Parents and Carers of Infants: Support

Debate between Tim Loughton and Sally-Ann Hart

Tuesday 12th March 2024 Westminster Hall

[Tim Loughton (East Worthing and Shoreham) (Con)]

I came along this afternoon just to listen, not to speak. However, I have been so inspired by my Sussex colleague, my hon. Friend the Member for Hastings and Rye (Sally-Ann Hart), and equally so shocked by the revelation that the hon. Member for Strangford (Jim Shannon) does not intend to make a speech in this debate—above and beyond the mini contribution he has already made—that I will use the time available to make a few comments. I want to speak particularly in support of my hon. Friend’s Bill, which I wish well this Friday, but also in the greater context of the Best Start for Life programme that has been championed over so many years by the Minister.

It is worth reminding ourselves why the whole issue of getting the best start in life and encouraging, nurturing and supporting parents at the very early stages is so important. I speak as the chair of the APPG on conception to age two—first 1,001 days. We have a display of officers from that eminent group here today, which was set up by the Minister herself some years ago. Those first 1,001 days are critical because it is a period of uniquely rapid growth in toddlers’ brains. More than a million new connections are formed every second in a baby’s brain, and babies’ growing brains are shaped by their experiences, particularly the interactions they have with their parents and other caregivers. What happens during this crucial time lays the foundations for future development, not just during childhood but into adulthood. They are effectively lifelong.

There is a lot of research showing that the way in which parents interact with their baby predicts the child’s later development. In order to thrive, children absolutely must have a loving and secure relationship with at least one sensitive, nurturing caregiver who can respond to his or her needs. That is why it is so important to support parents and parent-infant relationships to give children the best start in life. A range of stress factors during pregnancy and early years can be communicated to and can impact on a baby or growing toddler.

The cost of not getting it right is considerable. Some years ago, when the Maternal Mental Health Alliance issued its flagship report, it costed maternal perinatal mental health problems at some £8.1 billion. That is what it is costing for not giving mums and dads the best support to ensure that they can bond with their children. One in six new mothers will suffer some form of perinatal mental illness, and covid certainly worsened that situation, with all the pressures on first-time parents in particular of babies born during covid, as they did not have access to some of the support networks that we took for granted until then. In addition, child neglect has been costed at something like £15 billion each year, so we are spending £23 billion-plus on the consequences of not getting it right by intervening at a stage when it could have the maximum impact for the parent and, mostly importantly, the developing and growing child.

Healthy social and emotional development in the first 1,001 days means that individuals are more likely to have improved mental and physical health outcomes from cradle to grave. It means that children can start school with the language, social and emotional skills they need to play, explore and learn, and that children and young people are better able to understand and manage their emotions and behaviours, leading to less risky and antisocial behaviour later on. It also means that children can have the skills they need to form trusting, healthy relationships.

It has been calculated that some 28% of mothers with mental health problems report having difficulties bonding with their children. Research suggests that the initial dysfunctioning of mother-baby relationships affects children’s development by impairing their psychomotor and socio-emotional development. As well as the direct impact on the child, it can have longer-term adverse effects on the parents and wider family. The onset of a maternal mental health condition can precipitate relapse or recurrence of previous mental illness. It has the potential to herald the onset of long-term mental health problems and is associated with an increased risk of maternal suicide, and we know how alarming the figures are for women who commit suicide soon after giving birth. It is important to say that this is not limited to mothers; there is also an impact on fathers. Post-natal depression has been linked with depression in fathers and high rates of family breakdown, so this is all about families and the children. That is why it is important not only that we have a range of services available in a joined-up way, but that those parents know how to access those services and whom to speak to.

I will give an example from all those many centuries ago when I was the Children’s Minister. One of the first things I did in the first summer recess was to spend a week being a social worker in Stockport. I went out with real-life social workers, without cameras, just doing their daily job. One of the first places I was taken to, with a really impressive social worker—I think they chose one of the most challenging cases they could—was a house in one of the most deprived parts of Stockport, where a young mum with three young boys from three different fathers, none of whom was on the scene, were living in absolute squalor. There were no carpets on the floor, and they were literally eating off the floor. There was nothing in the fridge, some furniture dumped at the bottom of the garden and dirty mattresses that the kids were sleeping on.

One of the children had a bad toothache—I remember it distinctly as if it were yesterday—so the social worker said to the mother, “Why haven’t you taken the child to the dentist?” because it had been going on for some time. The mother herself had had a tooth problem the day before. She had gone to the emergency dentist and had it sorted out, but she had not had the presence of mind to take the son with her. Before long, if things went on like that, those children would have ended up in care. The mother would have been absolutely beside herself—she doted on and relied on those children greatly, and the kids relied on her. For all her problems and challenges in being a decent mother, that was all she knew; she had had poor parenting herself.

What struck me was that a number of professionals had been going in and out of that house over a period of time, and virtually every time they went, she had to start her whole story again about the various problems. There was no real joined-up action where that mum and her kids were almost literally taken by the scruff of the neck to children’s support services at the local children centre, taken to the dentist, or given information and classes on nutrition and feeding and things like that. What was needed was somebody to take control of that family’s life, get them back on the straight and narrow, and join up all the services and all that information, and that just was not happening. A lot of money, time and resources were being spent on that family, and things were not getting any better. That is why the Start for Life programme, and the Bill that my hon. Friend the Member for Hastings and Rye is putting together, are all about making sure that somebody takes control of the information around a family’s requirements and needs, points them in the right direction, and takes them physically to where they need to go if necessary, so that it does not constantly start again every time the family comes into contact with yet another agency or professional service. That is why the work on the red book—digitising it, for example—is important to make sure that information is readily available to everyone having contact with families that need that sort of help.

None of this is rocket science or, frankly, new; we have been talking about it for many years. Earlier, I dug out one of the reports from the conception to age two: first 1001 days all-party parliamentary group. “Building Great Britons”, which we produced back in 2015, is now almost 10 years old. I reread the foreword, which I wrote, and we made some recommendations. I will go through those quickly to see how many have become reality and how many can still become reality with the assistance of my hon. Friend’s Bill. We also came up with two conclusions. The first was:

“We want to create children who at the end of their first 1001 days have the social and emotional resources that form a strong foundation for good citizenship.”

Tick—that is absolutely still our goal. The second conclusion was:

“Without intervention, there will be in the future, as in the past, high intergenerational transmission of disadvantage, inequality, dysfunction and child maltreatment. These self-perpetuating cycles create untold and recurring costs for society. The economic value of breaking these cycles will be enormous.”

Tick—that absolutely applies today, as it did then. A case in point is the one I cited in Stockport, which is a textbook example of how failing to intervene properly is costing an awful lot of money.

The first recommendation was:

“Achieving the very best experience for children in their first 1001 days should be a mainstream undertaking by all political parties and a key priority for NHS England.”

I hope that the Start for Life programme, which the Minister proposed, was done with the sign-up of all the other main political parties. That is really important, because it is a long-term scheme. When there are changes of Government, it is important that one does not change everything for the sake of changing it—I was going to say, “Throw the baby out with the bathwater.” One might want a bit of rebranding or tweaking here and there, but this needs at least a decade to really take effect. I hope that the good work the Minister has done will carry over if there is a change of personnel and Government in the future.

The second recommendation was:

“Require local authorities, CCGs and Health & Wellbeing Boards to prioritise all factors leading to the development of socially and emotionally capable children at age 2, by: adopting …a ‘1001-days’ strategy”.

That is part of what the Bill proposed by my hon. Friend the Member for Hastings and Rye will impress on local authorities. Much of this is delivered through local authorities and local health professionals. It is all very well for the Government to say, “This is what needs to happen,” but it does not happen unless there is the buy-in, the infrastructure and the commitment to deliver it at the sharp end at local level.

The third recommendation was:

“National government should establish a ‘1001-days’ strategy fund to support local authorities and CCGs to make a decisive switch over the next 5 years, to a primary preventive approach”.

I think we are only part of the way on that one. The Minister may want to pick that up and explain how we can achieve that.

The fourth recommendation was:

“Hold Health & Wellbeing Boards responsible for ensuring that local authorities and CCGs demonstrate delivery of a sound primary prevention approach”,

as outlined in part 2 of our report. Again, that is what my hon. Friend’s Bill is trying to get at. We need to see commitment at a local level for local people to judge. They can do it in different ways. What might apply well in my constituency might not apply so well in my hon. Friend’s constituency, in large northern metropolitan boroughs, or in rural constituencies. It is up to local interpretation how it is best delivered, with a framework set out nationally, but with local authorities and local agencies having to describe and set out how they are going to achieve the goals and aims.

The fifth recommendation was:

“Build on the ‘Early Help’ recommendations of the Munro Review”,

which I commissioned in 2010,

“by requiring and supporting all relevant agencies in prevention to work together to prevent child maltreatment and promote secure attachment.”

As I found in office, joined-up government is an illusion. I hope that the appointment of my right hon. Friend the Minister, with a remit in several different Departments as well as Best Start for Life, achieves more of a joined-up approach in that regard.

The sixth recommendation was:

“Appoint a Minister for families and Best Start in Life with cross-departmental responsibility”,

which I hope the Minister is achieving. I hope it will survive and continue under whoever fills her shoes at some hopefully distant stage in the future.

The seventh recommendation was:

“Make joint inter-agency training on the importance of the early years for social and emotional development, for all professionals working with children and families in the early years, a priority in the ‘1001-days’ strategy.”

That is important, as I found in safeguarding. We need professionals from different bodies singing from the same song sheet. The most effective way to do that is with joint inter-agency training so that they learn about the requirements of the job sitting next to the police officer, the health visitor, the teacher, the GP, or whichever professional is involved. We do not do inter-agency joint training nearly effectively enough.

[Sally-Ann Hart]

My hon. Friend makes a valid point. Family hubs involve partnership working. I know that East Sussex family hubs partner with police, health and education, so they really do provide whole-family support.

[Tim Loughton]

That is absolutely right. We had children’s centres to an extent; we must have family hubs to a much larger extent. We need a sort of Piccadilly Circus of different professionals coming together, sharing information and nominating who will act for a particular family to make sure that the job is done and that a family in need does not fall foul of memos circulating between different professionals that never actually hit the spot. Somebody must pick it up and act on it. So many safeguarding cases end badly because somebody does not take responsibility, pick up the ball and act on it in whatever way. That is why family hubs are important.

We have all the relevant people in the same place, although hopefully going out of the family hub because most of the good things happen outside a family hub. It is not all about bricks and mortar, but where the services are targeted. The problem with children’s centres in the past, great idea though they were, was that the 15% most deprived families who would benefit most from the services offered by children’s centres tended to be those who did not access those centres. Family hubs are all about getting across thresholds where people live and go, work and shop and whatever it may be.

That was effectively the eighth recommendation. Children’s centres and youth hubs should be set up to be a melting pot of different services available.

The final recommendation was:

“Research evidence and good local area data are necessary to ensure effective changes are implemented to services. Where data and evidence are not available, these should be prioritised and supported with appropriate funding.”

I hope that as family hubs are rolled out and the Best Start for Life project becomes a reality they will start to produce the evidence we need to show that the impacts we are having on babies and their parents is life changing and dramatic. It is certainly a good investment socially and financially because hopefully we can prevent all the problems by getting in at the most appropriate time, at the earliest time.

Communication, information and all the things that my hon. Friend the Member for Hastings and Rye is endeavouring to achieve with her Bill—I wish her well with that on Friday—are all about continuing the jigsaw of the Best Start for Life, which my right hon. Friend the Minister started and which I hope will come to full fruition, because we desperately need it for so many of our children, families and babies in this country.