My Lords, giving every child the best start in life is central to the Government’s approach to reducing health inequalities. This ambition is supported by action across government and the health system at local and national level.
I thank the Minister for his reply. Is he aware of the report published this week by the National Children’s Bureau—I declare an interest as its president—called Poor Beginnings, which shows very vividly how the place where young children live can dramatically affect their health? In particular, it highlights really dramatic differences in areas such as obesity, tooth decay and getting injured, and shows very significant variations in child health outcomes between deprived local authorities. As local authorities take up responsibility for young children’s public health from this October, what steps are the Government taking to support them in their work to narrow the gap in outcomes?
I have indeed read the report by the NCB, although it came out only on Monday so I have not fully digested its conclusions. I think that it very much echoes the work done by Michael Marmot four or five years ago. He said that the first two years, and certainly the first five years, of a child’s life are crucial in determining their subsequent standard of living and health. The variation that the NCB’s report has identified is extremely important. It is a variation not just between rich areas and poor areas but within deprived areas. That level of variation is best tackled at local level by local authorities. The decision to push the commissioning process down to local authorities is probably the right one, but they will be heavily supported by Public Health England.
My Lords, all the evidence suggests that there is a direct link between poverty and poor health outcomes. In view of that—and I accept that the Minister’s department has noble aims—what is his response to the work of the Child Poverty Action Group, which estimated very recently that by 2020, 4.7 million children will live in poverty? What representations has his department made to the DWP about its disastrous welfare policies?
My Lords, the causes of childhood poverty are profound. They are to do with employment, family relationships and education. The work that the DWP is doing with its troubled families programme and the work that the Department for Education is doing in improving educational standards will have a much greater impact on childhood poverty than, for example, focusing solely on things such as tax credits.
My Lords, I do not have the numbers for paediatricians—whether or not there is a shortage. Certainly, there are shortages in some specialties, particularly in A&E and other emergency specialties. I cannot give the noble Baroness a definitive answer on the shortage of paediatricians but perhaps she will allow me to go back, look at the figures and write to her.
My Lords, one of the most significant aspects of child health is to do with access to health services, which is a particular problem in rural areas. The phenomenon of distance decay, the further away you are from where the service is provided, is well documented. Will the Minister tell us what Her Majesty’s Government are doing to increase access to health services for those 900,000 rural households living in income poverty?
My Lords, access to health services is not just a rural issue; it relates also to deprivation, be it urban or rural. I would point out to the House the increase in the number of health visitors, which has gone up from 8,000 to nearly 12,000 over the past five years, and also to the Family Nurse Partnership scheme, which now has 16,000 places on it for younger and teenage mothers. So the Government are doing a lot to improve access. I guess they could always do more.
My Lords, is the Minister aware that in some areas fewer than half the five year-olds reach a good level of development? Given how important this is for their health, education and future employment prospects, why have the Government decided that from next year, the collection of early years foundation stage profile data is no longer to be statutory? How are the Government going to monitor how well children are developing across the piece, and how individual nursery settings are doing?
I am not sure that I can give that question a full answer. I am aware of the early years programme and I think that it is largely up to schools to monitor the development performance of children when they come into reception classes, which they are doing. I have seen the figures that the noble Baroness refers to—the 40% figure of children who have not reached the right development age by the time they come into reception class. It is a serious issue and I will take her words on board.
My Lords, what is the Government’s response to the recent concerns expressed by the Royal College of Nursing about the reduction in the number of school nurses in recent years, and what assurance can the Minister give that the reduction in the public health budget will not lead to a still further reduction in the number of school nurses?
Do the Government accept that intrauterine exposure to environmental toxins, psychological stress and nutritional deficiencies in the mother have long-term health effects on the child, as well as problems that arise in the immediate postnatal period? Will the Government therefore undertake to support epidemiological research in these areas, linked to their reviews of maternity services?
I am well aware of the impact on the health of children before as well as after they are born. I cannot give the undertaking that the noble Baroness would like me to give here today but I am very happy to pick it up with her outside the Chamber.