Early Years Family Support

Maria Miller Excerpts

Tuesday 16th July 2019 Commons Chamber

[Mrs Maria Miller (Basingstoke) (Con)]

What has marked out this debate already is Members’ great passion for and commitment to this subject. It is a great pleasure to follow the hon. Member for Manchester Central (Lucy Powell) and to hear more about the work she has been doing. However, the absolute tribute has to go to my right hon. Friend the Member for South Northamptonshire (Andrea Leadsom), who is quite simply the oracle on early years and attachment theory.

I will always remember the first time I met my right hon. Friend, and I had a teach-in that most people would pay for on early years attachment theory. I think that it was in the car park of a pub, but I very much appreciated that teach-in. Actually, I do not think she realised it, but she sparked a real interest in this area for me. This conversation happened many years before we were both in Parliament together, and it really marked out a very deep interest for me. I was able to follow that up as a shadow Minister—not particularly when I had a ministerial post, but when I was a shadow Minister—in the years before 2010.

My right hon. Friend is an expert in early years and attachment theory, and I do not want to add to what she and, indeed, the hon. Member for Manchester Central have said on a number of these issues. I want to go on to some other areas to expand the debate a bit more, but before I do so, let me say that it is absolutely fundamental that we get it right for every single baby in this country. The early intervention that my right hon. Friend and the hon. Lady have talked about in the debate is completely critical and vital.

As my right hon. Friend has said, having universal and targeted services is a critical part of this. While she was talking, I was reflecting on the service offered in my own constituency by Basingstoke breastfeeding counsellors. They are a mixture of paid-for counsellors and volunteers, but this is very much focused on volunteers who are there for mums to be able effectively and successfully to breastfeed in those early weeks and months. It is a service, frankly, that the NHS finds quite difficult to provide and that involves those expert counsellors. That is one way we can help to improve not only the health of our babies, but attachment from those very early weeks and months. That sort of support can be so important for babies and new mums in the early weeks—certainly, it was for me when I had my three children. Health visitor support makes a real difference in supporting mental health, breastfeeding and the health of the mother and baby.

I want to expand on the specific issues talked about today, because we need to get it right for families, too. To get it right for babies, we need secure and stable families and parents before babies are born, as well as afterwards. My right hon. Friend talked about the stress that can be put on mothers during pregnancy and how it can be transferred to the unborn child. That is one reason why I introduced a 10-minute rule Bill to try to change the law with regard to redundancy and pregnant women. More than 50,000 women a year in this country feel that they have no choice but to leave their jobs when they are pregnant. Those of us who have been pregnant, or have had partners who have been pregnant, can think of no time of our lives when we have less wanted to leave a job. At a time when financial stability is so important, one can only imagine the pressure individuals who have to give up their jobs are under.

In addition to specific expert support for parents around attachment, the Government need to reflect specifically on how we ensure pregnant women receive the support they need. In Germany, a law is in place that stops, except in extreme circumstances, any pregnant woman being made redundant. Not only does that help to alleviate some of the stress we have talked about, it enables that country to ensure that more women go back into employment after they have had children, and that helps to close the gender pay gap. I hope that the UK Government will continue to think about this issue, particularly at a time when we now have more women than men coming out of our best universities with science degrees. We need to find a way to ensure that those women can stay in the labour market and have a successful family life.

My right hon. Friend touched on the mental health of women after they have given birth. I commend the National Childbirth Trust’s campaign for a six-week maternal post-natal check. I think that happened in the past, but it seems to have dropped out of the most recent iteration of the GP contract back in 2005 or 2006. It would be a great way to ensure that, as well as protecting mums before they give birth, we have a mental health check after they give birth. If mum’s mental health is good, attachment can be strong.

[Wera Hobhouse]

The right hon. Lady is making a very powerful point about the perinatal mental health of women. NHS England and the British Medical Association are conducting a review of post-natal checks and the GP contract. Does she agree that now is the right time to include in the GP contract a mandatory check, as the NCT is asking for?

[Mrs Miller]

I have very strong sympathies with that. It should happen by rote for every woman, and I think that it happens haphazardly now. I can remember having that sort of conversation with my GP after the birth of my children, but it does not happen routinely. The NCT is right to pick this up. If we are to ensure that early years family support is as good as it can be, it needs to include a mental health check for mums. All of us know individuals who have gone through post-natal depression. For the health of the mother as well as the children, it is so important that it is identified early on and action is taken.

As well as protecting mothers who are pregnant or have new babies, and as well as making sure that they get the right support from their GPs on mental health, the Government also need to reflect on a couple of other areas to make sure that our children have the best early years support possible. We heard about one of these earlier from my hon. Friend the Member for Faversham and Mid Kent (Helen Whately), who talked about flexible working. The Government have already heard an expert dissertation from her, so I will not repeat what she said. In summary, however, the more that we can give flexibility to families, particularly when they have very small children, but not solely then—I speak as the mother of a teenager, as my youngest is now—so that they can balance work and family life, the better. This goes on for our children’s entire lives, even beyond them being children, so I hope that the Government are making sure that they take very seriously flexibility and flexible working as a default, which my hon. Friend spoke about in relation to her ten-minute rule Bill.

No Government have gone further than this one and the coalition Government in making flexible working something that we can all now request. We will take no lessons from anybody about any lack of understanding from Government Members on that, and I commend the Government for all the work that they have done, but we now need to look at going further to make sure that businesses take that flexibility for granted. The best businesses already do, of course, but we need more to do it routinely.

My final point is on shared parental leave. If we are to get it really right for our littlest people—the half a million babies that are born every single year—we need to get it right for both parents. At the moment, we do not get it right for dads at all. All the research coming out of countries such as Germany shows that if we have proper shared parental leave, fathers and children have much better relationships not just in the early years, but throughout their lives, including even if the adult relationship with the other parent breaks down. It is absolutely proven that a shared parental leave policy involving fathers far more in the lives of their children at an early age can lead to far better relations later in life as well. I urge my hon. Friend the Minister to consider very carefully the role of shared parental leave in future. My Committee—the Women and Equalities Committee—has done an excellent paper on it, which he can read at his leisure. It shows clearly that three months of “use it or lose it” leave for dads is one of the best ways that we can support family life and help to address the gender pay gap.

Those are just some other ideas, building on the debate secured by my right hon. Friend the Member for South Northamptonshire, on how we can make sure that every child in this country gets the best start in life and that every family can thrive.

--- Later in debate ---

[Tim Loughton]

I am completely recharged and relieved by that. The hon. Lady is my absolute favourite Member of Parliament for Manchester Central, and many things besides. But this debate is getting far too consensual, so I shall return to the points that I was trying to make.

The phrase “1,000 days”—or, for those whose glass is half full, “1,001 days”—is almost becoming common parlance as well, and it needs to. It needs to be almost a brand. People need to understand that those 1,001-ish days of life from conception to the age of two are the period that will have the most impact on a child’s future life. If we do not invest in the right support then, the cost of picking up the pieces later will be so much greater, both financially and, as I think everyone here recognises, socially.

I should declare an interest, in that I chair PIP UK—the Parent Infant Partnership—which was set up by my right hon. Friend the Member for South Northamptonshire. I became chairman of the trustees, and am proud still to be so. Our most recent report is “Rare Jewels”. I pay tribute to Sally Hogg, who works for PIP and who did a great deal of research on the scarcity of parent and infant mental health specialist support. That was a false economy.

I shall now be slightly unconventional, and talk about the motion. The motion is about the inter-ministerial group, and I want to talk about some of the experiences of that group. As I found during my few years as a Minister, joined-up government is a complete myth. What the group almost uniquely did, because of the vim and force of my right hon. Friend the Member for South Northamptonshire, was bring together key Ministers from half a dozen key Departments to try to create joined-up solutions. A child’s mental health, and those early years affecting the child and his or her parents, are not just the preserve of the Department for Education and of children’s social care. They touch on the work of so many other Departments

I am glad that my right hon. Friend the Member for Basingstoke (Mrs Miller) is still here. She will remember that some years ago, when I was the Children’s Minister and Sarah Teather was also an Education Minister, we tried to put together the early intervention fund, which was largely intended to bring together different interests with a pooled budget so that we could work together on smarter solutions. However, that did not really fit the way in which the civil service worked.

We struggled for some months to pull together a plan that would involve various other Departments, and we were being frustrated at every turn; so we formed a pizza club, well before my right hon. Friend the Member for South Northamptonshire was on the scene. My then colleague Sarah Teather and I rang other colleagues—Housing Ministers, Health Ministers and others. I think that my right hon. Friend the Member for Basingstoke was then a Minister in the Department for Work and Pensions. We got together in “The Adjournment” restaurant, had a pizza, agreed what we wanted to do, and all went back to our Departments in the following days and told our civil servants what we wanted to do. The response was “Well, I’m sorry but that’s not the way we do things around here, Minister”, to which our response was “Tough, we’re now doing it.” That was the only way we could actually get through an important joined-up policy because the system just did not work. I do not think things have improved much at all.

Another innovation I set up then was the Youth Action Group. Again, there were problems and I tried to youth-proof all Government policy, which is something I still bang on about. There were many problems that transcended different Departments, and yet if there was a problem, it would go from one Department to another in a vicious triangle, as it were. So I got together six major charities led by The Prince’s Trust and Barnardo’s. I co-chaired it and, at one stage, I think we had nine Ministers from nine different Departments. Invariably most of those Ministers would turn up to those meetings and the children’s charities and youth charities would bring particular problems to us. One problem was about housing benefit for looked-after children who were care leavers, which was the responsibility of the Department for Education for care, the Department for Communities and Local Government—whatever it was called in those days—for housing and the Department for Work and Pensions for benefits. We got the three Ministers together with the three lead officials and said, “Here’s the problem; can you please take it away and solve it and come back with a solution that the children and youth workers can then take away?” Alas, that group no longer exists, but we need far more of that sort of rationale and mentality in Government. The inter-ministerial group showed how it could be done, and it is so important that the work continues. I hope that the recommendations that have been made are taken up and run with.

We need a Minister for early years children and families at Cabinet level. It should not just be left to civil servants to people those committees when what we need is a co-ordinated ministerial response. This needs to be led by a high-profile Minister who has the clout, enthusiasm and drive to bring all the relevant Departments together and come up with a cross-departmental solution. I am afraid that we are still a long way from that in common practice, and that is partly what is wrong with Government and with our civil service. So that is my main plea.

On the investment equation, I am not going to repeat everything that has been said, but we know that healthy social and emotional development in the first 1,001 days means that individuals are more likely to have improved mental and physical health outcomes from cradle to grave and children will start school with the language, social and emotional skills they need to play and explore and learn. Children and young people will also be better able to understand and manage their emotions and behaviours, leading to less risky and antisocial behaviours and the costs that these bring to individuals and society, and they will have the skills they need to form trusting, healthy relationships—something we heard about in the Chamber earlier. If they had that, we would not have to spend such a lot of time teaching it to them at school because it would come naturally, and they would know what a proper quality, trusting relationship actually is. And if they know, they are much more likely to be able to hand it on and nurture their own children as they become parents in the future.

The cost of getting this wrong is huge. Some years ago—although it is still as true and important today—the Maternal Mental Health Alliance calculated the cost of getting perinatal mental health care wrong for the one in six women who will have some form of perinatal mental illness. The cost of that was £8.1 billion each and every year, and the cost of child neglect in this country is £15 billion each and every year; so £23.1 billion is the price of getting it wrong. A fraction of that spent on early intervention—well-targeted, well-timed, well-positioned by well-qualified and trained professionals—could save so much personal grief and so much financial and social grief later on.

It is not rocket science, as I constantly say; it is technically neuroscience, but it really is something we should have been doing so many years ago. The troubled families programme is the model here, and it is essential that the troubled families programme is not just retained, but expanded in the comprehensive spending review. I have always said that we need a pre-troubled families programme, because in the troubled families programme we are dealing with the symptoms of getting it wrong earlier. If we prevented those symptoms in the first place, working in those very early years, so that we have a well-balanced parent or parents with well-balanced children, they are more likely to arrive at school eager and able to learn and be contributing members of society. That is so vital. Some 28% of mothers with mental health problems report having difficulties bonding with their child. Research suggests that this initial dysfunction in the mother-baby relationship affects the child’s development by impairing the baby’s psychomotor and socio-emotional development.

Postnatal depression has also been linked with depression in fathers, and with higher rates of family breakdown. We forget the impact on fathers of not knowing how to deal with a mum—a partner—who all of a sudden has some form of postnatal mental illness. A lot of fathers are affected by this. I know that my hon. Friend the Member for St Austell and Newquay (Steve Double), who chairs the all-party parliamentary group on fatherhood, is going to talk about this. It is essential that we look at all parents, when both parents are on the scene, and give support to the family as a whole.

[Mrs Miller]

I well remember working with my hon. Friend and I remember his huge commitment in this area. If there are now more debates and discussions about child mental health, a lot of that is down to him. I should like to highlight a report that the Select Committee is doing on men’s mental health. Does he agree that the NHS needs to think long and hard about the way in which men can access mental health services? We are receiving evidence that the way in which these services are delivered is almost highly feminised, making it difficult for men to access them.

[Tim Loughton]

My right hon. Friend is absolutely right. There is still this myth that it is not manly to admit to having some form of mental illness. I hope that we are getting away from the stigma of that, but we still have far to go in encouraging people. Hon. Members in this place who have come forward with their own very painful experiences have done a huge service by providing role models, as have celebrities in sport and showbusiness, and by showing that there is nothing unmanly or abnormal about coming forward when they have an illness that happens to be a mental illness, just as they would come forward if they had a physical illness. Why should there be any difference? However, we need to make it easier for men to cross that threshold in the first place. We need to ensure that they can come and talk to somebody and get checked out.

I am not going to go into the whole children’s centre argument. That is an important issue but this is not just about the bricks and mortar. However, one of my criticisms is that those places need to be much more dad-friendly, and much more imaginatively used. I have opened many children’s centres in my time, and I have seen some great ones that have football clubs on Saturday afternoons when the children’s centre is too often closed because it is a nine-to-five, Monday to Friday institution. Dads bring their kids and they play football together, then they do computers and reading with their kids afterwards. That is great bonding and co-educational time as well. Again, this is not rocket science. We need to make those places more welcoming for dads, and we need to put them in places that young fathers inhabit.

The killer statistic that I always use is that if a 15 or 16-year-old child in school has some form of depression, there is a 99% likelihood that their mother suffered from some form of mental illness during pregnancy or soon afterwards. The correlation is that close, and if we do nothing to help the mother at that early stage, we will certainly see the consequences later on. It is great that the Prime Minister has flagged up mental illness, and it is great that so much more will be happening with additional funding—not enough, but there will be additional funding—for mental health services in schools, but we need to do all this before school as well so that kids are less susceptible to mental illness problems, given all the pressures that they will face as they go through their school years. We need a much more joined-up approach.

Research by the Children’s Commissioner shows that 8,300 babies under the age of one in England currently live in a household where domestic violence, alcohol or drug dependency and severe mental illness are all present. That is a very worrying amount. That is why the Domestic Abuse Bill, which was at last introduced today, is very important, but we need to look at the impact on children as well as the impact on parents, because that trauma will be long-lasting. We tend to look at the immediate victim of domestic violence without looking at the collateral damage that it also causes. My right hon. Friend the Member for South Northamptonshire mentioned the horrific statistic of something like one third of domestic violence starting during pregnancy.

I will come to a conclusion shortly, Mr Deputy Speaker, although you do not look too impatient, so I might go on a bit. To join up Departments, it is crucial to have key players who are wedded and committed to the issue and who want to work to achieve solutions. Domestic violence is dealt with in the Home Office. Child sexual exploitation is now dealt with in the Home Office. There is an impact on housing, which is dealt with in the Ministry of Housing, Communities and Local Government. There is an impact on justice as well. The consequences of social media—now dealt with by the Department for Digital, Culture, Media and Sport—have an impact on children’s mental health. I used to deal with most of those things in one Department when I was Children’s Minister, but they have now been dispersed across Government, and we have to bring them back together.

I will finish on the role of the Ministry of Housing, Communities and Local Government, and public health. Health visitors are a huge resource. One of the great achievements of the Cameron Government—I was part of the discussions in the shadow Health team when we came up with the idea—was the huge expansion of the health visitor programme. Based on the research we did in the Netherlands with the Kraamzorg programme, which showed the impact that health visitors can have at an early stage when they have good, strong engagement with new mums and dads, there was a commitment in the 2010 manifesto to increase the number of health visitors to a figure of, I think, some 4,200. By 2015, that figure had just about been achieved. Alas, since then, things have gone into reverse.

I pay tribute particularly to Dr Cheryll Adams CBE, head of the Institute of Health Visiting, who has had a major input into the work that my right hon. Friend the Member for South Northamptonshire has already mentioned and the all-party parliamentary group that I chair. As the IHV recently noted, England is now at risk of sleepwalking into the loss of the health visiting service as we know it, unless urgent action is taken to address the current threats it faces. There are ongoing cuts to the public health grant, a 26% reduction in NHS- employed health visitors since 2015 and an unwarranted variation in the quality of services commissioned for families based on where they live rather than the level of need. As the IHV says, investing in the earliest years saves money in the long run and ensures that every child is supported to achieve the best start in life, yet the cuts to services in England persist at a time when inequalities are widening and infant mortality is increasing.

Health visitors are the trusted face on the doorstep. Whereas social workers are often treated with scepticism and fear when they knock on the door, the health visitor is usually welcomed over the threshold, particularly by new parents. He or she is an early warning system of some deficiency in parenting, as well as for safeguarding. It is absolutely essential that we build those numbers back up before we lose too many more of those experienced health visitors, working out of children centres or wherever—hot desking even, with social workers, with the district nurses and other welfare officers—so that they can detect and signpost families to the relevant services. They really are absolutely invaluable. Since the switch in responsibility from the NHS to local authorities—this is no detriment to local government—there has been a lack of experience in how those sorts of services are run, and therefore the issue is not treated as a priority. It is a priority and we need to get back to that.

Finally, I reiterate the recommendations made in the “Building Great Britons” report that the all-party parliamentary group produced in 2015. It was about having a joined-up Government approach to the 1,001 days; about every local authority drawing up its local plan and working with all the local agencies on how to deliver that plan for the 1,001 days, within a five-year term at least; and about having a monitoring system, which I based on the adoption scorecards that we brought in back in 2012, so that there is no place to hide and everyone has to be transparent about how they are progressing towards producing those services, compared with other parts of the country.

The solutions were in that report. We all know what needs to be done. My right hon. Friend the Member for South Northamptonshire led the way in bringing together the relevant parties and Departments to show how it could be done. Now we need to do it.