Healthcare Support Services: Conception to Age Two

Debate between Christopher Chope and Tim Loughton

Tuesday 15th December 2020 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir Christopher, and a great pleasure to be speaking in a debate secured by my very old, wise and aged colleague, my right hon. Friend the Member for South Northamptonshire (Andrea Leadsom)—the high priestess of early years. As she said, I speak as the chair of the all-party parliamentary group on the first 1,001 days. I also recently stood down as chair of the Parent-Infant Foundation, the charity that she founded and that is having such an important effect on the whole movement for 1,001 days. I have been very proud to chair that charity for the past six years.

It is great to see this subject coming into the mainstream. We have had a number of Westminster Hall debates, including on the impact of covid on maternity, families and children in lockdown. Before the general election, I held a debate on health visitors. Since “The 1001 Critical Days” manifesto, the important document produced about eight years ago by my right hon. Friend, we have had various reports, including “Babies in Lockdown”, “Rare Jewels” by the Parent-Infant Foundation, “Building Great Britons”, and several Select Committee reports, including by the Health and Social Care Committee and the Science and Technology Committee, all of which were serious, heavyweight studies of the first 1,001 days.

This is, at last, not a new subject. I come to this debate much in the mode of Elizabeth Taylor’s sixth husband: knowing what was expected of him, but struggling to make it new and fresh. But we will give it a go.

Children, particularly very young children, have been the forgotten element in the whole pandemic lockdown; so too have parents of very young children. The lockdown, the regulations, and the alienation from or unavailability of family member support networks—which many of us, as early parents, took for granted—have had mental health impacts on new parents and single parents in particular. We should not underestimate that. It will be a long time before we can get back to a degree of normality and start to see the impact that missing out on those important contacts and support mechanisms in those crucial early months has had and will have for many years to come.

Early years has for too long been forgotten when it comes to Government spending. Many of us have been going on about that for a long time, and it is worth repeating. Work done a few years ago estimated that the cost of perinatal mental illness is £8.1 billion each and every year. The cost of child neglect in this country is £15 billion each and every year. That means that we are spending more than £23 billion on getting it wrong for parents and very young children in those crucial early years. If we were to spend a fraction of that amount on greater preventative intervention measures for those who most need it in those crucial early years from conception to age two, that bill would be reduced significantly and it is a false economy not to be doing that.

It was disappointing to see just £300 million in additional funds being given to the social care sector—that is, the adult and children’s social care sector—in the spending review, even though there is a shortfall of some £3 billion in local authority children’s social care alone, not to mention all the problems with public health and the shrinking numbers of health visitors, which I will come back to in a moment.

Why is that important? My right hon. Friend the Member for South Northamptonshire has given us some of the figures. Up to 20% of women experience mental health problems in pregnancy or the first 12 months after birth, and 50% of all maltreatment is related to children under the age of one. It has been estimated that 122,000 babies under the age of one live with a parent who has a mental health problem. One third of domestic violence begins during pregnancy—a figure I could not believe when I first came across it. The Government are doing good work with domestic abuse legislation, but we need to be addressing the problem at source. If domestic violence is happening in a household, what sort of physical and psychological message is that sending to the newborn child? The same applies to even before it is born as well: there are signs that communication within the womb itself is a factor. Suicide is one of the leading causes of death during the period of pregnancy to one year after the birth of a child. That is a deeply tragic figure, but it preventable if proper systems and checks are in in place.

About 40% of children in the UK have an insecure attachment to a parent or carer by the age of 12 months. The figure that I have always used—this is, I think, the killer point—is that for a child at the age of 15 or 16 who is suffering from some form of depression or low-level mental illness while at school, there is a 99% likelihood that his or her mother suffered from some form of depression or mental illness during or after pregnancy. It is as direct a correlation as that. If we do not do something within those first 1,001 days, we will reap the consequences, as will children, not just during childhood but into adulthood as well.

Child obesity rates are all connected to what happens in the first 1,001 days. Last year we also had worrying figures—this is particularly topical now—about the dwindling vaccination rates in England. In particular, only 86.5% of children had received the full dose of the measles, mumps and rubella vaccine. We have effectively lost our immunity status, because the World Health Organisation target to protect a population from a disease is 95%. One hopes that parents in particular will take up the covid vaccination as it is rolled out, because we have seen the effects on the children’s population of not having vaccinations in recent years.

The Children’s Commissioner estimates that 2.3 million children are living with risk because of a vulnerable family background and that more than one third within that group are invisible—they are not known to services and are therefore not getting any support. That is why it is crucial, particularly before those children present at school and come on the radar, that health professionals at various levels are having contact with those children and families to ensure that everything is all right. They can give that help and support and that tender affection and empathy, but they are also an early warning system for when things are going wrong, right up to safeguarding issues. The one thing that all those ailments have in common—there are a lot more that I have not mentioned—is that they come under the remit of the health visitor to a varying extent. I will come back to the importance of health visitors.

The impact of covid is great, as I have said, and I will not go over that again, but more families with babies and young children under five have been tipped into vulnerability due to the secondary impacts of the lockdown. At a time when families, and particularly families from deprived communities and single-parent families, need face-to-face contact with people like health visitors the most—I also refer to health visitors as the trusted uniform services who are usually welcomed over the threshold, whereas with social workers and others a barrier goes up instantly—more than 70% of health visitors have been repurposed to other aspects of the health service to deal with covid. That really is a false economy.

I pay tribute to Cheryll Adams, the chief executive of the Institute of Health Visiting, who is standing down from the outstanding role she has played for the cause of health visitors and their importance in the first 1,001 days. She will be greatly missed, but I am sure she will not quit the scene altogether, because of her dedication to the cause. Her report showed that 82% of health visitors reported an increase in domestic violence and abuse; 81% an increase in perinatal mental illness and poverty; 76% an increase in the use of food banks and speech and communication delay among children; 61% an increase in neglect; and 45% an increase in substance abuse. Finally, 65% of health visitors have a case load of more than 300 children under the age of five.

Is that sustainable? My worry is that even in the good times without a pandemic, health visiting was greatly stretched. One of the great achievements of the coalition Government was the delivery of a promise to institute 4,200 additional health visitors, based on the Kraamzorg system in Holland, which we visited and saw. It was a huge achievement—I think we were just a few dozen short of 4,200 by the time we got to 2015—and yet I fear that those numbers have dwindled back almost to the level that was inherited. That is such a false economy. Health visitors are a critical part of a universal offer to all families in the first 1,001 days. The report by the First 1001 Days Movement says:

“It is essential that governments invest in the delivery of the Healthy Child Programme and that this programme supports babies’ emotional wellbeing and development. We believe that all families should be able to access care from a named health visitor who offers them a high-quality service that is proportionate to their needs.”

I wholeheartedly concur.

What should be done? Many suggestions have been made. The LGA recently brought out a report saying that the Government should

“properly resource councils to enable investment in preventative universal and early help services to ensure that children, young people and their families receive the practical, emotional, education and mental health support they need”.

That is absolutely right. The Parent-Infant Foundation, in its “Babies in Lockdown” report, recommended funding for a

“Baby Boost to enable local services to support families who have had a baby during or close to lockdown.”

As my right hon. Friend said, more than half a million babies were born in that period. The report also said we should have a

“new Parent-Infant Premium providing new funding for local commissioners, targeted at improving outcomes for the most vulnerable children.”

I obviously agree with that.

Finally, I will go back to the “Building Great Britons” report, which was produced back in 2015 and made nine main recommendations: that a 1,001 critical days policy should be a mainstream undertaking by central Government; that all local authorities should be required to produce and implement a 1,001 days strategy within the next five years; that national Government must establish a 1,001 days strategy blueprint; that local health and wellbeing boards should demonstrate delivery of a sound primary prevention approach; that the early help recommendations from the Munro review, which I commissioned back in 2010, should be picked up and carried; that we should have a Minister for families, either close to or at Cabinet level, to carry the banner for the importance of the early years and family contexts, which are so important to the social policy of any Government; that we should have more inter-agency training on the importance of the early years; that children’s centres should be repurposed to be these family hubs, which this Government have committed to and which should be a Piccadilly Circus of these services available to all families; and that we should have the research evidence to go with all of that.

In short, we need a full “team around the family” approach; we need to invest in health visitors and other health professionals, including GPs and mental health specialists, particularly around attachment issues. We need them to work with all of those in the early years setting, alongside social workers and others with safeguarding responsibilities—supporting, not supplanting parents, but signposting them to the most appropriate services and ensuring that they are accessible when needed. We need a national roll-out, national guidance and national scrutiny to ensure that it is being delivered, but it should be implemented locally and governed by local circumstances. To not do that is a false economy, and children in future generations will pay the price.

[Sir Christopher Chope (in the Chair)]

Before calling the next speaker, I will just say that the wind-ups will start at half past 10. There are four more speakers, so if each of them speaks for a maximum of five minutes, we should cover everybody.

Civil Partnerships, Marriages and Deaths (Registration Etc.) Bill

Debate between Christopher Chope and Tim Loughton

Ping Pong: House of Commons
Friday 15th March 2019 Commons Chamber

[Tim Loughton]

Thank you so much, Mr Speaker. Having made the journey back home, I eventually got to my office to realise that I had left my mobile phone in my jacket that I had taken off, so things can only get better today.

We have before us technical amendments. The Bill has had a long journey. It had its First Reading on 19 July 2017—those heady days when we had a relatively stable Government and could get legislation through the House. Today is a culmination of that, with ping-pong, which I hope will be solely ping and leave no pong.

Members will remember that when my Bill left the Commons last year, it contained my last-minute amendment obliging the Government to bring in the legislation on civil partnerships within six months of the Bill achieving Royal Assent. Curiously, although the Government at that time were not supportive of it, when it came to the possibility of a vote, a rather curious new parliamentary term was coined by the Immigration Minister, who said that the Government were not “actively” opposing my amendment. Hopefully that has now transmogrified into the Government supporting it.

While the wording of clause 2 has changed since the Bill left this House, I want to assure Members that the intention of the clause—to create equality between same and opposite-sex couples in their ability to form a civil relationship—remains. I amended my Bill on Report, before it left this House, to give the Government the ability to extend civil partnerships to opposite-sex couples, rather than just review the possibility of an extension. The Government, although slightly belatedly, came to support the principle of opposite-sex civil partnerships, perhaps spurred on by the Supreme Court judgment in a case last June. I accept that there were technical deficiencies in the drafting of my original amendment.

Since then, I have worked with the Government and the noble Baroness Hodgson of Abinger, to whom I pay great tribute. She guided the Bill through the Lords as a private Member’s Bill virgin, as she described herself, but did so skilfully and with great deftness, steering it on an even course so that it is back here with us today. Baroness Hodgson was able to correct those deficiencies and improve the drafting of the Bill. She then tabled and successfully moved the revised clause 2 and related changes in Committee in the other place, despite some rather indulgent attempts by certain peers in the other place to add their own agendas to the Bill, which were, alas, defective and would have had the result of scuppering the whole Bill. I pay tribute to the way that Baroness Hodgson steered those through potentially choppy waters to avoid the Bill being holed below the water line.

Lords amendments 1 and 2 replace my earlier version of clause 2. The new clause now requires the Secretary of State to amend by regulations the eligibility criteria of the Civil Partnership Act 2004 so that two people who are not of the same sex may form a civil partnership. The Bill requires that these changes be made so as to come in no later than 31 December. That will mean, as we have agreed with Ministers in the other place, that the legislation needs to be in place by 2 December, because notification of a clear 28 days is required before a ceremony can actually take place. There was an undertaking that civil partnerships would be available before the end of 2019, and I look forward to a series of invitations to civil partnership ceremonies on new year’s eve.

[Sir Christopher Chope (Christchurch) (Con)]

Many congratulations to my hon. Friend on steering this Bill through so successfully and on getting his timing absolutely right so that it could incorporate the decision of the Supreme Court. May I ask him whether he is concerned about the fact that subsection (1) of the new clause says:

“The Secretary of State may, by regulations”

thereby indicating a certain discretion, but subsection (2) says that if he exercises that discretion under subsection (1) then he “must” do so before 31 December? Is my hon. Friend suspicious that the contrast between “may” and “must” in subsections (1) and (2) could be used by the Government to undermine what he has just asserted?

[Tim Loughton]

I know my hon. Friend is always vigilant, rather than suspicious. Having sat through many Committees over many years in this House arguing the toss over whether the word “may” should be replaced by the word “must”, I have to say that I am not concerned about the wording of the Bill. I have had many conversations with the Ministers responsible, and the Government are absolutely committed to delivering on the undertakings in this Bill. It had to be put together in such a way to give some leeway to Ministers to be able to produce the right legislation at the right time. That involved a degree of discretion, which I know my hon. Friend and others in both Houses were concerned about. A number of undertakings were therefore added to the Bill and were given orally, not least a sunset clause, so that this clause, which I know my hon. Friend has had concerns about in the past, could not be used for other purposes as something of a Trojan horse. I entirely appreciate his observation, but I do not share his concern that this will not actually be produced. I think it will be produced in a fairly short space of time. Goodness knows, we tried for long enough to get mothers’ names on marriage certificates.

Civil Partnerships, Marriages and Deaths (Registration Etc.) Bill

Debate between Christopher Chope and Tim Loughton

3rd reading: House of Commons & Report stage: House of Commons
Friday 26th October 2018 Commons Chamber

[Tim Loughton]

I beg to move, That the Bill be now read the Third time. I said at the beginning of my previous remarks that this morning would be a breeze. There have been a few headwinds, but so far, so good. I hope we can continue in that spirit of agreement and consensus across the House regarding all four measures in the Bill, which are much needed and much supported. My Bill has been referred to as the hatch, match and dispatch Bill because it covers so many junctures in people’s lives. I like to view it rather more as a Bill to address anomalies and iniquities in the law that, in many cases, should have been dealt with a long time ago.

I want to apologise in advance to officials, because if the Bill now goes through as amended, as I hope will be the case, they will have a lot of work to do in a relatively short space of time, but we now have a timeline, and that work should be a welcome distraction for them from Brexit, so there are upsides as well as downsides.

There are four aspects of the Bill, as I have mentioned. Clause 1, which is about marriage registration, seems to have excited the most vociferous support this morning. I am sure that the Minister will actively support it, rather than not actively support it—she appeared to say earlier that she did not like new clause 1 but would not actively oppose it, although passively she would have done. But we have moved on to Third Reading now—we are on the final bend.

I pay tribute to the Bishop of St Albans for the Bill that he has steered through the Lords, ably supported by my right hon. Friend the Member for Meriden (Dame Caroline Spelman), whose name is attached to it on today’s Order Paper, albeit somewhat later on. She has been a champion for this issue over many years, as have other Members who have attached their names to various private Members’ Bills to try to address this anomaly. It is absurd that mothers have been able to put their signatures on marriage certificates in Scotland since 1855—and indeed in Northern Ireland—and in respect of civil partnerships in England and Wales since 2004, but that not since Victorian times has a mother’s name been recognised on a marriage certificate.

On Second Reading, I produced my own marriage certificate. My dear late mother’s name is absent from it, and to add insult to injury, my father’s name is on it twice, because he signed not only as witness but as the vicar who married us, adding double insult to injury. There are countless cases of people saying, “I never knew my father because he assaulted my mother and did a runner on us before I ever knew him, yet his name has to go on my marriage certificate, and the name of my mother, who has done all the heavy lifting, suffered all the abuse, and brought up, nurtured and loved me as a daughter, does not appear.” That is not right. I hope that the Bill will at last address that anomaly and that mothers can then proudly put their names on the marriage register in the new electronic form, which will bring it up to date for the future.

I am not going to go into the second aspect of the Bill, which is civil partnerships, at length again. We have been debating the matter since the 2013 same-sex marriage Bill. If my amendment had been agreed at that time, we would not still be having this discussion now. There have been many opportunities to address this unintended inequality.

[Sir Christopher Chope]

Since the Government are in the mood to apologise for all sorts of historical events, does my hon. Friend think they should apologise for getting the law completely wrong?

[Tim Loughton]

I am in a generous frame of mind this morning, and rather than their saying sorry, we should be saying hurrah that we are now doing something about it—[Hon. Members: “Hurrah!”] I do not know how Hansard will treat that.

The third aspect of the Bill relates to the production of a report on the registration of pregnancy loss. Again, clause 3 has already achieved its objective, partly in the light of our Second Reading debate, which we had back on 2 February, when we were all moved by the extraordinarily touching personal testimony of the hon. Member for Washington and Sunderland West (Mrs Hodgson) about her own experiences—I wonder whether she will draw her attention away from her mobile phone, because I know she would like to listen to this tribute and not be distracted. As a result of the strength of feeling in the speeches and the subsequent response from our constituents, the then Health Secretary—he is now Foreign Secretary—said, “Well, actually I think we just need to get on with changing the law.” A group was set up with a mandate to see how we could change the law to acknowledge in some way those births that are stillborn but happen, by whatever quirk, to fall below the 24-week gestation line and are therefore not recognised in the eyes of the state. The situation has brought huge distress to parents who are already in distress at the trauma of losing a child. The fact that they happened to lose that child at 23 weeks and six days means that, in the eyes of the state, that child never existed and is classed as any other baby loss. In saying that, I in no way diminish the trauma of all baby loss, but there are so many examples of this.

My constituent Hayley Petts first brought this matter to me, and she served on the working group with the hon. Member for Washington and Sunderland West. The group has been discussing many aspects of how the law can be changed and has also thrown up a lot of problems about how we go about changing the law. Should we have a universal certificate for all baby loss, for example? Should the scheme be voluntary or mandatory? Should it be subject to medical verification, as is the case under the Australian scheme, and should it be retrospective? There is then the whole thorny issue of how we avoid getting into the minefield that is abortion and other forms of termination. The Bill has done its job before it has become an Act because such work is going on under the aegis of the Department of Health and Social Care, and I hope we will have some results in due course.