Giving Every Baby the Best Start in Life

Jonathan Edwards Excerpts

Tuesday 9th November 2021 Commons Chamber

[Sarah Olney]

I congratulate the hon. Member on the birth of his baby, and I hope that all is progressing well. I am grateful to him for raising that point about fathers, and I will come to it later in my speech.

My interest in this topic arose from conversations I have had with constituents who gave birth during lockdown. They told me about the isolating experience of not being able to have their partners in the delivery room with them, not being able to share their new babies with the wider family and not being able to meet up with other new parents to support each other and share their experiences. Thinking back to my own experiences of early motherhood—12 years ago—I remember how much it meant to me to have all those people around me as I recovered from the birth and got used to my new life as a parent. My heart goes out to all those who struggled in isolation during those early months, and I am determined that young families should be prioritised for support as we emerge out of the other side of the pandemic.

The UK Government’s recent focus on investment in the first 1,001 days in their “Best Start for Life” vision and funding is very welcome and will undoubtedly make a significant difference to families. I pay tribute in particular to the efforts of the right hon. Member for South Northamptonshire (Dame Andrea Leadsom), who has been unsparing in her work to bring the needs of our very youngest citizens to the forefront of public policy and funding.

One of the most important sources of support for new parents is a health visitor. Even for those who enjoyed the most robust mental health, having sudden responsibility for a tiny and vulnerable new baby who is entirely dependent on them is a source of great anxiety. Having a visit from a trained health care professional who can give them advice, answer their questions and, above all, reassure them is enormously helpful and can make all the difference to their early experience of parenthood.

Although the UK is no longer in lockdown, both access to services and working patterns have changed. Some support services, such as playgroups, have not survived, and some have closed altogether. Children’s centres have reopened, but numbers are limited and places need to be booked in advance, which may mean that the families with the least time on their hands will lose out. The co-ordinators and volunteers at Home-Start Richmond, Kingston & Hounslow have told me about the high levels of anxiety experienced by new mothers unable to access health visitor advice and reassurance. That is impacting new mothers’ confidence and their ability to meet their baby’s needs.

Health visitors are a skilled workforce of specialist public health nurses who have the expertise to provide holistic care to families. As the only professionals positioned to reach every young child before they start school, health visitors play a crucial role in child safety and early childhood development. They identify and manage developmental delay, as well as common and serious health problems. They also provide support around childhood immunisations and advice on infant feeding, safe sleeping and mental health, all of which relieves pressure on NHS emergency departments and specialist services.

However, there is currently no national plan to address falling health visiting workforce numbers. The Government's spending review stated that it

“maintains the Public Health Grant in real terms, enabling Local Authorities across the country to continue delivering frontline services like child health visits.”

In fact, the Government are maintaining the public health grant at a level that is too low for many local authorities to resource health visiting services that can deliver face-to-face visits and the support described in the healthy child programme and other national guidance.

Ahead of the spending review, 700 leading children’s sector organisations were united in their call for investment for 3,000 more health visitors over the next three years. However, I am concerned that £500 million over the next three years will not deliver the Government’s pledge to rebuild health visiting. It is of the most urgent importance that we restore face-to-face health visiting to every new mother as the most essential building block of support to families as they welcome their new babies.

The importance of early home visits by skilled healthcare professionals was highlighted to me by one constituent who wrote to me last summer. She said:

“My baby is now 6 months old and soon after birth he was diagnosed with SMA type 1. If you are not familiar with it, the full name is Spinal Muscular Atrophy and it’s a muscular wasting illness. There isn’t a cure for it and without treatments and proper care the life expectancy of a baby is less than 2 years. He is currently under treatment but, and here is the reason for this letter, every possible centre specialised in physiotherapy, hydrotherapy or other physical activities for disabled people is shut due to Covid-19.

My husband and I were the ones who had to notice something was not right with Peter because, due to Covid, no one came for home visits after birth to see the baby or me. I almost died in child birth and because we were left alone I had to endure 1 month bed ridden due to further complications, once again noticed by me. Only once I was able to walk again we saw something wasn’t right with the baby. If after 2 weeks the health visitor had been able to come home, my son would have started treatment sooner without losing the mobility of his legs.”

I want to talk a little more about the importance of diagnosing and treating perinatal mental health. Maternal suicide is the leading cause of direct deaths within a year of pregnancy. An estimated one in four women experience mental health problems in the first 1,001 days after pregnancy. While depression and anxiety are the most common perinatal mental health problems, other conditions include eating disorders, psychosis, bipolar disorder and schizophrenia. One in 10 fathers is also affected by perinatal mental health problems. Of the 241 families that Home-Start Richmond, Kingston & Hounslow supported during the most recent year, 66% were experiencing mental health difficulties, including post-natal depression, anxiety, depression and chronic mental health conditions.

I was privileged to be able to visit Springfield University Hospital in Tooting recently to meet the perinatal psychiatry team for the South West London and St George’s Mental Health NHS Trust. I was extremely pleased to hear about the work the trust is doing in successfully supporting new mothers who struggle with their mental health, and particularly that it was able to maintain its services during the lockdown and after. Akvinder Bola-Emerson, the clinical services lead for perinatal psychiatry, stressed in particular the need for peer support but also the importance of health visitors, whom she described as the “eyes and ears” of perinatal mental health services.

The visit highlighted for me that we also need better provision for new and expectant fathers. Currently only mothers can be formally diagnosed with a perinatal mental health problem. Springfield provides services for fathers, but it is currently able to identify mental health issues in fathers only when they accompany a mother who is attending the hospital for perinatal mental health issues.

[Jonathan Edwards (Carmarthen East and Dinefwr) (Ind)]

I am extremely grateful to the hon. Lady for securing the debate, and she is making some very important points. Does she agree that one of the worst situations expectant parents can find themselves in is when there is a miscarriage and that parental leave for such parents would be a welcome reform?

[Sarah Olney]

I am grateful to the hon. Member for his intervention. He is absolutely right that there are a large number of events and incidents surrounding pregnancy and birth—as I know from my own experience—that can cause huge distress, and it is right that mothers and the people supporting them, and fathers as well, get the support they need, including statutory leave from employment for the time it takes to come to terms with the miscarriage. That is certainly something we should be looking at.

We know that impending fatherhood can be a cause of great anxiety for men, and more services need to be developed to support them. We also know that over a third of domestic violence starts or gets worse when a woman is pregnant. I would speculate that some of that is attributable to undiagnosed and untreated mental health conditions in expectant fathers, which underlines the need to do more to support them.

In addition to health visiting and perinatal psychiatry, support for children and their families throughout their early years is vital for enhancing children’s prospects at school and beyond. Evidence shows that effective integration of services in the earliest years can bring broad benefits. For example, Sure Start children’s centres are shown to decisively reduce hospitalisations during childhood. However, 1,300 children’s centres have closed since 2010, and recent research has shown that 82% of parents of young children have struggled to access early years services. I am pleased that the Government have now committed £80 million to introducing family hubs to 75 local authorities across England, and £50 million for parenting programmes. However, we need more information on what family hubs can provide, and I would particularly like to ensure that health visiting and mental health support are included.

The importance of the right support in the early years was brought home to me after a recent meeting with primary headteachers in my constituency. I heard about how difficult it is for nursery and reception-age children to settle into class and to get used to spending time with other children and not spending all day at home with their parents. For adults, lockdown has been 18 months of inconvenience, after which we expect to be able to pick up the threads of our former life. However, some young children who started nursery this term will have spent up to a third of their life in lockdown, and we cannot yet know what the long-term impact will be.

--- Later in debate ---

[Dame Andrea Leadsom (South Northamptonshire) (Con)]

It is a pleasure to follow the hon. Member for Richmond Park (Sarah Olney) in this important debate, and I congratulate her and the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) as fellow co-sponsors and tireless fellow campaigners for giving every baby the best start in life.

Despite the rough and tumble of politics, there are times when colleagues from all parties in the House come together. Early years is one such cross-party issue. Over the past 11 years in Parliament, I have been proud to work with many colleagues on the early years. The hon. Members for Manchester Central (Lucy Powell) and for Washington and Sunderland West (Mrs Hodgson), my stalwart and long-standing hon. Friend the Member for East Worthing and Shoreham (Tim Loughton), and my hon. Friends the Members for Eddisbury (Edward Timpson) and for Winchester (Steve Brine) have all been amazing campaigners for the earliest years, as has the hon. Member for Glasgow Central (Alison Thewliss). The former Member for Birkenhead, Lord Field, and the former Member for East Dunbartonshire, Jo Swinson, have been great allies, as have all those Members who supported the all-party group conception to age two: first 1,001 days, and Ministers on the inter-ministerial group on early years family support from 2018-19.

It is fantastic that since the 2019 general election, the early years agenda has received fresh support from new colleagues such as my hon. Friends the Members for Penistone and Stocksbridge (Miriam Cates), for Stroud (Siobhan Baillie), for Cities of London and Westminster (Nickie Aiken), for Truro and Falmouth (Cherilyn Mackrory), and for Ruislip, Northwood and Pinner (David Simmonds). I also pay tribute to the late Baroness Tessa Jowell. She and I worked together on the 1,001 critical days agenda, and she campaigned for it to be introduced as part of the sustainable development goals at the United Nations. I must also mention the superb work of the Royal Foundation and its Centre for Early Childhood. The commitment from Her Royal Highness the Duchess of Cambridge and her team has generated fresh attention for ensuring that every baby gets the best start in life.

This subject has been my personal passion for more than 20 years, from chairing the Oxford parent-infant project, to setting up the parent infant partnership UK, and the Northamptonshire parent infant partnership, establishing the 1,001 critical days manifesto and the all-party group conception to age two: first 1,001 days, and chairing the inter-ministerial group in the Government of my right hon. Friend the Member for Maidenhead (Mrs May). July 2020 marked a huge opportunity when the Prime Minister commissioned the early years healthy development review and invited me to chair it. Since then, we have been able to build on years of cross-party support, and a wealth of knowledge and expertise from the early years sector, to create a new vision for the 1,001 critical days initiative that was launched in March this year. The review has put the baby’s needs at the centre of all our work. Through meetings with parents and carers, virtual visits to local areas, and detailed discussions with parliamentarians, practitioners, academics and charities, we heard about the experience of early years services and support, and about what is going well and where change is needed.

First and foremost, we learnt from every parent and carer of their strong desire to be the best parent they can be, but we also learnt that new prospective parents often struggle to find the support they need. We heard from many parents who had deep concerns about their own or their partner’s mental health, and struggled to get timely support. We heard from many mums who desperately wanted to breastfeed but gave up because the support was not there. Parents told us how frustrating it was to keep telling their story over and over again to different people. Their cry was, “Why don’t you people ever speak to each other?” Equally, we heard from professionals and volunteers who said it would have been so helpful for them if they had known before meeting a new parent or carer about previous trauma or health challenges.

We heard from many dads about how excluded they felt from what they saw as “mum-centric” services. Some felt that they should not ask for any support for themselves, while others just felt sidelined and, in some cases, traumatised by what their partner had gone through in childbirth. We heard from foster carers of babies how little information came their way when caring for a vulnerable baby. More specifically, in 40 cases of babies who went into foster care, only two arrived with their red book. Those carers had no formal information about that baby’s early traumas that had caused them to be taken away from their birth family.

We heard from same-sex couples about unhelpful assumptions by early years professionals about their relationship and parenting roles. We heard from black mums about how particular cultural and health issues can be overlooked by busy staff. We heard from single mums and single dads about how they can feel isolated, and sometimes stigmatised, at such a life-changing time. We heard from many parents with particular challenges, such as not speaking English well, concerns about possible disabilities, experiencing violence in their lives, or other significant challenges. We heard that support is inconsistent and sometimes hard to access.

It comes as no surprise that the covid pandemic has been an extraordinarily difficult time for new families who, through no fault of their own, have not been able to access services or support in the normal way. The “Babies in Lockdown” report from the Parent-Infant Foundation, Best Beginnings and Home-Start reveals that nearly seven in 10 parents felt that changes brought about by covid were affecting their unborn baby, their baby, or their young child, and that 35% of parents would like help with their concerns about their relationship with their baby. The report also found that nine out of 10 parents and carers experienced higher levels of anxiety during lockdown.

Despite the many stories of difficulties, we also heard fantastic examples of good support for families. Many health visitors went the extra mile to keep in contact with families who were struggling, and many families found it incredibly reassuring to be able to text or Zoom their health visitor at short notice. Parenting programmes have been a huge support to many families, and we virtually visited Camden’s Bump to Baby programme, where classes continued online throughout the pandemic, and have proved incredibly popular with new parents and carers who are also helped to make friendships outside the programme. Dads gave us positive feedback on services that gave them space to share their experiences, without worrying about whether they were taking the focus away from the other partner’s health and wellbeing.

In lockdown, we also heard about excellent online and virtual services, and how they came into their own. One such service, Parent Talk, provided by Action for Children, reported a 430% increase in the number of parents seeking advice online during the pandemic. The Baby Buddy app, produced by Best Beginnings, has seen a huge take-up of its digital and virtual advice for everything from breastfeeding to nappy changing, and from sleep management to mental health concerns. Many local authorities are now determined to improve their joined-up offer to new parents and carers, so I certainly feel that we are pushing against an open door.

Our report, “The Best Start for Life: A Vision for the 1,001 Critical Days”, was launched by the Prime Minister in March this year. It contains six action areas. The first is that every local area should publish its own joined-up set of start for life services so that every parent and carer knows where to go for help.

The second is a welcoming hub for every family, in the form of family hubs. Those will build on the excellent work done by the late Baroness Tessa Jowell and others on creating Sure Starts, but the benefit of family hubs is that they will be the place where every family goes for support and advice, including from midwives, health visitors, mental health support workers and breastfeeding advisers within their walls. Not only will those services be physically available but they will be virtually available through the family hub model.

The third action area is a digital version of the red book, which will provide parents and carers with a record of their baby’s earliest life, from lovely moments such as their first tooth and their first steps, all the way to records of immunisations and professional support interventions.

The fourth action area is about the workforce. We all know that health visitors provide critical support for new parents and carers, but we also know that their case load can be very heavy, and parents and carers have told us that they really want more continuity of care and more frequent contact in the earliest years. We are therefore working with health visitors and local areas to consider resourcing levels and training needs, and whether a mixed-skill workforce can provide that greater continuity of care.

The fifth action area is to continually improve the start for life offer. A key action will be to establish parent and carer panels in every local area to ensure that the voices of families are heard when services are designed and improved. We are looking at improving the collection of data, at the evaluation of different interventions and at the need for proportionate inspection of the start for life offer in each area. A final but critical action area is to ensure that there is sound leadership, both locally and nationally, to drive the ambition to give every baby the best start for life.

I want to say a huge thank you to the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Erewash (Maggie Throup), and to all the review’s sponsoring Ministers, past and present, for their support for the review. I am sure that it was their commitment, combined with the support of the Prime Minister and the Chancellor, that ensured such a positive spending review settlement for the earliest years, with £82 million for family hubs, £50 million for parenting programmes, £10 million for the start for life offer, £50 million for breastfeeding support, £100 million for infant and perinatal mental health support, £10 million for new workforce pilots, and a £200 million uplift for the supporting families programme. I believe that £500 million is a transformational sum that will allow many more parents and carers access to the vital help they need to give their baby the best start for life.

Why does this matter so much to our society? Well, we know that it is in the period from conception to the age of two when the building blocks for physical and emotional health are laid down. Babies born into secure and supportive homes will usually go on to become happy children who do well at school and grow into adults who cope well with life’s ups and downs and are more likely to hold down a job, have better health outcomes and form healthy relationships themselves. On the other hand, we know that in families under pressure, particularly where there is partner conflict, substance misuse, poor mental health or deprivation, the consequences for a baby’s developing mind in that critical early period can be far-reaching and very harmful.

Prevention is not just kinder; it is also significantly cheaper than cure. For example, the NHS has estimated that for every one-year cohort of births in England, the long-term cost of lack of timely access to quality perinatal mental health care is £1.2 billion to the NHS and social services and more than £8 billion to society. That is for every year’s cohort. We also know that up to 30% of domestic violence begins during pregnancy, and that health issues such as tooth decay and childhood obesity cost hundreds of millions of pounds every year in health-related expenses. We believe that those things could be significantly reduced by better education and support for new families.

With these six action areas, I think we can transform our approach to early years support and services, improving the health outcomes and life chances of the youngest in our society. Just as we need to level up economic opportunity across the country, we must also focus on where it begins—that critical period of human life from conception to the age of two.

[Jonathan Edwards]

The right hon. Member is giving a very comprehensive speech. Does she also agree that the Government should look at the issue of shared parental leave? The stats seem to indicate that fewer than 4% of eligible fathers take up the Government’s current policy. The Government need to look at that, and the forthcoming employment Bill may be an opportunity to strengthen those provisions.

[Dame Andrea Leadsom]

I completely agree with the hon. Gentleman that it would be fantastic for families and babies if more dads took up shared parental leave. Of course, as he will know, that has been legislated for. Unfortunately, as he points out, far too few fathers have taken it up to date. I certainly wish that more would have the confidence to do so.

I believe that all colleagues across the House would agree that the world in which we all want to live is one where every baby is nurtured to fulfil their potential, where good lifelong emotional wellbeing is the norm, where our society is productive and co-operative, and where every one of our citizens has the chance to be the very best that they can be.