Early Childhood Development

Fiona O'Donnell Excerpts

Thursday 30th January 2014 Westminster Hall

[Fiona O'Donnell (East Lothian) (Lab)]

I apologise for my late arrival. I congratulate the hon. Member for South Northamptonshire (Andrea Leadsom) on securing, with her friends and colleagues, such an important debate. It is excellent to have the opportunity to debate these important matters at length under your chairmanship, Mr Weir.

Hon. Members might be surprised to see a Scottish MP contributing to the debate, because Scotland and England have such separate and distinct approaches to child care, maternal care and paternal care, but there are lessons that we can learn from each other, and that is why I was keen to make a contribution today. In addition, I have been working closely with two third-sector organisations, the National Childbirth Trust and Bliss, on problems that arise when babies are born prematurely, and I want to focus on the needs of children, parents and the wider family when babies are born prematurely.

I have personal experience of the strain that that causes, having given birth to twin boys eight weeks prematurely when I also had a two-year-old and a four-year-old. When anyone asks me how I do the difficult job of Member of Parliament, I assure them that it is a piece of cake compared with being a mother of four children under four. My first-born—my daughter—has cerebral palsy, and when my twins were born I was living in rural Oxfordshire and not driving, so I faced multiple barriers to making that important bond with my premature babies. It is an awful experience for a mother to arrive home when it is more or less obvious that she has given birth—it is especially evident when twins have left the uterus—but because the babies are not with her, no one comes up to ask what happened. The mother is deprived of the opportunity to celebrate the birth of her children.

There is constant worry and strain over whether those children will grow up healthy and well, or even make it through that dangerous period in their lives, and parents have to take each day at a time. I pay tribute to the staff in the special care baby unit in Banbury who brought my babies—who are now 6 feet 2 inches and feet 3 inches and making a useful contribution to society—through that time. The right hon. Member for Banbury (Sir Tony Baldry) had newly been elected, and while my twins were still in the womb, I marched in protest to keep the special care baby unit open, not realising that they would soon be using the unit’s services.

There are particular strains for working parents. I was not a working parent at the time, so I did not have to make choices about maternity pay. People frequently do not understand that a baby who is born significantly prematurely often does not catch up, in terms of age and stage development, until they are at least two years old—I believe that it can take longer than that, and it certainly did in the case of my boys—and maternity pay does not allow for that. A mother is faced with the difficult choice of whether to take paid maternity leave while her baby is in hospital and possibly critically ill, or wait until the baby returns home. I would like the Government to look at that, because it puts such a strain on parents.

The hon. Member for Congleton (Fiona Bruce) spoke about the need for other Departments to be involved. Given its responsibility for maternity and paternity leave, the Department for Business, Innovation and Skills should be part of a joined-up approach. The Department for Work and Pensions must also be part of that, because although poverty and deprivation are certainly not the only factors that contribute to a lack of secure attachment or the health and well-being of parents and children, they can make a huge difference. In my case, we suffered from the combination of four children under five and huge financial pressure on our family, and we were at risk of losing our home. I started childminding the children of wealthy parents, so that they could have piano lessons and beauty spa treatments, to try to make ends meet. That puts a huge strain on a family, and for a mother or father at home, the child is often the only outlet for that frustration.

My hon. Friend the Member for Rotherham (Sarah Champion) rightly raised the issue of Sure Start centres. We do not have them in Scotland, but like many Members, I have watched at least two episodes of “Benefits Street.” When a Sure Start worker worked alongside some parents, it was incredibly inspiring to see how empowered the mother was. She was talking about the need to create a calm atmosphere and be consistent. It was the most inspiring and optimistic thing to see a parent given such skills. The way to do that is not by punishing them or withdrawing benefits, but by getting alongside people, showing them that we are on their side and understand, and giving them the necessary skills. I very much hope that the children from that family will grow up happier, healthier and able to contribute to society, and that they will not need that kind of support when they are parents. Investment in the early days is so important and can make such a difference to children’s outcomes.

[Sarah Champion]

I was surprised, and quite shocked, that 26% of babies in the UK—that is 198,000—are estimated to live in a traumatic family environment, and the effect on their well-being is considerable.

[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 ---

[Fiona O'Donnell]

I absolutely agree, and I am grateful to the hon. Lady for making that point. It is unacceptable that there should be a postcode lottery when there could not be a more vital time to intervene.

I return to my point about the importance of breastfeeding and supporting mothers in providing nourishment for their child. That is especially true in the case of premature babies, because the recommended start date for a mother to breastfeed is three weeks post-term. Maternity leave rights and—particularly when parents cannot afford to take unpaid leave—maternity pay are therefore vital. This was 27 years ago, so some time ago, but when I had premature twins, the support and encouragement for mothers of premature babies to breastfeed was not what it should have been. I hope that that has improved, because it is a vital part of the bonding process. Although the mother cannot put the baby to her breast, at least being involved in putting the milk into the baby’s gut—knowing that they are giving that nutrition—is a vital part of feeling a success as a mother.

I congratulate the hon. Member for South Northamptonshire again on securing this debate. I hope that the Minister will look at the recommendations in the manifesto and work with organisations such as the NCT and Bliss, so that across the UK, we are all working to give all our children the best possible start and opportunity in life.

[Damian Hinds (East Hampshire) (Con)]

I rise to support my hon. Friend the Member for South Northamptonshire (Andrea Leadsom) and her cross-party colleagues in the important work that they are doing in highlighting the issues we are discussing. The manifesto is accessible, understandable and persuasive. Speaking as a relatively new dad, so much of it is also very intuitive. It makes one think, “Yeah, of course; that is pretty straightforward and obvious,” although we need to see a lot more of it happening.

I want to take a slightly different angle and talk a little about social mobility and the effect of the first days and years of life on children’s eventual chances. When considering child development, it is always helpful to have in mind a sort of pyramid—in fact, there is such a pyramid in the manifesto. It creates a hierarchy of need. The sharp end of the pyramid is the very sharp end of the scale—the acute cases where, frankly, social mobility is not the top priority. The top priority is child protection, basic safety and health; social mobility is a worry for another day. At the base of the pyramid is the massive part—the world at large; most people. In the middle is the section of children I want to talk about today: those born into poverty and disadvantage who are not quite in the acute bracket.

We know that social mobility in this country is low by international standards—we are usually bracketed with Italy and the United States—and it has not been improving. On average, those of us here in our forties—including, as of a couple of days ago, my hon. Friend the Member for Winchester (Steve Brine)—have been less mobile in our lives than those of us here in their fifties. That is a poor state for any advanced democracy to find itself in. Why is that the case? When I was on the Education Committee, we used to find that everyone blamed the stage before. If we spoke to universities, they said that they were not getting the kids coming through from sixth forms; the sixth forms blamed the teachers doing the GCSEs; the secondary schools blamed the primary schools; the primary schools blamed the nurseries; and the nurseries said, “We are just not getting the kids through the door anymore.”

There is an element of truth in what they all said. The more one studies social mobility and children’s life chances, the more one realises that it increasingly does come down to the very earliest age. The all-party group on social mobility published a report called “Seven key truths about social mobility”. Truth No. 1 was that the point of greatest leverage for children’s life chances is what happens between the ages of zero and three—that is what we said, although it could equally be what happens between the ages of zero and two. The problem is that, of course, this is the public sector—we are trying to influence the Government and so on—and most of what happens between the ages of zero and two or three does not happen in a state-controlled or influenced setting; it happens at home. That makes things much more difficult.

Why is this a social mobility issue? How children are brought up is not particularly, or does not have to be, dependent on parents’ income, but there is quite a strong correlation. Figures from “An Anatomy of Economic Inequality in the UK”, a report made by the previous Government at the end of their term, show that on school readiness, for example, children from the poorest fifth of households reach about a third of the way up the percentile scale at age 3, versus more than 60% of children born into the wealthiest third. There is a bunch of statistics like that.

It is frightening that even toddlers’ cognitive ability test scores vary more dramatically according to their parents’ income than according to innate differences in ability. In the millennium cohort study, which tracks children through time, that gap does not narrow between the ages of three and five; in fact, it seems to widen as children go through school. Why? I am careful not to infer any direct causality. All sorts of factors may be involved, but there are significant differences in some things that people associate with home learning environments, and so on, according to socio-economic groups. In the lowest socio-economic group—the poorest fifth of households—only about 40% of children are read to every day at age 3, as opposed to more than 80% in the top 20%. Again, those figures are from “An Anatomy of Economic Inequality in the UK”. Those things can be tracked with a series of measures, including bed time, and so on.

[Fiona O'Donnell]

The hon. Gentleman may not be aware of work undertaken by the chief medical officer of Scotland, Harry Burns, on brain development in children from families with generations of economic deprivation. It showed that their brains were developing differently: the fight-or-flight part of the brain was overdeveloped. That shows that there is a real link between children’s life opportunities and deprivation.

[Damian Hinds]

Clearly, there is a link—a range of studies suggest different ways in which that link manifests itself—and I do not think that any commentator argues about its existence, but there is nothing inevitable about that; it ought to be possible to equalise children’s life chances. Of course, there are examples of both brilliant and awful parenting in every income bracket. Children’s development is no respecter of the home they happen to have been born into. As the right hon. Member for Birkenhead (Mr Field) says,

“it is primarily parents who shape their children’s outcomes—a healthy pregnancy, good mental health, the way that they parent and whether the home environment is educational”.

As he and many others say, what parents do is much more important than who they are.

Home life is difficult territory for the state. I suggest that we need to think harder about how to communicate what is known about successful, positive ways to parent—a quite substantial body of evidence—in a way that does not come across as, and in fact is not, telling people how to bring up their children.

Geography, as well as income group, reveals other interesting differences in early child development. There is a particular difference in London. When people are told this, they assume that child development is worse in London than elsewhere, because of all the issues in a big city like this. However, that is not so. There was another report last week about the different school results of children growing up in London, versus those growing up elsewhere. That is often attributed to the London Challenge, which started in 2003. There are a number of reasons to believe that the London Challenge was not the sole or primary cause of those improvements. One reason to disbelieve that is that the difference in attainment scores for disadvantaged children is apparent way before they get to secondary school; in fact, it is apparent even in pre-school assessments: on average, disadvantaged children in London seem to do about 20% better on the “good level of development” scale than disadvantaged children in the rest of the country. A bunch of things are different about London children and families.

--- Later in debate ---

[Damian Hinds]

I have a similar instinct. I want to be careful not to imply a causality that we do not know to exist, but one factor in some ethnic communities is that there is greater multi-generational support and more extended families. Intuitively, it makes sense that such support can be an advantage.

Where does all that leave early child development from the perspective of social mobility? First, the Government have to address, head-on, the thorny question of how to help parents to parent, while keeping in mind the pyramid of need, with acute cases at the top, children born into poverty and disadvantage in the next layer down and everyone else below that. I suggest that that should start pre-natally, which is a big part of the manifesto “The 1,001 Critical Days”. Speaking as a recent dad, it is amazing how little we were told or read about what was going to happen after birth, because we were so fixated on pain and the other things that people worry about at the moment of maternity. Sure Start and Sure Start outreach can play an important part in that. I echo what my hon. Friend the Member for Winchester said on the variety of views on what Sure Start is. On the Select Committee, I always used to ask people to define Sure Start, and even when talking to professionals in the field, I would get different responses.

There is also a question about the role of television and new media in supporting mums and families to bring up children. Bookstart is fantastic, but it could be more targeted. I was surprised when we received free books through our door. If people in the income bracket of all of us in this Chamber are failing to buy books, or to get them out of the library, to read to our children, it is not a problem that will be solved by being given two or three books when the child is born. Like my hon. Friend, I pay massive tribute to the work done by Home-Start UK and others on direct one-to-one support.

[Fiona O'Donnell]

Will the hon. Gentleman also pay tribute to Mumsnet? Mumsnet is a safe, non-judgmental and anonymous place where mothers can chat and seek advice and information.

[Damian Hinds]

The hon. Lady makes a good point. Mumsnet is the sort of thing to which I was alluding when I talked about new media. When we talk about Mumsnet, we are obliged to say that Netmums is also available. There is a range of sources of non-judgmental peer-to-peer support, which is vital.

Secondly, the importance of evaluation also comes out of the manifesto “The 1,001 Critical Days”. Intuitively, we all know that there are lots of things that we can do in the earliest years of life that will make a massive difference to a child’s development and later opportunities, but it is difficult to persuade other people of what those things are. Evaluation therefore trades at a huge premium. I pay tribute to the work of the hon. Member for Nottingham North (Mr Allen) on early intervention, which I hope will change our mindset as a polity on how we intervene.

Thirdly, I am not suggesting for a moment that I think I have the answers, but we should not be afraid of talking more about the wider social context and what some of the impacts might be. While respecting people’s life choices and celebrating the diversity of society—families now come in all shapes and sizes—we should not, for the sake of children, be agnostic about what those choices are. We should also see what we can learn from the differences between communities in different parts of the country.

[Steve Brine (Winchester) (Con)]

It is a pleasure to follow my neighbour, my hon. Friend the Member for East Hampshire (Damian Hinds), whom I thank for the age check. I congratulate my hon. Friend the Member for South Northamptonshire (Andrea Leadsom) on securing this debate and on the manifesto. She knows of my interest in this area, and she sent me a copy hot off the press. I read the manifesto avidly, and I am totally impressed with her work. She spoke eloquently about the cycle of deprivation, and she set out the case as to why, in many ways, society is broken. I will not go on about that, but I think the family unit is the answer that holds so much of this together. Some of my comments will probably tie together the interventions that we have had over the past 15 minutes.

Many Members will be familiar with the work of the Centre for Social Justice, which was set up by the Secretary of State for Work and Pensions when we were in opposition. The CSJ produced a report last year called “Fractured Families: Why stability matters,” which built on the seminal 2006 work “Breakdown Britain” and the 2007 work “Breakthrough Britain.” Basically, “Fractured Families” re-examines how family breakdown continues to plague our society, and it is blunt in saying that, despite the scale of the problem continuing to increase, Government action has been extremely weak. The report shows that the outcomes for children and adults who suffer from family breakdown are often terrible, and that there are huge costs to society. Someone mentioned a huge figure earlier, which I will repeat because it is so staggering. Family breakdown is currently estimated to cost the country some £46 billion a year, which is set to rise to just under £50 billion a year by the end of this Parliament. That is more than the Government spend on the defence budget—talk about ideas for deficit reduction.

The report also says that

“governments have chosen to ignore this problem, they have done so despite the public’s views.”

Those views are striking:

“89 per cent of people agree (52 per cent strongly agree) that ‘If we want to have any hope of mending our broken society, family and parenting is where we’ve got to start’…81 per cent of people think that it is important for children to grow up living with both parents.”

I think that it is time, and the report clearly agrees, that politicians on both sides of the House acknowledge that family breakdown is an issue that matters to the vast majority of people in this country and take whatever action they can to reverse it. The report makes a series of recommendations to all political parties in advance of the next general election, which people can read in their own time.

I want to restate something that my hon. Friend the Member for South Northamptonshire said. Earlier, I mentioned the statistics on speech and language difficulties among inmates. Some 80% of long-term prison inmates have attachment problems that stem from babyhood, which is staggering evidence. The good thing that must come out of that is to find a way to help families form the loving and secure bond that she talked so much about. That bond should come naturally when there is a new baby in the house but, as we know, post-natal depression, problems with conception or birth experience, domestic violence and the issues of poverty and deprivation set out by my hon. Friend the Member for East Hampshire can, and so often do, get in the way.

That is where Home-Start UK, which I mentioned earlier, has to be part of the toolbox. Its formula of parents helping parents has been incredibly successful over the course of my lifetime—40 years, as we have been reminded. In August 2013 I spoke at the annual general meeting of Home-Start Winchester and Districts, which has been going for a long time and does so much to help families through the really tough times.

When my wife and I had children, people said that children throw a hand grenade into marriages. I think that is nonsense; it is more like an atomic weapon. We had marriage preparation classes before we got married. The vicar who married us said that his one piece of advice was to share the teaspoon moments—the things that get on each other’s nerves. Ten years on—we celebrated 10 years last year—we still regularly share the teaspoon moments, more of them coming my way than going out. There is nothing like children, supercharged after a night of poor sleep or on a whiney day, to create teaspoon moments and to exaggerate them into whopping great soup ladles.

[Fiona O'Donnell]

I join the hon. Gentleman in praising Home-Start. I have experience of using its services in Banbury and it was the only group that came and said to me, “What do you need? What can we do for you?” Every other service said, “This is what we do. Is it of any use?”

[Steve Brine]

Absolutely. There are so many similar examples throughout the country. I urge all hon. Members who do not know their Home-Start people to get to know them. They work with families, and can share the teaspoon moments when they are there, or sometimes just shine a light of perspective. When new parents are exhausted, perspective is hard to come by. My experience of seeing Home-Start at work is that it helps parents to learn to live together after children. Learning to live together is hard enough, but doing so after children is a whole new skill.

Home-Start has been demonstrated to work. Its volunteer support and positive impact on parents and families have been shown to work. A three-year research project by a team at the universities of Amsterdam and Utrecht a couple of years ago revealed that children are still benefiting up to three years after their Home-Start volunteer stopped visiting. The good thing about what Home-Start is able to do here is that it is being copied: the Incredible Years programme and the family nurse partnership are both maternal and early-years public health programmes providing ongoing, intensive support to mums and dads and their babies.

The family nurse partnership is of particular interest to me. It is welcome that the Government have recently agreed to increase the number of family nurse partnership places to 16,000 at any one time by the end of this Parliament. I saw its inspiration at work last summer in Houston, Texas, where it is called the nurse family partnership. I was there with the Justice Committee and saw the partnership at work in Harris county. We were there as part of our major inquiry into crime reduction policies and the data we were shown were very impressive. The programme is expensive but the outcomes are good, with 60% fewer arrests and 72% fewer convictions among children of mothers participating in the programme than among those of mothers in a similar demographic and income bracket who did not. The number of days babies were hospitalised was reduced by around one third among programme participants. The figures are impressive.

It goes without saying that any remarks about early intervention in the first 1,000 days would not be complete without mentioning the troubled families programme. I am a big fan, and despite some mixed messages in the June 2013 spending review, the Government gave a commitment to extend the programme through the next five-year parliamentary period and confirmed £200 million from several Departments for a wider focus in 2015-16. That is sensible. I am regularly updated by Hampshire county council and Hampshire troubled families mapping, which have confirmed that 70% of client families are located in the top 30% of wards for health deprivation in the county. That laser-like focusing at a time of shrinking resources must be right. I know that it is bearing a dividend in Hampshire, as it is throughout the country.

The early years are about the state, but they are also about the big society, the third sector—the voluntary sector—and, ultimately, about creating more stable learned environments where those early years count, so that babies have a chance of normal development. The prize for us is absolutely huge, as all hon. Members who have spoken today have said, not just in money value, but in the value of human life. Ultimately, that is what we, as Members of Parliament, are about.

--- Later in debate ---

[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.

[Fiona O'Donnell]

The Minister speaks about bonding between mother, father and baby in the early days. May I draw her out on the issue of maternity and paternity pay being included in the cap on benefit spending announced by the Chancellor in his autumn statement? Will she give an undertaking that that will not lead to a freeze or a reduction in maternity and paternity pay?

[Jane Ellison]

The hon. Lady will understand that that is not in my portfolio, but I am happy to draw her concerns to the attention of colleagues in whose portfolio it rests. I undertake to do so after the debate.

The Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich, has asked Public Health England to commission a rapid review of the evidence base for the Healthy Child programme, with a focus on primary prevention. The Department of Health is also working with the WAVE Trust, which was instrumental in developing the evidence base for the manifesto, with the Early Intervention Foundation and with others to explore how valuable work in prevention can be built upon. We will be interested in the outcomes of that evaluation.