Health and Social Care Committee

Debate between Ben Bradshaw and Paul Williams

Thursday 28th February 2019 Westminster Hall

[Dr Paul Williams (Stockton South) (Lab)]

Thank you, Mr Sharma, for inviting me to address this Chamber, so that I can present the Health and Social Care Committee’s report into the first 1,000 days of life.

I have been studying and working in health for the past 27 years and I have concluded that if our society wants the most effective interventions to improve health, we must act in the period from conception to the age of two. That is because the seeds of health inequalities are sown during that time. Good social, emotional, physical and language development during that time is crucial to building healthy brains and children, and having a healthy society.

This week our report set out an ambition challenge to the Government and all our colleagues in the House. We want to kick-start the second revolution in early years services, as recommended by the Marmot review in 2010, so that our country can become the best place in the world for a child to be born. Building that kind of society drives me, not only as an MP, but as a father and doctor.

I thank the hon. Member for Totnes (Dr Wollaston) for letting me take the Chair of the Committee for this inquiry. It is typical of her generosity of spirit that she seeks to give opportunities to others. I hope that I have done justice to the chance she gave me. I thank my Committee colleagues—of all parties and of none—for their support and guidance during our inquiry. I thank our Health and Social Care Committee staff team, particularly Lewis Pickett, Dr Joe Freer and Huw Yardley, who played a crucial role in helping us to make this report a reality.

Almost all research into this subject demonstrates that our path in life is set during the crucial first 1,000 days from conception to the age of two. Healthy social and emotional development during that time lays the foundations for lifelong good physical and mental health. Yet, our current political system invests a fortune in reacting to problems much later in life, leaving a gaping void where we should be warriors for a fairer and healthier society.

During the first 1,000 days of life, more than 1 million new brain connections are made every single second, and babies’ brains are shaped by the way in which they interact with others. However, more than 8,000 babies under the age of one in England currently live in households where domestic violence, alcohol or drug dependency and severe mental illness are all present. Over 200,000 children under the age of one live with an adult who has experienced domestic violence or abuse. Two million children under the age of five live with an adult with a mental health problem.

We know that many children who experience such adversity become happy and healthy adults, but adversity in childhood is strongly linked to almost all health problems and many social problems. Children exposed to adverse childhood experiences are much more likely to get heart disease, cancer and mental health problems than those who are not. Children exposed to four or more ACEs are 30 times more likely to attempt suicide at some point in their life, 11 times more likely to end up in prison and three times more likely to smoke as adults than those exposed to no ACEs. Our politics is currently failing some of these babies and other children who are born into families where poverty strongly affects their chance of achieving good health.

As part of this inquiry, our Committee read 90 submissions of written evidence and held three focus groups with stakeholders. I thank those who made superb contributions to our three oral evidence sessions. I particularly thank David Munday from Unison, Sally Hogg from Parent Infant Partnership and Viv Bennett from Public Health England for their guidance to me.

Our Committee was keen to reach outside Westminster for evidence. We hosted an online forum on Mumsnet, where we heard 80 stories from parents telling us about their experiences of pregnancy and early childhood, as well as their views on services. We visited the Blackpool Better Start project, run by the National Society for the Prevention of Cruelty to Children and funded by the Big Lottery Fund. We held focus groups with representatives from councils, clinical commissioning groups and charities from across the country.

We all know how austerity has affected our councils and the NHS over the last nine years, but we saw how a relatively small Big Lottery Fund investment had helped local authorities to redesign their services. Staff were able to take time to reflect. The extra money brought added capacity and outside expertise. We saw joined-up, effective collaboration between the council, NHS commissioners and providers, the voluntary sector and the police.

We also saw the importance of investing in long-term goals and service transformation, rather than just using money to firefight short-term challenges. We heard how having a one-stop shop for families helped to provide better support, and helped professionals to have better relationships with each other and to share information. We visited community spaces across Blackpool, including a library and a local park, which had been transformed by members of the local community, to make them more suitable for families with young children. We heard about the importance of a father in a young child’s life. Some fathers say that they lack parenting skills and other fathers felt that the system excluded them.

I firmly believe that we need to devote much more attention and protection to resources for this crucial period of life. There are many people across the political divide who share that belief. This is an area where politicians should be working together. It was very encouraging to hear that the Early Years Family Support Ministerial Group, led by the Leader of the House, was announced shortly after the start of our inquiry. That has the potential to take forward some of our Committee’s recommendations. I will soon be meeting with the Leader of the House to hear about the group’s progress.

Our inquiry has identified the need for a long-term, cross-Government strategy for the first 1,000 days of life, setting demanding goals to reduce ACEs, improve school readiness, and reduce infant mortality and child poverty. Our report recommends that the Minister for the Cabinet Office should be given specific Cabinet-level responsibility for the oversight of this national strategy.

We want communities, the NHS and voluntary groups to be led by local authorities, to develop their plans to bring this Government strategy to life, inspiring improved support for children, parents and families in their area. We think that a Government transformation fund should be established to encourage these different groups to come together, to pool their resources and deliver shared, agreed actions. We also think that a single nominated individual in each area should be accountable to the Government for progress.

Our report also calls for the existing, and actually very good, healthy child programme to be improved and be given greater impetus. It should be expanded to focus more on the whole family rather than just the child, begin before conception, deliver more continuity of care for families—something we found families really valued—and extend health visitor engagement beyond the age of two and a half, to ensure that all children become school-ready.

We heard from Scotland, Wales, Northern Ireland and parts of the United Kingdom that had enhanced the healthy child programme. However, we also heard from too many areas where some of the contact with health visitors was just a letter, and we were told that 65% of families do not even see a health visitor at all after the six to eight-week check. That clearly is not good enough. Our report recommends that information sharing needs to be significantly improved. Information needs to be better shared between organisations so care can be better co-ordinated and the long-term impact of an intervention can be tracked and assessed.

Alongside that, we need a workforce strategy to address the reduction in health visitors. That does not seem to have been a deliberate strategy, but happened because local authorities were given the funds for the healthy child programme at the same time as they had their budgets cut. We also want the strategy to make sure that knowledge and skills are improved, especially knowledge of ACEs and the importance of using motivational interviewing techniques.

If we get this crucial 1,000 days of life right, it will have huge benefits for everyone in our society. As politicians, we should try to get it right not just because it makes financial sense, but because every single one of us in Parliament has a moral responsibility to our country’s children. Every child deserves the best start in life.

[Mr Ben Bradshaw (Exeter) (Lab)]

I congratulate my hon. Friend on his excellent chairing of the inquiry, his drafting of the report and his speech. Children in their first 1,000 years do not have as much of a political voice as other lobby groups, but does he agree that when Governments face difficult decisions about spending priorities, spending money on those children makes more sense than spending money on older young people in higher education, many of whom are well-off and talented and will do perfectly well in the rest of their lives? The best investment is in those first 1,000 years.

[Dr Williams]

I agree with my right hon. Friend’s proposition that investment at the beginning of life is likely to pay the greatest dividends, particularly in reducing inequalities. As politicians, we should represent all members of our communities, not just those who are old enough to vote or who choose to vote. There is an opportunity in the comprehensive spending review to make the case for long-term investment in that group of children.