Health Visitors (England)

I beg to move,

That this House has considered the reduction in the number of health visitors in England.

I am grateful to the hon. Members who have come to speak on this important subject. I declare an interest as the chair of the all-party parliamentary group for conception to age two—the first 1,001 days. I also chair the board of trustees of the Parent-Infant Foundation, which runs attachment facilities and lobbies for better early intervention around the country.

I will start with some slightly alarming statistics. The cost of perinatal mental ill health in this country has been worked out at £8.1 billion per annum, according to the Maternal Mental Health Alliance, with up to 20% of women experiencing some form of mental health problem during pregnancy or the first 12 months after birth. The cost of child neglect in this country has been estimated at some £15 billion, with 50% of all maltreatment-related deaths and serious injuries occurring to infants and babies under the age of one. We currently spend in excess of £23 billion getting it wrong in those early years, particularly for mums and new babies. That is equivalent to something like half the defence budget.

There are 122,000 babies under the age of one living with a parent who has some form of mental health problem. Amazingly—this statistic came out time and again during conversations on the Domestic Abuse Bill—a third of domestic violence begins during pregnancy, and suicide is one of the leading causes of death for women during pregnancy or in the year after giving birth. About 40% of children in the United Kingdom have an insecure attachment to a parent or carer at the age of 12 months, according to Professor Peter Fonagy and others. Alarmingly, there is a 99% correlation between a teenager experiencing some form of mental illness or depression at the age of 15 or 16 and his or her mother having had some form of perinatal mental ill health during pregnancy. It is that close a correlation, making it that much more important that we make sure that the mums bearing those children, and also fathers, are as happy, settled and healthy as possible in those early stages, from conception to age two.

The hon. Gentleman set out the costs incurred in trying to prevent such travesties. Does he agree that the figures he refers to are actually conservative estimates? I believe that he was at the launch, quite a number of years ago, of the Maternal Mental Health Alliance, which arrived at the figure of more than £8 billion. Is it not the case that, although the economic costs are significant, it is the social and moral reasons that have brought Members from both sides of the House here for this important debate?

If the hon. Lady is patient, I will come on to the social impacts. I think the MMHA report came out in 2014 or 2015, so obviously things will have moved on, although the birth rate has slightly fallen in that time as well. These are substantial financial figures, but as she says, most important are the social impacts and the impact on the child.

On the physical impacts, our childhood obesity rates are among the worst in Europe, while breastfeeding rates in the United Kingdom are among the lowest in the world. We have rising emergency department attendances by children under the age of five, and infant mortality reductions have recently stalled. Just last week, we had the worrying figures about the dwindling vaccination rates in England in particular, with only 86.4% of children having received a full dose of the MMR vaccine. We have effectively lost our immune status, because the World Health Organisation vaccination target to protect a population from a disease is 95%.

The Children’s Commissioner estimates that, in total, 2.3 million children live with risk because of a vulnerable family background, but that, within that group, more than a third are effectively invisible and not known to services and therefore do not get any support. We are talking about an expensive and widespread problem.

I pay tribute to the remarkable work of health visitors in my constituency. Does the hon. Gentleman agree that cutting the health visitor service by 30% over the last few years has clearly made it even harder for the profession and for the families and mums that they take care of?

Again, I ask the hon. Gentleman to be patient, because I will come on to all that. I realise that he wants to put on the record his tribute to health visitors in Eastbourne, as do I—as someone who was born in Eastbourne and had wonderful health visitors, I am sure, albeit 57 years ago now.

The one thing that all these problems, and a lot more problems I have not mentioned, have in common is that they come under the remit of the health visitor, to some extent or other. The health visiting service provides an important safety net for infants and young children—as well as mums and dads—who are at particularly high risk of having their needs missed, as they are not visible in the same way as children who are accessing an early years setting or a school, for example.

Will my hon. Friend give way?

Another one? Yes, why not?

My hon. Friend is making a very good speech—

But hon. Members keep interrupting it!

I am very pleased to briefly interrupt him my hon. Friend. I pay tribute to the health visitors in my constituency. Is it not an important role of theirs to ensure that health inequalities are drummed out of the system?

That is a serious point; my hon. Friend is absolutely right. Health inequalities are still a big problem in this country, and those professionals on the ground, not least health visitors, are the first to come face to face with them and have the practical means, in many cases, to do something about them.

Will the hon. Gentleman give way?

I am happy to take interventions, but it will mean that hon. Members will have to make shorter speeches, as I am sure Mr Bone will point out.

The Royal College of Nursing’s briefing for the debate says that the number of health visitors with caseloads of more than 500 children rose from 12% to 21% between 2015 and 2017, so it will have risen even more in the two years that have elapsed since. The caseload is really worrying, in terms of people being missed.

The hon. Lady pre-empts a point I was going to make on page 5 of my notes, so I will take that bit out.

Unlike some other public service professionals, health visitors are non-stigmatising and usually welcomed over the threshold into homes, enabling them to give early advice and support to prevent later problems, encourage healthier choices, detect problems early and, in some cases, act as an early warning safeguarding alarm. Often when social workers are the ones to knock on the door, it may be too late, and that professional has a completely different sort of relationship with the family.

I am grateful to the hon. Gentleman for securing this timely debate. What he just said is so important. The mandatory health visitor contacts in my constituency are not taking place as they should. When constituents complain or I complain, we are essentially told that they are profiled based on risk, which is clearly not how a mandatory set of contacts should work. I worry that we sometimes make assumptions about socioeconomic status or other factors, whereas the kind of problems we are talking about can manifest themselves in any family. If we are serious about having a mandatory system, should it not be that, rather than discretionary? If it is about capacity, let us talk about that.

Again, the hon. Gentleman makes a good point, which was on page 5 of my notes. This issue affects everybody across society, often better-off, more affluent families who might be better at hiding it or less inclined to come forward to seek help. The charity that I chair has units in Liverpool, Newcastle, London and so on, and we see that middle-class parents who have serious attachment dysfunction problems with their children are less likely to come forward. Those, ironically, may be harder-to-reach people. Health visitors are the early warning system and are able to signpost some of those people to services. They can also point out, “I think you have a problem,” and it will be taken on trust.

I appreciate the good points that have been made, but I will make some progress. The cost of failing to intervene early is enormous—financially and, more importantly, socially. The impact of not intervening early can disadvantage a child through early years, school years, adolescence and often into adulthood. In some cases, it can be life-defining.

One of the great achievements of the coalition Government was to pledge a massive increase in health visitors. In opposition, the then shadow Health Minister, Andrew Lansley, championed the recruitment of no fewer than 4,300 new health visitors, based on the successful model of the Dutch Kraamzorg system—I was involved in research into that—where post-natal care is provided to a new mother and her baby an initial eight to 10 days immediately after birth.

Four years ago, the Government’s health visitor implementation plan and the “Call to action” scheme were the pride of the nation. The policy was built on sound evidence that the health visiting profession had the power to drive health improvements and provide a universal service designed to give every child that best possible start in life, as we all want to see. Impressively, for a Government target, it was achieved—just about—in the lifetime of the 2010 to 2015 Parliament.