Children’s Mental Health

Wera Hobhouse Excerpts

Tuesday 8th February 2022 Commons Chamber

[Dr Allin-Khan]

My hon. Friend is right to remind us that adverse childhood experiences and inequalities, including health inequalities, lead to worse mental health outcomes in later life and stop children from achieving their full potential.

Imagine being a mum or dad whose child is self-harming or presenting with symptoms of depression, anxiety or phobia, and being without specialist support for extended periods. We all agree that the pressure that that puts on families and parents is just so crippling. The number of children who needed specialist treatment for severe mental health crises between April 2021 and October 2021 was 77% higher than in the same period in 2019.

This is the UK in 2022. The bar to being seen by a specialist is high, the delays are long and three quarters of children were not seen within four weeks of referral. That time is one of anguish for them and their family. Does the Minister believe that making 369,000 children wait for vital mental health support is acceptable?

According to the latest report by the Children’s Commissioner, waiting times depend on where people live—so much for levelling up—and when they are eventually seen, services may be hundreds of miles away. It is making the situation so much worse. Ask any parent or any young person; they will tell us that the uncertainty and paucity of mental health services damages mental health, exacerbates mental health conditions, allows symptoms to persist and makes conditions harder to treat down the line. Ultimately, it also costs more.

[Wera Hobhouse (Bath) (LD)]

The mental health disorders with the highest mortality rate are eating disorders. What the hon. Member says is particularly true for eating disorders: the longer somebody waits for treatment, the longer the disorder persists, which makes it worse. We really need to look at prevention and early intervention in all our services. Does the hon. Member agree that instead of saving money at the wrong end, it makes absolute sense to put money into early intervention and, better still, prevention?

[Dr Allin-Khan]

I entirely agree. It has been a pleasure to work alongside the hon. Member in looking at eating disorder issues over the past couple of years; she is a powerful advocate. She reiterates my point that prevention is better than cure. We know that in the pandemic, eating disorders have increased. Young people who feel the loss of their sense of control through fear can, in trying to understand what is going on in their lives, develop habits that are unfortunately very difficult to break. We know that the earlier someone can intervene when there are such issues, the better the outcomes will be.

Sometimes the damage, especially the damage done by waiting, is permanent. Imagine if we treated childhood cancer like we do children’s mental illness: waiting for symptoms to get worse before seeing a specialist, waiting for months or even years for treatment and leaving patients and parents to rely on charity. There would be an outcry, yet that is what the Government are doing with children’s mental health. When the Minister responds, I invite them to tell the House what new measures the Government are taking, what new money is being allocated to CAMHS, and where it is going. How many mental health staff will be recruited? How will they deal specifically with the impact of the pandemic on mental health? How will they tackle the deep-rooted mental health inequalities on the lines of place, race, class and income?

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[Wera Hobhouse (Bath) (LD)]

I am speaking today, as I have done before, as the chair of the all-party parliamentary group on eating disorders. Eating disorders are the mental health disorders with the highest mortality rate. My hon. Friend the Member for Twickenham (Munira Wilson) talked today with a breaking voice about cases in her constituency and the hon. Member for Birmingham, Yardley (Jess Phillips) talked about the terrible things happening to our constituents that we see and hear about; I worry about the lives of a number of young people I know and about their families, who are worried sick about losing them. That is what we are talking about today.

Eating disorders are complex and potentially life-threatening, and the number of cases has increased fourfold in the last two years. They have no single cause and often start at school age. Recovery from an eating disorder takes on average three times as long as having the disorder itself. The fact that eating disorders all too often go undiagnosed—we have heard again and again about how long waiting times are—and that people are waiting so long to get treatment adds to the problem.

Eating Disorders Awareness Week is fast approaching. This year’s focus will be on training doctors to recognise these disorders. A 2019 report from the Parliamentary and Health Service Ombudsman identified a “serious lack of training” about eating disorders, which received just a few hours of attention on medical courses. That means that children, who often cannot adequately express their needs or condition, have been left on their own with these complex and debilitating conditions. Three years on, very little has changed.

Moving forward, we must recognise the importance of prevention and early intervention, which dramatically improve the chances of recovery. School counselling is an ideal form of early intervention. Scotland, Wales and Northern Ireland all have statutory school counselling services. England does not. Meanwhile, community services and the voluntary sector face a backlog of people desperate for urgent help. Our voluntary sector, such as the regional eating disorders charities network, has taken on the lion’s share of school counselling and shouldered the burden of addressing the mental health of our children. We must recognise the invaluable work that they are doing and make sure that they get more funding. Some £11 million has been allocated to improve eating disorder services, but only £1.1 million has been spent on the frontline. I have raised that worrying statistic with the Minister before, and I urge her to listen. We must make sure that every penny that the Government make available actually gets to the frontline.

NHS Dentistry: Bristol and the South-west

Wera Hobhouse Excerpts

Monday 24th January 2022 Commons Chamber

[Darren Jones]

I absolutely agree, and I thank my hon. Friend for her contributions, not least as a leading voice on healthcare policy, knowing that prevention is more important than cure.

A third constituent of mine rang over 25 practices across the south-west, but was unable to secure an appointment as an NHS patient—something that has affected patients who were pregnant as well as everyone else. Southmead in particular is now left without any NHS dentists at all.

[Wera Hobhouse (Bath) (LD)]

The number of child patients nearly halved in 2021 compared with 2019, with a 42% decrease in the south-west, including my constituency and his. Is the hon. Member as concerned as I am that the most worrying part of these statistics concerns the loss of access to dental treatment for children?

[Darren Jones]

I do share that concern, because we know that children in particular are seeing the dentist on a fewer and fewer occasions, and I understand that the tooth extraction rate for children is increasing significantly because of a lack of prevention.

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[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to respond to this important debate and I thank the hon. Member for Bristol North West (Darren Jones) for securing it. I acknowledge many of his points but reassure him that dentistry is an absolute priority for the Government. He said he has previously tried to make contact with Ministers; he has not formally asked me for a meeting but I am happy to meet him should that be of assistance.

Let me touch on two of the main reasons why patients up and down the country currently struggle to see dentists. The first relates to covid. This is not a lame excuse for why there are currently difficulties: dentistry and dental services have gone above and beyond during covid. I am sure my hon. Friend the Member for Mole Valley (Sir Paul Beresford), who is a dentist, will back me up when I say that many dentistry procedures are aerosol-generating, so significant infection-control measures have been in place to protect patients and dentists and their teams.

At the start of the pandemic, when we first went into lockdown, only urgent procedures were allowed, so no routine procedures could be carried out. It was not until 8 June 2020 that infection-control measures allowed the reintroduction of some routine care. Even then, dental practices were able to work at only 20% of normal activity. That has of course had knock-on effects throughout England in respect of patient access to routine care.

Later that year, infection-control measures allowed up to 45% of normal activity, but it was not until last year that that proportion went up to 60%. Just before Christmas, NHS England and the chief dental officer wrote to practices to say that they could go up to 85% of normal activity and 90% of orthodontic activity. They are still not up to 100% of activity so they are literally treading water to try to keep the service going. I pay tribute to all those who have done such significant work to try to deliver services to the patients who have needed them.

Urgent care has been back at pre-pandemic levels since December 2020, so the backlog is in respect of routine services, whether fillings, caps, crowns or routine dental-hygiene work. Covid has significantly contributed to that backlog.

[Wera Hobhouse]

I understand from the dentists I speak to in my Bath constituency that the Government funding provided per patient just covers hygiene, not any of the repairs or dental work the Minister has just mentioned. Can she confirm or deny that?

[Maria Caulfield]

I will come to that in a moment, but let me first conclude on the impact of covid on dental services. The hon. Member for Bristol North West may be reassured to hear that the proportion of adults and children accessing dentists in Bristol, North Somerset and South Gloucestershire remains higher than the average for access to dentistry in England. It is probably no consolation to his constituents, but access is slightly higher.

Covid-19 Update

Wera Hobhouse Excerpts

Thursday 13th January 2022 Commons Chamber

[Sajid Javid]

First, I agree with every word my hon. Friend says about pregnant women. That is a message that has been reinforced to every NHS trust. I thank her for how she has campaigned on this issue and brought it to light, because that is making a difference. On the issue she raised about domestic certification, I share her instinctive discomfort, and I assure her and the House that as far as I am concerned we will not be keeping domestic certification in place a moment longer than absolutely necessary.

[Wera Hobhouse (Bath) (LD)]

May I, from the Liberal Democrat Benches, also pay tribute to the services of Professor Sir Jonathan Van-Tam? The Government are still ignoring people who are clinically extremely vulnerable, and their concerns at the lack of guidance and support. I raised this with the Secretary of State before Christmas and I still have many of my Bath constituents writing in about it. Two thirds of housebound people have not received the booster. What are the Government doing to ensure that the vaccines are accessible to everybody, including the housebound?

[Sajid Javid]

The hon. Lady talks about ensuring everyone gets access to the booster. The people at the top of the list should be those who are clinically extremely vulnerable, as long as the vaccine is something that can work for them. That is why, during the month of December, especially when we accelerated the booster programme, working mainly with GPs but also with others, those who are housebound or are in care homes were a priority and we saw the booster rate rise substantially.

I also point the hon. Lady to what I said in my statement about the 1.3 million clinically extremely vulnerable. The NHS has contacted them directly to ensure that they have access to the new antivirals that we have procured. I am sure that she would welcome that.

Public Health

Wera Hobhouse Excerpts

Tuesday 14th December 2021 Commons Chamber

[Wera Hobhouse (Bath) (LD)]

Thank you, Mr Deputy Speaker. I might even stick to the four-minute limit.

No doubt we are at a pivotal point in the fight against covid, and my constituents in Bath, like many across the country, are doing their best to keep covid levels low in their community. I thank everyone for their efforts.

I am glad for the consensus in this place that getting vaccinated is the most important thing. What we are debating is the most effective way of getting the most people vaccinated, and I hope this debate does not distract from the fact that we all believe vaccines are the best way to beat covid. We will beat all the conspiracy theories about vaccines and about covid being an invention. I am glad there is consensus on the importance of us all getting vaccinated.

The Liberal Democrats have always supported mask wearing, which reduces but does not entirely eliminate the risk. It is important to wear a mask, and we deplored the fact that the requirement, which is not difficult, had been dropped, including in this House. Mask wearing is not just about keeping ourselves safe or even about keeping our loved ones safe; it is about keeping everyone safe. Yes, we enjoy our civil liberties and we should protect them, but they do not include the liberty to harm others. That is an important principle, and it is why we support these public safety measures.

Many of my constituents have been in touch with me to share their concern about the logistical difficulties of following Government advice. They want to do the right thing, but they often find it difficult. I met one of my constituents last week, and he has recently returned from Zambia, where his work is based. As Zambia is a red-list country, he was required to quarantine in a hotel for 10 days. He continually tried to book a quarantine hotel, but he was unable to do so because the hotels were fully booked. When he was finally able to book one, he received an email from Corporate Travel Management saying his booking had been cancelled due to an error on its part. Upon speaking to the call centre, a member of staff told him there was no problem.

The red-list system has now been dropped, but the stress and cost to people who tried to do the right thing has been considerable and needs to be addressed urgently. Will there be compensation for those who faced considerable cost and, as has already been asked, will those who are still in quarantine be released immediately?

Another constituent is housebound. Her son lives in Southampton and her multiple health conditions make it impossible for her to get to a vaccination centre on her own, which means she has not yet had a booster. Her story is all too common. The local clinical commissioning group says it is in the process of contacting people who are housebound, but many are still waiting to be contacted. Obviously they are very worried, so I hope the Minister is able to outline the steps being taken to ensure the housebound are able to receive their booster as a priority.

Lastly, another constituent was vaccinated abroad, yet is still unable to receive confirmation of his double-vaccinated status, because his vaccines are not recognised on the NHS app—a problem that has been noted since the summer. To make matters worse, my constituent and many others like him are not able to get their booster, because the system will not recognise them as having been doubly vaccinated.

The Government must address these issues as a matter of urgency. It should not be this difficult for those who are trying to do the right thing to follow the Government’s own guidelines. My constituents and many across the country want to do the right thing, but the Government must do their bit or people will lose further confidence at this already highly volatile time, when we need as many people as possible to have confidence in the system and the Government.

[Mr Deputy Speaker (Mr Nigel Evans)]

There is now a four-minute limit. I call Jane Stevenson.

Covid-19 Update

Wera Hobhouse Excerpts

Monday 13th December 2021 Commons Chamber

[Sajid Javid]

I understand the situation that the hon. Gentleman describes, and there will be others across the country in a similar situation, so we understand the importance of this issue. The JCVI, as he says, is looking at this, which I confirmed earlier, but I say to the hon. Gentleman that before we can deploy any vaccine in any particular age group, it needs to be approved by our independent regulator, the Medicines and Healthcare products Regulatory Agency, as safe and effective. At this point in time, we do not have that approval. The MHRA is actively looking at this, but those two things are crucial before Ministers can make a decision.

[Wera Hobhouse (Bath) (LD)]

I, too, had my booster vaccine last week. It was easy, and I had five different options near me, but that was here in London and after weeks of unsuccessfully trying in Bath to find anything near me or anything that was convenient with the times I had available. That is the experience of all my constituents in Bath. When will we have services that match those available here in London in constituencies such as Bath?

[Sajid Javid]

It is an important to make sure that capacity is increased throughout the country. I am pleased that the hon. Member has got boosted, by the way, but she is right to say that she, like her constituents, should be able to get it closer to home. With the plans that we have announced recently, and especially with the plans from this morning, I am confident that there will be many more opportunities to get boosted in Bath.

Giving Every Baby the Best Start in Life

Wera Hobhouse Excerpts

Tuesday 9th November 2021 Commons Chamber

[Sarah Olney]

I am grateful to the hon. Member for his intervention. He is absolutely right that there are a large number of events and incidents surrounding pregnancy and birth—as I know from my own experience—that can cause huge distress, and it is right that mothers and the people supporting them, and fathers as well, get the support they need, including statutory leave from employment for the time it takes to come to terms with the miscarriage. That is certainly something we should be looking at.

We know that impending fatherhood can be a cause of great anxiety for men, and more services need to be developed to support them. We also know that over a third of domestic violence starts or gets worse when a woman is pregnant. I would speculate that some of that is attributable to undiagnosed and untreated mental health conditions in expectant fathers, which underlines the need to do more to support them.

In addition to health visiting and perinatal psychiatry, support for children and their families throughout their early years is vital for enhancing children’s prospects at school and beyond. Evidence shows that effective integration of services in the earliest years can bring broad benefits. For example, Sure Start children’s centres are shown to decisively reduce hospitalisations during childhood. However, 1,300 children’s centres have closed since 2010, and recent research has shown that 82% of parents of young children have struggled to access early years services. I am pleased that the Government have now committed £80 million to introducing family hubs to 75 local authorities across England, and £50 million for parenting programmes. However, we need more information on what family hubs can provide, and I would particularly like to ensure that health visiting and mental health support are included.

The importance of the right support in the early years was brought home to me after a recent meeting with primary headteachers in my constituency. I heard about how difficult it is for nursery and reception-age children to settle into class and to get used to spending time with other children and not spending all day at home with their parents. For adults, lockdown has been 18 months of inconvenience, after which we expect to be able to pick up the threads of our former life. However, some young children who started nursery this term will have spent up to a third of their life in lockdown, and we cannot yet know what the long-term impact will be.

[Wera Hobhouse (Bath) (LD)]

Is my hon. Friend alarmed, as I am, by the fact that domestic violence has increased during lockdown, which has particularly affected young or very young children? The Government need to look at the backlog of cases that have arisen through the lack of attention to domestic violence, or inability to look at it, during lockdown, as it did not really come to our attention.

[Sarah Olney]

My hon. Friend is absolutely right, and incidents of domestic violence during lockdown are a matter of grave concern. We know there is a clear link between domestic violence starting or worsening and a pregnancy in a family. That issue needs a huge amount of attention; more mental health support for both partners would help a great deal.

The lockdown will have increased disparities in educational outcomes between those from poorer backgrounds and their richer classmates, and I call on the Government to do more to provide catch-up funding to our schools, and allow them to spend it on a greater range of services. Local headteachers tell me that funding can be allocated only to academic tuition, and that they have identified many children, including the very youngest, who need mental and emotional support to help them in school.

I will conclude by saying thank you to everyone who has talked to me about their experiences in this area, but particularly our health visiting and perinatal mental health teams, who do so much good and valuable work for new families. I also acknowledge the huge contribution made by the voluntary sector in supporting new families, in particular the work of Home-Start, which provides an excellent network of support. It takes only a small amount of encouragement, a little word of advice or a sympathetic listening ear to give a new parent confidence, but it can make a world of difference to their children. A small investment in the beginning of life can reap huge rewards, not just for individual children and their families but for whole communities, and the right start can enhance not just individual educational achievement and wellbeing but reduce risky and antisocial behaviours. Few pounds could be better spent, or yield a more valuable return, than those invested in our youngest citizens.

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[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

I thank the Backbench Business Committee for granting time to debate this incredibly important subject. I also commend my colleagues, the hon. Member for Richmond Park (Sarah Olney) and the right hon. Member for South Northamptonshire (Dame Andrea Leadsom), for setting out so eloquently and passionately the case for focusing on this issue. I had hoped that, as co-sponsors of the debate and co-conspirators on this issue, we would not just repeat one another’s arguments, and I believe that, without co-ordinating in any way, we will not. We agree on the problem—we agree on the challenge and the importance of this issue—but today I want to focus on the enormous challenge presented by poverty in overcoming many of these issues.

We know from international evidence that so many important life outcomes, from health to wealth and wellbeing, have their origins in early childhood, but the reality is that not all childhoods are equal. If we truly want to give every child the best start in life, we must tackle poverty and economic disadvantage. There is substantial evidence demonstrating the damaging, stigmatising and often lifelong impact of experiencing poverty in childhood. It affects cognitive skills, social and emotional development, physical health, mental health, educational outcomes, employment prospects, the likelihood of being in poverty as an adult, and life expectancy.

Recent reports have highlighted starkly that the impact of poverty begins in very early childhood, or even pre-birth. For example, last month, MBRRACE-UK— Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK—reported that

“babies born to women living in the most deprived areas are twice as likely to be stillborn, and at a 73% excess risk of neonatal death compared to babies born to women living in the least deprived areas”.

Likewise, national child mortality database research published in May found a clear link between deprivation and child death. It concluded that around 700 fewer child deaths per year—a fifth of all child deaths—might be avoided if children living in the most deprived areas had the same mortality risk as those living in the least deprived. Poverty is literally killing children.

[Wera Hobhouse]

Is the hon. Member as concerned and shocked as I am about data showing that a mother from an ethnic minority background has a much higher likelihood of experiencing complications during pregnancy or birth that result in their baby being either stillborn or born with a disability? Does she agree that we need absolutely to focus on such discrimination and disadvantages?

[Catherine McKinnell]

Yes, I absolutely agree with the hon. Lady. As the Chair of the Petitions Committee, I can say we received petitions on that issue and debated it in Parliament. We have been given some assurances from the Government, but it is imperative that all of us in this House ensure an improvement in both the statistics and the reality for those who experience it.

It is well established in education research that on average the longer a child has been disadvantaged the worse their performance will be at school, particularly in key stage 4 assessments. Even where children from more deprived backgrounds do achieve the same results as their better-off peers, they are still likely to have lower lifetime earnings. How unbelievably disheartening is that?

Sadly, child poverty is getting worse. Government statistics on households below average income published this spring show just how many families were struggling before covid-19. In 2020, 200,000 more children were pushed into poverty compared to the previous year, using the measure of relative poverty after housing costs. That means 4.3 million children living in poverty: real children living in real hardship. I know the Government do not readily accept the concept of relative poverty, but Ministers should listen to the recommendation of the Work and Pensions Committee to end the sole focus on absolute poverty and look at broader measures. After all, if the Government are committed to levelling up, improving the position of a child in Newcastle relative to a child in Middlesex is surely more relevant to comparing a child in Newcastle today with a child in Newcastle 11 years ago.

Even if we use only the Government’s preferred absolute poverty measure, the proportion of children living in poverty rose by an average of four percentage points in every north-east local authority area between 2014-15 and 2019-20, while the number of children living in absolute poverty across the north-east rose by more than 21,000 during that period. The latter point is particularly concerning as absolute poverty is a measure that has always tended to naturally improve over time as living standards rise, but in the north-east it is going in the opposite direction. As troubling as the pre-pandemic figures are, none of that should come as a surprise given the direction of Government policy over the last 10 years. Indeed, the country went into the pandemic expecting to spend £36 billion less on social security because of Government welfare policy. That has to come from somewhere, and it is coming from the poorest pockets and the mouths of children.

Just as Government action can lead to increases in child poverty, it can bring them down too. We have seen it before, especially under the previous Labour Government. What we need is a cross-governmental strategy for tackling child poverty, something groups such as the North East Child Poverty Commission and the Child Poverty Action Group have consistently called for. It needs to go a lot further than anything we have heard from the Government to date. It should include a welfare system that prevents and reduces poverty, giving all families a dignified safety net when they are going through tough times. It should tackle unemployment and low-paid insecure work, the kind of work that means most children living in poverty are now in working families. We need concerted action to support families with the cost of major outgoings: energy, housing and childcare.

All those things were problems pre-pandemic and they still need to be addressed, but covid-19 and the lockdowns of the last year-and-a-half have brought additional challenges for parents and young children. For the past 18 months, the Petitions Committee, which I Chair, has investigated the pandemic’s impact on new parents and children, and expressed its deep concerns that it is being overlooked by the Government. Our first report in July 2020 highlighted the need for urgent catch-up investment to help new parents access support services disrupted by the pandemic, and to do more to ensure employers meet their health and safety duties towards pregnant women. Unfortunately, the Government rejected almost all our recommendations, saying that support was “sufficiently generous” for

“the vast majority of parents”.

That, however, did not match up with all the evidence we heard from new parents about their struggles. We heard that crucial support for children’s wellbeing and development was being missed, that there were concerns about employers not meeting their health and safety duties towards pregnant women, and about additional difficulties in accessing childcare. I fear that the Government know that the impacts of all of that are long term, and that by the time the impacts of their failure to invest will be seen, they may be well gone, or at least their failure forgotten.

This year the Committee decided to revisit those issues with a follow-up report, but unfortunately it is already clear that we are seeing the impact of the Government’s lack of action in this area, including: children coming into early years classes behind in their social development; increasing rates of poor mental health among new mothers; and childcare providers going out of business. The Committee found that new and expectant parents’ access to support has remained severely limited. Many have lost out entirely on the crucial window of support available in the early months of their child’s life, and issues around children’s development and parents’ mental health will have been missed. I have said repeatedly that there is a good reason why we wrap a blanket of support around new mums and their babies—and dads, too. It is needed at the time and the long-term impacts of not providing it are well known. Urgent investment is needed to provide catch-up mental health and health visiting support.

The Government have failed to deliver on stronger workplace discrimination protections for new and expectant mothers, and they have repeatedly promised to do that. That is especially concerning as the economic impact of the pandemic continues to be felt. I pressed the Prime Minister on that at the Liaison Committee, and I urge the Government to pass those protections into law as soon as possible. If mums are being discriminated against, it is bad for their children, too.

The pandemic has also exacerbated pre-existing problems in the early years sector. Government financial support has been welcome, but it has not prevented many early years providers seeing a significant impact on their finances, with low pay for staff, many of whom are mums too, and high costs for parents. The pandemic may well contribute to or even accelerate an ongoing erosion of provision. I therefore urge the Government to consider a review of early years funding to ensure it is affordable and meets the needs of new parents seeking to return to work. They could set out a clear vision for our children, our undervalued early years and childcare workforce, and ensure that no parent must choose between their child and their career.

Before I conclude, I want to ask the Minister some specific questions on the Government’s proposed family hubs. Given that there are 152 upper-tier councils in England and there will be 75 family hubs, it looks like just under half of local authorities will benefit from the programme. Have the Government already determined the criteria by which the funding will be allocated? We assume it will be based on some measure of deprivation, but will the Minister confirm that? May I urge the Government not to continue their approach of forcing overstretched local authorities to commit their scarce resources to making funding applications? We should not be pitting local authorities with high levels of deprivation and child poverty, such as those in the north-east, against each other to receive support. How does the Minister see family hubs working in large local authority areas, often with poor public transport links? For example, getting across Newcastle with young children to access services via public transport can be challenging, particularly for my constituents in the Outer West. Large rural areas like Durham and Northumberland face their own challenges. I hope when the Minster responds, she will confirm that services will be “within pram-pushing distance” of the families they are intended to help, as was the aim of the Sure Start programme.

In conclusion, the crushing pressure that poverty places on families and children is clear. It impacts our children’s lives directly when parents and carers do not have enough money to meet their children’s material, social and educational needs. It impacts on them indirectly by creating stress, insecurity and conflict at home.

These adverse childhood experiences inevitably influence children’s development and wellbeing, creating a vicious cycle. To escape that cycle, we need a coherent, cross-departmental anti-child poverty strategy, backed by proper investment. It is fair to say that we are pretty far from that at the moment when the Government often seem unsure about which Minister to send to respond to child poverty debates. Such pervasive child poverty is not inevitable. The last Labour Government reduced child poverty and the concerns about child welfare that it creates. We can do it again and truly give every child the best start in life. We just need the Government to care truly about achieving it.

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[Wera Hobhouse (Bath) (LD)]

It has been a real pleasure to listen to all the different contributions made this afternoon. I congratulate my hon. Friend the Member for Richmond Park (Sarah Olney) and her co-sponsors on securing this debate. One of the observations I want to make is in reference to the hon. Member for Penistone and Stocksbridge (Miriam Cates), who asked why we cannot give women the choice. I absolutely agree. We all know that the most nurturing environment for young children is with their parents. The question then is why this country has one of the poorest maternity pay and leave settlements compared with any other country with a similar economy. We need to look at statutory maternity pay.

[Miriam Cates]

I completely agree with the hon. Lady. Maternity benefits are certainly something we should look at. As well as that, we have a taxation system that penalises families—to the tune of 20% or 30% for the poorest families—compared with the taxation systems of, say, France, Germany or America. One of the problems we have in this country is that we do not recognise the importance of those early years in terms of protecting families from those costs. That would have a far bigger impact on parents’ ability to choose in those early years.

[Wera Hobhouse]

I absolutely agree with the hon. Member. We are on the same page. We need to recognise the importance of parenting and the early years and help families of all incomes to make that happen, but the issue mostly strikes families of poorer backgrounds, where women are then being forced into work much earlier than they would like. The Government need to look urgently at that, as well as shared parental leave, which is actually a transfer of parental leave, rather than shared leave. We should look at how we can fix that system, too.

I will speak briefly as the chair of the all-party parliamentary group for the prevention of childhood trauma. Preventing adverse childhood experiences from occurring is vital, particularly in those first 1,001 days. Within the APPG, we are working to improve understanding of adverse childhood experiences or childhood trauma, how to heal them, and ultimately how to prevent them. It is about breaking that cycle of trauma, which can so often pass from a parent to their child.

Those who experience childhood trauma are two times more likely to develop depression and three times more likely to develop anxiety disorders. Adults who reported four or more adverse childhood experiences had a four to twelvefold increase in alcoholism, drug abuse and suicide attempts, compared with adults who experienced none of those. Recently, the APPG heard from Josh MacAlister, the chair of the independent review of children’s social care, which produced “The Case for Change”. He made the critical point that we have children in care who become parents, and they often pass their childhood trauma to that next generation of children unless it is treated and recognised. One of the most important things on which I campaign as a Member of Parliament is preventing childhood trauma, recognising trauma in those who experience it later in life and making all our services trauma-informed.

I pay tribute to the WAVE—Worldwide Alternatives to Violence—trust, which does excellent work alongside the APPG. Its 70/30 campaign needs no introduction because it has just reached 500 supporters in the House—an incredible milestone. The campaign aims to reduce child abuse, neglect and other adverse childhood experiences by at least 70% by 2030. Professor Sir Harry Burns, a former chief medical officer, said that

“reducing child maltreatment by 70%...is the minimum acceptable outcome in responding to this unacceptable—and profoundly costly—harm to our youngest children.”

We have all heard in various forms about how important it is to get to childhood trauma. The Government can do much to achieve that, but they must start by increasing early years funding, by appointing a senior Minister for families and the best start in life and by prioritising prevention in the early years.

Earlier this year, I tabled an early-day motion on giving every child the best start in life, which calls on the Government to adopt a comprehensive early years strategy to prevent harm to children before it happens. It has now been signed by 100 Members from across the House. I grateful to all of those who have put their name to it and hope that many more will join them.

I have just two questions for the Minister. Given the overwhelming support for the 70/30 campaign and my EDM, will she give her public support to the campaign today? Will she also commit to meeting the APPG so that we can discuss a way forward and end childhood trauma once and for all? Let us start now to ensure that every family has the full support needed to give their child the best start in life. That would be to all our benefit.

Covid-19 Vaccinations

Wera Hobhouse Excerpts

Thursday 4th November 2021 Commons Chamber

[Maggie Throup]

No death is acceptable and my condolences go to everyone who has lost somebody in this terrible pandemic. Our best wall of defence is through vaccinations. Vaccinations do work, so my message is: get your booster. If people have not had their first jab, they should get their first jab and continue to build that wall of defence.

[Wera Hobhouse (Bath) (LD)]

Many of my Bath constituents have got in touch to say that they have trouble getting access to the booster vaccines. This is particularly worrying for the clinically extremely vulnerable, as we have already heard. The support for the clinically extremely vulnerable has been woefully inadequate, including the advice that they were given throughout the pandemic. As we head into winter, what guidance is the Minister giving to the 3.7 million people who were advised to shield last winter?

[Maggie Throup]

I think it is important that everybody takes personal responsibility and makes sure that they protect themselves. As we know, people were shielding last winter, but we did not have this highly successful vaccination programme. The best way for people to protect themselves is to get jabbed, get protected and to protect themselves from the virus.

NHS England Funding: Announcement to Media

Wera Hobhouse Excerpts

Monday 25th October 2021 Commons Chamber

[Edward Argar]

As my hon. Friend alludes to, I met her and other hon. Friends from Cornwall last week to discuss this matter. I appreciate the pressures facing the NHS in Cornwall, particularly after the pressures it faced over the summer, when other parts of the system may have experienced slightly less pressure, because of all the holidaymakers who rightly go to visit Cornwall. I look forward to working with her further on this and thank the staff of the trust for what they are doing. We recognise the challenges, which is why we are providing this extra capital funding, including capital funding from previous pots, to her trust. I am happy to have a further meeting with her and her chief exec, if she feels that would be helpful.

[Wera Hobhouse (Bath) (LD)]

The Royal College of Radiologists reports that, as of today, another 1,675 consultants are needed to keep up with current NHS demand. The Minister pointed earlier to a recruitment drive and said that 48% more have been recruited. Still, 1,675 consultant staff are needed. If he cannot give us the answer today, how on earth will he recruit these important people very soon? Will he come back with a statement very soon on how this situation will be resolved?

[Edward Argar]

What I said in response to the hon. Member for St Albans (Daisy Cooper) and other hon. Members was that we have seen the number of radiographers and radiologists grow steadily since 2010, and it continues to increase. I appreciate the point made by the hon. Member for Bath (Wera Hobhouse) about the rate of growth, but it is growing. We are recruiting and training more, so I think we are on track to continue recruiting more into that space.

Support for Carers

Wera Hobhouse Excerpts

Thursday 22nd July 2021 Westminster Hall

[Wera Hobhouse (Bath) (LD)]

It is a pleasure to serve under your chairship, Mr Hollobone, and a great pleasure to follow my right hon. Friend the Member for Kingston and Surbiton (Ed Davey). I thank the Backbench Business Committee for granting this important debate.

Tomorrow, schools will close for the summer holiday. For most children, that will mean a well-earned break after the most difficult of school years, spending more time with family and friends and taking a holiday. For up to 100,000 children in England alone, school holidays are particularly difficult. During the six-week break, some young carers will have to fit in up to 30 hours of caring responsibilities every week. Caring for a sibling or parent will come before any summer holiday plans.

The 2011 census identified nearly 200,000 young carers in England and Wales. One in eight were under eight years old. Recent research suggests that that figure represents only the tip of an iceberg. Young carers are a very big silent community. Some estimates suggest that one in five schoolchildren are young carers.

That is one in five schoolchildren watching over family members, carrying things for them, making sure that they do not fall. That is one in five schoolchildren cooking meals, collecting prescriptions or doing admin tasks for parents with learning disabilities. That is just the number we know about. The challenges that these children face can vary greatly. As in many areas, the challenges have been made much worse by the pandemic.

A recent Carers Trust survey found that 58% of young carers are caring for longer, spending an average of 10 hours a week more on their caring responsibilities. These children face these challenges for somebody they love. While they would not do anything differently, that does not make it any easier. Young carers carry with them a great deal of worry—worry that can often make those they care for feel guilty.

Being a young carer can have a massive impact on the things that many of us take for granted as an important part of growing up such as education. The Children’s Society found that young carers were likely to have significantly lower educational attainment at GCSE level. Some 73% report having to take time off school. Carers aged 16 to 18 are twice as likely not to be in education, employment or training, and 45% of carers report mental health problems. That is not good enough. Like every child, young carers deserve an equal chance in life. They do a remarkable job, but they need more support. This Government owe them that.

The Government must bring forward plans to reform social care, so that we have a well-funded sustainable system that can deliver consistent high-quality care. My right hon. Friend the Member for Kingston and Surbiton rightly called for an immediate £1,000 per year increase to the carer’s allowance. I urge the Government to go one step further and extend the eligibility criteria to those in full-time education.

I would also like to see the Government work to increase social awareness. Too many people are unaware that they can self-identify as carers and access the support they are entitled to. Caring is often poorly understood by peers, and teachers need to be better trained to identify young carers.

To finish, I pay tribute to one of the most exciting young carers’ programmes in this country, which happens to be in my own constituency. Bath Philharmonia is the only UK orchestra that delivers a music-making programme for young carers. It has reached more than 1,000 young carers and helped them benefit from the power of music. It supports them to play, create and perform their own original music. The programme gives young carers a safe space to express themselves, make friends and build their confidence and self-esteem. One young carer said:

“Bath Phil has taught me how to take part in something with a team. It has shown me how to be confident in myself, even if it’s just for a moment. It has given me something to look towards, which has helped me through some really tough times.”

This positive environment not only reduces isolation but raises aspiration. Gaining skills in not only music but communication, teamwork and confidence helps many of these young carers find a way forward, and it has helped young carers and their families when they are struggling. I leave Members with a comment from Jason Thornton, BathPhil’s music director, about the power of programmes that support and lift young carers:

“We’ve got children being children. And that’s wonderful.”

--- Later in debate ---

[The Minister for Care (Helen Whately)]

It is a pleasure to serve under your chairmanship, Mr Hollobone.

I start by thanking the right hon. Member for Kingston and Surbiton (Ed Davey) and the hon. Member for Bath (Wera Hobhouse) for securing this debate on such an important topic. The right hon. Member spoke powerfully of his own first-hand experience of care, first as a child and now as an adult caring for his disabled child. As others have said, sharing such personal experiences adds so much to the conversations we have in this House. I am also truly grateful for all the work he does to champion the voice of carers.

Other Members have also spoken powerfully. For instance, the hon. Member for Sheffield Central (Paul Blomfield) talked about Holly, and what he said really brought to life the experiences of a young carer. The hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) described some things a Member of Parliament can do for their constituents. Sometimes, they seem to be small things, but they make such a big difference to an individual’s life. The things we can do as constituency MPs to unlock something that has been locked away because of a decision made somewhere up there makes all the difference. The hon. Gentleman really brought that issue to life.

I pay tribute to all the carers and young carers across the country. Caring for a relative, a friend or a neighbour is something that many people do. In fact, around one adult in 10 provides care, and about 23% of carers have high-intensity caring responsibilities, providing more than 50 hours of care a week. Carers do an amazing thing. The compassion and fortitude they demonstrate, often in difficult circumstances, are truly inspiring to all of us, but their task is hard. It can leave people with so little time and energy for themselves.

I come back to the numbers. There are at least 6.5 million unpaid carers in the UK, and about 5.4 million in England. That is based on the 2011 census, which is now around 10 years out of date, so we know that the figure is now significantly higher, and may have increased due to the pandemic.

The last sixteen months have clearly been incredibly challenging—especially in the early weeks and months of the outbreak, when we all found ourselves facing the steepest of learning curves. For carers, as for frontline health and care workers, the complex and demanding routines that they follow became even more complex and intense due to the restrictions. Many carers were also looking after somebody who was likely to be vulnerable to covid, so had the added worry of what would happen if that person was to catch the virus. However, just like our dedicated NHS and social care colleagues, carers of all ages kept going throughout the pandemic: they kept caring and doing what was needed for the person close to them.

I want to briefly mention the support the Government have provided to carers during the pandemic. We have focused on supporting them—a focus that continues to this day, even as the remaining restrictions lift and we try to move towards a new kind of normality. That is why we included exemptions from some regulations and added flexibility to help carers, including allowing emotional support to count towards the 35 hours of care provided by carers, and relaxing the rules for breaks in care. We listened to carers’ concerns about access to testing, and made them a priority group alongside other essential workers.

There is one vital achievement that I want to mention: the fact that hundreds of thousands of unpaid carers have now received their vaccine—an important step in protecting them and the people they care for from coronavirus. I would beg to differ from the portrayal presented by the right hon. Member for Kingston and Surbiton. Ministers have worked hard—and I can say this for myself, personally—to ensure that carers were prioritised to receive the vaccination after recognising their concerns, often, for the individuals who they cared for.

A huge collective effort went into identifying carers during the vaccination programme—identifying those already known to GPs, the DWP and local authorities, and working with local carers’ organisations to identify carers eligible to be prioritised for the vaccine. That work has also brought other benefits; it has fostered new local connections and dialogues, and has helped to raise awareness across primary care services about the critical role that carers play and the significant contribution that they make.

I will pick up on a point made, I think, by the hon. Member for Sheffield Central, on the importance of identifying carers. There has been ongoing work to better identify who carers are. We know that carers do not necessarily even think of themselves as carers, and that young carers can often be overlooked. There is a particular line of work in working with schools to identify young carers and provide them with more support.

[Wera Hobhouse]

I thank the Minister for giving way, for her response and for her clear understanding. Will she listen to our demand to look at the eligibility criteria so that all in education can be included in the carer’s allowance?

[Helen Whately]

Yes, I have heard that. I have also received correspondence about the situation of somebody who may be in full-time education and seeking eligibility for the carer’s allowance. Yes, I am absolutely listening to that. I truly recognise the pressures that carers experience, whether it is juggling caring with work or with education. I have spoken myself to younger carers in that situation as well.

I want to go further on identifying carers—overcoming some potential data protection issues—and on trying to bring together our data sources, so that we have a clearer sense of who carers are and so that we will be able to contact them to offer support. During the pandemic, I found that it was not possible to write to all the carers in the country and say, “This is what is available to you.” I want us to go further on having the best data that we can.

Children and Young People’s Mental Health

Wera Hobhouse Excerpts

Wednesday 16th June 2021 Westminster Hall

[Wera Hobhouse (Bath) (LD)]

I thank my hon. Friend the Member for Twickenham (Munira Wilson) for securing this important debate. We have a long way to go to properly respond to our growing mental health crisis, especially for young people.

Eating disorders are a serious mental health issue, affecting many thousands of young people. They are complex and potentially life-threatening. They have no single cause, and they have the highest mortality rate of all mental health disorders. Recovery from an eating disorder takes, on average, three times as long as having the disorder itself. The fact that, all too often, an eating disorder goes undiagnosed and untreated for years adds to the problem.

Access to help continues to be a postcode lottery. NHS data on eating disorders show a fourfold increase in the number of children and young people waiting for urgent care. Behind these awful statistics hide thousands of real-life tragedies, not just for the sufferers themselves, but also for the friends and relatives who watch loved ones suffering from this awful illness virtually disappear before their eyes. With face-to-face appointments not going ahead, it has been much easier for sufferers to say that they are fine and not to ask for help until they reach crisis point. Like many forms of mental illness, eating disorders thrive in isolation. Some people have described their eating disorder as the only thing they have felt able to control during lockdown.

The demand for children and young people’s community services was already rising before the pandemic, but now these services are backlogged. The news that CCGs in England would increase their funding for eating disorders by an additional £11 million to help them cope with increased referrals was extremely welcome. However, this funding is not reaching the frontlines. Research commissioned by the all-party parliamentary group on eating disorders, which I chair, and carried out by the eating disorder charity Beat, shows that CCGs in England increased their spending on children and young people’s community eating disorder services by just £1.1 million in 2019-20. Only 15% of CCGs increased their spending in line with the increase in additional funding; 21% spent less. On behalf of the APPG and Beat, I ask the Minister and the Government to hold NHS leaders to account, because they must make sure that every penny that the Government have made available goes to frontline services.

The impact of the pandemic on the mental health of disabled children and young people has been considerable. Research from the Disabled Children’s Partnership consistently shows that disabled children have been more isolated than the rest of the population. Its latest survey shows that 90% of disabled children are socially isolated, and 72% of parents said their children are

“often unhappy, downhearted or tearful.”

Disabled children are at risk of being forgotten in the national recovery from the pandemic. It is deeply disappointing that the Government’s recently announced education recovery plan provides no tailored support for disabled children to meet their complex needs. I urge the Minister to back calls for immediate dedicated catch-up funding and services for disabled children and their families. In the autumn spending review the Government must go further. They should commit to proper funding to tackle the pre-pandemic gap in disabled children’s social care services.

Childhood trauma is at the bottom of a very large number of mental illnesses. Many children take their traumatic experiences into later life and it affects their life chances in every aspect, from educational achievement and professional qualifications, to health and wellbeing, to the risk of coming into contact with the criminal justice system. We still lack a proper understanding of the effects of childhood trauma and how to prevent it. Trauma-informed services across the board, in schools, the NHS, the police and our prisons, would have a transformative impact on the whole of our society. As the chair of the all-party parliamentary group for the prevention of adverse childhood experiences, I hope very much that we can engage with the Minister on the work we are doing in that field.

Our children’s mental health is deteriorating. We must do all we can to improve it.

--- Later in debate ---

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

It is a pleasure to serve under your chairmanship, Sir Gary. I thank the hon. Member for Twickenham (Munira Wilson) for bringing forward this important debate. We have had a number of interactions and I know how genuinely important the issue is to her. I am aware of the meeting she had with the Minister for Health, my hon. Friend the Member for Charnwood (Edward Argar). I will give some information, but also reassure her that we are continually working on these issues. More has happened as a result of her meeting. I know she is genuinely very concerned about this issue and has been since the day she arrived in Parliament.

As the Minister, I speak to all stakeholders, trusts, organisations and just about everyone involved in the area of mental health, particularly among children and young people. It is incredibly important that we keep our language and our comments about children and young people both proportionate and responsible. There is not a mental health pandemic. I will go on to explain what I mean by that.

It is very important that we divide wellbeing from mental illness, not least because we do not want mental illness to fall by the wayside in people’s awareness and understanding of mental health, because the conversation is dominated by mental health and an overarching title that is not appropriate. Mental health is divided—it is not just a catch-all title. We have people who suffer with serious mental illness and childhood mental illnesses, such as schizophrenia, psychosis and eating disorders. I congratulate the hon. Member for Bath (Wera Hobhouse) on her speech; we have discussed eating disorders many times, and she is compassionate and is compelled to improve eating disorder services for children and young people in the UK. I thank her for her commitment to the issue.

It is incorrect to describe 140,000 children as having been turned away. The measurement of progress against the five-year forward target is based on two contacts with NHS services—this is an important point. Many children and young people have one session. After that, it is jointly decided to close their referral. To quote the 140,000 figure is misleading. One session is thought enough to provide them with the help they need or, more importantly, to provide pathways to their carers, parents and those who accompany them to the appointment. The expansion of Every Mind Matters, which was developed by Public Health England, to include children and young people under the age of 18 has been a huge boost. It is wrong to say—to misquote—that 140,000 children have been turned away. It is important to look at the reasons why.

I began by saying that I speak to stakeholders, trusts and others. I would like to quote from a letter a trust sent to MPs, following a debate on the issue only days ago. The trust said: “Partner organisations work incredibly closely to ensure children and young people receive the services they need.” It was referring to the narrative used by parliamentarians. It said that frontline staff had worked tirelessly throughout the pandemic and had taken the additional investment that the Government had provided to increase their workforce, and that to describe their services as failing had an impact on the morale and wellbeing of dedicated frontline staff and those who are delivering services to children and young people. It went on to say that the statements that were being made caused concern and alarm to children and young people and their families at an anxious time.

We have a responsibility in Parliament when we are talking about mental health, particularly of children and young people, to keep language proportionate. For me, talking in a debate about children throwing themselves off a bridge is completely beyond the mark and I am afraid that I think that that type of language is exactly what the trust was referring to—[Interruption.] The hon. Member for Tooting (Dr Allin-Khan) is commenting from a sedentary position. I reiterate my comments, Sir Gary. It is important that we consider the families and the people that we are representing and do not make inflammatory statements.

I have heard first hand from NHS staff that thousands of children and young people have had to adapt to the challenges of covid-19. It has been an incredibly tough year for everybody, and many children and young people have felt anxiety, apprehension and a gamut of emotions that adults also felt when faced with the unknown, sudden and rapid change to routines as well as a lack of understanding of what would happen and how life was to continue. However, many people are resilient, and many of those children and young people, who at stages reported they felt all those emotions and were included in that statistic of one in six, came through once there was a greater understanding of what was happening and how it was going to work. They were incredibly resilient, and we should be proud of those children and how they helped others too.

We take the pandemic and the mental health of children and young people extremely seriously. I work seven days a week on what this Government do, what we provide and how we assist. Although I have been criticised by the hon. Member for Tooting for talking about the investment we provide, we cannot provide services without the money for them. We cannot increase our mental health workforce if we do not provide the money to train people and to provide those services and that is exactly what we have done. I have no shame in quoting the figure of £2.3 billion a year that is going into mental health services—more than any Government has ever ploughed in, plus an additional £500 million to a mental health recovery plan for the pandemic this year, of which £79 million has gone into eating disorder services based in the community. We hope that that funding will allow around 22,500 more children and young people to access community health services.

[Wera Hobhouse]

The Minister has quoted the numbers for what the Government have made available. As I said, unfortunately a lot of that money has not reached the frontline. Will she make CCGs accountable and that money goes where it is meant to?

[Ms Dorries]

It is a constant pressure for me to ensure that. NHS England has worked incredibly hard to establish community-based services. It is important to say that the uptick in eating disorders came before the pandemic—it was spotted before it struck. We can have another debate on why we were beginning to see that rise in eating disorders, and the hon. Member for Twickenham and I have had that discussion. I am proud of how the NHS has rapidly looked at how we can deal with this exponential rise in eating disorders, because that is where our problem is.

We know exactly who has been affected by the pandemic, in terms of mental health services. We know from the referrals that have gone to our partners across the board and to local services. I am saddened to say that eating disorders are our toughest problem at the moment because of the exponential rise—over 22% over the past year.

NHS England is using that money. As I said a moment ago, having the workforce to provide services is really important, so we have accelerated the number of mental health support teams that we are putting in. The first question I asked when I took up my ministerial post was: “Can we have more mental health support teams in schools faster? Can we accelerate the long-term plan so that we get more areas covered quicker?” It took the pandemic to make that happen, but now—I have not even used my speaking notes; I have gone completely off piste—I think we have another 112 school areas covered. I will write to Members attending today to give them the figures on mental health support teams. We have managed to accelerate the programme by over a year as a result of the £500 million of funding that we put in.

Something that we can really shout about is that we have people coming forward. Mental health was never an area where people really wanted to work. I remember during my nurse training that we were given the option to take 12 weeks’ maternity or 12 weeks’ mental health, and my entire cohort took 12 weeks’ maternity. Nobody went to do the mental health training. Now—the pandemic has highlighted this—we have 100 applications for every place in university for people to train in mental health. That means mental health support teams to go into schools, deal with eating disorders and work with children and young people. When we put that kind of money in, run those kinds of courses and have the commitment to accelerate mental health workers, we do not see those results overnight, but that work is being done now to ensure we have the results. We want to ensure that people come out of universities and go into mental health support teams in schools. I have seen the work they do and how they work with children and young people.

Time has whizzed on, and I would just like to make a few points. The hon. Member for Lewisham West and Penge (Ellie Reeves) spoke about young mums and infant mental health. I am totally with her. That is why I worked so hard during the lockdowns to ensure that we kept support groups open for mums and young babies, and particularly those that give mental health support to mums. That included all sorts of groups, such as playgroups—Monkey Music is one that somebody used—where mums could meet together with their young babies. I argued for that and made the case for supporting their mental health. During the pandemic, those groups were kept open for young mums because I felt it was so important that they were supported.