Oral Answers to Questions

Paul Williams Excerpts

Tuesday 29th October 2019 Commons Chamber

[Ms Dorries]

It goes without saying that anyone affected by a friend or family member taking their own life will be absolutely devastated. We made an announcement at the weekend of nearly £1 million of funding to target 10 areas to help to provide assistance and support to the bereaved. We will assess those 10 sites to see what is delivered and how it works, and we will hopefully be able to roll the scheme out across the UK in the future.

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

I refer the House to my entry in the Register of Members’ Financial Interests. The time in a woman’s life when she is most likely to struggle with her mental health is when she is pregnant or shortly after delivery, but half of all women with depression during that period say that their problem remains unidentified by the NHS. Does the Minister think that it is time for all women to get a postnatal check from their GP as part of the GP contract?

[Ms Dorries]

We are looking into that. Perinatal support is provided to women across the UK. We have been pushing this from the Department. The hon. Gentleman is absolutely right that this is a time in a woman’s life when she may suffer from poor mental health or a mental health condition that is directly related to her pregnancy, and that is when women need support most. We are looking into this, we are pushing this and we are looking into providing that, hopefully as part of the GP contract.

Oral Answers to Questions

Paul Williams Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Jackie Doyle-Price]

My hon. Friend is right: people with mental health conditions do tend to develop them as children. Clearly, the earlier we can give them support to help them manage those conditions, the better for their long-term wellbeing. Equally, however, we need to make sure we have sufficient community services when they leave school and get older, so that having invested in their wellbeing, it can be continued through later life.

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

Is the Minister confident that the mental health of the 5,000 children with special educational needs who spent time in school isolation booths last year was not harmed, and if not, what representations has she made to the Secretary of State for Education about this practice?

[Jackie Doyle-Price]

The hon. Gentleman, as usual, raises a very important issue indeed. Of course, people with special educational needs will be at risk of mental ill health more than any other cohort of children. I am having regular meetings with the Under-Secretary of State for Education, my hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi), who has responsibility for children and families, about this very vulnerable group. Having targeted mental health provision across mainstream schooling generally and put in such investment, we now really need to home in on the groups at highest risk.

Oral Answers to Questions

Paul Williams Excerpts

Tuesday 18th June 2019 Commons Chamber

[Jackie Doyle-Price]

It is essential that we end the practice of out-of-area placements because, as my hon. Friend rightly says, being in close proximity to family and friends is clearly going to aid the recovery of anyone suffering from mental ill health. This has been a particular problem for children and young people, and a particular problem in the south-west, but I can report to him that NHS England is making sure that we have more adequate bed provision across the country, and we will continue to drive down these out-of-area placements.

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

Somebody is much more likely to need mental health services if they have experienced childhood adversity. The all-party group on the prevention of adverse childhood experiences has looked in detail at the evidence base on policies to prevent this adversity. What is the best thing the group can do to influence the Government’s prevention strategy?

[Jackie Doyle-Price]

I have to say, the hon. Gentleman does it very well: he continually makes noise about this important issue. He is absolutely right that adverse childhood experiences inform people’s future mental health, or mental ill health. We are currently looking at our provision for early years intervention and the first 1,001 days—the hon. Gentleman and I have discussed the importance of that—but we need to make sure that state organisations take advantage of every contact they have with children, to ensure that we pick people up when they are vulnerable.

Interim NHS People Plan

Paul Williams Excerpts

Wednesday 5th June 2019 Commons Chamber

[Stephen Hammond]

I am sorry, I wholeheartedly apologise to the right hon. Gentleman. I certainly join him in welcoming the RCN’s welcome for a people plan. It is a great and sensible step forward, without being complacent about what needs to be done in the next phase, which will be published later in the year. He will know that we have been working with other EU members to ensure that, after what I hope is an orderly Brexit, there is continued recognition of medical qualifications. He will know that the European Commission has already set out its desire for a wide-ranging, extensive reciprocal healthcare agreement, and the Government continue to work to achieve that ambition.

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

I do not think that the Minister is taking this seriously. In the past two years, 5,000 nurses and midwives from EU countries have left the NHS, at a time when we are 40,000 nurses short. Does he agree with David Behan, the chair of Health Education England, who agreed yesterday that Brexit was exacerbating the NHS staffing crisis?

[Stephen Hammond]

I have already set out the fact that the Department, the whole NHS management, the whole NHS, and we as a country welcome and recognise the huge contribution of EU nationals in the NHS. I have set out our desire to continue to ensure that EU nationals work in the NHS. Alongside that, I know that Sir David Behan will have also said to the hon. Gentleman that it is important that we have more routes into nursing to ensure that those 40,000 vacancies that he discussed do not continue, which is why we have set out in the plan more nursing apprenticeships, more nursing associates and more clinical placements. It is important to have both international and domestic recruitment.

Health

Paul Williams Excerpts

Tuesday 14th May 2019 Commons Chamber

[Matt Hancock]

No. I agree with the hon. Gentleman about the importance of clean air, but I gently point out that dealing with the deficit—the annual amount by which the Government was overspending—is, and must be, the precursor to getting the debt down. Now, thankfully, the debt is falling relative to the economy, but there has been an awful lot of hard work to get us there.

Let us look at some of the things the NHS is delivering. The entire population now has access to evening and weekend GP appointments. More than a million GP appointments a month are now booked online, and consultation increasingly takes place online. More than three million repeat prescriptions are done online. There are more than 2 million more operations a year than in 2010, and we see 11.5 million more out-patient appointments than in 2010. Since last year, more than 500 extra beds a day have been freed up in hospitals.

When it comes to the future, only yesterday we announced that a new treatment aid for brain cancer can be rolled out across the country, benefiting up to 2,000 patients, all because of the extra money we are putting in. My right hon. Friend the Member for Wokingham (John Redwood) is quite right that in return for the extra taxpayers’ money we are putting in, we must get extra out, too.

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

Extra investment in the NHS is welcome, but when will the Secretary of State start talking about health visitors, school nurses, drug treatment services and other services funded out of the public health grant—the topic of the debate?

[Matt Hancock]

The public health grant is settled in the spending review. The NHS settlement has come before the spending review, and the public health grant is only one part of the approach to public health. In 2015, this House agreed, with broad acceptance across parties—I know the hon. Gentleman was not in the House then—that local authorities should take responsibilities for public health, to ensure that the entirety of local authority activity could be focused on better public health.

Public health is not just what happens in the NHS, with councils or in GP surgeries or hospitals. For instance, the Government have taken a global lead in getting social media companies to remove suicide and self-harm content online because of the danger that poses to people’s mental health, and in particular that of children and young people. That is a public health issue. Likewise, the efforts we are making to reduce air pollution in the environment Bill—a broader piece of legislation than just a clean air Act—are about a public health matter. It is not in the public health grant, but it is a public health matter.

--- Later in debate ---

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

It is a pleasure to follow my colleague the hon. Member for St Ives (Derek Thomas), who serves with me on the Health and Social Care Committee. I warmly welcome the new Minister to her place, but if she thought she would learn about public health in the debate, she will be sadly disappointed. I and Opposition colleagues have sat and listened to Government Members talk about anything other than public health. It is so disappointing that Government Members do not seem to know what public health is.

I really care about public health. I care about it so much that, after spending five years training to be a doctor and another four years training to be a GP, I did a master’s degree in public health. It is so important because it is about health inequalities and the massive gap in life expectancy, which we are seeing increasing. I represent the town of Stockton-on-Tees, where the life expectancy gap between men living in the most deprived areas of town and those in the wealthiest is more than 11 years; for women, it is more than 16 years. Much of that is because of the inverse care law that tells us that the people with the highest need are those least likely to access healthcare. Those with the highest need for cervical screening are least likely to access it. Those with the highest mental health problems are less likely to access those services. Those with the highest needs for smoking cessation services are least likely to access them. Investment in public health makes economic sense, because prevention is better than cure, and it makes really good social justice sense.

Tempting as it may be to invest in another building or buy another machine that goes ping, the real difference that can be made to health inequalities and public health comes right at the beginning of life. The first 1,000 days are where most health inequalities are sown. It was a privilege recently to chair the Health and Social Care Committee’s inquiry on the first 1,000 days of life: a time when developing brains make a million new connections every single second. If we get it right then, we can build healthy minds and healthy bodies, but if we get it wrong, that can cause all kinds of problems.

The fact is that more than 8,000 children in this country live in homes with the triad of a parent with a mental health problem, a parent with substance misuse problems and domestic violence. What intervention will make the real difference? How can we help those children? That is done largely through the work of health visitors, and I am afraid that since public health funding and the responsibility for public health was transferred to local authorities, we have seen a cut of 2,000 health visitors employed by the NHS and 1,000 Sure Start centres have closed.

These are the things that make the real difference. They make a difference to breastfeeding, of which our rate is one of the lowest in Europe; to child mortality, our levels of which are much higher than those in comparably rich countries; and to detecting the hidden half of women with perinatal mental health problems who say they were not detected by health services.

I hope that it has not been a deliberate strategy to disinvest from these important services. I think that it has happened by accident. Either way, we have to make a difference; the situation must be rectified. I welcome the work of the cross-departmental ministerial working group that the Leader of the House is leading, and I hope that the new Minister is lobbying the Treasury and making a passionate case for investment at the start of life.

[Liz Twist (Blaydon) (Lab)]

My hon. Friend is making a powerful speech about the importance of public health, especially in the early years. In Blaydon, which is part of Gateshead Council, the public health budget has reduced by 15% since the transfer of health visitor services, which has led to the loss of services that make a big difference to people on the ground. Is it not a shame that we are losing vital public health services?

[Dr Williams]

It is painful that that is happening in places such as Blaydon, where life expectancy is declining. Life expectancy in the north is declining, and there are huge life expectancy gaps between north and south. It is the very part of the country where we should be investing in public health, not making cuts. In Stockton-on-Tees, public health has been cut by £1 million in the past two years.

What do we want? It is 10 years since the Marmot review set out the evidence base for how to reduce health inequalities. We should be doubling down on investment in health inequalities. We should be investing in sexual health services. We should be investing in drug treatment services, which nationally have been cut by 16.5%. Instead, we see year-on-year funding reductions, public health is being cut to the bone, life expectancy is falling and health inequalities are rising. The Government need to show an absolute commitment not just to treatment services but to grassroots prevention services in communities up and down the country, and they must invest properly in public health services. Local authorities are the right place for them to be, but they have to be properly funded and supported.

Oral Answers to Questions

Paul Williams Excerpts

Tuesday 7th May 2019 Commons Chamber

[Caroline Dinenage]

My hon. Friend is absolutely right to raise this issue. Reasonable adjustments are critical for improving the experiences of health and care for autistic people. That is why the long-term plan commits to a digital flag in patient records, which will ensure that staff know whether a patient has a learning disability or autism. At the same time, we are looking at how we record where a diagnosis of autism has been made.

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

In 2017, more than 100 MPs wrote to the then Health Secretary demanding a national target of a three-month waiting time for autism diagnosis because waits were more than four years in some areas. Stockton clinical commissioning group and Stockton Council have reduced waits, but what do current figures show? Will the Government now set a target in line with National Institute for Health and Care Excellence guidance?

[Caroline Dinenage]

I am pleased the hon. Gentleman has raised this issue, because he is absolutely right that we need to drive up performance nationally on diagnosis for autistic people. It is only with diagnosis that people can get the support and help they need. We are collecting data for the first time. It will be published later this year for the first time. It will mean that each area can be held to account and given the help and support it needs to drive up those figures.

Government Mandate for the NHS

Paul Williams Excerpts

Thursday 25th April 2019 Commons Chamber

[Stephen Hammond]

My hon. Friend is right. At the heart of the long-term plan is the emphasis on primary care and prevention. Providing care for people in their own homes undoubtedly achieves better outcomes for patients and he is right to welcome it.

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

The Minister will know that NHS England is currently consulting on proposals to change the law to remove mandatory competition, but billions of pounds’-worth of NHS services are currently out to tender. Has he considered, as part of the mandate, issuing clear guidance to CCGs that while the consultation is taking place they do not need to put many services out to the market? Or is he happy for that privatisation to continue on his watch?

[Stephen Hammond]

The hon. Gentleman is right to point out that a consultation is being undertaken on various aspects of the long-term plan and the legal framework that needs to be put in place. It is entirely up to local CCGs to make decisions on their procurement policy.

Oral Answers to Questions

Paul Williams Excerpts

Tuesday 26th March 2019 Commons Chamber

[Matt Hancock]

Yes, absolutely. Driving the social prescribing agenda, which is based on increasingly strong evidence of the power of social prescribing to help people stay healthy and get them healthy again when they are ill, will also involve wider use of personal budgets. Almost 1 million people have personal budgets.

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

I join my hon. Friend the Member for Manchester Central (Lucy Powell) in paying tribute to the very hon. Member for Winchester (Steve Brine), and I also pay tribute to my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders). Has the Secretary of State seen Professor Clare Bambra’s research in the Journal of Epidemiology & Community Health this month, showing that inequalities in infant mortality between deprived and more affluent areas fell between 1999 and 2010 when there was a Labour Government, and then increased from 2011 to 2017? Is it not true that only Labour has the range of co-ordinated, cross-governmental policies that reduce inequalities in child health?

[Matt Hancock]

No. The NHS long-term plan has a whole swathe of policy to reduce health inequalities. The best thing we can do to reduce health inequalities is ensure that more people are in work, and the record number of jobs that have been delivered is a vital part of that agenda.

Integrated Care Regulations

Paul Williams Excerpts

Monday 18th March 2019 Commons Chamber

[Stephen Hammond]

As the hon. Lady knows, this has been subject to considerable scrutiny. It has been scrutinised by the Health and Social Care Committee, as she has already heard from its Chairman. She will also have heard that it has been subject to a number of other scrutiny processes, including judicial reviews.

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

The Minister is correct in saying that there has been some analysis of integrated care partnerships by the Health and Social Care Committee, but it has not scrutinised this statutory instrument. The Select Committee actually recommended very clearly that ACOs or ICPs should be NHS organisations. Will the Minister say why he should not accept the Committee’s recommendation?

[Stephen Hammond]

As the hon. Gentleman knows, the long-term plan has set out that the ICP contracts will be held by public statutory providers. That point has been made and reiterated several times not only in the Select Committee’s scrutiny, but in the remarks that the Committee and a number of people have made about privatisation. The Chairman of the Health and Social Care Committee has already intervened on the shadow Secretary of State, but she has said:

“The evidence to our inquiry was that ACOs, and other efforts to integrate health systems and social care, will not extend the scope of NHS privatisation and may effectively do the opposite.”

Health and Social Care Committee

Paul Williams Excerpts

Thursday 28th February 2019 Westminster Hall

[Mr Virendra Sharma (in the Chair)]

We begin with the Select Committee statement. Dr Paul Williams will speak on the publication of the thirteenth report of the Health and Social Care Committee, “First 1,000 days of life”, for up to 10 minutes, during which no interventions may be taken. At the conclusion of his statement, I will call hon. Members to put questions on the subject of the statement and call Dr Williams to respond to these in turn. Members can expect to be called only once and their questions should be brief.

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

Thank you, Mr Sharma, for inviting me to address this Chamber, so that I can present the Health and Social Care Committee’s report into the first 1,000 days of life.

I have been studying and working in health for the past 27 years and I have concluded that if our society wants the most effective interventions to improve health, we must act in the period from conception to the age of two. That is because the seeds of health inequalities are sown during that time. Good social, emotional, physical and language development during that time is crucial to building healthy brains and children, and having a healthy society.

This week our report set out an ambition challenge to the Government and all our colleagues in the House. We want to kick-start the second revolution in early years services, as recommended by the Marmot review in 2010, so that our country can become the best place in the world for a child to be born. Building that kind of society drives me, not only as an MP, but as a father and doctor.

I thank the hon. Member for Totnes (Dr Wollaston) for letting me take the Chair of the Committee for this inquiry. It is typical of her generosity of spirit that she seeks to give opportunities to others. I hope that I have done justice to the chance she gave me. I thank my Committee colleagues—of all parties and of none—for their support and guidance during our inquiry. I thank our Health and Social Care Committee staff team, particularly Lewis Pickett, Dr Joe Freer and Huw Yardley, who played a crucial role in helping us to make this report a reality.

Almost all research into this subject demonstrates that our path in life is set during the crucial first 1,000 days from conception to the age of two. Healthy social and emotional development during that time lays the foundations for lifelong good physical and mental health. Yet, our current political system invests a fortune in reacting to problems much later in life, leaving a gaping void where we should be warriors for a fairer and healthier society.

During the first 1,000 days of life, more than 1 million new brain connections are made every single second, and babies’ brains are shaped by the way in which they interact with others. However, more than 8,000 babies under the age of one in England currently live in households where domestic violence, alcohol or drug dependency and severe mental illness are all present. Over 200,000 children under the age of one live with an adult who has experienced domestic violence or 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 are much more likely to get heart disease, cancer and mental health problems than those who are not. Children exposed to four or more ACEs are 30 times more likely to attempt suicide at some point in their life, 11 times more likely to end up in prison and three times more likely to smoke as adults than those exposed to no ACEs. Our politics is currently failing some of these babies and other children who are born into families where poverty strongly affects their chance of achieving good health.

As part of this inquiry, our Committee read 90 submissions of written evidence and held three focus groups with stakeholders. I thank those who made superb contributions to our three oral evidence sessions. I particularly thank David Munday from Unison, Sally Hogg from Parent Infant Partnership and Viv Bennett from Public Health England for their guidance to me.

Our Committee was keen to reach outside Westminster for evidence. We hosted an online forum on Mumsnet, where we heard 80 stories from parents telling us about their experiences of pregnancy and early childhood, as well as their views on services. We visited the Blackpool Better Start project, run by the National Society for the Prevention of Cruelty to Children and funded by the Big Lottery Fund. We held focus groups with representatives from councils, clinical commissioning groups and charities from across the country.

We all know how austerity has affected our councils and the NHS over the last nine years, but we saw how a relatively small Big Lottery Fund investment had helped local authorities to redesign their services. Staff were able to take time to reflect. The extra money brought added capacity and outside expertise. We saw joined-up, effective collaboration between the council, NHS commissioners and providers, the voluntary sector and the police.

We also saw the importance of investing in long-term goals and service transformation, rather than just using money to firefight short-term challenges. We heard how having a one-stop shop for families helped to provide better support, and helped professionals to have better relationships with each other and to share information. We visited community spaces across Blackpool, including a library and a local park, which had been transformed by members of the local community, to make them more suitable for families with young children. We heard about the importance of a father in a young child’s life. Some fathers say that they lack parenting skills and other fathers felt that the system excluded them.

I firmly believe that we need to devote much more attention and protection to resources for this crucial period of life. There are many people across the political divide who share that belief. This is an area where politicians should be working together. It was very encouraging to hear that the Early Years Family Support Ministerial Group, led by the Leader of the House, was announced shortly after the start of our inquiry. That has the potential to take forward some of our Committee’s recommendations. I will soon be meeting with the Leader of the House to hear about the group’s progress.

Our inquiry has identified the need for a long-term, cross-Government strategy for the first 1,000 days of life, setting demanding goals to reduce ACEs, improve school readiness, and reduce infant mortality and child poverty. Our report recommends that the Minister for the Cabinet Office should be given specific Cabinet-level responsibility for the oversight of this national strategy.

We want communities, the NHS and voluntary groups to be led by local authorities, to develop their plans to bring this Government strategy to life, inspiring improved support for children, parents and families in their area. We think that a Government transformation fund should be established to encourage these different groups to come together, to pool their resources and deliver shared, agreed actions. We also think that a single nominated individual in each area should be accountable to the Government for progress.

Our report also calls for the existing, and actually very good, healthy child programme to be improved and be given greater impetus. It should be expanded to focus more on the whole family rather than just the child, begin before conception, deliver more continuity of care for families—something we found families really valued—and extend health visitor engagement beyond the age of two and a half, to ensure that all children become school-ready.

We heard from Scotland, Wales, Northern Ireland and parts of the United Kingdom that had enhanced the healthy child programme. However, we also heard from too many areas where some of the contact with health visitors was just a letter, and we were told that 65% of families do not even see a health visitor at all after the six to eight-week check. That clearly is not good enough. Our report recommends that information sharing needs to be significantly improved. Information needs to be better shared between organisations so care can be better co-ordinated and the long-term impact of an intervention can be tracked and assessed.

Alongside that, we need a workforce strategy to address the reduction in health visitors. That does not seem to have been a deliberate strategy, but happened because local authorities were given the funds for the healthy child programme at the same time as they had their budgets cut. We also want the strategy to make sure that knowledge and skills are improved, especially knowledge of ACEs and the importance of using motivational interviewing techniques.

If we get this crucial 1,000 days of life right, it will have huge benefits for everyone in our society. As politicians, we should try to get it right not just because it makes financial sense, but because every single one of us in Parliament has a moral responsibility to our country’s children. Every child deserves the best start in life.

[Mr Ben Bradshaw (Exeter) (Lab)]

I congratulate my hon. Friend on his excellent chairing of the inquiry, his drafting of the report and his speech. Children in their first 1,000 years do not have as much of a political voice as other lobby groups, but does he agree that when Governments face difficult decisions about spending priorities, spending money on those children makes more sense than spending money on older young people in higher education, many of whom are well-off and talented and will do perfectly well in the rest of their lives? The best investment is in those first 1,000 years.

[Dr Williams]

I agree with my right hon. Friend’s proposition that investment at the beginning of life is likely to pay the greatest dividends, particularly in reducing inequalities. As politicians, we should represent all members of our communities, not just those who are old enough to vote or who choose to vote. There is an opportunity in the comprehensive spending review to make the case for long-term investment in that group of children.

[Dr Sarah Wollaston (Totnes) (Ind)]

I pay tribute to the hon. Gentleman for his effective chairing of the inquiry, and for his powerful speech. I also pay tribute to the other Committee members and the wider Committee team for the excellent report. It is fantastic that it sets out effectively the importance of early intervention in the first 1,000 days if we are to make the greatest difference and have the greatest impact on reducing inequalities.

Will the hon. Gentleman join me in paying tribute to a group in my constituency, the Dartmouth Nurslings, for its work to support breastfeeding mothers through peer-to-peer support? Will he touch on the evidence about the important of breastfeeding in the first 1,000 days of life, and how effective it can be? Will he also join me in hoping that we can reduce some of the fragmentation that means there is not a consistent level of support across the country? I hope that such groups will receive the support they deserve.

[Mr Virendra Sharma (in the Chair)]

Order. Hon. Members should keep their questions short.

[Dr Paul Williams]

I absolutely join the hon. Lady in commending the breastfeeding peer support workers in Totnes, and those in many other parts of the country—I have met some in my constituency, too. There is a common theme: when services are reconfigured and new services are put out to tender, the people who have devoted a lot of time and effort as volunteers can find themselves excluded. That is partly because of the nature of commissioning and tendering.

The Royal College of Paediatrics and Child Health gave us compelling evidence about breastfeeding. In the United Kingdom, we have some of the lowest breastfeeding rates in the whole of Europe, and there are wide socioeconomic disparities. Investment in breastfeeding support is crucial.

[Alison Thewliss (Glasgow Central) (SNP)]

I will pick up where the Chair of the Select Committee, the hon. Member for Totnes (Dr Wollaston), left off. I saw from the report that there was extensive consultation with Mumsnet. Why is there not a more specific recommendation in the report for more comprehensive breastfeeding support? What the hon. Gentleman says is correct, but it would have been good to see it in the report. During the Committee’s visit to Blackpool, were the cuts to the Breastfeeding Network’s star buddies programme mentioned? That service was lost in 2017.

[Dr Williams]

I thank the hon. Lady for those questions. One of the Committee’s early reports of this session was about childhood obesity. We made specific recommendations in that report that we have not necessarily repeated in this one.

We saw many wonderful things in Blackpool. We did not learn about the specific service to which the hon. Lady refers, but we did learn that many services have come under a lot of financial pressure. Even though there was some Big Lottery investment for transformation, services still needed to be cut, which sounds counterintuitive.

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

I declare an interest as the chair of the all-party parliamentary group for conception to age two—first 1,001 days, which is slightly more long-term than the first 1,000 days of life, but not nearly as ambitious as the first 1,000 years of life, to which the right hon. Member for Exeter (Mr Bradshaw) erroneously referred. I am also the chairman of the charity Parent Infant Partnership UK. I am grateful to the hon. Member for Stockton South (Dr Williams) for referring to Sally Hogg, one of our staff members, and Beckie Lang, our chief executive, who gave evidence.

I welcome the report, and particularly the ambitious way that the hon. Gentleman has described it as the “second revolution” in early years services. He is absolutely dedicated to the whole subject, which is so important, and which many of us have been banging on about for some time. I have two questions. First, a slight disappointment is the shortage of space given to the case for investment. The hon. Gentleman knows as well as I do that, as we said in our all-party group report, “Building Great Britons”, the cost of child neglect is £15 billion a year, and the cost of maternal perinatal mental illness is £8.1 billion; that is £23 billion each year that we are spending on getting it wrong. Does he agree that we need to make the case that investment in this area will save substantial amounts financially and, more importantly, socially? The Treasury needs to understand that it is a serious investment case for the future.

Secondly, I approve of what the report says about locally delivered and joined-up services—a point that we put forward in our report, too. Does the hon. Gentleman agree that there is also a case, which we have made in the past, that that should be time-dated? Certainly, it should not take more than five years for every local area to have a united, joined-up, coherent and co-ordinated strategy for delivering this. It also needs to be measured, just as adoption scorecards were used at the Department for Education to measure the quality of the service delivery, so that it is not just a tick-box exercise. If we can get those two things right, the quality of the delivery will be much greater.

[Dr Williams]

I thank the hon. Gentleman for his advice and input at the start of the inquiry, and for the work that he has done as the chair of the all-party group, which is about the first 1,001 days—what is a day between friends? The economic case is exceptionally strong, and I am sure that the Minister has heard him make it eloquently. We all need to work together to make sure that we put the case to the Treasury. Ultimately, those spending decisions will have to be made in the comprehensive spending review; that feels like an opportune time.

The hon. Gentleman suggested that we ensure that there is a timeframe, that the commitment is not open-ended, and that local authorities have plans within a short time. We learned in our inquiry that local authorities are often left to just get on with it. The Committee felt that there was a need for much more central control and measurement, and for more accountability by central Government.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Stockton South (Dr Williams) on setting the scene so very well, and I thank the Chair of the Committee, the hon. Member for Totnes (Dr Wollaston), and the other members of the Committee for all that they have done to produce what I regard as a very helpful and significant publication.

The Government do not provide financial or practical help for parents of multiples. That needs to change. If someone is blessed with twins, triplets or more, they are on their own. What consideration did the Committee give to addressing this issue, as we have many concerns in this Chamber about the two-child tax credit limit?

Secondly, each year thousands of parents are forced to go back to work when their baby is still critically ill, as provisions for maternity and paternity leave are inadequate. Again, what consideration did the Committee give to combating this? It is not unreasonable to extend statutory leave and pay for parents whose baby is admitted to neonatal care by a week for every week that their baby stays in hospital. I will just explain that, because I may have rushed through it as quickly as I can, in my usual quick way. The parent of a baby who is premature, and whose peers at four months are rolling over, will be told by a health visitor not to worry, as their baby is not considered to be four months old. However, the fact is that when it comes to wages and money, that baby is considered to be that age, and the cost is £2,256 per family, so there is a financial strain.

Thirdly and lastly, nearly three quarters of multiple birth families get no discount on their childcare costs, and for triplets those costs can be as high as £2,500 per month. It is quite clear that that is not sustainable; unfortunately, it usually rings the death knell for someone’s career. What consideration was given to that issue in this report?

[Dr Williams]

I thank the hon. Member for so eloquently making the case on an issue that we did not look at specifically in the report; we did not look at multiple-child families. However, we made some comments in a more general way.

I will make two points in response. The first is that providing services to families is not enough. The whole environment in which they live, including the poverty that many families find themselves living in, is probably as important as the provision of services. The second point, which we make in the report, is that we should consider the impact on the early years in all policies as a principle—as a “health in all policies” principle—and we should particularly consider the impact of all policies on the developing brain of children. We state that very clearly as a recommendation in our report.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I congratulate the hon. Member for Stockton South (Dr Williams) on chairing an absolutely transformative report, and I also congratulate all the other members of the Health and Social Care Committee for their excellent work in putting the report together. All too often, trauma has been excluded from the work that we have done; we as a society have not recognised the importance of trauma in a young child’s life. I think trauma is at the root of many societal issues, as the hon. Gentleman says.

My question is on the work that the hon. Gentleman said had been done to involve fathers. What are the recommendations to involve fathers further, and to make sure that the system does not exclude them? Also, a number of grandparents, particularly paternal grandparents, who come to my surgeries feel excluded, but very much want to be involved in the first years, because those are the transformative years.

[Dr Williams]

I thank the hon. Member for the contribution that she has made to the Health and Social Care Committee, and to our thoughts in developing these ideas. We learned during our inquiry that fathers often feel excluded—systematically excluded. Much of the literature and many of the interventions are targeted at mothers. Culturally, services tend to push fathers a little bit further away, rather than bringing them in.

We recommend that the healthy child programme becomes a healthy family programme, and of course we know that every family is different. Families have different members; in some families, grandparents play a huge role, and in others, a lesser role. Our main recommendation is about a cultural emphasis, or a cultural change, in the healthy child programme, to make it a more holistic family experience.

[Paula Sherriff (Dewsbury) (Lab)]

I congratulate my hon. Friend on a very thoughtful—indeed, excellent—speech, and I look forward to reading the report in full. I am also very grateful to him for the work that he does on the all-party parliamentary group on the prevention of adverse childhood experiences.

I will talk a little about the service in my area through which mums who may be prone to post-natal depression are identified, even prior to conception. If men and women who are thinking of conceiving have a history of mental illness, or perhaps even fairly low-level depression or anxiety, they are identified, and the mental health support team work with that couple throughout pregnancy and then after the child is born. I note that my hon. Friend identified mental health as one of the key issues in relation to adverse childhood experiences, but would he welcome a wider roll-out of this kind of work, to support children’s first years?

[Dr Williams]

I thank my hon. Friend for emphasising maternal mental health. The Government have made significant progress in improving services, particularly for people with more severe perinatal health problems, but we still have too many cases where people are likely to develop mental health problems, even if those problems are not predicted, and who say they have mental health problems in the perinatal period, but services do not detect those problems. The National Childbirth Trust has estimated that perhaps up to 50% of mothers with perinatal mental health problems never get asked about their mental health. It is welcome that some areas of the country are responding to that issue in an assertive way and seeking to prevent perinatal mental health problems, rather than just detecting them early. However, we are left with a lottery, whereby some areas do this work exceptionally well, and other areas still have to catch up.

The idea of a local authority-led plan, with some central accountability, might help to bring the kind of services that are obviously being provided already in Dewsbury to many other parts of the country.

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

May I, too, thank the Committee for its excellent report?

As Members are aware, tackling inequalities is part of my brief and, frankly, there is no more obvious place to start than in the very early years. If we can get all children a good start, we will not only be well on the way to making life better for them, but will, as the hon. Member for Stockton South (Dr Williams) has observed, make savings for the taxpayer, too. I encourage him to continue pushing this work. As he is aware, prevention is very much at the heart of this Secretary of State’s agenda, and what we can do in the first 1,000 days is clearly a big part of prevention.

I note that the hon. Gentleman will meet the Leader of the House very shortly. He will find that she is very enthusiastic about and receptive to a lot of the themes that are discussed in this report, so my message—indeed, my plea—to him is this: please carry on with this work.