Giving Every Baby the Best Start in Life

Tim Loughton Excerpts

Tuesday 9th November 2021 Commons Chamber

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

I pay tribute to the hon. Member for Richmond Park (Sarah Olney) and the other colleagues who secured the debate. It is great to be having a debate about early years again; we are having a few of them these days. It never happened when I first became a Member of the House and has not for much of my 24 years here. It is really fantastic that such a relevant and important subject to so many of our constituents is now commonplace in the Chamber and that there is real, concerted action. We may disagree over the extent or detail of that, or the amount of money that is going into it, but I think we all agree about the direction and emphasis.

It is a great pleasure to follow the hon. Member for Newcastle upon Tyne North (Catherine McKinnell), and I agree with much of what she said. It is also a great pleasure—but a great challenge—to follow my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), who is such a guru on this subject that anything the rest of us say subsequently will pale into relative irrelevance, but I will give it a bash anyway.

I want to recount an episode that happened when I was Children’s Minister 11 years ago. I used to spend a week of the summer recess going out on the frontline with some of the workforce, without any fuss and without any cameras, just to see what their job involved at first hand. I remember my first time: I spent a week in Stockport going out with social workers, knocking on doors, seeing cases at first hand, manning the overnight emergency helplines, sitting in on morning meetings and liaising with police and others. It was a fascinating experience, which I recommend to any other Member. I think it should be compulsory for all Ministers and their officials to spend time with the professionals over whose regulations that Department has responsibility. That is where we find out the most. I used to find out most of my information from sitting down with groups of children in care, as the Minister responsible for children in care; that is where we find out what is really going on.

A really good social worker took me to my first case, and I think that she deliberately chose the most challenging case in the most run-down, depressing part of the town. We went into a house that was a complete mess. There was a young mum with three young boys. There were no carpets on the floor. There was virtually no furniture, other than what had been dumped in the garden. There was no food in the house—the fridge was bare—other than what the kids literally were eating off the floor. There were bare mattresses for beds and piles of dirty clothing.

One of the kids had had a really dire toothache for some weeks, and the social worker had gone on at the mum about getting the child some treatment for it. On the day that we visited, the mum had had a toothache problem. On the previous day, she had gone down to the emergency dentist and had her tooth fixed, but she did not have the presence of mind to take her son who was suffering from toothache along with her.

What does someone do with a family like that? Plenty of professionals had been going in and out of that house to offer different bits of help, but that mum required some serious support. She had been abused as a child, as is so often the case. The father was not on the scene and she had been subject to domestic abuse, as is so often the case. We all know, extraordinarily, that about a third of domestic violence starts during pregnancy. So there she was, highly vulnerable and desperately in need of support, but her life was not improving and the life chances of her children were certainly not. So what does someone do?

Those children could have been taken into care. They probably would have been split up, going to different families across the area and perhaps beyond. The mum would have been completely distraught at that prospect. Inadequate though she was, for whatever reason, in the care that she provided, she absolutely doted on those kids and they doted on her, so what was the solution? That is the sort of judgment of Solomon that our social workers have to make day in, day out when dealing with those really complex, challenging cases.

That case, which I will remember for the rest of the time that I am involved in these areas, encapsulates all the challenges that we face in children’s social care and all the challenges relating to the whole issue of the best start in life and the project that the Government have undertaken, thanks to my right hon. Friend the Member for South Northamptonshire. That is why it is so important. One of the answers is to have a joined-up approach locally, with all the different professionals working together as a team to encapsulate mum and family. It is about having somebody who can literally take her by the arm and march her down to a children’s centre to get family support and advice or march her down to the dentist with little Johnny to make sure that he gets dental treatment—somebody to take control of people’s lives and get them on the straight and narrow until they can fend for themselves and their family again. We need local professionals working as one, with a lead person who has responsibility, who has all the joined-up knowledge about what needs to happen, and who has the force and confidence to make it happen.

We also need the Government to be joined up at the centre. I remember that when we were trying to get the early intervention grant sorted, we were getting the run- around from officials because the fund would affect various Departments. We were told, “Oh, we can book you an appointment with the Minister in that Department in a few weeks’ time, and then perhaps you can have another meeting with that Minister.” In the end, the only way my co-Minister Sarah Teather and I got the problem sorted was by ringing up all the Housing, Health, Home Office and other Ministers responsible. We all had pizza in the Adjournment, agreed what the strategy should be, went back to our Departments the following morning and told our civil servants, “This is what we want to happen.” All the civil servants said, “That’s not the way we do things here, Minister,” to which we all said, “Tough. Do it.”

The problem is that government does not work in a joined-up way, which is why the approach that my right hon. Friend the Member for South Northamptonshire has taken is really pioneering. I pay tribute to her for the way she has brought things together, forcing Departments to sit down, work together and have a strategy that works as one. That is the only way we will sort the problem sustainably for the future, which is key to the whole approach.

The hon. Member for Richmond Park has set out the problems: the £8.1 billion that perinatal mental illness costs each year; the £15 billion that we spend each year in this country on child neglect, particularly in relation to younger children; the £6 billion that childhood obesity costs each year, which is likely to rise to £9 billion within the next few years. As well as the cost of domestic abuse and safeguarding, we are spending £20 billion to £30 billion-plus each year as the cost of getting it wrong for some of the most vulnerable children and their families. Spending a fraction of that on solutions to get it right will be absolutely transformational.

Let us look at some research from the Institute of Health Visiting. I will always speak up for health visitors; in my view, frankly, they are one of our emergency services. They have been diverted too often during the pandemic to other parts of the health service, and their absence has been greatly felt. There is a shortage of several thousand: the institute says that we need at least 3,000 additional health visitors over the next three years, and I completely agree. One of the great achievements of the Cameron Government was building up the health visitor workforce, which has since diminished, alas. A survey of health visitors shows that 81% have seen an increase in perinatal mental illness, 80% have seen an increase in domestic abuse, 80% have seen an increase in child behaviour problems, 72% have seen an increase in poverty affecting families and 71% have seen an increase in child safeguarding.

The hon. Member for Newcastle upon Tyne North is right, too. Research from Action for Children shows that

“only 57% of children from poorer backgrounds were ready for school at age five, compared to 74% of their better-off peers…82% of parents of 0-5s in England struggled, or were unable, to access vital non-childcare early years services…78% of parents who were unable to access a service were worried about potential impacts on themselves or their children. The most common concerns were children’s development, and parents’ own mental health and wellbeing.”

That is the cost of failure, and that is why it is so important to have a co-ordinated, joined-up approach. One statistic that has always stayed in my mind is that if a 15 or 16-year-old at school suffers from depression or some form of mental illness, there is a 99% likelihood that their mum suffered from some form of perinatal mental illness or depression—the link is that close. We should be spending so much more time and resources on looking at the pre-school period, particularly from conception to age two, because that is where it all goes pear-shaped. We see the consequences throughout childhood, and they so often carry on into adulthood and stay with the person for the rest of their life. So of course we should be doing more about this, and I am glad that at last the Government have recognised that that is where all the action—or a lot more of the action —needs to be focused.

On health visitors, I agree with the Local Government Association, which has said it is important for the Government to work

“on a children’s workforce strategy to support the development of a well-qualified, well-resourced workforce with the appropriate knowledge, skills and experience to work in a preventative way. This needs to be an integrated strategy between local authorities, health, education and community and voluntary sector partners, which links effectively with established programmes, such as Supporting Families, Sure Start and Family Hubs and puts the child’s journey at the centre.”

That strategy, it adds, needs to be properly resourced. Well, we are having a lot of extra resource. We could all argue that it is not enough, and the more Opposition Members argue that it is not enough the more I will welcome that, because we could always do with more money; but I think this has been a good start.

Let us look briefly at some of the action areas. One of them is the provision of seamless support for families. As my right hon. Friend the Member for South Northamptonshire has said, we need to have a lead person who knows all the facts and history of the family involved, and who has the power to say, “This is what needs to happen for that family”, and make sure that it happens. Then there is the welcoming hub for families. I can answer the earlier question from the hon. Member for Newcastle upon Tyne North by saying that 75 family hubs have been identified, in about half the number of local authority areas. I hope very much that the other 75 will follow very quickly, so that there is at least one per authority.

Can we get away from the idea that these hubs are a challenge to, or in place of, children’s centres? They are building on the experience of children’s centres and are complementary to them, but they are not just about bricks and mortar; they are about services. I think that in the past we have been too hung up about the amount of bricks and mortar that we have rather than the quality of the services provided, whether as outreach or within children’s centres, and, most important, the outcomes that they are creating for the children for whom they exist and their families.

It is important to ensure that families have the right information at the time when they need it. When people are reluctant to cross the threshold of a children’s centre or a family hub, as my family in Stockport were, they need to have other ways of obtaining that information. It may be a night-time call line, or it may be online, on the internet. It may mean having another professional to call on, or even volunteers—even members of another family who are looking out for vulnerable families. What those people need is a trusted source of information that they can access, rely on and then act on to their benefit.

I think we have all learnt in the past that a top- down approach, with all the geeks in the civil service coming up with whizzy new schemes and trying to impose the same scheme in Newcastle as in a village in South Northamptonshire or a coastal town like Worthing, rarely works. We need national frameworks and national quality thresholds, and we need local design and local implementation. We need to hold people’s feet to the fire. Every local authority needs to come up with a best start in life plan. That local plan needs to meet the thresholds for children’s outcomes, and then the centre needs to ensure that authorities go ahead with those plans and achieve those outcomes. In that way we can have local ownership, local design and local flexibility that are in the best interests of children and their families.

I welcome the “best start in life” programme, and I congratulate all who have made it possible. This has been a huge joint effort. It has been a false economy not to look at those initial few pre-school years, because that is when we can have the biggest impact on the nurturing value of parents and the attachment that is so essential between a parent or parents and their children, when a child’s brain is growing exponentially—and will be impacted on for the rest of his or her life. At last we have a programme that realises that. Let us ensure that we make it a success for our future generations.

[Madam Deputy Speaker (Dame Rosie Winterton)]

Before I call the next speaker, I must tell the House that we have another debate following this one in which 11 Members have put in to speak so far, so we must be conscious that there are slight time pressures.

Covid-19 Update

Tim Loughton Excerpts

Tuesday 9th November 2021 Commons Chamber

[Sajid Javid]

We will be publishing the impact statement today.

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

Although I want everybody to be vaccinated, I do not support mandatory medical interventions, and I worry about the impact on the already high vacancy rate in the workforce. My right hon. Friend the Secretary of State must have done some risk assessments, so can he tell me this? As previously asked, how many of the 10% who are un-jabbed does he assess will be subject to medical exemptions? What calculations has he made of the likely job losses overall? When will he publish a list of exactly what personnel are involved? Will it involve cleaners, for example, who do not have medical engagement with patients but are certainly in proximity to them? When will he publish the evidence and the data on the number of patients who have been infected with covid by unvaccinated staff while in hospital?

[Sajid Javid]

I hope my hon. Friend appreciates that there were a lot of questions. The impact statement will be published today, and the impact assessment will be published before he and other Members are asked to vote. Those documents will help to answer their questions. I also draw his attention to the experience thus far of the condition of deployment measure that we took in a similar way with care homes, and how dramatically the numbers were cut from the point of announcement.

Menopause (Support and Services) Bill

Tim Loughton Excerpts

2nd reading
Friday 29th October 2021 Commons Chamber

[Carolyn Harris (Swansea East) (Lab)]

I beg to move, That the Bill be now read a Second time.

The private Members’ Bills ballot at the start of each Session of Parliament gives each of us the opportunity to put in to champion a cause that we believe will make a real difference. When I was drawn at No. 3, I thought long and hard about what I should focus on. I wanted an issue that meant something to me and that would make a difference in the lives of people who really need it—not just in my constituency, but right across the UK. Being the only female Member drawn in the top seven, I particularly wanted to focus on something that would improve the lives of women up and down the country, and so the Menopause (Support and Services) Bill began to take shape in my head.

I have said all along that this Bill and the menopause more widely is not a political issue, and I maintain that. Women’s health should never be political. So I am not here today to win points; I am here because, right now, menopause support in this country, and indeed around the world, is falling short and failing women. GP training in medical schools, support in workplaces, public health messaging and curriculum content in our schools all need addressing, and I will come to each of those in turn in my speech.

However, I needed more: I needed something that only a change of legislation would put right, and it was a conversation with one of my colleagues in this place that gave me that something. I have always considered myself very fortunate to be a Welshwoman, and why wouldn’t I?—we are taking over the world, guys—but it had not occurred to me until that conversation that there was another reason why being Welsh was an advantage: NHS prescriptions are free in Wales. My colleague, on the other hand, was off to pick up her hormone replacement therapy prescription and was going to pay for it. She could afford to pay for it, but not everyone can. It was one of those eureka moments when I realised that this was the final piece in the jigsaw of my menopause Bill, which was always going to be about raising awareness and bringing a focus to the menopause as an issue we all need to consider.

Some 51% of the population are female, which means that 51% of us will personally experience the menopause at some point in our lives. Our experiences will all be unique. Some will sail through and barely notice. Others will suffer the most extreme symptoms: headaches, hot flushes, night sweats, brain fog, brittle nails, weight gain, insomnia, anxiety, low libido, vaginal dryness—and I could go on and on. Many women will present at their GP’s with one or more of those symptoms, and that can be the first hurdle. With 41% of medical schools offering no mandatory menopause training at all, thousands of GPs are qualifying and entering practice with no knowledge of how to diagnose menopause.

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

I congratulate the hon. Lady on again bringing a taboo subject out of the shadows. I am delighted, as one of the 49%, to be a sponsor of her Bill, not just because she would have beaten me up if I had not been, but because this is a genuinely needed and worthwhile Bill. Does she agree with me that it is not just the 51% or the 13 million who are peri or post-menopausal who are affected, but that it affects many of the 49% and younger women? Many of the conditions that she has described are a huge additional cost to the NHS that, if prescribed for properly—and diagnosed properly—would save a lot of money for the NHS and an awful lot of angst for many women going through that, and the people around them.

[Carolyn Harris]

I agree with the hon. Gentleman and thank him for sponsoring the Bill. I would say that this is about not just the symptoms women feel, but the consequences in relationships; we have seen far too many marriages and relationships fall by the wayside because of menopause and its symptoms, and now is the time to change all that.

Women presenting to their doctor are often diagnosed with anxiety and depression. That happened to me and I have told my story previously: I presented to my GP believing I was having a nervous breakdown and ended up on antidepressants for 11 years. It was only when I spoke to friends and colleagues in this place and we shared conversations that people do not normally have—or did not have until now—that I realised that many other women were also experiencing what I was experiencing. That means we are seeing women being prescribed antidepressants when hormone replacement therapy may well have been more suitable, or presenting with insomnia and being given sleeping tablets when HRT may well have been more suitable, or being sent to consultants for tests for early onset dementia when visiting their GP about their brain fog and forgetfulness when, again, HRT may well have been more suitable. As hormone levels drop, women are at greater risk of developing a series of other conditions—cardiovascular disease, osteoporosis, type 2 diabetes, obesity, osteoarthritis, depression and dementia—and the cost of investigating and treating these as well as the other additional appointments is putting extra unnecessary pressure on our NHS.

I have heard countless stories of misdiagnosis. As I have said, I went on to suffer for 11 years with what I considered to be depression. Little did I know that over a decade later when I started HRT, I would see my life become transformed and I would have more energy. God, isn’t that scary: more energy? My husband is heading for the backdoor now. But we cannot blame GPs; we must make sure our medical schools reassess their curriculums so in future doctors are educated in the menopause and are able to offer all women the same high-quality care and support. Women are routinely called for cervical smears and breast screening; we need to see them being called for a menopause check-up around the time they turn 40. This would be a quick and an easy solution to helping women become more aware of the symptoms so that they are prepared and, importantly, educated in the available treatments.

Covid-19 Vaccinations: 12 to 15-year-olds

Tim Loughton Excerpts

Monday 13th September 2021 Commons Chamber

[Nadhim Zahawi]

I am grateful for the hon. Lady’s support for tonight’s decision. The Department for Education is rolling out, I think, 300,000 carbon dioxide monitors. It is very important that ventilation is very much part of what we do as we transition this virus from pandemic to endemic status.

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

May I come back to the issue of parental consent and, in doing so, declare my entry in the Register of Members’ Financial Interests? I welcome the fact that this will be done with parental consent, because all the pressures would be far greater if it were left up to individual children, with all the peer pressure and stigma that that could bring. Will the Minister tell us what the situation will be for children in care? Will the default position be, as corporate parents, that all children in the care system will be vaccinated? What then happens if the birth parent or the long-term foster carer has an objection to that?

[Nadhim Zahawi]

I thank my hon. Friend for his important question. The deemed carer for that child will be requested to give that consent.

Coronavirus

Tim Loughton Excerpts

Wednesday 16th June 2021 Commons Chamber

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

Happy Sussex day, Madam Deputy Speaker. Like every good, horny-handed son and daughter of Sussex, I am afraid I “wunt be druv” into the Government Lobby this evening.

The hashtag #i’mdone was the overwhelming message on social media on Monday when independence day, so tantalisingly close, was again cruelly whipped away from my constituents. Madam Deputy Speaker, I’m done with making excuses to my constituents about when their lives might get back to some degree of normality.

We are constantly told that these decisions are about data, not dates—quite right—but we have the imminent dates by which the vaccination programme will have achieved effective herd immunity, which is well ahead of what was imagined when the lockdown road map was designed. Now, 80% of adults have had their first dose. We have data showing that the Pfizer vaccine is 96% effective against the delta variant after two doses, and that the AstraZeneca vaccine is 92% effective. We have data showing an average of nine deaths a day at the moment, and 136 hospitalisations—a world away from where we were at the start of the road map. We have data from Public Health England that only 3% of the delta variant cases have received two vaccinations.

We also have dodgy data from three modelling studies by the University of Warwick, Imperial College, and the London School of Hygiene and Tropical Medicine. They show widely different scenarios, with the most pessimistic warning that the UK could experience a further 203,000 deaths by next June, which is around 50,000 more than the first and second waves combined. Yet how can that be when we know the vaccine works, and the data show a likely 90% take-up rate?

Those doomsday models by largely anonymous wonks with no remit for considering the impact of further lockdown on life at large seem to trump all the other data, and the Government put them on a pedestal above all others. They are confusing modelling for scientific forecasts.

[Mr Bone]

Is my hon. Friend saying that the scientists are concentrating on one thing and ignoring everything else?

[Tim Loughton]

The trouble is that there are lots of different scientists and they do not agree with each other, yet only certain scientists seem to have an impact on the Government. Usually, it is the most doomsday of those scenarios.

Where is the data that shows that allowing six people inside a pub has increased infection rates, and by how much? Where is the data that shows how much faster an infection has spread because up to 30 people have been able to meet outside since the original journey out of lockdown? Where is the data showing that the NHS is being overwhelmed, not by covid patients, but by a huge increase in children and families suffering mental illness, including many worrying episodes that we have seen as constituency MPs, or by the surge in advanced cancer cases that could not be diagnosed and treated early? Where is the data showing how many businesses, particularly in the hospitality sector, cannot wait a further four weeks to be profitable and are likely now to fail, with the accompanying impact on people’s jobs, livelihoods and wellbeing? Where is the data showing the impact on the wellbeing of children now denied sports days for another year and school proms? Students are again being denied graduation ceremonies for a second year, having missed out on so much of their university experience. Where is the data on the impact of domestic abuse, which has risen so much, as we have seen? Where is the data showing the continued impact on babies? The problem is that the only data considered seems exclusively to be the worst-case scenarios about the spread of covid, regardless of the current single-figure average death rates.

No covid strategy is risk-free, but a further delay is by no means a victimless decision. It is time that we trusted people to live with covid just, as the Prime Minister announced in February, in the same way that we “live with flu”: we do not let flu get in the way of living our lives. The Government promised at that stage that we would move to personal responsibility. My fear is that if the Government continue to try to nanny people, they will just not take any notice and no amount of retained rules will make any difference. People are already increasingly making their own risk assessments. As somebody tweeted the other day:

“I had Covid. I have antibodies. I have had both jabs. I’ve worn a mask. I’ve sanitised to within an inch of my life… But now, #ImDone no more. It's over.”

My fear is that this will become a much more widely held view if the Government just keep delaying freedom day, without the evidence to back it up.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I really do not mind interventions taking place, but we have 13 people to get in before I start the wind-ups, so every intervention means that somebody is not going to get in. I urge people to speak for fewer than three minutes if they can.

Maternal Mental Health

Tim Loughton Excerpts

Wednesday 10th March 2021 Westminster Hall

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

It is good to see you in the Chair, Mr Robertson, in this new Chamber, which is a first for us all. I congratulate the hon. Member for Richmond Park (Sarah Olney) on securing the debate. It is good that we have had a number of debates in recent months about maternal challenges during the pandemic, the impact on families and the impact on the mental health of parents and children. There is little that is more important, frankly. It is something that we will have to spend a lot of time concentrating on as we build out of the pandemic in the coming months.

Let me declare my interests. I am chair of the all-party parliamentary group for conception to age two: first 1001 days. Given the hon. Lady’s comments, I think we have a new recruit. If she is not already one of our members, I would be delighted to welcome her along. It is a very active group. I also chair the all-party group for children, and until recently I was the chairman of trustees of the Parent-Infant Foundation charity, which concentrates on the initial 1,001 days and the attachment between parent carers and their children.

I was impressed by the response from the digital teams in the House. It was a very good exercise. As the hon. Lady said, 11,265 responses is not to be sniffed at. Alas, the responses were all too familiar. We have heard similar anecdotes from our constituents about what has been going on during lockdown. There were responses about parents, and particularly mums, feeling lonely. They feel isolated in hospital, particularly if they have to stay in for any length of time because of complications. They have problems even getting their partners—the fathers—to be able to visit them. They feel isolated from family support networks that we normally take from granted. They feel isolated from new mum and baby groups. One of the respondents to the survey called them a safety valve where completely new mums, in particular, learn from other mums—either new mums or experienced mums—and the babies interact too. It was interesting that, for colleagues who gave birth during the lockdown, it was several months before their babies were actually able to meet another baby, and there was a bit of a shock factor there. We perhaps underestimate the impact of that social contact from the very earliest stages after a child is born.

In particular, as the hon. Lady mentioned, there is the isolation from health professionals on a face-to-face basis. I know that there have been a lot of substitute virtual visits, but they are not a substitute and they must not become the norm. We need to build back our health visitor numbers, as we did so well in the coalition Government between 2010 and 2015, when we produced 4,200 additional health visitors, who were absolutely invaluable. They are the friendly face that new parents will welcome across a threshold, where they may be more suspicious of a social worker or other care workers. They are also an early warning system for problems that may be going on with a new parent and ultimately any safeguarding issues.

A report that the First 1001 Days Movement produced last year, called “Working for babies”, said that services supporting nought to twos were highly depleted during the first spring lockdown last year. The majority of services for nought to twos did not bounce back quickly as lockdown measures were eased. We need to make sure that mistake is not made again this time.

This lockdown has been especially stressful for first-time mums, single mums, and families having to balance working remotely, new forms of working and working covid-safely, and juggling home schooling if they have other children too—thank goodness all my children are above school age and we have not had that additional challenge. Even before the covid pandemic, at least one in six mums suffered from some form of perinatal mental illness—commonly anxiety disorders and depression. We know that the pandemic and lockdown have impacted on the mental health of just about everybody, but particularly on that cohort of mums.

A survey by the excellent baby charity Bliss found that, among its members who had received neonatal care during the pandemic, 90% of parents said they felt more isolated as a result of having a baby in neonatal care during the pandemic; 70% said their mental health was negatively affected as a result of the experience; 56% said the mental health of their partner and wider family had been affected; and 47% said they were not offered support for their mental health while their baby was in neonatal care. We know that, in extremis, suicide is the biggest cause of maternal death. We must do so much more to ensure that women do not get in that position and that support is there and accessible.

The shortage of health visitors is a false economy. I have always said that; we had a debate specifically on that last year. I pay tribute in particular to Cheryll Adams, who set up and has led the Institute of Health Visiting. She is retiring at the end of the month. The service she has given to that area has been extraordinary and has informed many debates in this place. I put on the record our thanks and gratitude to her.

There is also the whole issue of increased domestic abuse during pregnancy. The figure that I always find hard to take on board is that a third of domestic abuse happens during pregnancy as well, and we know that domestic abuse has gone up during the pandemic, so all the additional pressures on women who are about to give birth or who have just given birth are extraordinary.

The cost of perinatal mental illness, as calculated by the Maternal Mental Health Alliance some years ago—it still holds true, and today it is probably an underestimate—was £8.1 billion each and every year. On top of that, the cost of child neglect is £15 billion, so we as taxpayers are paying £23 billion-plus into the health service to get it wrong. To prevent us getting it wrong, if we spent a fraction of that on the support services—the health visitors and those networks—being there in the first place, that would be money well spent and well saved.

Of course, the key is good attachment between babies and their parents or primary carers from those very earliest stages and during conception, hence the founding of the First 1001 Days Movement. My right hon. Friend the Member for South Northamptonshire (Andrea Leadsom) launched the 1,001 critical days manifesto back in, I think, 2012, which was signed up to by colleagues across parties, the royal colleges, clinicians, academics and children’s charities alike. It is still relevant today.

To quote research by the First 1001 Days Movement and the Parent-Infant Foundation—I pay tribute in particular to Sally Hogg, who does so much of the good work there—it is estimated that 10% to 25% of young children experience significantly distorted relationships with their main carer or carers, and from that a range of poor social, emotional and educational outcomes in childhood and across the life course can be predicted. Maternal mental illness in pregnancy and the early years of a child’s life can have adverse effects on the child’s brain development and long-term outcomes. Maternal mental illness can affect children both directly and indirectly. For example, exposure to stress hormones in the womb is thought to affect the child’s developing stress response systems, and mental illness after birth can affect a mother’s ability to care for her baby, her parenting style and her developing relationship with her baby. Even relatively mild mental illness, if untreated, can inhibit a mother’s ability to provide her baby with the sensitive, responsive care that they need.

This, again, is a statistic that I always use. If a 15 or 16-year-old teenager is suffering from some form of depression or low-lying mental illness, there is a 99% likelihood that that child’s mother suffered some form of perinatal mental illness—the connection is that close. So why are we not doing more to support the mother before and soon after she gives birth? The implications of not doing so will be with her child and her for many years to come, and often into adulthood for the child.

It is also important to note that although perinatal mental illness increases the risk of disruptions in early relationships, they are not inevitable. Some mothers can continue to give their babies the sensitive, responsive care they need, particularly with the right support—and good, effective support can be had, if it is available. That is the problem: it is not always there, or not always there at the right time or in the right place.



Other risk factors put early relationships and infant mental health at risk, including families where fathers or other care-givers have serious mental health problems themselves. Again, we underestimate the impact of becoming a father, particularly for the first time, on the mental health of dad. In most cases this is a joint partnership, but fathers often get overlooked. They often get excluded from the whole neonatal process within hospitals, as well. They need looking after too, because if they can be looked after, they can look after their partner and there is a mutual benefit from all of that. We need to do more for fathers.

The NHS long-term plan includes a commitment to expand access to evidence-based parent-infant interventions within specialist perinatal mental health services, which is indeed welcome. It will ensure that attention is given to the parent-infant relationship alongside the mother’s own mental health when mothers have moderate or severe mental health problems. We must not just look at the child or the mum in isolation; we are looking at the bonded family.

However, access to mental health services for babies should be dependent on the risks to their mental health and not contingent on other factors, such as their mother’s mental health needs. So, the NHS long-term plan for England also committed to improving access to specialist services for all children from 0 to 25, but delivering that commitment requires specialist provision for all babies who need it, as they are children, too. Such provision would need to be delivered by parent-infant specialists. However, the NHS long-term plan says nothing explicitly about specialist mental health services for the youngest children in their own right.

The solution is that we need specialised parent-infant relationship teams providing therapeutic support where a baby’s development is most at risk due to severe, complex and/or enduring difficulties in their relationships. Such teams focus on the relationship between a baby and his or her parents or care-givers as the main way to improve infant mental health. However, there are fewer than 40 specialised parent-infant relationship teams in the whole of the UK, and most babies live in an area where these services just do not exist; vast areas of the country have no provision.

One of the aims of the Parent-Infant Foundation charity, which was set up by the right hon. Member for South Northamptonshire, is setting up parent-infant projects around the country, where practitioners are available, to work on the attachment of parents and their children. We just need it to be mainstream across the whole of the national health service.

As the Royal College of Psychiatrists has said, the need for more perinatal psychiatrists to work in these services is crucial. These specialist services need a highly trained specialist workforce, but the workforce census in 2019 showed that 13% of consultant and perinatal psychiatrist positions remained unfilled. Without more psychiatrists, ambitious plans to transform and expand services will be put at risk.

We are soon to have the Leadsom review, if I may call it that; it does not really ring true as “the South Northamptonshire review”. The right hon. Member for South Northamptonshire is producing the review; hopefully it will be published later this month. I have been privileged to play a part in it, and chaired a parliamentary advisory group.

Absolutely key to that review are a joined-up support service between the NHS, local government and other key professionals, to give that wraparound service to parents in those crucial early months and years; a digital record, so that all those professions are working from the same information, rather than every visit to mum being a new visit; and a national template of the quality that we need to reach, but with local implementation, so that a service in Richmond, although it may look a bit different from a service in my part of the world on the Sussex coast, is none the less required to produce quality outcomes and clear the same threshold.

We look forward to that report in the coming weeks and months, and I very much hope that the Government will take it on board and produce the goods, because little, if anything, is more important than the welfare, good health and good mental health of our children. And a child is given the very best opportunity—the best start in life—if their parents are in a safe and stable place as well.

[Mr Laurence Robertson (in the Chair)]

In order to call everyone, I wonder if I might ask all Back Benchers to stick to around five minutes in their contributions, please.

Public Health

Tim Loughton Excerpts

Wednesday 6th January 2021 Commons Chamber

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

Thank you, Mr Deputy Speaker, for saving me up till last. It is difficult to say something new at No. 67 on the list.

Let me say at the outset that I recognise the seriousness of the situation, particularly given the new strain of the virus. I recognise the huge pressures on hospitals and I pay tribute to them. However, I am not convinced that another hurriedly announced national lockdown is the right solution. That is why I am loth to vote for the regulations, especially when we have had just three hours to debate the biggest infringement of our constituents’ civil liberties that I have ever had to vote on as an MP, and given that Parliament could have sat all this week, and we would then have considered the regulations before they came into force.

The sunset expiry date of the regulations has been surreptitiously moved to the end of March rather than the end of January as we were earlier led to believe. The regulations have no impact assessment, and there are measures in them that were brought into law in the first lockdown, but later removed or relaxed.

I have said all along that the Government have a difficult job to balance advice about risk from the medical experts with the economic impact and the public’s confidence in abiding by the regulations. After 10 months, that confidence has been sorely tested and there is a high level of lockdown fatigue. It is therefore even more important that what we ask our constituents is logical, consistent and fair. Banning golf, tennis, angling and other outside pursuits was not considered logical previously and was relaxed in earlier regulations. Banning people from buying beer from outside closed pubs rather than crowding into supermarkets and off-licences was also inconsistent and relaxed in earlier regulations. It is therefore frustrating and regressive to see those and many other unnecessary and illogical restrictions creeping back in again. I ask the Secretary of State to be sensible and sensitive to the lobbying to remove them before they undermine confidence further.

My main point concerns the vaccine. It must be the Government’s single biggest imperative. We need a national effort—a “little ships” effort—to deliver, buoyed up by the sea of vaccine the Government wisely bought up early. So when Ministers and clinicians proudly claim that we will be vaccinating 12 hours a day, seven days a week, my reaction is to ask: what about the other 12 hours—the other 50% of the day? We should be vaccinating 24 hours a day, seven days a week, until everyone who qualifies is jabbed. Many volunteers have come forward to work shifts in the middle of the night—many little old ladies in Worthing who would readily bring tea and biscuits round at 4 o’clock in the morning, with others to run the technology. If they are offered a jab at 4 am rather than four weeks hence, people will turn up.

We should be getting more juice, as the Secretary of State put it earlier, including by approving the Moderna vaccine already given the go-ahead in the US, for example. Create drive-through jab centres, develop online booking of slots, allow walk-in services for spare appointments, allow diabetics to self-jab when they get their insulin. Only when we are vaccinating full-time can the Government claim to be doing absolutely everything they can, at pace, to get us out of this revolving pandemic lockdown door.

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. Sorry Tim.

Healthcare Support Services: Conception to Age Two

Tim Loughton Excerpts

Tuesday 15th December 2020 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir Christopher, and a great pleasure to be speaking in a debate secured by my very old, wise and aged colleague, my right hon. Friend the Member for South Northamptonshire (Andrea Leadsom)—the high priestess of early years. As she said, I speak as the chair of the all-party parliamentary group on the first 1,001 days. I also recently stood down as chair of the Parent-Infant Foundation, the charity that she founded and that is having such an important effect on the whole movement for 1,001 days. I have been very proud to chair that charity for the past six years.

It is great to see this subject coming into the mainstream. We have had a number of Westminster Hall debates, including on the impact of covid on maternity, families and children in lockdown. Before the general election, I held a debate on health visitors. Since “The 1001 Critical Days” manifesto, the important document produced about eight years ago by my right hon. Friend, we have had various reports, including “Babies in Lockdown”, “Rare Jewels” by the Parent-Infant Foundation, “Building Great Britons”, and several Select Committee reports, including by the Health and Social Care Committee and the Science and Technology Committee, all of which were serious, heavyweight studies of the first 1,001 days.

This is, at last, not a new subject. I come to this debate much in the mode of Elizabeth Taylor’s sixth husband: knowing what was expected of him, but struggling to make it new and fresh. But we will give it a go.

Children, particularly very young children, have been the forgotten element in the whole pandemic lockdown; so too have parents of very young children. The lockdown, the regulations, and the alienation from or unavailability of family member support networks—which many of us, as early parents, took for granted—have had mental health impacts on new parents and single parents in particular. We should not underestimate that. It will be a long time before we can get back to a degree of normality and start to see the impact that missing out on those important contacts and support mechanisms in those crucial early months has had and will have for many years to come.

Early years has for too long been forgotten when it comes to Government spending. Many of us have been going on about that for a long time, and it is worth repeating. Work done a few years ago estimated that the cost of perinatal mental illness is £8.1 billion each and every year. The cost of child neglect in this country is £15 billion each and every year. That means that we are spending more than £23 billion on getting it wrong for parents and very young children in those crucial early years. If we were to spend a fraction of that amount on greater preventative intervention measures for those who most need it in those crucial early years from conception to age two, that bill would be reduced significantly and it is a false economy not to be doing that.

It was disappointing to see just £300 million in additional funds being given to the social care sector—that is, the adult and children’s social care sector—in the spending review, even though there is a shortfall of some £3 billion in local authority children’s social care alone, not to mention all the problems with public health and the shrinking numbers of health visitors, which I will come back to in a moment.

Why is that important? My right hon. Friend the Member for South Northamptonshire has given us some of the figures. Up to 20% of women experience mental health problems in pregnancy or the first 12 months after birth, and 50% of all maltreatment is related to children under the age of one. It has been estimated that 122,000 babies under the age of one live with a parent who has a mental health problem. One third of domestic violence begins during pregnancy—a figure I could not believe when I first came across it. The Government are doing good work with domestic abuse legislation, but we need to be addressing the problem at source. If domestic violence is happening in a household, what sort of physical and psychological message is that sending to the newborn child? The same applies to even before it is born as well: there are signs that communication within the womb itself is a factor. Suicide is one of the leading causes of death during the period of pregnancy to one year after the birth of a child. That is a deeply tragic figure, but it preventable if proper systems and checks are in in place.

About 40% of children in the UK have an insecure attachment to a parent or carer by the age of 12 months. The figure that I have always used—this is, I think, the killer point—is that for a child at the age of 15 or 16 who is suffering from some form of depression or low-level mental illness while at school, there is a 99% likelihood that his or her mother suffered from some form of depression or mental illness during or after pregnancy. It is as direct a correlation as that. If we do not do something within those first 1,001 days, we will reap the consequences, as will children, not just during childhood but into adulthood as well.

Child obesity rates are all connected to what happens in the first 1,001 days. Last year we also had worrying figures—this is particularly topical now—about the dwindling vaccination rates in England. In particular, only 86.5% of children had received the full dose of the measles, mumps and rubella vaccine. We have effectively lost our immunity status, because the World Health Organisation target to protect a population from a disease is 95%. One hopes that parents in particular will take up the covid vaccination as it is rolled out, because we have seen the effects on the children’s population of not having vaccinations in recent years.

The Children’s Commissioner estimates that 2.3 million children are living with risk because of a vulnerable family background and that more than one third within that group are invisible—they are not known to services and are therefore not getting any support. That is why it is crucial, particularly before those children present at school and come on the radar, that health professionals at various levels are having contact with those children and families to ensure that everything is all right. They can give that help and support and that tender affection and empathy, but they are also an early warning system for when things are going wrong, right up to safeguarding issues. The one thing that all those ailments have in common—there are a lot more that I have not mentioned—is that they come under the remit of the health visitor to a varying extent. I will come back to the importance of health visitors.

The impact of covid is great, as I have said, and I will not go over that again, but more families with babies and young children under five have been tipped into vulnerability due to the secondary impacts of the lockdown. At a time when families, and particularly families from deprived communities and single-parent families, need face-to-face contact with people like health visitors the most—I also refer to health visitors as the trusted uniform services who are usually welcomed over the threshold, whereas with social workers and others a barrier goes up instantly—more than 70% of health visitors have been repurposed to other aspects of the health service to deal with covid. That really is a false economy.

I pay tribute to Cheryll Adams, the chief executive of the Institute of Health Visiting, who is standing down from the outstanding role she has played for the cause of health visitors and their importance in the first 1,001 days. She will be greatly missed, but I am sure she will not quit the scene altogether, because of her dedication to the cause. Her report showed that 82% of health visitors reported an increase in domestic violence and abuse; 81% an increase in perinatal mental illness and poverty; 76% an increase in the use of food banks and speech and communication delay among children; 61% an increase in neglect; and 45% an increase in substance abuse. Finally, 65% of health visitors have a case load of more than 300 children under the age of five.

Is that sustainable? My worry is that even in the good times without a pandemic, health visiting was greatly stretched. One of the great achievements of the coalition Government was the delivery of a promise to institute 4,200 additional health visitors, based on the Kraamzorg system in Holland, which we visited and saw. It was a huge achievement—I think we were just a few dozen short of 4,200 by the time we got to 2015—and yet I fear that those numbers have dwindled back almost to the level that was inherited. That is such a false economy. Health visitors are a critical part of a universal offer to all families in the first 1,001 days. The report by the First 1001 Days Movement says:

“It is essential that governments invest in the delivery of the Healthy Child Programme and that this programme supports babies’ emotional wellbeing and development. We believe that all families should be able to access care from a named health visitor who offers them a high-quality service that is proportionate to their needs.”

I wholeheartedly concur.

What should be done? Many suggestions have been made. The LGA recently brought out a report saying that the Government should

“properly resource councils to enable investment in preventative universal and early help services to ensure that children, young people and their families receive the practical, emotional, education and mental health support they need”.

That is absolutely right. The Parent-Infant Foundation, in its “Babies in Lockdown” report, recommended funding for a

“Baby Boost to enable local services to support families who have had a baby during or close to lockdown.”

As my right hon. Friend said, more than half a million babies were born in that period. The report also said we should have a

“new Parent-Infant Premium providing new funding for local commissioners, targeted at improving outcomes for the most vulnerable children.”

I obviously agree with that.

Finally, I will go back to the “Building Great Britons” report, which was produced back in 2015 and made nine main recommendations: that a 1,001 critical days policy should be a mainstream undertaking by central Government; that all local authorities should be required to produce and implement a 1,001 days strategy within the next five years; that national Government must establish a 1,001 days strategy blueprint; that local health and wellbeing boards should demonstrate delivery of a sound primary prevention approach; that the early help recommendations from the Munro review, which I commissioned back in 2010, should be picked up and carried; that we should have a Minister for families, either close to or at Cabinet level, to carry the banner for the importance of the early years and family contexts, which are so important to the social policy of any Government; that we should have more inter-agency training on the importance of the early years; that children’s centres should be repurposed to be these family hubs, which this Government have committed to and which should be a Piccadilly Circus of these services available to all families; and that we should have the research evidence to go with all of that.

In short, we need a full “team around the family” approach; we need to invest in health visitors and other health professionals, including GPs and mental health specialists, particularly around attachment issues. We need them to work with all of those in the early years setting, alongside social workers and others with safeguarding responsibilities—supporting, not supplanting parents, but signposting them to the most appropriate services and ensuring that they are accessible when needed. We need a national roll-out, national guidance and national scrutiny to ensure that it is being delivered, but it should be implemented locally and governed by local circumstances. To not do that is a false economy, and children in future generations will pay the price.

[Sir Christopher Chope (in the Chair)]

Before calling the next speaker, I will just say that the wind-ups will start at half past 10. There are four more speakers, so if each of them speaks for a maximum of five minutes, we should cover everybody.

Covid-19 Update

Tim Loughton Excerpts

Thursday 15th October 2020 Commons Chamber

[Matt Hancock]

We have prepared for years to ensure that we have the supplies that are needed, and I have of course been in contact with Roche over this distribution issue. It is actually an issue about distribution from a warehouse in England, and these distribution issues do happen from time to time in very large organisations such as the NHS. We are working closely with Roche, and I thank it for all its efforts to solve this technical problem.

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

I agree with the local approach that my right hon. Friend is taking. He has to make a judgment based on balancing what the science is telling us, what the economy is telling us and the sustainability of public consent. I am concerned about care homes. My care home managers tell me that their staff are knackered. They are exhausted from covering extra shifts when other staff are isolating or have childcare challenges. They are also exhausted from dealing with online GP appointments because GPs will not visit those homes, and from dealing with angry relatives, particularly those of elderly mentally infirm residents, because they cannot visit them face to face. What can we do to help sustain those care home staff and, in particular, to approve volunteers from the massive register that we have, in order to help to share the load?

[Matt Hancock]

I would be very happy to take up my hon. Friend’s suggestion about the volunteers. I commend to him the social care winter plan, which sets out how we will balance the very difficult issues that he mentions.

Coronavirus

Tim Loughton Excerpts

Tuesday 15th September 2020 Commons Chamber

[Matt Hancock]

Yes, absolutely. The hon. Lady is right to raise the concerns in Warrington about the increase in the number of people testing positive. I am happy to work with her, Warrington Borough Council and my hon. Friend the Member for Warrington South (Andy Carter) to ensure that we get the best possible response, including putting in that extra testing.

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

Traditionally, the start of the autumn term is the peak for returning schoolchildren showing signs of colds and sniffles. I am now increasingly getting reports from my constituency of young children being turned away or returned from nurseries and primary schools if they display any cold symptoms. I am afraid that I have to tell the Secretary of State that testing is not at a record high in my constituency, because of capacity being moved up north and to hotspots, despite Worthing now being on the watch list because of a single outbreak of 23 people not abiding by the regulations. I heard yesterday from a constituent who had been referred from the Sussex coast all the way to Aberdeen. Can he not forget those very young children and the huge impact that they can have on families and schools if testing is not properly available for them?

[Matt Hancock]

Yes, of course. It is so important in Worthing, as it is across the rest of the country, that we prioritise the testing that we have. My hon. Friend is quite right that, when schools go back, children often do get a cold, a non-coronavirus illness—a normal illness if you like. Obviously, that is contributing to the increase in demand, as well as people who are not eligible coming forward. That is one reason why we have been building capacity throughout the summer, and I look forward to working with him to make sure that we solve the problems in Worthing.