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Conception to Age 2: The First 1001 Days

Volume 603: debated on Thursday 17 December 2015

Old Whip’s habits die hard, but we accept the overtures of the hon. Member for Nottingham North (Mr Allen).

I beg to move,

That this House calls on the Government to consider the adoption of the recommendations in the cross-party manifesto entitled The 1001 Critical Days, the importance of the conception to age two period.

In this my seventh contribution of the day, let me wish you a happy Christmas, Madam Deputy Speaker, when it eventually starts. I am grateful to the Backbench Business Committee for giving us this important debate, particularly as it is so close to the launch of this excellent manifesto, which I will also be promoting today. I know that every single Member in this Chamber and beyond has been sent a copy of it. I am also grateful to those Members who have stayed for the final debate on the last day before the Christmas recess.

It is perhaps appropriate that the final debate should be about babies and conception to age two just eight days before we celebrate the birth of one particular baby, albeit the subject of an immaculate conception and in which the confusion over paternity, a somewhat unprepared and astounded mother and inadequate birthing facilities could have given rise in normal circumstances to some attachment dysfunction problems.

It is good to see the Minister for Community and Social Care here. I know that his door is well and truly open to what we have been promoting. It is particularly good to see my old great friend the Minister of State in the Department of Energy and Climate Change, my hon. Friend the hon. Member for South Northamptonshire (Andrea Leadsom). I wish to pay tribute to her. Effectively, she conceived this whole manifesto, gestated it and gave birth to it, and has done so much to champion the cause of early years attachment and perinatal mental health in this House and for many years before she came to this House. She continues to combine her advocacy with her new day job in DECC. She championed “The 1001 Critical Days” manifesto, which is now three years old and which was relaunched this week with more support and recognition than ever before.

On Monday, no fewer than 200 people came to the House of Commons Terrace to support this manifesto. Those present included academics, senior practitioners in paediatric and mental health, commissioners, voluntary organisations and politicians of all parties. It is particularly gratifying that the manifesto has now been sponsored by Members from eight different parties across the House. There really is a genuine cross-party consensus to promote this manifesto.

There has been big progress since the manifesto was launched in 2012 and promoted in the party conferences in 2013. The manifesto is now becoming part of the mainstream. It was supported at its launch and continues to be supported by the WAVE Trust—I pay particular tribute to George Hosking and all the work that he has done well before our time in the House—the National Society for the Prevention of Cruelty to Children, and PIP, the parent and infant partnership charity. I declare an interest as the chairman of the trustees.

PIP is putting the “The 1001 Critical Days” manifesto into practical action through children’s centres around the country and changing the mindsets of commissioners. Our projects started in Oxford with OxPIP. We now have NorPIP in the constituency of my hon. Friend the Member for South Northamptonshire, projects in Enfield and Liverpool, and others in Brighton, Croydon and Newcastle coming online in the near future. We want to spread that network across the whole country.

It is crucial to change mindsets in relation to how we intervene early and reconfigure our health—particularly mental health—services, education and children’s social care services to intervene earlier to prevent the causes of poor mental health for mother and baby from leading to indisputable life disadvantages that become mired in a vicious cycle of intergenerational underachievement. The alternative is that we continue to firefight the symptoms at great cost to our society both financially and, more importantly, socially.

The Government have made good progress, largely through the troubled families programme, in acknowledging that if we recognise the problems of dysfunctional families early and intervene with intensive focus and joined-up support we can often get those families back on track and convert them to balanced, contributing members of society, rather than a huge challenge to it and drain on it. I am proud to have been involved with that work when it was started in the Department for Education in my time as a Minister there.

But we need to go further, with what I have termed a “pre-troubled families programme”. That is, in effect, what the “The 1001 Critical Days” manifesto is about, and this is why. Last year the Maternal Mental Health Alliance, so ably led by Dr Alain Gregoire, produced a report which estimated that the cost of perinatal mental illness at more than £8 billion for each one-year cohort of births in the United Kingdom. That is equivalent to a cost of almost £10,000 for every single British birth. Nearly three quarters of this cost relates to adverse impacts on the child, rather than the mother. Perinatal mental health problems are very common, affecting up to 20% of women at some point during and after pregnancy, yet about half of all cases of perinatal depression and anxiety go undetected and many of those which are detected fail to receive evidence-based forms of treatment.

As the Minister well knows, the current provision of services is patchy at best, with significant variations in coverage and quality around the country. Most alarmingly, just 3% of clinical commissioning groups in England have a strategy for commissioning perinatal mental health services and a large majority still have no plans to develop one. I am sure that with the new Minister’s laser-like focus and zeal, and the fact that NHS England has adopted perinatal mental health as a priority, this will start to change soon.

Why does this matter? Apart from the obvious major public health epidemic going largely under-appreciated at its extreme, the statistics are alarming. Just last week a report by the maternal research group MBRRACE, analysing maternal deaths between 2011 and 2013, found that one in four of those deaths between six weeks and one year after giving birth were linked to mental health issues, one in seven were a result of suicide, and mental health problems were instrumental in the deaths of one in 11 new mothers within the first six weeks after giving birth. At this extreme the figures are shocking, but they are also largely preventable with better and early detection and intervention, yet 40% of those women who committed suicide in that timescale would not have been able to access any specialist perinatal mental health care in their areas.

For those who lived through pregnancy and the early years of a baby with a mental illness, the impact on that child can be considerable. Another major negative impact might be substance abuse, poor parenting skills—often inherited as a result of a young mum being poorly parented herself—and being exposed to domestic violence. Incredibly, more than a third of domestic violence cases begin in pregnancy. This is a statistic that many of us would find hard to believe. Sadly, these negative influences are all too prevalent among new parents. Those is by no means a problem limited to those from poorer backgrounds. Parents unable to form a strong attachment with a new baby come from all parts of society, and we need a multifaceted approach for detection and intervention at all levels.

Children need nurturing from the earliest age. From birth to age 18 months, it has been calculated that connections in the brain are created at a rate of a million per second. The earliest experiences shape a baby’s brain development, literally, and have a lifelong impact on that baby’s mental and emotional health.

A pregnant mother suffering from stress can sometimes pass on to her unborn baby the message that the world will be dangerous, and the child might struggle with many social and emotional problems as a result; their responses to experiences of fear or tension have been set to danger and high alert. That will also occur at any time during the first 1001 days when a baby is exposed to overwhelming stress from any cause within the family, such as parental mental illness, maltreatment or exposure to domestic violence.

Attachment is the name given to the bond that a baby makes with his or her care givers or parents. There is long-standing evidence that a baby’s social and emotional development is affected by his or her attachment to his or her parents. As the chief medical officer, Sally Davies, puts it in her foreword endorsing “The 1001 Critical Days”:

“The early years of life are a crucial period of change; alongside adolescence this is a key moment for brain development. As our understanding of the science of development improves, it becomes clearer and clearer how the events that happen to children and babies lead to structural changes that have life-long ramifications. Science is helping us to understand how love and nurture by caring adults is hard wired into the brains of children.”

The all-party group for conception to age two—the first 1001 days, which I have the privilege of chairing, produced a report in February called “Building Great Britons”. That, too, was sent to every hon. Member and it complemented “The 1001 Critical Days”. The report calculated the cost of child neglect to be some £15 billion each and every year. When combined with perinatal mental illness, that makes a cost of more than £23 billion every year for getting it wrong for our youngest children and their parents. That is equivalent to two thirds of the annual defence budget.

In concentrating on perinatal mental illness in young mums, it is also important to stress how a child benefits most from forming strong and empathetic attachments with both parents. We should not forget that 39% of first-time fathers also experience high levels of distress during a child’s first year. We need a strong whole-family approach, and it is especially important to get that strong attachment with fathers in the second year of a child’s life as well.

Another big problem in this country is that it has been calculated that 1 million children suffer from the type of problems—attention deficit hyperactivity disorder, conduct disorder and so on—that are clearly increased by antenatal depression, anxiety and stress. Yet the cost of appropriate and timely intervention and support has been calculated at a fraction of the annual cost of failure. It equates to roughly £1.3 million per annum for an average clinical commissioning group with a budget of around £500 million.

The “Building Great Britons” report calculated that preventing these adverse childhood experiences could reduce hard drug use later in life by 59%, incarceration by 53%, violence by 51%, and unplanned teen pregnancies by 38%. It is not rocket science—technically, it is neuroscience. More and more people are coming to realise that this is an investment that we cannot afford not to make.

I congratulate the hon. Gentleman on securing this debate. He and I have worked on children’s issues for a very long time. This is a brilliant initiative. As we are listening to his brilliant analysis, we have to consider whether we have the right skills in the communities. Are we training people the right way? Are we depending too much on people with PhDs in educational psychology, rather than on trained people based in GP surgeries who can identify problems and support families at an early stage?

I am grateful to the hon. Gentleman for his support. He has been working on this stuff for even longer than I have and has great experience. We need to ensure that we are training the people who know about this stuff, appreciate its importance and know how to communicate with other professionals to have a joined-up approach. There is too much silo thinking going on. When Minister and shadow Minister, I saw families who seemed to be having all sorts of different professionals going in and out of the house but no joined-up approach to bring it all together and make the difference that the family needed.

We also need those professionals to be able to work with the parents, and to be able to communicate and empathise with them, because ultimately it is the parents who will have the biggest influence on the children. They need to be guided and supported. The state needs to take over only in extreme circumstances in which children might be at harm. We need to do more to ensure that parents know what good parenting looks like and are able to do it.

That is why “The 1001 Critical Days” manifesto is so important. It is not simply a political wish list; it has been endorsed by a very wide cross-section of children’s organisations, charities, practitioners, and academic and professional bodies, including the royal colleges of paediatrics and child health, midwives, psychiatrists, obstetricians and gynaecologists, and general practitioners; the NSPCC; Bliss; the Tavistock Centre for Couple Relationships; and the Centre for Social Justice. The Institute of Health Visiting said:

“As far as health visitors are concerned, the 1001 Critical Days Manifesto may yet prove to be one of the most important developments of the new millennium. It has created a long overdue focus on the essential first days of life when the blue print for an individual’s future health and wellbeing is laid down.”

I will not go into great detail about what the manifesto calls for, because every hon. Member has received a copy. In essence, it is about allowing vulnerable families to access specialist services; working closely together to share vital data between the different agencies I have spoken about; and making sure that every woman with past or present serious mental illness should have access to a consultant perinatal psychiatrist and specialist support in relation to mother-infant interaction, as required and in accordance with existing National Institute for Health and Care Excellence guidelines.

The manifesto has a truly holistic approach involving many Government Departments and agencies at a national level and a local level. In essence, it is about changing mindsets so that that should be the approach we ordinarily have and take for granted, because it is the right one. The aim is that “The 1001 Critical Days” becomes a recognised term with a recognised programme being delivered across every community, focused on children’s centres. I know that the Minister is already on board with this aim, and I urge him to promote and champion its adoption to his colleagues across Government. I commend the motion to the House.

First, I declare an interest as the founder of the Early Intervention Foundation, and take this probably unique opportunity to put on record my thanks to its chief executive, Carey Oppenheim, its director of evidence, Professor Leon Feinstein, its director of policy, Donna Molloy, and all the fantastic staff there.

Secondly, I pay tribute to colleagues who secured this debate. If I may say so, the inspiration behind a lot of this comes from the hon. Member for South Northamptonshire (Andrea Leadsom). I do not suppose that she is allowed to contribute today, but we are getting thought beams from her as our speeches progress and drawing great inspiration from that.

Order. The hon. Member for South Northamptonshire (Andrea Leadsom) may, on this unusual occasion, acknowledge the praise being heaped on her, and rightly so, from around the House.

I would gladly give way to the hon. Lady if it did not break all sorts of precedents.

I come to this issue as a constituency Member of Parliament representing the fifth most deprived constituency in the United Kingdom who is learning how to resolve some of the intergenerational problems that start with the very youngest in our communities—indeed, as “The 1001 Critical Days” implies, before birth. Trying to break some of these cycles is my own personal learning curve. I share that, surprisingly but very importantly, with the right hon. Member for Chingford and Woodford Green (Mr Duncan Smith), who has been on a similar journey to mine, in very different circumstances. I hope that those two strange bedfellows, he and I, have demonstrated that we must have an all-party view on this. As with the previous debate on the sexual abuse of 16 and 17-year-olds, we will make no progress unless we agree across the House, in all parties, because getting something from one Government only for it to fall under the next is no progress at all. The problems we tackle are intergenerational and long-running. They require us to invest in individuals, whether with love or with money, and take a very long-term approach. We must all unite across the House to make sure that this moves forward.

I absolutely agree. Throughout my time in the House, there has been cross-party support on issues affecting very small children and children before they are born. The one thing that I always stipulated when I chaired the Children, Schools and Families Committee was that we should determine policy on the basis of good evidence and what works in countries such as ours.

I hope that my own journey has exemplified that approach. The two reports the Prime Minister asked me to do in 2010 and 2011 were signed off, as it were, with very nice pictures of the then leaders of all the main political parties. The reports are still valid and they are still available, albeit not at all good bookshops, but if anybody who is viewing wishes to contact me, I would be very happy to share them. I hope they have been of some help and influence to the excellent “The 1001 Critical Days” campaign.

Whenever I dig out such reports, having not looked at them for a couple years, I look to see whether they are still relevant. In an opening paragraph, I use the term “early intervention” to refer to

“the general approaches, and the specific policies and programmes, which help to give children aged 0–3 the social and emotional bedrock they need to reach their full potential; and to those which help older children become the good parents of tomorrow.”

I hope that is in line with the superb work of my hon. Friend, the influential former Chair of the Children, Schools and Families Committee.

For me, early intervention is a philosophy, not a set of programmes. It is about changing the way we do business, whether as a political party, a family, a community or an individual. That philosophy is essentially about giving the nought-to-threes the social and emotional bedrock to become great people in their own right, and to be able to grow and flourish. It is about applying what we wanted for our own children to as many children as possible, not least those throughout the United Kingdom.

I will be extremely brief. The hon. Gentleman is absolutely right about ensuring that the nought-to-threes become great people in their own right. One of the things that can help is recognition of when in the school year they were born. Does he agree that the Summer Born campaign, which wants local education authorities to properly assess children born in July and August, and the anticipated change to the code of practice, which is welcome, will help those children?

That is a classic case—we referred to this earlier—of the need to rely on the evidence and the science. Let us listen to people who know about these things, rather than do something because that is the way we have always done it or because it is a reflex reaction. That is why the Early Intervention Foundation is central. Best practice needs to be collected in and propagated from one place, so that anyone who visits the website or who makes a phone call can learn from the experience of all those who have gone before them.

I agreed with so much of what the hon. Member for East Worthing and Shoreham (Tim Loughton) said about how this will save us all not only a lot of grief, but a lot of money. I remember telling the Chancellor of the Exchequer that early intervention is the biggest deficit reduction programme he could possibly have. There are various views of the total amount that could be saved, but the Early Intervention Foundation puts the cost of late intervention at £17 billion a year. People are very quick to jump up and ask, “How much is this programme going to cost?”, but they are very slow to say that what we are currently doing is incredibly costly. If someone said, “I’ve got a budget for you: it’s called the late intervention budget and it’s going to cost you £17 billion a year,” there would be an uproar. People would cry, “We can’t afford that!” Of course we cannot afford it, but that is the cost of the criminal justice system having to deal with dysfunctional young people who could have had a chance earlier in life; of mental and physical ill-health; of the court system; and of educational underachievement.

We are wasting money, which we can ill afford, rather than spending a bit of money to start us off. It is received wisdom to talk about a stitch in time, and we often say that prevention is better than cure. In religious terms, we say, “Give me the boy and I’ll give you the man.” We use such phrases in our daily lives, but somehow we cannot bring them to bear on the political choices we make.

It is essential to support this 1001 days campaign. It is very important to underline that helping a child or a mum-to-be is money in the bank in terms of both the child’s development and financial prudence for us as a community and a society. Brain development was mentioned earlier. Given the plasticity of the brain, it is now absolutely without doubt—the neuroscience is incontrovertible—that if we can influence the development of a child’s brain pathways during the nought-to-three phase, we will be helping them for the rest of their life. It is absolutely essential to do so.

We will continue to do all this work together and to have overlapping campaigns, including with Governments of all parties. I must say that that was very difficult when my party was in government. I have to be honest and repeat that we made more progress with a Conservative Prime Minister in a coalition Government than we did with two Labour Prime Ministers.

This is an all-party campaign, and all parties need to use the vocabulary of early intervention. One thing that I and the right hon. Member for Chingford and Woodford Green did, if I may say so, was to make such vocabulary commonplace in this House. We now talk sensibly about early intervention, rather than about “ASBOs on embryos” or “hugging a hoodie”, and all the other terms of abuse bandied about, to no effect whatever, by both parties 10 years ago.

We are growing, improving and getting more mature. With the example of hard science and the example of practice—the Early Intervention Foundation has been involved in 20 local areas to prove what works—we are on the verge of breaking the philosophy out of purely children’s policy into something that we should do in every policy area of government.

Does devolution have anything to do with this issue? Of course it does, because if we allow people in our constituencies, boroughs or councils sensitively to develop things that they know will work, we will spend public money better, even when the early intervention grant is being abolished and austerity is striking at every local authority. At such times, we need to spend money more accurately and with more precision.

I would argue that there may be an early intervention aspect to confronting international questions. Some fascinating work has been done on trauma by Suzanne Zeedyk and Robin Grille from the National Consortium for the Study of Terrorism and Responses to Terrorism. What greater trauma is there for a growing child than to be involved in a civil war or appalling acts of violence? That is the very breeding ground of religious fundamentalism and terrorism.

Early intervention is a philosophy whose time is about to come. Let us make sure that late intervention as a philosophy is consigned to the dustbin of history. One of the best ways for us to do so is to continue to support early intervention, to back initiatives such as the Early Intervention Foundation and to give this motion on the 1001 most critical days a resounding cheer of support from both sides of the House as it is, I hope, approved unanimously.

I must apologise to the Minister. I have a long-standing engagement in my constituency this evening, and I would be grateful to him if he released me to attend it. I will not therefore be able to listen to his winding-up speech.

I want to concentrate on the first part of the 1001 days—the period between conception and birth. A report was published earlier this year by a team from leading UK and US universities who had studied pregnant women in rural Gambia and the children to whom they gave birth. It is clear that the children conceived in the dry season, when there was not an abundance of leafy green vegetables, were seven times more likely to die in young adulthood than those conceived in the wet season, when their mothers’ diet was so much better. The research team said that later in life the impact could be seen in a lack of ability to fight viral infections and in their chances of surviving cancers such as leukaemia and lung cancer. That report shows the clear impact of what the mother ingests on her system and that of the unborn child.

Something that we ought to be much clearer about in this country, but that we sadly are not, is the effect of alcohol consumed by the mother during those first precious days of a child’s life in the womb. The National Society for the Prevention of Cruelty to Children estimates that about 7,000 babies born in the UK each year suffer the effects of alcohol drunk during pregnancy.

I pay tribute to the hon. Member for Sefton Central (Bill Esterson), who is chair of the all-party parliamentary group for foetal alcohol spectrum disorder, of which I am the vice-chair. This week, we published a report on the picture of FASD in the UK today, following an inquiry that ran throughout the autumn. We held a number of hearings with families and young people who have been affected by FASD, as well as with members of the medical professions and other interested organisations. The report is so substantial and so deeply concerning that, although you have been good enough to call me before the chair of the all-party group, Madam Deputy Speaker, it might have been more appropriate if we had been called the other way around. None the less, the report has such a lot of substance that I hope what I say will complement, rather than duplicate, what he will say.

The evidence that we gathered was severely alarming in respect of both the far wider impact of FASD compared with what is understood in this country and the lack of clinical and other support available to families who are affected. We learned that a mother need not consume large amounts of alcohol during her pregnancy to be affected, because individual women’s constitutions respond differently to alcohol consumption.

The impact on the unborn child, which can last for the rest of their life, can be profound. FASD causes organic brain damage in an unborn child. We were told that it causes heart defects, dental issues, eyesight problems, bladder difficulties, walking difficulties, cognitive challenges and memory and behavioural difficulties. Often it means that babies are premature. We heard about the emotional impact on those affected by FASD as they develop into young people and move into adulthood: they can withdraw from society, become unpredictable and even become suicidal. That places great stress on parents and carers, many of whom experience periods of isolation and ill health. The inquiry heard that it is likely that a much higher proportion of children are born with FASD than is currently recognised. Those children will have a variety of difficulties in childhood and in later life.

The tragedy is that, theoretically, FASD is 100% preventable if all pregnant women are given clear advice on the risks of alcohol intake to their unborn child. We were told that the best advice for young women is not to drink if they are considering becoming pregnant, since there are effects even at the earliest stage.

Equally tragic is the fact that in the UK there have been decades of mixed messages regarding the right level of alcohol intake during pregnancy. I remember that from when I had my children, which is well over 20 years ago. The all-party group was advised that a clear message should be given by Government Departments that, just as smoking during pregnancy affected the unborn child and should be avoided, so too did alcohol and it too should be avoided.

For the UK not to be sending that message is not only tragic for the families concerned; it goes against international best practice, which is to advocate that alcohol be avoided if a woman is pregnant, thinks she might be pregnant or is trying to conceive. In Canada, children as young as primary school age are taught that. Pregnant women in Denmark, France, Israel, Norway, Mexico, Australia, Ireland, New Zealand, Spain and the Netherlands are advised to abstain completely from alcohol. Since 1981, the USA has advocated that

“no alcohol is safest for baby and you.”

Without such a clear message, pregnant women in the UK are left confused and uncertain. I know from my work as the chair of the all-party group on alcohol harm that few people can accurately measure one unit of alcohol. If a message is sent out that one or two units a week is okay, it is probably easy to think, “Well, why not three or even four or more?”

One of the reasons that women are confused stems from the unclear guidelines provided by UK professional and governmental bodies. Although NICE and the Department of Health warn of the potential for alcohol to harm an unborn child, incredibly they do not go on to stipulate that women should abstain from drinking during pregnancy. The Government are currently carrying out an alcohol review, and I hope they will seriously consider that issue. By contrast, the British Medical Association advocates that no alcohol should be drunk during pregnancy. As a result of those mixed messages, not only are women confused but many midwives are uncomfortable about giving advice on alcohol. A study that questioned 200 midwives found that only 60% asked women about their drinking habits, 30% advised against binge-drinking, and only 10% were aware of FASD. As our report says:

“this is astonishing and deeply worrying, and something which must be rectified as a matter of urgency.”

More encouragingly, 93% of midwives said that they would be comfortable advising that no alcohol should be drunk during pregnancy if that was the consistent message from the Government. In the absence of such clarity, however, they are afraid to offer such advice.

Our inquiry also revealed a similar lack of in-depth knowledge about FASD across the medical profession. There is only one specialist FASD clinic in the UK, and it is wholly overstretched. That lack of in-depth knowledge means that children with FASD are often given multiple inaccurate diagnoses, such as ADHD, autism or an attachment disorder. Appropriate support mechanisms are rarely put in place, and families are left frustrated and confused. It is critical that FASD is given a higher priority within the NHS for research, diagnostic, and support services.

The hon. Lady is making a fascinating contribution. Given that the Minister is in his place, is this a good moment for her to comment on the failure to fund research into the prevalence of foetal alcohol syndrome? I am sure she is coming to that, but given that the Minister is paying great attention, perhaps this is a good moment to get that message sprayed on to the Department’s eyeballs.

I thank the hon. Gentleman for that intervention. Our report states that because of inadequate research in this country, there is insufficient information to encourage those involved—including, we believe, Government representatives—to take action.

Several of our witnesses testified that there must be more appropriate training on FASD among the medical profession, and national standards must be adhered to. For example, we heard how diagnosis could take place as early as for a one-month-old child, or as late as at 10 years, or not at all. It appears to rely on which professional a child sees. Time and again we heard from families, including parents, grandparents, adoptive parents and foster carers, that they had to explain to medical staff the diagnostic nuances of FASD.

As I have said, the extent of this condition has been under-recognised by successive Governments. Research now indicates that 30% to 50% of children in foster care could be affected by FASD, and a study mentioned in our report from an audit in Peterborough, published in October 2015, showed that 75% of children referred for adoption had a history of pre-natal alcohol exposure. If those figures are extrapolated across the UK, that should have major implications for Government policy on fostering and adoption. Sadly, there are also impacts on the criminal justice system, and our inquiry heard of vulnerable young people with FASD who move into adulthood where they cannot meet societal expectations and behavioural norms. Those people are being exploited by criminal gangs and sexual predators, which is a result—certainly in part—of a lack of concern, understanding and support for them and their condition.

In conclusion, the seriousness of the problem cannot be overstated. Our report makes a number of recommendations that the hon. Member for Sefton Central may well go into in more detail. The impact on the early stages of a child’s life cannot be overstated. Even the alcohol industry has taken considerable steps to send warnings not to drink during pregnancy. Ninety-one per cent. of alcoholic drinks in bottles and cans now carry a warning.

That is not enough, however. A study by Drinkaware revealed that more than half of pregnant women in the UK receive no advice at all about drinking while pregnant. The original clinical diagnosis of FASD was made in 1973. Our inquiry showed that

“in the four decades since then, the UK as a whole has still barely acknowledged its existence.”

That must change, and the Government must take a lead.

I am grateful to the hon. Member for Congleton (Fiona Bruce), who has been an excellent vice-chair of the all-party group on foetal alcohol spectrum disorder. I congratulate hon. Members on bringing the debate to the House because it gives us a timely opportunity to talk about the initial findings of our inquiry, of which the hon. Member for East Worthing and Shoreham (Tim Loughton) was another valued member.

I want to repeat as forcefully as I can the point that the hon. Lady made about the need for a prevalence study. I have asked the Minister about it previously in questions, and I put it to him that such a study is essential. The evidence we took in our inquiry is backed up by evidence that has come from around the world over many years—the hon. Lady identified a number of those countries. The time has long since passed for us getting that evidence base in this country so that we can understand as well as possible exactly how great a problem it is and what solutions are needed. The Minister can intervene now, but perhaps he will address that point later.

The hon. Member for East Worthing and Shoreham and my hon. Friend the Member for Nottingham North (Mr Allen) mentioned brain development and the damage done by alcohol during pregnancy when a mother and baby are susceptible to that damage. They are frightening results.

One other area we need to consider is malnutrition and micro-malnutrition. Regardless of obesity or weight, we are seeing a more malnourished diet in this country from poor quality food and reliance on food bank food. Work done has shown low levels of iodine, which increases cretinism, and low levels of folate, in girls in their late teens, which means that, as they enter the child-bearing age, they are at high risk of having children who have major disabilities.

I am glad the hon. Lady managed to get that point on the record. That is an incredibly important part of the picture of the damage done to brain development. I want to concentrate my remarks on the damage from alcohol and the inquiry report that the all-party group has just published, but I am grateful to her. Her point is very complementary to my remarks.

My hon. Friend the Member for Nottingham North made a powerful point on the potential of early intervention—he said it could be the biggest deficit reduction scheme of all and mentioned the figure of £17 billion. That is an important point when it comes to foetal alcohol spectrum disorders. In Canada and the US, they use the term “million dollar baby”. It refers to the lifetime costs of the damage done by alcohol during pregnancy. The hon. Member for Congleton and others have mentioned many of those costs, whether it is the inability to engage socially or hold down a job. Many end up in the criminal justice system and many of us care for children and young adults who were damaged by alcohol during pregnancy. All of these things have huge economic and social costs. It is incredibly important that we take those points on board, whether on alcohol harm or other forms of damage and deprivation caused during pregnancy and in the early years.

The all-party group took evidence from a great many experts: Martin Clarke of the Adolescent and Children’s Trust; the consultant psychiatrist and nationally renowned expert on FASD, Dr Raja Mukherjee; Sir Al Ainsley Green, now President of the British Medical Association; SABMiller from the drinks industry; the British Pregnancy Advisory Service; Public Health Research; a midwife; and parents and carers, as well as young adults living with foetal alcohol spectrum disorders. We heard heartrending examples of damage done, difficulties faced and the life-limiting effects of alcohol during pregnancy.

I want to pay tribute to and thank the Foetal Alcohol Spectrum Disorder Trust for the secretariat support, and other organisations such as the National Organisation for Foetal Alcohol Syndrome, which has for many years attempted to improve the education of professionals in health, education and other sectors on what is needed to prevent the disorder and to support people who care for children and young adults; and Mencap, which advises GPs.

There have been some puzzling changes over the past 20 or 30 years, something the hon. Lady touched on. In the 1970s, alcohol consumption in the UK was one of the lowest in the western world. From that low base, however, there has been a steady increase. There is a remarkably strong correlation between the increase in alcohol consumption and the increase in the incidence of mental health problems, attention deficit hyperactivity disorder, autism, Asperger’s, and many different kinds of learning and physical disabilities. The remarkably close correlation suggests causality. Brain damage is not reversible and is clearly significant. As the hon. Lady said, the World Health Organisation estimates that 1% of people born today are affected by FASD. Even at 1%, that is 7,000 children born every year. That is 7,000 too many.

For anyone new to this subject, there is a widely shared video of the effect of a small drop of alcohol on an embryo, which is compared with an embryo that does not experience the ingestion of a small drop of alcohol. The difference is stark. For two hours, the embryo stops moving altogether. We can only wonder at the damage done at that very early stage of pregnancy. International evidence suggests that the damage is done in the early days and weeks in particular.

As the hon. Lady said, the advice is far from clear. On the one hand, people are told not to drink. That seems clear. From the evidence heard by the all-party group, that is the right advice. However, the advice also says that if a woman chooses to drink, she should drink only one or two units. The advice appears inconsistent and contradictory. We took evidence from health professionals, the vast majority of whom do not appear to be aware of the real level of risk and danger. They do not appear to be passing on advice to women planning to conceive or who are pregnant. That is why our inquiry recommended it be made clear that the best thing for mother and baby is for the mother not to drink at all.

I hope that the Minister—I am sure he will—and all who are interested will read the report and carefully consider its recommendations. It is only an initial report—we plan to continue our work—and I hope that he or one of his colleagues will come to one of our meetings to discuss this matter in greater detail. As my hon. Friend the Member for Nottingham North said, early intervention gives us a fantastic opportunity not only to improve the life chances of many people but to save a lot of money. When it comes to the damage done by alcohol during pregnancy, the 7,000 figure, which, from the evidence we received, might well be on the low side, suggests that there is a huge opportunity. I hope that, as a result of the work we have done and the fine work of those Members responsible for today’s report, progress can be made and that the Minister will agree to commission the prevalence study, so that we can start to reduce the number of children damaged every year in this country.

It is a pleasure to follow the hon. Members for Congleton (Fiona Bruce) and for Sefton Central (Bill Esterson), and I completely endorse their points about foetal alcohol syndrome. It feels like we have not caught up with the evidence, and we need to do so urgently, given the awful carnage being done to babies by this dreadful condition, so I congratulate the all-party group on foetal alcohol spectrum disorder on its work.

I also congratulate the right hon. Member for East Worthing and Shoreham (Tim Loughton)—

Oh, I do apologise. To me, he is right honourable. He has shown great leadership, both as a Minister and in his work since, and I applaud him for that. I also join others in acknowledging the fantastic leadership shown by the hon. Members for South Northamptonshire (Andrea Leadsom) and for Nottingham North (Mr Allen).

Like the hon. Member for East Worthing and Shoreham, I had the one-to-one seminar with George Hosking from the WAVE Trust. I had it many years ago, but I remember it still very clearly: the evidence he showed me, from Australia and the United States, was compelling. He is rightly on a mission and has had a significant influence, which should be acknowledged, so I join the hon. Gentleman in thanking him for his amazing work.

I want to focus on perinatal mental health. Here, we are dealing with two lives: the mother’s and the baby’s. The impact of mental ill health in the first year after birth is profound. As the hon. Gentleman said, it affects up to 20% of women. We often think of it as post-natal depression, but it goes much wider than that. The London School of Economics’ personal social services research unit and the Centre for Mental Health have produced an important piece of work on the economics of this. They refer to anxiety, psychosis, post-traumatic stress disorder and other conditions, including obsessive compulsive disorder. The impact of these conditions on the mother, but also on the baby and the wider family, can be very profound.

The cost of failure, as the hon. Member for Nottingham North made clear, is enormous. The report by the LSE and the Centre for Mental Health estimates the cost of perinatal ill health as being £8.1 billion at the very minimum. The basis for calculation was the mothers who suffered depression, anxiety and psychosis, but they recognised that other conditions were relevant, too, which have not been costed, so the overall cost is bigger. We must understand that. As the hon. Member for East Worthing and Shoreham made clear, this amounts to £10,000 for every baby born in this country. The cost of failure is just enormous.

How have we responded to this extraordinary impact? Slowly but surely, things are changing, but if we look at the recently published map on the availability of services around the country—this relates to the UK’s specialist community perinatal mental health teams—we see that in 2015, the map is still horribly red. This does not indicate constituencies held by the Labour party—[Interruption.] Thank goodness! This indicates the parts of the country where no specialist team is available. Let us imagine for one moment that this was the case for stroke care or heart conditions: there would be a national outcry.

No party or Government is responsible for this situation. We are dealing with an emerging understanding, and it is about developing a new service. When I look at the whole of East Anglia, my own region, I see that not a single specialist team is available. That is truly shocking. As the hon. Member for East Worthing and Shoreham said, people are dying, and some even take their own lives, yet these are deaths that could be prevented by the application of specialist services around our country. None of us can be comfortable with the fact that so much of our country does not have the ready availability of support for mothers in this situation.

There is an urgency to ensuring that we act to get the whole country covered. I was pleased when in response to the cross-party campaign for equality for mental health, we had the basic simple principle that there should be equal access to care and support—irrespective of whether people have a mental or a physical health problem. At the moment, that does not exist, but the campaign that we launched in the run-up to the spending review secured a response from the Chancellor of an extra £600 million for mental health. In his statement to Parliament, the Chancellor specifically mentioned the importance of perinatal mental health services. That money must be used.

I end by urging the Minister to do everything in his power to instil a real sense of urgency, with a programme and a timetable to get every part of the country covered by specialist services. I find it unbelievable in this day and age that the CCGs mentioned by the hon. Gentleman have not even started to think about this yet. These are the people who hold responsibility in our NHS for commissioning services for our populations, but a significant number of them have not yet even started the process of thinking about the problem. The message needs to go out from the Minister, but also from NHS England nationally, that this situation is intolerable and cannot be sustained. We must ensure that this Parliament reaches the point by 2020 when the whole of that map of the United Kingdom is green, so that every mother, when she is in need, following birth, can get access to the specialist services that can help her to recover.

It is a pleasure to follow the right hon. Member for North Norfolk (Norman Lamb), who touched strongly on perinatal mental health. That is one of the issues addressed in the work of the all-party parliamentary group on conception to age two—the first 1001 days. In common with others, I pay tribute to the hon. Member for East Worthing and Shoreham (Tim Loughton) not just for his introduction to the debate, but for the way in which he has chaired that all-party group and the thorough way in which evidence has been drawn and accumulated from so many practitioners, academics and others. He has followed up the pioneering work done by the hon. Member for South Northamptonshire (Andrea Leadsom) in establishing the group, along with the right hon. Member for Birkenhead (Frank Field) and the hon. Member for Brighton, Pavilion (Caroline Lucas).

I have been a member of the all-party parliamentary group since its own conception, and I have been particularly impressed by the way in which so many different organisations, all of which have pledged their support to this manifesto, have engaged with its work with the aim of making us better informed about the policy questions that we raise, the policy priorities that we identify, and the ideas that we present.

It is great that the hon. Member for Nottingham North (Mr Allen) has been here to contribute to the debate, because in a number of respects he has been a policy prophet. For many years, people who talked about early years policy tended to mean the year or two before a child went to school, when the child was three or four years old. All too often, early intervention or early years policy has concentrated less on the role of parents as parents than on their role as workers who have parental responsibilities and are therefore in need of childcare, and who, along with their employers, benefit from good childcare support. We need to support parents in their capacity as parents with key responsibilities for their children, and that means supporting them when the children are experiencing those first, formative stages of their lives.

We have already heard today about all the scientific evidence relating to the plasticity of the brain and the key development of neurological pathways during the early stages of life. One of the academics who gave evidence to the all-party parliamentary group made the telling point that many of the experiences that affect people over their lifetimes can be traced back to childhood experiences that could have been averted, or prevented, by good early years support, and that means adequate support for parents during the formative years of their children’s lives. For instance, there may be a high correlation between child and adolescent mental health issues in the later stages of people’s lives and some of their experiences during their early years, when they may have faced challenges such as an upbringing in distressed circumstances or the absence of opportunities that could have been afforded if their parents had been given proper support.

That academic used a striking phrase. He was a north American, so perhaps it came from him all the better. He said, “Unlike what happens in Las Vegas, what happens in the early years does not stay in the early years.” For good or bad, what happens in the early years is with us throughout our lives, and many of those experiences may inform our expectations in life and of life. That is all the more reason for us to invest strongly in the early years, not just in terms of family love but in terms of policy and programme planning, and of actual support in the form of local services.

While I have been hugely impressed by much of the evidence that I have received as a member of the all-party parliamentary group—and, like the right hon. Member for North Norfolk (Norman Lamb), by the compelling case that has been put forward by George Hosking and others—I am happy to say that I have benefited from the presence in my constituency of the Lifestart Foundation, which was established in Ireland back in the 1980s and which operates active programmes in different parts of that country. Its essential mission is to provide high-quality parental support in order to produce better child development outcomes. It gives parents evidence-based information about the way in which young children learn and develop, and helps them to use the knowledge that they have gained.

The foundation also promotes the delivery of its Growing Child programme. Unfortunately time does not permit me to spell out the details of the programme, but they chime with all the points that Members have made today, and accord very strongly with the main points and principles in the manifesto that we are discussing. The foundation delivers a systematic evidence-based child development programme by means of home visiting, from which, as a parent myself, I benefited in my own area. That goes to parents of children from birth right up to pre-school, and indeed school entry. The outcomes are informed by sound empirical research, and they are designed and reviewed by child development and parenting experts.

There has been a randomised control trial conducted by Queen’s University from 2008 to this year and beyond. It involves 848 parents and children, and it has already proved the findings that argue for this manifesto. I encourage the Minister to look up those findings from the centre for effective education at Queen’s University in Belfast, because they prove that the Lifestart programme and the home visiting service work as predicted, with significant positive outcomes for parents and improved outcomes for children. Parents are less stressed, have greater knowledge of child development, demonstrate higher levels of parenting efficacy, are more confident around child discipline and boundary setting, report better parenting mood, have increased feelings of attachment with their children—the hon. Member for East Worthing and Shoreham stressed that earlier—and feel less restricted in their parenting role. Of course, for children there are better cognitive skills, better social and emotional development, improved behaviour, and fewer speech and language referrals, and these positive effects on children will be expected to continue through life. This research team will be following the children’s development through school.

This all goes to show what international research points to: the quality of parenting, the amount of time adults spend interacting with children, and the nature of the whole learning environment are critical to child development and ensuring we avoid many of the social stresses and problems and behavioural issues that affect us all, and inform some of our debates on other subjects in this House.

As well as giving that example of Lifestart and its work in my constituency and elsewhere in the north and south of Ireland, I encourage the Minister not just to look at this manifesto in terms of what he can do in his own departmental responsibilities and in talking to ministerial colleagues here, but to see whether he should have a wider conversation not just with devolved Ministers, but using the British Irish Council model which takes in all eight Administrations on these islands, to talk about how we might roll out truly effective early years and proactive early intervention policies more widely, building on the arguments in this manifesto and drawing on the evidential experiences from elsewhere. What this shows is that all the rendered science chimes with our most tender instincts about what is the best thing to do for children in these early years.

I congratulate the hon. Member for East Worthing and Shoreham (Tim Loughton) and the Backbench Business Committee on bringing this important debate and issue to the House.

“The 1001 Critical Days” document is an extremely important manifesto, attracting support from across the political spectrum as well as from a wide range of professional and third sector organisations. It highlights how vital the early days of childhood are for both parents and children, and the importance of acting early and focusing policies in order to enhance the outcomes for children both over the short term and the long term. This is of benefit for the individual child, their families and society as a whole.

The principle of early intervention encourages a holistic approach to meeting the needs of children and families, including though play, learning, social relationships, and emotional, psychological and physical wellbeing, along with health, nutrition, growth development and safety. Evidence has highlighted that this early part of the child’s life between conception and the age of two is a formative period in all spheres of their development. Although there is little narrative memory of this period, a child’s experiences from this time impacts upon their cognitive, social and emotional functioning and in turn their relationships, behaviour, educational attainment and opportunities throughout the course of their life.

In this regard, “The 1001 Critical Days” manifesto highlights evidence from international studies that demonstrate that when a baby’s development lags behind the norm during the first years of their life, this gap tends to increase over subsequent years rather than to improve. Prior to being elected, I was employed in the NHS as a clinical psychologist and, in the various areas where I worked, I have seen at first hand the long-term impact of adverse childhood experiences on development and on later life chances.

A lack of parenting skills can be a product of intentional or non-intentional conduct by carers, and it is recognised that the period between pregnancy and the first years of a child’s life is a time of great vulnerability. Secure attachment and nurture are crucial to children’s emotional wellbeing and development, and it is important that parents who lack confidence in their abilities or who are struggling should have access to the support, mentoring and skills building opportunities that they need. Parenting skills classes have therefore been rolled out across Scotland.

Babies are disproportionately represented in the child protection system and statistically more likely to die prematurely than older children. In addition, any neglect or abuse occurring during this period can have life-changing effects, owing to infants’ bodies being fragile and their brains being at a crucial stage of their development. Because of the additional pressures of parenthood, parents are also at risk of perinatal mental health problems and of coping difficulties during this period. Individual, social and environmental factors can have an impact in this regard.

However, as well as being a time of vulnerability, this period of a child’s life is also a time of great opportunity when it comes to providing support and changing patterns. In this regard, I note it has been reported that during pregnancy and the first year of a child’s life is an ideal time to work with families, as it is a time when parents are particularly open to support and motivated to change, and when firm foundations for family life can be established. There is a growing body of evidence that intervention in early life can transform the lives of babies and of their parents.

“The 1001 Critical Days” manifesto states that it aims for every baby to receive sensitive, appropriate and responsive care from their main care givers in the first years of life, with more proactive assistance from the NHS, health visitors, children’s centres and other public bodies that are engaged in a coherent preventive strategy. My own experience tells me that additional monitoring and early assessment does not happen often enough in cases where there could be developmental disorders such as autistic spectrum disorder. That can have a negative effect on children, as well as on their parents, who might find it difficult to cope and therefore require additional support at an early stage. Early assessment of developmental disorders can ensure that the right resources are swiftly put in place, which will improve a child’s chances and their adaptation.

Our party agrees that the early years are a crucial time for development and intervention because, when it comes to breaking the cycle of inequality, we recognise that prevention, resources and support are key. Throughout our time in government in Scotland, we have promoted an early years framework and been committed to strategies aimed at promoting and facilitating a stable and nurturing environment for children. In recent years, the Scottish Government have developed and introduced legislation in the form of the Children and Young People (Scotland) Act 2014, which gives Scottish Ministers and public bodies a legal requirement to issue reports on how they take the United Nations convention on the rights of the child into account. It also extends free pre-school provision from 475 to 600 hours a year of early learning and childcare for all three and four-year-olds and for just over a quarter of all two-year-olds—those from low- income households. It also gives children and young people access to a named person service. In the early years, that is the health visitor. The named person is a single point of contact who can help to co-ordinate support and advise families, and those working with them, when required. This can involve the monitoring of emerging perinatal mental health difficulties.

In 2010, through collaboration with a wide range of experts, the Scottish Government also launched their pre-birth to three strategy, based on four main areas: the rights of the child; relationships; responsive care; and respect. Those strategies are not all-encompassing, and there is room for continued improvement. However, the Scottish Government understand the importance of the early years of children’s lives and the benefit to society as a whole of trying to prevent future issues through early intervention. A child’s sense of interaction with the world develops at this time, alongside its learning of emotional regulation and well-being, and the development of its neurological functioning. As such, we are committed to continuing to make early years the key priority it deserves to be, focusing funding accordingly and trying to ensure that all children have the best start in life possible.

My party will work collaboratively across this House to ensure that in Scotland and across the UK children have the very best start, which they deserve. I am impressed and pleased that we have guidelines from the all-party group on foetal alcohol spectrum disorder and I am happy to share those with the Scottish Government and to look at key recommendations.

In finishing today, I would like to thank sincerely all of the House staff for their extraordinary efforts this year. I wish all Members of the House, the House staff and of course, you, Madam Deputy Speaker, a very merry Christmas and a happy new year from my party.

First, I commend and congratulate the hon. Members for East Worthing and Shoreham (Tim Loughton) and for Dwyfor Meirionnydd (Liz Saville Roberts) on securing this debate. I also pay tribute to the members of the all-party group for conception to age two—the first 1001 days for developing the manifesto and raising the profile of these important issues. All the Members who have spoken today have done so with great eloquence on these issues.

Let me go through some of today’s contributions. The hon. Member for East Worthing and Shoreham, in his opening remarks, correctly said that this is about challenging the mindset and going beyond the troubled families programme, which has proved to be a success around the country. He rightly highlighted the shocking statistics on suicide among new mothers and rightly said that much of it is preventable. He gave us a volley of statistics and they all point towards this manifesto as being something on which there should be widespread agreement, and I think that agreement has been apparent from today’s contributions.

It was also a pleasure to hear from my hon. Friend the Member for Nottingham North (Mr Allen), whose work in this area I was a keen reader of before entering this place. I was glad to hear his contributions today. He rightly said that this is about investment in individuals, that a consistent approach has to be taken across changes of Government and that this is about a philosophy in the way we do things. He made an interesting point when he said that, if we proposed spending £17 billion on an early intervention programme, we may have a little difficulty in getting that past the Treasury, but that is actually the potential saving that might be realised if this is done correctly. Of course, this is about so much more than simply making savings. He said that early intervention should mean that late intervention is consigned to the dustbin of history, and we would all welcome that.

Like the hon. Member for East Worthing and Shoreham (Tim Loughton), and many others who spoke, including the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), I did not have a chance to speak about a broad policy area in this field—social investment. There is now a way of monetising and finding out how much we can save ourselves, and the many social instruments and social investments out there are growing by the day. I hope my hon. Friend will consider that in his remarks, because massive savings can be made in this area—indeed, money can be made in order to reinvest in new services.

I am grateful for that intervention, and my hon. Friend is right to say that this can be monetised. I recall that when my local authority carried out an examination of the early intervention scheme, a figure of about £100 million was mooted. There are challenges in getting different Departments to buy into that, because they are all quite protective about their own sources of money, but if we take a holistic approach, we can see that there will be savings right across Departments. I hope that we can begin to develop that approach.

The hon. Member for Congleton (Fiona Bruce) rightly highlighted the staggering and shocking statistics about alcohol intake during and indeed before pregnancy, and rightly said that a clear message needs to be sent out about the risks. She rightly paid tribute to the work of my hon. Friend the Member for Sefton Central (Bill Esterson) with his all-party group on foetal alcohol spectrum disorder. The group took a great deal of evidence in preparation for its report, which has been released today. It is unambiguous in its recommendations about the need for clear and consistent advice to be given on the dangers of alcohol during pregnancy and the need to improve training and education across the board. He has laid down a clear challenge for the Minister in this area and I look forward to hearing what his response will be.

The hon. Member for Foyle (Mark Durkan) spoke with his usual passion and sincerity on the subject. He gave us the memorable phrase, “What happens in our early years stays with us throughout our years.” I am not sure what he meant about the goings on in Las Vegas. Perhaps he will enlighten me outside the Chamber. He rightly pointed out the academic research that is set out in the manifesto. Clearly, an evidence-based approach is welcome, because the evidence is there and it is clear.

The hon. Member for East Kilbride, Strathaven and Lesmahagow spoke with great personal experience on this area. She rightly pointed out that early experiences can affect a child’s relationships throughout their lives. We have heard from a number of Members about how difficulties in relationships can perpetuate the cycle of despair that we currently see and have been discussing today. She made a valid point about early assessment of development disorders, especially autism. At the moment, that assessment does not happen quickly enough. She also talked about this idea of a named person being the point of contact for the families, and saw it as a positive development. I am certainly aware of a number of similar initiatives that have shown the benefit of such an approach.

We have had a great many informed, respectful and consensual contributions today. I will try my best in this season of goodwill to maintain that. I am speaking here as a member of the shadow Health team. The NHS is really where my focus is. It was first conceived to be a responsive treatment-based service that supports everyone in society from the cradle to the grave. It is only in recent years that we have begun to understand how that short time in the cradle—those very first few months—can ultimately decide how long, healthy and happy a newborn baby’s life will be.

I will keep my remarks quite brief as we have been squeezed out by other business today. Let me just touch on a few areas that highlight why this period is so vital and a few areas where we should be doing a little better.

As we know, the manifesto takes its title from the period from conception to age 2 when a baby’s brain is developing at its fastest. We know that the earliest experiences have a lifelong impact on mental and emotional health. We also know that, when a baby’s development falls behind the norm during the first years of life, rather than catch up with those who have had a better start, they are actually more likely to fall even further behind in subsequent years. More than a quarter of all babies in the UK are living in complex family situations that present heightened risks to their wellbeing. The sad reality is that babies are far more likely to suffer from abuse and neglect and up to seven times more likely to die in distressing circumstances than older children. We have a duty to give every child an equal opportunity to lead a healthy and fulfilling life.

“The 1001 Critical Days” manifesto is the best chance for us to make that happen. Not only is it the right thing to do for our children, but it is the right thing for the public purse. According to the Royal College of Paediatrics and Child Health, there is increasing evidence to show that spending on early years intervention can yield a return on investment as high as 6% to 10%. My hon. Friend the Member for Nottingham North eloquently showed how that could be translated into significant savings across Government.

I sense that my hon. Friend may be coming to the end of his remarks, so I am going to squeeze in one more intervention, if I may, and it is in respect of the next Government. There may be a change of Government in 2020. My hon. Friend has an opportunity to spend some time developing an early intervention philosophy across, as I mentioned, not only health and children’s services, but the economy and even international affairs. That preventive view, rather than attempting to cure, could be fundamental to the next Government, as it should be and increasingly is to the current Government. Will he give us an assurance that this will be in his thoughts as he develops policy in his area?

I thank my hon. Friend for his intervention. I am certain that I will be able to take those comments on board. As I said, it is a subject in which I took an interest before I entered this place. I believe that is the right approach and I am confident that in four and a half years’ time we will have the opportunity to put it into practice. [Interruption.] Some may disagree about that. In the season of good will, a little latitude is surely permissible.

If it is done in the right way, early intervention can save money, save lives and improve the wellbeing of parents and children. The former Scottish Health and Finance Minister, Tom McCabe, summed it up perfectly when he said,

“We have heard evidence, stacked from the floor to the sky, that this is the right thing to do.”

Focusing on the first 1001 days is not just about ensuring the healthy development of future generations of children, but about making our NHS and many other public services sustainable.

I want to say a few words about perinatal mental health, as I know this is an issue that many Members feel passionately about, not least the shadow Minister for mental health. Perinatal mental health problems affect up to 20% of women at some point during pregnancy or in the year after childbirth. We heard from the right hon. Member for North Norfolk (Norman Lamb), who pointed out the impact not only on the mother, but on the child and the wider family. About half of all cases of perinatal depression and anxiety go undetected and even those that are detected fail to receive evidence-based forms of intervention. This is important because severe perinatal mental health problems are bad not only for the women affected, but for the development of the children involved, as the right hon. Gentleman highlighted.

In particular we need to ensure that all women affected have access to appropriate treatment, and that variation in access is addressed. The right hon. Gentleman referred to a map which starkly highlighted that. It is worrying that 41% of maternity units have no access to a trained mental health worker, 30% are unable to offer psychological support, and on a wider but connected issue, about a third have no overnight accommodation. It is also regrettably the case that under this Government there has been a reduction in the number of specialist in-patient mother and baby units. The Government’s pledge to spend £15 million on perinatal mental health was extremely welcome, but we need to see that pledge put into action. I would be grateful if the Minister could update the House on what he has been doing in that respect.

We will tackle the problems that parents and children might have in this period, and spot the problems early enough, only if we have joined-up multi-agency working between health services and local family support services. Children’s centres have a critical role to play in this mix in many areas. As a former member of the advisory board of the Stanlaw Abbey children’s centre in my constituency, I have seen at first hand what a welcoming and safe place it is for families to visit, as indeed are all children’s centres. In addition they have a wealth of experience and knowledge, and trained staff who have the skills to identify problems at an early stage, whether in bonding, the mother’s mental health or child development, so that that disadvantage can be tackled.

I have heard from Stanlaw Abbey the great strides made by children coming into the centre and how much progress they make, as well the support given to the parents, many of whom have re-entered education and the world of work, thanks to the help of the centre. The one challenge that continually remains, though, is how to engage with those families who do not come through the door. We know that they are out there. They will not all need support, but some will, and despite extensive efforts to reach out to these families, they simply stay outside the system for too long, missing out on the crucial support that this debate is trying to highlight.

For me children’s centres have to be the cornerstone of a successful early years policy. That is why it is so concerning that under this Government we do not appear to have any strategy for children’s centres. The Prime Minister famously promised to protect such centres, but there are 700 fewer designated children’s centres than there were in 2010.

Alongside that, many of the local government services that families used to rely on are taking a massive hit. The transfer to local authorities in October this year of the healthy child programme for children up to five years of age presents an important opportunity for local authorities to integrate health, education, social care and wider council-led services and to focus on improving outcomes for children from birth. But I find it difficult to square the circle of this announcement alongside the £200 million in-year cut to public health that this Government have introduced.

There is a real risk that the decision could cost more money than it saves and that the good intentions behind passing responsibility to local authorities could be stymied from the off as a result of the short-term approach to funding that the cuts represent. I would therefore be grateful if the Minister updated the House on what support he is giving to local authorities to ensure that commissioning is properly resourced when they assume this new responsibility. What steps is he taking to ensure that the cuts do not affect front-line services?

As we know, many local authorities have been forced to pare back to the statutory minimum, which is totally against the grain of what we are trying to achieve. Taken together, the failure to invest in early help services and the lack of priority the Government give to this type of provision mean that Ministers will fail to support adequately all children and families in those critical 1001 days. The cross-party agreement we have heard about today needs to be matched by cross-departmental harmony across Government.

In conclusion, the evidence is overwhelming. It is so obvious that it should have underpinned Government policy decades ago. Anyone who is a parent will recognise the intensity of feeling when observing how their child is developing. That innate desire for one’s offspring to grow up to be happy, healthy and wise should be all the encouragement we need to support this incredibly important document, not just for our children but for everyone’s children. On that note, I would like to wish everyone in the House a very merry Christmas.

I thank all colleagues who have taken part in what is a most important debate, despite being the last of this parliamentary term. It was handled in an exemplary way by a number of colleagues who know a great deal about the subject. I commend them for the breadth of interest and knowledge they demonstrated. I thank my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) and the hon. Member for Dwyfor Meirionnydd (Liz Saville Roberts) for securing the debate through the Backbench Business Committee.

I also pay tribute, as others have done, to my hon. Friend the Member for South Northamptonshire (Andrea Leadsom). The debate has been graced by a number of colleagues who have taken a huge interest in these matters over a lengthy period, often in quiet rooms, talking to people about the issues, and raising them on the Floor of the House. That often unsung work has been vital in giving us the information we need, and a number of hon. Friends deserve real credit for it, not least my hon. Friend the Member for South Northamptonshire.

I congratulate the all-party group for conception to age two—the first 1001 days on relaunching its manifesto, “The 1001 Critical Days”. I popped into the relaunch for a short time, but a few weeks earlier I was grilled by the group’s members on my interest in the subject. I am not the Minister responsible for children’s health, but one of the issues is that a number of different agencies are involved, and I understand very well that one of the requirements of the manifesto is to ensure that they work more closely together. I also have a particular interest in perinatal mental health, which I will spend a bit of time speaking about today. I certainly take the manifesto’s point about the range of different actors that need to be involved, and the fact that we need to work together more effectively. I will be glad to take that message back to colleagues. I thank the all-party group for its work.

I note that the manifesto includes a foreword by Dame Sally Davies, the chief medical officer. I must say that that is probably at least three quarters of the work done. I do not know how many Members have met Sally Davies, but they should know that anything she gets behind tends to happen. I therefore congratulate the all-party group on securing her support, which will be vital.

At the manifesto’s core is a clear and simple message: the first 1001 days of a child’s life are a critical window of opportunity. Prevention and early intervention at that stage can improve outcomes and transform life chances. There is no dispute about that across the House; there is perhaps sadness and regret that more was not done in the past, but we must all start from where we are and make progress. Much work has been done in recent years, and colleagues have been generous in their praise of it, but clearly there is more to do, and the manifesto sets out some of the challenges.

I will make a few general remarks about the speeches we have heard, and then I will refer to others as I go through my speech. The hon. Member for Nottingham North (Mr Allen), who has spent a great deal of time working on early intervention, spoke about the philosophy that was needed to understand this, and he is absolutely right—few could have done more than he has to bring that forward. Some of these issues are cultural; they are about taking people out of silos. He was generous in his praise of my right hon. Friend the Member for Chingford and Woodford Green (Mr Duncan Smith). My right hon. Friend, and I suspect a number of other Members, was much inspired by the work of a chap called Bob Holman—a family worker and an academic who chose to live in Easterhouse in the centre of Glasgow—on social justice. Bob is unfortunately quite ill at present. I would like to send good wishes to him for the remarkable work he has done. He is well known for his work in Scotland, and in the United Kingdom. We are sorry that he is ill and send our best wishes to him and to Annette.

The hon. Members for Foyle (Mark Durkan) and for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) —thank you, John Ronald, who follows on me on Twitter, for helping me with the pronunciation—pointed out the importance of all of us in the British Isles looking to what work is done by one another. I will certainly inform ministerial colleagues of the work being done by the unit at Queen’s University Belfast, and that being done in Scotland, and we can follow that up. I said to the hon. Member for East Kilbride, Strathaven and Lesmahagow after her intervention on mental health that I am keen to see what is being done in other places, and I will follow that up as well. We do have parenting skills classes in England. That provision has been much boosted by the health visitor programme, and it is as vital to us as it is in Scotland. I am sure that others will be interested in looking further at that.

The manifesto highlights the importance of high-quality universal services from conception to age two, which have rightly been described as a “lynchpin”. For the vast majority of women and babies in England, NHS maternity services provide a positive experience and good-quality care. We also have a good, strong, evidence-based universal public health programme—the healthy child programme from pregnancy to age five—which is delivered by health visitors. To strengthen the delivery of the programme, we have increased the number of health visitors by almost 50% in the past four years—one of the most rapid workforce expansions in NHS history. At the same time, the landscape for delivering services to under-fives is changing. On 1 October, responsibility for commissioning nought-to-five public health services transferred to local authorities. This change is of course a challenge for services, but it also presents an opportunity for local leaders to commission and provide more joined-up services for young children and families, across health, education and social care, based on their understanding of local need.

The manifesto contains a number of recommendations, including one mentioned by my hon. Friend the Member for East Worthing and Shoreham about the attachment needs of families:

“Childminders, nurseries and childcare settings caring for under 2s must focus on the attachment needs of babies and infants, with OFSTED providing specific guidance on how this can be measured effectively.”

The Government absolutely agree. Personal, social and emotional development is one of the three prime areas of the early years foundation stage curriculum, and forming positive relationships, including with adults, is key to this. I will ensure that my colleagues in the Department look particularly closely at that recommendation, for attachment is absolutely crucial.

My hon. Friend the Member for Congleton (Fiona Bruce) and the hon. Member for Sefton Central (Bill Esterson) raised foetal alcohol issues. I commend them for the report that has, I think, come out today, following the inquiry by the all-party group on foetal alcohol spectrum disorder.

Thank you very much.

It is too early to respond to the report, but I can say that it is really important. It is not like a Select Committee report, in that the Government do not have a duty to respond to it, but I would be extremely surprised if colleagues did not want to do so in due course, because it is so important. The official advice given is this:

“Our advice remains that women who are trying to conceive or are pregnant should avoid alcohol…If women choose to drink, to minimise the risk to the baby, they should not drink more than one to two units of alcohol once or twice a week and should not get drunk.”

We will shortly publish a consultation on the UK chief medical officer’s alcohol guidelines review. This will offer an opportunity to work with clinicians and other professionals to ensure that they are fully informed about the content of the guidelines and able to explain them to the women they care for and help them make informed choices on alcohol consumption. I would imagine that the substance of the inquiry ought to form part of that consultation and discussion. I think that the most important part of the advice is:

“Our advice remains that women who are trying to conceive or are pregnant should avoid alcohol”.

I am grateful to the Minister for those comments. The international examples given by his colleague the hon. Member for Congleton (Fiona Bruce) are very clear. The advice is not in two parts; it is a simple, single piece of advice: the best advice for mum and baby is to not drink at all. That is what happens around the world. The Minister has mentioned Dame Sally Davies. I hope she will agree with that and that that is what we will end up with, because it would make a massive difference.

I absolutely understand the hon. Gentleman’s point and hope that comes to pass. The Government will respond in due course.

I am the Minister with responsibility for mental health, which was raised by the right hon. Member for North Norfolk (Norman Lamb) in particular and the hon. Member for Ellesmere Port and Neston (Justin Madders).

If the Minister is moving on from foetal alcohol syndrome, it is important to put it on the record again that, as of a couple of weeks ago, the attempt to have a prevalence study on foetal alcohol syndrome has not found funding. It is really important that we try to understand the issue in depth and get some evidence on how widespread it is. Will the Minister please consider looking at the matter in the light of the report he will receive today?

I take the hon. Gentleman’s point and I will raise it with the appropriate Minister.

I have only a couple of minutes left, so I want to cover a couple of other things. Perinatal mental health is really important to me. I am disappointed that we have lost a couple of perinatal mother and baby units over the past few years. The increased emphasis on the issue is absolutely right. An NHS England working group is doing some intensive work on the £75 million that was committed in the last Budget to improve perinatal mental health services over the next five years. The report will come to me in the early weeks of January, as we look at the first tranche of that funding and then beyond. It is not as simple as just providing the units; it is about the community support care and everything else.

I was horrified by last week’s MBRRACE report. The association between people taking their own lives and perinatal mental health issues is very stark. Both of those issues are a very high priority for me. We will return in due course to say more about the detail. I offer the right hon. Member for North Norfolk that assurance.

Is the Minister satisfied that Health Education England recognises the importance of building the capacity of the workforce in order to ensure that there is a national service?

Yes, I am. HEE takes a real interest in the issue and I am sure there is more to be done. I take the right hon. Gentleman’s point about urgency as well. I am committed to doing more about that.

I am sure we will come back to this issue. This has been an excellent debate and I want to leave time for the mover of the motion to say a few words.

Madam Deputy Speaker, I wish you and all colleagues in the House a happy Christmas. If we conclude on a consensual note, with a debate as good as this one with very well informed people, the House is more than doing its job and is ready for a break.

I am grateful to all hon. Members who have taken part in this debate. There have been some weighty contributions and I am grateful to those who have stayed for this last debate on the last parliamentary day of the year.

I am particularly grateful to the hon. Member for Nottingham North (Mr Allen) for his contribution. He spoke of the intergenerational problems we are inheriting, which he has done so much to address. He was also right in a later intervention to mention social finance and the possibility of social impact bonds, which we certainly want to develop.

At times the debate risked being hijacked by the report of the all-party group on foetal alcohol spectrum disorder, of which I am a member. I am delighted that we had an opportunity to give the group a voice, because it is a very important subject.

I am grateful to the right hon. Member for North Norfolk (Norman Lamb), who did so much on perinatal mental health when he was a Minister. The map he produced puts starkly, in graphic terms, the service provider gaps around the country. I was also grateful to hear from the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), who speaks on behalf of the Scottish National party, who spoke of the Scottish experience and her time as a clinical psychologist in the NHS.

I pay tribute to the Opposition spokesman, the hon. Member for Ellesmere Port and Neston (Justin Madders), not least for his optimism about the political fortunes of his party. I am grateful for the cross-party consensus, to which he contributed. He is absolutely right to say that it is a false economy not to be doing this. We need to impress on the Chancellor the fact that, just as we invest in roads and factories to aid the economy, we should invest in our youngest children as citizens who are going to contribute to society in the future.

This is an urgent matter for the whole Government and I urge the Minister to promote it as such. In doing so, I wish everybody a very happy and peaceful Christmas and an “attachment” new year.

Question put and agreed to.


That this House calls on the Government to consider the adoption of the recommendations in the cross-party manifesto entitled The 1001 Critical Days, the importance of the conception to age two period.