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Children: Maternal Care

Volume 769: debated on Thursday 17 March 2016

Question for Short Debate

Asked by

To ask Her Majesty’s Government what steps they are taking to promote ongoing maternal care for children.

My Lords, I look forward to the comments and guidance of colleagues speaking today and thank them very much for their interest in this debate. In my remarks I would like to touch on three aspects: first, the obvious connection between an early solid quality of childcare and a later stability of adulthood; secondly, a distinction between the effect of childcare within the home on the one hand and that in day centres on the other; following from this and, thirdly, the case for giving better financial incentives to mothers to stay at home with their children if that is what they might prefer to do in the first place.

On how it may have induced quality or otherwise, childcare policy should of course be judged on several fronts, not least, when the child is a bit older, through early education itself and the extent to which that may have reached all income groups. Here the Government deserve credit for their commitment to a package of schemes. This includes 15 hours of free early education for all three year-olds and for around 40% of the most disadvantaged two year-olds, administered by local authorities; and 30 hours of free childcare a week, worth around £5,000 a year per child, to working parents of three and four-year olds. In a written government paper, replying to the Affordable Childcare report’s recommendations, my noble friend the Minister announced these and other measures; that government response also followed our debate last year on that report, moved by the noble Lord, Lord Sutherland.

All political parties agree the priority of giving the child from the start the best possible deal of security, confidence and education. Each political party seeks to raise such standards, acknowledging the connection between an early quality of childcare and a later stability of adulthood, while also recognising the enormous contribution that success in this way can make to reducing the problems of society, such as the current huge increase in mental health ailments.

The next point is the distinction between the effect of childcare within the home and that outside it in day centres. All of us are grateful for the availability and national distribution of day centres. Many of these are very good, as well as essential to working mothers. Daycare can also assist academic performance from low-income homes and, along with parent-infant therapy, even improve children’s emotional well-being. Yet it is misleading to assert that babies or toddlers need stimulation, education or friends. The truth is that at that age they develop best as a result of close supervision by and affection from a familiar responsive adult in the home. Every study reveals that the child’s emotional security develops in a far more assured way through maternal bonding than it can ever hope to do in day centres, however good these may be.

This leads to the choices of mothers themselves. Recent opinion polls show that 80% of them believe that one parent should be able to stay at home, while 88% of mothers with very young children have said that the main reason for returning to work is financial pressure. My noble friend the Minister may concur that if mothers and families express such views, they should be offered wider choices than those at present. The objective would not be to discourage mothers who want to work from so doing. Instead, the aim would be to enable those mothers who prefer to stay at home to do that rather than working simply because they consider that the family cannot otherwise afford for them not to do so.

Of course, there is also the distinction between maternal and family home care of children who are under three years old and that for older children. Does my noble friend the Minister therefore consider that if in better corresponding to family wishes much wider choices should be offered in general, the Government should also analyse much more sharply in particular how these preferences may differ in regard to home care for children under three years old and that for older children?

Most countries operate either a joint taxation system or an individual tax system which allows families the option of being taxed jointly, either by transferable allowances or credits. Will my noble friend the Minister agree to review the merits of certain expedients, including: a system of transferable personal allowances where a non-earning spouse would be able to transfer the whole or part of the basic income tax personal allowance to their earning spouse; income-splitting, under which for tax purposes families would be able to split family income in two and allocate half to each partner, as well as keeping both personal tax allowances; and child allowances, already practised by some countries, which allow an extra tax allowance per child? In fact, a recent OECD assessment notes that, apart from Mexico, the UK is the only developed country with a population of more than 10 million to apply tax based on individual income with no allowances for spouses or transferable allowances.

Perhaps inevitably, there are trade-offs inherent in any government policy that seeks on the one hand to promote child development and on the other to facilitate parental employment. For example, cheap low-quality childcare might help parents to work but would not meet the Government’s child development objectives. Yet, through adoption of some of these financial and fiscal adjustments as proposed, that anomaly reflected by trade-offs could be quite considerably redressed. Such steps would assist ongoing maternal care for children. As a result, to a greater extent children would become more secure, society more stable and, through choice rather than necessity, family employment much fairer.

My Lords, I thank the noble Earl for securing this debate today and for introducing it in such eloquent fashion. Early years, the early start in life and maternal support were a key priority for the coalition Government. It is good to have the opportunity to return to this issue. We do so in the week that a new all-party group has been set up. I am not really a fan of new all-party groups because there are thousands of them already, but this is the All-Party Parliamentary Group for Conception to Age Two—The First 1,001 Days. That shows the consensus which now exists around the importance of the first 1,000 days of a child’s existence. Throughout the mother’s pregnancy and up until the age of two, approximately, is the key formative stage in any person’s life, physically, mentally and socially. I am glad that we now have that consensus about the importance of interventions during that time to make sure children grow up happy, healthy and well adjusted.

Needless to say, midwives have a key role in assisting mothers. This House, under the repeated instruction of the noble Baroness, Lady Cumberlege, has over the years come to understand the continuing importance of midwives, not just in the support and information that they give to women during pregnancy but also in their ability to prioritise post-natal care plans with women so that they, once they come out of hospital, have in place a way to see them through what is sometimes the most demanding not to say frightening time in a parent’s life.

It is recognised by all parties that continuity in midwifery is extremely important. Quite often, one hears women talking not about the fact that they could not see a midwife but that they had to see different midwives. On each occasion they had to start from scratch and go through all sorts of details, so that by the time they got to the end of a short consultation they had had very little time in which to have a proper discussion about the issues bothering them. In the light of the recent report by the noble Baroness, Lady Cumberlege, what impact does the Minister believe that the introduction of personal budgets, as she proposed, would have on the availability of midwives? What is his assessment of the impact that it might have on the training—and access to that training—of midwifery students, who are so important for the future?

On 1 October 2015, services for children aged under five were transferred from the NHS to local authorities, which are now required to make provision for maintaining the universal health visitor reviews as part of the healthy child programme—specifically, the antenatal promotion review; new baby review; six to eight week assessment; one year assessment; and two to two and a half year review. We know, because there is a lot of evidence now both from this country and abroad, that early intervention with disadvantaged families can have a profound effect on the life chances of a child. We know that the public health interventions that are needed have to be integrated at a local level with the NHS to ensure that the healthy child programme and family nurse partnerships can identify and work with those families who are most in need. We know that investment in health visitor programmes pays off in terms of the benefits that they bring to families and the way in which they enable children to thrive and not to need far more expensive interventions later on. The transfer of powers to local authorities is well founded in evidence. How will the programme’s implementation be monitored and evaluated in practice and when can we expect to see the initial results? When will we be able to see figures, particularly in relation to the eradication of child poverty, which is a target by which this and all previous Governments are judged?

I touch briefly on mothers, work and childcare, which the noble Earl, Lord Dundee, alluded to. According to the Department for Education survey of parents in 2014-15, two-thirds of mothers—about 66%—were in employment and one-third of mothers were not working. About half of those non-working mothers agreed that they would prefer to go out to work if they could arrange good-quality childcare that was convenient, reliable and affordable. Among the mothers who had returned to work in the previous two years, the most commonly reported factor that had influenced their return to work was finding a job that enabled them to combine work and childcare. The availability of not just childcare but of suitable childcare is the single biggest problem for working parents. It is quite often the case that it is impossible to find childcare for half a day. Yet, when children start at nursery schools, sometimes they go for only half a day, which leaves parents desperately trying to juggle work around the time they have to get back to pick up the kids. Equally, some parents have to work part time but can only arrange with their employers to work for, say, two full days. If they cannot find childcare to fit around that, their chances of moving back into work—as the majority wish to do—are severely hampered.

We in the Liberal Democrats supported the extension of free childcare, particularly to parents who were not in work: free childcare is a very early-stage intervention and makes a big difference to children in deprived communities. We also recognise the importance of the role of fathers and believe that shared parental leave should be the aim of all Governments, so that individual families can arrive at solutions that work best for them and their children. Will the present Government continue the work of the coalition in trying to work with employers to improve the availability of affordable high-quality childcare, so that those parents who wish to can continue to work while giving their children the best start in life, which is what the vast majority of parents in this country want?

My Lords, it is a privilege to follow the noble Baroness, Lady Barker. I think I can say that I agree with every word that she said. I was particularly pleased that she referred to the work of the noble Baroness, Lady Cumberlege, and the importance of the continuity of care from midwives, specifically from practices where midwives are there at the beginning of pregnancy, deliver the child and keep in contact for a short time after pregnancy. That is definitely the ideal situation. I am also grateful to the noble Earl for calling this important debate. Many of these issues have been raised with the Minister in the course of the Childcare Bill. A particular concern is that many babies in childcare are often placed with the least qualified and experienced staff. I hope the Minister will perhaps have a chance to look at that.

I would like to address three issues: family learning as a means of promoting ongoing maternal care for children; the particular importance of continual maternal care from conception to the age of two; and the impact of homelessness on maternal care. I hope to concentrate most of my remarks on the area of the Minister’s immediate responsibility, which is schools. I begin by welcoming the new investment in schools by the Chancellor. I am delighted that he has chosen to introduce the sugar tax and will invest the benefit of that in education. The Government have also committed to expand still further the number of academy schools. I hope I may encourage noble Lords of all parties or none to use any business contacts they may have to promote application for high-quality sponsorship. Whatever one may think of academies it is becoming clear that it is vital for our children that there are sufficient excellent sponsors.

On family learning, I suggest that continuing good maternal care throughout a child’s development is becoming increasingly important. On the one hand, fathers are becoming increasingly absent. By the 2030s about 30% of our children will be growing up without a father in the home. On the other hand, housing continues to be in short supply and children are being obliged to remain at school: they cannot move out. It is becoming increasingly important that mothers stick with their children through the difficult adolescent years. Family learning can strengthen maternal relationships through the early school years and so help mothers tolerate their teenagers later.

Family learning can also hit another number of important goals. It improves children’s educational attainment. It engages fathers more effectively in their families. It can help migrant families to settle well, and may help combat childhood and adult obesity. I developed an understanding of family learning by meeting foster carers who had benefited from the prepared reading developed by Dr Andrea Warman at the British Association for Adoption & Fostering. Many of the foster carers themselves had difficulties at school and were taught to draw on those difficulties in efforts to understand the challenges that some of their foster children experienced. The training package gave the foster carers the confidence to read regularly with their children, and the results were significantly improved literacy results for their foster children and a reduction in placement breakdowns—foster parents and foster children sticking with each other. John Coughlan initiated paired reading at the local authority at which he is director of children’s services in Hampshire. Early indications suggested that paired reading also reduced the breakdown in placements in children’s homes.

I then had the opportunity to meet mothers at one of the National Institute of Adult Continuing Education events to celebrate family learning. One mother had had a heroin addiction but was now able to work, thanks to the confidence that she had gained through family learning. Another mother had gone to get driving lessons following her success; another still described her joy at taking her son on a field trip to explore the natural history of a field and pond.

More recently, I spoke with the mother of a child who graduated from the Pimlico Academy, which the Minister established. The mother is the catering manager in a local secondary school and has a second, part-time job in a launderette. She is an immigrant of African origin; she said that in her country mothers will sell their jewellery to secure a good education for their child. Every school day, she and her son and daughter read together for 20 minutes, looking up any difficult words. She spoke of her pride in her daughter’s academic success. Now reading physics at a prestigious university, she gained 12 GCSEs, A*s or As, and four A-levels. Family learning arguably strengthens maternal bonds with children and certainly leads to significant increased attainment. If the Minister wishes to extend academic success to areas of generational deprivation, such as County Durham, he could do worse than to consult the National Institute of Adult Continuing Education and the Workers’ Educational Association. The WEA has spoken to me about how it would position its teachers near the primary school gates to engage parents as their children begin their education.

No doubt, the Minister is also concerned about childhood obesity. Only this morning I heard about a project led by North Eastern Electricity which provides parents with cooking classes so that they can avoid wasting money on takeaways and feed their children more healthily. We heard on the “Today” programme that many schools require their pupils to run a mile a day. Schools find that their pupils lose weight, sleep better and have more concentration in lessons. So it may be possible to offer opportunities to parents to learn about exercise and so encourage their children to walk, and to run with their children. In all the above, I remember my own family experience and the importance for me of learning with my mother and father things such as cookery, reading and other study.

I commend to the Minister NIACE’s report on family learning, chaired by my noble friend Lady Howarth of Breckland, the chair of the All-Party Parliamentary Group for Children. With the expansion of academies, free schools and early years care, and the additional funds, I hope that he may wish to weave family learning much more strongly into what he offers.

On the importance of the continuity of maternal care between conception to the age of two, which the noble Earl, Lord Dundee, emphasised strongly in what he said, I hope that I can pay tribute to the many parliamentary colleagues who have raised the importance of early years to successive Governments. I think particularly of the right honourable Iain Duncan Smith MP, Graham Allen MP, Andrea Leadsom MP and the vice-chair and officers of the All-Party Parliamentary Group for Conception to Age Two—The First 1001 Days, to which the noble Baroness referred. Then there are Tim Loughton MP, Frank Field MP and others. Following on last year’s report for the parliamentary group, Building Great Britons, we recently heard from health professionals from Croydon how their trust was enacting the report’s inquiry in building a seamless partnership between midwives and health visitors, so extending even further the continuity of care to which the noble Baroness referred. I commend the report to your Lordships and am very grateful for the efforts of midwives, visitors and other health professionals to provide excellent perinatal care to mothers.

As a society, we need to give every attention to perinatal maternal care, if mothers are successfully to make a strong, continued attachment to their infant, which is vital to their child’s future health, education, economic independence and own family. I applaud again the Government’s investment, and that of the previous coalition Government, in health visiting, and indeed the resurrection of that service.

In my final area, I would like to explore the importance of homelessness on maternal care. Here again the perinatal period is a particular concern, and I much appreciate the work that the London Scholars at the University of East London have undertaken in the last six months of the effects of homelessness on perinatal maternal care. I await those conclusions. I was grateful to the noble Lord, Lord Bates, for undertaking to the noble Baroness, Lady Lister of Burtersett, that the Government would review policy on those pregnant women in detention, awaiting immigration removal, on Report of the Immigration Bill. Regrettably, in recent years the number of homeless children has increased to 100,000 in England alone. The Government’s legislation on housing and planning and their investment are a golden opportunity to make more secure affordable housing available to families with low incomes. I declare my interest as a landowner and residential landlord.

Again, I am very grateful to the noble Earl for calling this important debate and look forward to the Minister’s reply.

My Lords, I am also grateful to the noble Earl for securing this debate because I am utterly convinced about the importance of ongoing maternal care for children. I speak as the father of two adopted children. I have learned through experience and study how crucial is the relationship that children have with their mother. It is an essential and defining part of the process of perinatal life that a bond is formed between child and mother, regardless of the latter’s conscious attitude towards her baby.

Research shows that healthy development depends on the quality of attachment from primary carers during the first three years of life when the brain’s structural plasticity is most available to being shaped by interactions with parents. In systemic terms, there is a benign, recursive, interactional loop operating between parent and child such that the baby’s brain responds to parental input—love, care, et cetera—by developing and growing physically and psychologically. This in turn triggers the parent or carer to provide more love and care.

As the noble Earl has said, the Government deserve much credit for their determination to improve the lot of children. I do, however, believe that other measures would help significantly. With this is mind, I applaud the Motion which the noble Earl and others introduced to the Parliamentary Assembly of the Council of Europe in September 2015, advocating, among other things, financial assistance for maternal care in the home for a minimum of three years, ensuring that such a care subsidy is independent of paid work. The organisation CARE, summarising its latest annual review of taxation in this country, said:

“According to our most recent research, a single-earner married couple with two children on the average OECD wage are liable to 35% more tax than the OECD average”.

Of course mothers should be able to go back to work when they wish but CARE boss Nola Leach said, when the report was published:

“Stay-at-home parents are making an important investment in their children and yet at present they end up being discriminated against by our current tax system”.

I should add that I have nothing against single parents or working parents: I am one. However, I would like the tax break for couples, which was announced in April 2014, to be extended, along the lines that the noble Earl suggested, to a 100% transferable allowance, which would carry far more significance and would mean that couples could benefit to the tune of £2,000 a year. The campaigning group Mothers at Home Matter argues that it matters for families to have choices in care, so that all are able to choose what works for them in their unique circumstances. That will surely be for the good of all.

Mothers are also presently concerned about conditionality placed on households on the new universal credit. Will family responsibilities at home be properly factored in? How much pressure will there be on second earners to return to work? Preliminary research seems to indicate that more mothers will be “encouraged” to sign up for interviews when children are 12 months old, even when they have significant care responsibilities at home.

As has been intimated, our concern should not just be about the early years: it is important for someone to be there for children in the middle and teenage years as family circumstances and pressures change. The availability of decent, part-time, paid work, particularly during secondary school, is key to achieving balance for some parents with care responsibilities. We need, in sum, a greater recognition of the loving one-to-one care that babies need and of children’s need for family time at all ages. We need to do all we can to facilitate it.

At the same time, while ongoing maternal care is important, so is parenting in general. The noble Earl, Lord Listowel, pointed to the importance of family and family learning. Churches are also doing much to provide training on parenting, for which there is an appalling lacuna in our society. The Mothers’ Union runs and trains facilitators for its “passionate about parenting” course. A participant said:

“This parents’ group helped me in so many ways. We talked in small groups and helped each other, my children found my parenting handbook (a resource I was given that I could take away and read through at home) so I thought I had been busted. But it was great, after a few weeks my 18-year-old gave me a hug. The first in years and he wasn’t the teenager I was having problems with!”.

Similarly, Care for the Family runs many positive parenting programmes, and Alpha provides parenting children and parenting teenagers courses.

As the father of adopted children, I know that the separation of children from their mothers is immensely traumatic. It is referred to by adoption specialist Nancy Verrier as “the primal wound”. It takes a great deal of love on the part of adoptive parents to begin to heal this wound. That shows the importance of the maternal bond and maternal care. It can be done, as was done by my wife. Tragically, she died when my children were aged nine and 15. That brought home to me, by tragic means, the importance of ongoing maternal care.

It is, of course, not true to say that healthy adults cannot develop if they have experienced a lack of maternal care. There are alternatives to it; attachment from other loving and caring adults, most especially fathers, can be very nurturing and healing. These are important alternatives, but no substitute for ongoing maternal care.

My Lords, I thank the noble Earl, Lord Dundee, for initiating the debate. Perhaps he and I are the only two people in the Room who know that our titles are very closely associated—although maybe not in their level. Invergowrie is a village on the outskirts of Dundee, where I spent all but the first 18 months of my life. I have an affinity in that sense, if not with the noble Earl.

I should also say that my mother was a teacher. At that time, when female teachers got married they had to give up the job. That seems incredible these days. I am sure that that has brought a sharp intake of breath from the noble Lord, Lord Nash, but that is what happened. In that sense, what the noble Earl seeks happened in some way for some women because they were forced to give up what they had trained to do. They could take other employment, of course, but they could not follow their chosen vocation. I am obviously not advocating that and it is long in the past, but I certainly appreciate the noble Earl’s motivation in the debate. He introduced it in a manner that underlines his clear commitment to ensuring that every child has the best possible start in life. I hope he will forgive me if I say I will not comment on his fiscal proposals. As far as I am concerned there is quite enough in the education portfolio, so I will leave that to others.

As the parent of a child currently in reception, I can say from experience that I appreciate the benefit of the integrated approach to early learning and care promoted by the early years foundation stage framework. It provides a clear set of common principles and commitments for professionals to deliver quality early education and childcare experiences to all children. Some changes were made to the framework in 2014, which have strengthened standards for the learning, development and care of children from birth to the age of five, producing a uniformity that, in theory at least, offers all children the same opportunities. But, of course, I think we know that life is not like that.

There is no equality of opportunity for newborn babies. That is much to be regretted, because the first two years are crucial in shaping a child’s life chances. When a child is just 22 months old it can already be accurately predicted what her or his educational attainment will be at 22 years of age. The noble Earl said that studies reveal that a child’s emotional security develops in a more assured way through maternal bonding than in day centres or nurseries. I certainly agree that maternal—and, let us not underestimate it, paternal—bonding is essential from the minute the child draws its first breath. However, the extent to which bonding alone can sustain the crucial early development of a child depends to a great extent on the home environment to which the baby is introduced. That is where I part company with the noble Earl, because I am convinced that it is both unrealistic and, in most cases, unfair to expect the mother alone to keep the child at home and provide it with all the support that it needs in its first two years.

We have already heard the noble Baroness, Lady Barker, say that two-thirds of women either want or need to seek employment, but the reason I believe a mother needs support is that it may be her first child, in which case she is on a really steep learning curve, or if it is a subsequent child then, for obvious reasons, the time available to have sole responsibility for that child is limited, so she should seek support from a variety of sources. Not least among those is interaction with her contemporaries as mothers, in formal or informal group settings.

In 2010-11 report after report emphasised the enormous importance of early intervention, including the Tickell review of the early years and two reports by Graham Allen MP. At that time it seemed that a cross-party consensus was emerging to prioritise early intervention, but it seems that that soon evaporated, because the coalition Government began to cut early intervention budgets and poorer families have been suffering ever since. Hardest hit, in that sense, has been the network of Sure Start centres. When Sure Start was established by the Labour Government in 1998 the aim was to provide an accessible children’s centre in every community. Each centre would offer a wide range of high-quality services for families with children under the age of five. Sure Start was immediately popular and a network of some 3,500 centres was quickly established.

What was also established was that Sure Start works. There is comprehensive, independent evidence that it delivers quantifiable outcomes and that it is immensely popular with families. However, since 2010 funding has been cut by some 35% and over one-fifth of all children’s centres have now closed, meaning that Sure Start is approaching a point of no return. Last year the Government promised a consultation on the future of Sure Start. We still await this and I very much hope that the Minister can tell noble Lords today when it is likely to begin.

Sure Start was founded on the basis of extensive academic research. There is a plethora of evidence that demonstrates beyond doubt that Sure Start works. The national evaluation of Sure Start has been analysing the long-term development of 5,000 families who used Sure Start when their children were young. The evaluation has found clear evidence that children attending Sure Start centres are less likely to be overweight and more likely to be immunised; they have better social development and are less likely to offend in later life. Parents attending Sure Start centres provide more stable home environments and are more likely to move into work. It is a win-win situation for parents and children, yet the network is having to be dismantled.

Children’s centres have been found to be immensely popular with parents and evidence shows that they have been successful in reaching the parents who are likely to be the most disadvantaged. Also, the beneficial effects for parents persist at least two years after their last contact with Sure Start; often, social interventions do not have such a sustained impact. These findings have been reinforced by the children’s centre census produced annually by the charity 4Children. Its 2015 census found that, from 600 responses, 90% of parents reported that their children’s centre had a positive impact on their child and 83% reported that it had a positive impact on themselves. Tellingly, 80% reported that life would be harder for their family without their children’s centre.

It has been suggested by Government, or perhaps by some of those speaking on their behalf, that Sure Start is dominated by the sharp-elbowed middle classes. Evidence completely contradicts this. Independent Oxford University research in 2015 found that disadvantaged families use children’s centres for an average five months longer than more affluent families. This is because,

“the open-access, walk-in activities encouraged vulnerable families to take part because they did not feel there was a stigma attached to using the Centres”.

The Government have attempted to conceal some of the cuts that Sure Start has suffered. In 2011 the ring-fence established by the Labour Government was ended. In 2013 Sure Start funding was merged into local authorities’ general funding, and we all know what has since happened to that, most recently in the Chancellor’s Autumn Statement and, indeed, in yesterday’s Budget. Last year the charity Barnardo’s called on the Government to act to stop the life being squeezed out of children’s centres as many local authorities face impossible stresses and strains on their budgets.

No doubt the Minister will note that the amount of free childcare for three and four year-olds is to be extended, which is an important step, even if it will perhaps not be quite as extensive as we were first led to believe. He will also refer to the fact that more children aged five are making good progress against the early years foundation stage profile, and that is, of course, to be welcomed. More children are reaching the expected level of development in maths and literacy as well as in the key areas of social and emotional development, physical development and language. That is all to be welcomed, but these are measurements of children at the age of five. The progress made by many of them could be much better and much more likely to be sustained if more of them had an early opportunity to benefit from the support provided in so many forms by children’s centres, whose value is widely appreciated. It is to be regretted that the Government do not appear to share that appreciation.

It surely goes without saying that maternal care is of prime importance to any child, but it must be enhanced by external influences: everything from health visitors to educational psychologists and the benefits of interacting with their contemporaries in a secure, welcoming setting. Children’s centres have a vital role to play in that, and I invite the Minister to acknowledge that.

My Lords, I thank my noble friend Lord Dundee for calling a debate on this important subject and congratulate him on an excellent speech. I also thank other noble Lords who have contributed. My noble friend had a number of suggestions about how the overall system could be improved. Our provisions for flexible working and for parental and shared parental leave are now substantial. We have one of the longest periods of paid maternity leave in the EU and our rate of maternity pay exceeds the requirements of the EU directive. I am tempted to agree with the noble Lord, Lord Watson, about the point my noble friend made about financial incentives, but it is rather beyond my pay grade. On the tax incentive to which he and the right reverend Prelate the Bishop of Worcester referred, I will write to him and refer the matter to Her Majesty’s Treasury.

I think we all agree on the importance of maternal care and attachment in early childhood and its implications for longer term social and emotional development. International and UK studies have shown that the foundations for virtually every aspect of human development—physical, intellectual and emotional—are laid in early childhood. The noble Lord, Lord Watson, referred to the importance of this. What happens to a child from the womb to the age of five has lifelong effects on many aspects of health and well-being from obesity, heart disease and mental health to educational achievement and economic status.

The noble Baroness, Lady Barker, referred to the importance of health visitors, and I am pleased to report that there are now 4,000 health visitors, which is nearly double the number there were in May 2010. This expansion supports effective, sustainable services that help families to give all children the best start and promote local communities’ health and well-being.

The evidence-based healthy child programme is the key universal public health service for improving the health and well-being of children. It aims to prevent problems in child health and development and to contribute to a reduction in health inequalities. The healthy child programme is the overarching service for the provision of interventions to strengthen parent-child relationships. Health visitors’ support can identify families who will benefit from extra help, including support for parents and children early in life. This can include referring families to specialist services, arranging access to support groups and practical support. I should mention here our extremely successful troubled families programme.

The noble Baroness asked about the introduction of personal budgets and the impact on midwives and on access to training for student midwives. The Department of Health and NHS England are considering all the recommendations of the maternity review and more detail on implementation will follow shortly. She also asked how the healthy child programme will be implemented and monitored post its transfer to local authorities and when we will get the initial results and figures, especially in relation to child poverty. The Department of Health has commissioned Public Health England to review mandation arrangements for the healthy child programme. Post transfer to local authorities, Public Health England is expected to report its findings later this year. The life chances strategy is expected to be published in July and will set out the Government’s plans for improving the life chances of all children. The strategy will introduce new indicators for measuring children’s life chances. The noble Baroness referred to childcare and I am delighted to report, as I have in the House, that 96% of three and four year-olds are accessing it and, of course, we have had a massive increase in childcare places over the past six years, an increase of nearly 250,000 places. I assure the noble Baroness that we will continue to push for more quality, available and flexible childcare.

The noble Earl, Lord Listowel, made a number of points in relation to this Government’s policies ranging from sugar tax to academies. I am extremely grateful for his support, and I share his great concern about absent fathers, a problem I see constantly in our schools. He also referred to obesity, and I was pleased that the Chancellor yesterday doubled the pupil sports premium for primary schools and created an extra fund for all schools to extend their day for activities, particularly sport.

There are also opportunities through schools for parents to learn more themselves and to work with their children. Good schools have been particularly good at involving parents in school life and bringing them in for assessment, and an effective use of IT can be helpful in this regard. The noble Earl referred to family learning, which is obviously integral to strengthening paternal relationships and widening horizons. I am delighted that following the spending review, the Government are protecting funding for the core adult skills participation budgets—in cash terms, £1.5 billion. This will support families that are socially disadvantaged and will build confidence and resilience.

I am grateful to the noble Earl for his comments on family and child homelessness, and I share his concern in this regard. The Government believe that the most important thing for a family who have become homeless is to resolve their housing crisis and get them into settled accommodation as soon as possible. To do this, the Government have invested more than half a billion pounds in the past five years, enabling local authorities to help nearly a million households in becoming homeless. I also remind the noble Earl that the number of children in temporary accommodation is just over 100,000, which I agree is far too many, but it remains well below the peak achieved in 2006, when it was more than 130,000.

The Autumn Statement announced real-terms protection for central funding for homelessness, demonstrating our commitment to this area. Further support was available in the Budget, which included £100 million to deliver low-cost, second-stage accommodation for rough sleepers, £10 million over two years to support and scale up innovative ways to prevent and reduce rough sleeping, doubling the funding for the rough sleeping social impact bond announced in the Autumn Statement from £5 million to £10 million, and other action to decrease the number of rough sleepers. I pay tribute to the right reverend Prelate the Bishop of Worcester. He referred to the work of the church in improving parenting skills and, of course, I pay tribute to the church’s work in the whole area of schools.

The noble Lord, Lord Watson, referred in detail to children’s centres. The Government are considering their policy in this area as part of the development of the cross-government life chances strategy and plan to publish details in the summer. At that point we will make clear how stakeholders and members of the public can contribute. We want a strong network of children’s centres, and we believe the debate should be about the effectiveness of those services. Quite a few centres have merged, and some have closed. The debate should be about the effectiveness of the services, not purely about counting buildings.

We have also substantially increased the money available for childcare. The 4Children’s survey of children’s centres suggested that more than a million families frequently accessed children’s centres in 2015. This estimate is unchanged since these statistics were first published in 2013. As the noble Lord, Lord Watson, said, the latest Early Years Foundation Stage profile data reveal that an increasing proportion of children are achieving a good level of achievement at the age of five, 66% in 2015 compared with 52% in 2013, which is a substantial and impressive increase. I thank all noble Lords for contributing to today’s very stimulating debate.