and then inviting them to opt out at a later date? There is a wealth of evidence to suggest that many doctors are working hours that are unpaid because their contract allows them to be paid for only 48 hours a week. Perhaps the Minister will comment on that in his response.

[Charlotte Leslie]

Does my hon. Friend agree that there are inconsistencies across the landscape? When I applied to work for the BBC, although I cannot remember exactly how it was worded in my contract, I was left under no illusion that if I wanted a job, I was to tick the little box that signed me out of that 48 hours business.

[Andrea Leadsom]

That is very interesting. Clearly, my hon. Friend’s contractual employment was not correct because she should not have been asked that question at the same time as signing the contract.

I would like to cite a case study of a junior doctor who was employed under the working time directive in foundation training between 2009 and 2011. This is his story:

“When I was on my surgical placement as part of my training, we were told by the hospital to take a mandatory ‘zero hours’ day off every week, as we were working 8 am to 6 pm on the other weekdays, as well as some longer on-call days and on-call weekends at times. The purpose was to keep our average working week within the 48-hour limit.”

That is utterly bizarre.

“We rotated who took the day off among our team, but this meant that on any particular day only one or two doctors would know the patients who had been admitted the day before. However, those particular doctors might not be there the next day, so would have to hand over patient information to a colleague. Unsurprisingly, much information was ‘lost in translation’. Trainee doctors would also not know which registrar, or even consultant, to expect on any particular day, due to the irregular working patterns of these people also caused by the limits on working time.

Furthermore, patients no longer knew who would see them on the ward round. The effect was poor patient experience, as patients were unable to build a rapport with individual doctors. People would be very frustrated that the doctors seeing them did not know what the same medical team had planned/achieved the day before.

There is also much less time for on-the-job training for junior doctors. This was compounded by the fact that we often had to cover for other trainees who were rostered off due to the working time directive, missing our regular teaching sessions. Lack of training time has made it difficult for us to establish a rapport with our seniors, and gain adequate support in terms of mentorship and career advice. In fact, trainee doctors no longer feel that we ‘belong’ to a team, given the new shift patterns that have broken up teams of trainee doctors and their seniors. Morale is certainly lower and junior doctor sickness rates much higher. This is a negative spiral—more doctors off means that when you do turn up, your working day is more hectic and stressful, and you are much more likely to fall ill and take time off yourself.

Diary carding exercises (whereby doctors record the actual hours they work) have shown almost universally high rates of non-compliance with the working time directive. During my general medicine attachment in training, I ended up working 1.5 to to 2 extra hours (unpaid) per day and was consistently non-compliant…Doctors that do opt out of the 48-hour limit on the working week are sometimes not sure whether they will be remunerated appropriately for their time.”

That is interesting and highlights some of the problems faced by doctors who are trying to do the right thing by their patients. Of course, this is not only about doctors but about patients. My right hon. Friend the Minister will be aware of two recent cases where coroners have recorded problems associated with the working time directive. They said that it impacted on the ability of doctors to understand what was going on with patients, and that was one of the factors that caused the untimely death of a patient. The other case involved a patient undergoing a routine operation.

Let me quickly turn to the solutions.

[The Minister of State, Department of Health (Mr Simon Burns)]

It might be helpful if I give my hon. Friend the answer to her question about when one can opt out and whether one gets paid. A doctor can opt out at any time with the agreement of the employer, and the junior doctors are expected to work up to 56 hours because of their contracts. If they work more than 56 hours and it is agreed, they will be paid for those hours.

[Andrea Leadsom]

I am grateful to my right hon. Friend for that important clarification. He will note the experience of the case study that I have just read out. There is an uncertainty about payment for extra hours and the recording of extra hours. That is clearly an issue that needs to be resolved at the sharp end, if not in the principle.

[Mr Burns]

If it is of any help to my hon. Friend, I will re-clarify the matter. Junior doctors will be paid for hours over the 56 hours in their contract, but it is only with the authorisation of the employer that they can work those hours.

[Andrea Leadsom]

I am grateful to my right hon. Friend. As my hon. Friend the Member for Bristol North West pointed out, representatives of doctors and NHS staff do not agree among themselves about whether they support the European working time directive. Certainly, the Royal College of Physicians, NHS Employers and the Royal College of Surgeons are concerned not only that the working time directive causes a problem for doctors and patients, but that it does not do what it sets out to do, which is to deal with the exhaustion of doctors themselves. The Royal College of Surgeons says:

“We know from our members that working in a full shift pattern is more tiring when compared to working using an ‘on-call’ system, and creates a working environment that is impairing to patient safety.”

The British Medical Association believes that the European working time directive is entirely right in all of its manifestations. Patient and doctor representatives need to resolve the question of where they stand, as representatives of health service workers, on the implications of the working time directive.

Turning to the options for change, the Fresh Start project has done a great deal of work on this. Certainly, there are things Britain could do in isolation to try to improve the situation, and we have heard about some of them today. Some doctors in other European Union countries have two contracts, which has been used as a way of getting round the working time directive. We have heard about all sorts of workarounds that Britain does not tend to use, and the Government might want to consider what other countries have done. Certainly, MEPs in Europe have told me that some doctors will take on two 48-hour contracts, which seems to be going back to dangerous practice. Nevertheless, if an impossible situation is created, we end up with people just trying to defeat the problems.

A far more likely scenario is that we negotiate for change with other members that are unhappy with the consequences of the working time directive. We should get together with the 16 other member states that are determined to see change and that have negotiated an opt-out, so that we can get the directive changed specifically in relation to the NHS and make our economy more flexible.

What we are proposing is a concrete option for change. At the time of the European members’ attempt to get their recent fiscal consolidation agreement into the main treaties, there will be an opportunity for Britain to go to the EU Council with its own proposal for change. This is a clear opportunity, which has arisen from the need for fiscal consolidation in other EU countries, for Britain to prepare a list of changes to various elements of the treaties that it would like to see, and to go all out to negotiate those changes when the time comes, in three or four years. In line with the proposal put forward at the all-party parliamentary group for European reform, I recommend a triple lock whereby Britain arranges to opt out.

[Debbie Abrahams]

This is an interesting and useful debate. Is the hon. Lady aware of the recent systematic review—the highest level of evidence we have—that was inconclusive on the impact of the working time directive? I think there has been only one UK study undertaken since 2009, and one recommendation in the systematic review is that there should be more research. Is that not one of the outcomes we should be pressing for here, so that we have a full, evidence-based understanding that will enable us to ensure that policy is adhered to correctly?

[Andrea Leadsom]

I thank the hon. Lady again, but a mistake that many Opposition Members fall into is to think that only the European Union can legislate to protect the British NHS. Of course, that is simply not the case. Britain is perfectly able to legislate for its own NHS needs without the support of the European Union.

[Debbie Abrahams]

Will the hon. Lady give way?

[Andrea Leadsom]

I would like to finish now. I have given way to the hon. Lady twice.

The first lock would be for the UK to argue that it should opt out completely from the social policy section of the EU treaties. The second lock should be for the UK to have the ability to opt out of any future EU proposal that it believed would impact intolerably on its social and employment law. The third lock would be for Britain to negotiate that the ECJ should not be allowed to have jurisdiction over ruling whether the UK was right to opt out of that legislation. That is the only way, once and for all, to enable Britain again to have control over its own working time hours—not only for the NHS, but for the future of the whole of our British economy.

--- Later in debate ---

[Mr Burns]

I am tempted to go down that path, because I have considerable sympathy with my hon. Friend. However, time is short and I do not want to upset you, Mr Howarth. I will avoid temptation and keep myself on the straight and narrow.

We could not be clearer about how we want things to move forward. In the coalition agreement almost two years ago, the Government resolved to limit the application of the working time directive in the NHS. That position has not changed. We still believe strongly that working people should be able to work the hours they want. That means they should be able to choose to opt out of the directive’s limit on working hours. However, no one wants a situation where tired doctors are working for far too long, and for that reason it is important that doctors who choose to opt out, and their employers, agree working hours that ensure that patients are not at risk. A common thread running through the contribution of every hon. Member was the importance and necessity of not returning to what is known as the bad old days. Nobody on this side of the House, in any shape or form, would want that to happen. However, it is equally viable and intellectually respectable to argue for more flexibility, as the current situation —as highlighted in many speeches—is causing problems for the NHS. That has to be done in an ordered way. We cannot unilaterally take any action that would compromise the legality of how the European Union works, our contribution and how we operate within the EU.

[Andrea Leadsom]

Does my right hon. Friend recognise that Sweden agreed legally to join the euro and has failed to do so, and so our inability to implement all our commitments might be seen by some as trivial in comparison?

[Mr Burns]

My hon. Friend makes an interesting point that could tempt me, but I will not be tempted. Each member state of the European Union is answerable for its decisions and behaviour. I believe that if one is a member of an organisation and has signed up and committed oneself to certain procedures and legal ways to do business, it is only right that the British Government—

Adult Social Care

Andrea Leadsom Excerpts

Thursday 8th March 2012 Commons Chamber

[Andrea Leadsom (South Northamptonshire) (Con)]

My hon. Friends the Members for South Thanet (Laura Sandys) and for Congleton (Fiona Bruce) made interesting points specifically about caring for carers, which is the issue I want to address, too. I have one specific policy suggestion for the Minister, on which I would be interested to hear his thoughts: we should seriously consider introducing a post-retirement carer’s allowance.

It has always been the case in our society that no more than about a fifth of all the caring that goes on has been achieved by the state. In recent years, that fifth has expanded slightly to about a quarter, but if we were to try to pay via the state and taxation for all the caring in our society—whether it be for children, disabled relatives or the elderly—we would never raise enough in tax to be able to achieve it. For me, it has always seemed nonsense simply to look at the budgets and try to spend a bit more and a bit more. That will not be the solution in the longer term, particularly in an ageing society where the issue will crop up time and again.

I applaud my hon. Friends the Members for Congleton and for South Thanet for focusing instead on the carers—the people who carry out the caring. There are currently about 1 million people in England alone who are aged over 65 yet are caring for a relative. A constituent wrote to tell me that he was disabled, that his wife was his carer and that they also had a disabled adult child for whom his wife had been the carer since the child was born. He told me that his wife, who had retired at 62, was not eligible for any carer’s allowance because she was drawing a state pension. She is trying to care 24/7 for a disabled husband and travelling at her own expense to care for an adult disabled child. That is simply impossible, and he told me that it was inevitable that the family would have to go to the local council and call for help. His wife will give up that caring role because she will not be able to cope—financially, let alone physically—with the stress of having to care for two people in her own family.

If we turn that on its head and think about what happens with a carer’s allowance, we find that the carer gets £55.55 for 35 hours of care a week—£1.58 an hour in comparison with the national minimum wage of £5.59 an hour for an adult. Carers thus get an incredibly small sum of money. Looked at from the state’s perspective, it is an absolute bargain. If the person was not doing that caring for that kind of money, the state would be the default and have to pick up the pieces, as that is how things work in this country.

What we should be looking at is how we can continue to benefit from the love and cherishing of family members in order to give the people being cared for a quality of life that is so much better. We all know that £1 spent in the home saves £4 in the NHS. How much more is £1 spent on a carer who knows and loves the person they are caring for worth than £1 spent on a carer who, perhaps, comes in periodically through the day and who may frequently be replaced by another carer? The outcomes for the person being cared for are so much better if they are cared for by someone who genuinely loves them.

We should therefore seriously consider introducing a post-retirement carer's allowance that is available only to retired carers who continue to be the only carer for their loved one. That carer's allowance would cease on the day that they call on social care from social services or the local council. There will therefore be an incentive for people to continue to care for their loved ones, which is better for everybody. I absolutely take on board what my hon. Friend the Member for Congleton said about the need to provide a care package for the carers themselves, but the principle of enabling carers to continue to provide that support for as long as possible should not be overruled by the need to care for the carers.

The Department for Work and Pensions has estimated that this year the cost of simply retaining the carer's allowance alongside the state pension would be about £950 million. What it did not take into account was the fact that there would be a commensurate reduction in the pension credit, and also the enormous potential reduction in the cost of providing social care. We might be paying a family loved one £1.53 or £1.58 an hour, but we would be paying an official carer £10 or £20 an hour, perhaps, to go in and look after that person—and in a far less assiduous way.

The taxpayer, through Government aid, is simply not going to be able to foot the bill for all the care that will be needed in the future. We must find a way to support society, communities and carers, so that loved ones can continue to care for their own family members. I would be interested to hear the Minister’s thoughts on this idea.

Health and Social Care Bill

Andrea Leadsom Excerpts

Tuesday 28th February 2012 Commons Chamber

[Mr Lansley]

The hon. Gentleman, himself, was present at 40 sittings in Committee, during which his hon. Friend the Member for Halton (Derek Twigg), the shadow spokesman, said that the Bill had been thoroughly scrutinised. We have debated it; in another place they continue to debate it very fully and very constructively; and I believe that that will deliver us the right Bill for the NHS.

[Andrea Leadsom (South Northamptonshire) (Con)]

Will my right hon. Friend confirm that this Bill is superb news for patients, and that under the Secretary of State’s new Bill, my constituent who requires less invasive hip treatment in a neighbouring county will be able to choose to go to that other provider for a less expensive operation that will do him less harm and more good?

[Mr Lansley]

Yes, indeed. For the first time, not just through the legislation but through the modernisation of the national health service, patients will be able to see, through the data, the quality of the service provided in the NHS by a range of providers. When patients are asked whether they want—on that basis, as NHS patients with a free service based on their need—to be able to choose who should provide them with care, 81% say that they want that choice. We will give them that choice; Labour would not.

NHS Care of Older People

Andrea Leadsom Excerpts

Thursday 27th October 2011 Westminster Hall

[Margot James]

I thank my hon. Friend for his observation, and I certainly agreed with the first point he made. I shall conclude in a minute as I am aware that many Members wish to speak.

The CQC should be resourced to ensure that its inspections include weekend visits. All the observations it makes in its recently published report were based on visits it paid during the week—for cost reasons, I imagine—but I was delighted to hear the Secretary of State announce yesterday that there will be more inspections. I hope, however, that the Minister will discuss with the CQC the possibility of visits being paid at weekends, when—I hear—care can sometimes deteriorate rapidly.

Some complaints are very serious, and I am not commenting on serious medical negligence, but with many complaints the system comes over as a sledgehammer to crack a nut. A patient or family member should be able to make an informal, non-legalistic and reasonable complaint and receive a sensitive hearing from a senior member of staff, rather than be instantly given a form that starts a three-week process of churning and often ends in Members’ surgeries. I ask the Minister to discuss with the Justice Department how we enable that but avoid opening the hospital to legal challenge, which is one of the motivators to the heavy-handed system we have at present.

We must be able to distinguish between the training needs of nurses and health care assistants.

[Andrea Leadsom (South Northamptonshire) (Con)]

It seems that the nursing profession lacks some accountability. What does my hon. Friend think about the idea of bringing back matrons, who are visible on the ward and who manage nurses?

[Margot James]

I thank my hon. Friend for that intervention, and I am attracted to that good idea. Somebody must be in charge of the ward—a nurse manager or a matron. Although that happens in the best wards, it is not universal.

We must look at the training of health care assistants, who increasingly perform sensitive, caring roles; the system cannot be left as informal as it is at present. There must be minimum standards and training. We know that there is pressure to register health care assistants. I am not sure that that is necessary, but training and minimum standards certainly are.

I challenge where Project 2000 has got us. Nurse training could remain at degree level but follow a more apprenticeship-based model. I ask the Minister to meet the Nursing and Midwifery Council to discuss how the nursing degree can learn from the apprenticeship model so that far more time is spent on the ward, alongside the academic study that has brought such benefits.

There is much more to be said, and I look forward to hearing from other hon. Members and learning from their contributions. I thank the many organisations that have been in touch with me and helped with my research since I secured the debate last week.