That this House has considered provision of healthcare support services in the period between conception and age two.
It is a pleasure to serve under your chairmanship, Sir Christopher. Today’s debate takes place against the backdrop of such a disruptive and damaging year. This year, as ever, it is the very youngest, the very oldest and the most vulnerable in our society who suffer when times are tough. It is timely that we are having the debate today, as the early years healthy development review, which my right hon. Friend the Prime Minister asked me to chair, is now gathering together its phase 1 recommendations.
Personally, I am grateful for the chance to highlight what has been my real passion in politics for more than 20 years. The first chapter in my early years story begins with OXPIP—the Oxford Parent-Infant Project—a charity in Oxford providing psychotherapeutic support for families struggling to cope with their new baby. I got involved as a banker, writing a business plan and successfully applying for a substantial lottery grant. I very soon found myself chairing the charity, and that was when I learned the vital importance of the period from conception to the age of two.
I was introduced to OXPIP by my mum, who was a midwife and a trauma therapist and had seen at first hand how so many new parents have unspoken and appalling birth experiences or traumas in their personal lives that leave them unable to focus on their baby and that precious early bond. Having had my own brief experience of post-natal depression in 1995, with my first born, I could empathise with how hopeless and helpless someone can feel as a new mum. Even with a loving partner and family around, those first few weeks can be frightening, sleep-deprived and, in many ways, overwhelming. Statistics show that up to one in seven women has that sort of experience after having a baby, so it really is an invisible epidemic.
Therefore, when I became the parliamentary candidate for South Northamptonshire in 2006, my family moved to the constituency and I set up NorPIP, the Northamptonshire Parent Infant Partnership, which is the Northamptonshire sister charity to OXPIP. I then established PIP UK, Parent Infant Partnership UK, a national charity that would lobby for better support in the early years and oversee a programme of building new PIPs around the country. I chaired PIP UK until I became a Minister in 2014 and had to leave the role overnight, whereupon my very old friend, my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton), picked up that work. I want today to pay tribute to him for all that he has done for the PIP movement and on the first 1,001 critical days.
During my early years as a Back Bencher, from 2010, I became chairman of the all-party parliamentary group on Sure Start Children’s Centres and set up the APPG for conception to age two—the first 1,001 days. With cross-party support from colleagues such as Lord Field and the hon. Member for Brighton, Pavilion (Caroline Lucas), I launched the first “The 1001 Critical Days” manifesto in 2013.
Under the leadership of my hon. Friend the Member for East Worthing and Shoreham, PIP UK has become the Parent-Infant Foundation and the “The 1001 Critical Days” manifesto has become a movement with the support of more than 160 charities and professional organisations. There is no doubt that there is overwhelming support from the early years sector for significant Government action, and the opportunity for that is now, as we build back better. This has personal backing from the Prime Minister himself.
How do the first 1,001 days shape a baby’s lifelong potential? From conception to the age of two, a secure and loving relationship between baby and carer literally shapes the way the baby’s brain develops. It is where the building blocks for lifelong physical and emotional health are laid out and, like a sponge, the developing brain will soak up the sense that the world is a good place and that problems can be solved. Humans are unique in the animal kingdom in the extent of their underdevelopment at birth. What other animal cannot walk until it is a year old and cannot fend for itself in any other way until it is at least two years old? The physical underdevelopment is only a small part of the story. The human brain is only partially formed when we are born, with billions of undifferentiated neurons, and parts of the brain that are yet to exist. At birth and in the precious months that follow, a baby has no cognitive skills; it can only cry, sleep or look around. Its neural connections are stimulated by the loving attention of its carer and the world around it, which makes those things so important for the baby’s future development and secure attachment.
Those people who have children will all remember walking up and down the landing in the middle of the night with baby in their arms, saying, “Go to sleep, go to sleep”. We wind them, we change them and we feed them, all of which comes naturally to most parents. The baby whose basic needs are met learns that the world is a good place and they retain that instinct throughout their life. The baby who develops secure attachment will grow up able to cope with life’s ups and downs. They will develop speech skills and they will be able to pay attention in school, make friends, hold down a job and then go on to become a good enough parent themselves.
On the other hand, a baby who is ignored, neglected or abused will find life much harder, and in the most extreme cases of abuse there will be a severe impact on the developing brain. A baby cannot regulate his or her own feelings. If their needs are not being met, they will cry, and that cry will get more and more persistent. If no help comes, that baby will eventually take refuge in sleep.
We know that a baby left to scream continually for days and weeks on end will experience raised levels of the stress hormone cortisol. We also know that excessive amounts of that hormone can damage the baby’s immune system, with lifelong implications for their physical and emotional health. Such damage can happen in the womb itself and there is strong evidence to suggest that high-risk behaviours evidenced in adults have a link to a high tolerance to raised stress levels that started in the earliest years.
We know that a pregnant woman who suffers from stress produces more cortisol, and the more stressed the mother, the more the foetus is exposed to higher levels of that chemical. This exposure can lead to modifications in gene expressions while the child’s brain is still developing. A baby’s brain development has deep implications for society, and we know that a human being without a properly developed social brain will find it difficult to empathise with others and to regulate his or her emotions, which will make it harder to cope with life’s stresses, as well as with building and keeping relationships in later life.
We have seen the lack of human connection at its most extreme, particularly in the case of the Romanian orphans under Ceauescu’s regime. Their minimal physical and emotional contact left them profoundly and permanently damaged. Sadly, we know that long-term violence, self-harm, poor mental health and substance misuse have roots stemming back to the earliest experiences in childhood.
What we do with a baby from conception to the age of two is about building the human and emotional capacity of that infant, and what we do after the age of two will be about trying to reverse damage that has already been done. In the words of the Royal Foundation, the early years are the most important time of life to set out the building blocks for a human being’s future development and success, and I truly applaud the Duchess of Cambridge for her passion to ensure that every baby gets the best start in life.
It is utterly indisputable that the first 1,001 days is the most crucial period of human development, and I want to set out where we are now. Between 2018 and 2019, I chaired an inter-ministerial group on the early years, under the premiership of my right hon. Friend the Member for Maidenhead (Mrs May). That group made some key recommendations, the main one being that the Government should set out and identify a vision for the critical first 1,001 days.
Our current Prime Minister has always been a supporter of greater help for new families. During many Cabinet meetings and conversations over several years, his commitment has always been clear, so I was delighted earlier this year when he asked me to chair the early years healthy development review on behalf of the Government. The review has three advisory groups—parliamentary, practitioners and academics—using the knowledge, experience and passion of colleagues across both Houses and across the early years sector. Lockdown has prevented any physical visits, so instead our group has taken part in a series of virtual visits, meeting parents, health professionals and service providers in Camden, Devon, Stoke, Leeds, Essex, Newcastle and other places. We had a series of deep dives looking into and hearing from professionals and stakeholders on everything from breastfeeding to parenting apps to parental mental health. We have engaged with parents and carers through a questionnaire that has gathered over 3,500 responses. A personal favourite has been the Mumsnet thread that I have logged into every week to chat with new mums.
We are now at the point of bringing together the review’s recommendations with a view to communicating them at the end of January. I do not want to spoil that by talking about them now, but I want to raise a few key learning points today, because, I am sorry to say, during the lockdown there has been much suffering that has come to the review’s attention. We have heard troubling stories of isolation with partners unable to be at health checks and even unable to stay with mum and baby after the delivery. Parents have experienced limited face time with health visitors and disastrously there has been a rise in cases of domestic violence.
Half a million babies were born during the first lockdown alone, with 1,800 babies born every day in England. Far too many have entered a world of isolation and limited social contact. There have been few cuddles with granny and grandad, much less support for mums and dads, and barely any time spent with other babies. If a baby’s potential for good lifelong health and wellbeing is derived from their earliest experiences, surely we need to make sure that every new family is now getting the best possible support. That is why it is vital that once the vaccine is rolled out and we start to get our lives back to a sense of normality, we improve and increase the care given to new families who have had such a tough year.
Despite the troubling stories, there are some silver linings. We should not lose sight of them. I would particularly like to highlight the use of digital and remote support. Many parents have said that during lockdown they really valued being able to text or have a Zoom call with their GP or health visitor on a much faster timescale than an in-person appointment. Some mums told the review that they preferred remote breast-feeding support to a physical group setting. Those who have taken advantage of mental health therapies online have felt it has been a positive step forward. This rapid adaptation to change has pushed open the door for the possibilities of technology in backing up good face-to-face support for new parents.
Another silver lining is the better joining up of services. From family centre workers to health visitors, from midwives to mental health therapists, professionals have found getting together on a Zoom call to discuss how better to support a family has been a vast improvement to their working practice and one that they do not want to lose.
Although the pandemic is not yet over and therefore until the vaccine has been rolled out sufficiently there will still be the need to remember hands, face, space, I call on the Minister to think about what more can be done for those 1,800 babies born every day. One in seven women and up to one in 10 new dads suffer post-natal depression. That was even before lockdown. We can only begin to imagine how many more families are struggling today. I urge the Minister to consider allowing new families at least two other supporting family members to bubble with them, or two other individuals if they are a lone parent. I also encourage her to make sure that health visitors and early years health services remain available and accessible face-to-face for everybody.
The strength of feeling of those here today, of sector stakeholders and, importantly, of parents, gives me the confidence that we can create real change in the early years and make sure that every baby gets the best start in life. For me it has been a long journey—more than 20 years—to reach this point, and I thank colleagues in both Houses who have committed themselves to this agenda. I also want to thank the hundreds of thousands of people across this country who, through their professional careers or through volunteering, are supporting the next generation day in, day out.
Finally, I want to end my remarks with a thought from Nelson Mandela, who is a bit of a hero of mine. He said,
“Our children are our greatest treasure. They are our future.”
The actions that we take in the present will help to shape not only the future of the youngest in society, but the outcomes of generations to come.
It is a pleasure to see you in the Chair, Sir Christopher. I thank the right hon. Member for South Northamptonshire (Andrea Leadsom) for securing this debate and for the work that she has done on this agenda. I chair the all-party parliamentary group on infant feeding and inequalities. We have worked on many of the things that she has been working on, but in a very focused way around the importance and significance of infant feeding for babies between conception and age two.
Breastfeeding is a really important part of babies’ health as they grow up, but that has not been matched by breastfeeding support services and investment in them across the UK. Breastfeeding support services have been very much a Cinderella service. They are run by dedicated volunteers who are often unpaid and the first to go when budget cuts are made. They are often treated as a “nice to have” rather than as the essential support service that they are for many families. We know and all the evidence suggests that women want to breastfeed, but they are being failed and let down time and again because the services that they need when things get tough are simply not there.
On the Breastfeeding Cuts UK Facebook page, Ayala Ochert has documented cuts in recent years in Sunderland, Stoke-on-Trent, Peterborough, Wigan, Dudley, Luton, Kent and Reading among many others. Services have been cut without any thought being given to the impact on the women and babies. There is a real postcode lottery in these services. Some local authorities value breastfeeding and invest in services, but some do not even consider it. Since lockdown, breastfeeding support services have been forced to close due to social distancing requirements. We understand why that is, but it has been a huge blow to the many who use those services and who might struggle to go online. In many cases, it is difficult to get that support online because of the need to have somebody there by their side to show them exactly what needs to be done. Not having that makes it incredibly difficult.
It is a pleasure to serve under your chairmanship, Sir Christopher, and a great pleasure to be speaking in a debate secured by my very old, wise and aged colleague, my right hon. Friend the Member for South Northamptonshire (Andrea Leadsom)—the high priestess of early years. As she said, I speak as the chair of the all-party parliamentary group on the first 1,001 days. I also recently stood down as chair of the Parent-Infant Foundation, the charity that she founded and that is having such an important effect on the whole movement for 1,001 days. I have been very proud to chair that charity for the past six years.
It is great to see this subject coming into the mainstream. We have had a number of Westminster Hall debates, including on the impact of covid on maternity, families and children in lockdown. Before the general election, I held a debate on health visitors. Since “The 1001 Critical Days” manifesto, the important document produced about eight years ago by my right hon. Friend, we have had various reports, including “Babies in Lockdown”, “Rare Jewels” by the Parent-Infant Foundation, “Building Great Britons”, and several Select Committee reports, including by the Health and Social Care Committee and the Science and Technology Committee, all of which were serious, heavyweight studies of the first 1,001 days.
This is, at last, not a new subject. I come to this debate much in the mode of Elizabeth Taylor’s sixth husband: knowing what was expected of him, but struggling to make it new and fresh. But we will give it a go.
Children, particularly very young children, have been the forgotten element in the whole pandemic lockdown; so too have parents of very young children. The lockdown, the regulations, and the alienation from or unavailability of family member support networks—which many of us, as early parents, took for granted—have had mental health impacts on new parents and single parents in particular. We should not underestimate that. It will be a long time before we can get back to a degree of normality and start to see the impact that missing out on those important contacts and support mechanisms in those crucial early months has had and will have for many years to come.
Before calling the next speaker, I will just say that the wind-ups will start at half past 10. There are four more speakers, so if each of them speaks for a maximum of five minutes, we should cover everybody.
Thank you, Sir Christopher. I thank the right hon. Lady for South Northamptonshire (Andrea Leadsom) for setting the scene so well, and to all those hon. Members who have made contributions.
As the grandfather of five grandchildren, this is an issue that is close to my heart. There is little that brings me as much joy as seeing my grandchildren—though that has not happened as often over the past few weeks because of the lockdown—and knowing that they are healthy and happy. Katie, Mia, Austin, Rhea, and Max, who is just eight weeks old, are bright and happy in these dark days. That brings so much joy and I thank God daily for them.
I thank the Duchess of Cambridge, to whom the right the hon. Lady referred in her introduction, for the wonderful work she has done. She came to my constituency but unfortunately I was unable to be there. She visited the Ark Open Farm in Newtownards, and the results of what was done that day are clear.
Early years matter a great deal and the overarching response to the questionnaire undertaken is that more support must be given to young mums and families. Over the pandemic, many of us have realised how much we underestimated the support and help provided by the mums and toddlers groups in the local church or community centre. We had not understood that talking to another mum about their horrific day with their wee toddler—even if it was never really all that horrific—and exchanging viewpoints about how they felt made coping that little bit better. We have learned, more than ever, that it takes a village to raise a child, and so it does. It is little wonder that dedication and christening services highlight that a mum and dad cannot and should not do it alone.
When my parliamentary aide was pregnant with her daughter, one of the first signs I noticed was that her 10 cups of coffee per day were reduced to zero. She had read that caffeine would make her baby’s heart beat up to six times as fast; she loved her coffee, but she loved that unborn child even more. Mothers all through this nation make changes before a baby arrives, including eating more healthily, taking vitamins, stopping drinking. There are no laws that say they must do these things, but the mother knows to do it. Prenatal support for mum at this time is essential, and I believe that we need to give more advice, more listening ears and more communication for those who worry at this stage.
It is always a pleasure to follow my friend, the hon. Member for Strangford (Jim Shannon). I commend my right hon. Friend the Member for South Northamptonshire (Andrea Leadsom) not only on securing this debate and on her excellent speech, but on the many years of work that she has undertaken in support of nought to three-year-olds. I very much support that.
The Early Intervention Foundation’s new report, “Planning early childhood services in 2020,” states:
“It is difficult to think of a more effective way in which the government might realise its vision to ‘level up’ Britain and ensure equality of opportunity than through ensuring access to high-quality local family services which start in maternity and run throughout childhood.”
It goes on to say:
“There is a logical case for more holistic and joined-up approaches to delivering area-based family services, which respond to concerns about a lack of service integration and artificial service boundaries.”
Recently, in making the levelling-up fund announcement, the Chancellor spoke about the opportunity to upgrade the centres of our communities:
“This is about funding the infrastructure of everyday life”—[Official Report, 25 November 2020; Vol. 684, c. 831.]
As vulnerable children and their families struggle with isolation, relationship conflict, poverty, addiction, death and many other problems during this pandemic, we need now more than ever to strengthen our community infrastructure so that every family needing support can access it locally and easily, when they need to. Many of us here are aware that the most pressured point in family life is often when the children are aged nought to three.
It will come as no surprise to colleagues that I want to use the rest of the two short minutes I have today to talk about family hubs. To put it bluntly, family hubs’ time has come. My hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) made an excellent speech in which he said that sometimes it is difficult to find something new to say about something one has been speaking about for years, but I should say that family hubs are local centres that ensure that families with children and young people can receive help to overcome a range of difficulties, and get the face-to-face support that, as we have heard this morning, is so necessary.
10:15 am
Cherilyn Mackrory (Truro and Falmouth) (Con)
I thank my right hon. Friend the Member for South Northamptonshire (Andrea Leadsom) for securing this debate. I pay tribute to the work that she has done over the past 20 years and that of other right hon. and hon. Members. I am only just starting my journey in this House, and it is a pleasure to work with such experienced colleagues, but hopefully I can bring some real-life experience to the table, having only recently finished being at what my sister would call “the cliff face” of having a baby or a small child in the house.
I had two pregnancies. One ended with the joy of my eldest daughter, and one ended in tragedy with a loss. I am now the co-chair of the all-party parliamentary group on baby loss with my right hon. Friend the Member for South West Surrey (Jeremy Hunt). He is doing an inquiry with the Health Committee on maternity services. We have been able to listen and drill down on some of the risks to babies’ lives and some of the solutions. If we can improve the outcomes for stillbirth and neonatal death, we will automatically improve outcomes for at-risk children who survive. In theory, all families should benefit.
Many tools will need to be deployed in conjunction with how we reimagine supporting the first 1,001 days, and I look forward to reading the recommendations when they come forward. Today, I want to focus on just one tool: continuity of carer. As we have heard, nurturing relationships begin before birth. The foetal brain develops rapidly during pregnancy and is influenced by the physical environment of the mother’s womb and the environment beyond it. Babies can experience adversity in the womb. For example, where domestic abuse occurs, research shows that babies’ stress regulation systems adapt accordingly, leaving them more responsive to threat, and consequently more irritable and difficult to settle once they are born.
Research from NHS England shows that one in five mums and one in 10 dads experience mental health problems during pregnancy and after birth. As we have already heard, pregnancy can often be a trigger for domestic abuse, and between 15% and 30% of domestic violence cases start during that time. The impact of those adversities can have a profound effect on an infant, whose healthy social and emotional development depends on loving and consistent care.
Professor Jacqueline Dunkley-Bent, the chief midwifery officer for England, spoke to our APPG earlier this year, and I was struck by the work that midwives are already doing in this area and the results they are getting. Continuity of carer is relationship-based care that saves babies’ lives. Baby loss is reduced by 16%, and women are 19% less likely to lose their baby before 24 weeks. It also reduces pre-term birth. We are asking for women to have the same midwife or a small team of midwives. In March 2019, 10,500 women were on the continuity of carer pathway—17% of all women booked in. That will hopefully rise to 35% by March 2021, and black and Asian women, and those living in deprived neighbourhoods, are currently being targeted. I would like to see that rolled out.
It is, as always, a pleasure to serve under your chairmanship, Sir Christopher. As others have done, I want to start by congratulating the right hon. Member for South Northamptonshire (Andrea Leadsom) on securing today’s debate. The right hon. Lady—I would say she is a friend—has been an absolutely tenacious campaigner on this issue. I remember badgering her with questions on a Thursday morning when she was Leader of the House; she would always, even in Government, still find ways of getting this issue to the Dispatch Box. I think it is fair to say that the Government’s loss is this policy area’s gain. The issue is a massive passion of the right hon. Lady’s, so it is right that she leads the debate today.
In summing up for the Scottish National party today, I want to acknowledge the five contributions from Back-Bench Members. We have had very thoughtful speeches from my hon. Friend the Member for Glasgow Central (Alison Thewliss) and the hon. Members for East Worthing and Shoreham (Tim Loughton), for Strangford (Jim Shannon), for Congleton (Fiona Bruce) and for Truro and Falmouth (Cherilyn Mackrory). People who have a genuine interest in a policy will come to debate in Westminster Hall; I certainly felt this morning that Members were speaking about something they knew about, rather than something from a parliamentary research unit or parliamentary Labour party handout.
Before I outline what the Scottish Government’s policy landscape looks like in terms of the first 1,000 days, I want to reflect on the Royal Foundation’s study conducted last month in partnership with Ipsos MORI on early years in the UK. The results were fascinating: only 10% of parents mentioned taking the time to look after their own wellbeing when asked how they had prepared for the arrival of their baby. Ninety per cent. of people see parental mental health and wellbeing as critical to a child’s development. Parental loneliness has dramatically increased during the pandemic, from 38% feeling lonely before to 63%, and more than a third of all parents expect the covid-19 pandemic to have a negative impact on their long-term mental wellbeing. That focuses some of the immediate challenges, but what are the solutions?
My hon. Friend makes a good point about the Best Start Foods grant. The level of the equivalent payment in England is woeful and, although it will go up in April, there are families just now who cannot afford essentials like infant formula. Does he agree that the Government should put up the payment now to see families through the winter?
I am grateful to my hon. Friend for that intervention. I can remember—in a previous life, before I was elected to this place, when I worked for her—helping on the all-party parliamentary group on infant feeding and inequalities. I pay tribute to the work that she has done on that. The point she has made to the Government today is very much based on what the APPG has heard, so I would be more than happy to take that comment on to the Minister.
The Scottish child payment is also—and I quote—a “game changer” in the fight against child poverty that is available nowhere else in the UK. It could support up to 194,000 children this year. Together with the Best Start grant and Best Start Foods, this will provide over £5,200 in financial support for eligible families by the time their child turns six; for the second and subsequent children, it will provide over £4,900. To further support that early years provision, the Scottish Government will continue to review and transform maternity and neonatal services over five years through the Best Start programme. Through that, we will deliver person-centred care that reduces inequalities, keeps mother and baby together, provides choices and improves experience of care and clinical outcomes for the 50,000 pregnant women and their babies who use the services every year.
In the brief time I have spoken this morning, I have taken a quick canter through some of the support being provided in Scotland. I hope it has been helpful in adding to the wealth of information and policy initiatives that we have considered. I very much look forward to supporting the right hon. Member for South Northamptonshire as she seeks to raise the early years agenda in this place. She will have all of our support.
It is an honour to serve under your chairship, Sir Christopher. I congratulate the right hon. Member for South Northamptonshire (Andrea Leadsom) for securing this debate. She really is one of the leading parliamentarians on this issue, so we were very pleased to see her appointed as the early years healthy development adviser. She has shared with us a lot of insight from her 20 years as well as from the current review. I look forward to hearing those findings and recommendations from that first phase. I hope that we will have a parliamentary opportunity, whether here or the main Chamber, to discuss them further. Hopefully, they will really turbocharge this debate and lead to a renaissance of early intervention at the very forefront of public policy in Britain. I very much hope that will be the case, and I think this is a key moment.
The right hon. Lady’s point about brain development was so interesting; I cannot hear these points enough. Like many colleagues here, I have been involved in early intervention-type activities throughout my time in Parliament, but we have been really reminded of the physical impact of emotion in the early stages and how profoundly responsible it is for whether young people—even babies—learn that the world is a good place. The hon. Member for East Worthing and Shoreham (Tim Loughton) said that these things have been well rehearsed, and they have, but I do not think they can be heard enough as they are very important.
The phrase that I underlined twice was “indisputable”; I completely agree there. The evidence for early intervention is indisputable. However, I am struck by the Royal Foundation research with Ipsos MORI that says that only one in four of our constituents understands that. We have a real job to do in taking something about which we are in such profound agreement in this place out to our constituents, so that they understand why it is such a good investment for the individual and for us all as a whole. That is something I am going to return to. The right hon. Member for South Northamptonshire’s points about the lockdown were extremely well made, and I look forward to the Minister’s response to them.
10:39 am
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Emma Pickett, a fantastic breastfeeding counsellor, has mentioned the ongoing issue of the shortage of venues as they have closed because of lockdown. She has asked whether other health providers plead with café owners and vicars to set up clinics. I do not think so, Sir Christopher. It is important that the venues are there for people when they need them.
On the issue of the postcode lottery, I should like to mention the issue of tongue-tie treatment. Getting tongue-tie assessed and treated in newborn babies is incredibly important for people trying to make sure that their babies latch on properly, but this again is a postcode lottery. Many places do not think it is important, and many parents are forced, if they can afford it, to pay for private treatment for tongue-tie division, which is not acceptable. It is an important service, it ensures that breastfeeding can continue, and the Government need to see it as such.
I want to thank all of the volunteers at the National Breastfeeding Helpline who have had to do an incredible job to support families through lockdown. Their volunteers saw 124% more calls between April and September than this time last year. That is an awful lot to ask of volunteers. They have had to ramp up their training and make sure that the calls are answered, because they know that the people at the other end of the phone are absolutely dependent on their expertise and advice. It is important for the Government to look at more funding for services at the National Breastfeeding Helpline because they need to be seen as an essential service and funded properly.
Women and babies have been left out of the conversations around lockdown. Very little consideration has been given to the impact on women who were on maternity leave or about to be on maternity leave, who lost out on provision and were often forced to either take their maternity leave early and lose out on that provision or were told that they were not eligible for furlough. Many have lost out. I pay credit to Bethany Power and all her colleagues, who have pushed so hard on behalf of those excluded groups who have experienced gaps in support and have not had the maternity experience they wanted. That has been compounded by the Government’s failure to provide the financial support they needed at such a vital time, which has in turn compounded their isolation.
The spending review provided no specific funding for public health services such as breastfeeding support, which, as I have said, is absolutely essential. Breastfeeding has been overlooked by the Government’s obesity strategy and online harms strategy, even though we know that online advertising can have a huge impact on how women choose to feed their babies.
A significant number of people have raised concerns about babies and mothers being separated in hospital, despite all the evidence showing that it is desperately important for mums and babies to stay together in those early months, and that breast milk is a protective factor due to the antibodies present in it. Mums and babies should be kept together unless it is impossible to do so; in many cases, it is possible to do so. Advice should be given by Public Health England as well as other health authorities to make sure that can happen. If we separate mums from babies unnecessarily, it upsets the rhythms of breast milk and leads to complications for mothers, such as mastitis, if they are not able to breastfeed when they need to.
Issues have also been raised by Dr Wendy Jones, who runs the Breastfeeding Network’s drugs in breastmilk helpline. She has concerns about the advice on vaccination for lactating mothers. I fully appreciate that there are ethics involved in the drug and vaccine trials and that generally we would not test on pregnant and breastfeeding mothers, but her concerns are about the advice in the PHE Green Book, which changed in just a matter of days. Initially, it said:
“There is no known risk associated with giving inactivated, recombinant viral or bacterial vaccines or toxoids during pregnancy or whilst breast-feeding”.
Two days later, however, that changed to say:
“Until more information is available, it is also recommended that women who are breastfeeding should not be vaccinated until they have finished breastfeeding.”
I would like some clarity from the Minister as to precisely why that advice changed. There will be many people working on the frontline of health and social care who are breastfeeding, which can continue for much longer than the recommended six months. It can last for up to two years and beyond, so we need to be giving proper advice, with evidence behind it, to those mums on the frontline who might be breastfeeding. They need to know what the advice is and what it is based on, so that they can make the best possible choice. They should not be told just to cease breastfeeding, because, as I have said, the impact on babies is considerable, and the antibodies passed through breast milk are very helpful. Interesting research has been done on mums who have had coronavirus, and on the antibodies passed through to babies. The Government should pay attention to the incredibly interesting research that is emerging.
There is a lot more that the UK Government can do to support breastfeeding. I could talk about this for quite some time, but I want to make sure that other colleagues are able to speak. I urge the Minister and the right hon. Member for South Northamptonshire, who secured the debate, to meet the all-party parliamentary group on infant feeding and inequalities at the next possible opportunity. We have been having meetings online, which has been great in encouraging people to come together, but I urge the Minister to put some funding towards this—not just warm words—and make sure that breastfeeding is protected in everything that the UK Government do.
Early years has for too long been forgotten when it comes to Government spending. Many of us have been going on about that for a long time, and it is worth repeating. Work done a few years ago estimated that the cost of perinatal mental illness is £8.1 billion each and every year. The cost of child neglect in this country is £15 billion each and every year. That means that we are spending more than £23 billion on getting it wrong for parents and very young children in those crucial early years. If we were to spend a fraction of that amount on greater preventive intervention measures for those who most need it in those crucial early years from conception to age two, that bill would be reduced significantly and it is a false economy not to be doing that.
It was disappointing to see just £300 million in additional funds being given to the social care sector—that is, the adult and children’s social care sector—in the spending review, even though there is a shortfall of some £3 billion in local authority children’s social care alone, not to mention all the problems with public health and the shrinking numbers of health visitors, which I will come back to in a moment.
Why is that important? My right hon. Friend the Member for South Northamptonshire has given us some of the figures. Up to 20% of women experience mental health problems in pregnancy or the first 12 months after birth, and 50% of all maltreatment is related to children under the age of one. It has been estimated that 122,000 babies under the age of one live with a parent who has a mental health problem. One third of domestic violence begins during pregnancy—a figure I could not believe when I first came across it. The Government are doing good work with domestic abuse legislation, but we need to be addressing the problem at source. If domestic violence is happening in a household, what sort of physical and psychological message is that sending to the newborn child? The same applies to even before it is born as well: there are signs that communication within the womb itself is a factor. Suicide is one of the leading causes of death during the period of pregnancy to one year after the birth of a child. That is a deeply tragic figure, but it is preventable if proper systems and checks are in in place.
About 40% of children in the UK have an insecure attachment to a parent or carer by the age of 12 months. The figure that I have always used—this is, I think, the killer point—is that for a child at the age of 15 or 16 who is suffering from some form of depression or low-level mental illness while at school, there is a 99% likelihood that his or her mother suffered from some form of depression or mental illness during or after pregnancy. It is as direct a correlation as that. If we do not do something within those first 1,001 days, we will reap the consequences, as will children, not just during childhood but into adulthood as well.
Child obesity rates are all connected to what happens in the first 1,001 days. Last year we also had worrying figures—this is particularly topical now—about the dwindling vaccination rates in England. In particular, only 86.5% of children had received the full dose of the measles, mumps and rubella vaccine. We have effectively lost our immunity status, because the World Health Organisation target to protect a population from a disease is 95%. One hopes that parents in particular will take up the covid vaccination as it is rolled out, because we have seen the effects on the children’s population of not having vaccinations in recent years.
The Children’s Commissioner estimates that 2.3 million children are living with risk because of a vulnerable family background and that more than one third within that group are invisible—they are not known to services and are therefore not getting any support. That is why it is crucial, particularly before those children present at school and come on the radar, that health professionals at various levels are having contact with those children and families to ensure that everything is all right. They can give that help and support and that tender affection and empathy, but they are also an early warning system for when things are going wrong, right up to safeguarding issues. The one thing that all those ailments have in common—there are a lot more that I have not mentioned—is that they come under the remit of the health visitor to a varying extent. I will come back to the importance of health visitors.
The impact of covid is great, as I have said, and I will not go over that again, but more families with babies and young children under five have been tipped into vulnerability due to the secondary impacts of the lockdown. At a time when families, and particularly families from deprived communities and single-parent families, need face-to-face contact with people like health visitors the most—I also refer to health visitors as the trusted uniform services who are usually welcomed over the threshold, whereas with social workers and others a barrier goes up instantly—more than 70% of health visitors have been repurposed to other aspects of the health service to deal with covid. That really is a false economy.
I pay tribute to Cheryll Adams, the chief executive of the Institute of Health Visiting, who is standing down from the outstanding role she has played for the cause of health visitors and their importance in the first 1,001 days. She will be greatly missed, but I am sure she will not quit the scene altogether, because of her dedication to the cause. Her report showed that 82% of health visitors reported an increase in domestic violence and abuse; 81% an increase in perinatal mental illness and poverty; 76% an increase in the use of food banks and speech and communication delay among children; 61% an increase in neglect; and 45% an increase in substance abuse. Finally, 65% of health visitors have a case load of more than 300 children under the age of five.
Is that sustainable? My worry is that even in the good times without a pandemic, health visiting was greatly stretched. One of the great achievements of the coalition Government was the delivery of a promise to institute 4,200 additional health visitors, based on the Kraamzorg system in Holland, which we visited and saw. It was a huge achievement—I think we were just a few dozen short of 4,200 by the time we got to 2015—and yet I fear that those numbers have dwindled back almost to the level that was inherited. That is such a false economy. Health visitors are a critical part of a universal offer to all families in the first 1,001 days. The report by the First 1001 Days Movement says:
“It is essential that governments invest in the delivery of the Healthy Child Programme and that this programme supports babies’ emotional wellbeing and development. We believe that all families should be able to access care from a named health visitor who offers them a high-quality service that is proportionate to their needs.”
I wholeheartedly concur.
What should be done? Many suggestions have been made. The LGA recently brought out a report saying that the Government should
“properly resource councils to enable investment in preventative universal and early help services to ensure that children, young people and their families receive the practical, emotional, education and mental health support they need”.
That is absolutely right. The Parent-Infant Foundation, in its “Babies in Lockdown” report, recommended funding for a
“Baby Boost to enable local services to support families who have had a baby during or close to lockdown.”
As my right hon. Friend said, more than half a million babies were born in that period. The report also said we should have a
“new Parent-Infant Premium providing new funding for local commissioners, targeted at improving outcomes for the most vulnerable children.”
I obviously agree with that.
Finally, I will go back to the “Building Great Britons” report, which was produced back in 2015 and made nine main recommendations: that a 1,001 critical days policy should be a mainstream undertaking by central Government; that all local authorities should be required to produce and implement a 1,001 days strategy within the next five years; that national Government must establish a 1,001 days strategy blueprint; that local health and wellbeing boards should demonstrate delivery of a sound primary prevention approach; that the early help recommendations from the Munro review, which I commissioned back in 2010, should be picked up and carried; that we should have a Minister for families, either close to or at Cabinet level, to carry the banner for the importance of the early years and family contexts, which are so important to the social policy of any Government; that we should have more inter-agency training on the importance of the early years; that children’s centres should be repurposed to be these family hubs, which this Government have committed to and which should be a Piccadilly Circus of these services available to all families; and that we should have the research evidence to go with all of that.
In short, we need a full “team around the family” approach; we need to invest in health visitors and other health professionals, including GPs and mental health specialists, particularly around attachment issues. We need them to work with all of those in the early years setting, alongside social workers and others with safeguarding responsibilities—supporting, not supplanting parents, but signposting them to the most appropriate services and ensuring that they are accessible when needed. We need a national roll-out, national guidance and national scrutiny to ensure that it is being delivered, but it should be implemented locally and governed by local circumstances. To not do that is a false economy, and children in future generations will pay the price.
Together for Short Lives contacted me and asked me to briefly highlight a number of issues, as not all pregnancies end in the dream photo-op at the end of labour. Some have a much sadder story to tell—that is a fact of life. The majority of child death occurs in the first 28 days of life—the neonatal period. Every year, over 100,000 babies are admitted to neonatal intensive care in the UK. While many of these babies will only need to receive treatment for a few days or weeks before being discharged home, a minority will need more intensive care. The “Make Every Child Count” study, published this year, found that the prevalence of life-limiting conditions is highest in the under-one-year age group, at 226.5 per 10,000. That is the point that the right hon. Member for South Northamptonshire is making, and the very point of this debate. On average, there are 1,267 neonatal deaths each year from causes likely to require palliative care.
With this in mind, Together for Short Lives has highlighted the importance of the specific challenges faced by babies and children with life-limiting conditions and their families; they are not forgotten. The NHS England children’s hospice grant will increase to £25 million per year by 2023-24. It will be reallocated equitably to children’s hospices and there will be £7 million funding for children’s palliative care.
In conclusion, Sir Christopher, I briefly highlight the phenomenal work done by the WAVE Trust and Alex Williamson, and their 70/30 Campaign, which is about reducing the number of children who experience maltreatment by at least 70% by 2030. It is difficult to argue against their proposals or those of Together for Short Lives.
I look to the Minister, as I always do, to confirm that pregnancy and early years matter; if we want to see a generation of well-adjusted and happy youth it must be not simply because their parents have invested time and love. It has to be more than that. Our Government have to understand that funding for early years is not a grant of money, but an investment in our future—one certain to return a great yield. As the good book says, as you diligently sow, so you will reap. We must sow good for our children to get good from them as adults, and that must begin today.
Recently, calls for progress in supporting family hubs have grown louder. The Children’s Commissioner wrote in July:
“Some parents may want help to find work, or deal with the new strains on their relationship, or on their mental health, that can come with having a baby—and those stressful issues may also be making it harder for them to give their young children the loving attention they need. The Hubs would also have these more targeted services—including perinatal and infant mental health teams, JobCentre advisors, Speech and Language Therapists and housing teams—co-located within the service.”
Recently, family law practitioners have got on the case as they see far too many—40%, in fact—separating couples using fractious court proceedings to determine child contact and residency. Last month, the Family Solutions Group concluded that
“Crucially, the Family Hub…could provide the signposting and gateway to the range of other direct support services for children which are so sadly lacking at present.”
Thankfully, the Government are now on the same page. Their manifesto commitment says that they will
“champion Family Hubs to serve vulnerable families with the intensive, integrated support they need to care for children – from the early years and throughout their lives.”
Recently, the Family Hubs Network was established to share best practice and drive the family hubs movement across the country. The movement is characterised by an understanding of the importance of early help and provision; by a relational approach, adopted by everyone who works in the hub; and by a whole-family approach, so that families have somewhere they know they can go to get information, advice or guidance. Parents can get help for difficulties in their own relationships, and there can be integrated health and public health priorities, including health visiting and maternity, with social services and, if necessary, troubled families programmes.
This month, the Department for Education is taking the first steps in establishing a national centre for family hubs, which will not only develop the evidence base but share good practice on how best to support families in the early years. There is no time to lose.
I would like continuity of carer to be promoted to all families and replicated in the health visitor sector, because it is so important. Parents’ responses shape their experiences; if they have a trusted carer they can go to if they are in crisis or struggling, whether it is with domestic violence or coercion in a relationship—or post-natal depression, which many of us have felt—an awful lot of that stress will be expelled. They might even go to the trusted carer for things such as reduced movement. Yes, it is okay to go and talk to a healthcare professional, but many women think that they are bothering a midwife, especially if they do not know them. If they have continuity of carer, all those problems can potentially be solved by a quick phone call, because they will trust somebody at the end of the phone.
I conclude by saying that I look forward to the recommendations coming forward. It is my hope that this issue will be cross-party and long term and that we will have enough funding to put real change in place for all families to come.
For a start, Members will forgive me if I reference largely what happens in Scotland. This is very much a devolved area, but as a result of third-party obligations I want to offer some thoughts from that perspective. North of the border, the Scottish Government are investing £50 million, overseen and directed by the perinatal and infant mental health programme board, to improve perinatal and infant mental health services in Scotland across all levels of need—from specialist services, through to befriending and peer support. In addition, the Scottish Government have established the infant mental health implementation and advisory group. It provides clinical advice and support to inform the development of mental healthcare from conception to three years of age, and oversees the testing and implementation of evidence-based and innovative models for the delivery of those infant mental health services.
I want to look slightly wider at the policy initiatives currently in place and how those tie in with the topic we have been focusing on this morning. North of the border, the Scottish Government recognise that life chances and future attainment start at birth and we are certainly using our devolved powers to deliver a comprehensive package of support to ensure the best start for every child in Scotland. The Scottish Government provide a generous package of support for families to help them through this challenging time, including the three Best Start grant payments for people on low incomes, all providing a higher level of support or eligibility than the Department for Work and Pensions benefits that they replace. We have replaced the British Government’s Sure Start maternity grant with the Best Start grant and pregnancy and baby payment. That payment is higher than the UK Government payment and does not put a limit on the number of children supported: we believe that every child should be treated equally.
We have introduced baby boxes, which provide essentials to new parents in Scotland, of which more than 47,000 were delivered in 2019. Indeed, 93% of parents are taking up a baby box at the moment and there is nearly a 100% parent satisfaction rate. I declare an interest and speak from experience, as a result of receiving one in 2018 when my daughter Jessica was born. We are also delivering both nursery and school-age payments for our Best Start plan, together with the pregnancy and baby payment. We made £21 million of awards in 2019-20. Best Start Foods also provides a £17 payment for healthy food every four weeks during pregnancy and for any children between one and three years old, and £34 for babies up to the age of one.
I turn to the contributions of other Members. I was glad that the hon. Member for Glasgow Central (Alison Thewliss) referenced her tireless work on breastfeeding and the importance of support services for that; I will reflect on the public health grant in England shortly. On what the hon. Member for East Worthing and Shoreham said, I make no comments about “old or very old”—I leave that only to the Member in charge. But I recall from his time as a Minister and our time serving together on the Home Affairs Committee his strong commitment to getting all children the best start in life. I thought his contribution was very much in line with that. I loved what he said about health visitors. That is such an important distinction in understanding. Health visitors are the best at getting uniformed services over the threshold for some of the hardest families to reach in our communities. That has to be an important part of our public health response.
The comment the hon. Member made about all the big spending we do on getting it wrong is at the nub. I will expand on the point shortly, but we have to work it out. We know we are spending the money, but we also know that the old argument we make about what a difference it would make, if only we had a fraction of it invested, does not work with the Treasury. That has not worked with successive Treasuries of whatever political persuasion. We have to try to answer that question of how to do it in a way that is “cashable”, for want of a better word, and deliverable on a timeline that the Treasury will accept.
I will repeat what I said to the hon. Member for Strangford (Jim Shannon) when he and I were here in the late debate last night. In the early debate this morning, his contribution, as always, comes with a burden of empathy behind it. That is at the root of the issue: understanding the impact of empathy on the development of a young person. The reason that matters is because it is important for public finances, of course, but we are all here because we care about people. We do not want anybody to have their potential and outcomes curtailed before they have even had a chance. That is the importance of a source of empathy.
I will take great interest in family hubs and their development, having listened to the hon. Member for Congleton (Fiona Bruce). I recognised a lot of what she said from Sure Start. The loss of Sure Start is a real sadness, but I look forward to reading and hearing more as those other ideas develop.
I will finish by congratulating the hon. Member for Truro and Falmouth (Cherilyn Mackrory) on the anniversary of her first year here. I am sure it has gone in seconds. I know that colleagues and those watching will appreciate her work and her bravery in sharing her personal story of baby loss. That makes such a big difference to people listening and watching. Her points about continuity of care were really important and I hope the Minister will reflect on that.
I will make a few points of my own. Early intervention is the best gift we can give ourselves. It is brilliant for the individual, transforms lives and is great for the collective, not least financially. We saw that with Sure Start under the previous Labour Government, which made a tremendous difference, especially in the most disadvantaged communities such as mine. I see that work and its legacy close up in my community today, as I saw it when I was lead for health and social care on Nottingham City Council, prior to coming to this place.
Nottingham has a proud history in this area. My predecessor, Graham Allen, the previous Member for Nottingham North, was a real leader in the area of early intervention. It is 10 years next month since his first report, “Early Intervention: The Next Steps”, was published, and almost eight years since the founding of the Early Intervention Foundation, following his second report. He has played a formative role in my development on this issue, in politics and in life more generally, so I know he will not mind if I run out his ideas. He texted me on my way to this debate with a quote reminding me that the best early interventions we can make start 100 years prior to a baby’s birth, but I will start at conception, because that is what the right hon. Member for South Northamptonshire chose to do. I am sure he will forgive me for that.
We have good examples of the impact of failing to make these early interventions. I will draw on the Department for Education’s Wave Trust report of 2013 that provided the foundation for the 2014 cross-party manifesto, which was so important and provides a theme I hope we can return to in this decade. Disadvantaged mothers are more likely to have babies of low birth weight and low birth weight is associated with raised blood pressure, coronary heart disease, as well as reduced educational attainment, qualifications and employment. Optimal infant nutrition, especially breastfeeding, increases children’s chances of leading a future healthy life. By age five, according to analysis from the Millennium Cohort Study, breastfed children were already one to six months ahead of those who never were.
Those are little examples of the difference that one thing at birth or in the first two years makes for the rest of a life. We could also have drawn on stress and smoking during pregnancy, trauma, language inequalities and communications. I could go on and on. We know what is at the root of this. Those households in the lowest socioeconomic groups have significantly worse health outcomes. If levelling up is the term of the day, this is the crucial piece of levelling up.
This is not a theoretical exercise. As colleagues have said, we are in significant agreement but not just in theory. We have seen excellent early intervention models working over the past decade. I have talked about Sure Start but there is the Family Nurse Partnership, which has supported young parents and their babies for 13 years and is now in 60 areas across England, including my constituency. My friends at Roots of Empathy have reached over a million children around the world, and their Seeds of Empathy programme is incredible. I have joined in with that, and it helps young children learn by watching a baby’s development. It is a wonderful programme. Those sorts of things make such a big difference, and we can do more to champion them.
The Government have to do their bit. Over the last decade, early intervention grants were reduced by almost two thirds: £2.8 billion to £1.1 billion. The public health grant has been exceptionally distressed over the last seven years. From my three years stewarding that grant in Nottingham, I know that after demand-led services such as drug, alcohol and sexual health services have been dealt with, there is not an awful lot left. Sometimes, some of those services with longer term impacts—such as early intervention services—are the ones that can get forgotten. It is a prime example of that. Similarly, local authority children’s services departments have been forced to cut back children’s centres—family support services that make such an impact—because of their finances. I do not know what Ministers think they have saved in the last decade by making those cuts, but the cost to the country’s finances in years to come will significantly exceed the savings. It is the falsest of false economies.
Well-implemented preventive services—along with early intervention in the foundation years and in the long run—deliver economic and social benefits, as well as being likely to do more to reduce abuse and neglect than would reactive services. Social return on investment studies have shown a return of between £2 and £9 on every £1 invested when there are well-designed early year interventions. The return could possibly be even greater. But that is easy to say. Similarly, the Royal Foundation says that its figure for late intervention was £17 billion each year. It is easy—certainly in Opposition—to say, “If only the Government were enlightened enough to hive off 10% of that and invest it. They would save all that money.” That is true but that is the argument of fixing an aeroplane in flight, so we must have a real conversation. I would be interested to hear the Minister’s reflections on that. The Treasury does not buy that argument and says that it is for idealists and daydreamers who do not understand the reality of public finances. But as the hon. Member for East Worthing and Shoreham says, we are spending an awful lot to get it wrong.
What do we have to change? How do we have to recalibrate that investment conversation to get the Treasury to move on the issue? Colleagues who are more enlightened on the issue than I am have been trying to do that year after year after year, and it does not happen. What is stopping us here? I have reflected—as have colleagues—on the Royal Foundation, now led by the Duchess of Cambridge, which has now spent nine years on early childhood experiences. That is wonderful political leadership, and has highlighted the fact that only one in four people in this country think that it is a priority. The royals would, hopefully, be good people for leading the conversation and helping to grow that figure, but we must also play our role and talk about the successes. We would be keen to do that in a cross-party manner because it needs helium in the public conversation so that we have greater public space to invest in it. We would all be better off if we did so.
I will not repeat points made by colleagues on the pandemic about the impact of isolation. The impact of covid will be the subject of longitudinal studies for the rest of my life. I want to raise the issue of the impact on local authorities, which is significant. That worries me because my local authority—and, I suspect, the vast majority of the 150 authorities in England—will be doing in-year budgets. They are a bad way to run public finances, because twice as much has to be cut to get the half-year effect. The public health grant, in particular, is likely to be distressed and squeezed by that. We will lose early intervention type activities from that. The Government need to look at that and to back-fill that public health grant loss from the previous seven years, not just from this year. That is the big prize. Dealing with covid and dealing with Brexit are vital. It is right that we spend these weeks and months doing that. As for getting our country where we want it to be—a country in which everybody can reach their potential and flourish—it is about those early interventions we make in the life course. I am glad to see the complete and cross-party agreement we have on the issue. We now need to translate that into more action.