Infants, Parents and Carers Bill (First sitting)
Wednesday 14th October 2026
(1 day, 13 hours ago)
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The Chair
Will everyone ensure that all electronic devices are turned off or switched to silent mode? We will now begin line-by-line consideration of the Bill. The selection list for today’s sitting, which is available in the room and on the parliamentary website, shows how the clauses and selected amendment have been grouped for debate.
There are two groups for debate, each of which is led by the Question that a clause stand part of the Bill. The Member in charge, Sir Desmond Swayne, will be called to speak first and will address the Bill as a whole; I understand that he does not want to speak separately on the second group. Other Members will then be free to indicate, by bobbing, that they wish to speak in the debate. At the end of the debate on each group, I will call Sir Desmond again. Any Member who has tabled an amendment in a particular group will need to indicate whether they wish to withdraw it or seek a decision. I hope that explanation is helpful.
Clause 1
Services and functions to which this Act applies
Question proposed, That the clause stand part of the Bill.
The Chair
With this it will be convenient to discuss the following:
Amendment 1, in clause 2, page 2, line 4, at end insert—
“(1A) An assessment under subsection (1) must consider—
(a) the well-being of infants, parents, carers and prospective parents and carers, and
(b) inequalities between infants, parents, carers and prospective parents and carers.
(1B) In this Act “well-being” means—
(a) physical, mental and emotional health, and
(b) in respect of infants, protection from harm and neglect.”
Clauses 2 to 6 stand part.
Sir Desmond Swayne (New Forest West) (Con)
It is always a pleasure and a privilege to address the Chair, but particularly so when you are in it, Dame Siobhain. With your permission, I will make one contribution dealing with both groups.
Clause 1 sets out the statutory powers available to the Minister to secure services and functions with respect to
“pregnancy or childbirth…the health and development needs of infants, or…the relationship between parent or carer and infant.”
Although the amendment would amend clause 2, it clearly has implications for clause 1. In substance, it would require consideration of
“the well-being of infants, parents, carers and prospective parents and carers, and…inequalities between infants, parents, carers and prospective parents and carers.”
“Well-being” is defined in the amendment as
“physical, mental and emotional health, and…in respect of infants, protection from harm and neglect.”
My reading of the powers in clause 1 is that they are clearly inclusive of the wellbeing of infants and parents. The wellbeing of infants and parents must fall within
“pregnancy or childbirth…the health and development needs of infants, or…the relationship between parent or carer and infant.”
In that respect, I am confident that the amendment would be consistent with the powers granted in clause 1.
I am not so sure that equalities comes within those three powers set out in clause 1. I fear that the amendment would leave Ministers making an assessment that included health and wellbeing and inequalities, but with no power to address the issue of inequalities in statutory instruments under clause 1. It is a technical matter on which I defer to the Minister, but that is my take on it.
Rachael Maskell (York Central) (Lab/Co-op)
May I bring greater clarity? Discussion of the wellbeing of prospective parents or carers could include their wellbeing pre-conception, as I will argue later. In that case, a technical amendment may be needed to the definition in clause 1(2).
Sir Desmond Swayne
That is a fair point and undoubtedly a matter for debate. The clause sets out that regulatory powers are to be made by a statutory instrument under the affirmative procedure.
Clause 2 sets out the requirement for an assessment and a consultation within that assessment. Amendment 1 would explicitly add the need for health and wellbeing and inequalities to be included in the assessment. I believe that the assessment of need implicitly includes those things—as it should; these are important matters. My argument is that they are implicitly there already. However, it is important that the Minister, when making her assessment, should look beyond demand to how babies and families are faring, especially those that are at risk of doing poorly.
I can entirely understand the desire to make explicit that which is implicit in the Bill. After all, if the Bill is doing it anyway, what danger is there of adding an explicit requirement—belt and braces? The difficulty as I see it is that that opens it up to danger on Report, when Members might seek to explicitly add other things that are implicit in the Bill. I have received a number of suggested amendments from organisations representing different aspects of childcare in infancy and pregnancy, which state things that could be added explicitly but that I believe are clearly implicit in the powers the Bill gives to Ministers. That is why I resist the amendment.
Clause 3 covers the exercise of functions that ensure the appropriate level of provision. Having made an assessment, the Minister must then make appropriate levels of provision to meet those needs. That concludes my assessment of the first group.
Clause 4 concerns the annual reporting power and the laying of a report on provisions and outcomes before Parliament. Clause 5 is about the interpretation of various terms—what we mean by “infant”, “parent”, or “prospective parent or carer”. Clause 6 defines the short title of the Act and sets out the rules for commencement.
I commend these clauses to the Committee, but ask that amendment 1 be withdrawn.
Jess Asato (Lowestoft) (Lab)
It is a pleasure to serve under your chairship, Dame Siobhain. I am incredibly grateful to be sitting on this Committee.
Reforging cross-party consensus on the value of investing in the early years is essential, and the Bill helps us to get back to where we ought to be. It focuses on improving support for children and their families so that everyone can get the best possible start in life. I reiterate my thanks to the right hon. Member for New Forest West (Sir Desmond Swayne) for introducing this important piece of legislation.
I tabled an amendment to the Bill to make what is implicit in its intention explicit, and will describe why I have done so. To address the right hon. Member’s concerns about further amendments, it is always the case that where campaigners see an opportunity for further reform within the law, they seek to influence it. Many of us would like to see this legislation proceed and become law swiftly. I am sure that those campaigners will understand the need to make sure of the outcomes on inequalities, which speak to many of their aims with the legislation, and will want to see the amendment succeed.
If we want to improve experiences at the beginning of life—recognising how determinative that period is for life chances—it stands to reason that this legislation should make explicit the inequalities of outcomes for babies and infants. This was a key requirement of the Childcare Act 2006, and it was part of the governing philosophy behind Sure Start, which, as the Institute for Fiscal Studies has found, had the biggest impact on improving outcomes for children in the most disadvantaged neighbourhoods.
As it stands, the Bill relies on the Government reporting on the views of parents and carers and their prospective counterparts. Although that insight is incredibly valuable, it ignores those who cannot speak for themselves.
Sir Desmond Swayne
Has the hon. Lady considered the impact of section 149 of the Equality Act 2010 and its requirement that Ministers, as an ordinary part of making the assessment, have to include the issue of inequality?
Jess Asato
Indeed I have, and I will come to that in a moment.
As I was saying, the Bill does not give sufficient voice to those who cannot speak for themselves—babies and infants. My amendment seeks to ensure that the Government will assess how successful services are in improving the physical, mental and emotional wellbeing of infants, parents and carers and, crucially, will assess our progress in tackling inequalities in the early years.
Although there is other legislation, such as the Equality Act, to guide secondary legislation, we know from bitter experience that future Governments could repeal legislation that has equality as its goal. Indeed, we are in difficult and divisive times in our country at the moment. There are those who would seek to repeal the Equality Act, thereby undoing any of the protective features that that Act would bring to this important Bill.
To anticipate future Government policies, the Bill must make reporting on inequality of outcomes paramount, because significant inequalities exist in many of the most fundamental measures of babies’ health and development. Black babies, for example, are more than twice as likely as white babies to be stillborn. Babies in the 10% most-deprived areas are more than twice as likely to die as babies in the 10% least-deprived areas. Babies growing up in poverty are more likely to experience domestic abuse in their family and are less likely to be breastfed.
At the moment, these inequalities, which are reported on by Government through auspices such as the Equality Act, might be identified, but in future there may be no requirement for that to be the case as part of the Bill. Simply showing that there is provision for babies, infants and their parents and carers could ensure that the Secretary of State is able to discharge their duty under the Bill, whether it actually operates to reduce inequalities or not. Under our current legislation, we still have deep inequalities, in part because the focus on reducing inequalities between areas has been lost—and lost deliberately. I think we ought to see whether we can return to making sure that that is the focus.
As it stands, the Bill does not explicitly require the Secretary of State to look at outcomes for babies and their parents, or at what those outcomes may indicate about the quality and availability of services. Although the views and experiences of parents and carers are incredibly important in understanding need, they do not paint the full picture and we cannot rely solely on them to analyse successes and failures of services. The public deserve to know the realities of inequalities in early childhood, and Governments must welcome robust scrutiny of their policies to help support babies.
The amendment also requires the Government to look at the wellbeing of parents. That is particularly important given the Maternal Mental Health Alliance report that said that one in four mothers experiences a mental health condition during pregnancy or after birth. Suicide remains the leading cause of death for women between six weeks and a year after giving birth. The amendment keeps the Bill flexible and streamlined, and I understand that it would not increase any financial cost of the Bill. It also clarifies the role of the Government in measuring success.
The Bill needs to be future-proof—indeed, the purpose of the Bill is to ensure, on a cross-party basis, that our services genuinely lead to a change in outcomes for babies, infants and children throughout their lives. It must stand the test of time, regardless of the colour, priorities or whims of future Governments. I have absolute faith in this Government and their commitment to early years investment, including the wonderful growth of Best Start family hubs, but we all saw how quickly the consensus behind Sure Start fell apart with a change in Government and how a generation of children and their parents were disadvantaged by its collapse.
Dr Simon Opher (Stroud) (Lab)
I thank the right hon. Member for New Forest West for bringing forward this excellent Bill. I await the technical appraisal of whether it needs to be amended, but we cannot deny that inequalities directly influence specific types of services. In my role as a GP, I have seen that children born in deprived areas need a much higher level of support from Sure Start-type services and video interactive guidance, because often relationships are poor. Those poor relationships can lead to children starting school not being able to hold a knife and fork or still being in nappies. Inequalities influence what types of services are needed. I accept the point from the right hon. Member that there may be technical guidance, but perhaps it should be integrated within the Bill.
Sir Desmond Swayne
I agree entirely with the force of the argument in favour of equality being included in the Bill. It is important that these issues be addressed. The difference between us is that I think they are already implicit in the Bill. Demand that it be explicit is predicated on future-proofing it. Alas, were a future Government determined to remove equalities and repeal the Equalities Act, they would soon enough repeal the provision within this Bill. The difficulty with Sure Start was that there was no statutory provision, and it was done by administrative fiat without putting legislation before the Commons.
Jess Asato
When developing legislation, the core purpose that we want to achieve needs to be explicit within it, because otherwise it could get watered down. The right hon. Member is right that any future Government can overturn any previous Government’s legislation, unless bound by international law and so forth. Making the intention explicit makes it more difficult for future Governments to undo what has come before, because it allows the brilliant light of transparency to be shone where we might need it most in the future. To make the issue of equality explicit in the Bill, and for the Government to recognise its importance, would be a small but, perhaps in the future, important way of maintaining the integrity of the legislation.
I am delighted that the amendment has the support of a number of children’s charities working in this space, including Start Strong, the National Society for the Prevention of Cruelty to Children, the National Children’s Bureau, Barnardo’s, the first 1,001 days movement, the Royal College of Paediatrics and Child Health and the Tessa Jowell Foundation.
Jess Brown-Fuller (Chichester) (LD)
I thank the right hon. Member for New Forest West for introducing this important piece of legislation, and all the Members who have supported its progress. I have two points that I hope the Minister can clarify.
The amendment mentions prospective parents, and a prospective parent is defined as somebody who is experiencing a pregnancy. I wonder whether that includes parents who are undergoing IVF. They might not know whether an embryo transfer has worked, but at the moment after an embryo transfer, they are pregnant. There is a postcode lottery in respect of IVF services in this country. Someone can live on one road and get three rounds of IVF or live on another road and get only one. Those people are prospective parents in my mind, because they are working very hard and going through real difficulties to bring into this world young people who would be loved.
I refer Members to my entry in the Register of Members’ Interests as the chair of the all-party parliamentary group for infant feeding and inequalities. When I launched the APPG, it was called the APPG for infant feeding; we added “and inequalities” afterwards because it is so important to make sure that inequalities are addressed throughout everything we do. Families from more deprived areas are half as likely to breastfeed their children, even though breastfeeding can have positive outcomes for the health of both the mother and the baby and in terms of affordability for those families.
Will the Minister clarify whether breastfeeding support will be included in the infant support services that are assessed under the Bill? A recently published survey found that seven in 10 mothers who stopped breastfeeding by the time their baby was four to six months old said that they would have liked to have breastfed for longer, so there is clear demand in the public realm. If people saw more support for breastfeeding, they would be able to continue to do it for longer. For whatever reason—perhaps all the challenges that come alongside breastfeeding—they stop earlier than they would like to.
There are also positive steps. The infant feeding survey that was published in June 2026 shows that breastfeeding rates are going up, but it would be helpful to understand whether that will be monitored as part of the process so we can make sure that trajectory continues. Reducing health inequalities should include making sure that no mother experiences the postcode lottery of breastfeeding support that is currently so apparent. So many breastfeeding services are run by volunteers, midwives on their days off or health visitors who are squeezing in the time to provide those services. For many families, those services are not available at all.
Will the Minister commit to publishing clear statutory guidance that defines the breastfeeding and infant feeding support services that local authorities ought to provide under the Bill? The most recent Government announcement on the roll-out of Healthy Babies funding to all local authorities is excellent, but it did not explicitly mention breastfeeding and infant feeding support, whereas the wording in respect of the previous roll-out was far more explicit.
Mrs Sharon Hodgson (Washington and Gateshead South) (Lab)
It is a pleasure to speak in support of the Bill and the amendment. The right hon. Member for New Forest West laid out clearly on Second Reading why the Bill is important. He spoke very well again this morning and made case for why the amendment is perhaps not needed. I hesitated to add my name to the amendment for the very reasons he laid out, and the last thing we want is to risk the Government withdrawing their support for the Bill or to make it a Christmas tree Bill. However, I came to the conclusion that the amendment was very much needed, for the reasons set out by my hon. Friend the Member for Lowestoft in her excellent speech in support of her amendment and the Bill.
Without amendment, the Bill will require reasonable steps to be taken to find out the views of current and prospective parents and carers in assessing the need for infant support services, but it does not currently require an assessment of outcomes. The right hon. Member for New Forest West said that that is already implicit in the Bill, but we need a strong focus on data and evidence to see how babies and their parents are faring and to understand where provision is working and where it is not, with the scope to hold future Governments to account. The right hon. Gentleman said that we cannot always future-proof everything, but we do have to have a view on how a future Government of whatever colour might feel about issues of equality or inequality. It is important to try to make the new legislation we are considering today as good as it can possibly be, including if that involves future-proofing it.
Sir Desmond Swayne
It is quite explicit under clause 4 that the reporting should include outcomes in respect of what is set out in sub-paragraphs (i), (ii) and (iii) of clause 1(2)(b). That is where there is clearly, in my estimate, an omission of inequalities. I am quite confident that health and wellbeing are included within pregnancy or childbirth, the health and development needs of infants, and the relationship between parent or carer and infant. I am not convinced that the Bill includes powers to make regulations on inequalities, so if there were to be an amendment, in my estimate it would need to address that issue in clause 1.
Mrs Hodgson
I agree, and outcomes are mentioned in clause 4(2)(b). I pondered including the word “inequality” at length, for all the reasons we heard about from my hon. Friend the Member for Lowestoft, as well as in respect of what the Lib Dem spokesperson, the hon. Member for Chichester, said about breastfeeding. The survey she mentioned showed that only 41% of women in the north-east—my part of the world—are still breastfeeding at six to eight weeks, compared with 60% in the south-west, for example. Why is that? Is it inequality? Is it lack of support? Is it a postcode lottery of services? We need not just to measure outcomes but to know why, and whether inequality is behind that. That should therefore perhaps be the one and only amendment that we make to this important Bill, and it would be worth doing if the right hon. Member for New Forest West and the Minister support it.
It is of course very welcome that parents and carers should have a say in shaping services, but we must also ensure that the outcomes and, more importantly, the inequality of those outcomes are considered when assessing need. I am very proud to support the Bill, to see it become law and to support the amendment.
Dr Allison Gardner (Stoke-on-Trent South) (Lab)
I welcome the Bill’s ambition to strengthen support for babies, parents and carers during pregnancy and the earliest years of life. Parents love their babies and want them to be happy and healthy, and Governments must support them in that important role.
I acknowledge that the simplicity of the Bill is part of its beauty. I understand that there is a little resistance to adding amendments and creating Christmas tree legislation, but I worry that in fear of creating such legislation we risk—apologies for the pun—throwing the baby out with the bathwater if we do not make explicit in the Bill amendments on inequalities that will be difficult to change in future. To put it starkly, we have to be honest that it would be very hard, politically, to argue for the removal of provision on inequalities from the babies Bill. It is important to build that into the Bill.
I strongly support amendment 1, which would require the Secretary of State to consider the wellbeing of babies and their parents, and inequalities in their outcomes, when assessing need and reporting on infant support services. The amendment speaks to why we are all here: to improve babies and parents lives. We need to understand whether families are doing well, where outcomes are falling short and where further action is needed. We cannot just look at national statistics. An improvement in the national average can conceal the fact that some babies are being left further behind. We need to be able to look at the outliers.
Across the country, there are stark and persistent inequalities. A baby’s chance of surviving pregnancy, birth and their first years of life, and of growing up healthy and developing well, are affected by factors including family income, ethnicity, disability and where they live. The amendment would ensure that future Secretaries of State pay attention to those differences when making decisions in what they do and where they target action and resources.
On Second Reading I talked about Stoke-on-Trent’s persistently high infant mortality rate. The number of babies in Stoke-on-Trent who die before their first birthday is almost twice the national rate. We frequently top that saddest of all charts. If national Government do not pay attention to those local differences and inequalities, they will miss opportunities to improve and save babies lives.
Behind every statistic is a real baby whose life has been lost. [Interruption.] It is a hard one, this one. I will never forget little Chloe Wilshaw, or her brave mum Ashley, who I talked about on Second Reading. These are the babies and families I think of when we talk about the need to do better. I am very grateful that, following that debate, not only has the Minister agreed to meet Ashley, but so has the maternity commissioner, to really bring about change. I am very grateful to the right hon. Member for New Forest West for enabling that opportunity.
Sir Desmond Swayne
I draw the hon. Lady’s attention to clause 3(3), which states:
“The Secretary of State may determine that different levels of provision are appropriate in different areas.”
She makes the point very well that Ministers have to bear in mind exactly what she is drawing the Committee’s attention to.
Dr Gardner
I acknowledge that point, and it is clear in that clause, but I feel very strongly that the Bill should deal with inequality explicitly.
The amendment would establish a clear and consistent base for assessing needs and holding Governments to account. Governments and priorities change. We all know the future Governments may not care as much as today’s Ministers do about how babies are doing or addressing inequalities, as my hon. Friend the Member for Lowestoft so clearly explained. Putting outcomes and inequalities on the face of the Bill would help to ensure that they remain central to decision making and reporting in the years ahead.
We owe it to every baby and every family to understand where support is falling short, to confront the inequalities that persist and to ensure that no child’s early experiences and life chances—and no parent’s experience of their children—are determined by their postcode or family circumstances.
Ruth Jones (Newport West and Islwyn) (Lab)
It is a pleasure to serve under your chairmanship, Dame Siobhain. I commend my friend, the right hon. Member for New Forest West, for introducing this excellent Bill. I am so pleased that, as No. 1 in the ballot, he chose this issue and to build on the work of Dame Andrea Leadsom in the other place. So many people in this Parliament, including my hon. Friend the Member for Washington and Gateshead South, have done so much good work to make sure that the Bill comes to fruition.
I spoke in support of the Bill on Second Reading, which was a real honour, and I would like to speak today in support of amendment 1, tabled by my hon. Friend the Member for Lowestoft. I take on board what the right hon. Member for New Forest West said about the Bill’s intricacies—I defer to his abundant knowledge of intricacies, because he knows far more in this place than I do—but I support the amendment because it is all about the inequalities. We also know that a number of charities and NGOs support the amendment.
There are currently stark and stubborn inequalities in outcomes in the UK, and factors including ethnicity, family income, geography and disability are all associated with differences in the likelihood of parents and babies surviving pregnancy and the first parts of life. It is also so important to ensure that they are healthy and developing well as they go forward.
The amendment would not prescribe which services the Government must provide, nor would it require them to achieve specific outcomes through any single service. Instead, it would require the Government to understand and report on whether babies and their parents are doing well, where inequalities exist, and whether they change over time. Putting those requirements on the face of the Bill would ensure that outcomes and inequalities remain a consistent part of the Government’s assessment and reporting, regardless of future changes in policy, Parliament or personnel. Those were the important points for me.
Obviously, I defer to the right hon. Gentleman’s interpretation, but it is important to recognise that we cannot go forward with a Bill unless we know what it is measuring. We need a baseline, and we then need to be able to return to the data, year after year, and ask whether we are making progress. It is an issue if we cannot do that, because we cannot then adequately amend services to make sure that they work in the future.
I declare an interest as a physiotherapist for 32 years, many of which I spent as a paediatric physio, so I know how important the Bill is for pre-term babies, when they are in the womb. My physiotherapy colleagues now treat babies in the womb, which is amazing stuff, and surgeons also operate in the womb. The first 1,000 days are really important, as the right hon. Gentleman said, and this is about conception through to the first couple of years, as well as pre-conception planning.
Once the baby is born, whether or not they are born pre-term and go to a neonatal intensive care unit—in my day we called it a special care baby unit—we know that those first 1,000 days are so important for every baby across the UK. I say that as a Welsh MP, because Flying Start in Wales never went away—it is a bit shaky, but it never went away, compared with Sure Start in England. It is really important to make sure we have a level playing field for all mums and babies. The evidence is clear that a brain needs stimulation from day one, because its neuroplasticity becomes so much less after the age of five. That is really important.
Whether or not the amendment is accepted, I believe this is an excellent Bill. It is a good start that allows us to go forward united and make sure that we do the best we possibly can for parents and babies in the future. I pay tribute to the hard work undertaken by all the right hon. and hon. Members who have been here much longer than I have, and I look forward to hearing what the Minister has to say.
Rachael Maskell
We are indebted to the right hon. Member for New Forest West for introducing the Bill, and for all the work he has done on this issue. I will start by focusing my contribution on clause 4(2)(b), on which this debate hinges. It looks at inputs into the services and then outcomes with respect to matters mentioned earlier in the Bill. We are talking about fine lines and distinctions, but they are incredibly important.
In my intervention, I talked about the need for outcomes. If we are serious about achieving equality in outcomes, we cannot simply start at the point of pregnancy or childbirth, as set out in the Bill, or the point at which someone becomes a prospective parent, as set out in the amendment. A prospective parent means someone who expects to become a parent as a result of a current pregnancy or someone who expects to become the parent or carer of an infant already born.
I raise this issue because taking a public health approach to pregnancy means acknowledging that many of the factors that impact on outcomes are determined preconception. One clear example is the exposure of infants to fetal alcohol spectrum disorder. Around 77% of parents at the point of conception have used alcohol, exposing the foetus to risk of developing FASD. The trajectory through pregnancy and beyond of that infant has therefore been impacted by what happened in preconception.
If we are serious about the outcomes as set out and addressing the inequalities, we cannot simply start at the point of conception because we would miss a huge opportunity to change the outcomes for those infants and address these issues. Given that children with FASD are now more prevalent than children on the autism spectrum, we must recognise the impact that focusing on preconception can have in ensuring that parents have support.
I spoke to my local director of public health just yesterday. As one might expect, he raised issues around smoking cessation, mental health, exercise and diet. Ensuring that women are healthy at the point at which they conceive means that their pregnancy will carry in a safer environment. If we are serious about addressing the inequalities, we must consider the opportunity provided by this amendment. There is some conflict, and that is why it is important to consider that through the earliest of years.
I also want to raise the factors that can have a real impact. Can the right hon. Member for New Forest West assure me that we are talking not just about physical, mental and emotional health, but environmental health? That would be an important public health intervention. I cannot count the times I have had to support pregnant women because they are in appalling housing conditions, which can cause real stress and anxiety throughout the pregnancy. That can lead to poorer outcomes.
It is important, when considering the Bill, that we are look holistically at women’s surroundings and make sure they have the support they need.
Sir Desmond Swayne
I am confident that the needs of infants, parents and babies, from conception onwards, would clearly include healthy housing and all those provisions. In my view, that will be implicit in the Minister’s assessment of the needs. If we start being explicit about all these things, the danger is that we would have a very long Bill and a prolonged Report stage.
Rachael Maskell
I am grateful to the right hon. Member for his clarity. I hope that airing the issue in this debate will ensure that we measure the elements and secure the right environments.
A further issue that is particularly important to me, as chair of the APPG on adoption and permanence, is that of children at risk. We know that if early interventions are made to support parents through a pregnancy, we can diminish the risk of a child being taken into the care system. I spoke to our director of midwifery about the distress caused to midwives by trying to support a distressed mother as her child is removed. Reducing the risk of that happening is important.
Information sharing between health services and local authorities is absolutely crucial for interventions to be made to try to secure the relationship between the child and their parents, and for reducing the risk of a child being removed at birth or in the early days after it. I recognise that, in the lone local authority in my constituency, much is done to secure family bonds at the point the baby is born, but it is important that interventions are made during pregnancy to reduce the risk of a child being removed. The issue often stems from inequalities, so being able to measure them is incredibly important.
My final two key points look at input under clause 4(2). We know that the issue of workforce has been incredibly difficult to address at times, because we do not have a comprehensive workforce plan for the multi-agency teams involved in work around an infant. I therefore propose that the Minister consider creating an integrated, multi-agency workforce plan for the 1,001 critical day period to ensure real integration of service. That would also ensure that we do not see a workforce deficit, because clearly, not having the workforce there would have a huge impact on outcomes, particularly for more vulnerable families.
On how the report will be produced under clause 4, we need a pathway within the measurement, as it is important that parents and carers with lived experience have agency and voice in its formulation. I would appreciate the Minister commenting on that in her remarks, because we have demonstrated in York that when parents and carers are involved in providing feedback, services improve.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
It is a pleasure to serve under your chairmanship, Dame Siobhain.
I start by congratulating my right hon. Friend the Member for New Forest West on introducing this important Bill. I also recognise the contributions of Members of both Houses, and that of the former Members of Parliament Andrea Leadsom and Will Quince, who have done so much work in this area. I declare an interest, Dame Siobhain, as a consultant paediatrician in the NHS and a member of the Royal College of Paediatrics and Child Health. I put on record that the Opposition support this Bill.
Child development is hugely important; that is why Committee members are here today. It is also why I am in this place at all, as it was a major motivator for me to become an MP. As a paediatrician, I saw the profound effect that children not receiving the care that they need in the early years can have. Some cases were of deliberate neglect, and I saw children who had delayed growth, delayed development or physical changes. I remember one little boy who was admitted with vomiting, but he was not ill with a medical condition. We discovered that he had learnt to vomit because nobody came when he cried. Those children need us to step up in a way that we do not always do at the moment.
There is a spectrum, and most of the children are thankfully not in that situation, but it does demonstrate the profound changes that can occur if children are not looked after. However, we also see the profound improvements that can occur if children receive all the things that they need to thrive to their best potential. Sometimes parents may not understand the importance of certain interventions, or they may need support to deliver them. That is where this Bill comes in.
Jess Brown-Fuller
The shadow Minister is making a really important point. Does she also agree that representation in politics is so important and that having women in politics matters because they are able to talk about their unique experiences when it comes to breastfeeding? We need to make sure that we get lots of women into politics so that they can raise important points like she has just done.
Dr Caroline Johnson
I think it is important that we have both women and men in politics, because fathers have an important role to play with babies too, and gentlemen can talk about their experiences of fatherhood. One of the challenges that some babies face is the lack of that male role model. It is a balance between the two. And, of course, women and men can talk about each or either topic if they wish to do so.
The other thing I want to talk about is interaction and play—the serve and return. Being played with and stimulated is very important for brain development, and a lack of it can lead to reduced attention span, reduced memory and weaker impulse control in the long run. People might believe that interaction and play come instinctively, and to some they do, but to others less so. Support and understanding of what they can do to help their baby is something that I think women and men value, because almost everyone loves their children intently, so they will want to do the best for their baby, and sometimes it is helpful to know what that is. I often get patients in clinic who come with one problem, but if they have a small infant, they will often say, “While I am here, doctor, can you just look at this? Can I just ask about that?” I am sure the hon. Member for Stroud, as a GP, will tell us the same. Parents ask because there are so many questions, and having the opportunity to have them answered is very important.
I also want to talk about inequalities, because we have talked a lot about them this morning. There is now inequality between the services provided in cities and those provided in rural areas. Does the Minister have any comments on how those services will be provided in rural environments? Very often the average income for a postcode may be good, but there will be hidden poverty within it, because of discrepancies within postcode averages that are seen less in cities. Transport can also be more difficult in rural areas. How will the Minister ensure that the services are accessible to those who need them?
I want to talk about the money, because if we invest £1 in a child’s life at this age, we can get £10 in return owing to better outcomes in the long run. Will the Minister confirm that the money for those services will be provided in full, and that there will be a workforce plan to ensure that there is a workforce to deliver them?
The hon. Member for Washington and Gateshead South, who I know has done a lot of work in this area over the years and cares about it very deeply, talks about outcomes. Outcomes are important, but so is value for money, because we must be careful with taxpayers’ money. What interventions are making the most difference, and how do we focus on achieving them? We need to think carefully about what we measure. Overall, however, this is a good Bill that will help infants and children to develop their full potential and have equality of opportunity, and therefore I will support it.
The Minister for Public Health and Patient Safety (Dame Diana Johnson)
It is a pleasure to serve under your chairwomanship this morning, Dame Siobhain. We have had a very thoughtful and well-informed debate on the Bill. I am grateful to all hon. Members who have contributed, but I pay particular tribute to the right hon. Member for New Forest West for introducing the Bill and for the care, determination and constructive spirit with which he has championed it. I will follow his lead and deal with both groupings in my remarks.
We can all agree that every baby should get the best possible start in life, and I am delighted that last month the Secretary of State for Health and Social Care announced the expansion of Healthy Babies to every local authority in England. Like Sure Start before it, Healthy Babies will make enhanced health support available in every part of England, giving all families access to trusted, practical help throughout the critical 1,001 days from conception to age two. The Bill will complement the Healthy Babies expansion by creating a clear and enduring framework for support from conception to age two, providing long-term visibility and accountability.
A number of important points have been raised in the debate today. First, the hon. Member for Chichester asked whether those undergoing IVF would be included as prospective parents. The Bill focuses on support from conception to age two, as we have heard, therefore parents who conceive through IVF will be covered from the point at which a pregnancy is established, in the same way as any other prospective parent.
The hon. Member for Chichester also asked about breastfeeding, and there were a number of contributions on that very important issue. She asked whether there would be support for it in the secondary legislation that would come forward. Our starting point for the secondary legislation will be the Healthy Babies offer, which includes maternity, health visiting, infant feeding support, perinatal mental health support and parent-infant relationship support, while remaining open to considering other services that evidence might show babies and families actually need—so the answer to that is absolutely yes.
We also heard from my hon. Friend the Member for Washington and Gateshead South. I pay tribute to her for all the work she did in her previous role to make sure that the Bill could come before us today and will move through its stages in the House. She made a thoughtful and well-informed contribution—as ever—in support of amendment 1. My hon. Friend the Member for Stoke-on-Trent South also supports amendment 1, and spoke so movingly about the very sad case of her constituent Chloe Wilshaw. I am glad that Ministers will be meeting my hon. Friend shortly.
My hon. Friend the Member for Newport West and Islwyn talked about her experience as a paediatric physiotherapist, and how important the support that families and mothers get from conception onwards is to ensuring that babies get the best start in life. My hon. Friend the Member for York Central made, as ever, a considered speech. She raised a number of points, including whether environmental issues would be considered. I was interested to hear the exchange between her and the right hon. Member for New Forest West on that point, and his belief that it is implicit in the Bill’s drafting that environmental issues would be considered, among others. The sharing of data among health and local authorities in respect of children at risk is absolutely a key issue that we need to work at.
The hon. Member for Sleaford and North Hykeham raised the workforce plan. I am told that we will not have to wait too much longer and that a workforce plan will be published shortly, but I take the point made by my hon. Friend the Member for York Central about the need for integrated workforce planning in respect of babies and children. I also recognise the need to include the voice and agency of families, mothers, fathers and carers in this whole issue.
Finally, pre-conception health is of course very important, but the Bill is deliberately focused on the clearly defined period from conception to age two, when support can be directly linked to pregnancy, childbirth and infant development. Extending the Bill further would significantly broaden its scope and duplicate wider public health policy.
Let me turn to the clauses. Clause 1 establishes the scope of the framework set out in the Bill. It requires the Secretary of State to make regulations specifying the publicly funded infant support services to which the Act will apply, together with the functions connected with their provision. Those services must support pregnancy or childbirth, an infant’s health and development, or the relationship between an infant and their parent or carer. Crucially, the clause allows services and functions to be updated as needs and provisions evolve, thereby helping support to remain relevant to babies and families. Any change will be made through regulations subject to parliamentary oversight. That approach allows the framework to evolve as evidence, services and families’ needs change. The regulations will be subject to the affirmative procedure, so both Houses will have an opportunity to scrutinise and approve them.
Clause 2 puts the needs and experience of infants, parents and carers at the heart of national decision making. It helps to ensure that babies, whose voices are too often unheard, are not overlooked. We all know that the period from conception to age two is a golden opportunity to shape life, health, learning and happiness. The clause therefore requires the Secretary of State to assess the expected level of need for infant support services specified in the Bill. This is a practical, evidence-informed approach. So that it can respond to the needs of babies and families as they change, the clause deliberately does not prescribe every detail of the assessment. It does, however, establish a clear expectation that need will be understood and kept under review, thereby helping to inform decisions about services and resources.
Iqbal Mohamed (Dewsbury and Batley) (Ind)
The Bill will monitor what services are available and where there are deficiencies. I welcome the Government’s commitment to expanding the Healthy Babies programme across England, but we know today that there is a 40% shortfall in the number of health visitors needed; some health visitors are covering up to 1,000 cases instead of 250. Will the Minister comment on the actions the Government are taking today to address known deficiencies in parallel with taking the Bill forward?
Dame Diana Johnson
I am grateful to the hon. Gentleman for raising that point. We all understand how important health visitors are, and I acknowledge the reduction in numbers over previous years; this Government are determined to do something about that. I take his point. Given my responsibility for children’s health, I am very conscious that in health visitors we have a service with great potential. I am thinking particularly about improving vaccination rates; work is going on with health visitors on that. I will write to the hon. Gentleman with more specific details, but I absolutely take his point.
I return to clause 2. The Secretary of State must “take reasonable steps” to include the views of parents and carers as well as prospective parents and carers when carrying out the assessment. Just as we encourage local areas to shape services for and with families, national decisions should begin with the experience of babies and those who care for them; that goes to the point raised by my hon. Friend the Member for York Central. Some babies and families, of course, face additional challenges due to issues such as poor mental health, isolation, financial pressure or housing insecurity, and a regular assessment will help bring those pressures into view and inform decisions about the appropriate levels of provision.
It might help at this point if I turn to the amendment tabled by my hon. Friend the Member for Lowestoft. She has long championed the rights of children and the need to address inequalities, and she made her points in this debate with her usual eloquence and passion. I understand and welcome the challenge that she has made. She is right to press the Government to ensure that the assessment looks beyond expressed demand, considering both wellbeing and inequalities, and pays particular attention to those experiencing the greatest disadvantage. The Government share that objective.
It was always intended that the clause 2 assessments would consider health inequalities, drawing on evidence of unmet need and differences between groups and places. We intended—and I think the right hon. Member for New Forest West did, too—that that would be implicit in the drafting of the Bill. We have heard reference to section 149 of the Equality Act 2010 and section 1C of the NHS Act 2006, the public sector equality duty and the duty to reduce inequalities in access to and outcomes from health services. Together, they require particular attention to those experiencing the greatest disadvantage.
However, I absolutely understand the importance of ensuring that the assessment considers wellbeing and inequalities. Families do not experience need equally, and the assessment must pay particular attention to those facing health inequalities so that unmet need is identified and services can respond fairly and effectively. I would therefore welcome the opportunity to work with my hon. Friend the Member for Lowestoft and the right hon. Member for New Forest West to further consider the amendment ahead of Report. On that basis, I ask my hon. Friend whether she would consider not pushing her amendment to a vote at this stage and returning to it on Report.
Clause 3 concerns action. It builds on the assessment required by clause 2 and ensures that evidence of the needs of babies and families informs the exercise of the Secretary of State’s functions. The clause requires the Secretary of State, when exercising functions specified in the Bill, to act with a view to ensuring appropriate levels of service provision for infants, parents and carers, and prospective parents and carers. In doing so, the Secretary of State must have regard to the most recent assessment of need carried out under clause 2. That creates a clear link between understanding need and considering appropriate levels of provision.
The Bill deliberately does not impose a rigid or uniform national requirement. Needs, existing services and local circumstances differ, and an equal distribution of resources will not always deliver an equitable response. Instead, clause 3 allows the Secretary of State to take account of assessed need, differences between areas and the services already available. The level and type of provision may therefore vary, while the needs of babies and families remain central to decision making. This approach strengthens visibility and accountability, while retaining the flexibility needed to respond to circumstances changing. The needs of babies and families can change rapidly, and an agile response is required. Those 1,001 days cannot wait.
Clause 4 provides the accountability mechanism at the heart of the Bill. It requires the Secretary of State to prepare a report for each reporting period, and to lay that report before both Houses of Parliament. The report must assess the level of provision of the specified infant support services during the period, which will give Parliament regular and transparent information about the support available in England to infants, parents, carers, and prospective parents and carers.
Importantly, the report must consider not only what provision exists but the contribution that those services have made to positive outcomes in relation to pregnancy and childbirth, infant health and development, and the relationship between parents or carers and the infant. That includes examining those outcomes in the light of the needs assessed under clause 2. Clause 4 therefore completes the link between understanding need, considering the appropriate level of provision and reporting openly on the contributions that services are making to positive outcomes. By making provision and outcomes more visible, the clause will support sustained focus on babies and their families, and it will provide a clear basis for parliamentary scrutiny.
Clause 5 defines the Bill’s key terms. It defines an infant as
“a child under two years of age”,
which reflects the Bill’s focus on the earliest period of life, when the foundations for health, wellbeing and development are laid. It defines a parent broadly, including anyone with parental responsibility for a child or an infant. It also recognises carers who look after an infant without having parental responsibility. That inclusive approach reflects the range of family circumstances in which infants are cared for, ensuring that the Bill is not limited to one particular family structure or legal relationship.
Clause 5 also covers prospective parents and carers, meaning that the Bill can take account of people preparing to become responsible for an infant, whether through a current pregnancy or in relation to a child who has already been born. Those definitions do not create any separate duties or entitlement to services; they provide the clarity needed for the duties in the Bill to be understood and applied consistently.
Clause 6 contains standard provisions needed to bring the Bill into effect. It deals with territorial extent, commencement, transitional or saving arrangements and the short title of the Act. The Bill extends to England and Wales, but its substantive provisions apply to England. Clause 6 will take effect on Royal Assent, with the remaining provisions commenced by regulation, which allows time to prepare for implementation. As I have said, regulations specifying or changing the services and functions within scope will be subject to the affirmative procedure, giving both Houses the opportunity to scrutinise and approve them.
This is a really important Bill. It will help ensure that babies and families remain visible in national decision making, and that support during the critical period from conception to age two is informed by need, focused on outcomes and accountable to Parliament. I thank all Members again for their thoughtful and constructive contributions today. I pay tribute to the right hon. Member for New Forest West for introducing the Bill, and for his continued commitment to giving every baby the best possible start in life. The Government are pleased to support the Bill, and I commend it to the Committee.
Sir Desmond Swayne
I thank members of the Committee for their attendance and their contributions. In particular, I thank the hon. Member for Lowestoft for tabling amendment 1, which not only enabled the debate we have had but allowed the Minister to make the commitment she has now given to work further on the issue it deals with. After all, achieving such debate and scrutiny of a Bill is one of the principal duties of a Bill Committee. We are all, as a Committee, of one objective, even if we may have detected some minor difference as to how it might best be achieved.
I also thank the Minister and her officials for the work that has gone into preparing the Bill and getting it to this stage today, particularly the recent discussions we have had. I also thank the support of staff in my own office who have carried the burden of that. I ask all members of the Committee to put into their diaries Friday 29 January, when we will deal with the Bill’s remaining stages—that is certainly my estimate of when we will do so. I hope that there will not be a Division, but if there were to be it is vital that the Committee should be quorate.
Question put and agreed to.
Clause 1 accordingly ordered to stand part of the Bill.
Clauses 2 to 6 ordered to stand part of the Bill.
Bill to be reported, without amendment.
Infants, Parents and Carers Bill
(1 day, 13 hours ago)
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The Chair
Will everyone ensure that all electronic devices are turned off or switched to silent mode? We will now begin line-by-line consideration of the Bill. The selection list for today’s sitting, which is available in the room and on the parliamentary website, shows how the clauses and selected amendment have been grouped for debate.
There are two groups for debate, each of which is led by the Question that a clause stand part of the Bill. The Member in charge, Sir Desmond Swayne, will be called to speak first and will address the Bill as a whole; I understand that he does not want to speak separately on the second group. Other Members will then be free to indicate, by bobbing, that they wish to speak in the debate. At the end of the debate on each group, I will call Sir Desmond again. Any Member who has tabled an amendment in a particular group will need to indicate whether they wish to withdraw it or seek a decision. I hope that explanation is helpful.
Clause 1
Services and functions to which this Act applies
Question proposed, That the clause stand part of the Bill.
The Chair
With this it will be convenient to discuss the following:
Amendment 1, in clause 2, page 2, line 4, at end insert—
“(1A) An assessment under subsection (1) must consider—
(a) the well-being of infants, parents, carers and prospective parents and carers, and
(b) inequalities between infants, parents, carers and prospective parents and carers.
(1B) In this Act “well-being” means—
(a) physical, mental and emotional health, and
(b) in respect of infants, protection from harm and neglect.”
Clauses 2 to 6 stand part.
Sir Desmond Swayne (New Forest West) (Con)
It is always a pleasure and a privilege to address the Chair, but particularly so when you are in it, Dame Siobhain. With your permission, I will make one contribution dealing with both groups.
Clause 1 sets out the statutory powers available to the Minister to secure services and functions with respect to
“pregnancy or childbirth…the health and development needs of infants, or…the relationship between parent or carer and infant.”
Although the amendment would amend clause 2, it clearly has implications for clause 1. In substance, it would require consideration of
“the well-being of infants, parents, carers and prospective parents and carers, and…inequalities between infants, parents, carers and prospective parents and carers.”
“Well-being” is defined in the amendment as
“physical, mental and emotional health, and…in respect of infants, protection from harm and neglect.”
My reading of the powers in clause 1 is that they are clearly inclusive of the wellbeing of infants and parents. The wellbeing of infants and parents must fall within
“pregnancy or childbirth…the health and development needs of infants, or…the relationship between parent or carer and infant.”
In that respect, I am confident that the amendment would be consistent with the powers granted in clause 1.
I am not so sure that equalities comes within those three powers set out in clause 1. I fear that the amendment would leave Ministers making an assessment that included health and wellbeing and inequalities, but with no power to address the issue of inequalities in statutory instruments under clause 1. It is a technical matter on which I defer to the Minister, but that is my take on it.
Rachael Maskell (York Central) (Lab/Co-op)
May I bring greater clarity? Discussion of the wellbeing of prospective parents or carers could include their wellbeing pre-conception, as I will argue later. In that case, a technical amendment may be needed to the definition in clause 1(2).
Sir Desmond Swayne
That is a fair point and undoubtedly a matter for debate. The clause sets out that regulatory powers are to be made by a statutory instrument under the affirmative procedure.
Clause 2 sets out the requirement for an assessment and a consultation within that assessment. Amendment 1 would explicitly add the need for health and wellbeing and inequalities to be included in the assessment. I believe that the assessment of need implicitly includes those things—as it should; these are important matters. My argument is that they are implicitly there already. However, it is important that the Minister, when making her assessment, should look beyond demand to how babies and families are faring, especially those that are at risk of doing poorly.
I can entirely understand the desire to make explicit that which is implicit in the Bill. After all, if the Bill is doing it anyway, what danger is there of adding an explicit requirement—belt and braces? The difficulty as I see it is that that opens it up to danger on Report, when Members might seek to explicitly add other things that are implicit in the Bill. I have received a number of suggested amendments from organisations representing different aspects of childcare in infancy and pregnancy, which state things that could be added explicitly but that I believe are clearly implicit in the powers the Bill gives to Ministers. That is why I resist the amendment.
Clause 3 covers the exercise of functions that ensure the appropriate level of provision. Having made an assessment, the Minister must then make appropriate levels of provision to meet those needs. That concludes my assessment of the first group.
Clause 4 concerns the annual reporting power and the laying of a report on provisions and outcomes before Parliament. Clause 5 is about the interpretation of various terms—what we mean by “infant”, “parent”, or “prospective parent or carer”. Clause 6 defines the short title of the Act and sets out the rules for commencement.
I commend these clauses to the Committee, but ask that amendment 1 be withdrawn.
Jess Asato (Lowestoft) (Lab)
It is a pleasure to serve under your chairship, Dame Siobhain. I am incredibly grateful to be sitting on this Committee.
Reforging cross-party consensus on the value of investing in the early years is essential, and the Bill helps us to get back to where we ought to be. It focuses on improving support for children and their families so that everyone can get the best possible start in life. I reiterate my thanks to the right hon. Member for New Forest West (Sir Desmond Swayne) for introducing this important piece of legislation.
I tabled an amendment to the Bill to make what is implicit in its intention explicit, and will describe why I have done so. To address the right hon. Member’s concerns about further amendments, it is always the case that where campaigners see an opportunity for further reform within the law, they seek to influence it. Many of us would like to see this legislation proceed and become law swiftly. I am sure that those campaigners will understand the need to make sure of the outcomes on inequalities, which speak to many of their aims with the legislation, and will want to see the amendment succeed.
If we want to improve experiences at the beginning of life—recognising how determinative that period is for life chances—it stands to reason that this legislation should make explicit the inequalities of outcomes for babies and infants. This was a key requirement of the Childcare Act 2006, and it was part of the governing philosophy behind Sure Start, which, as the Institute for Fiscal Studies has found, had the biggest impact on improving outcomes for children in the most disadvantaged neighbourhoods.
As it stands, the Bill relies on the Government reporting on the views of parents and carers and their prospective counterparts. Although that insight is incredibly valuable, it ignores those who cannot speak for themselves.
Sir Desmond Swayne
Has the hon. Lady considered the impact of section 149 of the Equality Act 2010 and its requirement that Ministers, as an ordinary part of making the assessment, have to include the issue of inequality?
Jess Asato
Indeed I have, and I will come to that in a moment.
As I was saying, the Bill does not give sufficient voice to those who cannot speak for themselves—babies and infants. My amendment seeks to ensure that the Government will assess how successful services are in improving the physical, mental and emotional wellbeing of infants, parents and carers and, crucially, will assess our progress in tackling inequalities in the early years.
Although there is other legislation, such as the Equality Act, to guide secondary legislation, we know from bitter experience that future Governments could repeal legislation that has equality as its goal. Indeed, we are in difficult and divisive times in our country at the moment. There are those who would seek to repeal the Equality Act, thereby undoing any of the protective features that that Act would bring to this important Bill.
To anticipate future Government policies, the Bill must make reporting on inequality of outcomes paramount, because significant inequalities exist in many of the most fundamental measures of babies’ health and development. Black babies, for example, are more than twice as likely as white babies to be stillborn. Babies in the 10% most-deprived areas are more than twice as likely to die as babies in the 10% least-deprived areas. Babies growing up in poverty are more likely to experience domestic abuse in their family and are less likely to be breastfed.
At the moment, these inequalities, which are reported on by Government through auspices such as the Equality Act, might be identified, but in future there may be no requirement for that to be the case as part of the Bill. Simply showing that there is provision for babies, infants and their parents and carers could ensure that the Secretary of State is able to discharge their duty under the Bill, whether it actually operates to reduce inequalities or not. Under our current legislation, we still have deep inequalities, in part because the focus on reducing inequalities between areas has been lost—and lost deliberately. I think we ought to see whether we can return to making sure that that is the focus.
As it stands, the Bill does not explicitly require the Secretary of State to look at outcomes for babies and their parents, or at what those outcomes may indicate about the quality and availability of services. Although the views and experiences of parents and carers are incredibly important in understanding need, they do not paint the full picture and we cannot rely solely on them to analyse successes and failures of services. The public deserve to know the realities of inequalities in early childhood, and Governments must welcome robust scrutiny of their policies to help support babies.
The amendment also requires the Government to look at the wellbeing of parents. That is particularly important given the Maternal Mental Health Alliance report that said that one in four mothers experiences a mental health condition during pregnancy or after birth. Suicide remains the leading cause of death for women between six weeks and a year after giving birth. The amendment keeps the Bill flexible and streamlined, and I understand that it would not increase any financial cost of the Bill. It also clarifies the role of the Government in measuring success.
The Bill needs to be future-proof—indeed, the purpose of the Bill is to ensure, on a cross-party basis, that our services genuinely lead to a change in outcomes for babies, infants and children throughout their lives. It must stand the test of time, regardless of the colour, priorities or whims of future Governments. I have absolute faith in this Government and their commitment to early years investment, including the wonderful growth of Best Start family hubs, but we all saw how quickly the consensus behind Sure Start fell apart with a change in Government and how a generation of children and their parents were disadvantaged by its collapse.
Dr Simon Opher (Stroud) (Lab)
I thank the right hon. Member for New Forest West for bringing forward this excellent Bill. I await the technical appraisal of whether it needs to be amended, but we cannot deny that inequalities directly influence specific types of services. In my role as a GP, I have seen that children born in deprived areas need a much higher level of support from Sure Start-type services and video interactive guidance, because often relationships are poor. Those poor relationships can lead to children starting school not being able to hold a knife and fork or still being in nappies. Inequalities influence what types of services are needed. I accept the point from the right hon. Member that there may be technical guidance, but perhaps it should be integrated within the Bill.
Sir Desmond Swayne
I agree entirely with the force of the argument in favour of equality being included in the Bill. It is important that these issues be addressed. The difference between us is that I think they are already implicit in the Bill. Demand that it be explicit is predicated on future-proofing it. Alas, were a future Government determined to remove equalities and repeal the Equalities Act, they would soon enough repeal the provision within this Bill. The difficulty with Sure Start was that there was no statutory provision, and it was done by administrative fiat without putting legislation before the Commons.
Jess Asato
When developing legislation, the core purpose that we want to achieve needs to be explicit within it, because otherwise it could get watered down. The right hon. Member is right that any future Government can overturn any previous Government’s legislation, unless bound by international law and so forth. Making the intention explicit makes it more difficult for future Governments to undo what has come before, because it allows the brilliant light of transparency to be shone where we might need it most in the future. To make the issue of equality explicit in the Bill, and for the Government to recognise its importance, would be a small but, perhaps in the future, important way of maintaining the integrity of the legislation.
I am delighted that the amendment has the support of a number of children’s charities working in this space, including Start Strong, the National Society for the Prevention of Cruelty to Children, the National Children’s Bureau, Barnardo’s, the first 1,001 days movement, the Royal College of Paediatrics and Child Health and the Tessa Jowell Foundation.
Jess Brown-Fuller (Chichester) (LD)
I thank the right hon. Member for New Forest West for introducing this important piece of legislation, and all the Members who have supported its progress. I have two points that I hope the Minister can clarify.
The amendment mentions prospective parents, and a prospective parent is defined as somebody who is experiencing a pregnancy. I wonder whether that includes parents who are undergoing IVF. They might not know whether an embryo transfer has worked, but at the moment after an embryo transfer, they are pregnant. There is a postcode lottery in respect of IVF services in this country. Someone can live on one road and get three rounds of IVF or live on another road and get only one. Those people are prospective parents in my mind, because they are working very hard and going through real difficulties to bring into this world young people who would be loved.
I refer Members to my entry in the Register of Members’ Interests as the chair of the all-party parliamentary group for infant feeding and inequalities. When I launched the APPG, it was called the APPG for infant feeding; we added “and inequalities” afterwards because it is so important to make sure that inequalities are addressed throughout everything we do. Families from more deprived areas are half as likely to breastfeed their children, even though breastfeeding can have positive outcomes for the health of both the mother and the baby and in terms of affordability for those families.
Will the Minister clarify whether breastfeeding support will be included in the infant support services that are assessed under the Bill? A recently published survey found that seven in 10 mothers who stopped breastfeeding by the time their baby was four to six months old said that they would have liked to have breastfed for longer, so there is clear demand in the public realm. If people saw more support for breastfeeding, they would be able to continue to do it for longer. For whatever reason—perhaps all the challenges that come alongside breastfeeding—they stop earlier than they would like to.
There are also positive steps. The infant feeding survey that was published in June 2026 shows that breastfeeding rates are going up, but it would be helpful to understand whether that will be monitored as part of the process so we can make sure that trajectory continues. Reducing health inequalities should include making sure that no mother experiences the postcode lottery of breastfeeding support that is currently so apparent. So many breastfeeding services are run by volunteers, midwives on their days off or health visitors who are squeezing in the time to provide those services. For many families, those services are not available at all.
Will the Minister commit to publishing clear statutory guidance that defines the breastfeeding and infant feeding support services that local authorities ought to provide under the Bill? The most recent Government announcement on the roll-out of Healthy Babies funding to all local authorities is excellent, but it did not explicitly mention breastfeeding and infant feeding support, whereas the wording in respect of the previous roll-out was far more explicit.
Mrs Sharon Hodgson (Washington and Gateshead South) (Lab)
It is a pleasure to speak in support of the Bill and the amendment. The right hon. Member for New Forest West laid out clearly on Second Reading why the Bill is important. He spoke very well again this morning and made case for why the amendment is perhaps not needed. I hesitated to add my name to the amendment for the very reasons he laid out, and the last thing we want is to risk the Government withdrawing their support for the Bill or to make it a Christmas tree Bill. However, I came to the conclusion that the amendment was very much needed, for the reasons set out by my hon. Friend the Member for Lowestoft in her excellent speech in support of her amendment and the Bill.
Without amendment, the Bill will require reasonable steps to be taken to find out the views of current and prospective parents and carers in assessing the need for infant support services, but it does not currently require an assessment of outcomes. The right hon. Member for New Forest West said that that is already implicit in the Bill, but we need a strong focus on data and evidence to see how babies and their parents are faring and to understand where provision is working and where it is not, with the scope to hold future Governments to account. The right hon. Gentleman said that we cannot always future-proof everything, but we do have to have a view on how a future Government of whatever colour might feel about issues of equality or inequality. It is important to try to make the new legislation we are considering today as good as it can possibly be, including if that involves future-proofing it.
Sir Desmond Swayne
It is quite explicit under clause 4 that the reporting should include outcomes in respect of what is set out in sub-paragraphs (i), (ii) and (iii) of clause 1(2)(b). That is where there is clearly, in my estimate, an omission of inequalities. I am quite confident that health and wellbeing are included within pregnancy or childbirth, the health and development needs of infants, and the relationship between parent or carer and infant. I am not convinced that the Bill includes powers to make regulations on inequalities, so if there were to be an amendment, in my estimate it would need to address that issue in clause 1.
Mrs Hodgson
I agree, and outcomes are mentioned in clause 4(2)(b). I pondered including the word “inequality” at length, for all the reasons we heard about from my hon. Friend the Member for Lowestoft, as well as in respect of what the Lib Dem spokesperson, the hon. Member for Chichester, said about breastfeeding. The survey she mentioned showed that only 41% of women in the north-east—my part of the world—are still breastfeeding at six to eight weeks, compared with 60% in the south-west, for example. Why is that? Is it inequality? Is it lack of support? Is it a postcode lottery of services? We need not just to measure outcomes but to know why, and whether inequality is behind that. That should therefore perhaps be the one and only amendment that we make to this important Bill, and it would be worth doing if the right hon. Member for New Forest West and the Minister support it.
It is of course very welcome that parents and carers should have a say in shaping services, but we must also ensure that the outcomes and, more importantly, the inequality of those outcomes are considered when assessing need. I am very proud to support the Bill, to see it become law and to support the amendment.
Dr Allison Gardner (Stoke-on-Trent South) (Lab)
I welcome the Bill’s ambition to strengthen support for babies, parents and carers during pregnancy and the earliest years of life. Parents love their babies and want them to be happy and healthy, and Governments must support them in that important role.
I acknowledge that the simplicity of the Bill is part of its beauty. I understand that there is a little resistance to adding amendments and creating Christmas tree legislation, but I worry that in fear of creating such legislation we risk—apologies for the pun—throwing the baby out with the bathwater if we do not make explicit in the Bill amendments on inequalities that will be difficult to change in future. To put it starkly, we have to be honest that it would be very hard, politically, to argue for the removal of provision on inequalities from the babies Bill. It is important to build that into the Bill.
I strongly support amendment 1, which would require the Secretary of State to consider the wellbeing of babies and their parents, and inequalities in their outcomes, when assessing need and reporting on infant support services. The amendment speaks to why we are all here: to improve babies and parents lives. We need to understand whether families are doing well, where outcomes are falling short and where further action is needed. We cannot just look at national statistics. An improvement in the national average can conceal the fact that some babies are being left further behind. We need to be able to look at the outliers.
Across the country, there are stark and persistent inequalities. A baby’s chance of surviving pregnancy, birth and their first years of life, and of growing up healthy and developing well, are affected by factors including family income, ethnicity, disability and where they live. The amendment would ensure that future Secretaries of State pay attention to those differences when making decisions in what they do and where they target action and resources.
On Second Reading I talked about Stoke-on-Trent’s persistently high infant mortality rate. The number of babies in Stoke-on-Trent who die before their first birthday is almost twice the national rate. We frequently top that saddest of all charts. If national Government do not pay attention to those local differences and inequalities, they will miss opportunities to improve and save babies lives.
Behind every statistic is a real baby whose life has been lost. [Interruption.] It is a hard one, this one. I will never forget little Chloe Wilshaw, or her brave mum Ashley, who I talked about on Second Reading. These are the babies and families I think of when we talk about the need to do better. I am very grateful that, following that debate, not only has the Minister agreed to meet Ashley, but so has the maternity commissioner, to really bring about change. I am very grateful to the right hon. Member for New Forest West for enabling that opportunity.
Sir Desmond Swayne
I draw the hon. Lady’s attention to clause 3(3), which states:
“The Secretary of State may determine that different levels of provision are appropriate in different areas.”
She makes the point very well that Ministers have to bear in mind exactly what she is drawing the Committee’s attention to.
Dr Gardner
I acknowledge that point, and it is clear in that clause, but I feel very strongly that the Bill should deal with inequality explicitly.
The amendment would establish a clear and consistent base for assessing needs and holding Governments to account. Governments and priorities change. We all know the future Governments may not care as much as today’s Ministers do about how babies are doing or addressing inequalities, as my hon. Friend the Member for Lowestoft so clearly explained. Putting outcomes and inequalities on the face of the Bill would help to ensure that they remain central to decision making and reporting in the years ahead.
We owe it to every baby and every family to understand where support is falling short, to confront the inequalities that persist and to ensure that no child’s early experiences and life chances—and no parent’s experience of their children—are determined by their postcode or family circumstances.
Ruth Jones (Newport West and Islwyn) (Lab)
It is a pleasure to serve under your chairmanship, Dame Siobhain. I commend my friend, the right hon. Member for New Forest West, for introducing this excellent Bill. I am so pleased that, as No. 1 in the ballot, he chose this issue and to build on the work of Dame Andrea Leadsom in the other place. So many people in this Parliament, including my hon. Friend the Member for Washington and Gateshead South, have done so much good work to make sure that the Bill comes to fruition.
I spoke in support of the Bill on Second Reading, which was a real honour, and I would like to speak today in support of amendment 1, tabled by my hon. Friend the Member for Lowestoft. I take on board what the right hon. Member for New Forest West said about the Bill’s intricacies—I defer to his abundant knowledge of intricacies, because he knows far more in this place than I do—but I support the amendment because it is all about the inequalities. We also know that a number of charities and NGOs support the amendment.
There are currently stark and stubborn inequalities in outcomes in the UK, and factors including ethnicity, family income, geography and disability are all associated with differences in the likelihood of parents and babies surviving pregnancy and the first parts of life. It is also so important to ensure that they are healthy and developing well as they go forward.
The amendment would not prescribe which services the Government must provide, nor would it require them to achieve specific outcomes through any single service. Instead, it would require the Government to understand and report on whether babies and their parents are doing well, where inequalities exist, and whether they change over time. Putting those requirements on the face of the Bill would ensure that outcomes and inequalities remain a consistent part of the Government’s assessment and reporting, regardless of future changes in policy, Parliament or personnel. Those were the important points for me.
Obviously, I defer to the right hon. Gentleman’s interpretation, but it is important to recognise that we cannot go forward with a Bill unless we know what it is measuring. We need a baseline, and we then need to be able to return to the data, year after year, and ask whether we are making progress. It is an issue if we cannot do that, because we cannot then adequately amend services to make sure that they work in the future.
I declare an interest as a physiotherapist for 32 years, many of which I spent as a paediatric physio, so I know how important the Bill is for pre-term babies, when they are in the womb. My physiotherapy colleagues now treat babies in the womb, which is amazing stuff, and surgeons also operate in the womb. The first 1,000 days are really important, as the right hon. Gentleman said, and this is about conception through to the first couple of years, as well as pre-conception planning.
Once the baby is born, whether or not they are born pre-term and go to a neonatal intensive care unit—in my day we called it a special care baby unit—we know that those first 1,000 days are so important for every baby across the UK. I say that as a Welsh MP, because Flying Start in Wales never went away—it is a bit shaky, but it never went away, compared with Sure Start in England. It is really important to make sure we have a level playing field for all mums and babies. The evidence is clear that a brain needs stimulation from day one, because its neuroplasticity becomes so much less after the age of five. That is really important.
Whether or not the amendment is accepted, I believe this is an excellent Bill. It is a good start that allows us to go forward united and make sure that we do the best we possibly can for parents and babies in the future. I pay tribute to the hard work undertaken by all the right hon. and hon. Members who have been here much longer than I have, and I look forward to hearing what the Minister has to say.
Rachael Maskell
We are indebted to the right hon. Member for New Forest West for introducing the Bill, and for all the work he has done on this issue. I will start by focusing my contribution on clause 4(2)(b), on which this debate hinges. It looks at inputs into the services and then outcomes with respect to matters mentioned earlier in the Bill. We are talking about fine lines and distinctions, but they are incredibly important.
In my intervention, I talked about the need for outcomes. If we are serious about achieving equality in outcomes, we cannot simply start at the point of pregnancy or childbirth, as set out in the Bill, or the point at which someone becomes a prospective parent, as set out in the amendment. A prospective parent means someone who expects to become a parent as a result of a current pregnancy or someone who expects to become the parent or carer of an infant already born.
I raise this issue because taking a public health approach to pregnancy means acknowledging that many of the factors that impact on outcomes are determined preconception. One clear example is the exposure of infants to fetal alcohol spectrum disorder. Around 77% of parents at the point of conception have used alcohol, exposing the foetus to risk of developing FASD. The trajectory through pregnancy and beyond of that infant has therefore been impacted by what happened in preconception.
If we are serious about the outcomes as set out and addressing the inequalities, we cannot simply start at the point of conception because we would miss a huge opportunity to change the outcomes for those infants and address these issues. Given that children with FASD are now more prevalent than children on the autism spectrum, we must recognise the impact that focusing on preconception can have in ensuring that parents have support.
I spoke to my local director of public health just yesterday. As one might expect, he raised issues around smoking cessation, mental health, exercise and diet. Ensuring that women are healthy at the point at which they conceive means that their pregnancy will carry in a safer environment. If we are serious about addressing the inequalities, we must consider the opportunity provided by this amendment. There is some conflict, and that is why it is important to consider that through the earliest of years.
I also want to raise the factors that can have a real impact. Can the right hon. Member for New Forest West assure me that we are talking not just about physical, mental and emotional health, but environmental health? That would be an important public health intervention. I cannot count the times I have had to support pregnant women because they are in appalling housing conditions, which can cause real stress and anxiety throughout the pregnancy. That can lead to poorer outcomes.
It is important, when considering the Bill, that we are look holistically at women’s surroundings and make sure they have the support they need.
Sir Desmond Swayne
I am confident that the needs of infants, parents and babies, from conception onwards, would clearly include healthy housing and all those provisions. In my view, that will be implicit in the Minister’s assessment of the needs. If we start being explicit about all these things, the danger is that we would have a very long Bill and a prolonged Report stage.
Rachael Maskell
I am grateful to the right hon. Member for his clarity. I hope that airing the issue in this debate will ensure that we measure the elements and secure the right environments.
A further issue that is particularly important to me, as chair of the APPG on adoption and permanence, is that of children at risk. We know that if early interventions are made to support parents through a pregnancy, we can diminish the risk of a child being taken into the care system. I spoke to our director of midwifery about the distress caused to midwives by trying to support a distressed mother as her child is removed. Reducing the risk of that happening is important.
Information sharing between health services and local authorities is absolutely crucial for interventions to be made to try to secure the relationship between the child and their parents, and for reducing the risk of a child being removed at birth or in the early days after it. I recognise that, in the lone local authority in my constituency, much is done to secure family bonds at the point the baby is born, but it is important that interventions are made during pregnancy to reduce the risk of a child being removed. The issue often stems from inequalities, so being able to measure them is incredibly important.
My final two key points look at input under clause 4(2). We know that the issue of workforce has been incredibly difficult to address at times, because we do not have a comprehensive workforce plan for the multi-agency teams involved in work around an infant. I therefore propose that the Minister consider creating an integrated, multi-agency workforce plan for the 1,001 critical day period to ensure real integration of service. That would also ensure that we do not see a workforce deficit, because clearly, not having the workforce there would have a huge impact on outcomes, particularly for more vulnerable families.
On how the report will be produced under clause 4, we need a pathway within the measurement, as it is important that parents and carers with lived experience have agency and voice in its formulation. I would appreciate the Minister commenting on that in her remarks, because we have demonstrated in York that when parents and carers are involved in providing feedback, services improve.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
It is a pleasure to serve under your chairmanship, Dame Siobhain.
I start by congratulating my right hon. Friend the Member for New Forest West on introducing this important Bill. I also recognise the contributions of Members of both Houses, and that of the former Members of Parliament Andrea Leadsom and Will Quince, who have done so much work in this area. I declare an interest, Dame Siobhain, as a consultant paediatrician in the NHS and a member of the Royal College of Paediatrics and Child Health. I put on record that the Opposition support this Bill.
Child development is hugely important; that is why Committee members are here today. It is also why I am in this place at all, as it was a major motivator for me to become an MP. As a paediatrician, I saw the profound effect that children not receiving the care that they need in the early years can have. Some cases were of deliberate neglect, and I saw children who had delayed growth, delayed development or physical changes. I remember one little boy who was admitted with vomiting, but he was not ill with a medical condition. We discovered that he had learnt to vomit because nobody came when he cried. Those children need us to step up in a way that we do not always do at the moment.
There is a spectrum, and most of the children are thankfully not in that situation, but it does demonstrate the profound changes that can occur if children are not looked after. However, we also see the profound improvements that can occur if children receive all the things that they need to thrive to their best potential. Sometimes parents may not understand the importance of certain interventions, or they may need support to deliver them. That is where this Bill comes in.
Jess Brown-Fuller
The shadow Minister is making a really important point. Does she also agree that representation in politics is so important and that having women in politics matters because they are able to talk about their unique experiences when it comes to breastfeeding? We need to make sure that we get lots of women into politics so that they can raise important points like she has just done.
Dr Caroline Johnson
I think it is important that we have both women and men in politics, because fathers have an important role to play with babies too, and gentlemen can talk about their experiences of fatherhood. One of the challenges that some babies face is the lack of that male role model. It is a balance between the two. And, of course, women and men can talk about each or either topic if they wish to do so.
The other thing I want to talk about is interaction and play—the serve and return. Being played with and stimulated is very important for brain development, and a lack of it can lead to reduced attention span, reduced memory and weaker impulse control in the long run. People might believe that interaction and play come instinctively, and to some they do, but to others less so. Support and understanding of what they can do to help their baby is something that I think women and men value, because almost everyone loves their children intently, so they will want to do the best for their baby, and sometimes it is helpful to know what that is. I often get patients in clinic who come with one problem, but if they have a small infant, they will often say, “While I am here, doctor, can you just look at this? Can I just ask about that?” I am sure the hon. Member for Stroud, as a GP, will tell us the same. Parents ask because there are so many questions, and having the opportunity to have them answered is very important.
I also want to talk about inequalities, because we have talked a lot about them this morning. There is now inequality between the services provided in cities and those provided in rural areas. Does the Minister have any comments on how those services will be provided in rural environments? Very often the average income for a postcode may be good, but there will be hidden poverty within it, because of discrepancies within postcode averages that are seen less in cities. Transport can also be more difficult in rural areas. How will the Minister ensure that the services are accessible to those who need them?
I want to talk about the money, because if we invest £1 in a child’s life at this age, we can get £10 in return owing to better outcomes in the long run. Will the Minister confirm that the money for those services will be provided in full, and that there will be a workforce plan to ensure that there is a workforce to deliver them?
The hon. Member for Washington and Gateshead South, who I know has done a lot of work in this area over the years and cares about it very deeply, talks about outcomes. Outcomes are important, but so is value for money, because we must be careful with taxpayers’ money. What interventions are making the most difference, and how do we focus on achieving them? We need to think carefully about what we measure. Overall, however, this is a good Bill that will help infants and children to develop their full potential and have equality of opportunity, and therefore I will support it.
The Minister for Public Health and Patient Safety (Dame Diana Johnson)
It is a pleasure to serve under your chairwomanship this morning, Dame Siobhain. We have had a very thoughtful and well-informed debate on the Bill. I am grateful to all hon. Members who have contributed, but I pay particular tribute to the right hon. Member for New Forest West for introducing the Bill and for the care, determination and constructive spirit with which he has championed it. I will follow his lead and deal with both groupings in my remarks.
We can all agree that every baby should get the best possible start in life, and I am delighted that last month the Secretary of State for Health and Social Care announced the expansion of Healthy Babies to every local authority in England. Like Sure Start before it, Healthy Babies will make enhanced health support available in every part of England, giving all families access to trusted, practical help throughout the critical 1,001 days from conception to age two. The Bill will complement the Healthy Babies expansion by creating a clear and enduring framework for support from conception to age two, providing long-term visibility and accountability.
A number of important points have been raised in the debate today. First, the hon. Member for Chichester asked whether those undergoing IVF would be included as prospective parents. The Bill focuses on support from conception to age two, as we have heard, therefore parents who conceive through IVF will be covered from the point at which a pregnancy is established, in the same way as any other prospective parent.
The hon. Member for Chichester also asked about breastfeeding, and there were a number of contributions on that very important issue. She asked whether there would be support for it in the secondary legislation that would come forward. Our starting point for the secondary legislation will be the Healthy Babies offer, which includes maternity, health visiting, infant feeding support, perinatal mental health support and parent-infant relationship support, while remaining open to considering other services that evidence might show babies and families actually need—so the answer to that is absolutely yes.
We also heard from my hon. Friend the Member for Washington and Gateshead South. I pay tribute to her for all the work she did in her previous role to make sure that the Bill could come before us today and will move through its stages in the House. She made a thoughtful and well-informed contribution—as ever—in support of amendment 1. My hon. Friend the Member for Stoke-on-Trent South also supports amendment 1, and spoke so movingly about the very sad case of her constituent Chloe Wilshaw. I am glad that Ministers will be meeting my hon. Friend shortly.
My hon. Friend the Member for Newport West and Islwyn talked about her experience as a paediatric physiotherapist, and how important the support that families and mothers get from conception onwards is to ensuring that babies get the best start in life. My hon. Friend the Member for York Central made, as ever, a considered speech. She raised a number of points, including whether environmental issues would be considered. I was interested to hear the exchange between her and the right hon. Member for New Forest West on that point, and his belief that it is implicit in the Bill’s drafting that environmental issues would be considered, among others. The sharing of data among health and local authorities in respect of children at risk is absolutely a key issue that we need to work at.
The hon. Member for Sleaford and North Hykeham raised the workforce plan. I am told that we will not have to wait too much longer and that a workforce plan will be published shortly, but I take the point made by my hon. Friend the Member for York Central about the need for integrated workforce planning in respect of babies and children. I also recognise the need to include the voice and agency of families, mothers, fathers and carers in this whole issue.
Finally, pre-conception health is of course very important, but the Bill is deliberately focused on the clearly defined period from conception to age two, when support can be directly linked to pregnancy, childbirth and infant development. Extending the Bill further would significantly broaden its scope and duplicate wider public health policy.
Let me turn to the clauses. Clause 1 establishes the scope of the framework set out in the Bill. It requires the Secretary of State to make regulations specifying the publicly funded infant support services to which the Act will apply, together with the functions connected with their provision. Those services must support pregnancy or childbirth, an infant’s health and development, or the relationship between an infant and their parent or carer. Crucially, the clause allows services and functions to be updated as needs and provisions evolve, thereby helping support to remain relevant to babies and families. Any change will be made through regulations subject to parliamentary oversight. That approach allows the framework to evolve as evidence, services and families’ needs change. The regulations will be subject to the affirmative procedure, so both Houses will have an opportunity to scrutinise and approve them.
Clause 2 puts the needs and experience of infants, parents and carers at the heart of national decision making. It helps to ensure that babies, whose voices are too often unheard, are not overlooked. We all know that the period from conception to age two is a golden opportunity to shape life, health, learning and happiness. The clause therefore requires the Secretary of State to assess the expected level of need for infant support services specified in the Bill. This is a practical, evidence-informed approach. So that it can respond to the needs of babies and families as they change, the clause deliberately does not prescribe every detail of the assessment. It does, however, establish a clear expectation that need will be understood and kept under review, thereby helping to inform decisions about services and resources.
Iqbal Mohamed (Dewsbury and Batley) (Ind)
The Bill will monitor what services are available and where there are deficiencies. I welcome the Government’s commitment to expanding the Healthy Babies programme across England, but we know today that there is a 40% shortfall in the number of health visitors needed; some health visitors are covering up to 1,000 cases instead of 250. Will the Minister comment on the actions the Government are taking today to address known deficiencies in parallel with taking the Bill forward?
Dame Diana Johnson
I am grateful to the hon. Gentleman for raising that point. We all understand how important health visitors are, and I acknowledge the reduction in numbers over previous years; this Government are determined to do something about that. I take his point. Given my responsibility for children’s health, I am very conscious that in health visitors we have a service with great potential. I am thinking particularly about improving vaccination rates; work is going on with health visitors on that. I will write to the hon. Gentleman with more specific details, but I absolutely take his point.
I return to clause 2. The Secretary of State must “take reasonable steps” to include the views of parents and carers as well as prospective parents and carers when carrying out the assessment. Just as we encourage local areas to shape services for and with families, national decisions should begin with the experience of babies and those who care for them; that goes to the point raised by my hon. Friend the Member for York Central. Some babies and families, of course, face additional challenges due to issues such as poor mental health, isolation, financial pressure or housing insecurity, and a regular assessment will help bring those pressures into view and inform decisions about the appropriate levels of provision.
It might help at this point if I turn to the amendment tabled by my hon. Friend the Member for Lowestoft. She has long championed the rights of children and the need to address inequalities, and she made her points in this debate with her usual eloquence and passion. I understand and welcome the challenge that she has made. She is right to press the Government to ensure that the assessment looks beyond expressed demand, considering both wellbeing and inequalities, and pays particular attention to those experiencing the greatest disadvantage. The Government share that objective.
It was always intended that the clause 2 assessments would consider health inequalities, drawing on evidence of unmet need and differences between groups and places. We intended—and I think the right hon. Member for New Forest West did, too—that that would be implicit in the drafting of the Bill. We have heard reference to section 149 of the Equality Act 2010 and section 1C of the NHS Act 2006, the public sector equality duty and the duty to reduce inequalities in access to and outcomes from health services. Together, they require particular attention to those experiencing the greatest disadvantage.
However, I absolutely understand the importance of ensuring that the assessment considers wellbeing and inequalities. Families do not experience need equally, and the assessment must pay particular attention to those facing health inequalities so that unmet need is identified and services can respond fairly and effectively. I would therefore welcome the opportunity to work with my hon. Friend the Member for Lowestoft and the right hon. Member for New Forest West to further consider the amendment ahead of Report. On that basis, I ask my hon. Friend whether she would consider not pushing her amendment to a vote at this stage and returning to it on Report.
Clause 3 concerns action. It builds on the assessment required by clause 2 and ensures that evidence of the needs of babies and families informs the exercise of the Secretary of State’s functions. The clause requires the Secretary of State, when exercising functions specified in the Bill, to act with a view to ensuring appropriate levels of service provision for infants, parents and carers, and prospective parents and carers. In doing so, the Secretary of State must have regard to the most recent assessment of need carried out under clause 2. That creates a clear link between understanding need and considering appropriate levels of provision.
The Bill deliberately does not impose a rigid or uniform national requirement. Needs, existing services and local circumstances differ, and an equal distribution of resources will not always deliver an equitable response. Instead, clause 3 allows the Secretary of State to take account of assessed need, differences between areas and the services already available. The level and type of provision may therefore vary, while the needs of babies and families remain central to decision making. This approach strengthens visibility and accountability, while retaining the flexibility needed to respond to circumstances changing. The needs of babies and families can change rapidly, and an agile response is required. Those 1,001 days cannot wait.
Clause 4 provides the accountability mechanism at the heart of the Bill. It requires the Secretary of State to prepare a report for each reporting period, and to lay that report before both Houses of Parliament. The report must assess the level of provision of the specified infant support services during the period, which will give Parliament regular and transparent information about the support available in England to infants, parents, carers, and prospective parents and carers.
Importantly, the report must consider not only what provision exists but the contribution that those services have made to positive outcomes in relation to pregnancy and childbirth, infant health and development, and the relationship between parents or carers and the infant. That includes examining those outcomes in the light of the needs assessed under clause 2. Clause 4 therefore completes the link between understanding need, considering the appropriate level of provision and reporting openly on the contributions that services are making to positive outcomes. By making provision and outcomes more visible, the clause will support sustained focus on babies and their families, and it will provide a clear basis for parliamentary scrutiny.
Clause 5 defines the Bill’s key terms. It defines an infant as
“a child under two years of age”,
which reflects the Bill’s focus on the earliest period of life, when the foundations for health, wellbeing and development are laid. It defines a parent broadly, including anyone with parental responsibility for a child or an infant. It also recognises carers who look after an infant without having parental responsibility. That inclusive approach reflects the range of family circumstances in which infants are cared for, ensuring that the Bill is not limited to one particular family structure or legal relationship.
Clause 5 also covers prospective parents and carers, meaning that the Bill can take account of people preparing to become responsible for an infant, whether through a current pregnancy or in relation to a child who has already been born. Those definitions do not create any separate duties or entitlement to services; they provide the clarity needed for the duties in the Bill to be understood and applied consistently.
Clause 6 contains standard provisions needed to bring the Bill into effect. It deals with territorial extent, commencement, transitional or saving arrangements and the short title of the Act. The Bill extends to England and Wales, but its substantive provisions apply to England. Clause 6 will take effect on Royal Assent, with the remaining provisions commenced by regulation, which allows time to prepare for implementation. As I have said, regulations specifying or changing the services and functions within scope will be subject to the affirmative procedure, giving both Houses the opportunity to scrutinise and approve them.
This is a really important Bill. It will help ensure that babies and families remain visible in national decision making, and that support during the critical period from conception to age two is informed by need, focused on outcomes and accountable to Parliament. I thank all Members again for their thoughtful and constructive contributions today. I pay tribute to the right hon. Member for New Forest West for introducing the Bill, and for his continued commitment to giving every baby the best possible start in life. The Government are pleased to support the Bill, and I commend it to the Committee.
Sir Desmond Swayne
I thank members of the Committee for their attendance and their contributions. In particular, I thank the hon. Member for Lowestoft for tabling amendment 1, which not only enabled the debate we have had but allowed the Minister to make the commitment she has now given to work further on the issue it deals with. After all, achieving such debate and scrutiny of a Bill is one of the principal duties of a Bill Committee. We are all, as a Committee, of one objective, even if we may have detected some minor difference as to how it might best be achieved.
I also thank the Minister and her officials for the work that has gone into preparing the Bill and getting it to this stage today, particularly the recent discussions we have had. I also thank the support of staff in my own office who have carried the burden of that. I ask all members of the Committee to put into their diaries Friday 29 January, when we will deal with the Bill’s remaining stages—that is certainly my estimate of when we will do so. I hope that there will not be a Division, but if there were to be it is vital that the Committee should be quorate.
Question put and agreed to.
Clause 1 accordingly ordered to stand part of the Bill.
Clauses 2 to 6 ordered to stand part of the Bill.
Bill to be reported, without amendment.