Child Health (Nottingham)

Graham Allen Excerpts

Tuesday 6th July 2010 Westminster Hall

[Chris Leslie (Nottingham East) (Lab/Co-op)]

At the outset, I wish to provide a little context to the debate. Nottingham is the 13th most deprived authority in a total of 354, according to the Government’s 2007 deprivation index, with 81% of children falling within the first three deprivation deciles. In other words, the vast majority of young people form the poorest third of the population. There are some especially poor pockets of deprivation in the Nottingham constituencies. In my constituency, they can be found in the St Ann’s, Dales and Arboretum wards, and in Hyson Green and Forest Fields, to name only a few places.

In September 2009, about 700 young people were not in employment, education or training, the status of another 550 was not known, and 62% of all children lived in households where no adult worked or where earnings were so low that they received benefits or other state assistance. Although I am pleased to have the opportunity to debate child health in Nottingham, it is precisely because of the concentration of problems that afflict so many young people in the city that it was necessary to spend some time on that point.

It is important to recognise that much good work is being done, not least by the NHS services in Nottingham, the city council and others. I am glad that my hon. Friend the Member for Nottingham North (Mr Allen) is here, because it would not be possible to speak on the topic for more than 60 seconds without mentioning the early intervention approach of One Nottingham, the local strategic partnership that he has pioneered and championed. Breaking the cycle of poverty and poor lifestyle, and preventing problems from worsening or even occurring is critical to ensuring that we make progress. Poor health, particularly poor child health, is not new in Nottingham.

I pay tribute to Professors Elizabeth and John Newson—sadly John passed away last Monday—for their groundbreaking work on child health and psychology at Nottingham university. In their famous and influential book of 1963, “Infant care and motherhood in an urban community”, they followed 700 Nottingham families, particularly from the St Ann’s ward, considering the detailed habits of their lives and so forth. I shall briefly review some of the things that affect the city to illustrate the scale of the challenge that we face.

[Mr Graham Allen (Nottingham North) (Lab)]

I thank my hon. Friend for raising this important matter on behalf of the city. Will he tell the Minister about Nottingham’s fight-back with a set of early intervention policies that try to break the intergenerational nature of these problems? There is great concern in the city that the pioneering work that we have undertaken, which may go to national level, is now under threat because of the public expenditure cutbacks. We managed 14 early intervention programmes in Nottingham on a shoestring. If that shoestring is snipped, the work that has been started will not last the generation, which is necessary if it is to have its massive impact.

[Chris Leslie]

I could not agree more with my hon. Friend.

I shall take the opportunity to pay tribute to some of Nottingham’s councillors. Councillors Mike Edwards, David Mellen, Jon Collins and others have been involved in ensuring a strong early intervention approach. Partnership work needs to be supported, not undermined—particularly, in this context, the Nottingham children’s partnership. That partnership’s “think family” approach is holistic and integrated. Like my hon. Friend, I worry that such preventive partnership work may now be at a high water mark, going down again because of the pressures on those funds. Apart from the NHS, agencies that are not ring-fenced have hitherto put money into their pooled endeavours; now they will naturally and instinctively pull back from those activities, and it will be difficult for them to do anything more than their core work, which will endanger their crucial efforts.

I wish to review some of the key questions that need to be tackled. Sadly, there are many of them. Child mental health is important and is often hidden, but many young people can be held back by such difficulties because of the behavioural consequences. Studies suggest that as many as one in 10 young children or young people in Nottingham are diagnosable with some sort of classifiable mental disorder that might require intervention. Apparently, 10% of five-year-olds experience difficulties that cause distress or have other impacts on their lives. Nottinghamshire Community Health, along with the council, has much of the responsibility for safeguarding vulnerable children, and it does incredibly important work. Again, I am worried about the lack of ring-fencing for other less visible services, particularly social services. I urge the Minister to assure us that social services funding for mental health services will be maintained, because it is incredibly important.

On the question of substance misuse, it is estimated that 3,700 young people in Nottingham under 18 regularly use class A drugs of one sort of another, but the figure could be higher. Although the proportion of young people drinking alcohol has not risen in recent years, it is still far too high when compared with figures for the rest of the country. The number of young people whose carers or parents are involved in drug or alcohol abuse is high; it is estimated that parental alcohol abuse affects between 10,000 and 20,000 young people in the city, which is an incredibly high number.

Smoking is a widespread cause of respiratory problems among young people. The British Lung Foundation report, “Invisible lives” suggested that residents in Nottingham are 40% more likely to be admitted to hospital with chronic obstructive pulmonary disease than the UK average, and respiratory conditions are among the most commonly reported in children.

Another crucial problem is that of teenage pregnancy. By national standards, the figure for Nottingham is still very high. The latest annual data suggest that, within local authority boundaries, Nottingham had the ninth highest rate at nearly one in every 15 teenage girls. Again, that is a shocking statistic. Some Nottingham wards have an under-18 conception rate of twice the national average; 15 of the 20 wards have rates that are among the highest 20% for wards in England.

[Mr Allen]

My hon. Friend is generous in giving way a second time. I would be failing in my duty as chair of the teenage pregnancy task force in Nottingham if I did not point out that we have had a fall in eight consecutive quarters because of the sort of things that my hon. Friend has pointed out, such as working together in partnership, and having clear leadership and lines of accountability. We have fabulous people working on the front line who are pushing down the rates. We also have a family-nurse partnership which gives intensive health visiting for young mothers, and we are doing many other things. I am sure that my hon. Friend will want to pay tribute to those people, particularly the front-line workers.

[Chris Leslie]

My hon. Friend takes the words entirely out of my mouth. I was explaining that the problem is still significant, but thankfully some good progress has been made, particularly through partnership work. That crucial support is funded through the working neighbourhoods fund, but recent Treasury announcements suggest that Nottingham’s fund will cut by £1.2 million. The name on the tin—“working neighbourhoods fund”—does not say what it will do; supporting the programmes that help reduce teenage pregnancy is one purpose. It is incredibly important that we hear about its good work as well as about the shocking statistics.

I want to take the opportunity offered by this debate to highlight the issues of poor child dental health. Although the statistics and methodology of calculating such issues change from time to time, recent reports suggest that Nottingham children have, on average, three decayed missing or filled teeth each compared with just over one in typical parts of the rest of England. Shockingly, in some schools in Nottingham, a few children have been reported to have nearly six missing, decayed or filled teeth. Fluoride in toothpaste is improving matters, but the main factors are still poor diet and nutrition and poor oral hygiene. Although programmes such as the City Smiles dental health promotion programme and community-based services have promoted good oral hygiene and the use of fluoride varnish on teeth, much more still needs to be done. I want the funding for the City Smiles campaign to be confirmed and redoubled by the PCT, and I hope that the Minister will pass on that request. Moreover, we must think about the contentious issue of fluoridation of the water supply. In areas where fluoride is naturally occurring or where it is added, there is some protection against dental decay. Although I cannot claim to be a scientific expert in this area, I none the less hope that the PCT and the east midlands health authority will speed up their review and put some options on the table within the next year if possible.

There is not enough time to address all the crucial issues, which include young people leaving care, children with learning difficulties and serious disabilities and how people can access services. I want to pay tribute to the NHS staff who work so hard in Nottingham. They have recently consolidated the children’s services of City hospital with those of the Queen’s Medical Centre to create the Nottingham Children’s hospital at the QMC site with 15,000 inpatient occurrences and 50,000 outpatient contacts taking place annually. The hospital is very strong in renal and urology services, with 13 kidney transplants taking place last year. It is world renowned for its child integrated cancer services, with 135 children being treated there in 2009. There are also cystic fibrosis services and many others. None the less, there is still room for improvement. In particular, there is not enough accommodation for parents whose children are in hospital. It is important that young patients have the support of their family around them. I urge the Minister to find a way to provide capital support for the PCT and the hospital to ensure that more bed space is provided.

I am also concerned to hear that Nottingham’s speech and language therapy budgets, which are supported by the PCT, may be squeezed because of the financial pressures. Tragically, between 5% and 8% of pre-school children have speech and language problems, so there is a lot of concern about the loss of such resources in the Nottingham area.

I hope that the Minister will address recent policy changes. Childhood obesity and poor nutrition is one of the key underlying causal factors that come up time and again. A third of 10-year-olds in Nottingham are overweight or on the brink of the obesity category. Tragically, the free school meals pilot that had been on the cards has now been cancelled.

--- Later in debate ---

[The Minister of State, Department of Health (Mr Paul Burstow)]

It is a delight to serve under your chairmanship today, Mr Amess; I know you have taken an interest in health debates over the years. I congratulate the hon. Member for Nottingham East (Chris Leslie) on securing this debate. He is right to say that he has brought a serious range of issues to the attention of the House. I applaud him for ensuring that the concern that he and his hon. Friends share about improving children’s health in Nottingham is kept on the agenda both here in the House and in Nottingham.

I am delighted to have the opportunity to respond to this debate and to acknowledge some of the work that has already been done by hon. Members in Nottingham. In particular, the hon. Member for Nottingham North (Mr Allen) has been a staunch advocate on the subject, and has a good track record both in the House and in the local area. The hon. Member for Nottingham East should pay tribute to his leadership, particularly in respect of the teenage pregnancy taskforce, which has done important pioneering work on early intervention that has started to make a significant difference. The Government are determined to do everything they can to ensure that the lessons learned from the taskforce are embedded and sustained as we go forward.

I also want to thank the hon. Member for Nottingham East for his positive remarks about the work of local NHS staff. They are keen to build on the equally strong relationship they have with him and other hon. Members in the area by extending to me an invitation to have discussions with them. A lot of what the hon. Gentleman has said today was concerned with how we ensure that local services are better aligned with each other and collaborating effectively, and that the culture is right to promote effective joint working. Members have a key part to play in that process as local community leaders, and we already have an exemplar in that regard: the hon. Member for Nottingham North.

The hon. Member for Nottingham East cited a lot of statistics on this subject that are compelling and in some ways quite depressing. He pointed out that there is a significant concentration of deprivation and poverty indicators in parts of his constituency, and across the city of Nottingham more generally. Sadly, the map of poor child health aligns all too readily with the wider issues of social and economic deprivation. Clearly, there are challenges to be faced in that regard.

The local NHS should be congratulated on the progress it has made, because significant improvements have been made in some areas during the last decade. Those areas show that strong, well integrated, well resourced and well targeted mainstream services can indeed make all the difference.

We know that there is much more to do in Nottingham—a point that the primary care trust emphasised when I spoke to its representatives yesterday, ahead of this debate. For example, it reassured me that children’s health, particularly in the poorest communities, will remain a strong priority for the future and that it will continue to invest in local health services as well as contributing strongly to the children and young people’s plan, which is important. I understand that that plan, which is very important in driving delivery on the ground, will go to the city council in a few weeks’ time.

That culture of strong partnership working is particularly important: we need much more in the way of joined-up planning, commissioning and delivery in the future. The PCT has reassured me that its priority is continuity, and I hope that that reassures the hon. Members for Nottingham North and for Nottingham East. We want to ensure that we are pushing ahead in areas where progress has been made—there has been progress—and quickening the pace of improvement elsewhere. The Government intend to support such efforts and to ensure that the work that has been started on early intervention and prevention is not lost or thrown aside, but is seen as an essential investment. In truth, that work is not a waste of resources but unlocks resources; to stop it would indeed be a false economy. Therefore, we want to ensure that the poorest communities can get the well targeted services, run by confident and assertive staff, that they need.

Reference has been made to spending pressures. Those pressures existed before this Government came into office; indeed, the last Government acknowledged that the deficit presented a significant challenge to the public sector, including the health service. Indeed, they mapped out the challenge that would have to be faced. Through our first, emergency Budget, the new Government have recognised that not to act promptly would be to fail to deal with the difficulties and the legacy we inherited. In failing to reduce the deficit, we would not only endanger the whole economy but some of the most vulnerable people in our communities, through an inability to secure sustainable public investment in key services. So the decisions we have made, some of which have undoubtedly been painful, are absolutely essential if we are to deliver the sustainable economy and growth that we all need, and the support that is essential to ensure that services continue to develop.

However, as part of making those tough choices, the Government took the decision to protect the NHS and to secure real-terms increases each year for the duration of this Parliament. The hon. Member for Nottingham East was right to say that that does not mean it will all be plain sailing from now on; there will be difficulties and challenges ahead, and there are real pressures on the NHS budget. However, we do not believe that the sick should pay the price for the debt crisis, and this funding will enable the NHS in Nottingham to continue improving services.

That does not necessarily mean “more of the same”. One of the lessons that I took from last week’s National Audit Office report on health inequalities is that success is not all about spending more money. In many cases, it is about spending money more wisely, and the type of schemes the hon. Member for Nottingham North has led in Nottingham are a case in point. In that way, big differences can be made with relatively small amounts of investment.

We need a fresh approach, with a health service that is more preventive, more integrated, more answerable to local communities and more responsive to local needs. We will say more about that approach in the health service White Paper that will be published in the near future, and which will clearly have an impact on the way that health and social care services are delivered in the Nottingham area.

[Mr Allen]

My hon. Friend the Member for Nottingham East pointed out that one way we can make small amounts of money go a long way is through inventive use of the working neighbourhoods fund or its predecessor, the neighbourhood renewal fund, for example. Sadly, however, as my hon. Friend pointed out, those funds are the first things to go when an organisation starts looking at its core operation and contracting inside its own silo, rather than reaching out in partnership with others. That is a problem and the Minister really must address it.

[Mr Burstow]

It is a challenge, and one that both the Government and local organisations understand. When we publish the White Paper, I hope the hon. Gentleman will see that we are addressing that challenge in a very direct way, to ensure that every pound the taxpayer invests in our health service really delivers the maximum possible benefit for the communities it is meant to serve.

The hon. Member for Nottingham East raised a number of specific points and I want to address as many as possible in the time remaining. On child and adolescent mental health services, he said that up to one in 10 young people in Nottingham are diagnosed with mental health problems. Clearly, deprivation, isolation and exclusion are often the harbingers of poor mental health, and children living in poverty are frequently the worst hit. That carries a cost of the sort the hon. Gentleman talked about—one borne not only by those children personally but by the wider community. The hon. Gentleman was therefore right to talk about the vital role that children’s mental health services play. The children and young people’s plan is focused, rightly, on greater prevention and earlier intervention. I can therefore assure him that this Government attach a very high priority to early intervention, preventive mental health services and public mental health services; they are very important to us.

The children and young people’s plan also aims to stop young people experiencing behavioural problems, mental illness, substance misuse and low educational achievement. Again, that requires a confident and well equipped work force who bring together skills across the statutory and third sectors. I understand that the local NHS and the local council plan to improve the training and development of staff in dealing with such behavioural problems.

The hon. Gentleman asked about smoking, which I acknowledge is an important issue that we need to keep a clear focus on. I understand that work is progressing in that field that is targeted at reducing smoking during pregnancy. He also talked about the work that has been done on teenage pregnancy in Nottingham. He is right to say that we should applaud the fact that the teenage pregnancy rate in Nottingham has fallen for eight consecutive quarters. The rate in Nottingham was among the highest not only in the UK but in Europe. Clearly, the rate is now going in a different direction—one secured by the integration of services and effective leadership on the ground. However, the figures remain stubbornly high, and we need to ensure that there is more effort and focus on reducing them. The local PCT has reassured me that a number of schemes it is taking forward, such as the C-card scheme and various other initiatives involving sexual health services, are being maintained. By way of reinforcement, reducing teenage pregnancy will be a feature of the joined-up working produced by the children and young people’s plan.

The hon. Gentleman cited statistics on dental health that were even more stark than those I was presented with by my officials, including on schools that reported having pupils with six teeth that were either missing, decayed or filled. In fact, the latest figures show a slightly different and hopefully better picture. They suggest that five-year-olds in the Nottingham city area have, on average, 1.73 decayed, missing or filled teeth. That places the city’s PCT as the 31st worst performer on that indicator, whereas it was the second worst the last time such figures were published. That figure of 1.73 compares with an average figure of 1.11 for five-year-olds for the whole country. The hon. Gentleman is therefore right to say that more needs to be done about oral health and hygiene in Nottingham. The City Smiles programme will certainly continue to play an important part in that work. On the direct provision of dental health services in Nottingham, the hon. Gentleman will be pleased to know that two new dental practices will open in October, in Bulwell and Bilborough, which will obviously improve access to such services. He also talked about fluoridation. Clearly, such matters are to be decided upon locally, but I will pass his comments on to my ministerial colleagues.

The hon. Gentleman also spoke about funding for speech and language therapy. When I talked to representatives of the local PCT yesterday, they certainly gave no indication of any intention or plan to cut those services. I can assure him that I asked the PCT a lot of questions in preparation for this debate. However, if I am misinformed on this subject, I will certainly write to him to give him further details.

You, Mr Amess, will know about the importance of the issue of obesity, as we both served on the Health Committee when it produced a report on obesity some years ago. Again, the local PCT has told me that it will continue its work on the active schools programme, which encourages more children to take up sporting activities.

I am afraid I will probably run out of time shortly, but the hon. Gentleman has certainly given us a run-around the important issues that this Government will continue to maintain a clear focus on. We see delivery on those issues being provided by effective local leadership, effective integration of commissioning and provision, and good leadership from politicians nationally and locally. By doing that, we believe we can improve the nation’s health.