Evidence-based Early Years Intervention

Norman Lamb Excerpts

Thursday 21st March 2019 Westminster Hall

[Norman Lamb (North Norfolk) (LD)]

I beg to move,

That this House has considered the Eleventh Report of the Science and Technology Committee, Evidence-based early years intervention, HC 506, and the Government response, HC 1898.

It is a pleasure to serve under your chairmanship, Mr Davies—for the first time, I think. We are spending this afternoon talking about a subject that has absolutely nothing to do with Brexit, and which I hope might unite us.

Last year, the Science and Technology Committee held an inquiry into childhood adversity and trauma and the early-intervention approaches that can be used to address those problems. As I said in a statement in November in Westminster Hall, following the publication of our report, this issue is of significant national importance. Around one in two adults in the UK has suffered at least one adverse childhood experience. That may include abuse, neglect or growing up in some other difficult situation, such as a household where someone suffers substance abuse or domestic violence.

Interestingly, the website of NHS Health Scotland includes a list of typical adverse childhood experiences:

“domestic violence, parental abandonment through separation or divorce, a parent with a mental health condition”—

often that can have a significant impact on the child in the household. It continues:

“being the victim of abuse (physical, sexual and/or emotional), being the victim of neglect (physical and emotional), a member of the household being in prison”—

again, that has a significant potential impact.

[Dr Paul Williams (Stockton South) (Lab)]

I apologise for interrupting the right hon. Gentleman’s list. He mentioned that being a child of someone in prison is considered an adverse childhood experience. Has he seen the excellent report published this week by Crest Advisory, which identifies that there are many more children of prisoners than previously expected? It recommends that as part of the criminal justice process, those children should be identified and local authorities should be notified to provide them with enhanced support, because they may be at risk.

[Norman Lamb]

I would be grateful if the hon. Gentleman could refer me to that report; it sounds very interesting, but I have not seen it. That prompts the interesting point that many people in prison experienced bad things in their childhood that led to exclusion from school, involvement in the criminal justice system at an early age, low educational attainment and worklessness. There is an awful risk that the cycle will repeat itself. That sounds like a wise set of recommendations, and I would be interested to explore them further.

The final item in the list from NHS Health Scotland is

“growing up in a household in which there are adults experiencing alcohol and drug use problems.”

One in 10 adults has suffered four or more adverse childhood experiences—a disturbingly high statistic that often goes completely unnoticed. I remember visiting Philadelphia and hearing about the impressive work that was being done to confront the problems of trauma that children experience, often as a result of gun crime, in that quite troubled city. Mapping that city shows up areas of concentration where a substantial proportion of children have experienced repeated traumas, which have a clear effect on them.

The trauma that those experiences cause a child is tragedy enough, but we now know that they are also associated with long-term problems such as mental or physical ill health, worklessness and involvement in the criminal justice system. The prevalence of those problems increases with the number of adverse experiences that a person suffers in childhood. Those associated serious problems make the case for tackling childhood adversity as effectively as possible all the stronger.

In last week’s spring statement, the Chancellor said that he was

“in favour of early-intervention approaches where they can be shown to be effective.”—[Official Report, 13 March 2019; Vol. 656, c. 370.]

I welcome the evidence-based approach. From the inquiry undertaken by the Science and Technology Committee, which I chair, I know that the evidence for the effectiveness of early intervention to address adversity is strong. I encourage the Minister to make the case for such intervention to the Chancellor, along with other ministerial colleagues. The hon. Member for Stockton South (Dr Williams) has written—together with me and the Chair of the Education Committee, the right hon. Member for Harlow (Robert Halfon)—to the Chancellor to ask for a meeting to discuss the clear evidence to support the case for investing in early intervention.

The Early Intervention Foundation—the What Works centre for early intervention that the Government established to promote evidence-based policy in this field—reviewed the evidence for more than 100 early intervention programmes and found that 51 had robust evidence of a positive impact. Several of those have received the Early Intervention Foundation’s highest rating for proven effectiveness, having demonstrated

“a long-term positive impact through multiple rigorous evaluations.”

We have heard from organisations that champion the success of the early intervention programmes that they have delivered locally. One example is the Children and Parents Service in Manchester, led by the immensely impressive Dr Caroline White, who gave evidence to our Committee. Because we were so impressed by the evidence she gave, she ended up acting as an expert adviser to the Committee in the shaping of our report. The service accepts parents and pre-school children with early social and emotional problems. Those parents and children are referred to the service by multi-agency staff from across the early years workforce—for example, by health visitors. The service provides thorough psychological assessment and offers intervention as appropriate.

The service can demonstrate evidence of its positive impact since it started almost 20 years ago, including improvements in child behaviour, parental stress and depression and, critically, the risk that a child will face ongoing abuse or neglect. That is a prize worth grasping. The interesting thing about Manchester is that, despite very strained local government financial resources, it has chosen to prioritise the service. Of course there is an argument about the need to invest more in early intervention, because that is where we can be really effective, but lack of money is no excuse not to target resources in effective interventions. Manchester has shown that it is possible to do that in the most impressive way.

It is of relevance to the spending review that effective early intervention offers the opportunity to save precious public resources and help those who have suffered adversity. Tackling the problems associated with adversity as a child—ill health, domestic or substance abuse, low educational attainment and so forth—costs public bodies enormous sums of money over the course of a person’s life. Imagine someone who has low educational attainment, perhaps after being excluded from school, and ends up as an adult without work and potentially in the criminal justice system. Just imagine the total cost to the public purse of maintaining and supporting that person through their life. Just imagine what they could contribute to society if those problems were addressed at source, stopping the trauma becoming entrenched and giving them the chance of a good, productive life that contributes to the common good.

It is estimated that the annual cost of late intervention is at least £16.6 billion, but that does not capture the economic benefit of people living more fulfilled and successful lives. This is a clear case of investing to save over the long term, but between 2010-11 and 2017-18, local authority spending on early intervention fell from £3.7 billion to £1.9 billion. That coincided with an increase in spending on late intervention, which rose from £5.9 billion to £6.7 billion. It seems daft to me that we spend more on coping with the fallout from children being excluded from school, which of course is associated with the horrific violence we are seeing on our streets. Surely it would be so much better to invest early to prevent those problems from happening in the first place.

Regrettably, we have heard that the provision of effective, evidence-based early intervention is not uniform across the country. Pockets of good practice exist—I mentioned Greater Manchester—but the Early Intervention Foundation told us that there are

“lots of examples where we see a gap between what we know from robust, peer-reviewed literature and what happens in local services and systems.”

Given that early intervention is left to local authorities to deliver, without any clear national support or scrutiny or even data collection, that is perhaps unsurprising.

Bluntly, we have no idea as a nation how substantial sums of public money are spent and whether that has any impact at the most critical stage of a child’s life. We are in an extraordinary position, as a country. We collect lots of data from the point at which a child goes to school, but for their most critical, formative years, we have no national data of any substance that we can scrutinise to understand how money is spent nationally and whether it is having any impact.

That fragmented and unco-ordinated approach to early intervention is why we called on the Government to develop a national strategy—incidentally, the Scottish Government and the Welsh Government have already taken that approach—to empower and encourage local authorities to deliver effective, sustainable and evidence-based early intervention. Unfortunately, in their response to our report, the Government largely dismissed our recommendations. I must say to the Minister that we are deeply disappointed by the response from the Department of Health and Social Care. We really hope that a more considered view will be taken, and that the Government will review what we are actually saying and the case we are making. I hope the Minister—as the Science Minister, he is acutely interested in the application of evidence—will champion this issue in Government.

In its response, the Department of Health and Social Care argued that

“local areas are best placed to understand the needs of their local communities”

and

“to commission early intervention services to meet those needs”.

The national strategy we call for would not run contrary to that locally led approach. Instead, a new strategy could raise awareness and ambition among local authorities, provide guidance to them, and describe best practice and establish metrics against which local authorities could be held to account for the early intervention they deliver—without dictating from the centre exactly what each local authority does, because that is not the approach we argue for. Dr Jeanelle de Gruchy, who represents local directors of public health nationally, told us during our inquiry that an overarching national strategy would benefit those working to provide early intervention locally. That is exactly the opposite of what the Government said in their response.

More positively, however, the Government have established an inter-ministerial group to look at how families with children from conception through to age two can best be supported. I really welcome that. Although early intervention can support children of all ages, we know that that early period is critical to brain development. I urge that group to seize the opportunity presented by early intervention. Having highlighted my Committee’s recommendations to all the members of that group individually, I am disappointed that they are not here to respond to the debate. None the less, I welcome the Science Minister and hope very much that he responds positively to what we are saying.

I should also say that I have been encouraged by the reactions of many of the Ministers on that inter-ministerial group. I know that the hon. Member for Stockton South, who led an inquiry of the Select Committee on Health and Social Care into early years, is happy to work with my Committee to find a way of holding an evidence session with members of that inter-ministerial working group about the work they are doing. When does the Minister expect that group to report its findings? How will the Government move forward with its recommendations? Does the group intend to act on my Committee’s recommendations?

Let me briefly set out what my Committee believes a national strategy should contain. First, awareness of the impact of childhood adversity and how it can be addressed could be greater among those who work with children. The early years workforce needs to be defined, and its training reviewed, to ensure it has the knowledge it needs. We spend a lot of time talking about the prevalence of mental ill health among children and young people these days, but we do not spend nearly enough time talking about its causes. If we focused more on the causes, we might be more effective at reducing the prevalence of the problem, which is very disturbing.

[Dr David Drew (Stroud) (Lab/Co-op)]

I am struck by the fact that each of the various counselling organisations in my constituency has stressed to me how much worse children’s mental health has become since we lost the children’s network, particularly in rural areas. Those organisations are picking up a deluge of children who previously would have received at least some early support. That is not there anymore. It is a great tragedy that what we put in place—one of the things I think the last Labour Government did very well—has been lost. Does the right hon. Gentleman agree that we are seeing the consequences of that?

[Norman Lamb]

I guess the hon. Gentleman is talking about Sure Start centres.

[Dr Drew]

Children’s centres in general.

[Norman Lamb]

I will come on to that, but the hon. Gentleman makes an extremely important point. I mentioned earlier that investment in early years preventive services has fallen. That does not seem very wise in the long run.

[Dr Williams]

I thank the right hon. Gentleman for giving way again. Will he comment on the Government’s prevention strategy? Last November, the Government launched a consultation document on that strategy, saying that prevention was better than cure. Will he reflect on the adequacy or otherwise of the Government’s proposed approach to the kind of primary prevention in the early years that he talks about?

[Norman Lamb]

I welcomed the fact that the Secretary of State had identified the importance of prevention, although I noted that there was not much reference to mental health in the prevention strategy, and I have raised that with him. As I understand it, he plans to publish a Green Paper on prevention sometime in the spring, although the concept of seasons is elastic in Whitehall. I welcome that, but of course it has to have substance to it. We have to think about the social determinants of ill health, on which there generally is not sufficient focus. Poverty, poor housing and so forth are also critical factors, not only in our physical health but in our mental health.

I was going to mention that the Secretary of State has identified prevention as something that he wants to prioritise. It is up to us to guide and encourage him along a route that could reap real rewards, not only for individuals but for Government, in the longer term.

The next part of the proposed national strategy would be the collection and analysis of appropriate data. We believe that can help to identify families who would benefit from early intervention, to provide insight into how well different early intervention approaches are working, to drive continual improvement and to allow local authorities to be held to account. The national strategy should identify what data should be collected and support local authorities in delivering data-driven services. If a service is based on data and its analysis, it is more likely that evidence will be applied effectively and that we will make better use of public money. If we use public money in a way that is not based on evidence, we waste it; we cannot justify that to taxpayers, for whom the amount that they are expected to pay is often a strain. They demand that money be spent effectively in government.

The strategy should make use of the growing field of implementation science—a point that we were struck by in Dr Caroline White’s evidence. She focused on not taking an off-the-peg evidence-based programme and assuming that it will work effectively, and made the point that any programme should be properly implemented by trained staff who are supervised effectively, and that data should be used to monitor performance. Those factors are critical in ensuring that a programme can be effective in its application.

[Martin Whitfield (East Lothian) (Lab)]

I am grateful to the Chair of the Science and Technology Committee for giving way. He is right to make that point. In the report, we have provided vast amounts of evidence that the collection of data is important, but not the end. The final stage is taking the data and feeding the information it provides back to the individuals affected, so the systems that can and have been identified can be rolled out and attuned to the needs of the young people and families who will use them.

[Norman Lamb]

I thank the hon. Gentleman; it is an enormous pleasure to have him as a member of the Select Committee, when he is not tied up with High Speed 2. He is absolutely right. The point was made that when we train social workers, an understanding and an analysis of data is a terribly important part of the effectiveness of their work. We want to see a central, specialist team set up in the early intervention centre, not to impose anything, but to help local authorities to deliver the national strategy.

The strategy should shift the balance of funding from late intervention, which we know is less effective, to early intervention, which we know can be more effective. The spending review should establish how best this can be achieved. If the inter-ministerial group and the Government more generally reviewed the evidence base for early intervention and took up our call for a national strategy on these lines, it would make a massive difference to children across our country, now and in the future.

[Dr Drew]

One of the groups that I feel most sorry for now is health visitors. To be fair to Prime Minister Cameron, he identified health visitors as one of the key elements in early years intervention, yet all the health visitors who I talk to say that they are very much under pressure. They are struggling to do their statutory work, let alone some of the other things they do. Would the right hon. Gentleman agree, and did he discover something about that?

[Norman Lamb]

The hon. Gentleman must be psychic; I was just about to talk about the programmes that health visitors implement. He is right that the number of health visitors is falling after a significant rise during the coalition years. There was a target set for extra numbers, and they were recruited, but those numbers are now falling back.

The Government must also review some of the programmes that support the provision of early intervention. Foremost among these is the healthy child programme, which is delivered by health visitors and under which every child should receive five mandatory health visits before the age of three. However, Public Health England statistics show that only around 80% of children receive these visits, aside from the newborn visit, which means that 20% do not. That is despite the fact that Public Health England itself acknowledges that without health visits,

“it is possible for children not to be seen by any professional until they start school or not at all if they are home educated.”

I understand the importance of the role of the parent, but if a parent is neglecting a child’s needs and no professional is able to identify and pick that up during those critical early years, that is storing up huge problems for the future and massively letting down that child.

The Government’s response to our recommendation to increase coverage was silent on how that might be done; in fact, it was even silent about whether the Government aspired to achieve that at all. The Minister implied that so long as coverage was better in more deprived areas, it was not an issue to worry about too much, but we know that adversity can happen in any family, regardless of affluence. The Government must now set out a clear strategy for how they intend to increase coverage of the five mandated health visits to 100%, and must also make sure that that strategy does not simply increase the strain on the health visitor workforce, which was mentioned by the hon. Member for Stroud (Dr Drew), diluting health visitors’ impact on each family. I ask the Minister, are the Government really content with the patchy coverage of the five mandated health visits being achieved, and if not, what concrete steps are they taking to improve the situation?

We also call on the Government to address the issue of Sure Start children’s centres—the first point that the hon. Member for Stroud raised. Back in 2015, it was announced that there would be a consultation on the future of Sure Start centres. Four years on, we are still waiting for that consultation to take place, let alone any decision. In the aftermath of the announcement of the consultation, Ofsted announced that it would suspend inspections of children’s centres, so for four years we have had no inspections, either. That is surely a dreadful neglect of responsibility. Local authorities have no idea what the Government’s view is about children centres. Do they support them? Do they believe that they are valuable? Are they choosing to abandon them? Surely it is not unreasonable to expect a decision four years after the consultation was announced.

By now, the Department for Education should have developed an improved framework; it should not have left local authorities to tackle the situation when they do not have any clarity about the Government’s plans for these centres. Delegating quality assessment to local authorities, in the absence of central support or guidance, risks leading to the same fragmentation we see across all other aspects of early intervention. Local authorities are crying out for clarity on the future role of Sure Start centres. Will the Government hold a consultation on children’s centres inspections, or will they not? Sadly, we are seeing a gradual drift of closures around the country. In my county of Norfolk, a 50% cut in funding for children’s centres has been announced, so many of them will close down, without any clear plan of what the alternative should be. Surely that is unacceptable. Is it now established Government policy that the quality assurance of children’s centres has been devolved from Ofsted to individual local authorities, or is that still a stop-gap measure? Are we still waiting for a final permanent conclusion to this?

Returning to the wider scope of my Committee’s inquiry, early intervention used to tackle and ideally prevent childhood adversity can transform lives and reduce costs to Government. That is the great double prize to be won. There continues to be a pressing need for a fundamental shift in the Government’s approach to early intervention, targeting childhood adversity and trauma. The Government should match the ambition of the Scottish and Welsh Governments, and build on the example set by certain English councils, to make early intervention and childhood adversity a priority, and set out a clear, new national strategy to empower and encourage local authorities to deliver effective, sustainable, evidence-based early intervention. The new inter-ministerial group spans multiple Government Departments and has obvious authority. I call on that group to review our report, and to seize the opportunity offered by effective, evidence-based early intervention by making it a focus of its recommendations later this year.

[Darren Jones (Bristol North West) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Davies, and to speak as a member of the Science and Technology Committee. I pay tribute to our Chairman, the right hon. Member for North Norfolk (Norman Lamb), for providing the leadership and allowing us to undertake this work on the Select Committee, and to draw conclusions from a wide-ranging gathering of evidence.

I am sure this is not a party political issue. Everyone will agree that it is right to intervene when there are adverse childhood experiences. The evidence, as we have heard today and as we stated in our Select Committee report, is very strong on that point. We know that many of the problems that lead to adverse childhood experiences, whether increasing domestic violence, drug or alcohol misuse, mental health problems or financial stress and money worries, are part of the cycle of harm that can lead to a multi-generational impact of these heartbreaking situations.

In my view—as a member of the Labour party, this is inherent to my political decisions—that is linked to poverty and inequality. That is why, whether on adverse childhood experiences, Sure Start and children’s centres, or any form of investment in the early years, I keep finding myself back in this place talking about those issues, because they are the nub of the cause for many young people, who, through no fault of their own, suffer in their life as a consequence of the poverty in our country.

I congratulate the Chair of the Select Committee on making it clear that evidence, the use of data and investment in prevention are the way to go. I am sure the Science Minister will agree with that, given that he is the Science Minister, but I rather hope that he might share that conclusion with colleagues in his new cross-departmental group.

This is not only an issue of concern to me at a national level; I have a strong constituency interest in the matter, too. Bristol City Council, for example, is leading in innovation in this area of work. On 17 January 2019, my colleagues in City Hall held a conference on adverse childhood experiences in Bristol and how the council’s new vision statement could bring partners together to help tackle the causes. The event was held by the council in partnership with Avon and Somerset police and our clinical commissioning group.

[Norman Lamb]

I am grateful to the hon. Gentleman for his work on this subject on the Committee. He mentioned the police; I do not know whether he is aware of it, but there is some really good, innovative work going on, linking police to schools. When the police identify a situation of domestic violence overnight, they will alert the school first thing, so that a child arriving at school who has perhaps experienced the most horrific trauma overnight is given proper support and protection the following day, rather than perhaps being told off for being a naughty child, which can easily happen in ignorance of what has happened to them.

[Darren Jones]

The right hon. Gentleman is absolutely right. Partnership working is a phrase that we often hear in local government, and sometimes it is a bit amorphous, but that is a classic example of why it is so important. I have had cases where constituents have told me stories of when they would go to school, albeit a long time ago now, and end up being treated as if they were ill and having to sleep in the nurse’s room at the school as opposed to taking part in classes, because of the experiences they were dealing with at home. As a consequence they missed out on their education, when instead the support should have been put in place at that time to help them in the best possible way.

The involvement of Avon and Somerset police is important because we know, and the evidence shows, that for children who suffer adverse childhood experiences, especially those who suffer multiple ACEs, the outcomes associated with that cycle of harm include mental health problems and drug or alcohol misuse—criminal activity is therefore connected with that. The police have a role not only in tackling criminal activity but, as I said at the outset of my speech, in helping to deal with the causes.

--- Later in debate ---

[Darren Jones]

All I know in my part of the world is that the health service and our schools are having to pick up more and more of the work that others used to do in the past. Certainly, if I talk to headteachers in some of the more challenging parts of my constituency, they tell me that they are having to invest more and more in family support staff, who work with families and young pupils in a way that schools were never placed to do in the past. We all know that school budgets are extremely tight, so that particular school is using some of its pupil premium funding to help children in those scenarios. I am pretty sure that the original intention of pupil premium funding was not to offset cuts to children’s centres or local councils; it was to give an extra hand to pupils from poorer backgrounds to get on and do well in life. In fact, it is just covering cuts made from the centre, and is therefore ultimately not having a positive impact on the bottom line, either for individuals or for the country.

However, this is not only about council leadership, because we also often rely on the charitable sector for the delivery of services. In my constituency is the Southmead Project, led by a chap called Dr Mike Pierce, who received an MBE for his work in this space. Mike was born and bred in Southmead and was himself the victim of adverse childhood experiences, and he speaks powerfully on the issue. I have done so before, but I again pay tribute to him. His leadership over the 24 years that the project has supported young people in that area has been quite remarkable.

However, Mike is not optimistic about the future. He relies on generous charitable fundraising, philanthropic donations and sponsorship from local businesses in order to keep his project afloat, in the face of cuts not only to the council but to organisations such as clinical commissioning groups and the police, which previously supported his charitable organisation. At the same time, demand is increasing. The project has a waiting list of young people in households where domestic violence or drug or alcohol misuse—or worse—are present, and it cannot get around to giving those young people the support that they need because it does not have the capacity to do so.

As a consequence—this is often the case when there are cuts to public services—residents end up coming to see their MP because there is nowhere else to go. It really is heartbreaking when constituents are in front of me in tears, with no access to support. Quite frankly, there is very little I can do, as the Member of Parliament, other than raising issues such as this in the House. We must understand that the decisions we make on public policy, funding and national strategies flow through directly to the lives of these young people, whose potential is being lost.

[Norman Lamb]

We should add child sexual abuse to the hon. Gentleman’s examples of adversity. The Government commissioned an inquiry into child sexual abuse, which is under way. Its prevalence across the country is deeply disturbing, yet we do not really have any confidence that children who suffer from it get the support that they need in order to live a good life. In adulthood, they are often diagnosed with personality disorders or psychosis—horrors that completely change their lives. Supporting them at an early stage might make all the difference.

[Darren Jones]

I thank the right hon. Gentleman for that intervention, which is timely because the founding purpose of the Southmead Project was to support victims of child sexual exploitation. Its “Wall of Silence” exhibition portrays the impact that ACEs had on many people when they were young, and now. That impact lasts for the whole lifetime, but evidence shows that effective, immediate intervention at the right time—when victims are suffering from sexual exploitation or are in other distressing environments—has an enormous positive impact on life chances. The research is very clear on that.

Whether it is on the basis of stories that we have heard in our constituency surgeries, evidence received by our Select Committee or the statistics that we are offered at local authority level, we all agree that neither young people nor their families should be victims of these distressing and heartbreaking environments. Families who end up in these situations often do so not through their own fault, but as a result of living in poverty. We ought to do much more, not only by providing support to people who need it, but by investing—using evidence and data—in prevention. That is not only the right thing to do; it is right for those individuals and for our country.

I share the right hon. Gentleman’s concerns about the response that our Select Committee received from the Government. I look forward to the Minister’s confirming that we will be able to work with this new cross-departmental group, hopefully to elicit a more positive response.

[Dr Paul Williams (Stockton South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Davies. I wholeheartedly welcome the excellent report by the right hon. Member for North Norfolk (Norman Lamb) and his colleagues. I thank them for their attention to detail and their superb recommendations. I recently chaired a Health and Social Care Committee inquiry into “First 1000 days of life”—it is listed on the Order Paper as a connected report—and I will talk about some of our findings. I also chair the all-party parliamentary group for the prevention of adverse childhood experiences. The debate has real relevance to both.

In my 27 years’ experience of studying and then working in health services, as I still do, I have realised that if our society wants the most effective interventions that improve health and reduce inequalities, we have to act in the early years—particularly in the period from conception to the age of two, but generally the earlier, the better—because the real seeds of health inequalities are sown during that time. Good physical, emotional, social and language development during that time is crucial to building healthy brains and healthy children, which leads to our having a healthier and better society.

The Health and Social Care Committee’s “First 1000 days of life” report, which I recommend to colleagues—they may not get the chance to read it, so I will highlight a few recommendations later—sets the Government the ambitious challenge of kick-starting the second revolution in early years services, as recommended in the 2010 Marmot report, so that our country can become the best place in the world for a child to be born into. Almost all the research into this subject demonstrates that our path in life is set during the crucial early years. Healthy social and emotional development during that time lays the foundations for good physical and mental health.

However, our current political system invests a fortune in reacting to problems later on in life but is currently disinvesting in early years, leaving a gaping void where we should be warriors and champions for a healthier society. During the first 1,000 days of life, from when a baby is conceived until the age of two, more than 1 million new brain connections are made every single second. Imagine that: a million new brain connections made every single second.

Brains are shaped by their interactions with society, but tragically, more than 8,000 babies under the age of one in this country live in households where the trilogy of domestic violence, alcohol or drug dependency and severe mental illness are all present. More than 8,000 developing brains under the age of one—a crucial age—are exposed to that environment. More than 200,000 children under the age of one live with an adult who has experienced domestic violence or abuse. We have already heard powerful arguments for intervening to reduce that cycle of abuse. Two million children under the age of five live with an adult with a mental health problem.

We know that many children who experience such adversity become happy and healthy adults, but adversity in childhood is strongly linked to almost all health problems and many social problems. Children exposed to adverse childhood experiences such as those that my hon. Friend the Member for Bristol North West (Darren Jones) talked about are much more likely to get physical health problems, such as heart disease. Exposure to ACEs as a child increases the chances of getting heart disease, cancer and mental health problems in adulthood.

[Norman Lamb]

And obesity.

[Dr Williams]

And obesity.

Children exposed to four or more ACEs are 30 times more likely to attempt suicide at some point in their life. They are 11 times more likely to end up in prison. They are even three times more likely to smoke in adulthood than people who did not experience any ACEs. Our politics is currently failing many of these children, and it is failing other families in which children and young people are still living in poverty.

My belief is that we need to devote more attention to and provide more protection during the early years. As we have seen today, many people from across the political divide share that belief, even though we do not seem to have a politics that ends up delivering more resources in this area. It is an area in which politicians should be working together. It was really encouraging to see the announcement last year of the early years family support ministerial group, led by the Leader of the House. That has the potential to take forward some of the Science and Technology Committee’s recommendations.

To conclude, I would like to reflect on some of the parallel and supporting recommendations made by the Health and Social Care Committee following our inquiry. We also, and independently, identified the lack of a long-term cross-departmental strategy for the early years. The lack of strategy means that it is extremely difficult for local authorities to know what they should be doing. That results in some local authorities excelling, and it may well be that they are the ones that most come to the attention of Government, but many local authorities really would appreciate more central direction on this and would welcome it if the Government set some demanding goals to reduce ACEs, improve school-readiness and reduce infant mortality and child poverty. We have to consider all this in the context of increasing levels of child poverty, too.

Our report recommended that a Cabinet-level Minister, possibly the Minister for the Cabinet Office, should have specific Cabinet-level responsibility for the oversight of a national early years strategy. However, it is not enough just to have strong central leadership, although that is necessary; the Government are right to say that all the delivery must be local. The Committee that I chaired heard evidence of fantastic local community collaboration—the NHS, local authorities, the voluntary and community sector, and normal members of local communities working together. They should be the people bringing the Government’s national strategy to life at local level, inspiring improved support for children, parents and families in their areas.

However, that requires money and it requires organisations to pool budgets. We have seen health services and local authorities pool budgets into the better care fund in order to deliver on shared objectives for older adults. I think that we should have a better start fund, whereby local authorities, health services and the voluntary and community sector are pooling all their financial but also human resources around a set of shared objectives for the start of life.

There should also be a named, nominated individual in every local authority who is accountable to Government for that, because without accountability there is a real difficulty in ensuring that every local authority is meeting the required standards. There needs to be accountability and ring-fencing of money. There will always be urgent problems that demand attention and resources. We need to be able to secure this strategic shift from reaction to prevention, from constantly dealing with the urgent problems that are in front of us to investment in tackling the important problems that will reduce the urgent problems in subsequent years.

The Health and Social Care Committee’s report also calls for the existing and very good healthy child programme to be improved and given greater impetus. We think that it should be expanded to focus on the whole family, including fathers, rather than just the child, and that it should begin before conception. At the moment it does not begin until there is a child developing in a mother’s womb, but more work could be done before conception. The science of epigenetics is teaching us that what happens before conception can have a lifelong impact. The healthy child programme also needs to deliver more continuity of care for families. Having a different point of contact every time often leaves vulnerable families feeling isolated and confused. Health visitor engagement should be extended beyond the age of two and a half to ensure that all children are school-ready.

Our Committee heard from Scotland, Wales, Northern Ireland and other parts of the United Kingdom that had enhanced the healthy child programme. However, as the right hon. Member for North Norfolk has identified, there are many parts of the country where the healthy child programme is inadequate. At the moment there are five mandated contacts, and we heard that for some families that contact involves just sending a letter. How can a mum who is experiencing mental health problems, with all the associated stigma and the difficulty of disclosing that, possibly disclose it in the context of filling in a form rather than of having a supportive and engaged individual who is building a relationship with her? We were also told that 65% of families do not see a health visitor after the six to eight-week check. That clearly is not good enough.

Like the Science and Technology Committee, the Health and Social Care Committee identified the need for much better information sharing. Information needs to be shared among the different organisations. One problem is that there are often many different organisations helping to support a family and they are not talking to one another and do not use the same computer systems. Information governance rules can be an issue. Even though we know that the seventh Caldicott principle—sharing information when that is in someone’s best interests—is often the most important one, individuals working in those organisations often think that they are doing the right thing by not sharing information.

We also need to share information to make it possible for the long-term impact of interventions, perhaps in pregnancy or in early childhood, to be tracked to measure their effectiveness. At the moment, because we do not use a single identifier such as the NHS number, we cannot see whether a pregnancy intervention is having a desired outcome.

[Norman Lamb]

On the point about information sharing, it always strikes me that the tragedies that happen, such as that of Baby P, often happen because of a failure to share information and never because too much information has been shared. It is vital to change the culture, so that people understand the principle of the Caldicott rules about the importance of sharing information.

[Dr Williams]

I agree wholeheartedly. The right hon. Gentleman is right to use the word “culture”, because even though the guidance and rules are clear, and there are many circumstances in which it is in a person’s best interests for information to be shared, and actually the public expect us to be sharing information, the culture in health and care services is often one in which very well-intentioned and well-meaning professionals feel that they are acting in a patient’s interests by not sharing information. Perhaps the leaders of organisations are not permissive enough and encouraging enough about such sharing.

Last but certainly not least, the workforce are crucial to this. There must be a workforce strategy to tackle the reduction in the number of health visitors. I do not think that was a deliberate strategy, with the Government saying, “Let’s cut the number of health visitors by 2,000.” I think it has happened by accident. I think it has happened because the commissioning of the healthy child programme for the 0-to-19 age group was taken away from the NHS and given to local authorities, and that happened to coincide with a time when we had a Government who perhaps had less central control of that, and austerity. Of course, austerity was deliberate, but I do not think that anyone ever sat down and said, “It would be better for our country to have fewer health visitors.” Nevertheless, the consequence has been that there are fewer health visitors, and we need to make sure that those massive gaps are plugged.

We also need to make sure that the skills and knowledge of existing health visitors are improved. That is not to say that they do not have high levels of knowledge, but I have met many health visitors in the past year who had only recently become aware of the concept of ACEs, and who perhaps still lacked some skills around motivational interviewing and the ability to put themselves in another person’s shoes—to move towards where people are, rather than following the traditional, slightly more paternalistic approach of health services, which has been to try to persuade people to move to where we are.

If we get early years right, there will be huge benefits for everyone in our society. As politicians we should try to get them right, not just because it makes financial sense, but because every one of us knows that the evidence shows that doing so will create a better society. We should do it because we have a moral responsibility to our country’s children. Every child deserves the best start in life.

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[The Minister for Universities, Science, Research and Innovation (Chris Skidmore)]

It is a pleasure to serve under your chairmanship, Mr Davies. I congratulate the right hon. Member for North Norfolk (Norman Lamb) on securing this important debate on behalf of the Science and Technology Committee. I know this is an area that he cares passionately about, and I pay personal tribute to the work he did in a previous Parliament as Minister of State for Community and Social Care between 2012 and 2015.

I also thank other hon. Members who have participated in today’s debate. Their contributions have shown not only clarity of thought about these issues, but real passion about what is taking place in their local areas. It is a tribute to those Members’ local commitment that they have worked with their communities to address these issues. We have heard from the hon. Members for Bristol North West (Darren Jones), for Stockton South (Dr Williams), for Linlithgow and East Falkirk (Martyn Day) and for Batley and Spen (Tracy Brabin), and there have also been important interventions from the hon. Members for Stroud (Dr Drew) and for East Lothian (Martin Whitfield). I am grateful for the opportunity to set out the Government’s approach to addressing early childhood adversity and trauma, and the actions we are taking to improve children’s life chances through early intervention.

The Government are strongly committed to effective early intervention in childhood. That means not only effective prevention, identification and support for children and families in need, but building a strong evidence base to underpin those things. The hon. Member for Bristol North West asked whether I, as Science Minister, would commit to ensuring that we take forward an evidence-led approach. I passionately believe that the investment we make in research must not only go into healthcare research, but into the social sciences.

[Norman Lamb]

I appreciate the point that the Minister is making, but does he recognise that without collection and national analysis of data, we have no idea how public money is being spent across the country and whether it is being spent effectively?

[Chris Skidmore]

I appreciate the right hon. Gentleman’s point, and I agree with what he has said about data collection; I will return to that topic later on. I am also a new Minister in the Department for Education, covering the universities sector. I recently set up a higher education data advisory committee, because I value the importance of such evaluation at both local and national level— for example, when we look at university access and participation. We have also set up the Evidence and Impact Exchange in partnership with King’s College London and Nottingham Trent University, to examine the methodology behind encouraging more disadvantaged pupils to have access to, and opportunities at, university. That is at one end of the scale, but today we are talking about what we need to do at a far earlier stage of a child’s education.

When it comes to scientific research, and early years research in particular, we must ensure that we listen to the scientific community when it comes to neuroscience and cognitive behaviour; that we are careful about how we use that scientific research to make public arguments and develop public policy; and that we work with those scientists. I am sure that they will develop new innovations and scientific research, which may even challenge our understanding of these policies. It is important that we work together as a community, understanding that evidence base and drawing on the good work already conducted at national and local level.

I welcome the recent establishment of the early years ministerial group on family support, which is reviewing how to improve the support available to families in the first two years of a child’s life, identifying opportunities for co-ordination and improving cost-effectiveness. I look forward to the valuable contribution of that group, which will provide specific recommendations to the Secretary of State. I am unable to provide a timetable for that, as the hon. Member for Batley and Spen asked me to, but I will ensure that the group is aware of today’s debate. I am sure that its members will all wish to engage with the Science and Technology Committee regarding specific issues raised in its report, and on any future work that the Committee does. The Government value the work of that Committee and recognise its place in public discourse. As we proceed, we will make sure that we engage with some of the recommendations that the Committee has made.

[Mike Gapes in the Chair]

Turning to the role of Government in early intervention, the model for adverse childhood experiences gives us a helpful focus for action on early intervention. We must also ensure that there is an overarching model for care and support. Fundamental to that is the belief that local areas are best placed to understand the needs of their local communities, and to commission early intervention services that best meet those local needs as part of a whole systems model. We have heard about some excellent examples of local innovation, such as the one given by the hon. Member for Bristol North West, who talked about the work of Bristol City Council. The fact that the council had to hold its conferences twice clearly demonstrates the demand for those services. We also heard about the work in Greater Manchester. It is important that we allow that innovation and creativity to flourish as part of future work, but, importantly, we should not expect local areas to do that work alone. The matter is a serious and complex one, and our approach, which reaches across all Departments and Governments, reflects that.

Our approach is based on a number of principles, which are as follows. First, early rather than late intervention is key; secondly, the role of central Government is to support, facilitate and work with local government and other partners to tackle these issues together; thirdly, our solutions should be focused on outcomes and underpinned by evidence; and fourthly, successful strategies should be identified and shared widely within the sector. With that in mind, we have prioritised three key areas for central Government focus to build resilience to adversity and trauma. Those are: physical and mental health in pregnancy and childhood; protecting vulnerable children through effective children’s social care; and improving social mobility, supported in the early years by high-quality early education settings and learning in the home. That is underpinned at all levels by our work to improve services and partnerships locally, and to build the evidence base for what works.

I will address each of those areas in turn. First, when it comes to supporting physical and mental health in pregnancy and childhood, the Government recognise the serious impact that adversity in early childhood can have on children as they grow up; the hon. Member for Stockton South set out some striking examples. Support must begin as early as possible, and maternity services have a central role to play. The NHS long-term plan will make the NHS one of the best places in the world to give birth by offering mothers and babies better support. It will also expand the provision of quality mental health support for new and expectant mothers and their families. The evidence shows that this is a key opportunity to improve outcomes for mothers and children.

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[Chris Skidmore]

I will come to the question of health visitors later in my speech, but I will be more than happy to pass on the hon. Lady’s point about the collection of data and look at what evaluations might be possible. I will certainly make sure that hon. Members’ contributions are reflected in my discussions with the Department.

Local authorities are receiving £16 billion between 2015 and 2021 to spend on public health functions, which includes funding to support the healthy child programme and the mandated five health visits, which the hon. Lady mentioned, for children between the ages of nought and five. We are seizing the opportunities presented by such moments with families. A key piece of partnership working between the Department and Public Health England will see the Institute of Health Visiting train up to 1,000 health visitors in 2019 to identify and support children with speech, language and community needs early. The health visitors will then cascade the training to provide even greater reach. It is important to make sure that an evaluation takes place to make sure it is as effective as possible.

On the recruitment of additional health visitors and the quantity of visits, health visiting services are commissioned by local health authorities, and health visitors are employed by the local health service providers. However, the Government will continue to work with partners, child development experts and professional organisations representing health visitors to ensure that the healthy child programme remains an effective and evidence-based framework providing good health, wellbeing and resilience for every child.

On the wider issues around early intervention and making sure it is adversity-targeted among the early years workforce more broadly, it is crucial that early years practitioners are well trained to protect young children from the impacts of adversity and trauma. As part of the early years foundation stage statutory framework, service providers are obliged to ensure that all staff have up-to-date knowledge of safeguarding issues and are equipped to identify and address signs of abuse and trauma. We want to equip the early years workforce to deliver outstanding services, to adopt evidence-based approaches, to learn from best practice and to deliver quality outcomes. The Government are supporting that with a professional development fund and similar programmes, such as the newly established Social Work England, which will ensure that social workers receive the highest quality initial education access and continuing professional development.

[Norman Lamb]

It is helpful to hear what is happening now. Does the Minister see value in defining a national strategy—the approach taken in Scotland and Wales—to try to drive the good things that he says he wants and make sure they happen everywhere, or does he resist the idea? It is important for us to understand whether there is an opportunity to work together with the Department to try to achieve something that is greater than the sum of its parts. Is he up for that and could he persuade his colleagues, or does he positively resist what we are arguing for?

[Chris Skidmore]

The right hon. Gentleman has stolen the latter part of my speech. When it comes to the broader point, I recognise that the Committee’s work, for which the Government are extremely grateful, reflects on the development of a national strategy. Currently, the Government do not consider the formal publication of a national strategy to be necessary. However, the Government will seek to review the approach through the spending review and the upcoming prevention Green Paper, which will build on the November 2018 Department of Health and Social Care report “Prevention is better than cure”, and its priorities. Also, we will look forward to the value that the early years family support ministerial group will add to the Government’s approach. Although I cannot commit in today’s debate to taking forward a national strategy, the Government are certainly working on a future Green Paper and the approach might change.

It is important to reflect on a balanced collection of the evidence that demonstrates what works, which will then inform any future approaches as part of the future prevention Green Paper. I realise that my response does not entirely answer the right hon. Gentleman’s question, but I want to reflect on the fact that the present does not necessarily rule out a change of direction in future.

Various Members mentioned children’s centres. The Government believe that children’s centres have an important role to play in early intervention, but it is right that local councils continue to decide how to use them as part of the wider system of local services. As part of our local government programme, local authorities are looking into how early years services can be improved. The right hon. Gentleman raised the question of Ofsted inspections. When inspections of children’s centres were suspended, there was at the time an agreement that they were not fit for purpose. However, children’s social care services and all registered early years prevention, including that delivered in children’s centres, remain subject to robust and regular Ofsted inspections.

When it comes to the consultation that has been mentioned and the delay in moving forward, the Department still needs to understand how local authorities effectively use centres to improve outcomes as part of their broader strategy before we go further. That is why we will be investing in What Works, which I will talk about later in my speech, working with the Education Endowment Foundation and delivering the £8.5 million local government programme. The programmes will inform the next steps in our strategy, including any future consultation. We need to look at the evidence from the programmes before deciding whether a consultation is indeed the correct way ahead.

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[Norman Lamb]

It is very good to see you in the Chair, Mr Gapes, and it is a pleasure to serve under you for the last part of the debate. I do not want to detain people for long, but I thank the Minister, particularly given that this is not his portfolio, for engaging in the discussion. He made an interesting point at the end about the Government’s £6 billion investment in early years. How extraordinary it is that we are making that investment without really having any idea about how it is being spent and whether it will be in any way effective.

The shadow Minister, the hon. Member for Batley and Spen (Tracy Brabin), made the very good point that we are committing more Government resource to children whose parents are both in work than we are to the most disadvantaged children. I understand the value of that from a work perspective, but the Government have to understand that that increases the divide between the most disadvantaged and all the rest.

I thank the hon. Member for Bristol North West (Darren Jones), who has stayed to the bitter end, for all his work on the Committee. I thank the Scottish National party spokesperson, the hon. Member for Linlithgow and East Falkirk (Martyn Day), and the shadow Minister for their contributions. The striking thing was that everybody who contributed to the debate, including the hon. Member for Stroud (Dr Drew), was making the same points to the Minister.

Perhaps I am being over-optimistic in seeing a little chink of light. Although the Government’s approach is wholly inadequate and passive in response to such significant evidence, I note the point that the Minister made in response to my intervention. He said that we have three key things coming up: the inter-ministerial working group, the Government’s Green Paper on prevention, and the spending review. Combined, they provide us with an opportunity to follow the evidence, to start spending money in a way that applies evidence about what works, and to monitor what is happening around the country. It is not about directing local areas and imposing things on them from the centre, but holding them to account because we have the data nationally to do that.

We have an opportunity that, as has been said, is completely non-party political; it is just about the effective use of public money, and investing at the moment when it is of most value and impact—early, rather than later, when the damage has already been done. There is an opportunity here, and I urge the Minister and his colleagues to grasp it, rather than to continue in a way that fails too many children across our country.

Question put and agreed to.

Resolved,

That this House has considered the Eleventh Report of the Science and Technology Committee, Evidence-based early years intervention, HC 506, and the Government response, HC 1898.