Early Childhood Development

Debate between Sarah Champion and Andrea Leadsom

Thursday 30th January 2014 Westminster Hall

[Andrea Leadsom]

Yes. I am grateful to my hon. Friend for making that point. Benchill has that amazing ability to reach new families by offering birth registration. As hon. Members will know, if a man is not married to the mother of the child, the only way to have his name on the certificate is to be present physically at the registration as the father. Therefore, the advantage of offering registration in children’s centres to families is that it offers the opportunity for the children’s centre to look at the parents together. Benchill certainly encourages its staff to chat to dad. It encourages them not to focus just on mum or baby, but to talk to dad and the other children if they are there—to engage with them, try to give them support and let them see what services are offered to dads and babies and not just mums and babies. That is a perfect example of how to support the entire family. In one fell swoop, Benchill deals with the problem of stigma—everyone goes to the children’s centre, so clearly there is no stigma—and those families who are deemed hard to reach and who so often need services but do not get them are automatically engaged.

The fifth proposal in our manifesto is that there needs to be a presumption of data sharing among perinatal health professionals. The incorrect perception remains that sharing concerns about a mum, a family or children is against the law. In fact, professionals talking to one another and sharing their concerns and the information that they have on different families could very often save lives by allowing earlier interventions to be made.

[Sarah Champion (Rotherham) (Lab)]

The hon. Lady is making a very interesting point. I am doing an inquiry into child sexual abuse, and one of the key blocks to getting prosecutions is the lack of information sharing among health bodies, education bodies, local authorities and the police, so I fully support the recommendation on that, because it seems to me the only way in which we can prevent abuse and other forms of neglect.

[Andrea Leadsom]

The hon. Lady is absolutely right. Sadly, in serious case reviews there is very often an element of failure on the part of health professionals—a failure to talk to one another. Very often, that is a contributing factor to the disastrous outcomes that we sometimes see for families and children.

[Andrea Leadsom]

Yes. Even my hon. Friend’s harder line is absolutely right: there should be a presumption in favour of data sharing. It should not be a case of people saying, “Oh, I didn’t know,” or, “I didn’t think it was allowed.” It should be a case of people being told, “If you didn’t share information, you should have done.” At the moment, that is not understood strongly enough.

Of course, data sharing is relevant not only in child neglect or child abuse cases. Let us say that a midwife meets a mother antenatally and is aware that that mother is terrified at the prospect of giving birth because of the physical implications, because she is afraid that her partner might leave her or because she is afraid that she will lose her job as a new mum. Often, when such issues are picked up antenatally, there is, first, a lack of places to refer that mum on to and, secondly, a lack of a communication path to enable the midwife to think about whom they should be talking to.

There is, therefore, a very strong argument for creating formal links between midwives, health visitors and children’s centres to ensure not only that they can talk to someone else, but that they must talk to someone else. The relevance of that to the mum’s experience is that if a midwife is concerned about a mum, they can perhaps refer her on to a mental health specialist midwife and a mental health-focused health visitor. That could all take place under the auspices of a sensitively attuned children’s centre, so that the mum’s needs can be met throughout the perinatal period, giving her the best chance of forming the vital secure bond with her baby. Data sharing is relevant not only to cases involving severe child protection issues; it is also about supporting mums who are just struggling. As we know, the statistics suggest that as many as 100,000 mums a year may be just generally struggling. It is not that there are severe physical or neglect threats to their babies; it is just that those mums need a bit of support, and at the moment we are not giving them that.

That takes me on to our sixth proposal. There is a huge need to provide proper training for front-line health and social care professionals in the importance of attachment and early brain development. I have been involved for about 15 years with parent-infant partnership charities that provide psychotherapeutic support to families. We also provide training to front-line professionals. It is astonishing how many post-training evaluation forms we get from midwives, health visitors, GPs and social workers that say, “Wow! I wish I had known before how important the earliest relationship is.” That is not as much about the physical health as about the emotional health and the attachment.

Our seventh proposal is that local commissioning groups and health and wellbeing boards should specifically consider the social and emotional needs of babies in their local strategies.

The eighth proposal is that childminders and nurseries should consider how they can better meet the attachment needs of babies in their care, and that Ofsted inspections should specifically provide guidance and assess their performance. As a member of the Committee considering the Children and Families Bill, which passed through the House of Commons recently, I was pretty shocked, when we had Ofsted in to give pre-Committee evidence, to be told that Ofsted inspectors do not routinely assess those looking after the very youngest—potentially babies from the age of three months to two years old—on how well the care setting is meeting their attachment needs. There is this sense of schoolifying in the inspection regime. It forgets about how well the key worker is playing with the baby, responding to the baby, smiling at and cuddling the baby and being the key person who changes the nappy, does the feeds and so on. All those things are absolutely crucial for secondary attachment if mum or dad is out at work.

[Sarah Champion]

I know that the debate is about early years, but I was also surprised to find that in schools, there is no requirement for Ofsted to measure safeguarding; they deal only with educational attainment. We must look more holistically at a child from birth onwards.

[Andrea Leadsom]

As the hon. Lady said, the debate is about the earliest years. If we can get those right, there will be many fewer problems later in a child’s development. We can close down the pipeline of later problems by intervening and supporting families far earlier.

The final proposal in our manifesto “The 1001 Critical Days” is that although children’s centres should continue to provide a universal service, they should prioritise specialist services for families with the highest level of need regardless of their social and economic circumstances. Service provision must be needs-based and universal, but focused on specialist services for those who really need them.

As I have said, since 2001 I have been closely involved with parent-infant charities that provide psychotherapeutic support to families who are struggling to form a secure early bond with their baby. I am delighted to say that a year ago I set up a charity called Parent Infant Partnership UK, which has set out with philanthropic donations to establish specialist parent-infant psychotherapy services based in children’s centres around England and Wales. The first brand-new Parent Infant Partnership, LIVPIP, will launch this month in the constituency of the shadow Minister, the hon. Member for Liverpool, Wavertree (Luciana Berger). It will provide psychotherapeutic services for families who need them in the Liverpool area. I am absolutely delighted about that, and I hope that other local authorities will want to establish similar specialist services themselves.

[Sarah Champion]

I am very supportive of the scheme that the hon. Lady is describing, and I hope that it can be rolled out more widely. In Rotherham, we have some fantastic Sure Start centres that offer great parenting classes. Does the hon. Lady share my concern that because our early intervention grant has been reduced, we are having to look at cutting the number of Sure Starts from 22 to nine? I am concerned that the vital parenting support given by the Sure Starts will be lost.

[Andrea Leadsom]

The hon. Lady will know that there is a presumption against closure, and several local authorities have considered closing Sure Starts but have chosen not to. I once took my hat off in the Chamber to the Labour party for creating Sure Start—I was subsequently told that props were not allowed in the Chamber—but the problem is that they are not universally understood. If we ask the proverbial man on the Clapham omnibus what a school is for, we will get the same answer from every man on that omnibus. If we ask what a children’s centre is for, however, we will get all sorts of different answers. The fundamental problem with the Sure Start children’s centre system is that there is no common understanding of what they are for and the extent to which they should be provided.

My opinion—this is not part of our manifesto—is that children’s centres should have a statutory footing like schools do. If a school year 4 is failing, we do not say, “Well, shut it then, and those children can just go without learning to read and write.” The profound implications of children’s centre services on a child’s development may be far greater than whether they learn to read and write at the age of four, and far more fundamental for their life chances, but we are willing to shut children’s centres. I appreciate what the hon. Lady has said about cuts, but we need to improve understanding of children’s centres and spread the good practice that undeniably exists in some. We must persuade local authorities that children’s centres are not for cutting; they are profoundly important—at least as important as schools and hospitals. That is my opinion, but I hope that answers the hon. Lady’s good point.

Psychotherapeutic interventions from parent-infant partnerships have changed lives for the better for thousands of families. For those families whose babies now have the best start in life, rather than a disastrous one, politicians can count the savings to the public purse. Early years intervention has the potential to save billions of pounds from the cost of dealing with poor mental health, antisocial behaviour, crime and violence. My hope is that all political parties will adopt the achievable and sensible recommendations of our manifesto “The 1001 Critical Days”, and that we will together strive for the real prize, which is, surely, to change our society for the better.

Homelessness and Rough Sleeping

Debate between Sarah Champion and Andrea Leadsom

Wednesday 18th December 2013 Westminster Hall

[Andrea Leadsom]

Does the hon. Lady agree that physical and mental health needs often go hand in hand and cannot be separated? For example, back-ache is strongly correlated with depression, and it is often the combination of the two that results in homelessness.

[Sarah Champion]

I completely agree with the points that the hon. Lady raises, and will speak about them, a little, later.

We know that homeless people use four times as many acute health services and eight times as many in-patient health services as the general population, at a cost of around £85.6 million a year. However, despite that, homeless people often find it difficult to access health services that can provide suitable treatment, because their complex needs may make them ineligible for traditional health and social care support. Some report facing discrimination when they do seek support.

Common health conditions for homeless people include mental health issues, foot conditions, dental problems, infections, sexual health issues and tuberculosis. One in 10 people diagnosed with TB has a history of homelessness. Lack of suitable washing facilities can aggravate those problems and increase the spread of infection. Not surprisingly, people sleeping rough often find that the cold and damp exacerbate their health problems and cause the onset of respiratory illness. Some rough sleepers even wake up covered in frost.

The links between homelessness and health are cyclical. Although many homeless people are struggling to access health care, more must be done at an early stage to encourage people at risk of homelessness to access public services. Mental health issues particularly are one of the key triggers that lead to homelessness. Up to 70% of homeless people suffer mental health issues and 14% suffer a personality disorder. In London, almost one fifth of rough sleepers have mental health needs combined with substance abuse. Perhaps the most depressing news of all is that rough sleepers are 35 times more likely to commit suicide than the general population.

I am extremely fearful that in Rotherham, the problem will be dramatically compounded, because our excellent NHS mental health foundation trust—Rotherham Doncaster and South Humber NHS Foundation Trust, or RDaSH—is facing a £7 million budget cut next year. Unfortunately, I believe it is inevitable that this funding crisis will lead to people not receiving the support they need, and consequently to increasing rough sleeping on our streets. Is it not time for the Government to tackle these problems head on? Is it not time to acknowledge that we must make it easier for homeless people to access health care, not harder?

Under this Government, the sad fact is that in London alone, almost 6,500 people were seen sleeping rough between 2012 and 2013, and the number is increasing, year on year. Under this Government’s watch, rough sleeping has increased nationally by 31% in the last two years. Shockingly, the average age at which a homeless person dies is now 47.

Money directed at homelessness prevention is sent to local authorities, but is not always ring-fenced. Often, it is not used effectively to stop people becoming homeless, or to encourage preventive health interventions. Homeless people experience significant regional health inequalities, which should be recognised, measured and addressed in local needs assessments. If health and wellbeing boards are to meet their duty to reduce health inequalities effectively, they must recognise, measure and address the health needs of vulnerable and excluded members of society, and that must include homeless people.

Some local authorities are including homeless people in joint strategic needs assessments and joint health and well-being strategies, but this group of vulnerable people is often not accounted for. The needs of the local homeless population should be reflected in joint health and well-being strategies, and in the commissioning of appropriate services. The emphasis on setting a small number of priorities across the wider community may mean that the specific needs of small, marginalised groups are overlooked.

The mobility of homeless people, who may move from borough to borough, should also be considered, and a pan-borough approach should be taken to commissioning specialist services when appropriate. Local strategies should reflect the needs of the most excluded, as well as setting goals for wider public health improvement.

Commissioners and providers should be monitored to ensure that they are reducing health inequalities, including between the homeless and the general populations. When it comes to signing up with a GP, homeless people are turned away because they do not have an address. There is a shortage of specialist drug and alcohol services, particularly dual diagnosis services for people with substance addiction and mental health problems. Many homeless people with learning disabilities find it hard to live in the community and to access specialist support.

People in Rotherham tell me about the problems that homeless people have in finding accommodation when discharged from hospital. That is not just a problem in Rotherham; it is a national problem. Too many people are discharged from hospital with nowhere to go. We need integrated health and social care provision that includes homeless people. That approach could help to address health inequalities and ensure that some of the most excluded members of society have a better experience of the health and social care system. They deserve that.