Health Visitors (England)

Debate between David Drew and Tim Loughton

Wednesday 23rd October 2019 Westminster Hall

[Tim Loughton]

My hon. Friend is absolutely right. I have met many health visitors. They are a fantastic resource and do huge amounts of good work well beyond their remit. They are frustrated by some of the processes and financial considerations that are stopping them from doing their job to the best of their ability with sufficient support.

[Dr David Drew (Stroud) (Lab/Co-op)]

Will the hon. Gentleman give way?

[Tim Loughton]

This is the last intervention I will take, and I will finish shortly.

[Dr Drew]

One of the greatest frustrations is when families do not let the health visitors in, which is a growing trend. They come back time after time and they find there is nobody there or, if the people are there, they will not let them in. Does he agree that that is a very worrying development?

[Tim Loughton]

Earlier, I raised the contrast with social workers where there is a safeguarding issue. It is a completely different dynamic and relationship. There is a reluctance to let the social worker over the threshold. That is less the case with health visitors, because they are seen to be there to help. But there is a reluctance from some people, perhaps due to ignorance as to what the health visitor is there to do from people who think, “I know it all; I don’t need you,” or due to people who may fear that their vulnerability will result in their child being taken into care. That is why that friendly face is so important. The health visitor is on their side to help them in being a new parent, in a way that other professionals cannot be.

According to the state of health visiting survey by the Institute of Health Visiting, one in four health visitors did not have enough time to provide the post-natal mental health assessments to families at six to eight weeks, as recommended by the Government; the hon. Member for Stalybridge and Hyde (Jonathan Reynolds) mentioned that. These PMH checks are a key part of the Government’s maternal mental health pathway. Previous research involving clinical trials with 4,000 mothers found that those who received health visitor support were 40% less likely to develop post-natal depression after six months.

There are five mandated reviews under the healthy child programme that health visitors undertake. While those are spread across the first 1,001 days, they are concentrated in the first 12 months. Health visitors are concerned that the number of reviews is insufficient and leaves too large a gap between contact with families. Not enough scheduled reviews are happening, and we probably need more reviews intensively at those early stages.

There was also a lot of concern about steps being taken to help recruitment. I tabled a question earlier this week, which the Minister kindly answered. I asked

“the Secretary of State for Health and Social Care, what steps he is taking to reverse the fall in the number of health visitors.”

She replied in a written answer, saying that

“Since 2015, local authorities have been responsible for the commissioning of services for zero to five-year-olds and as such, they determine the required numbers of health visitors based upon local needs.”

We understand that. She continued:

“A Specialist Community and Public Health Nurse apprenticeship (Level 7) is currently in development. This will offer an alternative route directly into the health visiting profession.”

I am afraid that that answer raised some alarm among people at the Institute of Health Visiting, and the response to it that I got back was to point out that

“The apprenticeship route is not an alternative route directly into health visiting. Applicants still need to be nurses or midwives and the course presents a number of risks: it is longer, the end point assessment delays qualification unnecessarily…it does not deliver a national strategy for the profession. HVs”—

that is, health visitors—

“who are not employed by the NHS do not have the same opportunities to those covered by the NHS People Plan—this includes NHS funding for CPD”—

that is, continuous professional development—

“leadership development, pay rises, safer staffing and national action to address recruitment/retention difficulties.”

It also pointed out:

“Local Authorities determine the level of HVs dependent on local need, however there is no measure of quality of service or guidance on how far the service can ‘flex’ to meet those needs.”

In addition, the apprenticeship is still not ready to be rolled out; it takes longer than current training; and it is more costly and therefore less attractive to employers and/or recruits.

An urgent workforce plan is needed to tackle dwindling health visitor numbers. I have spoken to representatives of the Local Government Association. They are very concerned about this situation; as representatives of local government, they want to get their public health role right. The LGA said that

“it had offered to work with the Department of Health and Social Care, the NHS and Health Education England to help deliver a plan that would see the ‘right number’ of training places commissioned. It would also develop new policies to ensure health visiting remained an ‘attractive and valued’ profession.”

I hope that the Minister is receptive to that offer; I am sure she is.

What needs to be done? Again, we need to value the role of the health visiting profession. I am sure that all of us in this Chamber and beyond would want to do that, but we have to will not only the inclination but the means as well.

A publication by the Institute of Health Visiting, “Health Visiting in England: A Vision for the Future”, makes 18 sensible and practical recommendations, and they all involve some investment. I will touch very quickly on a few. The institute wants to see

“urgent and ring-fenced public health investment…A review of 0-5 public health funding…to cover the cost of delivery of the Healthy Child Programme in full in all Local Authorities in England.”

All local authorities in England will need that funding. It goes on to say:

“As we await the refreshed Healthy Child Programme, as an interim measure, the proposed metric should be a floor of 12,000”—

that is, 12,000 full-time equivalents—

“to restore the workforce to the target figure calculated for the Health Visiting Implementation Plan, 2011-2015…New National Standards for health visiting are needed to support consistency within the profession. The title ‘health visitor’ and its role should be protected and restored to statute. A review of health visiting training with a risk assessment of the impact of the removal of Health Education England funding of training and replacement by the use of the Apprenticeship Levy.”

Frankly, those are sensible measures. I very much hope that the Minister will look at them positively; I am sure she will. It would be a false economy not to do these things. They need to be part of a bigger shift in Government policy—the policy of any Government; I may be pushing at an open door—towards an earlier, more intensive, preventive intervention approach, from conception to the age of two especially. Health visitors are absolutely at the centre of that.

Drone Users: Registration

Debate between David Drew and Tim Loughton

Wednesday 10th July 2019 Westminster Hall

[Dr David Drew (Stroud) (Lab/Co-op)]

rose—

[Tim Loughton]

I will give way to the hon. Lady first, and then to the hon. Gentleman.

[Tim Loughton]

I agree. If the hon. Lady bears with me, I will come on to exactly that point. However, it is £16.50, not £16, just to be pernickety.

[Dr Drew]

To build on that point, people who fly radio-controlled model airplanes feel that the way this has been handled has ignored them, and that they were only brought in at the last moment. I hope the hon. Gentleman will talk about why they should be handled very delicately, because they have never been involved in any criminal activity but almost feel that they have been criminalised.

[Tim Loughton]

I entirely agree with the hon. Gentleman. I will come on to precisely that if he hangs around.

As I say, I think most people acknowledge that we need more robust rules. Back in 2018, the Government decided to mandate a drone registration and education scheme in the UK, to strengthen the accountability of drone users and their awareness of how to fly their drones safely and responsibly. Fortunately, it was agreed—after different thinking originally—that the scheme should register the operator, not every individual aircraft or drone, which could have made it a much more bureaucratic exercise. To that end, the Government propose that everyone in the UK operating drones or model aircraft between 250 grams and 20 kg in weight must register by the end of November this year and take an online safety test, or face a fine.

The scheme will be run by the Civil Aviation Authority which, as the hon. Member for Barnsley East (Stephanie Peacock) said, proposes an annual £16.50 charge per operator, supposedly to cover the cost of running the scheme. That is based on an estimated 170,000 assumed registrations, which would raise something like £2.8 million —not a small sum. The CAA claims that it needs to cover the costs of the IT service hosting the system, IT security packages, a major national drone safety and registration requirement campaign, variable costs linked to user volumes and the ongoing upgrade of drone registration services, although there is not a lot of detail on those ongoing costs and why such a large amount of money is required.

I agree with the hon. Lady. One of my constituents’ main concerns is why the charge is £16.50, and why it is levied every year. Why not just an up-front registration fee, without the need to re-register? The United States scheme costs just $5 for three years, in Ireland it is €5 for three years, and France brought in a free scheme, so £16.50 seems disproportionate, given the experiences of comparable countries. Why is it is as much as £16.50? Why not a one-off fee? What are the ongoing costs? Will it go up from £16.50? These things have a curious habit of going up but never going down when schemes begin. Is it fair to charge a teenager £16.50 for using a drone when Amazon, which in years to come will probably operate fleets of hundreds of drones to deliver goodies to everybody, will also be charged £16.50? Those are my first questions to the Minister.

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

Debate between David Drew and Tim Loughton

Committee Debate: House of Commons
Wednesday 18th July 2018 Public Bill Committees

[Dr David Drew (Stroud) (Lab/Co-op)]

Just so I am absolutely clear, is the hon. Gentleman saying that the matter can be handled through regulation, and the whole matter will be clarified? Or will we have to revisit it?

[Tim Loughton]

The clause is an enabling clause. It gives Ministers the power to give authority to coroners to investigate stillbirths. It empowers them to do that by amending the 2009 Act; the matter would not need to be revisited. The exact terms on which Ministers will give the power is subject to the report that is being prepared.

To return to the hon. Gentleman’s amendments, the work is happening now and a number of coroners have contributed to it, including the West Sussex coroner, Penelope Schofield, who brought the issue to me and asked me to include it in the Bill in the first place. She has been impressed by the input of the officials involved, and by the progress that the group preparing the report is making. For example, there seems to be a consensus for giving coroners powers to investigate full-term stillbirths—at 37 weeks onwards. Those are the ones that might be considered least likely, in comparison to those closer to 24 weeks, when the position is more delicate, and therefore more questions need to be asked. In some cases it might require a coroner to ask those questions.

That is probably a good starting point, and if, with experience of coroners investigations, it appears that the term in question should be brought forward, the issue can be revisited later. However, an important starting point is set out, which will give confidence to parents who have suffered a stillbirth that in a small number of cases—it is not a question of flooding coroners with an awful lot of additional work—if the questions have not been answered, the full independence and weight of open inquiry that a coroner can bring to bear will be available to them.

Coroners have made it clear to me that they are sufficiently resourced to deal with the likely demand. As well as being important for parents, the change could mean a financial saving, because getting to the bottom of why many stillbirths happen would make it possible to learn more. We might avoid some long drawn-out and contentious legal cases, on which the NHS pays out a lot of money.

For the reasons I have set out, I urge hon. Members to support the clause—and amendment 15 to the long title. I hope that my assurances will enable the hon. Member for Harrow West to withdraw what he says, because the intention is for coroners to do the work. I think that there was a worry that it would not be coroners, but the measure is all about coroners.

There has been good progress with the report, and I hope that more information may come back even before Report, to be confirmed in the Bill. However, the clause is an enabling clause that would give the Secretary of State the power to allow coroners to investigate stillbirths.

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

Debate between David Drew and Tim Loughton

2nd reading: House of Commons
Friday 2nd February 2018 Commons Chamber

[Tim Loughton]

I have precisely the statistics that my hon. Friend is looking for. If she is patient for a few minutes longer, I will give her exactly that information.

Such people are mostly in committed loving relationships, but if they do not want to go for a traditional marriage, they have no way of having that recognised in the eyes of the state. That brings me on to the third main rationale for this reform—I promise that I will then come to my hon. Friend’s point. Particularly worrying is the common misconception that there is such a thing as a common-law wife or husband, as a woman typically finds out abruptly on the death of the partner when there is an inheritance tax bill on the estate and potentially on the family home. If a woman has a child with her partner and the relationship breaks down, she is not entitled to any form of financial support if they are not married. There is no automatic entitlement to property, even if she had been paying into the mortgage.

When one partner is much older than the other and there is a reasonable expectation that one will die some years before the other, the long-term survivor would not receive the same tax benefits as a married woman or those in a civil partnership. That would be discriminatory towards the couples’ children. The same vulnerabilities can apply if one partner does a runner. Even a couple engaged to be married have more rights than a cohabiting opposite-sex couple.

[Dr David Drew (Stroud) (Lab/Co-op)]

I do not want to stop the hon. Gentleman’s flow, but he will be aware of the work of Resolution, the family solicitors group, which has a Cohabitation Awareness Week. It has drawn my attention, and I am sure that of many other hon. Members, to the lack of rights and the fact that people are totally ignorant about their lack of rights, if there is a breakdown or a loss of one of the cohabiting parents. Hopefully this change in the law will put that right.

[Tim Loughton]

I completely agree with the hon. Gentleman, and I am grateful for his intervention. I was not aware of the Cohabitation Awareness Week, but many family law solicitors have written to me and support the campaign, because they see the fall-out when this goes wrong. People come to them thinking that they had entitlements and legal status because they had been living together for so long, but they suddenly find out that they do not. They have a tax bill and lots of problems and headaches, and their children do not have a home to live in. If anything, I hope that the Bill will help to publicise that real problem in the law that the Government need to address at some stage. I am giving them the opportunity to take the bull by the horns and get on and do something about it now.

The question is: why should not those who have made a conscious choice not to go for a traditional marriage have the opportunity to have the same legal rights, responsibilities and protections in the eyes of the law that we, rightly and not before time, extended to same-sex couples back in 2004? There are also several further applications. Many people with strong religious beliefs—particularly Catholics who have ended up getting divorced, which is in conflict with certain religious teachings—may not be inclined to get married again if they meet a new partner, because their Church supposedly believes that they should be married for life. In many cases, however, they would be able to reconcile that position by entering into a new formal commitment through an opposite-sex civil partnership. In addition, as it stands, someone admitting to being in a civil partnership currently automatically carries the revelation that they are in a same-sex relationship. That could be an unintended invasion of their privacy when some may wish to keep that private. There are a number of practical, real-life scenarios in which civil partnerships for opposite-sex couples could achieve something very positive and non-discriminatory.

I am pleased with the widespread support that the measure has attracted. The Marriage Foundation, for example, has gone on record as saying that it “fully supports” the Bill

“to introduce civil partnerships for heterosexual couples. It is a strong pro-family measure which, crucially, encourages commitment and stability. By making civil partnerships available to heterosexual couples, we would provide a new, formal basis for those who want to make a solid and legally backed commitment to one another but who prefer not to marry for whatever reason.”

I also welcome the support from The Times and the campaign spearheaded by Frances Gibb as part of that newspaper’s family law reform campaign. I see this measure as an important part of reforming family law and making family arrangements fit for the 21st century. We need to grasp the nettle on no-fault divorces and bring relationships into the modern age, and we need to find new ways for the state to recognise committed relationships and give stability, especially to the children within them. Making sure that shared parenting works and keeping warring parents out of the courts, where their children become bargaining chips, still needs further work too.

I come to the point made by my hon. Friend the Member for Taunton Deane (Rebecca Pow). Opposite-sex civil partnerships are not something that has been cooked up in this country. In South Africa, the Civil Union Act 2006 gave same-sex and opposite-sex couples the option to register a civil union by way of a marriage or a civil partnership on the same basis. In France, the pacte civil de solidarité—or PACS, as it is known—was introduced in 1999 as a form of civil union between two adults of the same sex or the opposite sex. A few years ago, marriage was added to that. Interestingly, one in 10 PACS has been dissolved in France, yet one in three marriages ends in divorce. There is evidence that some of those civil partnerships have created greater stability, whether they are opposite-sex or same-sex partnerships, than traditional marriage.

No complications are involved in my proposal. I want opposite-sex civil partnerships to be offered on exactly the same basis as same-sex civil partnerships, notwithstanding the earlier comments from my hon. Friend the Member for Gainsborough (Sir Edward Leigh). It would not be possible for someone to become a civil partner with a close family member, or if that person was already in a union, and the partnership would need to be subject to the same termination criteria.

It is a simple proposal, and surely the case is now overwhelming. All that would be required is a simple one-line amendment to the Civil Partnership Act 2004. It could all be done and dusted in Committee by tea time—although I guess that by the time drafting officials have got their teeth into it, many more clauses will be required. That is what I originally intended in the Bill and put forward in my amendment to the Marriage (Same Sex Couples) Act 2013 and subsequent ten-minute rule Bill and presentation Bills.

I acknowledge, however, that the Government have concerns about taking the full plunge and going the whole hog at this stage, and want to carry out further research about the demand and practicalities for such a reform. I have doubts about what that would achieve, given that, as hon. Friends have mentioned, we have had two public consultations on the subject in the last five years, and we now have 13 years’ worth of civil partnerships for same-sex couples in practice from which to garner evidence. However, I recognise the Government’s caution, and in securing a clear commitment to learn from the experience so far and promote equality further, I hope that they will come to the same conclusion as I have, together with the Equal Civil Partnerships campaign and the now more than 80,000 people who have signed a petition in support, many of whom have been enthusiastically lobbying their MPs in recent weeks.

There is a growing tide of support for the measure, fuelled by a court case that is currently destined to go before the Supreme Court in May. I pay tribute to Rebecca Steinfeld and Charles Keidan, who have pioneered equal civil partnerships and whose application for a civil partnership to the authorities in Kensington and Chelsea triggered this campaign.