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House of Commons Hansard
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Health and Social Care Committee
28 February 2019
Volume 655

Select Committee statement

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We begin with the Select Committee statement. Dr Paul Williams will speak on the publication of the thirteenth report of the Health and Social Care Committee, “First 1,000 days of life”, for up to 10 minutes, during which no interventions may be taken. At the conclusion of his statement, I will call hon. Members to put questions on the subject of the statement and call Dr Williams to respond to these in turn. Members can expect to be called only once and their questions should be brief.

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Thank you, Mr Sharma, for inviting me to address this Chamber, so that I can present the Health and Social Care Committee’s report into the first 1,000 days of life.

I have been studying and working in health for the past 27 years and I have concluded that if our society wants the most effective interventions to improve health, we must act in the period from conception to the age of two. That is because the seeds of health inequalities are sown during that time. Good social, emotional, physical and language development during that time is crucial to building healthy brains and children, and having a healthy society.

This week our report set out an ambition challenge to the Government and all our colleagues in the House. We want to kick-start the second revolution in early years services, as recommended by the Marmot review in 2010, so that our country can become the best place in the world for a child to be born. Building that kind of society drives me, not only as an MP, but as a father and doctor.

I thank the hon. Member for Totnes (Dr Wollaston) for letting me take the Chair of the Committee for this inquiry. It is typical of her generosity of spirit that she seeks to give opportunities to others. I hope that I have done justice to the chance she gave me. I thank my Committee colleagues—of all parties and of none—for their support and guidance during our inquiry. I thank our Health and Social Care Committee staff team, particularly Lewis Pickett, Dr Joe Freer and Huw Yardley, who played a crucial role in helping us to make this report a reality.

Almost all research into this subject demonstrates that our path in life is set during the crucial first 1,000 days from conception to the age of two. Healthy social and emotional development during that time lays the foundations for lifelong good physical and mental health. Yet, our current political system invests a fortune in reacting to problems much later in life, leaving a gaping void where we should be warriors for a fairer and healthier society.

During the first 1,000 days of life, more than 1 million new brain connections are made every single second, and babies’ brains are shaped by the way in which they interact with others. However, more than 8,000 babies under the age of one in England currently live in households where domestic violence, alcohol or drug dependency and severe mental illness are all present. Over 200,000 children under the age of one live with an adult who has experienced domestic violence or abuse. Two million children under the age of five live with an adult with a mental health problem.

We know that many children who experience such adversity become happy and healthy adults, but adversity in childhood is strongly linked to almost all health problems and many social problems. Children exposed to adverse childhood experiences are much more likely to get heart disease, cancer and mental health problems than those who are not. Children exposed to four or more ACEs are 30 times more likely to attempt suicide at some point in their life, 11 times more likely to end up in prison and three times more likely to smoke as adults than those exposed to no ACEs. Our politics is currently failing some of these babies and other children who are born into families where poverty strongly affects their chance of achieving good health.

As part of this inquiry, our Committee read 90 submissions of written evidence and held three focus groups with stakeholders. I thank those who made superb contributions to our three oral evidence sessions. I particularly thank David Munday from Unison, Sally Hogg from Parent Infant Partnership and Viv Bennett from Public Health England for their guidance to me.

Our Committee was keen to reach outside Westminster for evidence. We hosted an online forum on Mumsnet, where we heard 80 stories from parents telling us about their experiences of pregnancy and early childhood, as well as their views on services. We visited the Blackpool Better Start project, run by the National Society for the Prevention of Cruelty to Children and funded by the Big Lottery Fund. We held focus groups with representatives from councils, clinical commissioning groups and charities from across the country.

We all know how austerity has affected our councils and the NHS over the last nine years, but we saw how a relatively small Big Lottery Fund investment had helped local authorities to redesign their services. Staff were able to take time to reflect. The extra money brought added capacity and outside expertise. We saw joined-up, effective collaboration between the council, NHS commissioners and providers, the voluntary sector and the police.

We also saw the importance of investing in long-term goals and service transformation, rather than just using money to firefight short-term challenges. We heard how having a one-stop shop for families helped to provide better support, and helped professionals to have better relationships with each other and to share information. We visited community spaces across Blackpool, including a library and a local park, which had been transformed by members of the local community, to make them more suitable for families with young children. We heard about the importance of a father in a young child’s life. Some fathers say that they lack parenting skills and other fathers felt that the system excluded them.

I firmly believe that we need to devote much more attention and protection to resources for this crucial period of life. There are many people across the political divide who share that belief. This is an area where politicians should be working together. It was very encouraging to hear that the Early Years Family Support Ministerial Group, led by the Leader of the House, was announced shortly after the start of our inquiry. That has the potential to take forward some of our Committee’s recommendations. I will soon be meeting with the Leader of the House to hear about the group’s progress.

Our inquiry has identified the need for a long-term, cross-Government strategy for the first 1,000 days of life, setting demanding goals to reduce ACEs, improve school readiness, and reduce infant mortality and child poverty. Our report recommends that the Minister for the Cabinet Office should be given specific Cabinet-level responsibility for the oversight of this national strategy.

We want communities, the NHS and voluntary groups to be led by local authorities, to develop their plans to bring this Government strategy to life, inspiring improved support for children, parents and families in their area. We think that a Government transformation fund should be established to encourage these different groups to come together, to pool their resources and deliver shared, agreed actions. We also think that a single nominated individual in each area should be accountable to the Government for progress.

Our report also calls for the existing, and actually very good, healthy child programme to be improved and be given greater impetus. It should be expanded to focus more on the whole family rather than just the child, begin before conception, deliver more continuity of care for families—something we found families really valued—and extend health visitor engagement beyond the age of two and a half, to ensure that all children become school-ready.

We heard from Scotland, Wales, Northern Ireland and parts of the United Kingdom that had enhanced the healthy child programme. However, we also heard from too many areas where some of the contact with health visitors was just a letter, and we were told that 65% of families do not even see a health visitor at all after the six to eight-week check. That clearly is not good enough. Our report recommends that information sharing needs to be significantly improved. Information needs to be better shared between organisations so care can be better co-ordinated and the long-term impact of an intervention can be tracked and assessed.

Alongside that, we need a workforce strategy to address the reduction in health visitors. That does not seem to have been a deliberate strategy, but happened because local authorities were given the funds for the healthy child programme at the same time as they had their budgets cut. We also want the strategy to make sure that knowledge and skills are improved, especially knowledge of ACEs and the importance of using motivational interviewing techniques.

If we get this crucial 1,000 days of life right, it will have huge benefits for everyone in our society. As politicians, we should try to get it right not just because it makes financial sense, but because every single one of us in Parliament has a moral responsibility to our country’s children. Every child deserves the best start in life.

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I congratulate my hon. Friend on his excellent chairing of the inquiry, his drafting of the report and his speech. Children in their first 1,000 years do not have as much of a political voice as other lobby groups, but does he agree that when Governments face difficult decisions about spending priorities, spending money on those children makes more sense than spending money on older young people in higher education, many of whom are well-off and talented and will do perfectly well in the rest of their lives? The best investment is in those first 1,000 years.

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I agree with my right hon. Friend’s proposition that investment at the beginning of life is likely to pay the greatest dividends, particularly in reducing inequalities. As politicians, we should represent all members of our communities, not just those who are old enough to vote or who choose to vote. There is an opportunity in the comprehensive spending review to make the case for long-term investment in that group of children.

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I pay tribute to the hon. Gentleman for his effective chairing of the inquiry, and for his powerful speech. I also pay tribute to the other Committee members and the wider Committee team for the excellent report. It is fantastic that it sets out effectively the importance of early intervention in the first 1,000 days if we are to make the greatest difference and have the greatest impact on reducing inequalities.

Will the hon. Gentleman join me in paying tribute to a group in my constituency, the Dartmouth Nurslings, for its work to support breastfeeding mothers through peer-to-peer support? Will he touch on the evidence about the important of breastfeeding in the first 1,000 days of life, and how effective it can be? Will he also join me in hoping that we can reduce some of the fragmentation that means there is not a consistent level of support across the country? I hope that such groups will receive the support they deserve.

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Order. Hon. Members should keep their questions short.

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I absolutely join the hon. Lady in commending the breastfeeding peer support workers in Totnes, and those in many other parts of the country—I have met some in my constituency, too. There is a common theme: when services are reconfigured and new services are put out to tender, the people who have devoted a lot of time and effort as volunteers can find themselves excluded. That is partly because of the nature of commissioning and tendering.

The Royal College of Paediatrics and Child Health gave us compelling evidence about breastfeeding. In the United Kingdom, we have some of the lowest breastfeeding rates in the whole of Europe, and there are wide socioeconomic disparities. Investment in breastfeeding support is crucial.

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I will pick up where the Chair of the Select Committee, the hon. Member for Totnes (Dr Wollaston), left off. I saw from the report that there was extensive consultation with Mumsnet. Why is there not a more specific recommendation in the report for more comprehensive breastfeeding support? What the hon. Gentleman says is correct, but it would have been good to see it in the report. During the Committee’s visit to Blackpool, were the cuts to the Breastfeeding Network’s star buddies programme mentioned? That service was lost in 2017.

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I thank the hon. Lady for those questions. One of the Committee’s early reports of this session was about childhood obesity. We made specific recommendations in that report that we have not necessarily repeated in this one.

We saw many wonderful things in Blackpool. We did not learn about the specific service to which the hon. Lady refers, but we did learn that many services have come under a lot of financial pressure. Even though there was some Big Lottery investment for transformation, services still needed to be cut, which sounds counterintuitive.

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I declare an interest as the chair of the all-party parliamentary group for conception to age two—first 1,001 days, which is slightly more long-term than the first 1,000 days of life, but not nearly as ambitious as the first 1,000 years of life, to which the right hon. Member for Exeter (Mr Bradshaw) erroneously referred. I am also the chairman of the charity Parent Infant Partnership UK. I am grateful to the hon. Member for Stockton South (Dr Williams) for referring to Sally Hogg, one of our staff members, and Beckie Lang, our chief executive, who gave evidence.

I welcome the report, and particularly the ambitious way that the hon. Gentleman has described it as the “second revolution” in early years services. He is absolutely dedicated to the whole subject, which is so important, and which many of us have been banging on about for some time. I have two questions. First, a slight disappointment is the shortage of space given to the case for investment. The hon. Gentleman knows as well as I do that, as we said in our all-party group report, “Building Great Britons”, the cost of child neglect is £15 billion a year, and the cost of maternal perinatal mental illness is £8.1 billion; that is £23 billion each year that we are spending on getting it wrong. Does he agree that we need to make the case that investment in this area will save substantial amounts financially and, more importantly, socially? The Treasury needs to understand that it is a serious investment case for the future.

Secondly, I approve of what the report says about locally delivered and joined-up services—a point that we put forward in our report, too. Does the hon. Gentleman agree that there is also a case, which we have made in the past, that that should be time-dated? Certainly, it should not take more than five years for every local area to have a united, joined-up, coherent and co-ordinated strategy for delivering this. It also needs to be measured, just as adoption scorecards were used at the Department for Education to measure the quality of the service delivery, so that it is not just a tick-box exercise. If we can get those two things right, the quality of the delivery will be much greater.

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I thank the hon. Gentleman for his advice and input at the start of the inquiry, and for the work that he has done as the chair of the all-party group, which is about the first 1,001 days—what is a day between friends? The economic case is exceptionally strong, and I am sure that the Minister has heard him make it eloquently. We all need to work together to make sure that we put the case to the Treasury. Ultimately, those spending decisions will have to be made in the comprehensive spending review; that feels like an opportune time.

The hon. Gentleman suggested that we ensure that there is a timeframe, that the commitment is not open-ended, and that local authorities have plans within a short time. We learned in our inquiry that local authorities are often left to just get on with it. The Committee felt that there was a need for much more central control and measurement, and for more accountability by central Government.

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I congratulate the hon. Member for Stockton South (Dr Williams) on setting the scene so very well, and I thank the Chair of the Committee, the hon. Member for Totnes (Dr Wollaston), and the other members of the Committee for all that they have done to produce what I regard as a very helpful and significant publication.

The Government do not provide financial or practical help for parents of multiples. That needs to change. If someone is blessed with twins, triplets or more, they are on their own. What consideration did the Committee give to addressing this issue, as we have many concerns in this Chamber about the two-child tax credit limit?

Secondly, each year thousands of parents are forced to go back to work when their baby is still critically ill, as provisions for maternity and paternity leave are inadequate. Again, what consideration did the Committee give to combating this? It is not unreasonable to extend statutory leave and pay for parents whose baby is admitted to neonatal care by a week for every week that their baby stays in hospital. I will just explain that, because I may have rushed through it as quickly as I can, in my usual quick way. The parent of a baby who is premature, and whose peers at four months are rolling over, will be told by a health visitor not to worry, as their baby is not considered to be four months old. However, the fact is that when it comes to wages and money, that baby is considered to be that age, and the cost is £2,256 per family, so there is a financial strain.

Thirdly and lastly, nearly three quarters of multiple birth families get no discount on their childcare costs, and for triplets those costs can be as high as £2,500 per month. It is quite clear that that is not sustainable; unfortunately, it usually rings the death knell for someone’s career. What consideration was given to that issue in this report?

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I thank the hon. Member for so eloquently making the case on an issue that we did not look at specifically in the report; we did not look at multiple-child families. However, we made some comments in a more general way.

I will make two points in response. The first is that providing services to families is not enough. The whole environment in which they live, including the poverty that many families find themselves living in, is probably as important as the provision of services. The second point, which we make in the report, is that we should consider the impact on the early years in all policies as a principle—as a “health in all policies” principle—and we should particularly consider the impact of all policies on the developing brain of children. We state that very clearly as a recommendation in our report.

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I congratulate the hon. Member for Stockton South (Dr Williams) on chairing an absolutely transformative report, and I also congratulate all the other members of the Health and Social Care Committee for their excellent work in putting the report together. All too often, trauma has been excluded from the work that we have done; we as a society have not recognised the importance of trauma in a young child’s life. I think trauma is at the root of many societal issues, as the hon. Gentleman says.

My question is on the work that the hon. Gentleman said had been done to involve fathers. What are the recommendations to involve fathers further, and to make sure that the system does not exclude them? Also, a number of grandparents, particularly paternal grandparents, who come to my surgeries feel excluded, but very much want to be involved in the first years, because those are the transformative years.

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I thank the hon. Member for the contribution that she has made to the Health and Social Care Committee, and to our thoughts in developing these ideas. We learned during our inquiry that fathers often feel excluded—systematically excluded. Much of the literature and many of the interventions are targeted at mothers. Culturally, services tend to push fathers a little bit further away, rather than bringing them in.

We recommend that the healthy child programme becomes a healthy family programme, and of course we know that every family is different. Families have different members; in some families, grandparents play a huge role, and in others, a lesser role. Our main recommendation is about a cultural emphasis, or a cultural change, in the healthy child programme, to make it a more holistic family experience.

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I congratulate my hon. Friend on a very thoughtful—indeed, excellent—speech, and I look forward to reading the report in full. I am also very grateful to him for the work that he does on the all-party parliamentary group on the prevention of adverse childhood experiences.

I will talk a little about the service in my area through which mums who may be prone to post-natal depression are identified, even prior to conception. If men and women who are thinking of conceiving have a history of mental illness, or perhaps even fairly low-level depression or anxiety, they are identified, and the mental health support team work with that couple throughout pregnancy and then after the child is born. I note that my hon. Friend identified mental health as one of the key issues in relation to adverse childhood experiences, but would he welcome a wider roll-out of this kind of work, to support children’s first years?

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I thank my hon. Friend for emphasising maternal mental health. The Government have made significant progress in improving services, particularly for people with more severe perinatal health problems, but we still have too many cases where people are likely to develop mental health problems, even if those problems are not predicted, and who say they have mental health problems in the perinatal period, but services do not detect those problems. The National Childbirth Trust has estimated that perhaps up to 50% of mothers with perinatal mental health problems never get asked about their mental health. It is welcome that some areas of the country are responding to that issue in an assertive way and seeking to prevent perinatal mental health problems, rather than just detecting them early. However, we are left with a lottery, whereby some areas do this work exceptionally well, and other areas still have to catch up.

The idea of a local authority-led plan, with some central accountability, might help to bring the kind of services that are obviously being provided already in Dewsbury to many other parts of the country.

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May I, too, thank the Committee for its excellent report?

As Members are aware, tackling inequalities is part of my brief and, frankly, there is no more obvious place to start than in the very early years. If we can get all children a good start, we will not only be well on the way to making life better for them, but will, as the hon. Member for Stockton South (Dr Williams) has observed, make savings for the taxpayer, too. I encourage him to continue pushing this work. As he is aware, prevention is very much at the heart of this Secretary of State’s agenda, and what we can do in the first 1,000 days is clearly a big part of prevention.

I note that the hon. Gentleman will meet the Leader of the House very shortly. He will find that she is very enthusiastic about and receptive to a lot of the themes that are discussed in this report, so my message—indeed, my plea—to him is this: please carry on with this work.

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It is the end of the time for the statement and questions about it. Thank you all very much. We move on to the next debate.