Mental Health (Infants)

Anne Milton Excerpts

Tuesday 26th October 2010 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

It is a pleasure to serve under your chairmanship, Mr Bone, which I have not done before. I start by echoing the comments by the hon. Member for Islington South and Finsbury (Emily Thornberry): it is a shame that more people do not listen to some of these debates. This debate has been of a high quality and is particularly poignant in that the serious case review on baby Peter is published today. Perhaps somewhere out there a member of the press will pick up on it, and realise that hon. Members across the House from all political parties are working together, to a large extent outside party political lines, to ensure that we get this issue right for families.

I congratulate my hon. Friend the Member for South Northamptonshire (Andrea Leadsom) on securing this important debate on a subject that is almost fundamental to everything else that we do. I am aware that she has maintained an active interest in infant mental health for a number of years as the former chairman and trustee of the Oxford Parent Infant Project. Its work was rightly recognised earlier this year when it was one of five winners of a national award from the Centre for Social Justice. I congratulate it on that; it is good to see its invaluable work recognised in that way.

My hon. Friend described with some clarity the significant impact of early parenting, the huge challenges that exist for some families, and the problems that ensue from poor parenting that falls short of the therapeutic, loving and securing attachment that children so desperately need. She mentioned the UNICEF report that cited us as the lowest of 25 industrialised countries. It is shocking that we are at the bottom of that table for the well-being and mental health of our children. She highlighted the fact that there is not one best route to get this right. The hon. Member for Southport (Dr Pugh) also talked about it. A huge variety of support is needed if we are not to lose people in the gaps. It is vital that we approach the matter from a multifaceted direction.

Early years intervention is being actively examined by the Minister of State, Department for Education, my hon. Friend the Member for Brent Central (Sarah Teather). We are working closely together. I have been hugely impressed by the work that we have achieved to date and the work that is ongoing. There is no doubt that we will not achieve what we want if we come at the issue from different silos of Government Departments. My hon. Friend the Member for South Northamptonshire is right to cite the growing evidence for what interventions work and to refer to fostering, looked-after children, adoption and a number of other issues on which I can assure her that I am working and will continue to work with other Departments.

There is increasing evidence about the importance of early life and warm parenting. An infant’s early experiences have a long-lasting impact on their future health, relationships and happiness. There are also important intergenerational effects. Warm, positive parenting and a strong bond between a mother and baby, as well as the father, lay the foundation for health and happiness throughout life.

I am a mother of four children, aged from 26 to 14. I feel like getting out my 26-year-old from a cupboard and saying, “This is one I prepared earlier,” to demonstrate to those who are struggling through the teenage years with their children that it does all turn out right in the end. However, parenting, from whatever background we come, is a challenge. I found it challenging. Even though we might not be in quite the situation that other parents are—we might be better resourced; we might have more money and be in better housing—all of us, in our lives as parents, have had a taste of the tensions and stresses that people feel, and can only imagine what things might be like if we did not have adequate housing and were living with three children in a one-bedroom flat.

The Government are determined to ensure that all families have the right support at the start of life. Health visitors are central to that by providing advice and support through pregnancy, after birth and through the pre-school years, supporting healthy child development and promoting parent-child attachment and positive parenting models. It was a pleasure for me to talk at the health visitors conference last week and re-emphasise our support for health visitors. We want more people in the profession and more people back in the profession to ensure that we have that universal visiting service. That is why, as my hon. Friend will be aware and as hon. Members mentioned, we are investing in 4,200 new health visitors by the end of this Parliament. That is an ambitious target, but we will do everything, pull out all the stops, to ensure that we achieve it. In last week’s spending review, my right hon. Friend the Chancellor of the Exchequer confirmed that the money is there to recruit and train those health visitors.

We also have the healthy child programme to provide the opportunity for health professionals to identify where additional parenting support is needed. Leading and delivering the healthy child programme, health visitors are well placed to identify those families, give them extra support and help them to access more specialised services. We have seen quite a significant decline in the number of health visitors, from just over 13,000 in 2004 to just over 10,000 in 2010, at a time when the birth rate is increasing, and we need to turn that round. The message must go out loud and clear to health visitors: “We want you, we need you and parents and the future generation need you.”

The chief nursing officer is working with the Community Practitioners and Health Visitors Association to define what makes a modern health visitor. The hon. Members for Mid Dorset and North Poole (Annette Brooke) and for Islington South and Finsbury mentioned training and whether there is adequate training on things such as mental health issues. It is extremely important that we get that right. The service model that has been built makes clear the value of health visitors and the contribution that they make to better family and community health. Next year we shall move on to a national recruitment drive for health visitors, and we are working on better training options for returners and new recruits, so that a bit more flexibility can be built in to attract people into the profession.

I want to say a few words about family-nurse partnerships for the more vulnerable. The family-nurse partnership is a preventive, intensive programme for first-time teenage parents and their babies, whose outcomes are not good and fall well below those for other parents. Specially trained nurses work with girls from early in pregnancy until their children are two, giving them support to help them to adopt healthier lifestyles, provide good care for their babies and plan their future life goals. Following the spending review, we shall be extending the family-nurse partnership programme, so alongside the support that health visitors will offer for all families, there will be increased access to the highly targeted, highly specialised support that the most vulnerable families need. We shall set out our plans for that shortly.

The outcomes from family-nurse partnerships are very significant. Over the past 30 years, the evidence in the US has shown that family-nurse partnership children have better health development and better educational achievement and are less likely to be abused, neglected or involved in crime. Cost savings are also substantial. Early evidence in the UK is very promising. Family-nurse partnerships successfully engage disadvantaged young parents, including fathers; 87% of those offered a family-nurse partnership take up that offer, so they are significant.

There are many examples of mental health services for infants being improved. A number of regions have set up perinatal and infant mental health networks to encourage partnership working and the sharing of good practice. Volunteers from the charity Home-Start do valuable work in increasing the confidence and independence of families by visiting families in their own homes to offer support, friendship and practical assistance and by reassuring parents that their child care problems are not unusual or unique. My goodness, I could have done with someone from Home-Start myself. We believe that we are the only person going through what can feel like a rather traumatic experience. Those volunteers also encourage parents’ strengths and emotional well-being for the ultimate benefit of their children and try to get the fun back into family life.

[Annette Brooke]

I declare an interest in the point that I am about to make. Along with many other voluntary groups, organisations such as Home-Start are very concerned about their funding. I am a patron of my local Home-Start, and already there has been a cut. I ask the Minister to do everything that she can to support the vital work by the voluntary sector, because, as we all know, it can get into places that the statutory services cannot.

[Anne Milton]

I thank the hon. Lady for her intervention. She took the words out of my mouth: I, too, must declare an interest as a patron of my local Home-Start. The important message to councils is that when funding is tight, they should think about what works, and as is always the case with the voluntary sector, £1 of taxpayers’ money buys significantly more than £1-worth of care and services. Councils need to think imaginatively about how they spend their money and how they get good value for money. That often involves looking to organisations such as Home-Start. It can be extraordinarily short-sighted to cut back on such schemes at a time when they offer much better value for money than can be had almost anywhere else.

There is no doubt that the need for early intervention has been recognised by us all. The hon. Lady rightly pointed out in her speech the huge variety of reasons why we end up in life where we do. I, too, must admit to having been a mother of the Penelope Leach generation, holding baby in one hand and my Penelope Leach book in the other and trying to look up what exactly parents do at 4 o’clock in the morning when their child will not go to sleep. Having been a chairman of the Hackney and Islington branch of the National Childbirth Trust, I must also admit to having been influenced by the likes of Sheila Kitzinger and Susie Orbach, who added to my knowledge base. Some of Susie Orbach’s words might still haunt me now, as my daughter approaches the age of 17 and I wonder what sort of effect I have had on her.

The hon. Lady emphasised the point about the nonsense of seeing, say, the fostering of looked-after children through the eyes of one Department. Clearly, that is nonsense—we have to look at it across the board.

I can give the assurance that mental health remains a priority. The Department is working closely with stakeholders to put together a mental health strategy—a child and adolescent mental health services stakeholder event was held earlier this year—and the mental health strategy will take a life course approach. I am determined, and I know that the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), who has responsibility in the Department, is determined that we have a mental health outcomes framework that sits alongside physical health outcomes. For too long we have concentrated on physical health, to the detriment of mental health.

The hon. Member for Southport went into some detail about the research, especially the problems with causality and, probably, the need for Governments to take account of continuing research that emerges, to see if we can better define why we are as we are. He is right that we do not do enough to talk about and inculcate parenting in school life and in the upbringing of our children. He is also right to highlight that one of the biggest determinants of educational outcomes is within the family.

In 2008, the hon. Member for Nottingham North (Mr Allen) and my right hon. Friend the Member for Chingford and Woodford Green (Mr Duncan Smith), now the Secretary of State for Work and Pensions—to whom my hon. Friend the Member for South Northamptonshire paid tribute—published “Early Intervention: Good Parents, Great Kids, Better Citizens”, which devoted a chapter to the importance of nought to three-year-olds and parental early intervention.

In July this year, the hon. Gentleman was asked by the Government to conduct an independent review of early intervention delivery. The review will focus on three key things: the identification of early intervention best practice, which goes back to the point about research; how we spread best practice, so we do not see the rather patchy outlook that we have at the moment; and new ways to fund early intervention in the future. What is impressive, and what we have seen again this morning, is the cross-party approach that has been adopted.

The Government have a role to play, but we all know that the first place that people turn to for help and advice is often their family and friends. We should not forget that. So, it is the individuals and organisations rooted in the community that can often have the greatest influence and impact, including local community groups, the voluntary sector and Sure Start centres.

Health visitors, as public health professionals working with families, are uniquely placed to bring people together across local communities to drive change on the problems that families face. As the health-visiting work force grows, there will be more opportunity for them to develop that wider role. We will provide support through a new training programme for health visitors, to be launched next year, to refresh and extend their community health skills.

The hon. Member for Islington South and Finsbury raised a number of issues. I hope that I have got them all down. I would like to touch on them before I conclude. We need to remember in so much of what we do that the issue is not necessarily about the quantity of money but how we spend it. We have an imperative to spend it more wisely than ever before, but the quality of what we get out of it is what matters, not necessarily the sum that goes in.

The hon. Lady rightly mentioned the importance of day care and the need for it to be of a high quality. It is not about whether parents stay at home or work, nor is it about making value judgments on how people live their lives. It is about providing a framework in which parents and children can thrive. Sure Start health visitors and the need for good-quality mental health awareness and intervention are crucial, and increasingly so. If one in four of us suffers from a mental health problem, we are looking at similar statistics among parents. The hon. Lady is right that universality is important—on stigma and access.

I must also point out that massive forms have been a feature of past Governments. They are always a feature of anyone trying to be a gatekeeper to scarce resources and are rarely effective. The Government are determined to banish them. The hon. Lady also mentioned early intervention grants. I can assure her that I met to discuss the matter with the Minister of State, Department for Education, my hon. Friend the Member for Brent Central, only yesterday. We are looking at it.

I have responsibility for public health, so I sit on a number of committees—a very large number—which is useful. I am in a group on families which the Prime Minister set up and a number of inter-ministerial groups, including the Cabinet Social Justice Committee. The same theme runs through all those areas—we have got to get this right, we have got to get the money focused in the right areas and we have got to get the money focused on areas giving us good outcomes.

In conclusion, I thank my hon. Friend the Member for South Northamptonshire for securing the debate. She made a number of important points about the mental health of infants. I hope that the NHS White Paper gives us a chance to refocus on achieving better results for them. The public health White Paper, which will be published later this year, will build on that. We also need an outcomes framework that will be a central driver of improvement, ensuring that the NHS treats the person as a whole—holistically—and not the disease.

Meeting parents’ needs effectively depends on good local partnerships. Groups such as the Oxford Parent Infant Project are a good example of that. I am keen on a strong dialogue with the voluntary sector. Indeed, the White Paper is all about opening the door to such organisations. By working together in that way, we can do much better for the mental health of our infants, families and communities. We have a duty to secure the future generation of parents.

[Mr Peter Bone (in the Chair)]

Thank you for that splendid debate. The sitting is suspended until 11 am.