Giving Every Baby the Best Start in Life

Although the UK is no longer in lockdown, both access to services and working patterns have changed. Some support services, such as playgroups, have not survived, and some have closed altogether. Children’s centres have reopened, but numbers are limited and places need to be booked in advance, which may mean that the families with the least time on their hands will lose out. The co-ordinators and volunteers at Home-Start Richmond, Kingston & Hounslow have told me about the high levels of anxiety experienced by new mothers unable to access health visitor advice and reassurance. That is impacting new mothers’ confidence and their ability to meet their baby’s needs.

Health visitors are a skilled workforce of specialist public health nurses who have the expertise to provide holistic care to families. As the only professionals positioned to reach every young child before they start school, health visitors play a crucial role in child safety and early childhood development. They identify and manage developmental delay, as well as common and serious health problems. They also provide support around childhood immunisations and advice on infant feeding, safe sleeping and mental health, all of which relieves pressure on NHS emergency departments and specialist services.

However, there is currently no national plan to address falling health visiting workforce numbers. The Government's spending review stated that it

“maintains the Public Health Grant in real terms, enabling Local Authorities across the country to continue delivering frontline services like child health visits.”

In fact, the Government are maintaining the public health grant at a level that is too low for many local authorities to resource health visiting services that can deliver face-to-face visits and the support described in the healthy child programme and other national guidance.

Ahead of the spending review, 700 leading children’s sector organisations were united in their call for investment for 3,000 more health visitors over the next three years. However, I am concerned that £500 million over the next three years will not deliver the Government’s pledge to rebuild health visiting. It is of the most urgent importance that we restore face-to-face health visiting for every new mother as the most essential building block of support to families as they welcome their new babies.

The importance of early home visits by skilled healthcare professionals was highlighted to me by one constituent who wrote to me last summer. She said:

“My baby is now 6 months old and soon after birth he was diagnosed with SMA type 1. If you are not familiar with it, the full name is Spinal Muscular Atrophy and it’s a muscular wasting illness. There isn’t a cure for it and without treatments and proper care the life expectancy of a baby is less than 2 years. He is currently under treatment but, and here is the reason for this letter, every possible centre specialised in physiotherapy, hydrotherapy or other physical activities for disabled people is shut due to Covid-19.

My husband and I were the ones who had to notice something was not right with Peter because, due to Covid, no one came for home visits after birth to see the baby or me. I almost died in child birth and because we were left alone I had to endure 1 month bed ridden due to further complications, once again noticed by me. Only once I was able to walk again we saw something wasn’t right with the baby. If after 2 weeks the health visitor had been able to come home, my son would have started treatment sooner without losing the mobility of his legs.”

I want to talk a little more about the importance of diagnosing and treating perinatal mental health conditions. Maternal suicide is the leading cause of direct deaths within a year of pregnancy. An estimated one in four women experience mental health problems in the first 1,001 days after pregnancy. While depression and anxiety are the most common perinatal mental health problems, other conditions include eating disorders, psychosis, bipolar disorder and schizophrenia. One father in 10 is also affected by perinatal mental health problems. Of the 241 families that Home-Start Richmond, Kingston & Hounslow supported during the most recent year, 66% were experiencing mental health difficulties, including post-natal depression, anxiety, depression and chronic mental health conditions.

I was privileged to be able to visit Springfield University Hospital in Tooting recently to meet the perinatal psychiatry team for the South West London and St George’s Mental Health NHS Trust. I was extremely pleased to hear about the work the trust is doing in successfully supporting new mothers who struggle with their mental health, and particularly pleased that it was able to maintain its services during the lockdown and after. Akvinder Bola-Emerson, the clinical services lead for perinatal psychiatry, stressed in particular the need for peer support but also the importance of health visitors, whom she described as the “eyes and ears” of perinatal mental health services.

The visit highlighted for me that we also need better provision for new and expectant fathers. Currently only mothers can be formally diagnosed with a perinatal mental health problem. Springfield provides services for fathers, but it is currently able to identify mental health issues in fathers only when they accompany mothers who are attending the hospital for perinatal mental health issues.

This subject has been my personal passion for more than 20 years, from chairing the Oxford parent-infant project, to setting up the parent infant partnership UK, and the Northamptonshire parent infant partnership, establishing the 1,001 critical days manifesto and the all-party parliamentary group conception to age two: first 1,001 days, and chairing the inter-ministerial group in the Government of my right hon. Friend the Member for Maidenhead (Mrs May). July 2020 marked a huge opportunity when the Prime Minister commissioned the early years healthy development review and invited me to chair the review team. Since then, we have been able to build on years of cross-party support, and a wealth of knowledge and expertise from the early years sector, to create a new vision for the 1,001 critical days initiative that was launched in March this year. The review has put the baby’s needs at the centre of all our work. Through meetings with parents and carers, virtual visits to local areas, and detailed discussions with parliamentarians, practitioners, academics and charities, we heard about the experience of early years services and support, and about what is going well and where change is needed.

First and foremost, we learnt from every parent and carer of their strong desire to be the best parent or carer they can be, but we also learnt that new prospective parents often struggle to find the support they need. We heard from many parents who had deep concerns about their own or their partner’s mental health, and struggled to get timely support. We heard from many mums who desperately wanted to breastfeed but gave up because the support was not there. Parents told us how frustrating it was to keep telling their story over and over again to different people. Their cry was, “Why don’t you people ever speak to each other?” Equally, we heard from professionals and volunteers who said it would have been so helpful for them if they had known before meeting a new parent or carer about previous trauma or health challenges.

We heard from many dads about how excluded they felt from what they saw as “mum-centric” services. Some felt that they should not ask for any support for themselves, while others just felt sidelined and, in some cases, traumatised by what their partner had gone through in childbirth. We heard from foster carers of babies how little information came their way when they were caring for a vulnerable baby. More specifically, in 40 cases of babies who went into foster care, only two arrived with their red book. Those carers had no formal information about those babies’ early traumas that had caused them to be taken away from their birth families.

We heard from same-sex couples about unhelpful assumptions by early years professionals about their relationship and parenting roles. We heard from black mums about how particular cultural and health issues can be overlooked by busy staff. We heard from single mums and single dads about how they can feel isolated, and sometimes stigmatised, at such a life-changing time. We heard from many parents with particular challenges, such as not speaking English well, concerns about possible disabilities, experiencing violence in their lives, or other significant challenges. We heard that support is inconsistent and sometimes hard to access.

It comes as no surprise that the covid pandemic has been an extraordinarily difficult time for new families who, through no fault of their own, have not been able to access services or support in the normal way. The “Babies in Lockdown” report from the Parent-Infant Foundation, Best Beginnings and Home-Start revealed that nearly seven in 10 parents felt that changes brought about by covid were affecting their unborn baby, their baby, or their young child, and that 35% of parents would like help with their concerns about their relationship with their baby. The report also found that nine out of 10 parents and carers experienced higher levels of anxiety during lockdown.

Despite the many stories of difficulties, we also heard fantastic examples of good support for families. Many health visitors went the extra mile to keep in contact with families who were struggling, and many families found it incredibly reassuring to be able to text or Zoom their health visitor at short notice. Parenting programmes have been a huge support to many families, and we— virtually—visited Camden’s Bump to Baby programme, where classes continued online throughout the pandemic, and have proved incredibly popular with new parents and carers who are also helped to make friendships outside the programme. Dads gave us positive feedback on services that gave them space to share their experiences, without worrying about whether they were taking the focus away from the other partner’s health and wellbeing.

In lockdown, we also heard about excellent online and virtual services, and how they came into their own. One such service, Parent Talk, provided by Action for Children, reported a 430% increase in the number of parents seeking advice online during the pandemic. The Baby Buddy app, produced by Best Beginnings, has seen a huge take-up of its digital and virtual advice for everything from breastfeeding to nappy changing, and from sleep management to mental health concerns. Many local authorities are now determined to improve their joined-up offer to new parents and carers, so I certainly feel that we are pushing against an open door.

Our report, “The best start for life: a vision for the 1,001 critical days”, was launched by the Prime Minister in March this year. It contains six action areas. The first is that every local area should publish its own joined-up set of start for life services so that every parent and carer knows where to go for help.

The second is a welcoming hub for every family, in the form of family hubs. Those will build on the excellent work done by the late Baroness Jowell and others on creating Sure Starts, but the benefit of family hubs is that they will be the place where every family goes for support and advice, including from midwives, health visitors, mental health support workers and breastfeeding advisers within their walls. Not only will those services be physically available, but they will be virtually available through the family hub model.

The third action area is a digital version of the red book, which will provide parents and carers with a record of their baby’s earliest life, from lovely moments such as their first tooth and their first steps all the way to records of immunisations and professional support interventions.

The fourth action area is about the workforce. We all know that health visitors provide critical support for new parents and carers, but we also know that their case load can be very heavy, and parents and carers have told us that they really want more continuity of care and more frequent contact in the earliest years. We are therefore working with health visitors and local areas to consider resourcing levels and training needs, and whether a mixed-skill workforce can provide that greater continuity of care.

The fifth action area is to continually improve the start for life offer. A key action will be to establish parent and carer panels in every local area to ensure that the voices of families are heard when services are designed and improved. We are looking at improving the collection of data, at the evaluation of different interventions, and at the need for proportionate inspection of the start for life offer in each area. A final but critical action area is to ensure that there is sound leadership, both locally and nationally, to drive the ambition to give every baby the best start for life.

I want to say a huge thank you to the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Erewash (Maggie Throup), and to all the review’s sponsoring Ministers, past and present, for their support for the review. I am sure that it was their commitment, combined with the support of the Prime Minister and the Chancellor, that ensured such a positive spending review settlement for the earliest years, with £82 million for family hubs, £50 million for parenting programmes, £10 million for the start for life offer, £50 million for breastfeeding support, £100 million for infant and perinatal mental health support, £10 million for new workforce pilots, and a £200 million uplift for the supporting families programme. I believe that £500 million is a transformational sum that will allow many more parents and carers to have access to the vital help they need to give their baby the best start for life.

Why does this matter so much to our society? Well, we know that it is in the period from conception to the age of two when the building blocks for physical and emotional health are laid down. Babies born into secure and supportive homes will usually go on to become happy children who do well at school and grow into adults who cope well with life’s ups and downs and are more likely to hold down a job, have better health outcomes and form healthy relationships themselves. On the other hand, we know that in families under pressure, particularly where there is partner conflict, substance misuse, poor mental health or deprivation, the consequences for a baby’s developing mind in that critical early period can be far-reaching and very harmful.

Prevention is not just kinder; it is also significantly cheaper than cure. For example, the NHS has estimated that for every one-year cohort of births in England, the long-term cost of lack of timely access to quality perinatal mental health care is £1.2 billion to the NHS and social services and more than £8 billion to society. That is for every year’s cohort. We also know that up to 30% of domestic violence begins during pregnancy, and that health issues such as tooth decay and childhood obesity cost hundreds of millions of pounds every year in health-related expenses. We believe that those problems could be significantly reduced by better education and support for new families.

With these six action areas, I think we can transform our approach to early years support and services, improving the health outcomes and life chances of the youngest in our society. Just as we need to level up economic opportunity across the country, we must also focus on where it begins—that critical period of human life from conception to the age of two.

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.

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 that 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 concern 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 are 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 from 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, and 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 the Minster, 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.

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 rundown, 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 were literally 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 would probably 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.