Oral Answers to Questions

Tim Loughton Excerpts

Tuesday 23rd June 2020 Commons Chamber

[Matt Hancock]

I have not got those data exactly—[Interruption.] If the Opposition would care to engage on the substance, rather than not taking this seriously, yesterday, we delivered the 8 millionth test in this country. We have delivered more than 100,000 tests on almost every day since the end of April and at the end of last week we were delivering 230,000 tests a day. I think what we need from the Opposition is support for the testing programme, because that is what people care about.

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

What steps he took to promote Infant Mental Health Awareness Week.

[The Minister for Patient Safety, Mental Health and Suicide Prevention (Ms Nadine Dorries) [V]]

[Inaudible.]

[The Secretary of State for Health and Social Care (Matt Hancock)]

I understand that Infant Mental Health Awareness Week was a great success. There is much to be gained from seeing the world through a baby’s eyes.

[Tim Loughton]

I am grateful to the Secretary of State for that short answer. We have heard much about the impact of lockdown on school-age children away from school, but little on the impact on babies and new parents facing particular challenges on their emotional wellbeing. Has the Secretary of State or the Minister, if she has got her voice back, seen the research published during Infant Mental Health Awareness Week by the First 1001 Days Movement last week, suggesting that three quarters of parents with children under two are feeling the detrimental impact of the lockdown, particularly BAME parents? What are the Government doing to put this crucial cohort on the radar and provide support before they grow up and take the problems to school and beyond?

[Mr Speaker]

Is the Minister available? No. I call the Secretary of State.

Social Distancing: 2 Metre Rule

Tim Loughton Excerpts

Monday 15th June 2020 Commons Chamber

[Edward Argar]

As the hon. Gentleman will have heard the Chancellor say on many occasions, we continue to keep all measures to support individuals and businesses under constant review, and I know that the Chancellor will have heard the point he makes.

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

I concur with what has been said by many right hon. and hon. Members who have warned about the implications for the hospitality industry, in particular, unless we change these rules sooner rather than later and about the impact on coastal towns. I come back to what was said by my hon. Friend the Member for Hazel Grove (Mr Wragg), because has there not been greater flexibility on social distancing for pupils in schools but not for the many adults? That is part of the problem as to why so few children are able to come back. Can we look at this urgently? Otherwise in September we will still have many, many children deprived of an education.

[Edward Argar]

My hon. Friend, a distinguished former children’s Minister, makes a very good point and that is exactly the sort of thing I will pass on to ensure that the review team considers it in the work it does.

Covid-19 Update

Tim Loughton Excerpts

Tuesday 24th March 2020 Commons Chamber

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

One of the glimmers of light in these troubling times are the amazing community volunteer projects that have sprung up in all our constituencies. The Secretary of State will be pleased to learn that on Sunday, we set up a “shopital” outside Worthing hospital, and I spent several hours selling rice, spuds and, crucially, loo paper to more than 100 ambulancemen, nurses and doctors. Should not that sort of arrangement be happening anyway with the supermarkets and with the new scheme delivering food packets, to make sure that NHS workers for whom going shopping at eight o’clock in the morning during the “golden hour” is not appropriate can get on with their job much more easily?

[Matt Hancock]

I did not know that my hon. Friend was engaged in that sort of activity on a Sunday morning, but I am delighted that he was. Making sure that we get hot meals to NHS staff who are working often many more shifts than gives them time to make a good meal is incredibly important. It is something that we are working hard on, but I am really glad when it happens spontaneously, as well as when we try to sort it from the Department.

Historical Stillbirth Burials and Cremations

Tim Loughton Excerpts

Thursday 6th February 2020 Commons Chamber

[Ms Dorries]

I certainly hope so. In fact, those parents and women who are coming forward now are enabling us to move along the pathway to women being given the full, correct information about what happens when a maternity incident takes place. We still have a long way to go, but, as I said at the beginning, the hon. Member for Swansea East is part of that process. The debates that we have here about baby loss are also part of that process. There is not one answer, one sledgehammer, that comes from the Department of Health and Social Care. Everybody has a role to play, because this is an issue that is spread over decades. It is about culture, and it is about the culture in hospitals today. It is about the esteem in which women and mothers are held within society. It is a complex picture with many parts, and everybody has an opportunity to play their part, as do those women who are now coming forward to ask where their babies’ ashes are.

Some hospitals arranged for stillborn babies to be cremated and told the parents that, because the baby was small, it would not be possible to recover any ashes. Even if ashes were recovered, their parents were not told. The ashes might have been spread in a dedicated garden of remembrance, but in other cases they might simply have been disposed of or kept in storage at the crematorium.

Over the past 20 years, we have heard about the discovery of mass graves containing the remains of stillborn babies in, among other places, Lancashire, Devon, Middlesbrough and Huddersfield. The 2015 review of infant cremations at Emstrey commercial crematorium in Shrewsbury found that, by using appropriate equipment and cremation techniques, it is normally possible to preserve ashes from infant cremations.

We now recognise that parents are committed and connected to their children long before birth—I think we knew that back then—perhaps at the point of conception or even earlier, when women imagine themselves being mothers for the first time. I am happy to say that, nowadays, parents of stillborn babies are able to be as involved in decisions about what happens to their baby as they choose to be. New regulations were introduced in 2016 to ensure that parents’ wishes for the cremation of their children are respected. The regulations introduced include a new statutory definition of what constitutes ashes or remains and require cremation request forms to be amended so that family’s wishes are explicitly recorded prior to any cremation.

Thanks to tireless campaigning by the hon. Member for Swansea East, the Government launched the children’s funeral fund last July so that bereaved parents do not have to worry about meeting the cost of burying or cremating their child or stillborn baby. The fund is available regardless of a family’s income and also includes a contribution towards the cost of the coffin. We have received over 1,000 claims to date, and I am sure that the hon. Lady must be incredibly proud.

The hon. Member for Swansea East called for this debate to consider what we in Parliament can do to help bereaved parents who did not have the opportunity to bury their stillborn babies and now wish to trace their final resting places. We know that parents never forget their babies, no matter how long ago their death occurred. Unfortunately, tracing a baby’s grave or a record of cremation may not be easy, and it can be a difficult time for people, both mentally and emotionally.

Records containing information about the locations of the remains of stillborn babies are not held centrally. Parents therefore need to start their search by contacting the hospital where the baby was stillborn, as I am sure the hon. Lady knows. If records are still available, the hospital should be able to tell parents whether the baby was buried or cremated and the name of the funeral director who made the arrangements at the time—if, indeed, a funeral director was involved. Hospitals do not keep records indefinitely, and some records may not contain enough detail to be helpful. The hospital where the baby was stillborn may have closed or the funeral director involved—if one was—may no longer be in business.

Cemeteries and crematoriums, though, are legally obliged to keep permanent records. If neither the hospital nor the funeral director has a record of which cemetery or crematorium was used, parents can contact local cemeteries and crematoriums, starting with those nearest to the hospital where their baby was stillborn. As I mentioned, in many cases stillborn babies were and may still be buried in a shared grave with other babies. These graves are usually unmarked, although they do have a plot number and can be located on a cemetery plan. In many cases, several babies were cremated together. The crematorium should have a record of where the ashes are scattered or buried, but I am afraid the emphasis is on the word “should”.

My sympathies lie with families who have had to deal with the pain of not knowing what happened to their children’s remains for so many years. It is hard for many of us to imagine how long that pain must last. The Department of Health and Social Care expects all hospitals to provide as much information as they have available to any parents who inquire about what happened to their stillborn babies, no matter how long ago they died.

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

I echo the Minister’s tribute to the hon. Member for Swansea East (Carolyn Harris).

It is unimaginable to think that parents who lost their child through stillbirth were not even privy to the arrangements for the cremation or burial of that child’s body—it was a completely different world.

On the Minister’s last point about urging hospitals to co-operate as much as possible, there is a bigger issue in that some of these children may not have been stillborn. Where a child lived for a while, as in the case she cited from 1976. there are greater questions to be asked about the child’s birth in that hospital. As a result of my Civil Partnerships, Marriages and Deaths (Registration etc) Act 2019, coroners will have the power, when the regulations are introduced, to look at such cases. Does she agree that there is a serious question not just on the whereabouts of a baby’s remains but on the circumstances of that baby’s birth?

[Ms Dorries]

That is an entirely different question but, yes, I completely agree with the substance of my hon. Friend’s point. I am sure he contributed to the Government’s consultation on the proposal for coroners to investigate stillbirths, which closed on 18 June 2019. The consultation attracted over 300 responses from a wide range of stakeholders. Officials in the Ministry of Justice and the Department of Health and Social Care have been working carefully to analyse the responses received. The question of babies who were not stillborn but who lived for a period of time before they died is possibly worth considering.

--- Later in debate ---

[Tim Loughton]

My right hon. Friend makes a good point about fathers. We talk a lot about the perinatal mental illness suffered by at least one in six women—and much more is being done about that—but it is less known that many fathers, particularly new fathers, suffer from perinatal mental illness as well. The impact of losing a newborn is of importance not just for the mother but equally for the father. We forget that at our peril.

[Sir John Hayes]

My hon. Friend, who served with me in the Department for Education, where he was responsible for matters concerning children, has a long track record of defending the interests of families and fathers. I pay tribute to that and entirely endorse what he has just said. Grandparents also feel these things very deeply. My children are only 19 and 15, so I am not enjoying grandparenthood yet, but those Members who are will know quite how profound their involvement is and their distress at loss can be. I entirely agree with what has been said about counselling, support and mental health.

I hope you will forgive me, Madam Deputy Speaker, for saying a word about public health funerals, a parallel but closely related matter on which the hon. Member for Swansea East and I have also co-operated. Councils in the UK spend about £4 million a year on nearly 15,000 burials or cremations for those with no next of kin or whose families are unable or unwilling to pay. They are known as public health funerals, although rather chillingly they are sometimes described as paupers’ funerals, which sounds so Dickensian, does it not? None the less, public health funerals are held for about 3% of all deaths, and there are real concerns about poor practice. The number of public health funerals has increased dramatically since 1997.

Tragically—in some cases councils are providing the bare minimum provision. Some of these funerals are held behind closed doors and families are prohibited from attending. There are instances of councils refusing to return ashes to families, even when requested. Sometimes, loved ones are not told when the funeral is going to take place, so they do not even know whether their loved one has been buried or, in most cases, cremated. I take this opportunity, with your permission, Madam Deputy Speaker, to call again on the Government to communicate with local authorities about the strict need to ensure that these funerals are dealt with in a decent, civilised and humane way. I am not confident that that is happening across the whole country, and it needs to do so without further delay.

I know that other Members want to contribute, so I shall draw my remarks to a conclusion simply by saying this. I spoke earlier of the Dickensian character of paupers’ funerals. Dickens said:

“A loving heart is the truest wisdom.”

Love is greater than life because love lasts longer and, because it does it should be at the heart of policy makers’ considerations when they deal with the highly important, very sensitive and profound issues that we debate today.

--- Later in debate ---

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

I had not intended to speak in this debate, but, as is usual with subjects brought here by the hon. Member for Swansea East (Carolyn Harris), it is difficult to resist; they are always such important and emotive issues, and the contributions we have heard have only heightened that fact. I also pay tribute to the sensitivity and real-world personal knowledge that the Minister has brought to this debate, and indeed to everything to do with children and babies generally. It greatly heightens the worth of what we do here.

Stillbirth, a hugely underappreciated subject, has been disproportionately debated in the Chamber in recent years, thanks to the brave personal testimonies of many right hon. and hon. Members whose families have been affected by baby loss in such tragic ways. Their contributions have been hugely valuable and moving, but, more importantly, have led to changes in legislation and greatly raised the profile of this important issue. It is an example of some of the great but underappreciated things we do in the House, and this is another great opportunity for us to do good on a really important issue.

My right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes) was right to mention the connection with mental illness, particularly around extended family members. Too often we look at mothers in isolation, with all the problems of pregnancy and childbirth, whether it is a healthy child or a stillborn child. We need to do more, as a society and as a Government, to think of the family in the round and the implications and impact that the tragedy of stillbirth can have on others, besides the mother.

We have made great progress in legislation in recent years, but, more importantly, we have made much progress in the sensitivity with which hospitals treat bereaved parents. We have legislated for bereavement leave, for example, but we should now consider extending that to this area as well. We have maternity and paternity leave, but losing a baby is hugely traumatic and impacts on the ability of parents to work normally afterwards.

I recently visited again the new bereavement suite in Worthing Hospital, which is officially the best hospital in the country with what is officially the best maternity department in the country. The bereavement suite is a fantastic facility. It is hard to imagine that until a few years ago mothers who had sadly just given birth to a stillborn child, or a child who died soon after, would be left within hearing range of children who had fortunately been born healthy to a mother in the same ward. Greater sensitivity is now shown throughout the whole NHS. It was great to visit that example of how well we now look after parents who tragically cannot take their child home with them.

It was through Worthing Hospital’s maternity department and the experience of my constituent Hayley from Worthing that I became much more familiar with the issue of stillbirth. She came to me to say that she had given birth to a stillborn child at about 19 and a half weeks at Worthing Hospital. She had been there in labour throughout the weekend and had gone through all the pains and anguish of giving birth to a stillborn child. That led to my Civil Partnerships, Marriages and Deaths (Registration etc) Act 2019 and a debate about the whole issue of how we look at and recognise the existence of children stillborn before the 24-week threshold.

Hayley’s experience goes back to the extraordinary revelations we have heard already about how we used to deal with stillborn babies and how the parents had no involvement. Once a woman was delivered of a stillborn baby, any authority or interest the parents had in that child apparently came to an end. It was an extraordinarily brutal and inhumane approach. In the case of Hayley, she and her partner held the child, named the child, had a formal funeral for the child and now know where the child is buried and can mourn. That has been part of the grieving process for them. It is right that the parents be able to do that, if it is their wish; they got the footprint and the photographs, and that was right for them.

The tragedy still is, however, that that child never existed in the eyes of the state, because he happened to have been born before the 24-week threshold, and that is what the 2019 Act aims to address. I wish to make a plea to the Minister. Section 3 obliges the Department of Health and Social Care to conduct a review into how we can do something about pre-24-week stillbirths—they are not technically called “stillbirths”. To give him his due, the former Secretary of State, my right hon. Friend the Member for South West Surrey (Jeremy Hunt), set up the review before the Act became law—I sat on and contributed to it, along with the hon. Member for Washington and Sunderland West (Mrs Hodgson)—but it has not met since 2018 and no subsequent review has been forthcoming. We still need to sort this out, because too many babies are being born just before 24 weeks. In previous debates, I have given examples of children born at 23 weeks, six days and a few hours. In one case, twins were born either side of the 24-week threshold. One was recognised and registered and one was not. This is an anomaly and an inhumanity and it is so important that we deal with it. I urge the Minister to inquire into where we are with the review.

We talk a lot in the House about historical injustices—this debate is technically about historical injustices, although we have spoken more about the present. I think of the historical child sex abuse scandal, the inquiry into which will go on for many years, but there are also parallels with the forced adoptions that occurred many years ago, when women, in an era of different morals, were forced to give up babies born out of wedlock. Many of those children ended up in Australia. There have been many reviews into how that was allowed to happen and into helping those children to re-establish connection with their birth parents.

What downside can there be to giving every assistance, difficult though it may be, to parents who, after having a stillborn child, were given no role in what happened to the body and have no knowledge of where the child’s remains are? I acknowledge that, as the Minister said, it would be difficult, particularly going back several decades, but we must make sure that hospitals, crematoriums and other public agencies do everything they can to respond sympathetically and extensively to queries from those people, just as we have done with child sex abuse and historical forced adoption.

The point I raised with the Minister might meet with some reluctance in some hospitals where practices were not of a quality we might have expected. Another section in my Act empowers coroners for the first time to investigate stillbirths. At the moment, they cannot do that, because a child who is stillborn is deemed never to have lived, and coroners can only investigate the deaths of humans who have lived. In a minority of cases—this practice was not extensive—children born alive have been designated as stillborn to avoid investigation through the coronial system. There is no reason why, once the further regulations are passed—I hope they will be soon; the Minister is right that the consultation ended last June—that we should not get on with giving coroners the power to investigate where they have reason to suspect that a stillbirth is not as simple or straightforward as it appears and that there might have been some medical negligence, oversight or whatever. If there were clusters of unexplained stillbirths, people might be reluctant to be co-operative in tracking down the details of what happened to that child and afterwards. I would hope, in the interests of providing parents who have already suffered a loss with some degree of closure, at least on what happened to the body of that child, that everyone involved in the national health service and other public agencies would want to be as co-operative as possible.

[Sir John Hayes]

I asked the Minister to consider new guidance for local authorities about both past and present practice, and perhaps my hon. Friend might echo that call by suggesting that the Government should make direct and urgent contact with health authorities, for exactly the reasons he has described, with the same kind of vehemence.

[Tim Loughton]

That is really the point that I was looking to make, but my right hon. Friend has done it much more clearly.

If it had not been her intention already, perhaps a takeaway from this debate for the Minister might be to send a communication around maternity departments, and indeed local authorities responsible for crematoriums and others, to express the hope that they would co-operate and to set out the exact extent of the potential issue that we are dealing with.

[Patricia Gibson]

To take the hon. Gentleman back to his earlier point, does he agree that the whole thrust behind instituting coroners’ inquiries—or, in Scotland, fatal accident inquiries—when these events happen is, added to the trauma, the complete lack of co-operation or willingness by hospitals to engage with parents in the appropriate way to give them the answers they need, as was certainly my experience?

[Tim Loughton]

That is right, but again, to give the Department of Health, the NHS and Ministers their due, there have been new innovations in internal inquiries into stillbirths that have made it much easier to get a dispassionate look at exactly what happened and give a full explanation of why it was that a pregnancy apparently without complication resulted in the child being stillborn.

The issue, and the reason my Act is so important, is that in a few complicated cases where the explanation is not sufficient for parents or where not enough disclosure is forthcoming—there has been some resistance from the medical profession; some were not in favour of the relevant clause—the fallback position is that if the coroner sees that there is a case to answer, he or she can launch an investigation, regardless of the view of the hospital or, importantly, of the parents, into whether there was more to the stillbirth that merits inquiry and whether there might be wider lessons, particularly with clusters of stillbirths, as we have had with various scandals in hospitals in this country, to ensure greater transparency.

I think the point I am getting at is that it is in everybody’s interests to have greater transparency, to ensure that we reduce the level of stillbirths, which has been too big a problem for this country compared with other western countries, and we can only do that if everybody has full access to all the information about exactly what the causes might have been. That is my ask of the Minister. Can we chase the Department on why the other bits of my Act have not been introduced yet?

I again pay tribute to the hon. Member for Swansea East, who we are all looking forward to hearing, for bringing together the House on another greatly important matter—a matter that may seem of niche interest, but which is of huge interest to parents who have had their lives so affected by the trauma of a stillbirth, particularly where they do not even know what happened to the body of the baby.

--- Later in debate ---

[Ms Dorries]

The hon. Lady is right; the NHS trust has the ability and the jurisdiction to conduct its own inquiry. I believe that NHS Improvement would have a similar responsibility. As a result of today’s debate, I am going to investigate a little more deeply within the Department how we can go about having an inquiry and what the terms of reference would be. It may be that such an inquiry is not possible, but I will certainly find out whether it is.

My hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) asked for an update on the pregnancy loss review. I attended the APPG on baby loss a few weeks ago. We expect the report being done by Zoe Clark-Coates and Samantha Collinge to be published in spring/summer, and we expect to publish a Government response to the consultation in spring going into summer. Again, I will push and see how much longer that will take.

[Tim Loughton]

The problem is that nothing has been agreed, because the pregnancy loss review group has not met since 2018. If a report is imminent, it has not been approved by the panel members, including me and the hon. Member for Washington and Sunderland West (Mrs Hodgson). I do not know what will be presented to the Government before they can even respond. The Minister might want to investigate how the group came to conclusions of which we know little.

[Ms Dorries]

I will. If my hon. Friend drops me an email at my departmental address, we will look into that, and the officials will take it away. I am grateful to him for raising that, because I was not aware of it.

I do not think I have missed out anyone who made a speech. We have heard today how important it is to many parents to find the final resting place of their stillborn children’s remains. Unfortunately, that is not always easy or possible, and I have explained that such records are not currently held by the Government. Rather, they are held by local hospitals that arranged for burials or cremations with local funeral directors or crematoriums. In some cases, records no longer exist, or they may not contain enough detail to be helpful.

Nevertheless, I reiterate that the Department of Health and Social Care expects all hospitals to provide as much information as they have available to them to any parents who inquire about what happened to their stillborn babies, no matter how long ago they died. I would like to praise the 800 parents who have attempted to find out where their babies’ remains are, because they have helped to raise the profile of this issue. As the hon. Member for Swansea East said, only by raising the profile do we manage to get something done. We need to continue to do that, because that is how we will make progress.

We have also heard today about the new regulations and systems to ensure that parents are involved, as they want to be, in the burial or cremation arrangements for their stillborn children. Parents are required by law to register a stillbirth, and once registration has been completed the registrar provides parents with all the certification they need to organise their babies’ burial or cremation, and a funeral service if they so wish. The required burial and cremation forms ensure that the wishes of parents are recorded and respected. Many NHS hospitals still do make arrangements for funeral services and support parents to consider various options and to make the decisions that are right for them. Some parents may wish to arrange a private burial or cremation with a funeral director. Most funeral directors do not charge for their services for stillborn babies. Thanks to the hon. Lady’s efforts, the new children’s funeral fund supports parents, as I said in my opening speech.

A funeral can sometimes be a catalyst for people to begin processing a deeply profound loss. At such a time, parents mourning their stillborn baby need as much emotional support, compassion and understanding as possible. However, the quality of support can vary from one maternity service to another. This is why the Government have funded Sands, the stillbirth and neonatal death charity, to work with other baby loss charities and the royal colleges to produce a national bereavement care pathway. The pathway covers a range of circumstances of baby loss, including miscarriage, stillbirth, termination of a pregnancy for medical reasons, neonatal death and sudden infant death syndrome. The NBCP is now embedded in 43 sites, and a further 59 sites have formally expressed their interest in joining the programme.

I would like to talk a little bit about mental health support. The hon. Member for Kingston upon Hull North is a campaigner on this, and she raised mental health during her speech. A couple of weeks ago, I visited nurses who are delivering perinatal mental health care support. As part of the new approach to and new funding for mental health, there are now specialist perinatal mental health community services in all 44 local NHS areas in England, and further developments are planned. Just in 2018-19, this has enabled over 13,000 additional women to receive support from specialist perinatal mental health services, against a target of 9,000.

I spoke to the nurses about the perinatal services that are being delivered, and in that particular trust they have helped 700 women who previously had no assistance whatsoever. It was incredible to hear the stories of how that assistance—the mental health support—is now being given to women. As I have said, all trusts now have in place those perinatal support services, which were never there before. Again, that is a huge step on the path towards delivering services that are focused on women and their needs.

Via maternity outreach clinics, we are also providing targeted assessment and intervention for women identified with moderate or complex mental health needs arising from or related to their maternity experience who would benefit from specialist support, but where it may not be appropriate or helpful for them to accept specialist perinatal mental health services, so we are even thinking further than that. In those services we are also assisting partners and families, so it is not just for the women, but for their partners and families.

A huge amount of work is being done in this area. I am not saying that we have finished—there is more to be done—but we are making progress. This actually fits in very well with our women’s agenda in the Department of Health and Social Care. The women’s agenda is not just about periods and menopause; it is about so many things. The particular area we are discussing today is a huge part of that.

Hon. Members present for the Baby Loss Awareness Week debate last October may recall that I undertook to write to Professor Jacqueline Dunkley-Bent, the chief midwifery officer in England, to ask if those bereaved by baby death could be included in the NHS long-term plan commitment to develop maternity outreach clinics that will integrate maternity, reproductive health and psychological therapy support for women with mental health difficulties arising from or related to the maternity experience. I am delighted to tell the House that I recently received a letter from the chief midwifery officer confirming that access to these services is available to women and their partners who are experiencing moderate or complex/severe issues, so we have listened and we have addressed that need. At this point, I should pay tribute to Professor Jacqueline Dunkley-Bent for her understanding of and support for my role in helping to deliver better services to women.

As I have said, a funeral can often be a catalyst for helping people to deal with death and stillbirth death, and I believe that that is so important today. It used to be about protecting women or just not holding them in high enough esteem to inform them about what happened, but we now know that actually the opposite is true. As my hon. Friend the Member for East Worthing and Shoreham mentioned, it is important to be involved not just in the death, but in what happened before, during and just afterwards. The question parents have at a time like this is: why? That question needs to be answered, and it does not get answered in a sentence or in a minute. Parents need to know and women need to know. They can only feel as though they have fulfilled their own responsibility to their child when they have explored every avenue and know every detail of what happened.

Wuhan Coronavirus

Tim Loughton Excerpts

Monday 3rd February 2020 Commons Chamber

[Matt Hancock]

I have not seen that report, but I will look into it.

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

I commend the response by the Secretary of State and his Department, but without wishing to appear a conspiracy theorist, serious questions are going round about the role of the Wuhan Institute of Virology, which incorporates the National Bio-safety Laboratory in China, and about whether there has been under-reporting of the level of fatalities and the number of people affected by this issue. Is the Secretary of State absolutely happy that the Chinese authorities have been completely transparent with the details of this virus and its impact?

[Matt Hancock]

When a virus such as this strikes, it causes a series of difficulties, especially in the epicentre, and it is clear that the health system in Wuhan is struggling to cope. Collecting the information is therefore necessarily difficult, even with the best of intentions. I understand that there is a lot of noise about this issue on the internet. The most important thing is to try to get the best information we can, analyse it, respond and follow the science wherever possible.

Health Visitors (England)

Tim Loughton Excerpts

Wednesday 23rd October 2019 Westminster Hall

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

I beg to move,

That this House has considered the reduction in the number of health visitors in England.

I am grateful to the hon. Members who have come to speak on this important subject. I declare an interest as the chair of the all-party parliamentary group for conception to age two—the first 1,001 days. I also chair the board of trustees of the Parent-Infant Foundation, which runs attachment facilities and lobbies for better early intervention around the country.

I will start with some slightly alarming statistics. The cost of perinatal mental ill health in this country has been worked out at £8.1 billion per annum, according to the Maternal Mental Health Alliance, with up to 20% of women experiencing some form of mental health problem during pregnancy or the first 12 months after birth. The cost of child neglect in this country has been estimated at some £15 billion, with 50% of all maltreatment-related deaths and serious injuries occurring to infants and babies under the age of one. We currently spend in excess of £23 billion getting it wrong in those early years, particularly for mums and new babies. That is equivalent to something like half the defence budget.

There are 122,000 babies under the age of one living with a parent who has some form of mental health problem. Amazingly—this statistic came out time and again during conversations on the Domestic Abuse Bill—a third of domestic violence begins during pregnancy, and suicide is one of the leading causes of death for women during pregnancy or in the year after giving birth. About 40% of children in the United Kingdom have an insecure attachment to a parent or carer at the age of 12 months, according to Professor Peter Fonagy and others. Alarmingly, there is a 99% correlation between a teenager experiencing some form of mental illness or depression at the age of 15 or 16 and his or her mother having had some form of perinatal mental ill health during pregnancy. It is that close a correlation, making it that much more important that we make sure that the mums bearing those children, and also fathers, are as happy, settled and healthy as possible in those early stages, from conception to age two.

[Luciana Berger (Liverpool, Wavertree) (LD)]

The hon. Gentleman set out the costs incurred in trying to prevent such travesties. Does he agree that the figures he refers to are actually conservative estimates? I believe that he was at the launch, quite a number of years ago, of the Maternal Mental Health Alliance, which arrived at the figure of more than £8 billion. Is it not the case that, although the economic costs are significant, it is the social and moral reasons that have brought Members from both sides of the House here for this important debate?

[Tim Loughton]

If the hon. Lady is patient, I will come on to the social impacts. I think the MMHA report came out in 2014 or 2015, so obviously things will have moved on, although the birth rate has slightly fallen in that time as well. These are substantial financial figures, but as she says, most important are the social impacts and the impact on the child.

On the physical impacts, our childhood obesity rates are among the worst in Europe, while breastfeeding rates in the United Kingdom are among the lowest in the world. We have rising emergency department attendances by children under the age of five, and infant mortality reductions have recently stalled. Just last week, we had the worrying figures about the dwindling vaccination rates in England in particular, with only 86.4% of children having received a full dose of the MMR vaccine. We have effectively lost our immune status, because the World Health Organisation vaccination target to protect a population from a disease is 95%.

The Children’s Commissioner estimates that, in total, 2.3 million children live with risk because of a vulnerable family background, but that, within that group, more than a third are effectively invisible and not known to services and therefore do not get any support. We are talking about an expensive and widespread problem.

[Stephen Lloyd (Eastbourne) (Ind)]

I pay tribute to the remarkable work of health visitors in my constituency. Does the hon. Gentleman agree that cutting the health visitor service by 30% over the last few years has clearly made it even harder for the profession and for the families and mums that they take care of?

[Tim Loughton]

Again, I ask the hon. Gentleman to be patient, because I will come on to all that. I realise that he wants to put on the record his tribute to health visitors in Eastbourne, as do I—as someone who was born in Eastbourne and had wonderful health visitors, I am sure, albeit 57 years ago now.

The one thing that all these problems, and a lot more problems I have not mentioned, have in common is that they come under the remit of the health visitor, to some extent or other. The health visiting service provides an important safety net for infants and young children—as well as mums and dads—who are at particularly high risk of having their needs missed, as they are not visible in the same way as children who are accessing an early years setting or a school, for example.

[John Howell (Henley) (Con)]

Will my hon. Friend give way?

[Tim Loughton]

Another one? Yes, why not?

[John Howell]

My hon. Friend is making a very good speech—

[Tim Loughton]

But hon. Members keep interrupting it!

[John Howell]

I am very pleased to briefly interrupt him my hon. Friend. I pay tribute to the health visitors in my constituency. Is it not an important role of theirs to ensure that health inequalities are drummed out of the system?

[Tim Loughton]

That is a serious point; my hon. Friend is absolutely right. Health inequalities are still a big problem in this country, and those professionals on the ground, not least health visitors, are the first to come face to face with them and have the practical means, in many cases, to do something about them.

[Karen Lee (Lincoln) (Lab)]

Will the hon. Gentleman give way?

--- Later in debate ---

[Tim Loughton]

I am happy to take interventions, but it will mean that hon. Members will have to make shorter speeches, as I am sure Mr Bone will point out.

[Karen Lee]

The Royal College of Nursing’s briefing for the debate says that the number of health visitors with caseloads of more than 500 children rose from 12% to 21% between 2015 and 2017, so it will have risen even more in the two years that have elapsed since. The caseload is really worrying, in terms of people being missed.

[Tim Loughton]

The hon. Lady pre-empts a point I was going to make on page 5 of my notes, so I will take that bit out.

Unlike some other public service professionals, health visitors are non-stigmatising and usually welcomed over the threshold into homes, enabling them to give early advice and support to prevent later problems, encourage healthier choices, detect problems early and, in some cases, act as an early warning safeguarding alarm. Often when social workers are the ones to knock on the door, it may be too late, and that professional has a completely different sort of relationship with the family.

[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

I am grateful to the hon. Gentleman for securing this timely debate. What he just said is so important. The mandatory health visitor contacts in my constituency are not taking place as they should. When constituents complain or I complain, we are essentially told that they are profiled based on risk, which is clearly not how a mandatory set of contacts should work. I worry that we sometimes make assumptions about socioeconomic status or other factors, whereas the kind of problems we are talking about can manifest themselves in any family. If we are serious about having a mandatory system, should it not be that, rather than discretionary? If it is about capacity, let us talk about that.

[Tim Loughton]

Again, the hon. Gentleman makes a good point, which was on page 5 of my notes. This issue affects everybody across society, often better-off, more affluent families who might be better at hiding it or less inclined to come forward to seek help. The charity that I chair has units in Liverpool, Newcastle, London and so on, and we see that middle-class parents who have serious attachment dysfunction problems with their children are less likely to come forward. Those, ironically, may be harder-to-reach people. Health visitors are the early warning system and are able to signpost some of those people to services. They can also point out, “I think you have a problem,” and it will be taken on trust.

I appreciate the good points that have been made, but I will make some progress. The cost of failing to intervene early is enormous—financially and, more importantly, socially. The impact of not intervening early can disadvantage a child through early years, school years, adolescence and often into adulthood. In some cases, it can be life-defining.

One of the great achievements of the coalition Government was to pledge a massive increase in health visitors. In opposition, the then shadow Health Minister, Andrew Lansley, championed the recruitment of no fewer than 4,300 new health visitors, based on the successful model of the Dutch Kraamzorg system—I was involved in research into that—where post-natal care is provided to a new mother and her baby an initial eight to 10 days immediately after birth.

Four years ago, the Government’s health visitor implementation plan and the “Call to action” scheme were the pride of the nation. The policy was built on sound evidence that the health visiting profession had the power to drive health improvements and provide a universal service designed to give every child that best possible start in life, as we all want to see. Impressively, for a Government target, it was achieved—just about—in the lifetime of the 2010 to 2015 Parliament.

Depressingly, since then, the numbers have started to drop dramatically. In June 2015, there were 10,042 full- time equivalent health visitors in England. A year later, that had fallen to 9,491 and the latest figures show a 31% drop from the peak. According to the Institute of Health Visiting,

“one in four health visitors do not have enough time to provide postnatal mental health assessment to families at six to eight weeks, as recommended by the government.”

In response to a survey that the institute put out,

“three quarters of respondents said they are unable to carry out government recommended maternal mental health checks three to four months after birth.”

That is a crucial stage at which to pick up mental health problems with the parents, which may already be impacting or will impact on the infant. It is not only about looking after the baby, but the family unit and particularly the prime carer.

To a large extent, the reason for that has been the transfer of responsibility for health visitors from the health service to local government, as part of its enhanced public health responsibilities. I am not challenging the wisdom of doing that, but it has come at the time of the greatest squeeze on local government spending recently. The architecture of the delivery of health and wellbeing services for babies and young children, I think, has been fragmented in a disorienting manner between local councils, Clinical Commissioning groups and NHS England, with insufficiently qualified scrutiny of how it works. There is an issue around the quality of informed local authority oversight over many of these public health roles.

[Steve Brine (Winchester) (Ind)]

I congratulate my hon. Friend on securing this debate. He has been consistently right in this area. My research ahead of this debate presented a worrying picture from GPs in Winchester, who report a distant relationship with health visitors. That is not their fault; it is because health visitors are so thinly spread. Does he agree that as well as providing more health visitors, it would be smart to address where they sit in the system and, maybe, to co-locate teams around the emerging primary care networks?

[Tim Loughton]

First, I pay tribute to the real acknowledgment of the importance of this area by my hon. Friend when he was public health Minister. He was always prepared to take our sometimes annoying approaches to prioritising the issue. He may be right. I am not too concerned with processes and structures; I am concerned with getting the professional face to face with the parent and baby. We need to be smarter about where we can make that engagement happen and ensure it is not through lack of workforce that we are unable to do it.

[Steve Brine]

rose—

[Tim Loughton]

If my hon. Friend wants to intervene again, he may, but it will eat into his own speech time.

[Steve Brine]

The issue is important because the primary care networks and the GPs who rightly run them are responsible for the outcomes of the patients they manage within those lists. If they had ownership of those health visitors, because they were commissioned within that structure, they would have every incentive to close the distant relationship that I mentioned.

[Tim Loughton]

My hon. Friend may well be right. One of my constituents is a health visitor. According to her, the current status of health is not serving families well, based, as it is, on universally delivered process outcomes, which risk, to use a phrase she quoted to me, “ticking the box but missing the point”. That plays to the point my hon. Friend is making.

To illustrate the most successful ways of dealing with vulnerable families, I will use children’s centres as an example, although I will not get into a whole argument about them. The most successful ones that I have seen are those where hot-desking occurs between a district nurse, a health visitor, a social worker, a school nurse and others, who are all signposting. The health visitor may get over the threshold and say, “I am a bit worried that there is a mental health problem there. When I go back and see the community mental health nurse at the children’s centre, I might suggest she has a word.” That is the way it must happen. These are interlinking problems and it is not just down to one professional to treat them.

On the local authority, public health budgets have seen a significant reduction from 2015. The recent 1% increase for 2021 is welcome, but there is a long distance to go to replace some of the past reductions. Some areas have suffered disproportionately. I want to flag Suffolk, where, I gather, the council has been considering plans to slash the health visiting workforce by 25% to save £1 million. I think that is a false economy and short-sighted.

The decline in the number of health visitors since 2015 has been due to qualified nurses retiring or moving to other roles within the health service and too few trainees entering the profession. Alongside workforce cuts by local authority commissioners, the health visiting profession is also facing recruitment and retention problems, falling staff morale and poor progression opportunities. Health visitors have also raised safeguarding concerns as their caseloads increase to meet increasing need and cover shortages.

In a 2017 survey by the Institute of Health Visiting, health visitors reported that children are put at risk due to cuts in the workforce and growing caseloads, finding that 21% of health visitors are working with caseloads of over 500 children, as the hon. Member for Lincoln (Karen Lee) pointed out.

[Jeremy Lefroy (Stafford) (Con)]

When health visitors visited me in my constituency surgery in Penkridge, their frustration was that, although they love their job and want to do it properly, they cannot do it to the best of their professional satisfaction, because of the caseloads and because there were too few of them. Health visitors want to serve my constituents—the mothers, families and children—but they cannot, for those reasons. I had huge respect for their professional attitude, but it showed their real sorrow that they could not do the job as well as they want to.

[Tim Loughton]

My hon. Friend is absolutely right. I have met many health visitors. They are a fantastic resource and do huge amounts of good work well beyond their remit. They are frustrated by some of the processes and financial considerations that are stopping them from doing their job to the best of their ability with sufficient support.

[Dr David Drew (Stroud) (Lab/Co-op)]

Will the hon. Gentleman give way?

[Tim Loughton]

This is the last intervention I will take, and I will finish shortly.

[Dr Drew]

One of the greatest frustrations is when families do not let the health visitors in, which is a growing trend. They come back time after time and they find there is nobody there or, if the people are there, they will not let them in. Does he agree that that is a very worrying development?

[Tim Loughton]

Earlier, I raised the contrast with social workers where there is a safeguarding issue. It is a completely different dynamic and relationship. There is a reluctance to let the social worker over the threshold. That is less the case with health visitors, because they are seen to be there to help. But there is a reluctance from some people, perhaps due to ignorance as to what the health visitor is there to do from people who think, “I know it all; I don’t need you,” or due to people who may fear that their vulnerability will result in their child being taken into care. That is why that friendly face is so important. The health visitor is on their side to help them in being a new parent, in a way that other professionals cannot be.

According to the state of health visiting survey by the Institute of Health Visiting, one in four health visitors did not have enough time to provide the post-natal mental health assessments to families at six to eight weeks, as recommended by the Government; the hon. Member for Stalybridge and Hyde (Jonathan Reynolds) mentioned that. These PMH checks are a key part of the Government’s maternal mental health pathway. Previous research involving clinical trials with 4,000 mothers found that those who received health visitor support were 40% less likely to develop post-natal depression after six months.

There are five mandated reviews under the healthy child programme that health visitors undertake. While those are spread across the first 1,001 days, they are concentrated in the first 12 months. Health visitors are concerned that the number of reviews is insufficient and leaves too large a gap between contact with families. Not enough scheduled reviews are happening, and we probably need more reviews intensively at those early stages.

There was also a lot of concern about steps being taken to help recruitment. I tabled a question earlier this week, which the Minister kindly answered. I asked

“the Secretary of State for Health and Social Care, what steps he is taking to reverse the fall in the number of health visitors.”

She replied in a written answer, saying that

“Since 2015, local authorities have been responsible for the commissioning of services for zero to five-year-olds and as such, they determine the required numbers of health visitors based upon local needs.”

We understand that. She continued:

“A Specialist Community and Public Health Nurse apprenticeship (Level 7) is currently in development. This will offer an alternative route directly into the health visiting profession.”

I am afraid that that answer raised some alarm among people at the Institute of Health Visiting, and the response to it that I got back was to point out that

“The apprenticeship route is not an alternative route directly into health visiting. Applicants still need to be nurses or midwives and the course presents a number of risks: it is longer, the end point assessment delays qualification unnecessarily…it does not deliver a national strategy for the profession. HVs”—

that is, health visitors—

“who are not employed by the NHS do not have the same opportunities to those covered by the NHS People Plan—this includes NHS funding for CPD”—

that is, continuous professional development—

“leadership development, pay rises, safer staffing and national action to address recruitment/retention difficulties.”

It also pointed out:

“Local Authorities determine the level of HVs dependent on local need, however there is no measure of quality of service or guidance on how far the service can ‘flex’ to meet those needs.”

In addition, the apprenticeship is still not ready to be rolled out; it takes longer than current training; and it is more costly and therefore less attractive to employers and/or recruits.

An urgent workforce plan is needed to tackle dwindling health visitor numbers. I have spoken to representatives of the Local Government Association. They are very concerned about this situation; as representatives of local government, they want to get their public health role right. The LGA said that

“it had offered to work with the Department of Health and Social Care, the NHS and Health Education England to help deliver a plan that would see the ‘right number’ of training places commissioned. It would also develop new policies to ensure health visiting remained an ‘attractive and valued’ profession.”

I hope that the Minister is receptive to that offer; I am sure she is.

What needs to be done? Again, we need to value the role of the health visiting profession. I am sure that all of us in this Chamber and beyond would want to do that, but we have to will not only the inclination but the means as well.

A publication by the Institute of Health Visiting, “Health Visiting in England: A Vision for the Future”, makes 18 sensible and practical recommendations, and they all involve some investment. I will touch very quickly on a few. The institute wants to see

“urgent and ring-fenced public health investment…A review of 0-5 public health funding…to cover the cost of delivery of the Healthy Child Programme in full in all Local Authorities in England.”

All local authorities in England will need that funding. It goes on to say:

“As we await the refreshed Healthy Child Programme, as an interim measure, the proposed metric should be a floor of 12,000”—

that is, 12,000 full-time equivalents—

“to restore the workforce to the target figure calculated for the Health Visiting Implementation Plan, 2011-2015…New National Standards for health visiting are needed to support consistency within the profession. The title ‘health visitor’ and its role should be protected and restored to statute. A review of health visiting training with a risk assessment of the impact of the removal of Health Education England funding of training and replacement by the use of the Apprenticeship Levy.”

Frankly, those are sensible measures. I very much hope that the Minister will look at them positively; I am sure she will. It would be a false economy not to do these things. They need to be part of a bigger shift in Government policy—the policy of any Government; I may be pushing at an open door—towards an earlier, more intensive, preventive intervention approach, from conception to the age of two especially. Health visitors are absolutely at the centre of that.

[Several hon. Members rose—]

Baby Loss Awareness Week

Tim Loughton Excerpts

Tuesday 8th October 2019 Commons Chamber

[Caroline Dinenage]

I am grateful to my hon. Friend for raising that point. He is absolutely right that we need to give that area a lot more attention. Having that ability to spend time together will be an incredibly valuable and important part of the process of grieving and coming to terms with the unbelievably tragic death of a baby.

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

On the question of raising awareness, a job that was so ably started by my hon. Friends, the Minister will be aware of my Civil Partnerships, Marriages and Deaths (Registration etc) Act 2019, which became law in May, two parts of which relate to stillbirth. One gives the Secretary of State the power to have coroners investigate stillbirths and the other sets up a review by the Secretary of State to look into the registration of pre-24-week stillbirths. That review body has not met for over a year, so can the Minister update us on when the legislation will be laid so that, for the first time, coroners will have the power and ability to investigate stillbirths where they see fit to do so?

[Caroline Dinenage]

I am grateful to my hon. Friend for raising that matter, because he brought forward a really important private Member’s Bill. The consultation concluded on 18 June after receiving over 350 responses. Officials are currently analysing all those responses and will report as soon as possible.

Much has been achieved since 2015 to improve the quality of bereavement care for parents, and I put on record the efforts of the all-party parliamentary group on baby loss, ably led by my hon. Friend the Member for Eddisbury with support from Members on both sides of the House. I will speak more about developments in bereavement care in a moment, but first I would like to talk about some of the progress made by the NHS on improving safety and reducing baby loss in maternity and neonatal services.

I cannot continue any further without putting on record my enormous thanks and gratitude to my right hon. Friend the Member for South West Surrey (Mr Hunt), who has done more than anybody to further the cause of patient safety and to investigate the untimely deaths of babies, and across the NHS. I thank him from all of us for his incredible work in that space.

Members will be aware of the Government’s ambition to halve the rates of stillbirths and neonatal deaths by 2025, with an interim ambition to achieve a 20% reduction in those rates by 2020. The ambition includes similar reductions in maternal mortality and serious brain injuries in babies during or soon after birth, and a 25% reduction in the pre-term birth rate from the current 8% to 6% by 2025.

This ambition was set in November 2015, when the Lancet stillbirth series ranked the UK 33rd out of 35 high-income countries for stillbirths. Case reviews of stillbirths and neonatal deaths suggest that many such deaths might have been prevented by better clinical care, and the Morecambe Bay investigation report made 44 recommendations for improving the safety of maternity services.

In 2016-17, the Department of Health launched a range of initiatives that are being delivered by the NHS under the auspices of the maternity transformation programme, and I would like to mention a few of those achievements. Every NHS trust with maternity services now has a board that includes obstetric and midwifery safety champions to lead the development of an organisational safety culture. Every trust has received a share of the £8.1 million maternity safety training fund, and 30,945 training places for multidisciplinary teams were delivered in 2018-19, with courses focusing on training for childbirth emergencies in labour wards and in the community, as well as on leadership, communication and resilience.

Evaluation of the “Saving Babies’ Lives” care bundle found that clinical improvements such as better monitoring of a baby’s growth and movement in pregnancy, as well as better monitoring in labour, mean that maternity staff have helped to save more than 160 babies’ lives across 19 maternity units. An estimated 600 stillbirths could be prevented annually if all maternity units adopted national best practice. A revised version of the care bundle is currently being rolled out across England, and it includes elements to reduce the number of pre-term births and to optimise care where pre-term delivery cannot be prevented.

Women’s Mental Health

Tim Loughton Excerpts

Thursday 3rd October 2019 Commons Chamber

[Wera Hobhouse]

I could not agree more. We need a strategy. More than half of women who experience mental ill health have a history of abuse, meaning that their conditions are rooted in experiences of gender-based violence. In yesterday’s moving debate, we heard many harrowing examples of that. We have a long way to go if we are to change the whole culture around domestic violence and treat its consequences. When it comes to treatment, we must ensure that frontline mental health services for women are trauma-informed. There is a legal framework that we could use; it is called the Istanbul convention. We signed up to it back in 2012, but so far we have failed to bring it into domestic law.

One consequence is that we do not have enough rape crisis centres across the country. Earlier this year, Fern Champion, a survivor of sexual violence, came forward after being turned away by her local rape crisis centre. She launched a petition asking the Government to ratify the Istanbul convention, which has so far received 171,000 signatures. It is hard to suggest that we can do the groundwork to support women and their mental health challenges effectively when there are fewer than 100 rape crisis centres across England and Wales. This is simply not good enough if we are to support women effectively and prevent them from developing serious mental health problems after suffering abuse. Ratifying the Istanbul convention would mean that the UK was upholding international standards on survivors’ rights.

Earlier this year, I tabled a Bill that would guarantee mothers a health check-up six weeks after giving birth. Depression before, during and after birth is a serious condition that is unrecognised and untreated for nearly half of new mothers who suffer from depression. Statistics suggest that mothers are afraid to speak up, and 47% of new mothers get less than three minutes to discuss their mental health with a healthcare professional. Conversations about the reality of motherhood and perinatal depression are still few and far between. This is a huge problem—and not just for the mother; undiagnosed mental health problems in mothers have serious consequences for the newborn child and their development.

I have been campaigning for better treatment of eating disorders. Eating disorders disproportionately affect women, although they do not discriminate. Women in the LGBTQ community are particularly susceptible.

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

I am absolutely in accord with the hon. Lady. Before she gets off the subject of perinatal illness, she will agree, I am sure, that it is a shocking statistic that in the UK, suicide is the leading cause of direct maternal deaths occurring within a year of the end of pregnancy. Perinatal mental illness can actually lead to a loss of life among mothers. We need to do so much better for them in those early mental health checks.

[Wera Hobhouse]

Absolutely. Post-natal depression is hidden, and the NCT’s “Hidden Half” campaign addresses that. Anyone who has been a parent knows that parenthood is not easy. Probably all mothers go through some form of depression, or feel really down after birth. I keep saying that if anybody had asked me how I felt, I would probably have said, “Oh God, I am not feeling particularly well.” The problem is in not addressing that early on, because these things can develop into something much more serious. That is why it is very important that there be a check-up six weeks after birth for women, not just for the newborn child.

--- Later in debate ---

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

I concur with every word of your comments, Madam Deputy Speaker, and the response to this debate, and the one we held yesterday on domestic abuse, has shown this Chamber in a much better light than that of a week or so ago. These are things we can agree on and that are of acute, everyday importance to our constituents.

As I have said previously, I have been in this House for 22 years and we never used to debate subjects such as this, and rarely held debates on children’s issues or many social issues. It is absolutely right that we hold such debates much more regularly these days, and they are enhanced by the personal, often emotional, harrowing and brave testimonies of hon. Members who bring such experience and richness to the debate. They show that we do have some understanding of the complex, complicated and challenging issues that face so many of our constituents every day.

I had not intended to speak in this debate, but I was moved by the contributions from my hon. Friend the Member for Southend West (Sir David Amess) and the hon. Member for Lewisham West and Penge (Ellie Reeves). I have a long-standing interest in this issue, and I declare an interest as chair of the all-party group for conception to age two—first 1001 days. That issue has growing traction and importance, and it should be mainstreamed. I also chair the charity Parent Infant Partnership, PIP UK, and co-chair the all-party group on mindfulness. If any hon. Members present have not attended a mindfulness course, I reiterate that they are available on Tuesday afternoons, usually at 5 o’clock in Committee Room 7. Given the stress of recent weeks, attendance has been noticeably higher and perhaps of more benefit than usual.

I am slightly daunted by speaking in this debate. Yesterday I said that I was daunted by speaking in the fantastic debate on domestic abuse, on the basis, first, that I am a man, and, secondly, that I am not from Wales. Today I am daunted, first because I am not a woman, and secondly because I am not from Essex, which seems to have a dominant geographical impact on the contributions that we have heard and will hear.

Next week we will celebrate Mental Health Awareness Week, and we will also relaunch the charity PIP UK. I have just written a letter to the Minister, and I very much welcome her and the huge amount of experience that she brings to her role from her health background. I am glad that perinatal mental health featured in the remarks of the hon. Members for Bath (Wera Hobhouse) and for Lewisham West and Penge, because that is where I think we can have the biggest impact on the mental health of future generations.

A few years ago, the Maternal Mental Health Alliance produced a valuable piece of work that estimated that perinatal mental health issues affect at least one in six women. Too often that happens in silence, which is why it is so important that the hon. Member for Lewisham West and Penge recounted how it happened to her—why would it not happen to somebody just because they happen to be an MP? The cost to the nation of perinatal mental health issues was estimated at £8.1 billion every year, which is probably an underestimate. We can add to that the cost of child neglect in this country, which is estimated at £15 billion and is often born out of problems with attachment in those early years, even before the child is born, and particularly if a woman is facing huge stresses and challenges, or domestic violence and so on. The statistic that I gave yesterday, which I still find hard to believe, is that a third of domestic violence cases start during pregnancy. The cost of getting this issue wrong is more than £23 billion a year. That is so much more than the more modest investment we could make to get this issue right and prevent those problems and the huge issues they create, financially but also socially—problems that are often lifelong for future generations.

We need better attached children, and attachment dysfunction has gone under the radar for so long. It is therefore essential—I am glad that the hon. Members for Bath and for Lewisham West and Penge mentioned this—that the vital six-week checks on new babies should also include the physical and mental health of new mums, particularly first-time mums. I make no apology for repeating that health visitors have been an important component in helping with those checks, and one great achievement of the coalition Government—I was also part of the shadow health team when we worked on this—was the substantial increase in health visitors. That was based on the Kraamzorg programme in Holland, which we went to see. It showed that if we work intensively with new parents in those early stages, we can prevent many problems from happening later on. Health visitors are such a good investment to ensure happy, healthy, stable new parents who are able to interact in a sensible, robust, proper and healthy way with their children, and that is in the best interests of kids and their parents.

[Wera Hobhouse]

The health visitors in the early weeks when I was first a mother, and subsequently, were wonderful and a real lifeline. We do need to continue with that, but the problem is that it is not systematic enough. Making sure that a mandatory six-week health check is done by a GP and a health professional is the way forward. Currently, the system is too haphazard and we need to have a much more watertight system to get help to every woman who needs it.

[Tim Loughton]

We need both. The health checks are NICE-recommended, but alas not mandatorily funded or instituted across the country. Frankly, all GPs need better training on mental health and mental illness prevention generally, and especially on perinatal mental health.

It was a huge success of the coalition Government that we recruited almost the 4,200 target for health visitors that was set back in 2010. We have lost as many as 30% of those now, since the responsibility for health visitors went from the NHS to local authorities. I am not saying whether that was the right move or not, but, given the cash constraints on local authorities, health visitors have turned out to be a soft target. That is a hugely false economy and certainly needs to be revisited as a priority by the health team.

The lifelong importance of early attachment should not be underestimated. It has been judged that for a 15 or 16-year-old suffering from depression—an all too common problem among teenage children in schools—there is around a 99% likelihood that his or her mother was suffering from depression or some other form of mental illness during or soon after pregnancy. The correlation is as close as that. Not getting it right during the conception to age two period will have an impact on many children for their childhood years and, for too many, continuing into their adult years too. Maternal mental health is very important, not just for the mother herself but for her children and the surrounding family.

Let us not underestimate the impact this has on fathers as well. I will be ruled out of order if I go too much into the subject of male mental health—although I hope we have a debate on male mental health too—but the impact of poor attachment between a mother and baby has significant impacts on fathers. It is important that they are also given every help and support to have that attachment to their children. Too often, children’s centres and other support mechanisms are mum-centric and we overlook the role of the father. The father has an important role to play in the life of the child and an important support role to play in the physical and mental health of his partner, the mother.

The Government have done an awful lot in recent years to raise the profile of the importance of mental health and flag up how we need to do much more. Importantly, they are also investing much more in mental health. We talk about the parity of esteem between mental health and physical health, and we all agree that that is necessary. Much has been done to reduce the stigma that was attached to mental illness just 20 years ago. It is good that so much more money is going into the area. We have a shortage of mental health practitioners and we need to make sure that we prioritise recruiting, training and getting them in service as soon as possible.

The criticism I have is that last year’s Green Paper on mental health included a lot about school-age children, which is important, but virtually nothing on pre-school-age children and perinatal mental health. Shifting the age profile forward and making it more about prevention and early detection—rather than dealing with the symptoms of a child who may already be damaged because their mother was damaged in their early years—is the way we have to go. We have to do much more in schools, but we need to do so much more before children get to school, by working with their mothers and fathers at an early stage.

[Jeff Smith]

The hon. Gentleman made an important point about the reduction in funding for local authorities. When it comes to trying to provide holistic support to the family and mother, does he share my regret at the closure of so many hundreds of Sure Start centres since 2010?

[Tim Loughton]

I do not want to make this a partisan issue. We can have a debate on this subject, and there have been some cuts to support services that have obviously not been helpful and will have some of the long-term impact that I have mentioned. I have visited, and even opened in my time as Minister, several children’s centres, and many of them do a fantastic job. But many were not doing a fantastic job and were failing to do a job of work for the 15% of the most deprived communities for whom they were originally most intended.

The failure to comprehend the importance of children’s centres is to put too much trust in bricks and mortar. Many of the outreach services that went with children centres were more important, and they were not getting out enough. We have children’s centres that have worked really well in my constituency, and we have not closed any in West Sussex, largely because we put them in the right places and turned them into what I call a Piccadilly Circus of services. They have district nurses, health visitors, mental health nurses and social workers hot-desking and sharing information about various families, especially vulnerable children and others, to give a wrap-around, comprehensive support mechanism. The challenge so often for children’s centres is getting the parents—particularly dads—to come across the threshold. Some children’s centres do that really well, but many do not. I know about the importance of children’s centres, but I also know some of their weaknesses. It is the services they offer and the outcomes they achieve that are so much more important than the amount of bricks and mortar that exist to provide them.

[Jeff Smith]

The hon. Gentleman is making an important point, but, with the greatest respect, West Sussex did not have the kind of cuts to its local authority funding that many more impoverished areas such as Manchester and other big northern cities did. He is right that it is not just about bricks and mortar: it is the support services that were also cut that have had the greatest impact on young families in those areas.

[Tim Loughton]

Nice try. West Sussex was the least funded shire county in the whole of England. Do not try and tell me that supposedly affluent areas such as West Sussex have not faced financial challenges. I do not know about the hon. Gentleman’s constituency, but the gap between the per capita funding that children get in my constituency and many of the London and other municipal boroughs is substantial. It is a question of how that funding is used and prioritised.

[Mr Kevan Jones]

Will the hon. Gentleman give way?

[Tim Loughton]

I will give way, now that I have set this hare running.

[Mr Jones]

The hon. Gentleman is making the fundamental mistake that Members on the Government Benches often do—the idea that every area in the country is the same. I am sure that there are many more looked-after children in inner cities such as Liverpool, Manchester and others—and even in Durham—than there are in his area. That comes with a cost, and the areas cannot be treated the same.

[Tim Loughton]

That shows a fundamental misunderstanding. I declare an interest because this was my issue. Where children are placed is not necessarily a reflection of how many children are in the care system in that authority. Children in care placed in other authorities, such as Kent, where accommodation is cheaper than in London, are paid for by the placing authorities, and they can cause challenges to the host authorities. That is a wholly different issue. The original point that the hon. Member for Manchester, Withington (Jeff Smith) made was that children’s centres are part of the solution. We need children’s centres with well-trained people offering well-targeted support services to those who need them, but saying that this is purely a numerical issue, because now we have 3,200 children’s centres as opposed to 3,500, is missing the point. It is about the quality of the care offered to those who most need it.

I will wrap up now—as I see you want me to, Madam Deputy Speaker—by touching on a couple of other points affecting older girls. They include the impact of bullying, social media and bullying online, peer pressure relating to body image, the reports by groups such as the Girl Guides and the surveys showing the number of young teenage girls who do not like their appearance and would, if they could, pay for plastic surgery, which is hugely alarming. We have to give young women in particular the confidence to be able to say, “I am who I am. This is who I am, and if you don’t like it—tough.” That is something that we have a major role in getting across in society, and frankly social media need to be part of those positive messages. We still have problems with the internet and social media companies hosting sites that masquerade as sites giving advice to people with eating disorders, but which are in fact malignly encouraging anorexia and things like that.

[Mark Tami (Alyn and Deeside) (Lab)]

Does the hon. Gentleman agree that social media companies that hide behind the claim that they are just platforms and are not responsible for the content need to take a serious look at themselves?

[Tim Loughton]

The hon. Gentleman is absolutely right, and I am glad that the Government are doing that with proposals, which are currently being consulted on, to fine social media companies that do not take down harmful comment. I am not just talking about hate crime or terrorism; this is about how it can undermine impressionable young people in particular. There are laws in places such as France about such sites, and Germany has introduced heavy fines that can be imposed on social media companies.

This is a big problem. Mental illness is a particular problem for women who might be affected by relationship breakdown, domestic violence, homelessness, housing difficulties, missed education opportunities, unemployment, financial difficulties, debt, ill health, substance misuse and interaction with the criminal justice system. Mental illness takes different guises and different forms, but the earlier we act, and with the most appropriate support, the more likely we will be to do the best job for future generations, and that starts at conception.

Decriminalisation of Abortion

Tim Loughton Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Jackie Doyle-Price]

I know I will disappoint the hon. Lady, and I know she has been a passionate campaigner on these issues for many years, with the welfare of women at her heart. I answer this question with great respect for her desire, but it remains the case that the Government are not minded to repeal the provisions of the 1861 Act in England and Wales, recognising that we have an Abortion Act that provides for access to abortion services.

From the perspective of the safety of women accessing abortion services, the issues raised by the hon. Lady do concern me. It is not good for the welfare of women that pills are being accessed online. I also observe that the Abortion Act is more than 50 years old and was the product of a very different time. Abortions were then entirely surgical, and the medical abortions to which we now have access are clearly far safer.

This is very much a personal view, and I am not speaking for the Government in advancing this view, but I think that making provision for early abortion and for recognising medical abortion in law will get us much further. We need to make sure we have a safe regime that enables women to access abortion services as safely as possible.

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

I supported decriminalisation, I supported the regularising of the abortion law in Northern Ireland last week, and on Friday I shall visit my local BPAS clinic. But changing the law is only part of it. Last year, I was out with an ambulance crew and we were called out to a woman who had been at an abortion clinic and taken the pills. She was bleeding heavily and had been taken very ill, and there was no out-of-hours service—this was on a Friday evening. Does the Minister agree, particularly in respect of the availability of do-it-yourself pills on the internet, that it is absolutely essential that, at a very difficult time for a woman who has taken that decision, the ongoing support is there 24 hours a day, seven days a week?

[Jackie Doyle-Price]

My hon. Friend reminds us that this is not always an easy process for women to go through. As with any medical procedure, full consent must be given, based on full information. As long as pills can be accessed via the internet rather than via medical professionals, it is clearly more likely that women will not be informed of the risks of taking the pills. Any medication can have risks and consequences, and women need to be fully advised so that they can manage what they are going through.

Oral Answers to Questions

Tim Loughton Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Jackie Doyle-Price]

Life expectancy has been increasing year on year, but it is also true that it is an international phenomenon that that rate of increase is coming to a halt. None the less, life expectancy in England is the highest it has ever been: 79.5 years for men and 83.1 years for women. We will continue to invest in our public health programmes and look at the wider issues facing society that can also contribute to good health outcomes, such as housing, work and so on. There is a lot that can be done; it is not just about NHS spending.

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

One of the best ways of getting early public health help across the doorstep is by investing in health visitors to give that much needed early support, especially to new parents to help to ensure that every child gets the best start in life. One of the best achievements of the Cameron Government was the creation of 4,200 additional health visitors. Does the Minister share my concern that since 2015, with the responsibility now having gone to local government, there has been a 26% reduction in the number of health visitors? That is something of a false economy.

[Jackie Doyle-Price]

I do share my hon. Friend’s belief that health visitors are probably the most important army in the war against health inequalities. They provide an intervention that is very family-based and not intimidating. It is based on good relationships and means we can provide intervention at the earliest possible time. He is right to highlight the massive investment we made during the Cameron Government. There has been a decline since, which we really must address if we are to get the earliest possible intervention and the best health outcomes for children.