Early Years Childcare: Staff-Child Ratios

Debate between Steve Brine and Vicky Ford

Monday 14th November 2022 Westminster Hall

[Steve Brine (Winchester) (Con)]

It is a pleasure to see you and your pink hair in the Chair, Ms Harris. It is not often that is said in this Chamber. I thank the petitioners, including a number of my constituents, for signing the e-petition. I thank those in the Public Gallery who have come to watch, and, of course, Zoe and Lewis for being here today. They are very brave.

I speak as constituency MP for Winchester, and in my capacity as chair of the all-party parliamentary group for childcare and early education. I will start with what I always say in these debates: early years education should be thought of and seen in terms of quality, not in terms of quantity. Investment early in a child’s life pays dividends later on as they move through the system. The impact upon a child’s future is priceless. Internationally, the UK has the second lowest level of Government investment in the early years, but the highest level of investment from parents. Thus, parents have every right to ask for the very best. I know that is what the early education professionals, whom I speak to all the time, seek to provide. I declare my interest in that I am married to an early years worker—so I had better be good.

My view is that increasing ratios would have an adverse effect on that quality. Seeing as the ratios are where they are now, it is incumbent on those who propose to change them to explain why I am wrong in that thesis. The stated intention of the last Prime Minister and the Prime Minister before last to change the ratios—potentially abolishing them altogether—would not, as hoped for, improve flexibility or reduce the cost of childcare. Research from Coram suggests that a full-time nursery for children under the age of two costs almost 66%—two thirds—of a parent’s weekly take-home pay in England.

As the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) set out in her excellent opening remarks, if the proposed reforms are to save money for parents in the cost of living crisis—a perfectly sensible and laudable aim—the evidence to back that up has to be laid before us and the Government have to show their workings out. I am not deaf to those arguments; I am perfectly willing to hear them and happy to see those figures—but see those figures, I must.

Early years settings have expressed concerns to me, and to those of us on the all-party group, that the relaxation of staffing ratios raises the risk of accidents for young children due to fewer staff needing to provide the same quality of care to a greater number of children.

[Vicky Ford (Chelmsford) (Con)]

I thank my hon. Friend for everything he does for the early years sector. I also give my condolences to Zoe and Lewis for their tragic loss. In my constituency of Chelmsford, people want to have outstanding childcare, and, like others across the country, they care about the safety of their children. As a mother who once had three under four, I know what tight ratios mean. But people are also concerned about the affordability of childcare. Does my hon. Friend agree with me that when looking at the issue of international comparisons on ratios, one should try to compare apples with apples? We have to look at not just the staffing numbers but the investment in qualifications. Does he agree with me that the Minister is right to look at rations, but needs to ensure that those comparisons are done on a level playing field, taking into account those other considerations too?

[Steve Brine]

I absolutely agree with my right hon. Friend, the former Minister. As set out in the opening speech, the situation is very different in Scotland; there are different qualification levels. Also, in Scotland practitioners have to register with the Scottish Social Services Council in order to work in early years, and they have to commit to continuing professional development qualification levels to do that. The hourly rate is also higher. I do think it is different. My right hon. Friend referred to having had three children—I only have two. Yes, it is about the qualification, but it is also simply a numbers game and about having eyes on the child. Our two children are 12 and 15 next week—it is a busy month—but when they were small, my wife and I would divide and rule. We had a 1:1 ratio. When we were looking after their cousins, the ratio went up and it was more challenging. Clearly, I am not suggesting a 1:1 ratio in early years education, but why on earth would we want to go the other way in a setting where children potentially spend seven or eight hours a day for five days a week? I question it but, as I say, show me the money. Show me the evidence, show me the workings out and show me the savings, and then we can make an informed judgment.

There are concerns among providers and parents about settings having the capacity to support children with any additional needs, such as children with SEND, who may need more, rather than less, time with educators. I know the Minister will touch on this issue in her remarks. My fear, and that of providers and parents, is that a further ratio reduction would reduce the capacity and parental confidence even further, potentially driving more exclusion in early years education.

Another point is that current staffing ratios reflect the requirements for facilities and space set out in the Ofsted framework, which is very clear. It would therefore be troubling if the Department contradicted the guidance of the official regulator. If we were to proceed with reducing staff to child ratios, do Ministers intend to consult on changing the Ofsted framework? Of course, that would require a statutory consultation.

I have said that good early years education is vital to supporting our young people to develop, and Ofsted has identified children aged two to three as needing a particular focus on speech and language in order to build necessary communication skills for later in life. More children per staff member can only mean less time per child. Why is that particularly acute right now? Because of the pandemic, young children who started nursery in September do not have the socialisation skills that my children had in the years before they started in early years education, so I would suggest that that is even more important than ever right now.

Let me give some figures. Some 52% of early years staff say their workload and a lack of work-life balance are a cause of stress or unhappiness for them. With the existing ratios, staff are under pressure—I hear that every night at home—and they tell me they are worried about the time they are able to give each child in their care. We face a staffing challenge in the early years sector, and staff are leaving the sector, with many choosing careers in retail with fewer hours but similar, or even greater, levels of pay. Data from the University of Leeds shows a post-pandemic net loss of workers from the sector above and beyond the usual churn of staff, and I often make the point that dog-sitters in my area are often paid more than the people who look after our most precious asset. Dogs are precious too, but they are not our children.

On Saturday I was out in my constituency, talking to constituents. I spoke to a lady in Winchester who said that she was very worried about the nursery round the corner—I will not identify it, for obvious reasons—because it is losing the key worker who looks after her young daughter. It is really disruptive for her young daughter, and she is very worried about it. The nursery is losing that key worker because she is going to work in an office job, as she can get paid better and probably have a lot less stress. This is the reality of life. As the new Minister—obviously, she is a constituency MP as well—gets out and about, I dare to say that she will hear that more and more from the people she meets in the sector.

I would suggest that increasing the number of children each member of staff is working with or responsible for will only increase the pressure and stress within the workforce, and more of these vital workers will leave the sector, which already faces a recruitment and retention crisis. That will drive up costs for parents and exacerbate the financial problems in the sector, with over 84% of providers telling the APPG on childcare and early education that they expect to operate at a loss or merely break even this year—up from just over half in 2018. Nursery and early education providers said it is more difficult to recruit, and some 20% of childminders told us that they did not think they would be working in the sector in six months’ time. Many of those people are concerned about working with new ratios, in what they regard as potentially unsafe conditions.

One nursery worker wrote to me to say that the changes to ratios gave her “nightmares”; she said that the situation was like an episode of “Crimewatch”. Another said that she was “extremely concerned” about the additional pressure on staff, “both physically and emotionally”. I have seen figures that suggest that almost two thirds of practitioners could leave the sector if ratios went in the wrong direction. That is not just a figure; parents across the country will be unable to find good childcare and early education for their children to enable them to go to work and feed the workforce—a challenge in many other parts of the economy. This is not just a childcare story. Childcare is to the economy what social care is to the NHS. If we do not get this right, the economy will slow down, and heaven knows that right now we need the economy to speed up. We need growth.

Staff are referencing workload, stress and burnout as key concerns. I am not defending the current way of working as being perfect—far from it. The all-party group that I chair has for a while been calling for a wholesale review of childcare and early education, and we will write to the new Chair of the Education Committee when they are elected on Wednesday to request that review. I have already spoken to some of those standing for that position, two of whom are in this room.

In conclusion, we do not need a change in ratios. We need a wholesale, fact-based review of childcare and early education that focuses on the workforce, parents and, ultimately—the most important stakeholder—children. Our children deserve nothing less. I have already spoken to the new Minister, the Under-Secretary of State for Education, my hon. Friend the Member for East Surrey (Claire Coutinho), about the issue. I congratulate her on her position. She is a thinker and a serious person, and I really look forward to working with her. I respectfully ask her to meet my all-party group as soon as possible; we look forward to that conversation.

Oral Answers to Questions

Debate between Steve Brine and Vicky Ford

Tuesday 24th July 2018 Commons Chamber

[Steve Brine]

The truth is that we work together. In July 2017, the Government published a comprehensive new drugs strategy, setting out what we think is a balanced approach that brings together the police, health, and community and global partners to tackle the illicit drugs trade, and to protect the most vulnerable in our societies who are struggling with drug dependency and help them to recover and turn their lives around. I know the hon. Gentleman takes a very different view, but that is our approach.

[Vicky Ford (Chelmsford) (Con)]

My nine-year-old constituent is currently having up to 400 epileptic seizures every week, and his family believe that medicinal cannabis may be beneficial. Will my hon. Friend update the House on what progress is being made regarding the use of medicinal cannabis for epilepsy sufferers?

[Steve Brine]

Obviously, our thoughts are with my hon. Friend’s constituent. A two-part review is going on. In the first part, the chief medical adviser considered the evidence available for the medicinal and therapeutic benefits of cannabis-based medicinal products, and found conclusive evidence of the benefits of those products. Part 2, which will be led by the Advisory Council on the Misuse of Drugs, will provide an assessment, based on the balance of harm and public need, of whether we need to do anything regarding the misuse of drugs regulations. While the review is under way, we have established, as an interim measure, the expert panel of clinicians to advise Ministers on any licence applications from senior clinicians, which helped Alfie Dingley, for example.

Phenylketonuria: Treatment and Support

Debate between Steve Brine and Vicky Ford

Tuesday 26th June 2018 Westminster Hall

[Steve Brine]

I was going to come on to talk about Kuvan; obviously, I stopped to listen to the hon. Lady’s intervention. No, I will not personally support an individual request. That would not be appropriate for a Minister at the Dispatch Box. That is not how our system works, but if she wishes to write to me with the specific example then of course I will see that she gets a reply. That should be handled through the right processes. I know that the processes for individual funding request applications are sometimes torturous, and I am sure that we could do them better.

Let us touch on Kuvan, which everybody has raised. It is one treatment option that has been found to lower blood phenylalanine levels in some patients with mild or moderate PKU. We know that the drug is effective in a small number of patients, depending on their genetic make-up, and is more likely to benefit those with milder forms of the condition. If patients respond to treatment, it is likely that they will still need to continue with some form of dietary restrictions—everyone understands that.

As we have heard, Kuvan is not currently routinely commissioned for use in children and adults. That is due to the lack of evidence of its effectiveness on nutritional status and cognitive development at the time the policy was developed in 2015. NHS England does, however, have a commissioning policy for PKU patients with the most urgent clinical need—namely, pregnant women, as we have heard.

[Vicky Ford]

Will the Minister give way?

[Steve Brine]

No, I will not. Although the decision taken by NHS England was not to commission Kuvan routinely, the system has the flexibility to review that decision if new evidence emerges. As the House heard during the debate in March, NHS England received a preliminary policy proposal for the use of Kuvan in the management of PKU for adults and children, because new evidence has now been published to support its use. Kuvan was subsequently referred to the National Institute for Health and Care Excellence for assessment through its topic selection process—the process through which NICE prioritises topics for appraisal in its technology appraisal or highly specialised technology programme.

The NICE process is important. It is independent of Ministers and provides a standardised, governed procedure to ensure that NICE addresses topics that are important to the patient population, carers, professionals and commissioners and, similarly, helps to make the best use of NHS resources. To update the House on progress, Kuvan has progressed through the first stage of the topic selection, and NICE is currently considering whether the drug should proceed to the draft scope creation stage. We are expecting that decision to be taken in the autumn. I will press NICE, along with the relevant Minister in the Department—the Under-Secretary who sits in the other place—to bring that to a conclusion as swiftly as possible.

People have asked today for me to personally get involved in access to Kuvan. NICE’s process is important and sits independently of Ministers. It would be a very strange situation if Ministers were able to sit in the Department of Health and, like a Roman emperor, give a thumbs up or thumbs down. I do not think that any Minister in this Government or previous Governments would want to be in that inappropriate position. As I said, we expect the decision to be taken in the autumn and we will press for that to be brought to a conclusion as soon as possible.

I will give the hon. Member for Blaydon time to wind up the debate, but let me say first that there are other promising treatments on the horizon. NICE is currently considering pegvaliase, an enzyme substitution therapy indicated for adults, through its topic selection process, and recently consulted stakeholders on its suitability for the technology appraisal. I can update the House that a scoping workshop on this topic is scheduled to take place tomorrow, 27 June.

Finally, my hon. Friend the Member for Chelmsford said that there had not been a response on BioMarin. She mentioned that point to me last night, and I am worried to hear it. As I said, Kuvan is currently going through the independent NICE assessment. If the topic goes ahead, there will be many opportunities for BioMarin to engage in commercial discussions, as per NICE’s usual process. BioMarin and NHS England are already in discussions about a number of other drugs, so it has the opportunity to raise the issue. However, it seems to me that NHS England could at least communicate better, because no answer sounds like a bad answer. I will take that away from the debate and ensure that it happens ASAP.

I know you want me to stop, Mr Robertson, and let the hon. Member for Blaydon close the debate, so I will do that.

Oral Answers to Questions

Debate between Steve Brine and Vicky Ford

Tuesday 19th June 2018 Commons Chamber

[Vicky Ford (Chelmsford) (Con)]

Stroke is the fourth largest single cause of death in Britain. What action are the Government taking to prevent stroke and to raise awareness? And will the Minister meet me to discuss my GP surgery at Sutherland Lodge?

[Steve Brine]

Two for the price of one. Up to 70% of strokes are preventable if hypertension, atrial fibrillation, diabetes, cholesterol and other lifestyle factors are detected and managed earlier. The current national stroke strategy came to an end last year, so we are working closely with NHS England and the Stroke Association on a new national plan, which I hope to publish this summer.

Southend Hospital

Debate between Steve Brine and Vicky Ford

Thursday 6th July 2017 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Steve Brine)]

I very much enjoyed the speech by my hon. Friend the Member for Southend West (Sir David Amess). I congratulate him on securing this debate and commend the fire in his belly that always shines through when he speaks in this House, or anywhere else, on behalf of his constituents. They are lucky to have him. I congratulate him on his re-election once again last month.

It is a strange that there is nobody in front of me and everybody I am talking to is behind me, but such is the layout of the House of Commons—and I am of course talking to you, Madam Deputy Speaker.

I understood before I came into the Chamber, and I certainly understand now, that there is significant local concern about the future of the A&E at Southend University Hospital NHS Foundation Trust. My understanding is that Southend A&E will continue to provide substantial emergency services 24 hours a day, 7 days a week, and any change—I underline, any change —to this position would need to meet the four tests of service change. For clarity, let me outline those tests, because they really are the bottom line of any proposed service change in the health service in England. First, proposed service changes must have support from commissioners; secondly, they must be based on clinical evidence; thirdly, they must be able to demonstrate public engagement; and fourthly, they must consider patient choice. An additional NHS England guidance has been added—that proposed service reconfigurations should be tested for their impact on overall bed numbers in the area, and the impact thereof on safety. It is important to set that out very clearly.

The work of the success regime has now fed into the Mid and South Essex success regime sustainability and transformation plan.

[Vicky Ford (Chelmsford) (Con)]

I would like to introduce Broomfield hospital in Chelmsford into the discussion as one of the hospitals in the mid-Essex area along with the three in Southend and those in Basildon. I congratulate my hon. Friend the Member for Southend West (Sir David Amess) on bringing so much experience to this debate. Broomfield is deeply loved. It serves our newest city. We too need our 24-hour consultant-led A&E. NHS England made it clear to me on Monday that it is not only 24-hour, but consultant-led. Can the Minister confirm that? Can he also confirm that any decisions made will put patient safety first? The future of our NHS relies on first-class training and innovation in Chelmsford. As part of the mid-Essex area, we have the country’s first new medical centre. Will the Minister confirm that he supports that medical centre?

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. The hon. Lady’s question is slightly tangential to the subject of the debate, but I appreciate that she has made a connection. The Minister might be able to make the connection between the subject of the debate and her question, but I know that he will concentrate on the subject of the debate introduced by the hon. Member for Southend West (Sir David Amess).