Conception to Age 2: The First 1001 Days

Tim Loughton Excerpts

Thursday 17th December 2015 Commons Chamber

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

Old Whip’s habits die hard, but we accept the overtures of the hon. Member for Nottingham North (Mr Allen).

I beg to move,

That this House calls on the Government to consider the adoption of the recommendations in the cross-party manifesto entitled The 1001 Critical Days, the importance of the conception to age two period.

In this my seventh contribution of the day, let me wish you a happy Christmas, Madam Deputy Speaker, when it eventually starts. I am grateful to the Backbench Business Committee for giving us this important debate, particularly as it is so close to the launch of this excellent manifesto, which I will also be promoting today. I know that every single Member in this Chamber and beyond has been sent a copy of it. I am also grateful to those Members who have stayed for the final debate on the last day before the Christmas recess.

It is perhaps appropriate that the final debate should be about babies and conception to age two just eight days before we celebrate the birth of one particular baby, albeit the subject of an immaculate conception and in which the confusion over paternity, a somewhat unprepared and astounded mother and inadequate birthing facilities could have given rise in normal circumstances to some attachment dysfunction problems.

It is good to see the Minister for Community and Social Care here. I know that his door is well and truly open to what we have been promoting. It is particularly good to see my old great friend the Minister of State in the Department of Energy and Climate Change, my hon. Friend the hon. Member for South Northamptonshire (Andrea Leadsom). I wish to pay tribute to her. Effectively, she conceived this whole manifesto, gestated it and gave birth to it, and has done so much to champion the cause of early years attachment and perinatal mental health in this House and for many years before she came to this House. She continues to combine her advocacy with her new day job in DECC. She championed “The 1001 Critical Days” manifesto, which is now three years old and which was relaunched this week with more support and recognition than ever before.

On Monday, no fewer than 200 people came to the House of Commons Terrace to support this manifesto. Those present included academics, senior practitioners in paediatric and mental health, commissioners, voluntary organisations and politicians of all parties. It is particularly gratifying that the manifesto has now been sponsored by Members from eight different parties across the House. There really is a genuine cross-party consensus to promote this manifesto.

There has been big progress since the manifesto was launched in 2012 and promoted in the party conferences in 2013. The manifesto is now becoming part of the mainstream. It was supported at its launch and continues to be supported by the WAVE Trust—I pay particular tribute to George Hosking and all the work that he has done well before our time in the House—the National Society for the Prevention of Cruelty to Children, and PIP, the parent and infant partnership charity. I declare an interest as the chairman of the trustees.

PIP is putting the “The 1001 Critical Days” manifesto into practical action through children’s centres around the country and changing the mindsets of commissioners. Our projects started in Oxford with OxPIP. We now have NorPIP in the constituency of my hon. Friend the Member for South Northamptonshire, projects in Enfield and Liverpool, and others in Brighton, Croydon and Newcastle coming online in the near future. We want to spread that network across the whole country.

It is crucial to change mindsets in relation to how we intervene early and reconfigure our health—particularly mental health—services, education and children’s social care services to intervene earlier to prevent the causes of poor mental health for mother and baby from leading to indisputable life disadvantages that become mired in a vicious cycle of intergenerational underachievement. The alternative is that we continue to firefight the symptoms at great cost to our society both financially and, more importantly, socially.

The Government have made good progress, largely through the troubled families programme, in acknowledging that if we recognise the problems of dysfunctional families early and intervene with intensive focus and joined-up support we can often get those families back on track and convert them to balanced, contributing members of society, rather than a huge challenge to it and drain on it. I am proud to have been involved with that work when it was started in the Department for Education in my time as a Minister there.

But we need to go further, with what I have termed a “pre-troubled families programme”. That is, in effect, what the “The 1001 Critical Days” manifesto is about, and this is why. Last year the Maternal Mental Health Alliance, so ably led by Dr Alain Gregoire, produced a report which estimated that the cost of perinatal mental illness at more than £8 billion for each one-year cohort of births in the United Kingdom. That is equivalent to a cost of almost £10,000 for every single British birth. Nearly three quarters of this cost relates to adverse impacts on the child, rather than the mother. Perinatal mental health problems are very common, affecting up to 20% of women at some point during and after pregnancy, yet about half of all cases of perinatal depression and anxiety go undetected and many of those which are detected fail to receive evidence-based forms of treatment.

As the Minister well knows, the current provision of services is patchy at best, with significant variations in coverage and quality around the country. Most alarmingly, just 3% of clinical commissioning groups in England have a strategy for commissioning perinatal mental health services and a large majority still have no plans to develop one. I am sure that with the new Minister’s laser-like focus and zeal, and the fact that NHS England has adopted perinatal mental health as a priority, this will start to change soon.

Why does this matter? Apart from the obvious major public health epidemic going largely under-appreciated at its extreme, the statistics are alarming. Just last week a report by the maternal research group MBRRACE, analysing maternal deaths between 2011 and 2013, found that one in four of those deaths between six weeks and one year after giving birth were linked to mental health issues, one in seven were a result of suicide, and mental health problems were instrumental in the deaths of one in 11 new mothers within the first six weeks after giving birth. At this extreme the figures are shocking, but they are also largely preventable with better and early detection and intervention, yet 40% of those women who committed suicide in that timescale would not have been able to access any specialist perinatal mental health care in their areas.

For those who lived through pregnancy and the early years of a baby with a mental illness, the impact on that child can be considerable. Another major negative impact might be substance abuse, poor parenting skills—often inherited as a result of a young mum being poorly parented herself—and being exposed to domestic violence. Incredibly, more than a third of domestic violence cases begin in pregnancy. This is a statistic that many of us would find hard to believe. Sadly, these negative influences are all too prevalent among new parents. Those is by no means a problem limited to those from poorer backgrounds. Parents unable to form a strong attachment with a new baby come from all parts of society, and we need a multifaceted approach for detection and intervention at all levels.

Children need nurturing from the earliest age. From birth to age 18 months, it has been calculated that connections in the brain are created at a rate of a million per second. The earliest experiences shape a baby’s brain development, literally, and have a lifelong impact on that baby’s mental and emotional health.

A pregnant mother suffering from stress can sometimes pass on to her unborn baby the message that the world will be dangerous, and the child might struggle with many social and emotional problems as a result; their responses to experiences of fear or tension have been set to danger and high alert. That will also occur at any time during the first 1001 days when a baby is exposed to overwhelming stress from any cause within the family, such as parental mental illness, maltreatment or exposure to domestic violence.

Attachment is the name given to the bond that a baby makes with his or her care givers or parents. There is long-standing evidence that a baby’s social and emotional development is affected by his or her attachment to his or her parents. As the chief medical officer, Sally Davies, puts it in her foreword endorsing “The 1001 Critical Days”:

“The early years of life are a crucial period of change; alongside adolescence this is a key moment for brain development. As our understanding of the science of development improves, it becomes clearer and clearer how the events that happen to children and babies lead to structural changes that have life-long ramifications. Science is helping us to understand how love and nurture by caring adults is hard wired into the brains of children.”

The all-party group for conception to age two—the first 1001 days, which I have the privilege of chairing, produced a report in February called “Building Great Britons”. That, too, was sent to every hon. Member and it complemented “The 1001 Critical Days”. The report calculated the cost of child neglect to be some £15 billion each and every year. When combined with perinatal mental illness, that makes a cost of more than £23 billion every year for getting it wrong for our youngest children and their parents. That is equivalent to two thirds of the annual defence budget.

In concentrating on perinatal mental illness in young mums, it is also important to stress how a child benefits most from forming strong and empathetic attachments with both parents. We should not forget that 39% of first-time fathers also experience high levels of distress during a child’s first year. We need a strong whole-family approach, and it is especially important to get that strong attachment with fathers in the second year of a child’s life as well.

Another big problem in this country is that it has been calculated that 1 million children suffer from the type of problems—attention deficit hyperactivity disorder, conduct disorder and so on—that are clearly increased by antenatal depression, anxiety and stress. Yet the cost of appropriate and timely intervention and support has been calculated at a fraction of the annual cost of failure. It equates to roughly £1.3 million per annum for an average clinical commissioning group with a budget of around £500 million.

The “Building Great Britons” report calculated that preventing these adverse childhood experiences could reduce hard drug use later in life by 59%, incarceration by 53%, violence by 51%, and unplanned teen pregnancies by 38%. It is not rocket science—technically, it is neuroscience. More and more people are coming to realise that this is an investment that we cannot afford not to make.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

I congratulate the hon. Gentleman on securing this debate. He and I have worked on children’s issues for a very long time. This is a brilliant initiative. As we are listening to his brilliant analysis, we have to consider whether we have the right skills in the communities. Are we training people the right way? Are we depending too much on people with PhDs in educational psychology, rather than on trained people based in GP surgeries who can identify problems and support families at an early stage?

[Tim Loughton]

I am grateful to the hon. Gentleman for his support. He has been working on this stuff for even longer than I have and has great experience. We need to ensure that we are training the people who know about this stuff, appreciate its importance and know how to communicate with other professionals to have a joined-up approach. There is too much silo thinking going on. When Minister and shadow Minister, I saw families who seemed to be having all sorts of different professionals going in and out of the house but no joined-up approach to bring it all together and make the difference that the family needed.

We also need those professionals to be able to work with the parents, and to be able to communicate and empathise with them, because ultimately it is the parents who will have the biggest influence on the children. They need to be guided and supported. The state needs to take over only in extreme circumstances in which children might be at harm. We need to do more to ensure that parents know what good parenting looks like and are able to do it.

That is why “The 1001 Critical Days” manifesto is so important. It is not simply a political wish list; it has been endorsed by a very wide cross-section of children’s organisations, charities, practitioners, and academic and professional bodies, including the royal colleges of paediatrics and child health, midwives, psychiatrists, obstetricians and gynaecologists, and general practitioners; the NSPCC; Bliss; the Tavistock Centre for Couple Relationships; and the Centre for Social Justice. The Institute of Health Visiting said:

“As far as health visitors are concerned, the 1001 Critical Days Manifesto may yet prove to be one of the most important developments of the new millennium. It has created a long overdue focus on the essential first days of life when the blue print for an individual’s future health and wellbeing is laid down.”

I will not go into great detail about what the manifesto calls for, because every hon. Member has received a copy. In essence, it is about allowing vulnerable families to access specialist services; working closely together to share vital data between the different agencies I have spoken about; and making sure that every woman with past or present serious mental illness should have access to a consultant perinatal psychiatrist and specialist support in relation to mother-infant interaction, as required and in accordance with existing National Institute for Health and Care Excellence guidelines.

The manifesto has a truly holistic approach involving many Government Departments and agencies at a national level and a local level. In essence, it is about changing mindsets so that that should be the approach we ordinarily have and take for granted, because it is the right one. The aim is that “The 1001 Critical Days” becomes a recognised term with a recognised programme being delivered across every community, focused on children’s centres. I know that the Minister is already on board with this aim, and I urge him to promote and champion its adoption to his colleagues across Government. I commend the motion to the House.

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[Norman Lamb (North Norfolk) (LD)]

It is a pleasure to follow the hon. Members for Congleton (Fiona Bruce) and for Sefton Central (Bill Esterson), and I completely endorse their points about foetal alcohol syndrome. It feels like we have not caught up with the evidence, and we need to do so urgently, given the awful carnage being done to babies by this dreadful condition, so I congratulate the all-party group on foetal alcohol spectrum disorder on its work.

I also congratulate the right hon. Member for East Worthing and Shoreham (Tim Loughton)—

[Tim Loughton]

Hon. Member.

[Norman Lamb]

Oh, I do apologise. To me, he is right honourable. He has shown great leadership, both as a Minister and in his work since, and I applaud him for that. I also join others in acknowledging the fantastic leadership shown by the hon. Members for South Northamptonshire (Andrea Leadsom) and for Nottingham North (Mr Allen).

Like the hon. Member for East Worthing and Shoreham, I had the one-to-one seminar with George Hosking from the WAVE Trust. I had it many years ago, but I remember it still very clearly: the evidence he showed me, from Australia and the United States, was compelling. He is rightly on a mission and has had a significant influence, which should be acknowledged, so I join the hon. Gentleman in thanking him for his amazing work.

I want to focus on perinatal mental health. Here, we are dealing with two lives: the mother’s and the baby’s. The impact of mental ill health in the first year after birth is profound. As the hon. Gentleman said, it affects up to 20% of women. We often think of it as post-natal depression, but it goes much wider than that. The London School of Economics’ personal social services research unit and the Centre for Mental Health have produced an important piece of work on the economics of this. They refer to anxiety, psychosis, post-traumatic stress disorder and other conditions, including obsessive compulsive disorder. The impact of these conditions on the mother, but also on the baby and the wider family, can be very profound.

The cost of failure, as the hon. Member for Nottingham North made clear, is enormous. The report by the LSE and the Centre for Mental Health estimates the cost of perinatal ill health as being £8.1 billion at the very minimum. The basis for calculation was the mothers who suffered depression, anxiety and psychosis, but they recognised that other conditions were relevant, too, which have not been costed, so the overall cost is bigger. We must understand that. As the hon. Member for East Worthing and Shoreham made clear, this amounts to £10,000 for every baby born in this country. The cost of failure is just enormous.

How have we responded to this extraordinary impact? Slowly but surely, things are changing, but if we look at the recently published map on the availability of services around the country—this relates to the UK’s specialist community perinatal mental health teams—we see that in 2015, the map is still horribly red. This does not indicate constituencies held by the Labour party—[Interruption.] Thank goodness! This indicates the parts of the country where no specialist team is available. Let us imagine for one moment that this was the case for stroke care or heart conditions: there would be a national outcry.

No party or Government is responsible for this situation. We are dealing with an emerging understanding, and it is about developing a new service. When I look at the whole of East Anglia, my own region, I see that not a single specialist team is available. That is truly shocking. As the hon. Member for East Worthing and Shoreham said, people are dying, and some even take their own lives, yet these are deaths that could be prevented by the application of specialist services around our country. None of us can be comfortable with the fact that so much of our country does not have the ready availability of support for mothers in this situation.

There is an urgency to ensuring that we act to get the whole country covered. I was pleased when in response to the cross-party campaign for equality for mental health, we had the basic simple principle that there should be equal access to care and support—irrespective of whether people have a mental or a physical health problem. At the moment, that does not exist, but the campaign that we launched in the run-up to the spending review secured a response from the Chancellor of an extra £600 million for mental health. In his statement to Parliament, the Chancellor specifically mentioned the importance of perinatal mental health services. That money must be used.

I end by urging the Minister to do everything in his power to instil a real sense of urgency, with a programme and a timetable to get every part of the country covered by specialist services. I find it unbelievable in this day and age that the CCGs mentioned by the hon. Gentleman have not even started to think about this yet. These are the people who hold responsibility in our NHS for commissioning services for our populations, but a significant number of them have not yet even started the process of thinking about the problem. The message needs to go out from the Minister, but also from NHS England nationally, that this situation is intolerable and cannot be sustained. We must ensure that this Parliament reaches the point by 2020 when the whole of that map of the United Kingdom is green, so that every mother, when she is in need, following birth, can get access to the specialist services that can help her to recover.

--- Later in debate ---

[Tim Loughton]

I am grateful to all hon. Members who have taken part in this debate. There have been some weighty contributions and I am grateful to those who have stayed for this last debate on the last parliamentary day of the year.

I am particularly grateful to the hon. Member for Nottingham North (Mr Allen) for his contribution. He spoke of the intergenerational problems we are inheriting, which he has done so much to address. He was also right in a later intervention to mention social finance and the possibility of social impact bonds, which we certainly want to develop.

At times the debate risked being hijacked by the report of the all-party group on foetal alcohol spectrum disorder, of which I am a member. I am delighted that we had an opportunity to give the group a voice, because it is a very important subject.

I am grateful to the right hon. Member for North Norfolk (Norman Lamb), who did so much on perinatal mental health when he was a Minister. The map he produced puts starkly, in graphic terms, the service provider gaps around the country. I was also grateful to hear from the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), who speaks on behalf of the Scottish National party, who spoke of the Scottish experience and her time as a clinical psychologist in the NHS.

I pay tribute to the Opposition spokesman, the hon. Member for Ellesmere Port and Neston (Justin Madders), not least for his optimism about the political fortunes of his party. I am grateful for the cross-party consensus, to which he contributed. He is absolutely right to say that it is a false economy not to be doing this. We need to impress on the Chancellor the fact that, just as we invest in roads and factories to aid the economy, we should invest in our youngest children as citizens who are going to contribute to society in the future.

This is an urgent matter for the whole Government and I urge the Minister to promote it as such. In doing so, I wish everybody a very happy and peaceful Christmas and an “attachment” new year.

Question put and agreed to.

Resolved,

That this House calls on the Government to consider the adoption of the recommendations in the cross-party manifesto entitled The 1001 Critical Days, the importance of the conception to age two period.