Health Visitors (England)

Luciana Berger Excerpts

Wednesday 23rd October 2019 Westminster Hall

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

I beg to move,

That this House has considered the reduction in the number of health visitors in England.

I am grateful to the hon. Members who have come to speak on this important subject. I declare an interest as the chair of the all-party parliamentary group for conception to age two—the first 1,001 days. I also chair the board of trustees of the Parent-Infant Foundation, which runs attachment facilities and lobbies for better early intervention around the country.

I will start with some slightly alarming statistics. The cost of perinatal mental ill health in this country has been worked out at £8.1 billion per annum, according to the Maternal Mental Health Alliance, with up to 20% of women experiencing some form of mental health problem during pregnancy or the first 12 months after birth. The cost of child neglect in this country has been estimated at some £15 billion, with 50% of all maltreatment-related deaths and serious injuries occurring to infants and babies under the age of one. We currently spend in excess of £23 billion getting it wrong in those early years, particularly for mums and new babies. That is equivalent to something like half the defence budget.

There are 122,000 babies under the age of one living with a parent who has some form of mental health problem. Amazingly—this statistic came out time and again during conversations on the Domestic Abuse Bill—a third of domestic violence begins during pregnancy, and suicide is one of the leading causes of death for women during pregnancy or in the year after giving birth. About 40% of children in the United Kingdom have an insecure attachment to a parent or carer at the age of 12 months, according to Professor Peter Fonagy and others. Alarmingly, there is a 99% correlation between a teenager experiencing some form of mental illness or depression at the age of 15 or 16 and his or her mother having had some form of perinatal mental ill health during pregnancy. It is that close a correlation, making it that much more important that we make sure that the mums bearing those children, and also fathers, are as happy, settled and healthy as possible in those early stages, from conception to age two.

[Luciana Berger (Liverpool, Wavertree) (LD)]

The hon. Gentleman set out the costs incurred in trying to prevent such travesties. Does he agree that the figures he refers to are actually conservative estimates? I believe that he was at the launch, quite a number of years ago, of the Maternal Mental Health Alliance, which arrived at the figure of more than £8 billion. Is it not the case that, although the economic costs are significant, it is the social and moral reasons that have brought Members from both sides of the House here for this important debate?

[Tim Loughton]

If the hon. Lady is patient, I will come on to the social impacts. I think the MMHA report came out in 2014 or 2015, so obviously things will have moved on, although the birth rate has slightly fallen in that time as well. These are substantial financial figures, but as she says, most important are the social impacts and the impact on the child.

On the physical impacts, our childhood obesity rates are among the worst in Europe, while breastfeeding rates in the United Kingdom are among the lowest in the world. We have rising emergency department attendances by children under the age of five, and infant mortality reductions have recently stalled. Just last week, we had the worrying figures about the dwindling vaccination rates in England in particular, with only 86.4% of children having received a full dose of the MMR vaccine. We have effectively lost our immune status, because the World Health Organisation vaccination target to protect a population from a disease is 95%.

The Children’s Commissioner estimates that, in total, 2.3 million children live with risk because of a vulnerable family background, but that, within that group, more than a third are effectively invisible and not known to services and therefore do not get any support. We are talking about an expensive and widespread problem.

--- Later in debate ---

[Luciana Berger (Liverpool, Wavertree) (LD)]

It is a pleasure to serve under your chairmanship this afternoon, Mr Bone. I congratulate the hon. Member for East Worthing and Shoreham (Tim Loughton) on securing this important debate and on his work with the all-party parliamentary group for conception to age two—the first 1,001 days.

I will start by paying tribute to the Institute of Health Visiting and, most importantly, to the army of health visitors themselves. I know what an important job they do from my own experience as a mum to a two-and-a-half-year-old and a seven-month-old. In particular, I put on record my thanks to Gill and Katie, who have helped me and my family. Health visitors do a brilliant job against a backdrop of falling numbers, growing caseloads and, in some cases, unconscionable pressures. In the wake of the cuts to public health, it is now clear that we have seen a steady diminution in health visitors across England.

As we have heard, since October 2015, the number of health visitors in England has reduced by a quarter from just over 10,000 to just under 8,000, which piles extra pressure on existing health visitors. Nearly a third of health visitors have case loads of more than 500, which is twice the safe level set by the Institute of Health Visiting. Unfortunately, that can only have a detrimental impact on the quality of care. At best, it risks health visitors being less helpful. At worst, it is counterproductive to their aims and goals.

Looking at a number of indicators, we see that there is mounting evidence that things are getting more challenging. The reductions in infant mortality have stalled. We have already heard about issues around breastfeeding, which is a subject that is particularly close to my heart. We now have some of the worst breastfeeding levels in Europe, and I say that as an MP in Liverpool, where so much work has gone on via our Babies and Mums Breastfeeding Information and Support—or BAMBIS—service to support and assist mums in their own homes. We have seen a great increase in the proportion of women breastfeeding in Liverpool, but levels countrywide are still far lower than they should be. We are facing an obesity crisis. Immunisation rates are falling. We have missed the target for measles and the UK has lost its measles-free status. We are living through a mental health crisis, and I reflect on the fact that the period of a woman’s life where she is 30 to 40 times more likely to experience a period of psychosis is the year after birth. That is the moment in her life where extra additional support is needed.

We see a particular challenge with adverse outcomes not being distributed evenly, which speaks to health inequalities. That issue falls far down the agenda and gets much less attention than it deserves, but we are seeing a widening of inequalities across the country. Poor health goes hand in hand with someone’s postcode, income, social status and what their parent or parents do for a living. The impact of inequality is keenly felt in too many areas, including in Liverpool and other disadvantaged neighbourhoods. Nearly 70% of health visitors have reported having to access emergency food aid and go to food banks on behalf of the families they are supporting. The Institute of Health Visiting stated in its report that those inequalities resulted in poorer physical and mental development, poorer academic achievement and poorer employment prospects at every stage of a child’s life.

We are talking about the most fundamental of issues: how can we ensure that every child born in this country has the best life outcomes and best life chances? Health visitors play such an important part in those outcomes and provide such a vital intervention in supporting new parents. The list of what they do goes on and on, and we have heard much about that already. They also play an important part in preventing ill health, rather than trying to cure it later. Health visitors play a critical role beyond health, whether that is supporting troubled families, improving early language development and learning at home, particularly where a child might have special educational needs, or improving parental confidence and knowledge to avoid unnecessary trips to our health service.

Health visitors should form part of a truly integrated system of health, care and wellbeing that is tailored to the parent and child, with the right interventions, advice and support at the right time. I reflect on that as a member of the Health and Social Care Select Committee on. We did a report called “First 1000 days of life”, in which the first priority was for every child to receive the five mandatory visits. In fact, we said that that number should be increased to six, with a visit at three or three and a half years old to ensure that every child is ready for school. We perhaps do not like to talk about that issue, but we are seeing increasing concern about it from teachers across the country.

I am conscious that my time is coming to an end, so I want to reflect on that recommendation from the Health and Social Care Committee. Health visitors play such an important role. They support families where others do not have the opportunity to do so. They enter people’s homes and they are trusted. When I think about all the health professionals I connected with as a new parent, it was my health visitor whom I relied on. We need to ensure that we are not creating the conditions for a public health crisis for future generations, and I hope that in the Minister’s response we will get some glimmers of hope that we will see an increase in the number of health visitors, not a further decrease.