Infants, Parents and Carers Bill (First sitting) Debate
Full Debate: Read Full DebateDesmond Swayne
Main Page: Desmond Swayne (Conservative - New Forest West)Department Debates - View all Desmond Swayne's debates with the Department of Health and Social Care
(1 day, 12 hours ago)
Public Bill Committees
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.
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.
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).
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.